II 

117TH CONGRESS 

1ST SESSION S. 927 

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 SENATE OF THE UNITED STATES 

MARCH 23, 2021 

Mr. TILLIS (for himself, Ms. HASSAN, Mr. MORAN, Ms. KLOBUCHAR, Mrs. 

BLACKBURN, Ms. BALDWIN, and Mrs. CAPITO) introduced the following 

bill; which was read twice and 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’’ or the 

6 ‘‘TEAM Act’’. 


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

2 this Act is as follows: 

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. Training of health care personnel of Department of Veterans Affairs 

on illnesses related to exposure to toxic substances. 

3 SEC. 2. DEFINITIONS. 

4 In this Act: 

5 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV6 ICE.—The term ‘‘active military, naval, or air serv7 ice’’ has the meaning given that term in section 101 

8 of title 38, United States Code. 

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

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


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1 201(c) of the Dignified Burial and Other Veterans’ 

2 Benefits Improvement Act of 2012 (Public Law 

3 112–260; 38 U.S.C. 527 note). 

4 (3) TOXIC SUBSTANCE.—The term ‘‘toxic sub5 stance’’ has the meaning given that term in subpara6 graph (G)(iii) of section 1710(e)(1) of such title, as 

7 added by section 101(a)(1). 

8 TITLE I—EXPANSION OF HEALTH 

9 CARE AND BENEFITS FOR 

10 VETERANS EXPOSED TO 

11 TOXIC SUBSTANCES 

12 SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

13 CERTAIN INDIVIDUALS EXPOSED TO OPEN 

14 BURN PITS AND OTHER TOXIC SUBSTANCES. 

15 (a) EXPANSION OF HEALTH CARE ELIGIBILITY.— 

16 (1) IN GENERAL.—Section 1710(e) of title 38, 

17 United States Code, is amended— 

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

19 the following new subparagraph: 

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

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

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

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

24 individual is an individual who— 


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

2 Hazards and Open Burn Pit Registry; or 

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

4 Defense to have been possibly exposed, inside or out5 side the United States, during active duty, active 

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

7 ‘‘(aa) an open burn pit; 

8 ‘‘(bb) a toxic substance; or 

9 ‘‘(cc) a site included in a database main10 tained by the Department of Defense and 

11 shared with the Department of Veterans Affairs 

12 to serve as the central portal for exposure-re13 lated data that compiles, collates, presents, and 

14 provides available occupational and environ15 mental exposure information to support the 

16 needs of the Department of Defense and the 

17 Department of Veterans Affairs. 

18 ‘‘(iii) In this subparagraph: 

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

20 Burn Pit Registry’ means the registry established by 

21 the Secretary under section 201 of the Dignified 

22 Burial and Other Veterans’ Benefits Improvement 

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

24 note). 


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

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

3 Burial and Other Veterans’ Benefits Improvement 

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

5 note). 

6 ‘‘(III) The term ‘toxic substance’ means a toxi7 cant or a toxin. 

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

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

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

11 of human activities. 

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

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

14 and that is produced naturally.’’; and 

15 (B) in paragraph (2)(B), by striking ‘‘or 

16 (F)’’ and inserting ‘‘(F), or (G)’’. 

17 (2) EFFECTIVE DATE.—The amendments made 

18 by paragraph (1) shall take effect on the date that 

19 is 90 days after the date of the enactment of this 

20 Act. 

21 (b) DETERMINATIONS OF EXPOSURE.— 

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

23 Affairs shall, to the extent practicable, establish and 

24 maintain a mechanism by which veterans may deter25 mine whether or not they have been possibly exposed 


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1 to an open burn pit or toxic substance described in 

2 subclause (II) of subparagraph (G)(ii) of section 

3 1710(e)(1) of title 38, United States Code, as added 

4 by subsection (a)(1), for purposes of being consid5 ered as covered individuals under such subpara6 graph. 

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 (c) 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)(1), the Secretary 

19 of Defense, in consultation with the Secretary of 

20 Veterans Affairs, shall submit to the appropriate 

21 committees of Congress a report. 

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

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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)(1). 

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)(1), is 

24 further amended— 


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

2 following new subparagraph: 

3 ‘‘(H) 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.’’; and 

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

15 inserting ‘‘(G), or (H)’’. 

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

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

18 after the date of the enactment of this Act. 

