S. 3373 

One Hundred Seventeenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Monday, 

the third day of January, two thousand and twenty two 

An Act 

To improve the Iraq and Afghanistan Service Grant and the Children of Fallen 

Heroes Grant. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES 

CODE; TABLE OF CONTENTS. 

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

First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022’’ or the ‘‘Honoring our PACT Act 

of 2022’’. 

(b) MATTERS RELATING TO AMENDMENTS TO TITLE 38, UNITED

STATES CODE.— (1) REFERENCES.—Except as otherwise expressly provided, 

when in this Act an amendment or repeal is expressed in 

terms of an amendment to, or repeal of, a section or other 

provision, the reference shall be considered to be made to 

a section or other provision of title 38, United States Code. 

(2) AMENDMENTS TO TABLES OF CONTENTS.—Except as 

otherwise expressly provided, when an amendment made by 

this Act to title 38, United States Code, adds a section or 

larger organizational unit to that title or amends the designation or heading of a section or larger organizational unit in 

that title, that amendment also shall have the effect of 

amending any table of sections in that title to alter the table 

to conform to the changes made by the amendment. 

(c) TABLE OF CONTENTS.—The table of contents for this Act 

is as follows: 

Sec. 1. Short title; references to title 38, United States Code; table of contents. 

TITLE I—EXPANSION OF HEALTH CARE ELIGIBILITY 

Subtitle A—Toxic-exposed Veterans 

Sec. 101. Short title. 

Sec. 102. Definitions relating to toxic-exposed veterans. 

Sec. 103. Expansion of health care for specific categories of toxic-exposed veterans 

and veterans supporting certain overseas contingency operations. 

Sec. 104. Assessments of implementation and operation. 

Subtitle B—Certain Veterans of Combat Service and Other Matters 

Sec. 111. Expansion of period of eligibility for health care for certain veterans of 

combat service. 

TITLE II—TOXIC EXPOSURE PRESUMPTION PROCESS 

Sec. 201. Short title. 

Sec. 202. Improvements to ability of Department of Veterans Affairs to establish 

presumptions of service connection based on toxic exposure. 
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Sec. 203. Outreach to claimants for disability compensation pursuant to changes in 

presumptions of service connection. 

Sec. 204. Reevaluation of claims for dependency and indemnity compensation involving presumptions of service connection. 

TITLE III—IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION 

PROCESS FOR TOXIC-EXPOSED VETERANS 

Sec. 301. Short title. 

Sec. 302. Presumptions of toxic exposure. 

Sec. 303. Medical nexus examinations for toxic exposure risk activities. 

TITLE IV—PRESUMPTIONS OF SERVICE CONNECTION 

Sec. 401. Treatment of veterans who participated in cleanup of Enewetak Atoll as 

radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by Department of Veterans Affairs. 

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

Palomares, Spain, or Thule, Greenland, as radiation-exposed veterans 

for purposes of presumption of service connection of certain disabilities 

by Department of Veterans Affairs. 

Sec. 403. Presumptions of service connection for diseases associated with exposures 

to certain herbicide agents for veterans who served in certain locations. 

Sec. 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for 

veterans who served in certain locations. 

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

veterans. 

Sec. 406. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins. 

Sec. 407. Rule of construction. 

TITLE V—RESEARCH MATTERS 

Sec. 501. Interagency working group on toxic exposure research. 

Sec. 502. Analysis and report on treatment of veterans for medical conditions related to toxic exposure. 

Sec. 503. Analysis relating to mortality of veterans who served in Southwest Asia. 

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

Sec. 505. Study on cancer rates among veterans. 

Sec. 506. Study on health effects of waste related to Manhattan Project on certain 

veterans. 

Sec. 507. Study on toxic exposure and mental health outcomes. 

Sec. 508. Study on veterans in Territories of the United States. 

Sec. 509. Department of Veterans Affairs public website for toxic exposure research. 

Sec. 510. Report on health effects of jet fuels used by Armed Forces. 

TITLE VI—IMPROVEMENT OF RESOURCES AND TRAINING REGARDING 

TOXIC-EXPOSED VETERANS 

Sec. 601. Short title; definitions. 

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

toxic-exposed veterans and veterans who report toxic exposures and outreach program for such veterans and caregivers and survivors of such 

veterans. 

Sec. 603. Incorporation of toxic exposure screening for veterans. 

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

to veterans who report toxic exposures. 

TITLE VII—RESOURCING 

Sec. 701. Authority to use appropriations to enhance claims processing capacity 

and automation. 

Sec. 702. Authorization of major medical facility leases of Department of Veterans 

Affairs for fiscal year 2023. 

Sec. 703. Treatment of major medical facility leases of the Department of Veterans 

Affairs. 

Sec. 704. Authority to enter into agreements with academic affiliates and other entities to acquire space for the purpose of providing health-care resources 

to veterans. 

Sec. 705. Modifications to enhanced-use lease authority of Department of Veterans 

Affairs. 

Sec. 706. Authority for joint leasing actions of Department of Defense and Department of Veterans Affairs. 
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Sec. 707. Appropriation of amounts for major medical facility leases. 

TITLE VIII—RECORDS AND OTHER MATTERS 

Sec. 801. Epidemiological study on Fort McClellan veterans. 

Sec. 802. Biennial briefing on Individual Longitudinal Exposure Record. 

Sec. 803. Correction of exposure records by members of the Armed Forces and veterans. Sec. 804. Federal cause of action relating to water at Camp Lejeune, North Carolina. 

Sec. 805. Cost of War Toxic Exposures Fund. 

Sec. 806. Appropriation for fiscal year 2022. 

Sec. 807. Authorization of electronic notice in claims under laws administered by 

the Secretary of Veterans Affairs. Sec. 808. Burn pit transparency. 

TITLE IX—IMPROVEMENT OF WORKFORCE OF DEPARTMENT OF 

VETERANS AFFAIRS 

Sec. 901. National rural recruitment and hiring plan for Veterans Health Administration. 

Sec. 902. Authority to buy out service contracts for certain health care professionals 

in exchange for employment at rural or highly rural facilities of Department of Veterans Affairs. 

Sec. 903. Qualifications for human resources positions within Department of Veterans Affairs and plan to recruit and retain human resources employees. Sec. 904. Modification of pay cap for certain employees of Veterans Health Administration. 

Sec. 905. Expansion of opportunities for housekeeping aides. 

Sec. 906. Modification of authority of the Secretary of Veterans Affairs relating to 

hours, conditions of employment, and pay for certain employees of Veterans Health Administration. 

Sec. 907. Waiver of pay limitation for certain employees of Department of Veterans 

Affairs. 

Sec. 908. Elimination of limitation on awards and bonus for employees of Department of Veterans Affairs. 

Sec. 909. Additional authority of the Secretary of Veterans Affairs relating to recruitment and retention of personnel. 

TITLE I—EXPANSION OF HEALTH CARE 

ELIGIBILITY 

Subtitle A—Toxic-exposed Veterans 

SEC. 101. SHORT TITLE. 

This title may be cited as the ‘‘Conceding Our Veterans’ Exposure Now and Necessitating Training Act of 2022’’ or the ‘‘COVENANT Act of 2022’’. 

SEC. 102. DEFINITIONS RELATING TO TOXIC-EXPOSED VETERANS. 

(a) IN GENERAL.—Section 1710(a)(2)(F) is amended by striking 

‘‘who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e)’’ and inserting ‘‘who is a toxicexposed veteran, in accordance with subsection (e)’’. 

(b) DEFINITIONS OF TOXIC EXPOSURE AND TOXIC-EXPOSED VETERAN.—Section 101 is amended by adding at the end the following 

new paragraphs: 

‘‘(37) The term ‘toxic exposure’ includes the following: 

‘‘(A) A toxic exposure risk activity, as defined in section 

1710(e)(4) of this title. 

‘‘(B) An exposure to a substance, chemical, or airborne 

hazard identified in the list under section 1119(b)(2) of this 

title. 

‘‘(38) The term ‘toxic-exposed veteran’ means any veteran 

described in section 1710(e)(1) of this title.’’. 
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(c) DEFINITION OF TOXIC EXPOSURE RISK ACTIVITY.—Section 

1710(e)(4) is amended by adding at the end the following new 

subparagraph: 

‘‘(C) The term ‘toxic exposure risk activity’ means any 

activity— 

‘‘(i) that requires a corresponding entry in an exposure 

tracking record system (as defined in section 1119(c) of 

this title) for the veteran who carried out the activity; 

or 

‘‘(ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what 

is reasonably prudent to protect the health of veterans.’’. 

SEC. 103. EXPANSION OF HEALTH CARE FOR SPECIFIC CATEGORIES 

OF TOXIC-EXPOSED VETERANS AND VETERANS SUPPORTING CERTAIN OVERSEAS CONTINGENCY OPERATIONS. 

(a) IN GENERAL.— 

(1) EXPANSION.—Subsection (e) of section 1710, as amended 

by section 102(c), is further amended— 

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

new subparagraphs: 

‘‘(G) Beginning not later than the applicable date specified 

in paragraph (6), and subject to paragraph (2), a veteran who 

participated in a toxic exposure risk activity while serving on active 

duty, active duty for training, or inactive duty training is eligible 

for hospital care (including mental health services and counseling), 

medical services, and nursing home care under subsection (a)(2)(F) 

for any illness. 

‘‘(H) Beginning not later than the applicable date specified 

in paragraph (6), and subject to paragraph (2), a covered veteran 

(as defined in section 1119(c) of this title) is eligible for hospital 

care (including mental health services and counseling), medical 

services, and nursing home care under subsection (a)(2)(F) for any 

illness. 

‘‘(I)(i) Beginning not later than the applicable date specified 

in paragraph (6), and subject to paragraph (2), a veteran who 

deployed in support of a contingency operation specified in clause 

(ii) is eligible for hospital care (including mental health services 

and counseling), medical services, and nursing home care under 

subsection (a)(2)(F) for any illness. 

‘‘(ii) A contingency operation specified in this clause is any 

of the following: 

‘‘(I) Operation Enduring Freedom. 

‘‘(II) Operation Freedom’s Sentinel. 

‘‘(III) Operation Iraqi Freedom. 

‘‘(IV) Operation New Dawn. 

‘‘(V) Operation Inherent Resolve. 

‘‘(VI) Resolute Support Mission.’’; and 

(B) in paragraph (2)(B)— 

(i) by striking ‘‘or (F)’’ and inserting ‘‘(F), (G), (H), 

or (I)’’; and 

(ii) by striking ‘‘service or testing’’ and inserting 

‘‘service, testing, or activity’’. 

(2) PHASE IN.—Such subsection is further amended by 

adding at the end the following new paragraph: 
S. 3373—5 

‘‘(6)(A) The Secretary shall determine the dates in subparagraphs (G), (H), and (I) of paragraph (1) as follows: 

‘‘(i) October 1, 2024, with respect to a veteran described 

in such subparagraph (G) or (H) who was discharged or released 

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

the period beginning on August 2, 1990, and ending on September 11, 2001. 

‘‘(ii) October 1, 2026, with respect to a veteran described 

in such subparagraph (G) or (H) who was discharged or released 

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

the period beginning on September 12, 2001, and ending on 

December 31, 2006. 

‘‘(iii) October 1, 2028, with respect to a veteran described 

in such subparagraph (G) or (H) who was discharged or released 

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

the period beginning on January 1, 2007, and ending on 

December 31, 2012. 

‘‘(iv) October 1, 2030, with respect to a veteran described 

in such subparagraph (G) or (H) who was discharged or released 

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

the period beginning on January 1, 2013, and ending on 

December 31, 2018. 

‘‘(v) October 1, 2032, with respect to a veteran described 

in such subparagraph (I). 

‘‘(B)(i) The Secretary may modify a date specified in subparagraph (A) to an earlier date, as the Secretary determines appropriate based on the number of veterans receiving hospital care, 

medical services, and nursing home care under subparagraphs (G), 

(H), and (I) of paragraph (1) and the resources available to the 

Secretary. 

‘‘(ii) If the Secretary determines to modify a date under clause 

(i), the Secretary shall— 

‘‘(I) notify the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives of the proposed modification; and 

‘‘(II) publish such modified date in the Federal Register.’’. 

(b) OUTREACH PLANS.—With respect to each of clauses (i) 

through (v) of section 1710(e)(6)(A) of title 38, United States Code 

(as added by subsection (a)(2)), not later than 180 days before 

the date specified in the clause (including a date modified pursuant 

to such section), the Secretary shall submit to the Committee on 

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

Affairs of the House of Representatives a plan to conduct outreach 

to the veterans described in the clause to notify such veterans 

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

home care under subparagraph (G), (H), or (I), of section 1710(e)(1) 

of such title, as the case may be. 

SEC. 104. ASSESSMENTS OF IMPLEMENTATION AND OPERATION. 

(a) INITIAL RESOURCE ASSESSMENT AND REPORT.—Not later 

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

Secretary of Veterans Affairs shall— 

(1) complete an assessment to determine— 

(A) the personnel and material resources necessary 

to implement section 103 (including the amendments made 

by such section); and 
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(B) the total number of covered veterans, as such term 

is defined in section 1119(c) of title 38, United States 

Code (as added by section 302), who receive hospital care 

or medical services furnished by the Secretary under 

chapter 17 of such title, disaggregated by priority group 

specified in section 1705(a) of such title; and 

(2) submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report containing the findings of the 

assessment completed under paragraph (1), including a specific 

determination as to whether the Department has the personnel 

and material resources necessary to implement section 103. 

(b) INFORMATION SYSTEMS.—Not later than October 1, 2024, 

the Secretary shall establish information systems to assess the 

implementation of section 103, including the amendments made 

by such section, and use the results of assessments under such 

systems to inform the reports under subsection (c). 

(c) ANNUAL REPORTS.— 

(1) REPORTS.—Not later than October 1, 2025, and on an 

annual basis thereafter until October 1, 2033, the Secretary 

shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report on the following: 

(A) The effect of the implementation of, and the provision and management of care under, section 103 (including 

the amendments made by such section) on the demand 

by veterans described in subparagraphs (G), (H), and (I) 

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

added by such section 103) for health care services furnished by the Secretary. 

(B) Any differing patterns of demand for health care 

services by such veterans, disaggregated by factors such 

as the relative distance of the veteran from medical facilities of the Department and whether the veteran had previously received hospital care or medical services furnished 

by the Secretary under chapter 17 of such title. 

(C) The extent to which the Secretary has met such 

demand. 

(D) Any changes, during the year covered by the report, 

in the delivery patterns of health care furnished by the 

Secretary under chapter 17 of such title, and the fiscal 

impact of such changes. 

(2) MATTERS.—Each report under paragraph (1) shall 

include, with respect to the year covered by the report, detailed 

information on the following: 

(A) The total number of veterans enrolled in the patient 

enrollment system who, during such year, received hospital 

care or medical services furnished by the Secretary under 

chapter 17 of title 38, United States Code. 

(B) Of the veterans specified in subparagraph (A), the 

number of such veterans who, during the preceding three 

fiscal years, had not received such care or services. 

(C) With respect to the veterans specified in subparagraph (B), the cost of providing health care to such veterans 

during the year covered by the report, shown in total 

and disaggregated by— 

(i) the level of care; and 
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(ii) whether the care was provided through the 

Veterans Community Care Program. 

(D) With respect to the number of veterans described 

in subparagraphs (G), (H), and (I) of section 1710(e)(1) 

of title 38, United States Code (as added by section 103), 

the following (shown in total and disaggregated by medical 

facility of the Department, as applicable): 

(i) The number of such veterans who, during the 

year covered by the report, enrolled in the patient 

enrollment system. 

(ii) The number of such veterans who applied for, 

but were denied, such enrollment. 

(iii) The number of such veterans who were denied 

hospital care or a medical service furnished by the 

Secretary that was considered to be medically necessary but not of an emergency nature. 

(E) The numbers and characteristics of, and the type 

and extent of health care furnished by the Secretary to, 

veterans enrolled in the patient enrollment system (shown 

in total and disaggregated by medical facility of the Department). 

(F) The numbers and characteristics of, and the type 

and extent of health care furnished by the Secretary to, 

veterans not enrolled in the patient enrollment system 

(disaggregated by each class of eligibility for care under 

section 1710 of title 38, United States Code, and further 

shown as a total per class and disaggregated by medical 

facility of the Department). 

(G) The specific fiscal impact (shown in total and 

disaggregated by geographic health care delivery areas) 

of changes in the delivery patterns of health care furnished 

by the Secretary under chapter 17 of such title as a result 

of the implementation of section 103 (including the amendments made by such section). 

(d) DEFINITIONS.—In this section: 

(1) PATIENT ENROLLMENT SYSTEM.—The term ‘‘patient 

enrollment system’’ means the patient enrollment system of 

the Department of Veterans Affairs established and operated 

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

(2) VETERANS COMMUNITY CARE PROGRAM.—The term ‘‘Veterans Community Care Program’’ means the program established under section 1703 of title 38, United States Code. 

Subtitle B—Certain Veterans of Combat 

Service and Other Matters 

SEC. 111. EXPANSION OF PERIOD OF ELIGIBILITY FOR HEALTH CARE 

FOR CERTAIN VETERANS OF COMBAT SERVICE. 

(a) EXPANDED PERIOD.—Section 1710(e)(3) is amended— 

(1) in subparagraph (A)— 

(A) by striking ‘‘January 27, 2003’’ and inserting ‘‘September 11, 2001’’; and 

(B) by striking ‘‘five-year period’’ and inserting ‘‘10- 

year period’’; 

(2) by amending subparagraph (B) to read as follows: 
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‘‘(B) With respect to a veteran described in paragraph 

(1)(D) who was discharged or released from the active military, 

naval, air, or space service after September 11, 2001, and 

before October 1, 2013, but did not enroll to receive such 

hospital care, medical services, or nursing home care under 

such paragraph pursuant to subparagraph (A) before October 

1, 2022, the one-year period beginning on October 1, 2022.’’; 

and 

(3) by striking subparagraph (C). 

(b) CLARIFICATION OF COVERAGE.—Section 1710(e)(1)(D) is 

amended by inserting after ‘‘Persian Gulf War’’ the following: 

‘‘(including any veteran who, in connection with service during 

such period, received the Armed Forces Expeditionary Medal, 

Service Specific Expeditionary Medal, Combat Era Specific Expeditionary Medal, Campaign Specific Medal, or any other combat theater award established by a Federal statute or an Executive order)’’. 

(c) OUTREACH PLAN.—Not later than December 1, 2022, the 

Secretary of Veterans Affairs shall submit to the Committee on 

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

Affairs of the House of Representatives a plan to conduct outreach 

to veterans described in subparagraph (B) of section 1710(e)(3) 

of title 38, United States Code, as amended by subsection (a)(2), 

to notify such veterans of their eligibility for hospital care, medical 

services, or nursing home care pursuant to such subparagraph. 

