,,ii ,calendar ,no4 #chh #aagth ,,congress #b;d ,session ,h4 ,r4 #cifg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #c1 #bjbb,received ,may #bd1 #bjbb ,read the first time ,may #be1 #bjbb,read the second time and placed on the calendar ,,an ,,act ,to improve health care and benefits for veterans exposed to toxic substances1 and for other purposes4 #a4 ,short title2 references to title #ch1 ,united ,states ,code2 table of contents 7a7 ,short title ,this ,act may be cited as the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba or the ,honoring our ,,pact ,act of #bjba4 7b7 ,matters relating to amendments to title #ch1 ,united ,states ,code 7#a7 ,references ,except as otherwise expressly provided1 when in this ,act an amendment or repeal is expressed in terms of an amendment to1 or repeal of1 a section or other provision1 the reference shall be considered to be made to a section or other provision of title #ch1 ,united ,states ,code4 7#b7 ,amendments to tables of contents ,except as otherwise expressly provided1 when an amendment made by this ,act to title #ch1 ,united ,states ,code1 adds a section or larger organizational unit to that title or amends the designation or heading of a section or larger organizational unit in that title1 that amendment also shall have the effect of amending any table of sections in that title to alter the table to conform to the changes made by the amendment4 7c7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 references to title #ch1 ,united ,states ,code2 table of contents4,title ,i--,expansion of health care eligibility,subtitle ,a--,toxic-exposed veterans,sec4 #aja4 ,short title4,sec4 #ajb4 ,definitions relating to toxic-exposed veterans4,sec4 #ajc4 ,expansion of health care for specific categories of toxic-exposed veterans and veterans supporting certain overseas contingency operations4,sec4 #ajd4 ,assessments of implementation and operation4,sec4 #aje4 ,revision of breast cancer mammography policy of ,department of ,veterans ,affairs to provide mammography screening for veterans who served in locations associated with toxic exposure4,subtitle ,b--,certain veterans of combat service and other matters,sec4 #aaa4 ,expansion of period of eligibility for health care for certain veterans of combat service4,sec4 #aab4 ,authorization period for emergency treatment in non-,department of ,veterans ,affairs medical facilities4,title ,,ii--,toxic exposure presumption process,sec4 #bja4 ,short title4,sec4 #bjb4 ,improvements to ability of ,department of ,veterans ,affairs to establish presumptions of service connection based on toxic exposure4,sec4 #bjc4 ,reevaluation of claims for compensation involving presumptions of service connection4,title ,,iii--,improving the establishment of service connection process for toxic-exposed veterans,sec4 #cja4 ,short title4,sec4 #cjb4 ,presumptions of toxic exposure4,sec4 #cjc4 ,medical nexus examinations for toxic exposure risk activities4,title ,,iv--,presumptions of service connection,sec4 #dja4 ,treatment of veterans who participated in cleanup of ,enewetak ,atoll as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by ,department of ,veterans ,affairs4,sec4 #djb4 ,treatment of veterans who participated in nuclear response near ,palomares1 ,spain1 or ,thule1 ,greenland1 as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by ,department of ,veterans ,affairs4,sec4 #djc4 ,presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations4,sec4 #djd4 ,addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations4,sec4 #dje4 ,improving compensation for disabilities occurring in ,persian ,gulf ,war veterans4,sec4 #djf4 ,presumption of service connection for certain diseases associated with exposure to burn pits and other toxins4,title ,v--,research matters,sec4 #eja4 ,interagency working group on toxic exposure research4,sec4 #ejb4 ,data collection1 analysis1 and report on treatment of veterans for illnesses related to toxic exposure4,sec4 #ejc4 ,studies related to veterans who served in ,southwest ,asia and certain other locations4,sec4 #ejd4 ,study on health trends of post #i_/aa veterans4,sec4 #eje4 ,study on cancer rates among veterans4,sec4 #ejf4 ,study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities4,sec4 #ejg4 ,study on health effects of waste related to ,manhattan ,project on certain veterans4,sec4 #ejh4 ,study on toxic exposure and mental health outcomes4,sec4 #eji4 ,study on veterans in ,territories of the ,united ,states4,sec4 #eaj4 ,department of ,veterans ,affairs public website for toxic exposure research4,sec4 #eaa4 ,biennial report on health effects of jet fuels used by ,armed ,forces4,title ,,vi--,improvement of resources and training regarding toxic-exposed veterans,sec4 #fja4 ,short title2 definitions4,sec4 #fjb4 ,publication of list of resources of ,department of ,veterans ,affairs for toxic-exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans4,sec4 #fjc4 ,incorporation of toxic exposure questionnaire during primary care appointments4,sec4 #fjd4 ,training for personnel of the ,department of ,veterans ,affairs with respect to toxic-exposed veterans4,sec4 #fje4 ,guidelines for active duty military on potential risks and prevention of toxic exposures4,title ,,vii--,registries1 records1 and other matters,sec4 #gja4 ,registry of individuals exposed to per- and polyfluoroalkyl substances on military installations4,sec4 #gjb4 ,fort ,mc,clellan ,health ,registry4,sec4 #gjc4 ,independent study on ,individual ,longitudinal ,exposure ,record4,sec4 #gjd4 ,biannual report on ,individual ,longitudinal ,exposure ,record4,sec4 #gje4 ,correction of exposure records by members of the ,armed ,forces and veterans4,sec4 #gjf4 ,federal cause of action relating to water at ,camp ,lejeune1 ,north ,carolina4,sec4 #gjg4 ,veterans ,toxic ,exposures ,fund4,sec4 #gjh4 ,authorization of electronic notice in claims under laws administered by the ,secretary of ,veterans ,affairs4,sec4 #gji4 ,authorization of appropriations for expansion of claims automation4,sec4 #gaj4 ,non-applicability of non-,department of ,veterans ,affairs covenants not to compete to appointment of ,veterans ,health ,administration personnel4,sec4 #gaa4 ,recruitment of physicians on a contingent basis prior to completion of training requirements4,sec4 #gab4 ,authority for ,secretary of ,veterans ,affairs to award grants to ,states to improve outreach to veterans4,sec4 #gac4 ,study and report on herbicide agent exposure in ,panama ,canal ,zone4,sec4 #gad4 ,budget information for alternatives to burn pits4,sec4 #gae4 ,authorization of appropriations for expansion of claims automation4,sec4 #gaf4 ,burn pit registry updates4,sec4 #gag4 ,burn pit transparency4 ,i ,expansion of health care eligibility ,a ,toxic-exposed veterans #aja4 ,short title ,this title may be cited as the ,conceding ,our ,veterans' ,exposures ,now ,and ,necessitating ,training ,act or the ,,covenant ,act4 #ajb4 ,definitions relating to toxic-exposed veterans 7a7 ,in general ,section #agaj7;a77#b77;,f7 is amended by striking who was exposed to a toxic substance1 radiation1 or other conditions1 as provided in subsection 7e7 and inserting in accordance with subsection 7e71 who is a toxic-exposed veteran4 7b7 ,definitions of toxic exposure and toxic-exposed veteran ,section #aja is amended by adding at the end the following new paragraphs3 7#cg7 ,the term toxic exposure includes the following3 7,a7 ,a toxic exposure risk activity1 as defined in section #agaj7;e77#d7 of this title4 7,b7 ,an exposure to a substance1 chemical1 or airborne hazard identified in the list under section #aaai7;b77#b7 of this title4 7#ch7 ,the term toxic-exposed veteran means a veteran described in section #agaj7;e77#a7 of this title4 4 7c7 ,definition of toxic exposure risk activity ,section #agaj7;e77#d7 is amended by adding at the end the following new subparagraph3 7,c7 ,the term toxic exposure risk activity means any activity-- 7i7 that requires a corresponding entry in an exposure tracking record system 7as defined in section #aaai7;c7 of this title7 for the veteran who carried out the activity2 or 7ii7 that the ,secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans4 4 #ajc4 ,expansion of health care for specific categories of toxic-exposed veterans and veterans supporting certain overseas contingency operations 7a7 ,in general 7#a7 ,expansion ,subsection 7e7 of section #agaj1 as amended by section #ajb7;c71 is further amended-- 7,a7 in paragraph 7#a71 by adding at the end the following new subparagraphs3 7,g7 ,beginning not later than the applicable date specified in paragraph 7#f71 and subject to paragraph 7#b71 a veteran who participated in a toxic exposure risk activity while serving on active duty1 active duty for training1 or inactive duty training is eligible for hospital care 7including mental health services and counseling71 medical services1 and nursing home care under subsection 7a77#b77;,f7 for any illness4 7,h7 ,beginning not later than the applicable date specified in paragraph 7#f71 and subject to paragraph 7#b71 a covered veteran 7as defined in section #aaai7;c7 of this title7 is eligible for hospital care 7including mental health services and counseling71 medical services1 and nursing home care under subsection 7a77#b77;,f7 for any illness4 7,i7 7i7 ,beginning not later than the applicable date specified in paragraph 7#f71 and subject to paragraph 7#b71 a veteran who deployed in support of a contingency operation specified in clause 7ii7 is eligible for hospital care 7including mental health services and counseling71 medical services1 and nursing home care under subsection 7a77#b77;,f7 for any illness4 7ii7 ,a contingency operation specified in this clause is any of the following3 7,i7 ,operation ,enduring ,freedom4 7,,ii7 ,operation ,freedom's ,sentinel4 7,,iii7 ,operation ,iraqi ,freedom4 7,,iv7 ,operation ,new ,dawn4 7,v7 ,operation ,inherent ,resolve4 7,,vi7 ,resolute ,support ,mission4 2 and 7,b7 in paragraph 7#b77;,b7-- 7i7 by striking or 7,f7 and inserting 7,f71 7,g71 7,h71 or 7,i72 and 7ii7 by striking service or testing and inserting service1 testing1 or activity4 7#b7 ,phase in ,such subsection is further amended by adding at the end the following new paragraph3 7#f7 7,a7 ,the ,secretary shall determine the dates in subparagraphs 7,g71 7,h71 and 7,i7 of paragraph 7#a7 as follows3 7i7 ,october #a1 #bjbd1 with respect to a veteran described in such subparagraph 7,g7 or 7,h7 who was discharged or released from the active military1 naval1 air1 or space service during the period beginning on ,august #b1 #aiij1 and ending on ,september #aa1 #bjja4 7ii7 ,october #a1 #bjbf1 with respect to a veteran described in such subparagraph 7,g7 or 7,h7 who was discharged or released from the active military1 naval1 air1 or space service during the period beginning on ,september #ab1 #bjja1 and ending on ,december #ca1 #bjjf4 7iii7 ,october #a1 #bjbh1 with respect to a veteran described in such subparagraph 7,g7 or 7,h7 who was discharged or released from the active military1 naval1 air1 or space service during the period beginning on ,january #a1 #bjjg1 and ending on ,december #ca1 #bjab4 7iv7 ,october #a1 #bjcj1 with respect to a veteran described in such subparagraph 7,g7 or 7,h7 who was discharged or released from the active military1 naval1 air1 or space service during the period beginning on ,january #a1 #bjac1 and ending on ,december #ca1 #bjah4 7v7 ,october #a1 #bjcb1 with respect to a veteran described in such subparagraph 7,i74 7,b7 ,the ,secretary may modify a date specified in subparagraph 7,a7 to an earlier date1 as the ,secretary determines appropriate based on the number of veterans receiving hospital care1 medical services1 and nursing home care under subparagraphs 7,g71 7,h71 and 7,i7 of paragraph 7#a7 and the resources available to the ,secretary4 ,if the ,secretary determines to so modify a date1 the ,secretary shall-- 7i7 notify the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate of the proposed modification2 and 7ii7 publish such modified date in the ,federal ,register4 4 7b7 ,outreach plans ,with respect to each of clauses 7i7 through 7v7 of section #agaj7;e77#f77;,a7 of title #ch1 ,united ,states ,code 7as added by subsection 7a77#b771 not later than #ahj days prior to the date specified in the clause 7including a date modified pursuant to such section71 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a plan to conduct outreach to the veterans referred to in the clause to notify such veterans of their eligibility for hospital care1 medical services1 or nursing home care under subparagraph 7,g71 7,h71 or 7,i71 of section #agaj7;e77#a7 of such title1 as the case may be4 #ajd4 ,assessments of implementation and operation 7a7 ,initial resource assessment and report ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall-- 7#a7 complete an assessment to determine-- 7,a7 the personnel and material resources necessary to implement section #ajc 7including the amendments made by such section72 and 7,b7 the total number of covered veterans1 as such term is defined in section #aaai7;c7 of title #ch1 ,united ,states ,code 7as added by section #cjb71 who receive hospital care or medical services furnished by the ,secretary under chapter #ag of such title1 disaggregated by priority group specified in section #agje7;a7 of such title2 and 7#b7 submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing the findings of the assessment completed under paragraph 7#a71 including a specific determination as to whether the ,department has the personnel and material resources necessary to implement section #ajc4 7b7 ,information systems ,not later than ,october #a1 #bjbd1 the ,secretary shall establish information systems to assess the implementation of section #ajc1 including the amendments made by such section1 and use the results of assessments under such systems to inform the reports under subsection 7c74 7c7 ,annual reports 7#a7 ,reports ,not later than ,october #a1 #bjbe1 and on an annual basis thereafter until ,october #a1 #bjcc1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the following3 7,a7 ,the effect of the implementation of1 and the provision and management of care under1 section #ajc1 7including the amendments made by such section7 on the demand by veterans described in subparagraphs 7,g71 7,h71 and 7,i7 of section #agaj7;e77#a7 of title #ch1 ,united ,states ,code 7as added by such section #ajc7 for health care services furnished by the ,secretary4 7,b7 ,any differing patterns of demand for health care services by such veterans1 disaggregated by factors such as the relative distance of the veteran from medical facilities of the ,department and whether the veteran had previously received hospital care or medical services furnished by the ,secretary under chapter #ag of such title4 7,c7 ,the extent to which the ,secretary has met such demand4 7,d7 ,any changes1 during the year covered by the report1 in the delivery patterns of health care furnished by the ,secretary under chapter #ag of such title1 and the fiscal impact of such changes4 7#b7 ,matters ,each report under paragraph 7#a7 shall include1 with respect to the year covered by the report1 detailed information on the following3 7,a7 ,the total number of veterans enrolled in the patient enrollment system who1 during such year1 received hospital care or medical services furnished by the ,secretary under chapter #ag of title #ch1 ,united ,states ,code4 7,b7 ,of the veterans specified in subparagraph 7,a71 the number of such veterans who1 during the preceding three fiscal years1 had not received such care or services4 7,c7 ,with respect to the veterans specified in subparagraph 7,b71 the cost of providing health care to such veterans during the year covered by the report1 shown in total and disaggregated by-- 7i7 the level of care2 and 7ii7 whether the care was provided through the ,veterans ,community ,care ,program4 7,d7 ,with respect to the number of veterans described in subparagraphs 7,g71 7,h71 and 7,i7 of section #agaj7;e77#a7 of title #ch1 ,united ,states ,code 7as added by section #ajc71 the following 7shown in total and disaggregated by medical facility of the ,department1 as applicable73 7i7 ,the number of such veterans who1 during the year covered by the report1 enrolled in the patient enrollment system4 7ii7 ,the number of such