,i #aaf? ,,congress #b;d ,session ,h4 ,r4 #hejf ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,octob] #b1 #bjbj,mr4 ,bilirakis 7= himself1 ,mr4 ,david ,p4 ,roe ( ,t5nessee1 ,mr4 ,w5/rup1 ,mr4 ,bo/1 & ,mr4 ,ma/7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,vet]ans' ,affairs ,a ,,bill ,to improve ! provision ( heal? c>e & o!r b5efits f ! ,dep>tm5t ( ,vet]ans ,affairs = vet]ans :o 7 expos$ to toxic sub/ances1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj or ! ,,team ,act ( #bjbj4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4,sec4 #b4 ,def9itions4,title ,i--,expansion ( heal? c>e & b5efits = vet]ans expos$ to toxic substances,sec4 #aja4 ,expansion ( heal? c>e eligibility = c]ta9 individuals expos$ to op5 burn pits & o!r toxic sub/ances4,sec4 #ajb4 ,expansion ( heal? c>e eligibility = vet]ans aw>d$ c]ta9 m$als4,sec4 #ajc4 ,presumptions ( s]vice connection = diseases associat$ ) exposure to c]ta9 toxic sub/ances4,title ,,ii--,rese>* & review reg>d+ exposure to toxic substances,sec4 #bja4 ,e/abli%m5t ( ,toxic ,exposure ,review ,commission4,sec4 #bjb4 ,agreem5t ) ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e conc]n+ ! exposure ( humans to toxic sub/ances4,sec4 #bjc4 ,collection1 analysis1 & report on treatm5t ( vet]ans = m$ical conditions relat$ to exposure to toxic sub/ances4,title ,,iii--,improvem5t ( res\rces ( ,dep>tm5t ( ,vet]ans ,affairs reg>d+ exposures to toxic substances,sec4 #cja4 ,publication ( li/ ( res\rces ( ,dep>tm5t ( ,vet]ans ,affairs = vet]ans expos$ to toxic sub/ances & outrea* program = su* vet]ans & c>egiv]s & survivors ( su* vet]ans4,sec4 #cjb4 ,incorporation ( toxic exposure que/ionnaire dur+ prim>y c>e appo9tm5ts4,sec4 #cjc4 ,s5se ( ,congress on portal = access by vet]ans to ,individual ,longitud9al ,exposure ,record4,sec4 #cjd4 ,tra9+ ( heal? c>e p]sonnel ( ,dep>tm5t ( ,vet]ans ,affairs on illnesses relat$ to exposure to toxic sub/ances4 #b4 ,def9itions ,9 ?is ,act3 7#a7 ,active milit>y1 naval1 or air s]vice ,! t]m active milit>y1 naval1 or air s]vice has ! mean+ giv5 t t]m 9 section #aja ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,op5 burn pit ,! t]m op5 burn pit has ! mean+ giv5 t t]m 9 section #bja7;c7 ( ! ,dignifi$ ,burial & ,o!r ,vet]ans' ,b5efits ,improvem5t ,act ( #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7#c7 ,toxic sub/ance ,! t]m toxic sub/ance has ! mean+ giv5 t t]m 9 subp>agraph 7,g77iv7 ( section #agaj7;e77#a7 ( su* title1 z add$ by section #aja7;a74 ,i ,expansion ( heal? c>e & b5efits = vet]ans expos$ to toxic sub/ances #aja4 ,expansion ( heal? c>e eligibility = c]ta9 individuals expos$ to op5 burn pits & o!r toxic sub/ances 7a7 ,9 g5]al ,section #agaj7;e7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 9 p>agraph 7#a71 by add+ at ! end ! foll[+ new subp>agraph3 7,g7 7i7 ,subject to p>agraph 7#b71 a cov]$ individual is eligible = hospital c>e1 m$ical s]vices1 & nurs+ home c>e "u subsection 7a77#b77;,f7 = any illness4 7ii7 ,= purposes ( ?is subp>agraph1 a cov]$ individual is an individual :o-- 7,i7 is eligible = inclusion 9 ! ,airborne ,haz>ds & ,op5 ,burn ,pit ,regi/ry2 or 7,,ii7 has be5 id5tifi$ by ! ,secret>y ( ,def5se to h be5 possibly expos$1 inside or outside ! ,unit$ ,/ates1 dur+ active duty1 active duty = tra9+1 or inactive duty tra9+1 to-- 7aa7 an op5 burn pit2 7bb7 a toxic sub/ance2 or 7cc7 a site includ$ 9 a database ma9ta9$ by ! ,dep>tm5t ( ,def5se & %>$ ) ! ,dep>tm5t ( ,vet]ans affairs to s]ve z ! c5tral portal = exposure-relat$ data t compiles1 collates1 pres5ts1 & provides available occupational & environm5tal exposure in=mation to support ! ne$s ( ! ,dep>tm5t ( ,def5se & ! ,dep>tm5t ( ,vet]ans ,affairs4 7iii7 ,a cov]$ individual %all be enroll$ 9 ! sy/em ( annual pati5t enrollm5t ( ! ,dep>tm5t 9 ! priority gr\p "u subsection 7a77#f7 ( section #agje ( ?is title4 7iv7 ,9 ?is subp>agraph3 7,i7 ,! t]m ,airborne ,haz>ds & ,op5 ,burn ,pit ,regi/ry means ! regi/ry e/abli%$ by ! ,secret>y "u section #bja ( ! ,dignifi$ ,burial & ,o!r ,vet]ans' ,b5efits ,improvem5t ,act ( #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7,,ii7 ,! t]m op5 burn pit has ! mean+ giv5 t t]m 9 section #bja7;c7 ( ! ,dignifi$ ,burial & ,o!r ,vet]ans' ,b5efits ,improvem5t ,act ( #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7,,iii7 ,! t]m toxic sub/ance means a toxicant or a tox94 7,,iv7 ,! t]m toxicant means any sub/ance t c injure or kill humans1 animals1 or plants & t is produc$ by humans or is a by-product ( human activities4 7,v7 ,! t]m tox9 means any sub/ance t c injure or kill humans1 animals1 or plants & t is produc$ naturally4 2 & 7#b7 9 p>agraph 7#b77;,b71 by /rik+ or 7,f7 & ins]t+ 7,f71 or 7,g74 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date t is #ij days aft] ! date ( ! enactm5t ( ?is ,act4 7c7 ,det]m9ations ( exposure 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all1 to ! ext5t practicable1 e/abli% & ma9ta9 a me*anism by :i* vet]ans may det]m9e :e!r or n !y h be5 possibly expos$ to an op5 burn pit or toxic sub/ance describ$ 9 subp>agraph 7,g77ii77,,ii7 ( section #agaj7;e77#a7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 = purposes ( be+ consid]$ z cov]$ vet]ans "u su* subp>agraph4 7#b7 ,approval ( ,secret>y ,any det]m9ation made "u p>agraph 7#a7 %all be subject to ! approval ( ! ,secret>y4 7#c7 ,appeals ,! ,secret>y %all e/abli% a me*anism = appeal+ a decision made by ! ,secret>y "u p>agraph 7#b74 7d7 ,report 7#a7 ,9 g5]al ,n lat] ?an #cj days aft] ! date on :i* ! ,secret>y ( ,def5se id5tifies ! individuals describ$ 9 subp>agraph 7,g77ii77,,ii7 ( section #agaj7;e77#a7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,vet]ans ,affairs1 %all submit to ! appropriate committees ( ,congress a report4 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! duty locations or units ( ! individuals describ$ 9 p>agraph 7#a71 or o!r in=mation on gr\ps to :i* su* individuals belong4 7,b7 ,! evid5ce consid]$ 9 id5tify+ individuals :o 7 possibly expos$ to an op5 burn pit1 toxic sub/ance1 or site z describ$ 9 subp>agraph 7,g77ii77,,ii7 ( section #agaj7;e77#a7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a74 7,c7 ,! crit]ia us$ to det]m9e :e!r an individual 0 s expos$4 7#c7 ,appropriate committees ( ,congress ,9 ?is subsection1 ! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,arm$ ,s]vices ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,arm$ ,s]vices ( ! ,h\se ( ,repres5tatives4 #ajb4 ,expansion ( heal? c>e eligibility = vet]ans aw>d$ c]ta9 m$als 7a7 ,9 g5]al ,section #agaj7;e7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #aja7;a71 is fur!r am5d$-- 7#a7 9 p>agraph 7#a71 by add+ at ! end ! foll[+ new subp>agraph3 7,h7 7i7 ,subject to p>agraph 7#b71 a vet]an is eligible = hospital c>e1 m$ical s]vices1 & nurs+ home c>e "u subsection 7a77#b77;,f7 = any illness if ! vet]an 0 aw>d$ any ( ! foll[+3 7,i7 ,! ,arm$ ,=ces ,s]vice ,m$al4 7,,ii7 ,! ,afghani/an ,campaign ,m$al4 7,,iii7 ,! ,global ,w> on ,t]rorism ,exp$ition>y ,m$al4 7,,iv7 ,! ,inh]5t ,resolve ,campaign ,m$al4 7,v7 ,! ,iraq ,campaign ,m$al4 7,,vi7 ,! ,s\?we/ ,asia ,s]vice ,m$al4 7ii7 ,a vet]an describ$ 9 clause 7i7 %all be enroll$ 9 ! sy/em ( annual pati5t enrollm5t ( ! ,dep>tm5t 9 ! priority gr\p "u subsection 7a77#f7 ( section #agje ( ?is title4 2 & 7#b7 9 p>agraph 7#b71 by /rik+ or 7,g7 & ins]t+ 7,g71 or 7,h74 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date t is #ij days aft] ! date ( ! enactm5t ( ?is ,act4 #ajc4 ,presumptions ( s]vice connection = diseases associat$ ) exposure to c]ta9 toxic sub/ances 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 = diseases associat$ ) exposure to c]ta9 toxic sub/ances 7a7 ,presumptions ( s]vice connection 7#a7 ,= purposes ( section #aaaj ( ?is title1 & subject to section #aaac ( ?is title1 ea* disease specifi$ 9 p>agraph 7#b7 becom+ manife/ z specifi$ 9 t p>agraph %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* disease dur+ ! p]iod ( su* s]vice4 7#b7 ,a disease specifi$ 9 ?is p>agraph is any disease t-- 7,a7 ! ,secret>y det]m9es 9 regulations prescrib$ "u ?is section w>rants a presumption ( s]vice connection by reason ( hav+ suffici5t evid5ce ( positive association ) exposure to a toxic sub/ance2 & 7,b7 becomes manife/ )9 ! p]iod1 if any1 prescrib$ 9 su* regulations 9 a vet]an :o 0 expos$ to t toxic sub/ance dur+ active milit>y1 naval1 or air s]vice4 7#c7 7,a7 ,= purposes ( ?is subsection1 ! ,secret>y may presume t a vet]an :o has a disease specifi$ 9 p>agraph 7#b7 0 expos$ to ! toxic sub/ance = :i* ! ,secret>y has det]m9$ "u p>agraph 7#b77;,a7 w>rants a presumption ( s]vice connection by reason ( hav+ suffici5t evid5ce ( positive association ) exposure to ! toxic sub/ance1 not)/&+ t !re is no record ( evid5ce ( su* exposure1 if ! ,secret>y det]m9es bas$ on "o or m ( ! factors set =? 9 subp>agraph 7,b7 t a presumption ( exposure is w>rant$4 7,b7 ,! factors set =? 9 ?is subp>agraph are z foll[s3 7i7 ,! duty location ( ! vet]an4 7ii7 ,! l5g? ( s]vice ( ! vet]an4 7iii7 ,su* o!r factors z ! ,secret>y consid]s appropriate4 7b7 ,det]m9ations relat+ to diseases 7#a7 ,:5ev] ! ,secret>y det]m9es1 on ! basis ( s\nd m$ical & sci5tific evid5ce1 t suffici5t evid5ce ( positive association exi/s betwe5 ! exposure ( humans to a toxic sub/ance & ! occurr5ce ( a disease 9 humans1 ! ,secret>y %all prescribe regulations provid+ t a presumption ( s]vice connection is w>rant$ = t disease = purposes ( ?is section4 7#b7 ,9 mak+ det]m9ations "u p>agraph 7#a71 ! ,secret>y %all take into acc\nt-- 7,a7 reports receiv$ by ! ,secret>y f ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e "u section #bjb7;g7 ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj2 & 7,b7 all o!r s\nd m$ical & sci5tific in=mation & analyses available to ! ,secret>y4 7#c7 7,a7 ,9 evaluat+ any report1 in=mation1 or analysis = purposes ( mak+ su* det]m9ations1 ! ,secret>y %all consid] only sci5tific /udies t are valid 9 accordance ) contempor>y sci5tific /&>ds4 7,b7 ,! ,secret>y may def9e ! /&>ds describ$ 9 subp>agraph 7,a7 = purposes ( t subp>agraph4 7c7 ,response to reports by ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 7#a7 ,n lat] ?an #fj days aft] ! date on :i* ! ,secret>y receives a report f ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e "u section #bjb7;g7 ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj1 ! ,secret>y %all det]m9e :e!r a presumption ( s]vice connection is w>rant$ = ea* disease cov]$ by ! report4 7#b7 ,if ! ,secret>y det]m9es "u p>agraph 7#a7 t a presumption ( s]vice connection is w>rant$ = a disease1 ! ,secret>y %all1 n lat] ?an #fj days aft] mak+ ! det]m9ation1 issue propos$ regulations sett+ =? ! det]m9ation4 7#c7 7,a7 ,if ! ,secret>y makes a det]m9ation describ$ 9 subp>agraph 7,b71 ! ,secret>y %all1 n lat] ?an #fj days aft] mak+ ! det]m9ation1 publi% 9 ! ,f$]al ,regi/] a notice ( ! det]m9ation4 7,b7 ,a det]m9ation describ$ 9 ?is subp>agraph is a det]m9ation by ! ,secret>y "u p>agraph 7#a7 t a presumption ( s]vice connection is n w>rant$ = a disease z to :i* ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e det]m9$ t !re 0-- 7i7 suffici5t evid5ce ( an association betwe5 ! exposure ( humans to a toxic sub/ance & ! occurr5ce ( ! disease 9 humans2 or 7ii7 limit$ evid5ce or sugge/ive evid5ce ( su* an association4 7,c7 ,any notice publi%$ "u subp>agraph 7,a7 %all include an explanation ( ! sci5tific basis = ! det]m9ation describ$ 9 subp>agraph 7,b74 7,d7 ,if a disease already presum$ to be s]vice connect$ "u ?is section is subject to a det]m9ation describ$ 9 subp>agraph 7,b71 ! ,secret>y %all1 n lat] ?an #fj days aft] publication ( ! notice "u subp>agraph 7,a71 issue propos$ regulations remov+ ! presumption ( s]vice connection = ! disease4 7#d7 ,n lat] ?an #ahj days aft] ! date on :i* ! ,secret>y issues any propos$ regulations "u ?is subsection1 ! ,secret>y %all issue f9al regulations4 7d7 ,removal ( presumption ( s]vice connection ,:5ev] ! presumption ( s]vice connection = a disease "u ?is section is remov$ "u subsection 7c7-- 7#a7 a vet]an :o 0 aw>d$ comp5sation = ! disease 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 ! disease on ! basis ( ! presumption be=e t date %all cont9ue to be entitl$ to receive dep5d5cy & indemnity comp5sation on t basis4 7e7 ,ref]5ce to ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e ,9 ! case t ! ,secret>y ent]s into an agreem5t ) ano!r organization z describ$ 9 section #bjb7;h77#a7 ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj1 any ref]5ce 9 ?is section to ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e %all be treat$ z a ref]5ce to ! o!r organization4 7f7 ,def9itions ,9 ?is section3 7#a7 ,! t]m suffici5t evid5ce ( positive association means1 ) respect to an association betwe5 exposure to a toxic sub/ance & ! occurr5ce ( a disease 9 humans1 t-- 7,a7 !re is cr$ible evid5ce = ! association & su* evid5ce is equal to or outweighs ! cr$ible evid5ce aga9/ ! association2 & 7,b7 ! association has be5 obs]v$ 9 /udies 9 :i* *ance1 bias1 & conf\nd+ c be rul$ out ) reasonable confid5ce4 7#b7 ,! t]m toxic sub/ance has ! mean+ giv5 t t]m 9 section #agaj7;e77#a77;,g77iv7 ( ?is title4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #aa ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #aaah ! foll[+ new item3 #aaai4 ,presumptions ( s]vice connection = diseases associat$ ) exposure to c]ta9 toxic sub/ances4 4 7c7 ,con=m+ am5dm5t ,section #aaac ( su* title is am5d$ by /rik+ or #aaah ea* place x appe>s & ins]t+ #aaah1 or #aaai4 ,,ii ,rese>* & review reg>d+ exposure to toxic sub/ances #bja4 ,e/abli%m5t ( ,toxic ,exposure ,review ,commission 7a7 ,9 g5]al ,sub*apt] ,,iii ( *apt] #e ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new section3 #edg4 ,toxic ,exposure ,review ,commission 7a7 ,e/abli%m5t ,! ,secret>y %all e/abli% an indep5d5t commission to be kn[n z ! ,toxic ,exposure ,review ,commission 79 ?is section ref]r$ to z ! ,commission74 7b7 ,purpose ,! ,commission %all-- 7#a7 advise ! ,secret>y on que/ions relat+ to exposure to toxic sub/ances t require sci5tific rese>*2 & 7#b7 assi/ 9 ! consid]ation ( possible presumptions ( s]vice connection4 7c7 ,duties ,! ,commission %all c>ry out ! foll[+ duties3 7#a7 ,collect any relevant in=mation f ! ,dep>tm5t ( ,def5se & o!r s\rces to id5tify possible toxic exposures relat$ to s]vice dur+ active duty1 active duty = tra9+1 or inactive duty tra9+ 9 ord] to det]m9e ! ne$ = a compreh5sive review "u an agreem5t "u section #bjb ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj4 ,relevant in=mation may be collect$ f ! foll[+3 7,a7 ,any ,f$]al ag5cy1 z ! ,commission consid]s necess>y to c>ry out ?is section4 ,^u reque/ ( ! ,*air1 ! head ( su* ag5cy %all furni% su* in=mation to ! ,commission1 unless su* in=mation is classifi$4 7,b7 ,public meet+s or he>+s1 :i* may be held to take su* te/imony & receive su* evid5ce z ! ,commission consid]s advisable to c>ry out ! duties ( ! ,commission4 7#b7 ,recomm5d to ! ,secret>y1 by majority vote1 :e!r a compreh5sive sci5tific review %\ld be conduct$ by ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e "u an agreem5t "u section #bjb ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj4 7#c7 ,recomm5d to ! ,secret>y1 by majority vote1 :e!r new1 indep5d5t /udies reg>d+ ! heal? outcomes ( exposure to toxic sub/ances1 or any o!r new1 indep5d5t /udies t ! ,commission deems necess>y & appropriate1 %\ld be conduct$4 7#d7 ,annually report to ,congress on progress reg>d+ ! duties set =? 