II 

Calendar No. 263 

117TH CONGRESS 

2D SESSION S. 3541 

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

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 1, 2022 

Mr. TESTER (for himself, Mr. MORAN, Ms. HASSAN, Mr. TILLIS, Mr. 

MANCHIN, Mr. SULLIVAN, Mr. BLUMENTHAL, Mr. BOOZMAN, Mrs. MURRAY, Mr. TUBERVILLE, Ms. HIRONO, Mr. CASSIDY, Mr. SANDERS, Mr. 

CRAMER, Ms. SINEMA, Mr. ROUNDS, Mr. BROWN, and Mrs. BLACKBURN) 

introduced the following bill; which was read twice and referred to the 

Committee on Veterans’ Affairs 

FEBRUARY 8 (legislative day, FEBRUARY 3), 2022 

Reported by Mr. TESTER, without amendment 

A BILL 

To improve health care and services for veterans exposed 

to toxic substances, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Care for Burn 

5 Pit Veterans Act’’. 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•S 3541 RS

1 SEC. 2. EXPANSION OF ELIGIBILITY FOR HEALTH CARE 

2 FROM DEPARTMENT OF VETERANS AFFAIRS 

3 FOR CERTAIN VETERANS EXPOSED TO TOXIC 

4 SUBSTANCES. 

5 (a) IN GENERAL.—Section 1710(e)(3) of title 38, 

6 United States Code, is amended— 

7 (1) in subparagraph (A)— 

8 (A) by striking ‘‘January 27, 2003’’ and 

9 inserting ‘‘September 11, 2001’’; and 

10 (B) by striking ‘‘five-year period’’ and in11 serting ‘‘ten-year period’’; 

12 (2) by amending subparagraph (B) to read as 

13 follows: 

14 ‘‘(B) With respect to a veteran described in 

15 paragraph (1)(D) who was discharged or released 

16 from the active military, naval, air, or space service 

17 after September 11, 2001, and before October 1, 

18 2013, but did not enroll to receive such hospital 

19 care, medical services, or nursing home care under 

20 such paragraph pursuant to subparagraph (A) be21 fore October 1, 2022, the one-year period beginning 

22 on October 1, 2022.’’; and 

23 (3) by striking subparagraph (C). 

24 (b) CLARIFICATION OF COVERAGE.—Section 

25 1710(e)(1)(D) of such title is amended by inserting after 

26 ‘‘Persian Gulf War’’ the following: ‘‘(to include any vetVerDate Sep 11 2014 23:07 Feb 08, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3541.RS S3541

pamtmann on DSKBC07HB2PROD with BILLS
3 

•S 3541 RS

1 eran who, in connection with service during such period, 

2 received the Armed Forces Expeditionary Medal, Service 

3 Specific Expeditionary Medal, Combat Era Specific Expe4 ditionary Medal, Campaign Specific Medal, or any other 

5 combat theater award established by a Federal statute or 

6 an Executive Order)’’. 

7 (c) REPORT.—Not later than October 1, 2024, the 

8 Secretary of Veterans Affairs shall submit to the Com9 mittee on Veterans’ Affairs of the Senate and the Com10 mittee on Veterans’ Affairs of the House of Representa11 tives a report on— 

12 (1) the number of veterans who enrolled in the 

13 system of annual patient enrollment of the Depart14 ment of Veterans Affairs established and operated 

15 under section 1705(a) of title 38, United States 

16 Code, to receive care pursuant to eligibility under 

17 subparagraph (B) of section 1710(e)(3) of such title, 

18 as amended by subsection (a)(2); and 

19 (2) of the veterans described in paragraph (1), 

20 the number of such veterans who reported a health 

21 concern related to exposure to a toxic substance or 

22 radiation. 

23 (d) OUTREACH PLAN.—Not later than December 1, 

24 2022, the Secretary shall submit to the Committee on Vet25 erans’ Affairs of the Senate and the Committee on VetVerDate Sep 11 2014 23:07 Feb 08, 2022 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3541.RS S3541

pamtmann on DSKBC07HB2PROD with BILLS
4 

•S 3541 RS

1 erans’ Affairs of the House of Representatives a plan to 

2 conduct outreach to veterans described in subparagraph 

3 (B) of section 1710(e)(3) of title 38, United States Code, 

4 as amended by subsection (a)(2), to notify such veterans 

5 of their eligibility for hospital care, medical services, or 

6 nursing home care under such subparagraph. 