(d) REPORT ON ENROLLMENTS.—Not later than January 30, 

2024, the Secretary shall submit to the Committee on Veterans’ 

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

the House of Representatives a report identifying, with respect 

to the one-year period beginning on October 1, 2022, the number 

of veterans described in section 1710(e)(3)(B) of title 38, United 

States Code, as amended by subsection (a)(2), who, during such 

period, enrolled in the patient enrollment system of the Department 

of Veterans Affairs established and operated under section 1705(a) 

of such title. 

(e) EFFECTIVE DATE.—This section and the amendments made 

by this section shall take effect on October 1, 2022. 

TITLE II—TOXIC EXPOSURE 

PRESUMPTION PROCESS 

SEC. 201. SHORT TITLE. 

This title may be cited as the ‘‘Toxic Exposure in the American 

Military Act of 2022’’ or the ‘‘TEAM Act of 2022’’. 

SEC. 202. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF VETERANS 

AFFAIRS TO ESTABLISH PRESUMPTIONS OF SERVICE 

CONNECTION BASED ON TOXIC EXPOSURE. 

(a) ADVISORY COMMITTEES, PANELS, AND BOARDS.—Chapter 11 

is amended by adding at the end the following new subchapter: 
S. 3373—9 

‘‘SUBCHAPTER VII—DETERMINATIONS RELATING TO PRESUMPTIONS OF SERVICE CONNECTION BASED ON TOXIC 

EXPOSURE 

‘‘§ 1171. Procedures to determine presumptions of service 

connection based on toxic exposure; definitions 

‘‘(a) PROCEDURES.—The Secretary shall determine whether to 

establish, or to remove, presumptions of service connection based 

on toxic exposure pursuant to this subchapter, whereby— 

‘‘(1) under section 1172 of this title— 

‘‘(A) the Secretary provides— 

‘‘(i) public notice regarding what formal evaluations the Secretary plans to conduct; and 

‘‘(ii) the public an opportunity to comment on the 

proposed formal evaluations; 

‘‘(B) the working group established under subsection 

(b) of such section provides— 

‘‘(i) advice to the Secretary on toxic-exposed veterans and cases in which veterans who, during active 

military, naval, air, or space service, may have experienced a toxic exposure or their dependents may have 

experienced a toxic exposure while the veterans were 

serving in the active military, naval, air, or space 

service; 

‘‘(ii) recommendations to the Secretary on corrections needed in the Individual Longitudinal Exposure 

Record to better reflect veterans and dependents 

described in clause (i); and 

‘‘(iii) recommendations to the Secretary regarding 

which cases of possible toxic exposure should be 

reviewed; 

‘‘(2) the Secretary provides for formal evaluations of such 

recommendations under section 1173 of this title and takes 

into account reports received by the Secretary from the National 

Academies of Sciences, Engineering, and Medicine under section 

1176 of this title; and 

‘‘(3) the Secretary issues regulations under section 1174 

of this title. 

‘‘(b) DEFINITIONS.—In this subchapter: 

‘‘(1) The term ‘illness’ includes a disease or other condition 

affecting the health of an individual, including mental and 

physical health. 

‘‘(2) The term ‘Individual Longitudinal Exposure Record’ 

includes— 

‘‘(A) service records; 

‘‘(B) any database maintained by the Department of 

Defense and shared with the Department of Veterans 

Affairs to serve as a central portal for exposure-related 

data that compiles, collates, presents, and provides available occupational and environmental exposure information 

to support the needs of the Department of Defense and 

the Department of Veterans Affairs; or 

‘‘(C) any successor system to a database described in 

subparagraph (B). 
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‘‘§ 1172. Annual notice and opportunity for public comment 

‘‘(a) NOTICE REQUIRED.—(1)(A) Not less frequently than once 

each year, the Secretary shall publish in the Federal Register 

notice of the formal evaluations that the Secretary plans to conduct 

pursuant to section 1173 of this title. 

‘‘(B) Each notice published under subparagraph (A) shall 

include, for each formal evaluation referred to in the notice, an 

explanation as to why the military environmental exposures and 

adverse health outcomes that are the subject of the formal evaluation were chosen by the Secretary for formal evaluation under 

section 1173 of this title. 

‘‘(2)(A) With each notice published under paragraph (1), the 

Secretary shall seek public comment on the military environmental 

exposures and adverse health outcomes that are the subject of 

the formal evaluations referred to in the notice. 

‘‘(B) The Secretary shall— 

‘‘(i) consider all public comment received under subparagraph (A); and 

‘‘(ii) publish in the Federal Register a response to the 

comments received under subparagraph (A). 

‘‘(3)(A) For each notice published under paragraph (1), the 

Secretary shall hold an open meeting for members of the public 

to voice their comments in response to the notice. 

‘‘(B) To help evaluate presumptions of service connection, the 

Secretary shall, not less frequently than quarterly, collaborate with, 

partner with, and give weight to the advice of veterans service 

organizations and such other stakeholders as the Secretary considers appropriate. 

‘‘(4) Failure to include a military environmental exposure or 

adverse health effect in a Federal Register notice published pursuant to subsection (a) shall not preclude the Secretary from initiating 

a formal evaluation of such exposure or health effect. 

‘‘(b) WORKING GROUP.—(1) The Secretary shall establish a 

working group within the Department (in this section referred 

to as the ‘Working Group’). 

‘‘(2) The Working Group shall include personnel of the Veterans 

Health Administration and the Veterans Benefits Administration. 

‘‘(3) The Secretary shall consult with, and seek the advice 

of, the Working Group with respect to cases in which— 

‘‘(A) a veteran may have, during active military, naval, 

air, or space service, experienced a toxic exposure; or 

‘‘(B) a dependent of a veteran may have experienced a 

toxic exposure during the active military, naval, air, or space 

service of the veteran. 

‘‘(c) ASSESSMENTS.—(1) The Working Group shall assess cases 

of the toxic exposure of veterans and their dependents that occurred 

during active military, naval, air, or space service, including by 

conducting ongoing surveillance and reviewing such exposure 

described in scientific literature, media reports, information from 

veterans, and information from Congress. 

‘‘(2) The assessments under paragraph (1) shall cover suspected 

and known toxic exposures occurring during active military, naval, 

air, or space service, including by identifying and evaluating new 

and emerging toxic exposures that are not recognized under existing 

presumptions of service connection. 
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‘‘(3) The Working Group may conduct an assessment under 

paragraph (1) in response to a comment received under paragraph 

(2) or (3) of subsection (a). 

‘‘(4) The Working Group shall, in consultation with the Secretary of Defense, on a periodic basis, assess the Individual Longitudinal Exposure Record to ensure the accuracy of data collected. 

‘‘(d) DEVELOPMENT OF RECOMMENDATIONS.—(1) Following an 

assessment of a case of the toxic exposure of veterans that occurred 

during active military, naval, air, or space service under subsection 

(c), or their dependents, the Working Group may develop a recommendation for formal evaluation under section 1173 of this title 

to conduct a review of the health effects related to the case of 

exposure if the Working Group determines that the research may 

change the current understanding of the relationship between an 

exposure to an environmental hazard and adverse health outcomes 

in humans. 

‘‘(2) Upon receipt of evidence suggesting that previous findings 

regarding the periods and locations of exposure covered by an 

existing presumption of service connection are no longer supported, 

the Working Group may nominate such evidence for formal evaluation under section 1173 of this title to modify the periods and 

locations. 

‘‘(e) REPORTS BY THE WORKING GROUP.—Not less frequently 

than once each year, the Working Group shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and 

the Committee on Veterans’ Affairs of the House of Representatives, 

and make publicly available, a report on— 

‘‘(1) recommendations developed under subsection (d), if 

any; and 

‘‘(2) recommendations for such legislative or administrative 

action as the Working Group considers necessary for the 

Working Group to be more effective in carrying out the requirements of this section. 

‘‘(f) RESPONSES BY SECRETARY.—In response to each report submitted under subsection (e), the Secretary shall, not later than 

30 days after receiving the report, initiate a formal evaluation 

pursuant to section 1173 of this title. 

‘‘§ 1173. Formal evaluation of recommendations 

‘‘(a) FORMAL EVALUATIONS.—The Secretary shall establish a 

process to conduct a formal evaluation with respect to each recommendation made by the Working Group under section 1172 of 

this title. 

‘‘(b) EVIDENCE, DATA, AND FACTORS.—The Secretary shall 

ensure that each formal evaluation under subsection (a) covers 

the following: 

‘‘(1) Scientific evidence, based on the review of available 

scientific literature, including human, toxicological, animal, and 

methodological studies, and other factors. 

‘‘(2) Claims data, based on the review of claim rate, grant 

rate, and service connection prevalence, and other factors. 

‘‘(3) Other factors the Secretary determines appropriate, 

such as— 

‘‘(A) the level of disability and mortality caused by 

the health effects related to the case of toxic exposure 

being evaluated; 
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‘‘(B) the quantity and quality of the information available and reviewed; 

‘‘(C) the feasibility of and period for generating relevant 

information and evidence; 

‘‘(D) whether such health effects are combat- or deployment-related; 

‘‘(E) the ubiquity or rarity of the health effects; and 

‘‘(F) any time frame during which a health effect must 

become manifest. 

‘‘(c) CONDUCT OF EVALUATIONS.—(1) The Secretary shall ensure 

that each formal evaluation under subsection (a)— 

‘‘(A) reviews scientific evidence in a manner that— 

‘‘(i) conforms to principles of scientific and data integrity; 

‘‘(ii) is free from suppression or distortion of scientific 

or technological findings, data, information, conclusions, 

or technical results; and 

‘‘(B)(i) evaluates the likelihood that a positive association 

exists between an illness and a toxic exposure while serving 

in the active military, naval, air, or space service; and 

‘‘(ii) assesses the toxic exposures and illnesses and determines whether the evidence supports a finding of a positive 

association between the toxic exposure and the illness. 

‘‘(2) In carrying out paragraph (1)(B)(ii), a formal evaluation 

under subsection (a) shall include reviewing all relevant data to 

determine the strength of evidence for a positive association based 

on the following four categories: 

‘‘(A) The ‘sufficient’ category, where the evidence is sufficient to conclude that a positive association exists. 

‘‘(B) The ‘equipoise and above’ category, where the evidence 

is sufficient to conclude that a positive association is at least 

as likely as not, but not sufficient to conclude that a positive 

association exists. 

‘‘(C) The ‘below equipoise’ category, where the evidence 

is not sufficient to conclude that a positive association is at 

least as likely as not, or is not sufficient to make a scientifically 

informed judgment. 

‘‘(D) The ‘against’ category, where the evidence suggests 

the lack of a positive association. 

‘‘(d) RECOMMENDATION FOR ESTABLISHING A PRESUMPTION OF

SERVICE CONNECTION.—Not later than 120 days after the date 

on which a formal evaluation is commenced, the element of the 

Department that conducts the evaluation shall submit to the Secretary a recommendation with respect to establishing a presumption 

of service connection for the toxic exposure and illness, or modifying 

an existing presumption of service connection, covered by the 

evaluation. 

‘‘§ 1174. Regulations regarding presumptions of service 

connection based on toxic exposure 

‘‘(a) ACTION UPON RECOMMENDATION.—Not later than 160 days 

after the date on which the Secretary receives a recommendation 

to establish or modify a presumption of service connection under 

section 1173 of this title— 

‘‘(1) if the Secretary determines, in the discretion of the 

Secretary, that the presumption, or modification, is warranted, 

the Secretary shall— 
S. 3373—13 

‘‘(A) commence issuing regulations in accordance with 

the provisions of subchapter II of chapter 5 of title 5 

(commonly referred to as the Administrative Procedures 

Act) setting forth the presumption or commence revising 

regulations to carry out such modification; and 

‘‘(B) include in such regulations any time frame during 

which a health effect must become manifest; or 

‘‘(2) if the Secretary determines, in the discretion of the 

Secretary, that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register 

a notice of the determination, including the reasons supporting 

the determination. 

‘‘(b) REMOVAL OF PRESUMPTION.—(1)(A) The Secretary may— 

‘‘(i) issue a regulation to remove an illness from a presumption of service connection previously established pursuant to 

a regulation issued under subsection (a); and 

‘‘(ii) issue a regulation to remove a presumption of service 

connection established pursuant to title IV of the Sergeant 

First Class Heath Robinson Honoring our Promise to Address 

Comprehensive Toxics Act of 2022 if the Secretary concludes 

that evidence suggests the lack of a positive association between 

the disease and the toxic exposure. 

‘‘(B) Under subparagraph (A)(ii), the Secretary shall not consider the lack of evidence as sufficient to support a decision for 

removal of a presumption. 

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

to paragraph (1), or the periods and locations of exposure covered 

by a presumption of service connection are modified under subsection (a)— 

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

chapter 11 of this title for such illness on the basis of the 

presumption provided under such regulations before the effective date of the removal or modification shall continue to be 

entitled to receive compensation on that basis; 

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

and indemnity compensation under chapter 13 of this title 

for the death of a veteran resulting from such illness on the 

basis of such presumption shall continue to be entitled to 

receive dependency and indemnity compensation on such basis; 

and 

‘‘(C) no veteran or survivor covered under subparagraph 

(A) or (B) shall have their compensation reduced solely because 

of the removal of an illness pursuant to paragraph (1). 

‘‘§ 1175. Authority to modify process; congressional oversight 

‘‘(a) IN GENERAL.—The Secretary may modify the process under 

which the working group established under subsection (b) of section 

1172 of this title conducts assessments under such section, the 

Secretary conducts formal evaluations under section 1173 of this 

title, and issues regulations under section 1174 of this title if— 

‘‘(1) such evaluations cover the evidence, data, and factors 

required by subsection (b) of such section 1173; and 

‘‘(2) a period of 180 days has elapsed following the date 

on which the Secretary submits the notice under subsection 

(b) regarding the modification. 

‘‘(b) NOTICE.—If the Secretary proposes to modify the process 

under which the working group established under subsection (b) 
S. 3373—14 

of section 1172 of this title conducts assessments under such section, 

the process under which the Secretary conducts formal evaluations 

under section 1173 of this title, or issues regulations under section 

1174 of this title, the Secretary shall submit to the Committee 

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

Affairs of the House of Representatives a notice of the proposed 

modifications containing the following: 

‘‘(1) A description of the proposed modifications. 

‘‘(2) A description of any exceptions to the requirements 

of such sections that are proposed because of limited available 

scientific evidence, and a description of how such evaluations 

will be conducted. 

‘‘§ 1176. Agreement with National Academies of Sciences, 

Engineering, and Medicine concerning toxic exposures 

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

the National Academies of Sciences, Engineering, and Medicine 

(in this section referred to as the ‘Academies’), an independent 

nonprofit scientific organization with appropriate expertise that 

is not part of the Federal Government, to review and evaluate 

the available scientific evidence regarding associations between diseases and toxic exposures. 

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

a five-year agreement with the Academies to perform the services 

covered by this section. 

‘‘(2) The Secretary shall seek to enter into an agreement 

described in paragraph (1) not later than 60 days after the date 

of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022. 

‘‘(3) An agreement under this section may be extended in fiveyear increments. 

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

between the Secretary and the Academies under this section, the 

Academies shall review and summarize the scientific evidence, and 

assess the strength thereof, concerning the association between 

toxic exposures during active military, naval, air, or space service 

and each disease suspected to be associated with such exposure 

in the human population. 

‘‘(d) SCIENTIFIC DETERMINATIONS CONCERNING DISEASES.—For 

each disease reviewed under subsection (c), the Academies shall 

determine, to the extent that available scientific data permit meaningful determinations— 

‘‘(1) whether an association exists between toxic exposures 

and the occurrence of the disease, taking into account the 

strength of the scientific evidence and the appropriateness of 

the statistical and epidemiological methods used to detect the 

association; 

‘‘(2) the increased risk of the disease among those reporting 

toxic exposures during active military, naval, air, or space 

service; 

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

or other evidence of a positive association between the toxic 

exposure and the occurrence of the disease; and 

‘‘(4) determine the strength of evidence for a positive 

association based on categories furnished under section 1173 

of this title. 
S. 3373—15 

‘‘(e) COOPERATION OF FEDERAL AGENCIES.—The head of each 

relevant Federal agency, including the Secretary of Defense, shall 

cooperate fully with the Academies in performing the services covered by this section. 

‘‘(f) RECOMMENDATIONS FOR ADDITIONAL SCIENTIFIC STUDIES.— 

(1) Under an agreement between the Secretary and the Academies 

under this section, the Academies shall make any recommendations 

for additional scientific studies to resolve areas of continuing scientific uncertainty relating to toxic exposures. 

‘‘(2) In making recommendations under paragraph (1), the Academies shall consider— 

‘‘(A) the scientific information that is available at the time 

of the recommendation; 

‘‘(B) the value and relevance of the information that could 

result from additional studies; and 

‘‘(C) the cost and feasibility of carrying out such additional 

studies. 

‘‘(g) REPORTS.—(1)(A) Under an agreement between the Secretary and the Academies under this section, not later than one 

year after the date of the enactment of the Sergeant First Class 

Heath Robinson Honoring our Promise to Address Comprehensive 

Toxics Act of 2022, the Academies shall submit to the Secretary, 

the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives an 

initial report on the activities of the Academies under the agreement. 

‘‘(B) The report submitted under subparagraph (A) shall include 

the following: 

‘‘(i) The determinations described in subsection (d). 

‘‘(ii) A full explanation of the scientific evidence and reasoning that led to such determinations. 

‘‘(iii) Any recommendations of the Academies under subsection (f). 

‘‘(2) Under an agreement between the Secretary and the Academies under this section, not less frequently than once every two 

years after the date on which the initial report is submitted under 

paragraph (1)(A), the Academies shall submit to the Secretary, 

the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives an 

updated report on the activities of the Academies under the agreement. 

‘‘(h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZATION.—(1) If 

the Secretary is unable within the time period prescribed in subsection (b)(2) to enter into an agreement with the Academies for 

the purposes of this section on terms acceptable to the Secretary, 

the Secretary shall seek to enter into an agreement for the purposes 

of this section with another appropriate scientific organization 

that— 

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

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

‘‘(C) has expertise and objectivity comparable to that of 

the Academies. 

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

organization as described in paragraph (1), any reference in this 

subchapter to the Academies shall be treated as a reference to 

the other organization.’’. 

(b) REPORTS AND BRIEFINGS.— 
S. 3373—16 

(1) REPORT.— 

(A) IN GENERAL.—Not later than two years after the 

date of the enactment of this Act, the Secretary of Veterans 

Affairs shall submit to the Committee on Veterans’ Affairs 

of the Senate and the Committee on Veterans’ Affairs of 

the House of Representatives a report on the implementation of, and recommendations for, subchapter VII of chapter 

11 of title 38, United States Code, as added by subsection 

(a). 

