II 

Calendar No. 145 

117TH CONGRESS 

1ST SESSION S. 3003 

To improve health care and benefits for veterans exposed to toxic substances, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 19, 2021 

Mr. TESTER, from the Committee on Veterans’ Affairs, reported the following 

original bill; which was read twice and placed on the calendar 

A BILL 

To improve health care and benefits for veterans exposed 

to toxic substances, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Comprehensive and Overdue Support for Troops of War 

6 Act of 2021’’ or the ‘‘COST of War Act of 2021’’. 

7 (b) TABLE OF CONTENTS.—The table of contents for 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—EXPANSION OF HEALTH CARE FOR TOXIC EXPOSURE 

VETERANS 

Sec. 101. Health care for certain toxic exposure veterans. 

Sec. 102. Expansion of health care eligibility for certain veterans exposed to 

open burn pits. 

Sec. 103. Expansion of health care eligibility for veterans awarded certain medals. 

Sec. 104. Study on feasibility and advisability of furnishing hospital care and 

medical services to dependents of veterans who participated in 

toxic exposure risk activities. 

TITLE II—REFORMS TO THE TOXIC EXPOSURE PRESUMPTION 

PROCESS 

Sec. 201. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure. 

Sec. 202. Technical corrections. 

TITLE III—REFORMS TO THE SERVICE CONNECTION PROCESS 

FOR TOXIC EXPOSURE VETERANS 

Sec. 301. Presumptions of toxic exposure. 

Sec. 302. Presumption of exposure to airborne hazards and substances from 

burn pits. 

Sec. 303. Medical nexus examinations for toxic exposures. 

TITLE IV—EXPANSION OF PRESUMPTIONS OF SERVICE 

CONNECTION FOR FORGOTTEN VETERANS 

Sec. 401. Mark Takai Atomic Veterans Healthcare Parity Act of 2021. 

Sec. 402. Treatment of veterans who participated in nuclear response near 

Palomares, Spain, as radiation-exposed veterans for purposes 

of presumption of service-connection of certain disabilities by 

Department of Veterans Affairs. 

Sec. 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in 

certain locations. 

Sec. 404. Addition of additional diseases associated with exposure to certain 

herbicide agents for which there is a presumption of service 

connection for veterans who served in the Republic of Vietnam. 

Sec. 405. Improving compensation for disabilities occurring in Persian Gulf 

War veterans. 

Sec. 406. Presumption of service connection for certain diseases associated with 

exposure to burn pits and other toxins. 

TITLE V—STRENGTHENING FEDERAL RESEARCH ON TOXIC 

EXPOSURES 

Sec. 501. Coordination by Department of Veterans Affairs of toxic exposure research. 

Sec. 502. Collection, analysis, and report on treatment of veterans for medical 

conditions related to toxic exposure. 

Sec. 503. Studies relating to veterans who served in Southwest Asia. 

Sec. 504. Study on health trends of post 9/11 veterans. 

Sec. 505. Study on cancer rates among veterans. 


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TITLE VI—IMPROVING SUPPORT TO TOXIC EXPOSURE VETERANS 

Sec. 601. Definitions. 

Sec. 602. Publication of list of resources of Department of Veterans Affairs for 

toxic exposure veterans and outreach program for such veterans and caregivers and survivors of such veterans. 

Sec. 603. Incorporation of toxic exposure questionnaire during primary care appointments. 

Sec. 604. Training for personnel of the Department of Veterans Affairs with 

respect to toxic exposure veterans. 

Sec. 605. SFC Heath Robinson Burn Pit Transparency Act. 

TITLE VII—STRENGTHENING RECORD-KEEPING OF TOXIC 

EXPOSURES BY DEPARTMENT OF DEFENSE 

Sec. 701. Definitions. 

Sec. 702. Independent study on Individual Longitudinal Exposure Record. 

Sec. 703. Biannual report on Individual Longitudinal Exposure Record. 

Sec. 704. Correction of toxic exposure records. 

1 TITLE I—EXPANSION OF HEALTH 

2 CARE FOR TOXIC EXPOSURE 

3 VETERANS 

4 SEC. 101. HEALTH CARE FOR CERTAIN TOXIC EXPOSURE 

5 VETERANS. 

6 (a) IN GENERAL.—Section 1710(e) of title 38, 

7 United States Code, is amended— 

8 (1) paragraph (1), by adding at the end the fol9 lowing new subparagraph: 

10 ‘‘(G) Subject to paragraph (2), any veteran who par11 ticipated in a toxic exposure risk activity while serving on 

12 active duty, active duty for training, or inactive duty train13 ing is eligible for hospital care, medical services, and nurs14 ing home care under subsection (a)(2)(F) for any illness, 

15 notwithstanding that there is insufficient medical evidence 

16 to conclude that such illness is attributable to such toxic 

17 exposure risk activity.’’; and 


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1 (2) in paragraph (2)(B)— 

2 (A) by striking ‘‘or (F)’’ and inserting 

3 ‘‘(F), or (G)’’; and 

4 (B) by striking ‘‘service or testing’’ and in5 serting ‘‘service, testing, or activity’’. 

6 (b) DEFINITIONS.—Section 101 of such title is 

7 amended by adding at the end the following new para8 graphs: 

9 ‘‘(37) The term ‘toxic exposure’ includes the 

10 following: 

11 ‘‘(A) A toxic exposure risk activity. 

12 ‘‘(B) An exposure to a toxic or hazardous 

13 substance that is subject to regulation by the 

14 Occupational Safety and Health Administra15 tion. 

16 ‘‘(38) The term ‘toxic exposure veteran’ means 

17 any veteran who— 

18 ‘‘(A) carried out a toxic exposure risk ac19 tivity; or 

20 ‘‘(B) received or receives hospital care, 

21 medical services, or nursing home care pursuant 

22 to section 1710(e)(1) of this title. 

23 ‘‘(39) The term ‘toxic exposure risk activity’ 

24 means any activity— 


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1 ‘‘(A) that requires a corresponding entry in 

2 the Individual Longitudinal Exposure Record of 

3 the veteran who carried out the activity; or 

4 ‘‘(B) that the Secretary determines quali5 fies for purposes of section 1710(e)(1) of this 

6 title when taking into account what is reason7 ably prudent to protect the health of veterans. 

8 ‘‘(40) The term ‘Individual Longitudinal Expo9 sure Record’ includes any pilot program or other 

10 program used by the Department of Veterans Af11 fairs or the Department of Defense to track how 

12 members of the Armed Forces or veterans have been 

13 exposed to various occupational or environmental 

14 hazards.’’. 

15 SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

16 CERTAIN VETERANS EXPOSED TO OPEN 

17 BURN PITS. 

18 (a) IN GENERAL.—Section 1710(e) of title 38, 

19 United States Code, as amended by section 101(a)(2)(A), 

20 is further amended— 

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

22 following new subparagraph: 

23 ‘‘(H)(i) Subject to paragraph (2), a covered veteran 

24 is eligible for hospital care, medical services, and nursing 

25 home care under subsection (a)(2)(F) for any illness. 


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1 ‘‘(ii) For purposes of this subparagraph, a covered 

2 veteran is a veteran who— 

3 ‘‘(I) is eligible for inclusion in the Airborne 

4 Hazards and Open Burn Pit Registry; or 

5 ‘‘(II) has been identified by the Secretary of 

6 Defense to have been possibly exposed, inside or out7 side the United States, during active duty, active 

8 duty for training, or inactive duty training, to an 

9 open burn pit. 

10 ‘‘(iii) In this subparagraph: 

11 ‘‘(I) The term ‘Airborne Hazards and Open 

12 Burn Pit Registry’ means the registry established by 

13 the Secretary under section 201 of the Dignified 

14 Burial and Other Veterans’ Benefits Improvement 

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

16 note). 

17 ‘‘(II) The term ‘open burn pit’ has the meaning 

18 given that term in section 201(c) of the Dignified 

19 Burial and Other Veterans’ Benefits Improvement 

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

21 note).’’; and 

22 (2) in paragraph (2)(B), as amended by section 

23 101(a)(2)(A), by striking ‘‘or (G)’’ and inserting 

24 ‘‘(G), or (H)’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall take effect on the date that is 90 days 

3 after the date of the enactment of this Act. 

4 SEC. 103. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

5 VETERANS AWARDED CERTAIN MEDALS. 

6 (a) IN GENERAL.—Section 1710(e) of title 38, 

7 United States Code, as amended by section 102(a)(1), is 

8 further amended— 

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

10 following new subparagraph: 

11 ‘‘(I) Subject to paragraph (2), a veteran is eligible 

12 for hospital care, medical services, and nursing home care 

13 under subsection (a)(2)(F) for any illness if the veteran 

14 was awarded any of the following: 

15 ‘‘(i) The Afghanistan Campaign Medal. 

16 ‘‘(ii) The Armed Forces Expeditionary Medal. 

17 ‘‘(iii) The Global War on Terrorism Expedi18 tionary Medal. 

19 ‘‘(iv) The Inherent Resolve Campaign Medal. 

20 ‘‘(v) The Iraqi Campaign Medal. 

21 ‘‘(vi) The Southwest Asia Service Medal.’’; and 

22 (2) in paragraph (2)(B), as amended by section 

23 102(a)(2), by striking ‘‘or (H)’’ and inserting ‘‘(H), 

24 or (I)’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall take effect on the date that is 90 days 

3 after the date of the enactment of this Act. 

4 SEC. 104. STUDY ON FEASIBILITY AND ADVISABILITY OF 

5 FURNISHING HOSPITAL CARE AND MEDICAL 

6 SERVICES TO DEPENDENTS OF VETERANS 

7 WHO PARTICIPATED IN TOXIC EXPOSURE 

8 RISK ACTIVITIES. 

9 (a) IN GENERAL.—The Secretary of Veterans Affairs 

10 shall conduct a study on the feasibility and advisability 

11 of furnishing hospital care and medical services to quali12 fying dependents of veterans described in section 

13 1710(e)(1)(G) of title 38, United States Code, as added 

14 by section 101(a)(1), for any illness or condition deter15 mined by the Secretary to be connected to a toxic exposure 

16 risk activity carried out by the veteran, as determined by 

17 the Secretary, notwithstanding that there is insufficient 

18 medical evidence to conclude that such illness or condition 

19 is attributable to such activity. 

