,i #aag? ,,congress #a/ ,session ,h4 ,r4 #cifg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #ag1 #bjba,mr4 ,takano 7= himself1 ,mrs4 ,luria1 ,mr4 ,ruiz1 ,ms4 ,slotk91 ,mr4 ,trone1 ,ms4 ,br[nley1 ,mr4 ,lev9 ( ,cali=nia1 ,mr4 ,pappas1 ,mr4 ,lamb1 ,mr4 ,br[n1 ,mr4 ,gallego1 ,ms4 ,und]wood1 ,mr4 ,sablan1 ,mr4 ,mrvan1 ,mr4 ,allr$1 ,ms4 ,kaptur1 ,ms4 ,lois ,frankel ( ,florida1 ,mr4 ,ryan1 ,mr4 ,mc,govern1 ,mr4 ,h>d] ( ,cali=nia1 ,mr4 ,fitzpatrick1 ,mr4 ,kilm]1 ,mr4 ,soto1 ,ms4 ,m5g1 ,ms4 ,/rickl&1 & ,ms4 ,spanb]g]7 introduc$ ! 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 improve heal? c>e & b5efits = vet]ans expos$ to toxic sub/ances1 & = o!r purposes4 #a4 ,%ort title2 ref]5ces to title #ch1 ,unit$ ,/ates ,code2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,honor+ our ,promise to ,address ,compreh5sive ,toxics ,act ( #bjba or ! ,honor+ our ,,pact ,act ( #bjba4 7b7 ,ref]5ces to title #ch1 ,unit$ ,/ates ,code ,except z o!rwise expressly provid$1 :5ev] 9 ?is title an am5dm5t or repeal is express$ 9 t]ms ( an am5dm5t to1 or repeal (1 a section or o!r provision1 ! ref]5ce %all be consid]$ to be made to a section or o!r provision ( title #ch1 ,unit$ ,/ates ,code4 7c7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 ref]5ces to title #ch1 ,unit$ ,/ates ,code2 table ( cont5ts4,title ,i--,expansion ( heal? c>e eligibility = toxic expos$ veterans,sec4 #aja4 ,%ort title4,sec4 #ajb4 ,def9itions relat+ to toxic expos$ vet]ans4,sec4 #ajc4 ,expansion ( heal? c>e = specific categories ( toxic expos$ vet]ans4,title ,,ii--,toxic exposure presumption process,sec4 #bja4 ,%ort title4,sec4 #bjb4 ,improvem5ts to ability ( ,dep>tm5t ( ,vet]ans ,affairs to e/abli% presumptions ( s]vice connection bas$ on toxic exposure4,sec4 #bjc4 ,reevaluation ( claims = comp5sation involv+ presumptions ( s]vice connection4,title ,,iii--,improv+ ! e/abli%m5t ( s]vice connection process = toxic expos$ veterans,sec4 #cja4 ,%ort title4,sec4 #cjb4 ,presumptions ( toxic exposure4,sec4 #cjc4 ,m$ical nexus exam9ations = toxic exposure risk activities4,title ,,iv--,presumptions ( s]vice connection,sec4 #dja4 ,treatm5t ( vet]ans :o p>ticipat$ 9 cleanup ( ,enewetak ,atoll z radiation-expos$ vet]ans = purposes ( presumption ( s]vice connection ( c]ta9 disabilities by ,dep>tm5t ( ,vet]ans ,affairs4,sec4 #djb4 ,treatm5t ( vet]ans :o p>ticipat$ 9 nucle> response ne> ,palom>es1 ,spa91 z radiation-expos$ vet]ans = purposes ( presumption ( s]vice connection ( c]ta9 disabilities by ,dep>tm5t ( ,vet]ans ,affairs4,sec4 #djc4 ,presumptions ( s]vice connection = diseases associat$ ) exposures to c]ta9 h]bicide ag5ts = vet]ans :o s]v$ 9 c]ta9 locations4,sec4 #djd4 ,addition ( additional diseases associat$ ) exposure to c]ta9 h]bicide ag5ts = :i* !re is a presumption ( s]vice connection = vet]ans :o s]v$ 9 c]ta9 locations4,sec4 #dje4 ,improv+ comp5sation = disabilities occurr+ 9 ,p]sian ,gulf ,w> vet]ans4,sec4 #djf4 ,presumption ( s]vice connection = c]ta9 diseases associat$ ) exposure to burn pits & o!r tox9s4,title ,v--,rese>* matters,sec4 #eja4 ,coord9ation by ,dep>tm5t ( ,vet]ans ,affairs ( toxic exposure rese>*4,sec4 #ejb4 ,data collection1 analysis1 & report on treatm5t ( vet]ans = illnesses relat$ to toxic exposure4,sec4 #ejc4 ,/udies relat$ to vet]ans :o s]v$ 9 ,s\?we/ ,asia & c]ta9 o!r locations4,sec4 #ejd4 ,/udy on heal? tr5ds ( po/ #i_/aa vet]ans4,sec4 #eje4 ,/udy on canc] rates among vet]ans4,sec4 #ejf4 ,/udy on feasibility & advisability ( furni%+ hospital c>e & m$ical s]vices to dep5d5ts ( vet]ans :o p>ticipat$ 9 toxic exposure risk activities4,title ,,vi--,improvem5t ( res\rces & tra9+ reg>d+ toxic expos$ veterans,sec4 #fja4 ,%ort title2 def9itions4,sec4 #fjb4 ,publication ( li/ ( res\rces ( ,dep>tm5t ( ,vet]ans ,affairs = toxic expos$ vet]ans & outrea* program = su* vet]ans & c>egiv]s & survivors ( su* vet]ans4,sec4 #fjc4 ,incorporation ( toxic exposure que/ionnaire dur+ prim>y c>e appo9tm5ts4,sec4 #fjd4 ,tra9+ = p]sonnel ( ! ,dep>tm5t ( ,vet]ans ,affairs ) respect to toxic expos$ vet]ans4,title ,,vii--,regi/ries1 records1 & o!r matters,sec4 #gja4 ,regi/ry ( individuals expos$ to p]- & polyfluoroalkyl sub/ances on milit>y in/allations4,sec4 #gjb4 ,=t ,mc,clellan ,heal? ,regi/ry4,sec4 #gjc4 ,indep5d5t /udy on ,individual ,longitud9al ,exposure ,record4,sec4 #gjd4 ,biannual report on ,individual ,longitud9al ,exposure ,record4,sec4 #gje4 ,correction ( exposure records by memb]s ( ! ,arm$ ,=ces & vet]ans4 ,i ,expansion ( heal? c>e eligibility = toxic expos$ vet]ans #aja4 ,%ort title ,?is title may be cit$ z ! ,conc$+ ,our ,vet]ans' ,exposures ,n[ ,& ,necessitat+ ,tra9+ ,act or ! ,,cov5ant ,act4 #ajb4 ,def9itions relat+ to toxic expos$ vet]ans 7a7 ,9 g5]al ,section #agaj7;a77#b77;,f7 is am5d$ by /rik+ :o 0 expos$ to a toxic sub/ance1 radiation1 or o!r conditions1 z provid$ 9 subsection 7e7 & ins]t+ 9 accordance ) subsection 7e71 :o is a toxic expos$ vet]an4 7b7 ,def9itions ( toxic exposure & toxic expos$ vet]an ,section #aja is am5d$ by add+ at ! end ! foll[+ new p>agraphs3 7#cg7 ,! t]m toxic exposure includes ! foll[+3 7,a7 ,a toxic exposure risk activity1 z def9$ 9 section #agaj7;e77#d7 ( ?is title4 7,b7 ,an exposure to a sub/ance1 *emical1 or airborne haz>d specifi$ 9 section #aaai7;b77#b74 7#ch7 ,! t]m toxic expos$ vet]an means a vet]an describ$ 9 section #agaj7;e77#a7 ( ?is title4 4 7c7 ,def9ition ( toxic exposure risk activity ,section #agaj7;e77#d7 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,! t]m toxic exposure risk activity means any activity-- 7i7 t requires a correspond+ entry 9 ! ,individual ,longitud9al ,exposure ,record ( ! ,dep>tm5t = ! vet]an :o c>ri$ out ! activity2 or 7ii7 t ! ,secret>y det]m9es qualifies = purposes ( ?is subsection :5 tak+ into acc\nt :at is reasonably prud5t to protect ! heal? ( vet]ans4 4 #ajc4 ,expansion ( heal? c>e = specific categories ( toxic expos$ vet]ans 7a7 ,9 g5]al ,section #agaj7;e71 z am5d$ by section #ajb7;c71 is fur!r am5d$-- 7#a7 9 p>agraph 7#a71 by add+ at ! end ! foll[+ new subp>agraphs3 7,g7 ,subject to p>agraph 7#b71 a vet]an :o p>ticipat$ 9 a toxic exposure risk activity :ile s]v+ on active duty1 active duty = tra9+1 or inactive duty tra9+ is eligible = hospital c>e1 m$ical s]vices1 & nurs+ home c>e "u subsection 7a77#b77;,f7 = any illness4 7,h7 ,subject to p>agraph 7#b71 a cov]$ vet]an 7z def9$ 9 section #aaai7;c7 ( ?is title7 is eligible = hospital c>e1 m$ical s]vices1 & nurs+ home c>e "u subsection 7a77#b77;,f7 = any illness4 2 & 7#b7 9 p>agraph 7#b77;,b7-- 7,a7 by /rik+ or 7,f7 & ins]t+ 7,f71 7,g71 or 7,h72 & 7,b7 by /rik+ s]vice or te/+ & ins]t+ s]vice1 te/+1 or activity4 7b7 ,res\rce assessm5t & report 7#a7 ,initial assessm5t & report ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all-- 7,a7 complete an assessm5t to det]m9e-- 7i7 ! p]sonnel & mat]ial res\rces necess>y to implem5t ! am5dm5ts made by subsection 7a72 & 7ii7 ! total numb] ( cov]$ vet]ans1 z su* t]m is def9$ 9 section #aaai7;c7 ( title #ch1 ,unit$ ,/ates ,code 7z add$ by section #cja71 :o receive hospital c>e or m$ical s]vices furni%$ by ! ,secret>y "u *apt] #ag ( su* title1 disaggregat$ by priority gr\p specifi$ 9 section #agje7;a7 ( su* title2 & 7,b7 submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate an initial report conta9+ ! f9d+s ( ! assessm5t complet$ "u subp>agraph 7,a71 includ+ a specific det]m9ation z to :e!r ! ,dep>tm5t has ! p]sonnel & mat]ial res\rces necess>y to implem5t ! am5dm5ts made by subsection 7a74 7#b7 ,subsequ5t reports ,if ! initial report submitt$ "u p>agraph 7#a77;,b7 conta9s a