,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dcic  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #cj1 #bjbj,mr4   
,tillis introduc$ ! foll[+ bill2 :i* 0  
read twice & 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 ( #bjbj  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             
,consultation1 te/+1 & treatm5t = c]ta9 
vet]ans :o receiv$ haz>d\s duty pay or 7
 expos$ to toxic sub/ances4,sec4 #ajb4  
,p]man5t reau?orization ( au?ority (    
,secret>y ( ,vet]ans ,affairs to        

prescribe regulations provid+ t a       
presumption ( s]vice connection is      
w>rant$ = a disease associat$ ) exposure
 to a h]bicide ag5t4,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$ic9e conc]n+ ! exposure (
 humans to toxic sub/ances4,sec4 #bjc4  
,analysis ( results ( consultation1     
te/+1 & treatm5t ( vet]ans =            
disabilities relat$ to exposure to toxic
 sub/ances4,sec4 #bjd4 ,report to       
evaluate & id5tify gr\ps at-risk (      
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 ,portal = access 
by vet]ans to individual longitud9al    
exposure record4,sec4 #cjd4 ,tra9+ (    
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 #aja7bd7 ( title #ch1 ,unit$    
,/ates ,code4  7#b7 ,toxic sub/ance ,!  
t]m toxic sub/ance has ! mean+ giv5 t   
t]m 9 section #agbj;,j7i7 ( su* title1 z
 add$ by section #aja7;a74  ,i          
,expansion ( heal? c>e & b5efits =      
vet]ans expos$ to toxic sub/ances  #aja4
 ,consultation1 te/+1 & treatm5t = c]ta9
 vet]ans :o receiv$ haz>d\s duty pay or 
7 expos$ to toxic sub/ances  7a7 ,9     
g5]al ,sub*apt] ,,ii ( *apt] #ag ( title

 #ch1 ,unit$ ,/ates ,code1 is am5d$ by  
add+ at ! end ! foll[+ new section3     
#agbj;,j4 ,consultation1 te/+1 &        
treatm5t ( vet]ans = exposure to toxic  
sub/ances  7a7 ,9 g5]al ,! ,secret>y    
%all furni% to cov]$ vet]ans-- 7#a7     
cov]$ consultation & te/+ reg>d+ !      
exposure ( ^? vet]ans to toxic          
sub/ances2 &  7#b7 treatm5t = any       
illness relat+ to su* exposure diagnos$ 
"u subsection 7b77#b71 subject to       
approval by ! ,"u ,secret>y = ,heal?4   
7b7 ,cov]$ consultation & te/+ ,=       
purposes ( ?is section1 cov]$           
consultation & te/+ is-- 7#a7           
consultation ) a prim>y c>e physician or
 o!r treat+ physician to det]m9e :e!r ! 
cov]$ vet]an has an illness relat$ to   
exposure to a toxic sub/ance :ile s]v+ 9
 ! ,arm$ ,=ces2  7#b7 diagnosis by su*  
physician ( any illness relat$ to       
exposure to a toxic sub/ance2 &  7#c7   
any m$ical te/+ necess>y to c>ry out    
p>agraphs 7#a7 & 7#b71 includ+ a ref]ral
 to a speciali/ physician4  7c7 ,cov]$  

vet]ans ,= purposes ( ?is section1 a    
cov]$ vet]an is a vet]an :o-- 7#a7      
receiv$ haz>d\s duty inc5tive pay "u    
section #cea ( title #cg = m ?an "o day2
 or  7#b7 has be5 id5tifi$ by !         
,secret>y ( ,def5se to h be5 possibly   
expos$1 inside or outside ! ,unit$      
,/ates1 dur+ s]vice 9 ! ,arm$ ,=ces1    
to-- 7,a7 an op5 burn pit2  7,b7 a toxic
 sub/ance2 or  7,c7 a site at :i* memb]s
 ( ! ,arm$ ,=ces 7 pot5tially expos$ to 
a toxic sub/ance1 z indicat$ 9 a        
database %>$ by ! ,dep>tm5t ( ,def5se & 
! ,dep>tm5t ( ,vet]ans ,affairs4  7d7   
,consultation ,a cov]$ vet]an is        
eligible "u ?is section = ?ree          
consultations ea* ye> unless a treat+   
physician = su* vet]an det]m9es t m     
consultations are necess>y "u subsection
 7b77#a74  7e7 ,provision ( s]vices     
,cov]$ consultation & te/+ & treatm5t   
may be provid$ "u ?is section at        
facilities ( ! ,dep>tm5t or "u contract 
arrangem5ts ) ! ,dep>tm5t = su* s]vices4
  7f7 ,det]m9ations relat+ to treatm5t  

7#a7 ,:5 det]m9+ :e!r to approve        
eligibility = treatm5t "u subsection    
7a77#b71 ! ,"u ,secret>y = ,heal? %all  
give heavy weight to ! diagnosis by !   
treat+ physician "u subsection 7b77#b74 
7#b7 ,! ,"u ,secret>y %all support any  
d5ial ( eligibility "u subsection       
7a77#b7 ) specific sci5tific evid5ce4   
7#c7 ,det]m9ations by ! ,"u ,secret>y "u
 subsection 7a77#b7 %all be made n lat] 
?an five bus9ess days aft] a reque/ =   
approval has be5 made by ! treat+       
physician "u subsection 7b77#b74  7g7   
,in=mation & tra9+ ,! ,secret>y %all    
provide in=mation & tra9+ on eligibility
 = s]vices "u ?is section & ! s]vices   
cov]$ "u ?is section to-- 7#a7 heal? c>e
 provid]s ( ! ,dep>tm5t2  7#b7 heal? c>e
 provid]s provid+ s]vices "u ?is section
 "u contract arrangem5ts2 &  7#c7 cov]$ 
vet]ans4  7h7 ,copaym5t ,a cov]$ vet]an 
is n requir$ to pay a copaym5t = cov]$  
consultation & te/+ or treatm5t "u ?is  
section4  7i7 ,def9itions ,9 ?is        
section3 7#a7 ,! 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#b7 ,! t]m toxic sub/ance 
means a toxicant or a tox94  7#c7 ,! 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#d7 ,! t]m tox9   
means any sub/ance t c injure or kill   
humans1 animals1 or plants & t is       
produc$ naturally4  7#e7 ,! team        
treatm5t means any commonly accept$     
m$ical treatm5t practic$ by ! m$ical    
community at l>ge4  4  7b7 ,cl]ical     
am5dm5t ,! table ( sections at ! beg9n+ 
( sub*apt] ,,ii ( *apt] #ag ( su* title 
is am5d$ by add+ at ! end ! foll[+ new  
item3  #agbj;,j4 ,consultation1 te/+1 & 
treatm5t ( vet]ans = exposure to toxic  
sub/ances4  4  #ajb4 ,p]man5t           
reau?orization ( au?ority ( ,secret>y ( 
,vet]ans ,affairs to prescribe          
regulations provid+ t a presumption (   

s]vice connection is w>rant$ = a disease
 associat$ ) exposure to a h]bicide ag5t
  7a7 ,9 g5]al ,section #aaaf ( title   
#ch1 ,unit$ ,/ates ,code1 is am5d$ by   
/rik+ subsection 7e74  7b7 ,effective   
date ,subsection 7a7 ( ?is section &    
subsections 7b7 ?r\gh 7d7 ( section     
#aaaf ( su* title %all take effect on ! 
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+ a 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+ a 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 a 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-- 7i7 a    
presumption ( s]vice connection is n    
w>rant$ = a disease2 &  7ii7 7,i7       
suffici5t evid5ce ( an association exi/s
 betwe5 ! exposure ( humans to a toxic  
sub/ance & ! occurr5ce ( ! disease 9    
humans2 or  7,,ii7 limit$ evid5ce or    
sugge/ive evid5ce ( su* an association  
exi/s4  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;i77#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 
positive association means1 ) respect to
 an association betwe5 exposure to a    
toxic sub/ance & ! occurr5ce ( a disease
 9 humans1 t !re is cr$ible evid5ce = ! 
association & su* evid5ce is equal to or
 outweighs ! cr$ible evid5ce aga9/ !    
association4  7#b7 ,! t]m toxic sub/ance
 has ! mean+ giv5 t t]m 9 section       
#agbj;,j7i7 ( ?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 ,!re is    
e/abli%$ )9 ! ,dep>tm5t an indep5d5t    
commission to be kn[n z ! ,toxic        
,exposure ,review ,commission 79 ?is    
section ref]r$ to z ! ,commission74  7b7
 ,duties ,! ,commission %all c>ry out ! 
foll[+ duties3 7#a7 ,collect any        
relevant public in=mation f ! ,dep>tm5t 
( ,def5se & o!r s\rces to id5tify       
possible exposures to toxic sub/ances   
p]ta9+ to active milit>y1 naval1 or air 
s]vice4  7#b7 ,hold public meet+s to    
ga!r relevant in=mation reg>d+ exposure 
to toxic sub/ances4  7#c7 ,review su*   
in=mation to assess :e!r to recomm5d t a
 /udy be conduct$ "u section #bjb7;e7 ( 
! ,toxic ,exposure 9 ! ,am]ican ,milit>y
 ,act ( #bjbj4  7#d7 ,recomm5d1 by      