20 (b) ELEMENTS OF STUDY.—The study required 

21 under subsection (a) shall— 

22 (1) assess the impact of furnishing hospital care 

23 and medical services to qualifying dependents as de24 scribed in such subsection on the ability of the DeVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 partment of Veterans Affairs to furnish hospital care 

2 and medical services to veterans; 

3 (2) assess the potential cost of furnishing hos4 pital care and medical services to qualifying depend5 ents as described in such subsection; 

6 (3) estimate the resources required to furnish 

7 such care and services; 

8 (4) assess any stress or other impact furnishing 

9 such care and services would have on the claims and 

10 appeals system of the Department; 

11 (5) estimate the number of qualifying depend12 ents who would be eligible for such care and serv13 ices; and 

14 (6) assess the feasibility of adjudicating claims 

15 for such care and services. 

16 (c) PHASED IN APPLICATION.—In conducting the 

17 study under subsection (a), the Secretary shall assess the 

18 feasibility and advisability of phasing in the furnishing of 

19 hospital care and medical services to qualifying depend20 ents described in such subsection by the decade in which 

21 such toxic exposure risk activity occurred, starting with 

22 the most recent decade. 

23 (d) REVIEW OF EXPOSURE CASES REGARDING LI24 ABILITY OF DEPARTMENT OF DEFENSE.—In conducting 

25 the study under subsection (a), the Secretary shall— 


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1 (1) review known cases of toxic exposure on in2 stallations of the Department of Defense in the 

3 United States; 

4 (2) explore the liability of the Department of 

5 Defense in each such case; and 

6 (3) assess whether the Department of Defense 

7 should provide care and services relating to such 

8 toxic exposures under the TRICARE program. 

9 (e) REPORT.—Not later than two years after the date 

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

11 to Congress a report on the study conducted under sub12 section (a). 

13 (f) DEFINITIONS.—In this section: 

14 (1) HOSPITAL CARE AND MEDICAL SERVICES.— 

15 The terms ‘‘hospital care’’ and ‘‘medical services’’ 

16 have the meanings given those terms in section 1701 

17 of title 38, United States Code. 

18 (2) QUALIFYING DEPENDENT.—The term 

19 ‘‘qualifying dependent’’ means— 

20 (A) a dependent of a veteran described in 

21 section 1710(e)(1)(G) of title 38, United States 

22 Code, as added by section 101(a)(2) who re23 sided with the veteran during the period in 

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1 eran participated in a toxic exposure risk activ2 ity; 

3 (B) an individual who was in utero of such 

4 a veteran or other qualifying dependent when 

5 the veteran participated in a toxic exposure risk 

6 activity; or 

7 (C) a dependent of such a veteran who is 

8 not described in subparagraph (A) or (B) but 

9 who may have an illness or condition that is 

10 connected to the toxic exposure risk activity of 

11 the veteran, as determined by the Secretary. 

12 (3) TRICARE PROGRAM.—The term 

13 ‘‘TRICARE program’’ has the meaning given that 

14 term in section 1072(7) of title 10, United States 

15 Code. 

16 TITLE II—REFORMS TO THE 

17 TOXIC EXPOSURE PRESUMP18 TION PROCESS 

19 SEC. 201. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF 

20 VETERANS AFFAIRS TO ESTABLISH PRE21 SUMPTIONS OF SERVICE CONNECTION 

22 BASED ON TOXIC EXPOSURE. 

23 (a) ADVISORY COMMITTEES, PANELS, AND

24 BOARDS.— 


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

2 United States Code, is amended by adding at the 

3 end the following new subchapter: 

4 ‘‘SUBCHAPTER VII—RESEARCH AND DETER5 MINATIONS RELATING TO PRESUMPTIONS 

6 OF SERVICE CONNECTION BASED ON TOXIC 

7 EXPOSURE 

8 ‘‘§ 1171. Procedures to determine presumptions of 

9 service connection based on toxic expo10 sure; definitions 

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

12 whether to establish, to modify, or to remove presumptions 

13 of service connection based on toxic exposure pursuant to 

14 this subchapter, whereby— 

15 ‘‘(1) the Toxic Exposure Review Commission 

16 advises the Secretary and makes recommendations 

17 pursuant to section 1172 of this title; 

18 ‘‘(2) the National Academies of Sciences, Engi19 neering, and Medicine, reviews and evaluates the 

20 available scientific evidence pursuant to an agree21 ment under section 1173 of this title; 

22 ‘‘(3) the working group established under sec23 tion 1174 of this title evaluates the conclusions of 

24 the National Academies of Sciences, Engineering, 

25 and Medicine pursuant to the agreement described 


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1 in paragraph (2) and makes recommendations to the 

2 Secretary under such section; and 

3 ‘‘(4) the Secretary prescribes regulations under 

4 section 1175 of this title. 

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

6 term ‘illness’ includes a disease or other condition affect7 ing the health of an individual. 

8 ‘‘(c) NONAPPLICATION OF FACA.—The Federal Ad9 visory Committee Act (5 U.S.C. App.) shall not apply to 

10 an entity established under this subchapter. 

11 ‘‘§ 1172. Toxic Exposure Review Commission 

12 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab13 lish an independent commission to be known as the ‘Toxic 

14 Exposure Review Commission’ (in this section referred to 

15 as the ‘Commission’). 

16 ‘‘(b) PURPOSE.—The Commission shall— 

17 ‘‘(1) advise the Secretary on questions relating 

18 to toxic exposures that require scientific research; 

19 and 

20 ‘‘(2) assist in the consideration of possible pre21 sumptions of service connection relating to toxic ex22 posure. 

23 ‘‘(c) DUTIES.—(1) The Commission shall carry out 

24 the following duties: 


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1 ‘‘(A) Collect any relevant information from the 

2 Department of Defense and other sources to identify 

3 possible toxic exposures relating to service during ac4 tive duty, active duty for training, or inactive duty 

5 training in order to determine the need for a com6 prehensive review under an agreement with the Na7 tional Academies of Sciences, Engineering, and Med8 icine under section 1173 of this title. 

9 ‘‘(B) Recommend to the Secretary, by majority 

10 vote, whether a review should be conducted under an 

11 agreement with the National Academies of Sciences, 

12 Engineering, and Medicine under section 1173 of 

13 this title. 

14 ‘‘(C) Recommend to the Secretary, by majority 

15 vote, whether new, independent studies regarding 

16 the health outcomes of toxic exposures, or any other 

17 new, independent studies that the Commission 

18 deems necessary and appropriate, should be con19 ducted. 

20 ‘‘(D) Annually report to Congress on progress 

21 regarding the duties set forth in subparagraphs (A) 

22 through (C), any recommendations made to the Sec23 retary, and any responses of the Secretary to such 

24 recommendations. 


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1 ‘‘(2)(A) Relevant information may be collected under 

2 paragraph (1)(A) from the following: 

3 ‘‘(i) Any Federal agency as the Commission 

4 considers necessary to carry out this section. 

5 ‘‘(ii) Public meetings or hearings, which may be 

6 held to take such testimony and receive such evi7 dence as the Commission considers advisable to 

8 carry out the duties of the Commission. 

9 ‘‘(B) Upon request of the chairperson of the Commis10 sion, the head of a Federal agency shall furnish informa11 tion collected under subparagraph (A)(i) to the Commis12 sion unless such information is classified. 

13 ‘‘(d) MEMBERSHIP.—(1)(A) The Commission shall be 

14 composed of nine members, appointed as follows: 

15 ‘‘(i) Two members appointed by the majority 

16 leader of the Senate. 

17 ‘‘(ii) Two members appointed by the minority 

18 leader of the Senate. 

19 ‘‘(iii) Two members appointed by the Speaker 

20 of the House of Representatives. 

21 ‘‘(iv) Two members appointed by the minority 

22 leader of the House of Representatives. 

23 ‘‘(v) One member appointed by the Secretary. 

24 ‘‘(B) The initial members of the Commission shall be 

25 appointed under subparagraph (A) not later than 180 


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1 days after the date of the enactment of the Comprehensive 

2 and Overdue Support for Troops of War Act of 2021. 

3 ‘‘(2) In appointing individuals under paragraph 

4 (1)(A), the majority leader of the Senate, the minority 

5 leader of the Senate, the Speaker of the House of Rep6 resentatives, the minority leader of the House of Rep7 resentatives, and the Secretary shall jointly ensure that 

8 at least five members of the Commission are scientists or 

9 health care professionals— 

10 ‘‘(A) of whom— 

11 ‘‘(i) one has a background in the field of 

12 respiratory medicine; 

13 ‘‘(ii) one has a background in the field of 

14 endocrinology and metabolic medicine; 

15 ‘‘(iii) one has a background in hematology; 

16 ‘‘(iv) one has a background in oncology; 

17 and 

18 ‘‘(v) one has a background in occupational 

19 and environmental health; and 

20 ‘‘(B) who are not officials or employees of the 

21 Federal Government. 

22 ‘‘(3) In appointing individuals under paragraph 

23 (1)(A), the majority leader of the Senate, the minority 

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1 resentatives, and the Secretary shall jointly ensure that 

2 at least two members of the Commission represent an or3 ganization recognized by the Secretary for the representa4 tion of veterans under section 5902 of this title. 

5 ‘‘(4) In appointing individuals under paragraph 

6 (1)(A), the majority leader of the Senate, the minority 

7 leader of the Senate, the Speaker of the House of Rep8 resentatives, the minority leader of the House of Rep9 resentatives, and the Secretary shall jointly give consider10 ation to including in the Commission at least one member 

11 who works with survivors of illnesses relating to toxic ex12 posures and has a background in the field of study of toxic 

13 exposures. 

14 ‘‘(e) MEETINGS.—(1) The Commission shall meet not 

15 less frequently than twice each year. 

16 ‘‘(2)(A) Each meeting of the Commission shall be 

17 open to the public. 

18 ‘‘(B) All the proceedings, information, and delibera19 tions of the Commission shall be available for review by 

20 the public. 

21 ‘‘(C) Meetings of the Commission may be carried out 

22 through the use of telephonic or other appropriate tele23 communication technology if the Commission determines 

24 that such technology will allow the members to commu25 nicate simultaneously. 


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1 ‘‘(f) CHAIRPERSON AND VICE CHAIR.—At the initial 

2 meeting of the Commission under subsection (e), the Com3 mission shall select a chairperson and vice chairperson 

4 from among the members of the Commission by a majority 

5 vote of the members of the Commission. 

6 ‘‘(g) PERIOD OF APPOINTMENT; VACANCIES.—(1) A 

7 member of the Commission shall be appointed for a term 

8 that may not exceed four years. 

