I 

116TH CONGRESS 

2D SESSION H. R. 8506 

To improve the provision of health care and other benefits from the Department of Veterans Affairs for veterans who were exposed to toxic substances, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 2, 2020 

Mr. BILIRAKIS (for himself, Mr. DAVID P. ROE of Tennessee, Mr. WENSTRUP, 

Mr. BOST, and Mr. MAST) introduced the following bill; which was referred to the Committee on Veterans’ Affairs 

A BILL 

To improve the provision of health care and other benefits 

from the Department of Veterans Affairs for veterans 

who were 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 ‘‘Toxic Exposure in the American Military Act of 2020’’ 

6 or the ‘‘TEAM Act of 2020’’. 

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

8 this Act is as follows: 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•HR 8506 IH

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—EXPANSION OF HEALTH CARE AND BENEFITS FOR 

VETERANS EXPOSED TO TOXIC SUBSTANCES 

Sec. 101. Expansion of health care eligibility for certain individuals exposed to 

open burn pits and other toxic substances. 

Sec. 102. Expansion of health care eligibility for veterans awarded certain medals. 

Sec. 103. Presumptions of service connection for diseases associated with exposure to certain toxic substances. 

TITLE II—RESEARCH AND REVIEW REGARDING EXPOSURE TO 

TOXIC SUBSTANCES 

Sec. 201. Establishment of Toxic Exposure Review Commission. 

Sec. 202. Agreement with National Academies of Sciences, Engineering, and 

Medicine concerning the exposure of humans to toxic substances. 

Sec. 203. Collection, analysis, and report on treatment of veterans for medical 

conditions related to exposure to toxic substances. 

TITLE III—IMPROVEMENT OF RESOURCES OF DEPARTMENT OF 

VETERANS AFFAIRS REGARDING EXPOSURES TO TOXIC SUBSTANCES 

Sec. 301. Publication of list of resources of Department of Veterans Affairs for 

veterans exposed to toxic substances and outreach program for 

such veterans and caregivers and survivors of such veterans. 

Sec. 302. Incorporation of toxic exposure questionnaire during primary care appointments. 

Sec. 303. Sense of Congress on portal for access by veterans to Individual Longitudinal Exposure Record. 

Sec. 304. Training of health care personnel of Department of Veterans Affairs 

on illnesses related to exposure to toxic substances. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV4 ICE.—The term ‘‘active military, naval, or air serv5 ice’’ has the meaning given that term in section 101 

6 of title 38, United States Code. 

7 (2) OPEN BURN PIT.—The term ‘‘open burn 

8 pit’’ has the meaning given that term in section 

9 201(c) of the Dignified Burial and Other Veterans’ 


pamtmann on DSKBC07HB2PROD with BILLS
3 

•HR 8506 IH

1 Benefits Improvement Act of 2012 (Public Law 

2 112–260; 38 U.S.C. 527 note). 

3 (3) TOXIC SUBSTANCE.—The term ‘‘toxic sub4 stance’’ has the meaning given that term in subpara5 graph (G)(iv) of section 1710(e)(1) of such title, as 

6 added by section 101(a). 

7 TITLE I—EXPANSION OF HEALTH 

8 CARE AND BENEFITS FOR 

9 VETERANS EXPOSED TO 

10 TOXIC SUBSTANCES 

11 SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

12 CERTAIN INDIVIDUALS EXPOSED TO OPEN 

13 BURN PITS AND OTHER TOXIC SUBSTANCES. 

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

15 United States Code, is amended— 

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

17 following new subparagraph: 

18 ‘‘(G)(i) Subject to paragraph (2), a covered individual 

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

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

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

22 individual is an individual who— 

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

24 Hazards and Open Burn Pit Registry; or 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•HR 8506 IH

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

2 Defense to have been possibly exposed, inside or out3 side the United States, during active duty, active 

4 duty for training, or inactive duty training, to— 

5 ‘‘(aa) an open burn pit; 

6 ‘‘(bb) a toxic substance; or 

7 ‘‘(cc) a site included in a database main8 tained by the Department of Defense and 

9 shared with the Department of Veterans affairs 

10 to serve as the central portal for exposure-re11 lated data that compiles, collates, presents, and 

12 provides available occupational and environ13 mental exposure information to support the 

14 needs of the Department of Defense and the 

15 Department of Veterans Affairs. 

16 ‘‘(iii) A covered individual shall be enrolled in the sys17 tem of annual patient enrollment of the Department in 

18 the priority group under subsection (a)(6) of section 1705 

19 of this title. 

20 ‘‘(iv) In this subparagraph: 

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

22 Burn Pit Registry’ means the registry established by 

23 the Secretary under section 201 of the Dignified 

24 Burial and Other Veterans’ Benefits Improvement 


pamtmann on DSKBC07HB2PROD with BILLS
5 

•HR 8506 IH

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

2 note). 

