Honoring our PACT Act of 2022

Bill: 117-hr-3967
Sponsor: full_name: Rep. Takano, Mark [D-CA-41]
Introduced: 2021-06-17
Policy area: Armed Forces and National Security
Subjects: Accidents

Advisory bodies

Afghanistan

Africa

Air quality

Alabama

Asia

Aviation and airports

Bahrain

Cambodia

Cancer

Cardiovascular and respiratory health

Conflicts and wars

Congressional oversight

Department of Veterans Affairs

Disability assistance

Djibouti

Egypt

Europe

Executive agency funding and structure

Fires

Government information and archives

Government studies and investigations

Hazardous wastes and toxic substances

Health care coverage and access

Health information and medical records

Health personnel

Health promotion and preventive care

Iraq

Jordan

Kuwait

Laos

Lebanon

Marshall Islands

Medical research

Medical tests and diagnostic methods

Middle East

Military facilities and property

Military operations and strategy

Military personnel and dependents

Neurological disorders

Oman

Philippines

Public-private cooperation

Qatar

Radiation

Radioactive wastes and releases

Saudi Arabia

Solid waste and recycling

Somalia

Spain

Syria

Thailand

United Arab Emirates

Uzbekistan

Veterans' medical care

Veterans' pensions and compensation

Vietnam

Yemen
Latest action: action_date: 2022-06-16
text: Message on Senate action sent to the House.

Summaries:
action_date: 2021-06-17
action_desc: Introduced in House
text: <p><strong>Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021</strong></p> <p>This bill addresses health care, presumption of service-connection, research, resources, and other matters related to veterans who were exposed to toxic substances during military service.</p> <p>The bill provides eligibility for Department of Veterans Affairs (VA) medical care to veterans who (1) participated in a toxic exposure risk activity (a qualifying activity that requires a corresponding entry in the Individual Longitudinal Exposure Record), or (2) served in specified locations on specified dates.</p> <p>The bill establishes within the VA the Formal Advisory Committee on Toxic Exposure, the Science Review Board, and the Working Group to assist with the various procedures in establishing or removing presumptions of service-connection.</p> <p>The bill modifies or establishes the presumption of service-connection for certain conditions or purposes for various groups of veterans. </p> <p>Among other requirements, the VA must</p> <ul> <li>provide a veteran with a medical examination regarding the nexus between a disability and toxic exposure risk activity if a veteran submits a disability compensation claim for a service-connected disability with insufficient evidence,</li> <li>incorporate a clinical questionnaire to help determine potential toxic exposures as part of the initial screening conducted for veterans with a VA primary care provider,</li> <li>establish a registry for current or past members of the Armed Forces who may have been exposed to per- and polyfluoroalkyl substances due to the environmental release of aqueous film-forming foam at a Department of Defense location, and</li> <li>establish and maintain the Fort McClellan Health Registry. </li> </ul>

action_date: 2022-02-22
action_desc: Reported to House, Part I
text: <p><strong>Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021</strong></p> <p>This bill addresses health care, presumption of service-connection, research, resources, and other matters related to veterans who were exposed to toxic substances during military service.</p> <p>The bill provides eligibility for Department of Veterans Affairs (VA) medical care to veterans who (1) participated in a toxic exposure risk activity (a qualifying activity that requires a corresponding entry in the Individual Longitudinal Exposure Record), or (2) served in specified locations on specified dates.</p> <p>The bill establishes within the VA the Formal Advisory Committee on Toxic Exposure, the Science Review Board, and the Working Group to assist with the various procedures in establishing or removing presumptions of service-connection.</p> <p>The bill modifies or establishes the presumption of service-connection for certain conditions or purposes for various groups of veterans. </p> <p>Among other requirements, the VA must</p> <ul> <li>provide a veteran with a medical examination regarding the nexus between a disability and toxic exposure risk activity if a veteran submits a disability compensation claim for a service-connected disability with insufficient evidence,</li> <li>incorporate a clinical questionnaire to help determine potential toxic exposures as part of the initial screening conducted for veterans with a VA primary care provider,</li> <li>establish a registry for current or past members of the Armed Forces who may have been exposed to per- and polyfluoroalkyl substances due to the environmental release of aqueous film-forming foam at a Department of Defense location, and</li> <li>establish and maintain the Fort McClellan Health Registry.</li></ul>

action_date: 2022-03-03
action_desc: Passed House
text: <p><strong>Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021</strong></p> <p>This bill addresses health care, presumption of service-connection, research, resources, and other matters related to veterans who were exposed to toxic substances during military service.</p> <p>The bill provides eligibility for Department of Veterans Affairs (VA) medical care, including mental health services and counseling, to veterans who (1) participated in a toxic exposure risk activity (a qualifying activity that requires a corresponding entry in an exposure tracking record system), (2) served in specified locations on specified dates, or (3) deployed in support of a specified contingency operation.</p> <p>The bill establishes the Formal Advisory Committee on Toxic Exposure to assist with the various procedures in establishing or removing presumptions of service-connection.</p> <p>The bill modifies or establishes the presumption of service-connection for certain conditions or purposes for various groups of veterans. </p> <p>Among other requirements, the VA must</p><ul> <li>provide a veteran with a medical examination regarding the nexus between a disability and toxic exposure risk activity if a veteran submits a disability compensation claim for a service-connected disability with insufficient evidence,</li> <li>incorporate a clinical questionnaire to help determine potential toxic exposures as part of the initial screening conducted for veterans with a VA primary care provider, and </li> <li>establish a registry for current or past members of the Armed Forces who may have been exposed to per- and polyfluoroalkyl substances due to the environmental release of aqueous film-forming foam at a Department of Defense location. </li> </ul>

action_date: 2022-06-16
action_desc: Passed Senate
text: <p><strong>Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 or the Honoring our PACT Act of 2022</strong></p> <p>This bill addresses health care, presumption of service-connection, research, resources, and other matters related to veterans who were exposed to toxic substances during military service.</p> <p>TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY</p> <p><em>Conceding Our Veterans' Exposure Now and Necessitating Training Act of 2022 or the COVENANT Act of 2022</em></p> <p>Subtitle A--Toxic-Exposed Veterans</p> <p>(Sec. 103) This section provides eligibility for Department of Veterans Affairs (VA) medical care, including mental health services and counseling, to veterans who (1) participated in a toxic exposure risk activity (e.g., a qualifying activity that requires a corresponding entry in an exposure tracking record system, such as the Individual Longitudinal Exposure Record); (2) served in specified locations on specified dates; or (3) deployed in support of a specified contingency operation.</p> <p>(Sec. 104) The VA must complete an assessment to determine (1) the personnel and material resources necessary to implement the expanded provision of care to the veterans specified in Section 103 of this bill (e.g., veterans who participated in a toxic exposure risk activity), and (2) the total number of veterans who served in specified locations on specified dates and receive hospital care or medical services from the VA, disaggregated by priority group.</p><p>Subtitle B--Certain Veterans Of Combat Service And Other Matters</p> <p>(Sec. 111) This section extends the eligibility period for VA hospital care, medical services, and nursing home care for combat veterans who served after September 11, 2001, and are toxic-exposed veterans, including those who did not enroll to receive VA care during the eligibility period.</p> <p>TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS</p> <p><em>Toxic Exposure in the American Military Act of 2022 or the TEAM Act of 2022</em></p> <p>(Sec. 202) This section prescribes the procedures for establishing or removing presumptions of service-connection based on toxic exposure, including by providing for public notice and comment periods and the establishment of a working group to advise and make recommendations regarding toxic exposures during military service.</p> <p>(Sec. 203) The VA must conduct outreach to certain claimants when a law establishes or modifies a presumption of service-connection. Specifically, the VA must identify and conduct outreach for all claims for compensation for a service-connected disability that (1) were submitted to the VA, (2) were evaluated and denied before the new law went into effect, and (3) might have been evaluated differently if the modification had been applicable to the claim.</p> <p>(Sec. 204) The VA must conduct outreach to certain claimants when a law establishes or modifies a presumption of service-connection in relation to dependency and indemnity compensation. Specifically, the VA must identify and conduct outreach for all claims for dependency and indemnity compensation related to service-connected conditions that (1) were submitted to the VA, (2) were evaluated and denied before the new law went into effect, and (3) might have been evaluated differently if the modification had been applicable to the claim.</p> <p>TITLE III--IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION PROCESS FOR TOXIC-EXPOSED VETERANS</p> <p><em>Veterans Burn Pits Exposure Recognition Act of 2022</em></p> <p>(Sec. 302) This section establishes a presumption that veterans were exposed to certain substances, chemicals, and airborne hazards during military service in specified locations in specified time frames (e.g., on or after August 2, 1990, in Bahrain).</p> <p>(Sec. 303) The VA must provide a veteran with a medical examination regarding the nexus between a disability and toxic exposure risk activity if a veteran submits a disability compensation claim for a service-connected disability with insufficient evidence. </p> <p>TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION</p> <p><em>Mark Takai Atomic Veterans Healthcare Parity Act of 2022</em></p> <p>(Sec. 401) This section includes veterans who participated in the cleanup of Enewetak Atoll in the Marshall Islands between January 1, 1977, and December 31, 1980, as radiation-exposed veterans for purposes of the VA presumption of service-connection for specified cancers.</p> <p><em>Palomares or Thule Veterans Act of 2022</em></p> <p>(Sec. 402) This section includes veterans who participated in the cleanup of radioactive materials at Palomares, Spain, or in the response effort following the on-board fire and crash of a U.S. Air Force B-52 bomber in the vicinity of Thule Air Force Base, Greenland, as radiation-exposed veterans for purposes of the presumption of service-connection for specified cancers.</p> <p><em>Veterans Agent Orange Exposure Equity Act of 2022</em></p> <p>(Sec. 403) This section expands the presumption of service-connection for diseases associated with exposure to certain herbicide agents for veterans who served in Vietnam between January 9, 1962, and May 7, 1975. Specifically, the bill expands the presumption to cover veterans who served during specified time frames in Thailand at any U.S. or Royal Thai bases, Laos, Cambodia, Guam or American Samoa or the waters thereof, or on Johnson Atoll. Under the bill, such veterans are eligible for VA hospital care, medical services, and nursing home care.</p> <p><em>Fair Care for Vietnam Veterans Act of 2022</em></p> <p>(Sec. 404) This section provides a presumption of service-connection for hypertension and monoclonal gammopathy of undetermined significance (MGUS) for veterans who performed service specified in Section 403 of this bill (e.g., in Thailand).</p> <p>(Sec. 405) This section addresses disability compensation and care issues for Persian Gulf War veterans, including by expanding who qualifies as a Persian Gulf Veteran.</p> <p><em>Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2022</em></p> <p>(Sec. 406) This section establishes a presumption of service-connection for specified diseases associated with exposure to specified substances, chemicals, or airborne hazards becoming manifest in veterans who served in specified locations during specified times (e.g., Iraq on or after August 2, 1990).</p> <p>TITLE V--RESEARCH MATTERS</p> <p>(Sec. 501) The VA must collaborate with various entities, such as the Department of Defense (DOD), to establish the Toxic Exposure Research Working Group to (1) identify collaborative research activities and resources and conduct such research related to health consequences of toxic exposure during military service, and (2) develop a five-year strategic plan for collaborative research activities. </p> <p>(Sec. 502) The VA must continually analyze all clinical data obtained in connection with its provision of hospital care, medical services, and nursing home care for toxic-exposed veterans that is likely to be scientifically useful in determining the association between a veteran's medical condition and a toxic exposure.</p> <p>(Sec. 503) The VA must conduct an updated analysis of total and respiratory disease mortality in veterans who served in specified locations at specified times, such as in Kuwait on or after August 2, 1990.</p> <p>(Sec. 504) The VA must conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001.</p> <p>(Sec. 505) The VA must study the incidence of cancer in veterans to determine trends in the rates of incidence of cancer in veterans.</p> <p>(Sec. 506) The VA must enter into an agreement with the National Academies of Sciences, Engineering, and Medicine (NASEM) to study the health trends of veterans who, during active service, participated in activities relating to the Manhattan Project or resided near specified locations proximate to waste arising from activities in connection with the Manhattan Project.</p> <p>(Sec. 507) The VA must enter an agreement with NASEM to study possible relationships between toxic exposures experienced during service in the Armed Forces and mental health conditions.</p> <p>(Sec. 508) The Government Accountability Office must study the state of access and barriers to benefits and services furnished by the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA) to veterans in territories and Freely Associated States of the United States.</p> <p>(Sec. 509) The VA must establish and maintain a publicly accessible website to serve as a clearinghouse for the publication of all toxic exposure research carried out or funded by the executive branch of the federal government.</p> <p>(Sec. 510) The VA must report to Congress on the health effects of jet fuels used by the Armed Forces.</p> <p>TITLE VI--IMPROVEMENT OF RESOURCES AND TRAINING REGARDING TOXIC-EXPOSED VETERANS</p> <p><em>Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act of 2022 or the FASTER Presumption Act of 2022</em></p> <p>(Sec. 602) The VA must publish a list of its resources for toxic-exposed veterans and veterans who report toxic exposure, families and caregivers of such veterans, and survivors of such veterans who are receiving death benefits. The VA must also develop an informative outreach program for veterans on illnesses that may be related to toxic exposures.</p> <p>(Sec. 603) The VA must incorporate a screening to help determine potential toxic exposures during active military service as part of the health care screening furnished to veterans enrolled in the VA health care system.</p> <p>(Sec. 604) The VA must provide its health care personnel with education and training to identify, treat, and assess the impact on veterans of illnesses related to toxic exposures. Additionally, the VA must incorporate an annual training program for processors of claims for disability benefits relating to service-connected disabilities based on toxic exposures. </p> <p>TITLE VII--RESOURCING </p> <p>(Sec. 701) The VA is authorized to use funds appropriated to the Cost of War Toxic Exposures Fund to continue the modernization, development, and expansion of capabilities and capacity of information technology systems and infrastructure of the VBA to support expected increased claims processing for newly eligible veterans. The VA must submit a plan to Congress for the modernization of the information technology systems of the VBA.</p> <p>(Sec. 702) This section authorizes the VA to carry out various medical facility leases at specified amounts in FY2023 (e.g., an outpatient clinic in Allentown, Pennsylvania). </p> <p>(Sec. 703) This section prohibits funds from being appropriated, obligated, or expended for any major VA medical facility lease unless the congressional veterans affairs committees each adopt a resolution approving the lease. </p> <p>Additionally, this section (1) modifies the requirements for the prospectus that must be submitted regarding a request for funding a major medical facility lease, and (2) authorizes the VA to carry out interim leasing actions as it considers necessary for approved major medical facility leases and replacement leases that do not require approval.</p> <p>(Sec. 704) The VA may enter into a lease with an academic affiliate or other specified entity to acquire space for the purpose of providing health care resources to veterans.</p> <p>(Sec. 705) This section modifies the enhanced-use lease authority of the VA, including by permanently authorizing such authority and extending the maximum term of such leases from 75 to 99 years. This section also provides appropriations for entering into enhanced-used leases and authorizes the VA to deposit unutilized funds received under an enhanced-use lease in the Medical Facilities or the Construction, Minor Projects accounts. </p> <p>(Sec. 706) This section prescribes the authority for joint leasing actions between DOD and the VA.</p> <p>(Sec. 707) This section provides specified appropriations for major medical facility leases through FY2031.</p> <p>TITLE VIII--RECORDS AND OTHER MATTERS</p> <p>(Sec. 801) The VA must conduct an epidemiological study on the health trends of veterans who served at Fort McClellan at any time between January 1, 1935, and May 20, 1999.</p> <p>(Sec. 802) DOD must brief Congress on the quality of its databases that provide the information presented in the Individual Longitudinal Exposure Record and the usefulness of the record in supporting members of the Armed Forces and veterans in receiving health care and benefits.</p> <p>(Sec. 803) The VA must provide a means for veterans to update their records as necessary to reflect exposures to occupational or environmental hazards in the Individual Longitudinal Exposure Record.</p> <p><em>Camp Lejeune Justice Act of 2022</em></p> <p>(Sec. 804) This section provides a federal cause of action for individuals who resided, worked, or were otherwise exposed (including in utero) for not less than 30 days to water at Camp Lejeune, North Carolina, between August 1, 1953, and December 31, 1987.</p> <p>(Sec. 805) This section establishes the Cost of War Toxic Exposures Fund in the Treasury to be administered by the VA to invest in the delivery of veterans' health care and benefits associated with exposures to environmental hazards during military services and medical and other research relating to exposure to environmental hazards.</p> <p>(Sec. 806) This section provides appropriations to the Cost of War Toxic Exposures Fund to remain available through FY2024. The VA must submit a plan for expending such amounts.</p> <p>(Sec. 807) This section authorizes the VA to provide notice related to claims in an electronic format upon the election of the claimant, including for decisions by the Board of Veterans' Appeals.</p> <p>(Sec. 808) The VA must annually submit a report related to veterans who submit a disability claim for a service-connected disability and were deployed at specified locations at specified times. Additionally, the VA must ensure that VA medical professionals inform a veteran of the Airborne Hazards and Open Burn Pit Registry if a veteran seeks treatment at a VA medical facility for issues related to, or ancillary to, the exposure to toxic airborne chemicals and fumes caused by open burn pits.</p> <p>TITLE IX--IMPROVEMENT OF WORKFORCE OF DEPARTMENT OF VETERANS AFFAIRS</p> <p>(Sec. 901) The VA must develop and implement a national rural recruitment and hiring plan for the VHA to, among other purposes, recruit health care professionals for rural and highly rural community-based outpatient clinics and medical centers.</p> <p>(Sec. 902) The VA may buy out a non-VA service contract of certain health care professionals to whom the VA has offered employment in exchange for the individual agreeing to be employed at a rural or highly rural facility for at least four years.</p> <p>(Sec. 903) The VA must establish qualifications for each of its human resources positions and establish standardized performance metrics for such positions. The VA must also establish or enhance its systems to monitor human resources actions that occur at local, regional, and national levels to improve performance of those actions. The VA must also submit a plan to Congress for the recruitment and retention of human resources employees within the VA.</p> <p>(Sec. 904) This section increases the pay cap for certain employees of the VHA. </p> <p>(Sec. 905) This section expands employment opportunities for housekeeping aides by removing the requirement that competition for VA housekeeping aide positions is restricted to preference eligibles.</p> <p>(Sec. 906) This section modifies the authority of the VA related to hours, conditions and employment, and pay for certain employees of the VHA, specifically certain appointees and Senior Executive Service positions. Additionally, the section authorizes the VA to establish an awards program for certain appointed personnel, such as physicians.</p> <p>(Sec. 907) The VA is authorized to waive any annual premium or aggregate limitation on pay for an employee of the VHA during the calendar year in which the official duty station of the employee is closed or the office, facility, activity, or organization of the employee is realigned. Similarly, the VA may waive any annual premium or aggregate limitation on pay for an employee whose primary duties include providing expanded care for veterans exposed to open burn pits.</p> <p>(Sec. 908) This section eliminates the limitation on aggregate amounts for awards and bonuses for employees of the VA.</p> <p>(Sec. 909) Among other elements, this section provides additional authority for the VA to provide recruitment and relocation bonuses, retention bonuses, merit awards, incentives for critical skills, and student loan repayments. The section increases the cap on the number of college graduates and post-secondary students the VA may hire through an expedited process. The VA may authorize the fixing of the rate of pay for critical positions in the VA, with some limitations. Additionally, the VA may establish a rate for special pay and may waive the limitation on certain payments, such as bonuses.</p>

tv_txt: I 117th CONGRESS 1st Session H. R. 3967 IN THE HOUSE OF REPRESENTATIVES June 17, 2021 Mr. Takano (for himself, Mrs. Luria , Mr. Ruiz , Ms. Slotkin , Mr. Trone , Ms. Brownley , Mr. Levin of California , Mr. Pappas , Mr. Lamb , Mr. Brown , Mr. Gallego , Ms. Underwood , Mr. Sablan , Mr. Mrvan , Mr. Allred , Ms. Kaptur , Ms. Lois Frankel of Florida , Mr. Ryan , Mr. McGovern , Mr. Harder of California , Mr. Fitzpatrick , Mr. Kilmer , Mr. Soto , Ms. Meng , Ms. Strickland , and Ms. Spanberger ) introduced the following bill; which was referred to the Committee on Veterans' Affairs , and in addition to the Committee on Armed Services , 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 improve health care and benefits for veterans exposed to toxic substances, and for other purposes.

1. Short title; references to title 38, United States Code; table of contents (a) Short title This Act may be cited as the Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021 . (b) References to title 38, United States Code Except as otherwise expressly provided, whenever in this title an amendment or repeal 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. (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 for 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. 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. Sec. 203. Reevaluation of claims for compensation involving 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 Veterans Affairs. Sec. 402. Treatment of veterans who participated in nuclear response near Palomares, Spain, as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by Department of Veterans Affairs. Sec. 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations. Sec. 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection 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. Title V—Research matters Sec. 501. Coordination by Department of Veterans Affairs of toxic exposure research. Sec. 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure. Sec. 503. Studies related to veterans who served in Southwest Asia and certain other locations. Sec. 504. Study on health trends of post 9/11 veterans. Sec. 505. Study on cancer rates among veterans. Sec. 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities. Title VI—Improvement of resources and training regarding toxic exposed veterans Sec. 601. Short title; definitions. Sec. 602. Publication of list of resources of Department of Veterans Affairs for toxic exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans. Sec. 603. Incorporation of toxic exposure questionnaire during primary care appointments. Sec. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic exposed veterans. Title VII—Registries, records, and other matters Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations. Sec. 702. Fort McClellan Health Registry. Sec. 703. Independent study on Individual Longitudinal Exposure Record. Sec. 704. Biannual report on Individual Longitudinal Exposure Record. Sec. 705. Correction of exposure records by members of the Armed Forces and veterans. I Expansion of health care eligibility for toxic exposed veterans 101. Short title This title may be cited as the Conceding Our Veterans’ Exposures Now And Necessitating Training Act or the COVENANT Act . 102. Definitions relating to toxic exposed veterans (a) In general Section 1710(a)(2)(F) is amended by striking who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e) and inserting in accordance with subsection (e), who is a toxic exposed veteran . (b) Definitions of toxic exposure and toxic exposed 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. (B) An exposure to a substance, chemical, or airborne hazard specified in section 1119(b)(2). (38) The term toxic exposed veteran means a veteran described in section 1710(e)(1) of this title. . (c) Definition of toxic exposure risk activity Section 1710(e)(4) is amended by adding at the end the following new subparagraph: (C) The term toxic exposure risk activity means any activity— (i) that requires a corresponding entry in the Individual Longitudinal Exposure Record of the Department for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans. . 103. Expansion of health care for specific categories of toxic exposed veterans (a) In general Section 1710(e), as amended by section 102(c), is further amended— (1) in paragraph (1), by adding at the end the following new subparagraphs: (G) 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, medical services, and nursing home care under subsection (a)(2)(F) for any illness. (H) Subject to paragraph (2), a covered veteran (as defined in section 1119(c) of this title) is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness. ; and (2) in paragraph (2)(B)— (A) by striking or (F) and inserting (F), (G), or (H) ; and (B) by striking service or testing and inserting service, testing, or activity . (b) Resource assessment and report (1) Initial assessment and report Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) complete an assessment to determine— (i) the personnel and material resources necessary to implement the amendments made by subsection (a); and (ii) 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 301), who receive hospital care or medical services furnished by the Secretary under chapter 17 of such title, disaggregated by priority group specified in section 1705(a) of such title; and (B) submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate an initial report containing the findings of the assessment completed under subparagraph (A), including a specific determination as to whether the Department has the personnel and material resources necessary to implement the amendments made by subsection (a). (2) Subsequent reports If the initial report submitted under paragraph (1)(B) contains a determination that the Department does not have the personnel or material resources necessary to implement the amendments made by subsection (a), beginning not later than 90 days after the submission of such initial report and every 90 days thereafter until the effective date specified in subsection (c), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a subsequent report containing an update to such determination. (c) Effective date The amendments made by subsection (a) shall take effect on the date that is the earlier of the following: (1) The date on which the Secretary submits a report under subsection (b) containing a determination that the Department has the personnel and material resources necessary to implement such amendments, and notifies the Law Revision Counsel of the House of Representatives of the submission of the report so the Law Revision Counsel may execute the amendments. (2) The date that is 18 months after the date of the enactment of this Act. II Toxic exposure presumption process 201. Short title This title may be cited as the Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act or the FASTER Presumptions Act . 202. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure (a) Advisory committees, panels, and boards (1) Establishment Chapter 11 is amended by adding at the end the following new 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 (a) Procedures The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby— (1) the Formal Advisory Committee on Toxic Exposure under section 1172 of this title— (A) provides advice to the Secretary on toxic exposed veterans and cases in which veterans who, during active military, naval, or air service, may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military, naval, or air service; (B) provides to the Secretary recommendations on corrections needed in the Individual Longitudinal Exposure Record to better reflect veterans and dependents described in subparagraph (A); and (C) provides to the Secretary recommendations regarding which cases of possible toxic exposure described in subparagraph (A) the Science Review Board should review; (2) the Science Review Board under section 1173 of this title— (A) reviews cases of possible toxic exposure nominated by the Secretary; (B) reviews research nominated by the Secretary; (C) develops recommendations for new research; and (D) determines the strength of evidence supporting positive association between toxic exposure and an illness; (3) the Working Group under section 1174 of this title evaluates the conclusions of the Science Review Board and recommends to the Secretary whether to establish or modify a presumption of service connection; and (4) the Secretary prescribes regulations under section 1175 of this title. (b) Illness defined In this subchapter, the term illness includes a disease or other condition affecting the health of an individual. (c) Nonapplication of sunset requirements Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an entity established under this subchapter. 1172. Formal Advisory Committee on Toxic Exposure (a) Establishment (1) There is in the Veterans Health Administration of the Department the Formal Advisory Committee on Toxic Exposure (in this section referred to as the Committee ). (2) (A) The Committee shall be composed of nine members appointed as follows: (i) Five members shall be appointed by the Secretary. (ii) One member shall be appointed by the Speaker of the House of Representatives. (iii) One member shall be appointed by the minority leader of the House of Representatives. (iv) One member shall be appointed by the majority leader of the Senate. (v) One member shall be appointed by the minority leader of the Senate. (B) The members appointed under subparagraph (A) shall meet the following criteria: (i) Not more than three members shall be appointed from among individuals who are officials or employees of the Veterans Benefits Administration or the Veterans Health Administration. (ii) At least one member shall be appointed from among individuals who are officials or employees 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 Prevention. (iii) At least one member shall be appointed from among individuals who are representatives of disabled veterans. (iv) 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. (3) The Secretary shall determine the pay and allowances of the members of the Committee, including with respect to any additional pay and allowances for members who are officials or employees of the Federal Government. (4) Each member of the Committee shall be appointed 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 cases in which veterans who, during active military, naval, or air service, are suspected of having experienced a toxic exposure or dependents of veterans who may have experienced a toxic exposure during such service. (c) Assessments (1) The Committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, or air service. (2) The assessments under paragraph (1) shall cover suspected and known toxic exposures occurring during active military, naval, or air service, including by identifying and evaluating new and emerging toxic 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 person described in subsection (e)(2), by a majority vote of the members of the Committee. (4) The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record to ensure the accuracy of data collected. (d) Research recommendations (1) Following an assessment of a case of the toxic exposure of veterans or their dependents that occurred during active military, naval, or air service under subsection (c), the Committee may develop a recommendation for the Secretary regarding whether there should be a review of the health effects related to the case of exposure conducted by the Science Review Board established under section 1173 of this title. (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 Committee may nominate such evidence for evaluation by the Working Group to modify the periods and locations. (e) Input (1) Not less than quarterly, the Committee 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 persons who may be affected by the actions of the Committee, including— (A) veterans, the families of veterans, veterans service organizations and representatives, researchers, and other members of the general public; and (B) departments and agencies of the Federal Government. (f) Reports by the Committee Not less frequently than once each year, the Committee shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) recommendations for research under subsection (d), if any; and (2) recommendations for such legislative or administrative action as the Committee considers necessary for the Committee to be more effective in carrying out the requirements of this section. (g) Responses by Secretary In response to each report submitted under subsection (f), the Secretary shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) the findings and opinions of the Secretary with respect to the report most recently submitted under subsection (f); and (2) whether the Secretary intends to nominate to the Science Review Board the review recommended by the Committee in the report, and if not, an explanation of why, including citations and sources. 1173. Science Review Board (a) Establishment (1) There is in the Veterans Health Administration of the Department 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, in consultation with the National Academies of Sciences, Engineering, and Medicine, from the general public from among individuals who are distinguished in the fields of medicine, biological sciences, or health administration. (B) An individual may not concurrently serve on the Board and the Formal Advisory Committee on Toxic Exposure 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 toxic exposures of members of the active military, naval, or air service or dependents of such members made by the Secretary, the Board shall— (A) evaluate the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military, naval, or air service; and (B) assess the toxic exposures and illnesses identified by the Secretary and determine whether the evidence supports a finding of a positive association between the toxic exposure and the illness. (2) In carrying out paragraph (1)(B), the Board shall review all relevant data to determine the strength of evidence for a positive association based on the following four categories: (A) The sufficient category, where the evidence is sufficient to conclude that a positive association exists. (B) The equipoise and above category, where the evidence is sufficient to conclude that a positive association is at least as likely as not, but not sufficient to conclude that a positive association exists. (C) The below equipoise category, where the evidence is not sufficient to conclude that a positive association is at least as likely as not, or is not sufficient to make a scientifically informed judgment. (D) The against category, where the evidence suggests the lack of a positive association. (3) (A) With respect to an evaluation conducted under this subsection, if the Board determines that the evidence for a positive association is categorized as either the sufficient or equipoise and above categories, the Board shall estimate the size of the positive association effect among those exposed by calculating the relative risk and exposure prevalence. (B) (i) The Board shall use the relative risk and exposure prevalence calculated under subparagraph (A) to estimate the service-attributable fraction of illness in a military setting to determine the probability of positive association for an individual. (ii) In calculating the service-attributable fraction of illness, the Board shall consider the dose-response relationships. (4) (A) With respect to an evaluation conducted under this subsection, if the Board determines that the evidence for a positive association is categorized as the below equipoise category, the Board shall develop a recommendation as to whether additional data gathering and research are necessary. (B) If the Board recommends additional data gathering and research pursuant to subparagraph (A), the Secretary shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine, or another nonprofit, nongovernmental entity that the Secretary determines has similar expertise and objectivity as the National Academies, to conduct such data gathering and research. (c) Reports (1) For each evaluation conducted under subsection (b) where the Board determines that the evidence for positive association is categorized as either the sufficient or equipoise and above categories, the Board shall submit to the Secretary a report identifying the evidence found to reach such positive association determinations. (2) In addition to submitting reports under paragraph (1), the Board shall submit to the Secretary reports, at such times and at such frequencies as the Board considers appropriate, containing such recommendations as the Board may have for additional or new research on matters relating to toxic exposures described in subsection (b)(1). (d) Responses from the Secretary (1) In response to each report received by the Secretary under subsection (c)(1), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on the findings and opinions of the Secretary with respect to the report received under such subsection. (2) Each report submitted under paragraph (1) of this subsection shall include, with respect to a report received under subsection (c)(1), the following: (A) The findings and opinions of the Secretary with respect to the report received under subsection (c)(1). (B) Whether the Secretary intends to nominate to the Working Group, established under section 1174(a) of this title, the work of the Science Review Board covered by the report received under subsection (c)(1) for further action, and if not, an explanation of why, including citations and sources. 1174. Working group on presumptions of service connection (a) Establishment The Secretary shall establish 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(d)(2) regarding the periods and locations of exposure covered by an existing presumption of service connection; and (2) develop and submit to the Secretary a recommendation with respect to whether— (A) to establish a presumption of service connection for the toxic exposure and illness covered by the report described in subparagraph (A) of paragraph (1); or (B) to modify an existing presumption of service connection described in subparagraph (B) of such paragraph. (b) Recommendations (1) In making a recommendation under subsection (a)(2), the Working Group shall— (A) in cases where the evidence for a positive association is categorized as either the sufficient or equipoise and above categories, as described in subparagraph (A) or (B) of section 1173(b)(2) of this title, weigh such evidence heavily in favor of establishing a presumption of service connection; (B) take into consideration such factors as may be determined appropriate by the Secretary; and (C) if the Working Group determines that additional research, studies, or reports are appropriate before making a final recommendation with respect to establishing or modifying a presumption of service connection, submit to the Secretary a description of such appropriate additional research, studies, or reports. (2) At the same time as when the Working Group submits to the Secretary a recommendation under paragraph (2) of subsection (a) with respect to an evaluation under paragraph (1) of such subsection, the Working Group shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a description of such recommendation. (c) Report The Secretary shall periodically publish on the internet website of the Department a report identifying any factors for the Working Group to consider under subsection (b)(1)(B), as determined appropriate by the Secretary. 1175. Regulations regarding presumptions of service connection based on toxic exposure (a) Action upon Working Group recommendation 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(a)(2) of this title— (1) if the Secretary determines that the presumption, or modification, is warranted, the Secretary shall issue proposed regulations setting forth the presumption or revise regulations to carry out such modification; or (2) if the Secretary determines that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register a notice of the determination, including the reasons supporting the determination. (b) Final regulation Not later than 180 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 Secretary 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 provided 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 entitled to receive dependency and indemnity compensation on such basis. . (2) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1165 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. . (b) Conforming amendments Chapter 11 is amended— (1) in section 1116— (A) by striking subsections (b), (c), (d), and (e); (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter VII of this chapter, including with respect to assessing reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991 ( Public Law 102–4 ). ; and (C) by redesignating subsection (f) as subsection (c); (2) in section 1116B(b)(2)(A), by inserting pursuant to subchapter VII of this chapter, before the Secretary determines ; and (3) in section 1118— (A) by striking subsections (b) through (e); and (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter. . 203. Reevaluation of claims for compensation involving presumptions of service connection (a) In general Subchapter VI of chapter 11 is amended by adding at the end the following new section: 1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection (a) Reevaluation Except as provided in subsection (b), whenever a law, including through a regulation or Federal court decision, establishes or modifies a presumption of service connection, the Secretary shall— (1) identify all claims for compensation under this chapter that— (A) were submitted to the Secretary; (B) were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and (C) might have been evaluated differently had the establishment or modification been applicable to the claim; (2) allow for the reevaluation of such claims at the election of the veteran; and (3) with respect to claims approved pursuant to such reevaluation, provide compensation under this chapter effective as if the establishment or modification of the presumption of service connection had been in effect on the date of the submission of the original claim described in paragraph (1). (b) Outreach With respect to each claim identified under subsection (a), the Secretary shall conduct outreach to inform relevant veterans that they may elect to have a claim be reevaluated in light of the establishment or modification of a presumption of service connection described in such subsection. Such outreach shall include the following: (1) The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to have a claim so reevaluated. (2) The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such veterans to elect to have a claim so reevaluated. (c) Relation to other laws The Secretary shall carry out subsection (a) to the degree that doing so does not conflict with any other provision of law. . (b) Clerical amendment The table of sections at the beginning of chapter 11 of such title is amended by inserting after the item relating to section 1165 the following new item: 1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection. . (c) Application Section 1167 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act. III Improving the establishment of service connection process for toxic exposed veterans 301. Short title This title may be cited as the Veterans Burn Pits Exposure Recognition Act . 302. Presumptions of toxic exposure (a) In general Subchapter II of chapter 11 is amended by adding at the end the following new section: 1119. Presumptions of toxic exposure (a) Consideration of Individual Longitudinal Exposure Record required If a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and a toxic exposure that occurred during active military, naval, or air service, the Secretary shall, in adjudicating such claim, consider— (1) the Individual Longitudinal Exposure Record of the veteran; and (2) if the Individual Longitudinal Exposure Record of the veteran does not indicate that the veteran was subject to a toxic exposure during active military, naval, or air service, the totality of the circumstances of the service of the veteran. (b) Presumption of specific toxic exposure for members who served in certain locations (1) The Secretary shall, for purposes of section 1110 and chapter 17 of this title, presume that any covered veteran was exposed to the substances, chemicals, and hazards listed in paragraph (2) during the service of the covered veteran specified in subsection (c)(1), unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. (2) (A) Subject to subparagraph (B), the substances, chemicals, and airborne hazards listed in this paragraph are as follows: (i) Particulate matter, including the following: (I) PM-10. (II) PM-2.5. (ii) Polycyclic aromatic hydrocarbons (PAHs), including the following: (I) Acenaphthene. (II) Acenaphthylene. (III) Anthracene. (IV) Benzo(a)anthracene. (V) Benzo(a)pyrene. (VI) Benzo(b)fluoranthene. (VII) Benzo(g,h,i)perylene. (VIII) Benzo(k)fluoranthene. (IX) Chrysene. (X) Dibenz(a,h)anthracene. (XI) Fluoranthene. (XII) Fluorene. (XIII) Indeno(1,2,3-cd)pyrene. (XIV) Naphthalene. (XV) Phenanthrene. (XVI) Pyrene. (iii) Volatile organic compounds (VOCs), including the following: (I) Acetone. (II) Acrolein. (III) Benzene. (IV) Carbon Disulfide. (V) Chlorodifluoromethane. (VI) Chloromethane. (VII) Ethylbenzene. (VIII) Hexachlorobutadiene. (IX) Hexane. (X) m/p-Xylene. (XI) Methylene Chloride. (XII) Pentane. (XIII) Propylene. (XIV) Styrene. (XV) Toluene. (iv) Toxic organic halogenated dioxins and furans (dioxins), including the following: (I) 1,2,3,4,6,7,8 HPCDD. (II) 1,2,3,4,6,7,8 HPCDF. (III) 1,2,3,4,7,8,9 HPCDF. (IV) 1,2,3,4,7,8 HXCDD. (V) 1,2,3,6,7,8 HXCDD. (VI) 1,2,3,7,8,9 HXCDD. (VII) 1,2,3,4,7,8 HXCDF. (VIII) 1,2,3,6,7,8 HXCDF. (IX) 1,2,3,7,8,9 HXCDF. (X) 1,2,3,7,8 PECDD. (XI) 1,2,3,7,8 PECDF. (XII) 2,3,4,6,7,8 HXCDF. (XIII) 2,3,4,7,8 PECDF. (XIV) 2,3,7,8 TCDD. (XV) 2,3,7,8 TCDF. (XVI) Octachlorodibenzodioxin. (XVII) Octachlorodibenzofuran. (v) Such other substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate. (B) (i) The Secretary may add to or remove from the list under subparagraph (A) as the Secretary, in collaboration with the Secretary of Defense, determines appropriate. (ii) Beginning not later than two years after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, and not less frequently than once every two years thereafter, the Secretary shall submit to Congress a report identifying any additions or removals made pursuant to subparagraph (A) during the period covered by the report. (c) Definitions In this section: (1) The term covered veteran means any veteran who— (A) on or after August 2, 1990, performed active military, naval, or air service while assigned to a duty station in— (i) Bahrain; (ii) Iraq; (iii) Kuwait; (iv) Oman; (v) Qatar; (vi) Saudi Arabia; (vii) Somalia; or (viii) United Arab Emirates; or (B) on or after September 11, 2001, performed active military, naval, or air service while assigned to a duty station in— (i) Afghanistan; (ii) Djibouti; (iii) Egypt; (iv) Jordan; (v) Lebanon; (vi) Syria; (vii) Yemen; (viii) Uzbekistan; (ix) the Philippines; or (x) any other country determined relevant by the Secretary. (2) The term Individual Longitudinal Exposure Record includes any pilot program or other program used by the Department of Veterans Affairs or the Department of Defense to track how members of the Armed Forces or veterans have been exposed to various occupational or environmental hazards. (3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . (b) Clerical amendment The table of sections at the beginning of chapter 11 is amended by inserting after the item relating to section 1118 the following new item: 1119. Presumptions of toxic exposure. . 303. Medical nexus examinations for toxic exposure risk activities (a) In general Subchapter VI of chapter 11, as amended by section 203 of this Act, is further amended by adding at the end the following new section: 1168. Medical nexus examinations for toxic exposure risk activities (a) Medical examinations and medical opinions (1) Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, or air service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall— (A) provide the veteran with a medical examination under section 5103A(d) of this title; and (B) request a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. (2) When providing the Secretary with a medical opinion requested under paragraph (1), the health care provider shall consider the total potential exposure through all applicable military deployments, and the synergistic, combined effect of all applicable toxic exposure risk activities. (b) Exception Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. (c) Toxic exposure risk activity defined In this section, the term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . (b) Clerical amendment The table of sections at the beginning of chapter 11 of such title, as amended by title II of this Act, is further amended by inserting after the item relating to section 1167, as added by such title, the following new item: 1168. Medical nexus examinations for toxic exposure risk activities. . IV Presumptions of service connection 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 Veterans Affairs (a) Short title This section may be cited as the Mark Takai Atomic Veterans Healthcare Parity Act . (b) Enewetak Atoll Section 1112(c)(3)(B) is amended by adding at the end the following new clause: (v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980. . 402. Treatment of veterans who participated in nuclear response near Palomares, Spain, as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by Department of Veterans Affairs (a) Short title This section may be cited as the Palomares Veterans Act . (b) Palomares Section 1112(c)(3)(B), as amended by section 401, is further amended by adding at the end the following new clause: (vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967. . 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations (a) Short title This section may be cited as the Veterans Agent Orange Exposure Equity Act . (b) In general Section 1116, as amended by section 202, is further amended— (1) by striking , during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; (2) by striking performed active military, naval, or air service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; and (3) by adding at the end the following new subsection: (d) In this section, the term covered service means active military, naval, or air service— (1) performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; (2) performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; (3) performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; (4) performed in Cambodia at Mimot or Krek, Kampong Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or (5) performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977. . (c) Eligibility for hospital care and medical services Section 1710(e)(4), as amended by section 103, is further amended by striking subparagraph (A) and inserting the following new subparagraph: (A) The term Vietnam-era herbicide-exposed veteran means a veteran who— (i) performed covered service, as defined in section 1116(d) of this title; or (ii) the Secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period. . (d) Clerical amendments (1) Section heading The heading for section 1116 is amended by striking the Republic of Vietnam and inserting certain locations . (2) Table of sections The table of sections at the beginning of chapter 11 is amended by striking the item relating to section 1116 and inserting the following new item: 1116. Presumptions of service connection for diseases associated with exposure to certain herbicide agents; presumption of exposure for veterans who served in certain locations. . 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations (a) Short title This section may be cited as the Fair Care for Vietnam Veterans Act . (b) Additional diseases Section 1116(a)(2), as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 ( Public Law 116–283 ), is further amended by adding at the end the following new subparagraphs: (L) Hypertension. (M) Monoclonal gammopathy of undetermined significance. . 405. Improving compensation for disabilities occurring in Persian Gulf War veterans (a) Reduction in threshold of eligibility Subsection (a)(1) of section 1117 is amended by striking became manifest— and all that follows through the period at the end and inserting became manifest to any degree at any time. . (b) Permanent extension of period of eligibility Such section is further amended— (1) by striking subsection (b); (2) by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and (3) in subsection (a)(2)(C), by striking under subsection (d) and inserting under subsection (c) . (c) Establishing singular disability-Based questionnaire Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new subsection (d): (d) If a Persian Gulf veteran at a medical facility of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care personnel of the Department use a disability benefits questionnaire, or successor questionnaire, to identify Gulf War Illness. . (d) Expansion of definition of Persian Gulf veteran Subsection (f) of such section is amended by inserting , Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, after operations . (e) Training Such section is further amended by adding at the end the following new subsection: (i) (1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department are appropriately trained to effectively carry out this section. (2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1). . 406. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Short title This section may be cited as the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act . (b) In general Subchapter II of chapter 11, as amended by section 303(a), is further amended by inserting after section 1119 the following new section: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Presumption of service connection For the purposes of section 1110 of this title, and subject to section 1113 of this title, a disease specified in subsection (b) becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, or air service, notwithstanding that there is no record of evidence of such disease during the period of such service. (b) Diseases specified The diseases specified in this subsection are the following: (1) Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). (2) The following types of cancer: (A) Head cancer of any type. (B) Neck cancer of any type. (C) Respiratory cancer of any type. (D) Gastrointestinal cancer of any type. (E) Reproductive cancer of any type. (F) Lymphoma cancer of any type. (G) Lymphomatic cancer of any type. (H) Kidney cancer. (I) Brain cancer. (J) Melanoma. (K) Pancreatic cancer. (3) Chronic bronchitis. (4) Chronic obstructive pulmonary disease. (5) Constrictive bronchiolitis or obliterative bronchiolitis. (6) Emphysema. (7) Granulomatous disease. (8) Interstitial lung disease. (9) Pleuritis. (10) Pulmonary fibrosis. (11) Sarcoidosis. (12) Chronic sinusitis. (13) Chronic rhinitis. (14) Glioblastoma. (15) Any other disease for which the Secretary determines, pursuant to regulations prescribed under subchapter VII that a presumption of service connection is warranted based on a positive association with a substance, chemical, or airborne hazard specified in section 1119(b)(2) of this title. (c) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of this title. . (c) Clerical amendment The table of sections at the beginning of chapter 11, as amended by section 302(b), is further amended by inserting after the item relating to section 1119 the following new item: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins. . (d) Conforming amendment Section 1113 is amended by striking or 1118 each place it appears and inserting 1118, or 1120 . V Research matters 501. Coordination by Department of Veterans Affairs of toxic exposure research (a) In general Subchapter II of chapter 73 is amended by adding at the end the following new section: 7330D. Coordination of toxic exposure research (a) In general The Secretary shall coordinate all research activities carried out or funded by the executive branch of the Federal Government on the health consequences of toxic exposures experienced during service in the Armed Forces. (b) Strategic plan In carrying out subsection (a), the Secretary shall establish a strategic plan, to be known as the Toxic Exposure Research Strategic Plan, to ensure that the research activities specified in such subsection are collaborative, transparent, and highly coordinated. (c) Report Not later than one year after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate a report on any research activities specified in subsection (a) carried out during the year covered by the report. . (b) Clerical amendment The table of sections at the beginning of such subchapter is amended by inserting after the item relating to section 7330C the following new item: 7330D. Coordination of toxic exposure research. . 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure (a) In general The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that— (1) is obtained by the Secretary in connection with hospital care, medical services, or nursing home care furnished to a veteran for an illness under section 1710(a)(2)(F) of title 38, United States Code, as amended by section 102; and (2) is likely to be scientifically useful, as determined by the Secretary, in determining whether a positive association exists between the illness of the veteran and a toxic exposure. (b) Consent of patients The Secretary shall ensure that the compilation and analysis of the clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, in a manner that is consistent with the informed consent of the veteran and in compliance with all applicable Federal law. (c) Annual report Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate a report containing— (1) any data compiled under subsection (a); (2) an analysis of any such data; (3) a description of the types and incidences of illnesses identified by the Secretary pursuant to such subsection; (4) an explanation by the Secretary for the incidence of such illnesses and such alternate explanations for the incidence of such illnesses as the Secretary may consider reasonable; and (5) a description of the views of the Secretary regarding the scientific validity of drawing conclusions from the incidence of such illnesses, as evidenced by the data compiled under subsection (a), regarding the existence of a positive association between such illness and a toxic exposure. (d) Definitions In this section: (1) The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. 503. Studies related to veterans who served in Southwest Asia and certain other locations (a) Analysis on mortality in covered veterans (1) Analysis Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct an updated analysis of total and respiratory disease mortality in covered veterans. (2) Elements The analysis under paragraph (1) shall include, to the extent practicable, the following: (A) Metrics of airborne exposures. (B) The location and timing of any deployments of the veteran. (C) The military occupational specialty of the veteran. (D) The Armed Force in which the veteran served. (E) The preexisting health status of the veteran, including with respect to asthma. (F) Such personal information of the veteran as the Secretary may consider relevant, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity. (b) Epidemiological study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct an epidemiological study of covered veterans that involves— (1) the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment; and (2) the collection of detailed information on the covered veterans studied through medical records, administrative data, and other existing sources, including, with respect to the covered veterans— (A) personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity; (B) deployment history, including locations, periods, and number of deployments; (C) biospecimen data; and (D) supplementary health status and outcomes data, including imaging and physiological parameters. (c) Toxicology study (1) Study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a toxicology study, to include variability, to replicate toxic exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions. (2) Elements The study under paragraph (1) shall include— (A) an analysis of results for mechanistic markers and clinically relevant outcomes; and (B) a validation of any serum, tissue, or other biomarkers of toxic exposure, susceptibility, or effect with respect to the subjects of the study. (d) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of title 38, United States Code, as added by section 302. 504. Study on health trends of post 9/11 veterans (a) Study The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001. (b) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 505. Study on cancer rates among veterans (a) Study The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans to determine trends in the rates of the incidence of cancer in veterans. (b) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The age of the veteran. (2) The period of service and length of service of the veteran in the Armed Forces. (3) Any military occupational speciality of the veteran. (4) The gender of the veteran. (5) Any type of cancer that the veteran has. (c) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities (a) Study The Secretary of Veterans Affairs shall conduct a study on the feasibility and advisability of furnishing hospital care and medical services to qualifying dependents of veterans described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 103(a)(1), for any illness determined by the Secretary to be connected to a toxic exposure risk activity carried out by the veteran, as determined by the Secretary, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such activity. (b) Elements The study under subsection (a) shall include— (1) an assessment of the impact of furnishing hospital care and medical services to qualifying dependents as described in such subsection on the ability of the Department of Veterans Affairs to furnish hospital care and medical services to veterans; (2) an assessment of the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection; (3) an estimate of the resources required to furnish such care and services; (4) an assessment of any stress or other effect furnishing such care and services would have on the claims and appeals system of the Department; (5) an estimate of the number of qualifying dependents who would be eligible for such care and services; and (6) an assessment of the feasibility of adjudicating claims for such care and services. (c) Phased-In application In conducting the study under subsection (a), the Secretary shall assess the feasibility and advisability of phasing in the furnishing of hospital care and medical services to qualifying dependents described in such subsection by the decade in which such toxic exposure risk activity occurred, starting with the most recent decade. (d) Review of toxic exposure cases regarding liability of Department of Defense In conducting the study under subsection (a), the Secretary shall— (1) review known cases of toxic exposure on military installations of the Department of Defense located in the United States; (2) analyze the liability of the Department of Defense in each such case; and (3) assess whether the Secretary of Defense should provide care and services relating to such toxic exposures under the TRICARE program. (e) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a). (f) Definitions In this section: (1) The terms hospital care and medical services have the meanings given those terms in section 1701 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. (3) The term qualifying dependent means— (A) a dependent of a veteran described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 103(a)(1), who resided with the veteran during the period in which, and on the installation at which, the veteran participated in a toxic exposure risk activity; (B) an individual who was in utero of such a veteran or other qualifying dependent when the veteran participated in a toxic exposure risk activity; or (C) a dependent of such a veteran who is not described in subparagraph (A) or (B) but who may have an illness that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary. (4) The term toxic exposure has the meaning given that term in section 101 of such title, as added by section 102(b). (5) The term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of such title, as added by section 103(a)(3). (6) The term TRICARE program has the meaning given that term in section 1072 of such title. VI Improvement of resources and training regarding toxic exposed veterans 601. Short title; definitions (a) Short title This title may be cited as the Toxic Exposure in the American Military Act or the TEAM Act . (b) Definitions In this title, the terms active military, naval, or air service , toxic exposure , and toxic exposed veteran have the meanings given those terms in section 101 of title 38, United States Code. 602. Publication of list of resources of Department of Veterans Affairs for toxic exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans (a) Publication of list of resources (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for— (A) toxic exposed veterans, including with respect to— (i) disability compensation under chapter 11 of title 38, United States Code; and (ii) hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title; (B) caregivers of toxic exposed veterans who are participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title; and (C) survivors of toxic exposed veterans who are receiving death benefits under the laws administered by the Secretary. (2) Update The Secretary shall periodically update the list published under paragraph (1). (b) Outreach The Secretary shall develop, with input from the community, an informative outreach program for veterans on illnesses that may be related to toxic exposure, including outreach with respect to benefits and support programs. 603. Incorporation of toxic exposure questionnaire during primary care appointments (a) In general The Secretary of Veterans Affairs shall incorporate a clinical questionnaire to help determine potential toxic exposures during active military, naval, or air service as part of the initial screening conducted for an appointment of a veteran with a primary care provider of the Department of Veterans Affairs to improve understanding by the Department of toxic exposures of veterans while serving in the Armed Forces. (b) Determination of questions The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic exposed veterans (a) Health care personnel The Secretary of Veterans Affairs shall provide to health care personnel of the Department of Veterans Affairs education and training to identify, treat, and assess the impact on toxic exposed veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures. (b) Benefits personnel (1) Standard claims processor training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a standard training curriculum for processors of claims under the laws administered by the Secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposure, including employees who adjudicate such claims. (B) Matters included The Secretary shall ensure that the training under subparagraph (A) includes the following explanations with respect to claims relating to toxic exposure: (i) A lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist. (ii) The claims adjudicator shall always consider whether direct service connection is applicable and request, as needed, an advisory medical opinion pursuant to section 1168 of title 38, United States Code, as added by section 303. (iii) The claims adjudicator shall always review and consider the Individual Longitudinal Exposure Record program of the Department of Veterans Affairs pursuant to section 1119 of such title, as added by section 302, but a lack of such information is not by itself sufficient to determine that such exposure did not occur or sufficient to deny the claim. (C) Provision of training The Secretary shall— (i) provide training under subparagraph (A) to each employee described in such subparagraph not less frequently than annually; and (ii) using the Systematic Technical Accuracy Review program, or such successor program, conduct a nationwide, quarterly, randomized review of the quality of adjudication of claims relating to toxic exposure. (2) Standard medical examiner training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a standard medical training curriculum for medical providers who conduct examinations and provide opinions pursuant to section 1168 of title 38, United States Code, as added by section 303, regardless of whether the provider is an employee of the Department or a contractor. (B) Standardized approach The Secretary shall ensure that the curriculum established under subparagraph (A)— (i) provides a standardized approach to conducting and providing examinations and opinions in accordance with such section 1168; and (ii) instructs medical providers to consider, when conducting an examination or providing an opinion— (I) relevant medical and scientific literature; (II) the proximity, intensity, and frequency of exposure of the individual to the identified toxic exposure; (III) medically unexplained chronic multisymptom illnesses; and (IV) all competent and credible evidence of record. VII Registries, records, and other matters 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations (a) Establishment of registry (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances (in this section referred to as PFAS ) due to the environmental release of aqueous film-forming foam (in this section referred to as AFFF ) on military installations to meet the requirements of military specification MIL–F–24385F; (B) include any information in such registry that the Secretary determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to PFAS associated with AFFF; (C) develop a public information campaign to inform eligible individuals about the registry, including how to register and the benefits of registering; and (D) periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to PFAS. (2) Coordination The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense in carrying out paragraph (1). (b) Reports (1) Initial report Not later than two years after the date on which the registry under subsection (a) is established, the Secretary of Veterans Affairs shall submit to Congress an initial report containing the following: (A) An assessment of the effectiveness of actions taken by the Secretary of Veterans Affairs and the Secretary of Defense to collect and maintain information on the health effects of exposure to PFAS. (B) Recommendations to improve the collection and maintenance of such information. (C) Using established and previously published epidemiological studies, recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to exposure to PFAS. (2) Followup report Not later than five years after submitting the initial report under paragraph (1), the Secretary of Veterans Affairs shall submit to Congress a followup report containing the following: (A) An update to the initial report submitted under paragraph (1). (B) An assessment of whether and to what degree the content of the registry established under subsection (a) is current and scientifically up to date. (3) Independent scientific organization The Secretary of Veterans Affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs (1) and (2). (c) Recommendations for additional exposures To be included Not later than five years after the date of the enactment of this Act, and every five years thereafter, the Secretary of Veterans Affairs, in consultation with the Secretary of Defense and the Administrator of the Environmental Protection Agency, shall submit to Congress recommendations for additional chemicals with respect to which individuals exposed to such chemicals should be included in the registry established under subsection (a). (d) Eligible individual defined In this section, the term eligible individual means any individual who, on or after a date specified by the Secretary of Veterans Affairs through regulations, served or is serving in the Armed Forces at a military installation where AFFF was used or at another location of the Department of Defense where AFFF was used. 702. Fort McClellan Health Registry (a) Establishment The Secretary of Veterans Affairs shall establish and maintain a special record to be known as the Fort McClellan Health Registry (in this section referred to as the Registry ). (b) Contents Except as provided in subsection (c), the Registry shall include the following information: (1) A list containing the name of each individual who, while serving as a member of the Armed Forces, was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, and who— (A) applies for care or services from the Department of Veterans Affairs under chapter 17 of title 38, United States Code; (B) files a claim for compensation under chapter 11 of such title on the basis of any disability which may be associated with such service; (C) dies and is survived by a spouse, child, or parent who files a claim for dependency and indemnity compensation under chapter 13 of such title on the basis of such service; (D) requests from the Secretary a health examination under subsection (d); or (E) receives from the Secretary a health examination similar to the health examination referred to in subparagraph (D) and requests inclusion in the Registry. (2) Relevant medical data relating to the health status of, and other information that the Secretary considers relevant and appropriate with respect to, each individual described in paragraph (1) who— (A) grants to the Secretary permission to include such information in the Registry; or (B) at the time the individual is listed in the Registry, is deceased. (c) Individuals submitting claims or making requests before date of enactment If in the case of an individual described in subsection (b)(1) the application, claim, or request referred to in such subsection was submitted, filed, or made before the date of the enactment of this Act, the Secretary shall, to the extent feasible, include in the Registry such individual's name and the data and information, if any, described in subsection (b)(2) relating to the individual. (d) Examinations Upon the request of a veteran who was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, the Secretary shall provide the veteran with a health examination (including any appropriate diagnostic tests) and consultation and counseling with respect to the results of the examination and the tests. (e) Outreach (1) Ongoing outreach to individuals listed in Registry The Secretary shall, from time to time, notify individuals listed in the Registry of significant developments in research on the health consequences of potential exposure to a toxic substance or environmental hazard related to service at Fort McClellan. (2) Examination outreach The Secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations (including any diagnostic tests) and consultation and counseling services under subsection (d). (f) Consultation The Secretary of Veterans Affairs shall consult with the Secretary of Defense to acquire information maintained by the Secretary of Defense that the Secretary of Veterans Affairs considers necessary to establish and maintain the Registry. 703. Independent study on Individual Longitudinal Exposure Record (a) In general Not later than 60 days after the date of the enactment of this Act, the Secretary of Defense shall enter into a contract with an independent research entity described in subsection (b) to carry out a comprehensive study of the development of the Individual Longitudinal Exposure Record to determine— (1) the quality of the location data, occupational and environmental exposure data, and health surveillance data; and (2) whether a member of the Armed Forces can be reasonably assured that any toxic exposure they experience during service in the Armed Forces will be accurately reflected in the Individual Longitudinal Exposure Record of the member. (b) Independent research entity The entity described in this subsection is an independent research entity that is a not-for-profit entity or a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b). 704. Biannual report on Individual Longitudinal Exposure Record (a) In general Not later than one year after the date on which the Individual Longitudinal Exposure Record achieves full operation capability, as determined by the Secretary of Defense, and every 180 days thereafter, the Secretary shall, in consultation with the Secretary of Veterans Affairs, submit to the appropriate committees of Congress a report on the data quality of the databases of the Department of Defense that provide the information presented in the Individual Longitudinal Exposure Record and the usefulness of the Individual Longitudinal Exposure Record in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. (b) Elements Each report required by subsection (a) shall include, for the period covered by the report, the following: (1) An identification of toxic exposure events that may not be fully captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. (2) An analysis of the quality of the location data used by the Department of Defense in determining toxic exposures of members of the Armed Forces and veterans, and recommendations for how to improve the quality of that location data if necessary. (c) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. (2) Toxic exposure The term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b). 705. Correction of exposure records by members of the Armed Forces and veterans (a) In general The Secretary of Defense and the Secretary of Veterans Affairs shall provide a means for members of the Armed Forces and veterans to update their records as necessary to reflect a toxic exposure by such member or veteran in the Individual Longitudinal Exposure Record. (b) Evidence (1) Provision of evidence To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, shall provide such evidence as the Secretary of Defense and the Secretary of Veterans Affairs jointly consider necessary. (2) Benefit of the doubt In reviewing evidence provided under paragraph (1), the Secretary of Defense and the Secretary of Veterans Affairs shall give the benefit of the doubt to the member of the Armed Forces or veteran who provided the evidence, as the case may be, in a manner that is equivalent to the benefit of the doubt required under section 5107(b) of title 38, United States Code. (3) Regulations The Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall prescribe by regulation the evidence considered necessary under paragraph (1). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b).