9 ‘‘(2) The Secretary shall ensure that terms of mem10 bers of the Commission are staggered so that no such 

11 terms end on the same date. 

12 ‘‘(3) A vacancy in the Commission shall be filled in 

13 the same manner as the original appointment, but the in14 dividual appointed to fill the vacancy shall serve only for 

15 the unexpired portion of the term for which the individ16 ual’s predecessor was appointed. 

17 ‘‘(4) In appointing the initial members of the Com18 mission, each official who is authorized to appoint two 

19 members of the Commission shall appoint— 

20 ‘‘(A) one member whose term expires after two 

21 years; and 

22 ‘‘(B) one member whose term expires after four 

23 years. 

24 ‘‘(h) PAY.—(1) Members of the Commission shall 

25 serve without pay. 


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1 ‘‘(2) Each member of the Commission who is an offi2 cer or employee of the United States shall serve without 

3 compensation in addition to that received for service as 

4 an officer or employee of the United States. 

5 ‘‘(3) Members shall receive travel expenses, including 

6 per diem in lieu of subsistence, in accordance with sections 

7 5702 and 5703 of title 5. 

8 ‘‘(i) DIRECTOR OF STAFF.—(1) The Commission 

9 shall appoint a Director who— 

10 ‘‘(A) has not served as an employee of the De11 partment during the one-year period preceding the 

12 date of such appointment; and 

13 ‘‘(B) is not otherwise barred or prohibited from 

14 serving as Director under Federal ethics laws and 

15 regulations, by reason of post-employment conflict of 

16 interest. 

17 ‘‘(2) The Director shall be paid at the rate of basic 

18 pay payable for level IV of the Executive Schedule under 

19 section 5315 of title 5. 

20 ‘‘(j) STAFF.—(1) Subject to paragraphs (2) and (3), 

21 the Director, with the approval of the Commission, may 

22 appoint and fix the pay of additional personnel. 

23 ‘‘(2) The Director may make such appointments 

24 without regard to the provisions of title 5 governing ap25 pointments in the competitive service, and any personnel 


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1 so appointed may be paid without regard to the provisions 

2 of chapter 51 and subchapter III of chapter 53 of that 

3 title relating to classification and General Schedule pay 

4 rates, except that an individual so appointed may not re5 ceive pay in excess of the annual rate of basic pay payable 

6 for GS–15 of the General Schedule. 

7 ‘‘(3)(A) Not more than two-thirds of the personnel 

8 employed by or detailed to the Commission may be on de9 tail from the Department. 

10 ‘‘(B) Not more than half of the professional analysts 

11 of the Commission staff may be persons detailed from the 

12 Department to the Commission. 

13 ‘‘(4) Subject to paragraph (3), the head of any Fed14 eral agency, upon the request of the Director, may detail 

15 any of the personnel of that agency to the Commission 

16 to assist the Commission in carrying out its duties under 

17 this section. 

18 ‘‘(5) The Commission may secure directly from any 

19 Federal agency such information as the Commission con20 siders necessary to carry out this section. Upon request 

21 of the chairperson of the Commission, the head of such 

22 agency shall furnish such information to the Commission, 

23 unless such information is classified. 

24 ‘‘(k) OTHER AUTHORITY.—(1) The Commission may 

25 procure by contract, to the extent funds are available, the 


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1 temporary or intermittent services of experts or consult2 ants pursuant to section 3109 of title 5. 

3 ‘‘(2) To the extent funds are available, the Commis4 sion may lease real property and acquire personal property 

5 either of its own accord or in consultation with the General 

6 Services Administration. 

7 ‘‘(l) COMMUNICATIONS.—(1)(A) Except as provided 

8 in subparagraph (B), no person may restrict an employee 

9 of the Department in communicating with the Commis10 sion. 

11 ‘‘(B) Subparagraph (A) does not apply to a commu12 nication that is unlawful. 

13 ‘‘(2) All ex parte communications with the Commis14 sion shall be made part of the public record. 

15 ‘‘(m) RESPONSES BY SECRETARY.—In response to 

16 each report submitted to the Secretary by the Commission 

17 under subsection (c)(1), the Secretary shall submit to the 

18 Committee on Veterans’ Affairs of the Senate and the 

19 Committee on Veterans’ Affairs of the House of Rep20 resentatives and make available to the public a report 

21 on— 

22 ‘‘(1) the findings and opinions of the Secretary 

23 with respect to the report most recently submitted 

24 under subsection (c)(1); 


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1 ‘‘(2) whether the Secretary intends to nominate 

2 for review under an agreement with the National 

3 Academies of Sciences, Engineering, and Medicine 

4 under section 1173 of this title the review rec5 ommended by the Committee in the report, and if 

6 not, an explanation of why, including citations and 

7 sources; and 

8 ‘‘(3) whether the Secretary intends to follow 

9 any other recommendation made by the Commission. 

10 ‘‘§ 1173. Science review agreement 

11 ‘‘(a) PURPOSE.—The purpose of this section is to 

12 provide for the National Academies of Sciences, Engineer13 ing, and Medicine (in this section referred to as the ‘Acad14 emies’), an independent nonprofit scientific organization 

15 with appropriate expertise that is not part of the Federal 

16 Government, to review and evaluate the available scientific 

17 evidence regarding associations between illnesses and toxic 

18 exposures. 

19 ‘‘(b) AGREEMENT.—(1) The Secretary shall seek to 

20 enter into a 10-year agreement with the Academies to per21 form the services covered by this section. 

22 ‘‘(2) The Secretary shall seek to enter into an agree23 ment described in paragraph (1) not later than 60 days 

24 after the date of the enactment of the Comprehensive and 

25 Overdue Support for Troops of War Act of 2021. 


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1 ‘‘(3) An agreement under this section may be ex2 tended in five-year or 10-year increments. 

3 ‘‘(c) REVIEW OF SCIENTIFIC EVIDENCE.—Under an 

4 agreement between the Secretary and the Academies 

5 under this section, the Academies shall review and summa6 rize the scientific evidence, and assess the strength there7 of, concerning the association between toxic exposures 

8 during active military, naval, or air service and each illness 

9 suspected to be associated with such exposure in the 

10 human population. 

11 ‘‘(d) SCIENTIFIC DETERMINATIONS CONCERNING

12 ILLNESSES.—For each illness reviewed under subsection 

13 (c), the Academies shall determine, to the extent that 

14 available scientific data permit meaningful determina15 tions— 

16 ‘‘(1) whether an association exists between a 

17 toxic exposure and the occurrence of the illness, tak18 ing into account the strength of the scientific evi19 dence and the appropriateness of the statistical and 

20 epidemiological methods used to detect the associa21 tion; 

22 ‘‘(2) the increased risk of the illness among 

23 those subject to toxic exposures during active mili24 tary, naval, or air service; and 


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1 ‘‘(3) whether there exists a plausible biological 

2 mechanism or other evidence of a causal relationship 

3 between the toxic exposure and the occurrence of the 

4 illness. 

5 ‘‘(e) COOPERATION OF FEDERAL AGENCIES.—The 

6 head of each relevant Federal agency, including the Sec7 retary of Defense, shall cooperate fully with the Academies 

8 in performing the services covered by this section. 

9 ‘‘(f) RECOMMENDATIONS FOR ADDITIONAL SCI10 ENTIFIC STUDIES.—(1) Under an agreement between the 

11 Secretary and the Academies under this section, the Acad12 emies shall make any recommendations for additional sci13 entific studies to resolve areas of continuing scientific un14 certainty relating to toxic exposures. 

15 ‘‘(2) In making recommendations under paragraph 

16 (1), the Academies shall consider— 

17 ‘‘(A) the scientific information that is available 

18 at the time of the recommendation; 

19 ‘‘(B) the value and relevance of the information 

20 that could result from additional studies; and 

21 ‘‘(C) the cost and feasibility of carrying out 

22 such additional studies. 

23 ‘‘(g) REPORTS.—(1) Under an agreement between 

24 the Secretary and the Academies under this section, for 

25 each review conducted under subsection (c), the AcadVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 emies shall submit to the Secretary, the Committee on 

2 Veterans’ Affairs of the Senate, and the Committee on 

3 Veterans’ Affairs of the House of Representatives an ini4 tial report on the activities of the Academies under the 

5 agreement. 

6 ‘‘(2) The report submitted under paragraph (1) shall 

7 include the following: 

8 ‘‘(A) The determinations described in sub9 section (d). 

10 ‘‘(B) A full explanation of the scientific evi11 dence and reasoning that led to such determinations. 

12 ‘‘(C) Any recommendations of the Academies 

13 under subsection (f). 

14 ‘‘(h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANI15 ZATION.—(1) If the Secretary is unable to enter into an 

16 agreement with the Academies for the purposes of this sec17 tion on terms acceptable to the Secretary, the Secretary 

18 shall seek to enter into an agreement for the purposes of 

19 this section with another appropriate scientific organiza20 tion that— 

21 ‘‘(A) is not part of the Federal Government; 

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

23 ‘‘(C) has expertise and objectivity comparable 

24 to that of the Academies. 


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1 ‘‘(2) If the Secretary enters into an agreement with 

2 another organization as described in paragraph (1), any 

3 reference in this subchapter to the National Academies of 

4 Sciences, Engineering, and Medicine shall be treated as 

5 a reference to the other organization. 

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’)— 

11 ‘‘(1) to evaluate the conclusions of the National 

12 Academies of Sciences, Engineering, and Medicine 

13 contained in each report submitted under section 

14 1173(g) of this title; and 

15 ‘‘(2) to develop and submit to the Secretary a 

16 recommendation within 60 days of the Secretary’s 

17 receipt of a report under section 1173(g) of this title 

18 with respect to whether— 

19 ‘‘(A) to establish a presumption of service 

20 connection between each toxic exposure and ill21 ness covered by a report described in paragraph 

22 (1); or 

23 ‘‘(B) to modify an existing presumption of 

24 service connection covered by a report described 

25 in paragraph (1). 


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1 ‘‘(b) RECOMMENDATIONS.—(1) In making a rec2 ommendation under subsection (a)(2), the Working Group 

3 shall, if the Working Group determines that additional re4 search, studies, or reports are appropriate before making 

5 a final recommendation with respect to establishing or 

6 modifying a presumption of service connection, submit to 

7 the Secretary a description of such additional research, 

8 studies, or reports. 

