I 

113TH CONGRESS 

2D SESSION H. R. 5680 

To direct the Secretary of Veterans Affairs to establish a registry for certain 

toxic exposures, to direct the Secretary to include certain information 

in the electronic health records of veterans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 19, 2014 

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

on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to establish a 

registry for certain toxic exposures, to direct the Secretary to include certain information in the electronic 

health records of veterans, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Veterans’ Toxic 

5 Wounds Research Act of 2014’’. 


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1 SEC. 2. COMPREHENSIVE PROGRAM OF RESEARCH INTO 

2 TOXIC EXPOSURES ENCOUNTERED BY VET3 ERANS DURING MILITARY SERVICE. 

4 (a) REGISTRY OF TOXIC EXPOSURES.— 

5 (1) ESTABLISHMENT.—Not later than 180 days 

6 after the date of the enactment of this Act, the Sec7 retary of Veterans Affairs shall establish a master 

8 registry of veterans who experienced toxic exposures 

9 while serving in the Armed Forces. 

10 (2) ELEMENTS.—The master registry estab11 lished under paragraph (1) shall consist of the reg12 istries described in paragraph (3). The Secretary 

13 shall establish each such registry using the Clinical 

14 Case Registry of the Department of Veterans Affairs 

15 as a model. 

16 (3) REGISTRIES DESCRIBED.—The registries 

17 described in this paragraph are registries for each of 

18 the following: 

19 (A) Agent Orange. 

20 (B) Exposure to toxins relating to a de21 ployment during the Persian Gulf War (as de22 fined in section 101(33) of title 38, United 

23 States Code), including with respect to such ex24 posures leading to Gulf War Illness (as defined 

25 by the Institute of Medicine of the National 

26 Academies). 


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1 (C) Exposure to toxins relating to a de2 ployment during Operation Iraqi Freedom, Op3 eration New Dawn, Operation Enduring Free4 dom, or the Global War on Terror. 

5 (D) Exposure to toxins relating to a de6 ployment to Bosnia, Somalia, the Philippines, 

7 or other locations determined appropriate by 

8 the Secretary. 

9 (E) Exposure to toxins relating to being 

10 stationed at a military installation potentially 

11 contaminated by toxic substances, including 

12 Camp Lejeune, North Carolina, Fort McClellan, 

13 Alabama, and such installations in Guam. 

14 (F) Any other toxic exposure the Secretary 

15 determines appropriate. 

16 (b) REVIEW.—The Secretary of Veterans Affairs 

17 shall enter into an agreement with the National Academy 

18 of Sciences to review published scientific information and 

19 studies on the health effects of toxic exposures covered in 

20 a registry described in subsection (a)(3). Under such 

21 agreement, the Institute of Medicine of the National Acad22 emies shall submit to the Secretary on a biennial basis 

23 a report on toxic substance exposure-related illnesses. 

24 Such report shall include— 


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1 (1) a review of all scientific studies and re2 search on the association between toxic substance 

3 exposures and specific diseases covered in such a 

4 registry, including the level of association between 

5 such exposures and the specific diseases; and 

6 (2) recommendations for future research. 

7 (c) RESEARCH INTO THE EFFECTS OF TOXIC EXPO8 SURE ON SECOND AND THIRD GENERATIONS.—In addi9 tion to the reviews under subsection (b), the Secretary 

10 shall enter into an agreement with the National Academy 

11 of Sciences to review published scientific information and 

12 studies on the health effects on the children and grand13 children of veterans with toxic exposures covered in a reg14 istry described in subsection (a)(3). Under such agree15 ment, the Institute of Medicine of the National Academies 

16 shall submit to the Secretary on a biennial basis a report 

17 on toxic substance exposure-related illnesses. Such report 

18 shall include— 

19 (1) a review of all scientific studies and re20 search on the association between toxic substance 

21 exposures and specific diseases covered in such a 

22 registry in such children and grandchildren, includ23 ing the level of association between such exposures 

24 and the specific diseases; and 

25 (2) recommendations for future research. 


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1 (d) RESEARCH.—The Secretary shall use the reviews 

2 conducted under subsections (b) and (c) to inform the de3 cisions made by the Secretary with respect to selecting the 

4 research to be conducted or funded by the Department 

5 of Veterans Affairs. The Secretary shall submit to the 

6 Committees on Veterans’ Affairs of the House of Rep7 resentatives and the Senate a report describing how the 

8 Secretary used such reviews to make such selections. 

9 SEC. 3. PRESUMPTIONS OF SERVICE CONNECTION FOR ILL10 NESSES ASSOCIATED WITH TOXIC EXPO11 SURES ENCOUNTERED BY VETERANS DURING 

12 MILITARY SERVICE. 

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

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

15 end the following new section: 

16 ‘‘§ 1119. Presumptions of service connection for ill17 nesses associated with toxic exposures 

18 ‘‘(a) PRESUMPTION.—(1) For purposes of section 

19 1110 of this title, and subject to section 1113 of this title, 

20 each illness, if any, described in paragraph (2) shall be 

21 considered to have been incurred in or aggravated by serv22 ice referred to in that paragraph, notwithstanding that 

23 there is no record of evidence of such illness during the 

24 period of such service. 


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1 ‘‘(2) An illness referred to in paragraph (1) is any 

2 diagnosed or undiagnosed illness that— 

3 ‘‘(A) the Secretary determines in regulations 

4 prescribed under this section to warrant a presump5 tion of service connection by reason of having a posi6 tive association with exposure to a toxic substance 

7 covered in the master registry; and 

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

9 any, prescribed in such regulations in a veteran who 

10 served in the Armed Forces and by reason of such 

11 service experienced such exposure. 

12 ‘‘(3) For purposes of this subsection, a veteran who 

13 served in the Armed Forces in a location recognized under 

14 the master registry as being a source of exposure and has 

15 an illness described in paragraph (2) shall be presumed 

16 to have been exposed by reason of such service unless 

17 there is conclusive evidence to establish that the veteran 

18 was not so exposed by reason of such service. 

19 ‘‘(b)(1)(A) Whenever the Secretary makes a deter20 mination described in subparagraph (B), the Secretary 

21 shall prescribe regulations providing that a presumption 

22 of service connection is warranted for the illness covered 

23 by that determination for purposes of this section. 

24 ‘‘(B) A determination referred to in subparagraph 

25 (A) is a determination based on sound medical and sciVerDate Sep 11 2014 18:18 Oct 06, 2014 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5680.IH H5680

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1 entific evidence that a positive association exists be2 tween— 

3 ‘‘(i) the exposure of humans or animals to a 

4 toxic substance covered in the master registry; and 

5 ‘‘(ii) the occurrence of a diagnosed or undiag6 nosed illness in humans or animals. 

7 ‘‘(2)(A) In making determinations for purposes of 

8 paragraph (1), the Secretary shall take into account— 

9 ‘‘(i) the reports submitted to the Secretary by 

10 the National Academy of Sciences under section 2(b) 

11 of the Veterans’ Toxic Wounds Research Act of 

12 2014; and 

13 ‘‘(ii) all other sound medical and scientific in14 formation and analyses available to the Secretary. 

15 ‘‘(B) In evaluating any report, information, or anal16 ysis for purposes of making such determinations, the Sec17 retary shall take into consideration whether the results are 

18 statistically significant, are capable of replication, and 

19 withstand peer review. 

20 ‘‘(3) An association between the occurrence of an ill21 ness in humans or animals and exposure to a toxic sub22 stance covered in the master registry shall be considered 

23 to be positive for purposes of this subsection if the credible 

24 evidence for the association is equal to or outweighs the 

25 credible evidence against the association. 


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1 ‘‘(c)(1) Not later than 60 days after the date on 

2 which the Secretary receives a report from the National 

3 Academy of Sciences under section 2(b) of the Veterans’ 

4 Toxic Wounds Research Act of 2014, the Secretary shall 

5 determine whether or not a presumption of service connec6 tion is warranted for each illness, if any, covered by the 

7 report. 