19 SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR 

20 DISEASES ASSOCIATED WITH EXPOSURE TO 

21 CERTAIN TOXIC SUBSTANCES. 

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

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

24 end the following new section: 


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1 ‘‘§ 1119. Presumptions of service connection for dis2 eases associated with exposure to certain 

3 toxic substances 

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

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

6 section 1113 of this title, each disease specified in para7 graph (2) becoming manifest as specified in that para8 graph shall be considered to have been incurred in or ag9 gravated by service referred to in that paragraph, notwith10 standing that there is no record of evidence of such disease 

11 during the period of such service. 

12 ‘‘(2) A disease specified in this paragraph is any dis13 ease that— 

14 ‘‘(A) the Secretary determines in regulations 

15 prescribed under this section warrants a presump16 tion of service connection by reason of having a posi17 tive association with exposure to a toxic substance; 

18 and 

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

20 any, prescribed in such regulations in a veteran who 

21 was exposed to that toxic substance during active 

22 military, naval, or air service. 

23 ‘‘(3)(A) For purposes of this subsection, the Sec24 retary may presume that a veteran who has a disease spec25 ified in paragraph (2) was exposed to the toxic substance 

26 for which the Secretary has determined under paragraph 


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

2 reason of having a positive association with exposure to 

3 the toxic substance, notwithstanding that there is no 

4 record of evidence of such exposure, if the Secretary deter5 mines based on one or more of the factors set forth in 

6 subparagraph (B) that a presumption of exposure is war7 ranted. 

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

9 as follows: 

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

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

12 ‘‘(iii) Such other factors as the Secretary con13 siders appropriate. 

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

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

16 sound medical and scientific evidence, that a positive asso17 ciation exists between the exposure of humans to a toxic 

18 substance and the occurrence of a disease in humans, the 

19 Secretary shall prescribe regulations providing that a pre20 sumption of service connection is warranted for that dis21 ease for purposes of this section. 

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

23 the Secretary shall take into account— 

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

25 National Academies of Sciences, Engineering, and 


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1 Medicine under section 202(g) of the Toxic Expo2 sure in the American Military Act; and 

3 ‘‘(B) all other sound medical and scientific in4 formation and analyses available to the Secretary. 

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

6 analysis for purposes of making such determinations, the 

7 Secretary shall consider only scientific studies that are 

8 valid in accordance with contemporary scientific stand9 ards. 

10 ‘‘(B) The Secretary may define the standards de11 scribed in subparagraph (A) for purposes of that subpara12 graph. 

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

14 ACADEMIES OF SCIENCES, ENGINEERING, AND MEDI15 CINE.—(1) Not later than 60 days after the date on which 

16 the Secretary receives a report from the National Acad17 emies of Sciences, Engineering, and Medicine under sec18 tion 202(g) of the Toxic Exposure in the American Mili19 tary Act, the Secretary shall determine whether a pre20 sumption of service connection is warranted for each dis21 ease covered by the report. 

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

23 that a presumption of service connection is warranted for 

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


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1 making the determination, issue proposed regulations set2 ting forth the determination. 

3 ‘‘(3)(A) If the Secretary makes a determination de4 scribed in subparagraph (B), the Secretary shall, not later 

5 than 60 days after making the determination, publish in 

6 the Federal Register a notice of the determination. 

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

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

9 that a presumption of service connection is not warranted 

10 for a disease as to which the National Academies of 

11 Sciences, Engineering, and Medicine determined that 

12 there was— 

13 ‘‘(i) sufficient evidence of an association be14 tween the exposure of humans to a toxic substance 

15 and the occurrence of the disease in humans; or 

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

17 such an association. 

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

19 shall include an explanation of the scientific basis for the 

20 determination described in subparagraph (B). 

21 ‘‘(D) If a disease already presumed to be service con22 nected under this section is subject to a determination de23 scribed in subparagraph (B), the Secretary shall, not later 

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1 paragraph (A), issue proposed regulations removing the 

2 presumption of service connection for the disease. 

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

4 the Secretary issues any proposed regulations under this 

5 subsection, the Secretary shall issue final regulations. 

6 ‘‘(d) REMOVAL OF PRESUMPTION OF SERVICE CON7 NECTION.—Whenever the presumption of service connec8 tion for a disease under this section is removed under sub9 section (c)— 

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

11 for the disease on the basis of the presumption be12 fore the effective date of the removal of the pre13 sumption shall continue to be entitled to receive 

14 compensation on that basis; and 

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

16 dependency and indemnity compensation for the 

17 death of a veteran resulting from the disease on the 

18 basis of the presumption before that date shall con19 tinue to be entitled to receive dependency and in20 demnity compensation on that basis. 