(B) CONSULTATION.—The Secretary shall develop the 

report under subparagraph (A) in consultation with 

organizations recognized by the Secretary for the representation of veterans under section 5902 of such title and 

any other entity the Secretary determines appropriate. 

(2) BRIEFING.—On a quarterly basis during the two-year 

period beginning on the date of the enactment of this Act, 

the Secretary shall provide to the Committee on Veterans’ 

Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a briefing on the implementation of subchapter VII of chapter 11 of such title, as added 

by subsection (a). 

(c) INDEPENDENT ASSESSMENT.— 

(1) AGREEMENT.—The Secretary shall seek to enter into 

an agreement with the National Academies of Science, 

Engineering, and Medicine (in this subsection referred to as 

the ‘‘Academies’’) before the date that is 90 days after the 

date of the enactment of this Act to perform the services set 

forth under paragraph (2). 

(2) ASSESSMENT.— 

(A) IN GENERAL.—Under an agreement between the 

Secretary and the Academies under paragraph (1), the 

Academies shall conduct an assessment of the implementation by the Department of Veterans Affairs of the process 

established under subchapter VII of chapter 11 of title 

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

(B) ELEMENTS.—The assessment conducted under 

subparagraph (A) shall include the following: 

(i) An assessment of the Department’s implementation of the process established under subsection (a) 

to determine whether the process is in accordance with 

current scientific standards for assessing the link 

between exposure to environmental hazards and the 

development of health outcomes, 

(ii) assess whether the criteria is fair and consistent, and 

(iii) provide recommendations for improvements to 

the process. 

(3) REPORT.—Not later than one year after the date on 

which the Secretary enters into an agreement under paragraph 

(1), the Secretary shall submit to the Committee on Veterans’ 

Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a report on the findings of 

the Academies pursuant to such agreement. 

(4) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZATION.— 

(A) IN GENERAL.—If the Secretary is unable within 

the time period prescribed in paragraph (1) to enter into 

an agreement with the Academies for the purposes of this 
S. 3373—17 

subsection on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for the purposes of this subsection with another appropriate scientific 

organization that— 

(i) is not part of the Federal Government; 

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

(iii) has expertise and objectivity comparable to 

that of the Academies. 

(B) TREATMENT.—If the Secretary enters into an agreement with another organization as described in subparagraph (A), any reference in this subsection to the Academies 

of Sciences, Engineering, and Medicine shall be treated 

as a reference to the other organization. 

(d) CONFORMING AMENDMENTS.—Chapter 11 is amended— 

(1) in section 1116— 

(A) by striking subsections (b), (c), (d), and (e); 

(B) by inserting after subsection (a) the following new 

subsection (b): 

‘‘(b) The Secretary shall ensure that any determination made 

on or after the date of the enactment of the Sergeant First Class 

Heath Robinson Honoring our Promise to Address Comprehensive 

Toxics Act of 2022 regarding a presumption of service connection 

based on exposure to an herbicide agent under this section is 

made pursuant to subchapter VII of this chapter, including with 

respect to assessing reports received by the Secretary from the 

National Academy of Sciences under section 3 of the Agent Orange 

Act of 1991 (Public Law 102–4).’’; and 

(C) by redesignating subsection (f) as subsection (c); 

(2) in section 1116B(b)(2)(A), by inserting ‘‘pursuant to 

subchapter VII of this chapter,’’ before ‘‘the Secretary determines’’; and 

(3) in section 1118— 

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

(B) by inserting after subsection (a) the following new 

subsection (b): 

‘‘(b) The Secretary shall ensure that any determination made 

on or after the date of the enactment of the Sergeant First Class 

Heath Robinson Honoring our Promise to Address Comprehensive 

Toxics Act of 2022 regarding a presumption of service connection 

based on a toxic exposure under this section is made pursuant 

to subchapter VII of this chapter.’’. 

SEC. 203. OUTREACH TO CLAIMANTS FOR DISABILITY COMPENSATION 

PURSUANT TO CHANGES IN PRESUMPTIONS OF SERVICE 

CONNECTION. 

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

by adding at the end the following new section: 

‘‘§ 1167. Outreach pursuant to changes in presumptions of 

service connection 

‘‘(a) IN GENERAL.—Whenever a law, including through a regulation or Federal court decision or settlement, establishes or modifies 

a presumption of service connection, the Secretary shall— 

‘‘(1) identify all claims for compensation under this chapter 

that— 

‘‘(A) were submitted to the Secretary; 
S. 3373—18 

‘‘(B) were evaluated and denied by the Secretary before 

the date on which such provision of law went into effect; 

and 

‘‘(C) might have been evaluated differently had the 

establishment or modification been applicable to the claim; 

and 

‘‘(2) pursuant to subsection (b), conduct outreach to the 

claimants. 

‘‘(b) OUTREACH.—(1) The Secretary shall conduct outreach to 

inform claimants identified under subsection (a) that they may 

submit a supplemental claim in light of the establishment or modification of a presumption of service connection described in subsection (a). 

‘‘(2) Outreach under paragraph (1) shall include the following: 

‘‘(A) The Secretary shall publish on the internet website 

of the Department a notice that such veterans may elect to 

file a supplemental claim. 

‘‘(B) The Secretary shall notify, in writing or by electronic 

means, veterans service organizations of the ability of such 

veterans to file a supplemental claim. 

‘‘(C) The Secretary shall contact each claimant identified 

under subsection (a) in the same manner that the Department 

last provided notice of a decision.’’. 

(b) APPLICATION.—Section 1167 of title 38, United States Code, 

as added by subsection (a), shall apply with respect to presumptions 

of service connection established or modified on or after the date 

of the enactment of this Act, including pursuant to amendments 

made by this Act. 

(c) RULE OF CONSTRUCTION.—Nothing in this section shall be 

construed as— 

(1) modifying the obligations of the Department of Veterans 

Affairs under Federal court decisions or settlements in effect 

as of the date of the enactment of this Act; or 

(2) requiring a retroactively applied effective date of a 

supplemental claim earlier than the date a presumption of 

service connection is established or modified. 

SEC. 204. REEVALUATION OF CLAIMS FOR DEPENDENCY AND INDEMNITY COMPENSATION INVOLVING PRESUMPTIONS OF 

SERVICE CONNECTION. 

(a) IN GENERAL.—Subchapter I of chapter 13 is amended by 

adding at the end the following new section: 

‘‘§ 1305. Reevaluation of dependency and indemnity compensation determinations pursuant to changes in 

presumptions of service connection 

‘‘(a) REEVALUATION.—Whenever a law, including through a 

regulation or Federal court decision or settlement, establishes or 

modifies a presumption of service connection, the Secretary shall— 

‘‘(1) identify all claims for dependency and indemnity compensation under this chapter that— 

‘‘(A) were submitted to the Secretary; 

‘‘(B) were evaluated and denied by the Secretary before 

the date on which such provision of law went into effect; 

and 

‘‘(C) might have been evaluated differently had the 

establishment or modification been applicable to the claim; 
S. 3373—19 

‘‘(2) allow for the reevaluation of such claims at the election 

of the claimant; and 

‘‘(3) notwithstanding section 5110 of this title, with respect 

to claims approved pursuant to such reevaluation, provide compensation under this chapter effective as if the establishment 

or modification of the presumption of service connection had 

been in effect on the date of the submission of the original 

claim described in paragraph (1). 

‘‘(b) OUTREACH.—(1) The Secretary shall conduct outreach to 

inform relevant claimants that they may elect to have a claim 

be reevaluated in light of the establishment or modification of 

a presumption of service connection described in subsection (a). 

‘‘(2) Outreach under paragraph (1) shall include the following: 

‘‘(A) The Secretary shall publish on the internet website 

of the Department a notice that such claimants may elect 

to have a claim so reevaluated. 

‘‘(B) The Secretary shall notify, in writing or by electronic 

means, veterans service organizations of the ability of such 

claimants to elect to have a claim so reevaluated. 

‘‘(C) The Secretary shall contact each claimant identified 

under subsection (a) in the same manner that the Department 

last provided notice of a decision.’’. 

(b) APPLICATION.—Section 1305 of title 38, United States Code, 

as added by subsection (a), shall apply with respect to presumptions 

of service connection established or modified on or after the date 

of the enactment of this Act, including pursuant to amendments 

made by this Act. 

(c) RULE OF CONSTRUCTION.—Nothing in this section shall be 

construed as modifying the obligations of the Department of Veterans Affairs under Federal court decisions or settlements in effect 

as of the date of the enactment of this Act. 

TITLE III—IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION 

PROCESS FOR TOXIC-EXPOSED VETERANS 

SEC. 301. SHORT TITLE. 

This title may be cited as the ‘‘Veterans Burn Pits Exposure 

Recognition Act of 2022’’. 

SEC. 302. PRESUMPTIONS OF TOXIC EXPOSURE. 

Subchapter II of chapter 11 is amended by adding at the 

end the following new section: 

‘‘§ 1119. Presumptions of toxic exposure 

‘‘(a) CONSIDERATION OF RECORDS.—If a veteran submits to the 

Secretary a claim for compensation for a service-connected disability 

under section 1110 of this title with evidence of a disability and 

a toxic exposure that occurred during active military, naval, air, 

or space service, the Secretary may, in adjudicating such claim, 

consider— 

‘‘(1) any record of the veteran in an exposure tracking 

record system; and 
S. 3373—20 

‘‘(2) if no record of the veteran in an exposure tracking 

record system indicates that the veteran was subject to a toxic 

exposure during active military, naval, air, or space service, 

the totality of the circumstances of the service of the veteran. 

‘‘(b) PRESUMPTION OF SPECIFIC TOXIC EXPOSURE FOR MEMBERS

WHO SERVED IN CERTAIN LOCATIONS.—(1) The Secretary shall, for 

purposes of section 1110 and chapter 17 of this title, presume 

that any covered veteran was exposed to the substances, chemicals, 

and airborne hazards identified in the list under paragraph (2) 

during the service of the covered veteran specified in subsection 

(c)(1), unless there is affirmative evidence to establish that the 

covered veteran was not exposed to any such substances, chemicals, 

or hazards in connection with such service. 

‘‘(2) The Secretary shall— 

‘‘(A) establish and maintain a list that contains an identification of one or more such substances, chemicals, and airborne 

hazards as the Secretary, in collaboration with the Secretary 

of Defense, may determine appropriate for purposes of this 

section; and 

‘‘(B) determine, using procedures consistent with section 

1172 of this title and through the conduct of a formal evaluation 

under section 1173 of this title, whether to establish an end 

date for a covered veteran to qualify for presumptions of exposure under this section, if appropriate, but in no case establish 

an end date earlier than the last day of the period specified 

in section 101(33) for the Persian Gulf War. 

‘‘(3) Beginning not later than two years after the date of the 

enactment of the Sergeant First Class Heath Robinson Honoring 

our Promise to Address Comprehensive Toxics Act of 2022, and 

not less frequently than once every two years thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the 

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

Representatives a report identifying any additions or removals to 

the list under paragraph (2) during the period covered by the 

report. 

‘‘(c) DEFINITIONS.—In this section: 

‘‘(1) The term ‘covered veteran’ means any veteran who— 

‘‘(A) on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty 

station in, including airspace above— 

‘‘(i) Bahrain; 

‘‘(ii) Iraq; 

‘‘(iii) Kuwait; 

‘‘(iv) Oman; 

‘‘(v) Qatar; 

‘‘(vi) Saudi Arabia; 

‘‘(vii) Somalia; or 

‘‘(viii) United Arab Emirates; or 

‘‘(B) on or after September 11, 2001, performed active 

military, naval, air, or space service while assigned to 

a duty station in, including airspace above— 

‘‘(i) Afghanistan; 

‘‘(ii) Djibouti; 

‘‘(iii) Egypt; 

‘‘(iv) Jordan; 

‘‘(v) Lebanon; 

‘‘(vi) Syria; 
S. 3373—21 

‘‘(vii) Yemen; 

‘‘(viii) Uzbekistan; or 

‘‘(ix) any other country determined relevant by 

the Secretary. 

‘‘(2) The term ‘exposure tracking record system’— 

‘‘(A) means any system, program, or pilot program 

used by the Secretary of Veterans Affairs or the Secretary 

of Defense to track how veterans or members of the Armed 

Forces have been exposed to various occupational or 

environmental hazards; and 

‘‘(B) includes the Individual Longitudinal Exposure 

Record, or successor system. 

‘‘(3) The term ‘toxic exposure risk activity’ has the meaning 

given such term in section 1710(e)(4) of this title.’’. 

SEC. 303. MEDICAL NEXUS EXAMINATIONS FOR TOXIC EXPOSURE RISK 

ACTIVITIES. 

Subchapter VI of chapter 11, as amended by section 203, is 

further amended by adding at the end the following new section: 

‘‘§ 1168. Medical nexus examinations for toxic exposure risk 

activities 

‘‘(a) MEDICAL EXAMINATIONS AND MEDICAL OPINIONS.—(1) 

Except as provided in subsection (b), if a veteran submits to the 

Secretary a claim for compensation for a service-connected disability 

under section 1110 of this title with evidence of a disability and 

evidence of participation in a toxic exposure risk activity during 

active military, naval, air, or space service, and such evidence 

is not sufficient to establish a service connection for the disability, 

the Secretary shall— 

‘‘(A) provide the veteran with a medical examination under 

section 5103A(d) of this title; and 

‘‘(B) obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under 

subparagraph (A)) as to whether it is at least as likely as 

not that there is a nexus between the disability and the toxic 

exposure risk activity. 

‘‘(2) When providing the Secretary with a medical opinion under 

paragraph (1)(B) for a veteran, the health care provider shall consider— 

‘‘(A) the total potential exposure through all applicable 

military deployments of the veteran; and 

‘‘(B) the synergistic, combined effect of all toxic exposure 

risk activities of the veteran. 

‘‘(3) The requirement under paragraph (2)(B) shall not be construed as requiring a health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and 

airborne hazards identified in the list under section 1119(b)(2) 

of this title. 

‘‘(b) EXCEPTION.—Subsection (a) shall not apply if the Secretary 

determines there is no indication of an association between the 

disability claimed by the veteran and the toxic exposure risk activity 

for which the veteran submitted evidence. 

‘‘(c) TOXIC EXPOSURE RISK ACTIVITY DEFINED.—In this section, 

the term ‘toxic exposure risk activity’ has the meaning given that 

term in section 1710(e)(4) of this title.’’. 
S. 3373—22 

TITLE IV—PRESUMPTIONS OF SERVICE 

CONNECTION 

SEC. 401. TREATMENT OF VETERANS WHO PARTICIPATED IN CLEANUP 

OF ENEWETAK ATOLL AS RADIATION-EXPOSED VETERANS 

FOR PURPOSES OF PRESUMPTION OF SERVICE CONNECTION OF CERTAIN DISABILITIES BY DEPARTMENT OF VETERANS AFFAIRS. 

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

Takai Atomic Veterans Healthcare Parity Act of 2022’’. 

(b) ENEWETAK ATOLL.—Section 1112(c)(3)(B) is amended by 

adding at the end the following new clause: 

‘‘(v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 

1980.’’. 

SEC. 402. TREATMENT OF VETERANS WHO PARTICIPATED IN NUCLEAR 

RESPONSE NEAR PALOMARES, SPAIN, OR THULE, GREENLAND, AS RADIATION-EXPOSED VETERANS FOR PURPOSES 

OF PRESUMPTION OF SERVICE CONNECTION OF CERTAIN 

DISABILITIES BY DEPARTMENT OF VETERANS AFFAIRS. 

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

or Thule Veterans Act of 2022’’. 

(b) PALOMARES OR THULE.—Section 1112(c)(3)(B), as amended 

by section 401, is further amended by adding at the end the following new clauses: 

‘‘(vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 

bomber and refueling plane that caused the release of 

four thermonuclear weapons in the vicinity of Palomares, 

Spain, during the period beginning January 17, 1966, and 

ending March 31, 1967. 

‘‘(vii) Onsite participation in the response effort following the on-board fire and crash of a United States 

Air Force B–52 bomber that caused the release of four 

thermonuclear weapons in the vicinity of Thule Air Force 

Base, Greenland, during the period beginning January 21, 

1968, and ending September 25, 1968.’’. 

SEC. 403. PRESUMPTIONS OF SERVICE CONNECTION FOR DISEASES 

ASSOCIATED WITH EXPOSURES TO CERTAIN HERBICIDE 

AGENTS FOR VETERANS WHO SERVED IN CERTAIN LOCATIONS. 

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

Agent Orange Exposure Equity Act of 2022’’. 

(b) IN GENERAL.—Section 1116, as amended by section 202, 

is further amended— 

(1) by striking ‘‘, during active military, naval, air, or 

space service, served in the Republic of Vietnam during the 

period beginning on January 9, 1962, and ending on May 7, 

1975’’ each place it appears and inserting ‘‘performed covered 

service’’; 

(2) by striking ‘‘performed active military, naval, air, or 

space service in the Republic of Vietnam during the period 

beginning on January 9, 1962, and ending on May 7, 1975’’ 
S. 3373—23 

each place it appears and inserting ‘‘performed covered service’’; 

and 

(3) by adding at the end the following new subsection: 

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

military, naval, air, or space service— 

‘‘(1) performed in the Republic of Vietnam during the period 

beginning on January 9, 1962, and ending on May 7, 1975; 

‘‘(2) performed in Thailand at any United States or Royal 

Thai base during the period beginning on January 9, 1962, 

and ending on June 30, 1976, without regard to where on 

the base the veteran was located or what military job specialty 

the veteran performed; 

‘‘(3) performed in Laos during the period beginning on 

December 1, 1965, and ending on September 30, 1969; 

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

Cham Province during the period beginning on April 16, 1969, 

and ending on April 30, 1969; or 

‘‘(5) performed on Guam or American Samoa, or in the 

territorial waters thereof, during the period beginning on 

January 9, 1962, and ending on July 31, 1980, or served on 

Johnston Atoll or on a ship that called at Johnston Atoll during 

the period beginning on January 1, 1972, and ending on September 30, 1977.’’. 

(c) ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES.— 

Section 1710(e)(4), as amended by section 102(c), is further amended 

by striking subparagraph (A) and inserting the following new 

subparagraph: 

‘‘(A) The term ‘Vietnam-era herbicide-exposed veteran’ 

means a veteran who— 

‘‘(i) performed covered service, as defined in section 

1116(d) of this title; or 

‘‘(ii) the Secretary finds may have been exposed during 

active military, naval, air, or space service to dioxin during 

the Vietnam era, regardless of the geographic area of such 

service, or was exposed during such service to a toxic 

substance found in a herbicide or defoliant used for military 

purposes during such era, regardless of the geographic 

area of such service.’’. 