9 p>agraphs 7#a7 ?r\gh 7#c71 any recomm5dations made to ! ,secret>y1 & any responses ( ! ,secret>y to su* recomm5dations4 7d7 ,memb]%ip 7#a7 7,a7 ,! ,commission %all be compos$ ( #i memb]s1 appo9t$ z foll[s3 7i7 ,two memb]s appo9t$ by ! ,speak] ( ! ,h\se ( ,repres5tatives4 7ii7 ,two memb]s appo9t$ by ! m9ority lead] ( ! ,h\se ( ,repres5tatives4 7iii7 ,two memb]s appo9t$ by ! majority lead] ( ! ,s5ate4 7iv7 ,two memb]s appo9t$ by ! m9ority lead] ( ! ,s5ate4 7v7 ,"o memb] appo9t$ by ! ,secret>y4 7,b7 ,! initial memb]s ( ! ,commission %all be appo9t$ "u subp>agraph 7,a7 n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj4 7#b7 ,9 appo9t+ individuals "u p>agraph 7#a77;,a71 ! ,speak] ( ! ,h\se ( ,repres5tatives1 ! m9ority lead] ( ! ,h\se ( ,repres5tatives1 ! majority lead] ( ! ,s5ate1 ! m9ority lead] ( ! ,s5ate1 & ! ,secret>y %all ensure t at lea/ five memb]s ( ! ,commission are sci5ti/s or heal? c>e pr(essionals-- 7,a7 ( :om-- 7i7 "o has a backgr\nd 9 ! field ( respiratory m$ic9e2 7ii7 "o has a backgr\nd 9 ! field ( endocr9ology & metabolic m$ic9e2 7iii7 "o has a backgr\nd 9 hematology2 7iv7 "o has a backgr\nd 9 oncology2 & 7v7 "o has a backgr\nd 9 occupational & environm5tal heal?2 & 7,b7 :o are n (ficials or employees ( ! ,f$]al ,gov]nm5t4 7#c7 ,9 appo9t+ individuals "u p>agraph 7#a77;,a71 ! ,speak] ( ! ,h\se ( ,repres5tatives1 ! m9ority lead] ( ! ,h\se ( ,repres5tatives1 ! majority lead] ( ! ,s5ate1 ! m9ority lead] ( ! ,s5ate1 & ! ,secret>y %all ensure t at lea/ two memb]s ( ! ,commission repres5t an organization recogniz$ by ! ,secret>y = ! repres5tation ( vet]ans "u section #eijb ( ?is title4 7#d7 ,9 appo9t+ individuals "u p>agraph 7#a77;,a71 ! ,speak] ( ! ,h\se ( ,repres5tatives1 ! m9ority lead] ( ! ,h\se ( ,repres5tatives1 ! majority lead] ( ! ,s5ate1 ! m9ority lead] ( ! ,s5ate1 & ! ,secret>y %all give consid]ation to includ+ 9 ! ,commission at lea/ "o memb] :o works ) survivors ( illnesses relat$ to exposure to toxic sub/ances & has a backgr\nd 9 ! field ( /udy ( exposure to toxic sub/ances4 7e7 ,meet+s 7#a7 ,! ,commission %all meet n less frequ5tly ?an twice ea* ye>4 7#b7 7,a7 ,ea* meet+ ( ! ,commission %all be op5 to ! public4 7,b7 ,all ! proce$+s1 in=mation1 & delib]ations ( ! ,commission %all be available = review by ! public4 7,c7 ,meet+s ( ! ,commission may be c>ri$ out ?r\gh ! use ( telephonic or o!r appropriate telecommunication te*nology if ! ,commission det]m9es t su* te*nology w all[ ! memb]s to communicate simultane\sly4 7f7 ,*air & ,vice ,*air ,at ! initial meet+ ( ! ,commission "u subsection 7e71 ! ,commission %all select a ,*air & ,vice ,*air f among ! memb]s ( ! ,commission by a majority vote ( ! memb]s ( ! ,commission4 7g7 ,p]iod ( appo9tm5t2 vacancies 7#a7 ,a memb] ( ! ,commission %all be appo9t$ = a t]m t may n exce$ f\r ye>s4 7#b7 ,! ,secret>y %all ensure t t]ms ( memb]s ( ! ,commission are /agg]$ s t no su* t]ms end on ! same date4 7#c7 ,a vacancy 9 ! ,commission %all be fill$ 9 ! same mann] z ! orig9al appo9tm5t1 b ! individual appo9t$ to fill ! vacancy %all s]ve only = ! unexpir$ portion ( ! t]m = :i* ! individual's pr$ecessor 0 appo9t$4 7#d7 ,9 appo9t+ ! initial memb]s ( ! ,commission1 ea* (ficial :o is au?oriz$ to appo9t two memb]s ( ! ,commission %all appo9t-- 7,a7 "o memb] ^: t]m expires aft] two ye>s2 & 7,b7 "o memb] ^: t]m expires aft] f\r ye>s4 7h7 ,pay 7#a7 ,memb]s ( ! ,commission %all s]ve )\t pay4 7#b7 ,ea* memb] ( ! ,commission :o is an (fic] or employee ( ! ,unit$ ,/ates %all s]ve )\t comp5sation 9 addition to t receiv$ = s]vice z an (fic] or employee ( ! ,unit$ ,/ates4 7#c7 ,memb]s %all receive travel exp5ses1 includ+ p] diem 9 lieu ( subsi/5ce1 9 accordance ) sections #egjb & #egjc ( title #e4 7i7 ,director ( /aff 7#a7 ,! ,commission %all appo9t a ,director :o-- 7,a7 has n s]v$ z an employee ( ! ,dep>tm5t dur+ ! "o-ye> p]iod prec$+ ! date ( su* appo9tm5t2 & 7,b7 is n o!rwise b>r$ or prohibit$ f s]v+ z ,director "u ,f$]al e?ics laws & regulations1 by reason ( po/-employm5t conflict ( int]e/4 7#b7 ,! ,director %all be paid at ! rate ( basic pay payable = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e4 7j7 ,/aff 7#a7 ,subject to p>agraphs 7#b7 & 7#c71 ! ,director1 ) ! approval ( ! ,commission1 may appo9t & fix ! pay ( additional p]sonnel4 7#b7 ,! ,director may make su* appo9tm5ts )\t reg>d to ! provisions ( title #e gov]n+ appo9tm5ts 9 ! competitive s]vice1 & any p]sonnel s appo9t$ may be paid )\t reg>d to ! provisions ( *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( t title relat+ to classification & ,g5]al ,s*$ule pay rates1 except t an individual s appo9t$ may n receive pay 9 excess ( ! annual rate ( basic pay payable = ,,gs-#ae ( ! ,g5]al ,s*$ule4 7#c7 7,a7 ,n m ?an two-?irds ( ! p]sonnel employ$ by or detail$ to ! ,commission may be on detail f ! ,dep>tm5t4 7,b7 ,n m ?an half ( ! pr(essional analy/s ( ! ,commission /aff may be p]sons detail$ f ! ,dep>tm5t to ! ,commission4 7#d7 ,subject to p>agraph 7#c71 ! head ( any ,f$]al ag5cy1 ^u ! reque/ ( ! ,director1 may detail any ( ! p]sonnel ( t ag5cy to ! ,commission to assi/ ! ,commission 9 c>ry+ out its duties "u ?is section4 7#e7 ,! ,commission may secure directly f any ,f$]al ag5cy su* in=mation z ! ,commission consid]s necess>y to c>ry out ?is section4 ,^u reque/ ( ! ,*air1 ! head ( su* ag5cy %all furni% su* in=mation to ! ,commission1 unless su* in=mation is classifi$4 7k7 ,o!r au?ority 7#a7 ,! ,commission may procure by contract1 to ! ext5t funds are available1 ! tempor>y or int]mitt5t s]vices ( exp]ts or consultants pursuant to section #caji ( title #e4 7#b7 ,to ! ext5t funds are available1 ! ,commission may lease real prop]ty & acquire p]sonal prop]ty ei!r ( its own accord or 9 consultation ) ! ,g5]al ,s]vices ,adm9i/ration4 7l7 ,communications 7#a7 7,a7 ,except z provid$ 9 subp>agraph 7,b71 no p]son may re/rict an employee ( ! ,dep>tm5t 9 communicat+ ) ! ,commission4 7,b7 ,subp>agraph 7,a7 does n apply to a communication t is unlawful4 7#b7 ,all ex p>te communications ) ! ,commission %all be made "p ( ! public record4 7m7 ,ref]5ce to ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e ,9 ! case t ! ,secret>y ent]s into an agreem5t ) ano!r organization z describ$ 9 section #bjb7;h77#a7 ( ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act ( #bjbj1 any ref]5ce 9 ?is section to ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e %all be treat$ z a ref]5ce to ! o!r organization4 7n7 ,toxic sub/ance def9$ ,9 ?is section1 ! t]m toxic sub/ance has ! mean+ giv5 t t]m 9 subp>agraph 7,g77iv7 ( section #agaj7;e77#a7 ( ?is title4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #e ( su* title is am5d$ by add+ at ! end ! foll[+ new item3 #edg4 ,toxic ,exposure ,review ,commission4 4 #bjb4 ,agreem5t ) ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e conc]n+ ! exposure ( humans to toxic sub/ances 7a7 ,purpose ,! purpose ( ?is section is to provide = ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 79 ?is section ref]r$ to z ! ,academies71 an indep5d5t nonpr(it sci5tific organization ) appropriate exp]tise t is n "p ( ! ,f$]al ,gov]nm5t1 to review & evaluate ! available sci5tific evid5ce reg>d+ associations betwe5 diseases & exposure to toxic sub/ances4 7b7 ,agreem5t 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all seek to ent] into a five-ye> agreem5t ) ! ,academies to p]=m ! s]vices cov]$ by ?is section4 7#b7 ,tim+ ,! ,secret>y %all seek to ent] into an agreem5t describ$ 9 p>agraph 7#a7 n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act4 7#c7 ,ext5sion ,an agreem5t "u ?is section may be ext5d$ 9 five-ye> increm5ts4 7c7 ,review ( sci5tific evid5ce ,"u an agreem5t betwe5 ! ,secret>y & ! ,academies "u ?is section1 ! ,academies %all review & summ>ize ! sci5tific evid5ce1 & assess ! /r5g? !re(1 conc]n+ ! association betwe5 exposure to toxic sub/ances dur+ active milit>y1 naval1 or air s]vice & ea* disease suspect$ to be associat$ ) su* exposure 9 ! human population4 7d7 ,sci5tific det]m9ations conc]n+ diseases ,= ea* disease review$ "u subsection 7c71 ! ,academies %all det]m9e1 to ! ext5t t available sci5tific data p]mit mean+ful det]m9ations-- 7#a7 :e!r