I 
116TH CONGRESS 
2D SESSION 
H. R. 8261 
To amend title 38, United States Code, to provide for a presumption of 
service connection for certain diseases associated with exposure to toxins, 
including emissions from open burn pits, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 15, 2020 
Mr. RUIZ introduced the following bill; which was referred to the Committee 
on Veterans’ Affairs, and in addition to the Committees on Armed Serv-
ices, and Education and Labor, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title 38, United States Code, to provide for a 
presumption of service connection for certain diseases 
associated with exposure to toxins, including emissions 
from open burn pits, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Presumptive Benefits 
for War Fighters Exposed to Burn Pits and Other Toxins 
Act of 2020’’. 
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SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR CER-
TAIN DISEASES ASSOCIATED WITH EXPO-
SURE TO OPEN BURN PITS AND OTHER TOX-
INS. 
(a) IN GENERAL.—Subchapter II of chapter 11 of 
title 38, United States Code, is amended by adding at the 
end the following new section: 
‘‘§ 1119. Presumption of service connection for cer-
tain diseases associated with exposure to 
open burn pits and other toxins 
‘‘(a) PRESUMPTION OF SERVICE CONNECTION.—(1) 
For the purposes of section 1110 of this title, and subject 
to section 1113 of this title, a disease specified in para-
graph (2) becoming manifest in a veteran described in 
paragraph (3) shall be considered to have been incurred 
in or aggravated during active military, naval, or air serv-
ice, notwithstanding that there is no record of evidence 
of such disease during the period of such service. 
‘‘(2) The diseases specified in this paragraph are the 
following: 
‘‘(A) Asthma that was diagnosed after service 
in a country or territory listed under paragraph 
(4)(B). 
‘‘(B) Cancer of any type. 
‘‘(C) Chronic bronchitis. 
‘‘(D) Chronic obstructive pulmonary disease. 
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‘‘(E) Constrictive bronchiolitis or obliterative 
bronchiolitis. 
‘‘(F) Emphysema. 
‘‘(G) Granulomatous disease. 
‘‘(H) Interstitial lung disease. 
‘‘(I) Lymphoma. 
‘‘(J) Pleuritis. 
‘‘(K) Pulmonary fibrosis. 
‘‘(L) Sarcoidosis. 
‘‘(M) Any other disease with respect to which 
final regulations have been prescribed under sub-
section (c)(3). 
‘‘(3) A veteran described in this paragraph is any vet-
eran who— 
‘‘(A) on or after January 1, 1990— 
‘‘(i) served as a member of the Armed 
Forces in support of a military operation de-
scribed in paragraph (4); and 
‘‘(ii) was present for 15 or more cumu-
lative days in a country or territory listed under 
subparagraph (B) of that paragraph; or 
‘‘(B) was awarded a campaign medal in rec-
ognition of service in any of the following— 
‘‘(i) Operation Enduring Freedom; 
‘‘(ii) Operation Iraqi Freedom; 
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‘‘(iii) Operation Nomad Shadow; 
‘‘(iv) Operation New Dawn; 
‘‘(v) Operation Inherent Resolve; 
‘‘(vi) Operation Freedom’s Sentinel; 
‘‘(vii) Operation Odyssey Lightning; or 
‘‘(viii) Operation Pacific Eagle. 
‘‘(4) A military operation described in this paragraph 
is any of the following: 
‘‘(A) A contingency operation (as defined in 
section 101(a)(13) of title 10). 
‘‘(B) A military operation in any of the fol-
lowing countries or territories: 
‘‘(i) Afghanistan. 
‘‘(ii) Bahrain. 
‘‘(iii) Burkina Faso. 
‘‘(iv) Cameroon. 
‘‘(v) Chad. 
‘‘(vi) Diego Garcia. 
‘‘(vii) Djibouti. 
‘‘(viii) Egypt. 
‘‘(ix) Ethiopia. 
‘‘(x) Gabon. 
‘‘(xi) Ghana. 
‘‘(xii) Iraq. 
‘‘(xiii) Jordan. 
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‘‘(xiv) Kenya. 
‘‘(xv) Kuwait. 
‘‘(xvi) Kyrgyzstan. 
‘‘(xvii) Libya. 
‘‘(xviii) Mali. 
‘‘(xix) Niger. 
‘‘(xx) Nigeria. 
‘‘(xxi) Oman. 
