I 
117TH CONGRESS 
1ST SESSION H. R. 2607 
To amend title 38, United States Code, to establish in the Department 
of Veterans Affairs procedures to determine presumptions of service 
connection based on toxic exposure, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 15, 2021 
Mr. TRONE introduced the following bill; which was referred to the Committee 
on Veterans’ Affairs, and in addition to the Committee on Armed Serv-
ices, for a period to be subsequently determined 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 establish in the 
Department of Veterans Affairs procedures to determine 
presumptions of service connection based on toxic expo-
sure, 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 ‘‘Fairly Assessing Serv-
ice-related Toxic Exposure Residuals Presumptions Act’’ 
or the ‘‘FASTER Presumptions Act’’. 
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SEC. 2. 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.— 
(1) ESTABLISHMENT.—Chapter 11 of title 38, 
United States Code, is amended by adding at the 
end the following new subchapter: 
‘‘SUBCHAPTER VII—RESEARCH AND DETER-
MINATIONS RELATING TO PRESUMPTIONS 
OF SERVICE CONNECTION 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 assesses research re-
garding veterans who, during active military, naval, 
or air service, were exposed to toxic substances, com-
missions additional research, and provides nomina-
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tions for the Science Review Board to evaluate the 
research; 
‘‘(2) the Science Review Board under section 
1173 evaluates research nominated by the Formal 
Advisory Committee on Toxic Exposure and deter-
mines the strength of evidence supporting a positive 
association between exposure to a toxic substance 
and an illness; 
‘‘(3) the Working Group under section 1174 
evaluates the conclusions of the Science Review 
Board and recommends to the Secretary whether to 
establish or modify a presumption of service connec-
tion; and 
‘‘(4) the Secretary prescribes regulations under 
section 1175. 
‘‘(b) ILLNESS DEFINED.—In this subchapter, the 
term ‘illness’ includes a disease or other condition affect-
ing the health of an individual. 
‘‘(c) 
NONAPPLICATION
OF
SUNSET
REQUIRE-
MENTS.—Section 14 of the Federal Advisory Committee 
Act (5 U.S.C. App.) shall not apply to an entity estab-
lished under this subchapter. 
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‘‘§ 1172. Formal Advisory Committee on Toxic Expo-
sure 
‘‘(a) ESTABLISHMENT.—(1) There is in the Veterans 
Benefits Administration of the Department the Formal 
Advisory Committee on Toxic Exposure (in this section 
referred to as the ‘Committee’). 
‘‘(2) The Secretary shall appoint not more than 10 
members to the Committee, of which— 
‘‘(A) at least one member shall be appointed 
from among individuals who are officials or employ-
ees of the Veterans Benefits Administration or the 
Veterans Health Administration; 
‘‘(B) 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; 
‘‘(C) at least three members shall be appointed 
from among individuals who are representatives of 
disabled veterans; and 
‘‘(D) 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. 
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‘‘(3) The Secretary shall determine the pay and al-
lowances of the members, including with respect to any 
additional pay and allowances for members who are offi-
cials or employees of the Federal Government. 
‘‘(4) Each member of the Committee shall be ap-
pointed for a two-year term, and may serve not more than 
three successive terms. 
‘‘(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 disability-related questions relating to veterans who, 
during active military, naval, or air service, are suspected 
of having been exposed to toxic substances. 
‘‘(c) ASSESSMENTS.—(1) The Committee shall assess 
the exposure of veterans to toxic substances that occurred 
during active military, naval, or air service. 
‘‘(2) The assessments under paragraph (1) shall 
cover suspected and known toxic exposures occurring dur-
ing active military, naval, or air service, including by iden-
tifying and evaluating new and emerging exposures that 
are not recognized under existing presumptions of service 
connection. 
‘‘(3) The Committee may conduct an assessment 
under paragraph (1) in response to a recommendation by 
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the 
Science 
Review 
Board 
pursuant 
to 
section 
1173(c)(2)(B) of this title or the Working Group under 
section 1174(c)(1)(B). 