(d) CONFORMING AMENDMENT.—The heading for section 1116 

is amended by striking ‘‘the Republic of Vietnam’’ and inserting 

‘‘certain locations’’. 

(e) EFFECTIVE DATE AND APPLICABILITY.—The amendments 

made by this section shall take effect on the date of the enactment 

of this Act and shall apply as follows: 

(1) On the date of the enactment of this Act for claimants 

for dependency and indemnity compensation under chapter 13 

of title 38, United States Code, and for veterans whom the 

Secretary of Veterans Affairs determines are— 

(A) terminally ill; 

(B) homeless; 

(C) under extreme financial hardship; 

(D) more than 85 years old; or 

(E) capable of demonstrating other sufficient cause. 

(2) On October 1, 2022, for everyone not described in paragraph (1). 
S. 3373—24 

SEC. 404. ADDITION OF ADDITIONAL DISEASES ASSOCIATED WITH 

EXPOSURE TO CERTAIN HERBICIDE AGENTS FOR WHICH 

THERE IS A PRESUMPTION OF SERVICE CONNECTION FOR 

VETERANS WHO SERVED IN CERTAIN LOCATIONS. 

(a) SHORT TITLE.—This section may be cited as the ‘‘Fair Care 

for Vietnam Veterans Act of 2022’’. 

(b) MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE.—Section 1116(a)(2) of title 38, United States Code, is 

amended by adding at the end the following new subparagraph: 

‘‘(L) Monoclonal gammopathy of undetermined significance.’’. 

(c) HYPERTENSION.—Such section, as amended by subsection 

(b), is further amended by adding at the end the following new 

subparagraph: 

‘‘(M) Hypertension.’’. 

(d) EFFECTIVE DATES AND APPLICABILITY.— 

(1) MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE.— 

(A) IN GENERAL.—The amendment made by subsection 

(b) shall take effect on the date of the enactment of this 

Act and shall apply as follows: 

(i) On the date of the enactment of this Act for 

claimants for dependency and indemnity compensation 

under chapter 13 of title 38, United States Code, and 

for veterans whom the Secretary of Veterans Affairs 

determines are— 

(I) terminally ill; 

(II) homeless; 

(III) under extreme financial hardship; 

(IV) more than 85 years old; or 

(V) capable of demonstrating other sufficient 

cause. 

(ii) On October 1, 2022, for everyone not described 

in clause (i). 

(B) RETROACTIVE APPLICATION.—Notwithstanding any 

Federal court decisions or settlements in effect on the day 

before the date of the enactment of this Act, the Secretary 

of Veterans Affairs shall award retroactive claims for a 

condition under section 1116(a)(2)(L) of title 38, United 

States Code, as added by subsection (b) of this section, 

only to claimants for dependency and indemnity compensation under chapter 13 of such title described in subparagraph (A)(i) of this paragraph. 

(2) HYPERTENSION.— 

(A) IN GENERAL.—The amendment made by subsection 

(c) shall take effect on the date of the enactment of this 

Act and shall apply as follows: 

(i) On the date of the enactment of this Act for 

claimants for dependency and indemnity compensation 

under chapter 13 of title 38, United States Code, and 

for veterans whom the Secretary of Veterans Affairs 

determines are— 

(I) terminally ill; 

(II) homeless; 

(III) under extreme financial hardship; 

(IV) more than 85 years old; or 
S. 3373—25 

(V) capable of demonstrating other sufficient 

cause. 

(ii) On October 1, 2026, for everyone not described 

in subparagraph (A). 

(B) RETROACTIVE APPLICATION.—Notwithstanding any 

Federal court decisions or settlements in effect on the day 

before the date of the enactment of this Act, the Secretary 

of Veterans Affairs shall award retroactive claims for a 

condition under section 1116(a)(2)(M) of title 38, United 

States Code, as added by subsection (c) of this section, 

only to claimants for dependency and indemnity compensation under chapter 13 of such title described in subparagraph (A)(i) of this paragraph. 

SEC. 405. IMPROVING COMPENSATION FOR DISABILITIES OCCURRING 

IN PERSIAN GULF WAR VETERANS. 

(a) REDUCTION IN THRESHOLD OF ELIGIBILITY.—Subsection 

(a)(1) of section 1117 is amended by striking ‘‘became manifest— 

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

‘‘became manifest to any degree at any time.’’. 

(b) PERMANENT EXTENSION OF PERIOD OF ELIGIBILITY.—Such 

section is further amended— 

(1) by striking subsection (b); 

(2) by redesignating subsections (c) and (d) as subsections 

(b) and (c), respectively; and 

(3) in subsection (a)(2)(C), by striking ‘‘under subsection 

(d)’’ and inserting ‘‘under subsection (c)’’. 

(c) ESTABLISHING SINGULAR DISABILITY-BASED QUESTIONNAIRE.—Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new 

subsection (d): 

‘‘(d) If a Persian Gulf veteran at a medical facility of the 

Department presents with any one symptom associated with Gulf 

War Illness, the Secretary shall ensure that health care personnel 

of the Department use a disability benefits questionnaire, or successor questionnaire, designed to identify Gulf War Illness, in addition to any other diagnostic actions the personnel determine appropriate.’’. 

(d) EXPANSION OF DEFINITION OF PERSIAN GULF VETERAN.— 

Subsection (f) of such section is amended by inserting ‘‘, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan,’’ after ‘‘operations’’. 

(e) TRAINING.—Such section is further amended by adding at 

the end the following new subsection: 

‘‘(i)(1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department 

are appropriately trained to effectively carry out this section. 

‘‘(2) Not less frequently than once each year, the Secretary 

shall submit to Congress a report on the actions taken by the 

Secretary to carry out paragraph (1).’’. 

SEC. 406. PRESUMPTION OF SERVICE CONNECTION FOR CERTAIN DISEASES ASSOCIATED WITH EXPOSURE TO BURN PITS AND 

OTHER TOXINS. 

(a) SHORT TITLE.—This section may be cited as the ‘‘Presumptive Benefits for War Fighters Exposed to Burn Pits and Other 

Toxins Act of 2022’’. 
S. 3373—26 

(b) IN GENERAL.—Subchapter II of chapter 11, as amended 

by section 302, is further amended by inserting after section 1119 

the following new section: 

‘‘§ 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and 

other toxins 

‘‘(a) PRESUMPTION OF SERVICE CONNECTION.—For the purposes 

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

title, a disease specified in subsection (b) becoming manifest in 

a covered veteran shall be considered to have been incurred in 

or aggravated during active military, naval, air, or space service, 

notwithstanding that there is no record of evidence of such disease 

during the period of such service. 

‘‘(b) DISEASES SPECIFIED.—The diseases specified in this subsection are the following: 

‘‘(1) Asthma that was diagnosed after service of the covered 

veteran as specified in subsection (c). 

‘‘(2) The following types of cancer: 

‘‘(A) Head cancer of any type. 

‘‘(B) Neck cancer of any type. 

‘‘(C) Respiratory cancer of any type. 

‘‘(D) Gastrointestinal cancer of any type. 

‘‘(E) Reproductive cancer of any type. 

‘‘(F) Lymphoma cancer of any type. 

‘‘(G) Lymphomatic cancer of any type. 

‘‘(H) Kidney cancer. 

‘‘(I) Brain cancer. 

‘‘(J) Melanoma. 

‘‘(K) Pancreatic cancer. 

‘‘(3) Chronic bronchitis. 

‘‘(4) Chronic obstructive pulmonary disease. 

‘‘(5) Constrictive bronchiolitis or obliterative bronchiolitis. 

‘‘(6) Emphysema. 

‘‘(7) Granulomatous disease. 

‘‘(8) Interstitial lung disease. 

‘‘(9) Pleuritis. 

‘‘(10) Pulmonary fibrosis. 

‘‘(11) Sarcoidosis. 

‘‘(12) Chronic sinusitis. 

‘‘(13) Chronic rhinitis. 

‘‘(14) Glioblastoma. 

‘‘(15) Any other disease for which the Secretary determines, 

pursuant to regulations prescribed under subchapter VII that 

a presumption of service connection is warranted based on 

a positive association with a substance, chemical, or airborne 

hazard identified in the list under section 1119(b)(2) of this 

title. 

‘‘(c) COVERED VETERAN DEFINED.—In this section, the term 

‘covered veteran’ has the meaning given that term in section 1119(c) 

of this title.’’. 

(c) CONFORMING AMENDMENT.—Section 1113 is amended by 

striking ‘‘or 1118’’ each place it appears and inserting ‘‘1118, or 

1120’’. 

(d) EFFECTIVE DATE AND APPLICABILITY.—The amendments 

made by this section shall take effect on the date of the enactment 

of this Act and shall apply as follows: 
S. 3373—27 

(1) On the date of the enactment of this Act for claimants 

for dependency and indemnity compensation under chapter 13 

of title 38, United States Code, and veterans whom the Secretary of Veterans Affairs determines are— 

(A) terminally ill; 

(B) homeless; 

(C) under extreme financial hardship; 

(D) more than 85 years old; or 

(E) capable of demonstrating other sufficient cause. 

(2) On the date of the enactment of this Act for everyone 

not described in paragraph (1), with respect to paragraphs 

(1), (2)(C), (2)(I), (5), (6), (7), (8), (9), (10), (11), (12), (13), 

and (14), of section 1120(b) of title 38, United States Code, 

as added by subsection (b). 

(3) On October 1, 2023, for everyone not described in paragraph (1), with respect to paragraphs (3) and (4) of section 

1120(b) of such title, as so added. 

(4) On October 1, 2024, for everyone not described in paragraph (1), with respect to subparagraphs (A), (B), (D), (E), 

(F), (G), and (K) of section 1120(b)(2) of such title, as so added. 

(5) On October 1, 2025, for everyone not described in paragraph (1), with respect to subparagraphs (H) and (J) of section 

1120(b)(2) of such title, as so added. 

SEC. 407. RULE OF CONSTRUCTION. 

(a) GENERALLY.—Nothing in this Act shall be construed to 

prevent the Secretary of Veterans Affairs from processing claims 

for benefits under title 38, United States Code, for a condition 

or disease for which this Act establishes a presumption of service 

connection, as a claim for benefits for a condition or disease with 

direct service connection. 

(b) EFFECTIVE DATES AND APPLICABILITY.—The Secretary shall 

not deny a claim for benefits under title 38, United States Code, 

for a condition or disease for which this Act establishes a presumption of service connection because the claimant filed the claim 

prior to the effective date or date of applicability for that particular 

condition or disease. 

TITLE V—RESEARCH MATTERS 

SEC. 501. INTERAGENCY WORKING GROUP ON TOXIC EXPOSURE 

RESEARCH. 

(a) ESTABLISHMENT.— (1) IN GENERAL.—Not later than one year after the date 

of the enactment of this Act, the Secretary of Veterans Affairs 

shall, in collaboration with the heads of the entities described 

in paragraph (2), establish the Toxic Exposure Research 

Working Group (in this section referred to as the ‘‘Working 

Group’’). 

(2) COMPOSITION.—The Working Group shall consist of 

employees, selected by the Secretary, of the following: 

(A) The Department of Veterans Affairs. 

(B) The Department of Defense. 

(C) The Department of Health and Human Services. 

(D) The Environmental Protection Agency. 
S. 3373—28 

(E) Other entities of the Federal Government involved 

in research activities regarding the health consequences 

of toxic exposures experienced during active military, naval, 

air, or space service. 

(b) FUNCTIONS.—The Working Group shall perform the following functions: 

(1) Identify collaborative research activities and resources 

available among entities represented by members of the 

Working Group to conduct such collaborative research activities. 

(2) Develop a five-year strategic plan for such entities to 

carry out collaborative research activities. 

(c) REPORTING.—The Secretary shall submit to the Committee 

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

Affairs of the House of Representatives the following: 

(1) Not later than one year after the date of the enactment 

of this Act, a report on the establishment of the Working 

Group under subsection (a). 

(2) Not later than two years after the date of the enactment 

of this Act, a report containing the collaborative research activities identified, and the strategic plan developed, by the Working 

Group under subsection (b). 

(3) Not less frequently than annually during the five-year 

period covered by the strategic plan under subsection (b), a 

progress report on implementation of the strategic plan. 

(d) TERMINATION.—The Working Group shall terminate after 

submitting the final report under subsection (c). 

(e) DEFINITIONS.—In this section: 

(1) ACTIVE MILITARY, NAVAL, AIR, OR SPACE SERVICE.—The 

term ‘‘active military, naval, air, or space service’’ has the 

meaning given that term in section 101 of title 38, United 

States Code. 

(2) COLLABORATIVE RESEARCH ACTIVITY.—The term 

‘‘collaborative research activity’’ means a research activity— 

(A) agreed upon by the Working Group; 

(B) conducted by an entity represented by a member 

of the Working Group; 

(C) funded by the Federal Government; and 

(D) regarding the health consequences of toxic exposures experienced during active military, naval, air, or 

space service. 

(3) TOXIC EXPOSURE.—The term ‘‘toxic exposure’’ has the 

meaning given such term in section 101 of title 38, United 

States Code, as amended by section 102(b). 

SEC. 502. ANALYSIS AND REPORT ON TREATMENT OF VETERANS FOR 

MEDICAL CONDITIONS RELATED TO TOXIC EXPOSURE. 

(a) IN GENERAL.—The Secretary of Veterans Affairs shall analyze, on a continuous basis, all clinical data that— 

(1) is obtained by the Department of Veterans Affairs in 

connection with hospital care, medical services, and nursing 

home care furnished under section 1710(a)(2)(F) of title 38, 

United States Code; and 

(2) is likely to be scientifically useful in determining the 

association, if any, between the medical condition of a veteran 

and a toxic exposure. 

(b) ANNUAL REPORT.—Not later than one year after the date 

of the enactment of this Act, and annually thereafter, the Secretary 
S. 3373—29 

shall submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives a report containing the following: 

(1) The aggregate data compiled under subsection (a). 

(2) An analysis of such data. 

(3) A description of the types and incidences of medical 

conditions identified by the Department under such subsection. 

(4) The explanation of the Secretary for the incidence of 

such medical conditions and other explanations for the 

incidence of such conditions as the Secretary considers reasonable. 

(5) The views of the Secretary on the scientific validity 

of drawing conclusions from the incidence of such medical conditions, as evidenced by the data compiled under subsection (a), 

regarding any association between such conditions and toxic 

exposures. 

(c) TOXIC EXPOSURE DEFINED.—In this section, the term ‘‘toxic 

exposure’’ has the meaning given such term in section 101 of title 

38, United States Code, as amended by section 102(b). 

SEC. 503. ANALYSIS RELATING TO MORTALITY OF VETERANS WHO 

SERVED IN SOUTHWEST ASIA. 

(a) ANALYSIS.— 

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

of the enactment of this Act, the Secretary of Veterans Affairs, 

in coordination with the Secretary of Defense, shall conduct 

an updated analysis of total and respiratory disease mortality 

in covered veterans. 

(2) ELEMENTS.—The analysis required by paragraph (1) 

shall include, to the extent practicable, the following with 

respect to each covered veteran: 

(A) Metrics of airborne exposures. 

(B) The location and timing of deployments of the 

veteran. 

(C) The military occupational specialty of the veteran. 

(D) The Armed Force in which the veteran served. 

(E) Pre-existing health status of the veteran, including 

with respect to asthma. 

(F) Relevant personal information of the veteran, 

including cigarette and e-cigarette smoking history, diet, 

sex, gender, age, race, and ethnicity. 

(b) COVERED VETERAN DEFINED.—In this section, the term ‘‘covered veteran’’ means any veteran who— 

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

(A) Bahrain; 

(B) Iraq; 

(C) Kuwait; 

(D) Oman; 

(E) Qatar; 

(F) Saudi Arabia; 

(G) Somalia; or 

(H) the United Arab Emirates; or 

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

in— 

(A) Afghanistan; 

(B) Djibouti; 

(C) Egypt; 
S. 3373—30 

(D) Jordan; 

(E) Lebanon; 

(F) Syria; or 

(G) Yemen. 

SEC. 504. STUDY ON HEALTH TRENDS OF POST–9/11 VETERANS. 

The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the 

Armed Forces after September 11, 2001. 

SEC. 505. STUDY ON CANCER RATES AMONG VETERANS. 

(a) IN GENERAL.—The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans to determine 

trends in the rates of the incidence of cancer in veterans. 

(b) ELEMENTS.—The study required by subsection (a) shall 

assess, with respect to each veteran included in the study, the 

following: 

(1) The age of the veteran. 

(2) The period of service and length of service of the veteran 

in the Armed Forces. 

(3) The military occupational specialty or specialties of 

the veteran. 

(4) The sex of the veteran. 

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

SEC. 506. STUDY ON HEALTH EFFECTS OF WASTE RELATED TO 

MANHATTAN PROJECT ON CERTAIN VETERANS. 

(a) STUDY.—Not later than 180 days after the date of the 

enactment of this Act, the Secretary of Veterans Affairs shall enter 

into an agreement with the National Academies of Sciences, 

Engineering, and Medicine for the conduct of a study on the health 

trends of veterans who, while serving in the active military, naval, 

air, or space service— 

(1) participated in activities relating to the Manhattan 

Project (including activities relating to covered waste) in connection with such service; or 

(2) resided at or near, as determined by the Secretary, 

the locations described in subsection (b). 

(b) COVERED LOCATIONS.—The locations described in this subsection are the following locations: 

(1) In the county of St. Louis, Missouri, the following: 

(A) Coldwater Creek, Missouri. 

(B) The St. Louis Airport Site, Missouri. 

(C) The West Lake Landfill. 

(2) Oak Ridge, Tennessee. 

(3) Hanford, Washington. 

(4) Any other location that is proximate to covered waste, 

as determined by the Secretary. 

(c) ELEMENTS.—The study under subsection (a) shall assess, 

with respect to each veteran included in the study, the following: 

(1) The age, sex, and race of the veteran. 

(2) The period and location of exposure to covered waste. 

(3) Any type of cancer, or other illness associated with 

toxic exposure, that the veteran has. 

(4) A comparison of the overall health condition of the 

veteran, including any illness of the veteran identified pursuant 

to paragraph (3), with the overall health condition of past 
S. 3373—31 

and present civilian populations residing at the same location 

of exposure, as determined by the Secretary. 

(d) REPORT.—Not later than three years after the date of the 

enactment of this Act, the Secretary shall submit to the Committee 

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

Affairs of the House of Representatives a report on the study 

under subsection (a) and include in such report an analysis of 

the data available and data reliability. 