‘‘(xxii) Pakistan. 
‘‘(xxiii) Philippines. 
‘‘(xxiv) Saudi Arabia. 
‘‘(xxv) Somalia. 
‘‘(xxvi) South Sudan. 
‘‘(xxvii) Sudan. 
‘‘(xxviii) Syria. 
‘‘(xxix) Tajikistan. 
‘‘(xxx) Tunisia. 
‘‘(xxxi) United Arab Emirates. 
‘‘(xxxii) Uzbekistan. 
‘‘(xxxiii) Yemen. 
‘‘(b) PROCESS TO ADD DISEASES THROUGH WRIT-
TEN PETITION.—(1) In the case that the Secretary re-
ceives a written petition from an interested party to add 
a disease to the list of diseases specified in subsection 
(a)(2), not later than 90 days after the date of receipt 
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of such petition, the Secretary shall request a determina-
tion by the National Academies of Sciences, Engineering, 
and Medicine (referred to in this section as the ‘National 
Academies’) with respect to whether there is a positive as-
sociation between— 
‘‘(A) the exposure of humans to one or more 
covered toxins, including emissions from open burn 
pits; and 
‘‘(B) the occurrence of the disease in humans. 
‘‘(2) For purposes of this subsection, the term ‘inter-
ested party’ includes a representative of— 
‘‘(A) a congressionally chartered veterans serv-
ice organization; 
‘‘(B) an organization that— 
‘‘(i) is described in section 501(c)(3) of the 
Internal Revenue Code of 1986 and exempt 
from taxation under section 501(a) of such 
Code; 
‘‘(ii) serves veterans or members of the 
Armed Forces; and 
‘‘(iii) has continuously operated for a pe-
riod of five years or more preceding the date of 
the submittal of the written petition under 
paragraph (1); 
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‘‘(C) a collective bargaining agent for civilian 
employees of the United States Government; 
‘‘(D) a nationally recognized medical associa-
tion; 
‘‘(E) the National Academies; or 
‘‘(F) a State or political subdivision of a State. 
‘‘(c) DETERMINATIONS BY NATIONAL ACADEMIES.— 
(1) If the Secretary receives a determination described in 
paragraph (2), not later than 180 days after receipt of 
such determination, the Secretary shall— 
‘‘(A) publish in the Federal Register proposed 
regulations to add the disease covered by the deter-
mination to the list of diseases specified in sub-
section (a)(2); 
‘‘(B) publish in the Federal Register, and sub-
mit to the Committee on Veterans’ Affairs of the 
Senate and the Committee on Veterans’ Affairs of 
the House of Representatives— 
‘‘(i) the decision of the Secretary not to 
publish such proposed regulations; and 
‘‘(ii) the basis for such decision, including 
specific medical science refuting the determina-
tion; or 
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‘‘(C) publish in the Federal Register a decision 
that insufficient evidence exists to take action under 
subparagraph (A) or (B). 
‘‘(2) A determination described in this paragraph— 
‘‘(A) is a determination by the National Acad-
emies that there is a positive association between— 
‘‘(i) the exposure humans to one or more 
covered toxins, including emissions from open 
burn pits; and 
‘‘(ii) the occurrence of the disease in hu-
mans; and 
‘‘(B) may be made pursuant to— 
‘‘(i) a request from the Secretary under 
subsection (b); or 
‘‘(ii) an agreement between the Secretary 
and the National Academies under section 3 of 
the Presumptive Benefits for War Fighters Ex-
posed to Burn Pits and Other Toxins Act of 
2020. 
‘‘(3)(A) Not later than 180 days after the date on 
which the Secretary publishes any proposed regulations 
under paragraph (1)(A) for a disease, the Secretary shall 
prescribe final regulations for that disease. 
‘‘(B) Such regulations shall be effective on the date 
of issuance. 
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‘‘(d) REFERENCE TO NATIONAL ACADEMIES.—In the 
case that the Secretary enters into an agreement with an-
other organization as described in section 3(h)(1) of the 
Presumptive Benefits for War Fighters Exposed to Burn 
Pits and Other Toxins Act of 2020, any reference in this 
section to the National Academies shall be treated as a 
reference to the other organization. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) The term ‘covered toxin’ means any toxic 
chemical, including— 
‘‘(A) hazardous waste, mixed waste, solid 
waste, or used oil (as those terms are defined 
in section 1004 of the Solid Waste Disposal Act 
(42 U.S.C. 6903)); 
‘‘(B) radiological waste; and 
‘‘(C) any other carcinogen. 