‘‘(4) In assessing the exposure of veterans to toxic 
substances under paragraph (1), the Commission shall de-
termine whether— 
‘‘(A) under subsection (d), further research into 
the exposure is warranted; 
‘‘(B) under subsection (e), the existing research 
being assessed is sufficient to nominate to the 
Science Review Board under section 1173 of this 
title for evaluation; 
‘‘(C) under subsection (f), there is sufficient 
evidence regarding an existing presumption of serv-
ice connection for review by the Science Review 
Board or Working Group under section 1174 of this 
title, as the case may be; or 
‘‘(D) no further action is warranted. 
‘‘(d) RESEARCH.—(1)(A) Following an assessment of 
the exposure of veterans to toxic substances that occurred 
during active military, naval, or air service under sub-
section (c), the Committee may commission an appropriate 
entity (including an element of the Department, an aca-
demic entity, or a private-sector entity) to conduct addi-
tional research into the exposure and the health effects 
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‘‘(B) Existing evidence of a connection between 
illnesses and service in the active military, naval, or 
air service, and the size or ability to define the 
group of affected veterans. 
‘‘(C) In accordance with subsection (g), input 
from persons who may be affected by the actions of 
the Committee. 
‘‘(D) Exposure assessments, including data on 
activities of the Armed Forces or exposures that 
may be classified. 
‘‘(E) Existing health tracking and surveillance, 
including veterans and members of the active mili-
tary, naval, or air service, such as the burn pit reg-
istry 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). 
‘‘(F) Research, including laboratory research 
discoveries and findings from studies of members of 
the active military, naval, or air service and civilian 
workers who were exposed to toxic substances. 
‘‘(G) The effect of sex, gender, age, race, and 
ethnicity on health outcomes. 
‘‘(3) The Committee shall ensure that the research 
commissioned under paragraph (1) is tailored to produce 
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results or conclusions necessary for the Science Review 
Board to make a fully informed assessment. 
‘‘(e) NOMINATION.—If the Committee determines 
further action is appropriate with respect to an assessment 
of the exposure of veterans to toxic substances that oc-
curred during active military, naval, or air service under 
subsection (c), the Committee may nominate the Science 
Review Board to evaluate either or both, as the case may 
be— 
‘‘(1) the existing research included in the as-
sessment; or 
‘‘(2) the further research conducted pursuant to 
subsection (d). 
‘‘(f) REVIEW
OF EXISTING PRESUMPTIONS.—(1) 
Upon receipt of evidence suggesting that previous findings 
supporting a positive association between an exposure and 
an illness are no longer valid, the Committee may nomi-
nate such exposure or illness for review by the Science Re-
view Board. 
‘‘(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 evaluation by the Working Group 
to modify the periods and locations. 
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‘‘(g) 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. 
‘‘(h) REPORTS TO CONGRESS.—On a biennial basis, 
the Committee shall submit to the Committees on Vet-
erans’ Affairs of the House of Representatives and the 
Senate, and make publicly available, a report on the ac-
tions of the Committee. Each such report shall include, 
with respect to the period covered by the report, the fol-
lowing: 
‘‘(1) A description of— 
‘‘(A) the exposure and evidence considered 
by the Committee; 
‘‘(B) any research commissioned by the 
Committee; and 
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‘‘(C) the rationale of the nominations made 
by the Committee to the Science Review Board 
for further evaluation. 
‘‘(2) A description of each specific action rec-
ommended by the Committee described in subsection 
(c)(3). 
‘‘(3) Each report received by the Committee 
under section 1173(c)(2) of this title. 
‘‘§ 1173. Science Review Board 
‘‘(a) ESTABLISHMENT.—(1) There is in the Depart-
ment the Science Review Board (in this section referred 
to as the ‘Board’). 
‘‘(2)(A) The members of the Board shall be appointed 
by the Secretary from the general public from among indi-
viduals who are distinguished in the fields of medicine, bio-
logical sciences, or health administration. 
‘‘(B) An individual may not concurrently serve on the 
Board and the Formal Advisory Committee on Toxic Ex-
posure under section 1172 of this title. 
‘‘(C) The Secretary shall determine the number, 
terms of service, and pay and allowances of members of 
the Board appointed by the Secretary. 
‘‘(b) DUTIES.—(1) Upon receiving a nomination for 
the evaluation of research on the health effects of exposure 
of members of the active military, naval, or air service to 
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toxic substances made by the Formal Advisory Committee 
on Toxic Exposure pursuant to section 1172 of this title, 
the Board shall— 
‘‘(A) evaluate the likelihood that an illness is 
associated with an exposure to a toxic substance 
while serving in the active military, naval, or air 
service; and 
‘‘(B) assess the exposures and illnesses identi-
fied by the Committee and determine whether the 
evidence supports a finding of a positive association 
between the exposure and the illness. 