(e) DEFINITIONS.—In this section: 

(1) ACTIVE MILITARY, NAVAL, AIR, OR SPACE SERVICE; TOXIC

EXPOSURE.—The terms ‘‘active military, naval, air, or space 

service’’ and ‘‘toxic exposure’’ have the meanings given those 

terms in section 101 of title 38, United States Code, as added 

by section 102(b). 

(2) COVERED WASTE.—The term ‘‘covered waste’’ means any 

waste arising from activities carried out in connection with 

the Manhattan Project. 

(3) ILLNESS.—The term ‘‘illness’’ has the meaning given 

that term in section 1171 of title 38, United States Code, 

as added by section 202. 

(4) TOXIC EXPOSURE.—The term ‘‘toxic exposure’’ has the 

meaning given such term in section 101 of title 38, United 

States Code, as amended by section 102(b). 

SEC. 507. STUDY ON TOXIC EXPOSURE AND MENTAL HEALTH OUTCOMES. 

(a) STUDY REQUIRED.—Not later than 180 days after the date 

of the enactment of this Act, the Secretary of Veterans Affairs 

shall enter into an agreement with the National Academies of 

Sciences, Engineering, and Medicine for the conduct of a study 

of veterans to assess possible relationships between toxic exposures 

experienced during service in the Armed Forces and mental health 

conditions, including chronic multisymptom illness, traumatic brain 

injury, post-traumatic stress disorder, depression, episodes of psychosis, schizophrenia, bipolar disorder, suicide attempts, and suicide 

deaths. 

(b) ELEMENTS.—For each veteran included in the study under 

subsection (a), the following information shall be collected and 

assessed: 

(1) Age. 

(2) Sex. 

(3) Race and ethnicity. 

(4) Period and length of service in the Armed Forces. 

(5) The military occupational specialty or specialties of 

the veteran. 

(6) History of toxic exposure during service in the Armed 

Forces. 

(7) Any diagnosis of chronic multisymptom illness. 

(8) Any diagnosis of a mental health or cognitive disorder. 

(9) Any history of suicide attempt or suicidality. 

(10) If the veteran died by suicide. 

(11) Any confounding traumatic experiences that could 

affect a veteran’s mental health. 

(c) REPORT.—Not later than three years after the date of the 

enactment of this Act, the Secretary shall submit to the Committee 

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

Affairs of the House of Representatives a report containing the 
S. 3373—32 

findings of the National Academies of Sciences, Engineering, and 

Medicine with respect to the study conducted under subsection 

(a). 

SEC. 508. STUDY ON VETERANS IN TERRITORIES OF THE UNITED 

STATES. 

(a) GAO STUDY.— 

(1) IN GENERAL.—The Comptroller General of the United 

States shall conduct a study on the state of access and barriers 

to benefits and services furnished by the Veterans Benefits 

Administration and the Veterans Health Administration under 

laws administered by the Secretary of Veterans Affairs to veterans in Territories and Freely Associated States of the United 

States, including deficits in the availability and accessibility 

of such benefits and services compared to veterans elsewhere 

in the United States. 

(2) ELEMENTS.—The study under paragraph (1) shall 

include— 

(A) the number of veterans in each Territory and Freely 

Associated State of the United States; 

(B) the number of veterans in each Territory and Freely 

Associated State who are enrolled in the system of annual 

patient enrollment of the Department of Veterans Affairs 

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

(C) a description of how the Department estimates 

the number of veterans in each Territory and Freely Associated State who are eligible for services under section 1710 

of such title but who are not enrolled as described in 

subparagraph (B); 

(D) a detailed description of obstacles facing veterans 

in each Territory and Freely Associated State in accessing 

health care services, including those involving the availability of such services to veterans in the Territory or 

Freely Associated State in which the veterans reside, and 

any distance impediments to receiving services at a regional 

medical center of the Veterans Health Administration, a 

community-based outpatient clinic, another full-service 

medical facility of the Department, or a Vet Center, respectively; 

(E) a detailed description of obstacles facing veterans 

in each Territory and Freely Associated State in accessing 

readjustment counseling services, including those involving 

the availability of such services to veterans in the Territory 

in which the veterans reside, and any distance impediments 

to receiving services at a readjustment counseling services 

center of the Department; 

(F) a detailed description of obstacles facing veterans 

in each Territory and Freely Associated State in accessing 

non-health care veterans benefits, including those involving 

the availability of benefits and services to veterans in the 

Territory or Freely Associated State in which the veterans 

reside, and any distance impediments to accessing the 

nearest office of the Veterans Benefits Administration; 

(G) an analysis of the staffing and quality of the offices 

of the Veterans Benefits Administration and Veterans 

Health Administration charged with serving veterans in 

the Territories and Freely Associated States, including the 
S. 3373—33 

availability of the full- and part-time staff of each office 

to the veterans they are charged with serving; 

(H) an analysis of the availability of the Veterans 

Community Care Program established under section 1703 

of title 38, United States Code, to veterans in each Territory 

and Freely Associated State; 

(I) an analysis of the economic and health outcomes 

for veterans in each Territory or Freely Associated State 

resulting from obstacles to accessing adequate assistance 

and health care at facilities of the Department; 

(J) an analysis of the access to benefit assistance and 

health care provided to veterans in the aftermath of major 

disasters declared in each of the Territories and Freely 

Associated States since September 4, 2017; and 

(K) such recommendations as the Comptroller General 

considers appropriate for improving access of veterans in 

the Territories and Freely Associated States to benefits 

and health care services furnished by the Secretary, and 

reducing barriers and deficits in the availability and accessibility of such benefits and services compared to veterans 

elsewhere in the United States. 

(b) BRIEFING.—Not later than one year after the date of the 

enactment of this Act, the Comptroller General shall provide to 

the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a 

briefing setting forth the results of the study conducted under 

subsection (a), including any recommendations developed under 

paragraph (2)(K) of such subsection. 

(c) DEFINITIONS.—In this section: 

(1) FREELY ASSOCIATED STATE.—The term ‘‘Freely Associated State’’ includes the Federated States of Micronesia, the 

Republic of the Marshall Islands, and the Republic of Palau. 

(2) TERRITORY.—The term ‘‘Territory’’ includes American 

Samoa, the Commonwealth of the Northern Marianas Islands, 

Guam, Puerto Rico, and the Virgin Islands. 

(3) VET CENTER.—The term ‘‘Vet Center’’ has the meaning 

given that term in section 1712A(h) of title 38, United States 

Code. 

SEC. 509. DEPARTMENT OF VETERANS AFFAIRS PUBLIC WEBSITE FOR 

TOXIC EXPOSURE RESEARCH. 

(a) WEBSITE.—Not later than one year after the date of the 

enactment of this Act, the Secretary of Veterans Affairs shall establish, and maintain thereafter, a publicly accessible internet website 

of the Department of Veterans Affairs that serves as a clearinghouse 

for the publication of all toxic exposure research carried out or 

funded by the executive branch of the Federal Government. 

(b) COORDINATION.—In carrying out subsection (a), the Secretary shall coordinate with— 

(1) the heads of each Federal agency carrying out or funding 

toxic exposure research; 

(2) the War Related Illness and Injury Study Center of 

the Department of Veterans Affairs, or successor center; and 

(3) any working group of the Department of Veterans 

Affairs or other similar entity responsible for coordinating toxic 

exposure research. 

(c) DEFINITIONS.—In this section: 
S. 3373—34 

(1) TOXIC EXPOSURE.—The term ‘‘toxic exposure’’ has the 

meaning given that term in section 101 of title 38, United 

States Code, as added by section 102(b). 

(2) TOXIC EXPOSURE RESEARCH.—The term ‘‘toxic exposure 

research’’ means research on the health consequences of toxic 

exposures experienced during service in the Armed Forces. 

SEC. 510. REPORT ON HEALTH EFFECTS OF JET FUELS USED BY 

ARMED FORCES. 

(a) INITIAL REPORT.—Not later than one year after the date 

of the enactment of this Act, the Secretary of Veterans Affairs 

shall submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives, and make publicly available, a report on health effects of 

jet fuels used by the Armed Forces. 

(b) CONTENTS.—The report submitted under subsection (a) shall 

include the following: 

(1) A discussion of the effect of various different types 

of jet fuels used by the Armed Forces on the health of individuals by length of exposure. 

(2) An identification of the immediate symptoms of jet 

fuel exposure that may indicate future health risks. 

(3) A chronology of health safeguards implemented by the 

Armed Forces intended to reduce the exposure of members 

of the Armed Forces to jet fuel. 

(4) An identification of any areas relating to jet fuel exposure about which new research needs to be conducted. 

(c) FOLLOW-UP REPORT.—Not later than five years after the 

date of the submittal of the report under subsection (a), the Secretary shall submit to the committees referred to in such subsection 

an update to such report. 

TITLE VI—IMPROVEMENT OF RESOURCES AND TRAINING REGARDING 

TOXIC-EXPOSED VETERANS 

SEC. 601. SHORT TITLE; DEFINITIONS. 

(a) SHORT TITLE.—This title may be cited as the ‘‘Fairly 

Assessing Service-related Toxic Exposure Residuals Presumptions 

Act of 2022’’ or the ‘‘FASTER Presumption Act of 2022’’. 

(b) DEFINITIONS.—In this title, the terms ‘‘active military, naval, 

air, or space service’’, ‘‘toxic exposure’’, and ‘‘toxic-exposed veteran’’ 

have the meanings given those terms in section 101 of title 38, 

United States Code, as amended by section 102. 

SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT 

OF VETERANS AFFAIRS FOR TOXIC-EXPOSED VETERANS 

AND VETERANS WHO REPORT TOXIC EXPOSURES AND 

OUTREACH PROGRAM FOR SUCH VETERANS AND CAREGIVERS AND SURVIVORS OF SUCH VETERANS. 

(a) PUBLICATION OF LIST OF RESOURCES.— 

(1) IN GENERAL.—Not later than one year after the date 

of the enactment of this Act, and annually thereafter, the 

Secretary of Veterans Affairs shall publish a list of resources 

of the Department of Veterans Affairs for— 
S. 3373—35 

(A) toxic-exposed veterans and veterans who report 

toxic exposure; 

(B) families and caregivers of such veterans; and 

(C) survivors of such veterans who are receiving death 

benefits under the laws administered by the Secretary. 

(2) UPDATE.—The Secretary shall periodically update the 

list published under paragraph (1). 

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

the community, an informative outreach program for veterans on 

illnesses that may be related to toxic exposures, including outreach 

with respect to benefits and support programs. 

SEC. 603. INCORPORATION OF TOXIC EXPOSURE SCREENING FOR VETERANS. 

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

date of the enactment of this Act, the Secretary of Veterans Affairs 

shall incorporate a screening to help determine potential toxic exposures during active military, naval, air, or space service as part 

of a health care screening furnished by the Department of Veterans 

Affairs to veterans enrolled in the system of annual patient enrollment of the Department established and operated under section 

1705 of title 38, United States Code, to improve understanding 

by the Department of toxic exposures while serving in the Armed 

Forces. 

(b) TIMING.—The Secretary shall ensure that a veteran 

described in subsection (a) completes the screening required under 

such subsection not less frequently than once every five years. 

(c) DETERMINATION OF QUESTIONS.— 

(1) IN GENERAL.—The questions included in the screening 

required under subsection (a) shall be determined by the Secretary with input from medical professionals. 

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

required under subsection (a) shall, with respect to a veteran, 

include— 

(A) a question about the potential exposure of the 

veteran to an open burn pit; and 

(B) a question regarding toxic exposures that are commonly associated with service in the Armed Forces. 

(3) OPEN BURN PIT DEFINED.—In this subsection, the term 

‘‘open burn pit’’ means an area of land that— 

(A) is designated by the Secretary of Defense to be 

used for disposing solid waste by burning in the outdoor 

air; and 

(B) does not contain a commercially manufactured 

incinerator or other equipment specifically designed and 

manufactured for the burning of solid waste. 

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

under subsection (a), the Secretary shall ensure that print materials 

complementary to such screening that outline related resources 

for veterans are available at each medical center of the Department 

to veterans who may not have access to the internet. 

(e) SCREENING UPDATES.—The Secretary shall consider updates 

to the content of the screening required under subsection (a) not 

less frequently than biennially to ensure the screening contains 

the most current information. 
S. 3373—36 

SEC. 604. TRAINING FOR PERSONNEL OF THE DEPARTMENT OF VETERANS AFFAIRS WITH RESPECT TO VETERANS WHO 

REPORT TOXIC EXPOSURES. 

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

Affairs shall provide to health care personnel of the Department 

of Veterans Affairs education and training to identify, treat, and 

assess the impact on veterans of illnesses related to toxic exposures 

and inform such personnel of how to ask for additional information 

from veterans regarding different toxic exposures. 

(b) BENEFITS PERSONNEL.— 

(1) IN GENERAL.—The Secretary shall incorporate a training 

program for processors of claims under the laws administered 

by the Secretary who review claims for disability benefits 

relating to service-connected disabilities based on toxic exposures. 

(2) ANNUAL TRAINING.—Training provided to processors 

under paragraph (1) shall be provided not less frequently than 

annually. 

TITLE VII—RESOURCING 

SEC. 701. AUTHORITY TO USE APPROPRIATIONS TO ENHANCE CLAIMS 

PROCESSING CAPACITY AND AUTOMATION. 

(a) AUTHORITY.—The Secretary of Veterans Affairs may use, 

from amounts appropriated to the Cost of War Toxic Exposures 

Fund established by section 324 of title 38, United States Code, 

as added by section 805 of this Act, such amounts as may be 

necessary to continue the modernization, development, and expansion of capabilities and capacity of information technology systems 

and infrastructure of the Veterans Benefits Administration, 

including for claims automation, to support expected increased 

claims processing for newly eligible veterans pursuant to this Act. 

(b) PLAN FOR MODERNIZATION OF VETERANS BENEFITS ADMINISTRATION INFORMATION TECHNOLOGY SYSTEMS.— 

(1) IN GENERAL.—Not later than 180 days after the date 

of the enactment of this Act, the Secretary of Veterans Affairs 

shall submit to the appropriate congressional committees a 

plan for the modernization of the information technology systems of the Veterans Benefits Administration. The plan shall 

cover the first fiscal year that begins after the date of the 

enactment of this Act and the subsequent four fiscal years 

and shall include each of the following: 

(A) An identification of any information system to be 

modernized or retired, if applicable, during the period covered by the plan. 

(B) A description of how the Secretary intends to incorporate the following principles into the modernization of 

such information systems: 

(i) The purpose of automation should be to increase 

the speed and accuracy of claims processing decisions. 

(ii) Automation should be conducted in a manner 

that enhances the productivity of employees of the 

Department of Veterans Affairs. 

(iii) Automation should be carried out in a manner 

that achieves greater consistency in the processing and 
S. 3373—37 

rating of claims by relying on patterns of similar evidence in claim files. 

(iv) To the greatest extent possible, automation 

should be carried out by drawing from information 

in the possession of the Department, other Government 

agencies, and applicants for benefits. 

(v) Automation of any claims analysis or determination process should not be end-to-end or lack intermediation. 

(vi) Employees of the Department should continue 

to make decisions with respect to the approval of claims 

and the granting of benefits. 

(vii) Automation should not be carried out in a 

manner that reduces or infringes upon the due process 

rights of applicants for benefits under the laws 

administered by the Secretary; or the duties of the 

Secretary to assist and notify claimants. 

(viii) Automation should be carried out while 

taking all necessary measures to protect the privacy 

of claimants and their personally identifiable information. 

(ix) Automation of claims processing should not 

eliminate or reduce the workforce of the Veterans 

Benefits Administration. 

(C) An identification of targets, for each fiscal year, 

by which the Secretary intends to complete the modernization of each information system or major component or 

functionality of such system identified under subparagraph 

(A). 

(D) Cost estimates for the modernization of each 

information system identified under paragraph (A) for each 

fiscal year covered by the plan and in total. 

(2) APPROPRIATE CONGRESSIONAL COMMITTEES.—In this section, the term ‘‘appropriate congressional committees’’ means— 

(A) the Committee on Veterans’ Affairs and the Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies of the Committee on Appropriations of 

the Senate; and 

(B) the Committee on Veterans’ Affairs and the Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies of the Committee on Appropriations of 

the House of Representatives. 

SEC. 702. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES OF 

DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR 

2023. 

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

out the following major medical facility leases in fiscal year 2023: 

(1) Lease for an outpatient clinic in the vicinity of Allentown, Pennsylvania, in an estimated amount of $31,832,000. 

(2) Lease for a facility for member services for the Veterans 

Health Administration in the vicinity of Atlanta, Georgia, in 

an estimated amount of $27,134,000. 

(3) Lease for an outpatient clinic in the vicinity of Baltimore, Maryland, in an estimated amount of $43,041,000. 

(4) Lease for an outpatient clinic in the vicinity of Baton 

Rouge, Louisiana, in an estimated amount of $29,550,000. 
S. 3373—38 

(5) Lease for an outpatient clinic in the vicinity of Beaufort, 

South Carolina, in an estimated amount of $24,254,000. 

(6) Lease for an outpatient clinic in the vicinity of Beaumont, Texas, in an estimated amount of $15,632,000. 

(7) Lease for an outpatient clinic in the vicinity of Brainerd, 

Minnesota, in an estimated amount of $14,669,000. 

(8) Lease for a facility for research in the vicinity of Buffalo, 

New York, in an estimated amount of $11,106,000. 

(9) Lease for an outpatient clinic in the vicinity of Clarksville, Tennessee, in an estimated amount of $75,135,000. 

(10) Lease of a facility for research in the vicinity of 

Columbia, Missouri, in an estimated amount of $20,726,000. 

(11) Lease for an outpatient clinic in the vicinity of 

Cookeville, Tennessee, in an estimated amount of $10,958,000. 

(12) Lease for a residential treatment facility in the vicinity 

of Denver, Colorado, in an estimated amount of $9,133,000. 

(13) Lease for an outpatient clinic in the vicinity of 

Elizabethtown, Kentucky, in an estimated amount of 

$16,671,000. 

(14) Lease for an outpatient clinic in the vicinity of Farmington, Missouri, in an estimated amount of $17,940,000. 

(15) Lease for an outpatient clinic in the vicinity of 

Hampton, Virginia, in an estimated amount of $63,085,000. 

(16) Lease for an outpatient clinic in the vicinity of Jacksonville, North Carolina, in an estimated amount of $61,450,000. 

(17) Lease for an outpatient clinic in the vicinity of Killeen, 

Texas, in an estimated amount of $61,030,000. 

(18) Lease for an outpatient clinic in the vicinity of Lawrence, Indiana, in an estimated amount of $15,811,000. 

(19) Lease for an outpatient clinic in the vicinity of Lecanto, 

Florida, in an estimated amount of $15,373,000. 

(20) Lease for an outpatient clinic in the vicinity of Nashville, Tennessee, in an estimated amount of $58,038,000. 