tv_txt: IB Union Calendar No. 179 117th CONGRESS 2d Session H. R. 3967 [Report No. 117–249, Part I] IN THE HOUSE OF REPRESENTATIVES June 17, 2021 Mr. Takano (for himself, Mrs. Luria , Mr. Ruiz , Ms. Slotkin , Mr. Trone , Ms. Brownley , Mr. Levin of California , Mr. Pappas , Mr. Lamb , Mr. Brown of Maryland , Mr. Gallego , Ms. Underwood , Mr. Sablan , Mr. Mrvan , Mr. Allred , Ms. Kaptur , Ms. Lois Frankel of Florida , Mr. Ryan , Mr. McGovern , Mr. Harder of California , Mr. Fitzpatrick , Mr. Kilmer , Mr. Soto , Ms. Meng , Ms. Strickland , and Ms. Spanberger ) introduced the following bill; which was referred to the Committee on Veterans' Affairs , and in addition to the Committee on Armed Services , 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 February 22, 2022 Additional sponsors: Mrs. Kirkpatrick , Ms. Norton , Mr. Malinowski , Ms. Newman , Ms. Sherrill , Mr. Khanna , Mr. Rush , Mr. Aguilar , Mrs. Hayes , Mrs. Trahan , Ms. Omar , Mr. Levin of Michigan , Mr. O'Halleran , Mr. Kind , Mr. Carson , Mr. San Nicolas , Mr. Perlmutter , Mr. Neguse , Ms. Lofgren , Mrs. Dingell , Ms. Davids of Kansas , Mr. Cohen , Mrs. Axne , Mr. Grijalva , Mr. Grothman , Mr. Cooper , Mr. Moulton , Mr. Pocan , Mr. Swalwell , Mr. Tonko , Ms. Blunt Rochester , Ms. Bonamici , Ms. Porter , Mr. Krishnamoorthi , Mr. Blumenauer , Mrs. Bustos , Ms. DeGette , Mr. Jones , Mr. Courtney , Ms. Pingree , Ms. Bourdeaux , Ms. Manning , Mr. Welch , Ms. Leger Fernandez , Mr. Langevin , Mr. Keating , Mr. Bishop of Georgia , Mr. Lieu , Mr. Cline , Mr. Larsen of Washington , Ms. Kelly of Illinois , Mr. Lynch , Mrs. Torres of California , Ms. Williams of Georgia , Ms. Houlahan , Ms. Sewell , Mr. Casten , Mr. Cicilline , Mr. Schiff , Mr. Cartwright , Mr. Espaillat , Mr. Horsford , Mr. DeFazio , Mr. Schrader , Mr. Carbajal , Ms. Castor of Florida , Ms. Jacobs of California , Mr. Castro of Texas , Mr. Raskin , Mrs. Cherfilus-McCormick , Ms. Scanlon , Mr. Stanton , Mr. Costa , Mr. Gottheimer , and Ms. Bass February 22, 2022 Reported from the Committee on Veterans' Affairs February 22, 2022 Committee on Armed Services discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed A BILL To improve health care and benefits for veterans exposed to toxic substances, and for other purposes.

1. Short title; references to title 38, United States Code; table of contents (a) Short title This Act may be cited as the Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021 . (b) References to title 38, United States Code Except as otherwise expressly provided, whenever in this title an amendment or repeal 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. (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 for 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. 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. Sec. 203. Reevaluation of claims for compensation involving 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 Veterans Affairs. Sec. 402. Treatment of veterans who participated in nuclear response near Palomares, Spain, as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by Department of Veterans Affairs. Sec. 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations. Sec. 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection 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. Title V—Research matters Sec. 501. Coordination by Department of Veterans Affairs of toxic exposure research. Sec. 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure. Sec. 503. Studies related to veterans who served in Southwest Asia and certain other locations. Sec. 504. Study on health trends of post 9/11 veterans. Sec. 505. Study on cancer rates among veterans. Sec. 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities. Title VI—Improvement of resources and training regarding toxic exposed veterans Sec. 601. Short title; definitions. Sec. 602. Publication of list of resources of Department of Veterans Affairs for toxic exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans. Sec. 603. Incorporation of toxic exposure questionnaire during primary care appointments. Sec. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic exposed veterans. Title VII—Registries, records, and other matters Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations. Sec. 702. Fort McClellan Health Registry. Sec. 703. Independent study on Individual Longitudinal Exposure Record. Sec. 704. Biannual report on Individual Longitudinal Exposure Record. Sec. 705. Correction of exposure records by members of the Armed Forces and veterans. I Expansion of health care eligibility for toxic exposed veterans 101. Short title This title may be cited as the Conceding Our Veterans’ Exposures Now And Necessitating Training Act or the COVENANT Act . 102. Definitions relating to toxic exposed veterans (a) In general Section 1710(a)(2)(F) is amended by striking who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e) and inserting in accordance with subsection (e), who is a toxic exposed veteran . (b) Definitions of toxic exposure and toxic exposed 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. (B) An exposure to a substance, chemical, or airborne hazard specified in section 1119(b)(2). (38) The term toxic exposed veteran means a veteran described in section 1710(e)(1) of this title. . (c) Definition of toxic exposure risk activity Section 1710(e)(4) is amended by adding at the end the following new subparagraph: (C) The term toxic exposure risk activity means any activity— (i) that requires a corresponding entry in the Individual Longitudinal Exposure Record of the Department for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans. . 103. Expansion of health care for specific categories of toxic exposed veterans (a) In general Section 1710(e), as amended by section 102(c), is further amended— (1) in paragraph (1), by adding at the end the following new subparagraphs: (G) 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, medical services, and nursing home care under subsection (a)(2)(F) for any illness. (H) Subject to paragraph (2), a covered veteran (as defined in section 1119(c) of this title) is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness. ; and (2) in paragraph (2)(B)— (A) by striking or (F) and inserting (F), (G), or (H) ; and (B) by striking service or testing and inserting service, testing, or activity . (b) Resource assessment and report (1) Initial assessment and report Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) complete an assessment to determine— (i) the personnel and material resources necessary to implement the amendments made by subsection (a); and (ii) 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 301), who receive hospital care or medical services furnished by the Secretary under chapter 17 of such title, disaggregated by priority group specified in section 1705(a) of such title; and (B) submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate an initial report containing the findings of the assessment completed under subparagraph (A), including a specific determination as to whether the Department has the personnel and material resources necessary to implement the amendments made by subsection (a). (2) Subsequent reports If the initial report submitted under paragraph (1)(B) contains a determination that the Department does not have the personnel or material resources necessary to implement the amendments made by subsection (a), beginning not later than 90 days after the submission of such initial report and every 90 days thereafter until the effective date specified in subsection (c), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a subsequent report containing an update to such determination. (c) Effective date The amendments made by subsection (a) shall take effect on the date that is the earlier of the following: (1) The date on which the Secretary submits a report under subsection (b) containing a determination that the Department has the personnel and material resources necessary to implement such amendments, and notifies the Law Revision Counsel of the House of Representatives of the submission of the report so the Law Revision Counsel may execute the amendments. (2) The date that is 18 months after the date of the enactment of this Act. II Toxic exposure presumption process 201. Short title This title may be cited as the Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act or the FASTER Presumptions Act . 202. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure (a) Advisory committees, panels, and boards (1) Establishment Chapter 11 is amended by adding at the end the following new 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 (a) Procedures The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby— (1) the Formal Advisory Committee on Toxic Exposure under section 1172 of this title— (A) provides advice to the Secretary on toxic exposed veterans and cases in which veterans who, during active military, naval, or air service, may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military, naval, or air service; (B) provides to the Secretary recommendations on corrections needed in the Individual Longitudinal Exposure Record to better reflect veterans and dependents described in subparagraph (A); and (C) provides to the Secretary recommendations regarding which cases of possible toxic exposure described in subparagraph (A) the Science Review Board should review; (2) the Science Review Board under section 1173 of this title— (A) reviews cases of possible toxic exposure nominated by the Secretary; (B) reviews research nominated by the Secretary; (C) develops recommendations for new research; and (D) determines the strength of evidence supporting positive association between toxic exposure and an illness; (3) the Working Group under section 1174 of this title evaluates the conclusions of the Science Review Board and recommends to the Secretary whether to establish or modify a presumption of service connection; and (4) the Secretary prescribes regulations under section 1175 of this title. (b) Illness defined In this subchapter, the term illness includes a disease or other condition affecting the health of an individual. (c) Nonapplication of sunset requirements Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an entity established under this subchapter. 1172. Formal Advisory Committee on Toxic Exposure (a) Establishment (1) There is in the Veterans Health Administration of the Department the Formal Advisory Committee on Toxic Exposure (in this section referred to as the Committee ). (2) (A) The Committee shall be composed of nine members appointed as follows: (i) Five members shall be appointed by the Secretary. (ii) One member shall be appointed by the Speaker of the House of Representatives. (iii) One member shall be appointed by the minority leader of the House of Representatives. (iv) One member shall be appointed by the majority leader of the Senate. (v) One member shall be appointed by the minority leader of the Senate. (B) The members appointed under subparagraph (A) shall meet the following criteria: (i) Not more than three members shall be appointed from among individuals who are officials or employees of the Veterans Benefits Administration or the Veterans Health Administration. (ii) At least one member shall be appointed from among individuals who are officials or employees 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 Prevention. (iii) At least one member shall be appointed from among individuals who are representatives of disabled veterans. (iv) 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. (3) The Secretary shall determine the pay and allowances of the members of the Committee, including with respect to any additional pay and allowances for members who are officials or employees of the Federal Government. (4) Each member of the Committee shall be appointed 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 cases in which veterans who, during active military, naval, or air service, are suspected of having experienced a toxic exposure or dependents of veterans who may have experienced a toxic exposure during such service. (c) Assessments (1) The Committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, or air service. (2) The assessments under paragraph (1) shall cover suspected and known toxic exposures occurring during active military, naval, or air service, including by identifying and evaluating new and emerging toxic 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 person described in subsection (e)(2), by a majority vote of the members of the Committee. (4) The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record to ensure the accuracy of data collected. (d) Research recommendations (1) Following an assessment of a case of the toxic exposure of veterans or their dependents that occurred during active military, naval, or air service under subsection (c), the Committee may develop a recommendation for the Secretary regarding whether there should be a review of the health effects related to the case of exposure conducted by the Science Review Board established under section 1173 of this title. (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 Committee may nominate such evidence for evaluation by the Working Group to modify the periods and locations. (e) Input (1) Not less than quarterly, the Committee 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 persons who may be affected by the actions of the Committee, including— (A) veterans, the families of veterans, veterans service organizations and representatives, researchers, and other members of the general public; and (B) departments and agencies of the Federal Government. (f) Reports by the Committee Not less frequently than once each year, the Committee shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) recommendations for research under subsection (d), if any; and (2) recommendations for such legislative or administrative action as the Committee considers necessary for the Committee to be more effective in carrying out the requirements of this section. (g) Responses by Secretary In response to each report submitted under subsection (f), the Secretary shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) the findings and opinions of the Secretary with respect to the report most recently submitted under subsection (f); and (2) whether the Secretary intends to nominate to the Science Review Board the review recommended by the Committee in the report, and if not, an explanation of why, including citations and sources. 1173. Science Review Board (a) Establishment (1) There is in the Veterans Health Administration of the Department 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, in consultation with the National Academies of Sciences, Engineering, and Medicine, from the general public from among individuals who are distinguished in the fields of medicine, biological sciences, or health administration. (B) An individual may not concurrently serve on the Board and the Formal Advisory Committee on Toxic Exposure 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 toxic exposures of members of the active military, naval, or air service or dependents of such members made by the Secretary, the Board shall— (A) evaluate the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military, naval, or air service; and (B) assess the toxic exposures and illnesses identified by the Secretary and determine whether the evidence supports a finding of a positive association between the toxic exposure and the illness. (2) In carrying out paragraph (1)(B), the Board shall review all relevant data to determine the strength of evidence for a positive association based on the following four categories: (A) The sufficient category, where the evidence is sufficient to conclude that a positive association exists. (B) The equipoise and above category, where the evidence is sufficient to conclude that a positive association is at least as likely as not, but not sufficient to conclude that a positive association exists. (C) The below equipoise category, where the evidence is not sufficient to conclude that a positive association is at least as likely as not, or is not sufficient to make a scientifically informed judgment. (D) The against category, where the evidence suggests the lack of a positive association. (3) (A) With respect to an evaluation conducted under this subsection, if the Board determines that the evidence for a positive association is categorized as either the sufficient or equipoise and above categories, the Board shall estimate the size of the positive association effect among those exposed by calculating the relative risk and exposure prevalence. (B) (i) The Board shall use the relative risk and exposure prevalence calculated under subparagraph (A) to estimate the service-attributable fraction of illness in a military setting to determine the probability of positive association for an individual. (ii) In calculating the service-attributable fraction of illness, the Board shall consider the dose-response relationships. (4) (A) With respect to an evaluation conducted under this subsection, if the Board determines that the evidence for a positive association is categorized as the below equipoise category, the Board shall develop a recommendation as to whether additional data gathering and research are necessary. (B) If the Board recommends additional data gathering and research pursuant to subparagraph (A), the Secretary shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine, or another nonprofit, nongovernmental entity that the Secretary determines has similar expertise and objectivity as the National Academies, to conduct such data gathering and research. (c) Reports (1) For each evaluation conducted under subsection (b) where the Board determines that the evidence for positive association is categorized as either the sufficient or equipoise and above categories, the Board shall submit to the Secretary a report identifying the evidence found to reach such positive association determinations. (2) In addition to submitting reports under paragraph (1), the Board shall submit to the Secretary reports, at such times and at such frequencies as the Board considers appropriate, containing such recommendations as the Board may have for additional or new research on matters relating to toxic exposures described in subsection (b)(1). (d) Responses from the Secretary (1) In response to each report received by the Secretary under subsection (c)(1), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on the findings and opinions of the Secretary with respect to the report received under such subsection. (2) Each report submitted under paragraph (1) of this subsection shall include, with respect to a report received under subsection (c)(1), the following: (A) The findings and opinions of the Secretary with respect to the report received under subsection (c)(1). (B) Whether the Secretary intends to nominate to the Working Group, established under section 1174(a) of this title, the work of the Science Review Board covered by the report received under subsection (c)(1) for further action, and if not, an explanation of why, including citations and sources. 1174. Working group on presumptions of service connection (a) Establishment The Secretary shall establish 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(d)(2) regarding the periods and locations of exposure covered by an existing presumption of service connection; and (2) develop and submit to the Secretary a recommendation with respect to whether— (A) to establish a presumption of service connection for the toxic exposure and illness covered by the report described in subparagraph (A) of paragraph (1); or (B) to modify an existing presumption of service connection described in subparagraph (B) of such paragraph. (b) Recommendations (1) In making a recommendation under subsection (a)(2), the Working Group shall— (A) in cases where the evidence for a positive association is categorized as either the sufficient or equipoise and above categories, as described in subparagraph (A) or (B) of section 1173(b)(2) of this title, weigh such evidence heavily in favor of establishing a presumption of service connection; (B) take into consideration such factors as may be determined appropriate by the Secretary; and (C) if the Working Group determines that additional research, studies, or reports are appropriate before making a final recommendation with respect to establishing or modifying a presumption of service connection, submit to the Secretary a description of such appropriate additional research, studies, or reports. (2) At the same time as when the Working Group submits to the Secretary a recommendation under paragraph (2) of subsection (a) with respect to an evaluation under paragraph (1) of such subsection, the Working Group shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a description of such recommendation. (c) Report The Secretary shall periodically publish on the internet website of the Department a report identifying any factors for the Working Group to consider under subsection (b)(1)(B), as determined appropriate by the Secretary. 1175. Regulations regarding presumptions of service connection based on toxic exposure (a) Action upon Working Group recommendation 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(a)(2) of this title— (1) if the Secretary determines that the presumption, or modification, is warranted, the Secretary shall issue proposed regulations setting forth the presumption or revise regulations to carry out such modification; or (2) if the Secretary determines that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register a notice of the determination, including the reasons supporting the determination. (b) Final regulation Not later than 180 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 Secretary 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 provided 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 entitled to receive dependency and indemnity compensation on such basis. . (2) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1165 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. . (b) Conforming amendments Chapter 11 is amended— (1) in section 1116— (A) by striking subsections (b), (c), (d), and (e); (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter VII of this chapter, including with respect to assessing reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991 ( Public Law 102–4 ). ; and (C) by redesignating subsection (f) as subsection (c); (2) in section 1116B(b)(2)(A), by inserting pursuant to subchapter VII of this chapter, before the Secretary determines ; and (3) in section 1118— (A) by striking subsections (b) through (e); and (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter. . 203. Reevaluation of claims for compensation involving presumptions of service connection (a) In general Subchapter VI of chapter 11 is amended by adding at the end the following new section: 1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection (a) Reevaluation Except as provided in subsection (b), whenever a law, including through a regulation or Federal court decision, establishes or modifies a presumption of service connection, the Secretary shall— (1) identify all claims for compensation under this chapter that— (A) were submitted to the Secretary; (B) were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and (C) might have been evaluated differently had the establishment or modification been applicable to the claim; (2) allow for the reevaluation of such claims at the election of the veteran; and (3) with respect to claims approved pursuant to such reevaluation, provide compensation under this chapter effective as if the establishment or modification of the presumption of service connection had been in effect on the date of the submission of the original claim described in paragraph (1). (b) Outreach With respect to each claim identified under subsection (a), the Secretary shall conduct outreach to inform relevant veterans that they may elect to have a claim be reevaluated in light of the establishment or modification of a presumption of service connection described in such subsection. Such outreach shall include the following: (1) The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to have a claim so reevaluated. (2) The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such veterans to elect to have a claim so reevaluated. (c) Relation to other laws The Secretary shall carry out subsection (a) to the degree that doing so does not conflict with any other provision of law. . (b) Clerical amendment The table of sections at the beginning of chapter 11 of such title is amended by inserting after the item relating to section 1165 the following new item: 1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection. . (c) Application Section 1167 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act. III Improving the establishment of service connection process for toxic exposed veterans 301. Short title This title may be cited as the Veterans Burn Pits Exposure Recognition Act . 302. Presumptions of toxic exposure (a) In general Subchapter II of chapter 11 is amended by adding at the end the following new section: 1119. Presumptions of toxic exposure (a) Consideration of Individual Longitudinal Exposure Record required If a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and a toxic exposure that occurred during active military, naval, or air service, the Secretary shall, in adjudicating such claim, consider— (1) the Individual Longitudinal Exposure Record of the veteran; and (2) if the Individual Longitudinal Exposure Record of the veteran does not indicate that the veteran was subject to a toxic exposure during active military, naval, or air service, the totality of the circumstances of the service of the veteran. (b) Presumption of specific toxic exposure for members who served in certain locations (1) The Secretary shall, for purposes of section 1110 and chapter 17 of this title, presume that any covered veteran was exposed to the substances, chemicals, and hazards listed in paragraph (2) during the service of the covered veteran specified in subsection (c)(1), unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. (2) (A) Subject to subparagraph (B), the substances, chemicals, and airborne hazards listed in this paragraph are as follows: (i) Particulate matter, including the following: (I) PM-10. (II) PM-2.5. (ii) Polycyclic aromatic hydrocarbons (PAHs), including the following: (I) Acenaphthene. (II) Acenaphthylene. (III) Anthracene. (IV) Benzo(a)anthracene. (V) Benzo(a)pyrene. (VI) Benzo(b)fluoranthene. (VII) Benzo(g,h,i)perylene. (VIII) Benzo(k)fluoranthene. (IX) Chrysene. (X) Dibenz(a,h)anthracene. (XI) Fluoranthene. (XII) Fluorene. (XIII) Indeno(1,2,3-cd)pyrene. (XIV) Naphthalene. (XV) Phenanthrene. (XVI) Pyrene. (iii) Volatile organic compounds (VOCs), including the following: (I) Acetone. (II) Acrolein. (III) Benzene. (IV) Carbon Disulfide. (V) Chlorodifluoromethane. (VI) Chloromethane. (VII) Ethylbenzene. (VIII) Hexachlorobutadiene. (IX) Hexane. (X) m/p-Xylene. (XI) Methylene Chloride. (XII) Pentane. (XIII) Propylene. (XIV) Styrene. (XV) Toluene. (iv) Toxic organic halogenated dioxins and furans (dioxins), including the following: (I) 1,2,3,4,6,7,8 HPCDD. (II) 1,2,3,4,6,7,8 HPCDF. (III) 1,2,3,4,7,8,9 HPCDF. (IV) 1,2,3,4,7,8 HXCDD. (V) 1,2,3,6,7,8 HXCDD. (VI) 1,2,3,7,8,9 HXCDD. (VII) 1,2,3,4,7,8 HXCDF. (VIII) 1,2,3,6,7,8 HXCDF. (IX) 1,2,3,7,8,9 HXCDF. (X) 1,2,3,7,8 PECDD. (XI) 1,2,3,7,8 PECDF. (XII) 2,3,4,6,7,8 HXCDF. (XIII) 2,3,4,7,8 PECDF. (XIV) 2,3,7,8 TCDD. (XV) 2,3,7,8 TCDF. (XVI) Octachlorodibenzodioxin. (XVII) Octachlorodibenzofuran. (v) Such other substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate. (B) (i) The Secretary may add to or remove from the list under subparagraph (A) as the Secretary, in collaboration with the Secretary of Defense, determines appropriate. (ii) Beginning not later than two years after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, and not less frequently than once every two years thereafter, the Secretary shall submit to Congress a report identifying any additions or removals made pursuant to subparagraph (A) during the period covered by the report. (c) Definitions In this section: (1) The term covered veteran means any veteran who— (A) on or after August 2, 1990, performed active military, naval, or air service while assigned to a duty station in— (i) Bahrain; (ii) Iraq; (iii) Kuwait; (iv) Oman; (v) Qatar; (vi) Saudi Arabia; (vii) Somalia; or (viii) United Arab Emirates; or (B) on or after September 11, 2001, performed active military, naval, or air service while assigned to a duty station in— (i) Afghanistan; (ii) Djibouti; (iii) Egypt; (iv) Jordan; (v) Lebanon; (vi) Syria; (vii) Yemen; (viii) Uzbekistan; (ix) the Philippines; or (x) any other country determined relevant by the Secretary. (2) The term Individual Longitudinal Exposure Record includes any pilot program or other program used by the Department of Veterans Affairs or the Department of Defense to track how members of the Armed Forces or veterans have been exposed to various occupational or environmental hazards. (3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . (b) Clerical amendment The table of sections at the beginning of chapter 11 is amended by inserting after the item relating to section 1118 the following new item: 1119. Presumptions of toxic exposure. . 303. Medical nexus examinations for toxic exposure risk activities (a) In general Subchapter VI of chapter 11, as amended by section 203 of this Act, is further amended by adding at the end the following new section: 1168. Medical nexus examinations for toxic exposure risk activities (a) Medical examinations and medical opinions (1) Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, or air service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall— (A) provide the veteran with a medical examination under section 5103A(d) of this title; and (B) request a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. (2) When providing the Secretary with a medical opinion requested under paragraph (1), the health care provider shall consider the total potential exposure through all applicable military deployments, and the synergistic, combined effect of all applicable toxic exposure risk activities. (b) Exception Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. (c) Toxic exposure risk activity defined In this section, the term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . (b) Clerical amendment The table of sections at the beginning of chapter 11 of such title, as amended by title II of this Act, is further amended by inserting after the item relating to section 1167, as added by such title, the following new item: 1168. Medical nexus examinations for toxic exposure risk activities. . IV Presumptions of service connection 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 Veterans Affairs (a) Short title This section may be cited as the Mark Takai Atomic Veterans Healthcare Parity Act . (b) Enewetak Atoll Section 1112(c)(3)(B) is amended by adding at the end the following new clause: (v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980. . 402. Treatment of veterans who participated in nuclear response near Palomares, Spain, as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by Department of Veterans Affairs (a) Short title This section may be cited as the Palomares Veterans Act . (b) Palomares Section 1112(c)(3)(B), as amended by section 401, is further amended by adding at the end the following new clause: (vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967. . 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations (a) Short title This section may be cited as the Veterans Agent Orange Exposure Equity Act . (b) In general Section 1116, as amended by section 202, is further amended— (1) by striking , during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; (2) by striking performed active military, naval, or air service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; and (3) by adding at the end the following new subsection: (d) In this section, the term covered service means active military, naval, or air service— (1) performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; (2) performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; (3) performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; (4) performed in Cambodia at Mimot or Krek, Kampong Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or (5) performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977. . (c) Eligibility for hospital care and medical services Section 1710(e)(4), as amended by section 103, is further amended by striking subparagraph (A) and inserting the following new subparagraph: (A) The term Vietnam-era herbicide-exposed veteran means a veteran who— (i) performed covered service, as defined in section 1116(d) of this title; or (ii) the Secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period. . (d) Clerical amendments (1) Section heading The heading for section 1116 is amended by striking the Republic of Vietnam and inserting certain locations . (2) Table of sections The table of sections at the beginning of chapter 11 is amended by striking the item relating to section 1116 and inserting the following new item: 1116. Presumptions of service connection for diseases associated with exposure to certain herbicide agents; presumption of exposure for veterans who served in certain locations. . 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations (a) Short title This section may be cited as the Fair Care for Vietnam Veterans Act . (b) Additional diseases Section 1116(a)(2), as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 ( Public Law 116–283 ), is further amended by adding at the end the following new subparagraphs: (L) Hypertension. (M) Monoclonal gammopathy of undetermined significance. . 405. Improving compensation for disabilities occurring in Persian Gulf War veterans (a) Reduction in threshold of eligibility Subsection (a)(1) of section 1117 is amended by striking became manifest— and all that follows through the period at the end and inserting became manifest to any degree at any time. . (b) Permanent extension of period of eligibility Such section is further amended— (1) by striking subsection (b); (2) by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and (3) in subsection (a)(2)(C), by striking under subsection (d) and inserting under subsection (c) . (c) Establishing singular disability-Based questionnaire Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new subsection (d): (d) If a Persian Gulf veteran at a medical facility of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care personnel of the Department use a disability benefits questionnaire, or successor questionnaire, to identify Gulf War Illness. . (d) Expansion of definition of Persian Gulf veteran Subsection (f) of such section is amended by inserting , Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, after operations . (e) Training Such section is further amended by adding at the end the following new subsection: (i) (1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department are appropriately trained to effectively carry out this section. (2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1). . 406. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Short title This section may be cited as the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act . (b) In general Subchapter II of chapter 11, as amended by section 303(a), is further amended by inserting after section 1119 the following new section: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Presumption of service connection For the purposes of section 1110 of this title, and subject to section 1113 of this title, a disease specified in subsection (b) becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, or air service, notwithstanding that there is no record of evidence of such disease during the period of such service. (b) Diseases specified The diseases specified in this subsection are the following: (1) Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). (2) The following types of cancer: (A) Head cancer of any type. (B) Neck cancer of any type. (C) Respiratory cancer of any type. (D) Gastrointestinal cancer of any type. (E) Reproductive cancer of any type. (F) Lymphoma cancer of any type. (G) Lymphomatic cancer of any type. (H) Kidney cancer. (I) Brain cancer. (J) Melanoma. (K) Pancreatic cancer. (3) Chronic bronchitis. (4) Chronic obstructive pulmonary disease. (5) Constrictive bronchiolitis or obliterative bronchiolitis. (6) Emphysema. (7) Granulomatous disease. (8) Interstitial lung disease. (9) Pleuritis. (10) Pulmonary fibrosis. (11) Sarcoidosis. (12) Chronic sinusitis. (13) Chronic rhinitis. (14) Glioblastoma. (15) Any other disease for which the Secretary determines, pursuant to regulations prescribed under subchapter VII that a presumption of service connection is warranted based on a positive association with a substance, chemical, or airborne hazard specified in section 1119(b)(2) of this title. (c) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of this title. . (c) Clerical amendment The table of sections at the beginning of chapter 11, as amended by section 302(b), is further amended by inserting after the item relating to section 1119 the following new item: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins. . (d) Conforming amendment Section 1113 is amended by striking or 1118 each place it appears and inserting 1118, or 1120 . V Research matters 501. Coordination by Department of Veterans Affairs of toxic exposure research (a) In general Subchapter II of chapter 73 is amended by adding at the end the following new section: 7330D. Coordination of toxic exposure research (a) In general The Secretary shall coordinate all research activities carried out or funded by the executive branch of the Federal Government on the health consequences of toxic exposures experienced during service in the Armed Forces. (b) Strategic plan In carrying out subsection (a), the Secretary shall establish a strategic plan, to be known as the Toxic Exposure Research Strategic Plan, to ensure that the research activities specified in such subsection are collaborative, transparent, and highly coordinated. (c) Report Not later than one year after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate a report on any research activities specified in subsection (a) carried out during the year covered by the report. . (b) Clerical amendment The table of sections at the beginning of such subchapter is amended by inserting after the item relating to section 7330C the following new item: 7330D. Coordination of toxic exposure research. . 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure (a) In general The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that— (1) is obtained by the Secretary in connection with hospital care, medical services, or nursing home care furnished to a veteran for an illness under section 1710(a)(2)(F) of title 38, United States Code, as amended by section 102; and (2) is likely to be scientifically useful, as determined by the Secretary, in determining whether a positive association exists between the illness of the veteran and a toxic exposure. (b) Consent of patients The Secretary shall ensure that the compilation and analysis of the clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, in a manner that is consistent with the informed consent of the veteran and in compliance with all applicable Federal law. (c) Annual report Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate a report containing— (1) any data compiled under subsection (a); (2) an analysis of any such data; (3) a description of the types and incidences of illnesses identified by the Secretary pursuant to such subsection; (4) an explanation by the Secretary for the incidence of such illnesses and such alternate explanations for the incidence of such illnesses as the Secretary may consider reasonable; and (5) a description of the views of the Secretary regarding the scientific validity of drawing conclusions from the incidence of such illnesses, as evidenced by the data compiled under subsection (a), regarding the existence of a positive association between such illness and a toxic exposure. (d) Definitions In this section: (1) The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. 503. Studies related to veterans who served in Southwest Asia and certain other locations (a) Analysis on mortality in covered veterans (1) Analysis Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct an updated analysis of total and respiratory disease mortality in covered veterans. (2) Elements The analysis under paragraph (1) shall include, to the extent practicable, the following: (A) Metrics of airborne exposures. (B) The location and timing of any deployments of the veteran. (C) The military occupational specialty of the veteran. (D) The Armed Force in which the veteran served. (E) The preexisting health status of the veteran, including with respect to asthma. (F) Such personal information of the veteran as the Secretary may consider relevant, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity. (b) Epidemiological study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct an epidemiological study of covered veterans that involves— (1) the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment; and (2) the collection of detailed information on the covered veterans studied through medical records, administrative data, and other existing sources, including, with respect to the covered veterans— (A) personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity; (B) deployment history, including locations, periods, and number of deployments; (C) biospecimen data; and (D) supplementary health status and outcomes data, including imaging and physiological parameters. (c) Toxicology study (1) Study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a toxicology study, to include variability, to replicate toxic exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions. (2) Elements The study under paragraph (1) shall include— (A) an analysis of results for mechanistic markers and clinically relevant outcomes; and (B) a validation of any serum, tissue, or other biomarkers of toxic exposure, susceptibility, or effect with respect to the subjects of the study. (d) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of title 38, United States Code, as added by section 302. 504. Study on health trends of post 9/11 veterans (a) Study The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001. (b) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 505. Study on cancer rates among veterans (a) Study The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans to determine trends in the rates of the incidence of cancer in veterans. (b) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The age of the veteran. (2) The period of service and length of service of the veteran in the Armed Forces. (3) Any military occupational speciality of the veteran. (4) The gender of the veteran. (5) Any type of cancer that the veteran has. (c) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities (a) Study The Secretary of Veterans Affairs shall conduct a study on the feasibility and advisability of furnishing hospital care and medical services to qualifying dependents of veterans described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 103(a)(1), for any illness determined by the Secretary to be connected to a toxic exposure risk activity carried out by the veteran, as determined by the Secretary, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such activity. (b) Elements The study under subsection (a) shall include— (1) an assessment of the impact of furnishing hospital care and medical services to qualifying dependents as described in such subsection on the ability of the Department of Veterans Affairs to furnish hospital care and medical services to veterans; (2) an assessment of the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection; (3) an estimate of the resources required to furnish such care and services; (4) an assessment of any stress or other effect furnishing such care and services would have on the claims and appeals system of the Department; (5) an estimate of the number of qualifying dependents who would be eligible for such care and services; and (6) an assessment of the feasibility of adjudicating claims for such care and services. (c) Phased-In application In conducting the study under subsection (a), the Secretary shall assess the feasibility and advisability of phasing in the furnishing of hospital care and medical services to qualifying dependents described in such subsection by the decade in which such toxic exposure risk activity occurred, starting with the most recent decade. (d) Review of toxic exposure cases regarding liability of Department of Defense In conducting the study under subsection (a), the Secretary shall— (1) review known cases of toxic exposure on military installations of the Department of Defense located in the United States; (2) analyze the liability of the Department of Defense in each such case; and (3) assess whether the Secretary of Defense should provide care and services relating to such toxic exposures under the TRICARE program. (e) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a). (f) Definitions In this section: (1) The terms hospital care and medical services have the meanings given those terms in section 1701 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. (3) The term qualifying dependent means— (A) a dependent of a veteran described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 103(a)(1), who resided with the veteran during the period in which, and on the installation at which, the veteran participated in a toxic exposure risk activity; (B) an individual who was in utero of such a veteran or other qualifying dependent when the veteran participated in a toxic exposure risk activity; or (C) a dependent of such a veteran who is not described in subparagraph (A) or (B) but who may have an illness that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary. (4) The term toxic exposure has the meaning given that term in section 101 of such title, as added by section 102(b). (5) The term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of such title, as added by section 103(a)(3). (6) The term TRICARE program has the meaning given that term in section 1072 of such title. VI Improvement of resources and training regarding toxic exposed veterans 601. Short title; definitions (a) Short title This title may be cited as the Toxic Exposure in the American Military Act or the TEAM Act . (b) Definitions In this title, the terms active military, naval, or air service , toxic exposure , and toxic exposed veteran have the meanings given those terms in section 101 of title 38, United States Code. 602. Publication of list of resources of Department of Veterans Affairs for toxic exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans (a) Publication of list of resources (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for— (A) toxic exposed veterans, including with respect to— (i) disability compensation under chapter 11 of title 38, United States Code; and (ii) hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title; (B) caregivers of toxic exposed veterans who are participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title; and (C) survivors of toxic exposed veterans who are receiving death benefits under the laws administered by the Secretary. (2) Update The Secretary shall periodically update the list published under paragraph (1). (b) Outreach The Secretary shall develop, with input from the community, an informative outreach program for veterans on illnesses that may be related to toxic exposure, including outreach with respect to benefits and support programs. 603. Incorporation of toxic exposure questionnaire during primary care appointments (a) In general The Secretary of Veterans Affairs shall incorporate a clinical questionnaire to help determine potential toxic exposures during active military, naval, or air service as part of the initial screening conducted for an appointment of a veteran with a primary care provider of the Department of Veterans Affairs to improve understanding by the Department of toxic exposures of veterans while serving in the Armed Forces. (b) Determination of questions The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic exposed veterans (a) Health care personnel The Secretary of Veterans Affairs shall provide to health care personnel of the Department of Veterans Affairs education and training to identify, treat, and assess the impact on toxic exposed veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures. (b) Benefits personnel (1) Standard claims processor training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a standard training curriculum for processors of claims under the laws administered by the Secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposure, including employees who adjudicate such claims. (B) Matters included The Secretary shall ensure that the training under subparagraph (A) includes the following explanations with respect to claims relating to toxic exposure: (i) A lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist. (ii) The claims adjudicator shall always consider whether direct service connection is applicable and request, as needed, an advisory medical opinion pursuant to section 1168 of title 38, United States Code, as added by section 303. (iii) The claims adjudicator shall always review and consider the Individual Longitudinal Exposure Record program of the Department of Veterans Affairs pursuant to section 1119 of such title, as added by section 302, but a lack of such information is not by itself sufficient to determine that such exposure did not occur or sufficient to deny the claim. (C) Provision of training The Secretary shall— (i) provide training under subparagraph (A) to each employee described in such subparagraph not less frequently than annually; and (ii) using the Systematic Technical Accuracy Review program, or such successor program, conduct a nationwide, quarterly, randomized review of the quality of adjudication of claims relating to toxic exposure. (2) Standard medical examiner training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a standard medical training curriculum for medical providers who conduct examinations and provide opinions pursuant to section 1168 of title 38, United States Code, as added by section 303, regardless of whether the provider is an employee of the Department or a contractor. (B) Standardized approach The Secretary shall ensure that the curriculum established under subparagraph (A)— (i) provides a standardized approach to conducting and providing examinations and opinions in accordance with such section 1168; and (ii) instructs medical providers to consider, when conducting an examination or providing an opinion— (I) relevant medical and scientific literature; (II) the proximity, intensity, and frequency of exposure of the individual to the identified toxic exposure; (III) medically unexplained chronic multisymptom illnesses; and (IV) all competent and credible evidence of record. VII Registries, records, and other matters 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations (a) Establishment of registry (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances (in this section referred to as PFAS ) due to the environmental release of aqueous film-forming foam (in this section referred to as AFFF ) on military installations to meet the requirements of military specification MIL–F–24385F; (B) include any information in such registry that the Secretary determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to PFAS associated with AFFF; (C) develop a public information campaign to inform eligible individuals about the registry, including how to register and the benefits of registering; and (D) periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to PFAS. (2) Coordination The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense in carrying out paragraph (1). (b) Reports (1) Initial report Not later than two years after the date on which the registry under subsection (a) is established, the Secretary of Veterans Affairs shall submit to Congress an initial report containing the following: (A) An assessment of the effectiveness of actions taken by the Secretary of Veterans Affairs and the Secretary of Defense to collect and maintain information on the health effects of exposure to PFAS. (B) Recommendations to improve the collection and maintenance of such information. (C) Using established and previously published epidemiological studies, recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to exposure to PFAS. (2) Followup report Not later than five years after submitting the initial report under paragraph (1), the Secretary of Veterans Affairs shall submit to Congress a followup report containing the following: (A) An update to the initial report submitted under paragraph (1). (B) An assessment of whether and to what degree the content of the registry established under subsection (a) is current and scientifically up to date. (3) Independent scientific organization The Secretary of Veterans Affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs (1) and (2). (c) Recommendations for additional exposures To be included Not later than five years after the date of the enactment of this Act, and every five years thereafter, the Secretary of Veterans Affairs, in consultation with the Secretary of Defense and the Administrator of the Environmental Protection Agency, shall submit to Congress recommendations for additional chemicals with respect to which individuals exposed to such chemicals should be included in the registry established under subsection (a). (d) Eligible individual defined In this section, the term eligible individual means any individual who, on or after a date specified by the Secretary of Veterans Affairs through regulations, served or is serving in the Armed Forces at a military installation where AFFF was used or at another location of the Department of Defense where AFFF was used. 702. Fort McClellan Health Registry (a) Establishment The Secretary of Veterans Affairs shall establish and maintain a special record to be known as the Fort McClellan Health Registry (in this section referred to as the Registry ). (b) Contents Except as provided in subsection (c), the Registry shall include the following information: (1) A list containing the name of each individual who, while serving as a member of the Armed Forces, was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, and who— (A) applies for care or services from the Department of Veterans Affairs under chapter 17 of title 38, United States Code; (B) files a claim for compensation under chapter 11 of such title on the basis of any disability which may be associated with such service; (C) dies and is survived by a spouse, child, or parent who files a claim for dependency and indemnity compensation under chapter 13 of such title on the basis of such service; (D) requests from the Secretary a health examination under subsection (d); or (E) receives from the Secretary a health examination similar to the health examination referred to in subparagraph (D) and requests inclusion in the Registry. (2) Relevant medical data relating to the health status of, and other information that the Secretary considers relevant and appropriate with respect to, each individual described in paragraph (1) who— (A) grants to the Secretary permission to include such information in the Registry; or (B) at the time the individual is listed in the Registry, is deceased. (c) Individuals submitting claims or making requests before date of enactment If in the case of an individual described in subsection (b)(1) the application, claim, or request referred to in such subsection was submitted, filed, or made before the date of the enactment of this Act, the Secretary shall, to the extent feasible, include in the Registry such individual's name and the data and information, if any, described in subsection (b)(2) relating to the individual. (d) Examinations Upon the request of a veteran who was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, the Secretary shall provide the veteran with a health examination (including any appropriate diagnostic tests) and consultation and counseling with respect to the results of the examination and the tests. (e) Outreach (1) Ongoing outreach to individuals listed in Registry The Secretary shall, from time to time, notify individuals listed in the Registry of significant developments in research on the health consequences of potential exposure to a toxic substance or environmental hazard related to service at Fort McClellan. (2) Examination outreach The Secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations (including any diagnostic tests) and consultation and counseling services under subsection (d). (f) Consultation The Secretary of Veterans Affairs shall consult with the Secretary of Defense to acquire information maintained by the Secretary of Defense that the Secretary of Veterans Affairs considers necessary to establish and maintain the Registry. 703. Independent study on Individual Longitudinal Exposure Record (a) In general Not later than 60 days after the date of the enactment of this Act, the Secretary of Defense shall enter into a contract with an independent research entity described in subsection (b) to carry out a comprehensive study of the development of the Individual Longitudinal Exposure Record to determine— (1) the quality of the location data, occupational and environmental exposure data, and health surveillance data; and (2) whether a member of the Armed Forces can be reasonably assured that any toxic exposure they experience during service in the Armed Forces will be accurately reflected in the Individual Longitudinal Exposure Record of the member. (b) Independent research entity The entity described in this subsection is an independent research entity that is a not-for-profit entity or a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b). 704. Biannual report on Individual Longitudinal Exposure Record (a) In general Not later than one year after the date on which the Individual Longitudinal Exposure Record achieves full operation capability, as determined by the Secretary of Defense, and every 180 days thereafter, the Secretary shall, in consultation with the Secretary of Veterans Affairs, submit to the appropriate committees of Congress a report on the data quality of the databases of the Department of Defense that provide the information presented in the Individual Longitudinal Exposure Record and the usefulness of the Individual Longitudinal Exposure Record in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. (b) Elements Each report required by subsection (a) shall include, for the period covered by the report, the following: (1) An identification of toxic exposure events that may not be fully captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. (2) An analysis of the quality of the location data used by the Department of Defense in determining toxic exposures of members of the Armed Forces and veterans, and recommendations for how to improve the quality of that location data if necessary. (c) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. (2) Toxic exposure The term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b). 705. Correction of exposure records by members of the Armed Forces and veterans (a) In general The Secretary of Defense and the Secretary of Veterans Affairs shall provide a means for members of the Armed Forces and veterans to update their records as necessary to reflect a toxic exposure by such member or veteran in the Individual Longitudinal Exposure Record. (b) Evidence (1) Provision of evidence To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, shall provide such evidence as the Secretary of Defense and the Secretary of Veterans Affairs jointly consider necessary. (2) Benefit of the doubt In reviewing evidence provided under paragraph (1), the Secretary of Defense and the Secretary of Veterans Affairs shall give the benefit of the doubt to the member of the Armed Forces or veteran who provided the evidence, as the case may be, in a manner that is equivalent to the benefit of the doubt required under section 5107(b) of title 38, United States Code. (3) Regulations The Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall prescribe by regulation the evidence considered necessary under paragraph (1). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b).

