In the Senate of the United States, 
June 16, 2022. 
Resolved, That the bill from the House of Representa-
tives (H.R. 3967) entitled ‘‘An Act to improve health care 
and benefits for veterans exposed to toxic substances, and for 
other purposes.’’, do pass with the following 
AMENDMENT: 
Strike all after the enacting clause and insert the 
following: 
SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, 
UNITED STATES CODE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Ser-
geant First Class Heath Robinson Honoring our Promise 
to Address Comprehensive Toxics Act of 2022’’ or the ‘‘Hon-
oring our PACT Act of 2022’’. 
(b) MATTERS RELATING TO AMENDMENTS TO TITLE 
38, UNITED STATES CODE.— 
(1) REFERENCES.—Except as otherwise expressly 
provided, when in this Act an amendment or repeal
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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 veterans 
and veterans supporting certain overseas contingency operations. 
Sec. 104. Assessments of implementation and operation. 
Subtitle B—Certain Veterans of Combat Service and Other Matters 
Sec. 111. Expansion of period of eligibility for health care for certain veterans 
of combat service. 
TITLE II—TOXIC EXPOSURE PRESUMPTION PROCESS 
Sec. 201. Short title. 
Sec. 202. Improvements to ability of Department of Veterans Affairs to establish 
presumptions of service connection based on toxic exposure.
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Sec. 203. Outreach to claimants for disability compensation pursuant to changes 
in presumptions of service connection. 
Sec. 204. Reevaluation of claims for dependency and indemnity compensation in-
volving 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 cer-
tain 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 cer-
tain locations. 
Sec. 404. Addition of additional diseases associated with exposure to certain her-
bicide agents for which there is a presumption of service connec-
tion for veterans who served in certain locations. 
Sec. 405. Improving compensation for disabilities occurring in Persian Gulf War 
veterans. 
Sec. 406. Presumption of service connection for certain diseases associated with 
exposure to burn pits and other toxins. 
Sec. 407. Rule of construction. 
TITLE V—RESEARCH MATTERS 
Sec. 501. Interagency working group on toxic exposure research. 
Sec. 502. Analysis and report on treatment of veterans for medical conditions re-
lated to toxic exposure. 
Sec. 503. Analysis relating to mortality of veterans who served in Southwest 
Asia. 
Sec. 504. Study on health trends of post–9/11 veterans. 
Sec. 505. Study on cancer rates among veterans. 
Sec. 506. Study on health effects of waste related to Manhattan Project on certain 
veterans. 
Sec. 507. Study on toxic exposure and mental health outcomes. 
Sec. 508. Study on veterans in Territories of the United States. 
Sec. 509. Department of Veterans Affairs public website for toxic exposure re-
search. 
Sec. 510. Report on health effects of jet fuels used by Armed Forces. 
TITLE VI—IMPROVEMENT OF RESOURCES AND TRAINING 
REGARDING TOXIC-EXPOSED VETERANS 
Sec. 601. Short title; definitions.
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Sec. 602. Publication of list of resources of Department of Veterans Affairs for 
toxic-exposed veterans and veterans who report toxic exposures 
and outreach program for such veterans and caregivers and sur-
vivors of such veterans. 
Sec. 603. Incorporation of toxic exposure screening for veterans. 
Sec. 604. Training for personnel of the Department of Veterans Affairs with re-
spect to veterans who report toxic exposures. 
TITLE VII—RESOURCING 
Sec. 701. Authority to use appropriations to enhance claims processing capacity 
and automation. 
Sec. 702. Authorization of major medical facility leases of Department of Vet-
erans Affairs for fiscal year 2023. 
Sec. 703. Treatment of major medical facility leases of the Department of Vet-
erans Affairs. 
Sec. 704. Authority to enter into agreements with academic affiliates and other 
entities to acquire space for the purpose of providing health-care 
resources to veterans. 
Sec. 705. Modifications to enhanced-use lease authority of Department of Veterans 
Affairs. 
Sec. 706. Authority for joint leasing actions of Department of Defense and De-
partment of Veterans Affairs. 
Sec. 707. Appropriation of amounts for major medical facility leases. 
TITLE VIII—RECORDS AND OTHER MATTERS 
Sec. 801. Epidemiological study on Fort McClellan veterans. 
Sec. 802. Biennial briefing on Individual Longitudinal Exposure Record. 
Sec. 803. Correction of exposure records by members of the Armed Forces and vet-
erans. 
Sec. 804. Federal cause of action relating to water at Camp Lejeune, North Caro-
lina. 
