ered by such clause or who was in utero while the mother 
of such family member resided at such location shall be 
eligible for hospital care and medical services furnished 
by the Secretary for any disease, illness, or condition for 
which a veteran may receive hospital care and medical 
services under clause (ii) of such section, notwithstanding 
that there is insufficient medical evidence to conclude that 
such disease, illness, or condition is attributable to such 
residence. 
‘‘(b) LIMITATIONS.—(1) The Secretary may only fur-
nish hospital care and medical services under subsection 
(a) to the extent and in the amount provided in advance 
in appropriations Acts for such purpose. 
‘‘(2) Hospital care and medical services may not be 
furnished under subsection (a) for a disease, illness, or 
condition of a family member that is found, in accordance 
with guidelines issued by the Under Secretary for Health, 
to have resulted from a cause other than the residence 
of the family member described in that subsection. 
‘‘(3) The Secretary may provide reimbursement for 
hospital care or medical services provided to a family 
member under this section only after the family member 
or the provider of such care or services has exhausted 
without success all claims and remedies reasonably avail-
able to the family member or provider against a third 
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party (as defined in section 1725(f) of this title) for pay-
ment of such care or services, including with respect to 
health-plan contracts (as defined in such section).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 1787 
the following new item: 
‘‘1787A. Health care of family members of veterans stationed at certain military 
installations.’’. 
(c) ANNUAL REPORTS.— 
(1) IN GENERAL.—During the three-year period 
beginning in the year in which the study conducted 
under section 316 of the National Defense Author-
ization Act for Fiscal Year 2018 (Public Law 115– 
91) is submitted to Congress, the Secretary of Vet-
erans Affairs shall submit to the Committee on Vet-
erans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives an 
annual report on the care and services provided 
under sections 1710(e)(1)(J) and 1787A of title 38, 
United States Code (as added by subsections (a) and 
(b)(1), respectively). 
(2) ELEMENTS.—Each report under paragraph 
(1) shall set forth the following: 
(A) The number of veterans and family 
members provided hospital care and medical 
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services under the provisions of law specified in 
paragraph (1) during the period covered by the 
report. 
(B) The illnesses, conditions, and disabil-
ities for which care and services have been pro-
vided such veterans and family members under 
such provisions of law during that period. 
(C) The number of veterans and family 
members who applied for care and services 
under such provisions of law during that period 
but were denied, including information on the 
reasons for such denials. 
(D) The number of veterans and family 
members who applied for care and services 
under such provisions of law and are awaiting 
a decision from the Secretary on eligibility for 
such care and services as of the date of such re-
port. 
(3) VETERAN
DEFINED.—In this subsection, 
the term ‘‘veteran’’ includes a former member of the 
reserve components of the Armed Forces covered by 
such section 1710(e)(1)(J). 
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SEC. 3. PRESUMPTION OF SERVICE CONNECTION FOR CER-
TAIN 
VETERANS 
EXPOSED 
TO 
PERFLUOROOCTANOIC ACID OR OTHER PER- 
AND POLYFLUOROALKYL SUBSTANCES. 
(a) IN GENERAL.—Chapter 11 of title 38, United 
States Code, is amended by inserting after section 1116B 
the following new section: 
‘‘§ 1116C. Presumption of service connection for cer-
tain 
veterans 
exposed 
to 
perfluorooctanoic acid or other per- and 
polyfluoroalkyl substances 
‘‘(a) PRESUMPTION OF SERVICE CONNECTION.—(1) 
For the purposes of section 1110 of this title, and subject 
to section 1113 of this title, each disease or illness speci-
fied in subsection (b) that becomes manifest in a veteran 
described in paragraph (2) shall be considered to have 
been incurred or aggravated in the line of duty in the ac-
tive military, naval, or air service, notwithstanding that 
there is no record of evidence of such disease or illness 
during the period of such service. 
‘‘(2) A veteran described in this paragraph is a vet-
eran who, during active military, naval, or air service, 
served at a military installation at which individuals were 
exposed to perfluorooctanoic acid or other per- and 
polyfluoroalkyl substances, including exposure through a 
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well that provides water for human consumption that is 
contaminated with such substances. 
‘‘(b) DISEASES OR ILLNESSES.—A disease or illness 
specified in this subsection is any of the following: 
‘‘(1) 
With 
respect 
to 
exposure 
to 
perfluorooctanoic acid— 
‘‘(A) diagnosed high cholesterol; 
‘‘(B) ulcerative colitis; 
‘‘(C) thyroid disease; 
‘‘(D) testicular cancer; 
‘‘(E) kidney cancer; and 
‘‘(F) pregnancy-induced hypertension. 
‘‘(2) With respect to exposure to other per- and 
polyfluoroalkyl substances, any other disease, illness, 
or condition that the Secretary of Veterans Affairs, 
in consultation with the Administrator of the Agency 
for Toxic Substances and Disease Registry of the 
Department of Health and Human Services, deter-
mines pursuant to the study conducted under section 
316 of the National Defense Authorization Act for 
Fiscal Year 2018 (Public Law 115–91) that a posi-
tive association exists between exposure to per- and 
polyfluoroalkyl substances and such disease or ill-
ness. 
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‘‘(c) ACTIVE MILITARY, NAVAL, OR AIR SERVICE.— 
For purposes of this section, any service by a member of 
the reserve components for a period specified by the Sec-
retary at a military installation described in subsection 
(a)(2) shall be treated as active military, naval, or air serv-
ice, notwithstanding section 101(24) of this title.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 1116B the following new 
item: 
‘‘1116C. Presumption of service connection for certain veterans exposed to 
perfluorooctanoic acid or other per- and polyfluoroalkyl sub-
stances.’’. 
Æ 
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