February 22, 2022 Reported from the Committee on Veterans' Affairs February 22, 2022 Committee on Armed Services discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed

tv_txt: I 117th CONGRESS 2d Session H. R. 3967 IN THE HOUSE OF REPRESENTATIVES AN ACT To improve health care and benefits for veterans exposed to toxic substances, and for other purposes.

1. Short title; references to title 38, United States Code; table of contents (a) Short title This Act may be cited as the Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021 . (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 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 heading 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. Sec. 105. Revision of breast cancer mammography policy of Department of Veterans Affairs to provide mammography screening for veterans who served in locations associated with toxic exposure. 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. Sec. 112. Authorization period for emergency treatment in non-Department of Veterans Affairs medical facilities. 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. Sec. 203. Reevaluation of claims for compensation involving 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 Veterans 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 certain disabilities by Department of Veterans Affairs. Sec. 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations. Sec. 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection 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. Title V—Research matters Sec. 501. Interagency working group on toxic exposure research. Sec. 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure. Sec. 503. Studies related to veterans who served in Southwest Asia and certain other locations. Sec. 504. Study on health trends of post 9/11 veterans. Sec. 505. Study on cancer rates among veterans. Sec. 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities. Sec. 507. Study on health effects of waste related to Manhattan Project on certain veterans. Sec. 508. Study on toxic exposure and mental health outcomes. Sec. 509. Study on veterans in Territories of the United States. Sec. 510. Department of Veterans Affairs public website for toxic exposure research. Sec. 511. Biennial 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. Sec. 602. Publication of list of resources of Department of Veterans Affairs for toxic-exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans. Sec. 603. Incorporation of toxic exposure questionnaire during primary care appointments. Sec. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic-exposed veterans. Sec. 605. Guidelines for active duty military on potential risks and prevention of toxic exposures. Title VII—Registries, records, and other matters Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations. Sec. 702. Fort McClellan Health Registry. Sec. 703. Independent study on Individual Longitudinal Exposure Record. Sec. 704. Biannual report on Individual Longitudinal Exposure Record. Sec. 705. Correction of exposure records by members of the Armed Forces and veterans. Sec. 706. Federal cause of action relating to water at Camp Lejeune, North Carolina. Sec. 707. Veterans Toxic Exposures Fund. Sec. 708. Authorization of electronic notice in claims under laws administered by the Secretary of Veterans Affairs. Sec. 709. Authorization of appropriations for expansion of claims automation. Sec. 710. Non-applicability of non-Department of Veterans Affairs covenants not to compete to appointment of Veterans Health Administration personnel. Sec. 711. Recruitment of physicians on a contingent basis prior to completion of training requirements. Sec. 712. Authority for Secretary of Veterans Affairs to award grants to States to improve outreach to veterans. Sec. 713. Study and report on herbicide agent exposure in Panama Canal Zone. Sec. 714. Budget information for alternatives to burn pits. Sec. 715. Authorization of appropriations for expansion of claims automation. Sec. 716. Burn pit registry updates. Sec. 717. Burn pit transparency. I Expansion of health care eligibility A Toxic-exposed veterans 101. Short title This title may be cited as the Conceding Our Veterans’ Exposures Now And Necessitating Training Act or the COVENANT Act . 102. Definitions relating to toxic-exposed veterans (a) In general Section 1710(a)(2)(F) is amended by striking who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e) and inserting in accordance with subsection (e), who is a toxic-exposed veteran . (b) Definitions of toxic exposure and toxic-exposed 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. (B) An exposure to a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title. (38) The term toxic-exposed veteran means a veteran described in section 1710(e)(1) of this title. . (c) Definition of toxic exposure risk activity Section 1710(e)(4) is amended by adding at the end the following new subparagraph: (C) The term toxic exposure risk activity means any activity— (i) that requires a corresponding entry in an exposure tracking record system (as defined in section 1119(c) of this title) for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans. . 103. Expansion of health care for specific categories of toxic-exposed veterans and veterans supporting certain overseas contingency operations (a) In general (1) Expansion Subsection (e) of section 1710, as amended by section 102(c) , is further amended— (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 (including 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 operation specified in clause (ii) 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. (ii) A contingency operation specified in this clause is any of the following: (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 subparagraphs (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 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) The Secretary may modify a date specified in subparagraph (A) to an earlier date, as the Secretary determines appropriate based on the number of veterans receiving hospital care, medical services, and nursing home care under subparagraphs (G), (H), and (I) of paragraph (1) and the resources available to the Secretary. If the Secretary determines to so modify a date, the Secretary shall— (i) notify the Committees on Veterans’ Affairs of the House of Representatives and the Senate of the proposed modification; 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 prior to the date specified in the clause (including a date modified pursuant to such section), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a plan to conduct outreach to the veterans referred to 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. 104. Assessments of implementation and operation (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 (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 services 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 Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing the findings of the assessment completed under paragraph (1), including a specific determination as to whether the Department has the personnel and material 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 Committees on Veterans’ Affairs of the House of Representatives and the Senate a report 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 described 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 distance of the veteran from medical facilities of the Department and whether the veteran had previously 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. (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 subparagraph (A), the number of such veterans who, during the preceding three fiscal years, had not received 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 Program. (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 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, enrolled in the patient enrollment system. (ii) The number of such veterans who applied for, but were denied, such enrollment. (iii) The number of such veterans who were denied hospital care or a medical service furnished by the Secretary that was considered 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 Department). (F) The numbers and characteristics of, and the type and extent of health care furnished by the Secretary to, veterans not enrolled in the patient enrollment system (disaggregated by each class of eligibility for care under section 1710 of title 38, United States Code, and further shown 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 Secretary 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) The term patient enrollment system means the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38, United States Code. (2) The term Veterans Community Care Program means the program established under section 1703 of title 38, United States Code. 105. Revision of breast cancer mammography policy of Department of Veterans Affairs to provide mammography screening for veterans who served in locations associated with toxic exposure (a) In general Section 7322 of title 38, United States Code, is amended— (1) in subsection (a), by striking The and inserting In general .—The ; (2) in subsection (b)— (A) by striking The and inserting Standards for screening .—The ; and (B) in paragraph (2)(B), by inserting a record of service in a location and during a period specified in subsection (d), after risk factors, ; and (3) by adding at the end the following new subsections: (c) Eligibility for screening for veterans exposed to toxic substances The Under Secretary for Health shall ensure that, under the policy developed under subsection (a), any veteran who, during active military, naval, or air service, was deployed in support of a contingency operation in a location and during a period specified in subsection (d), is eligible for a mammography screening by a health care provider of the Department. (d) Locations and periods specified (1) The locations and periods specified in this subsection are the following: (A) Iraq during following periods: (i) The period beginning on August 2, 1990, and ending on February 28, 1991. (ii) The period beginning on March 19, 2003, and ending on such date as the Secretary determines burn pits are no longer used in Iraq. (B) The Southwest Asia theater of operations, other than Iraq, during the period beginning on August 2, 1990, and ending on such date as the Secretary determines burn pits are no longer used in such location, including the following locations: (i) Kuwait. (ii) Saudi Arabia. (iii) Oman. (iv) Qatar. (C) Afghanistan during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Afghanistan. (D) Djibouti during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Djibouti. (E) Syria during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Syria. (F) Jordan during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Jordan. (G) Egypt during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Egypt. (H) Lebanon during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Lebanon. (I) Yemen during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Yemen. (J) Such other locations and corresponding periods as set forth by the Airborne Hazards and Open Burn Pit Registry 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). (K) Such other locations and corresponding periods as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate in a report submitted under paragraph (2). (2) Not later than two years after the date of the enactment of the Supporting Expanded Review for Veterans In Combat Environments Act of 2021 , and not less frequently than once every two years thereafter, the Secretary of Veterans Affairs, in collaboration with the Secretary of Defense, shall submit to Congress a report specifying other locations and corresponding periods for purposes of paragraph (1)(K). (3) A location under this subsection shall not include any body of water around or any airspace above such location. (4) In this subsection, the term burn pit means an area of land that is used for disposal of solid waste by burning in the outdoor air. . (b) Report on breast cancer rates for veterans deployed to certain areas Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report that compares the rates of breast cancer among members of the Armed Forces deployed to the locations and during the periods specified in section 7322(d) of title 38, United States Code, as added by subsection (a), as compared to members of the Armed Forces who were not deployed to those locations during those periods and to the civilian population. B Certain veterans of combat service and other matters 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 inserting September 11, 2001 ; and (B) by striking five-year period and inserting 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, medical services, or nursing home care under such paragraph pursuant to subparagraph (A) before October 1, 2022, the one-year period beginning on October 1, 2022. ; and (3) by striking subparagraph (C). (b) Clarification of coverage Section 1710(e)(1)(D) is amended by inserting after Persian Gulf War the following: (including any veteran who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary 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 shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a plan to conduct outreach to veterans described in subparagraph (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 services, or nursing home care pursuant to such subparagraph. (d) Report on enrollments Not later than January 30, 2024, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report identifying, with respect to the one-year period beginning on October 1, 2022, the number of veterans described in section 1710(e)(3)(B) of title 38, United States Code, as amended by subsection (a)(2), who, during such period, enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of such title. (e) Effective date This section and the amendments made by this section shall take effect on October 1, 2022. 112. Authorization period for emergency treatment in non-Department of Veterans Affairs medical facilities Section 1703(a)(3) of title 38, United States Code, is amended— (1) by striking A covered veteran and inserting (A) Except as provided by subparagraph (B), a covered veteran ; and (2) by adding at the end the following new subparagraph: (B) In the case of an emergency which existed at the time of admission of a covered veteran to a health care provider, the Secretary shall deem the care or services received by the veteran during such admission to be authorized under subparagraph (A) if the covered veteran (or an individual acting on behalf of the covered veteran) makes an application for such authorization during the period following such admission that the Secretary determines appropriate for purposes of this paragraph, except such period may not be less than 96 hours. . II Toxic exposure presumption process 201. Short title This subtitle may be cited as the Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act or the FASTER Presumptions Act . 202. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure (a) Advisory committees, panels, and boards Chapter 11 is amended by adding at the end the following new subchapter: VII Determinations relating to presumptions of service connection based on toxic exposure 1171. Procedures to determine presumptions of service connection based on toxic exposure; definitions (a) Procedures The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby— (1) the Formal Advisory Committee on Toxic Exposure under section 1172 of this title— (A) provides advice to the Secretary on toxic-exposed veterans and cases in which veterans who, during active military, naval, air, or space service, may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military, naval, air, or space service; (B) provides to the Secretary recommendations on corrections needed in the Individual Longitudinal Exposure Record, or successor system, to better reflect veterans and dependents described in subparagraph (A); and (C) provides to the Secretary recommendations regarding which cases of possible toxic exposure should be reviewed; and (2) the Secretary provides for formal evaluations of such recommendations under section 1173 of this title; and (3) the Secretary issues regulations under section 1174 of this title. (b) Illness defined In this subchapter, the term illness includes a disease or other condition affecting the health of an individual, including mental and physical health. 1172. Formal Advisory Committee on Toxic Exposure (a) Establishment (1) There is in the Veterans Health Administration of the Department the Formal Advisory Committee on Toxic Exposure (in this section referred to as the Committee ). (2) (A) The Committee shall be composed of nine members appointed as follows: (i) Five members shall be appointed by the Secretary. (ii) One member shall be appointed by the Speaker of the House of Representatives. (iii) One member shall be appointed by the minority leader of the House of Representatives. (iv) One member shall be appointed by the majority leader of the Senate. (v) One member shall be appointed by the minority leader of the Senate. (B) The members appointed under subparagraph (A) shall meet the following criteria: (i) Not more than three members shall be appointed from among individuals who are officials or employees of the Veterans Benefits Administration or the Veterans Health Administration. (ii) At least one member shall be appointed from among individuals who are officials or employees 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 Prevention. (iii) At least two members shall represent an organization recognized by the Secretary for the representation of veterans under section 5902 of this title. (iv) 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. (3) The Secretary shall determine the pay and allowances of the members of the Committee, including with respect to any additional pay and allowances for members who are officials or employees of the Federal Government. (4) (A) Except as provided by subparagraph (B), each member of the Committee shall be appointed for a two-year term, and may serve not more than three successive terms. (B) With respect to the five members who are initially appointed by the Secretary under subparagraph (A)(i), the Secretary shall determine the length of the term of each such member in a manner that ensures the expiration of the terms on a staggered basis. (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 cases in which veterans who, during active military, naval, air, or space service, are suspected of having experienced a toxic exposure or dependents of veterans who may have experienced a toxic exposure during such service. (c) Assessments (1) The Committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, air, or space service, including by conducting ongoing surveillance and reviewing such exposure described in scientific literature, media reports, information from veterans, and information from Congress. (2) The assessments under paragraph (1) shall cover suspected and known toxic exposures occurring during active military, naval, air, or space service, including by identifying and evaluating new and emerging toxic exposures that are not recognized under existing presumptions of service connection. (3) The Committee may conduct an assessment under paragraph (1) in response to comments by a person described in subsection (e)(2), by a majority vote of the members of the Committee. (4) The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record, or successor system, to ensure the accuracy of data collected. (d) Research recommendations (1) Following an assessment of a case of the toxic exposure of veterans or their dependents that occurred during active military, naval, air, or space service under subsection (c), the Committee may develop a recommendation for formal evaluation under section 1173 of this title to conduct a review of the health effects related to the case of exposure if the Committee determines that the research may change the current understanding of the relationship between 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 Committee may nominate such evidence for formal evaluation under section 1173 of this title to modify the periods and locations. (e) Input (1) Not less than quarterly, the Committee 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 persons who may be affected by the actions of the Committee, including— (A) veterans, the families of veterans, veterans service organizations and representatives, researchers, and other members of the general public; and (B) departments and agencies of the Federal Government. (f) Reports by the Committee Not less frequently than once each year, the Committee shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) recommendations for research under subsection (d), if any; and (2) recommendations for such legislative or administrative action as the Committee considers necessary for the Committee to be more effective in carrying out the requirements of this section. (g) Responses by Secretary In response to each report submitted under subsection (f), the Secretary shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) the findings and opinions of the Secretary with respect to the report most recently submitted under subsection (f); and (2) whether the Secretary will conduct research recommended under subsection (f) included in the report, and if not, an explanation of why, including citations and sources. (h) Nonapplication of sunset requirements Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Committee. 1173. Formal evaluation of recommendations (a) Formal evaluation The Secretary shall establish a process to conduct a formal evaluation with respect to each recommendation made by the Formal Advisory Committee on Toxic Exposure under section 1172 of this title— (1) to conduct research regarding the health effects related to a case of toxic exposure; or (2) to evaluate evidence regarding the periods and locations of exposure covered by an existing presumption of service connection. (b) Evidence, data, and factors The Secretary shall ensure that each formal evaluation under paragraph (1) covers the following: (1) Scientific evidence, based on the review of available scientific literature, including human, toxicological, animal, and methodological studies, and other factors. (2) Claims data, based on the review of claim rate, grant rate, and service connection prevalence, and other factors. (3) Other factors the Secretary determines appropriate, such as— (A) the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated; (B) the level of assistance required to remain in the community because of such health effects; (C) the quantity and quality of the information available and reviewed; (D) the feasibility of and period for generating relevant information and evidence; (E) whether such health effects are combat- or deployment-related; and (F) the ubiquity or rarity of the health effects. (c) Conduct of evaluations (1) The Secretary shall ensure that each formal evaluation under subsection (a)— (A) reviews scientific evidence in a manner that— (i) conforms to principles of scientific and data integrity; (ii) is free from suppression or distortion of scientific or technological findings, data, information, conclusions, or technical results; and (B) (i) evaluates the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military, naval, air, or space service; and (ii) assesses the toxic exposures and illnesses and determines whether the evidence supports a finding of a positive association between the toxic exposure and the illness. (2) In carrying out paragraph (1)(B)(ii), a formal evaluation under subsection (a) shall include reviewing all relevant data to determine the strength of evidence for a positive association based on the following four categories: (A) The sufficient category, where the evidence is sufficient to conclude that a positive association exists. (B) The equipoise and above category, where the evidence is sufficient to conclude that a positive association is at least as likely as not, but not sufficient to conclude that a positive association exists. (C) The below equipoise category, where the evidence is not sufficient to conclude that a positive association is at least as likely as not, or is not sufficient to make a scientifically informed judgment. (D) The against category, where the evidence suggests the lack of a positive association. (d) Recommendation for rulemaking Not later than 120 days after the date on which a formal evaluation is commenced, the element of the Department that conducts the evaluation shall submit to the Secretary a recommendation with respect to establishing a presumption of service connection for the toxic exposure and illness, or modifying an existing presumption of service connection, covered by the evaluation. 1174. Regulations regarding presumptions of service connection based on toxic exposure (a) Action upon recommendation Not later than 160 days after the date on which the Secretary receives a recommendation to establish or modify a presumption of service connection under section 1173 of this title— (1) if the Secretary determines that the presumption, or modification, is warranted, the Secretary shall commence issuing regulations in accordance with the provisions of subchapter II of chapter 5 of title 5 (commonly referred to as the Administrative Procedures Act) setting forth the presumption or commence revising regulations to carry out such modification; or (2) if the Secretary determines that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register a notice of the determination, including the reasons supporting the determination. (b) Removal of presumption (1) The Secretary may issue regulations to remove an illness from a presumption of service connection previously established pursuant to a regulation issued under subsection (a). (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 provided 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 entitled to receive dependency and indemnity compensation on such basis. 1175. Authority to modify process; congressional oversight (a) Authority (1) The Secretary may modify the process under which the Secretary conducts formal evaluations under section 1173 of this title and issues regulations under section 1174 if— (A) such evaluations cover the evidence, data, and factors required by subsection (b) of such section 1173; and (B) a period of 180 days has elapsed following the date on which the Secretary submits the notice under paragraph (2) regarding the modification. (2) If the Secretary proposes to modify the process under which the Secretary conducts formal evaluations under section 1173 of this title or issues regulations under section 1174, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a notice of the proposed modifications containing the following: (A) A description of the proposed modifications. (B) A description of any exceptions to the requirements of such sections that are proposed because of limited available scientific evidence, and a description of how such evaluations will be conducted. (b) Reports and briefings (1) (A) Not later than two years after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the implementation of, and recommendations for, this subchapter. (B) The Secretary shall develop the report under subparagraph (A) in consultation with organizations recognized by the Secretary for the representation of veterans under section 5902 of this title and any other entity the Secretary determines appropriate. (2) On a quarterly basis during the two-year period beginning on the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, the Secretary shall provide to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a briefing on the implementation of this subchapter. (c) Independent review The Secretary shall seek to enter into an agreement with a nongovernmental entity or a federally funded research and development center to conduct a review of the implementation of this subchapter. Not later than 540 days after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing such review. . (b) Conforming amendments Chapter 11 is amended— (1) in section 1116— (A) by striking subsections (b), (c), (d), and (e); (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter VII of this chapter, including with respect to assessing reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991 ( Public Law 102–4 ). ; and (C) by redesignating subsection (f) as subsection (c); (2) in section 1116B(b)(2)(A), by inserting pursuant to subchapter VII of this chapter, before the Secretary determines ; and (3) in section 1118— (A) by striking subsections (b) through (e); and (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter. . (c) Rule of construction Nothing in section 1172(a)(2)(A) of title 38, United States Code, as added by subsection (a), shall be construed so as to require the advice and consent of the Senate in the appointment of members of the Formal Advisory Committee on Toxic Exposure. 203. Reevaluation of claims for compensation involving presumptions of service connection (a) In general Subchapter VI of chapter 11 is amended by adding at the end the following new section: 1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection (a) Reevaluation Whenever a law, including through a regulation or Federal court decision, establishes or modifies a presumption of service connection, the Secretary shall— (1) identify all claims for compensation under this chapter that— (A) were submitted to the Secretary; (B) were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and (C) might have been evaluated differently had the establishment or modification been applicable to the claim; (2) allow for the reevaluation of such claims at the election of the veteran; and (3) notwithstanding section 5110 of this title, with respect to claims approved pursuant to such reevaluation, provide compensation under this chapter effective as if the establishment or modification of the presumption of service connection had been in effect on the date of the submission of the original claim described in paragraph (1). (b) Outreach The Secretary shall conduct outreach to inform relevant veterans that they may elect to have a claim be reevaluated in light of the establishment or modification of a presumption of service connection described in subsection (a). Such outreach shall include the following: (1) The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to have a claim so reevaluated. (2) The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such veterans to elect to have a claim so reevaluated. . (b) Application Section 1167 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act. III Improving the establishment of service connection process for toxic-exposed veterans 301. Short title This title may be cited as the Veterans Burn Pits Exposure Recognition Act . 302. Presumptions of toxic exposure Subchapter II of chapter 11 is amended by adding at the end the following new section: 1119. Presumptions of toxic exposure (a) Consideration of records If a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and a toxic exposure that occurred during active military, naval, air, or space service, the Secretary may, in adjudicating such claim, consider— (1) any record of the veteran in an exposure tracking record system; and (2) if no record of the veteran in an exposure tracking record system indicates that the veteran was subject to a toxic exposure during active military, naval, air, or space service, the totality of the circumstances of the service of the veteran. (b) Presumption of specific toxic exposure for members who served in certain locations (1) The Secretary shall, for purposes of section 1110 and chapter 17 of this title, presume that any covered veteran was exposed to the substances, chemicals, and airborne hazards identified in the list under paragraph (2) during the service of the covered veteran specified in subsection (c)(1), unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. (2) The Secretary shall establish and maintain a list that contains an identification of one or more such substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate for purposes of this section. (3) Beginning not later than two years after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, and not less frequently than once every two years thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report identifying any additions or removals to the list under paragraph (2) during the period covered by the report. (c) Definitions In this section: (1) The term covered veteran means any veteran who— (A) on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in— (i) Bahrain; (ii) Iraq; (iii) Kuwait; (iv) Oman; (v) Qatar; (vi) Saudi Arabia; (vii) Somalia; or (viii) United Arab Emirates; or (B) on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in— (i) Afghanistan; (ii) Djibouti; (iii) Egypt; (iv) Jordan; (v) Lebanon; (vi) Syria; (vii) Yemen; (viii) Uzbekistan; (ix) the Philippines; or (x) any other country determined relevant by the Secretary. (2) The term exposure tracking record system — (A) means any system, program, or pilot program used by the Secretary of Veterans Affairs or the Secretary of Defense to track how veterans or members of the Armed Forces have been exposed to various occupational or environmental hazards; and (B) includes the Individual Longitudinal Exposure Record, or successor system. (3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . 303. Medical nexus examinations for toxic exposure risk activities Subchapter VI of chapter 11, as amended by section 203, is further amended by adding at the end the following new section: 1168. Medical nexus examinations for toxic exposure risk activities (a) Medical examinations and medical opinions (1) Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall— (A) provide the veteran with a medical examination under section 5103A(d) of this title; and (B) obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under subparagraph (A)) as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. (2) When providing the Secretary with a medical opinion under paragraph (1)(B) for a veteran, the health care provider shall consider— (A) the total potential exposure through all applicable military deployments of the veteran; and (B) the synergistic, combined effect of all toxic exposure risk activities of the veteran. (3) The requirement under paragraph (2)(B) shall not be construed as requiring a health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and airborne hazards identified in the list under section 1119(b)(2) of this title. (b) Exception Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. (c) Toxic exposure risk activity defined In this section, the term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of this title. . IV Presumptions of service connection 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 Veterans Affairs (a) Short title This section may be cited as the Mark Takai Atomic Veterans Healthcare Parity Act . (b) Enewetak Atoll Section 1112(c)(3)(B) is amended by adding at the end the following new clause: (v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980. . 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 certain disabilities by Department of Veterans Affairs (a) Short title This section may be cited as the Palomares or Thule Veterans Act (b) Palomares or Thule Section 1112(c)(3)(B), as amended by section 401 , is further amended by adding at the end the following new clauses: (vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967. (vii) Onsite participation in the response effort following the on-board fire and crash of a United States Air Force B–52 bomber that caused the release of four thermonuclear weapons in the vicinity of Thule Air Force Base, Greenland, during the period beginning January 21, 1968, and ending September 25, 1968. . 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations (a) Short title This section may be cited as the Veterans Agent Orange Exposure Equity Act . (b) In general Section 1116, as amended by section 202, is further amended— (1) by striking , during active military, naval, air, or space service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; (2) by striking performed active military, naval, air, or space service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; and (3) by adding at the end the following new subsection: (d) In this section, the term covered service means active military, naval, air, or space service— (1) performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; (2) performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; (3) performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; (4) performed in Cambodia at Mimot or Krek, Kampong Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or (5) performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977. . (c) Eligibility for hospital care and medical services Section 1710(e)(4), as amended by section 102(c), is further amended by striking subparagraph (A) and inserting the following new subparagraph: (A) The term Vietnam-era herbicide-exposed veteran means a veteran who— (i) performed covered service, as defined in section 1116(d) of this title; or (ii) the Secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period. . (d) Conforming amendment The heading for section 1116 is amended by striking the Republic of Vietnam and inserting certain locations . 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations (a) Short title This section may be cited as the Fair Care for Vietnam Veterans Act . (b) Additional diseases Section 1116(a)(2), as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 ( Public Law 116–283 ), is further amended by adding at the end the following new subparagraphs: (L) Hypertension. (M) Monoclonal gammopathy of undetermined significance. . 405. Improving compensation for disabilities occurring in Persian Gulf War veterans (a) Reduction in threshold of eligibility Subsection (a)(1) of section 1117 is amended by striking became manifest— and all that follows through the period at the end and inserting became manifest to any degree at any time. . (b) Permanent extension of period of eligibility Such section is further amended— (1) by striking subsection (b); (2) by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and (3) in subsection (a)(2)(C), by striking under subsection (d) and inserting under subsection (c) . (c) Establishing singular disability-based questionnaire Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new subsection (d): (d) If a Persian Gulf veteran at a medical facility of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care personnel of the Department use a disability benefits questionnaire, or successor questionnaire, designed to identify Gulf War Illness, in addition to any other diagnostic actions the personnel determine appropriate. . (d) Expansion of definition of Persian Gulf veteran Subsection (f) of such section is amended by inserting , Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, after operations . (e) Training Such section is further amended by adding at the end the following new subsection: (i) (1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department are appropriately trained to effectively carry out this section. (2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1). . 406. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Short title This section may be cited as the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act . (b) In general Subchapter II of chapter 11, as amended by section 302 , is further amended by inserting after section 1119 the following new section: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Presumption of service connection For the purposes of section 1110 of this title, and subject to section 1113 of this title, a disease specified in subsection (b) becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service, notwithstanding that there is no record of evidence of such disease during the period of such service. (b) Diseases specified The diseases specified in this subsection are the following: (1) Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). (2) The following types of cancer: (A) Head cancer of any type. (B) Neck cancer of any type. (C) Respiratory cancer of any type. (D) Gastrointestinal cancer of any type. (E) Reproductive cancer of any type. (F) Lymphoma cancer of any type. (G) Lymphomatic cancer of any type. (H) Kidney cancer. (I) Brain cancer. (J) Melanoma. (K) Pancreatic cancer. (3) Chronic bronchitis. (4) Chronic obstructive pulmonary disease. (5) Constrictive bronchiolitis or obliterative bronchiolitis. (6) Emphysema. (7) Granulomatous disease. (8) Interstitial lung disease. (9) Pleuritis. (10) Pulmonary fibrosis. (11) Sarcoidosis. (12) Chronic sinusitis. (13) Chronic rhinitis. (14) Glioblastoma. (15) Any other disease for which the Secretary determines, pursuant to regulations prescribed under subchapter VII that a presumption of service connection is warranted based on a positive association with a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title. (c) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of this title. . (c) Conforming amendment Section 1113 is amended by striking or 1118 each place it appears and inserting 1118, or 1120 . V Research matters 501. Interagency working group on toxic exposure research (a) In general Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section: 7330D. Interagency working group on toxic exposure research (a) Establishment (1) The Secretary shall establish the Toxic Exposure Research Working Group (in this section referred to as the Working Group ). (2) The Working Group shall consist of employees, selected by the Secretary, of the following: (A) The Department. (B) The Department of Defense. (C) The Department of Health and Human Services. (D) The Environmental Protection Agency. (E) Other Federal entities involved in research activities regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service. (b) Functions The Working Group shall perform the following functions: (1) Identify collaborative research activities and resources available among entities represented by members of the Working Group to conduct such collaborative research activities. (2) Develop a 5-year strategic plan for Federal entities represented in the Working Group to carry out collaborative research activities. (c) Reporting The Secretary shall submit, to the Committees on Veterans’ Affairs of the Senate and House of Representatives, the following: (1) Not later than one year after the date of the enactment of the Act, a report on the establishment of the Working Group under subsection (a). (2) Not later than two years after the date of enactment of the Act, a report containing the collaborative research activities identified, and the Strategic Plan developed, by the Working Group, under subsection (b). (3) Annually during the 5-year period covered by the strategic plan under subsection (b), a progress reports on implementation of the Strategic Plan under subsection (b). (d) Termination The Working Group shall terminate after submitting the final report under subsection (c). (e) Definitions For purposes of this section— (1) The term Act means the Honoring our Promise to Address Comprehensive Toxics Act of 2021. (2) The term collaborative research activity means a research activity— (A) conducted by an entity represented by a member of the Working Group; (B) funded by the Federal Government; and (C) regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service. . (b) Clerical amendment The table of sections at the beginning of such subchapter is amended by inserting after the item relating to section 7330C the following new item: 7330D. Interagency working group on toxic exposure research. . (c) Implementation The Secretary of Veterans Affairs shall establish the Working Group under section 7330D of such title, as added by subsection (a), not later than one year after the date of the enactment of this Act. 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure (a) In general The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that— (1) is obtained by the Secretary in connection with hospital care (including mental health services and counseling), medical services, or nursing home care furnished to a veteran for an illness under section 1710(a)(2)(F) of title 38, United States Code, as amended by section 102 ; and (2) is likely to be scientifically useful, as determined by the Secretary, in determining whether a positive association exists between the illness of the veteran and a toxic exposure. (b) Consent of patients The Secretary shall ensure that the compilation and analysis of the clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, in a manner that is consistent with the informed consent of the veteran and in compliance with all applicable Federal law. (c) Annual report Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing— (1) any data compiled under subsection (a); (2) an analysis of any such data; (3) a description of the types and incidences of illnesses identified by the Secretary pursuant to such subsection; (4) an explanation by the Secretary for the incidence of such illnesses and such alternate explanations for the incidence of such illnesses as the Secretary may consider reasonable; and (5) a description of the views of the Secretary regarding the scientific validity of drawing conclusions from the incidence of such illnesses, as evidenced by the data compiled under subsection (a), regarding the existence of a positive association between such illness and a toxic exposure. (d) Definitions In this section: (1) The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. 503. Studies related to veterans who served in Southwest Asia and certain other locations (a) Analysis on mortality in covered veterans (1) Analysis Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct an updated analysis of total and respiratory disease mortality in covered veterans. (2) Elements The analysis under paragraph (1) shall include, to the extent practicable, the following: (A) Metrics of airborne exposures. (B) The location and timing of any deployments of the veteran. (C) The military occupational specialty of the veteran. (D) The Armed Force in which the veteran served. (E) The preexisting health status of the veteran, including with respect to asthma. (F) Such personal information of the veteran as the Secretary may consider relevant, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity. (b) Epidemiological study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct an epidemiological study of covered veterans that involves— (1) the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment; and (2) the collection of detailed information on the covered veterans studied through medical records, administrative data, and other existing sources, including, with respect to the covered veterans— (A) personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity; (B) deployment history, including locations, periods, and number of deployments; (C) biospecimen data; and (D) supplementary health status and outcomes data, including imaging and physiological parameters. (c) Toxicology study (1) Study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a toxicology study, to include variability, to replicate toxic exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions. (2) Elements The study under paragraph (1) shall include— (A) an analysis of results for mechanistic markers and clinically relevant outcomes; and (B) a validation of any serum, tissue, or other biomarkers of toxic exposure, susceptibility, or effect with respect to the subjects of the study. (d) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of title 38, United States Code, as added by section 302. 504. Study on health trends of post 9/11 veterans (a) Study The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001. (b) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The race and ethnicity of the veteran. (2) The age of the veteran. (3) The period of service and length of service of the veteran in the Armed Forces. (4) Any military occupational speciality of the veteran. (5) The gender of the veteran. (6) The disability status of the veteran. (c) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 505. Study on cancer rates among veterans (a) Study The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans, to determine trends in the rates of the incidence of cancer in veterans, and on available early detection diagnostics, to determine the feasibility and advisability of including such diagnostics as part of the health care furnished to veterans by the Secretary. (b) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The race and ethnicity of the veteran. (2) The age of the veteran. (3) The period of service and length of service of the veteran in the Armed Forces. (4) Any military occupational speciality of the veteran. (5) The gender of the veteran. (6) Any type of cancer that the veteran has. (c) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities (a) Study The Secretary of Veterans Affairs shall conduct a study on the feasibility and advisability of furnishing hospital care and medical services to qualifying dependents of veterans described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 103(a)(1), for any illness determined by the Secretary to be connected to a toxic exposure risk activity carried out by the veteran, as determined by the Secretary, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such activity. (b) Elements The study under subsection (a) shall include— (1) an assessment of the impact of furnishing hospital care and medical services to qualifying dependents as described in such subsection on the ability of the Department of Veterans Affairs to furnish hospital care and medical services to veterans; (2) an assessment of the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection; (3) an estimate of the resources required to furnish such care and services; (4) an assessment of any stress or other effect furnishing such care and services would have on the claims and appeals system of the Department; (5) an estimate of the number of qualifying dependents who would be eligible for such care and services; and (6) an assessment of the feasibility of adjudicating claims for such care and services. (c) Phased-In application In conducting the study under subsection (a), the Secretary shall assess the feasibility and advisability of phasing in the furnishing of hospital care and medical services to qualifying dependents described in such subsection by the decade in which such toxic exposure risk activity occurred, starting with the most recent decade. (d) Review of toxic exposure cases regarding liability of Department of Defense In conducting the study under subsection (a), the Secretary shall— (1) review known cases of toxic exposure on military installations of the Department of Defense; (2) analyze the liability of the Department of Defense in each such case; and (3) assess whether the Secretary of Defense should provide care and services relating to such toxic exposures under the TRICARE program. (e) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a). (f) Definitions In this section: (1) The terms hospital care and medical services have the meanings given those terms in section 1701 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. (3) The term qualifying dependent means— (A) a dependent of a veteran described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 104(a)(1), who resided with the veteran during the period in which, and on the installation at which, the veteran participated in a toxic exposure risk activity; (B) an individual who was in utero of such a veteran or other qualifying dependent when the veteran participated in a toxic exposure risk activity; or (C) a dependent of such a veteran who is not described in subparagraph (A) or (B) but who may have an illness that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary. (4) The term toxic exposure has the meaning given that term in section 101 of such title, as added by section 102(b) . (5) The term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of such title, as added by section 102(c) . (6) The term TRICARE program has the meaning given that term in section 1072 of such title. 