(21) Lease for an outpatient clinic in the vicinity of North 

Kansas City, Missouri, in an estimated amount of $40,027,000. 

(22) Lease for an outpatient clinic in the vicinity of 

Pflugerville, Texas, in an estimated amount of $16,654,000. 

(23) Lease for an outpatient clinic in the vicinity of Plano, 

Texas, in an estimated amount of $32,796,000. 

(24) Lease for an outpatient clinic in the vicinity of Prince 

George’s County, Maryland, in an estimated amount of 

$31,754,000. 

(25) Lease for an outpatient clinic in the vicinity of Rolla, 

Missouri, in an estimated amount of $21,352,000. 

(26) Lease for an outpatient clinic in the vicinity of Salt 

Lake City, Utah, in an estimated amount of $29,466,000. 

(27) Lease for an outpatient clinic in the vicinity of Sarasota, Florida, in an estimated amount of $36,517,000. 

(28) Lease for an outpatient clinic in the vicinity of Springfield, Massachusetts, in an estimated amount of $30,918,000. 

(29) Lease for a community living center in the vicinity 

of Tampa, Florida, in an estimated amount of $51,682,000. 

(30) Lease for an outpatient clinic in the vicinity of The 

Villages, Florida, in an estimated amount of $48,267,000. 

(31) Lease for an outpatient clinic in the vicinity of TriCities, Washington, in an estimated amount of $36,136,000. 
S. 3373—39 

(b) TREATMENT OF AUTHORIZATIONS.—The authorization of 

leases under subsection (a) shall be considered to be a specific 

authorization by law of the funds for such leases for purposes 

of section 8104(a)(2) of title 38, United States Code, as in effect 

on the day before the date of the enactment of this Act. 

(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 

to be appropriated to the Secretary of Veterans Affairs for fiscal 

year 2023, or the year in which funds are appropriated for the 

Medical Facilities account, $998,137,000 for the leases authorized 

in subsection (a). 

SEC. 703. TREATMENT OF MAJOR MEDICAL FACILITY LEASES OF THE 

DEPARTMENT OF VETERANS AFFAIRS. 

(a) CONGRESSIONAL APPROVAL OF MAJOR MEDICAL FACILITY

LEASES.—Paragraph (2) of subsection (a) of section 8104 of title 

38, United States Code, is amended— 

(1) by striking ‘‘No funds’’ and inserting ‘‘(A) No funds’’; 

(2) by striking ‘‘or any major medical facility lease’’; 

(3) by striking ‘‘or lease’’; and 

(4) by adding at the end the following new subparagraph: 

‘‘(B) No funds may be appropriated for any fiscal year, 

and the Secretary may not obligate or expend funds (other 

than for advance planning and design), for any major medical 

facility lease unless the Committee on Veterans’ Affairs of 

the Senate and the Committee on Veterans’ Affairs of the 

House of Representatives each adopt a resolution approving 

the lease.’’. 

(b) MODIFICATION OF DEFINITION OF MAJOR MEDICAL FACILITY

LEASE.—Subparagraph (B) of paragraph (3) of such subsection is 

amended to read as follows: 

‘‘(B) The term ‘major medical facility lease’— 

‘‘(i) means a lease for space for use as a new medical 

facility approved through the General Services Administration under section 3307(a) of title 40 at an average annual 

rent equal to or greater than the appropriate dollar 

threshold described in such section, which shall be subject 

to annual adjustment in accordance with section 3307(h) 

of such title; and 

‘‘(ii) does not include a lease for space for use as a 

shared Federal medical facility for which the Department’s 

estimated share of the lease costs does not exceed such 

dollar threshold.’’. 

(c) SEPARATE PROSPECTUS REQUIREMENT FOR MAJOR MEDICAL

FACILITY LEASES.—Subsection (b) of such section is amended— 

(1) by striking paragraph (7); 

(2) in paragraph (1), by redesignating subparagraphs (A) 

through (E) as clauses (i) through (v), respectively; 

(3) in paragraph (6), by redesignating subparagraphs (A) 

through (C) as clauses (i) through (iii), respectively; 

(4) by redesignating paragraphs (1) through (6) as subparagraphs (A) through (F), respectively; 

(5) in the matter preceding subparagraph (A), as redesignated by paragraph (4)— 

(A) by striking ‘‘Whenever the President’’ and inserting 

‘‘(1) Whenever the President’’; 

(B) by striking ‘‘the Congress’’ and inserting ‘‘Congress’’; and 
S. 3373—40 

(C) by striking ‘‘or a major medical facility lease (as 

defined in subsection (a)(3)(b))’’; 

(6) in subparagraph (A), as redesignated by paragraph 

(4), by striking ‘‘leased,’’; 

(7) in subparagraph (E), as redesignated by paragraph 

(4)— 

(A) by striking ‘‘or lease’’ each place it appears; and 

(B) by striking ‘‘or leases’’; and 

(8) by adding at the end the following new paragraph: 

‘‘(2) Whenever the President or the Secretary submit to Congress a request for the funding of a major medical facility lease 

(as defined in subsection (a)(3)(B)), the Secretary shall submit to 

each committee, on the same day, a prospectus of the proposed 

medical facility. Any such prospectus shall include the following: 

‘‘(A) A description of the facility to be leased. 

‘‘(B) An estimate of the cost to the Federal Government 

of the facility to be leased. 

‘‘(C) An estimate of the energy performance of the proposed 

lease space, to include a description of anticipated utilization 

of renewable energy, energy efficient and climate resilient elements, and related matters. 

‘‘(D) Current and projected workload and utilization data 

regarding the facility to be leased, including information on 

projected changes in workload and utilization over a five-year 

period, a ten-year period, and a twenty-year period. 

‘‘(E) A detailed analysis of how the lease is expected to 

comply with Office of Management and Budget Circular A– 

11 and section 1341 of title 31 (commonly referred to as the 

‘Anti-Deficiency Act’). Any such analysis shall include— 

‘‘(i) an analysis of the classification of the lease as 

a ‘lease purchase’, a ‘capital lease’, or an ‘operating lease’ 

as those terms are defined in Office of Management and 

Budget Circular A–11; 

‘‘(ii) an analysis of the obligation of budgetary resources 

associated with the lease; and 

‘‘(iii) an analysis of the methodology used in determining the asset cost, fair market value, and cancellation 

costs of the lease.’’. 

(d) INTERIM LEASING ACTIONS.—Such section is further 

amended by adding at the end the following new subsection: 

‘‘(i)(1) Notwithstanding subsection (a)(2)(B), the Secretary may 

carry out interim leasing actions as the Secretary considers necessary for the following leases: 

‘‘(A) Major medical facility leases (as defined in subsection 

(a)(3)(B)) approved pursuant to this section and for which a 

prospectus for a replacement lease has been submitted to Congress pursuant to subsection (b)(2). 

‘‘(B) Replacement leases that do not require approval under 

this section and for which a prospectus has been submitted 

to Congress pursuant to subsection (b)(2). 

‘‘(2) In this subsection, the term ‘interim leasing actions’ has 

the meaning given that term by the Administrator of the General 

Services Administration.’’. 

(e) PURCHASE OPTIONS.—Such section is further amended by 

adding at the end the following new subsection: 
S. 3373—41 

‘‘(j) The Secretary may obligate and expend funds to exercise 

a purchase option included in any major medical facility lease 

(as defined in subsection (a)(3)(B)).’’. 

(f) APPLICABILITY.—The amendments made by this section shall 

apply with respect to any lease that has not been specifically 

authorized by law on or before the date of the enactment of this 

Act. 

SEC. 704. AUTHORITY TO ENTER INTO AGREEMENTS WITH ACADEMIC 

AFFILIATES AND OTHER ENTITIES TO ACQUIRE SPACE 

FOR THE PURPOSE OF PROVIDING HEALTH-CARE 

RESOURCES TO VETERANS. 

Section 8103 of title 38, United States Code, is amended by 

adding at the end the following new subsection: 

‘‘(h)(1) Notwithstanding any other provision of law requiring 

the use of competitive procedures, including section 2304 of title 

10, when the Secretary determines it to be in the best interest 

of the Department, the Secretary may enter into a lease with 

an academic affiliate or covered entity to acquire space for the 

purpose of providing health-care resources to veterans. 

‘‘(2) In this subsection: 

‘‘(A) The term ‘academic affiliate’ means an institution 

or organization described in section 7302(d) of this title. 

‘‘(B) The term ‘covered entity’ means a unit or subdivision 

of a State, local, or municipal government, public or nonprofit 

agency, institution, or organization, or other institution or 

organization as the Secretary considers appropriate that owns 

property controlled by an academic affiliate to be leased under 

this subsection. 

‘‘(C) The term ‘health -care resource’ has the meaning given 

that term in section 8152(1) of this title. 

‘‘(D) The term ‘space’ means any room, unit, floor, wing, 

building, parking facility, or other subdivision of a building 

or facility owned or controlled by an academic affiliate.’’. 

SEC. 705. MODIFICATIONS TO ENHANCED-USE LEASE AUTHORITY OF 

DEPARTMENT OF VETERANS AFFAIRS. 

(a) MODIFICATIONS TO AUTHORITY.—Paragraph (2) of section 

8162(a) of title 38, United States Code, is amended to read as 

follows: 

‘‘(2)(A) The Secretary may enter into an enhanced-use lease 

on or after the date of the enactment of this paragraph only if 

the Secretary determines— 

‘‘(i) that the lease will not be inconsistent with, and will 

not adversely affect— 

‘‘(I) the mission of the Department; or 

‘‘(II) the operation of facilities, programs, and services 

of the Department in the area of the leased property; 

and 

‘‘(ii) that— 

‘‘(I) the lease will enhance the use of the leased property by directly or indirectly benefitting veterans; or 

‘‘(II) the leased property will provide supportive 

housing. 

‘‘(B) The Secretary shall give priority to enhanced-use leases 

that, on the leased property— 

‘‘(i) provide supportive housing for veterans; 
S. 3373—42 

‘‘(ii) provide direct services or benefits targeted to veterans; 

or 

‘‘(iii) provide services or benefits that indirectly support 

veterans.’’. 

(b) EXTENSION OF MAXIMUM TERM OF ENHANCED-USE LEASE.— 

Section 8162(b)(2) of such title is amended by striking ‘‘75 years’’ 

and inserting ‘‘99 years’’. 

(c) MODIFICATION OF USE OF PROCEEDS.—Section 8165(a)(1) 

of such title is amended by striking ‘‘shall be deposited in the 

Department of Veterans Affairs Medical Care Collections Fund 

established under section 1729A of this title.’’ and inserting ‘‘shall, 

at the discretion of the Secretary, be deposited in— 

‘‘(A) the Department of Veterans Affairs Medical Care 

Collections Fund established under section 1729A of this title; 

or 

‘‘(B) the Medical Facilities or Construction, Minor Projects 

account of the Department to be used to defray the costs of 

administration, maintenance, repair, and related expenses 

incurred by the Department with respect to property that is 

owned by or under the jurisdiction or control of the Department.’’. 

(d) REPEAL OF SUNSET.—Section 8169 of such title is repealed. 

(e) APPROPRIATION.—In addition to amounts otherwise available, there is appropriated for fiscal year 2022, out of any funds 

in the Treasury not otherwise appropriated, $922,000,000 for an 

additional amount for the Department of Veterans Affairs, to remain 

available until expended, to enter into enhanced-use leases pursuant 

to section 8162 of title 38, United States Code, as amended by 

this section. 

SEC. 706. AUTHORITY FOR JOINT LEASING ACTIONS OF DEPARTMENT 

OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS. 

(a) DEPARTMENT OF DEFENSE.—Section 1104A of title 10, 

United States Code, is amended— 

(1) by inserting ‘‘, or the leasing,’’ after ‘‘design, and 

construction’’ each place it appears; and 

(2) in subsection (c)(2), by inserting ‘‘, or the leasing,’’ 

after ‘‘design’’. 

(b) DEPARTMENT OF VETERANS AFFAIRS.—Section 8111B of title 

38, United States Code, is amended— 

(1) in subsection (a), by inserting ‘‘, or the leasing,’’ after 

‘‘design, and construction’’; 

(2) in subsection (b), by adding at the end the following 

new paragraph: 

‘‘(3) The Secretary of Veterans Affairs may transfer to the 

Department of Defense amounts appropriated to the ‘Medical Facilities’ account of the Department of Veterans Affairs for the purpose 

of leasing space for a shared medical facility if the estimated share 

of the Department of Veterans Affairs for the lease costs does 

not exceed the amount specified in section 8104(a)(3)(B) of this 

title.’’; and 

(3) in subsection (c), by adding at the end the following 

new paragraph: 

‘‘(3) Any amount transferred to the Secretary of Veterans Affairs 

by the Secretary of Defense for the purpose of leasing space for 

a shared medical facility may be credited to the ‘Medical Facilities’ 
S. 3373—43 

account of the Department of Veterans Affairs and may be used 

for such purpose.’’. 

SEC. 707. APPROPRIATION OF AMOUNTS FOR MAJOR MEDICAL 

FACILITY LEASES. 

(a) FISCAL YEAR 2023.—In addition to amounts otherwise available, there is appropriated for fiscal year 2023, out of any funds 

in the Treasury not otherwise appropriated, $1,880,000,000 for an 

additional amount for the Medical Facilities account of the Department of Veterans Affairs, to remain available until expended, for 

major medical facility leases authorized by section 702. 

(b) ADDITIONAL YEARS.—In addition to amounts otherwise available, there is appropriated, out of any funds in the Treasury not 

otherwise appropriated, for an additional amount for the Medical 

Facilities account of the Department of Veterans Affairs, to remain 

available until expended, for major medical facility leases authorized by section 702 or approved pursuant to subchapter I of chapter 

81 of title 38, United States Code, as amended by section 703— 

(1) $100,000,000 for fiscal year 2024; 

(2) $200,000,000 for fiscal year 2025; 

(3) $400,000,000 for fiscal year 2026; 

(4) $450,000,000 for fiscal year 2027; 

(5) $600,000,000 for fiscal year 2028; 

(6) $610,000,000 for fiscal year 2029; 

(7) $620,000,000 for fiscal year 2030; and 

(8) $650,000,000 for fiscal year 2031. 

TITLE VIII—RECORDS AND OTHER 

MATTERS 

SEC. 801. EPIDEMIOLOGICAL STUDY ON FORT MCCLELLAN VETERANS. 

The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the 

Armed Forces at Fort McClellan at any time during the period 

beginning January 1, 1935, and ending on May 20, 1999. 

SEC. 802. BIENNIAL BRIEFING ON INDIVIDUAL LONGITUDINAL EXPOSURE RECORD. 

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

which the Individual Longitudinal Exposure Record achieves full 

operational capability, as determined by the Secretary of Defense, 

and every two years thereafter, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall provide the 

appropriate committees of Congress a briefing on— 

(1) the quality of the databases of the Department of 

Defense that provide the information presented in such Individual Longitudinal Exposure Record; and 

(2) the usefulness of such Individual Longitudinal Exposure 

Record or system in supporting members of the Armed Forces 

and veterans in receiving health care and benefits from the 

Department of Defense and the Department of Veterans Affairs. 

(b) ELEMENTS.—Each briefing required by subsection (a) shall 

include, for the period covered by the report, the following: 

(1) An identification of potential exposures to occupational 

or environmental hazards captured by the current systems 

of the Department of Defense for environmental, occupational, 
S. 3373—44 

and health monitoring, and recommendations for how to 

improve those systems. 

(2) An analysis of the quality and accuracy of the location 

data used by the Department of Defense in determining potential exposures to occupational or environmental hazards by 

members of the Armed Forces and veterans, and recommendations for how to improve the quality of such data if necessary. 

(c) DEFINITIONS.—In this section: 

(1) APPROPRIATE COMMITTEES OF CONGRESS.—The term 

‘‘appropriate committees of Congress’’ means— 

(A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and 

(B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. 

(2) INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.—The 

term ‘‘Individual Longitudinal Exposure Record’’ has the 

meaning given such term in section 1171 of title 38, United 

States Code, as added by section 202. 

SEC. 803. CORRECTION OF EXPOSURE RECORDS BY MEMBERS OF THE 

ARMED FORCES AND VETERANS. 

(a) IN GENERAL.—The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense to provide a means for veterans 

to update their records as necessary to reflect exposures to occupational or environmental hazards by such member or veteran in 

the Individual Longitudinal Exposure Record. 

(b) EVIDENCE.— 

(1) PROVISION OF EVIDENCE.—To update a record under 

subsection (a), a veteran shall provide such evidence as the 

Secretary of Veterans Affairs considers necessary. 

(2) REGULATIONS.—The Secretary of Veterans Affairs shall 

prescribe by regulation the evidence considered necessary under 

paragraph (1). 

(c) DEFINITIONS.—In this section: 

(1) INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.—The 

term ‘‘Individual Longitudinal Exposure Record’’ has the 

meaning given such term in section 1171 of title 38, United 

States Code, as added by section 202. 

(2) TOXIC EXPOSURE.—The term ‘‘toxic exposure’’ has the 

meaning given such term in section 101 of title 38, United 

States Code, as amended by section 102(b). 

SEC. 804. FEDERAL CAUSE OF ACTION RELATING TO WATER AT CAMP 

LEJEUNE, NORTH CAROLINA. 

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

Lejeune Justice Act of 2022’’. 

(b) IN GENERAL.—An individual, including a veteran (as defined 

in section 101 of title 38, United States Code), or the legal representative of such an individual, who resided, worked, or was otherwise 

exposed (including in utero exposure) for not less than 30 days 

during the period beginning on August 1, 1953, and ending on 

December 31, 1987, to water at Camp Lejeune, North Carolina, 

that was supplied by, or on behalf of, the United States may 

bring an action in the United States District Court for the Eastern 

District of North Carolina to obtain appropriate relief for harm 

that was caused by exposure to the water at Camp Lejeune. 

(c) BURDENS AND STANDARD OF PROOF.— 
S. 3373—45 

(1) IN GENERAL.—The burden of proof shall be on the 

party filing the action to show one or more relationships 

between the water at Camp Lejeune and the harm. 

(2) STANDARDS.—To meet the burden of proof described 

in paragraph (1), a party shall produce evidence showing that 

the relationship between exposure to the water at Camp 

Lejeune and the harm is— 

(A) sufficient to conclude that a causal relationship 

exists; or 

(B) sufficient to conclude that a causal relationship 

is at least as likely as not. 

(d) EXCLUSIVE JURISDICTION AND VENUE.—The United States 

District Court for the Eastern District of North Carolina shall 

have exclusive jurisdiction over any action filed under subsection 

(b), and shall be the exclusive venue for such an action. Nothing 

in this subsection shall impair the right of any party to a trial 

by jury. 