7 (e) EFFECTIVE DATE.—This section and the amend8 ments made by this section shall take effect on October 

9 1, 2022. 

10 SEC. 3. INCORPORATION OF TOXIC EXPOSURE SCREENING 

11 FOR VETERANS. 

12 (a) IN GENERAL.—Beginning not later than 90 days 

13 after the date of the enactment of this Act, the Secretary 

14 of Veterans Affairs shall incorporate a screening to help 

15 determine potential exposures to toxic substances during 

16 active military, naval, air, or space service as part of a 

17 health care screening furnished by the Department of Vet18 erans Affairs to veterans enrolled in the system of annual 

19 patient enrollment of the Department established and op20 erated under section 1705 of title 38, United States Code, 

21 to improve understanding by the Department of exposures 

22 of veterans to toxic substances while serving in the Armed 

23 Forces. 

24 (b) TIMING.—The Secretary shall ensure that a vet25 eran described in subsection (a) completes the screening 


pamtmann on DSKBC07HB2PROD with BILLS
5 

•S 3541 RS

1 required under such subsection not less frequently than 

2 once every five years. 

3 (c) DETERMINATION OF QUESTIONS.— 

4 (1) IN GENERAL.—The questions included in 

5 the screening required under subsection (a) shall be 

6 determined by the Secretary with input from medical 

7 professionals. 

8 (2) SPECIFIC QUESTIONS.—At a minimum, the 

9 screening required under subsection (a) shall, with 

10 respect to a veteran, include— 

11 (A) a question about the potential exposure 

12 of the veteran to an open burn pit; and 

13 (B) a question regarding exposures that 

14 are commonly associated with service in the 

15 Armed Forces. 

16 (3) OPEN BURN PIT DEFINED.—In this sub17 section, the term ‘‘open burn pit’’ means an area of 

18 land that— 

19 (A) is designated by the Secretary of De20 fense to be used for disposing solid waste by 

21 burning in the outdoor air; and 

22 (B) does not contain a commercially manu23 factured incinerator or other equipment specifi24 cally designed and manufactured for the burn25 ing of solid waste. 


pamtmann on DSKBC07HB2PROD with BILLS
6 

•S 3541 RS

1 (d) PRINT MATERIAL.—In developing the screening 

2 established under subsection (a), the Secretary shall en3 sure that print materials complementary to such screening 

4 that outline related resources for veterans are available at 

5 each medical center of the Department to veterans who 

6 may not have access to the internet. 

7 (e) SCREENING UPDATES.—The Secretary shall con8 sider updates to the content of the screening required 

9 under subsection (a) not less frequently than biennially to 

10 ensure the screening contains the most current informa11 tion. 

12 (f) ACTIVE MILITARY, NAVAL, AIR, OR SPACE SERV13 ICE DEFINED.—In this section, the term ‘‘active military, 

14 naval, air, or space service’’ has the meaning given that 

15 term in section 101(24) of title 38, United States Code. 

16 SEC. 4. TRAINING FOR PERSONNEL OF THE DEPARTMENT 

17 OF VETERANS AFFAIRS WITH RESPECT TO 

18 VETERANS EXPOSED TO TOXIC SUBSTANCES. 

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

20 Veterans Affairs shall provide to health care personnel of 

21 the Department of Veterans Affairs education and train22 ing to identify, treat, and assess the impact on veterans 

23 of illnesses related to exposure to toxic substances and in24 form such personnel of how to ask for additional informa25 tion from veterans regarding different exposures. 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•S 3541 RS

1 (b) BENEFITS PERSONNEL.— 

2 (1) IN GENERAL.—The Secretary shall incor3 porate a training program for processors of claims 

4 under the laws administered by the Secretary who 

5 review claims for disability benefits relating to serv6 ice-connected disabilities based on exposure to toxic 

7 substances. 

8 (2) ANNUAL TRAINING.—Training provided to 

9 processors under paragraph (1) shall be provided not 

10 less frequently than annually. 

11 SEC. 5. ANALYSIS AND REPORT ON TREATMENT OF VET12 ERANS FOR MEDICAL CONDITIONS RELATED 

13 TO TOXIC EXPOSURE. 

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

15 shall analyze, on a continuous basis, all clinical data 

16 that— 

17 (1) is obtained by the Department of Veterans 

18 Affairs in connection with hospital care, medical 

19 services, and nursing home care furnished under sec20 tion 1710(a)(2)(F) of title 38, United States Code; 

21 and 

22 (2) is likely to be scientifically useful in deter23 mining the association, if any, between the medical 

24 condition of a veteran and the exposure of the vet25 eran to a toxic substance. 


pamtmann on DSKBC07HB2PROD with BILLS
8 

•S 3541 RS

1 (b) 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 and the Committee on Vet5 erans’ Affairs of the House of Representatives a report 

6 containing— 

7 (1) the aggregate data compiled under sub8 section (a); 

9 (2) an analysis of such data; 

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

11 medical conditions identified by the Department 

12 under such subsection; 

13 (4) the explanation of the Secretary for the in14 cidence of such medical conditions and other expla15 nations for the incidence of such conditions as the 

16 Secretary considers reasonable; and 

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

18 validity of drawing conclusions from the incidence of 

19 such medical conditions, as evidenced by the data 

20 compiled under subsection (a), regarding any asso21 ciation between such conditions and exposure to a 

22 toxic substance. 

23 SEC. 6. ANALYSIS RELATING TO MORTALITY OF VETERANS 

24 WHO SERVED IN SOUTHWEST ASIA. 

25 (a) ANALYSIS.— 


pamtmann on DSKBC07HB2PROD with BILLS
9 

•S 3541 RS

1 (1) IN GENERAL.—Not later than 270 days 

2 after the date of the enactment of this Act, the Sec3 retary of Veterans Affairs, in coordination with the 

4 Secretary of Defense, shall conduct an updated anal5 ysis of total and respiratory disease mortality in cov6 ered veterans. 

7 (2) ELEMENTS.—The analysis required by 

8 paragraph (1) shall include, to the extent prac9 ticable, the following with respect to each covered 

10 veteran: 

11 (A) Metrics of airborne exposures. 

12 (B) The location and timing of deploy13 ments of the veteran. 

14 (C) The military occupational specialty of 

15 the veteran. 

16 (D) The Armed Force in which the veteran 

17 served. 

18 (E) Pre-existing health status of the vet19 eran, including with respect to asthma. 

20 (F) Relevant personal information of the 

21 veteran, including cigarette and e-cigarette 

22 smoking history, diet, sex, gender, age, race, 

23 and ethnicity. 

24 (b) COVERED VETERAN DEFINED.—In this section, 

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


pamtmann on DSKBC07HB2PROD with BILLS
10 

•S 3541 RS

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

2 duty in— 

3 (A) Bahrain; 

4 (B) Iraq; 

5 (C) Kuwait; 

6 (D) Oman; 

7 (E) Qatar; 

8 (F) Saudi Arabia; 

9 (G) Somalia; or 

10 (H) the United Arab Emirates; or 

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

12 active duty in— 

13 (A) Afghanistan; 

14 (B) Djibouti; 

15 (C) Egypt; 

16 (D) Jordan; 

17 (E) Lebanon; 

18 (F) Syria; or 

19 (G) Yemen. 

20 SEC. 7. STUDY ON HEALTH TRENDS OF POST 9/11 VET21 ERANS. 

22 The Secretary of Veterans Affairs shall conduct an 

23 epidemiological study on the health trends of veterans who 

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


pamtmann on DSKBC07HB2PROD with BILLS
11 

•S 3541 RS

1 SEC. 8. STUDY ON CANCER RATES AMONG VETERANS. 

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

3 shall conduct a study on the incidence of cancer in vet4 erans to determine trends in the rates of the incidence 

5 of cancer in veterans. 

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

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

8 the study, the following: 

9 (1) The age of the veteran. 

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

11 of the veteran in the Armed Forces. 

12 (3) The military occupational specialty or spe13 cialties of the veteran. 

14 (4) The gender of the veteran. 

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

16 has. 

17 SEC. 9. PUBLICATION OF LIST OF RESOURCES OF DEPART18 MENT OF VETERANS AFFAIRS FOR VETERANS 

19 EXPOSED TO TOXIC SUBSTANCES AND OUT20 REACH PROGRAM FOR SUCH VETERANS AND 

21 CAREGIVERS AND SURVIVORS OF SUCH VET22 ERANS. 

23 (a) PUBLICATION OF LIST OF RESOURCES.— 

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

25 after the date of the enactment of this Act, and an26 nually thereafter, the Secretary of Veterans Affairs 


pamtmann on DSKBC07HB2PROD with BILLS
12 

•S 3541 RS

1 shall publish a list of resources of the Department 

2 of Veterans Affairs for— 

3 (A) veterans who were exposed to toxic 

4 substances; 

5 (B) families and caregivers of such vet6 erans; and 

7 (C) survivors of such veterans who are re8 ceiving death benefits under the laws adminis9 tered by the Secretary. 

10 (2) UPDATE.—The Secretary shall periodically 

11 update the list published under paragraph (1). 

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

13 input from the community, an informative outreach pro14 gram for veterans on illnesses that may be related to expo15 sure to toxic substances, including outreach with respect 

16 to benefits and support programs. 

17 SEC. 10. REPORT ON INDIVIDUAL LONGITUDINAL EXPO18 SURE RECORD. 

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

20 date on which the Individual Longitudinal Exposure 

21 Record achieves full operational capability, the Secretary 

22 of Veterans Affairs shall submit to the appropriate com23 mittees of Congress a report on the data quality of the 

24 Individual Longitudinal Exposure Record and the useful25 ness of the Individual Longitudinal Exposure Record in 


pamtmann on DSKBC07HB2PROD with BILLS
13 

•S 3541 RS

1 supporting veterans in receiving health care and benefits 

2 from the Department of Veterans Affairs. 

3 (b) ELEMENTS.—The report required by subsection 

4 (a) shall include the following: 

5 (1) An identification of exposures to toxic sub6 stances that may not be fully captured by the cur7 rent systems for environmental and occupational 

8 health monitoring and recommendations for how to 

9 improve those systems. 

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

11 data in determining exposures of veterans to toxic 

12 substances and recommendations for how to improve 

13 the quality of that location data. 

14 (3) Recommendations on how to improve the 

15 usefulness of the Individual Longitudinal Exposure 

16 Record. 

17 (c) DEFINITIONS.—In this section: 

18 (1) APPROPRIATE COMMITTEES OF CONGRESS

19 DEFINED.—The term ‘‘appropriate committees of 

20 Congress’’ means— 

21 (A) the Committee on Armed Services and 

22 the Committee on Veterans’ Affairs of the Sen23 ate; and 


pamtmann on DSKBC07HB2PROD with BILLS
14 

•S 3541 RS

1 (B) the Committee on Armed Services and 

2 the Committee on Veterans’ Affairs of the 

3 House of Representatives. 

4 (2) INDIVIDUAL LONGITUDINAL EXPOSURE

5 RECORD.—The term ‘‘Individual Longitudinal Expo6 sure Record’’ includes any pilot program or other 

7 program used by the Department of Veterans Af8 fairs or the Department of Defense to track how 

9 members of the Armed Forces or veterans have been 

10 exposed to various occupational or environmental 

11 hazards. 


pamtmann on DSKBC07HB2PROD with BILLS

pamtmann on DSKBC07HB2PROD with BILLS
Calendar No. 263 

117TH CONGRESS 

2D SESSION S. 3541 

A BILL 

To improve health care and services for veterans 

exposed to toxic substances, and for other purposes. 

FEBRUARY 8 (legislative day, FEBRUARY 3), 2022 

Reported without amendment 


pamtmann on DSKBC07HB2PROD with BILLS