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

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

5 Burial and Other Veterans’ Benefits Improvement 

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

7 note). 

8 ‘‘(III) The term ‘toxic substance’ means a toxi9 cant or a toxin. 

10 ‘‘(IV) The term ‘toxicant’ means any substance 

11 that can injure or kill humans, animals, or plants 

12 and that is produced by humans or is a by-product 

13 of human activities. 

14 ‘‘(V) The term ‘toxin’ means any substance 

15 that can injure or kill humans, animals, or plants 

16 and that is produced naturally.’’; and 

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

18 and inserting ‘‘(F), or (G)’’. 

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

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

21 after the date of the enactment of this Act. 

22 (c) DETERMINATIONS OF EXPOSURE.— 

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

24 Affairs shall, to the extent practicable, establish and 

25 maintain a mechanism by which veterans may deterVerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506

pamtmann on DSKBC07HB2PROD with BILLS
6 

•HR 8506 IH

1 mine whether or not they have been possibly exposed 

2 to an open burn pit or toxic substance described in 

3 subparagraph (G)(ii)(II) of section 1710(e)(1) of 

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

5 (a), for purposes of being considered as covered vet6 erans under such subparagraph. 

7 (2) APPROVAL OF SECRETARY.—Any deter8 mination made under paragraph (1) shall be subject 

9 to the approval of the Secretary. 

10 (3) APPEALS.—The Secretary shall establish a 

11 mechanism for appealing a decision made by the 

12 Secretary under paragraph (2). 

13 (d) REPORT.— 

14 (1) IN GENERAL.—Not later than 30 days after 

15 the date on which the Secretary of Defense identifies 

16 the individuals described in subparagraph (G)(ii)(II) 

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

18 Code, as added by subsection (a), the Secretary, in 

19 consultation with the Secretary of Veterans Affairs, 

20 shall submit to the appropriate committees of Con21 gress a report. 

22 (2) ELEMENTS.—The report required by para23 graph (1) shall include the following: 

24 (A) The duty locations or units of the indi25 viduals described in paragraph (1), or other inVerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506

pamtmann on DSKBC07HB2PROD with BILLS
7 

•HR 8506 IH

1 formation on groups to which such individuals 

2 belong. 

3 (B) The evidence considered in identifying 

4 individuals who were possibly exposed to an 

5 open burn pit, toxic substance, or site as de6 scribed in subparagraph (G)(ii)(II) of section 

7 1710(e)(1) of title 38, United States Code, as 

8 added by subsection (a). 

9 (C) The criteria used to determine whether 

10 an individual was so exposed. 

11 (3) APPROPRIATE COMMITTEES OF CON12 GRESS.—In this subsection, the term ‘‘appropriate 

13 committees of Congress’’ means— 

14 (A) the Committee on Veterans’ Affairs 

15 and the Committee on Armed Services of the 

16 Senate; and 

17 (B) the Committee on Veterans’ Affairs 

18 and the Committee on Armed Services of the 

19 House of Representatives. 

20 SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

21 VETERANS AWARDED CERTAIN MEDALS. 

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

23 United States Code, as amended by section 101(a), is fur24 ther amended— 


pamtmann on DSKBC07HB2PROD with BILLS
8 

•HR 8506 IH

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

2 following new subparagraph: 

3 ‘‘(H)(i) Subject to paragraph (2), a veteran is eligible 

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

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

6 was awarded any of the following: 

7 ‘‘(I) The Armed Forces Service Medal. 

8 ‘‘(II) The Afghanistan Campaign Medal. 

9 ‘‘(III) The Global War on Terrorism Expedi10 tionary Medal. 

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

12 ‘‘(V) The Iraq Campaign Medal. 

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

14 ‘‘(ii) A veteran described in clause (i) shall be enrolled 

15 in the system of annual patient enrollment of the Depart16 ment in the priority group under subsection (a)(6) of sec17 tion 1705 of this title.’’; and 

18 (2) in paragraph (2), by striking ‘‘or (G)’’ and 

19 inserting ‘‘(G), or (H)’’. 

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

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

22 after the date of the enactment of this Act. 


pamtmann on DSKBC07HB2PROD with BILLS
9 

•HR 8506 IH

1 SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR 

2 DISEASES ASSOCIATED WITH EXPOSURE TO 

3 CERTAIN TOXIC SUBSTANCES. 

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. Presumptions of service connection for dis8 eases associated with exposure to certain 

9 toxic substances 

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

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

12 section 1113 of this title, each disease specified in para13 graph (2) becoming manifest as specified in that para14 graph shall be considered to have been incurred in or ag15 gravated by service referred to in that paragraph, notwith16 standing that there is no record of evidence of such disease 

17 during the period of such service. 

