I 

117TH CONGRESS 

1ST SESSION H. R. 2607 

To amend title 38, United States Code, to establish in the Department 

of Veterans Affairs procedures to determine presumptions of service 

connection based on toxic exposure, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 15, 2021 

Mr. TRONE introduced the following bill; which was referred to the Committee 

on Veterans’ Affairs, and in addition to the Committee on Armed Services, 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 amend title 38, United States Code, to establish in the 

Department of Veterans Affairs procedures to determine 

presumptions of service connection based on toxic exposure, 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 ‘‘Fairly Assessing Serv5 ice-related Toxic Exposure Residuals Presumptions Act’’ 

6 or the ‘‘FASTER Presumptions Act’’. 


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1 SEC. 2. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF 

2 VETERANS AFFAIRS TO ESTABLISH PRE3 SUMPTIONS OF SERVICE CONNECTION 

4 BASED ON TOXIC EXPOSURE. 

5 (a) ADVISORY COMMITTEES, PANELS, AND

6 BOARDS.— 

7 (1) ESTABLISHMENT.—Chapter 11 of title 38, 

8 United States Code, is amended by adding at the 

9 end the following new subchapter: 

10 ‘‘SUBCHAPTER VII—RESEARCH AND DETER11 MINATIONS RELATING TO PRESUMPTIONS 

12 OF SERVICE CONNECTION BASED ON TOXIC 

13 EXPOSURE 

14 ‘‘§ 1171. Procedures to determine presumptions of 

15 service connection based on toxic expo16 sure; definitions 

17 ‘‘(a) PROCEDURES.—The Secretary shall determine 

18 whether to establish, or to remove, presumptions of service 

19 connection based on toxic exposure pursuant to this sub20 chapter, whereby— 

21 ‘‘(1) the Formal Advisory Committee on Toxic 

22 Exposure under section 1172 assesses research re23 garding veterans who, during active military, naval, 

24 or air service, were exposed to toxic substances, com25 missions additional research, and provides nominaVerDate Sep 11 2014 23:43 Jun 01, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2607.IH H2607

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1 tions for the Science Review Board to evaluate the 

2 research; 

3 ‘‘(2) the Science Review Board under section 

4 1173 evaluates research nominated by the Formal 

5 Advisory Committee on Toxic Exposure and deter6 mines the strength of evidence supporting a positive 

7 association between exposure to a toxic substance 

8 and an illness; 

9 ‘‘(3) the Working Group under section 1174 

10 evaluates the conclusions of the Science Review 

11 Board and recommends to the Secretary whether to 

12 establish or modify a presumption of service connec13 tion; and 

14 ‘‘(4) the Secretary prescribes regulations under 

15 section 1175. 

16 ‘‘(b) ILLNESS DEFINED.—In this subchapter, the 

17 term ‘illness’ includes a disease or other condition affect18 ing the health of an individual. 

19 ‘‘(c) NONAPPLICATION OF SUNSET REQUIRE20 MENTS.—Section 14 of the Federal Advisory Committee 

21 Act (5 U.S.C. App.) shall not apply to an entity estab22 lished under this subchapter. 


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1 ‘‘§ 1172. Formal Advisory Committee on Toxic Expo2 sure 

3 ‘‘(a) ESTABLISHMENT.—(1) There is in the Veterans 

4 Benefits Administration of the Department the Formal 

5 Advisory Committee on Toxic Exposure (in this section 

6 referred to as the ‘Committee’). 

7 ‘‘(2) The Secretary shall appoint not more than 10 

8 members to the Committee, of which— 

9 ‘‘(A) at least one member shall be appointed 

10 from among individuals who are officials or employ11 ees of the Veterans Benefits Administration or the 

12 Veterans Health Administration; 

13 ‘‘(B) at least one member shall be appointed 

14 from among individuals who are officials or employ15 ees of other departments or agencies of the Federal 

16 Government, including the Department of Defense 

17 and the Agency of Toxic Substances and Disease 

18 Registry of the Centers for Disease Control and Pre19 vention; 

20 ‘‘(C) at least three members shall be appointed 

21 from among individuals who are representatives of 

22 disabled veterans; and 

23 ‘‘(D) at least one member shall be appointed 

24 from among individuals in the private sector, State 

25 or local government, or academia, who are experts in 

26 toxicology and epidemiology. 


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1 ‘‘(3) The Secretary shall determine the pay and al2 lowances of the members, including with respect to any 

3 additional pay and allowances for members who are offi4 cials or employees of the Federal Government. 

