SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, 
UNITED STATES CODE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Honoring our Promise to Address Comprehensive Toxics 
Act of 2021’’ or the ‘‘Honoring our PACT Act of 2021’’. 
(b) MATTERS RELATING TO AMENDMENTS TO TITLE 
38, UNITED STATES CODE.— 
(1) REFERENCES.—Except as otherwise ex-
pressly 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 head-
ing 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 vet-
erans and veterans supporting certain overseas contingency op-
erations. 
Sec. 104. Assessments of implementation and operation. 
Sec. 105. Revision of breast cancer mammography policy of Department of Vet-
erans Affairs to provide mammography screening for veterans 
who served in locations associated with toxic exposure. 
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. 
Sec. 112. Authorization period for emergency treatment in non-Department of 
Veterans Affairs medical facilities. 
TITLE II—TOXIC EXPOSURE PRESUMPTION PROCESS 
Sec. 201. Short title. 
Sec. 202. Improvements to ability of Department of Veterans Affairs to estab-
lish presumptions of service connection based on toxic expo-
sure. 
Sec. 203. Reevaluation of claims for 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 Vet-
erans 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 expo-
sures 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.
TITLE V—RESEARCH MATTERS 
Sec. 501. Interagency working group on toxic exposure research. 
Sec. 502. Data collection, analysis, and report on treatment of veterans for ill-
nesses related to toxic exposure. 
Sec. 503. Studies related to veterans who served in Southwest Asia and certain 
other locations. 
Sec. 504. Study on health trends of post 9/11 veterans. 
Sec. 505. Study on cancer rates among veterans. 
Sec. 506. Study on feasibility and advisability of furnishing hospital care and 
medical services to dependents of veterans who participated in 
toxic exposure risk activities. 
Sec. 507. Study on health effects of waste related to Manhattan Project on cer-
tain veterans. 
Sec. 508. Study on toxic exposure and mental health outcomes. 
Sec. 509. Study on veterans in Territories of the United States. 
Sec. 510. Department of Veterans Affairs public website for toxic exposure re-
search. 
Sec. 511. Biennial 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 outreach program for such veterans 
and caregivers and survivors of such veterans. 
Sec. 603. Incorporation of toxic exposure questionnaire during primary care ap-
pointments. 
Sec. 604. Training for personnel of the Department of Veterans Affairs with 
respect to toxic-exposed veterans. 
Sec. 605. Guidelines for active duty military on potential risks and prevention 
of toxic exposures. 
TITLE VII—REGISTRIES, RECORDS, AND OTHER MATTERS 
Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl substances 
on military installations. 
Sec. 702. Fort McClellan Health Registry. 
Sec. 703. Independent study on Individual Longitudinal Exposure Record. 
Sec. 704. Biannual report on Individual Longitudinal Exposure Record. 
Sec. 705. Correction of exposure records by members of the Armed Forces and 
veterans. 
Sec. 706. Federal cause of action relating to water at Camp Lejeune, North 
Carolina. 
Sec. 707. Veterans Toxic Exposures Fund. 
Sec. 708. Authorization of electronic notice in claims under laws administered 
by the Secretary of Veterans Affairs. 
Sec. 709. Authorization of appropriations for expansion of claims automation. 
Sec. 710. Non-applicability of non-Department of Veterans Affairs covenants 
not to compete to appointment of Veterans Health Administra-
tion personnel. 
Sec. 711. Recruitment of physicians on a contingent basis prior to completion 
of training requirements. 
Sec. 712. Authority for Secretary of Veterans Affairs to award grants to States 
to improve outreach to veterans.
Sec. 713. Study and report on herbicide agent exposure in Panama Canal Zone. 
Sec. 714. Budget information for alternatives to burn pits. 
Sec. 715. Authorization of appropriations for expansion of claims automation. 
Sec. 716. Burn pit registry updates. 
Sec. 717. Burn pit transparency. 
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 Vet-
erans’ Exposures Now And Necessitating Training Act’’ 
or the ‘‘COVENANT Act’’. 
SEC. 102. DEFINITIONS RELATING TO TOXIC-EXPOSED VET-
ERANS. 
(a) IN GENERAL.—Section 1710(a)(2)(F) is amend-
ed by striking ‘‘who was exposed to a toxic substance, ra-
diation, or other conditions, as provided in subsection (e)’’ 
and inserting ‘‘in accordance with subsection (e), who is 
a toxic-exposed veteran’’. 
(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 fol-
lowing: 
‘‘(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 a vet-
eran described in section 1710(e)(1) of this title.’’. 
(c) DEFINITION OF TOXIC EXPOSURE RISK ACTIV-
ITY.—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 quali-
fies for purposes of this subsection when taking 
into account what is reasonably prudent to pro-
tect the health of veterans.’’. 
SEC. 103. EXPANSION OF HEALTH CARE FOR SPECIFIC CAT-
EGORIES 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 (includ-
ing mental health services and counseling), medical serv-
ices, 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 oper-
ation 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: 
‘‘(6)(A) The Secretary shall determine the dates in 
subparagraphs (G), (H), and (I) of paragraph (1) as fol-
lows: 
‘‘(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 begin-
ning 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 begin-
ning on September 12, 2001, and ending on Decem-
ber 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 begin-
ning 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 begin-
ning 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) The Secretary may modify a date specified in 
subparagraph (A) to an earlier date, as the Secretary de-
termines appropriate based on the number of veterans re-
ceiving hospital care, medical services, and nursing home 
care under subparagraphs (G), (H), and (I) of paragraph 
(1) and the resources available to the Secretary. If the 
Secretary determines to so modify a date, the Secretary 
shall— 
‘‘(i) notify the Committees on Veterans’ Affairs 
of the House of Representatives and the Senate 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 prior to the date specified in the 
clause (including a date modified pursuant to such sec-
tion), the Secretary shall submit to the Committees on 
Veterans’ Affairs of the House of Representatives and the 
Senate a plan to conduct outreach to the veterans referred 
to 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 OPER-
ATION. 
(a) INITIAL
RESOURCE
ASSESSMENT
AND
RE-
PORT.—Not later than 180 days after the date of the en-
actment 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 
(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 sec-
tion 302), who receive hospital care or medical 
services furnished by the Secretary under chap-
ter 17 of such title, disaggregated by priority 
group specified in section 1705(a) of such title; 
and 
(2) submit to the Committees on Veterans’ Af-
fairs of the House of Representatives and the Senate 
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 imple-
ment section 103.
previously received hospital care or medical 
services furnished by the Secretary under chap-
ter 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 chap-
ter 17 of title 38, United States Code. 
(B) Of the veterans specified in subpara-
graph (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 
(ii) whether the care was provided 
through the Veterans Community Care 
Program. 
(D) With respect to the number of vet-
erans described in subparagraphs (G), (H), and 
(I) of section 1710(e)(1) of title 38, United 
States Code (as added by section 103), the fol-
lowing (shown in total and disaggregated by 
medical facility of the Department, as applica-
ble): 
(i) The number of such veterans who, 
during the year covered by the report, en-
rolled in the patient enrollment system. 
(ii) The number of such veterans who 
applied for, but were denied, such enroll-
ment. 
(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 fur-
nished by the Secretary to, veterans enrolled in 
the patient enrollment system (shown in total 
and disaggregated by medical facility of the De-
partment). 
(F) The numbers and characteristics of, 
and the type and extent of health care fur-
nished by the Secretary to, veterans not en-
rolled 
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 Sec-
retary 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) The term ‘‘patient enrollment system’’ 
means the patient enrollment system of the Depart-
ment of Veterans Affairs established and operated 
under section 1705 of title 38, United States Code. 