veterans who applied for1 but were denied1 such enrollment4 7iii7 ,the number of such veterans who were denied hospital care or a medical service furnished by the ,secretary that was considered to be medically necessary but not of an emergency nature4 7,e7 ,the numbers and characteristics of1 and the type and extent of health care furnished by the ,secretary to1 veterans enrolled in the patient enrollment system 7shown in total and disaggregated by medical facility of the ,department74 7,f7 ,the numbers and characteristics of1 and the type and extent of health care furnished by the ,secretary to1 veterans not enrolled in the patient enrollment system 7disaggregated by each class of eligibility for care under section #agaj of title #ch1 ,united ,states ,code1 and further shown as a total per class and disaggregated by medical facility of the ,department74 7,g7 ,the specific fiscal impact 7shown in total and disaggregated by geographic health care delivery areas7 of changes in the delivery patterns of health care furnished by the ,secretary under chapter #ag of such title as a result of the implementation of section #ajc 7including the amendments made by such section74 7d7 ,definitions ,in this section3 7#a7 ,the term patient enrollment system means the patient enrollment system of the ,department of ,veterans ,affairs established and operated under section #agje of title #ch1 ,united ,states ,code4 7#b7 ,the term ,veterans ,community ,care ,program means the program established under section #agjc of title #ch1 ,united ,states ,code4 #aje4 ,revision of breast cancer mammography policy of ,department of ,veterans ,affairs to provide mammography screening for veterans who served in locations associated with toxic exposure 7a7 ,in general ,section #gcbb of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in subsection 7a71 by striking ,the and inserting ,in general4--,the2 7#b7 in subsection 7b7-- 7,a7 by striking ,the and inserting ,standards for screening4--,the2 and 7,b7 in paragraph 7#b77;,b71 by inserting a record of service in a location and during a period specified in subsection 7d71 after risk factors12 and 7#c7 by adding at the end the following new subsections3 7c7 ,eligibility for screening for veterans exposed to toxic substances ,the ,under ,secretary for ,health shall ensure that1 under the policy developed under subsection 7a71 any veteran who1 during active military1 naval1 or air service1 was deployed in support of a contingency operation in a location and during a period specified in subsection 7d71 is eligible for a mammography screening by a health care provider of the ,department4 7d7 ,locations and periods specified 7#a7 ,the locations and periods specified in this subsection are the following3 7,a7 ,iraq during following periods3 7i7 ,the period beginning on ,august #b1 #aiij1 and ending on ,february #bh1 #aiia4 7ii7 ,the period beginning on ,march #ai1 #bjjc1 and ending on such date as the ,secretary determines burn pits are no longer used in ,iraq4 7,b7 ,the ,southwest ,asia theater of operations1 other than ,iraq1 during the period beginning on ,august #b1 #aiij1 and ending on such date as the ,secretary determines burn pits are no longer used in such location1 including the following locations3 7i7 ,kuwait4 7ii7 ,saudi ,arabia4 7iii7 ,oman4 7iv7 ,qatar4 7,c7 ,afghanistan during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,afghanistan4 7,d7 ,djibouti during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,djibouti4 7,e7 ,syria during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,syria4 7,f7 ,jordan during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,jordan4 7,g7 ,egypt during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,egypt4 7,h7 ,lebanon during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,lebanon4 7,i7 ,yemen during the period beginning on ,september #aa1 #bjja1 and ending on such date as the ,secretary determines burn pits are no longer used in ,yemen4 7,j7 ,such other locations and corresponding periods as set forth by the ,airborne ,hazards and ,open ,burn ,pit ,registry established under section #bja of the ,dignified ,burial and ,other ,veterans' ,benefits ,improvement ,act of #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7,k7 ,such other locations and corresponding periods as the ,secretary1 in collaboration with the ,secretary of ,defense1 may determine appropriate in a report submitted under paragraph 7#b74 7#b7 ,not later than two years after the date of the enactment of the ,supporting ,expanded ,review for ,veterans ,in ,combat ,environments ,act of #bjba1 and not less frequently than once every two years thereafter1 the ,secretary of ,veterans ,affairs1 in collaboration with the ,secretary of ,defense1 shall submit to ,congress a report specifying other locations and corresponding periods for purposes of paragraph 7#a77,k74 7#c7 ,a location under this subsection shall not include any body of water around or any airspace above such location4 7#d7 ,in this subsection1 the term burn pit means an area of land that is used for disposal of solid waste by burning in the outdoor air4 4 7b7 ,report on breast cancer rates for veterans deployed to certain areas ,not later than two years after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report that compares the rates of breast cancer among members of the ,armed ,forces deployed to the locations and during the periods specified in section #gcbb7;d7 of title #ch1 ,united ,states ,code1 as added by subsection 7a71 as compared to members of the ,armed ,forces who were not deployed to those locations during those periods and to the civilian population4 ,b ,certain veterans of combat service and other matters #aaa4 ,expansion of period of eligibility for health care for certain veterans of combat service 7a7 ,expanded period ,section #agaj7;e77#c7 is amended-- 7#a7 in subparagraph 7,a7-- 7,a7 by striking ,january #bg1 #bjjc and inserting ,september #aa1 #bjja2 and 7,b7 by striking five-year period and inserting #aj-year period2 7#b7 by amending subparagraph 7,b7 to read as follows3 7,b7 ,with respect to a veteran described in paragraph 7#a77;,d7 who was discharged or released from the active military1 naval1 air1 or space service after ,september #aa1 #bjja1 and before ,october #a1 #bjac1 but did not enroll to receive such hospital care1 medical services1 or nursing home care under such paragraph pursuant to subparagraph 7,a7 before ,october #a1 #bjbb1 the one-year period beginning on ,october #a1 #bjbb4 2 and 7#c7 by striking subparagraph 7,c74 7b7 ,clarification of coverage ,section #agaj7;e77#a77;,d7 is amended by inserting after ,persian ,gulf ,war the following3 7including any veteran who1 in connection with service during such period1 received the ,armed ,forces ,expeditionary ,medal1 ,service ,specific ,expeditionary ,medal1 ,combat ,era ,specific ,expeditionary ,medal1 ,campaign ,specific ,medal1 or any other combat theater award established by a ,federal statute or an ,executive order74 7c7 ,outreach plan ,not later than ,december #a1 #bjbb1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a plan to conduct outreach to veterans described in subparagraph 7,b7 of section #agaj7;e77#c7 of title #ch1 ,united ,states ,code1 as amended by subsection 7a77#b71 to notify such veterans of their eligibility for hospital care1 medical services1 or nursing home care pursuant to such subparagraph4 7d7 ,report on enrollments ,not later than ,january #cj1 #bjbd1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report identifying1 with respect to the one-year period beginning on ,october #a1 #bjbb1 the number of veterans described in section #agaj7;e77#c77;,b7 of title #ch1 ,united ,states ,code1 as amended by subsection 7a77#b71 who1 during such period1 enrolled in the patient enrollment system of the ,department of ,veterans ,affairs established and operated under section #agje of such title4 7e7 ,effective date ,this section and the amendments made by this section shall take effect on ,october #a1 #bjbb4 #aab4 ,authorization period for emergency treatment in non-,department of ,veterans ,affairs medical facilities ,section #agjc7;a77#c7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking ,a covered veteran and inserting 7,a7 ,except as provided by subparagraph 7,b71 a covered veteran2 and 7#b7 by adding at the end the following new subparagraph3 7,b7 ,in the case of an emergency which existed at the time of admission of a covered veteran to a health care provider1 the ,secretary shall deem the care or services received by the veteran during such admission to be authorized under subparagraph 7,a7 if the covered veteran 7or an individual acting on behalf of the covered veteran7 makes an application for such authorization during the period following such admission that the ,secretary determines appropriate for purposes of this paragraph1 except such period may not be less than #if hours4 4 ,,ii ,toxic exposure presumption process #bja4 ,short title ,this subtitle may be cited as the ,fairly ,assessing ,service-related ,toxic ,exposure ,residuals ,presumptions ,act or the ,,faster ,presumptions ,act4 #bjb4 ,improvements to ability of ,department of ,veterans ,affairs to establish presumptions of service connection based on toxic exposure 7a7 ,advisory committees1 panels1 and boards ,chapter #aa is amended by adding at the end the following new subchapter3 ,,vii ,determinations relating to presumptions of service connection based on toxic exposure #aaga4 ,procedures to determine presumptions of service connection based on toxic exposure2 definitions 7a7 ,procedures ,the ,secretary shall determine whether to establish1 or to remove1 presumptions of service connection based on toxic exposure pursuant to this subchapter1 whereby-- 7#a7 the ,formal ,advisory ,committee on ,toxic ,exposure under section #aagb of this title-- 7,a7 provides advice to the ,secretary on toxic-exposed veterans and cases in which veterans who1 during active military1 naval1 air1 or space service1 may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military1 naval1 air1 or space service2 7,b7 provides to the ,secretary recommendations on corrections needed in the ,individual ,longitudinal ,exposure ,record1 or successor system1 to better reflect veterans and dependents described in subparagraph 7,a72 and 7,c7 provides to the ,secretary recommendations regarding which cases of possible toxic exposure should be reviewed2 and 7#b7 the ,secretary provides for formal evaluations of such recommendations under section #aagc of this title2 and 7#c7 the ,secretary issues regulations under section #aagd of this title4 7b7 ,illness defined ,in this subchapter1 the term illness includes a disease or other condition affecting the health of an individual1 including mental and physical health4 #aagb4 ,formal ,advisory ,committee on ,toxic ,exposure 7a7 ,establishment 7#a7 ,there is in the ,veterans ,health ,administration of the ,department the ,formal ,advisory ,committee on ,toxic ,exposure 7in this section referred to as the ,committee74 7#b7 7,a7 ,the ,committee shall be composed of nine members appointed as follows3 7i7 ,five members shall be appointed by the ,secretary4 7ii7 ,one member shall be appointed by the ,speaker of the ,house of ,representatives4 7iii7 ,one member shall be appointed by the minority leader of the ,house of ,representatives4 7iv7 ,one member shall be appointed by the majority leader of the ,senate4 7v7 ,one member shall be appointed by the minority leader of the ,senate4 7,b7 ,the members appointed under subparagraph 7,a7 shall meet the following criteria3 7i7 ,not more than three members shall be appointed from among individuals who are officials or employees of the ,veterans ,benefits ,administration or the ,veterans ,health ,administration4 7ii7 ,at least one member shall be appointed from among individuals who are officials or employees of other departments or agencies of the ,federal ,government1 including the ,department of ,defense and the ,agency of ,toxic ,substances and ,disease ,registry of the ,centers for ,disease ,control and ,prevention4 7iii7 ,at least two members shall represent an organization recognized by the ,secretary for the representation of veterans under section #eijb of this title4 7iv7 ,at least one member shall be appointed from among individuals in the private sector1 ,state or local government1 or academia1 who are experts in toxicology and epidemiology4 7#c7 ,the ,secretary shall determine the pay and allowances of the members of the ,committee1 including with respect to any additional pay and allowances for members who are officials or employees of the ,federal ,government4 7#d7 7,a7 ,except as provided by subparagraph 7,b71 each member of the ,committee shall be appointed for a two-year term1 and may serve not more than three successive terms4 7,b7 ,with respect to the five members who are initially appointed by the ,secretary under subparagraph 7,a77i71 the ,secretary shall determine the length of the term of each such member in a manner that ensures the expiration of the terms on a staggered basis4 7#e7 ,a vacancy in the ,committee shall be filled in the manner in which the original appointment was made4 7b7 ,consultation ,the ,secretary may consult with1 and seek the advice of1 the ,committee with respect to cases in which veterans who1 during active military1 naval1 air1 or space service1 are suspected of having experienced a toxic exposure or dependents of veterans who may have experienced a toxic exposure during such service4 7c7 ,assessments 7#a7 ,the ,committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military1 naval1 air1 or space service1 including by conducting ongoing surveillance and reviewing such exposure described in scientific literature1 media reports1 information from veterans1 and information from ,congress4 7#b7 ,the assessments under paragraph 7#a7 shall cover suspected and known toxic exposures occurring during active military1 naval1 air1 or space service1 including by identifying and evaluating new and emerging toxic exposures that are not recognized under existing presumptions of service connection4 7#c7 ,the ,committee may conduct an assessment under paragraph 7#a7 in response to comments by a person described in subsection 7e77#b71 by a majority vote of the members of the ,committee4 7#d7 ,the ,committee shall on a periodic basis assess the ,individual ,longitudinal ,exposure ,record1 or successor system1 to ensure the accuracy of data collected4 7d7 ,research recommendations 7#a7 ,following an assessment of a case of the toxic exposure of veterans or their dependents that occurred during active military1 naval1 air1 or space service under subsection 7c71 the ,committee may develop a recommendation for formal evaluation under section #aagc of this title to conduct a review of the health effects related to the case of exposure if the ,committee determines that the research may change the current understanding of the relationship between an exposure to an environmental hazard and adverse health outcomes in humans4 7#b7 ,upon receipt of evidence suggesting that previous findings regarding the periods and locations of exposure covered by an existing presumption of service connection are no longer supported1 the ,committee may nominate such evidence for formal evaluation under section #aagc of this title to modify the periods and locations4 7e7 ,input 7#a7 ,not less than quarterly1 the ,committee shall provide an opportunity for persons described in paragraph 7#b7 to present written or oral comments to the ,committee4 7#b7 ,the persons described in this paragraph are persons who may be affected by the actions of the ,committee1 including-- 7,a7 veterans1 the families of veterans1 veterans service organizations and representatives1 researchers1 and other members of the general public2 and 7,b7 departments and agencies of the ,federal ,government4 7f7 ,reports by the ,committee ,not less frequently than once each year1 the ,committee shall submit to the ,secretary and the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives1 and make publicly available1 a report on-- 7#a7 recommendations for research under subsection 7d71 if any2 and 7#b7 recommendations for such legislative or administrative action as the ,committee considers necessary for