det]m9ation t ! ,dep>tm5t does n h ! p]sonnel or mat]ial res\rces necess>y to implem5t ! am5dm5ts made by subsection 7a71 beg9n+ n lat] ?an #ij days aft] ! submission ( su* initial report & e #ij days !reaft] until ! effective date specifi$ 9 subsection 7c71 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a subsequ5t report conta9+ an update to su* det]m9ation4 7c7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date t is ! e>li] ( ! foll[+3 7#a7 ,! date on :i* ! ,secret>y submits a report "u subsection 7b7 conta9+ a det]m9ation t ! ,dep>tm5t has ! p]sonnel & mat]ial res\rces necess>y to implem5t su* am5dm5ts1 & notifies ! ,law ,revision ,c\nsel ( ! ,h\se ( ,repres5tatives ( ! submission ( ! report s ! ,law ,revision ,c\nsel may execute ! am5dm5ts4 7#b7 ,! date t is #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act4 ,,ii ,toxic exposure presumption process #bja4 ,%ort title ,?is title may be cit$ z ! ,fairly ,assess+ ,s]vice-relat$ ,toxic ,exposure ,residuals ,presumptions ,act or ! ,,fa/] ,presumptions ,act4 #bjb4 ,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 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 ( ?is title-- 7,a7 provides advice to ! ,secret>y on toxic expos$ vet]ans & cases 9 :i* vet]ans :o1 dur+ active milit>y1 naval1 or air s]vice1 may h exp]i5c$ a toxic exposure or _! dep5d5ts may h exp]i5c$ a toxic exposure :ile ! vet]ans 7 s]v+ 9 ! active milit>y1 naval1 or air s]vice2 7,b7 provides to ! ,secret>y recomm5dations on corrections ne$$ 9 ! ,individual ,longitud9al ,exposure ,record to bett] reflect vet]ans & dep5d5ts describ$ 9 subp>agraph 7,a72 & 7,c7 provides to ! ,secret>y recomm5dations reg>d+ :i* cases ( possible toxic exposure describ$ 9 subp>agraph 7,a7 ! ,sci5ce ,review ,bo>d %\ld review2 7#b7 ! ,sci5ce ,review ,bo>d "u section #aagc ( ?is title-- 7,a7 reviews cases ( possible toxic exposure nom9at$ by ! ,secret>y2 7,b7 reviews rese>* nom9at$ by ! ,secret>y2 7,c7 develops recomm5dations = new rese>*2 & 7,d7 det]m9es ! /r5g? ( evid5ce support+ positive association betwe5 toxic exposure & an illness2 7#c7 ! ,work+ ,gr\p "u section #aagd ( ?is title 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 #aage ( ?is title4 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 ,heal? ,adm9i/ration ( ! ,dep>tm5t ! ,=mal ,advisory ,committee on ,toxic ,exposure 79 ?is section ref]r$ to z ! ,committee74 7#b7 7,a7 ,! ,committee %all be compos$ ( n9e memb]s appo9t$ z foll[s3 7i7 ,five memb]s %all be appo9t$ by ! ,secret>y4 7ii7 ,"o memb] %all be appo9t$ by ! ,speak] ( ! ,h\se ( ,repres5tatives4 7iii7 ,"o memb] %all be appo9t$ by ! m9ority lead] ( ! ,h\se ( ,repres5tatives4 7iv7 ,"o memb] %all be appo9t$ by ! majority lead] ( ! ,s5ate4 7v7 ,"o memb] %all be appo9t$ by ! m9ority lead] ( ! ,s5ate4 7,b7 ,! memb]s appo9t$ "u subp>agraph 7,a7 %all meet ! foll[+ crit]ia3 7i7 ,n m ?an ?ree memb]s %all be appo9t$ f among individuals :o are (ficials or employees ( ! ,vet]ans ,b5efits ,adm9i/ration or ! ,vet]ans ,heal? ,adm9i/ration4 7ii7 ,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 & ,prev5tion4 7iii7 ,at lea/ "o memb] %all be appo9t$ f among individuals :o are repres5tatives ( disabl$ vet]ans4 7iv7 ,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]s ( ! ,committee1 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 cases 9 :i* vet]ans :o1 dur+ active milit>y1 naval1 or air s]vice1 are suspect$ ( hav+ exp]i5c$ a toxic exposure or dep5d5ts ( vet]ans :o may h exp]i5c$ a toxic exposure dur+ su* s]vice4 7c7 ,assessm5ts 7#a7 ,! ,committee %all assess cases ( ! toxic exposure ( vet]ans & _! dep5d5ts 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+ toxic 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 p]son describ$ 9 subsection 7e77#b71 by a majority vote ( ! memb]s ( ! ,committee4 7#d7 ,! ,committee %all on a p]iodic basis assess ! ,individual ,longitud9al ,exposure ,record to ensure ! accuracy ( data collect$4 7d7 ,rese>* recomm5dations 7#a7 ,foll[+ an assessm5t ( a case ( ! toxic exposure ( vet]ans or _! dep5d5ts t occurr$ dur+ active milit>y1 naval1 or air s]vice "u subsection 7c71 ! ,committee may develop a recomm5dation = ! ,secret>y reg>d+ :e!r !re %\ld be a review ( ! heal? effects relat$ to ! case ( exposure conduct$ by ! ,sci5ce ,review ,bo>d e/abli%$ "u section #aagc ( ?is title4 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 7e7 ,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 7f7 ,reports by ! ,committee ,n less frequ5tly ?an once ea* ye>1 ! ,committee %all submit to ! ,secret>y & ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives1 & make publicly available1 a report on-- 7#a7 recomm5dations = rese>* "u subsection 7d71 if any2 & 7#b7 recomm5dations = su* legislative or adm9i/rative action z ! ,committee consid]s necess>y = ! ,committee to be m effective 9 c>ry+ out ! requirem5ts ( ?is section4 7g7 ,responses by ,secret>y ,9 response to ea* report submitt$ "u subsection 7f71 ! ,secret>y %all submit to ! ,secret>y & ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives1 & make publicly available1 a report on-- 7#a7 ! f9d+s & op9ions ( ! ,secret>y ) respect to ! report mo/ rec5tly submitt$ "u subsection 7f72 & 7#b7 :e!r ! ,secret>y int5ds to nom9ate to ! ,sci5ce ,review ,bo>d ! review recomm5d$ by ! ,committee 9 ! report1 & if n1 an explanation ( :y1 includ+ citations & s\rces4 #aagc4 ,sci5ce ,review ,bo>d 7a7 ,e/abli%m5t 7#a7 ,!re is 9 ! ,vet]ans ,heal? ,adm9i/ration ( ! ,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>y1 9 consultation ) ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e1 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 ( toxic exposures ( memb]s ( ! active milit>y1 naval1 or air s]vice or dep5d5ts ( su* memb]s made by ! ,secret>y1 ! ,bo>d %all-- 7,a7 evaluate ! likelihood t a positive association exi/s betwe5 an illness & a toxic exposure :ile s]v+ 9 ! active milit>y1 naval1 or air s]vice2 & 7,b7 assess ! toxic exposures & illnesses id5tifi$ by ! ,secret>y & det]m9e :e!r ! evid5ce supports a f9d+ ( a positive association betwe5 ! toxic exposure & ! illness4 7#b7 ,9 c>ry+ out p>agraph 7#a77;,b71 ! ,bo>d %all review all relevant data to det]m9e ! /r5g? ( evid5ce = a positive association bas$ on ! foll[+ f\r categories3 7,a7 ,! suffici5t category1 :]e ! evid5ce is suffici5t to conclude t a positive association exi/s4 7,b7 ,! equipoise & above category1 :]e ! evid5ce is suffici5t to conclude t a positive association is at lea/ z likely z n1 b n suffici5t to conclude t a positive association exi/s4 7,c7 ,! bel[ equipoise category1 :]e ! evid5ce is n suffici5t to conclude t a positive association is at lea/ z likely z n1 or is n suffici5t to make a sci5tifically in=m$ judgm5t4 7,d7 ,! aga9/ category1 :]e ! evid5ce sugge/s ! lack ( a positive association4 7#c7 7,a7 ,) respect to an evaluation conduct$ "u ?is subsection1 if ! ,bo>d det]m9es t ! evid5ce = a positive association is categoriz$ z ei!r ! suffici5t or equipoise & above categories1 ! ,bo>d %all e/imate ! size ( ! positive association effect among ^? expos$ by calculat+ ! relative risk & exposure preval5ce4 7,b7 7i7 ,! ,bo>d %all use ! relative risk & exposure preval5ce calculat$ "u subp>agraph 7,a7 to e/imate ! s]vice-attributable fraction ( illness 9 a milit>y sett+ to det]m9e ! probability ( positive association = an individual4 7ii7 ,9 calculat+ ! s]vice-attributable fraction ( illness1 ! ,bo>d %all consid] ! dose-response relation%ips4 7#d7 7,a7 ,) respect to an evaluation conduct$ "u ?is subsection1 if ! ,bo>d det]m9es t ! evid5ce = a positive