18 ‘‘(2) A disease specified in this paragraph is any dis19 ease that— 

20 ‘‘(A) the Secretary determines in regulations 

21 prescribed under this section warrants a presump22 tion of service connection by reason of having suffi23 cient evidence of positive association with exposure 

24 to a toxic substance; and 

25 ‘‘(B) becomes manifest within the period, if 

26 any, prescribed in such regulations in a veteran who 


pamtmann on DSKBC07HB2PROD with BILLS
10 

•HR 8506 IH

1 was exposed to that toxic substance during active 

2 military, naval, or air service. 

3 ‘‘(3)(A) For purposes of this subsection, the Sec4 retary may presume that a veteran who has a disease spec5 ified in paragraph (2) was exposed to the toxic substance 

6 for which the Secretary has determined under paragraph 

7 (2)(A) warrants a presumption of service connection by 

8 reason of having sufficient evidence of positive association 

9 with exposure to the toxic substance, notwithstanding that 

10 there is no record of evidence of such exposure, if the Sec11 retary determines based on one or more of the factors set 

12 forth in subparagraph (B) that a presumption of exposure 

13 is warranted. 

14 ‘‘(B) The factors set forth in this subparagraph are 

15 as follows: 

16 ‘‘(i) The duty location of the veteran. 

17 ‘‘(ii) The length of service of the veteran. 

18 ‘‘(iii) Such other factors as the Secretary con19 siders appropriate. 

20 ‘‘(b) DETERMINATIONS RELATING TO DISEASES.— 

21 (1) Whenever the Secretary determines, on the basis of 

22 sound medical and scientific evidence, that sufficient evi23 dence of positive association exists between the exposure 

24 of humans to a toxic substance and the occurrence of a 

25 disease in humans, the Secretary shall prescribe regulaVerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506

pamtmann on DSKBC07HB2PROD with BILLS
11 

•HR 8506 IH

1 tions providing that a presumption of service connection 

2 is warranted for that disease for purposes of this section. 

3 ‘‘(2) In making determinations under paragraph (1), 

4 the Secretary shall take into account— 

5 ‘‘(A) reports received by the Secretary from the 

6 National Academies of Sciences, Engineering, and 

7 Medicine under section 202(g) of the Toxic Expo8 sure in the American Military Act of 2020; and 

9 ‘‘(B) all other sound medical and scientific in10 formation and analyses available to the Secretary. 

11 ‘‘(3)(A) In evaluating any report, information, or 

12 analysis for purposes of making such determinations, the 

13 Secretary shall consider only scientific studies that are 

14 valid in accordance with contemporary scientific stand15 ards. 

16 ‘‘(B) The Secretary may define the standards de17 scribed in subparagraph (A) for purposes of that subpara18 graph. 

19 ‘‘(c) RESPONSE TO REPORTS BY THE NATIONAL

20 ACADEMIES OF SCIENCES, ENGINEERING, AND MEDI21 CINE.—(1) Not later than 60 days after the date on which 

22 the Secretary receives a report from the National Acad23 emies of Sciences, Engineering, and Medicine under sec24 tion 202(g) of the Toxic Exposure in the American Mili25 tary Act of 2020, the Secretary shall determine whether 


pamtmann on DSKBC07HB2PROD with BILLS
12 

•HR 8506 IH

1 a presumption of service connection is warranted for each 

2 disease covered by the report. 

3 ‘‘(2) If the Secretary determines under paragraph (1) 

4 that a presumption of service connection is warranted for 

5 a disease, the Secretary shall, not later than 60 days after 

6 making the determination, issue proposed regulations set7 ting forth the determination. 

8 ‘‘(3)(A) If the Secretary makes a determination de9 scribed in subparagraph (B), the Secretary shall, not later 

10 than 60 days after making the determination, publish in 

11 the Federal Register a notice of the determination. 

12 ‘‘(B) A determination described in this subparagraph 

13 is a determination by the Secretary under paragraph (1) 

14 that a presumption of service connection is not warranted 

15 for a disease as to which the National Academies of 

16 Sciences, Engineering, and Medicine determined that 

17 there was— 

18 ‘‘(i) sufficient evidence of an association be19 tween the exposure of humans to a toxic substance 

20 and the occurrence of the disease in humans; or 

21 ‘‘(ii) limited evidence or suggestive evidence of 

22 such an association. 

23 ‘‘(C) Any notice published under subparagraph (A) 

24 shall include an explanation of the scientific basis for the 

25 determination described in subparagraph (B). 


pamtmann on DSKBC07HB2PROD with BILLS
13 

•HR 8506 IH

1 ‘‘(D) If a disease already presumed to be service con2 nected under this section is subject to a determination de3 scribed in subparagraph (B), the Secretary shall, not later 

4 than 60 days after publication of the notice under sub5 paragraph (A), issue proposed regulations removing the 

6 presumption of service connection for the disease. 