8 ‘‘(2) If the Secretary determines under this sub9 section that a presumption of service connection is war10 ranted, the Secretary shall, not later than 60 days after 

11 making the determination, issue proposed regulations set12 ting forth the Secretary’s determination. 

13 ‘‘(3)(A) If the Secretary determines under this sub14 section that a presumption of service connection is not 

15 warranted, the Secretary shall, not later than 60 days 

16 after making the determination, publish in the Federal 

17 Register a notice of the determination. The notice shall 

18 include an explanation of the scientific basis for the deter19 mination. 

20 ‘‘(B) If an illness already presumed to be service con21 nected under this section is subject to a determination 

22 under subparagraph (A), the Secretary shall, not later 

23 than 60 days after publication of the notice under that 

24 subparagraph, issue proposed regulations removing the 

25 presumption of service connection for the illness. 


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1 ‘‘(4) Not later than 90 days after the date on which 

2 the Secretary issues any proposed regulations under this 

3 subsection, the Secretary shall issue final regulations. 

4 Such regulations shall be effective on the date of issuance. 

5 ‘‘(d) Whenever the presumption of service connection 

6 for an illness under this section is removed under sub7 section (c)— 

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

9 for the illness on the basis of the presumption before 

10 the effective date of the removal of the presumption 

11 shall continue to be entitled to receive compensation 

12 on that basis; and 

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

14 dependency and indemnity compensation for the 

15 death of a veteran resulting from the illness on the 

16 basis of the presumption before that date shall con17 tinue to be entitled to receive dependency and in18 demnity compensation on that basis. 

19 ‘‘(e) MASTER REGISTRY DEFINED.—In this section, 

20 the term ‘master registry’ means the registry of veterans 

21 who experienced toxic exposures established by section 2 

22 of the Veterans’ Toxic Wounds Research Act of 2014.’’. 

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

24 at the beginning of such chapter is amended by inserting 


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1 after the item relating to section 1118 the following new 

2 item: 

‘‘1119. Presumptions of service connection for illnesses associated with toxic exposures.’’. 

3 SEC. 4. INCLUSION OF CERTAIN INFORMATION IN ELEC4 TRONIC HEALTH RECORDS. 

5 In implementing the electronic health record system 

6 of the Department of Veterans Affairs, the Secretary of 

7 Veterans Affairs shall ensure that the electronic health 

8 record of each individual includes, at a minimum, the fol9 lowing information: 

10 (1) Whether the individual served in the Armed 

11 Forces. 

12 (2) The Armed Force in which the individual 

13 served. 

14 (3) The locations in which the individual was 

15 stationed or deployed to during such service. 

16 (4) The dates of such service. 

17 (5) The military occupational specialty of the 

18 individual. 

19 (6) The results of any tests or assessments of 

20 the individual regarding— 

21 (A) vision; 

22 (B) hearing; 

23 (C) hepatitis C; 

24 (D) HIV; 


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1 (E) blood pressure; 

2 (F) cholesterol; 

3 (G) blood glucose test and diabetes infor4 mation; 

5 (H) body mass index measurement; 

6 (I) bone density, as appropriate based on 

7 the age or sex of the individual; 

8 (J) cancer screenings (as appropriate 

9 based on the age, sex, race, or ethnicity of the 

10 individual) for— 

11 (i) breast cancer; 

12 (ii) colorectal cancer; 

13 (iii) lung cancer; 

14 (iv) prostate cancer; and 

15 (v) skin cancer; 

16 (K) preventive immunizations, if not cur17 rent; 

18 (L) spirometry (for lung function); 

19 (M) smoking; 

20 (N) a mental health evaluation; 

21 (O) substance abuse; or 

22 (P) infectious diseases or parasites or 

23 other adverse health conditions endemic to 


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1 where the individual served while in the mili2 tary. 

Æ 


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