507. Study on health effects of waste related to Manhattan Project on certain veterans (a) Study The Secretary of Veterans Affairs shall conduct a study on the health trends of veterans who, while serving in the active military, naval, air, or space service— (1) participated in activities relating to the Manhattan Project (including activities relating to covered waste) in connection with such service; or (2) resided at or near, as determined by the Secretary, the locations described in subsection (b). (b) Covered locations The locations described in this subsection are the following locations in the county of St. Louis, Missouri: (1) Coldwater Creek. (2) The St. Louis Airport Site. (3) The West Lake Landfill. (4) Any other location in the county of St. Louis, Missouri that is proximate to covered waste, as determined by the Secretary. (c) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The age, gender, and race of the veteran. (2) The period and location of exposure to covered waste. (3) Any type of cancer, or other illness associated with toxic exposure, that the veteran has. (4) A comparison of the overall health condition of the veteran, including any illness of the veteran identified pursuant to paragraph (3), with the overall health condition of past and present civilian populations residing at the same location of exposure. (d) Report Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). (e) Definitions In this section: (1) The term covered waste means any waste arising from activities carried out in connection with the Manhattan Project. (2) The term illness has the meaning given that term in section 1171 of title 38, United States Code, as added by section 202. (3) The term toxic exposure has the meaning given that term in section 101 of such title, as added by section 102(b). 508. Study on toxic exposure and mental health outcomes (a) Study required The Secretary of the Department of Veterans Affairs shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for the conduct of a study of veterans to assess possible relationships between toxic exposures experienced during service in the Armed Forces and mental health outcomes, including chronic multisymptom illness, traumatic brain injury, post-traumatic stress disorder, depression, psychosis, suicide attempts, and suicide deaths. (b) Elements For each veteran included in the study under subsection (a), the following information shall be collected and assessed: (1) Age. (2) Gender. (3) Race and ethnicity. (4) Period and length of service in the Armed Forces. (5) History of toxic exposure during service in the Armed Forces. (6) Any diagnosis of chronic multisymptom illness. (7) Any diagnosis of a mental health or cognitive disorder. (8) Any history of suicide attempt or suidcidality. (9) If the veteran died by suicide. (c) Report Not later than two years after the date after the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report containing the findings of the study conducted under subsection (a). 509. Study on veterans in Territories of the United States (a) GAO study (1) In general The Comptroller General of the United States shall conduct a study on the state of access and barriers to benefits and services furnished under laws administered by the Secretary of Veterans Affairs to veterans in Territories of the United States, including deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the United States. (2) Elements The study under paragraph (1) shall include— (A) the number of veterans in each Territory of the United States; (B) the number of veterans in each Territory who are enrolled in the system of annual patient enrollment of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code; (C) the number of veterans in each Territory who are eligible for services under section 1710 of such title but who are not enrolled as described in subparagraph (B); (D) a detailed description of obstacles facing veterans in each Territory in accessing health care services, including those involving the availability of such services to veterans in the Territory in which the veterans reside, and the distance required of veterans to journey to receive services at a regional medical center of the Veterans Health Administration, a community-based outpatient clinic, or other full-service medical facility of the Department, or death center, respectively; (E) a detailed description of obstacles facing veterans in each Territory in accessing readjustment counseling services, including those involving the availability of such services to veterans in the Territory in which the veterans reside, and the distance required of veterans to journey to receive services at a readjustment counseling services center of the Department; (F) a detailed description of obstacles facing veterans in each Territory in accessing other veterans benefits, including those involving the availability of benefits and services to veterans in the Territory in which the veterans reside, and the distance required of the veterans to journey to the nearest office of the Veterans Benefits Administration; (G) an analysis of the staffing and recordkeeping levels and quality of the offices of the Department charged with serving veterans in the Territories, including the availability of the full- and part-time staff of each office to the veterans they are charged with serving, and the continuity of care provided by such staff to such veterans; (H) an analysis of the availability of the Veterans Community Care Program established under section 1703 of title 38, United States Code, to veterans in each Territory; (I) an analysis of the economic and health consequences for veterans in each Territory resulting from obstacles to accessing adequate assistance and health care at facilities of the Department; (J) an analysis of the access to assistance and health care provided to veterans in the aftermath of major disasters declared in each of the Territories since September 4, 2017; and (K) recommendations for improving access of veterans in the Territories to benefits and services furnished by the Secretary, and reducing barriers and deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the United States. (b) Report Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a final report setting forth the results of the study conducted under subsection (a), including the recommendations developed under paragraph (2)(K) of such subsection. (c) Territory defined In this section, the term Territory includes American Samoa, the Commonwealth of the Northern Marianas Islands, Guam, Puerto Rico, and the Virgin Islands. 510. Department of Veterans Affairs public website for toxic exposure research (a) Website Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish, and maintain thereafter, a publically accessible internet website of the Department of Veterans Affairs that serves as a clearinghouse for the publication of all toxic exposure research carried out or funded by the executive branch of the Federal Government. (b) Relation to War Related Illness and Injury Study Center The website developed and maintained under subsection (a) shall be housed under the website of the War Related Illness and Injury Study Center of the Department of Veterans Affairs, or successor center. (c) Coordination In carrying out subsection (a), the Secretary shall coordinate with— (1) the heads of each Federal department or agency carrying out or funding toxic exposure research; (2) the War Related Illness and Injury Study Center of the Department of Veterans Affairs, or successor center; and (3) any working group of the Department of Veterans Affairs or other similar entity responsible for coordinating toxic exposure research. (d) Definitions In this section: (1) The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code, as added by section 102(b). (2) The term toxic exposure research means research on the health consequences of toxic exposures experienced during service in the Armed Forces. 511. Biennial report on health effects of jet fuels used by Armed Forces Not later than one year after the date of the enactment of this Act, and biennially thereafter during the subsequent eight-year period, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate, and make publicly available, a report that includes— (1) a discussion of the effect of various different types of jet fuels used by the Armed Forces on the health of individuals by length of exposure; (2) an identification of the immediate symptoms of jet fuel exposure that may indicate future health risks; (3) a chronology of health safeguards implemented by the Armed Forces intended to reduce the exposure of members of the Armed Foces to jet fuel; and (4) an identification of any areas relating to jet fuel exposure about which new research needs to be conducted. VI Improvement of resources and training regarding toxic-exposed veterans 601. Short title; definitions (a) Short title This title may be cited as the Toxic Exposure in the American Military Act or the TEAM Act . (b) Definitions In this title, the terms active military, naval, air, or space service , toxic exposure , and toxic-exposed veteran have the meanings given those terms in section 101 of title 38, United States Code. 602. Publication of list of resources of Department of Veterans Affairs for toxic-exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans (a) Publication of list of resources (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for— (A) toxic-exposed veterans, including with respect to— (i) disability compensation under chapter 11 of title 38, United States Code; and (ii) hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title; (B) caregivers of toxic-exposed veterans who are participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title; and (C) survivors of toxic-exposed veterans who are receiving death benefits under the laws administered by the Secretary. (2) Update The Secretary shall periodically update the list published under paragraph (1). (3) Languages The Secretary shall publish the list under paragraph (1) in languages including the following: (A) English. (B) Spanish. (C) Chinese. (D) The seven other most commonly spoken languages in the United States. (b) Outreach The Secretary shall develop, with input from the community, an informative outreach program for veterans on illnesses that may be related to toxic exposure, including outreach with respect to benefits and support programs. Information distributed under the outreach program shall be treated as a fact sheet of the Department of Veterans Affairs for purposes of making the information available in multiple languages pursuant to section 2 of the Veterans and Family Information Act ( Public Law 117–62 ; 38 U.S.C. 6303 note). (c) Veterans organizations To the extent practicable, the Secretary shall share with national veterans service organizations and other veterans groups, including such organizations and groups that improve access by veterans to health care and benefits, the list of resources under subsection (a) and the outreach program under subsection (b). 603. Incorporation of toxic exposure questionnaire during primary care appointments (a) In general The Secretary of Veterans Affairs shall incorporate a clinical questionnaire to help determine potential toxic exposures during active military, naval, air, or space service as part of the initial screening conducted for an appointment of a veteran with a primary care provider of the Department of Veterans Affairs to improve understanding by the Department of toxic exposures of veterans while serving in the Armed Forces. (b) Determination of questions The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic-exposed veterans (a) Health care personnel The Secretary of Veterans Affairs shall provide to health care personnel of the Department of Veterans Affairs education and training to identify, treat, and assess the impact on toxic-exposed veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures. (b) Benefits personnel (1) Standard claims processor training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall ensure that a standard training curriculum exists for processors of claims under the laws administered by the Secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposure, including employees who adjudicate such claims. (B) Matters included The Secretary shall ensure that the training under subparagraph (A) includes the following explanations with respect to claims relating to toxic exposure: (i) A lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist. (ii) The claims adjudicator shall always consider whether direct service connection is applicable and request, as needed, an advisory medical opinion pursuant to section 1168 of title 38, United States Code, as added by section 303 . (iii) The claims adjudicator may review and consider any record of the claimant in an exposure tracking record system pursuant to section 1119 of such title, as added by section 302 , but a lack of such information is not by itself sufficient to determine that such exposure did not occur or sufficient to deny the claim. (C) Provision of training The Secretary shall— (i) provide training under subparagraph (A) to each employee described in such subparagraph not less frequently than annually; and (ii) using the Systematic Technical Accuracy Review program, or such successor program, conduct a nationwide, quarterly, randomized review of the quality of adjudication of claims relating to toxic exposure. (2) Standard medical examiner training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall ensure that a standard medical training curriculum exists for medical providers who conduct examinations and provide opinions pursuant to section 1168 of title 38, United States Code, as added by section 303 , regardless of whether the provider is an employee of the Department or a contractor. (B) Standardized approach The Secretary shall ensure that the curriculum established under subparagraph (A)— (i) provides a standardized approach to conducting and providing examinations and opinions in accordance with such section 1168; and (ii) instructs medical providers to consider, when conducting an examination or providing an opinion— (I) relevant medical and scientific literature; (II) the proximity, intensity, and frequency of exposure of the individual to the identified toxic exposure; (III) medically unexplained chronic multisymptom illnesses; and (IV) all competent and credible evidence of record. 605. Guidelines for active duty military on potential risks and prevention of toxic exposures Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense and the Secretary of Veterans Affairs shall jointly coordinate and establish guidelines to be used during training of members of the Armed Forces serving on active duty to provide the members awareness of the potential risks of toxic exposures and ways to prevent being exposed during combat. VII Registries, records, and other matters 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations (a) Establishment of registry (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances (in this section referred to as PFAS ) due to the environmental release of aqueous film-forming foam (in this section referred to as AFFF ) on military installations to meet the requirements of military specification MIL–F–24385F; (B) include any information in such registry that the Secretary determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to PFAS associated with AFFF; (C) develop a public information campaign to inform eligible individuals about the registry, including how to register and the benefits of registering; and (D) periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to PFAS. (2) Coordination The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense in carrying out paragraph (1). (b) Reports (1) Initial report Not later than one year after the date of the enactment of this Act, the Secretary of Defense shall submit to Congress a report regarding the following: (A) Sources of PFAS on military installations other than AFFF. (B) Any recommendation of the Secretary regarding whether to expand eligibility for the registry to individuals exposed to sources of PFAS described in subparagraph (A). (2) Interim report Not later than two years after the date on which the registry under subsection (a) is established, the Secretary of Veterans Affairs shall submit to Congress an initial report containing the following: (A) An assessment of the effectiveness of actions taken by the Secretary of Veterans Affairs and the Secretary of Defense to collect and maintain information on the health effects of exposure to PFAS. (B) Recommendations to improve the collection and maintenance of such information. (C) Using established and previously published epidemiological studies, recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to exposure to PFAS. (3) Followup report Not later than five years after submitting the initial report under paragraph (1), the Secretary of Veterans Affairs shall submit to Congress a followup report containing the following: (A) An update to the initial report submitted under paragraph (1). (B) An assessment of whether and to what degree the content of the registry established under subsection (a) is current and scientifically up to date. (4) Independent scientific organization The Secretary of Veterans Affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs (1) and (2). (c) Recommendations for additional exposures To be included Not later than five years after the date of the enactment of this Act, and every five years thereafter, the Secretary of Veterans Affairs, in consultation with the Secretary of Defense and the Administrator of the Environmental Protection Agency, shall submit to Congress recommendations for additional chemicals with respect to which individuals exposed to such chemicals should be included in the registry established under subsection (a). (d) Eligible individual defined In this section, the term eligible individual means any individual who, on or after a date specified by the Secretary of Veterans Affairs through regulations, served or is serving in the Armed Forces at a military installation where AFFF was used or at another location of the Department of Defense where AFFF was used. 702. Fort McClellan Health Registry (a) Establishment The Secretary of Veterans Affairs shall establish and maintain a special record to be known as the Fort McClellan Health Registry (in this section referred to as the Registry ). (b) Contents Except as provided in subsection (c), the Registry shall include the following information: (1) A list containing the name of each individual who, while serving as a member of the Armed Forces, was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, and who— (A) applies for care or services from the Department of Veterans Affairs under chapter 17 of title 38, United States Code; (B) files a claim for compensation under chapter 11 of such title on the basis of any disability which may be associated with such service; (C) dies and is survived by a spouse, child, or parent who files a claim for dependency and indemnity compensation under chapter 13 of such title on the basis of such service; (D) requests from the Secretary a health examination under subsection (d); or (E) receives from the Secretary a health examination similar to the health examination referred to in subparagraph (D) and requests inclusion in the Registry. (2) Relevant medical data relating to the health status of, and other information that the Secretary considers relevant and appropriate with respect to, each individual described in paragraph (1) who— (A) grants to the Secretary permission to include such information in the Registry; or (B) at the time the individual is listed in the Registry, is deceased. (c) Individuals submitting claims or making requests before date of enactment If in the case of an individual described in subsection (b)(1) the application, claim, or request referred to in such subsection was submitted, filed, or made before the date of the enactment of this Act, the Secretary shall, to the extent feasible, include in the Registry such individual's name and the data and information, if any, described in subsection (b)(2) relating to the individual. (d) Examinations Upon the request of a veteran who was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, the Secretary shall provide the veteran with a health examination (including any appropriate diagnostic tests) and consultation and counseling with respect to the results of the examination and the tests. (e) Outreach (1) Ongoing outreach to individuals listed in Registry The Secretary shall, from time to time, notify individuals listed in the Registry of significant developments in research on the health consequences of potential exposure to a toxic substance or environmental hazard related to service at Fort McClellan. (2) Examination outreach The Secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations (including any diagnostic tests) and consultation and counseling services under subsection (d). (f) Consultation The Secretary of Veterans Affairs shall consult with the Secretary of Defense to acquire information maintained by the Secretary of Defense that the Secretary of Veterans Affairs considers necessary to establish and maintain the Registry. 703. Independent study on Individual Longitudinal Exposure Record (a) In general Not later than 60 days after the date of the enactment of this Act, the Secretary of Defense shall enter into a contract with an independent research entity described in subsection (b) to carry out a comprehensive study of the development of the Individual Longitudinal Exposure Record, or successor system, to determine— (1) the quality of the location data, occupational and environmental exposure data, and health surveillance data; and (2) whether a member of the Armed Forces can be reasonably assured that any toxic exposure they experience during service in the Armed Forces will be accurately reflected in the record of the member in such Individual Longitudinal Exposure Record. (b) Independent research entity The entity described in this subsection is an independent research entity that is a not-for-profit entity or a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b). 704. Biannual report on Individual Longitudinal Exposure Record (a) In general Not later than one year after the date on which the Individual Longitudinal Exposure Record, or successor system, achieves full operation capability, as determined by the Secretary of Defense, and every 180 days thereafter, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall submit to the appropriate committees of Congress a report on— (1) the data quality of the databases of the Department of Defense that provide the information presented in such Individual Longitudinal Exposure Record; and (2) the usefulness of such Individual Longitudinal Exposure Record in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. (b) Elements Each report required by subsection (a) shall include, for the period covered by the report, the following: (1) An identification of toxic exposure events that may not be fully captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. (2) An analysis of the quality of the location data used by the Department of Defense in determining toxic exposures of members of the Armed Forces and veterans, and recommendations for how to improve the quality of that location data if necessary. (c) Report on National Guard use of ILER Not later than one year after the date of the enactment of this Act, the Secretary of Defense shall submit to the appropriate committees of Congress a report on the feasibility of modifying the Individual Longitudinal Exposure Record to ensure that a member of the National Guard who is deployed in the United States in connection with a natural disaster, without regard to duty status (including any duty under title 10 or title 32, United States Code, or State active duty), may record information regarding a suspected exposure by the member to toxic substances during such deployment. (d) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. (2) Toxic exposure The term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b) . 705. Correction of exposure records by members of the Armed Forces and veterans (a) In general The Secretary of Defense shall provide a means for members of the Armed Forces and veterans to update their records as necessary to reflect a toxic exposure by such member or veteran in the Individual Longitudinal Exposure Record, or successor system. (b) Evidence (1) Provision of evidence To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, shall provide such evidence as the Secretary of Defense considers necessary. (2) Benefit of the doubt In reviewing evidence provided under paragraph (1), the Secretary of Defense shall give the benefit of the doubt to the member of the Armed Forces or veteran who provided the evidence, as the case may be, in a manner that is equivalent to the benefit of the doubt required under section 5107(b) of title 38, United States Code. (3) Regulations The Secretary of Defense shall prescribe by regulation the evidence considered necessary under paragraph (1). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b) . 706. Federal cause of action relating to water at Camp Lejeune, North Carolina (a) In general An individual, including a veteran (as defined in section 101 of title 38, United States Code), or the legal representative of such an individual, who resided, worked, or was otherwise exposed (including in utero exposure) for not less than 30 days during the period beginning on August 1, 1953, and ending on December 31, 1987, to water at Camp Lejeune, North Carolina, that was supplied by, or on behalf of, the United States may bring an action in the United States District Court for the Eastern District of North Carolina to obtain appropriate relief for harm that was caused by exposure to the water at Camp Lejeune. (b) Burdens and standard of proof (1) In general The burden of proof shall be on the party filing the action to show one or more relationships between the water at Camp Lejeune and the harm. (2) Standards To meet the burden of proof described in paragraph (1), a party shall produce evidence showing that the relationship between exposure to the water at Camp Lejeune and the harm is— (A) sufficient to conclude that a causal relationship exists; or (B) sufficient to conclude that a causal relationship is at least as likely as not. (c) Exclusive jurisdiction and venue The United States District Court for the Eastern District of North Carolina shall have exclusive jurisdiction over any action filed under subsection (a), and shall be the exclusive venue for such an action. Nothing in this subsection shall impair the right of any party to a trial by jury. (d) Exclusive remedy (1) In general An individual, or legal representative of an individual, who brings an action under this section for a harm described in subsection (a), including a latent disease, may not thereafter bring a tort action against the United States for such harm pursuant to any other law. (2) Health and disability benefits relating to water exposure Any award made to an individual, or legal representative of an individual, under this section shall be offset by the amount of any disability award, payment, or benefit provided to the individual, or legal representative— (A) under— (i) any program under the laws administered by the Secretary of Veterans Affairs; (ii) the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); or (iii) the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ); and (B) in connection with health care or a disability relating to exposure to the water at Camp Lejeune. (e) Immunity limitation The United States may not assert any claim to immunity in an action under this section that would otherwise be available under section 2680(a) of title 28, United States Code. (f) No punitive damages Punitive damages may not be awarded in any action under this section. (g) Disposition by Federal agency required An individual may not bring an action under this section before complying with section 2675 of title 28, United States Code. (h) Exception for combatant activities This section does not apply to any claim or action arising out of the combatant activities of the Armed Forces. (i) Applicability; period for filing (1) Applicability This section shall apply only to a claim accruing before the date of enactment of this Act. (2) Statute of limitations A claim in an action under this section may not be commenced after the later of— (A) the date that is two years after the date of enactment of this Act; or (B) the date that is 180 days after the date on which the claim is denied under section 2675 of title 28, United States Code. (3) Inapplicability of other limitations Any applicable statute of repose or statute of limitations, other than under paragraph (2), shall not apply to a claim under this section. 707. Veterans Toxic Exposures Fund Chapter 3 is amended by adding at the end the following new section: 324. Veterans Toxic Exposures Fund (a) Establishment There is hereby established in the Treasury of the United States an account to be known as the “Veterans Toxic Exposures Fund” (the “Fund”), to be administered through the Department of Veterans Affairs, to provide for investment in the delivery of veterans’ health care, research, and benefits associated with hazardous exposure in service. (b) Authorization of appropriations There is authorized to be appropriated to the Fund for fiscal year 2023 and each subsequent fiscal year such sums as are necessary to increase funding, over the fiscal year 2021 level for the Veterans Health Administration of the Department of Veterans Affairs, for any expenses incident to the delivery of veterans’ health care and benefits associated with exposure to environmental hazards in service, including administrative expenses, such as claims processing and appeals, and for medical research related to hazardous exposures. Amounts appropriated to the Fund pursuant to this subsection shall be counted as direct spending under the Congressional Budget and Impoundment Control Act of 1974 and any other Act. (c) Estimates for congressional consideration The Secretary shall include in documents submitted to Congress in support of the President’s budget submitted pursuant to section 1105 of title 31, United States Code, detailed estimates of the sums described in subsection (b) for the applicable fiscal year. (d) Procedures for estimates The Secretary, after consultation with the Committees on Appropriations of the House of Representatives and the Senate, may establish policies and procedures for developing the annual detailed estimates required in subsection (c). . 708. Authorization of electronic notice in claims under laws administered by the Secretary of Veterans Affairs Title 38, United States Code, is amended as follows: (1) By striking section 5100 and inserting the following: 5100. Definitions In this chapter: (1) The term claimant means any individual applying for, or submitting a claim for, any benefit under the laws administered by the Secretary. (2) The term notice means a communication issued through means (including electronic means) prescribed by the Secretary. . (2) In section 5104, by adding at the end the following new subsection: (c) The Secretary may provide notice under subsection (a) electronically if a claimant (or the claimant’s representative) elects to receive such notice electronically. A claimant (or the claimant’s representative) may revoke such an election at any time, by means prescribed by the Secretary. (d) The Secretary shall annually— (1) solicit recommendations from stakeholders on how to improve notice under this section; and (2) publish such recommendations on a publicly available website of the Department. . (3) In section 5104B(c), in the matter preceding paragraph (1) by striking in writing and inserting to the claimant (and any representative of such claimant) . (4) In section 7104— (A) in the heading, by adding ; decisions; notice at the end; and (B) by striking subsection (e) and inserting the following: (e) After reaching a decision on an appeal, the Board shall promptly issue notice (as that term is defined in section 5100 of this title) of such decision to the following: (1) The appellant. (2) Any other party with a right to notice of such decision. (3) Any authorized representative of the appellant or party described in paragraph (2). (f) The Secretary may provide notice under subsection (e) electronically if a claimant (or the claimant’s representative) elects to receive such notice electronically. A claimant (or the claimant’s representative) may revoke such an election at any time, by means prescribed by the Secretary. . (5) In section 7105(b)(1)(A), by striking mailing and inserting issuance . (6) In section 7105A(a), by striking mailed and inserting issued . (7) In section 7266(a), by striking mailed and inserting issued . 709. Authorization of appropriations for expansion of claims automation There is authorized to be appropriated to the Secretary of Veterans Affairs $30,000,000 for fiscal year 2023 to support expected increased claims processing for newly eligible veterans pursuant to this Act and the amendments made by this Act by— (1) supporting the automation of processing claims by the Veterans Benefits Administration of the Department of Veterans Affairs; (2) adding self-service features to the system by which individuals file claims; (3) removing duplicative efforts regarding the processing of claims; and (4) reducing the dependency of the Department on the legacy claim system. 710. Non-applicability of non-Department of Veterans Affairs covenants not to compete to appointment of Veterans Health Administration personnel (a) In general Subchapter I of chapter 74 of title 38, United States Code, is amended by adding at the end the following new section: 7414. Effect of non-Department covenants not to compete (a) Non-Applicability Except as provided in subsection (b), in the case of an individual who is an applicant for appointment to a position in the Veterans Health Administration described in section 7401 of this title, any covenant not to compete into which the individual has entered with a non-Department facility or party shall have no force or effect with respect to the appointment of the individual to such a position. (b) Service obligation (1) Any individual who is appointed to such a position in the Veterans Health Administration shall, as a condition of such appointment, agree to provide clinical services at a Department medical facility for the duration of the period described in paragraph (2). (2) The period described in this paragraph is the period that begins on the date on which an individual is appointed to such a position and ends on the latter of the following dates: (A) The date that is one year after such date of appointment. (B) The date of the termination of any covenant not to compete entered into between the individual and a non-Department facility or party. (3) The Secretary may waive the requirement under paragraph (1) with respect to an individual at the discretion of the Secretary. (c) Termination of Department employment In the case of an individual who is appointed to such a position in the Veterans Health Administration who has entered into a covenant not to compete that is rendered non-applicable pursuant to subsection (a), if the individual’s employment at the Veterans Health Administration is terminated for any reason before the specified termination date of such covenant, subsection (a) shall not apply with respect to such covenant after the date of the termination of the individual’s employment at the Veterans Health Administration. (d) Covenant not To compete In this section, the term covenant not to compete means an agreement— (1) between an employee and employer or a contractor and principal that restricts such employee or contractor from performing— (A) any work for another employer for a specified period of time; (B) any work in a specified geographical area; or (C) work for another employer performing work that is similar to the work such employee or contractor performed for the employer or principal, included as a party to the agreement; and (2) that is entered into after the date of enactment of this Act. . (b) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7413 the following new item: 7414. Effect of non-Department covenants not to compete. . 711. Recruitment of physicians on a contingent basis prior to completion of training requirements Section 7402 of title 38, United States Code, is amended— (1) in subsection (b)(1)— (A) in the matter preceding subparagraph (A) by inserting or to be offered an appointment to such position on a contingent basis under subsection (h) after position ; and (B) by striking subparagraph (B) and inserting the following: (B) (i) have completed a residency leading to board eligibility in a specialty, satisfactory to the Secretary; or (ii) with respect to an offer for an appointment on a contingent basis under subsection (h), complete such a residency by not later than two years after the date of such offer; and ; and (2) by adding at the end the following new subsection: (h) (1) The Secretary may appoint an individual under subsection (b)(1) on a contingent basis in accordance with this subsection if the Secretary reasonably anticipated that the individual will have completed the requirements for appointment under such subsection (b)(1) by not later than two years after the date on which the individual is so appointed. (2) An individual who is appointed to a position on a contingent basis under paragraph (1) shall be appointed to such position on a permanent basis if, by not later than two years after the date of the contingent appointment, the individual completes all the requirements for appointment under subsection (b)(1). (3) An individual who is appointed on a contingent basis under paragraph (1) who fails to complete the requirements for appointment under subsection (b)(1) by not later than two years after the date on which the individual is so appointed may not be appointed to such position on a permanent basis. . 712. Authority for Secretary of Veterans Affairs to award grants to States to improve outreach to veterans (a) In general Chapter 63 of title 38, United States Code, is amended— (1) by redesignating sections 6307 and 6308 and sections 6308 and 6309, respectively; and (2) by inserting after section 6306 the following new section 6307: 6307. Grants to States to improve outreach to veterans (a) Purpose It is the purpose of this section to provide for assistance by the Secretary to States to carry out programs that— (1) improve outreach and assistance to veterans and the spouses, children, and parents of veterans, to ensure that such individuals are fully informed about any veterans and veterans-related benefits and programs (including State veterans programs) for which they may be eligible; and (2) facilitate opportunities for such individuals to receive competent, qualified services in the preparation, presentation, and prosecution of veterans benefits claims. (b) Authority The Secretary may award grants to States— (1) to carry out, coordinate, improve, or otherwise enhance outreach activities; (2) to increase the number of county or tribal veterans service officers serving in the State by hiring new, additional such officers; or (3) to expand, carry out, coordinate, improve, or otherwise enhance existing programs, activities, and services of the State’s existing organization that has been recognized by the Department of Veterans Affairs pursuant to section 5902, in the preparation, presentation, and prosecution of claims for veterans benefits through representatives who hold positions as county or Tribal veterans service officers. (c) Application (1) To be eligible for a grant under this section, a State shall submit to the Secretary an application therefor at such time, in such manner, and containing such information as the Secretary may require. (2) Each application submitted under paragraph (1) shall include the following: (A) A detailed plan for the use of the grant. (B) A description of the programs through which the State will meet the outcome measures developed by the Secretary under subsection (i). (C) A description of how the State will distribute grant amounts equitably among counties (or Tribal lands, as the case may be) with varying levels of urbanization. (D) A plan for how the grant will be used to meet the unique needs of American Indian or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities. (d) Distribution The Secretary shall seek to ensure that grants awarded under this section are equitably distributed among States with varying levels of urbanization. (e) Priority The Secretary shall prioritize awarding grants under this section that will serve the following areas: (1) Areas with a critical shortage of county or tribal veterans service officers. (2) Areas with high rates of— (A) suicide among veterans; or (B) referrals to the Veterans Crisis Line. (f) Use of county or tribal veterans service officers A State that receives a grant under this section to carry out an activity described in subsection (b)(1) shall carry out the activity through— (1) a county or Tribal veterans service officer of the State; or (2) if the State does not have a county or tribal veterans service officer, or if the county or Tribal veterans service officers of the State cover only a portion of that State, an appropriate entity of a State, local, or Tribal government, or another publicly funded entity, as determined by the Secretary. (g) Required activities Any grant awarded under this section shall be used— (1) to expand existing programs, activities, and services; (2) to hire and maintain new, additional county or Tribal veterans service officers; or (3) for travel and transportation to facilitate carrying out paragraph (1) or (2). (h) Other permissible activities A grant under this section may be used to provide education and training, including on-the-job training, for State, county, local, and tribal government employees who provide (or when trained will provide) veterans outreach services in order for those employees to obtain and maintain accreditation in accordance with procedures approved by the Secretary. (i) Outcome measures (1) The Secretary shall develop and provide to each State that receives a grant under this section written guidance on the following: (A) Outcome measures. (B) Policies of the Department. (2) In developing outcome measures under paragraph (1), the Secretary shall consider the following goals: (A) Increasing the use of veterans and veterans-related benefits, particularly among vulnerable populations. (B) Increasing the number of county and tribal veterans service officers recognized by the Secretary for the representation of veterans under chapter 59 of this title. (j) Tracking requirements (1) With respect to each grant awarded under this section, the Secretary shall track the use of veterans benefits among the population served by the grant, including the average period of time between the date on which a veteran or other eligible claimant applies for such a benefit and the date on which the veteran or other eligible claimant receives the benefit, disaggregated by type of benefit. (2) Not less frequently than annually during the life of the grant program established under this section, the Secretary shall submit to Congress a report on— (A) the information tracked under paragraph (1); (B) how the grants awarded under this section serve the unique needs of American Indian or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities; and (C) other information provided by States pursuant to the grant reporting requirements. (k) Performance review (1) The Secretary shall— (A) review the performance of each State that receives a grant under this section; and (B) make information regarding such performance publicly available. (l) Remediation plan (1) In the case of a State that receives a grant under this section and does not meet the outcome measures developed by the Secretary under subsection (i), the Secretary shall require the State to submit a remediation plan under which the State shall describe how and when it plans to meet such outcome measures. (2) The Secretary may not award a subsequent grant under this section to a State described in paragraph (1) unless the Secretary approves the remediation plan submitted by the State. (m) Maximum amount The amount of a grant awarded under this section may not exceed 10 percent of amounts made available for grants under this section for the fiscal year in which the grant is awarded. (n) Supplement, not supplant Any grant awarded under this section shall be used to supplement and not supplant State and local funding that is otherwise available. (o) Authorization of appropriations There is authorized to be appropriated to the Secretary for each of fiscal years 2023 through 2027, $50,000,000 to carry out this section. (p) Definitions In this section: (1) The term county or tribal veterans service officer includes a local equivalent veterans service officer. (2) The term State includes each Indian Tribe, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and any territory or possession of the United States. (3) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . (b) Clerical amendment The table of sections at the beginning of chapter 63 of such title is amended by striking the items relating to sections 6307 and 6308 and inserting the following new items: 6307. Grants to States to improve outreach to veterans. 6308. Outreach for eligible dependents. 6309. Biennial report to Congress. . (c) Authorization of additional full-time equivalent employee During fiscal years 2023 through 2027, the Secretary of Veterans Affairs may hire an additional full-time equivalent employee in the Office of the General Counsel of the Department of Veterans Affairs, as compared to the number of full-time equivalent employees that would otherwise be authorized for such office, to carry out duties under the accreditation, discipline, and fees program. 713. Study and report on herbicide agent exposure in Panama Canal Zone (a) Study The Secretary of Defense shall conduct a study on the exposure of members of the Armed Forces to herbicide agents, including Agent Orange and Agent Purple, in the Panama Canal Zone during the period beginning on January 1, 1958, and ending on December 31, 1999. (b) Report Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a). 714. Budget information for alternatives to burn pits The Secretary of Defense shall include in the budget submission of the President under section 1105(a) of title 31, United States Code, for each of fiscal years 2023 through 2027, a dedicated budget line item for incinerators and waste-to-energy waste disposal alternatives to burn pits. 715. Authorization of appropriations for expansion of claims automation There is authorized to be appropriated to the Secretary of Veterans Affairs $150,000,000 for fiscal year 2023 to continue the modernization and expansion of capabilities and capacity of the Veterans Benefits Management System of the Department of Veterans Affairs to support expected increased claims processing for newly eligible veterans pursuant to this Act and the amendments made by this Act. 716. Burn pit registry updates (a) Individuals eligible to update (1) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall take actions necessary to ensure that the burn pit registry may be updated with the cause of death of a deceased registered individual by— (A) an individual designated by such deceased registered individual; or (B) if no such individual is designated, an immediate family member of such deceased registered individual. (2) Designation The Secretary shall provide, with respect to the burn pit registry, a process by which a registered individual may make a designation for purposes of paragraph (1)(A). (b) Definitions In this section: (1) The term burn pit registry means the registry 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). (2) The term immediate family member , with respect to a deceased individual, means— (A) the spouse, parent, brother, sister, or adult child of the individual; (B) an adult person to whom the individual stands in loco parentis; or (C) any other adult person— (i) living in the household of the individual at the time of the death of the individual; and (ii) related to the individual by blood or marriage. (3) The term registered individual means an individual registered with the burn pit registry. 717. Burn pit transparency (a) Short title This section may be cited as the SFC Heath Robinson Burn Pit Transparency Act . (b) Notifications and reports regarding reported cases of burn pit exposure (1) Quarterly notifications (A) In general On a quarterly basis, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report on each reported case of burn pit exposure by a covered veteran reported during the previous quarter. (B) Elements Each report submitted under subparagraph (A) shall include, with respect to each reported case of burn pit exposure of a covered veteran included in the report, the following: (i) Notice of the case, including the medical facility at which the case was reported. (ii) Notice of, as available— (I) the enrollment status of the covered veteran with respect to the patient enrollment system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code; (II) a summary of all health care visits by the covered veteran at the medical facility at which the case was reported that are related to the case; (III) the demographics of the covered veteran, including age, sex, and race; (IV) any non-Department of Veterans Affairs health care benefits that the covered veteran receives; (V) the Armed Force in which the covered veteran served and the rank of the covered veteran; (VI) the period in which the covered veteran served; (VII) each location of an open burn pit from which the covered veteran was exposed to toxic airborne chemicals and fumes during such service; (VIII) the medical diagnoses of the covered veteran and the treatment provided to the veteran; and (IX) whether the covered veteran is registered in the Airborne Hazards and Open Burn Pit Registry. (C) Protection of information The Secretary shall ensure that the reports submitted under subparagraph (A) do not include the identity of covered veterans or contain other personally identifiable data. (2) Annual report on cases (A) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, in collaboration with the Secretary of Defense, shall submit to the appropriate congressional committees a report detailing the following: (i) The total number of covered veterans. (ii) The total number of claims for disability compensation under chapter 11 of title 38, United States Code, approved and the total number denied by the Secretary of Veterans Affairs with respect to a covered veteran, and for each such denial, the rationale of the denial. (iii) A comprehensive list of— (I) the conditions for which covered veterans seek treatment; and (II) the locations of the open burn pits from which the covered veterans were exposed to toxic airborne chemicals and fumes. (iv) Identification of any illnesses relating to exposure to open burn pits that formed the basis for the Secretary to award benefits, including entitlement to service connection or an increase in disability rating. (v) The total number of covered veterans who died after seeking care for an illness relating to exposure to an open burn pit. (vi) Any updates or trends with respect to the information described in clauses (i), (ii), (iii), (iv), and (v) that the Secretary determines appropriate. (B) Matters included in first report The Secretary shall include in the first report under paragraph (1) information specified in paragraph (1)(B) with respect to reported cases of burn pit exposure made during the period beginning January 1, 1990, and ending on the day before the date of the enactment of this Act. (3) Information regarding the Airborne Hazards and Open Burn Pit Registry (A) Notice The Secretary of Veterans Affairs shall ensure that a medical professional of the Department of Veterans Affairs informs a veteran of the Airborne Hazards and Open Burn Pit Registry if the veteran presents at a medical facility of the Department for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits. (B) Display In making information public regarding the number of participants in the Airborne Hazards and Open Burn Pit Registry, the Secretary shall display such numbers by both State and by congressional district. (4) Comptroller General report Not later than 180 days after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the appropriate congressional committees a report containing an assessment of the effectiveness of any memorandum of understanding or memorandum of agreement entered into by the Secretary of Veterans Affairs with respect to— (A) the processing of reported cases of burn pit exposure; and (B) the coordination of care and provision of health care relating to such cases at medical facilities of the Department of Veterans Affairs and at non-Department facilities. (5) Definitions In this section: (A) The term Airborne Hazards and Open Burn Pit Registry means the registry established by the Secretary of Veterans Affairs 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). (B) The term appropriate congressional committees means— (i) the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and (ii) The Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. (C) The term covered veteran means a veteran who presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces. (D) The term open burn pit has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 ( Public Law 112–260 ; 38 U.S.C. 527 note). (E) The term reported case of burn pit exposure means each instance in which a veteran presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces.