7 ‘‘(4) Not later than 180 days after the date on which 

8 the Secretary issues any proposed regulations under this 

9 subsection, the Secretary shall issue final regulations. 

10 ‘‘(d) REMOVAL OF PRESUMPTION OF SERVICE CON11 NECTION.—Whenever the presumption of service connec12 tion for a disease under this section is removed under sub13 section (c)— 

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

15 for the disease on the basis of the presumption be16 fore the effective date of the removal of the pre17 sumption shall continue to be entitled to receive 

18 compensation on that basis; and 

19 ‘‘(2) a survivor of a veteran who was awarded 

20 dependency and indemnity compensation for the 

21 death of a veteran resulting from the disease on the 

22 basis of the presumption before that date shall con23 tinue to be entitled to receive dependency and in24 demnity compensation on that basis. 


pamtmann on DSKBC07HB2PROD with BILLS
14 

•HR 8506 IH

1 ‘‘(e) REFERENCE TO NATIONAL ACADEMIES OF

2 SCIENCES, ENGINEERING, AND MEDICINE.—In the case 

3 that the Secretary enters into an agreement with another 

4 organization as described in section 202(h)(1) of the Toxic 

5 Exposure in the American Military Act of 2020, any ref6 erence in this section to the National Academies of 

7 Sciences, Engineering, and Medicine shall be treated as 

8 a reference to the other organization. 

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

10 ‘‘(1) The term ‘sufficient evidence of positive 

11 association’ means, with respect to an association 

12 between exposure to a toxic substance and the occur13 rence of a disease in humans, that— 

14 ‘‘(A) there is credible evidence for the asso15 ciation and such evidence is equal to or out16 weighs the credible evidence against the associa17 tion; and 

18 ‘‘(B) the association has been observed in 

19 studies in which chance, bias, and confounding 

20 can be ruled out with reasonable confidence. 

21 ‘‘(2) The term ‘toxic substance’ has the mean22 ing given that term in section 1710(e)(1)(G)(iv) of 

23 this title.’’. 

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

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


pamtmann on DSKBC07HB2PROD with BILLS
15 

•HR 8506 IH

1 by inserting after the item relating to section 1118 the 

2 following new item: 

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

to certain toxic substances.’’. 

3 (c) 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 TITLE II—RESEARCH AND RE7 VIEW REGARDING EXPOSURE 

8 TO TOXIC SUBSTANCES 

9 SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW 

10 COMMISSION. 

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

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

13 end the following new section: 

14 ‘‘§ 547. Toxic Exposure Review Commission 

15 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab16 lish an independent commission to be known as the ‘Toxic 

17 Exposure Review Commission’ (in this section referred to 

18 as the ‘Commission’). 

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

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

21 to exposure to toxic substances that require sci22 entific research; and 

23 ‘‘(2) assist in the consideration of possible pre24 sumptions of service connection. 


pamtmann on DSKBC07HB2PROD with BILLS
16 

•HR 8506 IH

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

2 following duties: 

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

4 Department of Defense and other sources to identify 

5 possible toxic exposures related to service during ac6 tive duty, active duty for training, or inactive duty 

7 training in order to determine the need for a com8 prehensive review under an agreement under section 

9 202 of the Toxic Exposure in the American Military 

10 Act of 2020. Relevant information may be collected 

11 from the following: 

12 ‘‘(A) Any Federal agency, as the Commis13 sion considers necessary to carry out this sec14 tion. Upon request of the Chair, the head of 

15 such agency shall furnish such information to 

16 the Commission, unless such information is 

17 classified. 

18 ‘‘(B) Public meetings or hearings, which 

19 may be held to take such testimony and receive 

20 such evidence as the Commission considers ad21 visable to carry out the duties of the Commis22 sion. 

23 ‘‘(2) Recommend to the Secretary, by majority 

24 vote, whether a comprehensive scientific review 

25 should be conducted by the National Academies of 


pamtmann on DSKBC07HB2PROD with BILLS
17 

•HR 8506 IH

1 Sciences, Engineering, and Medicine under an agree2 ment under section 202 of the Toxic Exposure in the 

3 American Military Act of 2020. 

4 ‘‘(3) Recommend to the Secretary, by majority 

5 vote, whether new, independent studies regarding 

6 the health outcomes of exposure to toxic substances, 

7 or any other new, independent studies that the Com8 mission deems necessary and appropriate, should be 

9 conducted. 

