I 

117TH CONGRESS 

1ST SESSION H. R. 2372 

To amend title 38, United States Code, to provide for a presumption of 

service connection for certain diseases associated with exposure to toxins, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 5, 2021 

Mr. RUIZ (for himself, Mr. FITZPATRICK, and Mr. SUOZZI) introduced the following bill; which was referred to the Committee on Veterans’ Affairs, 

and in addition to the Committee on Education and Labor, 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 provide for a 

presumption of service connection for certain diseases 

associated with exposure to toxins, 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 ‘‘Presumptive Benefits 

5 for War Fighters Exposed to Burn Pits and Other Toxins 

6 Act of 2021’’. 


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1 SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR CER2 TAIN DISEASES ASSOCIATED WITH EXPO3 SURE TO BURN PITS AND OTHER TOXINS. 

4 (a) IN GENERAL.—Subchapter II of chapter 11 of 

5 title 38, United States Code, is amended by adding at the 

6 end the following new section: 

7 ‘‘§ 1119. Presumption of service connection for cer8 tain diseases associated with exposure to 

9 burn pits and other toxins 

10 ‘‘(a) PRESUMPTION OF SERVICE CONNECTION.—(1) 

11 For the purposes of section 1110 of this title, and subject 

12 to section 1113 of this title, a disease specified in para13 graph (2) becoming manifest in a veteran described in 

14 paragraph (3) shall be considered to have been incurred 

15 in or aggravated during active military, naval, or air serv16 ice, notwithstanding that there is no record of evidence 

17 of such disease during the period of such service. 

18 ‘‘(2) The diseases specified in this paragraph are the 

19 following: 

20 ‘‘(A) Asthma that was diagnosed after service 

21 in a country or territory for which a medal described 

22 in paragraph (3) was awarded. 

23 ‘‘(B)(i) Head cancer of any type. 

24 ‘‘(ii) Neck cancer of any type. 

25 ‘‘(iii) Respiratory cancer of any type. 

26 ‘‘(iv) Gastrointestinal cancer of any type. 


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1 ‘‘(v) Pancreatic cancer of any type. 

2 ‘‘(vi) Reproductive cancer of any type. 

3 ‘‘(vii) Lymphoma cancer of any type. 

4 ‘‘(viii) Lymphomatic cancer of any type. 

5 ‘‘(ix) Kidney cancer. 

6 ‘‘(x) Brain cancer. 

7 ‘‘(xi) Melanoma. 

8 ‘‘(C) Chronic bronchitis. 

9 ‘‘(D) Chronic obstructive pulmonary disease. 

10 ‘‘(E) Constrictive bronchiolitis or obliterative 

11 bronchiolitis. 

12 ‘‘(F) Emphysema. 

13 ‘‘(G) Granulomatous disease. 

14 ‘‘(H) Interstitial lung disease. 

15 ‘‘(I) Pleuritis. 

16 ‘‘(J) Pulmonary fibrosis. 

17 ‘‘(K) Sarcoidosis. 

18 ‘‘(L) Any other disease listed under subsection 

19 (a)(2) of section 1116 of this title or for which a 

20 presumption of service connection is warranted pur21 suant to regulations prescribed under section sub22 section (b)(1) of such section. 

23 ‘‘(M) Any other disease with respect to which 

24 final regulations have been prescribed under sub25 section (c)(3). 


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1 ‘‘(3) A veteran described in this paragraph is any vet2 eran who on or after August 2, 1990, was awarded any 

3 of the following: 

4 ‘‘(A) The Afghanistan Campaign Medal. 

5 ‘‘(B) The Armed Forces Expeditionary Medal. 

6 ‘‘(C) The Armed Forces Reserve Medal with M7 device. 

8 ‘‘(D) The Armed Forces Service Medal. 

9 ‘‘(E) The Global War On Terrorism Expedi10 tionary Medal. 

11 ‘‘(F) The Inherent Resolve Campaign Medal. 

12 ‘‘(G) The Iraqi Campaign Medal. 

13 ‘‘(H) The Southwest Asia Service Medal. 

14 ‘‘(b) PROCESS TO ADD DISEASES THROUGH WRIT15 TEN PETITION.—(1) In the case that the Secretary re16 ceives a written petition from an interested party to add 

17 a disease to the list of diseases specified in subsection 

18 (a)(2), not later than 90 days after the date of receipt 

19 of such petition, the Secretary shall request a determina20 tion by the National Academies of Sciences, Engineering, 

21 and Medicine (referred to in this section as the ‘National 

22 Academies’) with respect to whether there is a positive as23 sociation between— 

24 ‘‘(A) the exposure of humans to one or more 

25 covered toxins; and 


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1 ‘‘(B) the occurrence of the disease in humans. 