21 ‘‘(e) REFERENCE TO NATIONAL ACADEMIES OF

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

23 that the Secretary enters into an agreement with another 

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

25 Exposure in the American Military Act, any reference in 


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1 this section to the National Academies of Sciences, Engi2 neering, and Medicine shall be treated as a reference to 

3 the other organization. 

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

5 ‘‘(1) The term ‘positive association’ means, with 

6 respect to an association between exposure to a toxic 

7 substance and the occurrence of a disease in hu8 mans, that there is credible evidence for the associa9 tion and such evidence is equal to or outweighs the 

10 credible evidence against the association. 

11 ‘‘(2) The term ‘toxic substance’ has the mean12 ing given that term in section 1710(e)(1)(G)(iii) of 

13 this title.’’. 

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

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

16 by inserting after the item relating to section 1118 the 

17 following new item: 

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

to certain toxic substances.’’. 

18 (c) CONFORMING AMENDMENT.—Section 1113 of 

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

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


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1 TITLE II—RESEARCH AND RE2 VIEW REGARDING EXPOSURE 

3 TO TOXIC SUBSTANCES 

4 SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW 

5 COMMISSION. 

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

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

8 end the following new section: 

9 ‘‘§ 547. Toxic Exposure Review Commission 

10 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab11 lish an independent commission to be known as the ‘Toxic 

12 Exposure Review Commission’ (in this section referred to 

13 as the ‘Commission’). 

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

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

16 to exposure to toxic substances that require sci17 entific research; and 

18 ‘‘(2) assist in the consideration of possible pre19 sumptions of service connection. 

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

21 the following duties: 

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

23 Department of Defense and other sources to identify 

24 possible toxic exposures related to service during ac25 tive duty, active duty for training, or inactive duty 


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1 training in order to determine the need for a com2 prehensive review under an agreement under section 

3 202 of the Toxic Exposure in the American Military 

4 Act. 

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

6 vote, whether a comprehensive scientific review 

7 should be conducted by the National Academies of 

8 Sciences, Engineering, and Medicine under an agree9 ment under section 202 of the Toxic Exposure in the 

10 American Military Act. 

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

12 vote, whether new, independent studies regarding 

13 the health outcomes of exposure to toxic substances, 

14 or any other new, independent studies that the Com15 mission deems necessary and appropriate, should be 

16 conducted. 

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

18 regarding the duties set forth in subparagraphs (A) 

19 through (C), any recommendations made to the Sec20 retary, and any responses of the Secretary to such 

21 recommendations. 

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

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

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

25 considers necessary to carry out this section. 


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

2 held to take such testimony and receive such evi3 dence as the Commission considers advisable to 

4 carry out the duties of the Commission. 

5 ‘‘(B) Upon request of the Chair, the head of a Fed6 eral agency shall furnish information collected under sub7 paragraph (A)(i) to the Commission unless such informa8 tion is classified. 

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

10 composed of nine members, appointed as follows: 

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

12 the House of Representatives. 

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

14 leader of the House of Representatives. 

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

16 leader of the Senate. 

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

18 leader of the Senate. 

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

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

21 appointed under subparagraph (A) not later than 180 

22 days after the date of the enactment of the Toxic Expo23 sure in the American Military Act. 

24 ‘‘(2) In appointing individuals under paragraph 

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


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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 five mem4 bers of the Commission are scientists or health care pro5 fessionals— 

6 ‘‘(A) of whom— 

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

8 respiratory medicine; 

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

10 endocrinology and metabolic medicine; 

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

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

13 and 

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

15 and environmental health; and 

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

17 Federal Government. 

18 ‘‘(3) In appointing individuals under paragraph 

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

20 minority leader of the House of Representatives, the ma21 jority leader of the Senate, the minority leader of the Sen22 ate, and the Secretary shall ensure that at least two mem23 bers of the Commission represent an organization recog24 nized by the Secretary for the representation of veterans 

25 under section 5902 of this title. 


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1 ‘‘(4) In appointing individuals under paragraph 

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

3 minority leader of the House of Representatives, the ma4 jority leader of the Senate, the minority leader of the Sen5 ate, and the Secretary shall give consideration to including 

6 in the Commission at least one member who works with 

7 survivors of illnesses related to exposure to toxic sub8 stances and has a background in the field of study of expo9 sure to toxic substances. 

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

11 less frequently than twice each year. 

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

13 open to the public. 

