I 

111TH CONGRESS 

1ST SESSION H. R. 2389 

To require the Secretary of Defense to establish registries of members and 

former members of the Armed Forces exposed in the line of duty to 

occupational and environmental health chemical hazards, to amend title 

38, United States Code, to provide health care to veterans exposed 

to such hazards, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 13, 2009 

Mr. HILL (for himself, Mr. SCHRADER, Mr. ELLSWORTH, Mr. DEFAZIO, and 

Mr. DONNELLY of Indiana) introduced the following bill; which was referred to the Committee on Armed Services, and in addition to the Committee on Veterans’ Affairs, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To require the Secretary of Defense to establish registries 

of members and former members of the Armed Forces 

exposed in the line of duty to occupational and environmental health chemical hazards, to amend title 38, 

United States Code, to provide health care to veterans 

exposed to such hazards, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Care for Mem3 bers of the Armed Forces Exposed to Chemical Hazards 

4 Act of 2009’’. 

5 SEC. 2. ESTABLISHMENT OF REGISTRIES OF MEMBERS AND 

6 FORMER MEMBERS OF THE ARMED FORCES 

7 EXPOSED IN LINE OF DUTY TO OCCUPA8 TIONAL AND ENVIRONMENTAL HEALTH 

9 CHEMICAL HAZARDS. 

10 (a) ESTABLISHMENT.—For each occupational and 

11 environmental health chemical hazard of particular con12 cern, the Secretary of Defense shall establish and admin13 ister a registry of members and former members of the 

14 Armed Forces who were exposed in the line of duty to 

15 such hazard on or after September 11, 2001. 

16 (b) REGISTRATION.—For every member and former 

17 member of the Armed Forces who was exposed in the line 

18 of duty to a hazard described in subsection (a), the Sec19 retary shall— 

20 (1) register such member or former member in 

21 such registry; and 

22 (2) collect such information about such member 

23 or former member as the Secretary considers appro24 priate for purposes of establishing and administering 

25 such registry. 


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1 (c) NOTIFICATION.—In the case that the Secretary 

2 learns that a member or former member of the Armed 

3 Forces may have been exposed in the line of duty to a 

4 hazard described in subsection (a), the Secretary shall— 

5 (1) notify of such exposure— 

6 (A) such member or former member; 

7 (B) the commanding officer of the unit to 

8 which such member or former member belonged 

9 at the time of such exposure; and 

10 (C) in the case of a member of the Na11 tional Guard, the Adjutant General of the State 

12 concerned; and 

13 (2) inform such member or former member that 

14 such member or former member may be included in 

15 the registry required by subsection (a) for such haz16 ard. 

17 (d) EXAMINATION.—Not later than 30 days after the 

18 date on which the Secretary becomes aware of an exposure 

19 of a member or former member of the Armed Forces to 

20 a hazard described in subsection (a) and annually there21 after, the Secretary shall provide such member or former 

22 member— 

23 (1) a complete physical and medical examina24 tion; 


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1 (2) consultation and counseling with respect to 

2 the results of such physical and examination; and 

3 (3) a copy of the documentation of such expo4 sure in the member’s or former member’s medical 

5 record maintained by the Department of Defense. 

6 (e) OCCUPATIONAL AND ENVIRONMENTAL HEALTH

7 CHEMICAL HAZARD OF PARTICULAR CONCERN DE8 FINED.—In this section, the term ‘‘occupational and envi9 ronmental health chemical hazard of particular concern’’ 

10 means an occupational and environmental health chemical 

11 hazard that the Secretary of Defense determines is of par12 ticular concern after considering appropriate guidelines 

13 and standards for exposure, including the following: 

14 (1) The military exposure guidelines specified in 

15 the January 2002 Chemical Exposure Guidelines for 

16 Deployed Military Personnel, United States Army 

17 Center for Health Promotion and Preventive Medi18 cine Technical Guide 230 (or any successor technical 

19 guide that establishes military exposure guidelines 

20 for the assessment of the significance of field expo21 sures to occupational and environmental health 

22 chemical hazards during deployments). 

23 (2) Occupational and environmental health 

24 chemical exposure standards promulgated by the Oc25 cupational Safety and Health Administration. 


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1 SEC. 3. SCIENTIFIC REVIEW OF ASSOCIATION OF INCI2 DENTS OF EXPOSURE TO OCCUPATIONAL 

3 AND ENVIRONMENTAL HEALTH CHEMICAL 

4 HAZARDS WITH HEALTH CONSEQUENCES. 

5 (a) AGREEMENT.— 

6 (1) IN GENERAL.—The Secretary of Defense 

7 shall seek to enter into an agreement with the Insti8 tute of Medicine of the National Academies for the 

9 Institute of Medicine to perform the services covered 

10 by this section. 

11 (2) TIMING.—The Secretary shall seek to enter 

12 into the agreement described in paragraph (1) not 

13 later than 2 months after the date of the enactment 

14 of this Act. 

