I 113th CONGRESS 2d Session H. R. 5680 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 Secretary to include certain information in the electronic health records of veterans, and for other purposes.

1. Short title This Act may be cited as the Veterans’ Toxic Wounds Research Act of 2014 . 2. Comprehensive program of research into toxic exposures encountered by veterans 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 Secretary 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 established under paragraph (1) shall consist of the registries 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 deployment during the Persian Gulf War (as defined in section 101(33) of title 38, United States Code), including with respect to such exposures leading to Gulf War Illness (as defined by the Institute of Medicine of the National Academies). (C) Exposure to toxins relating to a deployment during Operation Iraqi Freedom, Operation New Dawn, Operation Enduring Freedom, or the Global War on Terror. (D) Exposure to toxins relating to a deployment 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 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 research 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 exposure on second and third generations In addition 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 grandchildren of veterans with toxic exposures covered in a registry described in subsection (a)(3). Under such agreement, 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 research on the association between toxic substance exposures and specific diseases covered in such a registry in such children and grandchildren, including the level of association between such exposures and the specific diseases; and (2) recommendations for future research. (d) Research The Secretary shall use the reviews conducted under subsections (b) and (c) to inform the decisions 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 Representatives and the Senate a report describing how the Secretary used such reviews to make such selections. 3. Presumptions of service connection for illnesses associated with toxic exposures 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 illnesses 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 service referred to in that paragraph, notwithstanding that there is no record of evidence of such illness during the period of such service. (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 presumption of service connection by reason of having a positive 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 determination 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 scientific evidence that a positive association exists between— (i) the exposure of humans or animals to a toxic substance covered in the master registry; and (ii) the occurrence of a diagnosed or un­di­ag­nosed 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 information and analyses available to the Secretary. (B) In evaluating any report, information, or analysis for purposes of making such determinations, the Secretary 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 illness in humans or animals and exposure to a toxic substance 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. (c) (1) Not later than 60 days after the date on which the Secretary receives a report from the National Academy of Sciences under section 2(b) of the Veterans’ Toxic Wounds Research Act of 2014, the Secretary shall determine whether or not a presumption of service connection is warranted for each illness, if any, covered by the report. (2) If the Secretary determines under this subsection that a presumption of service connection is warranted, the Secretary shall, not later than 60 days after making the determination, issue proposed regulations setting forth the Secretary’s determination. (3) (A) If the Secretary determines under this subsection that a presumption of service connection is not warranted, the Secretary shall, not later than 60 days after making the determination, publish in the Federal Register a notice of the determination. The notice shall include an explanation of the scientific basis for the determination. (B) If an illness already presumed to be service connected under this section is subject to a determination under subparagraph (A), the Secretary shall, not later than 60 days after publication of the notice under that subparagraph, issue proposed regulations removing the presumption of service connection for the illness. (4) Not later than 90 days after the date on which the Secretary issues any proposed regulations under this subsection, the Secretary shall issue final regulations. Such regulations shall be effective on the date of issuance. (d) Whenever the presumption of service connection for an illness under this section is removed under subsection (c)— (1) a veteran who was awarded compensation for the illness on the basis of the presumption before the effective date of the removal of the presumption shall continue to be entitled to receive compensation on that basis; and (2) a survivor of a veteran who was awarded dependency and indemnity compensation for the death of a veteran resulting from the illness on the basis of the presumption before that date shall continue to be entitled to receive dependency and indemnity compensation on that basis. (e) Master registry defined In this section, the term master registry means the registry of veterans who experienced toxic exposures established by section 2 of the Veterans’ Toxic Wounds Research Act of 2014. . (b) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1118 the following new item: 1119. Presumptions of service connection for illnesses associated with toxic exposures. . 4. Inclusion of certain information in electronic 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 following 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; (E) blood pressure; (F) cholesterol; (G) blood glucose test and diabetes information; (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 current; (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 where the individual served while in the military.