Passed the House of Representatives March 3, 2022. Cheryl L. Johnson, Clerk.

tv_txt: II Calendar No. 388 117th CONGRESS 2d Session H. R. 3967 IN THE SENATE OF THE UNITED STATES March 3, 2022 Received May 24, 2022 Read the first time May 25, 2022 Read the second time and placed on the calendar AN ACT To improve health care and benefits for veterans exposed to toxic substances, and for other purposes.

1. Short title; references to title 38, United States Code; table of contents (a) Short title This Act may be cited as the Honoring our Promise to Address Comprehensive Toxics Act of 2021 or the Honoring our PACT Act of 2021 . (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 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 heading 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. Sec. 105. Revision of breast cancer mammography policy of Department of Veterans Affairs to provide mammography screening for veterans who served in locations associated with toxic exposure. 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. Sec. 112. Authorization period for emergency treatment in non-Department of Veterans Affairs medical facilities. 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. Sec. 203. Reevaluation of claims for compensation involving 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 Veterans 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 certain disabilities by Department of Veterans Affairs. Sec. 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations. Sec. 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection 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. Title V—Research matters Sec. 501. Interagency working group on toxic exposure research. Sec. 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure. Sec. 503. Studies related to veterans who served in Southwest Asia and certain other locations. Sec. 504. Study on health trends of post 9/11 veterans. Sec. 505. Study on cancer rates among veterans. Sec. 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities. Sec. 507. Study on health effects of waste related to Manhattan Project on certain veterans. Sec. 508. Study on toxic exposure and mental health outcomes. Sec. 509. Study on veterans in Territories of the United States. Sec. 510. Department of Veterans Affairs public website for toxic exposure research. Sec. 511. Biennial 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. Sec. 602. Publication of list of resources of Department of Veterans Affairs for toxic-exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans. Sec. 603. Incorporation of toxic exposure questionnaire during primary care appointments. Sec. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic-exposed veterans. Sec. 605. Guidelines for active duty military on potential risks and prevention of toxic exposures. Title VII—Registries, records, and other matters Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations. Sec. 702. Fort McClellan Health Registry. Sec. 703. Independent study on Individual Longitudinal Exposure Record. Sec. 704. Biannual report on Individual Longitudinal Exposure Record. Sec. 705. Correction of exposure records by members of the Armed Forces and veterans. Sec. 706. Federal cause of action relating to water at Camp Lejeune, North Carolina. Sec. 707. Veterans Toxic Exposures Fund. Sec. 708. Authorization of electronic notice in claims under laws administered by the Secretary of Veterans Affairs. Sec. 709. Authorization of appropriations for expansion of claims automation. Sec. 710. Non-applicability of non-Department of Veterans Affairs covenants not to compete to appointment of Veterans Health Administration personnel. Sec. 711. Recruitment of physicians on a contingent basis prior to completion of training requirements. Sec. 712. Authority for Secretary of Veterans Affairs to award grants to States to improve outreach to veterans. Sec. 713. Study and report on herbicide agent exposure in Panama Canal Zone. Sec. 714. Budget information for alternatives to burn pits. Sec. 715. Authorization of appropriations for expansion of claims automation. Sec. 716. Burn pit registry updates. Sec. 717. Burn pit transparency. I Expansion of health care eligibility A Toxic-exposed veterans 101. Short title This title may be cited as the Conceding Our Veterans’ Exposures Now And Necessitating Training Act or the COVENANT Act . 102. Definitions relating to toxic-exposed veterans (a) In general Section 1710(a)(2)(F) is amended by striking who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e) and inserting in accordance with subsection (e), who is a toxic-exposed veteran . (b) Definitions of toxic exposure and toxic-exposed 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. (B) An exposure to a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title. (38) The term toxic-exposed veteran means a veteran described in section 1710(e)(1) of this title. . (c) Definition of toxic exposure risk activity Section 1710(e)(4) is amended by adding at the end the following new subparagraph: (C) The term toxic exposure risk activity means any activity— (i) that requires a corresponding entry in an exposure tracking record system (as defined in section 1119(c) of this title) for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans. . 103. Expansion of health care for specific categories of toxic-exposed veterans and veterans supporting certain overseas contingency operations (a) In general (1) Expansion Subsection (e) of section 1710, as amended by section 102(c) , is further amended— (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 (including 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 operation specified in clause (ii) 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. (ii) A contingency operation specified in this clause is any of the following: (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 subparagraphs (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 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) The Secretary may modify a date specified in subparagraph (A) to an earlier date, as the Secretary determines appropriate based on the number of veterans receiving hospital care, medical services, and nursing home care under subparagraphs (G), (H), and (I) of paragraph (1) and the resources available to the Secretary. If the Secretary determines to so modify a date, the Secretary shall— (i) notify the Committees on Veterans’ Affairs of the House of Representatives and the Senate of the proposed modification; 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 prior to the date specified in the clause (including a date modified pursuant to such section), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a plan to conduct outreach to the veterans referred to 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. 104. Assessments of implementation and operation (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 (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 services 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 Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing the findings of the assessment completed under paragraph (1), including a specific determination as to whether the Department has the personnel and material 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 Committees on Veterans’ Affairs of the House of Representatives and the Senate a report 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 described 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 distance of the veteran from medical facilities of the Department and whether the veteran had previously 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. (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 subparagraph (A), the number of such veterans who, during the preceding three fiscal years, had not received 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 Program. (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 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, enrolled in the patient enrollment system. (ii) The number of such veterans who applied for, but were denied, such enrollment. (iii) The number of such veterans who were denied hospital care or a medical service furnished by the Secretary that was considered 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 Department). (F) The numbers and characteristics of, and the type and extent of health care furnished by the Secretary to, veterans not enrolled in the patient enrollment system (disaggregated by each class of eligibility for care under section 1710 of title 38, United States Code, and further shown 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 Secretary 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) The term patient enrollment system means the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38, United States Code. (2) The term Veterans Community Care Program means the program established under section 1703 of title 38, United States Code. 105. Revision of breast cancer mammography policy of Department of Veterans Affairs to provide mammography screening for veterans who served in locations associated with toxic exposure (a) In general Section 7322 of title 38, United States Code, is amended— (1) in subsection (a), by striking The and inserting In general .—The ; (2) in subsection (b)— (A) by striking The and inserting Standards for screening .—The ; and (B) in paragraph (2)(B), by inserting a record of service in a location and during a period specified in subsection (d), after risk factors, ; and (3) by adding at the end the following new subsections: (c) Eligibility for screening for veterans exposed to toxic substances The Under Secretary for Health shall ensure that, under the policy developed under subsection (a), any veteran who, during active military, naval, or air service, was deployed in support of a contingency operation in a location and during a period specified in subsection (d), is eligible for a mammography screening by a health care provider of the Department. (d) Locations and periods specified (1) The locations and periods specified in this subsection are the following: (A) Iraq during following periods: (i) The period beginning on August 2, 1990, and ending on February 28, 1991. (ii) The period beginning on March 19, 2003, and ending on such date as the Secretary determines burn pits are no longer used in Iraq. (B) The Southwest Asia theater of operations, other than Iraq, during the period beginning on August 2, 1990, and ending on such date as the Secretary determines burn pits are no longer used in such location, including the following locations: (i) Kuwait. (ii) Saudi Arabia. (iii) Oman. (iv) Qatar. (C) Afghanistan during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Afghanistan. (D) Djibouti during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Djibouti. (E) Syria during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Syria. (F) Jordan during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Jordan. (G) Egypt during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Egypt. (H) Lebanon during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Lebanon. (I) Yemen during the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Yemen. (J) Such other locations and corresponding periods as set forth by the Airborne Hazards and Open Burn Pit Registry 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). (K) Such other locations and corresponding periods as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate in a report submitted under paragraph (2). (2) Not later than two years after the date of the enactment of the Supporting Expanded Review for Veterans In Combat Environments Act of 2021 , and not less frequently than once every two years thereafter, the Secretary of Veterans Affairs, in collaboration with the Secretary of Defense, shall submit to Congress a report specifying other locations and corresponding periods for purposes of paragraph (1)(K). (3) A location under this subsection shall not include any body of water around or any airspace above such location. (4) In this subsection, the term burn pit means an area of land that is used for disposal of solid waste by burning in the outdoor air. . (b) Report on breast cancer rates for veterans deployed to certain areas Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report that compares the rates of breast cancer among members of the Armed Forces deployed to the locations and during the periods specified in section 7322(d) of title 38, United States Code, as added by subsection (a), as compared to members of the Armed Forces who were not deployed to those locations during those periods and to the civilian population. B Certain veterans of combat service and other matters 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 inserting September 11, 2001 ; and (B) by striking five-year period and inserting 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, medical services, or nursing home care under such paragraph pursuant to subparagraph (A) before October 1, 2022, the one-year period beginning on October 1, 2022. ; and (3) by striking subparagraph (C). (b) Clarification of coverage Section 1710(e)(1)(D) is amended by inserting after Persian Gulf War the following: (including any veteran who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary 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 shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a plan to conduct outreach to veterans described in subparagraph (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 services, or nursing home care pursuant to such subparagraph. (d) Report on enrollments Not later than January 30, 2024, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report identifying, with respect to the one-year period beginning on October 1, 2022, the number of veterans described in section 1710(e)(3)(B) of title 38, United States Code, as amended by subsection (a)(2), who, during such period, enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of such title. (e) Effective date This section and the amendments made by this section shall take effect on October 1, 2022. 112. Authorization period for emergency treatment in non-Department of Veterans Affairs medical facilities Section 1703(a)(3) of title 38, United States Code, is amended— (1) by striking A covered veteran and inserting (A) Except as provided by subparagraph (B), a covered veteran ; and (2) by adding at the end the following new subparagraph: (B) In the case of an emergency which existed at the time of admission of a covered veteran to a health care provider, the Secretary shall deem the care or services received by the veteran during such admission to be authorized under subparagraph (A) if the covered veteran (or an individual acting on behalf of the covered veteran) makes an application for such authorization during the period following such admission that the Secretary determines appropriate for purposes of this paragraph, except such period may not be less than 96 hours. . II Toxic exposure presumption process 201. Short title This subtitle may be cited as the Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act or the FASTER Presumptions Act . 202. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure (a) Advisory committees, panels, and boards Chapter 11 is amended by adding at the end the following new subchapter: VII Determinations relating to presumptions of service connection based on toxic exposure 1171. Procedures to determine presumptions of service connection based on toxic exposure; definitions (a) Procedures The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby— (1) the Formal Advisory Committee on Toxic Exposure under section 1172 of this title— (A) provides advice to the Secretary on toxic-exposed veterans and cases in which veterans who, during active military, naval, air, or space service, may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military, naval, air, or space service; (B) provides to the Secretary recommendations on corrections needed in the Individual Longitudinal Exposure Record, or successor system, to better reflect veterans and dependents described in subparagraph (A); and (C) provides to the Secretary recommendations regarding which cases of possible toxic exposure should be reviewed; and (2) the Secretary provides for formal evaluations of such recommendations under section 1173 of this title; and (3) the Secretary issues regulations under section 1174 of this title. (b) Illness defined In this subchapter, the term illness includes a disease or other condition affecting the health of an individual, including mental and physical health. 1172. Formal Advisory Committee on Toxic Exposure (a) Establishment (1) There is in the Veterans Health Administration of the Department the Formal Advisory Committee on Toxic Exposure (in this section referred to as the Committee ). (2) (A) The Committee shall be composed of nine members appointed as follows: (i) Five members shall be appointed by the Secretary. (ii) One member shall be appointed by the Speaker of the House of Representatives. (iii) One member shall be appointed by the minority leader of the House of Representatives. (iv) One member shall be appointed by the majority leader of the Senate. (v) One member shall be appointed by the minority leader of the Senate. (B) The members appointed under subparagraph (A) shall meet the following criteria: (i) Not more than three members shall be appointed from among individuals who are officials or employees of the Veterans Benefits Administration or the Veterans Health Administration. (ii) At least one member shall be appointed from among individuals who are officials or employees 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 Prevention. (iii) At least two members shall represent an organization recognized by the Secretary for the representation of veterans under section 5902 of this title. (iv) 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. (3) The Secretary shall determine the pay and allowances of the members of the Committee, including with respect to any additional pay and allowances for members who are officials or employees of the Federal Government. (4) (A) Except as provided by subparagraph (B), each member of the Committee shall be appointed for a two-year term, and may serve not more than three successive terms. (B) With respect to the five members who are initially appointed by the Secretary under subparagraph (A)(i), the Secretary shall determine the length of the term of each such member in a manner that ensures the expiration of the terms on a staggered basis. (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 cases in which veterans who, during active military, naval, air, or space service, are suspected of having experienced a toxic exposure or dependents of veterans who may have experienced a toxic exposure during such service. (c) Assessments (1) The Committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, air, or space service, including by conducting ongoing surveillance and reviewing such exposure described in scientific literature, media reports, information from veterans, and information from Congress. (2) The assessments under paragraph (1) shall cover suspected and known toxic exposures occurring during active military, naval, air, or space service, including by identifying and evaluating new and emerging toxic exposures that are not recognized under existing presumptions of service connection. (3) The Committee may conduct an assessment under paragraph (1) in response to comments by a person described in subsection (e)(2), by a majority vote of the members of the Committee. (4) The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record, or successor system, to ensure the accuracy of data collected. (d) Research recommendations (1) Following an assessment of a case of the toxic exposure of veterans or their dependents that occurred during active military, naval, air, or space service under subsection (c), the Committee may develop a recommendation for formal evaluation under section 1173 of this title to conduct a review of the health effects related to the case of exposure if the Committee determines that the research may change the current understanding of the relationship between 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 Committee may nominate such evidence for formal evaluation under section 1173 of this title to modify the periods and locations. (e) Input (1) Not less than quarterly, the Committee 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 persons who may be affected by the actions of the Committee, including— (A) veterans, the families of veterans, veterans service organizations and representatives, researchers, and other members of the general public; and (B) departments and agencies of the Federal Government. (f) Reports by the Committee Not less frequently than once each year, the Committee shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) recommendations for research under subsection (d), if any; and (2) recommendations for such legislative or administrative action as the Committee considers necessary for the Committee to be more effective in carrying out the requirements of this section. (g) Responses by Secretary In response to each report submitted under subsection (f), the Secretary shall submit to the Secretary and the Committees on Veterans’ Affairs of the Senate and the House of Representatives, and make publicly available, a report on— (1) the findings and opinions of the Secretary with respect to the report most recently submitted under subsection (f); and (2) whether the Secretary will conduct research recommended under subsection (f) included in the report, and if not, an explanation of why, including citations and sources. (h) Nonapplication of sunset requirements Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Committee. 1173. Formal evaluation of recommendations (a) Formal evaluation The Secretary shall establish a process to conduct a formal evaluation with respect to each recommendation made by the Formal Advisory Committee on Toxic Exposure under section 1172 of this title— (1) to conduct research regarding the health effects related to a case of toxic exposure; or (2) to evaluate evidence regarding the periods and locations of exposure covered by an existing presumption of service connection. (b) Evidence, data, and factors The Secretary shall ensure that each formal evaluation under paragraph (1) covers the following: (1) Scientific evidence, based on the review of available scientific literature, including human, toxicological, animal, and methodological studies, and other factors. (2) Claims data, based on the review of claim rate, grant rate, and service connection prevalence, and other factors. (3) Other factors the Secretary determines appropriate, such as— (A) the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated; (B) the level of assistance required to remain in the community because of such health effects; (C) the quantity and quality of the information available and reviewed; (D) the feasibility of and period for generating relevant information and evidence; (E) whether such health effects are combat- or deployment-related; and (F) the ubiquity or rarity of the health effects. (c) Conduct of evaluations (1) The Secretary shall ensure that each formal evaluation under subsection (a)— (A) reviews scientific evidence in a manner that— (i) conforms to principles of scientific and data integrity; (ii) is free from suppression or distortion of scientific or technological findings, data, information, conclusions, or technical results; and (B) (i) evaluates the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military, naval, air, or space service; and (ii) assesses the toxic exposures and illnesses and determines whether the evidence supports a finding of a positive association between the toxic exposure and the illness. (2) In carrying out paragraph (1)(B)(ii), a formal evaluation under subsection (a) shall include reviewing all relevant data to determine the strength of evidence for a positive association based on the following four categories: (A) The sufficient category, where the evidence is sufficient to conclude that a positive association exists. (B) The equipoise and above category, where the evidence is sufficient to conclude that a positive association is at least as likely as not, but not sufficient to conclude that a positive association exists. (C) The below equipoise category, where the evidence is not sufficient to conclude that a positive association is at least as likely as not, or is not sufficient to make a scientifically informed judgment. (D) The against category, where the evidence suggests the lack of a positive association. (d) Recommendation for rulemaking Not later than 120 days after the date on which a formal evaluation is commenced, the element of the Department that conducts the evaluation shall submit to the Secretary a recommendation with respect to establishing a presumption of service connection for the toxic exposure and illness, or modifying an existing presumption of service connection, covered by the evaluation. 1174. Regulations regarding presumptions of service connection based on toxic exposure (a) Action upon recommendation Not later than 160 days after the date on which the Secretary receives a recommendation to establish or modify a presumption of service connection under section 1173 of this title— (1) if the Secretary determines that the presumption, or modification, is warranted, the Secretary shall commence issuing regulations in accordance with the provisions of subchapter II of chapter 5 of title 5 (commonly referred to as the Administrative Procedures Act) setting forth the presumption or commence revising regulations to carry out such modification; or (2) if the Secretary determines that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register a notice of the determination, including the reasons supporting the determination. (b) Removal of presumption (1) The Secretary may issue regulations to remove an illness from a presumption of service connection previously established pursuant to a regulation issued under subsection (a). (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 provided 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 entitled to receive dependency and indemnity compensation on such basis. 1175. Authority to modify process; congressional oversight (a) Authority (1) The Secretary may modify the process under which the Secretary conducts formal evaluations under section 1173 of this title and issues regulations under section 1174 if— (A) such evaluations cover the evidence, data, and factors required by subsection (b) of such section 1173; and (B) a period of 180 days has elapsed following the date on which the Secretary submits the notice under paragraph (2) regarding the modification. (2) If the Secretary proposes to modify the process under which the Secretary conducts formal evaluations under section 1173 of this title or issues regulations under section 1174, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a notice of the proposed modifications containing the following: (A) A description of the proposed modifications. (B) A description of any exceptions to the requirements of such sections that are proposed because of limited available scientific evidence, and a description of how such evaluations will be conducted. (b) Reports and briefings (1) (A) Not later than two years after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the implementation of, and recommendations for, this subchapter. (B) The Secretary shall develop the report under subparagraph (A) in consultation with organizations recognized by the Secretary for the representation of veterans under section 5902 of this title and any other entity the Secretary determines appropriate. (2) On a quarterly basis during the two-year period beginning on the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, the Secretary shall provide to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a briefing on the implementation of this subchapter. (c) Independent review The Secretary shall seek to enter into an agreement with a nongovernmental entity or a federally funded research and development center to conduct a review of the implementation of this subchapter. Not later than 540 days after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing such review. . (b) Conforming amendments Chapter 11 is amended— (1) in section 1116— (A) by striking subsections (b), (c), (d), and (e); (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter VII of this chapter, including with respect to assessing reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991 ( Public Law 102–4 ). ; and (C) by redesignating subsection (f) as subsection (c); (2) in section 1116B(b)(2)(A), by inserting pursuant to subchapter VII of this chapter, before the Secretary determines ; and (3) in section 1118— (A) by striking subsections (b) through (e); and (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter. . (c) Rule of construction Nothing in section 1172(a)(2)(A) of title 38, United States Code, as added by subsection (a), shall be construed so as to require the advice and consent of the Senate in the appointment of members of the Formal Advisory Committee on Toxic Exposure. 203. Reevaluation of claims for compensation involving presumptions of service connection (a) In general Subchapter VI of chapter 11 is amended by adding at the end the following new section: 1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection (a) Reevaluation Whenever a law, including through a regulation or Federal court decision, establishes or modifies a presumption of service connection, the Secretary shall— (1) identify all claims for compensation under this chapter that— (A) were submitted to the Secretary; (B) were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and (C) might have been evaluated differently had the establishment or modification been applicable to the claim; (2) allow for the reevaluation of such claims at the election of the veteran; and (3) notwithstanding section 5110 of this title, with respect to claims approved pursuant to such reevaluation, provide compensation under this chapter effective as if the establishment or modification of the presumption of service connection had been in effect on the date of the submission of the original claim described in paragraph (1). (b) Outreach The Secretary shall conduct outreach to inform relevant veterans that they may elect to have a claim be reevaluated in light of the establishment or modification of a presumption of service connection described in subsection (a). Such outreach shall include the following: (1) The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to have a claim so reevaluated. (2) The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such veterans to elect to have a claim so reevaluated. . (b) Application Section 1167 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act. III Improving the establishment of service connection process for toxic-exposed veterans 301. Short title This title may be cited as the Veterans Burn Pits Exposure Recognition Act . 302. Presumptions of toxic exposure Subchapter II of chapter 11 is amended by adding at the end the following new section: 1119. Presumptions of toxic exposure (a) Consideration of records If a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and a toxic exposure that occurred during active military, naval, air, or space service, the Secretary may, in adjudicating such claim, consider— (1) any record of the veteran in an exposure tracking record system; and (2) if no record of the veteran in an exposure tracking record system indicates that the veteran was subject to a toxic exposure during active military, naval, air, or space service, the totality of the circumstances of the service of the veteran. (b) Presumption of specific toxic exposure for members who served in certain locations (1) The Secretary shall, for purposes of section 1110 and chapter 17 of this title, presume that any covered veteran was exposed to the substances, chemicals, and airborne hazards identified in the list under paragraph (2) during the service of the covered veteran specified in subsection (c)(1), unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. (2) The Secretary shall establish and maintain a list that contains an identification of one or more such substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate for purposes of this section. (3) Beginning not later than two years after the date of the enactment of the Honoring our Promise to Address Comprehensive Toxics Act of 2021, and not less frequently than once every two years thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report identifying any additions or removals to the list under paragraph (2) during the period covered by the report. (c) Definitions In this section: (1) The term covered veteran means any veteran who— (A) on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in— (i) Bahrain; (ii) Iraq; (iii) Kuwait; (iv) Oman; (v) Qatar; (vi) Saudi Arabia; (vii) Somalia; or (viii) United Arab Emirates; or (B) on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in— (i) Afghanistan; (ii) Djibouti; (iii) Egypt; (iv) Jordan; (v) Lebanon; (vi) Syria; (vii) Yemen; (viii) Uzbekistan; (ix) the Philippines; or (x) any other country determined relevant by the Secretary. (2) The term exposure tracking record system — (A) means any system, program, or pilot program used by the Secretary of Veterans Affairs or the Secretary of Defense to track how veterans or members of the Armed Forces have been exposed to various occupational or environmental hazards; and (B) includes the Individual Longitudinal Exposure Record, or successor system. (3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . 303. Medical nexus examinations for toxic exposure risk activities Subchapter VI of chapter 11, as amended by section 203, is further amended by adding at the end the following new section: 1168. Medical nexus examinations for toxic exposure risk activities (a) Medical examinations and medical opinions (1) Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall— (A) provide the veteran with a medical examination under section 5103A(d) of this title; and (B) obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under subparagraph (A)) as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. (2) When providing the Secretary with a medical opinion under paragraph (1)(B) for a veteran, the health care provider shall consider— (A) the total potential exposure through all applicable military deployments of the veteran; and (B) the synergistic, combined effect of all toxic exposure risk activities of the veteran. (3) The requirement under paragraph (2)(B) shall not be construed as requiring a health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and airborne hazards identified in the list under section 1119(b)(2) of this title. (b) Exception Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. (c) Toxic exposure risk activity defined In this section, the term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of this title. . IV Presumptions of service connection 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 Veterans Affairs (a) Short title This section may be cited as the Mark Takai Atomic Veterans Healthcare Parity Act . (b) Enewetak Atoll Section 1112(c)(3)(B) is amended by adding at the end the following new clause: (v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980. . 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 certain disabilities by Department of Veterans Affairs (a) Short title This section may be cited as the Palomares or Thule Veterans Act (b) Palomares or Thule Section 1112(c)(3)(B), as amended by section 401 , is further amended by adding at the end the following new clauses: (vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967. (vii) Onsite participation in the response effort following the on-board fire and crash of a United States Air Force B–52 bomber that caused the release of four thermonuclear weapons in the vicinity of Thule Air Force Base, Greenland, during the period beginning January 21, 1968, and ending September 25, 1968. . 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations (a) Short title This section may be cited as the Veterans Agent Orange Exposure Equity Act . (b) In general Section 1116, as amended by section 202, is further amended— (1) by striking , during active military, naval, air, or space service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; (2) by striking performed active military, naval, air, or space service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; and (3) by adding at the end the following new subsection: (d) In this section, the term covered service means active military, naval, air, or space service— (1) performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; (2) performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; (3) performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; (4) performed in Cambodia at Mimot or Krek, Kampong Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or (5) performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977. . (c) Eligibility for hospital care and medical services Section 1710(e)(4), as amended by section 102(c), is further amended by striking subparagraph (A) and inserting the following new subparagraph: (A) The term Vietnam-era herbicide-exposed veteran means a veteran who— (i) performed covered service, as defined in section 1116(d) of this title; or (ii) the Secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period. . (d) Conforming amendment The heading for section 1116 is amended by striking the Republic of Vietnam and inserting certain locations . 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations (a) Short title This section may be cited as the Fair Care for Vietnam Veterans Act . (b) Additional diseases Section 1116(a)(2), as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 ( Public Law 116–283 ), is further amended by adding at the end the following new subparagraphs: (L) Hypertension. (M) Monoclonal gammopathy of undetermined significance. . 405. Improving compensation for disabilities occurring in Persian Gulf War veterans (a) Reduction in threshold of eligibility Subsection (a)(1) of section 1117 is amended by striking became manifest— and all that follows through the period at the end and inserting became manifest to any degree at any time. . (b) Permanent extension of period of eligibility Such section is further amended— (1) by striking subsection (b); (2) by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and (3) in subsection (a)(2)(C), by striking under subsection (d) and inserting under subsection (c) . (c) Establishing singular disability-based questionnaire Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new subsection (d): (d) If a Persian Gulf veteran at a medical facility of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care personnel of the Department use a disability benefits questionnaire, or successor questionnaire, designed to identify Gulf War Illness, in addition to any other diagnostic actions the personnel determine appropriate. . (d) Expansion of definition of Persian Gulf veteran Subsection (f) of such section is amended by inserting , Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, after operations . (e) Training Such section is further amended by adding at the end the following new subsection: (i) (1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department are appropriately trained to effectively carry out this section. (2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1). . 406. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Short title This section may be cited as the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act . (b) In general Subchapter II of chapter 11, as amended by section 302 , is further amended by inserting after section 1119 the following new section: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Presumption of service connection For the purposes of section 1110 of this title, and subject to section 1113 of this title, a disease specified in subsection (b) becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service, notwithstanding that there is no record of evidence of such disease during the period of such service. (b) Diseases specified The diseases specified in this subsection are the following: (1) Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). (2) The following types of cancer: (A) Head cancer of any type. (B) Neck cancer of any type. (C) Respiratory cancer of any type. (D) Gastrointestinal cancer of any type. (E) Reproductive cancer of any type. (F) Lymphoma cancer of any type. (G) Lymphomatic cancer of any type. (H) Kidney cancer. (I) Brain cancer. (J) Melanoma. (K) Pancreatic cancer. (3) Chronic bronchitis. (4) Chronic obstructive pulmonary disease. (5) Constrictive bronchiolitis or obliterative bronchiolitis. (6) Emphysema. (7) Granulomatous disease. (8) Interstitial lung disease. (9) Pleuritis. (10) Pulmonary fibrosis. (11) Sarcoidosis. (12) Chronic sinusitis. (13) Chronic rhinitis. (14) Glioblastoma. (15) Any other disease for which the Secretary determines, pursuant to regulations prescribed under subchapter VII that a presumption of service connection is warranted based on a positive association with a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title. (c) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of this title. . (c) Conforming amendment Section 1113 is amended by striking or 1118 each place it appears and inserting 1118, or 1120 . V Research matters 501. Interagency working group on toxic exposure research (a) In general Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section: 7330D. Interagency working group on toxic exposure research (a) Establishment (1) The Secretary shall establish the Toxic Exposure Research Working Group (in this section referred to as the Working Group ). (2) The Working Group shall consist of employees, selected by the Secretary, of the following: (A) The Department. (B) The Department of Defense. (C) The Department of Health and Human Services. (D) The Environmental Protection Agency. (E) Other Federal entities involved in research activities regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service. (b) Functions The Working Group shall perform the following functions: (1) Identify collaborative research activities and resources available among entities represented by members of the Working Group to conduct such collaborative research activities. (2) Develop a 5-year strategic plan for Federal entities represented in the Working Group to carry out collaborative research activities. (c) Reporting The Secretary shall submit, to the Committees on Veterans’ Affairs of the Senate and House of Representatives, the following: (1) Not later than one year after the date of the enactment of the Act, a report on the establishment of the Working Group under subsection (a). (2) Not later than two years after the date of enactment of the Act, a report containing the collaborative research activities identified, and the Strategic Plan developed, by the Working Group, under subsection (b). (3) Annually during the 5-year period covered by the strategic plan under subsection (b), a progress reports on implementation of the Strategic Plan under subsection (b). (d) Termination The Working Group shall terminate after submitting the final report under subsection (c). (e) Definitions For purposes of this section— (1) The term Act means the Honoring our Promise to Address Comprehensive Toxics Act of 2021. (2) The term collaborative research activity means a research activity— (A) conducted by an entity represented by a member of the Working Group; (B) funded by the Federal Government; and (C) regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service. . (b) Clerical amendment The table of sections at the beginning of such subchapter is amended by inserting after the item relating to section 7330C the following new item: 7330D. Interagency working group on toxic exposure research. . (c) Implementation The Secretary of Veterans Affairs shall establish the Working Group under section 7330D of such title, as added by subsection (a), not later than one year after the date of the enactment of this Act. 502. Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure (a) In general The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that— (1) is obtained by the Secretary in connection with hospital care (including mental health services and counseling), medical services, or nursing home care furnished to a veteran for an illness under section 1710(a)(2)(F) of title 38, United States Code, as amended by section 102 ; and (2) is likely to be scientifically useful, as determined by the Secretary, in determining whether a positive association exists between the illness of the veteran and a toxic exposure. (b) Consent of patients The Secretary shall ensure that the compilation and analysis of the clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, in a manner that is consistent with the informed consent of the veteran and in compliance with all applicable Federal law. (c) Annual report Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing— (1) any data compiled under subsection (a); (2) an analysis of any such data; (3) a description of the types and incidences of illnesses identified by the Secretary pursuant to such subsection; (4) an explanation by the Secretary for the incidence of such illnesses and such alternate explanations for the incidence of such illnesses as the Secretary may consider reasonable; and (5) a description of the views of the Secretary regarding the scientific validity of drawing conclusions from the incidence of such illnesses, as evidenced by the data compiled under subsection (a), regarding the existence of a positive association between such illness and a toxic exposure. (d) Definitions In this section: (1) The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. 503. Studies related to veterans who served in Southwest Asia and certain other locations (a) Analysis on mortality in covered veterans (1) Analysis Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct an updated analysis of total and respiratory disease mortality in covered veterans. (2) Elements The analysis under paragraph (1) shall include, to the extent practicable, the following: (A) Metrics of airborne exposures. (B) The location and timing of any deployments of the veteran. (C) The military occupational specialty of the veteran. (D) The Armed Force in which the veteran served. (E) The preexisting health status of the veteran, including with respect to asthma. (F) Such personal information of the veteran as the Secretary may consider relevant, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity. (b) Epidemiological study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct an epidemiological study of covered veterans that involves— (1) the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment; and (2) the collection of detailed information on the covered veterans studied through medical records, administrative data, and other existing sources, including, with respect to the covered veterans— (A) personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity; (B) deployment history, including locations, periods, and number of deployments; (C) biospecimen data; and (D) supplementary health status and outcomes data, including imaging and physiological parameters. (c) Toxicology study (1) Study Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a toxicology study, to include variability, to replicate toxic exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions. (2) Elements The study under paragraph (1) shall include— (A) an analysis of results for mechanistic markers and clinically relevant outcomes; and (B) a validation of any serum, tissue, or other biomarkers of toxic exposure, susceptibility, or effect with respect to the subjects of the study. (d) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of title 38, United States Code, as added by section 302. 504. Study on health trends of post 9/11 veterans (a) Study The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001. (b) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The race and ethnicity of the veteran. (2) The age of the veteran. (3) The period of service and length of service of the veteran in the Armed Forces. (4) Any military occupational speciality of the veteran. (5) The gender of the veteran. (6) The disability status of the veteran. (c) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 505. Study on cancer rates among veterans (a) Study The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans, to determine trends in the rates of the incidence of cancer in veterans, and on available early detection diagnostics, to determine the feasibility and advisability of including such diagnostics as part of the health care furnished to veterans by the Secretary. (b) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The race and ethnicity of the veteran. (2) The age of the veteran. (3) The period of service and length of service of the veteran in the Armed Forces. (4) Any military occupational speciality of the veteran. (5) The gender of the veteran. (6) Any type of cancer that the veteran has. (c) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). 506. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities (a) Study The Secretary of Veterans Affairs shall conduct a study on the feasibility and advisability of furnishing hospital care and medical services to qualifying dependents of veterans described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 103(a)(1), for any illness determined by the Secretary to be connected to a toxic exposure risk activity carried out by the veteran, as determined by the Secretary, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such activity. (b) Elements The study under subsection (a) shall include— (1) an assessment of the impact of furnishing hospital care and medical services to qualifying dependents as described in such subsection on the ability of the Department of Veterans Affairs to furnish hospital care and medical services to veterans; (2) an assessment of the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection; (3) an estimate of the resources required to furnish such care and services; (4) an assessment of any stress or other effect furnishing such care and services would have on the claims and appeals system of the Department; (5) an estimate of the number of qualifying dependents who would be eligible for such care and services; and (6) an assessment of the feasibility of adjudicating claims for such care and services. (c) Phased-In application In conducting the study under subsection (a), the Secretary shall assess the feasibility and advisability of phasing in the furnishing of hospital care and medical services to qualifying dependents described in such subsection by the decade in which such toxic exposure risk activity occurred, starting with the most recent decade. (d) Review of toxic exposure cases regarding liability of Department of Defense In conducting the study under subsection (a), the Secretary shall— (1) review known cases of toxic exposure on military installations of the Department of Defense; (2) analyze the liability of the Department of Defense in each such case; and (3) assess whether the Secretary of Defense should provide care and services relating to such toxic exposures under the TRICARE program. (e) Report Not later than two years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a). (f) Definitions In this section: (1) The terms hospital care and medical services have the meanings given those terms in section 1701 of title 38, United States Code. (2) The term illness has the meaning given that term in section 1171 of such title, as added by section 202. (3) The term qualifying dependent means— (A) a dependent of a veteran described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 104(a)(1), who resided with the veteran during the period in which, and on the installation at which, the veteran participated in a toxic exposure risk activity; (B) an individual who was in utero of such a veteran or other qualifying dependent when the veteran participated in a toxic exposure risk activity; or (C) a dependent of such a veteran who is not described in subparagraph (A) or (B) but who may have an illness that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary. (4) The term toxic exposure has the meaning given that term in section 101 of such title, as added by section 102(b) . (5) The term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of such title, as added by section 102(c) . (6) The term TRICARE program has the meaning given that term in section 1072 of such title. 