I 

117TH CONGRESS 

1ST SESSION H. R. 2368 

To amend title 38, United States Code, to establish a presumption of service 

connection for illnesses associated with exposure to certain airborne hazards, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 5, 2021 

Mrs. LURIA introduced the following bill; which was referred to the Committee 

on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to establish a presumption of service connection for illnesses associated 

with exposure to certain airborne 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Conceding Our Vet5 erans’ Exposures Now And Necessitating Training Act of 

6 2021’’ or the ‘‘COVENANT Act of 2021’’. 


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1 SEC. 2. PRESUMPTIONS OF SERVICE CONNECTION FOR ILL2 NESSES ASSOCIATED WITH EXPOSURE TO 

3 CERTAIN AIRBORNE HAZARDS. 

4 (a) SENSE OF CONGRESS.—It is the sense of Con5 gress that— 

6 (1) as in past theaters of operation, Southwest 

7 Asia and its supporting theaters of operation pose 

8 numerous natural and manmade hazards that nega9 tively affect the health outcomes of individuals serv10 ing in these foreign environments; 

11 (2) toxic exposures from burn pits, oil well 

12 fires, and other regional airborne hazards increase 

13 the potential for immediate and long-term illnesses 

14 to emerge among members of the Armed Forces; 

15 and 

16 (3) legislation is necessary— 

17 (A) to confront the scientific challenge of 

18 producing clear associations between in-theater 

19 toxic exposures and the illnesses confronting 

20 veterans who served in Southwest Asia and be21 yond; 

22 (B) to address the insufficient data hin23 dering the Secretary of Veterans Affairs, the 

24 Secretary of Defense, and relevant partners 

25 from reaching proactive determinations regard26 ing such associations; and 


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1 (C) to improve evaluations associated with 

2 claims for disability compensation that relate to 

3 toxic exposure. 

4 (b) PRESUMPTIONS OF SERVICE CONNECTION.— 

5 (1) IN GENERAL.—Subchapter II of chapter 11 

6 of title 38, United States Code, is amended by add7 ing at the end the following new section: 

8 ‘‘§ 1119. Presumptions of service connection for ill9 nesses associated with exposure to cer10 tain airborne hazards 

11 ‘‘(a) PRESUMPTIONS.—(1) For the purposes of sec12 tion 1110 of this title, and subject to section 1113 of this 

13 title, an illness specified in subsection (d) becoming mani14 fest in a covered veteran to a degree of 10 percent or more 

15 shall be considered to have been incurred in or aggravated 

16 during active military, naval, or air service, notwith17 standing that there is no record of evidence of such illness 

18 during a period of such service. 

19 ‘‘(2) A covered veteran shall be presumed to have 

20 been exposed to an airborne hazard specified in subsection 

21 (e) during service of the covered veteran specified in sub22 section (f)(1) unless there is affirmative evidence to estab23 lish that the covered veteran was not exposed to any such 

24 airborne hazard during such service. 


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1 ‘‘(b) MEDICAL EXAMINATIONS AND OPINIONS.—(1) 

2 If a covered veteran submits to the Secretary a claim for 

3 disability compensation for a diagnosed illness not speci4 fied in subsection (d) that includes an assertion that the 

5 illness is related to airborne hazard exposure (regardless 

6 of whether such assertion identifies a particular airborne 

7 hazard specified in subsection (e)) or open burn pit expo8 sure, and the evidence of record is insufficient to establish 

9 service connection for the illness, the Secretary shall pro10 vide to the covered veteran a medical examination and ob11 tain a medical opinion under section 5103A of this title 

12 to determine whether the illness is at least as likely as 

13 not caused by an airborne hazard specified in subsection 

14 (e). 

15 ‘‘(2) In carrying out paragraph (1), if the diagnosed 

16 illness for which a claim is submitted involves a sign or 

17 symptom specified in section 1117(g) of this title, the Sec18 retary shall ensure that— 

19 ‘‘(A) the medical examination provided pursu20 ant to such paragraph includes an evaluation of each 

21 corresponding body part or system that relates to 

22 the sign or symptom; and 

23 ‘‘(B) the sign or symptom is considered in mak24 ing the determination under such paragraph. 