14 ‘‘(B) All the proceedings, information, and delibera15 tions of the Commission shall be available for review by 

16 the public. 

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

18 through the use of telephonic or other appropriate tele19 communication technology if the Commission determines 

20 that such technology will allow the members to commu21 nicate simultaneously. 

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

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

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1 bers of the Commission by a majority vote of the members 

2 of the Commission. 

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

4 member of the Commission shall be appointed for a term 

5 that may not exceed four years. 

6 ‘‘(2) The Secretary shall ensure that terms of mem7 bers of the Commission are staggered so that no such 

8 terms end on the same date. 

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

10 the same manner as the original appointment, but the in11 dividual appointed to fill the vacancy shall serve only for 

12 the unexpired portion of the term for which the individ13 ual’s predecessor was appointed. 

14 ‘‘(4) In appointing the initial members of the Com15 mission, each official who is authorized to appoint two 

16 members of the Commission shall appoint— 

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

18 years; and 

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

20 years. 

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

22 serve without pay. 

23 ‘‘(2) Each member of the Commission who is an offi24 cer or employee of the United States shall serve without 


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1 compensation in addition to that received for service as 

2 an officer or employee of the United States. 

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

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

5 5702 and 5703 of title 5. 

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

7 shall appoint a Director who— 

8 ‘‘(A) has not served as an employee of the De9 partment during the one-year period preceding the 

10 date of such appointment; and 

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

12 serving as Director under Federal ethics laws and 

13 regulations, by reason of post-employment conflict of 

14 interest. 

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

16 pay payable for level IV of the Executive Schedule under 

17 section 5315 of title 5. 

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

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

20 appoint and fix the pay of additional personnel. 

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

22 without regard to the provisions of title 5 governing ap23 pointments in the competitive service, and any personnel 

24 so appointed may be paid without regard to the provisions 

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


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1 title relating to classification and General Schedule pay 

2 rates, except that an individual so appointed may not re3 ceive pay in excess of the annual rate of basic pay payable 

4 for GS–15 of the General Schedule. 

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

6 employed by or detailed to the Commission may be on de7 tail from the Department. 

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

9 of the Commission staff may be persons detailed from the 

10 Department to the Commission. 

11 ‘‘(4) Subject to paragraph (3), the head of any Fed12 eral agency, upon the request of the Director, may detail 

13 any of the personnel of that agency to the Commission 

14 to assist the Commission in carrying out its duties under 

15 this section. 

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

17 Federal agency such information as the Commission con18 siders necessary to carry out this section. Upon request 

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

20 information to the Commission, unless such information 

21 is classified. 

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

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

24 temporary or intermittent services of experts or consult25 ants pursuant to section 3109 of title 5. 


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1 ‘‘(2) To the extent funds are available, the Commis2 sion may lease real property and acquire personal property 

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

4 Services Administration. 

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

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

7 of the Department in communicating with the Commis8 sion. 

9 ‘‘(B) Subparagraph (A) does not apply to a commu10 nication that is unlawful. 

11 ‘‘(2) All ex parte communications with the Commis12 sion shall be made part of the public record. 

13 ‘‘(m) REFERENCE TO NATIONAL ACADEMIES OF

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

15 that the Secretary enters into an agreement with another 

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

17 Exposure in the American Military Act, any reference in 

18 this section to the National Academies of Sciences, Engi19 neering, and Medicine shall be treated as a reference to 

20 the other organization. 

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

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

23 term in subparagraph (G)(iii) of section 1710(e)(1) of this 

24 title.’’. 


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

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

3 adding at the end the following new item: 

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

4 SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF 

5 SCIENCES, ENGINEERING, AND MEDICINE 

6 CONCERNING THE EXPOSURE OF HUMANS TO 

7 TOXIC SUBSTANCES. 

8 (a) PURPOSE.—The purpose of this section is to pro9 vide for the National Academies of Sciences, Engineering, 

10 and Medicine (in this section referred to as the ‘‘Acad11 emies’’), an independent nonprofit scientific organization 

12 with appropriate expertise that is not part of the Federal 

13 Government, to review and evaluate the available scientific 

14 evidence regarding associations between diseases and ex15 posure to toxic substances. 

16 (b) AGREEMENT.— 

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

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

19 with the Academies to perform the services covered 

20 by this section. 

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

22 into an agreement described in paragraph (1) not 

23 later than 60 days after the date of the enactment 

24 of this Act. 