5 ‘‘(4) Each member of the Committee shall be ap6 pointed for a two-year term, and may serve not more than 

7 three successive terms. 

8 ‘‘(5) A vacancy in the Committee shall be filled in 

9 the manner in which the original appointment was made. 

10 ‘‘(b) CONSULTATION.—The Secretary may consult 

11 with, and seek the advice of, the Committee with respect 

12 to disability-related questions relating to veterans who, 

13 during active military, naval, or air service, are suspected 

14 of having been exposed to toxic substances. 

15 ‘‘(c) ASSESSMENTS.—(1) The Committee shall assess 

16 the exposure of veterans to toxic substances that occurred 

17 during active military, naval, or air service. 

18 ‘‘(2) The assessments under paragraph (1) shall 

19 cover suspected and known toxic exposures occurring dur20 ing active military, naval, or air service, including by iden21 tifying and evaluating new and emerging exposures that 

22 are not recognized under existing presumptions of service 

23 connection. 

24 ‘‘(3) The Committee may conduct an assessment 

25 under paragraph (1) in response to a recommendation by 


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1 the Science Review Board pursuant to section 

2 1173(c)(2)(B) of this title or the Working Group under 

3 section 1174(c)(1)(B). 

4 ‘‘(4) In assessing the exposure of veterans to toxic 

5 substances under paragraph (1), the Commission shall de6 termine whether— 

7 ‘‘(A) under subsection (d), further research into 

8 the exposure is warranted; 

9 ‘‘(B) under subsection (e), the existing research 

10 being assessed is sufficient to nominate to the 

11 Science Review Board under section 1173 of this 

12 title for evaluation; 

13 ‘‘(C) under subsection (f), there is sufficient 

14 evidence regarding an existing presumption of serv15 ice connection for review by the Science Review 

16 Board or Working Group under section 1174 of this 

17 title, as the case may be; or 

18 ‘‘(D) no further action is warranted. 

19 ‘‘(d) RESEARCH.—(1)(A) Following an assessment of 

20 the exposure of veterans to toxic substances that occurred 

21 during active military, naval, or air service under sub22 section (c), the Committee may commission an appropriate 

23 entity (including an element of the Department, an aca24 demic entity, or a private-sector entity) to conduct addi25 tional research into the exposure and the health effects 


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1 of the exposure, including such research to be conducted 

2 in response to data and analyses provided by the Secretary 

3 of Defense or the Secretary of Veterans Affairs relating 

4 to suspected toxic exposure occurring during such service. 

5 ‘‘(B) In carrying out subparagraph (A), the Com6 mittee shall determine whether additional research is 

7 needed with respect to the following: 

8 ‘‘(i) Identification of the composition of sus9 pected toxic substances. 

10 ‘‘(ii) Exposure assessments. 

11 ‘‘(iii) Epidemiological studies. 

12 ‘‘(iv) Toxicology and mechanistic studies. 

13 ‘‘(C) In carrying out subparagraph (A), the Com14 mittee shall consider the following information: 

15 ‘‘(i) All available health tracking data. 

16 ‘‘(ii) All available surveillance data. 

17 ‘‘(iii) All germane research previously consid18 ered by the Committee. 

19 ‘‘(2) In assessing the suitability of topics for addi20 tional research pursuant to subparagraph (A), the Com21 mittee shall consider the following: 

22 ‘‘(A) Conditions of service in the active military, 

23 naval, or air service, known or suspected exposure to 

24 agents, and circumstances of exposure. 


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1 ‘‘(B) Existing evidence of a connection between 

2 illnesses and service in the active military, naval, or 

3 air service, and the size or ability to define the 

4 group of affected veterans. 

5 ‘‘(C) In accordance with subsection (g), input 

6 from persons who may be affected by the actions of 

7 the Committee. 

8 ‘‘(D) Exposure assessments, including data on 

9 activities of the Armed Forces or exposures that 

10 may be classified. 

11 ‘‘(E) Existing health tracking and surveillance, 

12 including veterans and members of the active mili13 tary, naval, or air service, such as the burn pit reg14 istry established under section 201 of the Dignified 

15 Burial and Other Veterans’ Benefits Improvement 

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

17 note). 

18 ‘‘(F) Research, including laboratory research 

19 discoveries and findings from studies of members of 

20 the active military, naval, or air service and civilian 

21 workers who were exposed to toxic substances. 

22 ‘‘(G) The effect of sex, gender, age, race, and 

23 ethnicity on health outcomes. 