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1 ‘‘(3) In providing the Secretary with a medical opin2 ion pursuant to paragraph (1), a medical provider shall 

3 consider— 

4 ‘‘(A) the total potential exposure to airborne 

5 hazards through any service of the covered veteran 

6 specified in subsection (f)(1) and the synergistic ef7 fect of combined airborne hazards, including air8 borne hazards that involve exposure through inhala9 tion, dermal exposure, or ingestion; and 

10 ‘‘(B) the medical evidence and scientific report11 ing available at the time of the determination under 

12 paragraph (1). 

13 ‘‘(c) RELATIONSHIP TO PRESUMPTIONS FOR ILL14 NESSES ASSOCIATED WITH SERVICE IN PERSIAN

15 GULF.—A determination that a presumption of service 

16 connection is not warranted pursuant to this section shall 

17 not preclude the Secretary from— 

18 ‘‘(1) determining that a presumption of service 

19 connection is warranted pursuant to section 1118 of 

20 this title; or 

21 ‘‘(2) paying compensation to the veteran (or de22 pendency and indemnity compensation to a survivor 

23 of the veteran) pursuant to section 1117 of this title. 

24 ‘‘(d) ILLNESSES.—The illnesses specified in this sub25 section are the following: 


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1 ‘‘(1) Asthma that was diagnosed after a period 

2 of service specified in subsection (f)(1). 

3 ‘‘(2)(A) Head cancer of any type. 

4 ‘‘(B) Neck cancer of any type. 

5 ‘‘(C) Respiratory cancer of any type. 

6 ‘‘(D) Gastrointestinal cancer of any type. 

7 ‘‘(E) Reproductive cancer of any type. 

8 ‘‘(F) Lymphoma cancer of any type. 

9 ‘‘(G) Lymphomatic cancer of any type. 

10 ‘‘(H) Kidney cancer. 

11 ‘‘(I) Brain cancer. 

12 ‘‘(J) Melanoma. 

13 ‘‘(3) Chronic obstructive pulmonary disease. 

14 ‘‘(4) Chronic bronchitis. 

15 ‘‘(5) Constrictive bronchiolitis or obliterative 

16 bronchiolitis. 

17 ‘‘(6) Emphysema. 

18 ‘‘(7) Granulomatous disease. 

19 ‘‘(8) Interstitial lung disease. 

20 ‘‘(9) Pleuritis. 

21 ‘‘(10) Pulmonary fibrosis. 

22 ‘‘(11) Sarcoidosis. 

23 ‘‘(12) Rhinitis. 

24 ‘‘(13) Sinusitis. 


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1 ‘‘(e) AIRBORNE HAZARDS.—The airborne hazards 

2 specified in this subsection are the following: 

3 ‘‘(1) Particulate matter, including the following: 

4 ‘‘(A) PM-10. 

5 ‘‘(B) PM-2.5. 

6 ‘‘(2) Polycyclic aromatic hydrocarbons (PAHs), 

7 including the following: 

8 ‘‘(A) Acenaphthene. 

9 ‘‘(B) Acenaphthylene. 

10 ‘‘(C) Anthracene. 

11 ‘‘(D) Benzo(a)anthracene. 

12 ‘‘(E) Benzo(a)pyrene. 

13 ‘‘(F) Benzo(b)fluoroanthene. 

14 ‘‘(G) Benzo(g,h,i)perylene. 

15 ‘‘(H) Benzo(k)fluoroanthene. 

16 ‘‘(I) Chrysene. 

17 ‘‘(J) Dibenze(a,h)anthracene. 

18 ‘‘(K) Fluoranthene. 

19 ‘‘(L) Fluorene. 

20 ‘‘(M) Indeno(1,2,3-cd)pyrene. 