10 ‘‘(4) Annually report to Congress on progress 

11 regarding the duties set forth in paragraphs (1) 

12 through (3), any recommendations made to the Sec13 retary, and any responses of the Secretary to such 

14 recommendations. 

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

16 composed of 9 members, appointed as follows: 

17 ‘‘(i) Two members appointed by the Speaker of 

18 the House of Representatives. 

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

20 leader of the House of Representatives. 

21 ‘‘(iii) Two members appointed by the majority 

22 leader of the Senate. 

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

24 leader of the Senate. 

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


pamtmann on DSKBC07HB2PROD with BILLS
18 

•HR 8506 IH

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

2 appointed under subparagraph (A) not later than 180 

3 days after the date of the enactment of the Toxic Expo4 sure in the American Military Act of 2020. 

5 ‘‘(2) In appointing individuals under paragraph 

6 (1)(A), the Speaker of the House of Representatives, the 

7 minority leader of the House of Representatives, the ma8 jority leader of the Senate, the minority leader of the Sen9 ate, and the Secretary shall ensure that at least five mem10 bers of the Commission are scientists or health care pro11 fessionals— 

12 ‘‘(A) of whom— 

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

14 respiratory medicine; 

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

16 endocrinology and metabolic medicine; 

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

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

19 and 

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

21 and environmental health; and 

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

23 Federal Government. 

24 ‘‘(3) In appointing individuals under paragraph 

25 (1)(A), the Speaker of the House of Representatives, the 


pamtmann on DSKBC07HB2PROD with BILLS
19 

•HR 8506 IH

1 minority leader of the House of Representatives, the ma2 jority leader of the Senate, the minority leader of the Sen3 ate, and the Secretary shall ensure that at least two mem4 bers of the Commission represent an organization recog5 nized by the Secretary for the representation of veterans 

6 under section 5902 of this title. 

7 ‘‘(4) In appointing individuals under paragraph 

8 (1)(A), the Speaker of the House of Representatives, the 

9 minority leader of the House of Representatives, the ma10 jority leader of the Senate, the minority leader of the Sen11 ate, and the Secretary shall give consideration to including 

12 in the Commission at least one member who works with 

13 survivors of illnesses related to exposure to toxic sub14 stances and has a background in the field of study of expo15 sure to toxic substances. 

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

17 less frequently than twice each year. 

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

19 open to the public. 

20 ‘‘(B) All the proceedings, information, and delibera21 tions of the Commission shall be available for review by 

22 the public. 

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

24 through the use of telephonic or other appropriate tele25 communication technology if the Commission determines 


pamtmann on DSKBC07HB2PROD with BILLS
20 

•HR 8506 IH

1 that such technology will allow the members to commu2 nicate simultaneously. 

3 ‘‘(f) CHAIR AND VICE CHAIR.—At the initial meeting 

4 of the Commission under subsection (e), the Commission 

5 shall select a Chair and Vice Chair from among the mem6 bers of the Commission by a majority vote of the members 

7 of the Commission. 

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

9 member of the Commission shall be appointed for a term 

10 that may not exceed four years. 

11 ‘‘(2) The Secretary shall ensure that terms of mem12 bers of the Commission are staggered so that no such 

13 terms end on the same date. 

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

15 the same manner as the original appointment, but the in16 dividual appointed to fill the vacancy shall serve only for 

17 the unexpired portion of the term for which the individ18 ual’s predecessor was appointed. 

19 ‘‘(4) In appointing the initial members of the Com20 mission, each official who is authorized to appoint two 

21 members of the Commission shall appoint— 

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

23 years; and 

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

25 years. 


pamtmann on DSKBC07HB2PROD with BILLS
21 

•HR 8506 IH

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

2 serve without pay. 

3 ‘‘(2) Each member of the Commission who is an offi4 cer or employee of the United States shall serve without 

5 compensation in addition to that received for service as 

6 an officer or employee of the United States. 

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

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

9 5702 and 5703 of title 5. 

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

11 shall appoint a Director who— 

12 ‘‘(A) has not served as an employee of the De13 partment during the one-year period preceding the 

14 date of such appointment; and 

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

16 serving as Director under Federal ethics laws and 

17 regulations, by reason of post-employment conflict of 

18 interest. 

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

20 pay payable for level IV of the Executive Schedule under 

21 section 5315 of title 5. 

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

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

24 appoint and fix the pay of additional personnel. 


pamtmann on DSKBC07HB2PROD with BILLS
22 

•HR 8506 IH

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

2 without regard to the provisions of title 5 governing ap3 pointments in the competitive service, and any personnel 

4 so appointed may be paid without regard to the provisions 

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

6 title relating to classification and General Schedule pay 

7 rates, except that an individual so appointed may not re8 ceive pay in excess of the annual rate of basic pay payable 

9 for GS–15 of the General Schedule. 