‘‘(2) In carrying out paragraph (1)(B), the Board 
shall review all relevant data to determine, with respect 
to the strength of evidence for a positive association, that 
there is— 
‘‘(A) sufficient evidence of an association; 
‘‘(B) limited or suggestive evidence of an asso-
ciation; 
‘‘(C) inadequate or insufficient evidence to de-
termine an association; or 
‘‘(D) limited or suggestive evidence of no asso-
ciation. 
‘‘(3) With respect to an evaluation conducted under 
this subsection, if the Board determines that the evidence 
for a positive association is inadequate or insufficient to 
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determine an association as described in paragraph 
(2)(C), the Board shall develop a recommendation as to 
whether additional data gathering and research are nec-
essary. 
‘‘(c) REPORTS.—(1) For each evaluation conducted 
under subsection (b) where the Board determines that the 
evidence for a positive association is either sufficient or 
limited or suggestive of an association, as described in 
subparagraph (A) or (B) of paragraph (2) of such sub-
section, the Board shall submit to the Secretary, the 
Working Group under section 1174 of this title, and to 
the Committees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate a report identifying the evi-
dence found to reach such positive association determina-
tions. 
‘‘(2) For each evaluation conducted under subsection 
(b) where the Board determines that the evidence for posi-
tive association is inadequate or insufficient to determine 
an association as described in paragraph (2)(C) of such 
subsection, the Board shall submit to the Secretary, the 
Formal Advisory Committee on Toxic Exposure, and to 
the Committees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate a report— 
‘‘(A) identifying the evidence found to reach 
such positive association determinations; and 
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‘‘(B) containing the recommendations under 
subsection (b)(3) as to whether additional data gath-
ering and research are necessary and an outline of 
a report request proposal for such additional data 
and research. 
‘‘§ 1174. Working group on presumptions of service 
connection 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish a working group (in this section referred to as the 
‘Working Group’) to— 
‘‘(1) evaluate— 
‘‘(A) the conclusions of the Science Review 
Board contained in each report submitted under 
section 1173(c)(1) of this title; and 
‘‘(B) evidence nominated by the Formal 
Advisory Committee on Toxic Exposure under 
section 1172(f)(2) regarding the periods and lo-
cations of exposure covered by an existing pre-
sumption of service connection; and 
‘‘(2) make a recommendation to the Secretary 
with respect to whether to— 
‘‘(A) establish a presumption of service 
connection for the toxic exposure and illness 
covered by the report described in subparagraph 
(A) of paragraph (1); or 
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‘‘(B) modify an existing presumption of 
service connection described in subparagraph 
(B) of such paragraph. 
‘‘(b) EVALUATIONS.—(1) In evaluating the conclu-
sions of the Science Review Board, the Working Group 
shall consider factors, in addition to the conclusions of the 
Board, that the Working Group determines appropriate. 
‘‘(2) The Working Group shall provide a period of 
not fewer than 60 days for persons described in section 
1172(g)(2) of this title to present written comments to 
the Working Group with respect to each evaluation made 
under this section. 
‘‘(c) RECOMMENDATIONS.—(1) In making a rec-
ommendation under subsection (a)(2), the Working Group 
shall— 
‘‘(A) in cases where the evidence for a positive 
association is either sufficient or limited or sugges-
tive of an association, as described in subparagraph 
(A) or (B) of section 1173(b)(2) of this title, weigh 
heavily in favor of establishing a presumption of 
service connection; and 
‘‘(B) if the Working Group determines that ad-
ditional research, studies, or reports are appropriate 
before making a final recommendation with respect 
to establishing or modifying a presumption of service 
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connection, submit to the Formal Advisory Com-
mittee a description of such appropriate additional 
research, studies, or reports. 
‘‘(2) Not later than 60 days after the date on which 
the comment period under subsection (b)(2) ends with re-
spect to an evaluation made under this section, the Work-
ing Group shall submit to the Secretary and to the Com-
mittees on Veterans’ Affairs of the House of Representa-
tives and the Senate a description of the recommendation 
made under subsection (a)(2). 