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1 (3) EXTENSION.—An agreement under this sec2 tion may be extended in five-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 exposure to toxic 

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

9 each disease suspected to be associated with such exposure 

10 in the human population. 

11 (d) SCIENTIFIC DETERMINATIONS CONCERNING DIS12 EASES.—For each disease reviewed under subsection (c), 

13 the Academies shall determine, to the extent that available 

14 scientific data permit meaningful determinations— 

15 (1) whether an association exists between expo16 sure to toxic substances and the occurrence of the 

17 disease, taking into account the strength of the sci18 entific evidence and the appropriateness of the sta19 tistical and epidemiological methods used to detect 

20 the association; 

21 (2) the increased risk of the disease among 

22 those exposed to toxic substances during active mili23 tary, naval, or air service; and 

24 (3) whether there exists a plausible biological 

25 mechanism or other evidence of a causal relationship 


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1 between the exposure and the occurrence of the dis2 ease. 

3 (e) COOPERATION OF FEDERAL AGENCIES.—The 

4 head of each relevant Federal agency, including the Sec5 retary of Defense, shall cooperate fully with the Academies 

6 in performing the services covered by this section. 

7 (f) RECOMMENDATIONS FOR ADDITIONAL SCI8 ENTIFIC STUDIES.— 

9 (1) IN GENERAL.—Under an agreement be10 tween the Secretary and the Academies under this 

11 section, the Academies shall make any recommenda12 tions for additional scientific studies to resolve areas 

13 of continuing scientific uncertainty relating to the 

14 exposure of humans to toxic substances. 

15 (2) CONSIDERATIONS.—In making rec16 ommendations under paragraph (1), the Academies 

17 shall consider— 

18 (A) the scientific information that is avail19 able at the time of the recommendation; 

20 (B) the value and relevance of the informa21 tion that could result from additional studies; 

22 and 

23 (C) the cost and feasibility of carrying out 

24 such additional studies. 

25 (g) REPORTS.— 


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1 (1) INITIAL REPORT.— 

2 (A) IN GENERAL.—Under an agreement 

3 between the Secretary and the Academies under 

4 this section, not later than one year after the 

5 date of the enactment of this Act, the Acad6 emies shall submit to the Secretary, the Com7 mittee on Veterans’ Affairs of the Senate, and 

8 the Committee on Veterans’ Affairs of the 

9 House of Representatives an initial report on 

10 the activities of the Academies under the agree11 ment. 

12 (B) ELEMENTS.—The report submitted 

13 under subparagraph (A) shall include the fol14 lowing: 

15 (i) The determinations described in 

16 subsection (d). 

17 (ii) A full explanation of the scientific 

18 evidence and reasoning that led to such de19 terminations. 

20 (iii) Any recommendations of the 

21 Academies under subsection (f). 

22 (2) PERIODIC UPDATES.—Under an agreement 

23 between the Secretary and the Academies under this 

24 section, not less frequently than once every two 

25 years after the date on which the initial report is 


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

2 shall submit to the Secretary, the Committee on Vet3 erans’ Affairs of the Senate, and the Committee on 

4 Veterans’ Affairs of the House of Representatives an 

5 updated report on the activities of the Academies 

6 under the agreement. 

7 (h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA8 TION.— 

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

10 within the time period prescribed in subsection 

11 (b)(2) to enter into an agreement with the Acad12 emies for the purposes of this section on terms ac13 ceptable to the Secretary, the Secretary shall seek to 

14 enter into an agreement for the purposes of this sec15 tion with another appropriate scientific organization 

16 that— 

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

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

19 (C) has expertise and objectivity com20 parable to that of the Academies. 

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

22 an agreement with another organization as described 

23 in paragraph (1), any reference in this section, sec24 tion 547 of title 38, United States Code, as added 

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


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1 added by section 103(a), to the National Academies 

2 of Sciences, Engineering, and Medicine shall be 

3 treated as a reference to the other organization. 

4 SEC. 203. COLLECTION, ANALYSIS, AND REPORT ON TREAT5 MENT OF VETERANS FOR MEDICAL CONDI6 TIONS RELATED TO EXPOSURE TO TOXIC 

7 SUBSTANCES. 

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

9 shall compile and analyze, on a continuous basis, all clin10 ical data that— 

11 (1) is obtained by the Department of Veterans 

12 Affairs in connection with hospital care, medical 

13 services, and nursing home care furnished under sec14 tion 1710(a)(2)(F) of title 38, United States Code; 

15 and 

16 (2) is likely to be scientifically useful in deter17 mining the association, if any, between the medical 

18 condition of a veteran and exposure to a toxic sub19 stance. 