9 ‘‘(2) In making a recommendation under subsection 

10 (a)(2), the Working Group shall consider only the positive 

11 association between a toxic exposure and an illness. 

12 ‘‘(3) Concurrent with the submittal of a recommenda13 tion to the Secretary under subsection (a)(2), the Working 

14 Group shall submit to the Committee on Veterans’ Affairs 

15 of the Senate and the Committee on Veterans’ Affairs of 

16 the House of Representatives a description of such rec17 ommendation. 

18 ‘‘§ 1175. Regulations regarding presumptions of serv19 ice connection based on toxic exposure 

20 ‘‘(a) ACTION UPON WORKING GROUP RECOMMENDA21 TION.—Not later than 60 days after the date on which 

22 the Secretary receives a recommendation to establish or 

23 modify a presumption of service connection under section 

24 1174(a)(2) of this title— 


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1 ‘‘(1) if the Secretary determines that the pre2 sumption, or modification, is warranted, the Sec3 retary shall issue proposed regulations setting forth 

4 the presumption or revise regulations to carry out 

5 such modification; or 

6 ‘‘(2) if the Secretary determines that the pre7 sumption, or modification, is not warranted, the Sec8 retary shall publish in the Federal Register a notice 

9 of the determination, including the reasons sup10 porting the determination, and all materials the Sec11 retary relied upon for the determination. 

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

13 after the date on which the Secretary issues any proposed 

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

15 issue final regulations. Such regulations shall be effective 

16 on the date of issuance. 

17 ‘‘(c) REMOVAL OF PRESUMPTION.—(1) The Sec18 retary may issue regulations to remove an illness from a 

19 presumption of service connection previously established 

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

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

22 pursuant to paragraph (1), or the periods or locations of 

23 exposure covered by a presumption of service connection 

24 are modified under subsection (a)— 


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

2 for such illness on the basis of the presumption pro3 vided under such regulations before the effective 

4 date of the removal or modification shall continue to 

5 be entitled to receive compensation on that basis; 

6 and 

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

8 dependency and indemnity compensation for the 

9 death of a veteran resulting from such illness on the 

10 basis of such presumption shall continue to be enti11 tled to receive dependency and indemnity compensa12 tion on such basis.’’. 

13 (2) CLERICAL AMENDMENT.—The table of sec14 tions at the beginning of such chapter is amended 

15 by adding at the end 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. Toxic Exposure Review Commission. 

‘‘1173. Science review agreement. 

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

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

exposure.’’. 

16 (b) ESTABLISHMENT OF WORKING GROUP.—Not 

17 later than 120 days after the date of the enactment of 

18 this Act, the Secretary of Veterans Affairs shall establish 

19 the working group required by section 1174(a) of title 38, 

20 United States Code, as added by subsection (a). 


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1 (c) CONFORMING AMENDMENTS.—Chapter 11 of title 

2 38, United States Code, is amended— 

3 (1) in section 1116— 

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

5 and (e); 

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

7 following new subsection (b): 

8 ‘‘(b) The Secretary shall ensure that any determina9 tion made on or after the date of the enactment of the 

10 Comprehensive and Overdue Support for Troops of War 

11 Act of 2021 regarding a presumption of service connection 

12 based on exposure to an herbicide agent under this section 

13 is made pursuant to subchapter VII of this chapter, in14 cluding with respect to assessing reports received by the 

15 Secretary from the National Academy of Sciences under 

16 section 3 of the Agent Orange Act of 1991 (Public Law 

17 102–4).’’; and 

18 (C) by redesignating subsection (f) as sub19 section (c). 

20 (2) in section 1116B(b)(2)(A), by inserting 

21 ‘‘pursuant to subchapter VII of this chapter,’’ before 

22 ‘‘the Secretary determines’’; and 

23 (3) in section 1118— 

24 (A) by striking subsections (b) through (e); 

25 and 


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

2 following new subsection (b): 

3 ‘‘(b) The Secretary shall ensure that any determina4 tion made on or after the date of the enactment of the 

5 Comprehensive and Overdue Support for Troops of War 

6 Act of 2021 regarding a presumption of service connection 

7 based on a toxic exposure under this section is made pur8 suant to subchapter VII of this chapter.’’. 

9 SEC. 202. TECHNICAL CORRECTIONS. 

10 (a) IN GENERAL.—Subchapter VI of chapter 11 of 

11 title 38, United States Code, is amended— 

12 (1) by redesignating section 1165 as section 

13 1166; and 

14 (2) by redesignating the section 1164 that was 

15 added by section 5501(a)(1) of the Johnny Isakson 

16 and David P. Roe, M.D. Veterans Health Care and 

17 Benefits Improvement Act of 2020 (Public Law 

18 116–315) as section 1165. 

19 (b) CONFORMING CLERICAL AMENDMENTS.—The 

20 table of sections at the beginning of such chapter is 

21 amended by striking the items relating to the section 1164 

22 that was added by section 5501(a)(1) of the Johnny Isak23 son and David P. Roe, M.D. Veterans Health Care and 

24 Benefits Improvement Act of 2020 (Public Law 116–315) 

25 and section 1165 and inserting the following new items: 


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‘‘1165. Specialized teams to evaluate claims involving military sexual trauma. 

‘‘1166. Choice of sex of medical examiner for certain disabilities.’’. 

1 TITLE III—REFORMS TO THE 

2 SERVICE CONNECTION PROC3 ESS FOR TOXIC EXPOSURE 

4 VETERANS 

5 SEC. 301. PRESUMPTIONS OF TOXIC EXPOSURE. 

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

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

8 end the following new section: 

9 ‘‘§ 1119. Presumptions of toxic exposure 

10 ‘‘(a) PRESUMPTION OF TOXIC EXPOSURE.—Except 

11 as provided in section 1120 of this title, if a veteran sub12 mits to the Secretary a claim for compensation for a serv13 ice-connected disability under section 1110 of this title 

14 with indication of a toxic exposure that occurred during 

15 active military, naval, or air service, the Secretary shall 

16 presume that the veteran was subject to such toxic expo17 sure— 

18 ‘‘(1) if the Individual Longitudinal Exposure 

19 Record of the veteran includes evidence of the toxic 

20 exposure; or 

21 ‘‘(2) in a case in which the Individual Longitu22 dinal Exposure Record of the veteran does not indi23 cate that the veteran was subject to the claimed 

24 toxic exposure during active military, naval, or air 


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1 service, if credible evidence of the facts, places, and 

2 circumstances of the service of the veteran in the ac3 tive military, naval, or air service, including evidence 

4 of the veteran’s unit assignments, military specialty, 

5 or date and location of service, shows the veteran 

6 was subject to the claimed toxic exposure during 

7 such service. 

8 ‘‘(b) ROLE OF LAY STATEMENTS.—In a case de9 scribed in subsection (a)(2), the Secretary shall accept as 

10 credible evidence under such subsection a lay statement 

11 by the veteran or another that is consistent with the other 

12 credible evidence of the facts, places, and circumstances 

13 of the veteran’s service in the active military, naval, or 

14 air service.’’. 

15 (b) CLERICAL AMENDMENT.—The table of sections 

16 at the beginning of chapter 11 of such title is amended 

17 by inserting after the item relating to section 1118 the 

18 following new item: 

‘‘1119. Presumptions of toxic exposure.’’. 

19 (c) CONFORMING AMENDMENT.—Section 1113 of 

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

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

22 SEC. 302. PRESUMPTION OF EXPOSURE TO AIRBORNE HAZ23 ARDS AND SUBSTANCES FROM BURN PITS. 

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

25 title 38, United States Code, as amended by section 


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1 301(a), is further amended by adding at the end the fol2 lowing new section: 

3 ‘‘§ 1120. Presumption of exposure to certain airborne 

4 hazards and substances from participa5 tion in contingency operations 

6 ‘‘(a) IN GENERAL.—For purposes of section 1110 

7 and chapter 17 of this title, any veteran described in sub8 section (b) shall be presumed to have been exposed to the 

9 substances, chemicals, and hazards listed in subsection 

10 (c), unless there is affirmative evidence to establish that 

11 the veteran was not exposed to any such substances, 

12 chemicals, or hazards during that service. 

13 ‘‘(b) VETERANS DESCRIBED.—(1) A veteran de14 scribed in this paragraph is any veteran who— 

15 ‘‘(A) during active military, naval, or air serv16 ice, was deployed in support of a contingency oper17 ation while so serving and as part of such deploy18 ment served in a covered location during a cor19 responding period set forth under paragraph (2); or 

20 ‘‘(B) on or after August 2, 1990, was awarded 

21 any of the following: 

22 ‘‘(i) The Afghanistan Campaign Medal. 

23 ‘‘(ii) The Armed Forces Expeditionary 

24 Medal. 


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1 ‘‘(iii) The Global War On Terrorism Expe2 ditionary Medal. 

3 ‘‘(iv) The Inherent Resolve Campaign 

4 Medal. 

5 ‘‘(v) The Iraqi Campaign Medal. 

6 ‘‘(vi) The Southwest Asia Service Medal. 

7 ‘‘(2)(A) The covered locations and corresponding pe8 riods set forth under this subsection are as follows: 

9 ‘‘(i) Iraq and the following periods: 

10 ‘‘(I) The period beginning on August 2, 

11 1990, and ending on February 28, 1991. 

12 ‘‘(II) The period beginning on March 19, 

13 2003, and ending on such date as the Secretary 

14 determines burn pits are no longer used in Iraq. 

15 ‘‘(ii) The Southwest Asia Theater of operations, 

16 other than Iraq, and the period beginning on August 

17 2, 1990, and ending on such date as the Secretary 

18 determines burn pits are no longer used in such lo19 cation, including the following: 

20 ‘‘(I) Kuwait. 

21 ‘‘(II) Saudi Arabia. 

22 ‘‘(III) Oman. 

23 ‘‘(IV) Qatar. 