‘‘§ 1175. Regulations regarding presumptions of serv-
ice connection based on toxic exposure 
‘‘(a) ACTION UPON WORKING GROUP RECOMMENDA-
TION.—Not later than 60 days after the date on which 
the Secretary receives a recommendation to establish or 
modify a presumption of service connection under section 
1174(c)(2) of this title— 
‘‘(1) if the Secretary determines that the pre-
sumption, or modification, is warranted, the Sec-
retary shall issue proposed regulations setting forth 
the presumption or revise 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 
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of the determination, including the reasons sup-
porting the determination. 
‘‘(b) FINAL REGULATION.—Not later than 90 days 
after the date on which the Secretary issues any proposed 
regulations under subsection (a)(1), the Secretary shall 
issue final regulations. Such regulations shall be effective 
on the date of issuance. 
‘‘(c) 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 (b). 
‘‘(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-
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tled to receive dependency and indemnity compensa-
tion on such basis. 
‘‘§ 1176. Expert Advisory Panel on Constrictive 
Bronchiolitis 
‘‘(a) ESTABLISHMENT.—There is in the Department 
the Expert Advisory Panel on Constrictive Bronchiolitis 
(in this section referred to as the ‘Panel’). 
‘‘(b) MEMBERSHIP.—(1) The Panel shall be ap-
pointed by the Secretary from the general public from 
among individuals who are— 
‘‘(A) experts in pulmonary pathology; 
‘‘(B) experts in other fields the Secretary deter-
mines appropriate, such as pulmonary medicine, 
toxicology, epidemiology, exposure assessment, and 
radiology; and 
‘‘(C) individuals representing the veterans com-
munity. 
‘‘(2) The Secretary shall determine the number, 
terms of service, and pay and allowances of members of 
the Panel appointed by the Secretary. 
‘‘(c) DUTIES.—The panel shall develop specific guide-
lines for research conducted by the Department of sympto-
matic veterans who served in the active military, naval, 
or air service in the Southwest Asia theater of operations 
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whom the differential diagnosis includes bronchiolitis. The 
Panel shall— 
‘‘(1) determine the adequacy of lung biopsy ap-
proaches and recommend to the Secretary best prac-
tices; 
‘‘(2) make recommendations to the Secretary 
for processing, handling, and storing lung biopsies; 
‘‘(3) establish histologic and pathology criteria 
for confirming diagnoses; and 
‘‘(4) submit to the Secretary and to the Com-
mittees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate reports on the findings 
and results of such research.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 1163 
the following new items: 
‘‘SUBCHAPTER VII—RESEARCH AND DETERMINATIONS RELATING TO 
PRESUMPTIONS OF SERVICE CONNECTION BASED ON TOXIC EXPOSURE 
‘‘1171. Procedures to determine presumptions of service connection based on 
toxic exposure; definitions. 
‘‘1172. Formal Advisory Committee on Toxic Exposure. 
‘‘1173. Science Review Board. 
‘‘1174. Working group on presumptions of service connection. 
‘‘1175. Regulations regarding presumptions of service connection based on toxic 
exposure. 
‘‘1176. Expert Advisory Panel on Constrictive Bronchiolitis.’’. 
(b) CONFORMING AMENDMENTS.—Chapter 11 of 
title 38, United States Code, is amended as follows: 
(1) Section 1116 is amended— 
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FASTER Presumptions Act regarding a presumption of 
service connection based on exposure to a toxic substance 
under this section is made pursuant to subchapter VII of 
this chapter.’’. 
(c) ACCESS TO HEALTH CARE.—Section 1710(e) of 
title 38, United States Code, is amended— 
(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(G)(i) Subject to paragraph (2), as determined 
appropriate by the Secretary, a toxin-exposed vet-
eran is eligible for hospital care and medical services 
under subsection (a)(2)(F) for any diagnosed illness 
that the Secretary determines is covered by, or rea-
sonably could be covered by, pending research dur-
ing the period beginning on the date on which the 
Formal Advisory Committee on Toxic Exposure be-
gins assessing such research under section 1172(c) 
of this title and ending on the date specified in 
clause (ii). 