2 ‘‘(2) For purposes of this subsection, the term ‘inter3 ested party’ includes a representative of— 

4 ‘‘(A) a congressionally chartered veterans serv5 ice organization; 

6 ‘‘(B) an organization that— 

7 ‘‘(i) is described in section 501(c)(3) of the 

8 Internal Revenue Code of 1986 and exempt 

9 from taxation under section 501(a) of such 

10 Code; 

11 ‘‘(ii) serves veterans or members of the 

12 Armed Forces; and 

13 ‘‘(iii) has continuously operated for a pe14 riod of five years or more preceding the date of 

15 the submittal of the written petition under 

16 paragraph (1); 

17 ‘‘(C) a collective bargaining agent for civilian 

18 employees of the United States Government; 

19 ‘‘(D) a nationally recognized medical associa20 tion; 

21 ‘‘(E) the National Academies; or 

22 ‘‘(F) a State or political subdivision of a State. 

23 ‘‘(c) DETERMINATIONS BY NATIONAL ACADEMIES.— 

24 (1) If the Secretary receives a determination described in 


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1 paragraph (2), not later than 180 days after receipt of 

2 such determination, the Secretary shall— 

3 ‘‘(A) publish in the Federal Register proposed 

4 regulations to add the disease covered by the deter5 mination to the list of diseases specified in sub6 section (a)(2); 

7 ‘‘(B) publish in the Federal Register, and sub8 mit to the Committee on Veterans’ Affairs of the 

9 Senate and the Committee on Veterans’ Affairs of 

10 the House of Representatives— 

11 ‘‘(i) the decision of the Secretary not to 

12 publish such proposed regulations; and 

13 ‘‘(ii) the basis for such decision, including 

14 specific medical science refuting the determina15 tion; or 

16 ‘‘(C) publish in the Federal Register a decision 

17 that insufficient evidence exists to take action under 

18 subparagraph (A) or (B). 

19 ‘‘(2) A determination described in this paragraph— 

20 ‘‘(A) is a determination by the National Acad21 emies that there is a positive association between— 

22 ‘‘(i) the exposure of humans to one or 

23 more covered toxins; and 

24 ‘‘(ii) the occurrence of the disease in hu25 mans; and 


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1 ‘‘(B) may be made pursuant to— 

2 ‘‘(i) a request from the Secretary under 

3 subsection (b); or 

4 ‘‘(ii) an agreement between the Secretary 

5 and the National Academies under section 3 of 

6 the Presumptive Benefits for War Fighters Ex7 posed to Burn Pits and Other Toxins Act of 

8 2021. 

9 ‘‘(3)(A) Not later than 180 days after the date on 

10 which the Secretary publishes any proposed regulations 

11 under paragraph (1)(A) for a disease, the Secretary shall 

12 prescribe final regulations for that disease. 

13 ‘‘(B) Such regulations shall be effective on the date 

14 of issuance. 

15 ‘‘(d) REFERENCE TO NATIONAL ACADEMIES.—In the 

16 case that the Secretary enters into an agreement with an17 other organization as described in section 3(h)(1) of the 

18 Presumptive Benefits for War Fighters Exposed to Burn 

19 Pits and Other Toxins Act of 2021, any reference in this 

20 section to the National Academies shall be treated as a 

21 reference to the other organization. 

22 ‘‘(e) DEFINITIONS.—In this section: 

23 ‘‘(1) The term ‘covered toxin’ includes the fol24 lowing: 

25 ‘‘(A) Any toxic chemical or toxic fume. 


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1 ‘‘(B) Hazardous waste, mixed waste, solid 

2 waste, or used oil (as those terms are defined 

3 in section 1004 of the Solid Waste Disposal Act 

4 (42 U.S.C. 6903)). 

5 ‘‘(C) Radiological waste. 

6 ‘‘(D) Any other carcinogen. 

7 ‘‘(2) The term ‘veterans service organization’ 

8 means an organization recognized by the Secretary 

9 for the representation of veterans under section 

10 5902 of this title.’’. 

11 (b) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—The amendment made by 

13 subsection (a) shall take effect on the date that is 

14 180 days after the date of the enactment of this Act. 