association is categoriz$ z ! bel[ equipoise category1 ! ,bo>d %all develop a recomm5dation z to :e!r additional data ga!r+ & rese>* are necess>y4 7,b7 ,if ! ,bo>d recomm5ds additional data ga!r+ & rese>* pursuant to subp>agraph 7,a71 ! ,secret>y %all seek to ent] into an agreem5t ) ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e1 or ano!r nonpr(it1 nongov]nm5tal entity t ! ,secret>y det]m9es has simil> exp]tise & objectivity z ! ,national ,academies1 to conduct su* data ga!r+ & rese>*4 7c7 ,reports 7#a7 ,= ea* evaluation conduct$ "u subsection 7b7 :]e ! ,bo>d det]m9es t ! evid5ce = positive association is categoriz$ z ei!r ! suffici5t or equipoise & above categories1 ! ,bo>d %all submit to ! ,secret>y a report id5tify+ ! evid5ce f\nd to rea* su* positive association det]m9ations4 7#b7 ,9 addition to submitt+ reports "u p>agraph 7#a71 ! ,bo>d %all submit to ! ,secret>y reports1 at su* times & at su* frequ5cies z ! ,bo>d consid]s appropriate1 conta9+ su* recomm5dations z ! ,bo>d may h = additional or new rese>* on matt]s relat+ to toxic exposures describ$ 9 subsection 7b77#a74 7d7 ,responses f ! ,secret>y 7#a7 ,9 response to ea* report receiv$ by ! ,secret>y "u subsection 7c77#a71 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives1 & make publicly available1 a report on ! f9d+s & op9ions ( ! ,secret>y ) respect to ! report receiv$ "u su* subsection4 7#b7 ,ea* report submitt$ "u p>agraph 7#a7 ( ?is subsection %all include1 ) respect to a report receiv$ "u subsection 7c77#a71 ! foll[+3 7,a7 ,! f9d+s & op9ions ( ! ,secret>y ) respect to ! report receiv$ "u subsection 7c77#a74 7,b7 ,:e!r ! ,secret>y int5ds to nom9ate to ! ,work+ ,gr\p1 e/abli%$ "u section #aagd7;a7 ( ?is title1 ! "w ( ! ,sci5ce ,review ,bo>d cov]$ by ! report receiv$ "u subsection 7c77#a7 = fur!r action1 & if n1 an explanation ( :y1 includ+ citations & s\rces4 #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;d77#b7 reg>d+ ! p]iods & locations ( exposure cov]$ by an exi/+ presumption ( s]vice connection2 & 7#b7 develop & submit to ! ,secret>y a recomm5dation ) respect to :e!r-- 7,a7 to 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 to modify an exi/+ presumption ( s]vice connection describ$ 9 subp>agraph 7,b7 ( su* p>agraph4 7b7 ,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 categoriz$ z ei!r ! suffici5t or equipoise & above categories1 z describ$ 9 subp>agraph 7,a7 or 7,b7 ( section #aagc7;b77#b7 ( ?is title1 weigh su* evid5ce heavily 9 favor ( e/abli%+ a presumption ( s]vice connection2 7,b7 take into consid]ation su* factors z may be det]m9$ appropriate by ! ,secret>y2 & 7,c7 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 ! ,secret>y a description ( su* appropriate additional rese>*1 /udies1 or reports4 7#b7 ,at ! same "t z :5 ! ,work+ ,gr\p submits to ! ,secret>y a recomm5dation "u p>agraph 7#b7 ( subsection 7a7 ) respect to an evaluation "u p>agraph 7#a7 ( su* subsection1 ! ,work+ ,gr\p %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives a description ( su* recomm5dation4 7c7 ,report ,! ,secret>y %all p]iodically publi% on ! int]net website ( ! ,dep>tm5t a report id5tify+ any factors = ! ,work+ ,gr\p to consid] "u subsection 7b77#a77;,b71 z det]m9$ appropriate by ! ,secret>y4 #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;a77#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 #ahj 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 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #aafe ! 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 4 7b7 ,con=m+ am5dm5ts ,*apt] #aa is am5d$-- 7#a7 9 section #aaaf-- 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 ( ! ,honor+ our ,promise to ,address ,compreh5sive ,toxics ,act ( #bjba 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 7c72 7#b7 9 section #aaaf;,b7b77#b77;,a71 by ins]t+ pursuant to sub*apt] ,,vii ( ?is *apt]1 be=e ! ,secret>y det]m9es2 & 7#c7 9 section #aaah-- 7,a7 by /rik+ subsections 7b7 ?r\gh 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 ( ! ,honor+ our ,promise to ,address ,compreh5sive ,toxics ,act ( #bjba reg>d+ a presumption ( s]vice connection bas$ on a toxic exposure "u ?is section is made pursuant to sub*apt] ,,vii ( ?is *apt]4 4 #bjc4 ,reevaluation ( claims = comp5sation involv+ presumptions ( s]vice connection 7a7 ,9 g5]al ,sub*apt] ,,vi ( *apt] #aa is am5d$ by add+ at ! end ! foll[+ new section3 #aafg4 ,reevaluation ( comp5sation det]m9ations pursuant to *anges 9 presumptions ( s]vice connection 7a7 ,reevaluation ,except z provid$ 9 subsection 7b71 :5ev] a law1 includ+ ?r\gh a regulation or ,f$]al c\rt decision1 e/abli%es or modifies a presumption ( s]vice connection1 ! ,secret>y %all-- 7#a7 id5tify all claims = comp5sation "u ?is *apt] t-- 7,a7 7 submitt$ to ! ,secret>y2 7,b7 7 evaluat$ & d5i$ by ! ,secret>y be=e ! date on :i* su* provision ( law w5t into effect2 & 7,c7 might h be5 evaluat$ diff]5tly _h ! e/abli%m5t or modification be5 applicable to ! claim2 7#b7 all[ = ! reevaluation ( su* claims at ! election ( ! vet]an2 & 7#c7 ) respect to claims approv$ pursuant to su* reevaluation1 provide comp5sation "u ?is *apt] effective z if ! e/abli%m5t or modification ( ! presumption ( s]vice connection _h be5 9 effect on ! date ( ! submission ( ! orig9al claim describ$ 9 p>agraph 7#a74 7b7 ,outrea* ,) respect to ea* claim id5tifi$ "u subsection 7a71 ! ,secret>y %all conduct outrea* to in=m relevant vet]ans t !y may elect to h a claim be reevaluat$ 9 light ( ! e/abli%m5t or modification ( a presumption ( s]vice connection describ$ 9 su* subsection4 ,su* outrea* %all include ! foll[+3 7#a7 ,! ,secret>y %all publi% on ! int]net website ( ! ,dep>tm5t a notice t su* vet]ans may elect to h a claim s reevaluat$4 7#b7 ,! ,secret>y %all notify1 9 writ+ or by electronic means1 vet]ans s]vice organizations ( ! ability ( su* vet]ans to elect to h a claim s reevaluat$4 7c7 ,relation to o!r laws ,! ,secret>y %all c>ry out subsection 7a7 to ! degree t do+ s does n conflict ) any o!r provision ( law4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #aa ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #aafe ! foll[+ new item3 #aafg4 ,reevaluation ( comp5sation det]m9ations pursuant to *anges 9 presumptions ( s]vice connection4 4 7c7 ,application ,section #aafg ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 %all apply ) respect to presumptions ( s]vice connection e/abli%$ or modifi$ on or aft] ! date ( ! enactm5t ( ?is ,act1 includ+ pursuant to am5dm5ts made by ?is ,act4 ,,iii ,improv+ ! e/abli%m5t ( s]vice connection process = toxic expos$ vet]ans #cja4 ,%ort title ,?is title may be cit$ z ! ,vet]ans ,burn ,pits ,exposure ,recognition ,act4 #cjb4 ,presumptions ( toxic exposure 7a7 ,9 g5]al ,sub*apt] ,,ii ( *apt] #aa is am5d$ by add+ at ! end ! foll[+ new section3 #aaai4 ,presumptions ( toxic exposure 7a7 ,consid]ation ( ,individual ,longitud9al ,exposure ,record requir$ ,if a vet]an submits to ! ,secret>y a claim = comp5sation = a s]vice-connect$ disability "u section #aaaj ( ?is title ) evid5ce ( a disability & a toxic exposure t occurr$ dur+ active milit>y1 naval1 or air s]vice1 ! ,secret>y %all1 9 adjudicat+ su* claim1 consid]-- 7#a7 ! ,individual ,longitud9al ,exposure ,record ( ! vet]an2 & 7#b7 if ! ,individual ,longitud9al ,exposure ,record ( ! vet]an does n indicate t ! vet]an 0 subject to a toxic exposure dur+ active milit>y1 naval1 or air s]vice1 ! totality ( ! circum/ances ( ! s]vice ( ! vet]an4 7b7 ,presumption ( specific toxic exposure = memb]s :o s]v$ 9 c]ta9 locations 7#a7 ,! ,secret>y %all1 = purposes ( section #aaaj & *apt] #ag ( ?is title1 presume t any cov]$ vet]an 0 expos$ to ! sub/ances1 *emicals1 & haz>ds li/$ 9 p>agraph 7#b7 dur+ ! s]vice ( ! cov]$ vet]an specifi$ 9 subsection 7c77#a71 unless !re is affirmative evid5ce to e/abli% t ! cov]$ vet]an 0 n expos$ to any su* sub/ances1 *emicals1 or haz>ds 9 connection ) su* s]vice4 7#b7 7,a7 ,subject to subp>agraph 7,b71 ! sub/ances1 *emicals1 & airborne haz>ds li/$ 9 ?is p>agraph are z foll[s3 7i7 ,p>ticulate matt]1 includ+ ! foll[+3 7,i7 ,,pm-#aj4 7,,ii7 ,,pm-#b4e4 7ii7 ,polycyclic aromatic hydroc>bons 7,p,a,hs71 includ+ ! foll[+3 7,i7 ,ac5aph!ne4 7,,ii7 ,ac5aph?yl5e4 7,,iii7 ,an?rac5e4 7,,iv7 ,b5zo7a7an?rac5e4 7,v7 ,b5zo7a7pyr5e4 7,,vi7 ,b5zo7b7fluoran!ne4 7,,vii7 ,b5zo7g1h1i7p]yl5e4 7,,viii7 ,b5zo7k7fluoran!ne4 7,,ix7 ,*rys5e4 7,x7 ,dib5z7a1h7an?rac5e4 7,,xi7 ,fluoran!ne4 7,,xii7 ,fluor5e4 7,,xiii7 ,ind5o7#a1b1c-;cd7pyr5e4 7,,xiv7 ,naph?al5e4 7,,xv7 ,ph5an?r5e4 7,,xvi7 ,pyr5e4 7iii7 ,volatile organic comp\nds 7,v,o,cs71 includ+ ! foll[+3 7,i7 ,acetone4 7,,ii7 ,acrole94 7,,iii7 ,b5z5e4 7,,iv7 ,c>bon ,disulfide4 7,v7 ,*lorodifluorome?ane4 7,,vi7 ,*lorome?ane4 7,,vii7 ,e?ylb5z5e4 7,,viii7 ,hexa*lorobutadi5e4 7,,ix7 ,hexane4 7,x7 m_/p-,xyl5e4 7,,xi7 ,me?yl5e ,*loride4 7,,xii7 ,p5tane4 7,,xiii7 ,propyl5e4 7,,xiv7 ,/yr5e4 7,,xv7 ,tolu5e4 7iv7 ,toxic organic halog5at$ diox9s & furans 7diox9s71 includ+ ! foll[+3 7,i7 #a1b1c1d1f1g1h ,,hpcdd4 7,,ii7 #a1b1c1d1f1g1h ,,hpcdf4 7,,iii7 #a1b1c1d1g1h1i ,,hpcdf4 7,,iv7 #a1b1c1d1g1h ,,hxcdd4 7,v7 #a1b1c1f1g1h ,,hxcdd4 7,,vi7 #a1b1c1g1h1i ,,hxcdd4 7,,vii7 #a1b1c1d1g1h ,,hxcdf4 7,,viii7 #a1b1c1f1g1h ,,hxcdf4 7,,ix7 #a1b1c1g1h1i ,,hxcdf4 7,x7 #a1b1c1g1h ,,pecdd4 7,,xi7 #a1b1c1g1h ,,pecdf4 7,,xii7 #b1c1d1f1g1h ,,hxcdf4 7,,xiii7 #b1c1d1g1h ,,pecdf4 7,,xiv7 #b1c1g1h ,,tcdd4 7,,xv7 #b1c1g1h ,,tcdf4 7,,xvi7 ,octa*lorodib5zodiox94 7,,xvii7 ,octa*lorodib5z(uran4 7v7 ,su* o!r sub/ances1 *emicals1 & airborne haz>ds z ! ,secret>y1 9 collaboration ) ! ,secret>y ( ,def5se1 may det]m9e appropriate4 7,b7 7i7 ,! ,secret>y may add to or remove f ! li/ "u subp>agraph 7,a7 z ! ,secret>y1 9 collaboration ) ! ,secret>y ( ,def5se1 det]m9es appropriate4 7ii7 ,beg9n+ n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ! ,honor+ our ,promise to ,address ,compreh5sive ,toxics ,act ( #bjba1 & n less frequ5tly ?an once e two ye>s !reaft]1 ! ,secret>y %all submit to ,congress a report id5tify+ any additions or removals made pursuant to subp>agraph 7,a7 dur+ ! p]iod cov]$ by ! report4 7c7 ,def9itions ,9 ?is section3 7#a7 ,! t]m cov]$ vet]an means any vet]an :o-- 7,a7 on or aft] ,augu/ #b1 #aiij1 p]=m$ active milit>y1 naval1 or air s]vice :ile assign$ to a duty /ation 9-- 7i7 ,bahra92 7ii7 ,iraq2 7iii7 ,kuwait2 7iv7 ,oman2 7v7 ,qat>2 7vi7 ,saudi ,arabia2 7vii7 ,somalia2 or 7viii7 ,unit$ ,arab ,emirates2 or 7,b7 on or aft] ,septemb] #aa1 #bjja1 p]=m$ active milit>y1 naval1 or air s]vice :ile assign$ to a duty /ation 9-- 7i7 ,afghani/an2 7ii7 ,djib\ti2 7iii7 ,egypt2 7iv7 ,jordan2 7v7 ,lebanon2 7vi7 ,syria2 7vii7 ,yem52 7viii7 ,uzbeki/an2 7ix7 ! ,philipp9es2 or 7x7 any o!r c\ntry det]m9$ relevant by ! ,secret>y4 7#b7 ,! t]m ,individual ,longitud9al ,exposure ,record includes any pilot program or o!r program us$ by ! ,dep>tm5t ( ,vet]ans ,affairs or ! ,dep>tm5t ( ,def5se to track h[ memb]s ( ! ,arm$ ,=ces or vet]ans h be5 expos$ to v>i\s occupational or environm5tal haz>ds4 7#c7 ,! t]m toxic exposure risk activity has ! mean+ giv5 su* t]m 9 section #agaj7;e77#d7 ( ?is title4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #aa is am5d$ by ins]t+ aft] ! item relat+ to section #aaah ! foll[+ new item3 #aaai4 ,presumptions ( toxic exposure4 4 #cjc4 ,m$ical nexus exam9ations = toxic exposure risk activities 7a7 ,9 g5]al ,sub*apt] ,,vi ( *apt] #aa1 z am5d$ by section #bjc ( ?is ,act1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #aafh4 ,m$ical nexus exam9ations = toxic exposure risk activities 7a7 ,m$ical exam9ations & m$ical op9ions 7#a7 ,except z provid$ 9 subsection 7b71 if a vet]an submits to ! ,secret>y a claim = comp5sation = a s]vice-connect$ disability "u section #aaaj ( ?is title ) evid5ce ( a disability & evid5ce ( p>ticipation 9 a toxic exposure risk activity dur+ active milit>y1 naval1 or air s]vice1 & su* evid5ce is n suffici5t to e/abli% a s]vice connection = ! disability1 ! ,secret>y %all-- 7,a7 provide ! vet]an ) a m$ical exam9ation "u section #eajc;,a7d7 ( ?is title2 & 7,b7 reque/ a m$ical op9ion z to :e!r x is at lea/ z likely z n t !re is a nexus betwe5 ! disability & ! toxic exposure risk activity4 7#b7 ,:5 provid+ ! ,secret>y ) a m$ical op9ion reque/$ "u p>agraph 7#a71 ! heal? c>e provid] %all consid] ! total pot5tial exposure ?r\gh all applicable milit>y deploym5ts1 & ! syn]gi/ic1 comb9$ effect ( all applicable toxic exposure risk activities4 7b7 ,exception ,subsection 7a7 %all n apply if ! ,secret>y det]m9es !re is no indication ( an association betwe5 ! disability claim$ by ! vet]an & ! toxic exposure risk activity = :i* ! vet]an submitt$ evid5ce4 7c7 ,toxic exposure risk activity def9$ ,9 ?is section1 ! t]m toxic exposure risk activity has ! mean+ giv5 su* t]m 9 section #agaj7;e77#d7 ( ?is title4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #aa ( su* title1 z am5d$ by title ,,ii ( ?is ,act1 is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #aafg1 z add$ by su* title1 ! foll[+ new item3 #aafh4 ,m$ical nexus exam9ations = toxic exposure risk activities4 4 ,,iv ,presumptions ( s]vice connection #dja4 ,treatm5t ( vet]ans :o p>ticipat$ 9 cleanup ( ,enewetak ,atoll z radiation-expos$ vet]ans = purposes ( presumption ( s]vice connection ( c]ta9 disabilities by ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,%ort title ,?is section may be cit$ z ! ,m>k ,takai ,atomic ,vet]ans ,heal?c>e ,p>ity ,act4 7b7 ,enewetak ,atoll ,section #aaab7;c77#c77;,b7 is am5d$ by add+ at ! end ! foll[+ new clause3 7v7 ,cleanup ( ,enewetak ,atoll dur+ ! p]iod beg9n+ on ,janu>y #a1 #aigg1 & end+ on ,decemb] #ca1 #aihj4 4 #djb4 ,treatm5t ( vet]ans :o p>ticipat$ 9 nucle> response ne> ,palom>es1 ,spa91 z radiation-expos$ vet]ans = purposes ( presumption ( s]vice connection ( c]ta9 disabilities by ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,%ort title ,?is section may be cit$ z ! ,palom>es ,vet]ans ,act4 7b7 ,palom>es ,section #aaab7;c77#c77;,b71 z am5d$ by section #dja1 is fur!r am5d$ by add+ at ! end ! foll[+ new clause3 7vi7 ,onsite p>ticipation 9 ! response ef=t foll[+ ! collision ( a ,unit$ ,/ates ,air ,=ce ,b-#eb bomb] & refuel+ plane t caus$ ! release ( f\r !rmonucle> weapons 9 ! vic9ity ( ,palom>es1 ,spa91 dur+ ! p]iod beg9n+ ,janu>y #ag1 #aiff1 & end+ ,m>* #ca1 #aifg4 4 #djc4 ,presumptions ( s]vice connection = diseases associat$ ) exposures to c]ta9 h]bicide ag5ts = vet]ans :o s]v$ 9 c]ta9 locations 7a7 ,%ort title ,?is section may be cit$ z ! ,vet]ans ,ag5t ,orange ,exposure ,equity ,act4 7b7 ,9 g5]al ,section #aaaf1 z am5d$ by section #bjb1 is fur!r am5d$-- 7#a7 by /rik+ 1 dur+ active milit>y1 naval1 or air s]vice1 s]v$ 9 ! ,republic ( ,vietnam dur+ ! p]iod beg9n+ on ,janu>y #i1 #aifb1 & end+ on ,may #g1 #aige ea* place x appe>s & ins]t+ p]=m$ cov]$ s]vice2 7#b7 by /rik+ p]=m$ active milit>y1 naval1 or air s]vice 9 ! ,republic ( ,vietnam dur+ ! p]iod beg9n+ on ,janu>y #i1 #aifb1 & end+ on ,may #g1 #aige ea* place x appe>s & ins]t+ p]=m$ cov]$ s]vice2 & 7#c7 by add+ at ! end ! foll[+ new subsection3 7d7 ,9 ?is section1 ! t]m cov]$ s]vice means active milit>y1 naval1 or air s]vice-- 7#a7 p]=m$ 9 ! ,republic ( ,vietnam dur+ ! p]iod