the ,committee to be more effective in carrying out the requirements of this section4 7g7 ,responses by ,secretary ,in response to each report submitted under subsection 7f71 the ,secretary shall submit to the ,secretary and the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives1 and make publicly available1 a report on-- 7#a7 the findings and opinions of the ,secretary with respect to the report most recently submitted under subsection 7f72 and 7#b7 whether the ,secretary will conduct research recommended under subsection 7f7 included in the report1 and if not1 an explanation of why1 including citations and sources4 7h7 ,nonapplication of sunset requirements ,section #ad of the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the ,committee4 #aagc4 ,formal evaluation of recommendations 7a7 ,formal evaluation ,the ,secretary shall establish a process to conduct a formal evaluation with respect to each recommendation made by the ,formal ,advisory ,committee on ,toxic ,exposure under section #aagb of this title-- 7#a7 to conduct research regarding the health effects related to a case of toxic exposure2 or 7#b7 to evaluate evidence regarding the periods and locations of exposure covered by an existing presumption of service connection4 7b7 ,evidence1 data1 and factors ,the ,secretary shall ensure that each formal evaluation under paragraph 7#a7 covers the following3 7#a7 ,scientific evidence1 based on the review of available scientific literature1 including human1 toxicological1 animal1 and methodological studies1 and other factors4 7#b7 ,claims data1 based on the review of claim rate1 grant rate1 and service connection prevalence1 and other factors4 7#c7 ,other factors the ,secretary determines appropriate1 such as-- 7,a7 the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated2 7,b7 the level of assistance required to remain in the community because of such health effects2 7,c7 the quantity and quality of the information available and reviewed2 7,d7 the feasibility of and period for generating relevant information and evidence2 7,e7 whether such health effects are combat- or deployment-related2 and 7,f7 the ubiquity or rarity of the health effects4 7c7 ,conduct of evaluations 7#a7 ,the ,secretary shall ensure that each formal evaluation under subsection 7a7-- 7,a7 reviews scientific evidence in a manner that-- 7i7 conforms to principles of scientific and data integrity2 7ii7 is free from suppression or distortion of scientific or technological findings1 data1 information1 conclusions1 or technical results2 and 7,b7 7i7 evaluates the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military1 naval1 air1 or space service2 and 7ii7 assesses the toxic exposures and illnesses and determines whether the evidence supports a finding of a positive association between the toxic exposure and the illness4 7#b7 ,in carrying out paragraph 7#a77;,b77ii71 a formal evaluation under subsection 7a7 shall include reviewing all relevant data to determine the strength of evidence for a positive association based on the following four categories3 7,a7 ,the sufficient category1 where the evidence is sufficient to conclude that a positive association exists4 7,b7 ,the equipoise and above category1 where the evidence is sufficient to conclude that a positive association is at least as likely as not1 but not sufficient to conclude that a positive association exists4 7,c7 ,the below equipoise category1 where the evidence is not sufficient to conclude that a positive association is at least as likely as not1 or is not sufficient to make a scientifically informed judgment4 7,d7 ,the against category1 where the evidence suggests the lack of a positive association4 7d7 ,recommendation for rulemaking ,not later than #abj days after the date on which a formal evaluation is commenced1 the element of the ,department that conducts the evaluation shall submit to the ,secretary a recommendation with respect to establishing a presumption of service connection for the toxic exposure and illness1 or modifying an existing presumption of service connection1 covered by the evaluation4 #aagd4 ,regulations regarding presumptions of service connection based on toxic exposure 7a7 ,action upon recommendation ,not later than #afj days after the date on which the ,secretary receives a recommendation to establish or modify a presumption of service connection under section #aagc of this title-- 7#a7 if the ,secretary determines that the presumption1 or modification1 is warranted1 the ,secretary shall commence issuing regulations in accordance with the provisions of subchapter ,,ii of chapter #e of title #e 7commonly referred to as the ,administrative ,procedures ,act7 setting forth the presumption or commence revising regulations to carry out such modification2 or 7#b7 if the ,secretary determines that the presumption1 or modification1 is not warranted1 the ,secretary shall publish in the ,federal ,register a notice of the determination1 including the reasons supporting the determination4 7b7 ,removal of presumption 7#a7 ,the ,secretary may issue regulations to remove an illness from a presumption of service connection previously established pursuant to a regulation issued under subsection 7a74 7#b7 ,whenever an illness is removed from regulations pursuant to paragraph 7#a71 or the periods and locations of exposure covered by a presumption of service connection are modified under subsection 7a7-- 7,a7 a veteran who was awarded compensation for such illness on the basis of the presumption provided under such regulations before the effective date of the removal or modification shall continue to be entitled to receive compensation on that basis2 and 7,b7 a survivor of a veteran who was awarded dependency and indemnity compensation for the death of a veteran resulting from such illness on the basis of such presumption shall continue to be entitled to receive dependency and indemnity compensation on such basis4 #aage4 ,authority to modify process2 congressional oversight 7a7 ,authority 7#a7 ,the ,secretary may modify the process under which the ,secretary conducts formal evaluations under section #aagc of this title and issues regulations under section #aagd if-- 7,a7 such evaluations cover the evidence1 data1 and factors required by subsection 7b7 of such section #aagc2 and 7,b7 a period of #ahj days has elapsed following the date on which the ,secretary submits the notice under paragraph 7#b7 regarding the modification4 7#b7 ,if the ,secretary proposes to modify the process under which the ,secretary conducts formal evaluations under section #aagc of this title or issues regulations under section #aagd1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a notice of the proposed modifications containing the following3 7,a7 ,a description of the proposed modifications4 7,b7 ,a description of any exceptions to the requirements of such sections that are proposed because of limited available scientific evidence1 and a description of how such evaluations will be conducted4 7b7 ,reports and briefings 7#a7 7,a7 ,not later than two years after the date of the enactment of the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the implementation of1 and recommendations for1 this subchapter4 7,b7 ,the ,secretary shall develop the report under subparagraph 7,a7 in consultation with organizations recognized by the ,secretary for the representation of veterans under section #eijb of this title and any other entity the ,secretary determines appropriate4 7#b7 ,on a quarterly basis during the two-year period beginning on the date of the enactment of the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba1 the ,secretary shall provide to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a briefing on the implementation of this subchapter4 7c7 ,independent review ,the ,secretary shall seek to enter into an agreement with a nongovernmental entity or a federally funded research and development center to conduct a review of the implementation of this subchapter4 ,not later than #edj days after the date of the enactment of the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing such review4 4 7b7 ,conforming amendments ,chapter #aa is amended-- 7#a7 in section #aaaf-- 7,a7 by striking subsections 7b71 7c71 7d71 and 7e72 7,b7 by inserting after subsection 7a7 the following new subsection 7b73 7b7 ,the ,secretary shall ensure that any determination made on or after the date of the enactment of the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter ,,vii of this chapter1 including with respect to assessing reports received by the ,secretary from the ,national ,academy of ,sciences under section #c of the ,agent ,orange ,act of #aiia 7,public ,law #ajb-d74 2 and 7,c7 by redesignating subsection 7f7 as subsection 7c72 7#b7 in section #aaaf;,b7b77#b77;,a71 by inserting pursuant to subchapter ,,vii of this chapter1 before the ,secretary determines2 and 7#c7 in section #aaah-- 7,a7 by striking subsections 7b7 through 7e72 and 7,b7 by inserting after subsection 7a7 the following new subsection 7b73 7b7 ,the ,secretary shall ensure that any determination made on or after the date of the enactment of the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter ,,vii of this chapter4 4 7c7 ,rule of construction ,nothing in section #aagb7;a77#b77;,a7 of title #ch1 ,united ,states ,code1 as added by subsection 7a71 shall be construed so as to require the advice and consent of the ,senate in the appointment of members of the ,formal ,advisory ,committee on ,toxic ,exposure4 #bjc4 ,reevaluation of claims for compensation involving presumptions of service connection 7a7 ,in general ,subchapter ,,vi of chapter #aa is amended by adding at the end the following new section3 #aafg4 ,reevaluation of compensation determinations pursuant to changes in presumptions of service connection 7a7 ,reevaluation ,whenever a law1 including through a regulation or ,federal court decision1 establishes or modifies a presumption of service connection1 the ,secretary shall-- 7#a7 identify all claims for compensation under this chapter that-- 7,a7 were submitted to the ,secretary2 7,b7 were evaluated and denied by the ,secretary before the date on which such provision of law went into effect2 and 7,c7 might have been evaluated differently had the establishment or modification been applicable to the claim2 7#b7 allow for the reevaluation of such claims at the election of the veteran2 and 7#c7 notwithstanding section #eaaj of this title1 with respect to claims approved pursuant to such reevaluation1 provide compensation under this chapter effective as if the establishment or modification of the presumption of service connection had been in effect on the date of the submission of the original claim described in paragraph 7#a74 7b7 ,outreach ,the ,secretary shall conduct outreach to inform relevant veterans that they may elect to have a claim be reevaluated in light of the establishment or modification of a presumption of service connection described in subsection 7a74 ,such outreach shall include the following3 7#a7 ,the ,secretary shall publish on the internet website of the ,department a notice that such veterans may elect to have a claim so reevaluated4 7#b7 ,the ,secretary shall notify1 in writing or by electronic means1 veterans service organizations of the ability of such veterans to elect to have a claim so reevaluated4 4 7b7 ,application ,section #aafg of title #ch1 ,united ,states ,code1 as added by subsection 7a71 shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this ,act1 including pursuant to amendments made by this ,act4 ,,iii ,improving the establishment of service connection process for toxic-exposed veterans #cja4 ,short title ,this title may be cited as the ,veterans ,burn ,pits ,exposure ,recognition ,act4 #cjb4 ,presumptions of toxic exposure ,subchapter ,,ii of chapter #aa is amended by adding at the end the following new section3 #aaai4 ,presumptions of toxic exposure 7a7 ,consideration of records ,if a veteran submits to the ,secretary a claim for compensation for a service-connected disability under section #aaaj of this title with evidence of a disability and a toxic exposure that occurred during active military1 naval1 air1 or space service1 the ,secretary may1 in adjudicating such claim1 consider-- 7#a7 any record of the veteran in an exposure tracking record system2 and 7#b7 if no record of the veteran in an exposure tracking record system indicates that the veteran was subject to a toxic exposure during active military1 naval1 air1 or space service1 the totality of the circumstances of the service of the veteran4 7b7 ,presumption of specific toxic exposure for members who served in certain locations 7#a7 ,the ,secretary shall1 for purposes of section #aaaj and chapter #ag of this title1 presume that any covered veteran was exposed to the substances1 chemicals1 and airborne hazards identified in the list under paragraph 7#b7 during the service of the covered veteran specified in subsection 7c77#a71 unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances1 chemicals1 or hazards in connection with such service4 7#b7 ,the ,secretary shall establish and maintain a list that contains an identification of one or more such substances1 chemicals1 and airborne hazards as the ,secretary1 in collaboration with the ,secretary of ,defense1 may determine appropriate for purposes of this section4 7#c7 ,beginning not later than two years after the date of the enactment of the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba1 and not less frequently than once every two years thereafter1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report identifying any additions or removals to the list under paragraph 7#b7 during the period covered by the report4 7c7 ,definitions ,in this section3 7#a7 ,the term covered veteran means any veteran who-- 7,a7 on or after ,august #b1 #aiij1 performed active military1 naval1 air1 or space service while assigned to a duty station in-- 7i7 ,bahrain2 7ii7 ,iraq2 7iii7 ,kuwait2 7iv7 ,oman2 7v7 ,qatar2 7vi7 ,saudi ,arabia2 7vii7 ,somalia2 or 7viii7 ,united ,arab ,emirates2 or 7,b7 on or after ,september #aa1 #bjja1 performed active military1 naval1 air1 or space service while assigned to a duty station in-- 7i7 ,afghanistan2 7ii7 ,djibouti2 7iii7 ,egypt2 7iv7 ,jordan2 7v7 ,lebanon2 7vi7 ,syria2 7vii7 ,yemen2 7viii7 ,uzbekistan2 7ix7 the ,philippines2 or 7x7 any other country determined relevant by the ,secretary4 7#b7 ,the term exposure tracking record system-- 7,a7 means any system1 program1 or pilot program used by the ,secretary of ,veterans ,affairs or the ,secretary of ,defense to track how veterans or members of the ,armed ,forces have been exposed to various occupational or environmental hazards2 and 7,b7 includes the ,individual ,longitudinal ,exposure ,record1 or successor system4 7#c7 ,the term toxic exposure risk activity has the meaning given such term in section #agaj7;e77#d7 of this title4 4 #cjc4 ,medical nexus examinations for toxic exposure risk activities ,subchapter ,,vi of chapter #aa1 as amended by section #bjc1 is further amended by adding at the end the following new section3 #aafh4 ,medical nexus examinations for toxic exposure risk activities 7a7 ,medical examinations and medical opinions 7#a7 ,except as provided in subsection 7b71 if a veteran submits to the ,secretary a claim for compensation for a service-connected disability under section #aaaj of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military1 naval1 air1 or space service1 and such evidence is not sufficient to establish a service connection for the disability1 the ,secretary shall-- 7,a7 provide the veteran with a medical examination under section #eajc;,a7d7 of this title2 and 7,b7 obtain a medical opinion 7to be requested by the ,secretary in connection with the medical examination under subparagraph 7,a77 as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity4 7#b7 ,when providing the ,secretary with a medical opinion under paragraph 7#a77;,b7 for a veteran1 the health care provider shall consider-- 7,a7 the total potential exposure through all applicable military deployments of the veteran2 and 7,b7 the synergistic1 combined effect of all toxic exposure risk activities of the veteran4 7#c7 ,the requirement under paragraph 7#b77;,b7 shall not be construed as requiring