24 ‘‘(iii) Afghanistan and the period beginning on 

25 September 11, 2001, and ending on such date as the 


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1 Secretary determines burn pits are no longer used in 

2 Afghanistan. 

3 ‘‘(iv) Djibouti and the period beginning on Sep4 tember 11, 2001, and ending on such date as the 

5 Secretary determines burn pits are no longer used in 

6 Djibouti. 

7 ‘‘(v) Syria and the period beginning on Sep8 tember 11, 2001, and ending on such date as the 

9 Secretary determines burn pits are no longer used in 

10 Syria. 

11 ‘‘(vi) Jordan and the period beginning on Sep12 tember 11, 2001, and ending on such date as the 

13 Secretary determines burn pits are no longer used in 

14 Jordan. 

15 ‘‘(vii) Egypt and the period beginning on Sep16 tember 11, 2001, and ending on such date as the 

17 Secretary determines burn pits are no longer used in 

18 Egypt. 

19 ‘‘(viii) Lebanon and the period beginning on 

20 September 11, 2001, and ending on such date as the 

21 Secretary determines burn pits are no longer used in 

22 Lebanon. 

23 ‘‘(ix) Yemen and the period beginning on Sep24 tember 11, 2001, and ending on such date as the 


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1 Secretary determines burn pits are no longer used in 

2 Yemen. 

3 ‘‘(x) Such other locations as are set forth by the 

4 Airborne Hazards and Open Burn Pit Registry es5 tablished under section 201 of the Dignified Burial 

6 and Other Veterans’ Benefits Improvement Act of 

7 2012 (Public Law 112–260; 38 U.S.C. 527 note) 

8 and corresponding periods set forth in such registry. 

9 ‘‘(xi) Such other locations and corresponding 

10 periods as the Secretary, in collaboration with the 

11 Secretary of Defense, may determine appropriate in 

12 a report the Secretary of Veterans Affairs shall sub13 mit to Congress not later than two years after the 

14 date of the enactment of the Veterans Burn Pits Ex15 posure Recognition Act of 2021 and not less fre16 quently than once every two years thereafter. 

17 ‘‘(B) A location set forth under this paragraph shall 

18 not include any body of water around or any airspace 

19 above such location. 

20 ‘‘(c) SUBSTANCES, CHEMICALS, AND AIRBORNE HAZ21 ARDS.—(1) Subject to paragraph (2), the substances, 

22 chemicals, and airborne hazards listed in this subsection 

23 are as follows: 

24 ‘‘(A) Particulate matter, including the fol25 lowing: 


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1 ‘‘(i) PM-10. 

2 ‘‘(ii) PM-2.5. 

3 ‘‘(B) Polycyclic aromatic hydrocarbons (PAHs), 

4 including the following: 

5 ‘‘(i) Acenaphthene. 

6 ‘‘(ii) Acenaphthylene. 

7 ‘‘(iii) Anthracene. 

8 ‘‘(iv) Benzo(a)anthracene. 

9 ‘‘(v) Benzo(a)pyrene. 

10 ‘‘(vi) Benzo(b)fluoroanthene. 

11 ‘‘(vii) Benzo(g,h,i)perylene. 

12 ‘‘(viii) Benzo(k)fluoroanthene. 

13 ‘‘(ix) Chrysene. 

14 ‘‘(x) Dibenz(a,h)anthracene. 

15 ‘‘(xi) Fluoranthene. 

16 ‘‘(xii) Fluorene. 

17 ‘‘(xiii) Indeno(1,2,3-cd)pyrene. 

18 ‘‘(xiv) Naphthalene. 

19 ‘‘(xv) Phenanthrene. 

20 ‘‘(xvi) Pyrene. 

21 ‘‘(C) Volatile organic compounds (VOCs), in22 cluding the following: 

23 ‘‘(i) Acetone. 

24 ‘‘(ii) Acrolein. 

25 ‘‘(iii) Benzene. 


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1 ‘‘(iv) Carbon Disulfide. 

2 ‘‘(v) Chlorodifluoromethane. 

3 ‘‘(vi) Chloromethane. 

4 ‘‘(vii) Ethylbenzene. 

5 ‘‘(viii) Hexane. 

6 ‘‘(ix) Hexachlorobutadiene. 

7 ‘‘(x) m/p-Xylene. 

8 ‘‘(xi) Methylene Chloride. 

9 ‘‘(xii) Pentane. 

10 ‘‘(xiii) Propylene. 

11 ‘‘(xiv) Styrene. 

12 ‘‘(xv) Toluene. 

13 ‘‘(D) Toxic organic halogenated dioxins and 

14 furans (dioxins), including the following: 

15 ‘‘(i) 1,2,3,4,6,7,8 HPCDD. 

16 ‘‘(ii) 1,2,3,4,6,7,8 HPCDF. 

17 ‘‘(iii) 1,2,3,4,7,8,9 HPCDF. 

18 ‘‘(iv) 1,2,3,4,7,8 HXCDD. 

19 ‘‘(v) 1,2,3,4,7,8 HXCDF. 

20 ‘‘(vi) 1,2,3,6,7,8 HXCDD. 

21 ‘‘(vii) 1,2,3,6,7,8 HXCDF. 

22 ‘‘(viii) 1,2,3,7,8,9 HXCDD. 

23 ‘‘(ix) 1,2,3,7,8,9 HXCDF. 

24 ‘‘(x) 1,2,3,7,8 PECDD. 

25 ‘‘(xi) 1,2,3,7,8 PECDF. 


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1 ‘‘(xii) 2,3,4,6,7,8 HXCDF. 

2 ‘‘(xiii) 2,3,4,7,8 PECDF. 

3 ‘‘(xiv) 2,3,7,8 TCDD. 

4 ‘‘(xv) 2,3,7,8 TCDF. 

5 ‘‘(xvi) octachlorodibenzodioxin. 

6 ‘‘(xvii) octachlorodibenzofuran. 

7 ‘‘(E) Such other substances, chemicals, and air8 borne hazards as the Secretary, in collaboration with 

9 the Secretary of Defense, may add under paragraph 

10 (2). 

11 ‘‘(2) The Secretary may add to or remove from the 

12 list under paragraph (1) as the Secretary determines ap13 propriate in a report the Secretary shall submit to Con14 gress not later than two years after the date of the enact15 ment of the Comprehensive and Overdue Support for 

16 Troops of War Act of 2021, and not less frequently than 

17 once every two years thereafter.’’. 

18 (b) CLERICAL AMENDMENT.—The table of sections 

19 at the beginning of chapter 11 of such title, as amended 

20 by section 301(b), is further amended by inserting after 

21 the item relating to section 1119 the following new item: 

‘‘1120. Presumption of exposure to certain airborne hazards and substances 

from participation in contingency operations.’’. 

22 (c) CONFORMING AMENDMENT.—Section 1113 of 

23 such title, as amended by section 301, is amended by 


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1 striking ‘‘or 1119’’ each place it appears and inserting 

2 ‘‘1119, or 1120’’. 

3 SEC. 303. MEDICAL NEXUS EXAMINATIONS FOR TOXIC EX4 POSURES. 

5 (a) IN GENERAL.—Subchapter VI of chapter 11 of 

6 title 38, United States Code, as amended by title II of 

7 this Act, is further amended by adding at the end the fol8 lowing new section: 

9 ‘‘§ 1168. Medical nexus examinations for toxic expo10 sures 

11 ‘‘(a) IN GENERAL.—Except as provided in subsection 

12 (c), if a covered veteran submits to the Secretary a claim 

13 for compensation for a service-connected disability under 

14 section 1110 of this title relating to a toxic exposure or 

15 exposure to a substance, chemical, or hazard listed in sec16 tion 1120(c) of this title during active military, naval, or 

17 air service, and such evidence is not sufficient to establish 

18 a service connection for the disability, the Secretary 

19 shall— 

20 ‘‘(1) provide the veteran with a medical exam21 ination of the claimed disability relating to such ex22 posure; 

23 ‘‘(2) provide the veteran the option to have the 

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1 ducted by a specialist in the field of medicine which 

2 covers the specifically claimed disability; and 

3 ‘‘(3) request a medical opinion, as part of the 

4 medical examination provided under paragraph (1), 

5 as to whether it is at least as likely as not that there 

6 is a nexus between the claimed disability and the ex7 posure. 

8 ‘‘(b) COVERED VETERANS.—For purposes of this 

9 section, a covered veteran is— 

10 ‘‘(1) a veteran presumed under section 1119(a) 

11 of this title to have been subject to a toxic exposure; 

12 or 

13 ‘‘(2) a veteran presumed under subsection (a) 

14 of section 1120 of this title to have been exposed to 

15 a substance, chemical, or hazard listed in subsection 

16 (c) of such section. 

17 ‘‘(c) EXCEPTION.—Subsection (a) shall not apply in 

18 a case in which a covered veteran claims a disability that 

19 is clearly unrelated to the claimed exposure. 

20 ‘‘(d) CONSIDERATIONS IN PROVISION OF MEDICAL

21 OPINIONS.—When providing the Secretary with a medical 

22 opinion requested under subsection (a)(3), the examiner 

23 shall consider the total potential exposure through all ap24 plicable military deployments, and the synergistic, comVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 bined effect of all applicable toxic exposure risk activi2 ties.’’. 

3 (b) CLERICAL AMENDMENT.—The table of sections 

4 at the beginning of chapter 11 of such title, as amended 

5 by title II of this Act, is further amended by inserting 

6 after the item relating to section 1167, as added by such 

7 title, the following new item: 

‘‘1168. Medical nexus examinations for toxic exposures.’’. 

8 TITLE IV—EXPANSION OF PRE9 SUMPTIONS OF SERVICE CON10 NECTION FOR FORGOTTEN 

11 VETERANS 

12 SEC. 401. MARK TAKAI ATOMIC VETERANS HEALTHCARE 

13 PARITY ACT OF 2021. 

14 Section 1112(c)(3)(B) of title 38, United States 

15 Code, is amended by adding at the end the following new 

16 clause: 

17 ‘‘(v) Cleanup of Enewetak Atoll during the 

18 period beginning on January 1, 1977, and end19 ing on December 31, 1980.’’. 


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1 SEC. 402. TREATMENT OF VETERANS WHO PARTICIPATED 

2 IN NUCLEAR RESPONSE NEAR PALOMARES, 

3 SPAIN, AS RADIATION-EXPOSED VETERANS 

4 FOR PURPOSES OF PRESUMPTION OF SERV5 ICE-CONNECTION OF CERTAIN DISABILITIES 

6 BY DEPARTMENT OF VETERANS AFFAIRS. 

7 Section 1112(c)(3)(B) of title 38, United States 

8 Code, as amended by section 401, is further amended by 

9 adding at the end the following new clause: 

10 ‘‘(vi) Onsite participation in the response 

11 effort following the collision of a United States 

12 Air Force B–52 bomber and refueling plane 

13 that caused the release of four thermonuclear 

14 weapons in the vicinity of Palomares, Spain, 

15 during the period beginning January 17, 1966, 

16 and ending March 31, 1967.’’. 

