Toxic Exposure in the American Military Act of 2020 or the TEAM Act of 2020
This bill requires the Department of Veterans Affairs (VA) to address health care, research, and resources for veterans who were exposed to burn pits or toxic substances during their military service, including by expanding eligibility for VA hospital care, medical services, and nursing home care for such veterans.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8506 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 8506
To improve the provision of health care and other benefits from the
Department of Veterans Affairs for veterans who were exposed to toxic
substances, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 2, 2020
Mr. Bilirakis (for himself, Mr. David P. Roe of Tennessee, Mr.
Wenstrup, Mr. Bost, and Mr. Mast) introduced the following bill; which
was referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To improve the provision of health care and other benefits from the
Department of Veterans Affairs for veterans who were exposed to toxic
substances, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Toxic Exposure in
the American Military Act of 2020'' or the ``TEAM Act of 2020''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO
TOXIC SUBSTANCES
Sec. 101. Expansion of health care eligibility for certain individuals
exposed to open burn pits and other toxic
substances.
Sec. 102. Expansion of health care eligibility for veterans awarded
certain medals.
Sec. 103. Presumptions of service connection for diseases associated
with exposure to certain toxic substances.
TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES
Sec. 201. Establishment of Toxic Exposure Review Commission.
Sec. 202. Agreement with National Academies of Sciences, Engineering,
and Medicine concerning the exposure of
humans to toxic substances.
Sec. 203. Collection, analysis, and report on treatment of veterans for
medical conditions related to exposure to
toxic substances.
TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS
REGARDING EXPOSURES TO TOXIC SUBSTANCES
Sec. 301. Publication of list of resources of Department of Veterans
Affairs for veterans exposed to toxic
substances and outreach program for such
veterans and caregivers and survivors of
such veterans.
Sec. 302. Incorporation of toxic exposure questionnaire during primary
care appointments.
Sec. 303. Sense of Congress on portal for access by veterans to
Individual Longitudinal Exposure Record.
Sec. 304. Training of health care personnel of Department of Veterans
Affairs on illnesses related to exposure to
toxic substances.
SEC. 2. DEFINITIONS.
In this Act:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101 of title 38, United States Code.
(2) 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).
(3) Toxic substance.--The term ``toxic substance'' has the
meaning given that term in subparagraph (G)(iv) of section
1710(e)(1) of such title, as added by section 101(a).
TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO
TOXIC SUBSTANCES
SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR CERTAIN INDIVIDUALS
EXPOSED TO OPEN BURN PITS AND OTHER TOXIC SUBSTANCES.
(a) In General.--Section 1710(e) of title 38, United States Code,
is amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(G)(i) Subject to paragraph (2), a covered individual is eligible
for hospital care, medical services, and nursing home care under
subsection (a)(2)(F) for any illness.
``(ii) For purposes of this subparagraph, a covered individual is
an individual who--
``(I) is eligible for inclusion in the Airborne Hazards and
Open Burn Pit Registry; or
``(II) has been identified by the Secretary of Defense to
have been possibly exposed, inside or outside the United
States, during active duty, active duty for training, or
inactive duty training, to--
``(aa) an open burn pit;
``(bb) a toxic substance; or
``(cc) a site included in a database maintained by
the Department of Defense and shared with the
Department of Veterans affairs to serve as the 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.
``(iii) A covered individual shall be enrolled in the system of
annual patient enrollment of the Department in the priority group under
subsection (a)(6) of section 1705 of this title.
``(iv) In this subparagraph:
``(I) The term `Airborne Hazards and Open Burn Pit
Registry' means the registry established by the Secretary 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).
``(II) 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).
``(III) The term `toxic substance' means a toxicant or a
toxin.
``(IV) The term `toxicant' means any substance that can
injure or kill humans, animals, or plants and that is produced
by humans or is a by-product of human activities.
``(V) The term `toxin' means any substance that can injure
or kill humans, animals, or plants and that is produced
naturally.''; and
(2) in paragraph (2)(B), by striking ``or (F)'' and
inserting ``(F), or (G)''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is 90 days after the date of the enactment
of this Act.