(2) The term ‘‘Veterans Community Care Pro-
gram’’ means the program established under section 
1703 of title 38, United States Code. 
SEC. 105. REVISION OF BREAST CANCER MAMMOGRAPHY 
POLICY OF DEPARTMENT OF VETERANS AF-
FAIRS TO PROVIDE MAMMOGRAPHY SCREEN-
ING FOR VETERANS WHO SERVED IN LOCA-
TIONS ASSOCIATED WITH TOXIC EXPOSURE. 
(a) IN GENERAL.—Section 7322 of title 38, United 
States Code, is amended— 
(1) in subsection (a), by striking ‘‘The’’ and in-
serting ‘‘IN GENERAL.—The’’; 
(2) in subsection (b)— 
(A) by striking ‘‘The’’ and inserting 
‘‘STANDARDS FOR SCREENING.—The’’; and 
(B) in paragraph (2)(B), by inserting ‘‘a 
record of service in a location and during a pe-
riod specified in subsection (d),’’ after ‘‘risk 
factors,’’; and 
(3) by adding at the end the following new sub-
sections: 
‘‘(c) ELIGIBILITY FOR SCREENING FOR VETERANS 
EXPOSED TO TOXIC SUBSTANCES.—The Under Secretary
for Health shall ensure that, under the policy developed 
under subsection (a), any veteran who, during active mili-
tary, naval, or air service, was deployed in support of a 
contingency operation in a location and during a period 
specified in subsection (d), is eligible for a mammography 
screening by a health care provider of the Department. 
‘‘(d) LOCATIONS AND PERIODS SPECIFIED.—(1) The 
locations and periods specified in this subsection are the 
following: 
‘‘(A) Iraq during following periods: 
‘‘(i) The period beginning on August 2, 
1990, and ending on February 28, 1991. 
‘‘(ii) The period beginning on March 19, 
2003, and ending on such date as the Secretary 
determines burn pits are no longer used in Iraq. 
‘‘(B) The Southwest Asia theater of operations, 
other than Iraq, during the period beginning on Au-
gust 2, 1990, and ending on such date as the Sec-
retary determines burn pits are no longer used in 
such location, including the following locations: 
‘‘(i) Kuwait. 
‘‘(ii) Saudi Arabia. 
‘‘(iii) Oman. 
‘‘(iv) Qatar.
‘‘(C) Afghanistan during the period beginning 
on September 11, 2001, and ending on such date as 
the Secretary determines burn pits are no longer 
used in Afghanistan. 
‘‘(D) Djibouti during the period beginning on 
September 11, 2001, and ending on such date as the 
Secretary determines burn pits are no longer used in 
Djibouti. 
‘‘(E) Syria during the period beginning on Sep-
tember 11, 2001, and ending on such date as the 
Secretary determines burn pits are no longer used in 
Syria. 
‘‘(F) Jordan during the period beginning on 
September 11, 2001, and ending on such date as the 
Secretary determines burn pits are no longer used in 
Jordan. 
‘‘(G) Egypt during the period beginning on 
September 11, 2001, and ending on such date as the 
Secretary determines burn pits are no longer used in 
Egypt. 
‘‘(H) Lebanon during the period beginning on 
September 11, 2001, and ending on such date as the 
Secretary determines burn pits are no longer used in 
Lebanon.
‘‘(I) Yemen during the period beginning on 
September 11, 2001, and ending on such date as the 
Secretary determines burn pits are no longer used in 
Yemen. 
‘‘(J) Such other locations and corresponding pe-
riods as set forth by the Airborne Hazards and Open 
Burn Pit Registry established 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). 
‘‘(K) Such other locations and corresponding 
periods as the Secretary, in collaboration with the 
Secretary of Defense, may determine appropriate in 
a report submitted under paragraph (2). 
‘‘(2) Not later than two years after the date of the 
enactment of the Supporting Expanded Review for Vet-
erans In Combat Environments Act of 2021, and not less 
frequently than once every two years thereafter, the Sec-
retary of Veterans Affairs, in collaboration with the Sec-
retary of Defense, shall submit to Congress a report speci-
fying other locations and corresponding periods for pur-
poses of paragraph (1)(K). 
‘‘(3) A location under this subsection shall not in-
clude any body of water around or any airspace above such 
location.
‘‘(4) In this subsection, the term ‘burn pit’ means an 
area of land that is used for disposal of solid waste by 
burning in the outdoor air.’’. 
(b) REPORT ON BREAST CANCER RATES FOR VET-
ERANS DEPLOYED TO CERTAIN AREAS.—Not later than 
two years after the date of the enactment of this Act, the 
Secretary of Veterans Affairs shall submit to the Com-
mittee on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Representa-
tives a report that compares the rates of breast cancer 
among members of the Armed Forces deployed to the loca-
tions and during the periods specified in section 7322(d) 
of title 38, United States Code, as added by subsection 
(a), as compared to members of the Armed Forces who 
were not deployed to those locations during those periods 
and to the civilian population. 
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 in-
serting ‘‘10-year period’’; 
(2) by amending subparagraph (B) to read as 
follows: 
‘‘(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) be-
fore 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 Ex-
peditionary Medal, Combat Era Specific Expeditionary 
Medal, Campaign Specific Medal, or any other combat the-
ater award established by a Federal statute or an Execu-
tive order)’’.
(c) OUTREACH PLAN.—Not later than December 1, 
2022, the Secretary shall submit to the Committees on 
Veterans’ Affairs of the House of Representatives and the 
Senate 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 Com-
mittees on Veterans’ Affairs of the House of Representa-
tives and the Senate 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 of such title. 
(e) EFFECTIVE DATE.—This section and the amend-
ments made by this section shall take effect on October 
1, 2022.
SEC. 
112. 
AUTHORIZATION 
PERIOD 
FOR 
EMERGENCY 
TREATMENT IN NON-DEPARTMENT OF VET-
ERANS AFFAIRS MEDICAL FACILITIES. 
Section 1703(a)(3) of title 38, United States Code, 
is amended— 
(1) by striking ‘‘A covered veteran’’ and insert-
ing ‘‘(A) Except as provided by subparagraph (B), 
a covered veteran’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) In the case of an emergency which existed at 
the time of admission of a covered veteran to a health care 
provider, the Secretary shall deem the care or services re-
ceived by the veteran during such admission to be author-
ized under subparagraph (A) if the covered veteran (or 
an individual acting on behalf of the covered veteran) 
makes an application for such authorization during the pe-
riod following such admission that the Secretary deter-
mines appropriate for purposes of this paragraph, except 
such period may not be less than 96 hours.’’. 
TITLE II—TOXIC EXPOSURE 
PRESUMPTION PROCESS 
SEC. 201. SHORT TITLE. 
This subtitle may be cited as the ‘‘Fairly Assessing 
Service-related Toxic Exposure Residuals Presumptions 
Act’’ or the ‘‘FASTER Presumptions Act’’.
SEC. 202. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF 
VETERANS 
AFFAIRS 
TO 
ESTABLISH 
PRE-
SUMPTIONS 
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: 
‘‘SUBCHAPTER VII—DETERMINATIONS RELAT-
ING TO PRESUMPTIONS OF SERVICE CON-
NECTION BASED ON TOXIC EXPOSURE 
‘‘§ 1171. Procedures to determine presumptions of 
service connection based on toxic expo-
sure; definitions 
‘‘(a) PROCEDURES.—The Secretary shall determine 
whether to establish, or to remove, presumptions of service 
connection based on toxic exposure pursuant to this sub-
chapter, whereby— 
‘‘(1) the Formal Advisory Committee on Toxic 
Exposure under section 1172 of this title— 
‘‘(A) provides advice to the Secretary on 
toxic-exposed veterans and cases in which vet-
erans who, during active military, naval, air, or 
space service, may have experienced a toxic ex-
posure or their dependents may have experi-
enced a toxic exposure while the veterans were
serving in the active military, naval, air, or 
space service; 
‘‘(B) provides to the Secretary rec-
ommendations on corrections needed in the In-
dividual Longitudinal Exposure Record, or suc-
cessor system, to better reflect veterans and de-
pendents described in subparagraph (A); and 
‘‘(C) provides to the Secretary rec-
ommendations regarding which cases of possible 
toxic exposure should be reviewed; and 
‘‘(2) the Secretary provides for formal evalua-
tions of such recommendations under section 1173 
of this title; and 
‘‘(3) the Secretary issues regulations under sec-
tion 1174 of this title. 