Sec. 805. Cost of War Toxic Exposures Fund. 
Sec. 806. Appropriation for fiscal year 2022. 
Sec. 807. Authorization of electronic notice in claims under laws administered by 
the Secretary of Veterans Affairs. 
Sec. 808. Burn pit transparency. 
TITLE IX—IMPROVEMENT OF WORKFORCE OF DEPARTMENT OF 
VETERANS AFFAIRS 
Sec. 901. National rural recruitment and hiring plan for Veterans Health Ad-
ministration. 
Sec. 902. Authority to buy out service contracts for certain health care profes-
sionals in exchange for employment at rural or highly rural fa-
cilities of Department of Veterans Affairs. 
Sec. 903. Qualifications for human resources positions within Department of Vet-
erans Affairs and plan to recruit and retain human resources 
employees. 
Sec. 904. Modification of pay cap for certain employees of Veterans Health Ad-
ministration. 
Sec. 905. Expansion of opportunities for housekeeping aides. 
Sec. 906. Modification of authority of the Secretary of Veterans Affairs relating 
to hours, conditions of employment, and pay for certain employ-
ees of Veterans Health Administration.
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Sec. 907. Waiver of pay limitation for certain employees of Department of Vet-
erans Affairs. 
Sec. 908. Elimination of limitation on awards and bonus for employees of De-
partment of Veterans Affairs. 
Sec. 909. Additional authority of the Secretary of Veterans Affairs relating to re-
cruitment and retention of personnel. 
TITLE I—EXPANSION OF HEALTH 
CARE ELIGIBILITY 
Subtitle A—Toxic-exposed Veterans 
SEC. 101. SHORT TITLE. 
This title may be cited as the ‘‘Conceding Our Vet-
erans’ Exposure Now and Necessitating Training Act of 
2022’’ or the ‘‘COVENANT Act of 2022’’. 
SEC. 102. DEFINITIONS RELATING TO TOXIC-EXPOSED VET-
ERANS. 
(a) IN GENERAL.—Section 1710(a)(2)(F) is amended 
by striking ‘‘who was exposed to a toxic substance, radi-
ation, or other conditions, as provided in subsection (e)’’ 
and inserting ‘‘who is a toxic-exposed veteran, in accord-
ance with subsection (e)’’. 
(b) DEFINITIONS OF TOXIC EXPOSURE AND TOXIC-EX-
POSED VETERAN.—Section 101 is amended by adding at 
the end the following new paragraphs: 
‘‘(37) The term ‘toxic exposure’ includes the following: 
‘‘(A) A toxic exposure risk activity, as defined in 
section 1710(e)(4) of this title.
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(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 services, 
and nursing home care under subsection (a)(2)(F) for any 
illness. 
‘‘(H) Beginning not later than the applicable date 
specified in paragraph (6), and subject to paragraph (2), 
a covered veteran (as defined in section 1119(c) of this title) 
is eligible for hospital care (including mental health services 
and counseling), medical services, and nursing home care 
under subsection (a)(2)(F) for any illness. 
‘‘(I)(i) Beginning not later than the applicable date 
specified in paragraph (6), and subject to paragraph (2), 
a veteran who deployed in support of a contingency oper-
ation specified in clause (ii) is eligible for hospital care (in-
cluding 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:
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‘‘(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 sub-
paragraphs (G), (H), and (I) of paragraph (1) as follows: 
‘‘(i) October 1, 2024, with respect to a veteran 
described in such subparagraph (G) or (H) who was 
discharged or released from the active military, naval, 
air, or space service during the period beginning on 
August 2, 1990, and ending on September 11, 2001. 
‘‘(ii) October 1, 2026, with respect to a veteran 
described in such subparagraph (G) or (H) who was 
discharged or released from the active military, naval, 
air, or space service during the period beginning on
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September 12, 2001, and ending on December 31, 
2006. 
‘‘(iii) October 1, 2028, with respect to a veteran 
described in such subparagraph (G) or (H) who was 
discharged or released from the active military, naval, 
air, or space service during the period beginning on 
January 1, 2007, and ending on December 31, 2012. 
‘‘(iv) October 1, 2030, with respect to a veteran 
described in such subparagraph (G) or (H) who was 
discharged or released from the active military, naval, 
air, or space service during the period beginning on 
January 1, 2013, and ending on December 31, 2018. 
‘‘(v) October 1, 2032, with respect to a veteran 
described in such subparagraph (I). 