(c) Determinations of Exposure.--
(1) In general.--The Secretary of Veterans Affairs shall,
to the extent practicable, establish and maintain a mechanism
by which veterans may determine whether or not they have been
possibly exposed to an open burn pit or toxic substance
described in subparagraph (G)(ii)(II) of section 1710(e)(1) of
title 38, United States Code, as added by subsection (a), for
purposes of being considered as covered veterans under such
subparagraph.
(2) Approval of secretary.--Any determination made under
paragraph (1) shall be subject to the approval of the
Secretary.
(3) Appeals.--The Secretary shall establish a mechanism for
appealing a decision made by the Secretary under paragraph (2).
(d) Report.--
(1) In general.--Not later than 30 days after the date on
which the Secretary of Defense identifies the individuals
described in subparagraph (G)(ii)(II) of section 1710(e)(1) of
title 38, United States Code, as added by subsection (a), the
Secretary, in consultation with the Secretary of Veterans
Affairs, shall submit to the appropriate committees of Congress
a report.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) The duty locations or units of the individuals
described in paragraph (1), or other information on
groups to which such individuals belong.
(B) The evidence considered in identifying
individuals who were possibly exposed to an open burn
pit, toxic substance, or site as described in
subparagraph (G)(ii)(II) of section 1710(e)(1) of title
38, United States Code, as added by subsection (a).
(C) The criteria used to determine whether an
individual was so exposed.
(3) Appropriate committees of congress.--In this
subsection, the term ``appropriate committees of Congress''
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.
SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR VETERANS AWARDED
CERTAIN MEDALS.
(a) In General.--Section 1710(e) of title 38, United States Code,
as amended by section 101(a), is further amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(H)(i) Subject to paragraph (2), a veteran is eligible for
hospital care, medical services, and nursing home care under subsection
(a)(2)(F) for any illness if the veteran was awarded any of the
following:
``(I) The Armed Forces Service Medal.
``(II) The Afghanistan Campaign Medal.
``(III) The Global War on Terrorism Expeditionary Medal.
``(IV) The Inherent Resolve Campaign Medal.
``(V) The Iraq Campaign Medal.
``(VI) The Southwest Asia Service Medal.
``(ii) A veteran described in clause (i) shall be enrolled in the
system of annual patient enrollment of the Department in the priority
group under subsection (a)(6) of section 1705 of this title.''; and
(2) in paragraph (2), by striking ``or (G)'' and inserting
``(G), or (H)''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is 90 days after the date of the enactment
of this Act.
SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR DISEASES ASSOCIATED
WITH EXPOSURE TO CERTAIN TOXIC SUBSTANCES.
(a) In General.--Subchapter II of chapter 11 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1119. Presumptions of service connection for diseases associated
with exposure to certain toxic substances
``(a) Presumptions of Service Connection.--(1) For purposes of
section 1110 of this title, and subject to section 1113 of this title,
each disease specified in paragraph (2) becoming manifest as specified
in that paragraph shall be considered to have been incurred in or
aggravated by service referred to in that paragraph, notwithstanding
that there is no record of evidence of such disease during the period
of such service.
``(2) A disease specified in this paragraph is any disease that--
``(A) the Secretary determines in regulations prescribed
under this section warrants a presumption of service connection
by reason of having sufficient evidence of positive association
with exposure to a toxic substance; and
``(B) becomes manifest within the period, if any,
prescribed in such regulations in a veteran who was exposed to
that toxic substance during active military, naval, or air
service.
``(3)(A) For purposes of this subsection, the Secretary may presume
that a veteran who has a disease specified in paragraph (2) was exposed
to the toxic substance for which the Secretary has determined under
paragraph (2)(A) warrants a presumption of service connection by reason
of having sufficient evidence of positive association with exposure to
the toxic substance, notwithstanding that there is no record of
evidence of such exposure, if the Secretary determines based on one or
more of the factors set forth in subparagraph (B) that a presumption of
exposure is warranted.
``(B) The factors set forth in this subparagraph are as follows:
``(i) The duty location of the veteran.
``(ii) The length of service of the veteran.
``(iii) Such other factors as the Secretary considers
appropriate.