15 (b) REVIEW OF SCIENTIFIC EVIDENCE.—Under an 

16 agreement between the Secretary of Defense and the Insti17 tute of Medicine under this section, the Institute of Medi18 cine shall, for each incident of exposure involving one or 

19 more members of the Armed Forces reported in a registry 

20 established under section 2(a) to an occupational and envi21 ronmental health chemical hazard of particular concern, 

22 review and summarize the scientific evidence, and assess 

23 the strength thereof, concerning the association between 

24 the exposure to such hazard and acute and long-term 

25 health consequences of such exposure. 


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1 (c) SCIENTIFIC DETERMINATIONS CONCERNING

2 HEALTH CONSEQUENCES.— 

3 (1) IN GENERAL.—For each incident of expo4 sure reviewed under subsection (b), the Institute of 

5 Medicine shall determine (to the extent that avail6 able scientific data permit meaningful determina7 tions)— 

8 (A) whether a statistical association with 

9 the acute and long-term health consequences 

10 exists, taking into account the strength of the 

11 scientific evidence and the appropriateness of 

12 the statistical and epidemiological methods used 

13 to detect the association; and 

14 (B) whether there exists a plausible bio15 logical mechanism or other evidence of a causal 

16 relationship between the occupational and envi17 ronmental health chemical hazard and the 

18 health consequences. 

19 (2) DISCUSSION AND REASONING.—The Insti20 tute of Medicine shall include in its reports under 

21 subsection (f) a full discussion of the scientific evi22 dence and reasoning that led to its conclusions 

23 under this subsection. 

24 (d) RECOMMENDATIONS FOR ADDITIONAL SCI25 ENTIFIC STUDIES.— 


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1 (1) IN GENERAL.—The Institute of Medicine 

2 shall make any recommendations it has for addi3 tional scientific studies to resolve areas of continuing 

4 scientific uncertainty relating to exposure to occupa5 tional and environmental health chemical hazards of 

6 particular concern. 

7 (2) CONSIDERATIONS.—In making rec8 ommendations for further study, the Institute of 

9 Medicine shall consider the following: 

10 (A) The scientific information that is cur11 rently available. 

12 (B) The value and relevance of the infor13 mation that could result from additional stud14 ies. 

15 (e) SUBSEQUENT REVIEWS.—The agreement under 

16 subsection (a) shall require the Institute of Medicine— 

17 (1) to conduct periodically as comprehensive a 

18 review as is practicable of the evidence referred to 

19 in subsection (b) that has become available since the 

20 last review of such evidence under this section; and 

21 (2) to make its determinations and estimates on 

22 the basis of the results of such review and all other 

23 reviews conducted for the purposes of this section. 

24 (f) REPORTS.— 

25 (1) REPORTS TO CONGRESS.— 


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1 (A) IN GENERAL.—The agreement under 

2 subsection (a) shall require the Institute of 

3 Medicine to submit, not later than the end of 

4 the 18-month period beginning on the date of 

5 the enactment of this Act and not less fre6 quently than once every 2 years thereafter, to 

7 the appropriate committees of Congress a re8 port on the activities of the Institute of Medi9 cine under the agreement. 

10 (B) CONTENTS.—The report described in 

11 subparagraph (A) shall include the following: 

12 (i) The determinations and discussion 

13 referred to in subsection (c). 

14 (ii) Any recommendations of the Insti15 tute of Medicine under subsection (d). 

16 (2) REPORTS TO SECRETARY OF DEFENSE.— 

17 The agreement under subsection (a) shall require 

18 the Institute of Medicine, in the case that the Insti19 tute of Medicine makes any conclusive determination 

20 under subsection (c)(1) with respect to any incident 

21 of exposure studied under subsection (b), to submit, 

22 not later than 30 days after the date of such deter23 mination, to the Secretary of Defense a report de24 scribing such determination. 


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1 (g) NOTICE TO MEMBERS AND FORMER MEMBERS

2 OF THE ARMED FORCES.—The Secretary of Defense shall 

3 notify members and former members of the Armed Forces 

4 listed in a registry established under section 2(a) for expo5 sure to an occupational and environmental health chemical 

6 hazard of particular concern of— 

7 (1) any conclusive determinations made with re8 spect to such exposure under subsection (c)(1); and 

9 (2) any other significant developments in re10 search on the health consequences of exposure to 

11 such hazard. 

12 (h) LIMITATION ON AUTHORITY.—The agreement 

13 under this section shall be effective for a fiscal year to 

14 the extent that appropriations are available to carry out 

15 the agreement. 

16 (i) SUNSET.—This section shall cease to be effective 

17 10 years after the last day of the fiscal year in which the 

18 Institute of Medicine submits to the Secretary of Defense 

19 the first report under subsection (f). 

20 (j) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA21 TION.— 

22 (1) IN GENERAL.—If the Secretary of Defense 

23 is unable within the time period prescribed in sub24 section (a)(2) to enter into an agreement described 

25 in subsection (a)(1) with the Institute of Medicine 


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1 on terms acceptable to the Secretary, the Secretary 

2 shall seek to enter into such an agreement with an3 other appropriate scientific organization that— 

4 (A) is not part of the Government; 

5 (B) operates as a not-for-profit entity; and 

6 (C) has expertise and objectivity com7 parable to that of the Institute of Medicine. 