majority vote1 :e!r su* a /udy %\ld be  
conduct$4  7#e7 ,recomm5d to !          
,secret>y1 by majority vote1 :e!r new1  
indep5d5t /udies %\ld be conduct$ reg>d+
 ! heal? outcomes ( exposure to toxic   
sub/ances4  7#f7 ,annually report to    
,congress on progress reg>d+ ! duties   
set =? 9 p>agraphs 7#a7 ?r\gh 7#e74  7c7
 ,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 !   
foll[+ fields ( exp]i5ce are repres5t$  
on ! ,commission3 7,a7 ,! field (       
respiratory m$ic9e4  7,b7 ,! field (    
endocr9ology & metabolic m$ic9e4  7,c7  
,! field ( hematology4  7,d7 ,! field ( 
oncology4  7,e7 ,! field ( public heal?4
  7,f7 ,! field ( occupational &        
environm5tal heal?4  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  7d7 ,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$+s1          
in=mation1 & delib]ations ( !           
,commission %all be available = review  
by ! public4  7e7 ,*air & ,vice ,*air   
,at ! initial meet+ ( ! ,commission "u  
subsection 7d71 ! ,commission %all      
select a ,*air & ,vice ,*air f among !  
memb]s ( ! ,commission by a majority    
vote ( ! memb]s ( ! ,commission4  7f7   
,vacancies ,a vacancy 9 ! ,commission   
%all be fill$ 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$4  7g7 
,pay  7#a7 ,memb]s ( ! ,commission %all 
s]ve )\t pay4  7#b7 ,ea* memb] ( !      
,commission :o is an (fic] or employee (
 ! ,unit$ ,/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  7h7 ,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    
7i7 ,/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$4  7j7 ,o!r       
au?ority  7#a7 ,! ,commission may       
procure by contract1 to ! ext5t funds   
are available1 ! tempor>y or int]mitt5t 
s]vices ( exp]ts or consultants pursuant
 to section #caji ( title #e4  7#b7 ,to 
! ext5t funds are available1 !          
,commission may lease real prop]ty &    
acquire p]sonal prop]ty ei!r ( its own  
accord or 9 consultation ) ! ,g5]al     
,s]vices ,adm9i/ration4  7k7            
,communications  7#a7 7,a7 ,except z    
provid$ 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  4   
7b7 ,cl]ical am5dm5t ,! table ( sections
 at ! beg9n+ ( su* sub*apt] 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$]al ,gov]nm5t1 to review & 
evaluate ! available sci5tific evid5ce  
reg>d+ associations betwe5 diseases &   
exposure to toxic sub/ances4  7b7       
,agreem5t  7#a7 ,9 g5]al ,! ,secret>y ( 
,vet]ans ,affairs %all seek to ent] into
 an agreem5t ) ! ,academies to p]=m !   
s]vices cov]$ 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  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 ,sci5tific  

/udies  7#a7 ,9 g5]al ,"u an agreem5t   
betwe5 ! ,secret>y & ! ,academies "u ?is
 section1 ! ,academies %all conduct su* 
sci5tific /udies z ! ,toxic ,exposure   
,review ,commission recomm5ds pursuant  
to section #edg7;b77#d7 ( title #ch1    
,unit$ ,/ates ,code1 z add$ by section  
#bja7;a74  7#b7 ,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 subp>agraph 7,a71 !   
,academies %all consid]-- 7i7 !         
sci5tific in=mation t is available at ! 
"t ( ! recomm5dation2  7ii7 ! value &   
relevance ( ! in=mation t c\ld result f 
additional /udies2 &  7iii7 ! co/ &     
feasibility ( c>ry+ out su* additional  
/udies4  7f7 ,subsequ5t reviews ,"u an  
agreem5t betwe5 ! ,secret>y & !         

