I 
113TH CONGRESS 
2D SESSION 
H. R. 5680 
To direct the Secretary of Veterans Affairs to establish a registry for certain 
toxic exposures, to direct the Secretary to include certain information 
in the electronic health records of veterans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 19, 2014 
Mr. WALZ introduced the following bill; which was referred to the Committee 
on Veterans’ Affairs 
A BILL 
To direct the Secretary of Veterans Affairs to establish a 
registry for certain toxic exposures, to direct the Sec-
retary to include certain information in the electronic 
health records of veterans, 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 ‘‘Veterans’ Toxic 
Wounds Research Act of 2014’’. 
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
SEC. 2. COMPREHENSIVE PROGRAM OF RESEARCH INTO 
TOXIC EXPOSURES ENCOUNTERED BY VET-
ERANS DURING MILITARY SERVICE. 
(a) REGISTRY OF TOXIC EXPOSURES.— 
(1) ESTABLISHMENT.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall establish a master 
registry of veterans who experienced toxic exposures 
while serving in the Armed Forces. 
(2) ELEMENTS.—The master registry estab-
lished under paragraph (1) shall consist of the reg-
istries described in paragraph (3). The Secretary 
shall establish each such registry using the Clinical 
Case Registry of the Department of Veterans Affairs 
as a model. 
(3) REGISTRIES
DESCRIBED.—The registries 
described in this paragraph are registries for each of 
the following: 
(A) Agent Orange. 
(B) Exposure to toxins relating to a de-
ployment during the Persian Gulf War (as de-
fined in section 101(33) of title 38, United 
States Code), including with respect to such ex-
posures leading to Gulf War Illness (as defined 
by the Institute of Medicine of the National 
Academies). 
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
(C) Exposure to toxins relating to a de-
ployment during Operation Iraqi Freedom, Op-
eration New Dawn, Operation Enduring Free-
dom, or the Global War on Terror. 
(D) Exposure to toxins relating to a de-
ployment to Bosnia, Somalia, the Philippines, 
or other locations determined appropriate by 
the Secretary. 
(E) Exposure to toxins relating to being 
stationed at a military installation potentially 
contaminated by toxic substances, including 
Camp Lejeune, North Carolina, Fort McClellan, 
Alabama, and such installations in Guam. 
(F) Any other toxic exposure the Secretary 
determines appropriate. 
(b) REVIEW.—The Secretary of Veterans Affairs 
shall enter into an agreement with the National Academy 
of Sciences to review published scientific information and 
studies on the health effects of toxic exposures covered in 
a registry described in subsection (a)(3). Under such 
agreement, the Institute of Medicine of the National Acad-
emies shall submit to the Secretary on a biennial basis 
a report on toxic substance exposure-related illnesses. 
Such report shall include— 
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
(1) a review of all scientific studies and re-
search on the association between toxic substance 
exposures and specific diseases covered in such a 
registry, including the level of association between 
such exposures and the specific diseases; and 
(2) recommendations for future research. 
(c) RESEARCH INTO THE EFFECTS OF TOXIC EXPO-
SURE ON SECOND AND THIRD GENERATIONS.—In addi-
tion to the reviews under subsection (b), the Secretary 
shall enter into an agreement with the National Academy 
of Sciences to review published scientific information and 
studies on the health effects on the children and grand-
children of veterans with toxic exposures covered in a reg-
istry described in subsection (a)(3). Under such agree-
ment, the Institute of Medicine of the National Academies 
shall submit to the Secretary on a biennial basis a report 
on toxic substance exposure-related illnesses. Such report 
shall include— 
(1) a review of all scientific studies and re-
search on the association between toxic substance 
exposures and specific diseases covered in such a 
registry in such children and grandchildren, includ-
ing the level of association between such exposures 
and the specific diseases; and 
(2) recommendations for future research. 
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
(d) RESEARCH.—The Secretary shall use the reviews 
conducted under subsections (b) and (c) to inform the de-
cisions made by the Secretary with respect to selecting the 
research to be conducted or funded by the Department 
of Veterans Affairs. The Secretary shall submit to the 
Committees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate a report describing how the 
Secretary used such reviews to make such selections. 
SEC. 3. PRESUMPTIONS OF SERVICE CONNECTION FOR ILL-
NESSES 
ASSOCIATED 
WITH 
TOXIC 
EXPO-
SURES ENCOUNTERED BY VETERANS DURING 
MILITARY SERVICE. 