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

11 employed by or detailed to the Commission may be on de12 tail from the Department. 

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

14 of the Commission staff may be persons detailed from the 

15 Department to the Commission. 

16 ‘‘(4) Subject to paragraph (3), the head of any Fed17 eral agency, upon the request of the Director, may detail 

18 any of the personnel of that agency to the Commission 

19 to assist the Commission in carrying out its duties under 

20 this section. 

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

22 Federal agency such information as the Commission con23 siders necessary to carry out this section. Upon request 

24 of the Chair, the head of such agency shall furnish such 


pamtmann on DSKBC07HB2PROD with BILLS
23 

•HR 8506 IH

1 information to the Commission, unless such information 

2 is classified. 

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

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

5 temporary or intermittent services of experts or consult6 ants pursuant to section 3109 of title 5. 

7 ‘‘(2) To the extent funds are available, the Commis8 sion may lease real property and acquire personal property 

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

10 Services Administration. 

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

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

13 of the Department in communicating with the Commis14 sion. 

15 ‘‘(B) Subparagraph (A) does not apply to a commu16 nication that is unlawful. 

17 ‘‘(2) All ex parte communications with the Commis18 sion shall be made part of the public record. 

19 ‘‘(m) REFERENCE TO NATIONAL ACADEMIES OF

20 SCIENCES, ENGINEERING, AND MEDICINE.—In the case 

21 that the Secretary enters into an agreement with another 

22 organization as described in section 202(h)(1) of the Toxic 

23 Exposure in the American Military Act of 2020, any ref24 erence in this section to the National Academies of 


pamtmann on DSKBC07HB2PROD with BILLS
24 

•HR 8506 IH

1 Sciences, Engineering, and Medicine shall be treated as 

2 a reference to the other organization. 

3 ‘‘(n) TOXIC SUBSTANCE DEFINED.—In this section, 

4 the term ‘toxic substance’ has the meaning given that 

5 term in subparagraph (G)(iv) of section 1710(e)(1) of this 

6 title.’’. 

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

8 at the beginning of chapter 5 of such title is amended by 

9 adding at the end the following new item: 

‘‘547. Toxic Exposure Review Commission.’’. 

10 SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF 

11 SCIENCES, ENGINEERING, AND MEDICINE 

12 CONCERNING THE EXPOSURE OF HUMANS TO 

13 TOXIC SUBSTANCES. 

14 (a) PURPOSE.—The purpose of this section is to pro15 vide for the National Academies of Sciences, Engineering, 

16 and Medicine (in this section referred to as the ‘‘Acad17 emies’’), an independent nonprofit scientific organization 

18 with appropriate expertise that is not part of the Federal 

19 Government, to review and evaluate the available scientific 

20 evidence regarding associations between diseases and ex21 posure to toxic substances. 

22 (b) AGREEMENT.— 

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

24 Affairs shall seek to enter into a five-year agreement 


pamtmann on DSKBC07HB2PROD with BILLS
25 

•HR 8506 IH

1 with the Academies to perform the services covered 

2 by this section. 

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

4 into an agreement described in paragraph (1) not 

5 later than 60 days after the date of the enactment 

6 of this Act. 

7 (3) EXTENSION.—An agreement under this sec8 tion may be extended in five-year increments. 

9 (c) REVIEW OF SCIENTIFIC EVIDENCE.—Under an 

10 agreement between the Secretary and the Academies 

11 under this section, the Academies shall review and summa12 rize the scientific evidence, and assess the strength there13 of, concerning the association between exposure to toxic 

14 substances during active military, naval, or air service and 

15 each disease suspected to be associated with such exposure 

16 in the human population. 

17 (d) SCIENTIFIC DETERMINATIONS CONCERNING DIS18 EASES.—For each disease reviewed under subsection (c), 

19 the Academies shall determine, to the extent that available 

20 scientific data permit meaningful determinations— 

21 (1) whether an association exists between expo22 sure to toxic substances and the occurrence of the 

23 disease, taking into account the strength of the sci24 entific evidence and the appropriateness of the staVerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506

pamtmann on DSKBC07HB2PROD with BILLS
26 

•HR 8506 IH

1 tistical and epidemiological methods used to detect 

2 the association; 

3 (2) the increased risk of the disease among 

4 those exposed to toxic substances during active mili5 tary, naval, or air service; and 

6 (3) whether there exists a plausible biological 

7 mechanism or other evidence of a causal relationship 

8 between the exposure and the occurrence of the dis9 ease. 

10 (e) COOPERATION OF FEDERAL AGENCIES.—The 

11 head of each relevant Federal agency, including the Sec12 retary of Defense, shall cooperate fully with the Academies 

13 in performing the services covered by this section. 

