of total and respiratory disease mortality in covered vet-
erans. The study shall include, to the extent practicable— 
(1) metrics of airborne exposures; 
(2) the location and timing of deployments; 
(3) the military occupational specialty; 
(4) the Armed Force in which the veteran 
served; 
(5) pre-existing health status, including with re-
spect to asthma; and 
(6) relevant personal information, including cig-
arette and e-cigarette smoking history, 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 sponsor an epidemiological study of covered 
veterans that uses the following: 
(1) Improved spatio-temporal estimates of am-
bient air pollution exposures using advances in retro-
spective exposure assessment. 
(2) Detailed information on the study subjects 
obtained through medical records, administrative 
data, and other existing sources, that include— 
(A) personal characteristics, including ciga-
rette and e-cigarette smoking history, diet, sex, 
gender, age, race, and ethnicity; 
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(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.—Not later than 180 days 
after the date of the enactment of this Act, the Secretary 
shall sponsor a toxicology study to include variability to 
replicate exposures of healthy, young members of the 
Armed Forces, as well as potentially susceptible members, 
with preexisting health conditions. The study shall— 
(1) analyze the study results for mechanistic 
markers and clinically relevant outcomes; and 
(2) validate serum, tissue, and other biomarkers 
of exposure, susceptibility, or effect. 
(d) COVERED VETERAN DEFINED.—The term ‘‘cov-
ered 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; 
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(F) Saudi Arabia; 
(G) Somalia; or 
(H) United Arab Emirates; or 
(2) on or after September 11, 2001, served on 
active duty in— 
(A) Afghanistan; 
(B) Djibouti; 
(C) Egypt; 
(D) Jordan; 
(E) Lebanon; 
(F) Syria; or 
(G) Yemen. 
SEC. 5. TRAINING TO IMPROVE CLAIMS ADJUDICATIONS. 
(a) TRAINING ON ADJUDICATION.—The Secretary of 
Veterans Affairs shall provide training to each covered em-
ployee to improve the handling of claims for compensation 
and pension benefits that relate to toxic exposure. The 
Secretary shall provide such training annually and, in ad-
dition to the annual training, when the Secretary deter-
mines that a significant development has occurred in law 
or regulation with respect to such claims, such as the Sec-
retary establishing a new presumption of service connec-
tion. 
(b) MATTERS INCLUDED.— 
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(1) ALL TRAINEES.—The training under sub-
section (a) shall include the following explanations 
with respect to claims relating to toxic exposure: 
(A) A lack of a presumption of service con-
nection is not by itself sufficient to determine 
that service connection does not exist. 
(B) The claims adjudicator shall always 
consider whether direct service connection is ap-
plicable and request, as needed, an advisory 
medical opinion under section 5109 of title 38, 
United States Code. 
(C) While information included in the indi-
vidual longitudinal exposure record program of 
the Department of Veterans Affairs may be 
used to corroborate assertions of toxic exposure, 
a lack of such information, or a lack of other 
corroborating evidence of toxic exposure, is not 
by itself sufficient to determine that such expo-
sure did not occur or sufficient to deny the 
claim. 
(2) VETERANS SERVICE REPRESENTATIVES.— 
In addition to the matters under paragraph (1), the 
Secretary shall ensure that each employee described 
in subsection (d)(1) receives an individualized as-
sessment of— 
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(A) the ability of the employee to identify 
claims qualifying for presumptive service con-
nection; and 
(B) the compliance of the employee with 
standardized development requirements. 
(3) RATING VETERANS SERVICE REPRESENTA-
TIVE.—In addition to the matters under paragraph 
(1), the Secretary shall ensure that each employee 
described in subsection (d)(2) receives an individual-
ized assessment of— 
(A) the ability of the employee to identify 
claims qualifying for presumptive service con-
nection; and 
(B) the compliance of the employee with 
the schedule of ratings for disabilities adopted 
under section 1155 of title 38, United States 
Code. 
(4) COMPENSATION AND PENSION MEDICAL EX-
AMINERS.—In addition to the matters under para-
graph (1), the Secretary shall ensure that each em-
ployee described in subsection (d)(3) receives an in-
dividualized assessment of— 
(A) the ability of the employee to identify 
claims qualifying for presumptive service con-
nection; and 
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(B) the compliance of the employee with 
standardized examination and medical opinion 
procedures. 
(c) PROVISION OF TRAINING.—With respect to em-
ployees described in paragraph (1) or (2) of subsection 
(d), the Secretary shall— 
(1) ensure that the training under subsection 
(a) is provided as part of the initial training pro-
gram for such employees; 
(2) place each employee under a second signa-
ture review period for claims relating to toxic expo-
sure until the employee meets the required grade 
scale level quality standard for such claims; and 
(3) using the Systematic Technical Accuracy 
Review program, or such successor program, conduct 
a nationwide, quarterly, randomized review of the 
quality of adjudication of claims relating to toxic ex-
posure. 
(d) COVERED EMPLOYEE DEFINED.—In this section, 
the term ‘‘covered employee’’ means employees of the De-
partment of Veterans Affairs who handle claims for com-
pensation and pension benefits, including— 
(1) employees who adjudicate claims; 
(2) employees who apply the schedule of ratings 
for disabilities adopted under section 1155 of title 
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38, United States Code, and prepare rating deci-
sions; and 
(3) employees or contractors who provide med-
ical examinations or medical opinions pursuant to 
section 5103A(d) of such title. 
Æ 
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