24 ‘‘(3) The Committee shall ensure that the research 

25 commissioned under paragraph (1) is tailored to produce 


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1 results or conclusions necessary for the Science Review 

2 Board to make a fully informed assessment. 

3 ‘‘(e) NOMINATION.—If the Committee determines 

4 further action is appropriate with respect to an assessment 

5 of the exposure of veterans to toxic substances that oc6 curred during active military, naval, or air service under 

7 subsection (c), the Committee may nominate the Science 

8 Review Board to evaluate either or both, as the case may 

9 be— 

10 ‘‘(1) the existing research included in the as11 sessment; or 

12 ‘‘(2) the further research conducted pursuant to 

13 subsection (d). 

14 ‘‘(f) REVIEW OF EXISTING PRESUMPTIONS.—(1) 

15 Upon receipt of evidence suggesting that previous findings 

16 supporting a positive association between an exposure and 

17 an illness are no longer valid, the Committee may nomi18 nate such exposure or illness for review by the Science Re19 view Board. 

20 ‘‘(2) Upon receipt of evidence suggesting that pre21 vious findings regarding the periods and locations of expo22 sure covered by an existing presumption of service connec23 tion are no longer supported, the Committee may nomi24 nate such evidence for evaluation by the Working Group 

25 to modify the periods and locations. 


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1 ‘‘(g) INPUT.—(1) Not less than quarterly, the Com2 mittee shall provide an opportunity for persons described 

3 in paragraph (2) to present written or oral comments to 

4 the Committee. 

5 ‘‘(2) The persons described in this paragraph are per6 sons who may be affected by the actions of the Committee, 

7 including— 

8 ‘‘(A) veterans, the families of veterans, veterans 

9 service organizations and representatives, research10 ers, and other members of the general public; and 

11 ‘‘(B) departments and agencies of the Federal 

12 Government. 

13 ‘‘(h) REPORTS TO CONGRESS.—On a biennial basis, 

14 the Committee shall submit to the Committees on Vet15 erans’ Affairs of the House of Representatives and the 

16 Senate, and make publicly available, a report on the ac17 tions of the Committee. Each such report shall include, 

18 with respect to the period covered by the report, the fol19 lowing: 

20 ‘‘(1) A description of— 

21 ‘‘(A) the exposure and evidence considered 

22 by the Committee; 

23 ‘‘(B) any research commissioned by the 

24 Committee; and 


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1 ‘‘(C) the rationale of the nominations made 

2 by the Committee to the Science Review Board 

3 for further evaluation. 

4 ‘‘(2) A description of each specific action rec5 ommended by the Committee described in subsection 

6 (c)(3). 

7 ‘‘(3) Each report received by the Committee 

8 under section 1173(c)(2) of this title. 

9 ‘‘§ 1173. Science Review Board 

10 ‘‘(a) ESTABLISHMENT.—(1) There is in the Depart11 ment the Science Review Board (in this section referred 

12 to as the ‘Board’). 

13 ‘‘(2)(A) The members of the Board shall be appointed 

14 by the Secretary from the general public from among indi15 viduals who are distinguished in the fields of medicine, bio16 logical sciences, or health administration. 

17 ‘‘(B) An individual may not concurrently serve on the 

18 Board and the Formal Advisory Committee on Toxic Ex19 posure under section 1172 of this title. 

20 ‘‘(C) The Secretary shall determine the number, 

21 terms of service, and pay and allowances of members of 

22 the Board appointed by the Secretary. 

23 ‘‘(b) DUTIES.—(1) Upon receiving a nomination for 

24 the evaluation of research on the health effects of exposure 

25 of members of the active military, naval, or air service to 


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1 toxic substances made by the Formal Advisory Committee 

2 on Toxic Exposure pursuant to section 1172 of this title, 

3 the Board shall— 

4 ‘‘(A) evaluate the likelihood that an illness is 

5 associated with an exposure to a toxic substance 

6 while serving in the active military, naval, or air 

7 service; and 

8 ‘‘(B) assess the exposures and illnesses identi9 fied by the Committee and determine whether the 

10 evidence supports a finding of a positive association 

11 between the exposure and the illness. 

12 ‘‘(2) In carrying out paragraph (1)(B), the Board 

13 shall review all relevant data to determine, with respect 

14 to the strength of evidence for a positive association, that 

15 there is— 

16 ‘‘(A) sufficient evidence of an association; 

17 ‘‘(B) limited or suggestive evidence of an asso18 ciation; 

19 ‘‘(C) inadequate or insufficient evidence to de20 termine an association; or 

21 ‘‘(D) limited or suggestive evidence of no asso22 ciation. 