21 ‘‘(N) Naphthalene. 

22 ‘‘(O) Phenanthrene. 

23 ‘‘(P) Pyrene. 

24 ‘‘(3) Volatile organic compounds, including the 

25 following: 


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1 ‘‘(A) Acetone. 

2 ‘‘(B) Acrolein. 

3 ‘‘(C) Benzene. 

4 ‘‘(D) Carbon disulfide. 

5 ‘‘(E) Chlorofluoromethane. 

6 ‘‘(F) Chloromethane. 

7 ‘‘(G) Ethylbenzene. 

8 ‘‘(H) Hexane. 

9 ‘‘(I) Hexachlorobutadiene. 

10 ‘‘(J) M/p-Xylene. 

11 ‘‘(K) Methylene chloride. 

12 ‘‘(L) Pentane. 

13 ‘‘(M) Propylene. 

14 ‘‘(N) Styrene. 

15 ‘‘(O) Toluene. 

16 ‘‘(4) Toxic organic halogenated dioxins and 

17 furans (dioxins), including the following: 

18 ‘‘(A) 1,2,3,4,6,7,8-HPCDD. 

19 ‘‘(B) 1,2,3,4,6,7,8-HPCDF. 

20 ‘‘(C) 1,2,3,4,7,8,9-HPCDF. 

21 ‘‘(D) 1,2,3,4,7,8-HXCDD. 

22 ‘‘(E) 1,2,3,4,7,8-HXCDF. 

23 ‘‘(F) 1,2,3,6,7,8-HXCDD. 

24 ‘‘(G) 1,2,3,6,7,8-HXCDF. 

25 ‘‘(H) 1,2,3,7,8,9-HXCDD. 


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1 ‘‘(I) 1,2,3,7,8,9-HXCDF. 

2 ‘‘(J) 1,2,3,7,8-PECDD. 

3 ‘‘(K) 1,2,3,7,8-PECDF. 

4 ‘‘(L) 2,3,4,6,7,8-HXCDF. 

5 ‘‘(M) 2,3,4,7,8-PECDF. 

6 ‘‘(N) 2,3,7,8-TCDD. 

7 ‘‘(O) 2,3,7,8-TCDF. 

8 ‘‘(P) Octachlorodibenzodioxin. 

9 ‘‘(Q) Octachlorodibenzofuran. 

10 ‘‘(5) Any other airborne hazard determined rel11 evant by the Secretary. 

12 ‘‘(f) DEFINITIONS.—In this section: 

13 ‘‘(1) The term ‘covered veteran’ means any vet14 eran who— 

15 ‘‘(A) on or after August 2, 1990, per16 formed active military, naval, or air service 

17 while assigned to a duty station in— 

18 ‘‘(i) Bahrain; 

19 ‘‘(ii) Iraq; 

20 ‘‘(iii) Kuwait; 

21 ‘‘(iv) Oman; 

22 ‘‘(v) Qatar; 

23 ‘‘(vi) Saudi Arabia; 

24 ‘‘(vii) Somalia; or 

25 ‘‘(viii) United Arab Emirates; or 


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1 ‘‘(B) on or after September 11, 2001, per2 formed active military, naval, or air service 

3 while assigned to a duty station in— 

4 ‘‘(i) Afghanistan; 

5 ‘‘(ii) Djibouti; 

6 ‘‘(iii) Egypt; 

7 ‘‘(iv) Jordan; 

8 ‘‘(v) Lebanon; 

9 ‘‘(vi) Syria; 

10 ‘‘(vii) Yemen; 

11 ‘‘(viii) Uzbekistan; 

12 ‘‘(ix) the Philippines; or 

13 ‘‘(x) any other country determined rel14 evant by the Secretary. 

15 ‘‘(2) The term ‘illness’ means a disease or other 

16 condition that affects the health of an individual on 

17 a basis other than an acute or transient basis. 