‘‘(b) ILLNESS DEFINED.—In this subchapter, the 
term ‘illness’ includes a disease or other condition affect-
ing the health of an individual, including mental and phys-
ical health. 
‘‘§ 1172. Formal Advisory Committee on Toxic Expo-
sure 
‘‘(a) ESTABLISHMENT.—(1) There is in the Veterans 
Health Administration of the Department the Formal Ad-
visory Committee on Toxic Exposure (in this section re-
ferred to as the ‘Committee’).
‘‘(2)(A) The Committee shall be composed of nine 
members appointed as follows: 
‘‘(i) Five members shall be appointed by the 
Secretary. 
‘‘(ii) One member shall be appointed by the 
Speaker of the House of Representatives. 
‘‘(iii) One member shall be appointed by the mi-
nority leader of the House of Representatives. 
‘‘(iv) One member shall be appointed by the 
majority leader of the Senate. 
‘‘(v) One member shall be appointed by the mi-
nority leader of the Senate. 
‘‘(B) The members appointed under subparagraph 
(A) shall meet the following criteria: 
‘‘(i) Not more than three members shall be ap-
pointed from among individuals who are officials or 
employees of the Veterans Benefits Administration 
or the Veterans Health Administration. 
‘‘(ii) At least one member shall be appointed 
from among individuals who are officials or employ-
ees of other departments or agencies of the Federal 
Government, including the Department of Defense 
and the Agency of Toxic Substances and Disease 
Registry of the Centers for Disease Control and Pre-
vention.
‘‘(iii) At least two members shall represent an 
organization recognized by the Secretary for the rep-
resentation of veterans under section 5902 of this 
title. 
‘‘(iv) At least one member shall be appointed 
from among individuals in the private sector, State 
or local government, or academia, who are experts in 
toxicology and epidemiology. 
‘‘(3) The Secretary shall determine the pay and al-
lowances of the members of the Committee, including with 
respect to any additional pay and allowances for members 
who are officials or employees of the Federal Government. 
‘‘(4)(A) Except as provided by subparagraph (B), 
each member of the Committee shall be appointed for a 
two-year term, and may serve not more than three succes-
sive terms. 
‘‘(B) With respect to the five members who are ini-
tially appointed by the Secretary under subparagraph 
(A)(i), the Secretary shall determine the length of the 
term of each such member in a manner that ensures the 
expiration of the terms on a staggered basis. 
‘‘(5) A vacancy in the Committee shall be filled in 
the manner in which the original appointment was made. 
‘‘(b) CONSULTATION.—The Secretary may consult 
with, and seek the advice of, the Committee with respect
to cases in which veterans who, during active military, 
naval, air, or space service, are suspected of having experi-
enced a toxic exposure or dependents of veterans who may 
have experienced a toxic exposure during such service. 
‘‘(c) ASSESSMENTS.—(1) The Committee shall assess 
cases of the toxic exposure of veterans and their depend-
ents that occurred during active military, naval, air, or 
space service, including by conducting ongoing surveillance 
and reviewing such exposure described in scientific lit-
erature, media reports, information from veterans, and in-
formation from Congress. 
‘‘(2) The assessments under paragraph (1) shall 
cover suspected and known toxic exposures occurring dur-
ing active military, naval, air, or space service, including 
by identifying and evaluating new and emerging toxic ex-
posures that are not recognized under existing presump-
tions of service connection. 
‘‘(3) The Committee may conduct an assessment 
under paragraph (1) in response to comments by a person 
described in subsection (e)(2), by a majority vote of the 
members of the Committee. 
‘‘(4) The Committee shall on a periodic basis assess 
the Individual Longitudinal Exposure Record, or successor 
system, to ensure the accuracy of data collected.
‘‘(d) RESEARCH RECOMMENDATIONS.—(1) Following 
an assessment of a case of the toxic exposure of veterans 
or their dependents that occurred during active military, 
naval, air, or space service under subsection (c), the Com-
mittee may develop a recommendation for formal evalua-
tion under section 1173 of this title to conduct a review 
of the health effects related to the case of exposure if the 
Committee determines that the research may change the 
current understanding of the relationship between an ex-
posure to an environmental hazard and adverse health 
outcomes in humans. 
‘‘(2) Upon receipt of evidence suggesting that pre-
vious findings regarding the periods and locations of expo-
sure covered by an existing presumption of service connec-
tion are no longer supported, the Committee may nomi-
nate such evidence for formal evaluation under section 
1173 of this title to modify the periods and locations. 
‘‘(e) INPUT.—(1) Not less than quarterly, the Com-
mittee shall provide an opportunity for persons described 
in paragraph (2) to present written or oral comments to 
the Committee. 
‘‘(2) The persons described in this paragraph are per-
sons who may be affected by the actions of the Committee, 
including—
‘‘(A) veterans, the families of veterans, veterans 
service organizations and representatives, research-
ers, and other members of the general public; and 
‘‘(B) departments and agencies of the Federal 
Government. 
‘‘(f) REPORTS BY THE COMMITTEE.—Not less fre-
quently than once each year, the Committee shall submit 
to the Secretary and the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives, and make 
publicly available, a report on— 
‘‘(1) recommendations for research under sub-
section (d), if any; and 
‘‘(2) recommendations for such legislative or 
administrative action as the Committee considers 
necessary for the Committee to be more effective in 
carrying out the requirements of this section. 
‘‘(g) RESPONSES BY SECRETARY.—In response to 
each report submitted under subsection (f), the Secretary 
shall submit to the Secretary and the Committees on Vet-
erans’ Affairs of the Senate and the House of Representa-
tives, and make publicly available, a report on— 
‘‘(1) the findings and opinions of the Secretary 
with respect to the report most recently submitted 
under subsection (f); and
‘‘(2) whether the Secretary will conduct re-
search recommended under subsection (f) included 
in the report, and if not, an explanation of why, in-
cluding citations and sources. 
‘‘(h) 
NONAPPLICATION
OF
SUNSET
REQUIRE-
MENTS.—Section 14 of the Federal Advisory Committee 
Act (5 U.S.C. App.) shall not apply to the Committee. 
‘‘§ 1173. Formal evaluation of recommendations 
‘‘(a) FORMAL EVALUATION.—The Secretary shall es-
tablish a process to conduct a formal evaluation with re-
spect to each recommendation made by the Formal Advi-
sory Committee on Toxic Exposure under section 1172 of 
this title— 
‘‘(1) to conduct research regarding the health 
effects related to a case of toxic exposure; or 
‘‘(2) to evaluate evidence regarding the periods 
and locations of exposure covered by an existing pre-
sumption of service connection. 