beg9n+ on ,janu>y #i1 #aifb1 & end+ on ,may #g1 #aige2 7#b7 p]=m$ 9 ,?ail& at any ,unit$ ,/ates or ,royal ,?ai base dur+ ! p]iod beg9n+ on ,janu>y #i1 #aifb1 & end+ on ,june #cj1 #aigf1 )\t reg>d to :]e on ! base ! vet]an 0 locat$ or :at milit>y job specialty ! vet]an p]=m$2 7#c7 p]=m$ 9 ,laos dur+ ! p]iod beg9n+ on ,decemb] #a1 #aife1 & end+ on ,septemb] #cj1 #aifi2 7#d7 p]=m$ 9 ,cambodia at ,mimot or ,krek1 ,kampong ,*am ,prov9ce dur+ ! p]iod beg9n+ on ,april #af1 #aifi1 & end+ on ,april #cj1 #aifi2 or 7#e7 p]=m$ on ,guam or ,am]ican ,samoa1 or 9 ! t]ritorial wat]s !re(1 dur+ ! p]iod beg9n+ on ,janu>y #i1 #aifb1 & end+ on ,july #ca1 #aihj1 or s]v$ on ,john/on ,atoll or on a %ip t call$ at ,john/on ,atoll dur+ ! p]iod beg9n+ on ,janu>y #a1 #aigb1 & end+ on ,septemb] #cj1 #aigg4 4 7c7 ,eligibility = hospital c>e & m$ical s]vices ,section #agaj7;e77#d71 z am5d$ by section #ajc1 is fur!r am5d$ by /rik+ subp>agraph 7,a7 & ins]t+ ! foll[+ new subp>agraph3 7,a7 ,! t]m ,vietnam-era h]bicide-expos$ vet]an means a vet]an :o-- 7i7 p]=m$ cov]$ s]vice1 z def9$ 9 section #aaaf7;d7 ( ?is title2 or 7ii7 ! ,secret>y f9ds may h be5 expos$ dur+ su* s]vice to diox9 or 0 expos$ dur+ su* s]vice to a toxic sub/ance f\nd 9 a h]bicide or defoliant us$ = milit>y purposes dur+ su* p]iod4 4 7d7 ,cl]ical am5dm5ts 7#a7 ,section head+ ,! head+ = section #aaaf is am5d$ by /rik+ ! ,republic ( ,vietnam & ins]t+ c]ta9 locations4 7#b7 ,table ( sections ,! table ( sections at ! beg9n+ ( *apt] #aa is am5d$ by /rik+ ! item relat+ to section #aaaf & ins]t+ ! foll[+ new item3 #aaaf4 ,presumptions ( s]vice connection = diseases associat$ ) exposure to c]ta9 h]bicide ag5ts2 presumption ( exposure = vet]ans :o s]v$ 9 c]ta9 locations4 4 #djd4 ,addition ( additional diseases associat$ ) exposure to c]ta9 h]bicide ag5ts = :i* !re is a presumption ( s]vice connection = vet]ans :o s]v$ 9 c]ta9 locations 7a7 ,%ort title ,?is section may be cit$ z ! ,fair ,c>e = ,vietnam ,vet]ans ,act4 7b7 ,additional diseases ,section #aaaf7;a77#b71 z am5d$ by section #iaji ( ! ,william ,m4 7,mac7 ,?ornb]ry ,national ,def5se ,au?orization ,act = ,fiscal ,ye> #bjba 7,public ,law #aaf-bhc71 is fur!r am5d$ by add+ at ! end ! foll[+ new subp>agraphs3 7,l7 ,hyp]t5sion4 7,m7 ,monoclonal gammopa?y ( undet]m9$ significance4 4 #dje4 ,improv+ comp5sation = disabilities occurr+ 9 ,p]sian ,gulf ,w> vet]ans 7a7 ,r$uction 9 ?re%old ( eligibility ,subsection 7a77#a7 ( section #aaag is am5d$ by /rik+ became manife/-- & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ became manife/ to any degree at any "t44 7b7 ,p]man5t ext5sion ( p]iod ( eligibility ,su* section is fur!r am5d$-- 7#a7 by /rik+ subsection 7b72 7#b7 by r$esignat+ subsections 7c7 & 7d7 z subsections 7b7 & 7c71 respectively2 & 7#c7 9 subsection 7a77#b77;,c71 by /rik+ "u subsection 7d7 & ins]t+ "u subsection 7c74 7c7 ,e/abli%+ s+ul> disability-,bas$ que/ionnaire ,su* section is fur!r am5d$ by ins]t+ aft] subsection 7c7 7z r$esignat$ by subsection 7b77 ! foll[+ new subsection 7d73 7d7 ,if a ,p]sian ,gulf vet]an at a m$ical facility ( ! ,dep>tm5t pres5ts ) any "o symptom associat$ ) ,gulf ,w> ,illness1 ! ,secret>y %all ensure t heal? c>e p]sonnel ( ! ,dep>tm5t use a disability b5efits que/ionnaire1 or successor que/ionnaire1 to id5tify ,gulf ,w> ,illness4 4 7d7 ,expansion ( def9ition ( ,p]sian ,gulf vet]an ,subsection 7f7 ( su* section is am5d$ by ins]t+ 1 ,afghani/an1 ,israel1 ,egypt1 ,turkey1 ,syria1 or ,jordan1 aft] op]ations4 7e7 ,tra9+ ,su* section is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 7#a7 ,! ,secret>y %all take su* actions z may be necess>y to ensure t heal? c>e p]sonnel ( ! ,dep>tm5t are appropriately tra9$ to effectively c>ry out ?is section4 7#b7 ,n less frequ5tly ?an once ea* ye>1 ! ,secret>y %all submit to ,congress a report on ! actions tak5 by ! ,secret>y to c>ry out p>agraph 7#a74 4 #djf4 ,presumption ( s]vice connection = c]ta9 diseases associat$ ) exposure to burn pits & o!r tox9s 7a7 ,%ort title ,?is section may be cit$ z ! ,presumptive ,b5efits = ,w> ,fight]s ,expos$ to ,burn ,pits & ,o!r ,tox9s ,act4 7b7 ,9 g5]al ,sub*apt] ,,ii ( *apt] #aa1 z am5d$ by section #cjc7;a71 is fur!r am5d$ by ins]t+ aft] section #aaai ! foll[+ new section3 #aabj4 ,presumption ( s]vice connection = c]ta9 diseases associat$ ) exposure to burn pits & o!r tox9s 7a7 ,presumption ( s]vice connection ,= ! purposes ( section #aaaj ( ?is title1 & subject to section #aaac ( ?is title1 a disease specifi$ 9 subsection 7b7 becom+ manife/ 9 a cov]$ vet]an %all be consid]$ to h be5 incurr$ 9 or aggravat$ dur+ active milit>y1 naval1 or air s]vice1 not)/&+ t !re is no record ( evid5ce ( su* disease dur+ ! p]iod ( su* s]vice4 7b7 ,diseases specifi$ ,! diseases specifi$ 9 ?is subsection are ! foll[+3 7#a7 ,a/hma t 0 diagnos$ aft] s]vice ( ! cov]$ vet]an z specifi$ 9 subsection 7c74 7#b7 ,! foll[+ types ( canc]3 7,a7 ,head canc] ( any type4 7,b7 ,neck canc] ( any type4 7,c7 ,respiratory canc] ( any type4 7,d7 ,ga/ro9te/9al canc] ( any type4 7,e7 ,reproductive canc] ( any type4 7,f7 ,lymphoma canc] ( any type4 7,g7 ,lymphomatic canc] ( any type4 7,h7 ,kidney canc]4 7,i7 ,bra9 canc]4 7,j7 ,melanoma4 7,k7 ,pancreatic canc]4 7#c7 ,*ronic bron*itis4 7#d7 ,*ronic ob/ructive pulmon>y disease4 7#e7 ,con/rictive bron*iolitis or oblit]ative bron*iolitis4 7#f7 ,emphysema4 7#g7 ,granulomat\s disease4 7#h7 ,int]/itial lung disease4 7#i7 ,pleuritis4 7#aj7 ,pulmon>y fibrosis4 7#aa7 ,s>coidosis4 7#ab7 ,*ronic s9usitis4 7#ac7 ,*ronic rh9itis4 7#ad7 ,gliobla/oma4 7#ae7 ,any o!r disease = :i* ! ,secret>y det]m9es1 pursuant to regulations prescrib$ "u sub*apt] ,,vii t a presumption ( s]vice connection is w>rant$ bas$ on a positive association ) a sub/ance1 *emical1 or airborne haz>d specifi$ 9 section #aaai7;b77#b7 ( ?is title4 7c7 ,cov]$ vet]an def9$ ,9 ?is section1 ! t]m cov]$ vet]an has ! mean+ giv5 t t]m 9 section #aaai7;c7 ( ?is title4 4 7c7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #aa1 z am5d$ by section #cjb7;b71 is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #aaai ! foll[+ new item3 #aabj4 ,presumption ( s]vice connection = c]ta9 diseases associat$ ) exposure to burn pits & o!r tox9s4 4 7d7 ,con=m+ am5dm5t ,section #aaac is am5d$ by /rik+ or #aaah ea* place x appe>s & ins]t+ #aaah1 or #aabj4 ,v ,rese>* matt]s #eja4 ,coord9ation by ,dep>tm5t ( ,vet]ans ,affairs ( toxic exposure rese>* 7a7 ,9 g5]al ,sub*apt] ,,ii ( *apt] #gc is am5d$ by add+ at ! end ! foll[+ new section3 #gccj;,d4 ,coord9ation ( toxic exposure rese>* 7a7 ,9 g5]al ,! ,secret>y %all coord9ate all rese>* activities c>ri$ out or fund$ by ! executive bran* ( ! ,f$]al ,gov]nm5t on ! heal? consequ5ces ( toxic exposures exp]i5c$ dur+ s]vice 9 ! ,arm$ ,=ces4 7b7 ,/rategic plan ,9 c>ry+ out subsection 7a71 ! ,secret>y %all e/abli% a /rategic plan1 to be kn[n z ! ,toxic ,exposure ,rese>* ,/rategic ,plan1 to ensure t ! rese>* activities specifi$ 9 su* subsection are collaborative1 transp>5t1 & highly coord9at$4 7c7 ,report ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ! ,honor+ our ,promise to ,address ,compreh5sive ,toxics ,act ( #bjba1 & annually !reaft]1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a report on any rese>* activities specifi$ 9 subsection 7a7 c>ri$ out dur+ ! ye> cov]$ by ! report4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* sub*apt] is am5d$ by ins]t+ aft] ! item relat+ to section #gccj;,c ! foll[+ new item3 #gccj;,d4 ,coord9ation ( toxic exposure rese>*4 4 #ejb4 ,data collection1 analysis1 & report on treatm5t ( vet]ans = illnesses relat$ to