‘‘(B)(i) The Secretary may modify a date specified in 
subparagraph (A) to an earlier date, as the Secretary deter-
mines appropriate based on the number of veterans receiv-
ing hospital care, medical services, and nursing home care 
under subparagraphs (G), (H), and (I) of paragraph (1) 
and the resources available to the Secretary. 
‘‘(ii) If the Secretary determines to modify a date 
under clause (i), the Secretary shall— 
‘‘(I) notify the Committee on Veterans’ Affairs of 
the Senate and the Committee on Veterans’ Affairs of
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the House of Representatives of the proposed modi-
fication; and 
‘‘(II) publish such modified date in the Federal 
Register.’’. 
(b) OUTREACH PLANS.—With respect to each of clauses 
(i) through (v) of section 1710(e)(6)(A) of title 38, United 
States Code (as added by subsection (a)(2)), not later than 
180 days before the date specified in the clause (including 
a date modified pursuant to such section), the Secretary 
shall submit to the Committee on Veterans’ Affairs of the 
Senate and the Committee on Veterans’ Affairs of the House 
of Representatives a plan to conduct outreach to the vet-
erans described in the clause to notify such veterans of their 
eligibility for hospital care, medical services, or nursing 
home care under subparagraph (G), (H), or (I), of section 
1710(e)(1) of such title, as the case may be. 
SEC. 104. ASSESSMENTS OF IMPLEMENTATION AND OPER-
ATION. 
(a) INITIAL RESOURCE ASSESSMENT AND REPORT.— 
Not later than 180 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall— 
(1) complete an assessment to determine— 
(A) the personnel and material resources 
necessary to implement section 103 (including 
the amendments made by such section); and
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(B) the total number of covered veterans, as 
such term is defined in section 1119(c) of title 
38, United States Code (as added by section 
302), who receive hospital care or medical serv-
ices furnished by the Secretary under chapter 17 
of such title, disaggregated by priority group 
specified in section 1705(a) of such title; and 
(2) submit to the Committee on Veterans’ Affairs 
of the Senate and the Committee on Veterans’ Affairs 
of the House of Representatives a report containing 
the findings of the assessment completed under para-
graph (1), including a specific determination as to 
whether the Department has the personnel and mate-
rial resources necessary to implement section 103. 
(b) INFORMATION SYSTEMS.—Not later than October 
1, 2024, the Secretary shall establish information systems 
to assess the implementation of section 103, including the 
amendments made by such section, and use the results of 
assessments under such systems to inform the reports under 
subsection (c). 
(c) ANNUAL REPORTS.— 
(1) REPORTS.—Not later than October 1, 2025, 
and on an annual basis thereafter until October 1, 
2033, the Secretary shall submit to the Committee on 
Veterans’ Affairs of the Senate and the Committee on
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Veterans’ Affairs of the House of Representatives a re-
port on the following: 
(A) The effect of the implementation of, and 
the provision and management of care under, 
section 103 (including the amendments made by 
such section) on the demand by veterans de-
scribed in subparagraphs (G), (H), and (I) of 
section 1710(e)(1) of title 38, United States Code 
(as added by such section 103) for health care 
services furnished by the Secretary. 
(B) Any differing patterns of demand for 
health 
care 
services 
by 
such 
veterans, 
disaggregated by factors such as the relative dis-
tance of the veteran from medical facilities of the 
Department and whether the veteran had pre-
viously received hospital care or medical services 
furnished by the Secretary under chapter 17 of 
such title. 
(C) The extent to which the Secretary has 
met such demand. 
(D) Any changes, during the year covered 
by the report, in the delivery patterns of health 
care furnished by the Secretary under chapter 17 
of such title, and the fiscal impact of such 
changes.
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(2) MATTERS.—Each report under paragraph 
(1) shall include, with respect to the year covered by 
the report, detailed information on the following: 
(A) The total number of veterans enrolled in 
the patient enrollment system who, during such 
year, received hospital care or medical services 
furnished by the Secretary under chapter 17 of 
title 38, United States Code. 
(B) Of the veterans specified in subpara-
graph (A), the number of such veterans who, dur-
ing the preceding three fiscal years, had not re-
ceived 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 Pro-
gram. 
(D) With respect to the number of veterans 
described in subparagraphs (G), (H), and (I) of 
section 1710(e)(1) of title 38, United States Code 
(as added by section 103), the following (shown
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in total and disaggregated by medical facility of 
the Department, as applicable): 
(i) The number of such veterans who, 
during the year covered by the report, 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 serv-
ice furnished by the Secretary that was con-
sidered to be medically necessary but not of 
an emergency nature. 