``(b) Determinations Relating to Diseases.--(1) Whenever the
Secretary determines, on the basis of sound medical and scientific
evidence, that sufficient evidence of positive association exists
between the exposure of humans to a toxic substance and the occurrence
of a disease in humans, the Secretary shall prescribe regulations
providing that a presumption of service connection is warranted for
that disease for purposes of this section.
``(2) In making determinations under paragraph (1), the Secretary
shall take into account--
``(A) reports received by the Secretary from the National
Academies of Sciences, Engineering, and Medicine under section
202(g) of the Toxic Exposure in the American Military Act of
2020; and
``(B) all other sound medical and scientific information
and analyses available to the Secretary.
``(3)(A) In evaluating any report, information, or analysis for
purposes of making such determinations, the Secretary shall consider
only scientific studies that are valid in accordance with contemporary
scientific standards.
``(B) The Secretary may define the standards described in
subparagraph (A) for purposes of that subparagraph.
``(c) Response to Reports by the National Academies of Sciences,
Engineering, and Medicine.--(1) Not later than 60 days after the date
on which the Secretary receives a report from the National Academies of
Sciences, Engineering, and Medicine under section 202(g) of the Toxic
Exposure in the American Military Act of 2020, the Secretary shall
determine whether a presumption of service connection is warranted for
each disease covered by the report.
``(2) If the Secretary determines under paragraph (1) that a
presumption of service connection is warranted for a disease, the
Secretary shall, not later than 60 days after making the determination,
issue proposed regulations setting forth the determination.
``(3)(A) If the Secretary makes a determination described in
subparagraph (B), the Secretary shall, not later than 60 days after
making the determination, publish in the Federal Register a notice of
the determination.
``(B) A determination described in this subparagraph is a
determination by the Secretary under paragraph (1) that a presumption
of service connection is not warranted for a disease as to which the
National Academies of Sciences, Engineering, and Medicine determined
that there was--
``(i) sufficient evidence of an association between the
exposure of humans to a toxic substance and the occurrence of
the disease in humans; or
``(ii) limited evidence or suggestive evidence of such an
association.
``(C) Any notice published under subparagraph (A) shall include an
explanation of the scientific basis for the determination described in
subparagraph (B).
``(D) If a disease already presumed to be service connected under
this section is subject to a determination described in subparagraph
(B), the Secretary shall, not later than 60 days after publication of
the notice under subparagraph (A), issue proposed regulations removing
the presumption of service connection for the disease.
``(4) Not later than 180 days after the date on which the Secretary
issues any proposed regulations under this subsection, the Secretary
shall issue final regulations.
``(d) Removal of Presumption of Service Connection.--Whenever the
presumption of service connection for a disease under this section is
removed under subsection (c)--
``(1) a veteran who was awarded compensation for the
disease on the basis of the presumption before the effective
date of the removal of the presumption shall continue to be
entitled to receive compensation on that basis; and
``(2) a survivor of a veteran who was awarded dependency
and indemnity compensation for the death of a veteran resulting
from the disease on the basis of the presumption before that
date shall continue to be entitled to receive dependency and
indemnity compensation on that basis.
``(e) Reference to National Academies of Sciences, Engineering, and
Medicine.--In the case that the Secretary enters into an agreement with
another organization as described in section 202(h)(1) of the Toxic
Exposure in the American Military Act of 2020, any reference in this
section to the National Academies of Sciences, Engineering, and
Medicine shall be treated as a reference to the other organization.
``(f) Definitions.--In this section:
``(1) The term `sufficient evidence of positive
association' means, with respect to an association between
exposure to a toxic substance and the occurrence of a disease
in humans, that--
``(A) there is credible evidence for the
association and such evidence is equal to or outweighs
the credible evidence against the association; and
``(B) the association has been observed in studies
in which chance, bias, and confounding can be ruled out
with reasonable confidence.
``(2) The term `toxic substance' has the meaning given that
term in section 1710(e)(1)(G)(iv) of this title.''.
(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 1118 the following new item:
``1119. Presumptions of service connection for diseases associated with
exposure to certain toxic substances.''.