toxic exposure 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all compile & analyze1 on a cont9u\s basis1 all cl9ical data t-- 7#a7 is obta9$ by ! ,secret>y 9 connection ) hospital c>e1 m$ical s]vices1 or nurs+ home c>e furni%$ to a vet]an = an illness "u section #agaj7;a77#b77;,f7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #ajb2 & 7#b7 is likely to be sci5tifically useful1 z det]m9$ by ! ,secret>y1 9 det]m9+ :e!r a positive association exi/s betwe5 ! illness ( ! vet]an & a toxic exposure4 7b7 ,cons5t ( pati5ts ,! ,secret>y %all ensure t ! compilation & analysis ( ! cl9ical data ( a vet]an "u subsection 7a7 %all be conduct$1 & su* data %all be us$1 9 a mann] t is consi/5t ) ! in=m$ cons5t ( ! vet]an & 9 compliance ) all applicable ,f$]al law4 7c7 ,annual report ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a report conta9+-- 7#a7 any data compil$ "u subsection 7a72 7#b7 an analysis ( any su* data2 7#c7 a description ( ! types & incid5ces ( illnesses id5tifi$ by ! ,secret>y pursuant to su* subsection2 7#d7 an explanation by ! ,secret>y = ! incid5ce ( su* illnesses & su* alt]nate explanations = ! incid5ce ( su* illnesses z ! ,secret>y may consid] reasonable2 & 7#e7 a description ( ! views ( ! ,secret>y reg>d+ ! sci5tific validity ( draw+ conclusions f ! incid5ce ( su* illnesses1 z evid5c$ by ! data compil$ "u subsection 7a71 reg>d+ ! exi/5ce ( a positive association betwe5 su* illness & a toxic exposure4 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m toxic exposure has ! mean+ giv5 t t]m 9 section #aja ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,! t]m illness has ! mean+ giv5 t t]m 9 section #aaga ( su* title1 z add$ by section #bjb4 #ejc4 ,/udies relat$ to vet]ans :o s]v$ 9 ,s\?we/ ,asia & c]ta9 o!r locations 7a7 ,analysis on mortality 9 cov]$ vet]ans 7#a7 ,analysis ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all conduct an updat$ analysis ( total & respiratory disease mortality 9 cov]$ vet]ans4 7#b7 ,elem5ts ,! analysis "u p>agraph 7#a7 %all include1 to ! ext5t practicable1 ! foll[+3 7,a7 ,metrics ( airborne exposures4 7,b7 ,! location & tim+ ( any deploym5ts ( ! vet]an4 7,c7 ,! milit>y occupational specialty ( ! vet]an4 7,d7 ,! ,arm$ ,=ce 9 :i* ! vet]an s]v$4 7,e7 ,! preexi/+ heal? /atus ( ! vet]an1 includ+ ) respect to a/hma4 7,f7 ,su* p]sonal in=mation ( ! vet]an z ! ,secret>y may consid] relevant1 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 conduct an epidemiological /udy ( cov]$ vet]ans t involves-- 7#a7 ! use ( improv$ spatio-temporal e/imates ( ambi5t air pollution exposures t lev]age advances 9 retrospective exposure assessm5t2 & 7#b7 ! collection ( detail$ in=mation on ! cov]$ vet]ans /udi$ ?r\gh m$ical records1 adm9i/rative data1 & o!r exi/+ s\rces1 includ+1 ) respect to ! cov]$ vet]ans-- 7,a7 p]sonal in=mation1 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 7#a7 ,/udy ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all conduct a toxicology /udy1 to include v>iability1 to replicate toxic exposures ( heal?y1 "y memb]s ( ! ,arm$ ,=ces1 z well z pot5tially susceptible memb]s1 ) preexi/+ heal? conditions4 7#b7 ,elem5ts ,! /udy "u p>agraph 7#a7 %all include-- 7,a7 an analysis ( results = me*ani/ic m>k]s & cl9ically relevant outcomes2 & 7,b7 a validation ( any s]um1 tissue1 or o!r biom>k]s ( toxic exposure1 susceptibility1 or effect ) respect to ! subjects ( ! /udy4 7d7 ,cov]$ vet]an def9$ ,9 ?is section1 ! t]m cov]$ vet]an has ! mean+ giv5 t t]m 9 section #aaai7;c7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #cjb4 #ejd4 ,/udy on heal? tr5ds ( po/ #i_/aa vet]ans 7a7 ,/udy ,! ,secret>y ( ,vet]ans ,affairs %all conduct an epidemiological /udy on ! heal? tr5ds ( vet]ans :o s]v$ 9 ! ,arm$ ,=ces aft] ,septemb] #aa1 #bjja4 7b7 ,report ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a report on ! /udy "u subsection 7a74 #eje4 ,/udy on canc] rates among vet]ans 7a7 ,/udy ,! ,secret>y ( ,vet]ans ,affairs %all conduct a /udy on ! incid5ce ( canc] 9 vet]ans to det]m9e tr5ds 9 ! rates ( ! incid5ce ( canc] 9 vet]ans4 7b7 ,elem5ts ,! /udy "u subsection 7a7 %all assess1 ) respect to ea* vet]an includ$ 9 ! /udy1 ! foll[+3 7#a7 ,! age ( ! vet]an4 7#b7 ,! p]iod ( s]vice & l5g? ( s]vice ( ! vet]an 9 ! ,arm$ ,=ces4 7#c7 ,any milit>y occupational speciality ( ! vet]an4 7#d7 ,! g5d] ( ! vet]an4 7#e7 ,any type ( canc] t ! vet]an has4 7c7 ,report ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate a report on ! /udy "u subsection 7a74 #ejf4 ,/udy on feasibility & advisability ( furni%+ hospital c>e & m$ical s]vices to dep5d5ts ( vet]ans :o p>ticipat$ 9 toxic exposure risk activities 7a7 ,/udy ,! ,secret>y ( ,vet]ans ,affairs %all conduct a /udy on ! feasibility & advisability ( furni%+ hospital c>e & m$ical s]vices to qualify+ dep5d5ts ( vet]ans describ$ 9 section #agaj7;e77#a77;,g7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajc7;a77#a71 = any illness det]m9$ by ! ,secret>y to be connect$ to a toxic exposure risk activity c>ri$ out by ! vet]an1 z det]m9$ by ! ,secret>y1 not)/&+ t !re is insuffici5t m$ical evid5ce to conclude t su* illness is attributable to su* activity4 7b7 ,elem5ts ,! /udy "u subsection 7a7 %all include-- 7#a7 an assessm5t ( ! impact ( furni%+ hospital c>e & m$ical s]vices to qualify+ dep5d5ts z describ$ 9 su* subsection on ! ability ( ! ,dep>tm5t ( ,vet]ans ,affairs to furni% hospital c>e & m$ical s]vices to vet]ans2 7#b7 an assessm5t ( ! pot5tial co/ ( furni%+ hospital c>e & m$ical s]vices to qualify+ dep5d5ts z describ$ 9 su* subsection2 7#c7 an e/imate ( ! res\rces requir$ to furni% su* c>e & s]vices2 7#d7 an assessm5t ( any /ress or o!r effect furni%+ su* c>e & s]vices w\ld h on ! claims & appeals sy/em ( ! ,dep>tm5t2 7#e7 an e/imate ( ! numb] ( qualify+ dep5d5ts :o w\ld be eligible = su* c>e & s]vices2 & 7#f7 an assessm5t ( ! feasibility ( adjudicat+ claims = su* c>e & s]vices4 7c7 ,phas$-,9 application ,9 conduct+ ! /udy "u subsection 7a71 ! ,secret>y %all assess ! feasibility & advisability ( phas+ 9 ! furni%+ ( hospital c>e & m$ical s]vices to qualify+ dep5d5ts describ$ 9 su* subsection by ! decade 9 :i* su* toxic exposure risk activity occurr$1 />t+ ) ! mo/ rec5t decade4 7d7 ,review ( toxic exposure cases reg>d+ liability ( ,dep>tm5t ( ,def5se ,9 conduct+ ! /udy "u subsection 7a71 ! ,secret>y %all-- 7#a7 review kn[n cases ( toxic exposure on milit>y in/allations ( ! ,dep>tm5t ( ,def5se locat$ 9 ! ,unit$ ,/ates2 7#b7 analyze ! liability ( ! ,dep>tm5t ( ,def5se 9 ea* su* case2 & 7#c7 assess :e!r ! ,secret>y ( ,def5se %\ld provide c>e & s]vices relat+ to su* toxic exposures "u ! ,,tric>e program4 7e7 ,report ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a74 7f7 ,def9itions ,9 ?is section3 7#a7 ,! t]ms hospital c>e & m$ical s]vices h ! mean+s giv5 ^? t]ms 9 section #agja ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,! t]m illness has ! mean+ giv5 t t]m 9 section #aaga ( su* title1 z add$ by section #bjb4 7#c7 ,! t]m qualify+ dep5d5t means-- 7,a7 a dep5d5t ( a vet]an describ$ 9 section #agaj7;e77#a77;,g7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajc7;a77#a71 :o resid$ ) ! vet]an dur+ ! p]iod 9 :i*1 & on ! in/allation at :i*1 ! vet]an p>ticipat$ 9 a toxic exposure risk activity2 7,b7 an individual :o 0 9 ut]o ( su* a vet]an or o!r qualify+ dep5d5t :5 ! vet]an p>ticipat$ 9 a toxic exposure risk activity2 or 7,c7 a dep5d5t ( su* a vet]an :o is n describ$ 9 subp>agraph 7,a7 or 7,b7 b :o may h an illness t is connect$ to ! toxic exposure risk activity ( ! vet]an1 z det]m9$ by ! ,secret>y4 7#d7 ,! t]m