18 ‘‘(3) The term ‘open burn pit’ has the meaning 

19 given such term in section 201(c) of the Dignified 

20 Burial and Other Veterans’ Benefits Improvement 

21 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 

22 note), except that the area of land may be located 

23 in any country specified in paragraph (1) or deter24 mined relevant by the Secretary pursuant to such 

25 paragraph. 


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1 ‘‘(g) EFFECTIVE DATE OF AWARD.—The effective 

2 date of an award under this section shall be determined 

3 in accordance with section 5110 of this title, except that 

4 such date may not be earlier than the date of the enact5 ment of this Act.’’. 

6 (2) CLERICAL AMENDMENT.—The table of con7 tents at the beginning of chapter 11 of title 38, 

8 United States Code, is amended by inserting after 

9 the item relating to section 1118 the following new 

10 item: 

‘‘1119. Presumptions of service connection for illnesses associated with exposure 

to certain airborne hazards.’’. 

11 (3) IMPLEMENTATION DEADLINE.—The Sec12 retary of Veterans Affairs shall implement the 

13 amendments made by this subsection by not later 

14 than 18 months after the date of the enactment of 

15 this Act. 

16 (c) RELATIONSHIP TO PRESUMPTIONS FOR ILL17 NESSES ASSOCIATED WITH SERVICE IN THE PERSIAN

18 GULF.—Subchapter II of chapter 11 of title 38, United 

19 States Code, is further amended— 

20 (1) in section 1117, by adding at the end the 

21 following new subsection: 

22 ‘‘(i) A denial or termination of compensation paid to 

23 a veteran pursuant to this section shall not preclude the 

24 Secretary from determining that a presumption of service 


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1 connection is warranted pursuant to section 1119 of this 

2 title.’’; and 

3 (2) in section 1118, by adding at the end the 

4 following new subsection: 

5 ‘‘(f) A determination that a presumption of service 

6 connection is not warranted pursuant to this section shall 

7 not preclude the Secretary from determining that a pre8 sumption of service connection is warranted pursuant to 

9 section 1119 of this title.’’. 

10 (d) PENDING CASES.— 

11 (1) AUTHORITY TO STAY.—The Secretary may 

12 stay a claim described in paragraph (2) until the 

13 date on which the Secretary commences the imple14 mentation of section 1119 of title 38, United States 

15 Code (as added by subsection (b)). 

16 (2) CLAIMS DESCRIBED.—A claim described in 

17 this subparagraph is a claim for disability compensa18 tion that is pending at the Veterans Benefits Admin19 istration, the Board of Veterans’ Appeals, the Court 

20 of Appeals for Veterans Claims, or the Court of Ap21 peals for the Federal Circuit, on or after the date 

22 of the enactment of this Act and before the date on 

23 which the Secretary commences the implementation 

24 of such section 1119 and that relates to— 


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1 (A) the service and illnesses covered by 

2 such section 1119; or 

3 (B) the service covered by such section 

4 1119 and a diagnosed illness asserted in the 

5 claim to be related to airborne hazard exposure, 

6 regardless of whether such assertion identifies a 

7 particular airborne hazard, or open burn pit ex8 posure. 

9 (e) STANDARD MEDICAL TRAINING CURRICULUM.— 

10 (1) CURRICULUM.—Not later than 180 days 

11 after the date of the enactment of this Act, the Sec12 retary of Veterans Affairs shall establish a standard 

13 medical training curriculum for all medical providers 

14 conducting examinations and providing opinions 

15 under section 1119(b) of title 38, United States 

16 Code (as added by subsection (b)), that provides a 

17 standardized approach to conducting and providing 

18 examinations and opinions in accordance with such 

19 section. 

20 (2) ELEMENTS.—The Secretary shall include in 

21 the curriculum under paragraph (1) an instruction 

22 for each medical provider conducting an examination 

23 or providing an opinion to consider the following: 

24 (A) Relevant medical and scientific lit25 erature. 