15 (2) WRITTEN PETITIONS.—With respect to a 

16 written petition described in section 1119(b)(1) of 

17 title 38, United States Code, as added by subsection 

18 (a), that was received by the Secretary of Veterans 

19 Affairs before the effective date described in para20 graph (1), the Secretary shall make a request of the 

21 National Academies of Sciences, Engineering, and 

22 Medicine under such section, as so added, not later 

23 than 90 days after such effective date. 

24 (c) CLERICAL AMENDMENT.—The table of sections 

25 at the beginning of chapter 11 of title 38, United States 


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1 Code, is amended by inserting after the item relating to 

2 section 1118 the following new item: 

‘‘1119. Presumption of service connection for certain diseases associated with 

exposure to burn pits and other toxins.’’. 

3 (d) CONFORMING AMENDMENT.—Section 1113 of 

4 such title is amended by striking ‘‘or 1118’’ each place 

5 it appears and inserting ‘‘1118, or 1119’’. 

6 SEC. 3. AGREEMENT WITH THE NATIONAL ACADEMIES OF 

7 SCIENCES, ENGINEERING, AND MEDICINE 

8 CONCERNING THE EXPOSURE OF HUMANS TO 

9 BURN PITS AND OTHER TOXINS. 

10 (a) AGREEMENT.— 

11 (1) IN GENERAL.—The Secretary of Veterans 

12 Affairs shall seek to enter into an agreement with 

13 the National Academies of Sciences, Engineering, 

14 and Medicine (referred to in this section as the ‘‘Na15 tional Academies’’) to perform the services covered 

16 by this section. 

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

18 into the agreement described in paragraph (1) not 

19 later than 60 days after the date of the enactment 

20 of this Act. 

21 (b) REVIEWS OF SCIENTIFIC EVIDENCE.— 

22 (1) IN GENERAL.—Under an agreement be23 tween the Secretary and the National Academies, 

24 the National Academies shall review and summarize 


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1 the scientific evidence, and assess the strength there2 of, concerning the association between the exposure 

3 of humans to covered toxins and each disease sus4 pected to be associated with such exposure. 

5 (2) REVIEWS UPON REQUEST.—Under an 

6 agreement between the Secretary and the National 

7 Academies under this section, the National Acad8 emies shall conduct a review described in paragraph 

9 (1) in response to each request made by the Sec10 retary under section 1119(b)(1) of title 38, United 

11 States Code, as added by section 2(a). 

12 (c) SCIENTIFIC DETERMINATIONS CONCERNING DIS13 EASES.— 

14 (1) IN GENERAL.—For each disease reviewed 

15 under subsection (b), the National Academies shall 

16 determine (to the extent that available scientific data 

17 permit meaningful determinations) whether there is 

18 a positive association between the exposure of hu19 mans to one or more covered toxins and the occur20 rence of the disease in humans, taking into account 

21 the strength of the scientific evidence and the appro22 priateness of the statistical and epidemiological 

23 methods used to detect the association. 

24 (2) SUBMISSIONS FOR REVIEWS UPON RE25 QUEST.—Under an agreement between the Secretary 


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1 and the National Academies under this section, not 

2 later than 270 days after the date on which the Sec3 retary transmits a request to the National Acad4 emies with respect to a disease under section 

5 1119(b)(1) of title 38, United States Code, as added 

6 by section 2(a), the National Academies shall submit 

7 to the Secretary the determination made with re8 spect to that disease under paragraph (1). 

9 (d) RECOMMENDATIONS FOR ADDITIONAL SCI10 ENTIFIC STUDIES.— 

11 (1) IN GENERAL.—Under an agreement be12 tween the Secretary and the National Academies 

13 under this section, the National Academies shall 

14 make any recommendations it has for additional sci15 entific studies to resolve areas of continuing sci16 entific uncertainty relating to the exposure of hu17 mans to covered toxins. 

18 (2) CONSIDERATIONS.—In making rec19 ommendations for additional scientific studies, the 

20 National Academies shall consider— 

21 (A) the scientific information that is avail22 able at the time of the recommendation; 

23 (B) the value and relevance of the informa24 tion that could result from additional studies; 

25 and 


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1 (C) the feasibility of carrying out such ad2 ditional studies. 

3 (e) SUBSEQUENT REVIEWS.—Under an agreement 

4 between the Secretary and the National Academies under 

5 this section, the National Academies shall— 

6 (1) conduct as comprehensive a review as is 

7 practicable of the evidence referred to in subsection 

8 (b)(1) that became available since the last review of 

9 such evidence under this section; and 

10 (2) make determinations and estimates on the 

11 basis of the results of such review and all other re12 views conducted for the purposes of this section. 

