H.R. 3967 — what changed

“(37) The term toxic exposure includes the following:

“(A) A toxic exposure risk activity, as defined in section 1710(e)(4) of this title.

changed “(B) An exposure to a substance, chemical, or airborne hazard specified identified in the list under section 1119(b)(2).1119(b)(2) of this title.

changed “(38) The term toxic exposed toxic-exposed veteran means a veteran described in section 1710(e)(1) of this title.”

“(C) The term toxic exposure risk activity means any activity—

changed “(i) that requires a corresponding entry in the Individual Longitudinal Exposure Record an exposure tracking record system (as defined in section 1119(c) of the Department 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.”

added “(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.

added “(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.

added “(I)

added “(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.

added “(ii) A contingency operation specified in this clause is any of the following:

added “(I) Operation Enduring Freedom.

added “(II) Operation Freedom’s Sentinel.

added “(III) Operation Iraqi Freedom.

added “(IV) Operation New Dawn.

added “(V) Operation Inherent Resolve.

added “(VI) Resolute Support Mission.”

removed “(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.

removed “(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.”

added “(6)

added “(A) The Secretary shall determine the dates in subparagraphs (G), (H), and (I) of paragraph (1) as follows:

added “(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.

added “(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.

added “(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.

added “(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.

added “(v) October 1, 2032, with respect to a veteran described in such subparagraph (I).

added “(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—

added “(i) notify the Committees on Veterans’ Affairs of the House of Representatives and the Senate of the proposed modification; and

added “(ii) publish such modified date in the Federal Register.”

changed This title subtitle may be cited as the “Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act” or the “FASTER Presumptions Act”.

added “VII Determinations relating to presumptions of service connection based on toxic exposure

removed “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—

added “(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;

added “(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

added “(C) provides to the Secretary recommendations regarding which cases of possible toxic exposure should be reviewed; and

added “(2) the Secretary provides for formal evaluations of such recommendations under section 1173 of this title; and

added “(3) the Secretary issues regulations under section 1174 of this title.

added “(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.

removed “(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;

removed “(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

removed “(C) provides to the Secretary recommendations regarding which cases of possible toxic exposure described in subparagraph (A) the Science Review Board should review;

removed “(2) the Science Review Board under section 1173 of this title—

removed “(A) reviews cases of possible toxic exposure nominated by the Secretary;

removed “(B) reviews research nominated by the Secretary;

removed “(C) develops recommendations for new research; and

removed “(D) determines the strength of evidence supporting positive association between toxic exposure and an illness;

removed “(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

removed “(4) the Secretary prescribes regulations under section 1175 of this title.

removed “(b) Illness defined—In this subchapter, the term illness includes a disease or other condition affecting the health of an individual.

removed “(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.

added “(iii) At least two members shall represent an organization recognized by the Secretary for the representation of veterans under section 5902 of this title.

removed “(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.

added “(4)

added “(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.

added “(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.

removed “(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.

added “(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.

removed “(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

added “(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.

added “(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.

added “(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.

added “(4) The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record, or successor system, to ensure the accuracy of data collected.

removed “(1) The Committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, or air service.

removed “(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.

removed “(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.

removed “(4) The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record to ensure the accuracy of data collected.

“(d) Research recommendations

added “(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.

added “(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.

removed “(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.

removed “(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

added “(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.

added “(h) Nonapplication of sunset requirements—Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Committee.

added “1173. Formal evaluation of recommendations

added “(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—

added “(1) to conduct research regarding the health effects related to a case of toxic exposure; or

added “(2) to evaluate evidence regarding the periods and locations of exposure covered by an existing presumption of service connection.

added “(b) Evidence, data, and factors—The Secretary shall ensure that each formal evaluation under paragraph (1) covers the following:

added “(1) Scientific evidence, based on the review of available scientific literature, including human, toxicological, animal, and methodological studies, and other factors.

added “(2) Claims data, based on the review of claim rate, grant rate, and service connection prevalence, and other factors.

added “(3) Other factors the Secretary determines appropriate, such as—

added “(A) the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated;

added “(B) the level of assistance required to remain in the community because of such health effects;

added “(C) the quantity and quality of the information available and reviewed;

added “(D) the feasibility of and period for generating relevant information and evidence;

added “(E) whether such health effects are combat- or deployment-related; and

added “(F) the ubiquity or rarity of the health effects.

added “(c) Conduct of evaluations

added “(1) The Secretary shall ensure that each formal evaluation under subsection (a)—

added “(A) reviews scientific evidence in a manner that—

added “(i) conforms to principles of scientific and data integrity;

added “(ii) is free from suppression or distortion of scientific or technological findings, data, information, conclusions, or technical results; and

added “(B)

added “(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

added “(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.

added “(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:

removed “(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.

removed “1173. Science Review Board

removed “(a) Establishment

removed “(1) There is in the Veterans Health Administration of the Department the Science Review Board (in this section referred to as the “Board”).

removed “(2)

removed “(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.

removed “(B) An individual may not concurrently serve on the Board and the Formal Advisory Committee on Toxic Exposure under section 1172 of this title.

removed “(C) The Secretary shall determine the number, terms of service, and pay and allowances of members of the Board appointed by the Secretary.

removed “(b) Duties

removed “(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—

removed “(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

removed “(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.

removed “(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.

added “(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.

added “1174. Regulations regarding presumptions of service connection based on toxic exposure

added “(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—

added “(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

removed “(3)

removed “(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.

removed “(B)

removed “(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.

removed “(ii) In calculating the service-attributable fraction of illness, the Board shall consider the dose-response relationships.

removed “(4)

removed “(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.

removed “(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.

removed “(c) Reports

removed “(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.

removed “(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).

removed “(d) Responses from the Secretary

removed “(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.

removed “(2) Each report submitted under paragraph (1) of this subsection shall include, with respect to a report received under subsection (c)(1), the following:

removed “(A) The findings and opinions of the Secretary with respect to the report received under subsection (c)(1).

removed “(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.

removed “1174. Working group on presumptions of service connection

removed “(a) Establishment—The Secretary shall establish a working group (in this section referred to as the “Working Group”) to—

removed “(1) evaluate—

removed “(A) the conclusions of the Science Review Board contained in each report submitted under section 1173(c)(1) of this title; and

removed “(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

removed “(2) develop and submit to the Secretary a recommendation with respect to whether—

removed “(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

removed “(B) to modify an existing presumption of service connection described in subparagraph (B) of such paragraph.

removed “(b) Recommendations

removed “(1) In making a recommendation under subsection (a)(2), the Working Group shall—

removed “(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;

removed “(B) take into consideration such factors as may be determined appropriate by the Secretary; and

removed “(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.

removed “(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.

removed “(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.

removed “1175. Regulations regarding presumptions of service connection based on toxic exposure

removed “(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—

removed “(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.

added “(b) Removal of presumption

added “(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).

removed “(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.

removed “(c) Removal of presumption

removed “(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

added “(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.

added “1175. Authority to modify process; congressional oversight

added “(a) Authority

added “(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—

added “(A) such evaluations cover the evidence, data, and factors required by subsection (b) of such section 1173; and

added “(B) a period of 180 days has elapsed following the date on which the Secretary submits the notice under paragraph (2) regarding the modification.

added “(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:

added “(A) A description of the proposed modifications.

added “(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.

added “(b) Reports and briefings

added “(1)

added “(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.

added “(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.

added “(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.

added “(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.”

removed “(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.”

“(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).”

“(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.”

“1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection

changed “(a) Reevaluation—Except as provided in subsection (b), whenever 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

changed “(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).

changed “(b) Outreach—With respect to each claim identified under subsection (a), the 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 such subsection. 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.

changed “(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.reevaluated.”

removed “(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.”

added Subchapter II of chapter 11 is amended by adding at the end the following new section:

added “1119. Presumptions of toxic exposure

added “(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—

added “(1) any record of the veteran in an exposure tracking record system; and

added “(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.

added “(b) Presumption of specific toxic exposure for members who served in certain locations

added “(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.

added “(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.

added “(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.

added “(c) Definitions—In this section:

added “(1) The term “covered veteran” means any veteran who—

added “(A) on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in—

added “(i) Bahrain;

added “(ii) Iraq;

added “(iii) Kuwait;

added “(iv) Oman;

added “(v) Qatar;

added “(vi) Saudi Arabia;

added “(vii) Somalia; or

added “(viii) United Arab Emirates; or

added “(B) on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in—

added “(i) Afghanistan;

added “(ii) Djibouti;

added “(iii) Egypt;

added “(iv) Jordan;

added “(v) Lebanon;

added “(vi) Syria;

added “(vii) Yemen;

added “(viii) Uzbekistan;

added “(ix) the Philippines; or

added “(x) any other country determined relevant by the Secretary.

added “(2) The term “exposure tracking record system”—

added “(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

added “(B) includes the Individual Longitudinal Exposure Record, or successor system.

added “(3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title.”

removed “1119. Presumptions of toxic exposure

removed “(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—

removed “(1) the Individual Longitudinal Exposure Record of the veteran; and

removed “(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.

removed “(b) Presumption of specific toxic exposure for members who served in certain locations

removed “(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.

removed “(2)

removed “(A) Subject to subparagraph (B), the substances, chemicals, and airborne hazards listed in this paragraph are as follows:

removed “(i) Particulate matter, including the following:

removed “(I) PM-10.

removed “(II) PM-2.5.

removed “(ii) Polycyclic aromatic hydrocarbons (PAHs), including the following:

removed “(I) Acenaphthene.

removed “(II) Acenaphthylene.

removed “(III) Anthracene.

removed “(IV) Benzo(a)anthracene.

removed “(V) Benzo(a)pyrene.

removed “(VI) Benzo(b)fluoranthene.

removed “(VII) Benzo(g,h,i)perylene.

removed “(VIII) Benzo(k)fluoranthene.

removed “(IX) Chrysene.

removed “(X) Dibenz(a,h)anthracene.

removed “(XI) Fluoranthene.

removed “(XII) Fluorene.

removed “(XIII) Indeno(1,2,3-cd)pyrene.

removed “(XIV) Naphthalene.

removed “(XV) Phenanthrene.

removed “(XVI) Pyrene.

removed “(iii) Volatile organic compounds (VOCs), including the following:

removed “(I) Acetone.

removed “(II) Acrolein.

removed “(III) Benzene.

removed “(IV) Carbon Disulfide.

removed “(V) Chlorodifluoromethane.

removed “(VI) Chloromethane.

removed “(VII) Ethylbenzene.

removed “(VIII) Hexachlorobutadiene.

removed “(IX) Hexane.

removed “(X) m/p-Xylene.

removed “(XI) Methylene Chloride.

removed “(XII) Pentane.

removed “(XIII) Propylene.

removed “(XIV) Styrene.

removed “(XV) Toluene.

removed “(iv) Toxic organic halogenated dioxins and furans (dioxins), including the following:

removed “(I) 1,2,3,4,6,7,8 HPCDD.

removed “(II) 1,2,3,4,6,7,8 HPCDF.

removed “(III) 1,2,3,4,7,8,9 HPCDF.

removed “(IV) 1,2,3,4,7,8 HXCDD.

removed “(V) 1,2,3,6,7,8 HXCDD.

removed “(VI) 1,2,3,7,8,9 HXCDD.

removed “(VII) 1,2,3,4,7,8 HXCDF.

removed “(VIII) 1,2,3,6,7,8 HXCDF.

removed “(IX) 1,2,3,7,8,9 HXCDF.

removed “(X) 1,2,3,7,8 PECDD.

removed “(XI) 1,2,3,7,8 PECDF.

removed “(XII) 2,3,4,6,7,8 HXCDF.

removed “(XIII) 2,3,4,7,8 PECDF.

removed “(XIV) 2,3,7,8 TCDD.

removed “(XV) 2,3,7,8 TCDF.

removed “(XVI) Octachlorodibenzodioxin.

removed “(XVII) Octachlorodibenzofuran.

removed “(v) Such other substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate.

removed “(B)

removed “(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.

removed “(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.

removed “(c) Definitions—In this section:

removed “(1) The term “covered veteran” means any veteran who—

removed “(A) on or after August 2, 1990, performed active military, naval, or air service while assigned to a duty station in—

removed “(i) Bahrain;

removed “(ii) Iraq;

removed “(iii) Kuwait;

removed “(iv) Oman;

removed “(v) Qatar;

removed “(vi) Saudi Arabia;

removed “(vii) Somalia; or

removed “(viii) United Arab Emirates; or

removed “(B) on or after September 11, 2001, performed active military, naval, or air service while assigned to a duty station in—

removed “(i) Afghanistan;

removed “(ii) Djibouti;

removed “(iii) Egypt;

removed “(iv) Jordan;

removed “(v) Lebanon;

removed “(vi) Syria;

removed “(vii) Yemen;

removed “(viii) Uzbekistan;

removed “(ix) the Philippines; or

removed “(x) any other country determined relevant by the Secretary.

removed “(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.

removed “(3) The term toxic exposure risk activity has the meaning given such term in section 1710(e)(4) of this title.”

added Subchapter VI of chapter 11, as amended by section 203, is further amended by adding at the end the following new section:

added “1168. Medical nexus examinations for toxic exposure risk activities

added “(a) Medical examinations and medical opinions

added “(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—

added “(A) provide the veteran with a medical examination under section 5103A(d) of this title; and

added “(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.

added “(2) When providing the Secretary with a medical opinion under paragraph (1)(B) for a veteran, the health care provider shall consider—

added “(A) the total potential exposure through all applicable military deployments of the veteran; and

added “(B) the synergistic, combined effect of all toxic exposure risk activities of the veteran.

added “(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.

added “(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.

added “(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.”

removed “1168. Medical nexus examinations for toxic exposure risk activities

removed “(a) Medical examinations and medical opinions

removed “(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—

removed “(A) provide the veteran with a medical examination under section 5103A(d) of this title; and

removed “(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.

removed “(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.

removed “(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.

removed “(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.”

changed “(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.”1967.

added “(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.”

changed “(d) In this section, the term covered service means active military, naval, air, or air 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.”

“(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.”

changed “(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.”Illness, in addition to any other diagnostic actions the personnel determine appropriate.”

“(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).”

“1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins

changed “(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 air 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.

changed “(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 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.”

changed “7330D. Coordination of Interagency working group on toxic exposure research

changed “(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.Establishment

changed “(b) Strategic plan—In carrying out subsection (a), the “(1) The Secretary shall establish a strategic plan, to be known as the Toxic Exposure Research Strategic Plan, Working Group (in this section referred to ensure that as the research activities specified in such subsection are collaborative, transparent, and highly coordinated.“Working Group”).

changed “(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 “(2) The Working Group shall submit to the Committee on Veterans’ Affairs consist of employees, selected by the House Secretary, of Representatives and the Senate a report on any research activities specified in subsection (a) carried out during the year covered by the report.”following:

added “(A) The Department.

added “(B) The Department of Defense.

added “(C) The Department of Health and Human Services.

added “(D) The Environmental Protection Agency.

added “(E) Other Federal entities involved in research activities regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service.

added “(b) Functions—The Working Group shall perform the following functions:

added “(1) Identify collaborative research activities and resources available among entities represented by members of the Working Group to conduct such collaborative research activities.

added “(2) Develop a 5-year strategic plan for Federal entities represented in the Working Group to carry out collaborative research activities.

added “(c) Reporting—The Secretary shall submit, to the Committees on Veterans’ Affairs of the Senate and House of Representatives, the following:

added “(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).

added “(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).

added “(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).

added “(d) Termination—The Working Group shall terminate after submitting the final report under subsection (c).

added “(e) Definitions—For purposes of this section—

added “(1) The term “Act” means the Honoring our Promise to Address Comprehensive Toxics Act of 2021.

added “(2) The term “collaborative research activity” means a research activity—

added “(A) conducted by an entity represented by a member of the Working Group;

added “(B) funded by the Federal Government; and

added “(C) regarding the health consequences of toxic exposures experienced during active military, naval, air, or space service.”