(c) Conforming Amendment.--Section 1113 of such title is amended by
striking ``or 1118'' each place it appears and inserting ``1118, or
1119''.
TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES
SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW COMMISSION.
(a) In General.--Subchapter III of chapter 5 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 547. Toxic Exposure Review Commission
``(a) Establishment.--The Secretary shall establish an independent
commission to be known as the `Toxic Exposure Review Commission' (in
this section referred to as the `Commission').
``(b) Purpose.--The Commission shall--
``(1) advise the Secretary on questions relating to
exposure to toxic substances that require scientific research;
and
``(2) assist in the consideration of possible presumptions
of service connection.
``(c) Duties.--The Commission shall carry out the following duties:
``(1) Collect any relevant information from the Department
of Defense and other sources to identify possible toxic
exposures related to service during active duty, active duty
for training, or inactive duty training in order to determine
the need for a comprehensive review under an agreement under
section 202 of the Toxic Exposure in the American Military Act
of 2020. Relevant information may be collected from the
following:
``(A) Any Federal agency, as the Commission
considers necessary to carry out this section. Upon
request of the Chair, the head of such agency shall
furnish such information to the Commission, unless such
information is classified.
``(B) Public meetings or hearings, which may be
held to take such testimony and receive such evidence
as the Commission considers advisable to carry out the
duties of the Commission.
``(2) Recommend to the Secretary, by majority vote, whether
a comprehensive scientific review should be conducted by the
National Academies of Sciences, Engineering, and Medicine under
an agreement under section 202 of the Toxic Exposure in the
American Military Act of 2020.
``(3) Recommend to the Secretary, by majority vote, whether
new, independent studies regarding the health outcomes of
exposure to toxic substances, or any other new, independent
studies that the Commission deems necessary and appropriate,
should be conducted.
``(4) Annually report to Congress on progress regarding the
duties set forth in paragraphs (1) through (3), any
recommendations made to the Secretary, and any responses of the
Secretary to such recommendations.
``(d) Membership.--(1)(A) The Commission shall be composed of 9
members, appointed as follows:
``(i) Two members appointed by the Speaker of the House of
Representatives.
``(ii) Two members appointed by the minority leader of the
House of Representatives.
``(iii) Two members appointed by the majority leader of the
Senate.
``(iv) Two members appointed by the minority leader of the
Senate.
``(v) One member appointed by the Secretary.
``(B) The initial members of the Commission shall be appointed
under subparagraph (A) not later than 180 days after the date of the
enactment of the Toxic Exposure in the American Military Act of 2020.
``(2) In appointing individuals under paragraph (1)(A), the Speaker
of the House of Representatives, the minority leader of the House of
Representatives, the majority leader of the Senate, the minority leader
of the Senate, and the Secretary shall ensure that at least five
members of the Commission are scientists or health care professionals--
``(A) of whom--
``(i) one has a background in the field of
respiratory medicine;
``(ii) one has a background in the field of
endocrinology and metabolic medicine;
``(iii) one has a background in hematology;
``(iv) one has a background in oncology; and
``(v) one has a background in occupational and
environmental health; and
``(B) who are not officials or employees of the Federal
Government.
``(3) In appointing individuals under paragraph (1)(A), the Speaker
of the House of Representatives, the minority leader of the House of
Representatives, the majority leader of the Senate, the minority leader
of the Senate, and the Secretary shall ensure that at least two members
of the Commission represent an organization recognized by the Secretary
for the representation of veterans under section 5902 of this title.
``(4) In appointing individuals under paragraph (1)(A), the Speaker
of the House of Representatives, the minority leader of the House of
Representatives, the majority leader of the Senate, the minority leader
of the Senate, and the Secretary shall give consideration to including
in the Commission at least one member who works with survivors of
illnesses related to exposure to toxic substances and has a background
in the field of study of exposure to toxic substances.
``(e) Meetings.--(1) The Commission shall meet not less frequently
than twice each year.
``(2)(A) Each meeting of the Commission shall be open to the
public.
``(B) All the proceedings, information, and deliberations of the
Commission shall be available for review by the public.
``(C) Meetings of the Commission may be carried out through the use
of telephonic or other appropriate telecommunication technology if the
Commission determines that such technology will allow the members to
communicate simultaneously.