‘‘(b) EVIDENCE, DATA, AND FACTORS.—The Sec-
retary shall ensure that each formal evaluation under 
paragraph (1) covers the following: 
‘‘(1) Scientific evidence, based on the review of 
available scientific literature, including human, toxi-
cological, 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 ap-
propriate, such as— 
‘‘(A) the level of disability and mortality 
caused by the health effects related to the case 
of toxic exposure being evaluated; 
‘‘(B) the level of assistance required to re-
main in the community because of such health 
effects; 
‘‘(C) the quantity and quality of the infor-
mation available and reviewed; 
‘‘(D) the feasibility of and period for gen-
erating relevant information and evidence; 
‘‘(E) whether such health effects are 
combat- or deployment-related; and 
‘‘(F) the ubiquity or rarity of the health 
effects. 
‘‘(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, in-
formation, conclusions, or technical results; and 
‘‘(B)(i) evaluates the likelihood that a positive 
association exists between an illness and a toxic ex-
posure 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 evi-
dence is sufficient to conclude that a positive asso-
ciation 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 suffi-
cient 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 suffi-
cient to make a scientifically informed judgment. 
‘‘(D) The ‘against’ category, where the evidence 
suggests the lack of a positive association. 
‘‘(d) RECOMMENDATION
FOR RULEMAKING.—Not 
later than 120 days after the date on which a formal eval-
uation is commenced, the element of the Department that 
conducts the evaluation shall submit to the Secretary a 
recommendation with respect to establishing a presump-
tion of service connection for the toxic exposure and ill-
ness, or modifying an existing presumption of service con-
nection, covered by the evaluation. 
‘‘§ 1174. Regulations regarding presumptions of serv-
ice connection based on toxic exposure 
‘‘(a) ACTION UPON RECOMMENDATION.—Not later 
than 160 days after the date on which the Secretary re-
ceives a recommendation to establish or modify a pre-
sumption of service connection under section 1173 of this 
title— 
‘‘(1) if the Secretary determines that the pre-
sumption, or modification, is warranted, the Sec-
retary shall commence issuing regulations in accord-
ance with the provisions of subchapter II of chapter
5 of title 5 (commonly referred to as the Administra-
tive Procedures Act) setting forth the presumption 
or commence revising regulations to carry out such 
modification; or 
‘‘(2) if the Secretary determines that the pre-
sumption, or modification, is not warranted, the Sec-
retary shall publish in the Federal Register a notice 
of the determination, including the reasons sup-
porting the determination. 
‘‘(b) REMOVAL
OF PRESUMPTION.—(1) The Sec-
retary may issue regulations to remove an illness from a 
presumption of service connection previously established 
pursuant to a regulation issued under subsection (a). 
‘‘(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 
for such illness on the basis of the presumption pro-
vided under such regulations before the effective 
date of the removal or modification shall continue to 
be entitled to receive compensation on that basis; 
and 
‘‘(B) a survivor of a veteran who was awarded 
dependency and indemnity compensation for the
death of a veteran resulting from such illness on the 
basis of such presumption shall continue to be enti-
tled to receive dependency and indemnity compensa-
tion on such basis. 
‘‘§ 1175. Authority to modify process; congressional 
oversight 
‘‘(a) AUTHORITY.—(1) The Secretary may modify the 
process under which the Secretary conducts formal evalua-
tions under section 1173 of this title and issues regula-
tions under section 1174 if— 
‘‘(A) such evaluations cover the evidence, data, 
and factors required by subsection (b) of such sec-
tion 1173; and 
‘‘(B) a period of 180 days has elapsed following 
the date on which the Secretary submits the notice 
under paragraph (2) regarding the modification. 
‘‘(2) If the Secretary proposes to modify the process 
under which the Secretary conducts formal evaluations 
under section 1173 of this title or issues regulations under 
section 1174, the Secretary shall submit to the Commit-
tees on Veterans’ Affairs of the House of Representatives 
and the Senate a notice of the proposed modifications con-
taining the following: 
‘‘(A) A description of the proposed modifica-
tions.
‘‘(B) A description of any exceptions to the re-
quirements of such sections that are proposed be-
cause of limited available scientific evidence, and a 
description of how such evaluations will be con-
ducted. 
‘‘(b) REPORTS AND BRIEFINGS.—(1)(A) Not later 
than two years after the date of the enactment of the Hon-
oring our Promise to Address Comprehensive Toxics Act 
of 2021, the Secretary shall submit to the Committees on 
Veterans’ Affairs of the House of Representatives and the 
Senate a report on the implementation of, and rec-
ommendations for, this subchapter. 
‘‘(B) The Secretary shall develop the report under 
subparagraph (A) in consultation with organizations rec-
ognized by the Secretary for the representation of veterans 
under section 5902 of this title and any other entity the 
Secretary determines appropriate. 
‘‘(2) On a quarterly basis during the two-year period 
beginning on the date of the enactment of the Honoring 
our Promise to Address Comprehensive Toxics Act of 
2021, the Secretary shall provide to the Committees on 
Veterans’ Affairs of the House of Representatives and the 
Senate a briefing on the implementation of this sub-
chapter.
‘‘(c) INDEPENDENT REVIEW.—The Secretary shall 
seek to enter into an agreement with a nongovernmental 
entity or a federally funded research and development cen-
ter to conduct a review of the implementation of this sub-
chapter. Not later than 540 days after the date of the 
enactment of the Honoring our Promise to Address Com-
prehensive Toxics Act of 2021, the Secretary shall submit 
to the Committees on Veterans’ Affairs of the House of 
Representatives and the Senate a report containing such 
review.’’. 
(b) 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 determina-
tion made on or after the date of the enactment of the 
Honoring our Promise to Address Comprehensive Toxics 
Act of 2021 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, in-
cluding 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 sub-
section (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 determina-
tion made on or after the date of the enactment of the 
Honoring our Promise to Address Comprehensive Toxics 
Act of 2021 regarding a presumption of service connection 
based on a toxic exposure under this section is made pur-
suant to subchapter VII of this chapter.’’. 
(c) RULE OF CONSTRUCTION.—Nothing in section 
1172(a)(2)(A) of title 38, United States Code, as added 
by subsection (a), shall be construed so as to require the 
advice and consent of the Senate in the appointment of 
members of the Formal Advisory Committee on Toxic Ex-
posure.
SEC. 203. REEVALUATION OF CLAIMS FOR COMPENSATION 
INVOLVING 
PRESUMPTIONS 
OF 
SERVICE 
CONNECTION. 
(a) IN GENERAL.—Subchapter VI of chapter 11 is 
amended by adding at the end the following new section: 
‘‘§ 1167. Reevaluation of compensation determina-
tions pursuant to changes in presump-
tions of service connection 
‘‘(a) REEVALUATION.—Whenever a law, including 
through a regulation or Federal court decision, establishes 
or modifies a presumption of service connection, the Sec-
retary shall— 
‘‘(1) identify all claims for 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 provi-
sion of law went into effect; and 
‘‘(C) might have been evaluated differently 
had the establishment or modification been ap-
plicable to the claim; 
‘‘(2) allow for the reevaluation of such claims at 
the election of the veteran; and 
‘‘(3) notwithstanding section 5110 of this title, 
with respect to claims approved pursuant to such re-
evaluation, 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.—The Secretary shall conduct out-
reach to inform relevant veterans that they may elect to 
have a claim be reevaluated in light of the establishment 
or modification of a presumption of service connection de-
scribed in subsection (a). Such outreach shall include the 
following: 
‘‘(1) The Secretary shall publish on the internet 
website of the Department a notice that such vet-
erans may elect to have a claim so reevaluated. 
‘‘(2) The Secretary shall notify, in writing or by 
electronic means, veterans service organizations of 
the ability of such veterans to elect to have a claim 
so reevaluated.’’. 
(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.
TITLE III—IMPROVING THE ES-
TABLISHMENT 
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’’. 
