,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #efhj  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #ai1 #bjad  
,mr4 ,walz introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,vet]ans'   
,affairs  ,a ,,bill  ,to direct !       
,secret>y ( ,vet]ans ,affairs to e/abli%
 a regi/ry = c]ta9 toxic exposures1 to  
direct ! ,secret>y to include c]ta9     
in=mation 9 ! electronic heal? records (
 vet]ans1 & = o!r purposes4  #a4 ,%ort  
title  ,?is ,act may be cit$ z !        
,vet]ans' ,toxic ,w\nds ,rese>* ,act (  
#bjad4  #b4 ,compreh5sive program (     
rese>* into toxic exposures enc\nt]$ by 
vet]ans dur+ milit>y s]vice  7a7        
,regi/ry ( toxic exposures  7#a7        
,e/abli%m5t ,n lat] ?an #ahj days aft] !
 date ( ! enactm5t ( ?is ,act1 !        
,secret>y ( ,vet]ans ,affairs %all      
e/abli% a ma/] regi/ry ( vet]ans :o     
exp]i5c$ toxic exposures :ile s]v+ 9 !  
,arm$ ,=ces4  7#b7 ,elem5ts ,! ma/]     
regi/ry e/abli%$ "u p>agraph 7#a7 %all  
consi/ ( ! regi/ries describ$ 9 p>agraph

 7#c74 ,! ,secret>y %all e/abli% ea* su*
 regi/ry us+ ! ,cl9ical ,case ,regi/ry (
 ! ,dep>tm5t ( ,vet]ans ,affairs z a    
model4  7#c7 ,regi/ries describ$ ,!     
regi/ries describ$ 9 ?is p>agraph are   
regi/ries = ea* ( ! foll[+3  7,a7 ,ag5t 
,orange4  7,b7 ,exposure to tox9s relat+
 to a deploym5t dur+ ! ,p]sian ,gulf ,w>
 7z def9$ 9 section #aja7cc7 ( title    
#ch1 ,unit$ ,/ates ,code71 includ+ )    
respect to su* exposures lead+ to ,gulf 
,w> ,illness 7z def9$ by ! ,in/itute (  
,m$ic9e ( ! ,national ,academies74  7,c7
 ,exposure to tox9s relat+ to a         
deploym5t dur+ ,op]ation ,iraqi ,fre$om1
 ,op]ation ,new ,dawn1 ,op]ation ,endur+
 ,fre$om1 or ! ,global ,w> on ,t]ror4   
7,d7 ,exposure to tox9s relat+ to a     
deploym5t to ,bosnia1 ,somalia1 !       
,philipp9es1 or o!r locations det]m9$   
appropriate by ! ,secret>y4  7,e7       
,exposure to tox9s relat+ to be+ /ation$
 at a milit>y in/allation pot5tially    
contam9at$ by toxic sub/ances1 includ+  
,camp ,lejeune1 ,nor? ,c>ol9a1 ,=t      

,mc,clellan1 ,alabama1 & su*            
in/allations 9 ,guam4  7,f7 ,any o!r    
toxic exposure ! ,secret>y det]m9es     
appropriate4  7b7 ,review ,! ,secret>y (
 ,vet]ans ,affairs %all ent] into an    
agreem5t ) ! ,national ,academy (       
,sci5ces to review publi%$ sci5tific    
in=mation & /udies on ! heal? effects ( 
toxic exposures cov]$ 9 a regi/ry       
describ$ 9 subsection 7a77#c74 ,"u su*  
agreem5t1 ! ,in/itute ( ,m$ic9e ( !     
,national ,academies %all submit to !   
,secret>y on a bi5nial basis a report on
 toxic sub/ance exposure-relat$         
illnesses4 ,su* report %all include--   
7#a7 a review ( all sci5tific /udies &  
rese>* on ! association betwe5 toxic    
sub/ance exposures & specific diseases  
cov]$ 9 su* a regi/ry1 includ+ ! level (
 association betwe5 su* exposures & !   
specific diseases2 &  7#b7              
recomm5dations = future rese>*4  7c7    
,rese>* into ! effects ( toxic exposure 
on second & ?ird g5]ations ,9 addition  
to ! reviews "u subsection 7b71 !       

,secret>y %all ent] into an agreem5t ) !
 ,national ,academy ( ,sci5ces to review
 publi%$ sci5tific in=mation & /udies on
 ! heal? effects on ! *ildr5 & gr&*ildr5
 ( vet]ans ) toxic exposures cov]$ 9 a  
regi/ry describ$ 9 subsection 7a77#c74  
,"u su* agreem5t1 ! ,in/itute ( ,m$ic9e 
( ! ,national ,academies %all submit to 
! ,secret>y on a bi5nial basis a report 
on toxic sub/ance exposure-relat$       
illnesses4 ,su* report %all include--   
7#a7 a review ( all sci5tific /udies &  
rese>* on ! association betwe5 toxic    
sub/ance exposures & specific diseases  
cov]$ 9 su* a regi/ry 9 su* *ildr5 &    
gr&*ildr51 includ+ ! level ( association
 betwe5 su* exposures & ! specific      
diseases2 &  7#b7 recomm5dations =      
future rese>*4  7d7 ,rese>* ,! ,secret>y
 %all use ! reviews conduct$ "u         
subsections 7b7 & 7c7 to in=m !         
decisions made by ! ,secret>y ) respect 
to select+ ! rese>* to be conduct$ or   
fund$ by ! ,dep>tm5t ( ,vet]ans         
,affairs4 ,! ,secret>y %all submit to ! 

,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate a    
report describ+ h[ ! ,secret>y us$ su*  
reviews to make su* selections4  #c4    
,presumptions ( s]vice connection =     
illnesses associat$ ) toxic exposures   
enc\nt]$ by vet]ans dur+ milit>y s]vice 
7a7 ,9 g5]al ,sub*apt] ,,ii ( *apt] #aa 
( title #ch1 ,unit$ ,/ates ,code1 is    
am5d$ by add+ at ! end ! foll[+ new     
section3  #aaai4 ,presumptions ( s]vice 
connection = illnesses associat$ ) toxic
 exposures  7a7 ,presumption  7#a7 ,=   
purposes ( section #aaaj ( ?is title1 & 
subject to section #aaac ( ?is title1   
ea* illness1 if any1 describ$ 9 p>agraph
 7#b7 %all be consid]$ to h be5 incurr$ 
9 or aggravat$ by s]vice ref]r$ to 9 t  
p>agraph1 not)/&+ t !re is no record (  
evid5ce ( su* illness dur+ ! p]iod ( su*
 s]vice4  7#b7 ,an illness ref]r$ to 9  
p>agraph 7#a7 is any diagnos$ or        
undiagnos$ illness t--  7,a7 ! ,secret>y
 det]m9es 9 regulations prescrib$ "u ?is
 section to w>rant a presumption (      

s]vice connection by reason ( hav+ a    
positive association ) exposure to a    
toxic sub/ance cov]$ 9 ! ma/] regi/ry2 &
  7,b7 becomes manife/ )9 ! p]iod1 if   
any1 prescrib$ 9 su* regulations 9 a    
vet]an :o s]v$ 9 ! ,arm$ ,=ces & by     
reason ( su* s]vice exp]i5c$ su*        
exposure4  7#c7 ,= purposes ( ?is       
subsection1 a vet]an :o s]v$ 9 ! ,arm$  
,=ces 9 a location recogniz$ "u ! ma/]  
regi/ry z be+ a s\rce ( exposure & has  
an illness describ$ 9 p>agraph 7#b7 %all
 be presum$ to h be5 expos$ by reason ( 
su* s]vice unless !re is conclusive     
evid5ce to e/abli% t ! vet]an 0 n s     
expos$ by reason ( su* s]vice4  7b7     
7#a7  7,a7 ,:5ev] ! ,secret>y makes a   
det]m9ation describ$ 9 subp>agraph 7,b71
 ! ,secret>y %all prescribe regulations 
provid+ t a presumption ( s]vice        
connection is w>rant$ = ! illness cov]$ 
by t det]m9ation = purposes ( ?is       
section4  7,b7 ,a det]m9ation ref]r$ to 
9 subp>agraph 7,a7 is a det]m9ation bas$
 on s\nd m$ical & sci5tific evid5ce t a 

positive association exi/s betwe5--  7i7
 ! exposure ( humans or animals to a    
toxic sub/ance cov]$ 9 ! ma/] regi/ry2 &
  7ii7 ! occurr5ce ( a diagnos$ or      
undiagnos$ illness 9 humans or animals4 
7#b7  7,a7 ,9 mak+ det]m9ations =       
purposes ( p>agraph 7#a71 ! ,secret>y   
%all take into acc\nt--  7i7 ! reports  
submitt$ to ! ,secret>y by ! ,national  
,academy ( ,sci5ces "u section #b7;b7 ( 
! ,vet]ans' ,toxic ,w\nds ,rese>* ,act (
 #bjad2 &  7ii7 all o!r s\nd m$ical &   
sci5tific in=mation & analyses available
 to ! ,secret>y4  7,b7 ,9 evaluat+ any  
report1 in=mation1 or analysis =        
purposes ( mak+ su* det]m9ations1 !     
,secret>y %all take into consid]ation   
:e!r ! results are /ati/ically          
significant1 are capable ( replication1 
& )/& pe] review4  7#c7 ,an association 
betwe5 ! occurr5ce ( an illness 9 humans
 or animals & exposure to a toxic       
sub/ance cov]$ 9 ! ma/] regi/ry %all be 
consid]$ to be positive = purposes ( ?is
 subsection if ! cr$ible evid5ce = !    

association is equal to or outweighs !  
cr$ible evid5ce aga9/ ! association4    
7c7  7#a7 ,n lat] ?an #fj days aft] !   
date on :i* ! ,secret>y receives a      
report f ! ,national ,academy ( ,sci5ces
 "u section #b7;b7 ( ! ,vet]ans' ,toxic 
,w\nds ,rese>* ,act ( #bjad1 ! ,secret>y
 %all det]m9e :e!r or n a presumption ( 
s]vice connection is w>rant$ = ea*      
illness1 if any1 cov]$ by ! report4     
7#b7 ,if ! ,secret>y det]m9es "u ?is    
subsection t a presumption ( s]vice     
connection is w>rant$1 ! ,secret>y %all1
 n lat] ?an #fj days aft] mak+ !        
det]m9ation1 issue propos$ regulations  
sett+ =? ! ,secret>y's det]m9ation4     
7#c7  7,a7 ,if ! ,secret>y det]m9es "u  
?is subsection t a presumption ( s]vice 
connection is n w>rant$1 ! ,secret>y    
%all1 n lat] ?an #fj days aft] mak+ !   
det]m9ation1 publi% 9 ! ,f$]al ,regi/] a
 notice ( ! det]m9ation4 ,! notice %all 
include an explanation ( ! sci5tific    
basis = ! det]m9ation4  7,b7 ,if an     
illness already presum$ to be s]vice    

connect$ "u ?is section is subject to a 
det]m9ation "u subp>agraph 7,a71 !      
,secret>y %all1 n lat] ?an #fj days aft]
 publication ( ! notice "u t            
subp>agraph1 issue propos$ regulations  
remov+ ! presumption ( s]vice connection
 = ! illness4  7#d7 ,n lat] ?an #ij days
 aft] ! date on :i* ! ,secret>y issues  
any propos$ regulations "u ?is          
subsection1 ! ,secret>y %all issue f9al 
regulations4 ,su* regulations %all be   
effective on ! date ( issuance4  7d7    
,:5ev] ! presumption ( s]vice connection
 = an illness "u ?is section is remov$  
"u subsection 7c7--  7#a7 a vet]an :o 0 
aw>d$ comp5sation = ! illness on ! basis
 ( ! presumption be=e ! effective date (
 ! removal ( ! presumption %all cont9ue 
to be entitl$ to receive comp5sation on 
t basis2 &  7#b7 a survivor ( a vet]an  
:o 0 aw>d$ dep5d5cy & indemnity         
comp5sation = ! dea? ( a vet]an result+ 
f ! illness on ! basis ( ! presumption  
be=e t date %all cont9ue to be entitl$  
to receive dep5d5cy & indemnity         

comp5sation on t basis4  7e7 ,ma/]      
regi/ry def9$ ,9 ?is section1 ! t]m ma/]
 regi/ry means ! regi/ry ( vet]ans :o   
exp]i5c$ toxic exposures e/abli%$ by    
section #b ( ! ,vet]ans' ,toxic ,w\nds  
,rese>* ,act ( #bjad4  4  7b7 ,cl]ical  
am5dm5t ,! table ( sections at ! beg9n+ 
( su* *apt] is am5d$ by ins]t+ aft] !   
item relat+ to section #aaah ! foll[+   
new item3  #aaai4 ,presumptions ( s]vice
 connection = illnesses associat$ )     
toxic exposures4  4  #d4 ,inclusion (   
c]ta9 in=mation 9 electronic heal?      
records  ,9 implem5t+ ! electronic heal?
 record sy/em ( ! ,dep>tm5t ( ,vet]ans  
,affairs1 ! ,secret>y ( ,vet]ans        
,affairs %all ensure t ! electronic     
heal? record ( ea* individual includes1 
at a m9imum1 ! foll[+ in=mation3  7#a7  
,:e!r ! individual s]v$ 9 ! ,arm$ ,=ces4
  7#b7 ,! ,arm$ ,=ce 9 :i* ! individual 
s]v$4  7#c7 ,! locations 9 :i* !        
individual 0 /ation$ or deploy$ to dur+ 
su* s]vice4  7#d7 ,! dates ( su* s]vice4
  7#e7 ,! milit>y occupational specialty

 ( ! individual4  7#f7 ,! results ( any 
te/s or assessm5ts ( ! individual       
reg>d+--  7,a7 vision2  7,b7 he>+2  7,c7
 hepatitis ,c2  7,d7 ,,hiv2  7,e7 blood 
pressure2  7,f7 *ole/]ol2  7,g7 blood   
glucose te/ & diabetes in=mation2  7,h7 
body mass index measurem5t2  7,i7 bone  
d5sity1 z appropriate bas$ on ! age or  
sex ( ! individual2  7,j7 canc] scre5+s 
7z appropriate bas$ on ! age1 sex1 race1
 or e?nicity ( ! individual7 =--  7i7   
brea/ canc]2  7ii7 colorectal canc]2    
7iii7 lung canc]2  7iv7 pro/ate canc]2 &
  7v7 sk9 canc]2  7,k7 prev5tive        
immunizations1 if n curr5t2  7,l7       
spirometry 7= lung function72  7,m7     
smok+2  7,n7 a m5tal heal? evaluation2  
7,o7 sub/ance abuse2 or  7,p7 infecti\s 
diseases or p>asites or o!r adv]se heal?
 conditions endemic to :]e ! individual 
s]v$ :ile 9 ! milit>y4