13 (f) REPORTS.— 

14 (1) INITIAL REPORT.— 

15 (A) IN GENERAL.—Under an agreement 

16 between the Secretary and the National Acad17 emies under this section, not later than 540 

18 days after the date of the enactment of this 

19 Act, the National Academies shall submit to the 

20 Secretary and the Committee on Veterans’ Af21 fairs of the Senate and the Committee on Vet22 erans’ Affairs of the House of Representatives 

23 a report on the activities of the National Acad24 emies under the agreement. 


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1 (B) ELEMENTS.—The report submitted 

2 under subparagraph (A) shall include the fol3 lowing: 

4 (i) The determinations described in 

5 subsection (c)(1). 

6 (ii) An explanation of the scientific 

7 evidence and reasoning that led to such de8 terminations. 

9 (iii) Any recommendations of the Na10 tional Academies under subsection (d). 

11 (2) PERIODIC UPDATES.—Under an agreement 

12 between the Secretary and the National Academies 

13 under this section, not less frequently than once 

14 every two years, the National Academies shall sub15 mit to the Secretary and the Committee on Vet16 erans’ Affairs of the Senate and the Committee on 

17 Veterans’ Affairs of the House of Representatives an 

18 updated report on the activities of the National 

19 Academies under the agreement. 

20 (g) LIMITATION ON AUTHORITY.—The authority to 

21 enter into agreements under this section shall be effective 

22 for a fiscal year to the extent that appropriations are 

23 available. 

24 (h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA25 TION.— 


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1 (1) IN GENERAL.—If the Secretary is unable 

2 within the period prescribed in subsection (a)(2) to 

3 enter into an agreement with the National Acad4 emies on terms acceptable to the Secretary, the Sec5 retary shall seek to enter into such an agreement 

6 with another appropriate scientific organization 

7 that— 

8 (A) is not part of the Government; 

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

10 (C) has expertise and objectivity com11 parable to that of the National Academies. 

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

13 an agreement with another organization as described 

14 in paragraph (1), any reference in this section, sec15 tion 4, and section 1119 of title 38, United States 

16 Code, as added by section 2(a), to the National 

17 Academies shall be treated as a reference to the 

18 other organization. 

19 (i) COVERED TOXIN DEFINED.—In this section, the 

20 term ‘‘covered toxin’’ has the meaning given that term in 

21 section 1119(e) of title 38, United States Code, as added 

22 by section 2(a). 

23 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated to the Department of 


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1 Veterans Affairs such sums as may be necessary to carry 

2 out this section. 

3 SEC. 4. ACCESS OF THE NATIONAL ACADEMIES OF 

4 SCIENCES, ENGINEERING, AND MEDICINE TO 

5 INFORMATION FROM FEDERAL AGENCIES. 

6 (a) IN GENERAL.—Upon request by the National 

7 Academies of Sciences, Engineering, and Medicine (re8 ferred to in this section as the ‘‘National Academies’’), 

9 the head of any Federal agency with relevant information 

10 shall provide to the National Academies information in the 

11 possession of the agency that the National Academies de12 termines useful in conducting a review under section 3(b). 

13 (b) FEDERAL AGENCY DEFINED.—In this section, 

14 the term ‘‘Federal agency’’ means any agency as that term 

15 is defined in section 551 of title 5, United States Code. 

16 SEC. 5. PRESUMPTION RELATING TO PERSONAL INJURY OF 

17 CERTAIN FEDERAL EMPLOYEES. 

18 (a) IN GENERAL.—Section 8102 of title 5, United 

19 States Code, is amended by adding at the end the fol20 lowing: 

21 ‘‘(c)(1) In this subsection, the term ‘covered em22 ployee’ means an employee of the Department of State, 

23 the Department of Defense, or an element of the intel24 ligence community (as defined in section 3 of the National 

25 Security Act of 1947 (50 U.S.C. 3003)) who, on or after 


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1 August 2, 1990, carried out the job responsibilities of the 

2 employee for not fewer than 30 total days in a country 

3 or territory while the United States was conducting a con4 tingency operation (as defined in section 101 of title 10) 

5 in that country or territory. 

6 ‘‘(2) Disability or death from a disease described in 

7 paragraph (2) of such section suffered by a covered em8 ployee is deemed to have resulted from personal injury 

9 sustained while in the performance of the duty of the cov10 ered employee, whether or not the covered employee was 

11 engaged in the course of employment when the disability 

12 or disability resulting in death occurred.’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall take effect on the date that is 180 

15 days after the date of enactment of this Act. 

Æ 


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