(E) The numbers and characteristics of, and 
the type and extent of health care furnished by 
the Secretary to, veterans enrolled in the patient 
enrollment 
system 
(shown 
in 
total 
and 
disaggregated by medical facility of the Depart-
ment). 
(F) The numbers and characteristics of, and 
the type and extent of health care furnished by 
the Secretary to, veterans not enrolled in the pa-
tient enrollment system (disaggregated by each 
class of eligibility for care under section 1710 of 
title 38, United States Code, and further shown
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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) PATIENT ENROLLMENT SYSTEM.—The term 
‘‘patient enrollment system’’ means the patient enroll-
ment system of the Department of Veterans Affairs es-
tablished and operated under section 1705(a) of title 
38, United States Code. 
(2) VETERANS COMMUNITY CARE PROGRAM.—The 
term ‘‘Veterans Community Care Program’’ means 
the program established under section 1703 of title 38, 
United States Code.
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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 in-
serting ‘‘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, med-
ical services, or nursing home care under such para-
graph pursuant to subparagraph (A) before October 1, 
2022, the one-year period beginning on October 1, 
2022.’’; and 
(3) by striking subparagraph (C).
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(b) 
CLARIFICATION
OF
COVERAGE.—Section 
1710(e)(1)(D) is amended by inserting after ‘‘Persian Gulf 
War’’ the following: ‘‘(including any veteran who, in con-
nection with service during such period, received the Armed 
Forces Expeditionary Medal, Service Specific Expedi-
tionary Medal, Combat Era Specific Expeditionary Medal, 
Campaign Specific Medal, or any other combat theater 
award established by a Federal statute or an Executive 
order)’’. 
(c) OUTREACH PLAN.—Not later than December 1, 
2022, the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Representatives 
a plan to conduct outreach to veterans described in sub-
paragraph (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 serv-
ices, or nursing home care pursuant to such subparagraph. 
(d) REPORT ON ENROLLMENTS.—Not later than Janu-
ary 30, 2024, the Secretary shall submit to the Committee 
on Veterans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives a report 
identifying, with respect to the one-year period beginning 
on October 1, 2022, the number of veterans described in sec-
tion 1710(e)(3)(B) of title 38, United States Code, as
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‘‘(3) The Working Group may conduct an assessment 
under paragraph (1) in response to a comment received 
under paragraph (2) or (3) of subsection (a). 
‘‘(4) The Working Group shall, in consultation with 
the Secretary of Defense, on a periodic basis, assess the In-
dividual Longitudinal Exposure Record to ensure the accu-
racy of data collected. 
‘‘(d) DEVELOPMENT OF RECOMMENDATIONS.—(1) Fol-
lowing an assessment of a case of the toxic exposure of vet-
erans that occurred during active military, naval, air, or 
space service under subsection (c), or their dependents, the 
Working Group may develop a recommendation for formal 
evaluation under section 1173 of this title to conduct a re-
view of the health effects related to the case of exposure if 
the Working Group determines that the research may 
change the current understanding of the relationship be-
tween an exposure to an environmental hazard and adverse 
health outcomes in humans. 
‘‘(2) Upon receipt of evidence suggesting that previous 
findings regarding the periods and locations of exposure 
covered by an existing presumption of service connection 
are no longer supported, the Working Group may nominate 
such evidence for formal evaluation under section 1173 of 
this title to modify the periods and locations.
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‘‘(e) REPORTS BY THE WORKING GROUP.—Not less fre-
quently than once each year, the Working Group shall sub-
mit to the Secretary, the Committee on Veterans’ Affairs 
of the Senate, and the Committee on Veterans’ Affairs of 
the House of Representatives, and make publicly available, 
a report on— 
‘‘(1) recommendations developed under sub-
section (d), if any; and 
‘‘(2) recommendations for such legislative or ad-
ministrative action as the Working Group considers 
necessary for the Working Group to be more effective 
in carrying out the requirements of this section. 
‘‘(f) RESPONSES BY SECRETARY.—In response to each 
report submitted under subsection (e), the Secretary shall, 
not later than 30 days after receiving the report, initiate 
a formal evaluation pursuant to section 1173 of this title. 
‘‘§ 1173. Formal evaluation of recommendations 
‘‘(a) FORMAL EVALUATIONS.—The Secretary shall es-
tablish a process to conduct a formal evaluation with re-
spect to each recommendation made by the Working Group 
under section 1172 of this title. 
‘‘(b) EVIDENCE, DATA, AND FACTORS.—The Secretary 
shall ensure that each formal evaluation under subsection 
(a) covers the following: