,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #efhj  ,,in ,,the ,,house ,,of  
,,representatives  ,september #ai1 #bjad
 ,mr4 ,walz introduced the following    
bill2 which was referred to the         
,committee on ,veterans' ,affairs  ,a   
,,bill  ,to direct the ,secretary of    
,veterans ,affairs to establish a       
registry for certain toxic exposures1 to
 direct the ,secretary to include       
certain information in the electronic   
health records of veterans1 and for     
other purposes4  #a4 ,short title  ,this
 ,act may be cited as the ,veterans'    
,toxic ,wounds ,research ,act of #bjad4 
#b4 ,comprehensive program of research  
into toxic exposures encountered by     
veterans during military service  7a7   
,registry of toxic exposures  7#a7      
,establishment ,not later than #ahj days
 after the date of the enactment of this
 ,act1 the ,secretary of ,veterans      
,affairs shall establish a master       
registry of veterans who experienced    
toxic exposures while serving in the    

,armed ,forces4  7#b7 ,elements ,the    
master registry established under       
paragraph 7#a7 shall consist of the     
registries described in paragraph 7#c74 
,the ,secretary shall establish each    
such registry using the ,clinical ,case 
,registry of the ,department of         
,veterans ,affairs as a model4  7#c7    
,registries described ,the registries   
described in this paragraph are         
registries for each of the following3   
7,a7 ,agent ,orange4  7,b7 ,exposure to 
toxins relating to a deployment during  
the ,persian ,gulf ,war 7as defined in  
section #aja7cc7 of title #ch1 ,united  
,states ,code71 including with respect  
to such exposures leading to ,gulf ,war 
,illness 7as defined by the ,institute  
of ,medicine of the ,national           
,academies74  7,c7 ,exposure to toxins  
relating to a deployment during         
,operation ,iraqi ,freedom1 ,operation  
,new ,dawn1 ,operation ,enduring        
,freedom1 or the ,global ,war on        
,terror4  7,d7 ,exposure to toxins      

relating to a deployment to ,bosnia1    
,somalia1 the ,philippines1 or other    
locations determined appropriate by the 
,secretary4  7,e7 ,exposure to toxins   
relating to being stationed at a        
military installation potentially       
contaminated by toxic substances1       
including ,camp ,lejeune1 ,north        
,carolina1 ,fort ,mc,clellan1 ,alabama1 
and such installations in ,guam4  7,f7  
,any other toxic exposure the ,secretary
 determines appropriate4  7b7 ,review   
,the ,secretary of ,veterans ,affairs   
shall enter into an agreement with the  
,national ,academy of ,sciences to      
review published scientific information 
and studies on the health effects of    
toxic exposures covered in a registry   
described in subsection 7a77#c74 ,under 
such agreement1 the ,institute of       
,medicine of the ,national ,academies   
shall submit to the ,secretary on a     
biennial basis a report on toxic        
substance exposure-related illnesses4   
,such report shall include--  7#a7 a    

review of all scientific studies and    
research on the association between     
toxic substance exposures and specific  
diseases covered in such a registry1    
including the level of association      
between such exposures and the specific 
diseases2 and  7#b7 recommendations for 
future research4  7c7 ,research into the
 effects of toxic exposure on second and
 third generations ,in addition to the  
reviews under subsection 7b71 the       
,secretary shall enter into an agreement
 with the ,national ,academy of         
,sciences to review published scientific
 information and studies on the health  
effects on the children and             
grandchildren of veterans with toxic    
exposures covered in a registry         
described in subsection 7a77#c74 ,under 
such agreement1 the ,institute of       
,medicine of the ,national ,academies   
shall submit to the ,secretary on a     
biennial basis a report on toxic        
substance exposure-related illnesses4   
,such report shall include--  7#a7 a    

review of all scientific studies and    
research on the association between     
toxic substance exposures and specific  
diseases covered in such a registry in  
such children and grandchildren1        
including the level of association      
between such exposures and the specific 
diseases2 and  7#b7 recommendations for 
future research4  7d7 ,research ,the    
,secretary shall use the reviews        
conducted under subsections 7b7 and 7c7 
to inform the decisions made by the     
,secretary with respect to selecting the
 research to be conducted or funded by  
the ,department of ,veterans ,affairs4  
,the ,secretary shall submit to the     
,committees on ,veterans' ,affairs of   
the ,house of ,representatives and the  
,senate a report describing how the     
,secretary used such reviews to make    
such selections4  #c4 ,presumptions of  
service connection for illnesses        
associated with toxic exposures         
encountered by veterans during military 
service  7a7 ,in general ,subchapter    

,,ii of chapter #aa of title #ch1       
,united ,states ,code1 is amended by    
adding at the end the following new     
section3  #aaai4 ,presumptions of       
service connection for illnesses        
associated with toxic exposures  7a7    
,presumption  7#a7 ,for purposes of     
section #aaaj of this title1 and subject
 to section #aaac of this title1 each   
illness1 if any1 described in paragraph 
7#b7 shall be considered to have been   
incurred in or aggravated by service    
referred to in that paragraph1          
notwithstanding that there is no record 
of evidence of such illness during the  
period of such service4  7#b7 ,an       
illness referred to in paragraph 7#a7 is
 any diagnosed or undiagnosed illness   
that--  7,a7 the ,secretary determines  
in regulations prescribed under this    
section to warrant a presumption of     
service connection by reason of having a
 positive association with exposure to a
 toxic substance covered in the master  
registry2 and  7,b7 becomes manifest    

within the period1 if any1 prescribed in
 such regulations in a veteran who      
served in the ,armed ,forces and by     
reason of such service experienced such 
exposure4  7#c7 ,for purposes of this   
subsection1 a veteran who served in the 
,armed ,forces in a location recognized 
under the master registry as being a    
source of exposure and has an illness   
described in paragraph 7#b7 shall be    
presumed to have been exposed by reason 
of such service unless there is         
conclusive evidence to establish that   
the veteran was not so exposed by reason
 of such service4  7b7  7#a7  7,a7      
,whenever the ,secretary makes a        
determination described in subparagraph 
7,b71 the ,secretary shall prescribe    
regulations providing that a presumption
 of service connection is warranted for 
the illness covered by that             
determination for purposes of this      
section4  7,b7 ,a determination referred
 to in subparagraph 7,a7 is a           
determination based on sound medical and

 scientific evidence that a positive    
association exists between--  7i7 the   
exposure of humans or animals to a toxic
 substance covered in the master        
registry2 and  7ii7 the occurrence of a 
diagnosed or undiagnosed illness in     
humans or animals4  7#b7  7,a7 ,in      
making determinations for purposes of   
paragraph 7#a71 the ,secretary shall    
take into account--  7i7 the reports    
submitted to the ,secretary by the      
,national ,academy of ,sciences under   
section #b7;b7 of the ,veterans' ,toxic 
,wounds ,research ,act of #bjad2 and    
7ii7 all other sound medical and        
scientific information and analyses     
available to the ,secretary4  7,b7 ,in  
evaluating any report1 information1 or  
analysis for purposes of making such    
determinations1 the ,secretary shall    
take into consideration whether the     
results are statistically significant1  
are capable of replication1 and         
withstand peer review4  7#c7 ,an        
association between the occurrence of an

 illness in humans or animals and       
exposure to a toxic substance covered in
 the master registry shall be considered
 to be positive for purposes of this    
subsection if the credible evidence for 
the association is equal to or outweighs
 the credible evidence against the      
association4  7c7  7#a7 ,not later than 
#fj days after the date on which the    
,secretary receives a report from the   
,national ,academy of ,sciences under   
section #b7;b7 of the ,veterans' ,toxic 
,wounds ,research ,act of #bjad1 the    
,secretary shall determine whether or   
not a presumption of service connection 
is warranted for each illness1 if any1  
covered by the report4  7#b7 ,if the    
,secretary determines under this        
subsection that a presumption of service
 connection is warranted1 the ,secretary
 shall1 not later than #fj days after   
making the determination1 issue proposed
 regulations setting forth the          
,secretary's determination4  7#c7  7,a7 
,if the ,secretary determines under this

 subsection that a presumption of       
service connection is not warranted1 the
 ,secretary shall1 not later than #fj   
days after making the determination1    
publish in the ,federal ,register a     
notice of the determination4 ,the notice
 shall include an explanation of the    
scientific basis for the determination4 
7,b7 ,if an illness already presumed to 
be service connected under this section 
is subject to a determination under     
subparagraph 7,a71 the ,secretary shall1
 not later than #fj days after          
publication of the notice under that    
subparagraph1 issue proposed regulations
 removing the presumption of service    
connection for the illness4  7#d7 ,not  
later than #ij days after the date on   
which the ,secretary issues any proposed
 regulations under this subsection1 the 
,secretary shall issue final            
regulations4 ,such regulations shall be 
effective on the date of issuance4  7d7 
,whenever the presumption of service    
connection for an illness under this    

section is removed under subsection     
7c7--  7#a7 a veteran who was awarded   
compensation for the illness on the     
basis of the presumption before the     
effective date of the removal of the    
presumption shall continue to be        
entitled to receive compensation on that
 basis2 and  7#b7 a survivor of a       
veteran who was awarded dependency and  
indemnity compensation for the death of 
a veteran resulting from the illness on 
the basis of the presumption before that
 date shall continue to be entitled to  
receive dependency and indemnity        
compensation on that basis4  7e7 ,master
 registry defined ,in this section1 the 
term master registry means the registry 
of veterans who experienced toxic       
exposures established by section #b of  
the ,veterans' ,toxic ,wounds ,research 
,act of #bjad4  4  7b7 ,clerical        
amendment ,the table of sections at the 
beginning of such chapter is amended by 
inserting after the item relating to    
section #aaah the following new item3   

#aaai4 ,presumptions of service         
connection for illnesses associated with
 toxic exposures4  4  #d4 ,inclusion of 
certain information in electronic health
 records  ,in implementing the          
electronic health record system of the  
,department of ,veterans ,affairs1 the  
,secretary of ,veterans ,affairs shall  
ensure that the electronic health record
 of each individual includes1 at a      
minimum1 the following information3     
7#a7 ,whether the individual served in  
the ,armed ,forces4  7#b7 ,the ,armed   
,force in which the individual served4  
7#c7 ,the locations in which the        
individual was stationed or deployed to 
during such service4  7#d7 ,the dates of
 such service4  7#e7 ,the military      
occupational specialty of the           
individual4  7#f7 ,the results of any   
tests or assessments of the individual  
regarding--  7,a7 vision2  7,b7 hearing2
  7,c7 hepatitis ,c2  7,d7 ,,hiv2  7,e7 
blood pressure2  7,f7 cholesterol2  7,g7
 blood glucose test and diabetes        

information2  7,h7 body mass index      
measurement2  7,i7 bone density1 as     
appropriate based on the age or sex of  
the individual2  7,j7 cancer screenings 
7as appropriate based on the age1 sex1  
race1 or ethnicity of the individual7   
for--  7i7 breast cancer2  7ii7         
colorectal cancer2  7iii7 lung cancer2  
7iv7 prostate cancer2 and  7v7 skin     
cancer2  7,k7 preventive immunizations1 
if not current2  7,l7 spirometry 7for   
lung function72  7,m7 smoking2  7,n7 a  
mental health evaluation2  7,o7         
substance abuse2 or  7,p7 infectious    
diseases or parasites or other adverse  
health conditions endemic to where the  
individual served while in the military4