(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. Presumptions of service connection for ill-
nesses associated with toxic exposures 
‘‘(a) PRESUMPTION.—(1) For purposes of section 
1110 of this title, and subject to section 1113 of this title, 
each illness, if any, described in paragraph (2) shall be 
considered to have been incurred in or aggravated by serv-
ice referred to in that paragraph, notwithstanding that 
there is no record of evidence of such illness during the 
period of such service. 
VerDate Sep 11 2014 
00:20 Oct 08, 2014
Jkt 049200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
‘‘(2) An illness referred to in paragraph (1) is any 
diagnosed or undiagnosed illness that— 
‘‘(A) the Secretary determines in regulations 
prescribed under this section to warrant a presump-
tion of service connection by reason of having a posi-
tive association with exposure to a toxic substance 
covered in the master registry; and 
‘‘(B) becomes manifest within the period, if 
any, prescribed in such regulations in a veteran who 
served in the Armed Forces and by reason of such 
service experienced such exposure. 
‘‘(3) For purposes of this subsection, a veteran who 
served in the Armed Forces in a location recognized under 
the master registry as being a source of exposure and has 
an illness described in paragraph (2) shall be presumed 
to have been exposed by reason of such service unless 
there is conclusive evidence to establish that the veteran 
was not so exposed by reason of such service. 
‘‘(b)(1)(A) Whenever the Secretary makes a deter-
mination described in subparagraph (B), the Secretary 
shall prescribe regulations providing that a presumption 
of service connection is warranted for the illness covered 
by that determination for purposes of this section. 
‘‘(B) A determination referred to in subparagraph 
(A) is a determination based on sound medical and sci-
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
entific evidence that a positive association exists be-
tween— 
‘‘(i) the exposure of humans or animals to a 
toxic substance covered in the master registry; and 
‘‘(ii) the occurrence of a diagnosed or undiag-
nosed illness in humans or animals. 
‘‘(2)(A) In making determinations for purposes of 
paragraph (1), the Secretary shall take into account— 
‘‘(i) the reports submitted to the Secretary by 
the National Academy of Sciences under section 2(b) 
of the Veterans’ Toxic Wounds Research Act of 
2014; and 
‘‘(ii) all other sound medical and scientific in-
formation and analyses available to the Secretary. 
‘‘(B) In evaluating any report, information, or anal-
ysis for purposes of making such determinations, the Sec-
retary shall take into consideration whether the results are 
statistically significant, are capable of replication, and 
withstand peer review. 
‘‘(3) An association between the occurrence of an ill-
ness in humans or animals and exposure to a toxic sub-
stance covered in the master registry shall be considered 
to be positive for purposes of this subsection if the credible 
evidence for the association is equal to or outweighs the 
credible evidence against the association. 
VerDate Sep 11 2014 
00:20 Oct 08, 2014
Jkt 049200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
after the item relating to section 1118 the following new 
item: 
‘‘1119. Presumptions of service connection for illnesses associated with toxic ex-
posures.’’. 
SEC. 4. INCLUSION OF CERTAIN INFORMATION IN ELEC-
TRONIC HEALTH RECORDS. 
In implementing the electronic health record system 
of the Department of Veterans Affairs, the Secretary of 
Veterans Affairs shall ensure that the electronic health 
record of each individual includes, at a minimum, the fol-
lowing information: 
(1) Whether the individual served in the Armed 
Forces. 
(2) The Armed Force in which the individual 
served. 
(3) The locations in which the individual was 
stationed or deployed to during such service. 
(4) The dates of such service. 
(5) The military occupational specialty of the 
individual. 
(6) The results of any tests or assessments of 
the individual regarding— 
(A) vision; 
(B) hearing; 
(C) hepatitis C; 
(D) HIV; 
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
(E) blood pressure; 
(F) cholesterol; 
(G) blood glucose test and diabetes infor-
mation; 
(H) body mass index measurement; 
(I) bone density, as appropriate based on 
the age or sex of the individual; 
(J) cancer screenings (as appropriate 
based on the age, sex, race, or ethnicity of the 
individual) for— 
(i) breast cancer; 
(ii) colorectal cancer; 
(iii) lung cancer; 
(iv) prostate cancer; and 
(v) skin cancer; 
(K) preventive immunizations, if not cur-
rent; 
(L) spirometry (for lung function); 
(M) smoking; 
(N) a mental health evaluation; 
(O) substance abuse; or 
(P) infectious diseases or parasites or 
other adverse health conditions endemic to 
VerDate Sep 11 2014 
00:20 Oct 08, 2014
Jkt 049200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS
where the individual served while in the mili-
tary. 
Æ 
VerDate Sep 11 2014 
18:18 Oct 06, 2014
Jkt 049200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6301
E:\BILLS\H5680.IH
H5680
tkelley on DSK3SPTVN1PROD with BILLS