23 ‘‘(3) With respect to an evaluation conducted under 

24 this subsection, if the Board determines that the evidence 

25 for a positive association is inadequate or insufficient to 


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1 determine an association as described in paragraph 

2 (2)(C), the Board shall develop a recommendation as to 

3 whether additional data gathering and research are nec4 essary. 

5 ‘‘(c) REPORTS.—(1) For each evaluation conducted 

6 under subsection (b) where the Board determines that the 

7 evidence for a positive association is either sufficient or 

8 limited or suggestive of an association, as described in 

9 subparagraph (A) or (B) of paragraph (2) of such sub10 section, the Board shall submit to the Secretary, the 

11 Working Group under section 1174 of this title, and to 

12 the Committees on Veterans’ Affairs of the House of Rep13 resentatives and the Senate a report identifying the evi14 dence found to reach such positive association determina15 tions. 

16 ‘‘(2) For each evaluation conducted under subsection 

17 (b) where the Board determines that the evidence for posi18 tive association is inadequate or insufficient to determine 

19 an association as described in paragraph (2)(C) of such 

20 subsection, the Board shall submit to the Secretary, the 

21 Formal Advisory Committee on Toxic Exposure, and to 

22 the Committees on Veterans’ Affairs of the House of Rep23 resentatives and the Senate a report— 

24 ‘‘(A) identifying the evidence found to reach 

25 such positive association determinations; and 


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1 ‘‘(B) containing the recommendations under 

2 subsection (b)(3) as to whether additional data gath3 ering and research are necessary and an outline of 

4 a report request proposal for such additional data 

5 and research. 

6 ‘‘§ 1174. Working group on presumptions of service 

7 connection 

8 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab9 lish a working group (in this section referred to as the 

10 ‘Working Group’) to— 

11 ‘‘(1) evaluate— 

12 ‘‘(A) the conclusions of the Science Review 

13 Board contained in each report submitted under 

14 section 1173(c)(1) of this title; and 

15 ‘‘(B) evidence nominated by the Formal 

16 Advisory Committee on Toxic Exposure under 

17 section 1172(f)(2) regarding the periods and lo18 cations of exposure covered by an existing pre19 sumption of service connection; and 

20 ‘‘(2) make a recommendation to the Secretary 

21 with respect to whether to— 

22 ‘‘(A) establish a presumption of service 

23 connection for the toxic exposure and illness 

24 covered by the report described in subparagraph 

25 (A) of paragraph (1); or 


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1 ‘‘(B) modify an existing presumption of 

2 service connection described in subparagraph 

3 (B) of such paragraph. 

4 ‘‘(b) EVALUATIONS.—(1) In evaluating the conclu5 sions of the Science Review Board, the Working Group 

6 shall consider factors, in addition to the conclusions of the 

7 Board, that the Working Group determines appropriate. 

8 ‘‘(2) The Working Group shall provide a period of 

9 not fewer than 60 days for persons described in section 

10 1172(g)(2) of this title to present written comments to 

11 the Working Group with respect to each evaluation made 

12 under this section. 

13 ‘‘(c) RECOMMENDATIONS.—(1) In making a rec14 ommendation under subsection (a)(2), the Working Group 

15 shall— 

16 ‘‘(A) in cases where the evidence for a positive 

17 association is either sufficient or limited or sugges18 tive of an association, as described in subparagraph 

19 (A) or (B) of section 1173(b)(2) of this title, weigh 

20 heavily in favor of establishing a presumption of 

21 service connection; and 

22 ‘‘(B) if the Working Group determines that ad23 ditional research, studies, or reports are appropriate 

24 before making a final recommendation with respect 

25 to establishing or modifying a presumption of service 


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1 connection, submit to the Formal Advisory Com2 mittee a description of such appropriate additional 

3 research, studies, or reports. 

4 ‘‘(2) Not later than 60 days after the date on which 

5 the comment period under subsection (b)(2) ends with re6 spect to an evaluation made under this section, the Work7 ing Group shall submit to the Secretary and to the Com8 mittees on Veterans’ Affairs of the House of Representa9 tives and the Senate a description of the recommendation 

10 made under subsection (a)(2). 

11 ‘‘§ 1175. Regulations regarding presumptions of serv12 ice connection based on toxic exposure 

13 ‘‘(a) ACTION UPON WORKING GROUP RECOMMENDA14 TION.—Not later than 60 days after the date on which 

15 the Secretary receives a recommendation to establish or 

16 modify a presumption of service connection under section 

17 1174(c)(2) of this title— 

18 ‘‘(1) if the Secretary determines that the pre19 sumption, or modification, is warranted, the Sec20 retary shall issue proposed regulations setting forth 

21 the presumption or revise regulations to carry out 

22 such modification; or 

23 ‘‘(2) if the Secretary determines that the pre24 sumption, or modification, is not warranted, the Sec25 retary shall publish in the Federal Register a notice 


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1 of the determination, including the reasons sup2 porting the determination. 

3 ‘‘(b) FINAL REGULATION.—Not later than 90 days 

4 after the date on which the Secretary issues any proposed 

5 regulations under subsection (a)(1), the Secretary shall 

6 issue final regulations. Such regulations shall be effective 

7 on the date of issuance. 

8 ‘‘(c) REMOVAL OF PRESUMPTION.—(1) The Sec9 retary may issue regulations to remove an illness from a 

10 presumption of service connection previously established 

11 pursuant to a regulation issued under subsection (b). 

12 ‘‘(2) Whenever an illness is removed from regulations 

13 pursuant to paragraph (1), or the periods and locations 

14 of exposure covered by a presumption of service connection 

15 are modified under subsection (a)— 

16 ‘‘(A) a veteran who was awarded compensation 

17 for such illness on the basis of the presumption pro18 vided under such regulations before the effective 

19 date of the removal or modification shall continue to 

20 be entitled to receive compensation on that basis; 

21 and 

22 ‘‘(B) a survivor of a veteran who was awarded 

23 dependency and indemnity compensation for the 

24 death of a veteran resulting from such illness on the 

25 basis of such presumption shall continue to be entiVerDate Sep 11 2014 23:43 Jun 01, 2021 Jkt 019200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H2607.IH H2607

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1 tled to receive dependency and indemnity compensa2 tion on such basis. 

3 ‘‘§ 1176. Expert Advisory Panel on Constrictive 

4 Bronchiolitis 

5 ‘‘(a) ESTABLISHMENT.—There is in the Department 

6 the Expert Advisory Panel on Constrictive Bronchiolitis 

7 (in this section referred to as the ‘Panel’). 

8 ‘‘(b) MEMBERSHIP.—(1) The Panel shall be ap9 pointed by the Secretary from the general public from 

10 among individuals who are— 

11 ‘‘(A) experts in pulmonary pathology; 

12 ‘‘(B) experts in other fields the Secretary deter13 mines appropriate, such as pulmonary medicine, 

14 toxicology, epidemiology, exposure assessment, and 

15 radiology; and 

16 ‘‘(C) individuals representing the veterans com17 munity. 

18 ‘‘(2) The Secretary shall determine the number, 

19 terms of service, and pay and allowances of members of 

20 the Panel appointed by the Secretary. 

21 ‘‘(c) DUTIES.—The panel shall develop specific guide22 lines for research conducted by the Department of sympto23 matic veterans who served in the active military, naval, 

24 or air service in the Southwest Asia theater of operations 


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1 whom the differential diagnosis includes bronchiolitis. The 

2 Panel shall— 

3 ‘‘(1) determine the adequacy of lung biopsy ap4 proaches and recommend to the Secretary best prac5 tices; 

6 ‘‘(2) make recommendations to the Secretary 

7 for processing, handling, and storing lung biopsies; 

8 ‘‘(3) establish histologic and pathology criteria 

9 for confirming diagnoses; and 

10 ‘‘(4) submit to the Secretary and to the Com11 mittees on Veterans’ Affairs of the House of Rep12 resentatives and the Senate reports on the findings 

13 and results of such research.’’. 

14 (2) CLERICAL AMENDMENT.—The table of sec15 tions at the beginning of such chapter is amended 

16 by inserting after the item relating to section 1163 

17 the following new items: 

‘‘SUBCHAPTER VII—RESEARCH AND DETERMINATIONS RELATING TO

PRESUMPTIONS OF SERVICE CONNECTION BASED ON TOXIC EXPOSURE

‘‘1171. Procedures to determine presumptions of service connection based on 

toxic exposure; definitions. 

‘‘1172. Formal Advisory Committee on Toxic Exposure. 

‘‘1173. Science Review Board. 

‘‘1174. Working group on presumptions of service connection. 

‘‘1175. Regulations regarding presumptions of service connection based on toxic 

exposure. 

‘‘1176. Expert Advisory Panel on Constrictive Bronchiolitis.’’. 

18 (b) CONFORMING AMENDMENTS.—Chapter 11 of 

19 title 38, United States Code, is amended as follows: 

20 (1) Section 1116 is amended— 


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1 (A) by striking subsections (b), (c), (d), 

2 and (e); 

3 (B) by inserting after subsection (a) the 

4 following new subsection (b): 

5 ‘‘(b) The Secretary shall ensure that any determina6 tion made on or after the date of the enactment of the 

7 FASTER Presumptions Act regarding a presumption of 

8 service connection based on exposure to an herbicide agent 

9 under this section is made pursuant to subchapter VII of 

10 this chapter, including with respect to assessing reports 

11 received by the Secretary from the National Academy of 

12 Sciences under section 3 of the Agent Orange Act of 1991 

13 (Public Law 102–4).’’; and 

14 (C) by redesignating subsection (f) as sub15 section (c). 

16 (2) Section 1116B(b)(2)(A) is amended by in17 serting ‘‘pursuant to subchapter VII of this chap18 ter,’’ before ‘‘the Secretary determines’’. 

19 (3) Section 1118 is amended— 

20 (A) by striking subsections (b), (c), (d), 

21 and (e); and 

22 (B) by inserting after subsection (a) the 

23 following new subsection (b): 

24 ‘‘(b) The Secretary shall ensure that any determina25 tion made on or after the date of the enactment of the 


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1 FASTER Presumptions Act regarding a presumption of 

2 service connection based on exposure to a toxic substance 

3 under this section is made pursuant to subchapter VII of 

4 this chapter.’’. 

5 (c) ACCESS TO HEALTH CARE.—Section 1710(e) of 

6 title 38, United States Code, is amended— 

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

8 following new subparagraph: 

9 ‘‘(G)(i) Subject to paragraph (2), as determined 

10 appropriate by the Secretary, a toxin-exposed vet11 eran is eligible for hospital care and medical services 

12 under subsection (a)(2)(F) for any diagnosed illness 

13 that the Secretary determines is covered by, or rea14 sonably could be covered by, pending research dur15 ing the period beginning on the date on which the 

16 Formal Advisory Committee on Toxic Exposure be17 gins assessing such research under section 1172(c) 

18 of this title and ending on the date specified in 

19 clause (ii). 

20 ‘‘(ii) The date specified in this clause is the fol21 lowing: 

22 ‘‘(I) In cases of pending research for which 

23 the Secretary determines under section 

24 1175(a)(1) of this title that a presumption of 

25 service connection is warranted, the date on 


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1 which the toxin-exposed veteran is otherwise eli2 gible for hospital care and medical services pur3 suant to this section by reason of regulations 

4 issued under such section 1175. 

5 ‘‘(II) In cases of pending research for 

6 which the Secretary determines under section 

7 1175(a)(2) that a presumption of service con8 nection is not warranted, the date, if any, that 

9 the Secretary determines appropriate. 

10 ‘‘(iii) In this subparagraph: 

11 ‘‘(I) The term ‘pending research’ means 

12 research assessed or commissioned by the For13 mal Advisory Committee on Toxic Exposure 

14 under section 1172 regarding the exposure of 

15 veterans to toxic substances. 

16 ‘‘(II) The term ‘toxin-exposed veteran’ 

17 means a veteran— 

18 ‘‘(aa) whose service in the active mili19 tary, naval, or air service is covered by 

20 pending research; and 

21 ‘‘(bb) who is not otherwise eligible for 

22 hospital care and medical services pursuant 

23 to this paragraph.’’; and 

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

25 and inserting ‘‘(F), or (G)’’. 


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1 SEC. 3. IMPROVEMENTS TO DATA COLLECTION AND USE. 

2 (a) PLAN.—The Secretary of Defense, in consultation 

3 with the Secretary of Veterans Affairs, shall develop and 

4 implement a plan to strengthen the data collection with 

5 respect to members of the Armed Forces, including mem6 bers of the reserve components, who are exposed to toxic 

7 substances while serving in the Armed Forces. The plan 

8 shall provide for the following: 

9 (1) Detailing methods of continuous in-service 

10 surveillance, including data collection and analysis, 

11 of such exposures and the physical and mental 

12 health of the members. 

13 (2) Surveilling such exposures and the health of 

14 members from accession through separation, includ15 ing, where possible, through the use of wearable and 

16 portable devices to assess health outcomes, and ex17 tend such surveillance indefinitely post-separation 

18 for those veterans with suspected exposure to toxic 

19 substances. 

20 (3) Ensuring consistent surveillance efforts 

21 across the Armed Forces. 

22 (4) Determining the feasibility of collecting bio23 logical samples and the means by which such collec24 tion could be accomplished, including, at a min25 imum, through use of wearable and portable devices 


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1 and the collection of blood and urine, to measure ex2 posure in deployed environments. 