‘‘(2) The term ‘veterans service organization’ 
means an organization recognized by the Secretary 
for the representation of veterans under section 
5902 of this title. 
‘‘(3) The term ‘open burn pit’ means an area 
of land located that— 
‘‘(A) is designated by the Secretary of De-
fense to be used for disposing solid waste by 
burning in the outdoor air; and 
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‘‘(B) does not contain a commercially man-
ufactured incinerator or other equipment spe-
cifically designed and manufactured for the 
burning of solid waste.’’. 
(b) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendment made by 
subsection (a) shall take effect on the date that is 
180 days after the date of the enactment of this Act. 
(2) WRITTEN PETITIONS.—With respect to a 
written petition described in section 1119(b)(1) of 
title 38, United States Code, as added by subsection 
(a), that was received by the Secretary of Veterans 
Affairs before the effective date described in para-
graph (1), the Secretary shall make a request of the 
National Academies of Sciences, Engineering, and 
Medicine under such section, as so added, not later 
than 90 days after such effective date. 
(c) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 11 of title 38, United States 
Code, is amended by inserting after the item relating to 
section 1118 the following new item: 
‘‘1119. Presumption of service connection for certain diseases associated with 
exposure to open burn pits and other toxins.’’. 
(d) CONFORMING AMENDMENT.—Section 1113 of 
such title is amended by striking ‘‘or 1118’’ each place 
it appears and inserting ‘‘1118, or 1119’’. 
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SEC. 3. AGREEMENT WITH THE NATIONAL ACADEMIES OF 
SCIENCES, 
ENGINEERING, 
AND 
MEDICINE 
CONCERNING THE EXPOSURE OF HUMANS TO 
OPEN BURN PITS AND OTHER TOXINS. 
(a) AGREEMENT.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall seek to enter into an agreement with 
the National Academies of Sciences, Engineering, 
and Medicine (referred to in this section as the ‘‘Na-
tional Academies’’) to perform the services covered 
by this section. 
(2) TIMING.—The Secretary shall seek to enter 
into the agreement described in paragraph (1) not 
later than 60 days after the date of the enactment 
of this Act. 
(b) REVIEWS OF SCIENTIFIC EVIDENCE.— 
(1) IN
GENERAL.—Under an agreement be-
tween the Secretary and the National Academies, 
the National Academies shall review and summarize 
the scientific evidence, and assess the strength there-
of, concerning the association between the exposure 
of humans to one or more covered toxins, including 
emissions from open burn pits, and each disease sus-
pected to be associated with such exposure. 
(2) REVIEWS
UPON
REQUEST.—Under an 
agreement between the Secretary and the National 
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Academies under this section, the National Acad-
emies shall conduct a review described in paragraph 
(1) in response to each request made by the Sec-
retary under section 1119(b)(1) of title 38, United 
States Code, as added by section 2(a). 
(c) SCIENTIFIC DETERMINATIONS CONCERNING DIS-
EASES.— 
(1) IN GENERAL.—For each disease reviewed 
under subsection (b), the National Academies shall 
determine (to the extent that available scientific data 
permit meaningful determinations) whether there is 
a positive association between the exposure of hu-
mans to one or more covered toxins, including emis-
sions from open burn pits, and the occurrence of the 
disease in humans, taking into account the strength 
of the scientific evidence and the appropriateness of 
the statistical and epidemiological methods used to 
detect the association. 
(2) SUBMISSIONS
FOR
REVIEWS
UPON
RE-
QUEST.—Under an agreement between the Secretary 
and the National Academies under this section, not 
later than 270 days after the date on which the Sec-
retary transmits a request to the National Acad-
emies with respect to a disease under section 
1119(b)(1) of title 38, United States Code, as added 
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by section 2(a), the National Academies shall submit 
to the Secretary the determination made with re-
spect to that disease under paragraph (1). 
(d) RECOMMENDATIONS
FOR
ADDITIONAL
SCI-
ENTIFIC STUDIES.— 
(1) IN
GENERAL.—Under an agreement be-
tween the Secretary and the National Academies 
under this section, the National Academies shall 
make any recommendations it has for additional sci-
entific studies to resolve areas of continuing sci-
entific uncertainty relating to the exposure of hu-
mans to one or more covered toxins, including emis-
sions from open burn pits. 