``(f) Chair and Vice Chair.--At the initial meeting of the
Commission under subsection (e), the Commission shall select a Chair
and Vice Chair from among the members of the Commission by a majority
vote of the members of the Commission.
``(g) Period of Appointment; Vacancies.--(1) A member of the
Commission shall be appointed for a term that may not exceed four
years.
``(2) The Secretary shall ensure that terms of members of the
Commission are staggered so that no such terms end on the same date.
``(3) A vacancy in the Commission shall be filled in the same
manner as the original appointment, but the individual appointed to
fill the vacancy shall serve only for the unexpired portion of the term
for which the individual's predecessor was appointed.
``(4) In appointing the initial members of the Commission, each
official who is authorized to appoint two members of the Commission
shall appoint--
``(A) one member whose term expires after two years; and
``(B) one member whose term expires after four years.
``(h) Pay.--(1) Members of the Commission shall serve without pay.
``(2) Each member of the Commission who is an officer or employee
of the United States shall serve without compensation in addition to
that received for service as an officer or employee of the United
States.
``(3) Members shall receive travel expenses, including per diem in
lieu of subsistence, in accordance with sections 5702 and 5703 of title
5.
``(i) Director of Staff.--(1) The Commission shall appoint a
Director who--
``(A) has not served as an employee of the Department
during the one-year period preceding the date of such
appointment; and
``(B) is not otherwise barred or prohibited from serving as
Director under Federal ethics laws and regulations, by reason
of post-employment conflict of interest.
``(2) The Director shall be paid at the rate of basic pay payable
for level IV of the Executive Schedule under section 5315 of title 5.
``(j) Staff.--(1) Subject to paragraphs (2) and (3), the Director,
with the approval of the Commission, may appoint and fix the pay of
additional personnel.
``(2) The Director may make such appointments without regard to the
provisions of title 5 governing appointments in the competitive
service, and any personnel so appointed may be paid without regard to
the provisions of chapter 51 and subchapter III of chapter 53 of that
title relating to classification and General Schedule pay rates, except
that an individual so appointed may not receive pay in excess of the
annual rate of basic pay payable for GS-15 of the General Schedule.
``(3)(A) Not more than two-thirds of the personnel employed by or
detailed to the Commission may be on detail from the Department.
``(B) Not more than half of the professional analysts of the
Commission staff may be persons detailed from the Department to the
Commission.
``(4) Subject to paragraph (3), the head of any Federal agency,
upon the request of the Director, may detail any of the personnel of
that agency to the Commission to assist the Commission in carrying out
its duties under this section.
``(5) The Commission may secure directly from any Federal agency
such information as the Commission considers necessary to carry out
this section. Upon request of the Chair, the head of such agency shall
furnish such information to the Commission, unless such information is
classified.
``(k) Other Authority.--(1) The Commission may procure by contract,
to the extent funds are available, the temporary or intermittent
services of experts or consultants pursuant to section 3109 of title 5.
``(2) To the extent funds are available, the Commission may lease
real property and acquire personal property either of its own accord or
in consultation with the General Services Administration.
``(l) Communications.--(1)(A) Except as provided in subparagraph
(B), no person may restrict an employee of the Department in
communicating with the Commission.
``(B) Subparagraph (A) does not apply to a communication that is
unlawful.
``(2) All ex parte communications with the Commission shall be made
part of the public record.
``(m) Reference to National Academies of Sciences, Engineering, and
Medicine.--In the case that the Secretary enters into an agreement with
another organization as described in section 202(h)(1) of the Toxic
Exposure in the American Military Act of 2020, any reference in this
section to the National Academies of Sciences, Engineering, and
Medicine shall be treated as a reference to the other organization.
``(n) Toxic Substance Defined.--In this section, the term `toxic
substance' has the meaning given that term in subparagraph (G)(iv) of
section 1710(e)(1) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 5 of such title is amended by adding at the end the following
new item:
``547. Toxic Exposure Review Commission.''.
SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF SCIENCES, ENGINEERING,
AND MEDICINE CONCERNING THE EXPOSURE OF HUMANS TO TOXIC
SUBSTANCES.
