,,ii ,calendar ,no4 #fjb #aafth         
,,congress  #b;d ,session  ,s4 #dcic    
,,in ,,the ,,senate ,,of ,,the ,,united 
,,states  ,july #cj1 #bjbj,mr4 ,tillis  
7for himself1 ,mrs4 ,blackburn1 ,ms4    
,mc,sally1 and ,mrs4 ,capito7 introduced
 the following bill2 which was read     
twice and referred to the ,committee on 
,veterans' ,affairs  ,december #h1      
#bjbj,reported by ,mr4 ,moran1 with an  
amendment,strike out all after the      
enacting clause and insert the part     
printed in italic  ,a ,,bill  ,to       
improve the provision of health care and
 other benefits from the ,department of 
,veterans ,affairs for veterans who were
 exposed to toxic substances1 and for   
other purposes4  #a4 ,short title2 table
 of contents  7a7 ,short title ,this    
,act may be cited as the ,toxic         
,exposure in the ,american ,military    
,act of #bjbj or the ,,team ,act of     
#bjbj  7b7 ,table of contents ,the table
 of contents for this ,act is as        
follows3 ,sec4 #a4 ,short title2 table  

of contents4,sec4 #b4                   
,definitions4,,title ,i--,expansion of  
health care and benefits for veterans   
exposed to toxic substances,sec4 #aja4  
,consultation1 testing1 and treatment   
for certain veterans who received       
hazardous duty pay or were exposed to   
toxic substances4,sec4 #ajb4 ,permanent 
reauthorization of authority of         
,secretary of ,veterans ,affairs to     
prescribe regulations providing that a  
presumption of service connection is    
warranted for a disease associated with 
exposure to a herbicide agent4,sec4     
#ajc4 ,presumptions of service          
connection for diseases associated with 
exposure to certain toxic               
substances4,,title ,,ii--,research and  
review regarding exposure to toxic      
substances,sec4 #bja4 ,establishment of 
,toxic ,exposure ,review                
,commission4,sec4 #bjb4 ,agreement with 
,national ,academies of ,sciences1      
,engineering1 and ,medicine concerning  
the exposure of humans to toxic         

substances4,sec4 #bjc4 ,analysis of     
results of consultation1 testing1 and   
treatment of veterans for disabilities  
related to exposure to toxic            
substances4,sec4 #bjd4 ,report to       
evaluate and identify groups at-risk of 
exposure to toxic substances4,,title    
,,iii--,improvement of resources of     
,department of ,veterans ,affairs       
regarding exposures to toxic            
substances,sec4 #cja4 ,publication of   
list of resources of ,department of     
,veterans ,affairs for veterans exposed 
to toxic substances and outreach program
 for such veterans and caregivers and   
survivors of such veterans4,sec4 #cjb4  
,incorporation of toxic exposure        
questionnaire during primary care       
appointments4,sec4 #cjc4 ,portal for    
access by veterans to individual        
longitudinal exposure record4,sec4 #cjd4
 ,training of personnel of ,department  
of ,veterans ,affairs on illnesses      
related to exposure to toxic substances4
  #b4 ,definitions ,in this ,act3 7#a7  

,active military1 naval1 or air service 
,the term active military1 naval1 or air
 service has the meaning given that term
 in section #aja7bd7 of title #ch1      
,united ,states ,code4  7#b7 ,toxic     
substance ,the term toxic substance has 
the meaning given that term in section  
#agbj;,j7i7 of such title1 as added by  
section #aja7;a74  ,i ,expansion of     
health care and benefits for veterans   
exposed to toxic substances  #aja4      
,consultation1 testing1 and treatment   
for certain veterans who received       
hazardous duty pay or were exposed to   
toxic substances  7a7 ,in general       
,subchapter ,,ii of chapter #ag of title
 #ch1 ,united ,states ,code1 is amended 
by adding at the end the following new  
section3  #agbj;,j4 ,consultation1      
testing1 and treatment of veterans for  
exposure to toxic substances  7a7 ,in   
general ,the ,secretary shall furnish to
 covered veterans-- 7#a7 covered        
consultation and testing regarding the  
exposure of those veterans to toxic     

substances2 and  7#b7 treatment for any 
illness relating to such exposure       
diagnosed under subsection 7b77#b71     
subject to approval by the ,under       
,secretary for ,health4  7b7 ,covered   
consultation and testing ,for purposes  
of this section1 covered consultation   
and testing is-- 7#a7 consultation with 
a primary care physician or other       
treating physician to determine whether 
the covered veteran has an illness      
related to exposure to a toxic substance
 while serving in the ,armed ,forces2   
7#b7 diagnosis by such physician of any 
illness related to exposure to a toxic  
substance2 and  7#c7 any medical testing
 necessary to carry out paragraphs 7#a7 
and 7#b71 including a referral to a     
specialist physician4  7c7 ,covered     
veterans ,for purposes of this section1 
a covered veteran is a veteran who--    
7#a7 received hazardous duty incentive  
pay under section #cea of title #cg for 
more than one day2 or  7#b7 has been    
identified by the ,secretary of ,defense

 to have been possibly exposed1 inside  
or outside the ,united ,states1 during  
service in the ,armed ,forces1 to-- 7,a7
 an open burn pit2  7,b7 a toxic        
substance2 or  7,c7 a site at which     
members of the ,armed ,forces were      
potentially exposed to a toxic          
substance1 as indicated in a database   
shared by the ,department of ,defense   
and the ,department of ,veterans        
,affairs4  7d7 ,consultation ,a covered 
veteran is eligible under this section  
for three consultations each year unless
 a treating physician for such veteran  
determines that more consultations are  
necessary under subsection 7b77#a74  7e7
 ,provision of services ,covered        
consultation and testing and treatment  
may be provided under this section at   
facilities of the ,department or under  
contract arrangements with the          
,department for such services4  7f7     
,determinations relating to treatment   
7#a7 ,when determining whether to       
approve eligibility for treatment under 

subsection 7a77#b71 the ,under          
,secretary for ,health shall give heavy 
weight to the diagnosis by the treating 
physician under subsection 7b77#b74     
7#b7 ,the ,under ,secretary shall       
support any denial of eligibility under 
subsection 7a77#b7 with specific        
scientific evidence4  7#c7              
,determinations by the ,under ,secretary
 under subsection 7a77#b7 shall be made 
not later than five business days after 
a request for approval has been made by 
the treating physician under subsection 
7b77#b74  7g7 ,information and training 
,the ,secretary shall provide           
information and training on eligibility 
for services under this section and the 
services covered under this section to--
 7#a7 health care providers of the      
,department2  7#b7 health care providers
 providing services under this section  
under contract arrangements2 and  7#c7  
covered veterans4  7h7 ,copayment ,a    
covered veteran is not required to pay a
 copayment for covered consultation and 

testing or treatment under this section4
  7i7 ,definitions ,in this section3    
7#a7 ,the term open burn pit has the    
meaning given that term in section      
#bja7;c7 of the ,dignified ,burial and  
,other ,veterans' ,benefits ,improvement
 ,act of #bjab 7,public ,law #aab-bfj2  
#ch ,u4,s4,c4 #ebg note74  7#b7 ,the    
term toxic substance means a toxicant or
 a toxin4  7#c7 ,the term toxicant means
 any substance that can injure or kill  
humans1 animals1 or plants and that is  
produced by humans or is a by-product of
 human activities4  7#d7 ,the term toxin
 means any substance that can injure or 
kill humans1 animals1 or plants and that
 is produced naturally4  7#e7 ,the team 
treatment means any commonly accepted   
medical treatment practiced by the      
medical community at large4  4  7b7     
,clerical amendment ,the table of       
sections at the beginning of subchapter 
,,ii of chapter #ag of such title is    
amended by adding at the end the        
following new item3  #agbj;,j4          

,consultation1 testing1 and treatment of
 veterans for exposure to toxic         
substances4  4  #ajb4 ,permanent        
reauthorization of authority of         
,secretary of ,veterans ,affairs to     
prescribe regulations providing that a  
presumption of service connection is    
warranted for a disease associated with 
exposure to a herbicide agent  7a7 ,in  
general ,section #aaaf of title #ch1    
,united ,states ,code1 is amended by    
striking subsection 7e74  7b7 ,effective
 date ,subsection 7a7 of this section   
and subsections 7b7 through 7d7 of      
section #aaaf of such title shall take  
effect on the date of the enactment of  
this ,act4  #ajc4 ,presumptions of      
service connection for diseases         
associated with exposure to certain     
toxic substances  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 diseases         

associated with exposure to certain     
toxic substances  7a7 ,presumptions of  
service connection  7#a7 ,for purposes  
of section #aaaj of this title1 and     
subject to section #aaac of this title1 
each disease specified in paragraph 7#b7
 becoming manifest as specified in that 
paragraph 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 disease during the  
period of such service4  7#b7 ,a disease
 specified in this paragraph is any     
disease that-- 7,a7 the ,secretary      
determines in regulations prescribed    
under this section warrants a           
presumption of service connection by    
reason of having a positive association 
with exposure to a toxic substance2 and 
7,b7 becomes manifest within the period1
 if any1 prescribed in such regulations 
in a veteran who was exposed to that    
toxic substance during active military1 
naval1 or air service4  7#c7 7,a7 ,for  

purposes of this subsection1 the        
,secretary may presume that a veteran   
who has a disease specified in paragraph
 7#b7 was exposed to the toxic substance
 for which the ,secretary has determined
 under paragraph 7#b77;,a7 warrants a   
presumption of service connection by    
reason of having a positive association 
with exposure to the toxic substance1   
notwithstanding that there is no record 
of evidence of such exposure1 if the    
,secretary determines based on one or   
more of the factors set forth in        
subparagraph 7,b7 that a presumption of 
exposure is warranted4  7,b7 ,the       
factors set forth in this subparagraph  
are as follows3 7i7 ,the duty location  
of the veteran4  7ii7 ,the length of    
service of the veteran4  7iii7 ,such    
other factors as the ,secretary         
considers appropriate4  7b7             
,determinations relating to diseases    
7#a7 ,whenever the ,secretary           
determines1 on the basis of sound       
medical and scientific evidence1 that a 

positive association exists between the 
exposure of humans to a toxic substance 
and the occurrence of a disease in      
humans1 the ,secretary shall prescribe  
regulations providing that a presumption
 of service connection is warranted for 
that disease for purposes of this       
section4  7#b7 ,in making determinations
 under paragraph 7#a71 the ,secretary   
shall take into account-- 7,a7 reports  
received by the ,secretary from the     
,national ,academies of ,sciences1      
,engineering1 and ,medicine under       
section #bjb7;g7 of the ,toxic ,exposure
 in the ,american ,military ,act of     
#bjbj2 and  7,b7 all other sound medical
 and scientific information and analyses
 available to the ,secretary4  7#c7 7,a7
 ,in evaluating any report1 information1
 or analysis for purposes of making such
 determinations1 the ,secretary shall   
consider only scientific studies that   
are valid in accordance with            
contemporary scientific standards4  7,b7
 ,the ,secretary may define the         

standards described in subparagraph 7,a7
 for purposes of that subparagraph4  7c7
 ,response to reports by the ,national  
,academies of ,sciences1 ,engineering1  
and ,medicine  7#a7 ,not later than #fj 
days after the date on which the        
,secretary receives a report from the   
,national ,academies of ,sciences1      
,engineering1 and ,medicine under       
section #bjb7;g7 of the ,toxic ,exposure
 in the ,american ,military ,act of     
#bjbj1 the ,secretary shall determine   
whether a presumption of service        
connection is warranted for each disease
 covered by the report4  7#b7 ,if the   
,secretary determines under paragraph   
7#a7 that a presumption of service      
connection is warranted for a disease1  
the ,secretary shall1 not later than #fj
 days after making the determination1   
issue proposed regulations setting forth
 the determination4  7#c7 7,a7 ,if the  
,secretary makes a determination        
described in subparagraph 7,b71 the     
,secretary shall1 not later than #fj    

days after making the determination1    
publish in the ,federal ,register a     
notice of the determination4  7,b7 ,a   
determination described in this         
subparagraph is a determination by the  
,secretary under paragraph 7#a7 that--  
7i7 a presumption of service connection 
is not warranted for a disease2 and     
7ii7 7,i7 sufficient evidence of an     
association exists between the exposure 
of humans to a toxic substance and the  
occurrence of the disease in humans2 or 
7,,ii7 limited evidence or suggestive   
evidence of such an association exists4 
7,c7 ,any notice published under        
subparagraph 7,a7 shall include an      
explanation of the scientific basis for 
the determination described in          
subparagraph 7,b74  7,d7 ,if a disease  
already presumed to be service connected
 under this section is subject to a     
determination described in subparagraph 
7,b71 the ,secretary shall1 not later   
than #fj days after publication of the  
notice under subparagraph 7,a71 issue   

proposed regulations removing the       
presumption of service connection for   
the disease4  7#d7 ,not later than #ahj 
days after the date on which the        
,secretary issues any proposed          
regulations under this subsection1 the  
,secretary shall issue final            
regulations4  7d7 ,removal of           
presumption of service connection       
,whenever the presumption of service    
connection for a disease under this     
section is removed under subsection     
7c7-- 7#a7 a veteran who was awarded    
compensation for the disease 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 disease on 
the basis of the presumption before that
 date shall continue to be entitled to  
receive dependency and indemnity        

compensation on that basis4  7e7        
,reference to ,national ,academies of   
,sciences1 ,engineering1 and ,medicine  
,in the case that the ,secretary enters 
into an agreement with another          
organization as described in section    
#bjb7;i77#a7 of the ,toxic ,exposure in 
the ,american ,military ,act of #bjbj1  
any reference in this section to the    
,national ,academies of ,sciences1      
,engineering1 and ,medicine shall be    
treated as a reference to the other     
organization4  7f7 ,definitions ,in this
 section3 7#a7 ,the term positive       
association means1 with respect to an   
association between exposure to a toxic 
substance and the occurrence of a       
disease in humans1 that there is        
credible evidence for the association   
and such evidence is equal to or        
outweighs the credible evidence against 
the association4  7#b7 ,the term toxic  
substance has the meaning given that    
term in section #agbj;,j7i7 of this     
title4  4  7b7 ,clerical amendment ,the 

table of sections at the beginning of   
chapter #aa of such title is amended by 
inserting after the item relating to    
section #aaah the following new item3   
#aaai4 ,presumptions of service         
connection for diseases associated with 
exposure to certain toxic substances4  4
  7c7 ,conforming amendment ,section    
#aaac of such title is amended by       
striking or #aaah each place it appears 
and inserting #aaah1 or #aaai4  ,,ii    
,research and review regarding exposure 
to toxic substances  #bja4              
,establishment of ,toxic ,exposure      
,review ,commission  7a7 ,in general    
,subchapter ,,iii of chapter #e of title
 #ch1 ,united ,states ,code1 is amended 
by adding at the end the following new  
section3  #edg4 ,toxic ,exposure ,review
 ,commission  7a7 ,establishment ,there 
is established within the ,department an
 independent commission to be known as  
the ,toxic ,exposure ,review ,commission
 7in this section referred to as the    
,commission74  7b7 ,duties ,the         

,commission shall carry out the         
following duties3 7#a7 ,collect any     
relevant public information from the    
,department of ,defense and other       
sources to identify possible exposures  
to toxic substances pertaining to active
 military1 naval1 or air service4  7#b7 
,hold public meetings to gather relevant
 information regarding exposure to toxic
 substances4  7#c7 ,review such         
information to assess whether to        
recommend that a study be conducted     
under section #bjb7;e7 of the ,toxic    
,exposure in the ,american ,military    
,act of #bjbj4  7#d7 ,recommend1 by     
majority vote1 whether such a study     
should be conducted4  7#e7 ,recommend to
 the ,secretary1 by majority vote1      
whether new1 independent studies should 
be conducted regarding the health       
outcomes of exposure to toxic           
substances4  7#f7 ,annually report to   
,congress on progress regarding the     
duties set forth in paragraphs 7#a7     
through 7#e74  7c7 ,membership  7#a7    

7,a7 ,the ,commission shall be composed 
of #i members1 appointed as follows3 7i7
 ,two members appointed by the ,speaker 
of the ,house of ,representatives4  7ii7
 ,two members appointed by the minority 
leader of the ,house of                 
,representatives4  7iii7 ,two members   
appointed by the majority leader of the 
,senate4  7iv7 ,two members appointed by
 the minority leader of the ,senate4    
7v7 ,one member appointed by the        
,secretary4  7,b7 ,the initial members  
of the ,commission shall be appointed   
under subparagraph 7,a7 not later than  
#ahj days after the date of the         
enactment of the ,toxic ,exposure in the
 ,american ,military ,act of #bjbj4     
7#b7 ,in appointing individuals under   
paragraph 7#a77;,a71 the ,speaker of the
 ,house of ,representatives1 the        
minority leader of the ,house of        
,representatives1 the majority leader of
 the ,senate1 the minority leader of the
 ,senate1 and the ,secretary shall      
ensure that the following fields of     

experience are represented on the       
,commission3 7,a7 ,the field of         
respiratory medicine4  7,b7 ,the field  
of endocrinology and metabolic medicine4
  7,c7 ,the field of hematology4  7,d7  
,the field of oncology4  7,e7 ,the field
 of public health4  7,f7 ,the field of  
occupational and environmental health4  
7#c7 ,in appointing individuals under   
paragraph 7#a77;,a71 the ,speaker of the
 ,house of ,representatives1 the        
minority leader of the ,house of        
,representatives1 the majority leader of
 the ,senate1 the minority leader of the
 ,senate1 and the ,secretary shall      
ensure that at least two members of the 
,commission represent an organization   
recognized by the ,secretary for the    
representation of veterans under section
 #eijb of this title4  7#d7 ,in         
appointing individuals under paragraph  
7#a77;,a71 the ,speaker of the ,house of
 ,representatives1 the minority leader  
of the ,house of ,representatives1 the  
majority leader of the ,senate1 the     

minority leader of the ,senate1 and the 
,secretary shall give consideration to  
including in the ,commission at least   
one member who works with survivors of  
illnesses related to exposure to toxic  
substances and has a background in the  
field of study of exposure to toxic     
substances4  7d7 ,meetings  7#a7 ,the   
,commission shall meet not less         
frequently than twice each year4  7#b7  
7,a7 ,each meeting of the ,commission   
shall be open to the public4  7,b7 ,all 
the proceedings1 information1 and       
deliberations of the ,commission shall  
be available for review by the public4  
7e7 ,chair and ,vice ,chair ,at the     
initial meeting of the ,commission under
 subsection 7d71 the ,commission shall  
select a ,chair and ,vice ,chair from   
among the members of the ,commission by 
a majority vote of the members of the   
,commission4  7f7 ,vacancies ,a vacancy 
in the ,commission shall be filled in   
the same manner as the original         
appointment1 but the individual         

appointed to fill the vacancy shall     
serve only for the unexpired portion of 
the term for which the individual's     
predecessor was appointed4  7g7 ,pay    
7#a7 ,members of the ,commission shall  
serve without pay4  7#b7 ,each member of
 the ,commission who is an officer or   
employee of the ,united ,states shall   
serve without compensation in addition  
to that received for service as an      
officer or employee of the ,united      
,states4  7#c7 ,members shall receive   
travel expenses1 including per diem in  
lieu of subsistence1 in accordance with 
sections #egjb and #egjc of title #e4   
7h7 ,director of staff  7#a7 ,the       
,commission shall appoint a ,director   
who-- 7,a7 has not served as an employee
 of the ,department during the one-year 
period preceding the date of such       
appointment2 and  7,b7 is not otherwise 
barred or prohibited from serving as    
,director under ,federal ethics laws and
 regulations1 by reason of              
post-employment conflict of interest4   

7#b7 ,the ,director shall be paid at the
 rate of basic pay payable for level    
,,iv of the ,executive ,schedule under  
section #ecae of title #e4  7i7 ,staff  
7#a7 ,subject to paragraphs 7#b7 and    
7#c71 the ,director1 with the approval  
of the ,commission1 may appoint and fix 
the pay of additional personnel4  7#b7  
,the ,director may make such            
appointments without regard to the      
provisions of title #e governing        
appointments in the competitive service1
 and any personnel so appointed may be  
paid without regard to the provisions of
 chapter #ea and subchapter ,,iii of    
chapter #ec of that title relating to   
classification and ,general ,schedule   
pay rates1 except that an individual so 
appointed may not receive pay in excess 
of the annual rate of basic pay payable 
for ,,gs-#ae of the ,general ,schedule4 
7#c7 7,a7 ,not more than two-thirds of  
the personnel employed by or detailed to
 the ,commission may be on detail from  
the ,department4  7,b7 ,not more than   

half of the professional analysts of the
 ,commission staff may be persons       
detailed from the ,department to the    
,commission4  7#d7 ,subject to paragraph
 7#c71 the head of any ,federal agency1 
upon the request of the ,director1 may  
detail any of the personnel of that     
agency to the ,commission to assist the 
,commission in carrying out its duties  
under this section4  7#e7 ,the          
,commission may secure directly from any
 ,federal agency such information as the
 ,commission considers necessary to     
carry out this section4 ,upon request of
 the ,chair1 the head of such agency    
shall furnish such information to the   
,commission1 unless such information is 
classified4  7j7 ,other authority  7#a7 
,the ,commission may procure by         
contract1 to the extent funds are       
available1 the temporary or intermittent
 services of experts or consultants     
pursuant to section #caji of title #e4  
7#b7 ,to the extent funds are available1
 the ,commission may lease real property

 and acquire personal property either of
 its own accord or in consultation with 
the ,general ,services ,administration4 
7k7 ,communications  7#a7 7,a7 ,except  
as provided in subparagraph 7,b71 no    
person may restrict an employee of the  
,department in communicating with the   
,commission4  7,b7 ,subparagraph 7,a7   
does not apply to a communication that  
is unlawful4  7#b7 ,all ex parte        
communications with the ,commission     
shall be made part of the public record4
  4  7b7 ,clerical amendment ,the table 
of sections at the beginning of such    
subchapter is amended by adding at the  
end the following new item3  #edg4      
,toxic ,exposure ,review ,commission4  4
  #bjb4 ,agreement with ,national       
,academies of ,sciences1 ,engineering1  
and ,medicine concerning the exposure of
 humans to toxic substances  7a7        
,purpose ,the purpose of this section is
 to provide for the ,national ,academies
 of ,sciences1 ,engineering1 and        
,medicine 7in this section referred to  

as the ,academies71 an independent      
nonprofit scientific organization with  
appropriate expertise that is not part  
of the ,federal ,government1 to review  
and evaluate the available scientific   
evidence regarding associations between 
diseases and exposure to toxic          
substances4  7b7 ,agreement  7#a7 ,in   
general ,the ,secretary of ,veterans    
,affairs shall seek to enter into an    
agreement with the ,academies to perform
 the services covered by this section4  
7#b7 ,timing ,the ,secretary shall seek 
to enter into an agreement described in 
paragraph 7#a7 not later than #fj days  
after the date of the enactment of this 
,act4  7c7 ,review of scientific        
evidence ,under an agreement between the
 ,secretary and the ,academies under    
this section1 the ,academies shall      
review and summarize the scientific     
evidence1 and assess the strength       
thereof1 concerning the association     
between exposure to toxic substances    
during active military1 naval1 or air   

service and each disease suspected to be
 associated with such exposure in the   
human population4  7d7 ,scientific      
determinations concerning diseases ,for 
each disease reviewed under subsection  
7c71 the ,academies shall determine1 to 
the extent that available scientific    
data permit meaningful determinations-- 
7#a7 whether an association exists      
between exposure to toxic substances and
 the occurrence of the disease1 taking  
into account the strength of the        
scientific evidence and the             
appropriateness of the statistical and  
epidemiological methods used to detect  
the association2  7#b7 the increased    
risk of the disease among those exposed 
to toxic substances during active       
military1 naval1 or air service2 and    
7#c7 whether there exists a plausible   
biological mechanism or other evidence  
of a causal relationship between the    
exposure and the occurrence of the      
disease4  7e7 ,scientific studies  7#a7 
,in general ,under an agreement between 

the ,secretary and the ,academies under 
this section1 the ,academies shall      
conduct such scientific studies as the  
,toxic ,exposure ,review ,commission    
recommends pursuant to section          
#edg7;b77#d7 of title #ch1 ,united      
,states ,code1 as added by section      
#bja7;a74  7#b7 ,recommendations for    
additional scientific studies  7,a7 ,in 
general ,under an agreement between the 
,secretary and the ,academies under this
 section1 the ,academies shall make any 
recommendations for additional          
scientific studies to resolve areas of  
continuing scientific uncertainty       
relating to the exposure of humans to   
toxic substances4  7,b7 ,considerations 
,in making recommendations under        
subparagraph 7,a71 the ,academies shall 
consider-- 7i7 the scientific           
information that is available at the    
time of the recommendation2  7ii7 the   
value and relevance of the information  
that could result from additional       
studies2 and  7iii7 the cost and        

feasibility of carrying out such        
additional studies4  7f7 ,subsequent    
reviews ,under an agreement between the 
,secretary and the ,academies under this
 section1 the ,academies shall-- 7#a7   
conduct as comprehensive a review as is 
practicable of the evidence referred to 
in subsection 7c7 that became available 
since the last review of such evidence  
under this section2 and  7#b7 make      
determinations and estimates on the     
basis of the results of such review and 
all other reviews conducted for the     
purposes of this section4  7g7 ,reports 
7#a7 ,initial report  7,a7 ,in general  
,under an agreement between the         
,secretary and the ,academies under this
 section1 not later than one year after 
the date of the enactment of this ,act1 
the ,academies shall submit to the      
,secretary1 the ,committee on ,veterans'
 ,affairs of the ,senate1 and the       
,committee on ,veterans' ,affairs of the
 ,house of ,representatives an initial  
report on the activities of the         

,academies under the agreement4  7,b7   
,elements ,the report submitted under   
subparagraph 7,a7 shall include the     
following3 7i7 ,the determinations      
described in subsection 7d74  7ii7 ,a   
full explanation of the scientific      
evidence and reasoning that led to such 
determinations4  7iii7 ,any             
recommendations of the ,academies under 
subsection 7e77#b74  7iv7 ,the          
recommendation described in subparagraph
 7,c74  7,c7 ,recommendation for        
implementation of analysis of           
examinations and treatment of veterans  
for disabilities related to exposure to 
toxic substances  7i7 ,in general ,the  
recommendation described in this        
subparagraph is the recommendation of   
the ,academies as to whether section    
#bjc should take effect as provided in  
subsection 7d7 of such section4  7ii7   
,considerations ,in making a            
recommendation under clause 7i71 the    
,academies shall consider-- 7,i7 the    
scientific information that is available

 at the time of the recommendation2     
7,,ii7 the value and relevance of the   
information that could result from the  
implementation of section #bjc2 and     
7,,iii7 the cost and feasibility of such
 implementation4  7iii7 ,maintenance of 
clinical data ,if the ,academies        
recommend that section #bjc should take 
effect1 the ,academies shall recommend  
the means by which clinical data        
referred to in that section could be    
maintained in the most scientifically   
useful way4  7#b7 ,periodic updates     
,under an agreement between the         
,secretary and the ,academies under this
 section1 not less frequently than once 
every two years after the date on which 
the initial report is submitted under   
paragraph 7#a77;,a71 the ,academies     
shall submit to the ,secretary1 the     
,committee on ,veterans' ,affairs of the
 ,senate1 and the ,committee on         
,veterans' ,affairs of the ,house of    
,representatives an updated report on   
the activities of the ,academies under  

the agreement4  7h7 ,limitation on      
authority ,the authority to enter into  
agreements under this section shall be  
effective for a fiscal year to the      
extent that appropriations are available
 for such purpose4  7i7 ,alternative    
contract scientific organization  7#a7  
,in general ,if the ,secretary is unable
 within the time period prescribed in   
subsection 7b77#b7 to enter into an     
agreement with the ,academies for the   
purposes of this section on terms       
acceptable to the ,secretary1 the       
,secretary shall seek to enter into an  
agreement for the purposes of this      
section with another appropriate        
scientific organization that-- 7,a7 is  
not part of the ,federal ,government2   
7,b7 operates as a not-for-profit       
entity2 and  7,c7 has expertise and     
objectivity comparable to that of the   
,academies4  7#b7 ,treatment ,if the    
,secretary enters into an agreement with
 another organization as described in   
paragraph 7#a71 any reference in this   

section1 section #bjc1 and section #aaai
 of title #ch1 ,united ,states ,code1 as
 added by section #ajb7;a71 to the      
,national ,academies of ,sciences1      
,engineering1 and ,medicine shall be    
treated as a reference to the other     
organization4  #bjc4 ,analysis of       
results of consultation1 testing1 and   
treatment of veterans for disabilities  
related to exposure to toxic substances 
7a7 ,in general ,the ,secretary of      
,veterans ,affairs shall compile and    
analyze1 on a continuous basis1 all     
clinical data that-- 7#a7 is obtained by
 the ,department of ,veterans ,affairs  
in connection with consultation1        
testing1 and treatment furnished to     
veterans by the ,department under       
section #agbj;,j of title #ch1 ,united  
,states ,code1 as added by section      
#aja7;a72 and  7#b7 is likely to be     
scientifically useful in determining the
 association1 if any1 between the       
disability of a veteran and exposure to 
a toxic substance4  7b7 ,consent of     

patients ,compilation and analysis by   
the ,secretary of clinical data of a    
veteran under subsection 7a7 shall be   
conducted1 and such data shall be used1 
consistent with the informed consent of 
the veteran and in compliance with all  
applicable ,federal law4  7c7 ,annual   
report ,not later than one year after   
the effective date under subsection 7d71
 and annually thereafter1 the ,secretary
 shall submit to the ,committee on      
,veterans' ,affairs of the ,senate and  
the ,committee on ,veterans' ,affairs of
 the ,house of ,representatives a report
 containing-- 7#a7 the information      
compiled under subsection 7a72  7#b7 an 
analysis of such information2  7#c7 a   
description of the types and incidences 
of disabilities identified by the       
,department under such subsection2  7#d7
 the explanation of the ,secretary for  
the incidence of such disabilities and  
other explanations for the incidence of 
such disabilities as the ,secretary     
considers reasonable2 and  7#e7 the     

views of the ,secretary on the          
scientific validity of drawing          
conclusions from the incidence of such  
disabilities1 as evidenced by the data  
compiled under subsection 7a71 regarding
 any association between such           
disabilities and exposure to a toxic    
substance4  7d7 ,effective date  7#a7   
,in general ,except as provided in      
paragraph 7#b71 this section shall take 
effect on the date that is #ij days     
after the date on which the report      
submitted by the ,national ,academies of
 ,sciences1 ,engineering1 and ,medicine 
under section #bjb7;g77#a7 is received  
by the ,secretary4  7#b7 ,exception     
,this section shall not take effect if  
the ,secretary1 after receiving the     
report described in paragraph 7#a7 and  
before the end of the #ij-;day period   
described in such paragraph-- 7,a7      
determines that it is not feasible or   
cost-effective to carry out this section
 or that carrying out this section would
 not make a material contribution to the

 body of scientific knowledge concerning
 the health effects in humans of        
herbicide exposure2 and  7,b7 notifies  
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    
,representatives of that determination  
and the reasons therefor4  #bjd4 ,report
 to evaluate and identify groups at-risk
 of exposure to toxic substances  7a7   
,in general ,not later than one year    
after the date of the enactment of this 
,act1 and every two years thereafter1   
the ,secretary of ,defense shall submit 
to the appropriate committees of        
,congress and1 subject to applicable    
,federal privacy laws1 make available to
 the public a report evaluating and     
identifying the groups of members of the
 ,armed ,forces and former members of   
the ,armed ,forces who are at-risk of   
exposure to toxic substances4  7b7      
,existing data ,the ,secretary shall use
 data from existing record and tracking 
systems to develop each report under    

subsection 7a74  7c7 ,use of            
capabilities of ,national ,artificial   
,intelligence ,institute ,in developing 
each report under subsection 7a71 the   
,secretary shall use the capabilities of
 the ,national ,artificial ,intelligence
 ,institute of the ,department of       
,veterans ,affairs to interpret the     
veteran population data within the      
,individual ,longitudinal ,exposure     
,record of the ,department1 including   
data compiled under-- 7#a7 the ,million 
,veteran ,program of the ,department2   
7#b7 health records of veterans2 and    
7#c7 benefits records of veterans4  7d7 
,elements of report ,each report        
submitted under subsection 7a7 shall--  
7#a7 identify groups at a high-risk for 
illnesses relating to exposure to toxic 
substances and recommend an outreach    
strategy for those groups2 and  7#b7    
determine the viability of correlating  
the ,individual ,longitudinal ,exposure 
,record and health records maintained by
 the ,veterans ,health ,administration1 

including with respect to participation 
of a veteran in the ,million ,veteran   
,program of the ,department1 to provide 
more data to epidemiologists of the     
,department4  7e7 ,appropriate          
committees of ,congress defined ,in this
 section1 the term appropriate          
committees of ,congress means-- 7#a7 the
 ,committee on ,armed ,services and the 
,committee on ,veterans' ,affairs of the
 ,senate2 and  7#b7 the ,committee on   
,armed ,services and the ,committee on  
,veterans' ,affairs of the ,house of    
,representatives4  ,,iii ,improvement of
 resources of ,department of ,veterans  
,affairs regarding exposures to toxic   
substances  #cja4 ,publication of list  
of resources of ,department of ,veterans
 ,affairs for veterans exposed to toxic 
substances and outreach program for such
 veterans and caregivers and survivors  
of such veterans  7a7 ,publication of   
list of resources  7#a7 ,in general ,not
 later than one year after the date of  
the enactment of this ,act1 and annually

 thereafter1 the ,secretary of ,veterans
 ,affairs shall publish a list of       
resources of the ,department of         
,veterans ,affairs for-- 7,a7 veterans  
provided disability compensation under  
chapter #aa of title #ch1 ,united       
,states ,code1 relating to exposure to  
toxic substances2  7,b7 veterans        
eligible for consultation1 testing1 and 
treatment under section #agbj;,j of such
 title1 as added by section #aja7;a72   
7,c7 caregivers of veterans described in
 subparagraph 7,a7 or 7,b7 who are      
participating in the program of         
comprehensive assistance for family     
caregivers under section #agbj;,g7a7 of 
such title2 and  7,d7 survivors of      
veterans described in subparagraph 7,a7 
or 7,b7 7or who would be described in   
any such subparagraph were the veteran  
alive7 who are receiving death benefits 
under the laws administered by the      
,secretary4  7#b7 ,update ,the          
,secretary shall periodically update the
 list published under paragraph 7#a74   

7b7 ,outreach ,the ,secretary shall     
develop1 with input from the community1 
an informative outreach program for     
veterans on illnesses that may be       
related to exposure to toxic substances1
 including outreach with respect to     
benefits and support programs4  #cjb4   
,incorporation of toxic exposure        
questionnaire during primary care       
appointments  7a7 ,in general ,the      
,secretary of ,veterans ,affairs shall  
incorporate a clinical questionnaire to 
help determine potential exposure to    
toxic substances during active military1
 naval1 or air service as part of the   
initial screening conducted for an      
appointment of a veteran with a primary 
care provider of the ,department of     
,veterans ,affairs to improve           
understanding by the ,department of     
exposure of veterans to toxic substances
 while serving in the ,armed ,forces4   
7b7 ,determination of questions ,the    
questions included in the questionnaire 
required under subsection 7a7 shall be  

determined by the ,secretary with input 
from medical professionals4  #cjc4      
,portal for access by veterans to       
individual longitudinal exposure record 
7a7 ,in general ,the ,secretary of      
,veterans ,affairs shall establish a    
portal through which a veteran may      
access documents and information with   
respect to the veteran contained in the 
,individual ,longitudinal ,exposure     
,record of the ,department of ,veterans 
,affairs4  7b7 ,elements of portal ,the 
portal established under subsection 7a7 
shall-- 7#a7 present documents and      
information with respect to a veteran   
contained in the ,individual            
,longitudinal ,exposure ,record of the  
veteran in a printable1 read-only       
format2 and  7#b7 be hosted on an       
internet website of the ,department that
 is commonly used by veterans4  #cjd4   
,training of personnel of ,department of
 ,veterans ,affairs on illnesses related
 to exposure to toxic substances  7a7   
,in general ,the ,secretary of ,veterans