(e) EXCLUSIVE REMEDY.— 

(1) IN GENERAL.—An individual, or legal representative 

of an individual, who brings an action under this section for 

a harm described in subsection (b), including a latent disease, 

may not thereafter bring a tort action against the United States 

for such harm pursuant to any other law. 

(2) HEALTH AND DISABILITY BENEFITS RELATING TO WATER

EXPOSURE.—Any award made to an individual, or legal representative of an individual, under this section shall be offset 

by the amount of any disability award, payment, or benefit 

provided to the individual, or legal representative— 

(A) under— 

(i) any program under the laws administered by 

the Secretary of Veterans Affairs; 

(ii) the Medicare program under title XVIII of the 

Social Security Act (42 U.S.C. 1395 et seq.); or 

(iii) the Medicaid program under title XIX of the 

Social Security Act (42 U.S.C. 1396 et seq.); and 

(B) in connection with health care or a disability 

relating to exposure to the water at Camp Lejeune. 

(f) IMMUNITY LIMITATION.—The United States may not assert 

any claim to immunity in an action under this section that would 

otherwise be available under section 2680(a) of title 28, United 

States Code. 

(g) NO PUNITIVE DAMAGES.—Punitive damages may not be 

awarded in any action under this section. 

(h) DISPOSITION BY FEDERAL AGENCY REQUIRED.—An individual 

may not bring an action under this section before complying with 

section 2675 of title 28, United States Code. 

(i) EXCEPTION FOR COMBATANT ACTIVITIES.—This section does 

not apply to any claim or action arising out of the combatant 

activities of the Armed Forces. 

(j) APPLICABILITY; PERIOD FOR FILING.— 

(1) APPLICABILITY.—This section shall apply only to a claim 

accruing before the date of enactment of this Act. 

(2) STATUTE OF LIMITATIONS.—A claim in an action under 

this section may not be commenced after the later of— 

(A) the date that is two years after the date of enactment of this Act; or 
S. 3373—46 

(B) the date that is 180 days after the date on which 

the claim is denied under section 2675 of title 28, United 

States Code. 

(3) INAPPLICABILITY OF OTHER LIMITATIONS.—Any 

applicable statute of repose or statute of limitations, other 

than under paragraph (2), shall not apply to a claim under 

this section. 

SEC. 805. COST OF WAR TOXIC EXPOSURES FUND. 

(a) IN GENERAL.—Chapter 3 is amended by adding at the 

end the following new section: 

‘‘§ 324. Cost of War Toxic Exposures Fund 

‘‘(a) ESTABLISHMENT.—There is hereby established in the 

Treasury of the United States an account to be known as the 

‘Cost of War Toxic Exposures Fund’ (the ‘Fund’), to be administered 

by the Secretary. 

‘‘(b) DEPOSITS.—There shall be deposited in the Fund such 

amounts as may be appropriated to the Fund pursuant to subsection 

(c). 

‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 

to be appropriated to the Fund for fiscal year 2023 and each 

subsequent fiscal year such sums as are necessary to increase 

funding, over the fiscal year 2021 level, for investment in— 

‘‘(1) the delivery of veterans’ health care associated with 

exposure to environmental hazards in the active military, naval, 

air, or space service in programs administered by the Under 

Secretary for Health; 

‘‘(2) any expenses incident to the delivery of veterans’ 

health care and benefits associated with exposure to environmental hazards in the active military, naval, air, or space 

service, including administrative expenses, such as information 

technology and claims processing and appeals, and excluding 

leases as authorized or approved under section 8104 of this 

title; and 

‘‘(3) medical and other research relating to exposure to 

environmental hazards. 

‘‘(d) BUDGET SCOREKEEPING.—(1) Immediately upon enactment 

of the Sergeant First Class Heath Robinson Honoring our Promise 

to Address Comprehensive Toxics Act of 2022, expenses authorized 

to be appropriated to the Fund in subsection (c) shall be estimated 

for fiscal year 2023 and each subsequent fiscal year and treated 

as budget authority that is considered to be direct spending— 

‘‘(A) in the baseline for purposes of section 257 of the 

Balanced Budget and Emergency Deficit Control Act of 1985 

(2 U.S.C. 907); 

‘‘(B) by the Chairman of the Committee on the Budget 

of the Senate and the Chair of the Committee on the Budget 

of the House of Representatives, as appropriate, for purposes 

of budget enforcement in the Senate and the House of Representatives; 

‘‘(C) under the Congressional Budget Act of 1974 (2 U.S.C. 

621 et seq.), including in the reports required by section 308(b) 

of such Act (2 U.S.C. 639); and 

‘‘(D) for purposes of the Statutory Pay-As-You-Go Act of 

2010 (2 U.S.C. 931 et seq.). 
S. 3373—47 

‘‘(2) No amount appropriated to the Fund in fiscal year 2023 

or any subsequent fiscal year pursuant to this section shall be 

counted as discretionary budget authority and outlays or as direct 

spending for any estimate of an appropriation Act under the 

Congressional Budget and Impoundment Control Act of 1974 (2 

U.S.C. 621 et seq.) and any other Act. 

‘‘(3) Notwithstanding the Budget Scorekeeping Guidelines and 

the accompanying list of programs and accounts set forth in the 

joint explanatory statement of the committee of conference accompanying Conference Report 105–217, and for purposes of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 

900 et seq.) and the Congressional Budget Act of 1974 (2 U.S.C. 

621 et seq.), the Fund shall be treated as if it were an account 

designated as ‘Appropriated Entitlements and Mandatories for 

Fiscal Year 1997’ in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217. 

‘‘(e) ESTIMATES FOR CONGRESSIONAL CONSIDERATION.—The Secretary shall include in documents submitted to Congress in support 

of the President’s budget submitted pursuant to section 1105 of 

title 31 detailed estimates of the sums described in subsection 

(c) for the applicable fiscal year. 

‘‘(f) PROCEDURES FOR ESTIMATES.—The Secretary may, after 

consultation with the Committee on Appropriations of the Senate 

and the Committee on Appropriations of the House of Representatives, establish policies and procedures for developing the annual 

detailed estimates required by subsection (e).’’. 

(b) SEQUESTRATION.—Section 256(h)(4) of the Balanced Budget 

and Emergency Deficit Control Act of 1985 (2 U.S.C. 906(h)(4)) 

is amended by adding at the end the following new subparagraph: 

‘‘(G) Cost of War Toxic Exposures Fund.’’. 

SEC. 806. APPROPRIATION FOR FISCAL YEAR 2022. 

(a) APPROPRIATION.—In addition to amounts otherwise available, there is appropriated for fiscal year 2022, out of any funds 

in the Treasury not otherwise appropriated, $500,000,000 for the 

Cost of War Toxic Exposures Fund, established by section 324 

of title 38, United States Code, as added by section 805 of this 

Act, to remain available until September 30, 2024. 

(b) SPEND PLAN.—Not later than 30 days after enactment of 

this Act, the Secretary of Veterans Affairs shall submit a plan 

for expending amounts made available by subsection (a) by program, 

project or activity to the Committee on Appropriations of the Senate 

and the Committee on Appropriations of the House of Representatives. Funds may not be obligated until such Committees issue 

an approval, or absent a response, a period of 30 days has elapsed. 

SEC. 807. AUTHORIZATION OF ELECTRONIC NOTICE IN CLAIMS UNDER 

LAWS ADMINISTERED BY THE SECRETARY OF VETERANS 

AFFAIRS. 

(a) IN GENERAL.—Title 38, United States Code, is amended 

as follows: 

(1) By striking section 5100 and inserting the following: 

‘‘§ 5100. Definitions 

‘‘In this chapter: 

‘‘(1) The term ‘claimant’ means any individual applying 

for, or submitting a claim for, any benefit under the laws 

administered by the Secretary. 
S. 3373—48 

‘‘(2) The term ‘notice’ means a communication issued 

through means (including electronic means) prescribed by the 

Secretary.’’. 

(2) In section 5104, by adding at the end the following 

new subsection: 

‘‘(c) The Secretary may provide notice under subsection (a) 

electronically if a claimant (or the claimant’s representative) elects 

to receive such notice electronically. A claimant (or the claimant’s 

representative) may revoke such an election at any time, by means 

prescribed by the Secretary. 

‘‘(d) The Secretary shall annually— 

‘‘(1) solicit recommendations from stakeholders on how to 

improve notice under this section; and 

‘‘(2) publish such recommendations on a publicly available 

website of the Department.’’. 

(3) In section 5104B(c), in the matter preceding paragraph 

(1) by striking ‘‘in writing’’ and inserting ‘‘to the claimant 

(and any representative of such claimant)’’. 

(4) In section 5112(b)(6), by striking ‘‘(at the payee’s last 

address of record)’’. 

(5) In section 7104— 

(A) in the heading, by adding ‘‘; decisions; notice’’ 

at the end; and 

(B) by striking subsection (e) and inserting the following: 

‘‘(e) After reaching a decision on an appeal, the Board shall 

promptly issue notice (as that term is defined in section 5100 

of this title) of such decision to the following: 

‘‘(1) The appellant. 

‘‘(2) Any other party with a right to notice of such decision. 

‘‘(3) Any authorized representative of the appellant or party 

described in paragraph (2). 

‘‘(f)(1) The Secretary may provide notice under subsection (e) 

electronically if a claimant (or the claimant’s representative) elects 

to receive such notice electronically. 

‘‘(2) A claimant (or the claimant’s representative) may revoke 

such an election at any time, by means prescribed by the Secretary.’’. 

(6) In section 7105(b)(1)(A), by striking ‘‘mailing’’ and 

inserting ‘‘issuance’’. 

(7) In section 7105A(a), by striking ‘‘mailed’’ and inserting 

‘‘issued’’. 

(8) In section 7266(a), by striking ‘‘mailed’’ and inserting 

‘‘issued’’. 

(b) RULE OF CONSTRUCTION.—None of the amendments made 

by this section shall be construed to apply section 5104(a) of such 

title to decisions of the Board of Veterans’ Appeals under chapter 

71 of such title. 

SEC. 808. BURN PIT TRANSPARENCY. 

(a) ANNUAL REPORT ON DISABILITY CLAIMS.— 

(1) IN GENERAL.—Not later than 180 days after the date 

of the enactment of this Act, and annually thereafter, the 

Secretary of Veterans Affairs shall submit to the appropriate 

congressional committees a report detailing the following: 

(A) The total number of covered veterans. 
S. 3373—49 

(B) The total number of claimed issues for disability 

compensation under chapter 11 of title 38, United States 

Code, approved and the total number denied by the Secretary of Veterans Affairs with respect to a covered veteran, 

and a breakdown of the reasons for the denials. 

(C) A comprehensive list of the top 10 conditions from 

each body system for which the Secretary awarded service 

connection for covered veterans. 

(D) Any updates or trends with respect to the information described in subparagraphs (A), (B), and (C), that 

the Secretary determines appropriate. 

(2) COVERED VETERAN DEFINED.—In this subsection, the 

term ‘‘covered veteran’’ means a veteran who deployed to the 

Southwest Asia theater of operations any time after August 

1990, or Afghanistan, Syria, Djibouti, or Uzbekistan after September 19, 2001, and who submits a claim for disability compensation under chapter 11 of title 38, United States Code. 

(b) INFORMATION REGARDING THE AIRBORNE HAZARDS AND OPEN

BURN PIT REGISTRY.— 

(1) NOTICE.—The Secretary of Veterans Affairs shall ensure 

that a medical professional of the Department of Veterans 

Affairs informs a veteran of the Airborne Hazards and Open 

Burn Pit Registry if the veteran presents at a medical facility 

of the Department for treatment that the veteran describes 

as being related to, or ancillary to, the exposure of the veteran 

to toxic airborne chemicals and fumes caused by open burn 

pits. 

(2) DISPLAY.—In making information public regarding the 

number of participants in the Airborne Hazards and Open 

Burn Pit Registry, the Secretary shall display such numbers 

by both State and by congressional district. 

(c) DEFINITIONS.—In this section: 

(1) AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY.— 

The term ‘‘Airborne Hazards and Open Burn Pit Registry’’ 

means the registry established by the Secretary of Veterans 

Affairs under section 201 of the Dignified Burial and Other 

Veterans’ Benefits Improvement Act of 2012 (Public Law 112– 

260; 38 U.S.C. 527 note). 

(2) APPROPRIATE CONGRESSIONAL COMMITTEES.—The term 

‘‘appropriate congressional committees’’ means— 

(A) the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and 

(B) The Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. 

(3) OPEN BURN PIT.—The term ‘‘open burn pit’’ has the 

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

Burial and Other Veterans’ Benefits Improvement Act of 2012 

(Public Law 112–260; 38 U.S.C. 527 note). 
S. 3373—50 

TITLE IX—IMPROVEMENT OF WORKFORCE OF DEPARTMENT OF VETERANS AFFAIRS 

SEC. 901. NATIONAL RURAL RECRUITMENT AND HIRING PLAN FOR 

VETERANS HEALTH ADMINISTRATION. 

(a) IN GENERAL.—Not later than 18 months after the date 

of the enactment of this Act, the Secretary of Veterans Affairs, 

in collaboration with the directors of each community-based outpatient clinic and medical center of the Department of Veterans 

Affairs, shall develop and implement a national rural recruitment 

and hiring plan for the Veterans Health Administration to— 

(1) recruit health care professionals for rural and highly 

rural community-based outpatient clinics and rural and highly 

rural medical centers of the Department; 

(2) determine which such clinics or centers have a staffing 

shortage of health care professionals; 

(3) develop best practices and techniques for recruiting 

health care professionals for such clinics and centers; 

(4) not less frequently than annually, provide virtually 

based, on-demand training to human resources professionals 

of the Veterans Health Administration on the best practices 

and techniques developed under paragraph (3); and 

(5) provide recruitment resources, such as pamphlets and 

marketing material to— 

(A) Veterans Integrated Service Networks of the 

Department; 

(B) rural and highly rural community-based outpatient 

clinics of the Department; and 

(C) rural and highly rural medical centers of the 

Department. 

(b) ANNUAL REPORT.—Not later than 18 months after the date 

of the enactment of this Act, and annually thereafter, the Secretary 

shall submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives a report that includes— 

(1) the plan developed and implemented under subsection 

(a); and 

(2) an assessment of the outcomes related to recruitment 

and retention of employees of the Veterans Health Administration at rural and highly rural facilities of the Department. 

(c) DEFINITIONS.—In this section, the terms ‘‘rural’’ and ‘‘highly 

rural’’ have the meanings given those terms under the rural-urban 

commuting areas coding system of the Department of Agriculture. 

SEC. 902. AUTHORITY TO BUY OUT SERVICE CONTRACTS FOR CERTAIN 

HEALTH CARE PROFESSIONALS IN EXCHANGE FOR 

EMPLOYMENT AT RURAL OR HIGHLY RURAL FACILITIES 

OF DEPARTMENT OF VETERANS AFFAIRS. 

(a) IN GENERAL.—For any covered health care professional to 

whom the Secretary of Veterans Affairs has offered employment 

with the Department of Veterans Affairs, the Secretary may buy 

out the non-Department service contract of such individual in 

exchange for such individual agreeing to be employed at a rural 
S. 3373—51 

or highly rural facility of the Department for a period of obligated 

service specified in subsection (c). 

(b) PAYMENT OF AMOUNTS.— 

(1) IN GENERAL.—Payment of any amounts for a buy out 

of a service contract for a covered health care professional 

under subsection (a) shall be made directly to the individual 

or entity with respect to which the covered health care professional has a service obligation under such contract. 

(2) LIMITATION ON TOTAL AMOUNT.—The total amount paid 

by the Department under this section shall not exceed 

$40,000,000 per fiscal year. 

(c) OBLIGATED SERVICE.—In exchange for a contract buy out 

under subsection (a), a covered health care professional shall agree 

to be employed for not less than four years at a rural or highly 

rural facility of the Department. 

(d) LIABILITY.— 

(1) IN GENERAL.—Except as provided in paragraph (2), if 

a covered health care professional fails for any reason to complete the period of obligated service of the individual under 

subsection (c), the United States shall be entitled to recover 

from the individual an amount equal to— 

(A) the total amount paid under subsection (a) to buy 

out the non-Department service contract of the individual; 

multiplied by 

(B) a fraction— 

(i) the numerator of which is— 

(I) the total number of months in the period 

of obligated service of the individual; minus 

(II) the number of months served by the individual; and 

(ii) the denominator of which is the total number 

of months in the period of obligated service of the 

individual. 

(2) EXCEPTION.—Liability shall not arise under paragraph 

(1) in the case of an individual covered by that paragraph 

if the individual does not obtain, or fails to maintain, employment as an employee of the Department due to staffing changes 

approved by the Under Secretary for Health. 

(e) ANNUAL REPORT.— 

(1) IN GENERAL.—Not later than 18 months after the date 

of the enactment of this Act, and not less frequently than 

annually thereafter, the Secretary of Veterans Affairs shall 

submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of the House of Representatives a report on the use by the Secretary of the 

authority under this section. 

(2) ELEMENTS.—Each report required by paragraph (1) 

shall include the following: 

(A) The number of health care professionals for whom 

a service contract buyout payment was made under subsection (a) in the previous fiscal year, disaggregated by 

occupation or specialty. 

(B) The average, highest, and lowest amount of the 

service contract buyout payments made under subsection 

(a) for each occupation or specialty in the previous fiscal 

year. 
S. 3373—52 

(C) Each location where contract buyout authority 

under subsection (a) was utilized and the number of covered 

health care professionals who agreed to be employed at 

such location in the previous fiscal year. 

(f) DEFINITIONS.—In this section: 

(1) COVERED HEALTH CARE PROFESSIONAL.—The term ‘‘covered health care professional’’ means a physician, nurse anesthetist, physician assistant, or nurse practitioner offered 

employment with the Department regardless of the authority 

under which such employment is offered. 

(2) RURAL; HIGHLY RURAL.—The terms ‘‘rural’’ and ‘‘highly 

rural’’ have the meanings given those terms under the ruralurban commuting areas coding system of the Department of 

Agriculture. 

(g) SUNSET.—This section shall terminate on September 30, 

2027. 

SEC. 903. QUALIFICATIONS FOR HUMAN RESOURCES POSITIONS 

WITHIN DEPARTMENT OF VETERANS AFFAIRS AND PLAN 

TO RECRUIT AND RETAIN HUMAN RESOURCES 

EMPLOYEES. 

(a) ESTABLISHMENT OF QUALIFICATIONS.—Not later than 180 

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

of Veterans Affairs shall— 

(1) establish qualifications for each human resources position within the Department of Veterans Affairs in coordination 

with the Office of Personnel Management; 

(2) establish standardized performance metrics for each 

such position; and 

(3) submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report containing the qualifications and 

standardized performance metrics established under paragraphs (1) and (2). 