3 (5) Maintaining a repository of data and bio4 logical samples available for prospective research. 

5 (6) With respect to each member, tracking the 

6 military occupational specialty, deployment history, 

7 disease risk factors, sex, gender, age, race, and eth8 nicity. 

9 (b) REPORT.—Not later than 180 days after the date 

10 of the enactment of this Act, the Secretary shall submit 

11 to the Committees on Veterans’ Affairs and the Commit12 tees on Armed Services of the House of Representatives 

13 and the Senate, and annually thereafter for five years, a 

14 report containing the plan developed under subsection (a) 

15 and the status of implementing the plan. 

16 (c) INTEGRATION.—The Secretary of Defense shall 

17 integrate research access considerations of the plan devel18 oped under subsection (a) into the electronic health record 

19 modernization program and the individual longitudinal ex20 posure record program. 

21 (d) DETERMINATIONS.—The Secretary of Veterans 

22 Affairs, in consultation with the Formal Advisory Com23 mittee on Toxic Exposure established under section 1172 

24 of title 38, United States Code, as added by section 2, 

25 shall determine— 


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1 (1) whether studies of respiratory health out2 comes from other countries, including Australia, 

3 Canada, France, Poland, Sweden, and the United 

4 Kingdom, provide useful data, and whether the 

5 structure of these studies could be emulated in the 

6 United States to improve participation rates; and 

7 (2) whether the health records of veterans from 

8 health care systems other than the Department of 

9 Veterans Affairs, including private-sector health pro10 viders, the Centers for Medicare & Medicaid Serv11 ices, and the TRICARE program, can be accessed 

12 for research purposes. 

13 (e) SHARING OF INFORMATION.—The Secretary of 

14 Veterans Affairs shall provide to the Formal Advisory 

15 Committee on Toxic Exposure and the Science Review 

16 Board established under section 1173 of title 38, United 

17 States Code, as added by section 2, the results of surveil18 lance conducted pursuant to the plan developed under sub19 section (a), including data collection and analysis. 

20 SEC. 4. STUDIES RELATING TO VETERANS WHO SERVED IN 

21 SOUTHWEST ASIA. 

22 (a) ANALYSIS.—Not later than 180 days after the 

23 date of the enactment of this Act, the Secretary of Vet24 erans Affairs shall initiate or sponsor an updated analysis 


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1 of total and respiratory disease mortality in covered vet2 erans. The study shall include, to the extent practicable— 

3 (1) metrics of airborne exposures; 

4 (2) the location and timing of deployments; 

5 (3) the military occupational specialty; 

6 (4) the Armed Force in which the veteran 

7 served; 

8 (5) pre-existing health status, including with re9 spect to asthma; and 

10 (6) relevant personal information, including cig11 arette and e-cigarette smoking history, diet, sex, 

12 gender, age, race, and ethnicity. 

13 (b) EPIDEMIOLOGICAL STUDY.—Not later than 180 

14 days after the date of the enactment of this Act, the Sec15 retary shall sponsor an epidemiological study of covered 

16 veterans that uses the following: 

17 (1) Improved spatio-temporal estimates of am18 bient air pollution exposures using advances in retro19 spective exposure assessment. 

20 (2) Detailed information on the study subjects 

21 obtained through medical records, administrative 

22 data, and other existing sources, that include— 

23 (A) personal characteristics, including ciga24 rette and e-cigarette smoking history, diet, sex, 

25 gender, age, race, and ethnicity; 


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1 (B) deployment history, including loca2 tions, periods, and number of deployments; 

3 (C) biospecimen data; and 

4 (D) supplementary health status and out5 comes data, including imaging and physiological 

6 parameters. 

7 (c) TOXICOLOGY STUDY.—Not later than 180 days 

8 after the date of the enactment of this Act, the Secretary 

9 shall sponsor a toxicology study to include variability to 

10 replicate exposures of healthy, young members of the 

11 Armed Forces, as well as potentially susceptible members, 

12 with preexisting health conditions. The study shall— 

13 (1) analyze the study results for mechanistic 

14 markers and clinically relevant outcomes; and 

15 (2) validate serum, tissue, and other biomarkers 

16 of exposure, susceptibility, or effect. 