an association exi/s betwe5 exposure to toxic sub/ances & ! occurr5ce ( ! disease1 tak+ into acc\nt ! /r5g? ( ! sci5tific evid5ce & ! appropriat5ess ( ! /ati/ical & epidemiological me?ods us$ to detect ! association2 7#b7 ! increas$ risk ( ! disease among ^? expos$ to toxic sub/ances dur+ active milit>y1 naval1 or air s]vice2 & 7#c7 :e!r !re exi/s a plausible biological me*anism or o!r evid5ce ( a causal relation%ip betwe5 ! exposure & ! occurr5ce ( ! disease4 7e7 ,coop]ation ( ,f$]al ag5cies ,! head ( ea* relevant ,f$]al ag5cy1 includ+ ! ,secret>y ( ,def5se1 %all coop]ate fully ) ! ,academies 9 p]=m+ ! s]vices cov]$ by ?is section4 7f7 ,recomm5dations = additional sci5tific /udies 7#a7 ,9 g5]al ,"u an agreem5t betwe5 ! ,secret>y & ! ,academies "u ?is section1 ! ,academies %all make any recomm5dations = additional sci5tific /udies to resolve areas ( cont9u+ sci5tific unc]ta9ty relat+ to ! exposure ( humans to toxic sub/ances4 7#b7 ,consid]ations ,9 mak+ recomm5dations "u p>agraph 7#a71 ! ,academies %all consid]-- 7,a7 ! sci5tific in=mation t is available at ! "t ( ! recomm5dation2 7,b7 ! value & relevance ( ! in=mation t c\ld result f additional /udies2 & 7,c7 ! co/ & feasibility ( c>ry+ out su* additional /udies4 7g7 ,reports 7#a7 ,initial report 7,a7 ,9 g5]al ,"u an agreem5t betwe5 ! ,secret>y & ! ,academies "u ?is section1 n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,academies %all submit to ! ,secret>y1 ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives an initial report on ! activities ( ! ,academies "u ! agreem5t4 7,b7 ,elem5ts ,! report submitt$ "u subp>agraph 7,a7 %all include ! foll[+3 7i7 ,! det]m9ations describ$ 9 subsection 7d74 7ii7 ,a full explanation ( ! sci5tific evid5ce & reason+ t l$ to su* det]m9ations4 7iii7 ,any recomm5dations ( ! ,academies "u subsection 7f74 7#b7 ,p]iodic updates ,"u an agreem5t betwe5 ! ,secret>y & ! ,academies "u ?is section1 n less frequ5tly ?an once e two ye>s aft] ! date on :i* ! initial report is submitt$ "u p>agraph 7#a77;,a71 ! ,academies %all submit to ! ,secret>y1 ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives an updat$ report on ! activities ( ! ,academies "u ! agreem5t4 7h7 ,alt]native contract sci5tific organization 7#a7 ,9 g5]al ,if ! ,secret>y is unable )9 ! "t p]iod prescrib$ 9 subsection 7b77#b7 to ent] into an agreem5t ) ! ,academies = ! purposes ( ?is section on t]ms acceptable to ! ,secret>y1 ! ,secret>y %all seek to ent] into an agreem5t = ! purposes ( ?is section ) ano!r appropriate sci5tific organization t-- 7,a7 is n "p ( ! ,f$]al ,gov]nm5t2 7,b7 op]ates z a n-=-pr(it entity2 & 7,c7 has exp]tise & objectivity comp>able to t ( ! ,academies4 7#b7 ,treatm5t ,if ! ,secret>y ent]s into an agreem5t ) ano!r organization z describ$ 9 p>agraph 7#a71 any ref]5ce 9 ?is section1 section #edg ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #bja7;a71 & section #aaai ( su* title1 z add$ by section #aje7;a71 to ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e %all be treat$ z a ref]5ce to ! o!r organization4 #bjc4 ,collection1 analysis1 & report on treatm5t ( vet]ans = m$ical conditions relat$ to exposure to toxic sub/ances 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all compile & analyze1 on a cont9u\s basis1 all cl9ical data t-- 7#a7 is obta9$ by ! ,dep>tm5t ( ,vet]ans ,affairs 9 connection ) hospital c>e1 m$ical s]vices1 & nurs+ home c>e furni%$ "u section #agaj7;a77#b77;,f7 ( title #ch1 ,unit$ ,/ates ,code2 & 7#b7 is likely to be sci5tifically useful 9 det]m9+ ! association1 if any1 betwe5 ! m$ical condition ( a vet]an & exposure to a toxic sub/ance4 7b7 ,cons5t ( pati5ts ,compilation & analysis by ! ,secret>y ( cl9ical data ( a vet]an "u subsection 7a7 %all be conduct$1 & su* data %all be us$1 consi/5t ) ! in=m$ cons5t ( ! vet]an & 9 compliance ) all applicable ,f$]al law4 7c7 ,annual report ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives1 & ! ,toxic ,exposure ,review ,commission e/abli%$ by section #edg ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #bja7;a7 ( ?is ,act1 a report conta9+-- 7#a7 ! data compil$ "u subsection 7a72 7#b7 an analysis ( su* data2 7#c7 a description ( ! types & incid5ces ( m$ical conditions id5tifi$ by ! ,dep>tm5t "u su* subsection2 7#d7 ! explanation ( ! ,secret>y = ! incid5ce ( su* m$ical conditions & o!r explanations = ! incid5ce ( su* conditions z ! ,secret>y consid]s reasonable2 & 7#e7 ! views ( ! ,secret>y on ! sci5tific validity ( draw+ conclusions f ! incid5ce ( su* m$ical conditions1 z evid5c$ by ! data compil$ "u subsection 7a71 reg>d+ any association betwe5 su* conditions & exposure to a toxic sub/ance4 ,,iii ,improvem5t ( res\rces ( ,dep>tm5t ( ,vet]ans ,affairs reg>d+ exposures to toxic sub/ances #cja4 ,publication ( li/ ( res\rces ( ,dep>tm5t ( ,vet]ans ,affairs = vet]ans expos$ to toxic sub/ances & outrea* program = su* vet]ans & c>egiv]s & survivors ( su* vet]ans 7a7 ,publication ( li/ ( res\rces 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y ( ,vet]ans ,affairs %all publi% a li/ ( res\rces ( ! ,dep>tm5t ( ,vet]ans ,affairs =-- 7,a7 vet]ans provid$ disability comp5sation "u *apt] #aa ( title #ch1 ,unit$ ,/ates ,code1 relat+ to exposure to toxic sub/ances2 7,b7 vet]ans eligible = hospital c>e1 m$ical s]vices1 & nurs+ home c>e "u section #agaj7;a77#b77;,f7 ( su* title2 7,c7 c>egiv]s ( vet]ans describ$ 9 subp>agraph 7,a7 or 7,b7 :o are p>ticipat+ 9 ! program ( compreh5sive assi/ance = family c>egiv]s "u section #agbj;,g7a7 ( su* title2 & 7,d7 survivors ( vet]ans describ$ 9 subp>agraph 7,a7 or 7,b7 7or :o w\ld be describ$ 9 any su* subp>agraph 7 ! vet]an alive7 :o are receiv+ dea? b5efits "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,update ,! ,secret>y %all p]iodically update ! li/ publi%$ "u p>agraph 7#a74 7b7 ,outrea* ,! ,secret>y %all develop1 ) input f ! community1 an in=mative outrea* program = vet]ans on illnesses t may be relat$ to exposure to toxic sub/ances1 includ+ outrea* ) respect to b5efits & support programs4 #cjb4 ,incorporation ( toxic exposure que/ionnaire dur+ prim>y c>e appo9tm5ts 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all incorporate a cl9ical que/ionnaire to help det]m9e pot5tial exposure to toxic sub/ances dur+ active milit>y1 naval1 or air s]vice z "p ( ! initial scre5+ conduct$ = an appo9tm5t ( a vet]an ) a prim>y c>e provid] ( ! ,dep>tm5t ( ,vet]ans ,affairs to improve und]/&+ by ! ,dep>tm5t ( exposure ( vet]ans to toxic sub/ances :ile s]v+ 9 ! ,arm$ ,=ces4 7b7 ,det]m9ation ( que/ions ,! que/ions includ$ 9 ! que/ionnaire requir$ "u subsection 7a7 %all be det]m9$ by ! ,secret>y ) input f m$ical pr(essionals4 #cjc4 ,s5se ( ,congress on portal = access by vet]ans to ,individual ,longitud9al ,exposure ,record ,x is ! s5se ( ,congress t ! ,secret>y ( ,vet]ans ,affairs %\ld e/abli% a portal on ! int]net website ( ! ,dep>tm5t ( ,vet]ans ,affairs ?r\gh :i* a vet]an may access docum5ts & in=mation ) respect to ! vet]an conta9$ 9 ! ,individual ,longitud9al ,exposure ,record ( ! ,dep>tm5t ( ,vet]ans ,affairs4 #cjd4 ,tra9+ ( heal? c>e p]sonnel ( ,dep>tm5t ( ,vet]ans ,affairs on illnesses relat$ to exposure to toxic sub/ances 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all ensure t heal? c>e p]sonnel ( ! ,dep>tm5t ( ,vet]ans ,affairs are appropriately tra9$ to id5tify1 treat1 & assess ! impact ( illnesses relat$ to exposure to toxic sub/ances4 7b7 ,elem5ts ( tra9+ ,! tra9+ requir$ "u subsection 7a7 %all-- 7#a7 provide heal? c>e p]sonnel ( ! ,dep>tm5t ) specific education ) respect to illnesses relat$ to exposure to toxic sub/ances2 & 7#b7 in=m su* p]sonnel ( h[ to probe = additional in=mation f vet]ans reg>d+ exposures to diff]5t toxicants4 7c7 ,toxicant def9$ ,9 ?is section1 ! t]m toxicant has ! mean+ giv5 t t]m 9 subp>agraph 7,g77iv7 ( section #agaj7;e77#a7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #aja7;a74