14 (f) RECOMMENDATIONS FOR ADDITIONAL SCI15 ENTIFIC STUDIES.— 

16 (1) IN GENERAL.—Under an agreement be17 tween the Secretary and the Academies under this 

18 section, the Academies shall make any recommenda19 tions for additional scientific studies to resolve areas 

20 of continuing scientific uncertainty relating to the 

21 exposure of humans to toxic substances. 

22 (2) CONSIDERATIONS.—In making rec23 ommendations under paragraph (1), the Academies 

24 shall consider— 


pamtmann on DSKBC07HB2PROD with BILLS
27 

•HR 8506 IH

1 (A) the scientific information that is avail2 able at the time of the recommendation; 

3 (B) the value and relevance of the informa4 tion that could result from additional studies; 

5 and 

6 (C) the cost and feasibility of carrying out 

7 such additional studies. 

8 (g) REPORTS.— 

9 (1) INITIAL REPORT.— 

10 (A) IN GENERAL.—Under an agreement 

11 between the Secretary and the Academies under 

12 this section, not later than one year after the 

13 date of the enactment of this Act, the Acad14 emies shall submit to the Secretary, the Com15 mittee on Veterans’ Affairs of the Senate, and 

16 the Committee on Veterans’ Affairs of the 

17 House of Representatives an initial report on 

18 the activities of the Academies under the agree19 ment. 

20 (B) ELEMENTS.—The report submitted 

21 under subparagraph (A) shall include the fol22 lowing: 

23 (i) The determinations described in 

24 subsection (d). 


pamtmann on DSKBC07HB2PROD with BILLS
28 

•HR 8506 IH

1 (ii) A full explanation of the scientific 

2 evidence and reasoning that led to such de3 terminations. 

4 (iii) Any recommendations of the 

5 Academies under subsection (f). 

6 (2) PERIODIC UPDATES.—Under an agreement 

7 between the Secretary and the Academies under this 

8 section, not less frequently than once every two 

9 years after the date on which the initial report is 

10 submitted under paragraph (1)(A), the Academies 

11 shall submit to the Secretary, the Committee on Vet12 erans’ Affairs of the Senate, and the Committee on 

13 Veterans’ Affairs of the House of Representatives an 

14 updated report on the activities of the Academies 

15 under the agreement. 

16 (h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA17 TION.— 

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

19 within the time period prescribed in subsection 

20 (b)(2) to enter into an agreement with the Acad21 emies for the purposes of this section on terms ac22 ceptable to the Secretary, the Secretary shall seek to 

23 enter into an agreement for the purposes of this sec24 tion with another appropriate scientific organization 

25 that— 


pamtmann on DSKBC07HB2PROD with BILLS
29 

•HR 8506 IH

1 (A) is not part of the Federal Government; 

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

3 (C) has expertise and objectivity com4 parable to that of the Academies. 

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

6 an agreement with another organization as described 

7 in paragraph (1), any reference in this section, sec8 tion 547 of title 38, United States Code, as added 

9 by section 201(a), and section 1119 of such title, as 

10 added by section 105(a), to the National Academies 

11 of Sciences, Engineering, and Medicine shall be 

12 treated as a reference to the other organization. 

13 SEC. 203. COLLECTION, ANALYSIS, AND REPORT ON TREAT14 MENT OF VETERANS FOR MEDICAL CONDI15 TIONS RELATED TO EXPOSURE TO TOXIC 

16 SUBSTANCES. 

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

18 shall compile and analyze, on a continuous basis, all clin19 ical data that— 

20 (1) is obtained by the Department of Veterans 

21 Affairs in connection with hospital care, medical 

22 services, and nursing home care furnished under sec23 tion 1710(a)(2)(F) of title 38, United States Code; 

24 and 


pamtmann on DSKBC07HB2PROD with BILLS
30 

•HR 8506 IH

1 (2) is likely to be scientifically useful in deter2 mining the association, if any, between the medical 

3 condition of a veteran and exposure to a toxic sub4 stance. 

5 (b) CONSENT OF PATIENTS.—Compilation and anal6 ysis by the Secretary of clinical data of a veteran under 

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

8 used, consistent with the informed consent of the veteran 

9 and in compliance with all applicable Federal law. 

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

11 the date of the enactment of this Act, and annually there12 after, the Secretary shall submit to the Committee on Vet13 erans’ Affairs of the Senate, the Committee on Veterans’ 

14 Affairs of the House of Representatives, and the Toxic Ex15 posure Review Commission established by section 547 of 

16 title 38, United States Code, as added by section 201(a) 

17 of this Act, a report containing— 

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

19 (2) an analysis of such data; 

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

21 medical conditions identified by the Department 

22 under such subsection; 

23 (4) the explanation of the Secretary for the in24 cidence of such medical conditions and other explaVerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506

pamtmann on DSKBC07HB2PROD with BILLS
31 

•HR 8506 IH

1 nations for the incidence of such conditions as the 

2 Secretary considers reasonable; and 

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

4 validity of drawing conclusions from the incidence of 

5 such medical conditions, as evidenced by the data 

6 compiled under subsection (a), regarding any asso7 ciation between such conditions and exposure to a 

8 toxic substance. 