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 oc-
curred 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 
‘‘(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 mili-
tary, 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 sub-
stances, chemicals, or hazards in connection with such 
service. 
‘‘(2) The Secretary shall establish and maintain a list 
that contains an identification of one or more such sub-
stances, chemicals, and airborne hazards as the Secretary, 
in collaboration with the Secretary of Defense, may deter-
mine appropriate for purposes of this section. 
‘‘(3) Beginning not later than two years after the 
date of the enactment of the Honoring our Promise to Ad-
dress Comprehensive Toxics Act of 2021, and not less fre-
quently than once every two years thereafter, the Sec-
retary shall submit to the Committees on Veterans’ Affairs 
of the House of Representatives and the Senate 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 vet-
eran who— 
‘‘(A) on or after August 2, 1990, per-
formed active military, naval, air, or space serv-
ice while assigned to a duty station in— 
‘‘(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, per-
formed active military, naval, air, or space serv-
ice while assigned to a duty station in— 
‘‘(i) Afghanistan; 
‘‘(ii) Djibouti; 
‘‘(iii) Egypt; 
‘‘(iv) Jordan; 
‘‘(v) Lebanon; 
‘‘(vi) Syria; 
‘‘(vii) Yemen; 
‘‘(viii) Uzbekistan; 
‘‘(ix) the Philippines; or
‘‘(x) any other country determined rel-
evant by the Secretary. 
‘‘(2) The term ‘exposure tracking record sys-
tem’— 
‘‘(A) means any system, program, or pilot 
program used by the Secretary of Veterans Af-
fairs or the Secretary of Defense to track how 
veterans or members of the Armed Forces have 
been exposed to various occupational or envi-
ronmental 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 EX-
POSURE 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 expo-
sure risk activities 
‘‘(a) MEDICAL EXAMINATIONS AND MEDICAL OPIN-
IONS.—(1) Except as provided in subsection (b), if a vet-
eran 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 par-
ticipation 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 exam-
ination under section 5103A(d) of this title; and 
‘‘(B) obtain a medical opinion (to be requested 
by the Secretary in connection with the medical ex-
amination under subparagraph (A)) as to whether it 
is at least as likely as not that there is a nexus be-
tween the disability and the toxic exposure risk ac-
tivity. 
‘‘(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 asso-
ciation between the disability claimed by the veteran and 
the toxic exposure risk activity for which the veteran sub-
mitted 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.’’. 
TITLE IV—PRESUMPTIONS OF 
SERVICE CONNECTION 
SEC. 401. TREATMENT OF VETERANS WHO PARTICIPATED 
IN CLEANUP OF ENEWETAK ATOLL AS RADI-
ATION-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’’. 
(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 end-
ing on December 31, 1980.’’. 
SEC. 402. TREATMENT OF VETERANS WHO PARTICIPATED 
IN NUCLEAR RESPONSE NEAR PALOMARES, 
SPAIN, OR THULE, GREENLAND, AS RADI-
ATION-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’’ 
(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 weap-
ons in the vicinity of Thule Air Force Base, 
Greenland, during the period beginning Janu-
ary 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’’. 
(b) IN GENERAL.—Section 1116, as amended by sec-
tion 202, is further amended— 
(1) by striking ‘‘, during active military, naval, 
air, or space service, served in the Republic of Viet-
nam during the period beginning on January 9, 
1962, and ending on May 7, 1975’’ each place it ap-
pears and inserting ‘‘performed covered service’’; 
(2) by striking ‘‘performed active military, 
naval, air, or space service in the Republic of Viet-
nam during the period beginning on January 9, 
1962, and ending on May 7, 1975’’ each place it ap-
pears and inserting ‘‘performed covered service’’; 
and
(3) by adding at the end the following new sub-
section: 
‘‘(d) In this section, the term ‘covered service’ means 
active military, naval, air, or space service— 
‘‘(1) performed in the Republic of Vietnam dur-
ing 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 begin-
ning on January 9, 1962, and ending on June 30, 
1976, without regard to where on the base the vet-
eran was located or what military job specialty the 
veteran performed; 
‘‘(3) performed in Laos during the period be-
ginning on December 1, 1965, and ending on Sep-
tember 30, 1969; 
‘‘(4) performed in Cambodia at Mimot or Krek, 
Kampong Cham Province during the period begin-
ning 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 be-
ginning on January 1, 1972, and ending on Sep-
tember 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 ex-
posed during such service to dioxin or was ex-
posed during such service to a toxic substance 
found in a herbicide or defoliant used for mili-
tary purposes during such period.’’. 
(d) CONFORMING AMENDMENT.—The heading for 
section 1116 is amended by striking ‘‘the Republic of 
Vietnam’’ and inserting ‘‘certain locations’’.
SEC. 404. ADDITION OF ADDITIONAL DISEASES ASSOCI-
ATED WITH EXPOSURE TO CERTAIN HERBI-
CIDE AGENTS FOR WHICH THERE IS A PRE-
SUMPTION OF SERVICE CONNECTION FOR 
VETERANS WHO SERVED IN CERTAIN LOCA-
TIONS. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Fair Care for Vietnam Veterans Act’’. 
(b) ADDITIONAL DISEASES.—Section 1116(a)(2), as 
amended by section 9109 of the William M. (Mac) Thorn-
berry National Defense Authorization Act for Fiscal Year 
2021 (Public Law 116–283), is further amended by add-
ing at the end the following new subparagraphs: 
‘‘(L) Hypertension. 
‘‘(M) Monoclonal gammopathy of undetermined 
significance.’’. 
SEC. 405. IMPROVING COMPENSATION FOR DISABILITIES 
OCCURRING IN PERSIAN GULF WAR VET-
ERANS. 
(a) REDUCTION IN THRESHOLD OF ELIGIBILITY.— 
Subsection (a)(1) of section 1117 is amended by striking 
‘‘became manifest—’’ and all that follows through the pe-
riod at the end and inserting ‘‘became manifest to any 
degree at any time.’’. 
(b) PERMANENT EXTENSION OF PERIOD OF ELIGI-
BILITY.—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 in-
serting 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 associ-
ated with Gulf War Illness, the Secretary shall ensure that 
health care personnel of the Department use a disability 
benefits questionnaire, or successor questionnaire, de-
signed to identify Gulf War Illness, in addition to any 
other diagnostic actions the personnel determine appro-
priate.’’. 
(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 Sec-
retary 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 EXPO-
SURE 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’’. 
(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 cer-
tain 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 con-
sidered to have been incurred in or aggravated during ac-
tive 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 con-
nection is warranted based on a positive association 
with a substance, chemical, or airborne hazard iden-
tified 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’’. 
TITLE V—RESEARCH MATTERS 
SEC. 501. INTERAGENCY WORKING GROUP ON TOXIC EXPO-
SURE RESEARCH. 
(a) IN GENERAL.—Subchapter II of chapter 73 of 
title 38, United States Code, is amended by adding at the 
end the following new section:
‘‘§ 7330D. Interagency working group on toxic expo-
sure research 
‘‘(a) ESTABLISHMENT.—(1) The Secretary shall es-
tablish the Toxic Exposure Research Working Group (in 
this section referred to as the ‘Working Group’). 
‘‘(2) The Working Group shall consist of employees, 
selected by the Secretary, of the following: 
‘‘(A) The Department. 
‘‘(B) The Department of Defense. 
‘‘(C) The Department of Health and Human 
Services. 
‘‘(D) The Environmental Protection Agency. 
‘‘(E) Other Federal entities 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 per-
form 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 5-year strategic plan for Federal 
entities represented in the Working Group to carry 
out collaborative research activities.