507. Study on health effects of waste related to Manhattan Project on certain veterans (a) Study The Secretary of Veterans Affairs shall conduct a study on the health trends of veterans who, while serving in the active military, naval, air, or space service— (1) participated in activities relating to the Manhattan Project (including activities relating to covered waste) in connection with such service; or (2) resided at or near, as determined by the Secretary, the locations described in subsection (b). (b) Covered locations The locations described in this subsection are the following locations in the county of St. Louis, Missouri: (1) Coldwater Creek. (2) The St. Louis Airport Site. (3) The West Lake Landfill. (4) Any other location in the county of St. Louis, Missouri that is proximate to covered waste, as determined by the Secretary. (c) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The age, gender, and race of the veteran. (2) The period and location of exposure to covered waste. (3) Any type of cancer, or other illness associated with toxic exposure, that the veteran has. (4) A comparison of the overall health condition of the veteran, including any illness of the veteran identified pursuant to paragraph (3), with the overall health condition of past and present civilian populations residing at the same location of exposure. (d) Report Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a). (e) Definitions In this section: (1) The term covered waste means any waste arising from activities carried out in connection with the Manhattan Project. (2) The term illness has the meaning given that term in section 1171 of title 38, United States Code, as added by section 202. (3) The term toxic exposure has the meaning given that term in section 101 of such title, as added by section 102(b). 508. Study on toxic exposure and mental health outcomes (a) Study required The Secretary of the Department of Veterans Affairs shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for the conduct of a study of veterans to assess possible relationships between toxic exposures experienced during service in the Armed Forces and mental health outcomes, including chronic multisymptom illness, traumatic brain injury, post-traumatic stress disorder, depression, psychosis, suicide attempts, and suicide deaths. (b) Elements For each veteran included in the study under subsection (a), the following information shall be collected and assessed: (1) Age. (2) Gender. (3) Race and ethnicity. (4) Period and length of service in the Armed Forces. (5) History of toxic exposure during service in the Armed Forces. (6) Any diagnosis of chronic multisymptom illness. (7) Any diagnosis of a mental health or cognitive disorder. (8) Any history of suicide attempt or suidcidality. (9) If the veteran died by suicide. (c) Report Not later than two years after the date after the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report containing the findings of the study conducted under subsection (a). 509. Study on veterans in Territories of the United States (a) GAO study (1) In general The Comptroller General of the United States shall conduct a study on the state of access and barriers to benefits and services furnished under laws administered by the Secretary of Veterans Affairs to veterans in Territories of the United States, including deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the United States. (2) Elements The study under paragraph (1) shall include— (A) the number of veterans in each Territory of the United States; (B) the number of veterans in each Territory who are enrolled in the system of annual patient enrollment of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code; (C) the number of veterans in each Territory who are eligible for services under section 1710 of such title but who are not enrolled as described in subparagraph (B); (D) a detailed description of obstacles facing veterans in each Territory in accessing health care services, including those involving the availability of such services to veterans in the Territory in which the veterans reside, and the distance required of veterans to journey to receive services at a regional medical center of the Veterans Health Administration, a community-based outpatient clinic, or other full-service medical facility of the Department, or death center, respectively; (E) a detailed description of obstacles facing veterans in each Territory in accessing readjustment counseling services, including those involving the availability of such services to veterans in the Territory in which the veterans reside, and the distance required of veterans to journey to receive services at a readjustment counseling services center of the Department; (F) a detailed description of obstacles facing veterans in each Territory in accessing other veterans benefits, including those involving the availability of benefits and services to veterans in the Territory in which the veterans reside, and the distance required of the veterans to journey to the nearest office of the Veterans Benefits Administration; (G) an analysis of the staffing and recordkeeping levels and quality of the offices of the Department charged with serving veterans in the Territories, including the availability of the full- and part-time staff of each office to the veterans they are charged with serving, and the continuity of care provided by such staff to such veterans; (H) an analysis of the availability of the Veterans Community Care Program established under section 1703 of title 38, United States Code, to veterans in each Territory; (I) an analysis of the economic and health consequences for veterans in each Territory resulting from obstacles to accessing adequate assistance and health care at facilities of the Department; (J) an analysis of the access to assistance and health care provided to veterans in the aftermath of major disasters declared in each of the Territories since September 4, 2017; and (K) recommendations for improving access of veterans in the Territories to benefits and services furnished by the Secretary, and reducing barriers and deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the United States. (b) Report Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a final report setting forth the results of the study conducted under subsection (a), including the recommendations developed under paragraph (2)(K) of such subsection. (c) Territory defined In this section, the term Territory includes American Samoa, the Commonwealth of the Northern Marianas Islands, Guam, Puerto Rico, and the Virgin Islands. 510. Department of Veterans Affairs public website for toxic exposure research (a) Website Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish, and maintain thereafter, a publically accessible internet website of the Department of Veterans Affairs that serves as a clearinghouse for the publication of all toxic exposure research carried out or funded by the executive branch of the Federal Government. (b) Relation to War Related Illness and Injury Study Center The website developed and maintained under subsection (a) shall be housed under the website of the War Related Illness and Injury Study Center of the Department of Veterans Affairs, or successor center. (c) Coordination In carrying out subsection (a), the Secretary shall coordinate with— (1) the heads of each Federal department or agency carrying out or funding toxic exposure research; (2) the War Related Illness and Injury Study Center of the Department of Veterans Affairs, or successor center; and (3) any working group of the Department of Veterans Affairs or other similar entity responsible for coordinating toxic exposure research. (d) Definitions In this section: (1) The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code, as added by section 102(b). (2) The term toxic exposure research means research on the health consequences of toxic exposures experienced during service in the Armed Forces. 511. Biennial report on health effects of jet fuels used by Armed Forces Not later than one year after the date of the enactment of this Act, and biennially thereafter during the subsequent eight-year period, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate, and make publicly available, a report that includes— (1) a discussion of the effect of various different types of jet fuels used by the Armed Forces on the health of individuals by length of exposure; (2) an identification of the immediate symptoms of jet fuel exposure that may indicate future health risks; (3) a chronology of health safeguards implemented by the Armed Forces intended to reduce the exposure of members of the Armed Foces to jet fuel; and (4) an identification of any areas relating to jet fuel exposure about which new research needs to be conducted. VI Improvement of resources and training regarding toxic-exposed veterans 601. Short title; definitions (a) Short title This title may be cited as the Toxic Exposure in the American Military Act or the TEAM Act . (b) Definitions In this title, the terms active military, naval, air, or space service , toxic exposure , and toxic-exposed veteran have the meanings given those terms in section 101 of title 38, United States Code. 602. Publication of list of resources of Department of Veterans Affairs for toxic-exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans (a) Publication of list of resources (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for— (A) toxic-exposed veterans, including with respect to— (i) disability compensation under chapter 11 of title 38, United States Code; and (ii) hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title; (B) caregivers of toxic-exposed veterans who are participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title; and (C) survivors of toxic-exposed veterans who are receiving death benefits under the laws administered by the Secretary. (2) Update The Secretary shall periodically update the list published under paragraph (1). (3) Languages The Secretary shall publish the list under paragraph (1) in languages including the following: (A) English. (B) Spanish. (C) Chinese. (D) The seven other most commonly spoken languages in the United States. (b) Outreach The Secretary shall develop, with input from the community, an informative outreach program for veterans on illnesses that may be related to toxic exposure, including outreach with respect to benefits and support programs. Information distributed under the outreach program shall be treated as a fact sheet of the Department of Veterans Affairs for purposes of making the information available in multiple languages pursuant to section 2 of the Veterans and Family Information Act ( Public Law 117–62 ; 38 U.S.C. 6303 note). (c) Veterans organizations To the extent practicable, the Secretary shall share with national veterans service organizations and other veterans groups, including such organizations and groups that improve access by veterans to health care and benefits, the list of resources under subsection (a) and the outreach program under subsection (b). 603. Incorporation of toxic exposure questionnaire during primary care appointments (a) In general The Secretary of Veterans Affairs shall incorporate a clinical questionnaire to help determine potential toxic exposures during active military, naval, air, or space service as part of the initial screening conducted for an appointment of a veteran with a primary care provider of the Department of Veterans Affairs to improve understanding by the Department of toxic exposures of veterans while serving in the Armed Forces. (b) Determination of questions The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals. 604. Training for personnel of the Department of Veterans Affairs with respect to toxic-exposed veterans (a) Health care personnel The Secretary of Veterans Affairs shall provide to health care personnel of the Department of Veterans Affairs education and training to identify, treat, and assess the impact on toxic-exposed veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures. (b) Benefits personnel (1) Standard claims processor training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall ensure that a standard training curriculum exists for processors of claims under the laws administered by the Secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposure, including employees who adjudicate such claims. (B) Matters included The Secretary shall ensure that the training under subparagraph (A) includes the following explanations with respect to claims relating to toxic exposure: (i) A lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist. (ii) The claims adjudicator shall always consider whether direct service connection is applicable and request, as needed, an advisory medical opinion pursuant to section 1168 of title 38, United States Code, as added by section 303 . (iii) The claims adjudicator may review and consider any record of the claimant in an exposure tracking record system pursuant to section 1119 of such title, as added by section 302 , but a lack of such information is not by itself sufficient to determine that such exposure did not occur or sufficient to deny the claim. (C) Provision of training The Secretary shall— (i) provide training under subparagraph (A) to each employee described in such subparagraph not less frequently than annually; and (ii) using the Systematic Technical Accuracy Review program, or such successor program, conduct a nationwide, quarterly, randomized review of the quality of adjudication of claims relating to toxic exposure. (2) Standard medical examiner training curriculum (A) Curriculum Not later than 180 days after the date of the enactment of this Act, the Secretary shall ensure that a standard medical training curriculum exists for medical providers who conduct examinations and provide opinions pursuant to section 1168 of title 38, United States Code, as added by section 303 , regardless of whether the provider is an employee of the Department or a contractor. (B) Standardized approach The Secretary shall ensure that the curriculum established under subparagraph (A)— (i) provides a standardized approach to conducting and providing examinations and opinions in accordance with such section 1168; and (ii) instructs medical providers to consider, when conducting an examination or providing an opinion— (I) relevant medical and scientific literature; (II) the proximity, intensity, and frequency of exposure of the individual to the identified toxic exposure; (III) medically unexplained chronic multisymptom illnesses; and (IV) all competent and credible evidence of record. 605. Guidelines for active duty military on potential risks and prevention of toxic exposures Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense and the Secretary of Veterans Affairs shall jointly coordinate and establish guidelines to be used during training of members of the Armed Forces serving on active duty to provide the members awareness of the potential risks of toxic exposures and ways to prevent being exposed during combat. VII Registries, records, and other matters 701. Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations (a) Establishment of registry (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances (in this section referred to as PFAS ) due to the environmental release of aqueous film-forming foam (in this section referred to as AFFF ) on military installations to meet the requirements of military specification MIL–F–24385F; (B) include any information in such registry that the Secretary determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to PFAS associated with AFFF; (C) develop a public information campaign to inform eligible individuals about the registry, including how to register and the benefits of registering; and (D) periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to PFAS. (2) Coordination The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense in carrying out paragraph (1). (b) Reports (1) Initial report Not later than one year after the date of the enactment of this Act, the Secretary of Defense shall submit to Congress a report regarding the following: (A) Sources of PFAS on military installations other than AFFF. (B) Any recommendation of the Secretary regarding whether to expand eligibility for the registry to individuals exposed to sources of PFAS described in subparagraph (A). (2) Interim report Not later than two years after the date on which the registry under subsection (a) is established, the Secretary of Veterans Affairs shall submit to Congress an initial report containing the following: (A) An assessment of the effectiveness of actions taken by the Secretary of Veterans Affairs and the Secretary of Defense to collect and maintain information on the health effects of exposure to PFAS. (B) Recommendations to improve the collection and maintenance of such information. (C) Using established and previously published epidemiological studies, recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to exposure to PFAS. (3) Followup report Not later than five years after submitting the initial report under paragraph (1), the Secretary of Veterans Affairs shall submit to Congress a followup report containing the following: (A) An update to the initial report submitted under paragraph (1). (B) An assessment of whether and to what degree the content of the registry established under subsection (a) is current and scientifically up to date. (4) Independent scientific organization The Secretary of Veterans Affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs (1) and (2). (c) Recommendations for additional exposures To be included Not later than five years after the date of the enactment of this Act, and every five years thereafter, the Secretary of Veterans Affairs, in consultation with the Secretary of Defense and the Administrator of the Environmental Protection Agency, shall submit to Congress recommendations for additional chemicals with respect to which individuals exposed to such chemicals should be included in the registry established under subsection (a). (d) Eligible individual defined In this section, the term eligible individual means any individual who, on or after a date specified by the Secretary of Veterans Affairs through regulations, served or is serving in the Armed Forces at a military installation where AFFF was used or at another location of the Department of Defense where AFFF was used. 702. Fort McClellan Health Registry (a) Establishment The Secretary of Veterans Affairs shall establish and maintain a special record to be known as the Fort McClellan Health Registry (in this section referred to as the Registry ). (b) Contents Except as provided in subsection (c), the Registry shall include the following information: (1) A list containing the name of each individual who, while serving as a member of the Armed Forces, was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, and who— (A) applies for care or services from the Department of Veterans Affairs under chapter 17 of title 38, United States Code; (B) files a claim for compensation under chapter 11 of such title on the basis of any disability which may be associated with such service; (C) dies and is survived by a spouse, child, or parent who files a claim for dependency and indemnity compensation under chapter 13 of such title on the basis of such service; (D) requests from the Secretary a health examination under subsection (d); or (E) receives from the Secretary a health examination similar to the health examination referred to in subparagraph (D) and requests inclusion in the Registry. (2) Relevant medical data relating to the health status of, and other information that the Secretary considers relevant and appropriate with respect to, each individual described in paragraph (1) who— (A) grants to the Secretary permission to include such information in the Registry; or (B) at the time the individual is listed in the Registry, is deceased. (c) Individuals submitting claims or making requests before date of enactment If in the case of an individual described in subsection (b)(1) the application, claim, or request referred to in such subsection was submitted, filed, or made before the date of the enactment of this Act, the Secretary shall, to the extent feasible, include in the Registry such individual's name and the data and information, if any, described in subsection (b)(2) relating to the individual. (d) Examinations Upon the request of a veteran who was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, the Secretary shall provide the veteran with a health examination (including any appropriate diagnostic tests) and consultation and counseling with respect to the results of the examination and the tests. (e) Outreach (1) Ongoing outreach to individuals listed in Registry The Secretary shall, from time to time, notify individuals listed in the Registry of significant developments in research on the health consequences of potential exposure to a toxic substance or environmental hazard related to service at Fort McClellan. (2) Examination outreach The Secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations (including any diagnostic tests) and consultation and counseling services under subsection (d). (f) Consultation The Secretary of Veterans Affairs shall consult with the Secretary of Defense to acquire information maintained by the Secretary of Defense that the Secretary of Veterans Affairs considers necessary to establish and maintain the Registry. 703. Independent study on Individual Longitudinal Exposure Record (a) In general Not later than 60 days after the date of the enactment of this Act, the Secretary of Defense shall enter into a contract with an independent research entity described in subsection (b) to carry out a comprehensive study of the development of the Individual Longitudinal Exposure Record, or successor system, to determine— (1) the quality of the location data, occupational and environmental exposure data, and health surveillance data; and (2) whether a member of the Armed Forces can be reasonably assured that any toxic exposure they experience during service in the Armed Forces will be accurately reflected in the record of the member in such Individual Longitudinal Exposure Record. (b) Independent research entity The entity described in this subsection is an independent research entity that is a not-for-profit entity or a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b). 704. Biannual report on Individual Longitudinal Exposure Record (a) In general Not later than one year after the date on which the Individual Longitudinal Exposure Record, or successor system, achieves full operation capability, as determined by the Secretary of Defense, and every 180 days thereafter, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall submit to the appropriate committees of Congress a report on— (1) the data quality of the databases of the Department of Defense that provide the information presented in such Individual Longitudinal Exposure Record; and (2) the usefulness of such Individual Longitudinal Exposure Record in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. (b) Elements Each report required by subsection (a) shall include, for the period covered by the report, the following: (1) An identification of toxic exposure events that may not be fully captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. (2) An analysis of the quality of the location data used by the Department of Defense in determining toxic exposures of members of the Armed Forces and veterans, and recommendations for how to improve the quality of that location data if necessary. (c) Report on National Guard use of ILER Not later than one year after the date of the enactment of this Act, the Secretary of Defense shall submit to the appropriate committees of Congress a report on the feasibility of modifying the Individual Longitudinal Exposure Record to ensure that a member of the National Guard who is deployed in the United States in connection with a natural disaster, without regard to duty status (including any duty under title 10 or title 32, United States Code, or State active duty), may record information regarding a suspected exposure by the member to toxic substances during such deployment. (d) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. (2) Toxic exposure The term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b) . 705. Correction of exposure records by members of the Armed Forces and veterans (a) In general The Secretary of Defense shall provide a means for members of the Armed Forces and veterans to update their records as necessary to reflect a toxic exposure by such member or veteran in the Individual Longitudinal Exposure Record, or successor system. (b) Evidence (1) Provision of evidence To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, shall provide such evidence as the Secretary of Defense considers necessary. (2) Benefit of the doubt In reviewing evidence provided under paragraph (1), the Secretary of Defense shall give the benefit of the doubt to the member of the Armed Forces or veteran who provided the evidence, as the case may be, in a manner that is equivalent to the benefit of the doubt required under section 5107(b) of title 38, United States Code. (3) Regulations The Secretary of Defense shall prescribe by regulation the evidence considered necessary under paragraph (1). (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b) . 706. Federal cause of action relating to water at Camp Lejeune, North Carolina (a) In general An individual, including a veteran (as defined in section 101 of title 38, United States Code), or the legal representative of such an individual, who resided, worked, or was otherwise exposed (including in utero exposure) for not less than 30 days during the period beginning on August 1, 1953, and ending on December 31, 1987, to water at Camp Lejeune, North Carolina, that was supplied by, or on behalf of, the United States may bring an action in the United States District Court for the Eastern District of North Carolina to obtain appropriate relief for harm that was caused by exposure to the water at Camp Lejeune. (b) Burdens and standard of proof (1) In general The burden of proof shall be on the party filing the action to show one or more relationships between the water at Camp Lejeune and the harm. (2) Standards To meet the burden of proof described in paragraph (1), a party shall produce evidence showing that the relationship between exposure to the water at Camp Lejeune and the harm is— (A) sufficient to conclude that a causal relationship exists; or (B) sufficient to conclude that a causal relationship is at least as likely as not. (c) Exclusive jurisdiction and venue The United States District Court for the Eastern District of North Carolina shall have exclusive jurisdiction over any action filed under subsection (a), and shall be the exclusive venue for such an action. Nothing in this subsection shall impair the right of any party to a trial by jury. (d) Exclusive remedy (1) In general An individual, or legal representative of an individual, who brings an action under this section for a harm described in subsection (a), including a latent disease, may not thereafter bring a tort action against the United States for such harm pursuant to any other law. (2) Health and disability benefits relating to water exposure Any award made to an individual, or legal representative of an individual, under this section shall be offset by the amount of any disability award, payment, or benefit provided to the individual, or legal representative— (A) under— (i) any program under the laws administered by the Secretary of Veterans Affairs; (ii) the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); or (iii) the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ); and (B) in connection with health care or a disability relating to exposure to the water at Camp Lejeune. (e) Immunity limitation The United States may not assert any claim to immunity in an action under this section that would otherwise be available under section 2680(a) of title 28, United States Code. (f) No punitive damages Punitive damages may not be awarded in any action under this section. (g) Disposition by Federal agency required An individual may not bring an action under this section before complying with section 2675 of title 28, United States Code. (h) Exception for combatant activities This section does not apply to any claim or action arising out of the combatant activities of the Armed Forces. (i) Applicability; period for filing (1) Applicability This section shall apply only to a claim accruing before the date of enactment of this Act. (2) Statute of limitations A claim in an action under this section may not be commenced after the later of— (A) the date that is two years after the date of enactment of this Act; or (B) the date that is 180 days after the date on which the claim is denied under section 2675 of title 28, United States Code. (3) Inapplicability of other limitations Any applicable statute of repose or statute of limitations, other than under paragraph (2), shall not apply to a claim under this section. 707. Veterans Toxic Exposures Fund Chapter 3 is amended by adding at the end the following new section: 324. Veterans Toxic Exposures Fund (a) Establishment There is hereby established in the Treasury of the United States an account to be known as the “Veterans Toxic Exposures Fund” (the “Fund”), to be administered through the Department of Veterans Affairs, to provide for investment in the delivery of veterans’ health care, research, and benefits associated with hazardous exposure in service. (b) Authorization of appropriations There is authorized to be appropriated to the Fund for fiscal year 2023 and each subsequent fiscal year such sums as are necessary to increase funding, over the fiscal year 2021 level for the Veterans Health Administration of the Department of Veterans Affairs, for any expenses incident to the delivery of veterans’ health care and benefits associated with exposure to environmental hazards in service, including administrative expenses, such as claims processing and appeals, and for medical research related to hazardous exposures. Amounts appropriated to the Fund pursuant to this subsection shall be counted as direct spending under the Congressional Budget and Impoundment Control Act of 1974 and any other Act. (c) Estimates for congressional consideration The Secretary shall include in documents submitted to Congress in support of the President’s budget submitted pursuant to section 1105 of title 31, United States Code, detailed estimates of the sums described in subsection (b) for the applicable fiscal year. (d) Procedures for estimates The Secretary, after consultation with the Committees on Appropriations of the House of Representatives and the Senate, may establish policies and procedures for developing the annual detailed estimates required in subsection (c). . 708. Authorization of electronic notice in claims under laws administered by the Secretary of Veterans Affairs Title 38, United States Code, is amended as follows: (1) By striking section 5100 and inserting the following: 5100. Definitions In this chapter: (1) The term claimant means any individual applying for, or submitting a claim for, any benefit under the laws administered by the Secretary. (2) The term notice means a communication issued through means (including electronic means) prescribed by the Secretary. . (2) In section 5104, by adding at the end the following new subsection: (c) The Secretary may provide notice under subsection (a) electronically if a claimant (or the claimant’s representative) elects to receive such notice electronically. A claimant (or the claimant’s representative) may revoke such an election at any time, by means prescribed by the Secretary. (d) The Secretary shall annually— (1) solicit recommendations from stakeholders on how to improve notice under this section; and (2) publish such recommendations on a publicly available website of the Department. . (3) In section 5104B(c), in the matter preceding paragraph (1) by striking in writing and inserting to the claimant (and any representative of such claimant) . (4) In section 7104— (A) in the heading, by adding ; decisions; notice at the end; and (B) by striking subsection (e) and inserting the following: (e) After reaching a decision on an appeal, the Board shall promptly issue notice (as that term is defined in section 5100 of this title) of such decision to the following: (1) The appellant. (2) Any other party with a right to notice of such decision. (3) Any authorized representative of the appellant or party described in paragraph (2). (f) The Secretary may provide notice under subsection (e) electronically if a claimant (or the claimant’s representative) elects to receive such notice electronically. A claimant (or the claimant’s representative) may revoke such an election at any time, by means prescribed by the Secretary. . (5) In section 7105(b)(1)(A), by striking mailing and inserting issuance . (6) In section 7105A(a), by striking mailed and inserting issued . (7) In section 7266(a), by striking mailed and inserting issued . 709. Authorization of appropriations for expansion of claims automation There is authorized to be appropriated to the Secretary of Veterans Affairs $30,000,000 for fiscal year 2023 to support expected increased claims processing for newly eligible veterans pursuant to this Act and the amendments made by this Act by— (1) supporting the automation of processing claims by the Veterans Benefits Administration of the Department of Veterans Affairs; (2) adding self-service features to the system by which individuals file claims; (3) removing duplicative efforts regarding the processing of claims; and (4) reducing the dependency of the Department on the legacy claim system. 710. Non-applicability of non-Department of Veterans Affairs covenants not to compete to appointment of Veterans Health Administration personnel (a) In general Subchapter I of chapter 74 of title 38, United States Code, is amended by adding at the end the following new section: 7414. Effect of non-Department covenants not to compete (a) Non-Applicability Except as provided in subsection (b), in the case of an individual who is an applicant for appointment to a position in the Veterans Health Administration described in section 7401 of this title, any covenant not to compete into which the individual has entered with a non-Department facility or party shall have no force or effect with respect to the appointment of the individual to such a position. (b) Service obligation (1) Any individual who is appointed to such a position in the Veterans Health Administration shall, as a condition of such appointment, agree to provide clinical services at a Department medical facility for the duration of the period described in paragraph (2). (2) The period described in this paragraph is the period that begins on the date on which an individual is appointed to such a position and ends on the latter of the following dates: (A) The date that is one year after such date of appointment. (B) The date of the termination of any covenant not to compete entered into between the individual and a non-Department facility or party. (3) The Secretary may waive the requirement under paragraph (1) with respect to an individual at the discretion of the Secretary. (c) Termination of Department employment In the case of an individual who is appointed to such a position in the Veterans Health Administration who has entered into a covenant not to compete that is rendered non-applicable pursuant to subsection (a), if the individual’s employment at the Veterans Health Administration is terminated for any reason before the specified termination date of such covenant, subsection (a) shall not apply with respect to such covenant after the date of the termination of the individual’s employment at the Veterans Health Administration. (d) Covenant not To compete In this section, the term covenant not to compete means an agreement— (1) between an employee and employer or a contractor and principal that restricts such employee or contractor from performing— (A) any work for another employer for a specified period of time; (B) any work in a specified geographical area; or (C) work for another employer performing work that is similar to the work such employee or contractor performed for the employer or principal, included as a party to the agreement; and (2) that is entered into after the date of enactment of this Act. . (b) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7413 the following new item: 7414. Effect of non-Department covenants not to compete. . 711. Recruitment of physicians on a contingent basis prior to completion of training requirements Section 7402 of title 38, United States Code, is amended— (1) in subsection (b)(1)— (A) in the matter preceding subparagraph (A) by inserting or to be offered an appointment to such position on a contingent basis under subsection (h) after position ; and (B) by striking subparagraph (B) and inserting the following: (B) (i) have completed a residency leading to board eligibility in a specialty, satisfactory to the Secretary; or (ii) with respect to an offer for an appointment on a contingent basis under subsection (h), complete such a residency by not later than two years after the date of such offer; and ; and (2) by adding at the end the following new subsection: (h) (1) The Secretary may appoint an individual under subsection (b)(1) on a contingent basis in accordance with this subsection if the Secretary reasonably anticipated that the individual will have completed the requirements for appointment under such subsection (b)(1) by not later than two years after the date on which the individual is so appointed. (2) An individual who is appointed to a position on a contingent basis under paragraph (1) shall be appointed to such position on a permanent basis if, by not later than two years after the date of the contingent appointment, the individual completes all the requirements for appointment under subsection (b)(1). (3) An individual who is appointed on a contingent basis under paragraph (1) who fails to complete the requirements for appointment under subsection (b)(1) by not later than two years after the date on which the individual is so appointed may not be appointed to such position on a permanent basis. . 712. Authority for Secretary of Veterans Affairs to award grants to States to improve outreach to veterans (a) In general Chapter 63 of title 38, United States Code, is amended— (1) by redesignating sections 6307 and 6308 and sections 6308 and 6309, respectively; and (2) by inserting after section 6306 the following new section 6307: 6307. Grants to States to improve outreach to veterans (a) Purpose It is the purpose of this section to provide for assistance by the Secretary to States to carry out programs that— (1) improve outreach and assistance to veterans and the spouses, children, and parents of veterans, to ensure that such individuals are fully informed about any veterans and veterans-related benefits and programs (including State veterans programs) for which they may be eligible; and (2) facilitate opportunities for such individuals to receive competent, qualified services in the preparation, presentation, and prosecution of veterans benefits claims. (b) Authority The Secretary may award grants to States— (1) to carry out, coordinate, improve, or otherwise enhance outreach activities; (2) to increase the number of county or tribal veterans service officers serving in the State by hiring new, additional such officers; or (3) to expand, carry out, coordinate, improve, or otherwise enhance existing programs, activities, and services of the State’s existing organization that has been recognized by the Department of Veterans Affairs pursuant to section 5902, in the preparation, presentation, and prosecution of claims for veterans benefits through representatives who hold positions as county or Tribal veterans service officers. (c) Application (1) To be eligible for a grant under this section, a State shall submit to the Secretary an application therefor at such time, in such manner, and containing such information as the Secretary may require. (2) Each application submitted under paragraph (1) shall include the following: (A) A detailed plan for the use of the grant. (B) A description of the programs through which the State will meet the outcome measures developed by the Secretary under subsection (i). (C) A description of how the State will distribute grant amounts equitably among counties (or Tribal lands, as the case may be) with varying levels of urbanization. (D) A plan for how the grant will be used to meet the unique needs of American Indian or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities. (d) Distribution The Secretary shall seek to ensure that grants awarded under this section are equitably distributed among States with varying levels of urbanization. (e) Priority The Secretary shall prioritize awarding grants under this section that will serve the following areas: (1) Areas with a critical shortage of county or tribal veterans service officers. (2) Areas with high rates of— (A) suicide among veterans; or (B) referrals to the Veterans Crisis Line. (f) Use of county or tribal veterans service officers A State that receives a grant under this section to carry out an activity described in subsection (b)(1) shall carry out the activity through— (1) a county or Tribal veterans service officer of the State; or (2) if the State does not have a county or tribal veterans service officer, or if the county or Tribal veterans service officers of the State cover only a portion of that State, an appropriate entity of a State, local, or Tribal government, or another publicly funded entity, as determined by the Secretary. (g) Required activities Any grant awarded under this section shall be used— (1) to expand existing programs, activities, and services; (2) to hire and maintain new, additional county or Tribal veterans service officers; or (3) for travel and transportation to facilitate carrying out paragraph (1) or (2). (h) Other permissible activities A grant under this section may be used to provide education and training, including on-the-job training, for State, county, local, and tribal government employees who provide (or when trained will provide) veterans outreach services in order for those employees to obtain and maintain accreditation in accordance with procedures approved by the Secretary. (i) Outcome measures (1) The Secretary shall develop and provide to each State that receives a grant under this section written guidance on the following: (A) Outcome measures. (B) Policies of the Department. (2) In developing outcome measures under paragraph (1), the Secretary shall consider the following goals: (A) Increasing the use of veterans and veterans-related benefits, particularly among vulnerable populations. (B) Increasing the number of county and tribal veterans service officers recognized by the Secretary for the representation of veterans under chapter 59 of this title. (j) Tracking requirements (1) With respect to each grant awarded under this section, the Secretary shall track the use of veterans benefits among the population served by the grant, including the average period of time between the date on which a veteran or other eligible claimant applies for such a benefit and the date on which the veteran or other eligible claimant receives the benefit, disaggregated by type of benefit. (2) Not less frequently than annually during the life of the grant program established under this section, the Secretary shall submit to Congress a report on— (A) the information tracked under paragraph (1); (B) how the grants awarded under this section serve the unique needs of American Indian or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities; and (C) other information provided by States pursuant to the grant reporting requirements. (k) Performance review (1) The Secretary shall— (A) review the performance of each State that receives a grant under this section; and (B) make information regarding such performance publicly available. (l) Remediation plan (1) In the case of a State that receives a grant under this section and does not meet the outcome measures developed by the Secretary under subsection (i), the Secretary shall require the State to submit a remediation plan under which the State shall describe how and when it plans to meet such outcome measures. (2) The Secretary may not award a subsequent grant under this section to a State described in paragraph (1) unless the Secretary approves the remediation plan submitted by the State. (m) Maximum amount The amount of a grant awarded under this section may not exceed 10 percent of amounts made available for grants under this section for the fiscal year in which the grant is awarded. (n) Supplement, not supplant Any grant awarded under this section shall be used to supplement and not supplant State and local funding that is otherwise available. (o) Authorization of appropriations There is authorized to be appropriated to the Secretary for each of fiscal years 2023 through 2027, $50,000,000 to carry out this section. (p) Definitions In this section: (1) The term county or tribal veterans service officer includes a local equivalent veterans service officer. (2) The term State includes each Indian Tribe, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and any territory or possession of the United States. (3) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . (b) Clerical amendment The table of sections at the beginning of chapter 63 of such title is amended by striking the items relating to sections 6307 and 6308 and inserting the following new items: 6307. Grants to States to improve outreach to veterans. 6308. Outreach for eligible dependents. 6309. Biennial report to Congress. . (c) Authorization of additional full-time equivalent employee During fiscal years 2023 through 2027, the Secretary of Veterans Affairs may hire an additional full-time equivalent employee in the Office of the General Counsel of the Department of Veterans Affairs, as compared to the number of full-time equivalent employees that would otherwise be authorized for such office, to carry out duties under the accreditation, discipline, and fees program. 713. Study and report on herbicide agent exposure in Panama Canal Zone (a) Study The Secretary of Defense shall conduct a study on the exposure of members of the Armed Forces to herbicide agents, including Agent Orange and Agent Purple, in the Panama Canal Zone during the period beginning on January 1, 1958, and ending on December 31, 1999. (b) Report Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a). 714. Budget information for alternatives to burn pits The Secretary of Defense shall include in the budget submission of the President under section 1105(a) of title 31, United States Code, for each of fiscal years 2023 through 2027, a dedicated budget line item for incinerators and waste-to-energy waste disposal alternatives to burn pits. 715. Authorization of appropriations for expansion of claims automation There is authorized to be appropriated to the Secretary of Veterans Affairs $150,000,000 for fiscal year 2023 to continue the modernization and expansion of capabilities and capacity of the Veterans Benefits Management System of the Department of Veterans Affairs to support expected increased claims processing for newly eligible veterans pursuant to this Act and the amendments made by this Act. 716. Burn pit registry updates (a) Individuals eligible to update (1) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall take actions necessary to ensure that the burn pit registry may be updated with the cause of death of a deceased registered individual by— (A) an individual designated by such deceased registered individual; or (B) if no such individual is designated, an immediate family member of such deceased registered individual. (2) Designation The Secretary shall provide, with respect to the burn pit registry, a process by which a registered individual may make a designation for purposes of paragraph (1)(A). (b) Definitions In this section: (1) The term burn pit registry means the registry 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). (2) The term immediate family member , with respect to a deceased individual, means— (A) the spouse, parent, brother, sister, or adult child of the individual; (B) an adult person to whom the individual stands in loco parentis; or (C) any other adult person— (i) living in the household of the individual at the time of the death of the individual; and (ii) related to the individual by blood or marriage. (3) The term registered individual means an individual registered with the burn pit registry. 717. Burn pit transparency (a) Short title This section may be cited as the SFC Heath Robinson Burn Pit Transparency Act . (b) Notifications and reports regarding reported cases of burn pit exposure (1) Quarterly notifications (A) In general On a quarterly basis, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report on each reported case of burn pit exposure by a covered veteran reported during the previous quarter. (B) Elements Each report submitted under subparagraph (A) shall include, with respect to each reported case of burn pit exposure of a covered veteran included in the report, the following: (i) Notice of the case, including the medical facility at which the case was reported. (ii) Notice of, as available— (I) the enrollment status of the covered veteran with respect to the patient enrollment system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code; (II) a summary of all health care visits by the covered veteran at the medical facility at which the case was reported that are related to the case; (III) the demographics of the covered veteran, including age, sex, and race; (IV) any non-Department of Veterans Affairs health care benefits that the covered veteran receives; (V) the Armed Force in which the covered veteran served and the rank of the covered veteran; (VI) the period in which the covered veteran served; (VII) each location of an open burn pit from which the covered veteran was exposed to toxic airborne chemicals and fumes during such service; (VIII) the medical diagnoses of the covered veteran and the treatment provided to the veteran; and (IX) whether the covered veteran is registered in the Airborne Hazards and Open Burn Pit Registry. (C) Protection of information The Secretary shall ensure that the reports submitted under subparagraph (A) do not include the identity of covered veterans or contain other personally identifiable data. (2) Annual report on cases (A) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, in collaboration with the Secretary of Defense, shall submit to the appropriate congressional committees a report detailing the following: (i) The total number of covered veterans. (ii) The total number of claims for disability compensation under chapter 11 of title 38, United States Code, approved and the total number denied by the Secretary of Veterans Affairs with respect to a covered veteran, and for each such denial, the rationale of the denial. (iii) A comprehensive list of— (I) the conditions for which covered veterans seek treatment; and (II) the locations of the open burn pits from which the covered veterans were exposed to toxic airborne chemicals and fumes. (iv) Identification of any illnesses relating to exposure to open burn pits that formed the basis for the Secretary to award benefits, including entitlement to service connection or an increase in disability rating. (v) The total number of covered veterans who died after seeking care for an illness relating to exposure to an open burn pit. (vi) Any updates or trends with respect to the information described in clauses (i), (ii), (iii), (iv), and (v) that the Secretary determines appropriate. (B) Matters included in first report The Secretary shall include in the first report under paragraph (1) information specified in paragraph (1)(B) with respect to reported cases of burn pit exposure made during the period beginning January 1, 1990, and ending on the day before the date of the enactment of this Act. (3) Information regarding the Airborne Hazards and Open Burn Pit Registry (A) Notice The Secretary of Veterans Affairs shall ensure that a medical professional of the Department of Veterans Affairs informs a veteran of the Airborne Hazards and Open Burn Pit Registry if the veteran presents at a medical facility of the Department for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits. (B) Display In making information public regarding the number of participants in the Airborne Hazards and Open Burn Pit Registry, the Secretary shall display such numbers by both State and by congressional district. (4) Comptroller General report Not later than 180 days after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the appropriate congressional committees a report containing an assessment of the effectiveness of any memorandum of understanding or memorandum of agreement entered into by the Secretary of Veterans Affairs with respect to— (A) the processing of reported cases of burn pit exposure; and (B) the coordination of care and provision of health care relating to such cases at medical facilities of the Department of Veterans Affairs and at non-Department facilities. (5) Definitions In this section: (A) The term Airborne Hazards and Open Burn Pit Registry means the registry established by the Secretary of Veterans Affairs 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). (B) The term appropriate congressional committees means— (i) the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and (ii) The Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. (C) The term covered veteran means a veteran who presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces. (D) The term open burn pit has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 ( Public Law 112–260 ; 38 U.S.C. 527 note). (E) The term reported case of burn pit exposure means each instance in which a veteran presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces.