9 TITLE III—IMPROVEMENT OF 

10 RESOURCES OF DEPARTMENT 

11 OF VETERANS AFFAIRS RE12 GARDING EXPOSURES TO 

13 TOXIC SUBSTANCES 

14 SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DE15 PARTMENT OF VETERANS AFFAIRS FOR VET16 ERANS EXPOSED TO TOXIC SUBSTANCES AND 

17 OUTREACH PROGRAM FOR SUCH VETERANS 

18 AND CAREGIVERS AND SURVIVORS OF SUCH 

19 VETERANS. 

20 (a) PUBLICATION OF LIST OF RESOURCES.— 

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

22 after the date of the enactment of this Act, and an23 nually thereafter, the Secretary of Veterans Affairs 

24 shall publish a list of resources of the Department 

25 of Veterans Affairs for— 


pamtmann on DSKBC07HB2PROD with BILLS
32 

•HR 8506 IH

1 (A) veterans provided disability compensa2 tion under chapter 11 of title 38, United States 

3 Code, relating to exposure to toxic substances; 

4 (B) veterans eligible for hospital care, 

5 medical services, and nursing home care under 

6 section 1710(a)(2)(F) of such title; 

7 (C) caregivers of veterans described in sub8 paragraph (A) or (B) who are participating in 

9 the program of comprehensive assistance for 

10 family caregivers under section 1720G(a) of 

11 such title; and 

12 (D) survivors of veterans described in sub13 paragraph (A) or (B) (or who would be de14 scribed in any such subparagraph were the vet15 eran alive) who are receiving death benefits 

16 under the laws administered by the Secretary. 

17 (2) UPDATE.—The Secretary shall periodically 

18 update the list published under paragraph (1). 

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

20 input from the community, an informative outreach pro21 gram for veterans on illnesses that may be related to expo22 sure to toxic substances, including outreach with respect 

23 to benefits and support programs. 


pamtmann on DSKBC07HB2PROD with BILLS
33 

•HR 8506 IH

1 SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUES2 TIONNAIRE DURING PRIMARY CARE AP3 POINTMENTS. 

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

5 shall incorporate a clinical questionnaire to help determine 

6 potential exposure to toxic substances during active mili7 tary, naval, or air service as part of the initial screening 

8 conducted for an appointment of a veteran with a primary 

9 care provider of the Department of Veterans Affairs to 

10 improve understanding by the Department of exposure of 

11 veterans to toxic substances while serving in the Armed 

12 Forces. 

13 (b) DETERMINATION OF QUESTIONS.—The questions 

14 included in the questionnaire required under subsection 

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

16 medical professionals. 

17 SEC. 303. SENSE OF CONGRESS ON PORTAL FOR ACCESS BY 

18 VETERANS TO INDIVIDUAL LONGITUDINAL 

19 EXPOSURE RECORD. 

20 It is the sense of Congress that the Secretary of Vet21 erans Affairs should establish a portal on the internet 

22 website of the Department of Veterans Affairs through 

23 which a veteran may access documents and information 

24 with respect to the veteran contained in the Individual 

25 Longitudinal Exposure Record of the Department of Vet26 erans Affairs. 


pamtmann on DSKBC07HB2PROD with BILLS
34 

•HR 8506 IH

1 SEC. 304. TRAINING OF HEALTH CARE PERSONNEL OF DE2 PARTMENT OF VETERANS AFFAIRS ON ILL3 NESSES RELATED TO EXPOSURE TO TOXIC 

4 SUBSTANCES. 

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

6 shall ensure that health care personnel of the Department 

7 of Veterans Affairs are appropriately trained to identify, 

8 treat, and assess the impact of illnesses related to expo9 sure to toxic substances. 

10 (b) ELEMENTS OF TRAINING.—The training required 

11 under subsection (a) shall— 

12 (1) provide health care personnel of the Depart13 ment with specific education with respect to illnesses 

14 related to exposure to toxic substances; and 

15 (2) inform such personnel of how to probe for 

16 additional information from veterans regarding expo17 sures to different toxicants. 

18 (c) TOXICANT DEFINED.—In this section, the term 

19 ‘‘toxicant’’ has the meaning given that term in subpara20 graph (G)(iv) of section 1710(e)(1) of title 38, United 

21 States Code, as added by section 101(a). 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS