,i #aag? ,,congress #a/ ,session ,h4 ,r4 #bfjg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #ae1 #bjba,mr4 ,trone introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,vet]ans' ,affairs1 & 9 addition to ! ,committee on ,arm$ ,s]vices1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title #ch1 ,unit$ ,/ates ,code1 to e/abli% 9 ! ,dep>tm5t ( ,vet]ans ,affairs proc$ures to det]m9e presumptions ( s]vice connection bas$ on toxic exposure1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,fairly ,assess+ ,s]vice-relat$ ,toxic ,exposure ,residuals ,presumptions ,act or ! ,,fa/] ,presumptions ,act4 #b4 ,improvem5ts to ability ( ,dep>tm5t ( ,vet]ans ,affairs to e/abli% presumptions ( s]vice connection bas$ on toxic exposure 7a7 ,advisory committees1 panels1 & bo>ds 7#a7 ,e/abli%m5t ,*apt] #aa ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new sub*apt]3 ,,vii ,rese>* & det]m9ations relat+ to presumptions ( s]vice connection bas$ on toxic exposure #aaga4 ,proc$ures to det]m9e presumptions ( s]vice connection bas$ on toxic exposure2 def9itions 7a7 ,proc$ures ,! ,secret>y %all det]m9e :e!r to e/abli%1 or to remove1 presumptions ( s]vice connection bas$ on toxic exposure pursuant to ?is sub*apt]1 :]eby-- 7#a7 ! ,=mal ,advisory ,committee on ,toxic ,exposure "u section #aagb assesses rese>* reg>d+ vet]ans :o1 dur+ active milit>y1 naval1 or air s]vice1 7 expos$ to toxic sub/ances1 commissions additional rese>*1 & provides nom9ations = ! ,sci5ce ,review ,bo>d to evaluate ! rese>*2 7#b7 ! ,sci5ce ,review ,bo>d "u section #aagc evaluates rese>* nom9at$ by ! ,=mal ,advisory ,committee on ,toxic ,exposure & det]m9es ! /r5g? ( evid5ce support+ a positive association betwe5 exposure to a toxic sub/ance & an illness2 7#c7 ! ,work+ ,gr\p "u section #aagd evaluates ! conclusions ( ! ,sci5ce ,review ,bo>d & recomm5ds to ! ,secret>y :e!r to e/abli% or modify a presumption ( s]vice connection2 & 7#d7 ! ,secret>y prescribes regulations "u section #aage4 7b7 ,illness def9$ ,9 ?is sub*apt]1 ! t]m illness includes a disease or o!r condition affect+ ! heal? ( an individual4 7c7 ,nonapplication ( sunset requirem5ts ,section #ad ( ! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all n apply to an entity e/abli%$ "u ?is sub*apt]4 #aagb4 ,=mal ,advisory ,committee on ,toxic ,exposure 7a7 ,e/abli%m5t 7#a7 ,!re is 9 ! ,vet]ans ,b5efits ,adm9i/ration ( ! ,dep>tm5t ! ,=mal ,advisory ,committee on ,toxic ,exposure 79 ?is section ref]r$ to z ! ,committee74 7#b7 ,! ,secret>y %all appo9t n m ?an #aj memb]s to ! ,committee1 ( :i*-- 7,a7 at lea/ "o memb] %all be appo9t$ f among individuals :o are (ficials or employees ( ! ,vet]ans ,b5efits ,adm9i/ration or ! ,vet]ans ,heal? ,adm9i/ration2 7,b7 at lea/ "o memb] %all be appo9t$ f among individuals :o are (ficials or employees ( o!r dep>tm5ts or ag5cies ( ! ,f$]al ,gov]nm5t1 includ+ ! ,dep>tm5t ( ,def5se & ! ,ag5cy ( ,toxic ,sub/ances & ,disease ,regi/ry ( ! ,c5t]s = ,disease ,control & ,prev5tion2 7,c7 at lea/ ?ree memb]s %all be appo9t$ f among individuals :o are repres5tatives ( disabl$ vet]ans2 & 7,d7 at lea/ "o memb] %all be appo9t$ f among individuals 9 ! private sector1 ,/ate or local gov]nm5t1 or academia1 :o are exp]ts 9 toxicology & epidemiology4 7#c7 ,! ,secret>y %all det]m9e ! pay & all[ances ( ! memb]s1 includ+ ) respect to any additional pay & all[ances = memb]s :o are (ficials or employees ( ! ,f$]al ,gov]nm5t4 7#d7 ,ea* memb] ( ! ,committee %all be appo9t$ = a two-ye> t]m1 & may s]ve n m ?an ?ree successive t]ms4 7#e7 ,a vacancy 9 ! ,committee %all be fill$ 9 ! mann] 9 :i* ! orig9al appo9tm5t 0 made4 7b7 ,consultation ,! ,secret>y may consult )1 & seek ! advice (1 ! ,committee ) respect to disability-relat$ que/ions relat+ to vet]ans :o1 dur+ active milit>y1 naval1 or air s]vice1 are suspect$ ( hav+ be5 expos$ to toxic sub/ances4 7c7 ,assessm5ts 7#a7 ,! ,committee %all assess ! exposure ( vet]ans to toxic sub/ances t occurr$ dur+ active milit>y1 naval1 or air s]vice4 7#b7 ,! assessm5ts "u p>agraph 7#a7 %all cov] suspect$ & kn[n toxic exposures occurr+ dur+ active milit>y1 naval1 or air s]vice1 includ+ by id5tify+ & evaluat+ new & em]g+ exposures t are n recogniz$ "u exi/+ presumptions ( s]vice connection4 7#c7 ,! ,committee may conduct an assessm5t "u p>agraph 7#a7 9 response to a recomm5dation by ! ,sci5ce ,review ,bo>d pursuant to section #aagc7;c77#b77;,b7 ( ?is title or ! ,work+ ,gr\p "u section #aagd7;c77#a77;,b74 7#d7 ,9 assess+ ! exposure ( vet]ans to toxic sub/ances "u p>agraph 7#a71 ! ,commission %all det]m9e :e!r-- 7,a7 "u subsection 7d71 fur!r rese>* into ! exposure is w>rant$2 7,b7 "u subsection 7e71 ! exi/+ rese>* be+ assess$ is suffici5t to nom9ate to ! ,sci5ce ,review ,bo>d "u section #aagc ( ?is title = evaluation2 7,c7 "u subsection 7f71 !re is suffici5t evid5ce reg>d+ an exi/+ presumption ( s]vice connection = review by ! ,sci5ce ,review ,bo>d or ,work+ ,gr\p "u section #aagd ( ?is title1 z ! case may be2 or 7,d7 no fur!r action is w>rant$4 7d7 ,rese>* 7#a7 7,a7 ,foll[+ an assessm5t ( ! exposure ( vet]ans to toxic sub/ances t occurr$ dur+ active milit>y1 naval1 or air s]vice "u subsection 7c71 ! ,committee may commission an appropriate entity 7includ+ an elem5t ( ! ,dep>tm5t1 an academic entity1 or a private-sector entity7 to conduct additional rese>* into ! exposure & ! heal? effects ( ! exposure1 includ+ su* rese>* to be conduct$ 9 response to data & analyses provid$ by ! ,secret>y ( ,def5se or ! ,secret>y ( ,vet]ans ,affairs relat+ to suspect$ toxic exposure occurr+ dur+ su* s]vice4 7,b7 ,9 c>ry+ out subp>agraph 7,a71 ! ,committee %all det]m9e :e!r additional rese>* is ne$$ ) respect to ! foll[+3 7i7 ,id5tification ( ! composition ( suspect$ toxic sub/ances4 7ii7 ,exposure assessm5ts4 7iii7 ,epidemiological /udies4 7iv7 ,toxicology & me*ani/ic /udies4 7,c7 ,9 c>ry+ out subp>agraph 7,a71 ! ,committee %all consid] ! foll[+ in=mation3 7i7 ,all available heal? track+ data4 7ii7 ,all available surveillance data4 7iii7 ,all g]mane rese>* previ\sly consid]$ by ! ,committee4 7#b7 ,9 assess+ ! suitability ( topics = additional rese>* pursuant to subp>agraph 7,a71 ! ,committee %all consid] ! foll[+3 7,a7 ,conditions ( s]vice 9 ! active milit>y1 naval1 or air s]vice1 kn[n or suspect$ exposure to ag5ts1 & circum/ances ( exposure4 7,b7 ,exi/+ evid5ce ( a connection betwe5 illnesses & s]vice 9 ! active milit>y1 naval1 or air s]vice1 & ! size or ability to def9e ! gr\p ( affect$ vet]ans4 7,c7 ,9 accordance ) subsection 7g71 input f p]sons :o may be affect$ by ! actions ( ! ,committee4 7,d7 ,exposure assessm5ts1 includ+ data on activities ( ! ,arm$ ,=ces or exposures t may be classifi$4 7,e7 ,exi/+ heal? track+ & surveillance1 includ+ vet]ans & memb]s ( ! active milit>y1 naval1 or air s]vice1 su* z ! burn pit regi/ry e/abli%$ "u section #bja ( ! ,dignifi$ ,burial & ,o!r ,vet]ans' ,b5efits ,improvem5t ,act ( #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7,f7 ,rese>*1 includ+ laboratory rese>* discov]ies & f9d+s f /udies ( memb]s ( ! active milit>y1 naval1 or air s]vice & civilian work]s :o 7 expos$ to toxic sub/ances4 7,g7 ,! effect ( sex1 g5d]1 age1 race1 & e?nicity on heal? outcomes4 7#c7 ,! ,committee %all ensure t ! rese>* commission$ "u p>agraph 7#a7 is tailor$ to produce results or conclusions necess>y = ! ,sci5ce ,review ,bo>d to make a fully in=m$ assessm5t4 7e7 ,nom9ation ,if ! ,committee det]m9es fur!r action is appropriate ) respect to an assessm5t ( ! exposure ( vet]ans to toxic sub/ances t occurr$ dur+ active milit>y1 naval1 or air s]vice "u subsection 7c71 ! ,committee may nom9ate ! ,sci5ce ,review ,bo>d to evaluate ei!r or bo?1 z ! case may be-- 7#a7 ! exi/+ rese>* includ$ 9 ! assessm5t2 or 7#b7 ! fur!r rese>* conduct$ pursuant to subsection 7d74 7f7 ,review ( exi/+ presumptions 7#a7 ,^u receipt ( evid5ce sugge/+ t previ\s f9d+s support+ a positive association betwe5 an exposure & an illness are no long] valid1 ! ,committee may nom9ate su* exposure or illness = review by ! ,sci5ce ,review ,bo>d4 7#b7 ,^u receipt ( evid5ce sugge/+ t previ\s f9d+s reg>d+ ! p]iods & locations ( exposure cov]$ by an exi/+ presumption ( s]vice connection are no long] support$1 ! ,committee may nom9ate su* evid5ce = evaluation by ! ,work+ ,gr\p to modify ! p]iods & locations4 7g7 ,input 7#a7 ,n less ?an qu>t]ly1 ! ,committee %all provide an opportunity = p]sons describ$ 9 p>agraph 7#b7 to pres5t writt5 or oral comm5ts to ! ,committee4 7#b7 ,! p]sons describ$ 9 ?is p>agraph are p]sons :o may be affect$ by ! actions ( ! ,committee1 includ+-- 7,a7 vet]ans1 ! families ( vet]ans1 vet]ans s]vice organizations & repres5tatives1 rese>*]s1 & o!r memb]s ( ! g5]al public2 & 7,b7 dep>tm5ts & ag5cies ( ! ,f$]al ,gov]nm5t4 7h7 ,reports to ,congress ,on a bi5nial basis1 ! ,committee %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate1 & make publicly available1 a report on ! actions ( ! ,committee4 ,ea* su* report %all include1 ) respect to ! p]iod cov]$ by ! report1 ! foll[+3 7#a7 ,a description (-- 7,a7 ! exposure & evid5ce consid]$ by ! ,committee2 7,b7 any rese>* commission$ by ! ,committee2 & 7,c7 ! rationale ( ! nom9ations made by ! ,committee to ! ,sci5ce ,review ,bo>d = fur!r evaluation4 7#b7 ,a description ( ea* specific action recomm5d$ by ! ,committee describ$ 9 subsection 7c77#c74 7#c7 ,ea* report receiv$ by ! ,committee "u section #aagc7;c77#b7 ( ?is title4 #aagc4 ,sci5ce ,review ,bo>d 7a7 ,e/abli%m5t 7#a7 ,!re is 9 ! ,dep>tm5t ! ,sci5ce ,review ,bo>d 79 ?is section ref]r$ to z ! ,bo>d74 7#b7 7,a7 ,! memb]s ( ! ,bo>d %all be appo9t$ by ! ,secret>y f ! g5]al public f among individuals :o are di/+ui%$ 9 ! fields ( m$ic9e1 biological sci5ces1 or heal? adm9i/ration4 7,b7 ,an individual may n concurr5tly s]ve on ! ,bo>d & ! ,=mal ,advisory ,committee on ,toxic ,exposure "u section #aagb ( ?is title4 7,c7 ,! ,secret>y %all det]m9e ! numb]1 t]ms ( s]vice1 & pay & all[ances ( memb]s ( ! ,bo>d appo9t$ by ! ,secret>y4 7b7 ,duties 7#a7 ,^u receiv+ a nom9ation = ! evaluation ( rese>* on ! heal? effects ( exposure ( memb]s ( ! active milit>y1 naval1 or air s]vice to toxic sub/ances made by ! ,=mal ,advisory ,committee on ,toxic ,exposure pursuant to section #aagb ( ?is title1 ! ,bo>d %all-- 7,a7 evaluate ! likelihood t an illness is associat$ ) an exposure to a toxic sub/ance :ile s]v+ 9 ! active milit>y1 naval1 or air s]vice2 & 7,b7 assess ! exposures & illnesses id5tifi$ by ! ,committee & det]m9e :e!r ! evid5ce supports a f9d+ ( a positive association betwe5 ! exposure & ! illness4 7#b7 ,9 c>ry+ out p>agraph 7#a77;,b71 ! ,bo>d %all review all relevant data to det]m9e1 ) respect to ! /r5g? ( evid5ce = a positive association1 t !re is-- 7,a7 suffici5t evid5ce ( an association2 7,b7 limit$ or sugge/ive evid5ce ( an association2 7,c7 inadequate or insuffici5t evid5ce to det]m9e an association2 or 7,d7 limit$ or sugge/ive evid5ce ( no association4 7#c7 ,) respect to an evaluation conduct$ "u ?is subsection1 if ! ,bo>d det]m9es t ! evid5ce = a positive association is inadequate or insuffici5t to det]m9e an association z describ$ 9 p>agraph 7#b77;,c71 ! ,bo>d %all develop a recomm5dation z to :e!r additional data ga!r+ & rese>* are necess>y4 7c7 ,reports 7#a7 ,= ea* evaluation conduct$ "u subsection 7b7 :]e ! ,bo>d det]m9es t ! evid5ce = a positive association is ei!r suffici5t or limit$ or sugge/ive ( an association1 z describ$ 9 subp>agraph 7,a7 or 7,b7 ( p>agraph 7#b7 ( su* subsection1 ! ,bo>d %all submit to ! ,secret>y1 ! ,work+ ,gr\p "u section #aagd ( ?is title1 & to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a report id5tify+ ! evid5ce f\nd to rea* su* positive association det]m9ations4 7#b7 ,= ea* evaluation conduct$ "u subsection 7b7 :]e ! ,bo>d det]m9es t ! evid5ce = positive association is inadequate or insuffici5t to det]m9e an association z describ$ 9 p>agraph 7#b77;,c7 ( su* subsection1 ! ,bo>d %all submit to ! ,secret>y1 ! ,=mal ,advisory ,committee on ,toxic ,exposure1 & to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a report-- 7,a7 id5tify+ ! evid5ce f\nd to rea* su* positive association det]m9ations2 & 7,b7 conta9+ ! recomm5dations "u subsection 7b77#c7 z to :e!r additional data ga!r+ & rese>* are necess>y & an outl9e ( a report reque/ proposal = su* additional data & rese>*4 #aagd4 ,work+ gr\p on presumptions ( s]vice connection 7a7 ,e/abli%m5t ,! ,secret>y %all e/abli% a work+ gr\p 79 ?is section ref]r$ to z ! ,work+ ,gr\p7 to-- 7#a7 evaluate-- 7,a7 ! conclusions ( ! ,sci5ce ,review ,bo>d conta9$ 9 ea* report submitt$ "u section #aagc7;c77#a7 ( ?is title2 & 7,b7 evid5ce nom9at$ by ! ,=mal ,advisory ,committee on ,toxic ,exposure "u section #aagb7;f77#b7 reg>d+ ! p]iods & locations ( exposure cov]$ by an exi/+ presumption ( s]vice connection2 & 7#b7 make a recomm5dation to ! ,secret>y ) respect to :e!r to-- 7,a7 e/abli% a presumption ( s]vice connection = ! toxic exposure & illness cov]$ by ! report describ$ 9 subp>agraph 7,a7 ( p>agraph 7#a72 or 7,b7 modify an exi/+ presumption ( s]vice connection describ$ 9 subp>agraph 7,b7 ( su* p>agraph4 7b7 ,evaluations 7#a7 ,9 evaluat+ ! conclusions ( ! ,sci5ce ,review ,bo>d1 ! ,work+ ,gr\p %all consid] factors1 9 addition to ! conclusions ( ! ,bo>d1 t ! ,work+ ,gr\p det]m9es appropriate4 7#b7 ,! ,work+ ,gr\p %all provide a p]iod ( n few] ?an #fj days = p]sons describ$ 9 section #aagb7;g77#b7 ( ?is title to pres5t writt5 comm5ts to ! ,work+ ,gr\p ) respect to ea* evaluation made "u ?is section4 7c7 ,recomm5dations 7#a7 ,9 mak+ a recomm5dation "u subsection 7a77#b71 ! ,work+ ,gr\p %all-- 7,a7 9 cases :]e ! evid5ce = a positive association is ei!r suffici5t or limit$ or sugge/ive ( an association1 z describ$ 9 subp>agraph 7,a7 or 7,b7 ( section #aagc7;b77#b7 ( ?is title1 weigh heavily 9 favor ( e/abli%+ a presumption ( s]vice connection2 & 7,b7 if ! ,work+ ,gr\p det]m9es t additional rese>*1 /udies1 or reports are appropriate be=e mak+ a f9al recomm5dation ) respect to e/abli%+ or modify+ a presumption ( s]vice connection1 submit to ! ,=mal ,advisory ,committee a description ( su* appropriate additional rese>*1 /udies1 or reports4 7#b7 ,n lat] ?an #fj days aft] ! date on :i* ! comm5t p]iod "u subsection 7b77#b7 ends ) respect to an evaluation made "u ?is section1 ! ,work+ ,gr\p %all submit to ! ,secret>y & to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a description ( ! recomm5dation made "u subsection 7a77#b74 #aage4 ,regulations reg>d+ presumptions ( s]vice connection bas$ on toxic exposure 7a7 ,action ^u ,work+ ,gr\p recomm5dation ,n lat] ?an #fj days aft] ! date on :i* ! ,secret>y receives a recomm5dation to e/abli% or modify a presumption ( s]vice connection "u section #aagd7;c77#b7 ( ?is title-- 7#a7 if ! ,secret>y det]m9es t ! presumption1 or modification1 is w>rant$1 ! ,secret>y %all issue propos$ regulations sett+ =? ! presumption or revise regulations to c>ry out su* modification2 or 7#b7 if ! ,secret>y det]m9es t ! presumption1 or modification1 is n w>rant$1 ! ,secret>y %all publi% 9 ! ,f$]al ,regi/] a notice ( ! det]m9ation1 includ+ ! reasons support+ ! det]m9ation4 7b7 ,f9al regulation ,n lat] ?an #ij days aft] ! date on :i* ! ,secret>y issues any propos$ regulations "u subsection 7a77#a71 ! ,secret>y %all issue f9al regulations4 ,su* regulations %all be effective on ! date ( issuance4 7c7 ,removal ( presumption 7#a7 ,! ,secret>y may issue regulations to remove an illness f a presumption ( s]vice connection previ\sly e/abli%$ pursuant to a regulation issu$ "u subsection 7b74 7#b7 ,:5ev] an illness is remov$ f regulations pursuant to p>agraph 7#a71 or ! p]iods & locations ( exposure cov]$ by a presumption ( s]vice connection are modifi$ "u subsection 7a7-- 7,a7 a vet]an :o 0 aw>d$ comp5sation = su* illness on ! basis ( ! presumption provid$ "u su* regulations be=e ! effective date ( ! removal or modification %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 su* illness on ! basis ( su* presumption %all cont9ue to be entitl$ to receive dep5d5cy & indemnity comp5sation on su* basis4 #aagf4 ,exp]t ,advisory ,panel on ,con/rictive ,bron*iolitis 7a7 ,e/abli%m5t ,!re is 9 ! ,dep>tm5t ! ,exp]t ,advisory ,panel on ,con/rictive ,bron*iolitis 79 ?is section ref]r$ to z ! ,panel74 7b7 ,memb]%ip 7#a7 ,! ,panel %all be appo9t$ by ! ,secret>y f ! g5]al public f among individuals :o are-- 7,a7 exp]ts 9 pulmon>y pa?ology2 7,b7 exp]ts 9 o!r fields ! ,secret>y det]m9es appropriate1 su* z pulmon>y m$ic9e1 toxicology1 epidemiology1 exposure assessm5t1 & radiology2 & 7,c7 individuals repres5t+ ! vet]ans community4 7#b7 ,! ,secret>y %all det]m9e ! numb]1 t]ms ( s]vice1 & pay & all[ances ( memb]s ( ! ,panel appo9t$ by ! ,secret>y4 7c7 ,duties ,! panel %all develop specific guidel9es = rese>* conduct$ by ! ,dep>tm5t ( symptomatic vet]ans :o s]v$ 9 ! active milit>y1 naval1 or air s]vice 9 ! ,s\?we/ ,asia !at] ( op]ations :om ! diff]5tial diagnosis includes bron*iolitis4 ,! ,panel %all-- 7#a7 det]m9e ! adequacy ( lung biopsy approa*es & recomm5d to ! ,secret>y be/ practices2 7#b7 make recomm5dations to ! ,secret>y = process+1 h&l+1 & /or+ lung biopsies2 7#c7 e/abli% hi/ologic & pa?ology crit]ia = confirm+ diagnoses2 & 7#d7 submit to ! ,secret>y & to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate reports on ! f9d+s & results ( su* rese>*4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #aafc ! foll[+ new items3 ,sub*apt] ,,vii--,rese>* & det]m9ations relat+ to presumptions ( s]vice connection bas$ on toxic exposure #aaga4 ,proc$ures to det]m9e presumptions ( s]vice connection bas$ on toxic exposure2 def9itions4 #aagb4 ,=mal ,advisory ,committee on ,toxic ,exposure4 #aagc4 ,sci5ce ,review ,bo>d4 #aagd4 ,work+ gr\p on presumptions ( s]vice connection4 #aage4 ,regulations reg>d+ presumptions ( s]vice connection bas$ on toxic exposure4 #aagf4 ,exp]t ,advisory ,panel on ,con/rictive ,bron*iolitis4 4 7b7 ,con=m+ am5dm5ts ,*apt] #aa ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ z foll[s3 7#a7 ,section #aaaf is am5d$-- 7,a7 by /rik+ subsections 7b71 7c71 7d71 & 7e72 7,b7 by ins]t+ aft] subsection 7a7 ! foll[+ new subsection 7b73 7b7 ,! ,secret>y %all ensure t any det]m9ation made on or aft] ! date ( ! enactm5t ( ! ,,fa/] ,presumptions ,act reg>d+ a presumption ( s]vice connection bas$ on exposure to an h]bicide ag5t "u ?is section is made pursuant to sub*apt] ,,vii ( ?is *apt]1 includ+ ) respect to assess+ reports receiv$ by ! ,secret>y f ! ,national ,academy ( ,sci5ces "u section #c ( ! ,ag5t ,orange ,act ( #aiia 7,public ,law #ajb-d74 2 & 7,c7 by r$esignat+ subsection 7f7 z subsection 7c74 7#b7 ,section #aaaf;,b7b77#b77;,a7 is am5d$ by ins]t+ pursuant to sub*apt] ,,vii ( ?is *apt]1 be=e ! ,secret>y det]m9es4 7#c7 ,section #aaah is am5d$-- 7,a7 by /rik+ subsections 7b71 7c71 7d71 & 7e72 & 7,b7 by ins]t+ aft] subsection 7a7 ! foll[+ new subsection 7b73 7b7 ,! ,secret>y %all ensure t any det]m9ation made on or aft] ! date ( ! enactm5t ( ! ,,fa/] ,presumptions ,act reg>d+ a presumption ( s]vice connection bas$ on exposure to a toxic sub/ance "u ?is section is made pursuant to sub*apt] ,,vii ( ?is *apt]4 4 7c7 ,access to heal? c>e ,section #agaj7;e7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 9 p>agraph 7#a71 by add+ at ! end ! foll[+ new subp>agraph3 7,g7 7i7 ,subject to p>agraph 7#b71 z det]m9$ appropriate by ! ,secret>y1 a tox9-expos$ vet]an is eligible = hospital c>e & m$ical s]vices "u subsection 7a77#b77;,f7 = any diagnos$ illness t ! ,secret>y det]m9es is cov]$ by1 or reasonably c\ld be cov]$ by1 p5d+ rese>* dur+ ! p]iod beg9n+ on ! date on :i* ! ,=mal ,advisory ,committee on ,toxic ,exposure beg9s assess+ su* rese>* "u section #aagb7;c7 ( ?is title & end+ on ! date specifi$ 9 clause 7ii74 7ii7 ,! date specifi$ 9 ?is clause is ! foll[+3 7,i7 ,9 cases ( p5d+ rese>* = :i* ! ,secret>y det]m9es "u section #aage7;a77#a7 ( ?is title t a presumption ( s]vice connection is w>rant$1 ! date on :i* ! tox9-expos$ vet]an is o!rwise eligible = hospital c>e & m$ical s]vices pursuant to ?is section by reason ( regulations issu$ "u su* section #aage4 7,,ii7 ,9 cases ( p5d+ rese>* = :i* ! ,secret>y det]m9es "u section #aage7;a77#b7 t a presumption ( s]vice connection is n w>rant$1 ! date1 if any1 t ! ,secret>y det]m9es appropriate4 7iii7 ,9 ?is subp>agraph3 7,i7 ,! t]m p5d+ rese>* means rese>* assess$ or commission$ by ! ,=mal ,advisory ,committee on ,toxic ,exposure "u section #aagb reg>d+ ! exposure ( vet]ans to toxic sub/ances4 7,,ii7 ,! t]m tox9-expos$ vet]an means a vet]an-- 7aa7 ^: s]vice 9 ! active milit>y1 naval1 or air s]vice is cov]$ by p5d+ rese>*2 & 7bb7 :o is n o!rwise eligible = hospital c>e & m$ical s]vices pursuant to ?is p>agraph4 2 & 7#b7 9 p>agraph 7#b77;,b71 by /rik+ or 7,f7 & ins]t+ 7,f71 or 7,g74 #c4 ,improvem5ts to data collection & use 7a7 ,plan ,! ,secret>y ( ,def5se1 9 consultation ) ! ,secret>y ( ,vet]ans ,affairs1 %all develop & implem5t a plan to /r5g!n ! data collection ) respect to memb]s ( ! ,arm$ ,=ces1 includ+ memb]s ( ! res]ve compon5ts1 :o are expos$ to toxic sub/ances :ile s]v+ 9 ! ,arm$ ,=ces4 ,! plan %all provide = ! foll[+3 7#a7 ,detail+ me?ods ( cont9u\s 9-s]vice surveillance1 includ+ data collection & analysis1 ( su* exposures & ! physical & m5tal heal? ( ! memb]s4 7#b7 ,surveill+ su* exposures & ! heal? ( memb]s f accession ?r\gh sep>ation1 includ+1 :]e possible1 ?r\gh ! use ( we>able & portable devices to assess heal? outcomes1 & ext5d su* surveillance indef9itely po/-sep>ation = ^? vet]ans ) suspect$ exposure to toxic sub/ances4 7#c7 ,ensur+ consi/5t surveillance ef=ts across ! ,arm$ ,=ces4 7#d7 ,det]m9+ ! feasibility ( collect+ biological samples & ! means by :i* su* collection c\ld be accompli%$1 includ+1 at a m9imum1 ?r\gh use ( we>able & portable devices & ! collection ( blood & ur9e1 to measure exposure 9 deploy$ environm5ts4 7#e7 ,ma9ta9+ a repository ( data & biological samples available = prospective rese>*4 7#f7 ,) respect to ea* memb]1 track+ ! milit>y occupational specialty1 deploym5t hi/ory1 disease risk factors1 sex1 g5d]1 age1 race1 & e?nicity4 7b7 ,report ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs & ! ,committees on ,arm$ ,s]vices ( ! ,h\se ( ,repres5tatives & ! ,s5ate1 & annually !reaft] = five ye>s1 a report conta9+ ! plan develop$ "u subsection 7a7 & ! /atus ( implem5t+ ! plan4 7c7 ,integration ,! ,secret>y ( ,def5se %all integrate rese>* access consid]ations ( ! plan develop$ "u subsection 7a7 into ! electronic heal? record mod]nization program & ! individual longitud9al exposure record program4 7d7 ,det]m9ations ,! ,secret>y ( ,vet]ans ,affairs1 9 consultation ) ! ,=mal ,advisory ,committee on ,toxic ,exposure e/abli%$ "u section #aagb ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #b1 %all det]m9e-- 7#a7 :e!r /udies ( respiratory heal? outcomes f o!r c\ntries1 includ+ ,au/ralia1 ,canada1 ,france1 ,pol&1 ,sw$51 & ! ,unit$ ,k+dom1 provide useful data1 & :e!r ! /ructure ( ^! /udies c\ld be emulat$ 9 ! ,unit$ ,/ates to improve p>ticipation rates2 & 7#b7 :e!r ! heal? records ( vet]ans f heal? c>e sy/ems o!r ?an ! ,dep>tm5t ( ,vet]ans ,affairs1 includ+ private-sector heal? provid]s1 ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & ! ,,tric>e program1 c be access$ = rese>* purposes4 7e7 ,%>+ ( in=mation ,! ,secret>y ( ,vet]ans ,affairs %all provide to ! ,=mal ,advisory ,committee on ,toxic ,exposure & ! ,sci5ce ,review ,bo>d e/abli%$ "u section #aagc ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #b1 ! results ( surveillance conduct$ pursuant to ! plan develop$ "u subsection 7a71 includ+ data collection & analysis4 #d4 ,/udies relat+ to vet]ans :o s]v$ 9 ,s\?we/ ,asia 7a7 ,analysis ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all initiate or sponsor an updat$ analysis ( total & respiratory disease mortality 9 cov]$ vet]ans4 ,! /udy %all include1 to ! ext5t practicable-- 7#a7 metrics ( airborne exposures2 7#b7 ! location & tim+ ( deploym5ts2 7#c7 ! milit>y occupational specialty2 7#d7 ! ,arm$ ,=ce 9 :i* ! vet]an s]v$2 7#e7 pre-exi/+ heal? /atus1 includ+ ) respect to a/hma2 & 7#f7 relevant p]sonal in=mation1 includ+ cig>ette & e-cig>ette smok+ hi/ory1 diet1 sex1 g5d]1 age1 race1 & e?nicity4 7b7 ,epidemiological /udy ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all sponsor an epidemiological /udy ( cov]$ vet]ans t uses ! foll[+3 7#a7 ,improv$ spatio-temporal e/imates ( ambi5t air pollution exposures us+ advances 9 retrospective exposure assessm5t4 7#b7 ,detail$ in=mation on ! /udy subjects obta9$ ?r\gh m$ical records1 adm9i/rative data1 & o!r exi/+ s\rces1 t include-- 7,a7 p]sonal *>act]i/ics1 includ+ cig>ette & e-cig>ette smok+ hi/ory1 diet1 sex1 g5d]1 age1 race1 & e?nicity2 7,b7 deploym5t hi/ory1 includ+ locations1 p]iods1 & numb] ( deploym5ts2 7,c7 biospecim5 data2 & 7,d7 supplem5t>y heal? /atus & outcomes data1 includ+ imag+ & physiological p>amet]s4 7c7 ,toxicology /udy ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all sponsor a toxicology /udy to include v>iability to replicate exposures ( heal?y1 "y memb]s ( ! ,arm$ ,=ces1 z well z pot5tially susceptible memb]s1 ) preexi/+ heal? conditions4 ,! /udy %all-- 7#a7 analyze ! /udy results = me*ani/ic m>k]s & cl9ically relevant outcomes2 & 7#b7 validate s]um1 tissue1 & o!r biom>k]s ( exposure1 susceptibility1 or effect4 7d7 ,cov]$ vet]an def9$ ,! t]m cov]$ vet]an means any vet]an :o-- 7#a7 on or aft] ,augu/ #b1 #aiij1 s]v$ on active duty 9-- 7,a7 ,bahra92 7,b7 ,iraq2 7,c7 ,kuwait2 7,d7 ,oman2 7,e7 ,qat>2 7,f7 ,saudi ,arabia2 7,g7 ,somalia2 or 7,h7 ,unit$ ,arab ,emirates2 or 7#b7 on or aft] ,septemb] #aa1 #bjja1 s]v$ on active duty 9-- 7,a7 ,afghani/an2 7,b7 ,djib\ti2 7,c7 ,egypt2 7,d7 ,jordan2 7,e7 ,lebanon2 7,f7 ,syria2 or 7,g7 ,yem54 #e4 ,tra9+ to improve claims adjudications 7a7 ,tra9+ on adjudication ,! ,secret>y ( ,vet]ans ,affairs %all provide tra9+ to ea* cov]$ employee to improve ! h&l+ ( claims = comp5sation & p5sion b5efits t relate to toxic exposure4 ,! ,secret>y %all provide su* tra9+ annually &1 9 addition to ! annual tra9+1 :5 ! ,secret>y det]m9es t a significant developm5t has occurr$ 9 law or regulation ) respect to su* claims1 su* z ! ,secret>y e/abli%+ a new presumption ( s]vice connection4 7b7 ,matt]s includ$ 7#a7 ,all tra9ees ,! tra9+ "u subsection 7a7 %all include ! foll[+ explanations ) respect to claims relat+ to toxic exposure3 7,a7 ,a lack ( a presumption ( s]vice connection is n by itself suffici5t to det]m9e t s]vice connection does n exi/4 7,b7 ,! claims adjudicator %all always consid] :e!r direct s]vice connection is applicable & reque/1 z ne$$1 an advisory m$ical op9ion "u section #eaji ( title #ch1 ,unit$ ,/ates ,code4 7,c7 ,:ile in=mation includ$ 9 ! individual longitud9al exposure record program ( ! ,dep>tm5t ( ,vet]ans ,affairs may be us$ to corroborate ass]tions ( toxic exposure1 a lack ( su* in=mation1 or a lack ( o!r corroborat+ evid5ce ( toxic exposure1 is n by itself suffici5t to det]m9e t su* exposure did n occur or suffici5t to d5y ! claim4 7#b7 ,vet]ans ,s]vice ,repres5tatives ,9 addition to ! matt]s "u p>agraph 7#a71 ! ,secret>y %all ensure t ea* employee describ$ 9 subsection 7d77#a7 receives an individualiz$ assessm5t (-- 7,a7 ! ability ( ! employee to id5tify claims qualify+ = presumptive s]vice connection2 & 7,b7 ! compliance ( ! employee ) /&>diz$ developm5t requirem5ts4 7#c7 ,rat+ ,vet]ans ,s]vice ,repres5tative ,9 addition to ! matt]s "u p>agraph 7#a71 ! ,secret>y %all ensure t ea* employee describ$ 9 subsection 7d77#b7 receives an individualiz$ assessm5t (-- 7,a7 ! ability ( ! employee to id5tify claims qualify+ = presumptive s]vice connection2 & 7,b7 ! compliance ( ! employee ) ! s*$ule ( rat+s = disabilities adopt$ "u section #aaee ( title #ch1 ,unit$ ,/ates ,code4 7#d7 ,comp5sation & p5sion m$ical exam9]s ,9 addition to ! matt]s "u p>agraph 7#a71 ! ,secret>y %all ensure t ea* employee describ$ 9 subsection 7d77#c7 receives an individualiz$ assessm5t (-- 7,a7 ! ability ( ! employee to id5tify claims qualify+ = presumptive s]vice connection2 & 7,b7 ! compliance ( ! employee ) /&>diz$ exam9ation & m$ical op9ion proc$ures4 7c7 ,provision ( tra9+ ,) respect to employees describ$ 9 p>agraph 7#a7 or 7#b7 ( subsection 7d71 ! ,secret>y %all-- 7#a7 ensure t ! tra9+ "u subsection 7a7 is provid$ z "p ( ! initial tra9+ program = su* employees2 7#b7 place ea* employee "u a second signature review p]iod = claims relat+ to toxic exposure until ! employee meets ! requir$ grade scale level quality /&>d = su* claims2 & 7#c7 us+ ! ,sy/ematic ,te*nical ,accuracy ,review program1 or su* successor program1 conduct a nationwide1 qu>t]ly1 r&omiz$ review ( ! quality ( adjudication ( claims relat+ to toxic exposure4 7d7 ,cov]$ employee def9$ ,9 ?is section1 ! t]m cov]$ employee means employees ( ! ,dep>tm5t ( ,vet]ans ,affairs :o h&le claims = comp5sation & p5sion b5efits1 includ+-- 7#a7 employees :o adjudicate claims2 7#b7 employees :o apply ! s*$ule ( rat+s = disabilities adopt$ "u section #aaee ( title #ch1 ,unit$ ,/ates ,code1 & prep>e rat+ decisions2 & 7#c7 employees or contractors :o provide m$ical exam9ations or m$ical op9ions pursuant to section #eajc;,a7d7 ( su* title4