(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 exposure to toxic
substances.
(b) Agreement.--
(1) In general.--The Secretary of Veterans Affairs shall
seek to enter into a five-year agreement with the Academies to
perform the services covered by this section.
(2) Timing.--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 this Act.
(3) Extension.--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 exposure to toxic
substances during active military, naval, or air 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 exposure to toxic
substances 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 exposed
to toxic substances during active military, naval, or air
service; and
(3) whether there exists a plausible biological mechanism
or other evidence of a causal relationship between the exposure
and the occurrence of the disease.
(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) In general.--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
the exposure of humans to toxic substances.
(2) Considerations.--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) Initial report.--
(A) In general.--Under an agreement between the
Secretary and the Academies under this section, not
later than one year after the date of the enactment of
this Act, 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) Elements.--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) Periodic updates.--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) In general.--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) Treatment.--If the Secretary enters into an agreement
with another organization as described in paragraph (1), any
reference in this section, section 547 of title 38, United
States Code, as added by section 201(a), and section 1119 of
such title, as added by section 105(a), to the National
Academies of Sciences, Engineering, and Medicine shall be
treated as a reference to the other organization.
SEC. 203. COLLECTION, ANALYSIS, AND REPORT ON TREATMENT OF VETERANS FOR
MEDICAL CONDITIONS RELATED TO EXPOSURE TO TOXIC
SUBSTANCES.
(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 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 exposure to a toxic substance.
(b) Consent of Patients.--Compilation and analysis by the Secretary
of clinical data of a veteran under subsection (a) shall be conducted,
and such data shall be used, 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 Senate, the
Committee on Veterans' Affairs of the House of Representatives, and the
Toxic Exposure Review Commission established by section 547 of title
38, United States Code, as added by section 201(a) of this Act, a
report containing--
(1) the 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; and
(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
exposure to a toxic substance.
TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS
REGARDING EXPOSURES TO TOXIC SUBSTANCES
SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF VETERANS
AFFAIRS FOR VETERANS EXPOSED TO TOXIC SUBSTANCES 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) veterans provided disability compensation under
chapter 11 of title 38, United States Code, relating to
exposure to toxic substances;
(B) veterans eligible for hospital care, medical
services, and nursing home care under section
1710(a)(2)(F) of such title;
(C) caregivers of veterans described in
subparagraph (A) or (B) who are participating in the
program of comprehensive assistance for family
caregivers under section 1720G(a) of such title; and
(D) survivors of veterans described in subparagraph
(A) or (B) (or who would be described in any such
subparagraph were the veteran alive) 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 exposure to toxic substances, including outreach
with respect to benefits and support programs.
SEC. 302. 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
exposure to toxic substances 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 exposure of
veterans to toxic substances 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.
SEC. 303. SENSE OF CONGRESS ON PORTAL FOR ACCESS BY VETERANS TO
INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.
It is the sense of Congress that the Secretary of Veterans Affairs
should establish a portal on the internet website of the Department of
Veterans Affairs through which a veteran may access documents and
information with respect to the veteran contained in the Individual
Longitudinal Exposure Record of the Department of Veterans Affairs.
SEC. 304. TRAINING OF HEALTH CARE PERSONNEL OF DEPARTMENT OF VETERANS
AFFAIRS ON ILLNESSES RELATED TO EXPOSURE TO TOXIC
SUBSTANCES.
(a) In General.--The Secretary of Veterans Affairs shall ensure
that health care personnel of the Department of Veterans Affairs are
appropriately trained to identify, treat, and assess the impact of
illnesses related to exposure to toxic substances.
(b) Elements of Training.--The training required under subsection
(a) shall--
(1) provide health care personnel of the Department with
specific education with respect to illnesses related to
exposure to toxic substances; and
(2) inform such personnel of how to probe for additional
information from veterans regarding exposures to different
toxicants.
(c) Toxicant Defined.--In this section, the term ``toxicant'' has
the meaning given that term in subparagraph (G)(iv) of section
1710(e)(1) of title 38, United States Code, as added by section 101(a).
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Veterans' Affairs.
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