‘‘(c) REPORTING.—The Secretary shall submit, to the 
Committees on Veterans’ Affairs of the Senate and House 
of Representatives, the following: 
‘‘(1) Not later than one year after the date of 
the enactment of the Act, a report on the establish-
ment of the Working Group under subsection (a). 
‘‘(2) Not later than two years after the date of 
enactment of the Act, a report containing the col-
laborative research activities identified, and the 
Strategic Plan developed, by the Working Group, 
under subsection (b). 
‘‘(3) Annually during the 5-year period covered 
by the strategic plan under subsection (b), a 
progress reports on implementation of the Strategic 
Plan under subsection (b). 
‘‘(d) TERMINATION.—The Working Group shall ter-
minate after submitting the final report under subsection 
(c). 
‘‘(e) DEFINITIONS.—For purposes of this section— 
‘‘(1) The term ‘Act’ means the Honoring our 
Promise to Address Comprehensive Toxics Act of 
2021. 
‘‘(2) The term ‘collaborative research activity’ 
means a research activity—
‘‘(A) conducted by an entity represented by 
a member of the Working Group; 
‘‘(B) funded by the Federal Government; 
and 
‘‘(C) regarding the health consequences of 
toxic exposures experienced during active mili-
tary, naval, air, or space service.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such subchapter is amended by insert-
ing after the item relating to section 7330C the following 
new item: 
‘‘7330D. Interagency working group on toxic exposure research.’’. 
(c) IMPLEMENTATION.—The Secretary of Veterans 
Affairs shall establish the Working Group under section 
7330D of such title, as added by subsection (a), not later 
than one year after the date of the enactment of this Act. 
SEC. 502. DATA COLLECTION, ANALYSIS, AND REPORT ON 
TREATMENT OF VETERANS FOR ILLNESSES 
RELATED TO TOXIC EXPOSURE. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall compile and analyze, on a continuous basis, all clin-
ical data that— 
(1) is obtained by the Secretary in connection 
with hospital care (including mental health services 
and counseling), medical services, or nursing home 
care furnished to a veteran for an illness under sec-
tion 1710(a)(2)(F) of title 38, United States Code, 
as amended by section 102; and 
(2) is likely to be scientifically useful, as deter-
mined by the Secretary, in determining whether a 
positive association exists between the illness of the 
veteran and a toxic exposure. 
(b) CONSENT OF PATIENTS.—The Secretary shall en-
sure that the compilation and analysis of the clinical data 
of a veteran under subsection (a) shall be conducted, and 
such data shall be used, in a manner that is consistent 
with the informed consent of the veteran and in compli-
ance with all applicable Federal law. 
(c) ANNUAL REPORT.—Not later than one year after 
the date of the enactment of this Act, and annually there-
after, the Secretary shall submit to the Committees on 
Veterans’ Affairs of the House of Representatives and the 
Senate a report containing— 
(1) any data compiled under subsection (a); 
(2) an analysis of any such data; 
(3) a description of the types and incidences of 
illnesses identified by the Secretary pursuant to such 
subsection; 
(4) an explanation by the Secretary for the inci-
dence of such illnesses and such alternate expla-
nations for the incidence of such illnesses as the Sec-
retary may consider reasonable; and 
(5) a description of the views of the Secretary 
regarding the scientific validity of drawing conclu-
sions from the incidence of such illnesses, as evi-
denced by the data compiled under subsection (a), 
regarding the existence of a positive association be-
tween such illness and a toxic exposure. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘toxic exposure’’ has the meaning 
given that term in section 101 of title 38, United 
States Code. 
(2) The term ‘‘illness’’ has the meaning given 
that term in section 1171 of such title, as added by 
section 202. 
SEC. 503. STUDIES RELATED TO VETERANS WHO SERVED IN 
SOUTHWEST ASIA AND CERTAIN OTHER LO-
CATIONS. 
(a) ANALYSIS
ON MORTALITY
IN COVERED VET-
ERANS.— 
(1) ANALYSIS.—Not later than 180 days after 
the date of the enactment of this Act, the Secretary 
of Veterans Affairs shall conduct an updated anal-
ysis of total and respiratory disease mortality in cov-
ered veterans.
(2) ELEMENTS.—The analysis under paragraph 
(1) shall include, to the extent practicable, the fol-
lowing: 
(A) Metrics of airborne exposures. 
(B) The location and timing of any deploy-
ments of the veteran. 
(C) The military occupational specialty of 
the veteran. 
(D) The Armed Force in which the veteran 
served. 
(E) The preexisting health status of the 
veteran, including with respect to asthma. 
(F) Such personal information of the vet-
eran as the Secretary may consider relevant, in-
cluding cigarette and e-cigarette smoking his-
tory, diet, sex, gender, age, race, and ethnicity. 
(b) EPIDEMIOLOGICAL STUDY.—Not later than 180 
days after the date of the enactment of this Act, the Sec-
retary shall conduct an epidemiological study of covered 
veterans that involves— 
(1) the use of improved spatio-temporal esti-
mates of ambient air pollution exposures that lever-
age advances in retrospective exposure assessment; 
and
(2) the collection of detailed information on the 
covered veterans studied through medical records, 
administrative data, and other existing sources, in-
cluding, with respect to the covered veterans— 
(A) personal information, including ciga-
rette and e-cigarette smoking history, diet, sex, 
gender, age, race, and ethnicity; 
(B) deployment history, including loca-
tions, periods, and number of deployments; 
(C) biospecimen data; and 
(D) supplementary health status and out-
comes data, including imaging and physiological 
parameters. 
(c) TOXICOLOGY STUDY.— 
(1) STUDY.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary 
shall conduct a toxicology study, to include varia-
bility, to replicate toxic exposures of healthy, young 
members of the Armed Forces, as well as potentially 
susceptible members, with preexisting health condi-
tions. 
(2) ELEMENTS.—The study under paragraph 
(1) shall include— 
(A) an analysis of results for mechanistic 
markers and clinically relevant outcomes; and
(B) a validation of any serum, tissue, or 
other biomarkers of toxic exposure, suscepti-
bility, or effect with respect to the subjects of 
the study. 
(d) COVERED VETERAN DEFINED.—In this section, 
the term ‘‘covered veteran’’ has the meaning given that 
term in section 1119(c) of title 38, United States Code, 
as added by section 302. 
SEC. 504. STUDY ON HEALTH TRENDS OF POST 9/11 VET-
ERANS. 
(a) STUDY.—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. 
(b) ELEMENTS.—The study under subsection (a) 
shall assess, with respect to each veteran included in the 
study, the following: 
(1) The race and ethnicity of the veteran. 
(2) The age of the veteran. 
(3) The period of service and length of service 
of the veteran in the Armed Forces. 
(4) Any military occupational speciality of the 
veteran. 
(5) The gender of the veteran. 
(6) The disability status of the veteran.
(c) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Secretary shall submit 
to the Committees on Veterans’ Affairs of the House of 
Representatives and the Senate a report on the study 
under subsection (a). 
SEC. 506. STUDY ON FEASIBILITY AND ADVISABILITY OF 
FURNISHING HOSPITAL CARE AND MEDICAL 
SERVICES TO DEPENDENTS OF VETERANS 
WHO PARTICIPATED IN TOXIC EXPOSURE 
RISK ACTIVITIES. 
(a) STUDY.—The Secretary of Veterans Affairs shall 
conduct a study on the feasibility and advisability of fur-
nishing hospital care and medical services to qualifying de-
pendents of veterans described in section 1710(e)(1)(G) 
of title 38, United States Code, as added by section 
103(a)(1), for any illness determined by the Secretary to 
be connected to a toxic exposure risk activity carried out 
by the veteran, as determined by the Secretary, notwith-
standing that there is insufficient medical evidence to con-
clude that such illness is attributable to such activity. 