toxic exposure has ! mean+ giv5 t t]m 9 section #aja ( su* title1 z add$ by section #ajb7;b74 7#e7 ,! t]m toxic exposure risk activity has ! mean+ giv5 t t]m 9 section #agaj7;e77#d7 ( su* title1 z add$ by section #ajc7;a77#c74 7#f7 ,! t]m ,,tric>e program has ! mean+ giv5 t t]m 9 section #ajgb ( su* title4 ,,vi ,improvem5t ( res\rces & tra9+ reg>d+ toxic expos$ vet]ans #fja4 ,%ort title2 def9itions 7a7 ,%ort title ,?is title may be cit$ z ! ,toxic ,exposure 9 ! ,am]ican ,milit>y ,act or ! ,,team ,act4 7b7 ,def9itions ,9 ?is title1 ! t]ms active milit>y1 naval1 or air s]vice1 toxic exposure1 & toxic expos$ vet]an h ! mean+s giv5 ^? t]ms 9 section #aja ( title #ch1 ,unit$ ,/ates ,code4 #fjb4 ,publication ( li/ ( res\rces ( ,dep>tm5t ( ,vet]ans ,affairs = toxic expos$ vet]ans & outrea* program = su* vet]ans & c>egiv]s & survivors ( su* vet]ans 7a7 ,publication ( li/ ( res\rces 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y ( ,vet]ans ,affairs %all publi% a li/ ( res\rces ( ! ,dep>tm5t ( ,vet]ans ,affairs =-- 7,a7 toxic expos$ vet]ans1 includ+ ) respect to-- 7i7 disability comp5sation "u *apt] #aa ( title #ch1 ,unit$ ,/ates ,code2 & 7ii7 hospital c>e1 m$ical s]vices1 & nurs+ home c>e "u section #agaj7;a77#b77;,f7 ( su* title2 7,b7 c>egiv]s ( toxic expos$ vet]ans :o are p>ticipat+ 9 ! program ( compreh5sive assi/ance = family c>egiv]s "u section #agbj;,g7a7 ( su* title2 & 7,c7 survivors ( toxic expos$ vet]ans :o are receiv+ dea? b5efits "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,update ,! ,secret>y %all p]iodically update ! li/ publi%$ "u p>agraph 7#a74 7b7 ,outrea* ,! ,secret>y %all develop1 ) input f ! community1 an in=mative outrea* program = vet]ans on illnesses t may be relat$ to toxic exposure1 includ+ outrea* ) respect to b5efits & support programs4 #fjc4 ,incorporation ( toxic exposure que/ionnaire dur+ prim>y c>e appo9tm5ts 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all incorporate a cl9ical que/ionnaire to help det]m9e pot5tial toxic exposures dur+ active milit>y1 naval1 or air s]vice z "p ( ! initial scre5+ conduct$ = an appo9tm5t ( a vet]an ) a prim>y c>e provid] ( ! ,dep>tm5t ( ,vet]ans ,affairs to improve und]/&+ by ! ,dep>tm5t ( toxic exposures ( vet]ans :ile s]v+ 9 ! ,arm$ ,=ces4 7b7 ,det]m9ation ( que/ions ,! que/ions includ$ 9 ! que/ionnaire requir$ "u subsection 7a7 %all be det]m9$ by ! ,secret>y ) input f m$ical pr(essionals4 #fjd4 ,tra9+ = p]sonnel ( ! ,dep>tm5t ( ,vet]ans ,affairs ) respect to toxic expos$ vet]ans 7a7 ,heal? c>e p]sonnel ,! ,secret>y ( ,vet]ans ,affairs %all provide to heal? c>e p]sonnel ( ! ,dep>tm5t ( ,vet]ans ,affairs education & tra9+ to id5tify1 treat1 & assess ! impact on toxic expos$ vet]ans ( illnesses relat$ to toxic exposure & in=m su* p]sonnel ( h[ to ask = additional in=mation f vet]ans reg>d+ diff]5t toxic exposures4 7b7 ,b5efits p]sonnel 7#a7 ,/&>d claims processor tra9+ curriculum 7,a7 ,curriculum ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% a /&>d tra9+ curriculum = processors ( claims "u ! laws adm9i/]$ by ! ,secret>y :o review claims = disability b5efits relat+ to s]vice-connect$ disabilities bas$ on toxic exposure1 includ+ employees :o adjudicate su* claims4 7,b7 ,matt]s includ$ ,! ,secret>y %all ensure t ! tra9+ "u subp>agraph 7,a7 includes ! foll[+ explanations ) respect to claims relat+ to toxic exposure3 7i7 ,a lack ( a presumption ( s]vice connection is n by itself suffici5t to det]m9e t s]vice connection does n exi/4 7ii7 ,! claims adjudicator %all always consid] :e!r direct s]vice connection is applicable & reque/1 z ne$$1 an advisory m$ical op9ion pursuant to section #aafh ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #cjc4 7iii7 ,! claims adjudicator %all always review & consid] ! ,individual ,longitud9al ,exposure ,record program ( ! ,dep>tm5t ( ,vet]ans ,affairs pursuant to section #aaai ( su* title1 z add$ by section #cjb1 b a lack ( su* in=mation is n by itself suffici5t to det]m9e t su* exposure did n occur or suffici5t to d5y ! claim4 7,c7 ,provision ( tra9+ ,! ,secret>y %all-- 7i7 provide tra9+ "u subp>agraph 7,a7 to ea* employee describ$ 9 su* subp>agraph n less frequ5tly ?an annually2 & 7ii7 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 7#b7 ,/&>d m$ical exam9] tra9+ curriculum 7,a7 ,curriculum ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% a /&>d m$ical tra9+ curriculum = m$ical provid]s :o conduct exam9ations & provide op9ions pursuant to section #aafh ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #cjc1 reg>dless ( :e!r ! provid] is an employee ( ! ,dep>tm5t or a contractor4 7,b7 ,/&>diz$ approa* ,! ,secret>y %all ensure t ! curriculum e/abli%$ "u subp>agraph 7,a7-- 7i7 provides a /&>diz$ approa* to conduct+ & provid+ exam9ations & op9ions 9 accordance ) su* section #aafh2 & 7ii7 in/ructs m$ical provid]s to consid]1 :5 conduct+ an exam9ation or provid+ an op9ion-- 7,i7 relevant m$ical & sci5tific lit]ature2 7,,ii7 ! proximity1 int5sity1 & frequ5cy ( exposure ( ! individual to ! id5tifi$ toxic exposure2 7,,iii7 m$ically unexpla9$ *ronic multisymptom illnesses2 & 7,,iv7 all compet5t & cr$ible evid5ce ( record4 ,,vii ,regi/ries1 records1 & o!r matt]s #gja4 ,regi/ry ( individuals expos$ to p]- & polyfluoroalkyl sub/ances on milit>y in/allations 7a7 ,e/abli%m5t ( regi/ry 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all-- 7,a7 e/abli% & ma9ta9 a regi/ry = eligible individuals :o may h be5 expos$ to p]- & polyfluoroalkyl sub/ances 79 ?is section ref]r$ to z ,,pfas7 due to ! environm5tal release ( aque\s film-=m+ foam 79 ?is section ref]r$ to z ,,afff7 on milit>y in/allations to meet ! requirem5ts ( milit>y specification ,,mil-,f-#bdche;,f2 7,b7 include any in=mation 9 su* regi/ry t ! ,secret>y det]m9es necess>y to asc]ta9 & monitor ! heal? effects ( ! exposure ( memb]s ( ! ,arm$ ,=ces to ,,pfas associat$ ) ,,afff2 7,c7 develop a public in=mation campaign to in=m eligible individuals ab\t ! regi/ry1 includ+ h[ to regi/] & ! b5efits ( regi/]+2 & 7,d7 p]iodically notify eligible individuals ( significant developm5ts 9 ! /udy & treatm5t ( conditions associat$ ) exposure to ,,pfas4 7#b7 ,coord9ation ,! ,secret>y ( ,vet]ans ,affairs %all coord9ate ) ! ,secret>y ( ,def5se 9 c>ry+ out p>agraph 7#a74 7b7 ,reports 7#a7 ,initial report ,n lat] ?an two ye>s aft] ! date on :i* ! regi/ry "u subsection 7a7 is e/abli%$1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ,congress an initial report conta9+ ! foll[+3 7,a7 ,an assessm5t ( ! effectiv5ess ( actions tak5 by ! ,secret>y ( ,vet]ans ,affairs & ! ,secret>y ( ,def5se to collect & ma9ta9 in=mation on ! heal? effects ( exposure to ,,pfas4 7,b7 ,recomm5dations to improve ! collection & ma9t5ance ( su* in=mation4 7,c7 ,us+ e/abli%$ & previ\sly publi%$ epidemiological /udies1 recomm5dations reg>d+ ! mo/ effective & prud5t means ( address+ ! m$ical ne$s ( eligible individuals ) respect to exposure to ,,pfas4 7#b7 ,foll[up report ,n lat] ?an five ye>s aft] submitt+ ! initial report "u p>agraph 7#a71 ! ,secret>y ( ,vet]ans ,affairs %all submit to ,congress a foll[up report conta9+ ! foll[+3 7,a7 ,an update to ! initial report submitt$ "u p>agraph 7#a74 7,b7 ,an assessm5t ( :e!r & to :at degree ! cont5t ( ! regi/ry e/abli%$ "u subsection 7a7 is curr5t & sci5tifically up to date4 7#c7 ,indep5d5t sci5tific organization ,! ,secret>y ( ,vet]ans ,affairs %all ent] into an agreem5t ) an indep5d5t sci5tific organization to prep>e ! reports "u p>agraphs 7#a7 & 7#b74 7c7 ,recomm5dations = additional exposures ,to be includ$ ,n lat] ?an five ye>s aft] ! date ( ! enactm5t ( ?is ,act1 & e five ye>s !reaft]1 ! ,secret>y ( ,vet]ans ,affairs1 9 consultation ) ! ,secret>y ( ,def5se & ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy1 %all submit to ,congress recomm5dations = additional *emicals ) respect to :i* individuals expos$ to su* *emicals %\ld be includ$ 9 ! regi/ry e/abli%$ "u subsection 7a74 7d7 ,eligible individual def9$ ,9 ?is section1 ! t]m eligible individual means any individual :o1 on or aft] a date specifi$ by ! ,secret>y ( ,vet]ans ,affairs ?r\gh regulations1 s]v$ or is s]v+ 9 ! ,arm$ ,=ces at a milit>y in/allation :]e ,,afff 0 us$ or at ano!r location ( ! ,dep>tm5t ( ,def5se :]e ,,afff 0 us$4 #gjb4 ,=t ,mc,clellan ,heal? ,regi/ry 7a7 ,e/abli%m5t ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% & ma9ta9 a special record to be kn[n z ! ,=t ,mc,clellan ,heal? ,regi/ry 79 ?is section ref]r$ to z ! ,regi/ry74 7b7 ,cont5ts ,except z provid$ 9 subsection 7c71 ! ,regi/ry %all include ! foll[+ in=mation3 7#a7 ,a li/ conta9+ ! "n ( ea* individual :o1 :ile s]v+ z a memb] ( ! ,arm$ ,=ces1 0 /ation$ at ,=t ,mc,clellan1 ,alabama1 at any "t dur+ ! p]iod beg9n+ ,janu>y #a1 #aice1 & end+ on ,may #bj1 #aiii1 & :o-- 7,a7 applies = c>e or s]vices f ! ,dep>tm5t ( ,vet]ans ,affairs "u *apt] #ag ( title #ch1 ,unit$ ,/ates ,code2 7,b7 files a claim = comp5sation "u *apt] #aa ( su* title on ! basis ( any disability :i* may be associat$ ) su* s]vice2 7,c7 dies & is surviv$ by a sp\se1 *ild1 or p>5t :o files a claim = dep5d5cy & indemnity comp5sation "u *apt] #ac ( su* title on ! basis ( su* s]vice2 7,d7 reque/s f ! ,secret>y a heal? exam9ation "u subsection 7d72 or 7,e7 receives f ! ,secret>y a heal? exam9ation simil> to ! heal? exam9ation ref]r$ to 9 subp>agraph 7,d7 & reque/s inclusion 9 ! ,regi/ry4 7#b7 ,relevant m$ical data relat+ to ! heal? /atus (1 & o!r in=mation t ! ,secret>y consid]s relevant & appropriate ) respect to1 ea* individual describ$ 9 p>agraph 7#a7 :o-- 7,a7 grants to ! ,secret>y p]mission to include su* in=mation 9 ! ,regi/ry2 or 7,b7 at ! "t ! individual is li/$ 9 ! ,regi/ry1 is deceas$4 7c7 ,individuals submitt+ claims or mak+ reque/s be=e date ( enactm5t ,if 9 ! case ( an individual describ$ 9 subsection 7b77#a7 ! application1 claim1 or reque/ ref]r$ to 9 su* subsection 0 submitt$1 fil$1 or made be=e ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all1 to ! ext5t feasible1 include 9 ! ,regi/ry su* individual's "n & ! data & in=mation1 if any1 describ$ 9 subsection 7b77#b7 relat+ to ! individual4 7d7 ,exam9ations ,^u ! reque/ ( a vet]an :o 0 /ation$ at ,=t ,mc,clellan1 ,alabama1 at any "t dur+ ! p]iod beg9n+ ,janu>y #a1 #aice1 & end+ on ,may #bj1 #aiii1 ! ,secret>y %all provide ! vet]an ) a heal? exam9ation 7includ+ any appropriate diagno/ic te/s7 & consultation & c\nsel+ ) respect to ! results ( ! exam9ation & ! te/s4 7e7 ,outrea* 7#a7 ,ongo+ outrea* to individuals li/$ 9 ,regi/ry ,! ,secret>y %all1 f "t to "t1 notify individuals li/$ 9 ! ,regi/ry ( significant developm5ts 9 rese>* on ! heal? consequ5ces ( pot5tial exposure to a toxic sub/ance or environm5tal haz>d relat$ to s]vice at ,=t ,mc,clellan4 7#b7 ,exam9ation outrea* ,! ,secret>y %all c>ry out appropriate outrea* activities ) respect to ! provision ( any heal? exam9ations 7includ+ any diagno/ic te/s7 & consultation & c\nsel+ s]vices "u subsection 7d74 7f7 ,consultation ,! ,secret>y ( ,vet]ans ,affairs %all consult ) ! ,secret>y ( ,def5se to acquire in=mation ma9ta9$ by ! ,secret>y ( ,def5se t ! ,secret>y ( ,vet]ans ,affairs consid]s necess>y to e/abli% & ma9ta9 ! ,regi/ry4 #gjc4 ,indep5d5t /udy on ,individual ,longitud9al ,exposure ,record 7a7 ,9 g5]al ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,def5se %all ent] into a contract ) an indep5d5t rese>* entity describ$ 9 subsection 7b7 to c>ry out a compreh5sive /udy ( ! developm5t ( ! ,individual ,longitud9al ,exposure ,record to det]m9e-- 7#a7 ! quality ( ! location data1 occupational & environm5tal exposure data1 & heal? surveillance data2 & 7#b7 :e!r a memb] ( ! ,arm$ ,=ces c be reasonably assur$ t any toxic exposure !y exp]i5ce dur+ s]vice 9 ! ,arm$ ,=ces w be accurately reflect$ 9 ! ,individual ,longitud9al ,exposure ,record ( ! memb]4 7b7 ,indep5d5t rese>* entity ,! entity describ$ 9 ?is subsection is an indep5d5t rese>* entity t is a n-=-pr(it entity or a f$]ally fund$ rese>* & developm5t c5t] ) appropriate exp]tise & analytical capability to c>ry out ! /udy requir$ "u subsection 7a74 7c7 ,toxic exposure def9$ ,9 ?is section1 ! t]m toxic exposure has ! mean+ giv5 t t]m 9 section #aja7cg7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb7;b74 #gjd4 ,biannual report on ,individual ,longitud9al ,exposure ,record 7a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date on :i* ! ,individual ,longitud9al ,exposure ,record a*ieves full op]ation capability1 z det]m9$ by ! ,secret>y ( ,def5se1 & e #ahj days !reaft]1 ! ,secret>y %all1 9 consultation ) ! ,secret>y ( ,vet]ans ,affairs1 submit to ! appropriate committees ( ,congress a report on ! data quality ( ! databases ( ! ,dep>tm5t ( ,def5se t provide ! in=mation pres5t$ 9 ! ,individual ,longitud9al ,exposure ,record & ! usefulness ( ! ,individual ,longitud9al ,exposure ,record 9 support+ memb]s ( ! ,arm$ ,=ces & vet]ans 9 receiv+ heal? c>e & b5efits f ! ,dep>tm5t ( ,def5se & ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,elem5ts ,ea* report requir$ by subsection 7a7 %all include1 = ! p]iod cov]$ by ! report1 ! foll[+3 7#a7 ,an id5tification ( toxic exposure ev5ts t may n be fully captur$ by ! curr5t sy/ems ( ! ,dep>tm5t ( ,def5se = environm5tal1 occupational1 & heal? monitor+1 & recomm5dations = h[ to improve ^? sy/ems4 7#b7 ,an analysis ( ! quality ( ! location data us$ by ! ,dep>tm5t ( ,def5se 9 det]m9+ toxic exposures ( memb]s ( ! ,arm$ ,=ces & vet]ans1 & recomm5dations = h[ to improve ! quality ( t location data if necess>y4 7c7 ,def9itions ,9 ?is section3 7#a7 ,appropriate committees ( ,congress ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,arm$ ,s]vices & ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate2 & 7,b7 ! ,committee on ,arm$ ,s]vices & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives4 7#b7 ,toxic exposure ,! t]m toxic exposure has ! mean+ giv5 t t]m 9 section #aja7cg7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb7;b74 #gje4 ,correction ( exposure records by memb]s ( ! ,arm$ ,=ces & vet]ans 7a7 ,9 g5]al ,! ,secret>y ( ,def5se & ! ,secret>y ( ,vet]ans ,affairs %all provide a means = memb]s ( ! ,arm$ ,=ces & vet]ans to update _! records z necess>y to reflect a toxic exposure by su* memb] or vet]an 9 ! ,individual ,longitud9al ,exposure ,record4 7b7 ,evid5ce 7#a7 ,provision ( evid5ce ,to update a record "u subsection 7a71 a memb] ( ! ,arm$ ,=ces or vet]an1 z ! case may be1 %all provide su* evid5ce z ! ,secret>y ( ,def5se & ! ,secret>y ( ,vet]ans ,affairs jo9tly consid] necess>y4 7#b7 ,b5efit ( ! d\bt ,9 review+ evid5ce provid$ "u p>agraph 7#a71 ! ,secret>y ( ,def5se & ! ,secret>y ( ,vet]ans ,affairs %all give ! b5efit ( ! d\bt to ! memb] ( ! ,arm$ ,=ces or vet]an :o provid$ ! evid5ce1 z ! case may be1 9 a mann] t is equival5t to ! b5efit ( ! d\bt requir$ "u section #eajg7;b7 ( title #ch1 ,unit$ ,/ates ,code4 7#c7 ,regulations ,! ,secret>y ( ,vet]ans ,affairs1 9 consultation ) ! ,secret>y ( ,def5se1 %all prescribe by regulation ! evid5ce consid]$ necess>y "u p>agraph 7#a74 7c7 ,toxic exposure def9$ ,9 ?is section1 ! t]m toxic exposure has ! mean+ giv5 t t]m 9 section #aja7cg7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb7;b74