a health care provider to consider the synergistic1 combined effect of each of the substances1 chemicals1 and airborne hazards identified in the list under section #aaai7;b77#b7 of this title4 7b7 ,exception ,subsection 7a7 shall not apply if the ,secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence4 7c7 ,toxic exposure risk activity defined ,in this section1 the term toxic exposure risk activity has the meaning given that term in section #agaj7;e77#d7 of this title4 4 ,,iv ,presumptions of service connection #dja4 ,treatment of veterans who participated in cleanup of ,enewetak ,atoll as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by ,department of ,veterans ,affairs 7a7 ,short title ,this section may be cited as the ,mark ,takai ,atomic ,veterans ,healthcare ,parity ,act4 7b7 ,enewetak ,atoll ,section #aaab7;c77#c77;,b7 is amended by adding at the end the following new clause3 7v7 ,cleanup of ,enewetak ,atoll during the period beginning on ,january #a1 #aigg1 and ending on ,december #ca1 #aihj4 4 #djb4 ,treatment of veterans who participated in nuclear response near ,palomares1 ,spain1 or ,thule1 ,greenland1 as radiation-exposed veterans for purposes of presumption of service connection of certain disabilities by ,department of ,veterans ,affairs 7a7 ,short title ,this section may be cited as the ,palomares or ,thule ,veterans ,act 7b7 ,palomares or ,thule ,section #aaab7;c77#c77;,b71 as amended by section #dja1 is further amended by adding at the end the following new clauses3 7vi7 ,onsite participation in the response effort following the collision of a ,united ,states ,air ,force ,b-#eb bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of ,palomares1 ,spain1 during the period beginning ,january #ag1 #aiff1 and ending ,march #ca1 #aifg4 7vii7 ,onsite participation in the response effort following the on-board fire and crash of a ,united ,states ,air ,force ,b-#eb bomber that caused the release of four thermonuclear weapons in the vicinity of ,thule ,air ,force ,base1 ,greenland1 during the period beginning ,january #ba1 #aifh1 and ending ,september #be1 #aifh4 4 #djc4 ,presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations 7a7 ,short title ,this section may be cited as the ,veterans ,agent ,orange ,exposure ,equity ,act4 7b7 ,in general ,section #aaaf1 as amended by section #bjb1 is further amended-- 7#a7 by striking 1 during active military1 naval1 air1 or space service1 served in the ,republic of ,vietnam during the period beginning on ,january #i1 #aifb1 and ending on ,may #g1 #aige each place it appears and inserting performed covered service2 7#b7 by striking performed active military1 naval1 air1 or space service in the ,republic of ,vietnam during the period beginning on ,january #i1 #aifb1 and ending on ,may #g1 #aige each place it appears and inserting performed covered service2 and 7#c7 by adding at the end the following new subsection3 7d7 ,in this section1 the term covered service means active military1 naval1 air1 or space service-- 7#a7 performed in the ,republic of ,vietnam during the period beginning on ,january #i1 #aifb1 and ending on ,may #g1 #aige2 7#b7 performed in ,thailand at any ,united ,states or ,royal ,thai base during the period beginning on ,january #i1 #aifb1 and ending on ,june #cj1 #aigf1 without regard to where on the base the veteran was located or what military job specialty the veteran performed2 7#c7 performed in ,laos during the period beginning on ,december #a1 #aife1 and ending on ,september #cj1 #aifi2 7#d7 performed in ,cambodia at ,mimot or ,krek1 ,kampong ,cham ,province during the period beginning on ,april #af1 #aifi1 and ending on ,april #cj1 #aifi2 or 7#e7 performed on ,guam or ,american ,samoa1 or in the territorial waters thereof1 during the period beginning on ,january #i1 #aifb1 and ending on ,july #ca1 #aihj1 or served on ,johnston ,atoll or on a ship that called at ,johnston ,atoll during the period beginning on ,january #a1 #aigb1 and ending on ,september #cj1 #aigg4 4 7c7 ,eligibility for hospital care and medical services ,section #agaj7;e77#d71 as amended by section #ajb7;c71 is further amended by striking subparagraph 7,a7 and inserting the following new subparagraph3 7,a7 ,the term ,vietnam-era herbicide-exposed veteran means a veteran who-- 7i7 performed covered service1 as defined in section #aaaf7;d7 of this title2 or 7ii7 the ,secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period4 4 7d7 ,conforming amendment ,the heading for section #aaaf is amended by striking the ,republic of ,vietnam and inserting certain locations4 #djd4 ,addition of additional diseases associated with exposure to certain herbicide agents for which there is a presumption of service connection for veterans who served in certain locations 7a7 ,short title ,this section may be cited as the ,fair ,care for ,vietnam ,veterans ,act4 7b7 ,additional diseases ,section #aaaf7;a77#b71 as amended by section #iaji of the ,william ,m4 7,mac7 ,thornberry ,national ,defense ,authorization ,act for ,fiscal ,year #bjba 7,public ,law #aaf-bhc71 is further amended by adding at the end the following new subparagraphs3 7,l7 ,hypertension4 7,m7 ,monoclonal gammopathy of undetermined significance4 4 #dje4 ,improving compensation for disabilities occurring in ,persian ,gulf ,war veterans 7a7 ,reduction in threshold of eligibility ,subsection 7a77#a7 of section #aaag is amended by striking became manifest-- and all that follows through the period at the end and inserting became manifest to any degree at any time44 7b7 ,permanent extension of period of eligibility ,such section is further amended-- 7#a7 by striking subsection 7b72 7#b7 by redesignating subsections 7c7 and 7d7 as subsections 7b7 and 7c71 respectively2 and 7#c7 in subsection 7a77#b77;,c71 by striking under subsection 7d7 and inserting under subsection 7c74 7c7 ,establishing singular disability-based questionnaire ,such section is further amended by inserting after subsection 7c7 7as redesignated by subsection 7b77 the following new subsection 7d73 7d7 ,if a ,persian ,gulf veteran at a medical facility of the ,department presents with any one symptom associated with ,gulf ,war ,illness1 the ,secretary shall ensure that health care personnel of the ,department use a disability benefits questionnaire1 or successor questionnaire1 designed to identify ,gulf ,war ,illness1 in addition to any other diagnostic actions the personnel determine appropriate4 4 7d7 ,expansion of definition of ,persian ,gulf veteran ,subsection 7f7 of such section is amended by inserting 1 ,afghanistan1 ,israel1 ,egypt1 ,turkey1 ,syria1 or ,jordan1 after operations4 7e7 ,training ,such section is further amended by adding at the end the following new subsection3 7i7 7#a7 ,the ,secretary shall take such actions as may be necessary to ensure that health care personnel of the ,department are appropriately trained to effectively carry out this section4 7#b7 ,not less frequently than once each year1 the ,secretary shall submit to ,congress a report on the actions taken by the ,secretary to carry out paragraph 7#a74 4 #djf4 ,presumption of service connection for certain diseases associated with exposure to burn pits and other toxins 7a7 ,short title ,this section may be cited as the ,presumptive ,benefits for ,war ,fighters ,exposed to ,burn ,pits and ,other ,toxins ,act4 7b7 ,in general ,subchapter ,,ii of chapter #aa1 as amended by section #cjb1 is further amended by inserting after section #aaai the following new section3 #aabj4 ,presumption of service connection for certain diseases associated with exposure to burn pits and other toxins 7a7 ,presumption of service connection ,for the purposes of section #aaaj of this title1 and subject to section #aaac of this title1 a disease specified in subsection 7b7 becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military1 naval1 air1 or space service1 notwithstanding that there is no record of evidence of such disease during the period of such service4 7b7 ,diseases specified ,the diseases specified in this subsection are the following3 7#a7 ,asthma that was diagnosed after service of the covered veteran as specified in subsection 7c74 7#b7 ,the following types of cancer3 7,a7 ,head cancer of any type4 7,b7 ,neck cancer of any type4 7,c7 ,respiratory cancer of any type4 7,d7 ,gastrointestinal cancer of any type4 7,e7 ,reproductive cancer of any type4 7,f7 ,lymphoma cancer of any type4 7,g7 ,lymphomatic cancer of any type4 7,h7 ,kidney cancer4 7,i7 ,brain cancer4 7,j7 ,melanoma4 7,k7 ,pancreatic cancer4 7#c7 ,chronic bronchitis4 7#d7 ,chronic obstructive pulmonary disease4 7#e7 ,constrictive bronchiolitis or obliterative bronchiolitis4 7#f7 ,emphysema4 7#g7 ,granulomatous disease4 7#h7 ,interstitial lung disease4 7#i7 ,pleuritis4 7#aj7 ,pulmonary fibrosis4 7#aa7 ,sarcoidosis4 7#ab7 ,chronic sinusitis4 7#ac7 ,chronic rhinitis4 7#ad7 ,glioblastoma4 7#ae7 ,any other disease for which the ,secretary determines1 pursuant to regulations prescribed under subchapter ,,vii that a presumption of service connection is warranted based on a positive association with a substance1 chemical1 or airborne hazard identified in the list under section #aaai7;b77#b7 of this title4 7c7 ,covered veteran defined ,in this section1 the term covered veteran has the meaning given that term in section #aaai7;c7 of this title4 4 7c7 ,conforming amendment ,section #aaac is amended by striking or #aaah each place it appears and inserting #aaah1 or #aabj4 ,v ,research matters #eja4 ,interagency working group on toxic exposure research 7a7 ,in general ,subchapter ,,ii of chapter #gc of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #gccj;,d4 ,interagency working group on toxic exposure research 7a7 ,establishment 7#a7 ,the ,secretary shall establish the ,toxic ,exposure ,research ,working ,group 7in this section referred to as the ,working ,group74 7#b7 ,the ,working ,group shall consist of employees1 selected by the ,secretary1 of the following3 7,a7 ,the ,department4 7,b7 ,the ,department of ,defense4 7,c7 ,the ,department of ,health and ,human ,services4 7,d7 ,the ,environmental ,protection ,agency4 7,e7 ,other ,federal entities involved in research activities regarding the health consequences of toxic exposures experienced during active military1 naval1 air1 or space service4 7b7 ,functions ,the ,working ,group shall perform the following functions3 7#a7 ,identify collaborative research activities and resources available among entities represented by members of the ,working ,group to conduct such collaborative research activities4 7#b7 ,develop a #e-year strategic plan for ,federal entities represented in the ,working ,group to carry out collaborative research activities4 7c7 ,reporting ,the ,secretary shall submit1 to the ,committees on ,veterans' ,affairs of the ,senate and ,house of ,representatives1 the following3 7#a7 ,not later than one year after the date of the enactment of the ,act1 a report on the establishment of the ,working ,group under subsection 7a74 7#b7 ,not later than two years after the date of enactment of the ,act1 a report containing the collaborative research activities identified1 and the ,strategic ,plan developed1 by the ,working ,group1 under subsection 7b74 7#c7 ,annually during the #e-year period covered by the strategic plan under subsection 7b71 a progress reports on implementation of the ,strategic ,plan under subsection 7b74 7d7 ,termination ,the ,working ,group shall terminate after submitting the final report under subsection 7c74 7e7 ,definitions ,for purposes of this section-- 7#a7 ,the term ,act means the ,honoring our ,promise to ,address ,comprehensive ,toxics ,act of #bjba4 7#b7 ,the term collaborative research activity means a research activity-- 7,a7 conducted by an entity represented by a member of the ,working ,group2 7,b7 funded by the ,federal ,government2 and 7,c7 regarding the health consequences of toxic exposures experienced during active military1 naval1 air1 or space service4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such subchapter is amended by inserting after the item relating to section #gccj;,c the following new item3 #gccj;,d4 ,interagency working group on toxic exposure research4 4 7c7 ,implementation ,the ,secretary of ,veterans ,affairs shall establish the ,working ,group under section #gccj;,d of such title1 as added by subsection 7a71 not later than one year after the date of the enactment of this ,act4 #ejb4 ,data collection1 analysis1 and report on treatment of veterans for illnesses related to toxic exposure 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall compile and analyze1 on a continuous basis1 all clinical data that-- 7#a7 is obtained by the ,secretary in connection with hospital care 7including mental health services and counseling71 medical services1 or nursing home care furnished to a veteran for an illness under section #agaj7;a77#b77;,f7 of title #ch1 ,united ,states ,code1 as amended by section #ajb2 and 7#b7 is likely to be scientifically useful1 as determined by the ,secretary1 in determining whether a positive association exists between the illness of the veteran and a toxic exposure4 7b7 ,consent of patients ,the ,secretary shall ensure that the compilation and analysis of the clinical data of a veteran under subsection 7a7 shall be conducted1 and such data shall be used1 in a manner that is consistent with the informed consent of the veteran and in compliance with all applicable ,federal law4 7c7 ,annual report ,not later than one year after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing-- 7#a7 any data compiled under subsection 7a72 7#b7 an analysis of any such data2 7#c7 a description of the types and incidences of illnesses identified by the ,secretary pursuant to such subsection2 7#d7 an explanation by the ,secretary for the incidence of such illnesses and such alternate explanations for the incidence of such illnesses as the ,secretary may consider reasonable2 and 7#e7 a description of the views of the ,secretary regarding the scientific validity of drawing conclusions from the incidence of such illnesses1 as evidenced by the data compiled under subsection 7a71 regarding the existence of a positive association between such illness and a toxic exposure4 7d7 ,definitions ,in this section3 7#a7 ,the term toxic exposure has the meaning given that term in section #aja of title #ch1 ,united ,states ,code4 7#b7 ,the term illness has the meaning given that term in section #aaga of such title1 as added by section #bjb4 #ejc4 ,studies related to veterans who served in ,southwest ,asia and certain other locations 7a7 ,analysis on mortality in covered veterans 7#a7 ,analysis ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall conduct an updated analysis of total and respiratory disease mortality in covered veterans4 7#b7 ,elements ,the analysis under paragraph 7#a7 shall include1 to the extent practicable1 the following3 7,a7 ,metrics of airborne exposures4 7,b7 ,the location and timing of any deployments of the veteran4 7,c7 ,the military occupational specialty of the veteran4 7,d7 ,the ,armed ,force in which the veteran served4 7,e7 ,the preexisting health status of the veteran1 including with respect to asthma4 7,f7 ,such personal information of the veteran as the ,secretary may consider relevant1 including cigarette and e-cigarette smoking history1 diet1 sex1 gender1 age1 race1 and ethnicity4 7b7 ,epidemiological study ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall conduct an epidemiological study of covered veterans that involves-- 7#a7 the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment2 and 7#b7 the collection of detailed information on the covered veterans studied through medical records1 administrative data1 and other existing sources1 including1 with respect to the covered veterans-- 7,a7 personal information1 including cigarette and e-cigarette smoking history1 diet1 sex1 gender1 age1 race1 and ethnicity2 7,b7 deployment history1 including locations1 periods1 and number of deployments2 7,c7 biospecimen data2 and 7,d7 supplementary health status and outcomes data1 including imaging and physiological parameters4 7c7 ,toxicology study 7#a7 ,study ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall conduct a toxicology study1 to include variability1 to replicate toxic exposures of healthy1 young