‘‘(ii) The date specified in this clause is the fol-
lowing: 
‘‘(I) In cases of pending research for which 
the 
Secretary 
determines 
under 
section 
1175(a)(1) of this title that a presumption of 
service connection is warranted, the date on 
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which the toxin-exposed veteran is otherwise eli-
gible for hospital care and medical services pur-
suant to this section by reason of regulations 
issued under such section 1175. 
‘‘(II) In cases of pending research for 
which the Secretary determines under section 
1175(a)(2) that a presumption of service con-
nection is not warranted, the date, if any, that 
the Secretary determines appropriate. 
‘‘(iii) In this subparagraph: 
‘‘(I) The term ‘pending research’ means 
research assessed or commissioned by the For-
mal Advisory Committee on Toxic Exposure 
under section 1172 regarding the exposure of 
veterans to toxic substances. 
‘‘(II) The term ‘toxin-exposed veteran’ 
means a veteran— 
‘‘(aa) whose service in the active mili-
tary, naval, or air service is covered by 
pending research; and 
‘‘(bb) who is not otherwise eligible for 
hospital care and medical services pursuant 
to this paragraph.’’; and 
(2) in paragraph (2)(B), by striking ‘‘or (F)’’ 
and inserting ‘‘(F), or (G)’’. 
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SEC. 3. IMPROVEMENTS TO DATA COLLECTION AND USE. 
(a) PLAN.—The Secretary of Defense, in consultation 
with the Secretary of Veterans Affairs, shall develop and 
implement a plan to strengthen the data collection with 
respect to members of the Armed Forces, including mem-
bers of the reserve components, who are exposed to toxic 
substances while serving in the Armed Forces. The plan 
shall provide for the following: 
(1) Detailing methods of continuous in-service 
surveillance, including data collection and analysis, 
of such exposures and the physical and mental 
health of the members. 
(2) Surveilling such exposures and the health of 
members from accession through separation, includ-
ing, where possible, through the use of wearable and 
portable devices to assess health outcomes, and ex-
tend such surveillance indefinitely post-separation 
for those veterans with suspected exposure to toxic 
substances. 
(3) Ensuring consistent surveillance efforts 
across the Armed Forces. 
(4) Determining the feasibility of collecting bio-
logical samples and the means by which such collec-
tion could be accomplished, including, at a min-
imum, through use of wearable and portable devices 
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and the collection of blood and urine, to measure ex-
posure in deployed environments. 
(5) Maintaining a repository of data and bio-
logical samples available for prospective research. 
(6) With respect to each member, tracking the 
military occupational specialty, deployment history, 
disease risk factors, sex, gender, age, race, and eth-
nicity. 
(b) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary shall submit 
to the Committees on Veterans’ Affairs and the Commit-
tees on Armed Services of the House of Representatives 
and the Senate, and annually thereafter for five years, a 
report containing the plan developed under subsection (a) 
and the status of implementing the plan. 
(c) INTEGRATION.—The Secretary of Defense shall 
integrate research access considerations of the plan devel-
oped under subsection (a) into the electronic health record 
modernization program and the individual longitudinal ex-
posure record program. 
(d) DETERMINATIONS.—The Secretary of Veterans 
Affairs, in consultation with the Formal Advisory Com-
mittee on Toxic Exposure established under section 1172 
of title 38, United States Code, as added by section 2, 
shall determine— 
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(1) whether studies of respiratory health out-
comes from other countries, including Australia, 
Canada, France, Poland, Sweden, and the United 
Kingdom, provide useful data, and whether the 
structure of these studies could be emulated in the 
United States to improve participation rates; and 
(2) whether the health records of veterans from 
health care systems other than the Department of 
Veterans Affairs, including private-sector health pro-
viders, the Centers for Medicare & Medicaid Serv-
ices, and the TRICARE program, can be accessed 
for research purposes. 
(e) SHARING OF INFORMATION.—The Secretary of 
Veterans Affairs shall provide to the Formal Advisory 
Committee on Toxic Exposure and the Science Review 
Board established under section 1173 of title 38, United 
States Code, as added by section 2, the results of surveil-
lance conducted pursuant to the plan developed under sub-
section (a), including data collection and analysis. 
SEC. 4. STUDIES RELATING TO VETERANS WHO SERVED IN 
SOUTHWEST ASIA. 
(a) ANALYSIS.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs shall initiate or sponsor an updated analysis 
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