Passed the House of Representatives March 3, 2022. Cheryl L. Johnson, Clerk.

May 25, 2022 Read the second time and placed on the calendar

tv_txt: 117th CONGRESS 2d Session H.R. 3967 In the Senate of the United States, June 16, 2022. Amendment:

That the bill from the House of Representatives (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 Strike all after the enacting clause and insert the following: 1. Short title; references to title 38, United States Code; table of contents (a) Short title This Act may be cited as the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 or the Honoring 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 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 heading 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. 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 involving 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 Veterans 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 certain disabilities by Department of Veterans Affairs. Sec. 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations. Sec. 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection 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 related 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 research. 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. 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 survivors of such veterans. Sec. 603. Incorporation of toxic exposure screening for veterans. Sec. 604. Training for personnel of the Department of Veterans Affairs with respect 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 Veterans Affairs for fiscal year 2023. Sec. 703. Treatment of major medical facility leases of the Department of Veterans 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 Department 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 veterans. Sec. 804. Federal cause of action relating to water at Camp Lejeune, North Carolina. 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 Administration. Sec. 902. Authority to buy out service contracts for certain health care professionals in exchange for employment at rural or highly rural facilities of Department of Veterans Affairs. Sec. 903. Qualifications for human resources positions within Department of Veterans Affairs and plan to recruit and retain human resources employees. Sec. 904. Modification of pay cap for certain employees of Veterans Health Administration. 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 employees of Veterans Health Administration. Sec. 907. Waiver of pay limitation for certain employees of Department of Veterans Affairs. Sec. 908. Elimination of limitation on awards and bonus for employees of Department of Veterans Affairs. Sec. 909. Additional authority of the Secretary of Veterans Affairs relating to recruitment and retention of personnel. I Expansion of health care eligibility A Toxic-exposed veterans 101. Short title This title may be cited as the Conceding Our Veterans’ Exposure Now and Necessitating Training Act of 2022 or the COVENANT Act of 2022 . 102. Definitions relating to toxic-exposed veterans (a) In general Section 1710(a)(2)(F) is amended by striking who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e) and inserting who is a toxic-exposed veteran, in accordance with subsection (e) . (b) Definitions of toxic exposure and toxic-exposed 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. (B) An exposure to a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title. (38) The term toxic-exposed veteran means any veteran described in section 1710(e)(1) of this title. . (c) Definition of toxic exposure risk activity Section 1710(e)(4) is amended by adding at the end the following new subparagraph: (C) The term toxic exposure risk activity means any activity— (i) that requires a corresponding entry in an exposure tracking record system (as defined in section 1119(c) of this title) for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans. . 103. Expansion of health care for specific categories of toxic-exposed veterans and veterans supporting certain overseas contingency operations (a) In general (1) Expansion Subsection (e) of section 1710, as amended by section 102(c) , is further amended— (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 (including 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 operation specified in clause (ii) 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. (ii) A contingency operation specified in this clause is any of the following: (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 subparagraphs (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 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 determines appropriate based on the number of veterans receiving 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 the House of Representatives of the proposed modification; 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 veterans 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. 104. Assessments of implementation and operation (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 (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 services 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 paragraph (1), including a specific determination as to whether the Department has the personnel and material 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 Veterans’ Affairs of the House of Representatives a report 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 described 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 distance of the veteran from medical facilities of the Department and whether the veteran had previously 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. (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 subparagraph (A), the number of such veterans who, during the preceding three fiscal years, had not received 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 Program. (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 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, enrolled in the patient enrollment system. (ii) The number of such veterans who applied for, but were denied, such enrollment. (iii) The number of such veterans who were denied hospital care or a medical service furnished by the Secretary that was considered 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 Department). (F) The numbers and characteristics of, and the type and extent of health care furnished by the Secretary to, veterans not enrolled in the patient enrollment system (disaggregated by each class of eligibility for care under section 1710 of title 38, United States Code, and further shown 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 Secretary 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 enrollment system of the Department of Veterans Affairs established 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. B Certain veterans of combat service and other matters 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 inserting September 11, 2001 ; and (B) by striking five-year period and inserting 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, medical services, or nursing home care under such paragraph pursuant to subparagraph (A) before October 1, 2022, the one-year period beginning on October 1, 2022. ; and (3) by striking subparagraph (C). (b) Clarification of coverage Section 1710(e)(1)(D) is amended by inserting after Persian Gulf War the following: (including any veteran who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary 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 Committee on Veterans’ Affairs of the House of Representatives a plan to conduct outreach to veterans described in subparagraph (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 services, or nursing home care pursuant to such subparagraph. (d) Report on enrollments Not later than January 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 section 1710(e)(3)(B) of title 38, United States Code, as amended by subsection (a)(2), who, during such period, enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705(a) of such title. (e) Effective date This section and the amendments made by this section shall take effect on October 1, 2022. II Toxic exposure presumption process 201. Short title This title may be cited as the Toxic Exposure in the American Military Act of 2022 or the TEAM Act of 2022 . 202. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure (a) Advisory committees, panels, and boards Chapter 11 is amended by adding at the end the following new subchapter: VII Determinations relating to presumptions of service connection based on toxic exposure 1171. Procedures to determine presumptions of service connection based on toxic exposure; definitions (a) Procedures The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby— (1) under section 1172 of this title— (A) the Secretary provides— (i) public notice regarding what formal evaluations the Secretary plans to conduct; and (ii) the public an opportunity to comment on the proposed formal evaluations; (B) the working group established under subsection (b) of such section provides— (i) advice to the Secretary on toxic-exposed veterans and cases in which veterans who, during active military, naval, air, or space service, may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military, naval, air, or space service; (ii) recommendations to the Secretary on corrections needed in the Individual Longitudinal Exposure Record to better reflect veterans and dependents described in clause (i); and (iii) recommendations to the Secretary regarding which cases of possible toxic exposure should be reviewed; (2) the Secretary provides for formal evaluations of such recommendations under section 1173 of this title and takes into account reports received by the Secretary from the National Academies of Sciences, Engineering, and Medicine under section 1176 of this title; and (3) the Secretary issues regulations under section 1174 of this title. (b) Definitions In this subchapter: (1) The term illness includes a disease or other condition affecting the health of an individual, including mental and physical health. (2) The term Individual Longitudinal Exposure Record includes— (A) service records; (B) any database maintained by the Department of Defense and shared with the Department of Veterans Affairs to serve as a central portal for exposure-related data that compiles, collates, presents, and provides available occupational and environmental exposure information to support the needs of the Department of Defense and the Department of Veterans Affairs; or (C) any successor system to a database described in subparagraph (B). 1172. Annual notice and opportunity for public comment (a) Notice required (1) (A) Not less frequently than once each year, the Secretary shall publish in the Federal Register notice of the formal evaluations that the Secretary plans to conduct pursuant to section 1173 of this title. (B) Each notice published under subparagraph (A) shall include, for each formal evaluation referred to in the notice, an explanation as to why the military environmental exposures and adverse health outcomes that are the subject of the formal evaluation were chosen by the Secretary for formal evaluation under section 1173 of this title. (2) (A) With each notice published under paragraph (1), the Secretary shall seek public comment on the military environmental exposures and adverse health outcomes that are the subject of the formal evaluations referred to in the notice. (B) The Secretary shall— (i) consider all public comment received under subparagraph (A); and (ii) publish in the Federal Register a response to the comments received under subparagraph (A). (3) (A) For each notice published under paragraph (1), the Secretary shall hold an open meeting for members of the public to voice their comments in response to the notice. (B) To help evaluate presumptions of service connection, the Secretary shall, not less frequently than quarterly, collaborate with, partner with, and give weight to the advice of veterans service organizations and such other stakeholders as the Secretary considers appropriate. (4) Failure to include a military environmental exposure or adverse health effect in a Federal Register notice published pursuant to subsection (a) shall not preclude the Secretary from initiating a formal evaluation of such exposure or health effect. (b) Working Group (1) The Secretary shall establish a working group within the Department (in this section referred to as the Working Group ). (2) The Working Group shall include personnel of the Veterans Health Administration and the Veterans Benefits Administration. (3) The Secretary shall consult with, and seek the advice of, the Working Group with respect to cases in which— (A) a veteran may have, during active military, naval, air, or space service, experienced a toxic exposure; or (B) a dependent of a veteran may have experienced a toxic exposure during the active military, naval, air, or space service of the veteran. (c) Assessments (1) The Working Group shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, air, or space service, including by conducting ongoing surveillance and reviewing such exposure described in scientific literature, media reports, information from veterans, and information from Congress. (2) The assessments under paragraph (1) shall cover suspected and known toxic exposures occurring during active military, naval, air, or space service, including by identifying and evaluating new and emerging toxic exposures that are not recognized under existing presumptions of service connection. (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 Individual Longitudinal Exposure Record to ensure the accuracy of data collected. (d) Development of recommendations (1) Following an assessment of a case of the toxic exposure of veterans 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 review 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 between 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. (e) Reports by the Working Group Not less frequently than once each year, the Working Group shall submit 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 subsection (d), if any; and (2) recommendations for such legislative or administrative 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 establish a process to conduct a formal evaluation with respect 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: (1) Scientific evidence, based on the review of available scientific literature, including human, toxicological, animal, and methodological studies, and other factors. (2) Claims data, based on the review of claim rate, grant rate, and service connection prevalence, and other factors. (3) Other factors the Secretary determines appropriate, such as— (A) the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated; (B) the quantity and quality of the information available and reviewed; (C) the feasibility of and period for generating relevant information and evidence; (D) whether such health effects are combat- or deployment-related; (E) the ubiquity or rarity of the health effects; and (F) any time frame during which a health effect must become manifest. (c) Conduct of evaluations (1) The Secretary shall ensure that each formal evaluation under subsection (a)— (A) reviews scientific evidence in a manner that— (i) conforms to principles of scientific and data integrity; (ii) is free from suppression or distortion of scientific or technological findings, data, information, conclusions, or technical results; and (B) (i) evaluates the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military, naval, air, or space service; and (ii) assesses the toxic exposures and illnesses and determines whether the evidence supports a finding of a positive association between the toxic exposure and the illness. (2) In carrying out paragraph (1)(B)(ii), a formal evaluation under subsection (a) shall include reviewing all relevant data to determine the strength of evidence for a positive association based on the following four categories: (A) The sufficient category, where the evidence is sufficient to conclude that a positive association exists. (B) The equipoise and above category, where the evidence is sufficient to conclude that a positive association is at least as likely as not, but not sufficient to conclude that a positive association exists. (C) The below equipoise category, where the evidence is not sufficient to conclude that a positive association is at least as likely as not, or is not sufficient to make a scientifically informed judgment. (D) The against category, where the evidence suggests the lack of a positive association. (d) Recommendation for establishing a presumption of service connection Not later than 120 days after the date on which a formal evaluation is commenced, the element of the Department that conducts the evaluation shall submit to the Secretary a recommendation with respect to establishing a presumption of service connection for the toxic exposure and illness, or modifying an existing presumption of service connection, covered by the evaluation. 1174. Regulations regarding presumptions of service connection based on toxic exposure (a) Action upon recommendation Not later than 160 days after the date on which the Secretary receives a recommendation to establish or modify a presumption of service connection under section 1173 of this title— (1) if the Secretary determines, in the discretion of the Secretary, that the presumption, or modification, is warranted, the Secretary shall— (A) commence issuing regulations in accordance with the provisions of subchapter II of chapter 5 of title 5 (commonly referred to as the Administrative Procedures Act) setting forth the presumption or commence revising regulations to carry out such modification; and (B) include in such regulations any time frame during which a health effect must become manifest; or (2) if the Secretary determines, in the discretion of the Secretary, that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register a notice of the determination, including the reasons supporting the determination. (b) Removal of presumption (1) (A) The Secretary may— (i) issue a regulation to remove an illness from a presumption of service connection previously established pursuant to a regulation issued under subsection (a); and (ii) issue a regulation to remove a presumption of service connection established pursuant to title IV of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 if the Secretary concludes that evidence suggests the lack of a positive association between the disease and the toxic exposure. (B) Under subparagraph (A)(ii), the Secretary shall not consider the lack of evidence as sufficient to support a decision for removal of a presumption. (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 under chapter 11 of this title for such illness on the basis of the presumption provided under such regulations before the effective date of the removal or modification shall continue to be entitled to receive compensation on that basis; (B) a survivor of a veteran who was awarded dependency and indemnity compensation under chapter 13 of this title for the death of a veteran resulting from such illness on the basis of such presumption shall continue to be entitled to receive dependency and indemnity compensation on such basis; and (C) no veteran or survivor covered under subparagraph (A) or (B) shall have their compensation reduced solely because of the removal of an illness pursuant to paragraph (1). 1175. Authority to modify process; congressional oversight (a) In general The Secretary may modify the process under which the working group established under subsection (b) of section 1172 of this title conducts assessments under such section, the Secretary conducts formal evaluations under section 1173 of this title, and issues regulations under section 1174 of this title if— (1) such evaluations cover the evidence, data, and factors required by subsection (b) of such section 1173; and (2) a period of 180 days has elapsed following the date on which the Secretary submits the notice under subsection (b) regarding the modification. (b) Notice If the Secretary proposes to modify the process under which the working group established under subsection (b) of section 1172 of this title conducts assessments under such section, the process under which the Secretary conducts formal evaluations under section 1173 of this title, or issues regulations under section 1174 of this title, 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 notice of the proposed modifications containing the following: (1) A description of the proposed modifications. (2) A description of any exceptions to the requirements of such sections that are proposed because of limited available scientific evidence, and a description of how such evaluations will be conducted. 1176. Agreement with National Academies of Sciences, Engineering, and Medicine concerning toxic exposures (a) Purpose The purpose of this section is to provide for the National Academies of Sciences, Engineering, and Medicine (in this section referred to as the Academies ), an independent nonprofit scientific organization with appropriate expertise that is not part of the Federal Government, to review and evaluate the available scientific evidence regarding associations between diseases and toxic exposures. (b) Agreement (1) The Secretary shall seek to enter into a five-year agreement with the Academies to perform the services covered by this section. (2) The Secretary shall seek to enter into an agreement described in paragraph (1) not later than 60 days after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 . (3) An agreement under this section may be extended in five-year increments. (c) Review of scientific evidence Under an agreement between the Secretary and the Academies under this section, the Academies shall review and summarize the scientific evidence, and assess the strength thereof, concerning the association between toxic exposures during active military, naval, air, or space service and each disease suspected to be associated with such exposure in the human population. (d) Scientific determinations concerning diseases For each disease reviewed under subsection (c), the Academies shall determine, to the extent that available scientific data permit meaningful determinations— (1) whether an association exists between toxic exposures and the occurrence of the disease, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association; (2) the increased risk of the disease among those reporting toxic exposures during active military, naval, air, or space service; (3) whether there exists a plausible biological mechanism or other evidence of a positive association between the toxic exposure and the occurrence of the disease; and (4) determine the strength of evidence for a positive association based on categories furnished under section 1173 of this title. (e) Cooperation of Federal agencies The head of each relevant Federal agency, including the Secretary of Defense, shall cooperate fully with the Academies in performing the services covered by this section. (f) Recommendations for additional scientific studies (1) Under an agreement between the Secretary and the Academies under this section, the Academies shall make any recommendations for additional scientific studies to resolve areas of continuing scientific uncertainty relating to toxic exposures. (2) In making recommendations under paragraph (1), the Academies shall consider— (A) the scientific information that is available at the time of the recommendation; (B) the value and relevance of the information that could result from additional studies; and (C) the cost and feasibility of carrying out such additional studies. (g) Reports (1) (A) Under an agreement between the Secretary and the Academies under this section, not later than one year after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 , the Academies shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives an initial report on the activities of the Academies under the agreement. (B) The report submitted under subparagraph (A) shall include the following: (i) The determinations described in subsection (d). (ii) A full explanation of the scientific evidence and reasoning that led to such determinations. (iii) Any recommendations of the Academies under subsection (f). (2) Under an agreement between the Secretary and the Academies under this section, not less frequently than once every two years after the date on which the initial report is submitted under paragraph (1)(A), the Academies shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives an updated report on the activities of the Academies under the agreement. (h) Alternative contract scientific organization (1) If the Secretary is unable within the time period prescribed in subsection (b)(2) to enter into an agreement with the Academies for the purposes of this section on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for the purposes of this section with another appropriate scientific organization that— (A) is not part of the Federal Government; (B) operates as a not-for-profit entity; and (C) has expertise and objectivity comparable to that of the Academies. (2) If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this subchapter to the Academies shall be treated as a reference to the other organization. . (b) Reports and briefings (1) Report (A) In general Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the implementation of, and recommendations for, subchapter VII of chapter 11 of title 38, United States Code, as added by subsection (a). (B) Consultation The Secretary shall develop the report under subparagraph (A) in consultation with organizations recognized by the Secretary for the representation of veterans under section 5902 of such title and any other entity the Secretary determines appropriate. (2) Briefing On a quarterly basis during the two-year period beginning on the date of the enactment of this Act, the Secretary shall provide to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a briefing on the implementation of subchapter VII of chapter 11 of such title, as added by subsection (a). (c) Independent assessment (1) Agreement The Secretary shall seek to enter into an agreement with the National Academies of Science, Engineering, and Medicine (in this subsection referred to as the Academies ) before the date that is 90 days after the date of the enactment of this Act to perform the services set forth under paragraph (2). (2) Assessment (A) In general Under an agreement between the Secretary and the Academies under paragraph (1), the Academies shall conduct an assessment of the implementation by the Department of Veterans Affairs of the process established under subchapter VII of chapter 11 of title 38, United States Code, as added by subsection (a). (B) Elements The assessment conducted under subparagraph (A) shall include the following: (i) An assessment of the Department’s implementation of the process established under subsection (a) to determine whether the process is in accordance with current scientific standards for assessing the link between exposure to environmental hazards and the development of health outcomes, (ii) assess whether the criteria is fair and consistent, and (iii) provide recommendations for improvements to the process. (3) Report Not later than one year after the date on which the Secretary enters into an agreement under paragraph (1), 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 on the findings of the Academies pursuant to such agreement. (4) Alternative contract scientific organization (A) In general If the Secretary is unable within the time period prescribed in paragraph (1) to enter into an agreement with the Academies for the purposes of this subsection on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for the purposes of this subsection with another appropriate scientific organization that— (i) is not part of the Federal Government; (ii) operates as a not-for-profit entity; and (iii) has expertise and objectivity comparable to that of the Academies. (B) Treatment If the Secretary enters into an agreement with another organization as described in subparagraph (A), any reference in this subsection to the Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization. (d) Conforming amendments Chapter 11 is amended— (1) in section 1116— (A) by striking subsections (b), (c), (d), and (e); (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter VII of this chapter, including with respect to assessing reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991 ( Public Law 102–4 ). ; and (C) by redesignating subsection (f) as subsection (c); (2) in section 1116B(b)(2)(A), by inserting pursuant to subchapter VII of this chapter, before the Secretary determines ; and (3) in section 1118— (A) by striking subsections (b) through (e); and (B) by inserting after subsection (a) the following new subsection (b): (b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter. . 203. Outreach to claimants for disability compensation pursuant to changes in presumptions of service connection (a) In general Subchapter VI of chapter 11 is amended by adding at the end the following new section: 1167. Outreach pursuant to changes in presumptions of service connection (a) In general Whenever a law, including through a regulation or Federal court decision or settlement, establishes or modifies a presumption of service connection, the Secretary shall— (1) identify all claims for compensation under this chapter that— (A) were submitted to the Secretary; (B) were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and (C) might have been evaluated differently had the establishment or modification been applicable to the claim; and (2) pursuant to subsection (b), conduct outreach to the claimants. (b) Outreach (1) The Secretary shall conduct outreach to inform claimants identified under subsection (a) that they may submit a supplemental claim in light of the establishment or modification of a presumption of service connection described in subsection (a). (2) Outreach under paragraph (1) shall include the following: (A) The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to file a supplemental claim. (B) The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such veterans to file a supplemental claim. (C) The Secretary shall contact each claimant identified under subsection (a) in the same manner that the Department last provided notice of a decision. . (b) Application Section 1167 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act. (c) Rule of construction Nothing in this section shall be construed as— (1) modifying the obligations of the Department of Veterans Affairs under Federal court decisions or settlements in effect as of the date of the enactment of this Act; or (2) requiring a retroactively applied effective date of a supplemental claim earlier than the date a presumption of service connection is established or modified. 204. Reevaluation of claims for dependency and indemnity compensation involving presumptions of service connection (a) In general Subchapter I of chapter 13 is amended by adding at the end the following new section: 1305. Reevaluation of dependency and indemnity compensation determinations pursuant to changes in presumptions of service connection (a) Reevaluation Whenever a law, including through a regulation or Federal court decision or settlement, establishes or modifies a presumption of service connection, the Secretary shall— (1) identify all claims for dependency and indemnity compensation under this chapter that— (A) were submitted to the Secretary; (B) were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and (C) might have been evaluated differently had the establishment or modification been applicable to the claim; (2) allow for the reevaluation of such claims at the election of the claimant; and (3) notwithstanding section 5110 of this title, with respect to claims approved pursuant to such reevaluation, provide compensation under this chapter effective as if the establishment or modification of the presumption of service connection had been in effect on the date of the submission of the original claim described in paragraph (1). (b) Outreach (1) The Secretary shall conduct outreach to inform relevant claimants that they may elect to have a claim be reevaluated in light of the establishment or modification of a presumption of service connection described in subsection (a). (2) Outreach under paragraph (1) shall include the following: (A) The Secretary shall publish on the internet website of the Department a notice that such claimants may elect to have a claim so reevaluated. (B) The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such claimants to elect to have a claim so reevaluated. (C) The Secretary shall contact each claimant identified under subsection (a) in the same manner that the Department last provided notice of a decision. . (b) Application Section 1305 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act. (c) Rule of construction Nothing in this section shall be construed as modifying the obligations of the Department of Veterans Affairs under Federal court decisions or settlements in effect as of the date of the enactment of this Act. III Improving the establishment of service connection process for toxic-exposed veterans 301. Short title This title may be cited as the Veterans Burn Pits Exposure Recognition Act of 2022 . 302. Presumptions of toxic exposure Subchapter II of chapter 11 is amended by adding at the end the following new section: 1119. Presumptions of toxic exposure (a) Consideration of records If a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and a toxic exposure that occurred during active military, naval, air, or space service, the Secretary may, in adjudicating such claim, consider— (1) any record of the veteran in an exposure tracking record system; and (2) if no record of the veteran in an exposure tracking record system indicates that the veteran was subject to a toxic exposure during active military, naval, air, or space service, the totality of the circumstances of the service of the veteran. (b) Presumption of specific toxic exposure for members who served in certain locations (1) The Secretary shall, for purposes of section 1110 and chapter 17 of this title, presume that any covered veteran was exposed to the substances, chemicals, and airborne hazards identified in the list under paragraph (2) during the service of the covered veteran specified in subsection (c)(1), unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. (2) The Secretary shall— (A) establish and maintain a list that contains an identification of one or more such substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate for purposes of this section; and (B) determine, using procedures consistent with section 1172 of this title and through the conduct of a formal evaluation under section 1173 of this title, whether to establish an end date for a covered veteran to qualify for presumptions of exposure under this section, if appropriate, but in no case establish an end date earlier than the last day of the period specified in section 101(33) for the Persian Gulf War. (3) Beginning not later than two years after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 , and not less frequently than once every two years thereafter, 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 any additions or removals to the list under paragraph (2) during the period covered by the report. (c) Definitions In this section: (1) The term covered veteran means any veteran who— (A) on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in, including airspace above— (i) Bahrain; (ii) Iraq; (iii) Kuwait; (iv) Oman; (v) Qatar; (vi) Saudi Arabia; (vii) Somalia; or (viii) United Arab Emirates; or (B) on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in, including airspace above— (i) Afghanistan; (ii) Djibouti; (iii) Egypt; (iv) Jordan; (v) Lebanon; (vi) Syria; (vii) Yemen; (viii) Uzbekistan; or (ix) any other country determined relevant by the Secretary. (2) The term exposure tracking record system — (A) means any system, program, or pilot program used by the Secretary of Veterans Affairs or the Secretary of Defense to track how veterans or members of the Armed Forces have been exposed to various occupational or environmental hazards; and (B) includes the Individual Longitudinal Exposure Record, or successor system. (3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title. . 303. Medical nexus examinations for toxic exposure risk activities Subchapter VI of chapter 11, as amended by section 203, is further amended by adding at the end the following new section: 1168. Medical nexus examinations for toxic exposure risk activities (a) Medical examinations and medical opinions (1) Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall— (A) provide the veteran with a medical examination under section 5103A(d) of this title; and (B) obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under subparagraph (A)) as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. (2) When providing the Secretary with a medical opinion under paragraph (1)(B) for a veteran, the health care provider shall consider— (A) the total potential exposure through all applicable military deployments of the veteran; and (B) the synergistic, combined effect of all toxic exposure risk activities of the veteran. (3) The requirement under paragraph (2)(B) shall not be construed as requiring a health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and airborne hazards identified in the list under section 1119(b)(2) of this title. (b) Exception Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. (c) Toxic exposure risk activity defined In this section, the term toxic exposure risk activity has the meaning given that term in section 1710(e)(4) of this title. . IV Presumptions of service connection 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 Veterans Affairs (a) Short title This section may be cited as the Mark Takai Atomic Veterans Healthcare Parity Act of 2022 . (b) Enewetak Atoll Section 1112(c)(3)(B) is amended by adding at the end the following new clause: (v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980. . 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 certain disabilities by Department of Veterans Affairs (a) Short title This section may be cited as the Palomares or Thule Veterans Act of 2022 . (b) Palomares or Thule Section 1112(c)(3)(B), as amended by section 401, is further amended by adding at the end the following new clauses: (vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967. (vii) Onsite participation in the response effort following the on-board fire and crash of a United States Air Force B–52 bomber that caused the release of four thermonuclear weapons in the vicinity of Thule Air Force Base, Greenland, during the period beginning January 21, 1968, and ending September 25, 1968. . 403. Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations (a) Short title This section may be cited as the Veterans Agent Orange Exposure Equity Act of 2022 . (b) In general Section 1116, as amended by section 202, is further amended— (1) by striking , during active military, naval, air, or space service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; (2) by striking performed active military, naval, air, or space service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 each place it appears and inserting performed covered service ; and (3) by adding at the end the following new subsection: (d) In this section, the term covered service means active military, naval, air, or space service— (1) performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; (2) performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; (3) performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; (4) performed in Cambodia at Mimot or Krek, Kampong Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or (5) performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977. . (c) Eligibility for hospital care and medical services Section 1710(e)(4), as amended by section 102(c), is further amended by striking subparagraph (A) and inserting the following new subparagraph: (A) The term Vietnam-era herbicide-exposed veteran means a veteran who— (i) performed covered service, as defined in section 1116(d) of this title; or (ii) the Secretary finds may have been exposed during active military, naval, air, or space service to dioxin during the Vietnam era, regardless of the geographic area of such service, or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such era, regardless of the geographic area of such service. . (d) Conforming amendment The heading for section 1116 is amended by striking the Republic of Vietnam and inserting certain locations . (e) Effective date and applicability The amendments made by this section shall take effect on the date of the enactment of this Act and shall apply as follows: (1) On the date of the enactment of this Act for claimants for dependency and indemnity compensation under chapter 13 of title 38, United States Code, and for veterans whom the Secretary of Veterans Affairs determines are— (A) terminally ill; (B) homeless; (C) under extreme financial hardship; (D) more than 85 years old; or (E) capable of demonstrating other sufficient cause. (2) On October 1, 2022, for everyone not described in paragraph (1). 404. Addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations (a) Short title This section may be cited as the Fair Care for Vietnam Veterans Act of 2022 . (b) Monoclonal gammopathy of undetermined significance Section 1116(a)(2) of title 38, United States Code, is amended by adding at the end the following new subparagraph: (L) Monoclonal gammopathy of undetermined significance. . (c) Hypertension Such section, as amended by subsection (b), is further amended by adding at the end the following new subparagraph: (M) Hypertension. . (d) Effective dates and applicability (1) Monoclonal gammopathy of undetermined significance (A) In general The amendment made by subsection (b) shall take effect on the date of the enactment of this Act and shall apply as follows: (i) On the date of the enactment of this Act for claimants for dependency and indemnity compensation under chapter 13 of title 38, United States Code, and for veterans whom the Secretary of Veterans Affairs determines are— (I) terminally ill; (II) homeless; (III) under extreme financial hardship; (IV) more than 85 years old; or (V) capable of demonstrating other sufficient cause. (ii) On October 1, 2022, for everyone not described in clause (i). (B) Retroactive application Notwithstanding any Federal court decisions or settlements in effect on the day before the date of the enactment of this Act, the Secretary of Veterans Affairs shall award retroactive claims for a condition under section 1116(a)(2)(L) of title 38, United States Code, as added by subsection (b) of this section, only to claimants for dependency and indemnity compensation under chapter 13 of such title described in subparagraph (A)(i) of this paragraph. (2) Hypertension (A) In general The amendment made by subsection (c) shall take effect on the date of the enactment of this Act and shall apply as follows: (i) On the date of the enactment of this Act for claimants for dependency and indemnity compensation under chapter 13 of title 38, United States Code, and for veterans whom the Secretary of Veterans Affairs determines are— (I) terminally ill; (II) homeless; (III) under extreme financial hardship; (IV) more than 85 years old; or (V) capable of demonstrating other sufficient cause. (ii) On October 1, 2026, for everyone not described in subparagraph (A). (B) Retroactive application Notwithstanding any Federal court decisions or settlements in effect on the day before the date of the enactment of this Act, the Secretary of Veterans Affairs shall award retroactive claims for a condition under section 1116(a)(2)(M) of title 38, United States Code, as added by subsection (c) of this section, only to claimants for dependency and indemnity compensation under chapter 13 of such title described in subparagraph (A)(i) of this paragraph. 405. Improving compensation for disabilities occurring in Persian Gulf War veterans (a) Reduction in threshold of eligibility Subsection (a)(1) of section 1117 is amended by striking became manifest— and all that follows through the period at the end and inserting became manifest to any degree at any time. . (b) Permanent extension of period of eligibility Such section is further amended— (1) by striking subsection (b); (2) by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and (3) in subsection (a)(2)(C), by striking under subsection (d) and inserting under subsection (c) . (c) Establishing singular disability-based questionnaire Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new subsection (d): (d) If a Persian Gulf veteran at a medical facility of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care personnel of the Department use a disability benefits questionnaire, or successor questionnaire, designed to identify Gulf War Illness, in addition to any other diagnostic actions the personnel determine appropriate. . (d) Expansion of definition of Persian Gulf veteran Subsection (f) of such section is amended by inserting , Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, after operations . (e) Training Such section is further amended by adding at the end the following new subsection: (i) (1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department are appropriately trained to effectively carry out this section. (2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1). . 406. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Short title This section may be cited as the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2022 . (b) In general Subchapter II of chapter 11, as amended by section 302 , is further amended by inserting after section 1119 the following new section: 1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins (a) Presumption of service connection For the purposes of section 1110 of this title, and subject to section 1113 of this title, a disease specified in subsection (b) becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service, notwithstanding that there is no record of evidence of such disease during the period of such service. (b) Diseases specified The diseases specified in this subsection are the following: (1) Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). (2) The following types of cancer: (A) Head cancer of any type. (B) Neck cancer of any type. (C) Respiratory cancer of any type. (D) Gastrointestinal cancer of any type. (E) Reproductive cancer of any type. (F) Lymphoma cancer of any type. (G) Lymphomatic cancer of any type. (H) Kidney cancer. (I) Brain cancer. (J) Melanoma. (K) Pancreatic cancer. (3) Chronic bronchitis. (4) Chronic obstructive pulmonary disease. (5) Constrictive bronchiolitis or obliterative bronchiolitis. (6) Emphysema. (7) Granulomatous disease. (8) Interstitial lung disease. (9) Pleuritis. (10) Pulmonary fibrosis. (11) Sarcoidosis. (12) Chronic sinusitis. (13) Chronic rhinitis. (14) Glioblastoma. (15) Any other disease for which the Secretary determines, pursuant to regulations prescribed under subchapter VII that a presumption of service connection is warranted based on a positive association with a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title. (c) Covered veteran defined In this section, the term covered veteran has the meaning given that term in section 1119(c) of this title. . (c) Conforming amendment Section 1113 is amended by striking or 1118 each place it appears and inserting 1118, or 1120 . (d) Effective date and applicability The amendments made by this section shall take effect on the date of the enactment of this Act and shall apply as follows: (1) On the date of the enactment of this Act for claimants for dependency and indemnity compensation under chapter 13 of title 38, United States Code, and veterans whom the Secretary of Veterans Affairs determines are— (A) terminally ill; (B) homeless; (C) under extreme financial hardship; (D) more than 85 years old; or (E) capable of demonstrating other sufficient cause. (2) On the date of the enactment of this Act for everyone not described in paragraph (1), with respect to paragraphs (1), (2)(C), (2)(I), (5), (6), (7), (8), (9), (10), (11), (12), (13), and (14), of section 1120(b) of title 38, United States Code, as added by subsection (b). (3) On October 1, 2023, for everyone not described in paragraph (1), with respect to paragraphs (3) and (4) of section 1120(b) of such title, as so added. (4) On October 1, 2024, for everyone not described in paragraph (1), with respect to subparagraphs (A), (B), (D), (E), (F), (G), and (K) of section 1120(b)(2) of such title, as so added. (5) On October 1, 2025, for everyone not described in paragraph (1), with respect to subparagraphs (H) and (J) of section 1120(b)(2) of such title, as so added. 407. Rule of construction (a) Generally Nothing in this Act shall be construed to prevent the Secretary of Veterans Affairs from processing claims for benefits under title 38, United States Code, for a condition or disease for which this Act establishes a presumption of service connection, as a claim for benefits for a condition or disease with direct service connection. (b) Effective dates and applicability The Secretary shall not deny a claim for benefits under title 38, United States Code, for a condition or disease for which this Act establishes a presumption of service connection because the claimant filed the claim prior to the effective date or date of applicability for that particular condition or disease. V Research matters 501. Interagency working group on toxic exposure research (a) Establishment (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, in collaboration with the heads of the entities described in paragraph (2), establish the Toxic Exposure Research Working Group (in this section referred to as the Working Group ). (2) Composition The Working Group shall consist of employees, selected by the Secretary, of the following: (A) The Department of Veterans Affairs. (B) The Department of Defense. (C) The Department of Health and Human Services. (D) The Environmental Protection Agency. (E) Other entities of the Federal Government involved in research activities regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service. (b) Functions The Working Group shall perform the following functions: (1) Identify collaborative research activities and resources available among entities represented by members of the Working Group to conduct such collaborative research activities. (2) Develop a five-year strategic plan for such entities to carry out collaborative research activities. (c) Reporting The Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives the following: (1) Not later than one year after the date of the enactment of this Act, a report on the establishment of the Working Group under subsection (a). (2) Not later than two years after the date of the enactment of this Act, a report containing the collaborative research activities identified, and the strategic plan developed, by the Working Group under subsection (b). (3) Not less frequently than annually during the five-year period covered by the strategic plan under subsection (b), a progress report on implementation of the strategic plan. (d) Termination The Working Group shall terminate after submitting the final report under subsection (c). (e) Definitions In this section: (1) Active military, naval, air, or space service The term active military, naval, air, or space service has the meaning given that term in section 101 of title 38, United States Code. (2) Collaborative research activity The term collaborative research activity means a research activity— (A) agreed upon by the Working Group; (B) conducted by an entity represented by a member of the Working Group; (C) funded by the Federal Government; and (D) regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service. (3) Toxic exposure The term toxic exposure has the meaning given such term in section 101 of title 38, United States Code, as amended by section 102(b). 502. Analysis and report on treatment of veterans for medical conditions related to toxic exposure (a) In general The Secretary of Veterans Affairs shall analyze, on a continuous basis, all clinical data that— (1) is obtained by the Department of Veterans Affairs in connection with hospital care, medical services, and nursing home care furnished under section 1710(a)(2)(F) of title 38, United States Code; and (2) is likely to be scientifically useful in determining the association, if any, between the medical condition of a veteran and a toxic exposure. (b) Annual report Not later than one year after the date of the enactment of this Act, and annually thereafter, 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 containing the following: (1) The aggregate data compiled under subsection (a). (2) An analysis of such data. (3) A description of the types and incidences of medical conditions identified by the Department under such subsection. (4) The explanation of the Secretary for the incidence of such medical conditions and other explanations for the incidence of such conditions as the Secretary considers reasonable. (5) The views of the Secretary on the scientific validity of drawing conclusions from the incidence of such medical conditions, as evidenced by the data compiled under subsection (a), regarding any association between such conditions and toxic exposures. (c) Toxic exposure defined In this section, the term toxic exposure has the meaning given such term in section 101 of title 38, United States Code, as amended by section 102(b). 503. Analysis relating to mortality of veterans who served in Southwest Asia (a) Analysis (1) In general Not later than 270 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, in coordination with the Secretary of Defense, shall conduct an updated analysis of total and respiratory disease mortality in covered veterans. (2) Elements The analysis required by paragraph (1) shall include, to the extent practicable, the following with respect to each covered veteran: (A) Metrics of airborne exposures. (B) The location and timing of deployments of the veteran. (C) The military occupational specialty of the veteran. (D) The Armed Force in which the veteran served. (E) Pre-existing health status of the veteran, including with respect to asthma. (F) Relevant personal information of the veteran, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity. (b) Covered veteran defined In this section, the term covered veteran means any veteran who— (1) on or after August 2, 1990, served on active duty in— (A) Bahrain; (B) Iraq; (C) Kuwait; (D) Oman; (E) Qatar; (F) Saudi Arabia; (G) Somalia; or (H) the United Arab Emirates; or (2) on or after September 11, 2001, served on active duty in— (A) Afghanistan; (B) Djibouti; (C) Egypt; (D) Jordan; (E) Lebanon; (F) Syria; or (G) Yemen. 504. Study on health trends of post–9/11 veterans The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001. 505. Study on cancer rates among veterans (a) In general The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans to determine trends in the rates of the incidence of cancer in veterans. (b) Elements The study required by subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The age of the veteran. (2) The period of service and length of service of the veteran in the Armed Forces. (3) The military occupational specialty or specialties of the veteran. (4) The sex of the veteran. (5) The type or types of cancer that the veteran has. 506. Study on health effects of waste related to Manhattan Project on certain veterans (a) Study Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for the conduct of a study on the health trends of veterans who, while serving in the active military, naval, air, or space service— (1) participated in activities relating to the Manhattan Project (including activities relating to covered waste) in connection with such service; or (2) resided at or near, as determined by the Secretary, the locations described in subsection (b). (b) Covered locations The locations described in this subsection are the following locations: (1) In the county of St. Louis, Missouri, the following: (A) Coldwater Creek, Missouri. (B) The St. Louis Airport Site, Missouri. (C) The West Lake Landfill. (2) Oak Ridge, Tennessee. (3) Hanford, Washington. (4) Any other location that is proximate to covered waste, as determined by the Secretary. (c) Elements The study under subsection (a) shall assess, with respect to each veteran included in the study, the following: (1) The age, sex, and race of the veteran. (2) The period and location of exposure to covered waste. (3) Any type of cancer, or other illness associated with toxic exposure, that the veteran has. (4) A comparison of the overall health condition of the veteran, including any illness of the veteran identified pursuant to paragraph (3), with the overall health condition of past and present civilian populations residing at the same location of exposure, as determined by the Secretary. (d) Report Not later than three years after the date of the enactment of this Act, 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 on the study under subsection (a) and include in such report an analysis of the data available and data reliability. (e) Definitions In this section: (1) Active military, naval, air, or space service; toxic exposure The terms active military, naval, air, or space service and toxic exposure have the meanings given those terms in section 101 of title 38, United States Code, as added by section 102(b). (2) Covered waste The term covered waste means any waste arising from activities carried out in connection with the Manhattan Project. (3) Illness The term illness has the meaning given that term in section 1171 of title 38, United States Code, as added by section 202. (4) Toxic exposure The term toxic exposure has the meaning given such term in section 101 of title 38, United States Code, as amended by section 102(b). 507. Study on toxic exposure and mental health outcomes (a) Study required Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for the conduct of a study of veterans to assess possible relationships between toxic exposures experienced during service in the Armed Forces and mental health conditions, including chronic multisymptom illness, traumatic brain injury, post-traumatic stress disorder, depression, episodes of psychosis, schizophrenia, bipolar disorder, suicide attempts, and suicide deaths. (b) Elements For each veteran included in the study under subsection (a), the following information shall be collected and assessed: (1) Age. (2) Sex. (3) Race and ethnicity. (4) Period and length of service in the Armed Forces. (5) The military occupational specialty or specialties of the veteran. (6) History of toxic exposure during service in the Armed Forces. (7) Any diagnosis of chronic multisymptom illness. (8) Any diagnosis of a mental health or cognitive disorder. (9) Any history of suicide attempt or suicidality. (10) If the veteran died by suicide. (11) Any confounding traumatic experiences that could affect a veteran's mental health. (c) Report Not later than three years after the date of the enactment of this Act, 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 containing the findings of the National Academies of Sciences, Engineering, and Medicine with respect to the study conducted under subsection (a). 508. Study on veterans in Territories of the United States (a) GAO study (1) In general The Comptroller General of the United States shall conduct a study on the state of access and barriers to benefits and services furnished by the Veterans Benefits Administration and the Veterans Health Administration under laws administered by the Secretary of Veterans Affairs to veterans in Territories and Freely Associated States of the United States, including deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the United States. (2) Elements The study under paragraph (1) shall include— (A) the number of veterans in each Territory and Freely Associated State of the United States; (B) the number of veterans in each Territory and Freely Associated State who are enrolled in the system of annual patient enrollment of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code; (C) a description of how the Department estimates the number of veterans in each Territory and Freely Associated State who are eligible for services under section 1710 of such title but who are not enrolled as described in subparagraph (B); (D) a detailed description of obstacles facing veterans in each Territory and Freely Associated State in accessing health care services, including those involving the availability of such services to veterans in the Territory or Freely Associated State in which the veterans reside, and any distance impediments to receiving services at a regional medical center of the Veterans Health Administration, a community-based outpatient clinic, another full-service medical facility of the Department, or a Vet Center, respectively; (E) a detailed description of obstacles facing veterans in each Territory and Freely Associated State in accessing readjustment counseling services, including those involving the availability of such services to veterans in the Territory in which the veterans reside, and any distance impediments to receiving services at a readjustment counseling services center of the Department; (F) a detailed description of obstacles facing veterans in each Territory and Freely Associated State in accessing non-health care veterans benefits, including those involving the availability of benefits and services to veterans in the Territory or Freely Associated State in which the veterans reside, and any distance impediments to accessing the nearest office of the Veterans Benefits Administration; (G) an analysis of the staffing and quality of the offices of the Veterans Benefits Administration and Veterans Health Administration charged with serving veterans in the Territories and Freely Associated States, including the availability of the full- and part-time staff of each office to the veterans they are charged with serving; (H) an analysis of the availability of the Veterans Community Care Program established under section 1703 of title 38, United States Code, to veterans in each Territory and Freely Associated State; (I) an analysis of the economic and health outcomes for veterans in each Territory or Freely Associated State resulting from obstacles to accessing adequate assistance and health care at facilities of the Department; (J) an analysis of the access to benefit assistance and health care provided to veterans in the aftermath of major disasters declared in each of the Territories and Freely Associated States since September 4, 2017; and (K) such recommendations as the Comptroller General considers appropriate for improving access of veterans in the Territories and Freely Associated States to benefits and health care services furnished by the Secretary, and reducing barriers and deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the United States. (b) Briefing Not later than one year after the date of the enactment of this Act, the Comptroller General shall provide to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a briefing setting forth the results of the study conducted under subsection (a), including any recommendations developed under paragraph (2)(K) of such subsection. (c) Definitions In this section: (1) Freely Associated State The term Freely Associated State includes the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. (2) Territory The term Territory includes American Samoa, the Commonwealth of the Northern Marianas Islands, Guam, Puerto Rico, and the Virgin Islands. (3) Vet Center The term Vet Center has the meaning given that term in section 1712A(h) of title 38, United States Code. 509. Department of Veterans Affairs public website for toxic exposure research (a) Website Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish, and maintain thereafter, a publicly accessible internet website of the Department of Veterans Affairs that serves as a clearinghouse for the publication of all toxic exposure research carried out or funded by the executive branch of the Federal Government. (b) Coordination In carrying out subsection (a), the Secretary shall coordinate with— (1) the heads of each Federal agency carrying out or funding toxic exposure research; (2) the War Related Illness and Injury Study Center of the Department of Veterans Affairs, or successor center; and (3) any working group of the Department of Veterans Affairs or other similar entity responsible for coordinating toxic exposure research. (c) Definitions In this section: (1) Toxic exposure The term toxic exposure has the meaning given that term in section 101 of title 38, United States Code, as added by section 102(b). (2) Toxic exposure research The term toxic exposure research means research on the health consequences of toxic exposures experienced during service in the Armed Forces. 