 ,affairs shall ensure that personnel of
 the ,department of ,veterans ,affairs1 
including personnel involved with       
establishing disability ratings under   
the laws administered by the ,secretary1
 and non-,department health care        
personnel who provide care to veterans  
under the laws administered by the      
,secretary are appropriately trained to 
identify1 treat1 and assess the impact  
of illnesses related to exposure to     
toxic substances4  7b7 ,elements of     
training ,the training required under   
subsection 7a7 shall-- 7#a7 provide     
veterans and personnel with specific    
education with respect to illnesses     
related to exposure to toxic substances2
  7#b7 inform disability raters of      
secondary effects that can be attributed
 to exposure to toxic substances2 and   
7#c7 inform personnel of how to probe   
for additional information regarding    
exposures to different toxicants4  7c7  
,toxicant defined ,in this section1 the 
term toxicant has the meaning given that

 term in section #agbj;,j7i7 of title   
#ch1 ,united ,states ,code1 as added by 
section #aja7;a74  #a4 ,short title2    
table of contents  7a7 ,short title     
,this ,act may be cited as the ,toxic   
,exposure in the ,american ,military    
,act of #bjbj or the ,,team ,act of     
#bjbj4  7b7 ,table of contents ,the     
table of contents for this ,act is as   
follows3 ,sec4 #a4 ,short title2 table  
of contents4,sec4 #b4                   
,definitions4,,title ,i--,expansion of  
health care and benefits for veterans   
exposed to toxic substances,sec4 #aja4  
,expansion of health care eligibility   
for certain individuals exposed to open 
burn pits and other toxic               
substances4,sec4 #ajb4 ,expansion of    
health care eligibility for veterans    
awarded certain medals4,sec4 #ajc4      
,permanent reauthorization of authority 
of ,secretary of ,veterans ,affairs to  
prescribe regulations providing that a  
presumption of service connection is    
warranted for a disease associated with 

exposure to a herbicide agent4,sec4     
#ajd4 ,permanent reauthorization of     
authority of ,secretary of ,veterans    
,affairs to prescribe regulations       
providing that a presumption of service 
connection is warranted for an illness  
associated with service in the ,persian 
,gulf during the ,persian ,gulf         
,war4,sec4 #aje4 ,presumptions of       
service connection for diseases         
associated with exposure to certain     
toxic substances4,,title ,,ii--,research
 and review regarding exposure to toxic 
substances,sec4 #bja4 ,establishment of 
,toxic ,exposure ,review                
,commission4,sec4 #bjb4 ,agreement with 
,national ,academies of ,sciences1      
,engineering1 and ,medicine concerning  
the exposure of humans to toxic         
substances4,sec4 #bjc4 ,collection1     
analysis1 and report on treatment of    
veterans for medical conditions related 
to exposure to toxic substances4,,title 
,,iii--,improvement of resources of     
,department of ,veterans ,affairs       

regarding exposures to toxic            
substances,sec4 #cja4 ,publication of   
list of resources of ,department of     
,veterans ,affairs for veterans exposed 
to toxic substances and outreach program
 for such veterans and caregivers and   
survivors of such veterans4,sec4 #cjb4  
,incorporation of toxic exposure        
questionnaire during primary care       
appointments4,sec4 #cjc4 ,portal for    
access by veterans to ,individual       
,longitudinal ,exposure ,record4,sec4   
#cjd4 ,training of health care personnel
 of ,department of ,veterans ,affairs on
 illnesses related to exposure to toxic 
substances4  #b4 ,definitions ,in this  
,act3 7#a7 ,active military1 naval1 or  
air service ,the term active military1  
naval1 or air service has the meaning   
given that term in section #aja of title
 #ch1 ,united ,states ,code4  7#b7 ,open
 burn pit ,the term open burn pit has   
the meaning given that term in section  
#bja7;c7 of the ,dignified ,burial and  
,other ,veterans' ,benefits ,improvement

 ,act of #bjab 7,public ,law #aab-bfj2  
#ch ,u4,s4,c4 #ebg note74  7#c7 ,toxic  
substance ,the term toxic substance has 
the meaning given that term in          
subparagraph 7,g77iv7 of section        
#agaj7;e77#a7 of such title1 as added by
 section #aja7;a74  ,i ,expansion of    
health care and benefits for veterans   
exposed to toxic substances  #aja4      
,expansion of health care eligibility   
for certain individuals exposed to open 
burn pits and other toxic substances    
7a7 ,in general ,section #agaj7;e7 of   
title #ch1 ,united ,states ,code1 is    
amended-- 7#a7 in paragraph 7#a71 by    
adding at the end the following new     
subparagraph3  7,g7 7i7 ,subject to     
paragraph 7#b71 a covered individual is 
eligible for hospital care1 medical     
services1 and nursing home care under   
subsection 7a77#b77;,f7 for any illness4
  7ii7 ,for purposes of this            
subparagraph1 a covered individual is an
 individual who-- 7,i7 is eligible for  
inclusion in the ,airborne ,hazards and 

,open ,burn ,pit ,registry2 or  7,,ii7  
has been identified by the ,secretary of
 ,defense to have been possibly exposed1
 inside or outside the ,united ,states1 
during active duty1 active duty for     
training1 or inactive duty training1    
to-- 7aa7 an open burn pit2  7bb7 a     
toxic substance2 or  7cc7 a site        
included in a database maintained by the
 ,department of ,defense and shared with
 the ,department of ,veterans ,affairs  
to serve as the central portal for      
exposure-related data that compiles1    
collates1 presents1 and provides        
available occupational and environmental
 exposure information to support the    
needs of the ,department of ,defense and
 the ,department of ,veterans ,affairs4 
7iii7 ,a covered individual shall be    
enrolled in the system of annual patient
 enrollment of the ,department in the   
priority group under subsection 7a77#f7 
of section #agje of this title4  7iv7   
,in this subparagraph3 7,i7 ,the term   
,airborne ,hazards and ,open ,burn ,pit 

,registry means the registry established
 by the ,secretary under section #bja of
 the ,dignified ,burial and ,other      
,veterans' ,benefits ,improvement ,act  
of #bjab 7,public ,law #aab-bfj2 #ch    
,u4,s4,c4 #ebg note74  7,,ii7 ,the term 
open burn pit has the meaning given that
 term in section #bja7;c7 of the        
,dignified ,burial and ,other ,veterans'
 ,benefits ,improvement ,act of #bjab   
7,public ,law #aab-bfj2 #ch ,u4,s4,c4   
#ebg note74  7,,iii7 ,the term toxic    
substance means a toxicant or a toxin4  
7,,iv7 ,the term toxicant means any     
substance that can injure or kill       
humans1 animals1 or plants and that is  
produced by humans or is a by-product of
 human activities4  7,v7 ,the term toxin
 means any substance that can injure or 
kill humans1 animals1 or plants and that
 is produced naturally4  2 and  7#b7 in 
paragraph 7#b77;,b71 by striking or 7,f7
 and inserting 7,f71 or 7,g74  7b7      
,effective date ,the amendments made by 
subsection 7a7 shall take effect on the 

date that is #ij days after the date of 
the enactment of this ,act4  7c7        
,determinations of exposure  7#a7 ,in   
general ,the ,secretary of ,veterans    
,affairs shall1 to the extent           
practicable1 establish and maintain a   
mechanism by which veterans may         
determine whether or not they have been 
possibly exposed to an open burn pit or 
toxic substance described in            
subparagraph 7,g77ii77,,ii7 of section  
#agaj7;e77#a7 of title #ch1 ,united     
,states ,code1 as added by subsection   
7a71 for purposes of being considered as
 covered individuals under such         
subparagraph4  7#b7 ,approval of        
,secretary ,any determination made under
 paragraph 7#a7 shall be subject to the 
approval of the ,secretary4  7#c7       
,appeals ,the ,secretary shall establish
 a mechanism for appealing a decision   
made by the ,secretary under paragraph  
7#b74  7d7 ,report  7#a7 ,in general    
,not later than #cj days after the date 
on which the ,secretary of ,defense     

identifies the individuals described in 
subparagraph 7,g77ii77,,ii7 of section  
#agaj7;e77#a7 of title #ch1 ,united     
,states ,code1 as added by subsection   
7a71 the ,secretary1 in consultation    
with the ,secretary of ,veterans        
,affairs1 shall submit to the           
appropriate committees of ,congress a   
report4  7#b7 ,elements ,the report     
required by paragraph 7#a7 shall include
 the following3 7,a7 ,the duty locations
 or units of the individuals described  
in paragraph 7#a71 or other information 
on groups to which such individuals     
belong4  7,b7 ,the evidence considered  
in identifying individuals who were     
possibly exposed to an open burn pit1   
toxic substance1 or site as described in
 subparagraph 7,g77ii77,,ii7 of section 
#agaj7;e77#a7 of title #ch1 ,united     
,states ,code1 as added by subsection   
7a74  7,c7 ,the criteria used to        
determine whether an individual was so  
exposed4  7#c7 ,appropriate committees  
of ,congress ,in this subsection1 the   

term appropriate committees of ,congress
 means-- 7,a7 the ,committee on         
,veterans' ,affairs and the ,committee  
on ,armed ,services of the ,senate2 and 
7,b7 the ,committee on ,veterans'       
,affairs and the ,committee on ,armed   
,services of the ,house of              
,representatives4  #ajb4 ,expansion of  
health care eligibility for veterans    
awarded certain medals  7a7 ,in general 
,section #agaj7;e7 of title #ch1 ,united
 ,states ,code1 as amended by section   
#aja7;a71 is further amended-- 7#a7 in  
paragraph 7#a71 by adding at the end the
 following new subparagraph3  7,h7 7i7  
,subject to paragraph 7#b71 a veteran is
 eligible for hospital care1 medical    
services1 and nursing home care under   
subsection 7a77#b77;,f7 for any illness 
if the veteran was awarded any of the   
following3 7,i7 ,the ,armed ,forces     
,service ,medal4  7,,ii7 ,the           
,afghanistan ,campaign ,medal4  7,,iii7 
,the ,global ,war on ,terrorism         
,expeditionary ,medal4  7,,iv7 ,the     

,inherent ,resolve ,campaign ,medal4    
7,v7 ,the ,iraq ,campaign ,medal4       
7,,vi7 ,the ,southwest ,asia ,service   
,medal4  7ii7 ,a veteran described in   
clause 7i7 shall be enrolled in the     
system of annual patient enrollment of  
the ,department in the priority group   
under subsection 7a77#f7 of section     
#agje of this title4  2 and  7#b7 in    
paragraph 7#b71 by striking or 7,g7 and 
inserting 7,g71 or 7,h74  7b7 ,effective
 date ,the amendments made by subsection
 7a7 shall take effect on the date that 
is #ij days after the date of the       
enactment of this ,act4  #ajc4          
,permanent reauthorization of authority 
of ,secretary of ,veterans ,affairs to  
prescribe regulations providing that a  
presumption of service connection is    
warranted for a disease associated with 
exposure to a herbicide agent  7a7 ,in  
general ,section #aaaf of title #ch1    
,united ,states ,code1 is amended by    
striking subsection 7e74  7b7 ,effective
 date ,subsection 7a7 of this section   

and subsections 7b7 through 7d7 of      
section #aaaf of such title shall take  
effect on the date of the enactment of  
this ,act4  #ajd4 ,permanent            
reauthorization of authority of         
,secretary of ,veterans ,affairs to     
prescribe regulations providing that a  
presumption of service connection is    
warranted for an illness associated with
 service in the ,persian ,gulf during   
the ,persian ,gulf ,war  7a7 ,in general
 ,section #aaah of title #ch1 ,united   
,states ,code1 is amended by striking   
subsection 7e74  7b7 ,effective date    
,subsection 7a7 of this section and     
subsections 7b7 through 7d7 of section  
#aaah of such title shall take effect on
 the date of the enactment of this ,act4
  #aje4 ,presumptions of service        
connection for diseases associated with 
exposure to certain toxic substances    
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 diseases associated with 
exposure to certain toxic substances    
7a7 ,presumptions of service connection 
7#a7 ,for purposes of section #aaaj of  
this title1 and subject to section #aaac
 of this title1 each disease specified  
in paragraph 7#b7 becoming manifest as  
specified in that paragraph 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  
disease during the period of such       
service4  7#b7 ,a disease specified in  
this paragraph is any disease that--    
7,a7 the ,secretary determines in       
regulations prescribed under this       
section warrants a presumption of       
service connection by reason of having a
 positive association with exposure to a
 toxic substance2 and  7,b7 becomes     
manifest within the period1 if any1     
prescribed in such regulations in a     
veteran who was exposed to that toxic   

substance during active military1 naval1
 or air service4  7#c7 7,a7 ,for        
purposes of this subsection1 the        
,secretary may presume that a veteran   
who has a disease specified in paragraph
 7#b7 was exposed to the toxic substance
 for which the ,secretary has determined
 under paragraph 7#b77;,a7 warrants a   
presumption of service connection by    
reason of having a positive association 
with exposure to the toxic substance1   
notwithstanding that there is no record 
of evidence of such exposure1 if the    
,secretary determines based on one or   
more of the factors set forth in        
subparagraph 7,b7 that a presumption of 
exposure is warranted4  7,b7 ,the       
factors set forth in this subparagraph  
are as follows3 7i7 ,the duty location  
of the veteran4  7ii7 ,the length of    
service of the veteran4  7iii7 ,such    
other factors as the ,secretary         
considers appropriate4  7b7             
,determinations relating to diseases    
7#a7 ,whenever the ,secretary           

determines1 on the basis of sound       
medical and scientific evidence1 that a 
positive association exists between the 
exposure of humans to a toxic substance 
and the occurrence of a disease in      
humans1 the ,secretary shall prescribe  
regulations providing that a presumption
 of service connection is warranted for 
that disease for purposes of this       
section4  7#b7 ,in making determinations
 under paragraph 7#a71 the ,secretary   
shall take into account-- 7,a7 reports  
received by the ,secretary from the     
,national ,academies of ,sciences1      
,engineering1 and ,medicine under       
section #bjb7;g7 of the ,toxic ,exposure
 in the ,american ,military ,act of     
#bjbj2 and  7,b7 all other sound medical
 and scientific information and analyses
 available to the ,secretary4  7#c7 7,a7
 ,in evaluating any report1 information1
 or analysis for purposes of making such
 determinations1 the ,secretary shall   
consider only scientific studies that   
are valid in accordance with            

contemporary scientific standards4  7,b7
 ,the ,secretary may define the         
standards described in subparagraph 7,a7
 for purposes of that subparagraph4  7c7
 ,response to reports by the ,national  
,academies of ,sciences1 ,engineering1  
and ,medicine  7#a7 ,not later than #fj 
days after the date on which the        
,secretary receives a report from the   
,national ,academies of ,sciences1      
,engineering1 and ,medicine under       
section #bjb7;g7 of the ,toxic ,exposure
 in the ,american ,military ,act of     
#bjbj1 the ,secretary shall determine   
whether a presumption of service        
connection is warranted for each disease
 covered by the report4  7#b7 ,if the   
,secretary determines under paragraph   
7#a7 that a presumption of service      
connection is warranted for a disease1  
the ,secretary shall1 not later than #fj
 days after making the determination1   
issue proposed regulations setting forth
 the determination4  7#c7 7,a7 ,if the  
,secretary makes a determination        

described in subparagraph 7,b71 the     
,secretary shall1 not later than #fj    
days after making the determination1    
publish in the ,federal ,register a     
notice of the determination4  7,b7 ,a   
determination described in this         
subparagraph is a determination by the  
,secretary under paragraph 7#a7 that a  
presumption of service connection is not
 warranted for a disease as to which the
 ,national ,academies of ,sciences1     
,engineering1 and ,medicine determined  
that there was-- 7i7 sufficient evidence
 of an association between the exposure 
of humans to a toxic substance and the  
occurrence of the disease in humans2 or 
7ii7 limited evidence or suggestive     
evidence of such an association4  7,c7  
,any notice published under subparagraph
 7,a7 shall include an explanation of   
the scientific basis for the            
determination described in subparagraph 
7,b74  7,d7 ,if a disease already       
presumed to be service connected under  
this section is subject to a            

determination described in subparagraph 
7,b71 the ,secretary shall1 not later   
than #fj days after publication of the  
notice under subparagraph 7,a71 issue   
proposed regulations removing the       
presumption of service connection for   
the disease4  7#d7 ,not later than #ahj 
days after the date on which the        
,secretary issues any proposed          
regulations under this subsection1 the  
,secretary shall issue final            
regulations4  7d7 ,removal of           
presumption of service connection       
,whenever the presumption of service    
connection for a disease under this     
section is removed under subsection     
7c7-- 7#a7 a veteran who was awarded    
compensation for the disease 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 disease on 
the basis of the presumption before that
 date shall continue to be entitled to  
receive dependency and indemnity        
compensation on that basis4  7e7        
,reference to ,national ,academies of   
,sciences1 ,engineering1 and ,medicine  
,in the case that the ,secretary enters 
into an agreement with another          
organization as described in section    
#bjb7;h77#a7 of the ,toxic ,exposure in 
the ,american ,military ,act of #bjbj1  
any reference in this section to the    
,national ,academies of ,sciences1      
,engineering1 and ,medicine shall be    
treated as a reference to the other     
organization4  7f7 ,definitions ,in this
 section3 7#a7 ,the term positive       
association means1 with respect to an   
association between exposure to a toxic 
substance and the occurrence of a       
disease in humans1 that there is        
credible evidence for the association   
and such evidence is equal to or        
outweighs the credible evidence against 

the association4  7#b7 ,the term toxic  
substance has the meaning given that    
term in section #agaj7;e77#a77;,g77iv7  
of this title4  4  7b7 ,clerical        
amendment ,the table of sections at the 
beginning of chapter #aa of such title  
is amended by inserting after the item  
relating to section #aaah the following 
new item3  #aaai4 ,presumptions of      
service connection for diseases         
associated with exposure to certain     
toxic substances4  4  7c7 ,conforming   
amendment ,section #aaac of such title  
is amended by striking or #aaah each    
place it appears and inserting #aaah1 or
 #aaai4  ,,ii ,research and review      
regarding exposure to toxic substances  
#bja4 ,establishment of ,toxic ,exposure
 ,review ,commission  7a7 ,in general   
,subchapter ,,iii of chapter #e of title
 #ch1 ,united ,states ,code1 is amended 
by adding at the end the following new  
section3  #edg4 ,toxic ,exposure ,review
 ,commission  7a7 ,establishment ,the   
,secretary shall establish an           

independent commission to be known as   
the ,toxic ,exposure ,review ,commission
 7in this section referred to as the    
,commission74  7b7 ,purpose ,the        
,commission shall-- 7#a7 advise the     
,secretary on questions relating to     
exposure to toxic substances that       
require scientific research2 and  7#b7  
assist in the consideration of possible 
presumptions of service connection4  7c7
 ,duties ,the ,commission shall carry   
out the following duties3 7#a7 ,collect 
any relevant information from the       
,department of ,defense and other       
sources to identify possible toxic      
exposures related to service during     
active duty1 active duty for training1  
or inactive duty training in order to   
determine the need for a comprehensive  
review under an agreement under section 
#bjb of the ,toxic ,exposure in the     
,american ,military ,act of #bjbj4      
,relevant information may be collected  
from the following3 7,a7 ,any ,federal  
agency1 as the ,commission considers    

necessary to carry out this section4    
,upon request of the ,chair1 the head of
 such agency shall furnish such         
information to the ,commission1 unless  
such information is classified4  7,b7   
,public meetings or hearings1 which may 
be held to take such testimony and      
receive such evidence as the ,commission
 considers advisable to carry out the   
duties of the ,commission4  7#b7        
,recommend to the ,secretary1 by        
majority vote1 whether a comprehensive  
scientific review should be conducted by
 the ,national ,academies of ,sciences1 
,engineering1 and ,medicine under an    
agreement under section #bjb of the     
,toxic ,exposure in the ,american       
,military ,act of #bjbj4  7#c7          
,recommend to the ,secretary1 by        
majority vote1 whether new1 independent 
studies regarding the health outcomes of
 exposure to toxic substances1 or any   
other new1 independent studies that the 
,commission deems necessary and         
appropriate1 should be conducted4  7#d7 

,annually report to ,congress on        
progress regarding the duties set forth 
in paragraphs 7#a7 through 7#c71 any    
recommendations made to the ,secretary1 
and any responses of the ,secretary to  
such recommendations4  7d7 ,membership  
7#a7 7,a7 ,the ,commission shall be     
composed of #i members1 appointed as    
follows3 7i7 ,two members appointed by  
the ,speaker of the ,house of           
,representatives4  7ii7 ,two members    
appointed by the minority leader of the 
,house of ,representatives4  7iii7 ,two 
members appointed by the majority leader
 of the ,senate4  7iv7 ,two members     
appointed by the minority leader of the 
,senate4  7v7 ,one member appointed by  
the ,secretary4  7,b7 ,the initial      
members of the ,commission shall be     
appointed under subparagraph 7,a7 not   
later than #ahj days after the date of  
the enactment of the ,toxic ,exposure in
 the ,american ,military ,act of #bjbj4 
7#b7 ,in appointing individuals under   
paragraph 7#a77;,a71 the ,speaker of the

 ,house of ,representatives1 the        
minority leader of the ,house of        
,representatives1 the majority leader of
 the ,senate1 the minority leader of the
 ,senate1 and the ,secretary shall      
ensure that at least five members of the
 ,commission are scientists or health   
care professionals-- 7,a7 of whom-- 7i7 
one has a background in the field of    
respiratory medicine2  7ii7 one has a   
background in the field of endocrinology
 and metabolic medicine2  7iii7 one has 
a background in hematology2  7iv7 one   
has a background in oncology2 and  7v7  
one has a background in occupational and
 environmental health2 and  7,b7 who are
 not officials or employees of the      
,federal ,government4  7#c7 ,in         
appointing individuals under paragraph  
7#a77;,a71 the ,speaker of the ,house of
 ,representatives1 the minority leader  
of the ,house of ,representatives1 the  
majority leader of the ,senate1 the     
minority leader of the ,senate1 and the 
,secretary shall ensure that at least   

two members of the ,commission represent
 an organization recognized by the      
,secretary for the representation of    
veterans under section #eijb of this    
title4  7#d7 ,in appointing individuals 
under paragraph 7#a77;,a71 the ,speaker 
of the ,house of ,representatives1 the  
minority leader of the ,house of        
,representatives1 the majority leader of
 the ,senate1 the minority leader of the
 ,senate1 and the ,secretary shall give 
consideration to including in the       
,commission at least one member who     
works with survivors of illnesses       
related to exposure to toxic substances 
and has a background in the field of    
study of exposure to toxic substances4  
7e7 ,meetings  7#a7 ,the ,commission    
shall meet not less frequently than     
twice each year4  7#b7 7,a7 ,each       
meeting of the ,commission shall be open
 to the public4  7,b7 ,all the          
proceedings1 information1 and           
deliberations of the ,commission shall  
be available for review by the public4  

7,c7 ,meetings of the ,commission may be
 carried out through the use of         
telephonic or other appropriate         
telecommunication technology if the     
,commission determines that such        
technology will allow the members to    
communicate simultaneously4  7f7 ,chair 
and ,vice ,chair ,at the initial meeting
 of the ,commission under subsection    
7e71 the ,commission shall select a     
,chair and ,vice ,chair from among the  
members of the ,commission by a majority
 vote of the members of the ,commission4
  7g7 ,period of appointment2 vacancies 
7#a7 ,a member of the ,commission shall 
be appointed for a term that may not    
exceed four years4  7#b7 ,the ,secretary
 shall ensure that terms of members of  
the ,commission are staggered so that no
 such terms end on the same date4  7#c7 
,a vacancy in the ,commission shall be  
filled in the same manner as the        
original appointment1 but the individual
 appointed to fill the vacancy shall    
serve only for the unexpired portion of 

the term for which the individual's     
predecessor was appointed4  7#d7 ,in    
appointing the initial members of the   
,commission1 each official who is       
authorized to appoint two members of the
 ,commission shall appoint-- 7,a7 one   
member whose term expires after two     
years2 and  7,b7 one member whose term  
expires after four years4  7h7 ,pay     
7#a7 ,members of the ,commission shall  
serve without pay4  7#b7 ,each member of
 the ,commission who is an officer or   
employee of the ,united ,states shall   
serve without compensation in addition  
to that received for service as an      
officer or employee of the ,united      
,states4  7#c7 ,members shall receive   
travel expenses1 including per diem in  
lieu of subsistence1 in accordance with 
sections #egjb and #egjc of title #e4   
7i7 ,director of staff  7#a7 ,the       
,commission shall appoint a ,director   
who-- 7,a7 has not served as an employee
 of the ,department during the one-year 
period preceding the date of such       

appointment2 and  7,b7 is not otherwise 
barred or prohibited from serving as    
,director under ,federal ethics laws and
 regulations1 by reason of              
post-employment conflict of interest4   
7#b7 ,the ,director shall be paid at the
 rate of basic pay payable for level    
,,iv of the ,executive ,schedule under  
section #ecae of title #e4  7j7 ,staff  
7#a7 ,subject to paragraphs 7#b7 and    
7#c71 the ,director1 with the approval  
of the ,commission1 may appoint and fix 
the pay of additional personnel4  7#b7  
,the ,director may make such            
appointments without regard to the      
provisions of title #e governing        
appointments in the competitive service1
 and any personnel so appointed may be  
paid without regard to the provisions of
 chapter #ea and subchapter ,,iii of    
chapter #ec of that title relating to   
classification and ,general ,schedule   
pay rates1 except that an individual so 
appointed may not receive pay in excess 
of the annual rate of basic pay payable 

for ,,gs-#ae of the ,general ,schedule4 
7#c7 7,a7 ,not more than two-thirds of  
the personnel employed by or detailed to
 the ,commission may be on detail from  
the ,department4  7,b7 ,not more than   
half of the professional analysts of the
 ,commission staff may be persons       
detailed from the ,department to the    
,commission4  7#d7 ,subject to paragraph
 7#c71 the head of any ,federal agency1 
upon the request of the ,director1 may  
detail any of the personnel of that     
agency to the ,commission to assist the 
,commission in carrying out its duties  
under this section4  7#e7 ,the          
,commission may secure directly from any
 ,federal agency such information as the
 ,commission considers necessary to     
carry out this section4 ,upon request of
 the ,chair1 the head of such agency    
shall furnish such information to the   
,commission1 unless such information is 
classified4  7k7 ,other authority  7#a7 
,the ,commission may procure by         
contract1 to the extent funds are       

available1 the temporary or intermittent
 services of experts or consultants     
pursuant to section #caji of title #e4  
7#b7 ,to the extent funds are available1
 the ,commission may lease real property
 and acquire personal property either of
 its own accord or in consultation with 
the ,general ,services ,administration4 
7l7 ,communications  7#a7 7,a7 ,except  
as provided in subparagraph 7,b71 no    
person may restrict an employee of the  
,department in communicating with the   
,commission4  7,b7 ,subparagraph 7,a7   
does not apply to a communication that  
is unlawful4  7#b7 ,all ex parte        
communications with the ,commission     
shall be made part of the public record4
  7m7 ,reference to ,national ,academies
 of ,sciences1 ,engineering1 and        
,medicine ,in the case that the         
,secretary enters into an agreement with
 another organization as described in   
section #bjb7;h77#a7 of the ,toxic      
,exposure in the ,american ,military    
,act of #bjbj1 any reference in this    

section to the ,national ,academies of  
,sciences1 ,engineering1 and ,medicine  
shall be treated as a reference to the  
other organization4  7n7 ,toxic         
substance defined ,in this section1 the 
term toxic substance has the meaning    
given that term in subparagraph 7,g77iv7
 of section #agaj7;e77#a7 of this title4
  4  7b7 ,clerical amendment ,the table 
of sections at the beginning of chapter 
#e of such title is amended by adding at
 the end the following new item3  #edg4 
,toxic ,exposure ,review ,commission4  4
  #bjb4 ,agreement with ,national       
,academies of ,sciences1 ,engineering1  
and ,medicine concerning the exposure of
 humans to toxic substances  7a7        
,purpose ,the purpose of this section is
 to provide for the ,national ,academies
 of ,sciences1 ,engineering1 and        
,medicine 7in this section referred to  
as the ,academies71 an independent      
nonprofit scientific organization with  
appropriate expertise that is not part  
of the ,federal ,government1 to review  

and evaluate the available scientific   
evidence regarding associations between 
diseases and exposure to toxic          
substances4  7b7 ,agreement  7#a7 ,in   
general ,the ,secretary of ,veterans    
,affairs shall seek to enter into a     
five-year agreement with the ,academies 
to perform the services covered by this 
section4  7#b7 ,timing ,the ,secretary  
shall seek to enter into an agreement   
described in paragraph 7#a7 not later   
than #fj days after the date of the     
enactment of this ,act4  7#c7 ,extension
 ,an agreement under this section may be
 extended in five-year increments4  7c7 
,review of scientific evidence ,under an
 agreement between the ,secretary and   
the ,academies under this section1 the  
,academies shall review and summarize   
the scientific evidence1 and assess the 
strength thereof1 concerning the        
association between exposure to toxic   
substances during active military1      
naval1 or air service and each disease  
suspected to be associated with such    

exposure in the human population4  7d7  
,scientific determinations concerning   
diseases ,for each disease reviewed     
under subsection 7c71 the ,academies    
shall determine1 to the extent that     
available scientific data permit        
meaningful determinations-- 7#a7 whether
 an association exists between exposure 
to toxic substances and the occurrence  
of the disease1 taking into account the 
strength of the scientific evidence and 
the appropriateness of the statistical  
and epidemiological methods used to     
detect the association2  7#b7 the       
increased risk of the disease among     
those exposed to toxic substances during
 active military1 naval1 or air service2
 and  7#c7 whether there exists a       
plausible biological mechanism or other 
evidence of a causal relationship       
between the exposure and the occurrence 
of the disease4  7e7 ,cooperation of    
,federal agencies  7#a7 ,in general ,the
 head of each relevant ,federal agency1 
including the ,secretary of ,defense1   

shall cooperate fully with the          
,academies in performing the services   
covered by this section4  7#b7          
,technical and scientific capabilities  
,in performing the services covered by  
this section1 the ,academies shall make 
use of the technical and scientific     
capabilities of any ,federal agency4    
7f7 ,recommendations for additional     
scientific studies  7#a7 ,in general    
,under an agreement between the         
,secretary and the ,academies under this
 section1 the ,academies shall make any 
recommendations for additional          
scientific studies to resolve areas of  
continuing scientific uncertainty       
relating to the exposure of humans to   
toxic substances4  7#b7 ,considerations 
,in making recommendations under        
paragraph 7#a71 the ,academies shall    
consider-- 7,a7 the scientific          
information that is available at the    
time of the recommendation2  7,b7 the   
value and relevance of the information  
that could result from additional       

studies2 and  7,c7 the cost and         
feasibility of carrying out such        
additional studies4  7g7 ,reports  7#a7 
,initial report  7,a7 ,in general ,under
 an agreement between the ,secretary and
 the ,academies under this section1 not 
later than one year after the date of   
the enactment of this ,act1 the         
,academies shall submit to the          
,secretary1 the ,committee on ,veterans'
 ,affairs of the ,senate1 and the       
,committee on ,veterans' ,affairs of the
 ,house of ,representatives an initial  
report on the activities of the         
,academies under the agreement4  7,b7   
,elements ,the report submitted under   
subparagraph 7,a7 shall include the     
following3 7i7 ,the determinations      
described in subsection 7d74  7ii7 ,a   
full explanation of the scientific      
evidence and reasoning that led to such 
determinations4  7iii7 ,any             
recommendations of the ,academies under 
subsection 7f74  7#b7 ,periodic updates 
,under an agreement between the         

,secretary and the ,academies under this
 section1 not less frequently than once 
every two years after the date on which 
the initial report is submitted under   
paragraph 7#a77;,a71 the ,academies     
shall submit to the ,secretary1 the     
,committee on ,veterans' ,affairs of the
 ,senate1 and the ,committee on         
,veterans' ,affairs of the ,house of    
,representatives an updated report on   
the activities of the ,academies under  
the agreement4  7h7 ,alternative        
contract scientific organization  7#a7  
,in general ,if the ,secretary is unable
 within the time period prescribed in   
subsection 7b77#b7 to enter into an     
agreement with the ,academies for the   
purposes of this section on terms       
acceptable to the ,secretary1 the       
,secretary shall seek to enter into an  
agreement for the purposes of this      
section with another appropriate        
scientific organization that-- 7,a7 is  
not part of the ,federal ,government2   
7,b7 operates as a not-for-profit       

entity2 and  7,c7 has expertise and     
objectivity comparable to that of the   
,academies4  7#b7 ,treatment ,if the    
,secretary enters into an agreement with
 another organization as described in   
paragraph 7#a71 any reference in this   
section1 section #edg of title #ch1     
,united ,states ,code1 as added by      
section #bja7;a71 and section #aaai of  
such title1 as added by section         
#aje7;a71 to the ,national ,academies of
 ,sciences1 ,engineering1 and ,medicine 
shall be treated as a reference to the  
other organization4  #bjc4 ,collection1 
analysis1 and report on treatment of    
veterans for medical conditions related 
to exposure to toxic substances  7a7 ,in
 general ,the ,secretary of ,veterans   
,affairs shall compile and analyze1 on a
 continuous basis1 all clinical data    
that-- 7#a7 is obtained by the          
,department of ,veterans ,affairs in    
connection with hospital care1 medical  
services1 and nursing home care         
furnished under section                 

#agaj7;a77#b77;,f7 of title #ch1 ,united
 ,states ,code2 and  7#b7 is likely to  
be scientifically useful in determining 
the association1 if any1 between the    
medical condition of a veteran and      
exposure to a toxic substance4  7b7     
,consent of patients ,compilation and   
analysis by the ,secretary of clinical  
data of a veteran under subsection 7a7  
shall be conducted1 and such data shall 
be used1 consistent with the informed   
consent of the veteran and in compliance
 with all applicable ,federal law  7c7  
,annual report ,not later than one year 
after the date of the enactment of this 
,act1 and annually thereafter1 the      
,secretary shall submit to the          
,committee on ,veterans' ,affairs of the
 ,senate1 the ,committee on ,veterans'  
,affairs of the ,house of               
,representatives1 and the ,toxic        
,exposure ,review ,commission           
established by section #edg of title    
#ch1 ,united ,states ,code1 as added by 
section #bja7;a7 of this ,act1 a report 

containing-- 7#a7 the data compiled     
under subsection 7a72  7#b7 an analysis 
of such data2  7#c7 a description of the
 types and incidences of medical        
conditions identified by the ,department
 under such subsection2  7#d7 the       
explanation of the ,secretary for the   
incidence of such medical conditions and
 other explanations for the incidence of
 such conditions as the ,secretary      
considers reasonable2 and  7#e7 the     
views of the ,secretary on the          
scientific validity of drawing          
conclusions from the incidence of such  
medical conditions1 as evidenced by the 
data compiled under subsection 7a71     
regarding any association between such  
conditions and exposure to a toxic      
substance4  ,,iii ,improvement of       
resources of ,department of ,veterans   
,affairs regarding exposures to toxic   
substances  #cja4 ,publication of list  
of resources of ,department of ,veterans
 ,affairs for veterans exposed to toxic 
substances and outreach program for such

 veterans and caregivers and survivors  
of such veterans  7a7 ,publication of   
list of resources  7#a7 ,in general ,not
 later than one year after the date of  
the enactment of this ,act1 and annually
 thereafter1 the ,secretary of ,veterans
 ,affairs shall publish a list of       
resources of the ,department of         
,veterans ,affairs for-- 7,a7 veterans  
provided disability compensation under  
chapter #aa of title #ch1 ,united       
,states ,code1 relating to exposure to  
toxic substances2  7,b7 veterans        
eligible for hospital care1 medical     
services1 and nursing home care under   
section #agaj7;a77#b77;,f7 of such      
title2  7,c7 caregivers of veterans     
described in subparagraph 7,a7 or 7,b7  
who are participating in the program of 
comprehensive assistance for family     
caregivers under section #agbj;,g7a7 of 
such title2 and  7,d7 survivors of      
veterans described in subparagraph 7,a7 
or 7,b7 7or who would be described in   
any such subparagraph were the veteran  

alive7 who are receiving death benefits 
under the laws administered by the      
,secretary4  7#b7 ,update ,the          
,secretary shall periodically update the
 list published under paragraph 7#a74   
7b7 ,outreach ,the ,secretary shall     
develop1 with input from the community1 
an informative outreach program for     
veterans on illnesses that may be       
related to exposure to toxic substances1
 including outreach with respect to     
benefits and support programs4  #cjb4   
,incorporation of toxic exposure        
questionnaire during primary care       
appointments  7a7 ,in general ,the      
,secretary of ,veterans ,affairs shall  
incorporate a clinical questionnaire to 
help determine potential exposure to    
toxic substances during active military1
 naval1 or air service as part of the   
initial screening conducted for an      
appointment of a veteran with a primary 
care provider of the ,department of     
,veterans ,affairs to improve           
understanding by the ,department of     

exposure of veterans to toxic substances
 while serving in the ,armed ,forces4   
7b7 ,determination of questions ,the    
questions included in the questionnaire 
required under subsection 7a7 shall be  
determined by the ,secretary with input 
from medical professionals4  #cjc4      
,portal for access by veterans to       
,individual ,longitudinal ,exposure     
,record  7a7 ,in general ,the ,secretary
 of ,veterans ,affairs shall establish a
 portal through which a veteran may     
access documents and information with   
respect to the veteran contained in the 
,individual ,longitudinal ,exposure     
,record of the ,department of ,veterans 
,affairs4  7b7 ,elements of portal ,the 
portal established under subsection 7a7 
shall-- 7#a7 present documents and      
information with respect to a veteran   
contained in the ,individual            
,longitudinal ,exposure ,record of the  
veteran in a printable1 read-only       
format2 and  7#b7 be hosted on an       
internet website of the ,department that

 is commonly used by veterans4  #cjd4   
,training of health care personnel of   
,department of ,veterans ,affairs on    
illnesses related to exposure to toxic  
substances  7a7 ,in general ,the        
,secretary of ,veterans ,affairs shall  
ensure that health care personnel of the
 ,department of ,veterans ,affairs are  
appropriately trained to identify1      
treat1 and assess the impact of         
illnesses related to exposure to toxic  
substances4  7b7 ,elements of training  
,the training required under subsection 
7a7 shall-- 7#a7 provide health care    
personnel of the ,department with       
specific education with respect to      
illnesses related to exposure to toxic  
substances2 and  7#b7 inform such       
personnel of how to probe for additional
 information from veterans regarding    
exposures to different toxicants4  7c7  
,toxicant defined ,in this section1 the 
term toxicant has the meaning given that
 term in subparagraph 7,g77iv7 of       
section #agaj7;e77#a7 of title #ch1     

,united ,states ,code1 as added by      
section #aja7;a74  ,december #h1        
#bjbj,reported with an amendment