,academies "u ?is section1 ! ,academies 
%all-- 7#a7 conduct z compreh5sive a    
review z is practicable ( ! evid5ce     
ref]r$ to 9 subsection 7c7 t became     
available s9ce ! la/ review ( su*       
evid5ce "u ?is section2 &  7#b7 make    
det]m9ations & e/imates on ! basis ( !  
results ( su* review & all o!r reviews  
conduct$ = ! purposes ( ?is section4    
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 7e77#b74  7iv7 ,!            
recomm5dation describ$ 9 subp>agraph    
7,c74  7,c7 ,recomm5dation =            
implem5tation ( analysis ( exam9ations &
 treatm5t ( vet]ans = disabilities      
relat$ to exposure to toxic sub/ances   
7i7 ,9 g5]al ,! recomm5dation describ$ 9
 ?is subp>agraph is ! recomm5dation ( ! 
,academies z to :e!r section #bjc %\ld  
take effect z provid$ 9 subsection 7d7 (
 su* section4  7ii7 ,consid]ations ,9   
mak+ a recomm5dation "u clause 7i71 !   
,academies %all consid]-- 7,i7 !        
sci5tific in=mation t is available at ! 
"t ( ! recomm5dation2  7,,ii7 ! value & 
relevance ( ! in=mation t c\ld result f 
! implem5tation ( section #bjc2 &       
7,,iii7 ! co/ & feasibility ( su*       
implem5tation4  7iii7 ,ma9t5ance (      
cl9ical data ,if ! ,academies recomm5d t
 section #bjc %\ld take effect1 !       
,academies %all recomm5d ! means by :i* 
cl9ical data ref]r$ to 9 t section c\ld 
be ma9ta9$ 9 ! mo/ sci5tifically useful 

way4  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 ,limitation on au?ority  
,! au?ority to ent] into agreem5ts "u   
?is section %all be effective = a fiscal
 ye> to ! ext5t t appropriations are    
available = su* purpose4  7i7           
,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
 #bjc1 & section #aaai ( title #ch1     
,unit$ ,/ates ,code1 z add$ by section  
#ajb7;a71 to ! ,national ,academies (   
,sci5ces1 ,eng9e]+1 & ,m$ic9e %all be   
treat$ z a ref]5ce to ! o!r             
organization4  #bjc4 ,analysis ( results
 ( consultation1 te/+1 & treatm5t (     
vet]ans = disabilities 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 ) consultation1   
te/+1 & treatm5t furni%$ to vet]ans by !
 ,dep>tm5t "u section #agbj;,j ( title  
#ch1 ,unit$ ,/ates ,code1 z add$ by     

section #aja7;a72 &  7#b7 is likely to  
be sci5tifically useful 9 det]m9+ !     
association1 if any1 betwe5 ! disability
 ( 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$]al law4  7c7 ,annual report ,n lat] 
?an "o ye> aft] ! effective date "u     
subsection 7d71 & annually !reaft]1 !   
,secret>y %all submit to ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives a report        
conta9+-- 7#a7 ! in=mation compil$ "u   
subsection 7a72  7#b7 an analysis ( su* 
in=mation2  7#c7 a description ( ! types
 & incid5ces ( disabilities id5tifi$ by 
! ,dep>tm5t "u su* subsection2  7#d7 !  
explanation ( ! ,secret>y = ! incid5ce (
 su* disabilities & o!r explanations = !
 incid5ce ( su* disabilities z !        

,secret>y consid]s reasonable2 &  7#e7 !
 views ( ! ,secret>y on ! sci5tific     
validity ( draw+ conclusions f !        
incid5ce ( su* disabilities1 z evid5c$  
by ! data compil$ "u subsection 7a71    
reg>d+ any association betwe5 su*       
disabilities & exposure to a toxic      
sub/ance4  7d7 ,effective date  7#a7 ,9 
g5]al ,except z provid$ 9 p>agraph 7#b71
 ?is section %all take effect on ! date 
t is #ij days aft] ! date on :i* !      
report submitt$ by ! ,national          
,academies ( ,sci5ces1 ,eng9e]+1 &      
,m$ic9e "u section #bjb7;g77#a7 is      
receiv$ by ! ,secret>y4  7#b7 ,exception
 ,?is section %all n take effect if !   
,secret>y1 aft] receiv+ ! report        
describ$ 9 p>agraph 7#a7 & be=e ! end ( 
! #ij-;day p]iod describ$ 9 su*         
p>agraph-- 7,a7 det]m9es t x is n       
feasible or co/-effective to c>ry out   
?is section or t c>ry+ out ?is section  
w\ld n make a mat]ial contribution to ! 
body ( sci5tific k conc]n+ ! heal?      
effects 9 humans ( h]bicide exposure2 & 

7,b7 notifies ! ,committee on ,vet]ans' 
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives ( t det]m9ation & !     
reasons !re=4  #bjd4 ,report to evaluate
 & id5tify gr\ps at-risk ( exposure to  
toxic sub/ances  7a7 ,9 g5]al ,n lat]   
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act1 & e two ye>s !reaft]1 !       
,secret>y ( ,def5se %all submit to !    
appropriate committees ( ,congress &1   
subject to applicable ,f$]al privacy    
laws1 make available to ! public a      
report evaluat+ & id5tify+ ! gr\ps (    
memb]s ( ! ,arm$ ,=ces & =m] memb]s ( ! 
,arm$ ,=ces :o are at-risk ( exposure to
 toxic sub/ances4  7b7 ,exi/+ data ,!   
,secret>y %all use data f exi/+ record &
 track+ sy/ems to develop ea* report "u 
subsection 7a74  7c7 ,use ( capabilities
 ( ,national ,artificial ,intellig5ce   
,in/itute ,9 develop+ ea* report "u     
subsection 7a71 ! ,secret>y %all use !  
capabilities ( ! ,national ,artificial  
,intellig5ce ,in/itute ( ! ,dep>tm5t (  

,vet]ans ,affairs to int]pret ! vet]an  
population data )9 ! ,individual        
,longitud9al ,exposure ,record ( !      
,dep>tm5t1 includ+ data compil$ "u--    
7#a7 ! ,million ,vet]an ,program ( !    
,dep>tm5t2  7#b7 heal? records (        
vet]ans2 &  7#c7 b5efits records (      
vet]ans4  7d7 ,elem5ts ( report ,ea*    
report submitt$ "u subsection 7a7 %all--
 7#a7 id5tify gr\ps at a high-risk =    
illnesses relat+ to exposure to toxic   
sub/ances & recomm5d an outrea* /rategy 
= ^? gr\ps2 &  7#b7 det]m9e ! viability 
( correlat+ ! ,individual ,longitud9al  
,exposure ,record & heal? records       
ma9ta9$ by ! ,vet]ans ,heal?            
,adm9i/ration1 includ+ ) respect to     
p>ticipation ( a vet]an 9 ! ,million    
,vet]an ,program ( ! ,dep>tm5t1 to      
provide m data to epidemiologi/s ( !    
,dep>tm5t4  7e7 ,appropriate committees 
( ,congress def9$ ,9 ?is section1 ! t]m 
appropriate committees ( ,congress      
means-- 7#a7 ! ,committee on ,arm$      
,s]vices & ! ,committee on ,vet]ans'    

,affairs ( ! ,s5ate2 &  7#b7 !          
,committee on ,arm$ ,s]vices & !        
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives4  ,,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 = consultation1 te/+1 &
 treatm5t "u section #agbj;,j ( su*     
title1 z add$ by section #aja7;a72  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$ical pr(essionals4
  #cjc4 ,portal = access by vet]ans to  
individual longitud9al exposure record  
7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans    
,affairs %all e/abli% a portal ?r\gh :i*
 a vet]an may access docum5ts &         
in=mation ) respect to ! vet]an conta9$ 
9 ! ,individual ,longitud9al ,exposure  
,record ( ! ,dep>tm5t ( ,vet]ans        
,affairs4  7b7 ,elem5ts ( portal ,!     
portal e/abli%$ "u subsection 7a7 %all--
 7#a7 pres5t docum5ts & in=mation )     
respect to a vet]an conta9$ 9 !         
,individual ,longitud9al ,exposure      
,record ( ! vet]an 9 a pr9table1        
read-only =mat2 &  7#b7 be ho/$ on an   
int]net website ( ! ,dep>tm5t t is      

commonly us$ by vet]ans4  #cjd4 ,tra9+ (
 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 p]sonnel ( ! ,dep>tm5t (       
,vet]ans ,affairs1 includ+ p]sonnel     
involv$ ) e/abli%+ disability rat+s "u !
 laws adm9i/]$ by ! ,secret>y1 &        
non-,dep>tm5t heal? c>e p]sonnel :o     
provide c>e to vet]ans "u ! laws        
adm9i/]$ by ! ,secret>y 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      
vet]ans & p]sonnel ) specific education 
) respect to illnesses relat$ to        
exposure to toxic sub/ances2  7#b7 in=m 
disability rat]s ( second>y effects t c 
be attribut$ to exposure to toxic       
sub/ances2 &  7#c7 in=m p]sonnel ( h[ to
 probe = additional in=mation reg>d+    
exposures to diff]5t toxicants4  7c7    

,toxicant def9$ ,9 ?is section1 ! t]m   
toxicant has ! mean+ giv5 t t]m 9       
section #agbj;,j7i7 ( title #ch1 ,unit$ 
,/ates ,code1 z add$ by section         
#aja7;a74