members of the ,armed ,forces1 as well as potentially susceptible members1 with preexisting health conditions4 7#b7 ,elements ,the study under paragraph 7#a7 shall include-- 7,a7 an analysis of results for mechanistic markers and clinically relevant outcomes2 and 7,b7 a validation of any serum1 tissue1 or other biomarkers of toxic exposure1 susceptibility1 or effect with respect to the subjects of the study4 7d7 ,covered veteran defined ,in this section1 the term covered veteran has the meaning given that term in section #aaai7;c7 of title #ch1 ,united ,states ,code1 as added by section #cjb4 #ejd4 ,study on health trends of post #i_/aa veterans 7a7 ,study ,the ,secretary of ,veterans ,affairs shall conduct an epidemiological study on the health trends of veterans who served in the ,armed ,forces after ,september #aa1 #bjja4 7b7 ,elements ,the study under subsection 7a7 shall assess1 with respect to each veteran included in the study1 the following3 7#a7 ,the race and ethnicity of the veteran4 7#b7 ,the age of the veteran4 7#c7 ,the period of service and length of service of the veteran in the ,armed ,forces4 7#d7 ,any military occupational speciality of the veteran4 7#e7 ,the gender of the veteran4 7#f7 ,the disability status of the veteran4 7c7 ,report ,not later than two years after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the study under subsection 7a74 #eje4 ,study on cancer rates among veterans 7a7 ,study ,the ,secretary of ,veterans ,affairs shall conduct a study on the incidence of cancer in veterans1 to determine trends in the rates of the incidence of cancer in veterans1 and on available early detection diagnostics1 to determine the feasibility and advisability of including such diagnostics as part of the health care furnished to veterans by the ,secretary4 7b7 ,elements ,the study under subsection 7a7 shall assess1 with respect to each veteran included in the study1 the following3 7#a7 ,the race and ethnicity of the veteran4 7#b7 ,the age of the veteran4 7#c7 ,the period of service and length of service of the veteran in the ,armed ,forces4 7#d7 ,any military occupational speciality of the veteran4 7#e7 ,the gender of the veteran4 7#f7 ,any type of cancer that the veteran has4 7c7 ,report ,not later than two years after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the study under subsection 7a74 #ejf4 ,study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities 7a7 ,study ,the ,secretary of ,veterans ,affairs shall conduct a study on the feasibility and advisability of furnishing hospital care and medical services to qualifying dependents of veterans described in section #agaj7;e77#a77;,g7 of title #ch1 ,united ,states ,code1 as added by section #ajc7;a77#a71 for any illness determined by the ,secretary to be connected to a toxic exposure risk activity carried out by the veteran1 as determined by the ,secretary1 notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such activity4 7b7 ,elements ,the study under subsection 7a7 shall include-- 7#a7 an assessment of the impact of furnishing hospital care and medical services to qualifying dependents as described in such subsection on the ability of the ,department of ,veterans ,affairs to furnish hospital care and medical services to veterans2 7#b7 an assessment of the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection2 7#c7 an estimate of the resources required to furnish such care and services2 7#d7 an assessment of any stress or other effect furnishing such care and services would have on the claims and appeals system of the ,department2 7#e7 an estimate of the number of qualifying dependents who would be eligible for such care and services2 and 7#f7 an assessment of the feasibility of adjudicating claims for such care and services4 7c7 ,phased-,in application ,in conducting the study under subsection 7a71 the ,secretary shall assess the feasibility and advisability of phasing in the furnishing of hospital care and medical services to qualifying dependents described in such subsection by the decade in which such toxic exposure risk activity occurred1 starting with the most recent decade4 7d7 ,review of toxic exposure cases regarding liability of ,department of ,defense ,in conducting the study under subsection 7a71 the ,secretary shall-- 7#a7 review known cases of toxic exposure on military installations of the ,department of ,defense2 7#b7 analyze the liability of the ,department of ,defense in each such case2 and 7#c7 assess whether the ,secretary of ,defense should provide care and services relating to such toxic exposures under the ,,tricare program4 7e7 ,report ,not later than two years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a74 7f7 ,definitions ,in this section3 7#a7 ,the terms hospital care and medical services have the meanings given those terms in section #agja of title #ch1 ,united ,states ,code4 7#b7 ,the term illness has the meaning given that term in section #aaga of such title1 as added by section #bjb4 7#c7 ,the term qualifying dependent means-- 7,a7 a dependent of a veteran described in section #agaj7;e77#a77;,g7 of title #ch1 ,united ,states ,code1 as added by section #ajd7;a77#a71 who resided with the veteran during the period in which1 and on the installation at which1 the veteran participated in a toxic exposure risk activity2 7,b7 an individual who was in utero of such a veteran or other qualifying dependent when the veteran participated in a toxic exposure risk activity2 or 7,c7 a dependent of such a veteran who is not described in subparagraph 7,a7 or 7,b7 but who may have an illness that is connected to the toxic exposure risk activity of the veteran1 as determined by the ,secretary4 7#d7 ,the term toxic exposure has the meaning given that term in section #aja of such title1 as added by section #ajb7;b74 7#e7 ,the term toxic exposure risk activity has the meaning given that term in section #agaj7;e77#d7 of such title1 as added by section #ajb7;c74 7#f7 ,the term ,,tricare program has the meaning given that term in section #ajgb of such title4 #ejg4 ,study on health effects of waste related to ,manhattan ,project on certain veterans 7a7 ,study ,the ,secretary of ,veterans ,affairs shall conduct a study on the health trends of veterans who1 while serving in the active military1 naval1 air1 or space service-- 7#a7 participated in activities relating to the ,manhattan ,project 7including activities relating to covered waste7 in connection with such service2 or 7#b7 resided at or near1 as determined by the ,secretary1 the locations described in subsection 7b74 7b7 ,covered locations ,the locations described in this subsection are the following locations in the county of ,st4 ,louis1 ,missouri3 7#a7 ,coldwater ,creek4 7#b7 ,the ,st4 ,louis ,airport ,site4 7#c7 ,the ,west ,lake ,landfill4 7#d7 ,any other location in the county of ,st4 ,louis1 ,missouri that is proximate to covered waste1 as determined by the ,secretary4 7c7 ,elements ,the study under subsection 7a7 shall assess1 with respect to each veteran included in the study1 the following3 7#a7 ,the age1 gender1 and race of the veteran4 7#b7 ,the period and location of exposure to covered waste4 7#c7 ,any type of cancer1 or other illness associated with toxic exposure1 that the veteran has4 7#d7 ,a comparison of the overall health condition of the veteran1 including any illness of the veteran identified pursuant to paragraph 7#c71 with the overall health condition of past and present civilian populations residing at the same location of exposure4 7d7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the study under subsection 7a74 7e7 ,definitions ,in this section3 7#a7 ,the term covered waste means any waste arising from activities carried out in connection with the ,manhattan ,project4 7#b7 ,the term illness has the meaning given that term in section #aaga of title #ch1 ,united ,states ,code1 as added by section #bjb4 7#c7 ,the term toxic exposure has the meaning given that term in section #aja of such title1 as added by section #ajb7;b74 #ejh4 ,study on toxic exposure and mental health outcomes 7a7 ,study required ,the ,secretary of the ,department of ,veterans ,affairs shall enter into an agreement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine for the conduct of a study of veterans to assess possible relationships between toxic exposures experienced during service in the ,armed ,forces and mental health outcomes1 including chronic multisymptom illness1 traumatic brain injury1 post-traumatic stress disorder1 depression1 psychosis1 suicide attempts1 and suicide deaths4 7b7 ,elements ,for each veteran included in the study under subsection 7a71 the following information shall be collected and assessed3 7#a7 ,age4 7#b7 ,gender4 7#c7 ,race and ethnicity4 7#d7 ,period and length of service in the ,armed ,forces4 7#e7 ,history of toxic exposure during service in the ,armed ,forces4 7#f7 ,any diagnosis of chronic multisymptom illness4 7#g7 ,any diagnosis of a mental health or cognitive disorder4 7#h7 ,any history of suicide attempt or suidcidality4 7#i7 ,if the veteran died by suicide4 7c7 ,report ,not later than two years after the date after the enactment of this ,act1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,senate and ,house of ,representatives a report containing the findings of the study conducted under subsection 7a74 #eji4 ,study on veterans in ,territories of the ,united ,states 7a7 ,,gao study 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study on the state of access and barriers to benefits and services furnished under laws administered by the ,secretary of ,veterans ,affairs to veterans in ,territories of the ,united ,states1 including deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the ,united ,states4 7#b7 ,elements ,the study under paragraph 7#a7 shall include-- 7,a7 the number of veterans in each ,territory of the ,united ,states2 7,b7 the number of veterans in each ,territory who are enrolled in the system of annual patient enrollment of the ,department of ,veterans ,affairs under section #agje7;a7 of title #ch1 ,united ,states ,code2 7,c7 the number of veterans in each ,territory who are eligible for services under section #agaj of such title but who are not enrolled as described in subparagraph 7,b72 7,d7 a detailed description of obstacles facing veterans in each ,territory in accessing health care services1 including those involving the availability of such services to veterans in the ,territory in which the veterans reside1 and the distance required of veterans to journey to receive services at a regional medical center of the ,veterans ,health ,administration1 a community-based outpatient clinic1 or other full-service medical facility of the ,department1 or death center1 respectively2 7,e7 a detailed description of obstacles facing veterans in each ,territory in accessing readjustment counseling services1 including those involving the availability of such services to veterans in the ,territory in which the veterans reside1 and the distance required of veterans to journey to receive services at a readjustment counseling services center of the ,department2 7,f7 a detailed description of obstacles facing veterans in each ,territory in accessing other veterans benefits1 including those involving the availability of benefits and services to veterans in the ,territory in which the veterans reside1 and the distance required of the veterans to journey to the nearest office of the ,veterans ,benefits ,administration2 7,g7 an analysis of the staffing and recordkeeping levels and quality of the offices of the ,department charged with serving veterans in the ,territories1 including the availability of the full- and part-time staff of each office to the veterans they are charged with serving1 and the continuity of care provided by such staff to such veterans2 7,h7 an analysis of the availability of the ,veterans ,community ,care ,program established under section #agjc of title #ch1 ,united ,states ,code1 to veterans in each ,territory2 7,i7 an analysis of the economic and health consequences for veterans in each ,territory resulting from obstacles to accessing adequate assistance and health care at facilities of the ,department2 7,j7 an analysis of the access to assistance and health care provided to veterans in the aftermath of major disasters declared in each of the ,territories since ,september #d1 #bjag2 and 7,k7 recommendations for improving access of veterans in the ,territories to benefits and services furnished by the ,secretary1 and reducing barriers and deficits in the availability and accessibility of such benefits and services compared to veterans elsewhere in the ,united ,states4 7b7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a final report setting forth the results of the study conducted under subsection 7a71 including the recommendations developed under paragraph 7#b77,k7 of such subsection4 7c7 ,territory defined ,in this section1 the term ,territory includes ,american ,samoa1 the ,commonwealth of the ,northern ,marianas ,islands1 ,guam1 ,puerto ,rico1 and the ,virgin ,islands4 #eaj4 ,department of ,veterans ,affairs public website for toxic exposure research 7a7 ,website ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall establish1 and maintain thereafter1 a publically accessible internet website of the ,department of ,veterans ,affairs that serves as a clearinghouse for the publication of all toxic exposure research carried out or funded by the executive branch of the ,federal ,government4 7b7 ,relation to ,war ,related ,illness and ,injury ,study ,center ,the website developed and maintained under subsection 7a7 shall be housed under the website of the ,war ,related ,illness and ,injury ,study ,center of the ,department of ,veterans ,affairs1 or successor center4 7c7 ,coordination ,in carrying out subsection 7a71 the ,secretary shall coordinate with-- 7#a7 the heads of each ,federal department or agency carrying out or funding toxic exposure research2 7#b7 the ,war ,related ,illness and ,injury ,study ,center of the ,department of ,veterans ,affairs1 or successor center2 and 7#c7 any working group of the ,department of ,veterans ,affairs or other similar entity responsible for coordinating toxic exposure research4 7d7 ,definitions ,in this section3 7#a7 ,the term toxic exposure has the meaning given that term in section #aja of title #ch1 ,united ,states ,code1 as added by section #ajb7;b74 7#b7 ,the term toxic exposure research means research on the health consequences of toxic exposures experienced during service in the ,armed ,forces4 #eaa4 ,biennial report on health effects of jet fuels used by ,armed ,forces ,not later than one year after the date of the enactment of this ,act1 and biennially thereafter during the subsequent eight-year period1 the ,secretary of ,veterans ,affairs shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate1 and make publicly available1 a report that includes-- 7#a7 a discussion of the effect of various different types of jet fuels used by the ,armed ,forces on the health of individuals by length of exposure2 7#b7 an identification of the immediate symptoms of jet fuel exposure that may indicate future health risks2 7#c7 a chronology of health safeguards implemented by the ,armed ,forces intended to reduce the exposure of members of the ,armed ,foces to jet fuel2 and 7#d7 an identification of any areas relating to jet fuel exposure about which new research needs to be conducted4 ,,vi ,improvement of resources and training regarding toxic-exposed veterans #fja4 ,short title2 definitions 7a7 ,short title ,this title may be cited as the ,toxic ,exposure in the ,american ,military ,act or the ,,team ,act4 7b7 ,definitions ,in this title1 the terms active military1 naval1 air1 or space service1 toxic exposure1 and toxic-exposed veteran have the meanings given those terms in section #aja of title #ch1 ,united ,states ,code4 #fjb4 ,publication of list of resources of ,department of ,veterans ,affairs for toxic-exposed veterans and outreach program for such veterans and caregivers and survivors of such veterans 7a7 ,publication of list of resources 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary of ,veterans ,affairs shall publish a list of resources of the ,department of ,veterans ,affairs for-- 7,a7 toxic-exposed veterans1 including with