510. Report on health effects of jet fuels used by Armed Forces (a) Initial report Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to 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 health effects of jet fuels used by the Armed Forces. (b) Contents The report submitted under subsection (a) shall include the following: (1) A discussion of the effect of various different types of jet fuels used by the Armed Forces on the health of individuals by length of exposure. (2) An identification of the immediate symptoms of jet fuel exposure that may indicate future health risks. (3) A chronology of health safeguards implemented by the Armed Forces intended to reduce the exposure of members of the Armed Forces to jet fuel. (4) An identification of any areas relating to jet fuel exposure about which new research needs to be conducted. (c) Follow-up report Not later than five years after the date of the submittal of the report under subsection (a), the Secretary shall submit to the committees referred to in such subsection an update to such report. VI Improvement of resources and training regarding toxic-exposed veterans 601. Short title; definitions (a) Short title This title may be cited as the Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act of 2022 or the FASTER Presumption Act of 2022 . (b) Definitions In this title, the terms active military, naval, air, or space service , toxic exposure , and toxic-exposed veteran have the meanings given those terms in section 101 of title 38, United States Code, as amended by section 102. 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 survivors of such veterans (a) Publication of list of resources (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for— (A) toxic-exposed veterans and veterans who report toxic exposure; (B) families and caregivers of such veterans; and (C) survivors of such veterans who are receiving death benefits under the laws administered by the Secretary. (2) Update The Secretary shall periodically update the list published under paragraph (1). (b) Outreach The Secretary shall develop, with input from the community, an informative outreach program for veterans on illnesses that may be related to toxic exposures, including outreach with respect to benefits and support programs. 603. Incorporation of toxic exposure screening for veterans (a) In general Beginning not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall incorporate a screening to help determine potential toxic exposures during active military, naval, air, or space service as part of a health care screening furnished by the Department of Veterans Affairs to veterans enrolled in the system of annual patient enrollment of the Department established and operated under section 1705 of title 38, United States Code, to improve understanding by the Department of toxic exposures while serving in the Armed Forces. (b) Timing The Secretary shall ensure that a veteran described in subsection (a) completes the screening required under such subsection not less frequently than once every five years. (c) Determination of questions (1) In general The questions included in the screening required under subsection (a) shall be determined by the Secretary with input from medical professionals. (2) Specific questions At a minimum, the screening required under subsection (a) shall, with respect to a veteran, include— (A) a question about the potential exposure of the veteran to an open burn pit; and (B) a question regarding toxic exposures that are commonly associated with service in the Armed Forces. (3) Open burn pit defined In this subsection, the term open burn pit means an area of land that— (A) is designated by the Secretary of Defense to be used for disposing solid waste by burning in the outdoor air; and (B) does not contain a commercially manufactured incinerator or other equipment specifically designed and manufactured for the burning of solid waste. (d) Print material In developing the screening established under subsection (a), the Secretary shall ensure that print materials complementary to such screening that outline related resources for veterans are available at each medical center of the Department to veterans who may not have access to the internet. (e) Screening updates The Secretary shall consider updates to the content of the screening required under subsection (a) not less frequently than biennially to ensure the screening contains the most current information. 604. Training for personnel of the Department of Veterans Affairs with respect to veterans who report toxic exposures (a) Health care personnel The Secretary of Veterans Affairs shall provide to health care personnel of the Department of Veterans Affairs education and training to identify, treat, and assess the impact on veterans of illnesses related to toxic exposures and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures. (b) Benefits personnel (1) In general The Secretary shall incorporate a training program for processors of claims under the laws administered by the Secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposures. (2) Annual training Training provided to processors under paragraph (1) shall be provided not less frequently than annually. VII Resourcing 701. Authority to use appropriations to enhance claims processing capacity and automation (a) Authority The Secretary of Veterans Affairs may use, from amounts appropriated to the Cost of War Toxic Exposures Fund established by section 324 of title 38, United States Code, as added by section 805 of this Act, such amounts as may be necessary to continue the modernization, development, and expansion of capabilities and capacity of information technology systems and infrastructure of the Veterans Benefits Administration, including for claims automation, to support expected increased claims processing for newly eligible veterans pursuant to this Act. (b) Plan for modernization of Veterans Benefits Administration information technology systems (1) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a plan for the modernization of the information technology systems of the Veterans Benefits Administration. The plan shall cover the first fiscal year that begins after the date of the enactment of this Act and the subsequent four fiscal years and shall include each of the following: (A) An identification of any information system to be modernized or retired, if applicable, during the period covered by the plan. (B) A description of how the Secretary intends to incorporate the following principles into the modernization of such information systems: (i) The purpose of automation should be to increase the speed and accuracy of claims processing decisions. (ii) Automation should be conducted in a manner that enhances the productivity of employees of the Department of Veterans Affairs. (iii) Automation should be carried out in a manner that achieves greater consistency in the processing and rating of claims by relying on patterns of similar evidence in claim files. (iv) To the greatest extent possible, automation should be carried out by drawing from information in the possession of the Department, other Government agencies, and applicants for benefits. (v) Automation of any claims analysis or determination process should not be end-to-end or lack intermediation. (vi) Employees of the Department should continue to make decisions with respect to the approval of claims and the granting of benefits. (vii) Automation should not be carried out in a manner that reduces or infringes upon the due process rights of applicants for benefits under the laws administered by the Secretary; or the duties of the Secretary to assist and notify claimants. (viii) Automation should be carried out while taking all necessary measures to protect the privacy of claimants and their personally identifiable information. (ix) Automation of claims processing should not eliminate or reduce the workforce of the Veterans Benefits Administration. (C) An identification of targets, for each fiscal year, by which the Secretary intends to complete the modernization of each information system or major component or functionality of such system identified under subparagraph (A). (D) Cost estimates for the modernization of each information system identified under paragraph (A) for each fiscal year covered by the plan and in total. (2) Appropriate congressional committees In this section, the term appropriate congressional committees means— (A) the Committee on Veterans’ Affairs and the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies of the Committee on Appropriations of the Senate; and (B) the Committee on Veterans’ Affairs and the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies of the Committee on Appropriations of the House of Representatives. 702. Authorization of major medical facility leases of Department of Veterans Affairs for fiscal year 2023 (a) In general The Secretary of Veterans Affairs may carry out the following major medical facility leases in fiscal year 2023: (1) Lease for an outpatient clinic in the vicinity of Allentown, Pennsylvania, in an estimated amount of $31,832,000. (2) Lease for a facility for member services for the Veterans Health Administration in the vicinity of Atlanta, Georgia, in an estimated amount of $27,134,000. (3) Lease for an outpatient clinic in the vicinity of Baltimore, Maryland, in an estimated amount of $43,041,000. (4) Lease for an outpatient clinic in the vicinity of Baton Rouge, Louisiana, in an estimated amount of $29,550,000. (5) Lease for an outpatient clinic in the vicinity of Beaufort, South Carolina, in an estimated amount of $24,254,000. (6) Lease for an outpatient clinic in the vicinity of Beaumont, Texas, in an estimated amount of $15,632,000. (7) Lease for an outpatient clinic in the vicinity of Brainerd, Minnesota, in an estimated amount of $14,669,000. (8) Lease for a facility for research in the vicinity of Buffalo, New York, in an estimated amount of $11,106,000. (9) Lease for an outpatient clinic in the vicinity of Clarksville, Tennessee, in an estimated amount of $75,135,000. (10) Lease of a facility for research in the vicinity of Columbia, Missouri, in an estimated amount of $20,726,000. (11) Lease for an outpatient clinic in the vicinity of Cookeville, Tennessee, in an estimated amount of $10,958,000. (12) Lease for a residential treatment facility in the vicinity of Denver, Colorado, in an estimated amount of $9,133,000. (13) Lease for an outpatient clinic in the vicinity of Elizabethtown, Kentucky, in an estimated amount of $16,671,000. (14) Lease for an outpatient clinic in the vicinity of Farmington, Missouri, in an estimated amount of $17,940,000. (15) Lease for an outpatient clinic in the vicinity of Hampton, Virginia, in an estimated amount of $63,085,000. (16) Lease for an outpatient clinic in the vicinity of Jacksonville, North Carolina, in an estimated amount of $61,450,000. (17) Lease for an outpatient clinic in the vicinity of Killeen, Texas, in an estimated amount of $61,030,000. (18) Lease for an outpatient clinic in the vicinity of Lawrence, Indiana, in an estimated amount of $15,811,000. (19) Lease for an outpatient clinic in the vicinity of Lecanto, Florida, in an estimated amount of $15,373,000. (20) Lease for an outpatient clinic in the vicinity of Nashville, Tennessee, in an estimated amount of $58,038,000. (21) Lease for an outpatient clinic in the vicinity of North Kansas City, Missouri, in an estimated amount of $40,027,000. (22) Lease for an outpatient clinic in the vicinity of Pflugerville, Texas, in an estimated amount of $16,654,000. (23) Lease for an outpatient clinic in the vicinity of Plano, Texas, in an estimated amount of $32,796,000. (24) Lease for an outpatient clinic in the vicinity of Prince George’s County, Maryland, in an estimated amount of $31,754,000. (25) Lease for an outpatient clinic in the vicinity of Rolla, Missouri, in an estimated amount of $21,352,000. (26) Lease for an outpatient clinic in the vicinity of Salt Lake City, Utah, in an estimated amount of $29,466,000. (27) Lease for an outpatient clinic in the vicinity of Sarasota, Florida, in an estimated amount of $36,517,000. (28) Lease for an outpatient clinic in the vicinity of Springfield, Massachusetts, in an estimated amount of $30,918,000. (29) Lease for a community living center in the vicinity of Tampa, Florida, in an estimated amount of $51,682,000. (30) Lease for an outpatient clinic in the vicinity of The Villages, Florida, in an estimated amount of $48,267,000. (31) Lease for an outpatient clinic in the vicinity of Tri-Cities, Washington, in an estimated amount of $36,136,000. (b) Treatment of authorizations The authorization of leases under subsection (a) shall be considered to be a specific authorization by law of the funds for such leases for purposes of section 8104(a)(2) of title 38, United States Code, as in effect on the day before the date of the enactment of this Act. (c) Authorization of appropriations There is authorized to be appropriated to the Secretary of Veterans Affairs for fiscal year 2023, or the year in which funds are appropriated for the Medical Facilities account, $998,137,000 for the leases authorized in subsection (a). 703. Treatment of major medical facility leases of the Department of Veterans Affairs (a) Congressional approval of major medical facility leases Paragraph (2) of subsection (a) of section 8104 of title 38, United States Code, is amended— (1) by striking No funds and inserting (A) No funds ; (2) by striking or any major medical facility lease ; (3) by striking or lease ; and (4) by adding at the end the following new subparagraph: (B) No funds may be appropriated for any fiscal year, and the Secretary may not obligate or expend funds (other than for advance planning and design), for any major medical facility lease unless the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives each adopt a resolution approving the lease. . (b) Modification of definition of major medical facility lease Subparagraph (B) of paragraph (3) of such subsection is amended to read as follows: (B) The term major medical facility lease — (i) means a lease for space for use as a new medical facility approved through the General Services Administration under section 3307(a) of title 40 at an average annual rent equal to or greater than the appropriate dollar threshold described in such section, which shall be subject to annual adjustment in accordance with section 3307(h) of such title; and (ii) does not include a lease for space for use as a shared Federal medical facility for which the Department’s estimated share of the lease costs does not exceed such dollar threshold. . (c) Separate prospectus requirement for major medical facility leases Subsection (b) of such section is amended— (1) by striking paragraph (7); (2) in paragraph (1), by redesignating subparagraphs (A) through (E) as clauses (i) through (v), respectively; (3) in paragraph (6), by redesignating subparagraphs (A) through (C) as clauses (i) through (iii), respectively; (4) by redesignating paragraphs (1) through (6) as subparagraphs (A) through (F), respectively; (5) in the matter preceding subparagraph (A), as redesignated by paragraph (4)— (A) by striking Whenever the President and inserting (1) Whenever the President ; (B) by striking the Congress and inserting Congress ; and (C) by striking or a major medical facility lease (as defined in subsection (a)(3)(b)) ; (6) in subparagraph (A), as redesignated by paragraph (4), by striking leased, ; (7) in subparagraph (E), as redesignated by paragraph (4)— (A) by striking or lease each place it appears; and (B) by striking or leases ; and (8) by adding at the end the following new paragraph: (2) Whenever the President or the Secretary submit to Congress a request for the funding of a major medical facility lease (as defined in subsection (a)(3)(B)), the Secretary shall submit to each committee, on the same day, a prospectus of the proposed medical facility. Any such prospectus shall include the following: (A) A description of the facility to be leased. (B) An estimate of the cost to the Federal Government of the facility to be leased. (C) An estimate of the energy performance of the proposed lease space, to include a description of anticipated utilization of renewable energy, energy efficient and climate resilient elements, and related matters. (D) Current and projected workload and utilization data regarding the facility to be leased, including information on projected changes in workload and utilization over a five-year period, a ten-year period, and a twenty-year period. (E) A detailed analysis of how the lease is expected to comply with Office of Management and Budget Circular A–11 and section 1341 of title 31 (commonly referred to as the Anti-Deficiency Act ). Any such analysis shall include— (i) an analysis of the classification of the lease as a lease purchase , a capital lease , or an operating lease as those terms are defined in Office of Management and Budget Circular A–11; (ii) an analysis of the obligation of budgetary resources associated with the lease; and (iii) an analysis of the methodology used in determining the asset cost, fair market value, and cancellation costs of the lease. . (d) Interim leasing actions Such section is further amended by adding at the end the following new subsection: (i) (1) Notwithstanding subsection (a)(2)(B), the Secretary may carry out interim leasing actions as the Secretary considers necessary for the following leases: (A) Major medical facility leases (as defined in subsection (a)(3)(B)) approved pursuant to this section and for which a prospectus for a replacement lease has been submitted to Congress pursuant to subsection (b)(2). (B) Replacement leases that do not require approval under this section and for which a prospectus has been submitted to Congress pursuant to subsection (b)(2). (2) In this subsection, the term interim leasing actions has the meaning given that term by the Administrator of the General Services Administration. . (e) Purchase Options Such section is further amended by adding at the end the following new subsection: (j) The Secretary may obligate and expend funds to exercise a purchase option included in any major medical facility lease (as defined in subsection (a)(3)(B)). . (f) Applicability The amendments made by this section shall apply with respect to any lease that has not been specifically authorized by law on or before the date of the enactment of this Act. 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 Section 8103 of title 38, United States Code, is amended by adding at the end the following new subsection: (h) (1) Notwithstanding any other provision of law requiring the use of competitive procedures, including section 2304 of title 10, when the Secretary determines it to be in the best interest of the Department, the Secretary may enter into a lease with an academic affiliate or covered entity to acquire space for the purpose of providing health-care resources to veterans. (2) In this subsection: (A) The term academic affiliate means an institution or organization described in section 7302(d) of this title. (B) The term covered entity means a unit or subdivision of a State, local, or municipal government, public or nonprofit agency, institution, or organization, or other institution or organization as the Secretary considers appropriate that owns property controlled by an academic affiliate to be leased under this subsection. (C) The term health - care resource has the meaning given that term in section 8152(1) of this title. (D) The term space means any room, unit, floor, wing, building, parking facility, or other subdivision of a building or facility owned or controlled by an academic affiliate. . 705. Modifications to enhanced-use lease authority of Department of Veterans Affairs (a) Modifications to authority Paragraph (2) of section 8162(a) of title 38, United States Code, is amended to read as follows: (2) (A) The Secretary may enter into an enhanced-use lease on or after the date of the enactment of this paragraph only if the Secretary determines— (i) that the lease will not be inconsistent with, and will not adversely affect— (I) the mission of the Department; or (II) the operation of facilities, programs, and services of the Department in the area of the leased property; and (ii) that— (I) the lease will enhance the use of the leased property by directly or indirectly benefitting veterans; or (II) the leased property will provide supportive housing. (B) The Secretary shall give priority to enhanced-use leases that, on the leased property— (i) provide supportive housing for veterans; (ii) provide direct services or benefits targeted to veterans; or (iii) provide services or benefits that indirectly support veterans. . (b) Extension of maximum term of enhanced-use lease Section 8162(b)(2) of such title is amended by striking 75 years and inserting 99 years . (c) Modification of use of proceeds Section 8165(a)(1) of such title is amended by striking shall be deposited in the Department of Veterans Affairs Medical Care Collections Fund established under section 1729A of this title. and inserting “shall, at the discretion of the Secretary, be deposited in— (A) the Department of Veterans Affairs Medical Care Collections Fund established under section 1729A of this title; or (B) the Medical Facilities or Construction, Minor Projects account of the Department to be used to defray the costs of administration, maintenance, repair, and related expenses incurred by the Department with respect to property that is owned by or under the jurisdiction or control of the Department. . (d) Repeal of sunset Section 8169 of such title is repealed. (e) Appropriation In addition to amounts otherwise available, there is appropriated for fiscal year 2022, out of any funds in the Treasury not otherwise appropriated, $922,000,000 for an additional amount for the Department of Veterans Affairs, to remain available until expended, to enter into enhanced-use leases pursuant to section 8162 of title 38, United States Code, as amended by this section. 706. Authority for joint leasing actions of Department of Defense and Department of Veterans Affairs (a) Department of Defense Section 1104A of title 10, United States Code, is amended— (1) by inserting , or the leasing, after design, and construction each place it appears; and (2) in subsection (c)(2), by inserting , or the leasing, after design . (b) Department of Veterans Affairs Section 8111B of title 38, United States Code, is amended— (1) in subsection (a), by inserting , or the leasing, after design, and construction ; (2) in subsection (b), by adding at the end the following new paragraph: (3) The Secretary of Veterans Affairs may transfer to the Department of Defense amounts appropriated to the Medical Facilities account of the Department of Veterans Affairs for the purpose of leasing space for a shared medical facility if the estimated share of the Department of Veterans Affairs for the lease costs does not exceed the amount specified in section 8104(a)(3)(B) of this title. ; and (3) in subsection (c), by adding at the end the following new paragraph: (3) Any amount transferred to the Secretary of Veterans Affairs by the Secretary of Defense for the purpose of leasing space for a shared medical facility may be credited to the Medical Facilities account of the Department of Veterans Affairs and may be used for such purpose. . 707. Appropriation of amounts for major medical facility leases (a) Fiscal year 2023 In addition to amounts otherwise available, there is appropriated for fiscal year 2023, out of any funds in the Treasury not otherwise appropriated, $1,880,000,000 for an additional amount for the Medical Facilities account of the Department of Veterans Affairs, to remain available until expended, for major medical facility leases authorized by section 702. (b) Additional years In addition to amounts otherwise available, there is appropriated, out of any funds in the Treasury not otherwise appropriated, for an additional amount for the Medical Facilities account of the Department of Veterans Affairs, to remain available until expended, for major medical facility leases authorized by section 702 or approved pursuant to subchapter I of chapter 81 of title 38, United States Code, as amended by section 703— (1) $100,000,000 for fiscal year 2024; (2) $200,000,000 for fiscal year 2025; (3) $400,000,000 for fiscal year 2026; (4) $450,000,000 for fiscal year 2027; (5) $600,000,000 for fiscal year 2028; (6) $610,000,000 for fiscal year 2029; (7) $620,000,000 for fiscal year 2030; and (8) $650,000,000 for fiscal year 2031. VIII Records and other matters 801. Epidemiological study on Fort McClellan veterans The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces at Fort McClellan at any time during the period beginning January 1, 1935, and ending on May 20, 1999. 802. Biennial briefing on Individual Longitudinal Exposure Record (a) In general Not later than one year after the date on which the Individual Longitudinal Exposure Record achieves full operational capability, as determined by the Secretary of Defense, and every two years thereafter, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall provide the appropriate committees of Congress a briefing on— (1) the quality of the databases of the Department of Defense that provide the information presented in such Individual Longitudinal Exposure Record; and (2) the usefulness of such Individual Longitudinal Exposure Record or system in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. (b) Elements Each briefing required by subsection (a) shall include, for the period covered by the report, the following: (1) An identification of potential exposures to occupational or environmental hazards captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. (2) An analysis of the quality and accuracy of the location data used by the Department of Defense in determining potential exposures to occupational or environmental hazards by members of the Armed Forces and veterans, and recommendations for how to improve the quality of such data if necessary. (c) Definitions In this section: (1) Appropriate committees of Congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. (2) Individual Longitudinal Exposure Record The term Individual Longitudinal Exposure Record has the meaning given such term in section 1171 of title 38, United States Code, as added by section 202. 803. Correction of exposure records by members of the Armed Forces and veterans (a) In general The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense to provide a means for veterans to update their records as necessary to reflect exposures to occupational or environmental hazards by such member or veteran in the Individual Longitudinal Exposure Record. (b) Evidence (1) Provision of evidence To update a record under subsection (a), a veteran shall provide such evidence as the Secretary of Veterans Affairs considers necessary. (2) Regulations The Secretary of Veterans Affairs shall prescribe by regulation the evidence considered necessary under paragraph (1). (c) Definitions In this section: (1) Individual Longitudinal Exposure Record The term Individual Longitudinal Exposure Record has the meaning given such term in section 1171 of title 38, United States Code, as added by section 202. (2) Toxic exposure The term toxic exposure has the meaning given such term in section 101 of title 38, United States Code, as amended by section 102(b). 804. Federal cause of action relating to water at Camp Lejeune, North Carolina (a) Short title This section may be cited as the Camp Lejeune Justice Act of 2022 . (b) In general An individual, including a veteran (as defined in section 101 of title 38, United States Code), or the legal representative of such an individual, who resided, worked, or was otherwise exposed (including in utero exposure) for not less than 30 days during the period beginning on August 1, 1953, and ending on December 31, 1987, to water at Camp Lejeune, North Carolina, that was supplied by, or on behalf of, the United States may bring an action in the United States District Court for the Eastern District of North Carolina to obtain appropriate relief for harm that was caused by exposure to the water at Camp Lejeune. (c) Burdens and standard of proof (1) In general The burden of proof shall be on the party filing the action to show one or more relationships between the water at Camp Lejeune and the harm. (2) Standards To meet the burden of proof described in paragraph (1), a party shall produce evidence showing that the relationship between exposure to the water at Camp Lejeune and the harm is— (A) sufficient to conclude that a causal relationship exists; or (B) sufficient to conclude that a causal relationship is at least as likely as not. (d) Exclusive jurisdiction and venue The United States District Court for the Eastern District of North Carolina shall have exclusive jurisdiction over any action filed under subsection (b), and shall be the exclusive venue for such an action. Nothing in this subsection shall impair the right of any party to a trial by jury. (e) Exclusive remedy (1) In general An individual, or legal representative of an individual, who brings an action under this section for a harm described in subsection (b), including a latent disease, may not thereafter bring a tort action against the United States for such harm pursuant to any other law. (2) Health and disability benefits relating to water exposure Any award made to an individual, or legal representative of an individual, under this section shall be offset by the amount of any disability award, payment, or benefit provided to the individual, or legal representative— (A) under— (i) any program under the laws administered by the Secretary of Veterans Affairs; (ii) the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); or (iii) the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ); and (B) in connection with health care or a disability relating to exposure to the water at Camp Lejeune. (f) Immunity limitation The United States may not assert any claim to immunity in an action under this section that would otherwise be available under section 2680(a) of title 28, United States Code. (g) No punitive damages Punitive damages may not be awarded in any action under this section. (h) Disposition by Federal agency required An individual may not bring an action under this section before complying with section 2675 of title 28, United States Code. (i) Exception for combatant activities This section does not apply to any claim or action arising out of the combatant activities of the Armed Forces. (j) Applicability; period for filing (1) Applicability This section shall apply only to a claim accruing before the date of enactment of this Act. (2) Statute of limitations A claim in an action under this section may not be commenced after the later of— (A) the date that is two years after the date of enactment of this Act; or (B) the date that is 180 days after the date on which the claim is denied under section 2675 of title 28, United States Code. (3) Inapplicability of other limitations Any applicable statute of repose or statute of limitations, other than under paragraph (2), shall not apply to a claim under this section. 805. Cost of War Toxic Exposures Fund (a) In general Chapter 3 is amended by adding at the end the following new section: 324. Cost of War Toxic Exposures Fund (a) Establishment There is hereby established in the Treasury of the United States an account to be known as the Cost of War Toxic Exposures Fund (the Fund ), to be administered by the Secretary. (b) Deposits There shall be deposited in the Fund such amounts as may be appropriated to the Fund pursuant to subsection (c). (c) Authorization of appropriations There is authorized to be appropriated to the Fund for fiscal year 2023 and each subsequent fiscal year such sums as are necessary to increase funding, over the fiscal year 2021 level, for investment in— (1) the delivery of veterans’ health care associated with exposure to environmental hazards in the active military, naval, air, or space service in programs administered by the Under Secretary for Health; (2) any expenses incident to the delivery of veterans’ health care and benefits associated with exposure to environmental hazards in the active military, naval, air, or space service, including administrative expenses, such as information technology and claims processing and appeals, and excluding leases as authorized or approved under section 8104 of this title; and (3) medical and other research relating to exposure to environmental hazards. (d) Budget scorekeeping (1) Immediately upon enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 , expenses authorized to be appropriated to the Fund in subsection (c) shall be estimated for fiscal year 2023 and each subsequent fiscal year and treated as budget authority that is considered to be direct spending— (A) in the baseline for purposes of section 257 of the Balanced Budget and Emergency Deficit Control Act of 1985 ( 2 U.S.C. 907 ); (B) by the Chairman of the Committee on the Budget of the Senate and the Chair of the Committee on the Budget of the House of Representatives, as appropriate, for purposes of budget enforcement in the Senate and the House of Representatives; (C) under the Congressional Budget Act of 1974 ( 2 U.S.C. 621 et seq. ), including in the reports required by section 308(b) of such Act ( 2 U.S.C. 639 ); and (D) for purposes of the Statutory Pay-As-You-Go Act of 2010 ( 2 U.S.C. 931 et seq. ). (2) No amount appropriated to the Fund in fiscal year 2023 or any subsequent fiscal year pursuant to this section shall be counted as discretionary budget authority and outlays or as direct spending for any estimate of an appropriation Act under the Congressional Budget and Impoundment Control Act of 1974 ( 2 U.S.C. 621 et seq. ) and any other Act. (3) Notwithstanding the Budget Scorekeeping Guidelines and the accompanying list of programs and accounts set forth in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217, and for purposes of the Balanced Budget and Emergency Deficit Control Act of 1985 ( 2 U.S.C. 900 et seq. ) and the Congressional Budget Act of 1974 ( 2 U.S.C. 621 et seq. ), the Fund shall be treated as if it were an account designated as Appropriated Entitlements and Mandatories for Fiscal Year 1997 in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217. (e) Estimates for congressional consideration The Secretary shall include in documents submitted to Congress in support of the President’s budget submitted pursuant to section 1105 of title 31 detailed estimates of the sums described in subsection (c) for the applicable fiscal year. (f) Procedures for estimates The Secretary may, after consultation with the Committee on Appropriations of the Senate and the Committee on Appropriations of the House of Representatives, establish policies and procedures for developing the annual detailed estimates required by subsection (e). . (b) Sequestration Section 256(h)(4) of the Balanced Budget and Emergency Deficit Control Act of 1985 ( 2 U.S.C. 906(h)(4) ) is amended by adding at the end the following new subparagraph: (G) Cost of War Toxic Exposures Fund. . 806. Appropriation for fiscal year 2022 (a) Appropriation In addition to amounts otherwise available, there is appropriated for fiscal year 2022, out of any funds in the Treasury not otherwise appropriated, $500,000,000 for the Cost of War Toxic Exposures Fund, established by section 324 of title 38, United States Code, as added by section 805 of this Act, to remain available until September 30, 2024. (b) Spend plan Not later than 30 days after enactment of this Act, the Secretary of Veterans Affairs shall submit a plan for expending amounts made available by subsection (a) by program, project or activity to the Committee on Appropriations of the Senate and the Committee on Appropriations of the House of Representatives. Funds may not be obligated until such Committees issue an approval, or absent a response, a period of 30 days has elapsed. 807. Authorization of electronic notice in claims under laws administered by the Secretary of Veterans Affairs (a) In general Title 38, United States Code, is amended as follows: (1) By striking section 5100 and inserting the following: 5100. Definitions In this chapter: (1) The term claimant means any individual applying for, or submitting a claim for, any benefit under the laws administered by the Secretary. (2) The term notice means a communication issued through means (including electronic means) prescribed by the Secretary. . (2) In section 5104, by adding at the end the following new subsection: (c) The Secretary may provide notice under subsection (a) electronically if a claimant (or the claimant’s representative) elects to receive such notice electronically. A claimant (or the claimant’s representative) may revoke such an election at any time, by means prescribed by the Secretary. (d) The Secretary shall annually— (1) solicit recommendations from stakeholders on how to improve notice under this section; and (2) publish such recommendations on a publicly available website of the Department. . (3) In section 5104B(c), in the matter preceding paragraph (1) by striking in writing and inserting to the claimant (and any representative of such claimant) . (4) In section 5112(b)(6), by striking (at the payee's last address of record) . (5) In section 7104— (A) in the heading, by adding ; decisions; notice at the end; and (B) by striking subsection (e) and inserting the following: (e) After reaching a decision on an appeal, the Board shall promptly issue notice (as that term is defined in section 5100 of this title) of such decision to the following: (1) The appellant. (2) Any other party with a right to notice of such decision. (3) Any authorized representative of the appellant or party described in paragraph (2). (f) (1) The Secretary may provide notice under subsection (e) electronically if a claimant (or the claimant’s representative) elects to receive such notice electronically. (2) A claimant (or the claimant’s representative) may revoke such an election at any time, by means prescribed by the Secretary. . (6) In section 7105(b)(1)(A), by striking mailing and inserting issuance . (7) In section 7105A(a), by striking mailed and inserting issued . (8) In section 7266(a), by striking mailed and inserting issued . (b) Rule of construction None of the amendments made by this section shall be construed to apply section 5104(a) of such title to decisions of the Board of Veterans' Appeals under chapter 71 of such title. 808. Burn pit transparency (a) Annual report on disability claims (1) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report detailing the following: (A) The total number of covered veterans. (B) The total number of claimed issues for disability compensation under chapter 11 of title 38, United States Code, approved and the total number denied by the Secretary of Veterans Affairs with respect to a covered veteran, and a breakdown of the reasons for the denials. (C) A comprehensive list of the top 10 conditions from each body system for which the Secretary awarded service connection for covered veterans. (D) Any updates or trends with respect to the information described in subparagraphs (A), (B), and (C), that the Secretary determines appropriate. (2) Covered veteran defined In this subsection, the term covered veteran means a veteran who deployed to the Southwest Asia theater of operations any time after August 1990, or Afghanistan, Syria, Djibouti, or Uzbekistan after September 19, 2001, and who submits a claim for disability compensation under chapter 11 of title 38, United States Code. (b) Information regarding the Airborne Hazards and Open Burn Pit Registry (1) Notice The Secretary of Veterans Affairs shall ensure that a medical professional of the Department of Veterans Affairs informs a veteran of the Airborne Hazards and Open Burn Pit Registry if the veteran presents at a medical facility of the Department for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits. (2) Display In making information public regarding the number of participants in the Airborne Hazards and Open Burn Pit Registry, the Secretary shall display such numbers by both State and by congressional district. (c) Definitions In this section: (1) Airborne Hazards and Open Burn Pit Registry The term Airborne Hazards and Open Burn Pit Registry means the registry established by the Secretary of Veterans Affairs 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). (2) Appropriate congressional committees The term appropriate congressional committees means— (A) the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and (B) The Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. (3) Open burn pit The term open burn pit has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 ( Public Law 112–260 ; 38 U.S.C. 527 note). IX Improvement of workforce of Department of Veterans Affairs 901. National rural recruitment and hiring plan for Veterans Health Administration (a) In general Not later than 18 months after the date of the enactment of this Act, the Secretary of Veterans Affairs, in collaboration with the directors of each community-based outpatient clinic and medical center of the Department of Veterans Affairs, shall develop and implement a national rural recruitment and hiring plan for the Veterans Health Administration to— (1) recruit health care professionals for rural and highly rural community-based outpatient clinics and rural and highly rural medical centers of the Department; (2) determine which such clinics or centers have a staffing shortage of health care professionals; (3) develop best practices and techniques for recruiting health care professionals for such clinics and centers; (4) not less frequently than annually, provide virtually based, on-demand training to human resources professionals of the Veterans Health Administration on the best practices and techniques developed under paragraph (3); and (5) provide recruitment resources, such as pamphlets and marketing material to— (A) Veterans Integrated Service Networks of the Department; (B) rural and highly rural community-based outpatient clinics of the Department; and (C) rural and highly rural medical centers of the Department. (b) Annual report Not later than 18 months after the date of the enactment of this Act, and annually thereafter, 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 that includes— (1) the plan developed and implemented under subsection (a); and (2) an assessment of the outcomes related to recruitment and retention of employees of the Veterans Health Administration at rural and highly rural facilities of the Department. (c) Definitions In this section, the terms rural and highly rural have the meanings given those terms under the rural-urban commuting areas coding system of the Department of Agriculture. 902. Authority to buy out service contracts for certain health care professionals in exchange for employment at rural or highly rural facilities of Department of Veterans Affairs (a) In general For any covered health care professional to whom the Secretary of Veterans Affairs has offered employment with the Department of Veterans Affairs, the Secretary may buy out the non-Department service contract of such individual in exchange for such individual agreeing to be employed at a rural or highly rural facility of the Department for a period of obligated service specified in subsection (c). (b) Payment of amounts (1) In general Payment of any amounts for a buy out of a service contract for a covered health care professional under subsection (a) shall be made directly to the individual or entity with respect to which the covered health care professional has a service obligation under such contract. (2) Limitation on total amount The total amount paid by the Department under this section shall not exceed $40,000,000 per fiscal year. (c) Obligated service In exchange for a contract buy out under subsection (a), a covered health care professional shall agree to be employed for not less than four years at a rural or highly rural facility of the Department. (d) Liability (1) In general Except as provided in paragraph (2), if a covered health care professional fails for any reason to complete the period of obligated service of the individual under subsection (c), the United States shall be entitled to recover from the individual an amount equal to— (A) the total amount paid under subsection (a) to buy out the non-Department service contract of the individual; multiplied by (B) a fraction— (i) the numerator of which is— (I) the total number of months in the period of obligated service of the individual; minus (II) the number of months served by the individual; and (ii) the denominator of which is the total number of months in the period of obligated service of the individual. (2) Exception Liability shall not arise under paragraph (1) in the case of an individual covered by that paragraph if the individual does not obtain, or fails to maintain, employment as an employee of the Department due to staffing changes approved by the Under Secretary for Health. (e) Not a taxable benefit A contract buy out for a covered health care professional under subsection (a) shall not be considered a taxable benefit or event for the covered health care professional. (f) Annual report (1) In general Not later than 18 months after the date of the enactment of this Act, and not less frequently than annually thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the use by the Secretary of the authority under this section. (2) Elements Each report required by paragraph (1) shall include the following: (A) The number of health care professionals for whom a service contract buyout payment was made under subsection (a) in the previous fiscal year, disaggregated by occupation or specialty. (B) The average, highest, and lowest amount of the service contract buyout payments made under subsection (a) for each occupation or specialty in the previous fiscal year. (C) Each location where contract buyout authority under subsection (a) was utilized and the number of covered health care professionals who agreed to be employed at such location in the previous fiscal year. (g) Definitions In this section: (1) Covered health care professional The term covered health care professional means a physician, nurse anesthetist, physician assistant, or nurse practitioner offered employment with the Department regardless of the authority under which such employment is offered. (2) Rural; highly rural The terms rural and highly rural have the meanings given those terms under the rural-urban commuting areas coding system of the Department of Agriculture. (h) Sunset This section shall terminate on September 30, 2027. 903. Qualifications for human resources positions within Department of Veterans Affairs and plan to recruit and retain human resources employees (a) Establishment of qualifications Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (1) establish qualifications for each human resources position within the Department of Veterans Affairs in coordination with the Office of Personnel Management; (2) establish standardized performance metrics for each such position; and (3) 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 qualifications and standardized performance metrics established under paragraphs (1) and (2). (b) Improvement of human resources actions Not later than 90 days after the date of the enactment of this Act, the Secretary shall establish or enhance systems of the Department to monitor the hiring and other human resources actions that occur at the local, regional, and national levels of the Department to improve the performance of those actions. (c) Report Not later than one year after the establishment of the qualifications and performance metrics under subsection (a), the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing— (1) a description of the implementation of such qualifications and performance metrics; (2) an assessment of the quality of such qualifications and performance metrics; (3) an assessment of performance and outcomes based on such metrics; and (4) such other matters as the Comptroller General considers appropriate. (d) Plan to recruit and retain human resources employees Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan for the recruitment and retention of human resources employees within the Department of Veterans Affairs. 904. Modification of pay cap for certain employees of Veterans Health Administration (a) In general Section 7455(c) is amended— (1) in paragraph (1), by striking 30 percent inserting 50 percent ; (2) in paragraph (2), by striking level IV inserting level II ; and (3) by adding at the end the following new paragraph: (3) (A) Notwithstanding section 5304 of title 5 or any other provision of law, but subject to the limitation under paragraph (2), pursuant to an increase under subsection (a), the Secretary may pay a special rate or an adjusted rate of basic pay in excess of the rate of basic pay payable for level IV of the Executive Schedule. (B) If an employee is in receipt of a special rate of pay under subparagraph (A) in excess of the rate of basic pay payable for level IV of the Executive Schedule with an established special rate supplement of greater value than a supplement based on the applicable locality-based comparability payment percentage under section 5304 of title 5, but a pay adjustment would cause such established special rate supplement to be of lesser value, the special rate supplement shall be converted to a supplement based on the applicable locality-based comparability percentage unless the Secretary determines that some other action is appropriate. . (b) Pay for critical positions Section 7404(a)(1)(B) is amended by inserting 7306 or before 7401(4) . 905. Expansion of opportunities for housekeeping aides Section 3310 of title 5, United States Code, is amended by inserting (other than for positions of housekeeping aides in the Department of Veterans Affairs) after competitive service . 906. Modification of authority of the Secretary of Veterans Affairs relating to hours, conditions of employment, and pay for certain employees of Veterans Health Administration (a) Expansion of eligibility of employees for certain awards Section 7404(c) is amended— (1) by striking Notwithstanding and inserting (1) Notwithstanding ; (2) by inserting or 7401(4) after section 7306 ; (3) by striking who is not eligible for pay under subchapter III and inserting or in a covered executive position under section 7401(1) of this title ; (4) by striking sections 4507 and 5384 and inserting section 4507 ; and (5) by adding at the end the following new paragraph: (2) In this subsection, the term covered executive position means a position that the Secretary has determined is of equivalent rank to a Senior Executive Service position (as such term is defined in section 3132(a) of title 5) and is subject to an agency performance management system. . (b) Authority for awards programs of Department of Veterans Affairs (1) In general Subchapter I of chapter 74 is amended by inserting after section 7404 the following new section: 7404A. Awards (a) Superior accomplishments and performance awards program The Secretary may establish an awards program for personnel listed in section 7421(b) of this title consistent with chapter 45 of title 5, to the extent practicable. (b) Executive performance awards program Notwithstanding section 7425 of this title or any other provision of law, the Secretary may establish a performance awards program consistent with section 5384 of title 5 for— (1) personnel appointed under section 7401(1) of this title for a position that the Secretary has determined is of equivalent rank to a Senior Executive Service position (as such term is defined in section 3132(a) of title 5) and is subject to an agency performance management system; and (2) personnel appointed under section 7306 or 7401(4) of this title. (c) Payment of awards Awards under this section may be paid based on criteria established by the Secretary and shall not be considered in calculating the limitation under section 7431(e)(4) of this title. (d) Not considered basic pay Awards under this section shall not be considered basic pay for any purpose. (e) Regulations The Secretary may prescribe regulations for the administration of this section. . (2) Limitation on past awards Notwithstanding any other provision of law, awards made by the Secretary of Veterans Affairs for any period on or after January 1, 2017, and before the date of the enactment of this Act for an employee under section 7306 or 7401(4) of title 38, United States Code, or for a position described in section 7401(1) of such title that the Secretary has determined is of equivalent rank to a Senior Executive Service position (as such term is defined in section 3132(a) of title 5, United States Code), may be subject to section 7404A of title 38, United States Code, as added by paragraph (1). (c) Modification of employees subject to regulation by Secretary of Veterans Affairs of hours and conditions of employment and leaves of absence (1) In general Section 7421 is amended— (A) in subsection (a), by striking chapter and inserting title ; and (B) in subsection (b), by adding at the end the following new paragraph: (9) Any position for which the employee is appointed under section 7306 or 7401(4) of this title. . (2) Administration of full-time employees Section 7423 is amended— (A) in subsection (a)(2), by adding at the end the following new subparagraph: (D) The Secretary may exclude from the requirements of paragraph (1) employees hired under section 7306 or 7401(4) of this title or for a position described in section 7401(1) of this title that the Secretary has determined is of equivalent rank to a Senior Executive Service position (as such term is defined in section 3132(a) of title 5). ; and (B) in subsection (e)(1), by striking 7401(1) and inserting 7421(b) . (3) Additional pay authorities Section 7410(a) is amended— (A) by striking The Secretary and inserting (1) The Secretary ; (B) by striking the personnel described in paragraph (1) of section 7401 of this title and inserting personnel appointed under section 7306 of this title or section 7401(4) of this title, or personnel described in section 7401(1) of this title, ; and (C) by striking in the same manner, and subject to the same limitations, as in the case of and inserting in a manner consistent with ; and (D) by adding at the end the following new paragraph: (2) Payments under paragraph (1) shall not be considered in calculating the limitation under section 7431(e)(4) of this title. . (4) Treatment of pay authority changes For the purposes of the amendments made by paragraph (3), the Secretary of Veterans Affairs shall treat any award or payment made by the Secretary between January 1, 2017, and the date of the enactment of this Act to employees appointed under sections 7306, 7401(1), and 7401(4) of title 38, United States Code, that the Secretary has determined are of equivalent rank to a Senior Executive Service position (as such term is defined in section 3132(a) of title 5, United States Code), as if such amendments had been in effect at the time of such award or payment. (5) Treatment of prior leave balances Notwithstanding any other provision of law, the Secretary may adjust the leave balance and carryover leave balance of any employee described in section 7421(b)(9) of title 38, United States Code, as amended by paragraph (1)(B), to ensure any leave accrued or carried over before the date of the enactment of this Act remains available to such employee. (d) Treatment of certain employees as appointed under section 7306 Section 7306 is amended— (1) in subsection (a), by redesignating the second paragraph (11) as paragraph (12); and (2) by adding at the end the following new subsection: (g) For purposes of applying any provision of chapter 74 of this title, including sections 7404, 7410, and 7421, or any other provision of law, the Secretary may treat any appointment for a position under this chapter to be an appointment under this section. . (e) Conforming amendment Section 7431(e)(4) is amended by striking In no case and inserting Except as provided in sections 7404A(c) and 7410(a)(2) of this title, in no case . 907. Waiver of pay limitation for certain employees of Department of Veterans Affairs Subchapter I of chapter 7 is amended by inserting after section 703 the following new section: 704. Waiver of pay limitation for certain employees (a) Employees of Veterans Health Administration impacted by closure or realignment Notwithstanding any other provision of law, the Secretary may waive any annual premium or aggregate limitation on pay for an employee of the Veterans Health Administration for the calendar year during which— (1) the official duty station of the employee is closed; or (2) the office, facility, activity, or organization of the employee is realigned. (b) Employees providing care to veterans exposed to open burn pits (1) In general Notwithstanding any other provision of law, the Secretary may waive any annual premium or aggregate limitation on pay for an employee of the Department whose primary duties include providing expanded care for veterans exposed to open burn pits. (2) Open burn pit defined In this subsection, the term open burn pit has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 ( Public Law 112–260 ; 38 U.S.C. 527 note). (c) Coordination with Office of Personnel Management In implementing this section, the Secretary shall coordinate with the Director of the Office of Personnel Management. (d) Reports (1) In general For each quarter that the Secretary waives a limitation under this section, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Office of Personnel Management a report on the waiver or waivers. (2) Contents Each report submitted under paragraph (1) with respect to a waiver or waivers shall include the following: (A) Where the waiver or waivers were used, including in which component of the Department and, as the case may be, which medical center of the Department. (B) For how many employees the waiver or waivers were used, disaggregated by component of the Department and, if applicable, medical center of the Department. (C) The average amount by which each payment exceeded the pay limitation that was waived, disaggregated by component of the Department and, if applicable, medical center of the Department. (e) Employee defined In this section, the term employee means any employee regardless of the authority under which the employee was hired. (f) Termination This section shall terminate on September 30, 2027. . 908. Elimination of limitation on awards and bonus for employees of Department of Veterans Affairs (a) In general Section 705(a) of the Veterans Access, Choice, and Accountability Act of 2014 ( Public Law 113–146 ; 38 U.S.C. 703 note) is amended by striking paragraph (3). (b) Applicability Subsection (a) shall take effect on the date of the enactment of this Act and apply as if such subsection had been enacted on September 30, 2021. 909. Additional authority of the Secretary of Veterans Affairs relating to recruitment and retention of personnel Subchapter I of chapter 7 is amended by inserting after section 705 the following new section: 706. Additional authority relating to recruitment and retention of personnel (a) Recruitment and relocation bonuses The Secretary may pay a recruitment or relocation bonus under section 5753(e) of title 5 without regard to any requirements for certification or approval under that section. (b) Retention bonuses (1) The Secretary may pay a retention bonus under section 5754(f) of title 5 without regard to any requirement for certification or approval under that subsection. (2) The Secretary may pay a retention bonus as specified in subsection (e)(2) of section 5754 of title 5 and may pay the bonus as a single lump-sum payment at the beginning of the full period of service required by an agreement under subsection (d) of such section. (c) Merit awards The Secretary may grant a cash award under section 4502(b) of title 5 without regard to any requirement for certification or approval under that section. (d) Incentives for critical skills (1) Subject to the provisions of this paragraph, the Secretary may provide a critical skill incentive to an employee in a case in which the Secretary determines— (A) the employee possesses a high-demand skill or skill that is at a shortage; (B) such skill is directly related to the duties and responsibilities of the employee’s position; and (C) employment of an individual with such skill in such position serves a critical mission-related need of the Department. (2) An incentive provided to an employee under paragraph (1) may not to exceed 25 percent of the basic pay of the employee. (3) Provision of an incentive under paragraph (1) shall be contingent on the employee entering into a written agreement to complete a period of employment with the Department. (4) An incentive provided under paragraph (1) shall not be considered basic pay for any purpose. (5) The Secretary may prescribe conditions, including with respect to eligibility, and limitations on provision of incentive under paragraph (1). (6) Incentive provided under paragraph (1) shall not be included in the calculation of total amount of compensation under section 7431(e)(4) of this title. (e) Student loan repayments (1) Subject to the provisions of this subsection, the Secretary may repay a student loan pursuant to section 5379(b) of title 5. (2) Paragraph (2) of such section shall not apply to payment under this subsection. (3) Payment under this subsection shall be made subject to such terms, limitations, or conditions as may be mutually agreed to by the Secretary and the employee concerned, except that the amount paid by the Secretary under this subsection may not exceed— (A) $40,000 for any employee in any calendar year; or (B) a total of $100,000 in the case of any employee. (f) Expedited hiring authority for college graduates; competitive service (1) Subject to paragraph (2) of this subsection, the Secretary may expedite hiring for college graduates under section 3115 of title 5 without regard to subsection (e) of such section or any regulations prescribed by the Office of Personnel Management for administration of such subsection. (2) The number of employees the Secretary may appoint under section 3115 of title 5 may not exceed the number equal to 25 percent of individuals that the Secretary appointed during the previous fiscal year to a position in the competitive service classified in a professional or administrative occupational category, at the GS–11 level, or an equivalent level, or below, under a competitive examining procedure. (g) Expedited hiring authority for post-secondary students; competitive service (1) Subject to paragraph (2) of this subsection, the Secretary may expedite hiring of post-secondary students under section 3116 of title 5, without regard to subsection (d) of such section or any regulations prescribed by the Office of Personnel Management for administration of such subsection. (2) The number of employees the Secretary may appoint under section 3116 of title 5 may not exceed the number equal to 25 percent of the number of students that the Secretary appointed during the previous fiscal year to a position at the GS–11 level, or an equivalent level, or below. (h) Pay authority for critical positions (1) Subject to the provisions of this subsection, the Secretary may authorize the fixing of the rate of pay for a critical position in the Department consistent with the authorities and requirements of section 5377 of title 5 that apply to the Office of Personnel Management. (2) The Secretary may fix the rate of pay for a critical position under this subsection in excess of the limitation set forth by section 5377(d)(2) of such title. (3) Basic pay may not be fixed under this subsection at a rate greater than the rate payable for the Vice President of the United States established under section 104 of title 3, except upon written approval of the President. (4) Notwithstanding section 5377(f) of title 5, the Secretary may authorize the exercise of authority under this subsection with respect to up to 200 positions at any time. (i) Rates of special pay (1) The Secretary may establish a rate for special pay under section 5305(a)(1) of title 5. (2) In applying such section to the Secretary's authority under paragraph (1)— (A) 50 percent shall be substituted for 30 percent ; and (B) level II of the Executive Schedule shall be substituted for level IV of the Executive Schedule . (j) Waiver of limitations on certain payments under pay comparability system The Secretary may waive the limitation in section 5307 of title 5 for an employee or a payment. (k) Termination The authorities under this section shall terminate on September 30, 2027. .

Secretary