(b) ELEMENTS.—The study under subsection (a) 
shall include— 
(1) an assessment of the impact of furnishing 
hospital care and medical services to qualifying de-
pendents as described in such subsection on the abil-
ity of the Department of Veterans Affairs to furnish 
hospital care and medical services to veterans; 
(2) an assessment of the potential cost of fur-
nishing hospital care and medical services to quali-
fying dependents as described in such subsection; 
(3) an estimate of the resources required to fur-
nish such care and services; 
(4) an assessment of any stress or other effect 
furnishing such care and services would have on the 
claims and appeals system of the Department; 
(5) an estimate of the number of qualifying de-
pendents who would be eligible for such care and 
services; and 
(6) an assessment of the feasibility of adjudi-
cating claims for such care and services. 
(c) PHASED-IN APPLICATION.—In conducting the 
study under subsection (a), the Secretary shall assess the 
feasibility and advisability of phasing in the furnishing of 
hospital care and medical services to qualifying depend-
ents described in such subsection by the decade in which 
such toxic exposure risk activity occurred, starting with 
the most recent decade. 
(d) REVIEW OF TOXIC EXPOSURE CASES REGARDING 
LIABILITY
OF DEPARTMENT
OF DEFENSE.—In con-
ducting the study under subsection (a), the Secretary 
shall— 
(1) review known cases of toxic exposure on 
military installations of the Department of Defense; 
(2) analyze the liability of the Department of 
Defense in each such case; and 
(3) assess whether the Secretary of Defense 
should provide care and services relating to such 
toxic exposures under the TRICARE program. 
(e) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the study conducted under sub-
section (a). 
(f) DEFINITIONS.—In this section: 
(1) The terms ‘‘hospital care’’ and ‘‘medical 
services’’ have the meanings given those terms in 
section 1701 of title 38, United States Code. 
(2) The term ‘‘illness’’ has the meaning given 
that term in section 1171 of such title, as added by 
section 202. 
(3) The term ‘‘qualifying dependent’’ means— 
(A) a dependent of a veteran described in 
section 1710(e)(1)(G) of title 38, United States 
Code, as added by section 104(a)(1), who re-
sided with the veteran during the period in
which, and on the installation at which, the vet-
eran participated in a toxic exposure risk activ-
ity; 
(B) an individual who was in utero of such 
a veteran or other qualifying dependent when 
the veteran participated in a toxic exposure risk 
activity; or 
(C) a dependent of such a veteran who is 
not described in subparagraph (A) or (B) but 
who may have an illness that is connected to 
the toxic exposure risk activity of the veteran, 
as determined by the Secretary. 
(4) The term ‘‘toxic exposure’’ has the meaning 
given that term in section 101 of such title, as 
added by section 102(b). 
(5) The term ‘‘toxic exposure risk activity’’ has 
the meaning given that term in section 1710(e)(4) 
of such title, as added by section 102(c). 
(6) The term ‘‘TRICARE program’’ has the 
meaning given that term in section 1072 of such 
title.
SEC. 507. STUDY ON HEALTH EFFECTS OF WASTE RELATED 
TO MANHATTAN PROJECT ON CERTAIN VET-
ERANS. 
(a) STUDY.—The Secretary of Veterans Affairs shall 
conduct 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 in the county 
of St. Louis, Missouri: 
(1) Coldwater Creek. 
(2) The St. Louis Airport Site. 
(3) The West Lake Landfill. 
(4) Any other location in the county of St. 
Louis, Missouri 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, gender, and race of the veteran.
(2) The period and location of exposure to cov-
ered waste. 
(3) Any type of cancer, or other illness associ-
ated 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 over-
all health condition of past and present civilian pop-
ulations residing at the same location of exposure. 
(d) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit 
to the Committees on Veterans’ Affairs of the House of 
Representatives and the Senate a report on the study 
under subsection (a). 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘covered waste’’ means any waste 
arising from activities carried out in connection with 
the Manhattan Project. 
(2) The term ‘‘illness’’ has the meaning given 
that term in section 1171 of title 38, United States 
Code, as added by section 202. 
(3) The term ‘‘toxic exposure’’ has the meaning 
given that term in section 101 of such title, as 
added by section 102(b).
SEC. 508. STUDY ON TOXIC EXPOSURE AND MENTAL 
HEALTH OUTCOMES. 
(a) STUDY REQUIRED.—The Secretary of the De-
partment of Veterans Affairs shall enter into an agree-
ment with the National Academies of Sciences, Engineer-
ing, and Medicine for the conduct of a study of veterans 
to assess possible relationships between toxic exposures ex-
perienced during service in the Armed Forces and mental 
health outcomes, including chronic multisymptom illness, 
traumatic brain injury, post-traumatic stress disorder, de-
pression, psychosis, 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) Gender. 
(3) Race and ethnicity. 
(4) Period and length of service in the Armed 
Forces. 
(5) History of toxic exposure during service in 
the Armed Forces. 
(6) Any diagnosis of chronic multisymptom ill-
ness. 
(7) Any diagnosis of a mental health or cog-
nitive disorder.
(8) 
Any 
history 
of 
suicide 
attempt 
or 
suidcidality. 
(9) If the veteran died by suicide. 
(c) REPORT.—Not later than two years after the date 
after the enactment of this Act, the Secretary shall submit 
to the Committees on Veterans’ Affairs of the Senate and 
House of Representatives a report containing the findings 
of the study conducted under subsection (a). 
SEC. 509. 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 fur-
nished under laws administered by the Secretary of 
Veterans Affairs to veterans in Territories of the 
United States, including deficits in the availability 
and accessibility of such benefits and services com-
pared to veterans elsewhere in the United States. 
(2) ELEMENTS.—The study under paragraph 
(1) shall include— 
(A) the number of veterans in each Terri-
tory of the United States; 
(B) the number of veterans in each Terri-
tory who are enrolled in the system of annual
patient enrollment of the Department of Vet-
erans Affairs under section 1705(a) of title 38, 
United States Code; 
(C) the number of veterans in each Terri-
tory 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 fac-
ing veterans in each Territory in accessing 
health care services, including those involving 
the availability of such services to veterans in 
the Territory in which the veterans reside, and 
the distance required of veterans to journey to 
receive services at a regional medical center of 
the Veterans Health Administration, a commu-
nity-based outpatient clinic, or other full-service 
medical facility of the Department, or death 
center, respectively; 
(E) a detailed description of obstacles fac-
ing veterans in each Territory in accessing re-
adjustment counseling services, including those 
involving the availability of such services to vet-
erans in the Territory in which the veterans re-
side, and the distance required of veterans to
journey to receive services at a readjustment 
counseling services center of the Department; 
(F) a detailed description of obstacles fac-
ing veterans in each Territory in accessing 
other veterans benefits, including those involv-
ing the availability of benefits and services to 
veterans in the Territory in which the veterans 
reside, and the distance required of the veterans 
to journey to the nearest office of the Veterans 
Benefits Administration; 
(G) an analysis of the staffing and record-
keeping levels and quality of the offices of the 
Department charged with serving veterans in 
the Territories, including the availability of the 
full- and part-time staff of each office to the 
veterans they are charged with serving, and the 
continuity of care provided by such staff to 
such veterans; 
(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; 
(I) an analysis of the economic and health 
consequences for veterans in each Territory re-
sulting from obstacles to accessing adequate as-
sistance and health care at facilities of the De-
partment; 
(J) an analysis of the access to assistance 
and health care provided to veterans in the 
aftermath of major disasters declared in each of 
the Territories since September 4, 2017; and 
(K) recommendations for improving access 
of veterans in the Territories to benefits and 
services furnished by the Secretary, and reduc-
ing barriers and deficits in the availability and 
accessibility of such benefits and services com-
pared to veterans elsewhere in the United 
States. 