17 SEC. 403. PRESUMPTIONS OF SERVICE CONNECTION FOR 

18 DISEASES ASSOCIATED WITH EXPOSURES TO 

19 CERTAIN HERBICIDE AGENTS FOR VETERANS 

20 WHO SERVED IN CERTAIN LOCATIONS. 

21 (a) IN GENERAL.—Section 1116 of title 38, United 

22 States Code, as amended by section 201, is further amend23 ed— 

24 (1) by striking ‘‘, during active military, naval, 

25 or air service, served in the Republic of Vietnam 

26 during the period beginning on January 9, 1962, 


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1 and ending on May 7, 1975’’ each place it appears 

2 and inserting ‘‘performed covered service’’; 

3 (2) by striking ‘‘performed active military, 

4 naval, or air service in the Republic of Vietnam dur5 ing the period beginning on January 9, 1962, and 

6 ending on May 7, 1975’’ each place it appears and 

7 inserting ‘‘performed covered service’’; and 

8 (3) by adding at the end the following new sub9 section: 

10 ‘‘(d) In this section, the term ‘covered service’ means 

11 active military, naval, or air service— 

12 ‘‘(1) performed in the Republic of Vietnam dur13 ing the period beginning on January 9, 1962, and 

14 ending on May 7, 1975; 

15 ‘‘(2) performed in Thailand at any United 

16 States or Royal Thai base during the period begin17 ning on January 9, 1962, and ending on June 30, 

18 1976, without regard to where on the base the vet19 eran was located or what military job specialty the 

20 veteran performed; 

21 ‘‘(3) performed in Laos during the period be22 ginning on December 1, 1965, and ending on Sep23 tember 30, 1969; 

24 ‘‘(4) performed in Cambodia at Mimot or Krek, 

25 Kompon Cham Province during the period beginning 


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1 on April 16, 1969, and ending on April 30, 1969; 

2 or 

3 ‘‘(5) performed on Guam or American Samoa, 

4 or in the territorial waters thereof, during the period 

5 beginning on January 9, 1962, and ending on July 

6 31, 1980, or served on Johnston Atoll or on a ship 

7 that called at Johnston Atoll during the period be8 ginning on January 1, 1972, and ending on Sep9 tember 30, 1977.’’. 

10 (b) ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL

11 SERVICES.—Section 1710(e)(4) is amended by amending 

12 subparagraph (A) to read as follows: 

13 ‘‘(A) The term ‘Vietnam-era herbicide-exposed 

14 veteran’ means a veteran who— 

15 ‘‘(i) performed covered service, as defined 

16 in section 1116(c) of this title; or 

17 ‘‘(ii) the Secretary finds may have been ex18 posed during such service to dioxin or was ex19 posed during such service to a toxic substance 

20 found in a herbicide or defoliant used for mili21 tary purposes during such period.’’. 

22 (c) CLERICAL AMENDMENTS.— 

23 (1) SECTION HEADING.—The heading for sec24 tion 1116 is amended by striking and ‘‘the ReVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 public of Vietnam’’ and inserting ‘‘certain lo2 cations’’. 

3 (2) TABLE OF SECTIONS.—The table of sections 

4 at the beginning of chapter 11 of such title is 

5 amended by striking the item relating to section 

6 1116 and inserting the following new item: 

‘‘1116. Presumptions of service connection for diseases associated with exposure 

to certain herbicide agents; presumption of exposure for veterans who served in certain locations.’’. 

7 SEC. 404. ADDITION OF ADDITIONAL DISEASES ASSOCI8 ATED WITH EXPOSURE TO CERTAIN HERBI9 CIDE AGENTS FOR WHICH THERE IS A PRE10 SUMPTION OF SERVICE CONNECTION FOR 

11 VETERANS WHO SERVED IN THE REPUBLIC 

12 OF VIETNAM. 

13 Section 1116(a)(2) of title 38, United States Code, 

14 as amended by section 9109 of the William M. (Mac) 

15 Thornberry National Defense Authorization Act for Fiscal 

16 Year 2021 (Public Law 116–283), is further amended by 

17 adding at the end the following new subparagraphs: 

18 ‘‘(L) Hypertension. 

19 ‘‘(M) Monoclonal gammopathy of undetermined 

20 significance.’’. 


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1 SEC. 405. IMPROVING COMPENSATION FOR DISABILITIES 

2 OCCURRING IN PERSIAN GULF WAR VET3 ERANS. 

4 (a) REDUCTION IN THRESHOLD OF ELIGIBILITY.— 

5 Subsection (a)(1) of section 1117 of title 38, United 

6 States Code, is amended by striking ‘‘became manifest— 

7 ’’ and all that follows through the period at the end and 

8 inserting ‘‘became manifest to a degree of 10 percent or 

9 more at any time.’’. 

10 (b) PERMANENT EXTENSION OF PERIOD OF ELIGI11 BILITY.— 

12 (1) IN GENERAL.—Such section is amended by 

13 striking subsection (b). 

14 (2) CONFORMING AMENDMENTS.—Such section, 

15 as amended by paragraph (1), is further amended— 

16 (A) by redesignating subsections (c) and 

17 (d) as subsections (b) and (c), respectively; and 

18 (B) in subsection (a)(2)(C), by striking 

19 ‘‘under subsection (d)’’ and inserting ‘‘under 

20 subsection (c)’’. 

21 (c) ESTABLISHING SINGULAR DISABILITY BASED

22 QUESTIONNAIRE.—Such section, as amended by sub23 section (b), is further amended by inserting after sub24 section (c) the following new subsection (d): 

25 ‘‘(d) The Secretary shall develop a Disability Benefits 

26 Questionnaire (DBQ), or successor questionnaire, such 


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1 that if a Persian Gulf veteran presents with any one symp2 tom associated with Gulf War Illness, use of such ques3 tionnaire is mandatory for health care personnel of the 

4 Department for the identification of Gulf War Illness.’’. 

5 (d) TRAINING.—Such section is amended by adding 

6 at the end the following new subsection: 

7 ‘‘(i)(1) The Secretary shall take such actions as may 

8 be necessary to ensure that health care personnel of the 

9 Department are appropriately trained to effectively carry 

10 out this section. 

11 ‘‘(2) Not less frequently than once each year, the Sec12 retary shall submit to Congress a report on the actions 

13 taken by the Secretary to carry out paragraph (1).’’. 

14 SEC. 406. PRESUMPTION OF SERVICE CONNECTION FOR 

15 CERTAIN DISEASES ASSOCIATED WITH EXPO16 SURE TO BURN PITS AND OTHER TOXINS. 

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

18 title 38, United States Code, as amended by section 

19 302(a), is further amended by inserting after section 1120 

20 the following new section: 

21 ‘‘§ 1120A. Presumption of service connection for cer22 tain diseases associated with exposure to 

23 burn pits and other toxins 

24 ‘‘(a) PRESUMPTION OF SERVICE CONNECTION.—For 

25 the purposes of section 1110 of this title, and subject to 


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1 section 1113 of this title, a disease specified in subsection 

2 (c) becoming manifest in a covered veteran shall be consid3 ered to have been incurred in or aggravated during active 

4 military, naval, or air service, notwithstanding that there 

5 is no record of evidence of such disease during the period 

6 of such service. 

7 ‘‘(b) COVERED VETERANS.—For purposes of this 

8 section, a covered veteran is a veteran presumed under 

9 subsection (a) of section 1120 of this title to have been 

10 exposed to a substance, chemical, or hazard listed in sub11 section (c) of such section. 

12 ‘‘(c) DISEASES SPECIFIED.—The diseases specified 

13 in this subsection are the following: 

14 ‘‘(1) Asthma that was diagnosed after— 

15 ‘‘(A) a deployment described in subpara16 graph (A) of section 1120(b)(1) of this title; or 

17 ‘‘(B) a period of service for which a medal 

18 set forth under subparagraph (B) of such sec19 tion was awarded. 

20 ‘‘(2) Chronic obstructive pulmonary disease. 

21 ‘‘(3) Chronic bronchitis. 

22 ‘‘(4) Constrictive bronchiolitis or obliterative 

23 bronchiolitis. 

24 ‘‘(5) Emphysema. 

25 ‘‘(6) Pleuritis. 


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1 ‘‘(7) Pulmonary fibrosis. 

2 ‘‘(8) Interstitial lung disease. 

3 ‘‘(9) Sarcoidosis. 

4 ‘‘(10) Respiratory cancer of any type. 

5 ‘‘(11) Glioblastoma. 

6 ‘‘(12) Rhinitis. 

7 ‘‘(13) Sinusitis.’’. 

8 (b) CLERICAL AMENDMENT.—The table of sections 

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

10 Code, as amended by section 302(b), is further amended 

11 by inserting after the item relating to section 1120 the 

12 following new item: 

‘‘1120A. Presumption of service connection for certain diseases associated with 

exposure to burn pits and other toxins.’’. 

13 (c) CONFORMING AMENDMENT.—Section 1113 of 

14 such title, as amended by section 302, is further amended 

15 by striking ‘‘or 1120’’ each place it appears and inserting 

16 ‘‘1120, or 1120A’’. 

17 TITLE V—STRENGTHENING FED18 ERAL RESEARCH ON TOXIC 

19 EXPOSURES 

20 SEC. 501. COORDINATION BY DEPARTMENT OF VETERANS 

21 AFFAIRS OF TOXIC EXPOSURE RESEARCH. 

22 (a) IN GENERAL.—Subchapter II of chapter 73 of 

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

24 end the following new section: 


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1 ‘‘§ 7330D. Coordination of toxic exposure research 

2 ‘‘(a) IN GENERAL.—The Secretary shall coordinate 

3 all research activities undertaken or funded by the Execu4 tive Branch of the Federal Government on the health con5 sequences of toxic exposures experienced during service in 

6 the Armed Forces. 

7 ‘‘(b) STRATEGIC PLAN.—In carrying out subsection 

8 (a), the Secretary shall establish a strategic plan, to be 

9 known as the ‘Toxic Exposure Research Strategic Plan’, 

10 to ensure that the research activities described in such 

11 subsection are collaborative, transparent, and highly co12 ordinated. 

13 ‘‘(c) REPORT.—Not later than one year after the date 

14 of the enactment of the Comprehensive and Overdue Sup15 port for Troops of War Act of 2021, and annually there16 after, the Secretary shall submit to the Committee on Vet17 erans’ Affairs of the Senate and the Committee on Vet18 erans’ Affairs of the House of Representatives a report 

19 on all research activities described in subsection (a) under20 taken during the year covered by the report.’’. 