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1 (B) Available information on the prox2 imity, intensity, and frequency of exposure of 

3 the individual to airborne hazards. 

4 (C) Medically unexplained chronic multi5 symptom illnesses. 

6 (D) All competent and credible evidence of 

7 record. 

8 (3) SUBMISSION TO CONGRESS.—Prior to im9 plementation of the curriculum under paragraph (1), 

10 the Secretary shall submit to the Committees on 

11 Veterans’ Affairs of the House of Representatives 

12 and the Senate such curriculum. 

13 (f) DEFINITIONS.—In this section: 

14 (1) The terms ‘‘illness’’ and ‘‘open burn pit’’ 

15 have the meaning given such terms in section 1119 

16 of title 38, United States Code (as added by sub17 section (b)). 

18 (2) The term ‘‘medically unexplained chronic 

19 multisymptom illness’’ has the meaning given such 

20 term in section 1117(a)(2)(B) of title 38, United 

21 States Code. 


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1 SEC. 3. ELIGIBILITY FOR CARE AND SERVICES BASED ON 

2 POTENTIAL EXPOSURE TO CERTAIN AIR3 BORNE HAZARDS. 

4 (a) ELIGIBILITY FOR CARE AND SERVICES.—Section 

5 1710(e) of title 38, United States Code, is amended— 

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

7 following new subparagraph: 

8 ‘‘(G)(i) Subject to paragraph (2), a covered vet9 eran is eligible for hospital care, medical services, 

10 and nursing home care under subsection (a)(2)(F) 

11 for any diagnosed illness, notwithstanding that there 

12 is insufficient medical evidence to conclude that such 

13 illness is attributable to the service specified in sec14 tion 1119(f)(1) of this title. 

15 ‘‘(ii) In this subparagraph, the term ‘covered 

16 veteran’ has the meaning given such term in section 

17 1119 of this title.’’; and 

18 (2) in paragraph (2)(B), by striking ‘‘or (F)’’ 

19 and inserting ‘‘(F), or (G)’’. 

20 (b) RESOURCE ASSESSMENT AND REPORT.— 

21 (1) INITIAL ASSESSMENT AND REPORT.—Not 

22 later than 180 days after the date of the enactment 

23 of this Act, the Secretary of Veterans Affairs shall— 

24 (A) complete an assessment to deter25 mine— 


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1 (i) the personnel and material re2 sources necessary to implement the amend3 ments made by subsection (a); and 

4 (ii) the total number of covered vet5 erans, as such term is defined in section 

6 1119 of title 38, United States Code (as 

7 added by section 2(b)), who receive hos8 pital care or medical services furnished by 

9 the Secretary under chapter 17 of such 

10 title, disaggregated by priority group speci11 fied in section 1705(a) of such title; and 

12 (B) submit to the Committees on Veterans’ 

13 Affairs of the House of Representatives and the 

14 Senate an initial report containing the findings 

15 of the assessment completed under subpara16 graph (A), including a specific determination as 

17 to whether the Department has the personnel 

18 and material resources necessary to implement 

19 the amendments made by subsection (a). 

20 (2) SUBSEQUENT REPORTS.—If the initial re21 port submitted under paragraph (1)(B) contains a 

22 determination that the Department does not have 

23 the personnel or material resources necessary to im24 plement the amendments made by subsection (a), 

25 beginning not later than 90 days after the submisVerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368

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1 sion of such initial report and every 90 days there2 after until the effective date specified in subsection 

3 (c), the Secretary shall submit to the Committees on 

4 Veterans’ Affairs of the House of Representatives 

5 and the Senate a subsequent report containing an 

6 update to such determination. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 subsection (a) shall take effect on the date that is the ear9 lier of the following: 

10 (1) The date on which the Secretary submits a 

11 report under subsection (b) containing a determina12 tion that the Department has the personnel and ma13 terial resources necessary to implement such amend14 ments. 

15 (2) The date that is 18 months after the date 

16 of the enactment of this Act. 

Æ 


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