20 (b) CONSENT OF PATIENTS.—Compilation and anal21 ysis by the Secretary of clinical data of a veteran under 

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

23 used, consistent with the informed consent of the veteran 

24 and in compliance with all applicable Federal law. 


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

2 the date of the enactment of this Act, and annually there3 after, the Secretary shall submit to the Committee on Vet4 erans’ Affairs of the Senate, the Committee on Veterans’ 

5 Affairs of the House of Representatives, and the Toxic Ex6 posure Review Commission established by section 547 of 

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

8 of this Act, a report containing— 

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

10 (2) an analysis of such data; 

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

12 medical conditions identified by the Department 

13 under such subsection; 

14 (4) the explanation of the Secretary for the in15 cidence of such medical conditions and other expla16 nations for the incidence of such conditions as the 

17 Secretary considers reasonable; and 

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

19 validity of drawing conclusions from the incidence of 

20 such medical conditions, as evidenced by the data 

21 compiled under subsection (a), regarding any asso22 ciation between such conditions and exposure to a 

23 toxic substance. 


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1 TITLE III—IMPROVEMENT OF 

2 RESOURCES OF DEPARTMENT 

3 OF VETERANS AFFAIRS RE4 GARDING EXPOSURES TO 

5 TOXIC SUBSTANCES 

6 SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DE7 PARTMENT OF VETERANS AFFAIRS FOR VET8 ERANS EXPOSED TO TOXIC SUBSTANCES AND 

9 OUTREACH PROGRAM FOR SUCH VETERANS 

10 AND CAREGIVERS AND SURVIVORS OF SUCH 

11 VETERANS. 

12 (a) PUBLICATION OF LIST OF RESOURCES.— 

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

14 after the date of the enactment of this Act, and an15 nually thereafter, the Secretary of Veterans Affairs 

16 shall publish a list of resources of the Department 

17 of Veterans Affairs for— 

18 (A) veterans provided disability compensa19 tion under chapter 11 of title 38, United States 

20 Code, relating to exposure to toxic substances; 

21 (B) veterans eligible for hospital care, 

22 medical services, and nursing home care under 

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

24 (C) caregivers of veterans described in sub25 paragraph (A) or (B) who are participating in 


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1 the program of comprehensive assistance for 

2 family caregivers under section 1720G(a) of 

3 such title; and 

4 (D) survivors of veterans described in sub5 paragraph (A) or (B) (or who would be de6 scribed in any such subparagraph were the vet7 eran alive) who are receiving death benefits 

8 under the laws administered by the Secretary. 

9 (2) UPDATE.—The Secretary shall periodically 

10 update the list published under paragraph (1). 

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

12 input from the community, an informative outreach pro13 gram for veterans on illnesses that may be related to expo14 sure to toxic substances, including outreach with respect 

15 to benefits and support programs. 

16 SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUES17 TIONNAIRE DURING PRIMARY CARE AP18 POINTMENTS. 

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

20 shall incorporate a clinical questionnaire to help determine 

21 potential exposure to toxic substances during active mili22 tary, naval, or air service as part of the initial screening 

23 conducted for an appointment of a veteran with a primary 

24 care provider of the Department of Veterans Affairs to 

25 improve understanding by the Department of exposure of 


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1 veterans to toxic substances while serving in the Armed 

2 Forces. 

3 (b) DETERMINATION OF QUESTIONS.—The questions 

4 included in the questionnaire required under subsection 

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

6 medical professionals. 

7 SEC. 303. TRAINING OF HEALTH CARE PERSONNEL OF DE8 PARTMENT OF VETERANS AFFAIRS ON ILL9 NESSES RELATED TO EXPOSURE TO TOXIC 

10 SUBSTANCES. 

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

12 shall ensure that health care personnel of the Department 

13 of Veterans Affairs are appropriately trained to identify, 

14 treat, and assess the impact of illnesses related to expo15 sure to toxic substances. 

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

17 under subsection (a) shall— 

18 (1) provide health care personnel of the Depart19 ment with specific education with respect to illnesses 

20 related to exposure to toxic substances; and 

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

22 additional information from veterans regarding expo23 sures to different toxicants. 

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

25 ‘‘toxicant’’ has the meaning given that term in subparaVerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927

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1 graph (G)(iii) of section 1710(e)(1) of title 38, United 

2 States Code, as added by section 101(a)(1). 

Æ 


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