21 (b) CLERICAL AMENDMENT.—The table of sections 

22 at the beginning of such subchapter is amended by insert23 ing after the item relating to section 7330C the following 

24 new item: 

‘‘7330D. Coordination of toxic exposure research.’’. 


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1 SEC. 502. COLLECTION, ANALYSIS, AND REPORT ON TREAT2 MENT OF VETERANS FOR MEDICAL CONDI3 TIONS RELATED TO TOXIC EXPOSURE. 

4 (a) IN GENERAL.—The Secretary of Veterans Affairs 

5 shall compile and analyze, on a continuous basis, all clin6 ical data that— 

7 (1) is obtained by the Department of Veterans 

8 Affairs in connection with hospital care, medical 

9 services, and nursing home care furnished under sec10 tion 1710(a)(2)(F) of title 38, United States Code; 

11 and 

12 (2) is likely to be scientifically useful in deter13 mining the association, if any, between the medical 

14 condition of a veteran and a toxic exposure. 

15 (b) CONSENT OF PATIENTS.—Compilation and anal16 ysis by the Secretary of clinical data of a veteran under 

17 subsection (a) shall be conducted, and such data shall be 

18 used, consistent with the informed consent of the veteran 

19 and in compliance with all applicable Federal law. 

20 (c) ANNUAL REPORT.—Not later than one year after 

21 the date of the enactment of this Act, and annually there22 after, the Secretary shall submit to the Committee on Vet23 erans’ Affairs of the Senate and the Committee on Vet24 erans’ Affairs of the House of Representatives a report 

25 containing— 

26 (1) the data compiled under subsection (a); 


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1 (2) an analysis of such data; 

2 (3) a description of the types and incidences of 

3 medical conditions identified by the Department 

4 under such subsection; 

5 (4) the explanation of the Secretary for the in6 cidence of such medical conditions and other expla7 nations for the incidence of such conditions as the 

8 Secretary considers reasonable; and 

9 (5) the views of the Secretary on the scientific 

10 validity of drawing conclusions from the incidence of 

11 such medical conditions, as evidenced by the data 

12 compiled under subsection (a), regarding any asso13 ciation between such conditions and a toxic expo14 sure. 

15 (d) TOXIC EXPOSURE DEFINED.—In this section, the 

16 term ‘‘toxic exposure’’ has the meaning given that term 

17 in section 101(37) of title 38, United States Code. 

18 SEC. 503. STUDIES RELATING TO VETERANS WHO SERVED 

19 IN SOUTHWEST ASIA. 

20 (a) ANALYSIS.— 

21 (1) IN GENERAL.—Not later than 180 days 

22 after the date of the enactment of this Act, the Sec23 retary of Veterans Affairs, in coordination with the 

24 Secretary of Defense, shall conduct an updated analVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 ysis of total and respiratory disease mortality in cov2 ered veterans. 

3 (2) ELEMENTS.—The analysis required by 

4 paragraph (1) shall include, to the extent prac5 ticable, the following: 

6 (A) Metrics of airborne exposures. 

7 (B) The location and timing of deploy8 ments. 

9 (C) The military occupational specialty. 

10 (D) The Armed Force in which the veteran 

11 served. 

12 (E) Pre-existing health status, including 

13 with respect to asthma. 

14 (F) Relevant personal information, includ15 ing cigarette and e-cigarette smoking history, 

16 diet, sex, gender, age, race, and ethnicity. 

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

18 days after the date of the enactment of this Act, the Sec19 retary shall conduct an epidemiological study of covered 

20 veterans that uses the following: 

21 (1) Improved spatio-temporal estimates of am22 bient air pollution exposures using advances in retro23 spective exposure assessment. 


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1 (2) Detailed information on the study subjects 

2 obtained through medical records, administrative 

3 data, and other existing sources, that include— 

4 (A) personal characteristics, including ciga5 rette and e-cigarette smoking history, diet, sex, 

6 gender, age, race, and ethnicity; 

7 (B) deployment history, including loca8 tions, periods, and number of deployments; 

9 (C) biospecimen data; and 

10 (D) supplementary health status and out11 comes data, including imaging and physiological 

12 parameters. 

13 (c) TOXICOLOGY STUDY.— 

14 (1) IN GENERAL.—Not later than 180 days 

15 after the date of the enactment of this Act, the Sec16 retary shall conduct a toxicology study to include 

17 variability to replicate exposures of healthy, young 

18 members of the Armed Forces, as well as potentially 

19 susceptible members, with preexisting health condi20 tions. 

21 (2) ELEMENTS.—The study required under 

22 paragraph (1) shall— 

23 (A) analyze the study results for mecha24 nistic markers and clinically relevant outcomes; 

25 and 


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1 (B) validate serum, tissue, and other bio2 markers of exposure, susceptibility, or effect. 

3 (d) COVERED VETERAN DEFINED.—In this section, 

4 the term ‘‘covered veteran’’ means any veteran who— 

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

6 duty in— 

7 (A) Bahrain; 

8 (B) Iraq; 

9 (C) Kuwait; 

10 (D) Oman; 

11 (E) Qatar; 

12 (F) Saudi Arabia; 

13 (G) Somalia; or 

14 (H) the United Arab Emirates; or 

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

16 active duty in— 

17 (A) Afghanistan; 

18 (B) Djibouti; 

19 (C) Egypt; 

20 (D) Jordan; 

21 (E) Lebanon; 

22 (F) Syria; or 

23 (G) Yemen. 


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1 SEC. 504. STUDY ON HEALTH TRENDS OF POST 9/11 VET2 ERANS. 

3 The Secretary of Veterans Affairs shall conduct an 

4 epidemiological study on the health trends of veterans who 

5 served in the Armed Forces after September 11, 2001. 

6 SEC. 505. STUDY ON CANCER RATES AMONG VETERANS. 

7 (a) IN GENERAL.—The Secretary of Veterans Affairs 

8 shall conduct a study on the incidence of cancer in vet9 erans to determine trends in the rates of the incidence 

10 of cancer in veterans. 

11 (b) ELEMENTS.—The study required by subsection 

12 (a) shall assess, with respect to each veteran included in 

13 the study, the following: 

14 (1) The age of the veteran. 

15 (2) The period of service and length of service 

16 of the veteran in the Armed Forces. 

17 (3) The military occupational speciality or spe18 cialties of the veteran. 

19 (4) The gender of the veteran. 

20 (5) The type or types of cancer that the veteran 

21 has. 

22 TITLE VI—IMPROVING SUPPORT 

23 TO TOXIC EXPOSURE VETERANS 

24 SEC. 601. DEFINITIONS. 

25 In this title, the terms ‘‘active military, naval, or air 

26 service’’, ‘‘toxic exposure’’, and ‘‘toxic exposure veteran’’ 


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1 have the meanings given those terms in section 101 of title 

2 38, United States Code. 

3 SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DE4 PARTMENT OF VETERANS AFFAIRS FOR 

5 TOXIC EXPOSURE VETERANS AND OUTREACH 

6 PROGRAM FOR SUCH VETERANS AND CARE7 GIVERS AND SURVIVORS OF SUCH VETERANS. 

8 (a) PUBLICATION OF LIST OF RESOURCES.— 

9 (1) IN GENERAL.—Not later than one year 

10 after the date of the enactment of this Act, and an11 nually thereafter, the Secretary of Veterans Affairs 

12 shall publish a list of resources of the Department 

13 of Veterans Affairs for— 

14 (A) toxic exposure veterans; 

15 (B) families and caregivers of toxic expo16 sure veterans; and 

17 (C) survivors of toxic exposure veterans (or 

18 who would be toxic exposure veterans were the 

19 veterans alive) who are receiving death benefits 

20 under the laws administered by the Secretary. 

21 (2) UPDATE.—The Secretary shall periodically 

22 update the list published under paragraph (1). 

23 (b) OUTREACH.—The Secretary shall develop, with 

24 input from the community, an informative outreach pro25 gram for veterans on illnesses that may be related to toxic 


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1 exposure, including outreach with respect to benefits and 

2 support programs. 

3 SEC. 603. INCORPORATION OF TOXIC EXPOSURE QUES4 TIONNAIRE DURING PRIMARY CARE AP5 POINTMENTS. 

6 (a) IN GENERAL.—The Secretary of Veterans Affairs 

7 shall incorporate a clinical questionnaire to help determine 

8 potential toxic exposures during active military, naval, or 

9 air service as part of the initial screening conducted for 

10 an appointment of a veteran with a primary care provider 

11 of the Department of Veterans Affairs to improve under12 standing by the Department of toxic exposures of veterans 

13 while serving in the Armed Forces. 

14 (b) DETERMINATION OF QUESTIONS.—The questions 

15 included in the questionnaire required under subsection 

16 (a) shall be determined by the Secretary with input from 

17 medical professionals. 

18 SEC. 604. TRAINING FOR PERSONNEL OF THE DEPART19 MENT OF VETERANS AFFAIRS WITH RESPECT 

20 TO TOXIC EXPOSURE VETERANS. 

21 (a) HEALTH CARE PERSONNEL.—The Secretary of 

22 Veterans Affairs shall provide to health care personnel of 

23 the Department of Veterans Affairs education and train24 ing to identify, treat, and assess the impact on toxic expo25 sure veterans of illnesses related to toxic exposure and inVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 form such personnel of how to ask for additional informa2 tion from veterans regarding different toxic exposures. 

3 (b) BENEFITS PERSONNEL.— 

4 (1) IN GENERAL.—The Secretary shall establish 

5 a training program for processors of claims under 

6 the laws administered by the Secretary who review 

7 claims for disability benefits relating to service-con8 nected disabilities based on toxic exposure. 

9 (2) ANNUAL TRAINING.—Training provided to 

10 processors under paragraph (1) shall be provided not 

11 less frequently than annually. 

12 SEC. 605. SFC HEATH ROBINSON BURN PIT TRANSPARENCY 

13 ACT. 

14 (a) SHORT TITLE.—This section may be cited as the 

15 ‘‘SFC Heath Robinson Burn Pit Transparency Act’’. 

16 (b) QUARTERLY NOTIFICATIONS.— 

17 (1) IN GENERAL.—On a quarterly basis, the 

18 Secretary of Veterans Affairs shall submit to the ap19 propriate congressional committees a report on each 

20 reported case of burn pit exposure by a covered vet21 eran reported during the previous quarter. 