(b) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Comptroller General of 
the United States shall submit to Congress a final report 
setting forth the results of the study conducted under sub-
section (a), including the recommendations developed 
under paragraph (2)(K) of such subsection. 
(c) TERRITORY DEFINED.—In this section, the term 
‘‘Territory’’ includes American Samoa, the Commonwealth 
of the Northern Marianas Islands, Guam, Puerto Rico, 
and the Virgin Islands.
SEC. 510. 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 pub-
lically 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 Govern-
ment. 
(b) RELATION TO WAR RELATED ILLNESS AND IN-
JURY STUDY CENTER.—The website developed and main-
tained under subsection (a) shall be housed under the 
website of the War Related Illness and Injury Study Cen-
ter of the Department of Veterans Affairs, or successor 
center. 
(c) COORDINATION.—In carrying out subsection (a), 
the Secretary shall coordinate with— 
(1) the heads of each Federal department or 
agency carrying out or funding toxic exposure re-
search; 
(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. 
(d) DEFINITIONS.—In this section: 
(1) 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) The term ‘‘toxic exposure research’’ means 
research on the health consequences of toxic expo-
sures experienced during service in the Armed 
Forces. 
SEC. 511. BIENNIAL REPORT ON HEALTH EFFECTS OF JET 
FUELS USED BY ARMED FORCES. 
Not later than one year after the date of the enact-
ment of this Act, and biennially thereafter during the sub-
sequent eight-year period, the Secretary of Veterans Af-
fairs shall submit to the Committees on Veterans’ Affairs 
of the House of Representatives and the Senate, and make 
publicly available, a report that includes— 
(1) a discussion of the effect of various dif-
ferent types of jet fuels used by the Armed Forces 
on the health of individuals by length of exposure; 
(2) an identification of the immediate symp-
toms of jet fuel exposure that may indicate future 
health risks;
(3) a chronology of health safeguards imple-
mented by the Armed Forces intended to reduce the 
exposure of members of the Armed Foces to jet fuel; 
and 
(4) an identification of any areas relating to jet 
fuel exposure about which new research needs to be 
conducted. 
TITLE VI—IMPROVEMENT OF RE-
SOURCES AND TRAINING RE-
GARDING 
TOXIC-EXPOSED 
VETERANS 
SEC. 601. SHORT TITLE; DEFINITIONS. 
(a) SHORT TITLE.—This title may be cited as the 
‘‘Toxic Exposure in the American Military Act’’ or the 
‘‘TEAM Act’’. 
(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. 
SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DE-
PARTMENT 
OF 
VETERANS 
AFFAIRS 
FOR 
TOXIC-EXPOSED VETERANS AND OUTREACH 
PROGRAM FOR SUCH VETERANS AND CARE-
GIVERS 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 an-
nually thereafter, the Secretary of Veterans Affairs 
shall publish a list of resources of the Department 
of Veterans Affairs for— 
(A) toxic-exposed veterans, including with 
respect to— 
(i) 
disability 
compensation 
under 
chapter 11 of title 38, United States Code; 
and 
(ii) hospital care, medical services, 
and nursing home care under section 
1710(a)(2)(F) of such title; 
(B) caregivers of toxic-exposed veterans 
who are participating in the program of com-
prehensive assistance for family caregivers 
under section 1720G(a) of such title; and 
(C) survivors of toxic-exposed veterans who 
are receiving death benefits under the laws ad-
ministered by the Secretary. 
(2) UPDATE.—The Secretary shall periodically 
update the list published under paragraph (1). 
(3) LANGUAGES.—The Secretary shall publish 
the list under paragraph (1) in languages including 
the following:
(A) English. 
(B) Spanish. 
(C) Chinese. 
(D) The seven other most commonly spo-
ken languages in the United States. 
(b) OUTREACH.—The Secretary shall develop, with 
input from the community, an informative outreach pro-
gram for veterans on illnesses that may be related to toxic 
exposure, including outreach with respect to benefits and 
support programs. Information distributed under the out-
reach program shall be treated as a fact sheet of the De-
partment of Veterans Affairs for purposes of making the 
information available in multiple languages pursuant to 
section 2 of the Veterans and Family Information Act 
(Public Law 117–62; 38 U.S.C. 6303 note). 
(c) VETERANS ORGANIZATIONS.—To the extent prac-
ticable, the Secretary shall share with national veterans 
service organizations and other veterans groups, including 
such organizations and groups that improve access by vet-
erans to health care and benefits, the list of resources 
under subsection (a) and the outreach program under sub-
section (b).
SEC. 603. INCORPORATION OF TOXIC EXPOSURE QUES-
TIONNAIRE 
DURING 
PRIMARY 
CARE 
AP-
POINTMENTS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall incorporate a clinical questionnaire to help determine 
potential toxic exposures during active military, naval, air, 
or space service as part of the initial screening conducted 
for an appointment of a veteran with a primary care pro-
vider of the Department of Veterans Affairs to improve 
understanding by the Department of toxic exposures of 
veterans while serving in the Armed Forces. 
(b) DETERMINATION OF QUESTIONS.—The questions 
included in the questionnaire required under subsection 
(a) shall be determined by the Secretary with input from 
medical professionals. 
SEC. 604. TRAINING FOR PERSONNEL OF THE DEPART-
MENT OF VETERANS AFFAIRS WITH RESPECT 
TO TOXIC-EXPOSED VETERANS. 
(a) HEALTH CARE PERSONNEL.—The Secretary of 
Veterans Affairs shall provide to health care personnel of 
the Department of Veterans Affairs education and train-
ing to identify, treat, and assess the impact on toxic-ex-
posed veterans of illnesses related to toxic exposure and 
inform such personnel of how to ask for additional infor-
mation from veterans regarding different toxic exposures. 
(b) BENEFITS PERSONNEL.—
(1) STANDARD
CLAIMS
PROCESSOR
TRAINING 
CURRICULUM.— 
(A) CURRICULUM.—Not later than 180 
days after the date of the enactment of this 
Act, the Secretary shall ensure that a standard 
training curriculum exists for processors of 
claims under the laws administered by the Sec-
retary who review claims for disability benefits 
relating to service-connected disabilities based 
on toxic exposure, including employees who ad-
judicate such claims. 
(B) MATTERS INCLUDED.—The Secretary 
shall ensure that the training under subpara-
graph (A) includes the following explanations 
with respect to claims relating to toxic expo-
sure: 
(i) A lack of a presumption of service 
connection is not by itself sufficient to de-
termine that service connection does not 
exist. 
(ii) The claims adjudicator shall al-
ways consider whether direct service con-
nection is applicable and request, as need-
ed, an advisory medical opinion pursuant
to section 1168 of title 38, United States 
Code, as added by section 303. 
(iii) The claims adjudicator may re-
view and consider any record of the claim-
ant in an exposure tracking record system 
pursuant to section 1119 of such title, as 
added by section 302, but a lack of such 
information is not by itself sufficient to de-
termine that such exposure did not occur 
or sufficient to deny the claim. 
(C) PROVISION
OF
TRAINING.—The Sec-
retary shall— 
(i) provide training under subpara-
graph (A) to each employee described in 
such subparagraph not less frequently than 
annually; and 
(ii) using the Systematic Technical 
Accuracy Review program, or such suc-
cessor program, conduct a nationwide, 
quarterly, randomized review of the quality 
of adjudication of claims relating to toxic 
exposure. 
(2) STANDARD MEDICAL EXAMINER TRAINING 
CURRICULUM.—