17 (d) COVERED VETERAN DEFINED.—The term ‘‘cov18 ered veteran’’ means any veteran who— 

19 (1) on or after August 2, 1990, served on active 

20 duty in— 

21 (A) Bahrain; 

22 (B) Iraq; 

23 (C) Kuwait; 

24 (D) Oman; 

25 (E) Qatar; 


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1 (F) Saudi Arabia; 

2 (G) Somalia; or 

3 (H) United Arab Emirates; or 

4 (2) on or after September 11, 2001, served on 

5 active duty in— 

6 (A) Afghanistan; 

7 (B) Djibouti; 

8 (C) Egypt; 

9 (D) Jordan; 

10 (E) Lebanon; 

11 (F) Syria; or 

12 (G) Yemen. 

13 SEC. 5. TRAINING TO IMPROVE CLAIMS ADJUDICATIONS. 

14 (a) TRAINING ON ADJUDICATION.—The Secretary of 

15 Veterans Affairs shall provide training to each covered em16 ployee to improve the handling of claims for compensation 

17 and pension benefits that relate to toxic exposure. The 

18 Secretary shall provide such training annually and, in ad19 dition to the annual training, when the Secretary deter20 mines that a significant development has occurred in law 

21 or regulation with respect to such claims, such as the Sec22 retary establishing a new presumption of service connec23 tion. 

24 (b) MATTERS INCLUDED.— 


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1 (1) ALL TRAINEES.—The training under sub2 section (a) shall include the following explanations 

3 with respect to claims relating to toxic exposure: 

4 (A) A lack of a presumption of service con5 nection is not by itself sufficient to determine 

6 that service connection does not exist. 

7 (B) The claims adjudicator shall always 

8 consider whether direct service connection is ap9 plicable and request, as needed, an advisory 

10 medical opinion under section 5109 of title 38, 

11 United States Code. 

12 (C) While information included in the indi13 vidual longitudinal exposure record program of 

14 the Department of Veterans Affairs may be 

15 used to corroborate assertions of toxic exposure, 

16 a lack of such information, or a lack of other 

17 corroborating evidence of toxic exposure, is not 

18 by itself sufficient to determine that such expo19 sure did not occur or sufficient to deny the 

20 claim. 

21 (2) VETERANS SERVICE REPRESENTATIVES.— 

22 In addition to the matters under paragraph (1), the 

23 Secretary shall ensure that each employee described 

24 in subsection (d)(1) receives an individualized as25 sessment of— 


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1 (A) the ability of the employee to identify 

2 claims qualifying for presumptive service con3 nection; and 

4 (B) the compliance of the employee with 

5 standardized development requirements. 

6 (3) RATING VETERANS SERVICE REPRESENTA7 TIVE.—In addition to the matters under paragraph 

8 (1), the Secretary shall ensure that each employee 

9 described in subsection (d)(2) receives an individual10 ized assessment of— 

11 (A) the ability of the employee to identify 

12 claims qualifying for presumptive service con13 nection; and 

14 (B) the compliance of the employee with 

15 the schedule of ratings for disabilities adopted 

16 under section 1155 of title 38, United States 

17 Code. 

18 (4) COMPENSATION AND PENSION MEDICAL EX19 AMINERS.—In addition to the matters under para20 graph (1), the Secretary shall ensure that each em21 ployee described in subsection (d)(3) receives an in22 dividualized assessment of— 

23 (A) the ability of the employee to identify 

24 claims qualifying for presumptive service con25 nection; and 


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1 (B) the compliance of the employee with 

2 standardized examination and medical opinion 

3 procedures. 

4 (c) PROVISION OF TRAINING.—With respect to em5 ployees described in paragraph (1) or (2) of subsection 

6 (d), the Secretary shall— 

7 (1) ensure that the training under subsection 

8 (a) is provided as part of the initial training pro9 gram for such employees; 

10 (2) place each employee under a second signa11 ture review period for claims relating to toxic expo12 sure until the employee meets the required grade 

13 scale level quality standard for such claims; and 

14 (3) using the Systematic Technical Accuracy 

15 Review program, or such successor program, conduct 

16 a nationwide, quarterly, randomized review of the 

17 quality of adjudication of claims relating to toxic ex18 posure. 

19 (d) COVERED EMPLOYEE DEFINED.—In this section, 

20 the term ‘‘covered employee’’ means employees of the De21 partment of Veterans Affairs who handle claims for com22 pensation and pension benefits, including— 

23 (1) employees who adjudicate claims; 

24 (2) employees who apply the schedule of ratings 

25 for disabilities adopted under section 1155 of title 


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1 38, United States Code, and prepare rating deci2 sions; and 

3 (3) employees or contractors who provide med4 ical examinations or medical opinions pursuant to 

5 section 5103A(d) of such title. 

Æ 


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