(b) IMPROVEMENT OF HUMAN RESOURCES ACTIONS.—Not later 

than 90 days after the date of the enactment of this Act, the 

Secretary shall establish or enhance systems of the Department 

to monitor the hiring and other human resources actions that 

occur at the local, regional, and national levels of the Department 

to improve the performance of those actions. 

(c) REPORT.—Not later than one year after the establishment 

of the qualifications and performance metrics under subsection 

(a), the Comptroller General of the United States shall submit 

to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report 

containing— 

(1) a description of the implementation of such qualifications and performance metrics; 

(2) an assessment of the quality of such qualifications 

and performance metrics; 

(3) an assessment of performance and outcomes based on 

such metrics; and 

(4) such other matters as the Comptroller General considers 

appropriate. 

(d) PLAN TO RECRUIT AND RETAIN HUMAN RESOURCES

EMPLOYEES.—Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit 
S. 3373—53 

to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan 

for the recruitment and retention of human resources employees 

within the Department of Veterans Affairs. 

SEC. 904. MODIFICATION OF PAY CAP FOR CERTAIN EMPLOYEES OF 

VETERANS HEALTH ADMINISTRATION. 

(a) IN GENERAL.—Section 7455(c) is amended— 

(1) in paragraph (1), by striking ‘‘30 percent’’ inserting 

‘‘50 percent’’; 

(2) in paragraph (2), by striking ‘‘level IV’’ inserting ‘‘level 

II’’; and 

(3) by adding at the end the following new paragraph: 

‘‘(3)(A) Notwithstanding section 5304 of title 5 or any other 

provision of law, but subject to the limitation under paragraph 

(2), pursuant to an increase under subsection (a), the Secretary 

may pay a special rate or an adjusted rate of basic pay in excess 

of the rate of basic pay payable for level IV of the Executive 

Schedule. 

‘‘(B) If an employee is in receipt of a special rate of pay under 

subparagraph (A) in excess of the rate of basic pay payable for 

level IV of the Executive Schedule with an established special 

rate supplement of greater value than a supplement based on 

the applicable locality-based comparability payment percentage 

under section 5304 of title 5, but a pay adjustment would cause 

such established special rate supplement to be of lesser value, 

the special rate supplement shall be converted to a supplement 

based on the applicable locality-based comparability percentage 

unless the Secretary determines that some other action is appropriate.’’. 

(b) PAY FOR CRITICAL POSITIONS.—Section 7404(a)(1)(B) is 

amended by inserting ‘‘7306 or’’ before ‘‘7401(4)’’. 

SEC. 905. EXPANSION OF OPPORTUNITIES FOR HOUSEKEEPING AIDES. 

Section 3310 of title 5, United States Code, is amended by 

inserting ‘‘(other than for positions of housekeeping aides in the 

Department of Veterans Affairs)’’ after ‘‘competitive service’’. 

SEC. 906. MODIFICATION OF AUTHORITY OF THE SECRETARY OF VETERANS AFFAIRS RELATING TO HOURS, CONDITIONS OF 

EMPLOYMENT, AND PAY FOR CERTAIN EMPLOYEES OF 

VETERANS HEALTH ADMINISTRATION. 

(a) EXPANSION OF ELIGIBILITY OF EMPLOYEES FOR CERTAIN

AWARDS.—Section 7404(c) is amended— 

(1) by striking ‘‘Notwithstanding’’ and inserting ‘‘(1) Notwithstanding’’; 

(2) by inserting ‘‘or 7401(4)’’ after ‘‘section 7306’’; 

(3) by striking ‘‘who is not eligible for pay under subchapter 

III’’ and inserting ‘‘or in a covered executive position under 

section 7401(1) of this title’’; 

(4) by striking ‘‘sections 4507 and 5384’’ and inserting 

‘‘section 4507’’; and 

(5) by adding at the end the following new paragraph: 

‘‘(2) In this subsection, the term ‘covered executive position’ 

means a position that the Secretary has determined is of equivalent 

rank to a Senior Executive Service position (as such term is defined 

in section 3132(a) of title 5) and is subject to an agency performance 

management system.’’. 
S. 3373—54 

(b) AUTHORITY FOR AWARDS PROGRAMS OF DEPARTMENT OF

VETERANS AFFAIRS.— 

(1) IN GENERAL.—Subchapter I of chapter 74 is amended 

by inserting after section 7404 the following new section: 

‘‘§ 7404A. Awards 

‘‘(a) SUPERIOR ACCOMPLISHMENTS AND PERFORMANCE AWARDS

PROGRAM.—The Secretary may establish an awards program for 

personnel listed in section 7421(b) of this title consistent with 

chapter 45 of title 5, to the extent practicable. 

‘‘(b) EXECUTIVE PERFORMANCE AWARDS PROGRAM.—Notwithstanding section 7425 of this title or any other provision of law, 

the Secretary may establish a performance awards program consistent with section 5384 of title 5 for— 

‘‘(1) personnel appointed under section 7401(1) of this title 

for a position that the Secretary has determined is of equivalent 

rank to a Senior Executive Service position (as such term 

is defined in section 3132(a) of title 5) and is subject to an 

agency performance management system; and 

‘‘(2) personnel appointed under section 7306 or 7401(4) 

of this title. 

‘‘(c) PAYMENT OF AWARDS.—Awards under this section may 

be paid based on criteria established by the Secretary and shall 

not be considered in calculating the limitation under section 

7431(e)(4) of this title. 

‘‘(d) NOT CONSIDERED BASIC PAY.—Awards under this section 

shall not be considered basic pay for any purpose. 

‘‘(e) REGULATIONS.—The Secretary may prescribe regulations 

for the administration of this section.’’. 

(2) LIMITATION ON PAST AWARDS.—Notwithstanding any 

other provision of law, awards made by the Secretary of Veterans Affairs for any period on or after January 1, 2017, and 

before the date of the enactment of this Act for an employee 

under section 7306 or 7401(4) of title 38, United States Code, 

or for a position described in section 7401(1) of such title 

that the Secretary has determined is of equivalent rank to 

a Senior Executive Service position (as such term is defined 

in section 3132(a) of title 5, United States Code), may be 

subject to section 7404A of title 38, United States Code, as 

added by paragraph (1). 

(c) MODIFICATION OF EMPLOYEES SUBJECT TO REGULATION BY

SECRETARY OF VETERANS AFFAIRS OF HOURS AND CONDITIONS OF

EMPLOYMENT AND LEAVES OF ABSENCE.— 

(1) IN GENERAL.—Section 7421 is amended— 

(A) in subsection (a), by striking ‘‘chapter’’ and 

inserting ‘‘title’’; and 

(B) in subsection (b), by adding at the end the following 

new paragraph: 

‘‘(9) Any position for which the employee is appointed under 

section 7306 or 7401(4) of this title.’’. 

(2) ADMINISTRATION OF FULL-TIME EMPLOYEES.—Section 

7423 is amended— 

(A) in subsection (a)(2), by adding at the end the following new subparagraph: 

‘‘(D) The Secretary may exclude from the requirements of paragraph (1) employees hired under section 7306 or 7401(4) of this 

title or for a position described in section 7401(1) of this title 
S. 3373—55 

that the Secretary has determined is of equivalent rank to a Senior 

Executive Service position (as such term is defined in section 

3132(a) of title 5).’’; and 

(B) in subsection (e)(1), by striking ‘‘7401(1)’’ and 

inserting ‘‘7421(b)’’. 

(3) ADDITIONAL PAY AUTHORITIES.—Section 7410(a) is 

amended— 

(A) by striking ‘‘The Secretary’’ and inserting ‘‘(1) The 

Secretary’’; 

(B) by striking ‘‘the personnel described in paragraph 

(1) of section 7401 of this title’’ and inserting ‘‘personnel 

appointed under section 7306 of this title or section 7401(4) 

of this title, or personnel described in section 7401(1) of 

this title,’’; and 

(C) by striking ‘‘in the same manner, and subject to 

the same limitations, as in the case of’’ and inserting ‘‘in 

a manner consistent with’’; and 

(D) by adding at the end the following new paragraph: 

‘‘(2) Payments under paragraph (1) shall not be considered 

in calculating the limitation under section 7431(e)(4) of this title.’’. 

(4) TREATMENT OF PAY AUTHORITY CHANGES.—For the purposes of the amendments made by paragraph (3), the Secretary 

of Veterans Affairs shall treat any award or payment made 

by the Secretary between January 1, 2017, and the date of 

the enactment of this Act to employees appointed under sections 

7306, 7401(1), and 7401(4) of title 38, United States Code, 

that the Secretary has determined are of equivalent rank to 

a Senior Executive Service position (as such term is defined 

in section 3132(a) of title 5, United States Code), as if such 

amendments had been in effect at the time of such award 

or payment. 

(5) TREATMENT OF PRIOR LEAVE BALANCES.—Notwithstanding any other provision of law, the Secretary may adjust 

the leave balance and carryover leave balance of any employee 

described in section 7421(b)(9) of title 38, United States Code, 

as amended by paragraph (1)(B), to ensure any leave accrued 

or carried over before the date of the enactment of this Act 

remains available to such employee. 

(d) TREATMENT OF CERTAIN EMPLOYEES AS APPOINTED UNDER

SECTION 7306.—Section 7306 is amended— 

(1) in subsection (a), by redesignating the second paragraph 

(11) as paragraph (12); and 

(2) by adding at the end the following new subsection: 

‘‘(g) For purposes of applying any provision of chapter 74 of 

this title, including sections 7404, 7410, and 7421, or any other 

provision of law, the Secretary may treat any appointment for 

a position under this chapter to be an appointment under this 

section.’’. 

(e) CONFORMING AMENDMENT.—Section 7431(e)(4) is amended 

by striking ‘‘In no case’’ and inserting ‘‘Except as provided in sections 7404A(c) and 7410(a)(2) of this title, in no case’’. 

SEC. 907. WAIVER OF PAY LIMITATION FOR CERTAIN EMPLOYEES OF 

DEPARTMENT OF VETERANS AFFAIRS. 

Subchapter I of chapter 7 is amended by inserting after section 

703 the following new section: 
S. 3373—56 

‘‘§ 704. Waiver of pay limitation for certain employees 

‘‘(a) EMPLOYEES OF VETERANS HEALTH ADMINISTRATION

IMPACTED BY CLOSURE OR REALIGNMENT.—Notwithstanding any 

other provision of law, the Secretary may waive any annual premium or aggregate limitation on pay for an employee of the Veterans Health Administration for the calendar year during which— 

‘‘(1) the official duty station of the employee is closed; 

or 

‘‘(2) the office, facility, activity, or organization of the 

employee is realigned. 

‘‘(b) EMPLOYEES PROVIDING CARE TO VETERANS EXPOSED TO

OPEN BURN PITS.— 

‘‘(1) IN GENERAL.—Notwithstanding any other provision of 

law, the Secretary may waive any annual premium or aggregate 

limitation on pay for an employee of the Department whose 

primary duties include providing expanded care for veterans 

exposed to open burn pits. 

‘‘(2) OPEN BURN PIT DEFINED.—In this subsection, the term 

‘open burn pit’ has the meaning given that term in section 

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

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

note). 

‘‘(c) COORDINATION WITH OFFICE OF PERSONNEL MANAGEMENT.—In implementing this section, the Secretary shall coordinate 

with the Director of the Office of Personnel Management. 

‘‘(d) REPORTS.— 

‘‘(1) IN GENERAL.—For each quarter that the Secretary 

waives a limitation under this section, the Secretary shall 

submit to the Committee on Veterans’ Affairs of the Senate, 

the Committee on Veterans’ Affairs of the House of Representatives, and the Office of Personnel Management a report on 

the waiver or waivers. 

‘‘(2) CONTENTS.—Each report submitted under paragraph 

(1) with respect to a waiver or waivers shall include the following: 

‘‘(A) Where the waiver or waivers were used, including 

in which component of the Department and, as the case 

may be, which medical center of the Department. 

‘‘(B) For how many employees the waiver or waivers 

were used, disaggregated by component of the Department 

and, if applicable, medical center of the Department. 

‘‘(C) The average amount by which each payment 

exceeded the pay limitation that was waived, disaggregated 

by component of the Department and, if applicable, medical 

center of the Department. 

‘‘(e) EMPLOYEE DEFINED.—In this section, the term ‘employee’ 

means any employee regardless of the authority under which the 

employee was hired. 

‘‘(f) TERMINATION.—This section shall terminate on September 

30, 2027.’’. 

SEC. 908. ELIMINATION OF LIMITATION ON AWARDS AND BONUS FOR 

EMPLOYEES OF DEPARTMENT OF VETERANS AFFAIRS. 

(a) IN GENERAL.—Section 705(a) of the Veterans Access, Choice, 

and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 

703 note) is amended by striking paragraph (3). 
S. 3373—57 

(b) APPLICABILITY.—Subsection (a) shall take effect on the date 

of the enactment of this Act and apply as if such subsection had 

been enacted on September 30, 2021. 

SEC. 909. ADDITIONAL AUTHORITY OF THE SECRETARY OF VETERANS 

AFFAIRS RELATING TO RECRUITMENT AND RETENTION OF 

PERSONNEL. 

Subchapter I of chapter 7 is amended by inserting after section 

705 the following new section: 

‘‘§ 706. Additional authority relating to recruitment and 

retention of personnel 

‘‘(a) RECRUITMENT AND RELOCATION BONUSES.—The Secretary 

may pay a recruitment or relocation bonus under section 5753(e) 

of title 5 without regard to any requirements for certification or 

approval under that section. 

‘‘(b) RETENTION BONUSES.—(1) The Secretary may pay a retention bonus under section 5754(f) of title 5 without regard to any 

requirement for certification or approval under that subsection. 

‘‘(2) The Secretary may pay a retention bonus as specified 

in subsection (e)(2) of section 5754 of title 5 and may pay the 

bonus as a single lump-sum payment at the beginning of the full 

period of service required by an agreement under subsection (d) 

of such section. 

‘‘(c) MERIT AWARDS.—The Secretary may grant a cash award 

under section 4502(b) of title 5 without regard to any requirement 

for certification or approval under that section. 

‘‘(d) INCENTIVES FOR CRITICAL SKILLS.—(1) Subject to the provisions of this paragraph, the Secretary may provide a critical skill 

incentive to an employee in a case in which the Secretary determines— 

‘‘(A) the employee possesses a high-demand skill or skill 

that is at a shortage; 

‘‘(B) such skill is directly related to the duties and responsibilities of the employee’s position; and 

‘‘(C) employment of an individual with such skill in such 

position serves a critical mission-related need of the Department. 

‘‘(2) An incentive provided to an employee under paragraph 

(1) may not to exceed 25 percent of the basic pay of the employee. 

‘‘(3) Provision of an incentive under paragraph (1) shall be 

contingent on the employee entering into a written agreement to 

complete a period of employment with the Department. 

‘‘(4) An incentive provided under paragraph (1) shall not be 

considered basic pay for any purpose. 

‘‘(5) The Secretary may prescribe conditions, including with 

respect to eligibility, and limitations on provision of incentive under 

paragraph (1). 

‘‘(6) Incentive provided under paragraph (1) shall not be 

included in the calculation of total amount of compensation under 

section 7431(e)(4) of this title. 

‘‘(e) STUDENT LOAN REPAYMENTS.—(1) Subject to the provisions 

of this subsection, the Secretary may repay a student loan pursuant 

to section 5379(b) of title 5. 

‘‘(2) Paragraph (2) of such section shall not apply to payment 

under this subsection. 
S. 3373—58 

‘‘(3) Payment under this subsection shall be made subject to 

such terms, limitations, or conditions as may be mutually agreed 

to by the Secretary and the employee concerned, except that the 

amount paid by the Secretary under this subsection may not 

exceed— 

‘‘(A) $40,000 for any employee in any calendar year; or 

‘‘(B) a total of $100,000 in the case of any employee. 

‘‘(f) EXPEDITED HIRING AUTHORITY FOR COLLEGE GRADUATES; 

COMPETITIVE SERVICE.—(1) Subject to paragraph (2) of this subsection, the Secretary may expedite hiring for college graduates 

under section 3115 of title 5 without regard to subsection (e) of 

such section or any regulations prescribed by the Office of Personnel 

Management for administration of such subsection. 

‘‘(2) The number of employees the Secretary may appoint under 

section 3115 of title 5 may not exceed the number equal to 25 

percent of individuals that the Secretary appointed during the 

previous fiscal year to a position in the competitive service classified 

in a professional or administrative occupational category, at the 

GS–11 level, or an equivalent level, or below, under a competitive 

examining procedure. 

‘‘(g) EXPEDITED HIRING AUTHORITY FOR POST-SECONDARY STUDENTS; COMPETITIVE SERVICE.—(1) Subject to paragraph (2) of this 

subsection, the Secretary may expedite hiring of post-secondary 

students under section 3116 of title 5, without regard to subsection 

(d) of such section or any regulations prescribed by the Office 

of Personnel Management for administration of such subsection. 

‘‘(2) The number of employees the Secretary may appoint under 

section 3116 of title 5 may not exceed the number equal to 25 

percent of the number of students that the Secretary appointed 

during the previous fiscal year to a position at the GS–11 level, 

or an equivalent level, or below. 

‘‘(h) PAY AUTHORITY FOR CRITICAL POSITIONS.—(1) Subject to 

the provisions of this subsection, the Secretary may authorize the 

fixing of the rate of pay for a critical position in the Department 

consistent with the authorities and requirements of section 5377 

of title 5 that apply to the Office of Personnel Management. 

‘‘(2) The Secretary may fix the rate of pay for a critical position 

under this subsection in excess of the limitation set forth by section 

5377(d)(2) of such title. 

‘‘(3) Basic pay may not be fixed under this subsection at a 

rate greater than the rate payable for the Vice President of the 

United States established under section 104 of title 3, except upon 

written approval of the President. 

‘‘(4) Notwithstanding section 5377(f) of title 5, the Secretary 

may authorize the exercise of authority under this subsection with 

respect to up to 200 positions at any time. 

‘‘(i) RATES OF SPECIAL PAY.—(1) The Secretary may establish 

a rate for special pay under section 5305(a)(1) of title 5. 

‘‘(2) In applying such section to the Secretary’s authority under 

paragraph (1)— 

‘‘(A) ‘50 percent’ shall be substituted for ‘30 percent’; and 

‘‘(B) ‘level II of the Executive Schedule’ shall be substituted 

for ‘level IV of the Executive Schedule’. 
S. 3373—59 

‘‘(j) WAIVER OF LIMITATIONS ON CERTAIN PAYMENTS UNDER

PAY COMPARABILITY SYSTEM.—The Secretary may waive the limitation in section 5307 of title 5 for an employee or a payment. 

‘‘(k) TERMINATION.—The authorities under this section shall 

terminate on September 30, 2027.’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.