8 (2) TREATMENT.—If the Secretary enters into 

9 an agreement with another organization as described 

10 in paragraph (1), any reference in this section to the 

11 Institute of Medicine shall be treated as a reference 

12 to the other organization. 

13 (k) DEFINITIONS.—In this section: 

14 (1) APPROPRIATE COMMITTEES OF CON15 GRESS.—The term ‘‘appropriate committees of Con16 gress’’ means— 

17 (A) the Committee on Armed Services, the 

18 Committee on Veterans’ Affairs, and the Com19 mittee on Appropriations of the Senate; and 

20 (B) the Committee on Armed Services, the 

21 Committee on Veterans’ Affairs, and the Com22 mittee on Appropriations of the House of Rep23 resentatives. 

24 (2) OCCUPATIONAL AND ENVIRONMENTAL

25 HEALTH CHEMICAL HAZARD OF PARTICULAR CONVerDate Nov 24 2008 21:10 May 15, 2009 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2389.IH H2389

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1 CERN.—The term ‘‘occupational and environmental 

2 health chemical hazard of particular concern’’ means 

3 an occupational and environmental health chemical 

4 hazard that the Secretary of Defense determines is 

5 of particular concern after considering appropriate 

6 guidelines and standards for exposure, including the 

7 following: 

8 (A) The military exposure guidelines speci9 fied in the January 2002 Chemical Exposure 

10 Guidelines for Deployed Military Personnel, 

11 United States Army Center for Health Pro12 motion and Preventive Medicine Technical 

13 Guide 230 (or any successor technical guide 

14 that establishes military exposure guidelines for 

15 the assessment of the significance of field expo16 sures to occupational and environmental health 

17 chemical hazards during deployments). 

18 (B) Occupational and environmental health 

19 chemical exposure standards promulgated by 

20 the Occupational Safety and Health Adminis21 tration. 


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1 SEC. 4. REVISION IN AUTHORITIES FOR PROVISION OF 

2 HEALTH CARE FOR CERTAIN VETERANS EX3 POSED TO OCCUPATIONAL AND ENVIRON4 MENTAL HEALTH CHEMICAL HAZARDS. 

5 (a) AUTHORIZED INPATIENT CARE.—Section 

6 1710(e) of title 38, United States Code, is amended— 

7 (1) in paragraph (1), by adding at the end the 

8 following: 

9 ‘‘(F) A veteran who was exposed in the line of duty 

10 to an occupational and environmental health chemical haz11 ard of particular concern is eligible (subject to paragraph 

12 (2)) for hospital care, medical services, and nursing home 

13 care under subsection (a)(2)(F) for any disability, not14 withstanding that there is insufficient medical evidence to 

15 conclude that such disability may be associated with such 

16 exposure.’’; 

17 (2) in paragraph (2), by adding at the end the 

18 following: 

19 ‘‘(C) In the case of a veteran described in paragraph 

20 (1)(F), hospital care, medical services, and nursing home 

21 care may not be provided under subsection (a)(2)(F) with 

22 respect to— 

23 ‘‘(i) a disability that is found, in accordance 

24 with guidelines issued by the Under Secretary for 

25 Health, to have resulted from a cause other than an 

26 exposure described in paragraph (1)(F); or 


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1 ‘‘(ii) a health effect for which the National 

2 Academy of Sciences, in a report issued in accord3 ance with section 3 of the Health Care for Members 

4 of the Armed Forces Exposed to Chemical Hazards 

5 Act of 2009, has determined that there is limited or 

6 suggestive evidence of the lack of a positive associa7 tion between occurrence of the health consequences 

8 in humans and exposure to an occupational and en9 vironmental health chemical hazard of particular 

10 concern.’’; and 

11 (3) in paragraph (4), by adding at the end the 

12 following: 

13 ‘‘(C) The term ‘occupational and environmental 

14 health chemical hazard of particular concern’ means 

15 an occupational and environmental health chemical 

16 hazard that the Secretary of Defense determines is 

17 of particular concern after considering appropriate 

18 guidelines and standards for exposure, including the 

19 following: 

20 ‘‘(i) The military exposure guidelines speci21 fied in the January 2002 Chemical Exposure 

22 Guidelines for Deployed Military Personnel, 

23 United States Army Center for Health Pro24 motion and Preventive Medicine Technical 

25 Guide 230 (or any successor technical guide 


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1 that establishes military exposure guidelines for 

2 the assessment of the significance of field expo3 sures to occupational and environmental health 

4 chemical hazards during deployments). 

5 ‘‘(ii) Occupational and environmental 

6 health chemical exposure standards promul7 gated by the Occupational Safety and Health 

8 Administration.’’. 

9 (b) TECHNICAL AMENDMENT.—Section 1710(e)(4) 

10 of such title is amended in the matter before subparagraph 

11 (A) by striking ‘‘For purposes of this subsection—’’ and 

12 inserting ‘‘In this subsection:’’. 

Æ 


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