respect to-- 7i7 disability compensation under chapter #aa of title #ch1 ,united ,states ,code2 and 7ii7 hospital care1 medical services1 and nursing home care under section #agaj7;a77#b77;,f7 of such title2 7,b7 caregivers of toxic-exposed veterans who are participating in the program of comprehensive assistance for family caregivers under section #agbj;,g7a7 of such title2 and 7,c7 survivors of toxic-exposed veterans who are receiving death benefits under the laws administered by the ,secretary4 7#b7 ,update ,the ,secretary shall periodically update the list published under paragraph 7#a74 7#c7 ,languages ,the ,secretary shall publish the list under paragraph 7#a7 in languages including the following3 7,a7 ,english4 7,b7 ,spanish4 7,c7 ,chinese4 7,d7 ,the seven other most commonly spoken languages in the ,united ,states4 7b7 ,outreach ,the ,secretary shall develop1 with input from the community1 an informative outreach program for veterans on illnesses that may be related to toxic exposure1 including outreach with respect to benefits and support programs4 ,information distributed under the outreach program shall be treated as a fact sheet of the ,department of ,veterans ,affairs for purposes of making the information available in multiple languages pursuant to section #b of the ,veterans and ,family ,information ,act 7,public ,law #aag-fb2 #ch ,u4,s4,c4 #fcjc note74 7c7 ,veterans organizations ,to the extent practicable1 the ,secretary shall share with national veterans service organizations and other veterans groups1 including such organizations and groups that improve access by veterans to health care and benefits1 the list of resources under subsection 7a7 and the outreach program under subsection 7b74 #fjc4 ,incorporation of toxic exposure questionnaire during primary care appointments 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall incorporate a clinical questionnaire to help determine potential toxic exposures during active military1 naval1 air1 or space service as part of the initial screening conducted for an appointment of a veteran with a primary care provider of the ,department of ,veterans ,affairs to improve understanding by the ,department of toxic exposures of veterans while serving in the ,armed ,forces4 7b7 ,determination of questions ,the questions included in the questionnaire required under subsection 7a7 shall be determined by the ,secretary with input from medical professionals4 #fjd4 ,training for personnel of the ,department of ,veterans ,affairs with respect to toxic-exposed veterans 7a7 ,health care personnel ,the ,secretary of ,veterans ,affairs shall provide to health care personnel of the ,department of ,veterans ,affairs education and training to identify1 treat1 and assess the impact on toxic-exposed veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures4 7b7 ,benefits personnel 7#a7 ,standard claims processor training curriculum 7,a7 ,curriculum ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall ensure that a standard training curriculum exists for processors of claims under the laws administered by the ,secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposure1 including employees who adjudicate such claims4 7,b7 ,matters included ,the ,secretary shall ensure that the training under subparagraph 7,a7 includes the following explanations with respect to claims relating to toxic exposure3 7i7 ,a lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist4 7ii7 ,the claims adjudicator shall always consider whether direct service connection is applicable and request1 as needed1 an advisory medical opinion pursuant to section #aafh of title #ch1 ,united ,states ,code1 as added by section #cjc4 7iii7 ,the claims adjudicator may review and consider any record of the claimant in an exposure tracking record system pursuant to section #aaai of such title1 as added by section #cjb1 but a lack of such information is not by itself sufficient to determine that such exposure did not occur or sufficient to deny the claim4 7,c7 ,provision of training ,the ,secretary shall-- 7i7 provide training under subparagraph 7,a7 to each employee described in such subparagraph not less frequently than annually2 and 7ii7 using the ,systematic ,technical ,accuracy ,review program1 or such successor program1 conduct a nationwide1 quarterly1 randomized review of the quality of adjudication of claims relating to toxic exposure4 7#b7 ,standard medical examiner training curriculum 7,a7 ,curriculum ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall ensure that a standard medical training curriculum exists for medical providers who conduct examinations and provide opinions pursuant to section #aafh of title #ch1 ,united ,states ,code1 as added by section #cjc1 regardless of whether the provider is an employee of the ,department or a contractor4 7,b7 ,standardized approach ,the ,secretary shall ensure that the curriculum established under subparagraph 7,a7-- 7i7 provides a standardized approach to conducting and providing examinations and opinions in accordance with such section #aafh2 and 7ii7 instructs medical providers to consider1 when conducting an examination or providing an opinion-- 7,i7 relevant medical and scientific literature2 7,,ii7 the proximity1 intensity1 and frequency of exposure of the individual to the identified toxic exposure2 7,,iii7 medically unexplained chronic multisymptom illnesses2 and 7,,iv7 all competent and credible evidence of record4 #fje4 ,guidelines for active duty military on potential risks and prevention of toxic exposures ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,defense and the ,secretary of ,veterans ,affairs shall jointly coordinate and establish guidelines to be used during training of members of the ,armed ,forces serving on active duty to provide the members awareness of the potential risks of toxic exposures and ways to prevent being exposed during combat4 ,,vii ,registries1 records1 and other matters #gja4 ,registry of individuals exposed to per- and polyfluoroalkyl substances on military installations 7a7 ,establishment of registry 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall-- 7,a7 establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances 7in this section referred to as ,,pfas7 due to the environmental release of aqueous film-forming foam 7in this section referred to as ,,afff7 on military installations to meet the requirements of military specification ,,mil-,f-#bdche;,f2 7,b7 include any information in such registry that the ,secretary determines necessary to ascertain and monitor the health effects of the exposure of members of the ,armed ,forces to ,,pfas associated with ,,afff2 7,c7 develop a public information campaign to inform eligible individuals about the registry1 including how to register and the benefits of registering2 and 7,d7 periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to ,,pfas4 7#b7 ,coordination ,the ,secretary of ,veterans ,affairs shall coordinate with the ,secretary of ,defense in carrying out paragraph 7#a74 7b7 ,reports 7#a7 ,initial report ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,defense shall submit to ,congress a report regarding the following3 7,a7 ,sources of ,,pfas on military installations other than ,,afff4 7,b7 ,any recommendation of the ,secretary regarding whether to expand eligibility for the registry to individuals exposed to sources of ,,pfas described in subparagraph 7,a74 7#b7 ,interim report ,not later than two years after the date on which the registry under subsection 7a7 is established1 the ,secretary of ,veterans ,affairs shall submit to ,congress an initial report containing the following3 7,a7 ,an assessment of the effectiveness of actions taken by the ,secretary of ,veterans ,affairs and the ,secretary of ,defense to collect and maintain information on the health effects of exposure to ,,pfas4 7,b7 ,recommendations to improve the collection and maintenance of such information4 7,c7 ,using established and previously published epidemiological studies1 recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to exposure to ,,pfas4 7#c7 ,followup report ,not later than five years after submitting the initial report under paragraph 7#a71 the ,secretary of ,veterans ,affairs shall submit to ,congress a followup report containing the following3 7,a7 ,an update to the initial report submitted under paragraph 7#a74 7,b7 ,an assessment of whether and to what degree the content of the registry established under subsection 7a7 is current and scientifically up to date4 7#d7 ,independent scientific organization ,the ,secretary of ,veterans ,affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs 7#a7 and 7#b74 7c7 ,recommendations for additional exposures ,to be included ,not later than five years after the date of the enactment of this ,act1 and every five years thereafter1 the ,secretary of ,veterans ,affairs1 in consultation with the ,secretary of ,defense and the ,administrator of the ,environmental ,protection ,agency1 shall submit to ,congress recommendations for additional chemicals with respect to which individuals exposed to such chemicals should be included in the registry established under subsection 7a74 7d7 ,eligible individual defined ,in this section1 the term eligible individual means any individual who1 on or after a date specified by the ,secretary of ,veterans ,affairs through regulations1 served or is serving in the ,armed ,forces at a military installation where ,,afff was used or at another location of the ,department of ,defense where ,,afff was used4 #gjb4 ,fort ,mc,clellan ,health ,registry 7a7 ,establishment ,the ,secretary of ,veterans ,affairs shall establish and maintain a special record to be known as the ,fort ,mc,clellan ,health ,registry 7in this section referred to as the ,registry74 7b7 ,contents ,except as provided in subsection 7c71 the ,registry shall include the following information3 7#a7 ,a list containing the name of each individual who1 while serving as a member of the ,armed ,forces1 was stationed at ,fort ,mc,clellan1 ,alabama1 at any time during the period beginning ,january #a1 #aice1 and ending on ,may #bj1 #aiii1 and who-- 7,a7 applies for care or services from the ,department of ,veterans ,affairs under chapter #ag of title #ch1 ,united ,states ,code2 7,b7 files a claim for compensation under chapter #aa of such title on the basis of any disability which may be associated with such service2 7,c7 dies and is survived by a spouse1 child1 or parent who files a claim for dependency and indemnity compensation under chapter #ac of such title on the basis of such service2 7,d7 requests from the ,secretary a health examination under subsection 7d72 or 7,e7 receives from the ,secretary a health examination similar to the health examination referred to in subparagraph 7,d7 and requests inclusion in the ,registry4 7#b7 ,relevant medical data relating to the health status of1 and other information that the ,secretary considers relevant and appropriate with respect to1 each individual described in paragraph 7#a7 who-- 7,a7 grants to the ,secretary permission to include such information in the ,registry2 or 7,b7 at the time the individual is listed in the ,registry1 is deceased4 7c7 ,individuals submitting claims or making requests before date of enactment ,if in the case of an individual described in subsection 7b77#a7 the application1 claim1 or request referred to in such subsection was submitted1 filed1 or made before the date of the enactment of this ,act1 the ,secretary shall1 to the extent feasible1 include in the ,registry such individual's name and the data and information1 if any1 described in subsection 7b77#b7 relating to the individual4 7d7 ,examinations ,upon the request of a veteran who was stationed at ,fort ,mc,clellan1 ,alabama1 at any time during the period beginning ,january #a1 #aice1 and ending on ,may #bj1 #aiii1 the ,secretary shall provide the veteran with a health examination 7including any appropriate diagnostic tests7 and consultation and counseling with respect to the results of the examination and the tests4 7e7 ,outreach 7#a7 ,ongoing outreach to individuals listed in ,registry ,the ,secretary shall1 from time to time1 notify individuals listed in the ,registry of significant developments in research on the health consequences of potential exposure to a toxic substance or environmental hazard related to service at ,fort ,mc,clellan4 7#b7 ,examination outreach ,the ,secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations 7including any diagnostic tests7 and consultation and counseling services under subsection 7d74 7f7 ,consultation ,the ,secretary of ,veterans ,affairs shall consult with the ,secretary of ,defense to acquire information maintained by the ,secretary of ,defense that the ,secretary of ,veterans ,affairs considers necessary to establish and maintain the ,registry4 #gjc4 ,independent study on ,individual ,longitudinal ,exposure ,record 7a7 ,in general ,not later than #fj days after the date of the enactment of this ,act1 the ,secretary of ,defense shall enter into a contract with an independent research entity described in subsection 7b7 to carry out a comprehensive study of the development of the ,individual ,longitudinal ,exposure ,record1 or successor system1 to determine-- 7#a7 the quality of the location data1 occupational and environmental exposure data1 and health surveillance data2 and 7#b7 whether a member of the ,armed ,forces can be reasonably assured that any toxic exposure they experience during service in the ,armed ,forces will be accurately reflected in the record of the member in such ,individual ,longitudinal ,exposure ,record4 7b7 ,independent research entity ,the entity described in this subsection is an independent research entity that is a not-for-profit entity or a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection 7a74 7c7 ,toxic exposure defined ,in this section1 the term toxic exposure has the meaning given that term in section #aja7cg7 of title #ch1 ,united ,states ,code1 as added by section #ajb7;b74 #gjd4 ,biannual report on ,individual ,longitudinal ,exposure ,record 7a7 ,in general ,not later than one year after the date on which the ,individual ,longitudinal ,exposure ,record1 or successor system1 achieves full operation capability1 as determined by the ,secretary of ,defense1 and every #ahj days thereafter1 the ,secretary of ,defense1 in consultation with the ,secretary of ,veterans ,affairs1 shall submit to the appropriate committees of ,congress a report on-- 7#a7 the data quality of the databases of the ,department of ,defense that provide the information presented in such ,individual ,longitudinal ,exposure ,record2 and 7#b7 the usefulness of such ,individual ,longitudinal ,exposure ,record in supporting members of the ,armed ,forces and veterans in receiving health care and benefits from the ,department of ,defense and the ,department of ,veterans ,affairs4 7b7 ,elements ,each report required by subsection 7a7 shall include1 for the period covered by the report1 the following3 7#a7 ,an identification of toxic exposure events that may not be fully captured by the current systems of the ,department of ,defense for environmental1 occupational1 and health monitoring1 and recommendations for how to improve those systems4 7#b7 ,an analysis of the quality of the location data used by the ,department of ,defense in determining toxic exposures of members of the ,armed ,forces and veterans1 and recommendations for how to improve the quality of that location data if necessary4 7c7 ,report on ,national ,guard use of ,,iler ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,defense shall submit to the appropriate committees of ,congress a report on the feasibility of modifying the ,individual ,longitudinal ,exposure ,record to ensure that a member of the ,national ,guard who is deployed in the ,united ,states in connection with a natural disaster1 without regard to duty status 7including any duty under title #aj or title #cb1 ,united ,states ,code1 or ,state active duty71 may record information regarding a suspected exposure by the member to toxic substances during such deployment4 7d7 ,definitions ,in this section3 7#a7 ,appropriate committees of ,congress ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,armed ,services and the ,committee on ,veterans' ,affairs of the ,senate2 and 7,b7 the ,committee on ,armed ,services and the ,committee on ,veterans' ,affairs of the ,house of ,representatives4 7#b7 ,toxic exposure ,the term toxic exposure has the meaning given that term in section #aja7cg7 of title #ch1 ,united ,states ,code1 as added by section #ajb7;b74 #gje4 ,correction of exposure records by members of the ,armed ,forces and veterans 7a7 ,in general ,the ,secretary of ,defense shall provide a means for members of the ,armed ,forces and veterans to update their records as necessary to reflect a toxic exposure by such member or veteran in the ,individual ,longitudinal ,exposure ,record1 or successor system4 7b7 ,evidence 7#a7 ,provision of evidence ,to update a record under subsection 7a71 a member of the ,armed ,forces or veteran1 as the case may be1 shall provide such evidence as the ,secretary of ,defense considers necessary4 7#b7 ,benefit of the doubt ,in reviewing evidence provided under paragraph 7#a71 the ,secretary of ,defense shall give the benefit of the doubt to the member of the ,armed ,forces or veteran who provided the evidence1 as the case may be1 in a manner that is equivalent to the benefit of the doubt required under section #eajg7;b7 of title #ch1 ,united ,states ,code4 7#c7 ,regulations ,the ,secretary of ,defense shall prescribe by regulation the evidence considered necessary under paragraph 7#a74 7c7 ,toxic exposure defined ,in this section1 the term toxic exposure has the meaning given that term in section #aja7cg7 of title #ch1 ,united ,states ,code1 as added by section #ajb7;b74 #gjf4 ,federal cause of action relating to water at ,camp ,lejeune1 ,north ,carolina 7a7 ,in general ,an individual1 including a veteran 7as defined in section #aja of title #ch1 ,united ,states ,code71 or the legal representative of such an individual1 who resided1 worked1 or was otherwise exposed 7including in utero exposure7 for not less than #cj days during the period beginning on ,august #a1 #aiec1 and ending on ,december #ca1 #aihg1 to water at ,camp ,lejeune1 ,north ,carolina1 that was supplied by1 or on behalf of1 the ,united ,states may bring an action in the ,united ,states ,district ,court for the ,eastern ,district of ,north ,carolina to obtain appropriate relief for harm that was caused by exposure to the water at ,camp ,lejeune4 7b7 ,burdens and standard of proof 7#a7 ,in general ,the burden of proof shall be on the party filing the action to show one or more relationships between the water at ,camp ,lejeune and the harm4 7#b7 ,standards ,to meet the burden of proof described in paragraph 7#a71 a party shall produce evidence showing that the relationship between exposure to the water at ,camp ,lejeune and the harm is-- 7,a7 sufficient to conclude that a causal relationship exists2 or 7,b7 sufficient to conclude that a causal relationship is at least as likely as not4 7c7 ,exclusive jurisdiction and venue ,the ,united ,states ,district ,court for the ,eastern ,district of ,north ,carolina shall have exclusive jurisdiction over any action filed under subsection 7a71 and shall be the exclusive venue for such an action4 ,nothing in this subsection shall impair the right of any party to a trial by jury4 7d7 ,exclusive remedy 7#a7 ,in general ,an individual1 or legal representative of an individual1 who brings an action under this section for a harm described in subsection 7a71 including a latent disease1 may not thereafter bring a tort action against the ,united ,states for such harm pursuant to any other law4 7#b7 ,health and disability benefits relating to water exposure ,any award made to an individual1 or legal representative of an individual1 under this section shall be offset by the amount of any disability award1 payment1 or benefit provided to the individual1 or legal representative-- 7,a7 under-- 7i7 any program under the laws administered by the ,secretary of ,veterans ,affairs2 7ii7 the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 or 7iii7 the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 and 7,b7 in connection with health care or a disability relating to exposure to the water at ,camp ,lejeune4 7e7 ,immunity limitation ,the ,united ,states may not assert any claim to immunity in an action under this section that would otherwise be available under section #bfhj7;a7 of title #bh1 ,united ,states ,code4 7f7 ,no punitive damages ,punitive damages may not be awarded in any action under this section4 7g7 ,disposition by ,federal agency required ,an individual may not bring an action under this section before complying with section #bfge of title #bh1 ,united ,states ,code4 7h7 ,exception for combatant activities ,this section does not apply to any claim or action arising out of the combatant activities of the ,armed ,forces4 7i7 ,applicability2 period for filing 7#a7 ,applicability ,this section shall apply only to a claim accruing before the date of enactment of this ,act4 7#b7 ,statute of limitations ,a claim in an action under this section may not be commenced after the later of-- 7,a7 the date that is two years after the date of enactment of this ,act2 or 7,b7 the date that is #ahj days after the date on which the claim is denied under section #bfge of title #bh1 ,united ,states ,code4 7#c7 ,inapplicability of other limitations ,any applicable statute of repose or statute of limitations1 other than under paragraph 7#b71 shall not apply to a claim under this section4 #gjg4 ,veterans ,toxic ,exposures ,fund ,chapter #c is amended by adding at the end the following new section3 #cbd4 ,veterans ,toxic ,exposures ,fund 7a7 ,establishment ,there is hereby established in the ,treasury of the ,united ,states an account to be known as the 8,veterans ,toxic ,exposures ,fund0 7the 8,fund071 to be administered through the ,department of ,veterans ,affairs1 to provide for investment in the delivery of veterans' health care1 research1 and benefits associated with hazardous exposure in service4 7b7 ,authorization of appropriations ,there is authorized to be appropriated to the ,fund for fiscal year #bjbc and each subsequent fiscal year such sums as are necessary to increase funding1 over the fiscal year #bjba level for the ,veterans ,health ,administration of the ,department of ,veterans ,affairs1 for any expenses incident to the delivery of veterans' health care and benefits associated with exposure to environmental hazards in service1 including administrative expenses1 such as claims processing and appeals1 and for medical research related to hazardous exposures4 ,amounts appropriated to the ,fund pursuant to this subsection shall be counted as direct spending under the ,congressional ,budget and ,impoundment ,control ,act of #aigd and any other ,act4 7c7 ,estimates for congressional consideration ,the ,secretary shall include in documents submitted to ,congress in support of the ,president's budget submitted pursuant to section #aaje of title #ca1 ,united ,states ,code1 detailed estimates of the sums described in subsection 7b7 for the applicable fiscal year4 7d7 ,procedures for estimates ,the ,secretary1 after consultation with the ,committees on ,appropriations of the ,house of ,representatives and the ,senate1 may establish policies and procedures for developing the annual detailed estimates required in subsection 7c74 4 #gjh4 ,authorization of electronic notice in claims under laws administered by the ,secretary of ,veterans ,affairs ,title #ch1 ,united ,states ,code1 is amended as follows3 7#a7 ,by striking section #eajj and inserting the following3 #eajj4 ,definitions ,in this chapter3 7#a7 ,the term claimant means any individual applying for1 or submitting a claim for1 any benefit under the laws administered by the ,secretary4 7#b7 ,the term notice means a communication issued through means 7including electronic means7 prescribed by the ,secretary4 4 7#b7 ,in section #eajd1 by adding at the end the following new subsection3 7c7 ,the ,secretary may provide notice under subsection 7a7 electronically if a claimant 7or the claimant's representative7 elects to receive such notice electronically4 ,a claimant 7or the claimant's representative7 may revoke such an election at any time1 by means prescribed by the ,secretary4 7d7 ,the ,secretary shall annually-- 7#a7 solicit recommendations from stakeholders on how to improve notice under this section2 and 7#b7 publish such recommendations on a publicly available website of the ,department4 4 7#c7 ,in section #eajd;,b7c71 in the matter preceding paragraph 7#a7 by striking in writing and inserting to the claimant 7and any representative of such claimant74 7#d7 ,in section #gajd-- 7,a7 in the heading1 by adding 2 decisions2 notice at the end2 and 7,b7 by striking subsection 7e7 and inserting the following3 7e7 ,after reaching a decision on an appeal1 the ,board shall promptly issue notice 7as that term is defined in section #eajj of this title7 of such decision to the following3 7#a7 ,the appellant4 7#b7 ,any other party with a right to notice of such decision4 7#c7 ,any authorized representative of the appellant or party described in paragraph 7#b74 7f7 ,the ,secretary may provide notice under subsection 7e7 electronically if a claimant 7or the claimant's representative7 elects to receive such notice electronically4 ,a claimant 7or the claimant's representative7 may revoke such an election at any time1 by means prescribed by the ,secretary4 4 7#e7 ,in section #gaje7;b77#a77;,a71 by striking mailing and inserting issuance4 7#f7 ,in section #gaje;,a7a71 by striking mailed and inserting issued4 7#g7 ,in section #gbff7;a71 by striking mailed and inserting issued4 #gji4 ,authorization of appropriations for expansion of claims automation ,there is authorized to be appropriated to the ,secretary of ,veterans ,affairs #cj1jjj1jjj for fiscal year #bjbc to support expected increased claims processing for newly eligible veterans pursuant to this ,act and the amendments made by this ,act by-- 7#a7 supporting the automation of processing claims by the ,veterans ,benefits ,administration of the ,department of ,veterans ,affairs2 7#b7 adding self-service features to the system by which individuals file claims2 7#c7 removing duplicative efforts regarding the processing of claims2 and 7#d7 reducing the dependency of the ,department on the legacy claim system4 #gaj4 ,non-applicability of non-,department of ,veterans ,affairs covenants not to compete to appointment of ,veterans ,health ,administration personnel 7a7 ,in general ,subchapter ,i of chapter #gd of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #gdad4 ,effect of non-,department covenants not to compete 7a7 ,non-,applicability ,except as provided in subsection 7b71 in the case of an individual who is an applicant for appointment to a position in the ,veterans ,health ,administration described in section #gdja of this title1 any covenant not to compete into which the individual has entered with a non-,department facility or party shall have no force or effect with respect to the appointment of the individual to such a position4 7b7 ,service obligation 7#a7 ,any individual who is appointed to such a position in the ,veterans ,health ,administration shall1 as a condition of such appointment1 agree to provide clinical services at a ,department medical facility for the duration of the period described in paragraph 7#b74 7#b7 ,the period described in this paragraph is the period that begins on the date on which an individual is appointed to such a position and ends on the latter of the following dates3 7,a7 ,the date that is one year after such date of appointment4 7,b7 ,the date of the termination of any covenant not to compete entered into between the individual and a non-,department facility or party4 7#c7 ,the ,secretary may waive the requirement under paragraph 7#a7 with respect to an individual at the discretion of the ,secretary4 7c7 ,termination of ,department employment ,in the case of an individual who is appointed to such a position in the ,veterans ,health ,administration who has entered into a covenant not to compete that is rendered non-applicable pursuant to subsection 7a71 if the individual's employment at the ,veterans ,health ,administration is terminated for any reason before the specified termination date of such covenant1 subsection 7a7 shall not apply with respect to such covenant after the date of the termination of the individual's employment at the ,veterans ,health ,administration4 7d7 ,covenant not ,to compete ,in this section1 the term covenant not to compete means an agreement-- 7#a7 between an employee and employer or a contractor and principal that restricts such employee or contractor from performing-- 7,a7 any work for another employer for a specified period of time2 7,b7 any work in a specified geographical area2 or 7,c7 work for another employer performing work that is similar to the work such employee or contractor performed for the employer or principal1 included as a party to the agreement2 and 7#b7 that is entered into after the date of enactment of this ,act4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #gdac the following new item3 #gdad4 ,effect of non-,department covenants not to compete4 4 #gaa4 ,recruitment of physicians on a contingent basis prior to completion of training requirements ,section #gdjb of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in subsection 7b77#a7-- 7,a7 in the matter preceding subparagraph 7,a7 by inserting or to be offered an appointment to such position on a contingent basis under subsection 7h7 after position2 and 7,b7 by striking subparagraph 7,b7 and inserting the following3 7,b7 7i7 have completed a residency leading to board eligibility in a specialty1 satisfactory to the ,secretary2 or 7ii7 with respect to an offer for an appointment on a contingent basis under subsection 7h71 complete such a residency by not later than two years after the date of such offer2 and 2 and 7#b7 by adding at the end the following new subsection3 7h7 7#a7 ,the ,secretary may appoint an individual under subsection 7b77#a7 on a contingent basis in accordance with this subsection if the ,secretary reasonably anticipated that the individual will have completed the requirements for appointment under such subsection 7b77#a7 by not later than two years after the date on which the individual is so appointed4 7#b7 ,an individual who is appointed to a position on a contingent basis under paragraph 7#a7 shall be appointed to such position on a permanent basis if1 by not later than two years after the date of the contingent appointment1 the individual completes all the requirements for appointment under subsection 7b77#a74 7#c7 ,an individual who is appointed on a contingent basis under paragraph 7#a7 who fails to complete the requirements for appointment under subsection 7b77#a7 by not later than two years after the date on which the individual is so appointed may not be appointed to such position on a permanent basis4 4 #gab4 ,authority for ,secretary of ,veterans ,affairs to award grants to ,states to improve outreach to veterans 7a7 ,in general ,chapter #fc of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by redesignating sections #fcjg and #fcjh and sections #fcjh and #fcji1 respectively2 and 7#b7 by inserting after section #fcjf the following new section #fcjg3 #fcjg4 ,grants to ,states to improve outreach to veterans 7a7 ,purpose ,it is the purpose of this section to provide for assistance by the ,secretary to ,states to carry out programs that-- 7#a7 improve outreach and assistance to veterans and the spouses1 children1 and parents of veterans1 to ensure that such individuals are fully informed about any veterans and veterans-related benefits and programs 7including ,state veterans programs7 for which they may be eligible2 and 7#b7 facilitate opportunities for such individuals to receive competent1 qualified services in the preparation1 presentation1 and prosecution of veterans benefits claims4 7b7 ,authority ,the ,secretary may award grants to ,states-- 7#a7 to carry out1 coordinate1 improve1 or otherwise enhance outreach activities2 7#b7 to increase the number of county or tribal veterans service officers serving in the ,state by hiring new1 additional such officers2 or 7#c7 to expand1 carry out1 coordinate1 improve1 or otherwise enhance existing programs1 activities1 and services of the ,state's