(2) 
CONSIDERATIONS.—In 
making 
rec-
ommendations for additional scientific studies, the 
National Academies shall consider— 
(A) the scientific information that is avail-
able at the time of the recommendation; 
(B) the value and relevance of the informa-
tion that could result from additional studies; 
and 
(C) the feasibility of carrying out such ad-
ditional studies. 
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(e) SUBSEQUENT REVIEWS.—Under an agreement 
between the Secretary and the National Academies under 
this section, the National Academies shall— 
(1) conduct as comprehensive a review as is 
practicable of the evidence referred to in subsection 
(b)(1) that became available since the last review of 
such evidence under this section; and 
(2) make determinations and estimates on the 
basis of the results of such review and all other re-
views conducted for the purposes of this section. 
(f) REPORTS.— 
(1) INITIAL REPORT.— 
(A) IN
GENERAL.—Under an agreement 
between the Secretary and the National Acad-
emies under this section, not later than 540 
days after the date of the enactment of this 
Act, the National Academies shall submit to the 
Secretary and the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives 
a report on the activities of the National Acad-
emies under the agreement. 
(B) ELEMENTS.—The report submitted 
under subparagraph (A) shall include the fol-
lowing: 
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(i) The determinations described in 
subsection (c)(1). 
(ii) An explanation of the scientific 
evidence and reasoning that led to such de-
terminations. 
(iii) Any recommendations of the Na-
tional Academies under subsection (d). 
(2) PERIODIC UPDATES.—Under an agreement 
between the Secretary and the National Academies 
under this section, not less frequently than once 
every two years, the National Academies shall sub-
mit to the Secretary and the Committee on Vet-
erans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives an 
updated report on the activities of the National 
Academies under the agreement. 
(g) LIMITATION ON AUTHORITY.—The authority to 
enter into agreements under this section shall be effective 
for a fiscal year to the extent that appropriations are 
available. 
(h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA-
TION.— 
(1) IN GENERAL.—If the Secretary is unable 
within the period prescribed in subsection (a)(2) to 
enter into an agreement with the National Acad-
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emies on terms acceptable to the Secretary, the Sec-
retary shall seek to enter into such an agreement 
with another appropriate scientific organization 
that— 
(A) is not part of the Government; 
(B) operates as a not-for-profit entity; and 
(C) has expertise and objectivity com-
parable to that of the National Academies. 
(2) TREATMENT.—If the Secretary enters into 
an agreement with another organization as described 
in paragraph (1), any reference in this section, sec-
tion 4, and section 1119 of title 38, United States 
Code, as added by section 2(a), to the National 
Academies shall be treated as a reference to the 
other organization. 
(i) DEFINITIONS.—In this section, the terms ‘‘cov-
ered toxin’’ and ‘‘open burn pit’’ have the meanings given 
such terms in section 1119(e) of title 38, United States 
Code, as added by section 2(a). 
(j) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Department of 
Veterans Affairs such sums as may be necessary to carry 
out this section. 
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SEC. 
4. 
ACCESS 
OF 
THE 
NATIONAL 
ACADEMIES 
OF 
SCIENCES, ENGINEERING, AND MEDICINE TO 
INFORMATION FROM THE DEPARTMENT OF 
DEFENSE. 
(a) IN GENERAL.—Upon request by the National 
Academies of Sciences, Engineering, and Medicine (re-
ferred to in this section as the ‘‘National Academies’’), 
the Secretary of Defense shall provide to the National 
Academies information in the possession of the Depart-
ment of Defense that the National Academies determines 
useful in conducting a review under section 3(b). 
(b) INCLUSIONS.—The information described in sub-
section (a) shall include, at a minimum— 
(1) all environmental sampling data relative to 
any location included in the review; and 
(2) a list of all forward deployed positions at 
which members of the Armed Forces were deployed 
or stationed. 
SEC. 5. PRESUMPTION RELATING TO PERSONAL INJURY OF 
CERTAIN FEDERAL EMPLOYEES. 
(a) IN GENERAL.—Section 8102 of title 5, United 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘(c)(1) In this subsection, the term ‘covered em-
ployee’ means an employee who, on or after January 1, 
1990, carried out the job responsibilities of the employee 
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