22 (2) ELEMENTS.—Each report submitted under 

23 paragraph (1) shall include, with respect to each re24 ported case of burn pit exposure of a covered vet25 eran included in the report, the following: 


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1 (A) Notice of the case, including the med2 ical facility at which the case was reported. 

3 (B) Notice of, as available— 

4 (i) the enrollment status of the cov5 ered veteran with respect to the patient en6 rollment system of the Department of Vet7 erans Affairs under section 1705(a) of title 

8 38, United States Code; 

9 (ii) a summary of all health care visits 

10 by the covered veteran at the medical facil11 ity at which the case was reported that are 

12 related to the case; 

13 (iii) the demographics of the covered 

14 veteran, including age, sex, and race; 

15 (iv) any non-Department of Veterans 

16 Affairs health care benefits that the cov17 ered veteran receives; 

18 (v) the Armed Force in which the cov19 ered veteran served and the rank of the 

20 covered veteran; 

21 (vi) the period in which the covered 

22 veteran served; 

23 (vii) each location that the covered 

24 veteran reported as being a location at 

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1 borne chemicals and fumes from an open 

2 burn pit; 

3 (viii) the medical diagnoses of the cov4 ered veteran and the treatment provided to 

5 the veteran; and 

6 (ix) whether the covered veteran is 

7 registered in the Airborne Hazards and 

8 Open Burn Pit Registry. 

9 (3) PROTECTION OF INFORMATION.—The Sec10 retary shall ensure that the reports submitted under 

11 paragraph (1) do not include the identity of covered 

12 veterans or contain other personally identifiable 

13 data. 

14 (c) ANNUAL REPORT ON CASES.— 

15 (1) IN GENERAL.—Not later than 180 days 

16 after the date of the enactment of this Act, and an17 nually thereafter, the Secretary of Veterans Affairs, 

18 in collaboration with the Secretary of Defense, shall 

19 submit to the appropriate congressional committees 

20 a report detailing the following: 

21 (A) The total number of covered veterans. 

22 (B) The total number of claims for dis23 ability compensation under chapter 11 of title 

24 38, United States Code, approved and the total 

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1 fairs with respect to a covered veteran, and for 

2 each such denial, the rationale of the denial. 

3 (C) A comprehensive list of— 

4 (i) the conditions for which covered 

5 veterans seek treatment; and 

6 (ii) the locations that the covered vet7 erans reported as being locations at which 

8 the veterans were exposed to toxic airborne 

9 chemicals and fumes from open burn pits. 

10 (D) Identification of any illnesses relating 

11 to exposure to open burn pits that formed the 

12 basis for the Secretary to award benefits, in13 cluding entitlement to service connection or an 

14 increase in disability rating. 

15 (E) The total number of covered veterans 

16 who died after seeking care for an illness relat17 ing to exposure to an open burn pit. 

18 (F) Any updates or trends with respect to 

19 the information described in subparagraphs (A), 

20 (B), (C), (D), and (E) that the Secretary deter21 mines appropriate. 

22 (2) MATTERS INCLUDED IN FIRST REPORT.— 

23 The Secretary shall include in the first report under 

24 paragraph (1) information specified in subsection 

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1 posure made during the period beginning January 1, 

2 1990, and ending on the day before the date of the 

3 enactment of this Act. 

4 (d) COMPTROLLER GENERAL REPORT.—Not later 

5 than 180 days after the date of the enactment of this Act, 

6 the Comptroller General of the United States shall submit 

7 to the appropriate congressional committees a report con8 taining an assessment of the effectiveness of any memo9 randum of understanding or memorandum of agreement 

10 entered into by the Secretary of Veterans Affairs with re11 spect to— 

12 (1) the processing of reported cases of burn pit 

13 exposure; and 

14 (2) the coordination of care and provision of 

15 health care relating to such cases at medical facili16 ties of the Department of Veterans Affairs and at 

17 non-Department facilities. 

18 (e) DEFINITIONS.—In this section: 

19 (1) The term ‘‘Airborne Hazards and Open 

20 Burn Pit Registry’’ means the registry established 

21 by the Secretary of Veterans Affairs under section 

22 201 of the Dignified Burial and Other Veterans’ 

23 Benefits Improvement Act of 2012 (Public Law 

24 112–260; 38 U.S.C. 527 note). 


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1 (2) The term ‘‘appropriate congressional com2 mittees’’ means— 

3 (A) the Committee on Veterans’ Affairs 

4 and the Committee on Armed Services of the 

5 Senate; and 

6 (B) The Committee on Veterans’ Affairs 

7 and the Committee on Armed Services of the 

8 House of Representatives. 

9 (3) The term ‘‘covered veteran’’ means a vet10 eran who presents at a medical facility of the De11 partment of Veterans Affairs (or in a non-Depart12 ment facility pursuant to section 1703 or 1703A of 

13 title 38, United States Code) for treatment that the 

14 veteran describes as being related to, or ancillary to, 

15 the exposure of the veteran to toxic airborne chemi16 cals and fumes caused by open burn pits at any time 

17 while serving in the Armed Forces. 

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

19 given that 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). 

23 (5) The term ‘‘reported case of burn pit expo24 sure’’ means each instance in which a veteran pre25 sents at a medical facility of the Department of VetVerDate Sep 11 2014 00:04 Oct 20, 2021 Jkt 029200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S3003.RS S3003

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1 erans Affairs (or in a non-Department facility pur2 suant to section 1703 or 1703A of title 38, United 

3 States Code) for treatment that the veteran de4 scribes as being related to, or ancillary to, the expo5 sure of the veteran to toxic airborne chemicals and 

6 fumes caused by open burn pits at any time while 

7 serving in the Armed Forces. 

8 TITLE VII—STRENGTHENING 

9 RECORD-KEEPING OF TOXIC 

10 EXPOSURES BY DEPARTMENT 

11 OF DEFENSE 

12 SEC. 701. DEFINITIONS. 

13 In this title: 

14 (1) INDIVIDUAL LONGITUDINAL EXPOSURE

15 RECORD.—The term ‘‘Individual Longitudinal Expo16 sure Record’’ has the meaning given that term in 

17 section 101(40) of title 38, United States Code, as 

18 added by section 101(b). 

19 (2) TOXIC EXPOSURE.—The term ‘‘toxic expo20 sure’’ has the meaning given that term in section 

21 101(37) of such title, as so added. 

22 SEC. 702. INDEPENDENT STUDY ON INDIVIDUAL LONGITU23 DINAL EXPOSURE RECORD. 

24 (a) IN GENERAL.—Not later than 60 days after the 

25 date of the enactment of this Act, the Secretary of Defense 


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1 shall enter into a contract with an independent research 

2 entity described in subsection (b) to carry out a com3 prehensive study of the development of the Individual Lon4 gitudinal Exposure Record to evaluate— 

5 (1) the quality of the location data, occupa6 tional and environmental exposure data, and health 

7 surveillance data; and 

8 (2) whether a member of the Armed Forces can 

9 be reasonably assured that any toxic exposure expe10 rienced by the member during service in the Armed 

11 Forces will be accurately reflected in the Individual 

12 Longitudinal Exposure Record of the member. 

13 (b) INDEPENDENT RESEARCH ENTITY DE14 SCRIBED.—An independent research entity described in 

15 this subsection is a federally funded research and develop16 ment center with appropriate expertise and analytical ca17 pability to carry out the study required under subsection 

18 (a). 

19 SEC. 703. BIANNUAL REPORT ON INDIVIDUAL LONGITU20 DINAL EXPOSURE RECORD. 

21 (a) IN GENERAL.—Not later than one year after the 

22 date on which the Individual Longitudinal Exposure 

23 Record achieves full operation capability, as determined 

24 by the Secretary of Defense, and every 180 days there25 after, the Secretary of Defense shall, in consultation with 


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1 the Secretary of Veterans Affairs, submit to the appro2 priate committees of Congress a report on the data quality 

3 of the databases of the Department of Defense that pro4 vide the information presented in the Individual Longitu5 dinal Exposure Record and the usefulness of the Indi6 vidual Longitudinal Exposure Record in supporting mem7 bers of the Armed Forces and veterans in receiving health 

8 care and benefits from the Department of Defense and 

9 the Department of Veterans Affairs. 

10 (b) ELEMENTS.—Each report required by subsection 

11 (a) shall include, for the period covered by the report, the 

12 following: 

13 (1) An identification of toxic exposures that 

14 may not be fully captured by the current systems of 

15 the Department of Defense for environmental and 

16 occupational health monitoring, and recommenda17 tions for how to improve those systems. 

18 (2) An analysis of the quality of the location 

19 data used by the Department of Defense in deter20 mining toxic exposures of members of the Armed 

21 Forces and veterans, and recommendations for how 

22 to improve the quality of that location data. 

23 (c) APPROPRIATE COMMITTEES OF CONGRESS DE24 FINED.—In this section, the term ‘‘appropriate commit25 tees of Congress’’ means— 


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1 (1) the Committee on Armed Services and the 

2 Committee on Veterans’ Affairs of the Senate; and 

3 (2) the Committee on Armed Services and the 

4 Committee on Veterans’ Affairs of the House of 

5 Representatives. 

6 SEC. 704. CORRECTION OF TOXIC EXPOSURE RECORDS. 

7 (a) IN GENERAL.—The Secretary of Defense and the 

8 Secretary of Veterans Affairs shall provide a means for 

9 members of the Armed Forces and veterans to update 

10 their records as necessary to reflect a toxic exposure by 

11 such member or veteran in the Individual Longitudinal 

12 Exposure Record. 

13 (b) EVIDENCE.— 

14 (1) IN GENERAL.—To update a record under 

15 subsection (a), a member of the Armed Forces or 

16 veteran, as the case may be, must provide such evi17 dence as the Secretary of Defense and the Secretary 

18 of Veterans Affairs jointly consider sufficient. 

19 (2) REGULATIONS.—The Secretary of Veterans 

20 Affairs shall prescribe by regulation the evidence 

21 considered sufficient under paragraph (1). 


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pbinns on DSKJLVW7X2PROD with BILLS
Calendar No. 145 

117TH CONGRESS 

1ST SESSION S. 3003 

A BILL 

To improve health care and benefits for veterans 

exposed to toxic substances, and for other purposes. 

OCTOBER 19, 2021 

Read twice and placed on the calendar 


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