existing organization that has been recognized by the ,department of ,veterans ,affairs pursuant to section #eijb1 in the preparation1 presentation1 and prosecution of claims for veterans benefits through representatives who hold positions as county or ,tribal veterans service officers4 7c7 ,application 7#a7 ,to be eligible for a grant under this section1 a ,state shall submit to the ,secretary an application therefor at such time1 in such manner1 and containing such information as the ,secretary may require4 7#b7 ,each application submitted under paragraph 7#a7 shall include the following3 7,a7 ,a detailed plan for the use of the grant4 7,b7 ,a description of the programs through which the ,state will meet the outcome measures developed by the ,secretary under subsection 7i74 7,c7 ,a description of how the ,state will distribute grant amounts equitably among counties 7or ,tribal lands1 as the case may be7 with varying levels of urbanization4 7,d7 ,a plan for how the grant will be used to meet the unique needs of ,american ,indian or ,alaska ,native veterans1 elderly veterans1 women veterans1 and veterans from other underserved communities4 7d7 ,distribution ,the ,secretary shall seek to ensure that grants awarded under this section are equitably distributed among ,states with varying levels of urbanization4 7e7 ,priority ,the ,secretary shall prioritize awarding grants under this section that will serve the following areas3 7#a7 ,areas with a critical shortage of county or tribal veterans service officers4 7#b7 ,areas with high rates of-- 7,a7 suicide among veterans2 or 7,b7 referrals to the ,veterans ,crisis ,line4 7f7 ,use of county or tribal veterans service officers ,a ,state that receives a grant under this section to carry out an activity described in subsection 7b77#a7 shall carry out the activity through-- 7#a7 a county or ,tribal veterans service officer of the ,state2 or 7#b7 if the ,state does not have a county or tribal veterans service officer1 or if the county or ,tribal veterans service officers of the ,state cover only a portion of that ,state1 an appropriate entity of a ,state1 local1 or ,tribal government1 or another publicly funded entity1 as determined by the ,secretary4 7g7 ,required activities ,any grant awarded under this section shall be used-- 7#a7 to expand existing programs1 activities1 and services2 7#b7 to hire and maintain new1 additional county or ,tribal veterans service officers2 or 7#c7 for travel and transportation to facilitate carrying out paragraph 7#a7 or 7#b74 7h7 ,other permissible activities ,a grant under this section may be used to provide education and training1 including on-the-job training1 for ,state1 county1 local1 and tribal government employees who provide 7or when trained will provide7 veterans outreach services in order for those employees to obtain and maintain accreditation in accordance with procedures approved by the ,secretary4 7i7 ,outcome measures 7#a7 ,the ,secretary shall develop and provide to each ,state that receives a grant under this section written guidance on the following3 7,a7 ,outcome measures4 7,b7 ,policies of the ,department4 7#b7 ,in developing outcome measures under paragraph 7#a71 the ,secretary shall consider the following goals3 7,a7 ,increasing the use of veterans and veterans-related benefits1 particularly among vulnerable populations4 7,b7 ,increasing the number of county and tribal veterans service officers recognized by the ,secretary for the representation of veterans under chapter #ei of this title4 7j7 ,tracking requirements 7#a7 ,with respect to each grant awarded under this section1 the ,secretary shall track the use of veterans benefits among the population served by the grant1 including the average period of time between the date on which a veteran or other eligible claimant applies for such a benefit and the date on which the veteran or other eligible claimant receives the benefit1 disaggregated by type of benefit4 7#b7 ,not less frequently than annually during the life of the grant program established under this section1 the ,secretary shall submit to ,congress a report on-- 7,a7 the information tracked under paragraph 7#a72 7,b7 how the grants awarded under this section serve the unique needs of ,american ,indian or ,alaska ,native veterans1 elderly veterans1 women veterans1 and veterans from other underserved communities2 and 7,c7 other information provided by ,states pursuant to the grant reporting requirements4 7k7 ,performance review 7#a7 ,the ,secretary shall-- 7,a7 review the performance of each ,state that receives a grant under this section2 and 7,b7 make information regarding such performance publicly available4 7l7 ,remediation plan 7#a7 ,in the case of a ,state that receives a grant under this section and does not meet the outcome measures developed by the ,secretary under subsection 7i71 the ,secretary shall require the ,state to submit a remediation plan under which the ,state shall describe how and when it plans to meet such outcome measures4 7#b7 ,the ,secretary may not award a subsequent grant under this section to a ,state described in paragraph 7#a7 unless the ,secretary approves the remediation plan submitted by the ,state4 7m7 ,maximum amount ,the amount of a grant awarded under this section may not exceed #aj percent of amounts made available for grants under this section for the fiscal year in which the grant is awarded4 7n7 ,supplement1 not supplant ,any grant awarded under this section shall be used to supplement and not supplant ,state and local funding that is otherwise available4 7o7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary for each of fiscal years #bjbc through #bjbg1 #ej1jjj1jjj to carry out this section4 7p7 ,definitions ,in this section3 7#a7 ,the term county or tribal veterans service officer includes a local equivalent veterans service officer4 7#b7 ,the term ,state includes each ,indian ,tribe1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,commonwealth of the ,northern ,mariana ,islands1 and any territory or possession of the ,united ,states4 7#c7 ,the term ,veterans ,crisis ,line means the toll-free hotline for veterans established under section #agbj;,f7h7 of this title4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #fc of such title is amended by striking the items relating to sections #fcjg and #fcjh and inserting the following new items3 #fcjg4 ,grants to ,states to improve outreach to veterans4#fcjh4 ,outreach for eligible dependents4#fcji4 ,biennial report to ,congress4 4 7c7 ,authorization of additional full-time equivalent employee ,during fiscal years #bjbc through #bjbg1 the ,secretary of ,veterans ,affairs may hire an additional full-time equivalent employee in the ,office of the ,general ,counsel of the ,department of ,veterans ,affairs1 as compared to the number of full-time equivalent employees that would otherwise be authorized for such office1 to carry out duties under the accreditation1 discipline1 and fees program4 #gac4 ,study and report on herbicide agent exposure in ,panama ,canal ,zone 7a7 ,study ,the ,secretary of ,defense shall conduct a study on the exposure of members of the ,armed ,forces to herbicide agents1 including ,agent ,orange and ,agent ,purple1 in the ,panama ,canal ,zone during the period beginning on ,january #a1 #aieh1 and ending on ,december #ca1 #aiii4 7b7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a74 #gad4 ,budget information for alternatives to burn pits ,the ,secretary of ,defense shall include in the budget submission of the ,president under section #aaje7;a7 of title #ca1 ,united ,states ,code1 for each of fiscal years #bjbc through #bjbg1 a dedicated budget line item for incinerators and waste-to-energy waste disposal alternatives to burn pits4 #gae4 ,authorization of appropriations for expansion of claims automation ,there is authorized to be appropriated to the ,secretary of ,veterans ,affairs #aej1jjj1jjj for fiscal year #bjbc to continue the modernization and expansion of capabilities and capacity of the ,veterans ,benefits ,management ,system of the ,department of ,veterans ,affairs to support expected increased claims processing for newly eligible veterans pursuant to this ,act and the amendments made by this ,act4 #gaf4 ,burn pit registry updates 7a7 ,individuals eligible to update 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall take actions necessary to ensure that the burn pit registry may be updated with the cause of death of a deceased registered individual by-- 7,a7 an individual designated by such deceased registered individual2 or 7,b7 if no such individual is designated1 an immediate family member of such deceased registered individual4 7#b7 ,designation ,the ,secretary shall provide1 with respect to the burn pit registry1 a process by which a registered individual may make a designation for purposes of paragraph 7#a77;,a74 7b7 ,definitions ,in this section3 7#a7 ,the term burn pit registry means the registry established under section #bja of the ,dignified ,burial and ,other ,veterans' ,benefits ,improvement ,act of #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7#b7 ,the term immediate family member1 with respect to a deceased individual1 means-- 7,a7 the spouse1 parent1 brother1 sister1 or adult child of the individual2 7,b7 an adult person to whom the individual stands in loco parentis2 or 7,c7 any other adult person-- 7i7 living in the household of the individual at the time of the death of the individual2 and 7ii7 related to the individual by blood or marriage4 7#c7 ,the term registered individual means an individual registered with the burn pit registry4 #gag4 ,burn pit transparency 7a7 ,short title ,this section may be cited as the ,,sfc ,heath ,robinson ,burn ,pit ,transparency ,act4 7b7 ,notifications and reports regarding reported cases of burn pit exposure 7#a7 ,quarterly notifications 7,a7 ,in general ,on a quarterly basis1 the ,secretary of ,veterans ,affairs shall submit to the appropriate congressional committees a report on each reported case of burn pit exposure by a covered veteran reported during the previous quarter4 7,b7 ,elements ,each report submitted under subparagraph 7,a7 shall include1 with respect to each reported case of burn pit exposure of a covered veteran included in the report1 the following3 7i7 ,notice of the case1 including the medical facility at which the case was reported4 7ii7 ,notice of1 as available-- 7,i7 the enrollment status of the covered veteran with respect to the patient enrollment system of the ,department of ,veterans ,affairs under section #agje7;a7 of title #ch1 ,united ,states ,code2 7,,ii7 a summary of all health care visits by the covered veteran at the medical facility at which the case was reported that are related to the case2 7,,iii7 the demographics of the covered veteran1 including age1 sex1 and race2 7,,iv7 any non-,department of ,veterans ,affairs health care benefits that the covered veteran receives2 7,v7 the ,armed ,force in which the covered veteran served and the rank of the covered veteran2 7,,vi7 the period in which the covered veteran served2 7,,vii7 each location of an open burn pit from which the covered veteran was exposed to toxic airborne chemicals and fumes during such service2 7,,viii7 the medical diagnoses of the covered veteran and the treatment provided to the veteran2 and 7,,ix7 whether the covered veteran is registered in the ,airborne ,hazards and ,open ,burn ,pit ,registry4 7,c7 ,protection of information ,the ,secretary shall ensure that the reports submitted under subparagraph 7,a7 do not include the identity of covered veterans or contain other personally identifiable data4 7#b7 ,annual report on cases 7,a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary of ,veterans ,affairs1 in collaboration with the ,secretary of ,defense1 shall submit to the appropriate congressional committees a report detailing the following3 7i7 ,the total number of covered veterans4 7ii7 ,the total number of claims for disability compensation under chapter #aa of title #ch1 ,united ,states ,code1 approved and the total number denied by the ,secretary of ,veterans ,affairs with respect to a covered veteran1 and for each such denial1 the rationale of the denial4 7iii7 ,a comprehensive list of-- 7,i7 the conditions for which covered veterans seek treatment2 and 7,,ii7 the locations of the open burn pits from which the covered veterans were exposed to toxic airborne chemicals and fumes4 7iv7 ,identification of any illnesses relating to exposure to open burn pits that formed the basis for the ,secretary to award benefits1 including entitlement to service connection or an increase in disability rating4 7v7 ,the total number of covered veterans who died after seeking care for an illness relating to exposure to an open burn pit4 7vi7 ,any updates or trends with respect to the information described in clauses 7i71 7ii71 7iii71 7iv71 and 7v7 that the ,secretary determines appropriate4 7,b7 ,matters included in first report ,the ,secretary shall include in the first report under paragraph 7#a7 information specified in paragraph 7#a77;,b7 with respect to reported cases of burn pit exposure made during the period beginning ,january #a1 #aiij1 and ending on the day before the date of the enactment of this ,act4 7#c7 ,information regarding the ,airborne ,hazards and ,open ,burn ,pit ,registry 7,a7 ,notice ,the ,secretary of ,veterans ,affairs shall ensure that a medical professional of the ,department of ,veterans ,affairs informs a veteran of the ,airborne ,hazards and ,open ,burn ,pit ,registry if the veteran presents at a medical facility of the ,department for treatment that the veteran describes as being related to1 or ancillary to1 the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits4 7,b7 ,display ,in making information public regarding the number of participants in the ,airborne ,hazards and ,open ,burn ,pit ,registry1 the ,secretary shall display such numbers by both ,state and by congressional district4 7#d7 ,comptroller ,general report ,not later than #ahj days after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate congressional committees a report containing an assessment of the effectiveness of any memorandum of understanding or memorandum of agreement entered into by the ,secretary of ,veterans ,affairs with respect to-- 7,a7 the processing of reported cases of burn pit exposure2 and 7,b7 the coordination of care and provision of health care relating to such cases at medical facilities of the ,department of ,veterans ,affairs and at non-,department facilities4 7#e7 ,definitions ,in this section3 7,a7 ,the term ,airborne ,hazards and ,open ,burn ,pit ,registry means the registry established by the ,secretary of ,veterans ,affairs under section #bja of the ,dignified ,burial and ,other ,veterans' ,benefits ,improvement ,act of #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7,b7 ,the term appropriate congressional committees means-- 7i7 the ,committee on ,veterans' ,affairs and the ,committee on ,armed ,services of the ,senate2 and 7ii7 ,the ,committee on ,veterans' ,affairs and the ,committee on ,armed ,services of the ,house of ,representatives4 7,c7 ,the term covered veteran means a veteran who presents at a medical facility of the ,department of ,veterans ,affairs 7or in a non-,department facility pursuant to section #agjc or #agjc;,a of title #ch1 ,united ,states ,code7 for treatment that the veteran describes as being related to1 or ancillary to1 the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the ,armed ,forces4 7,d7 ,the term open burn pit has the meaning given that term in section #bja7;c7 of the ,dignified ,burial and ,other ,veterans' ,benefits ,improvement ,act of #bjab 7,public ,law #aab-bfj2 #ch ,u4,s4,c4 #ebg note74 7,e7 ,the term reported case of burn pit exposure means each instance in which a veteran presents at a medical facility of the ,department of ,veterans ,affairs 7or in a non-,department facility pursuant to section #agjc or #agjc;,a of title #ch1 ,united ,states ,code7 for treatment that the veteran describes as being related to1 or ancillary to1 the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the ,armed ,forces4 ,passed the ,house of ,representatives ,march #c1 #bjbb4;,cheryl ,l4 ,johnson1,clerk4 ,may #be1 #bjbb,read the second time and placed on the calendar