TEAM Act

II 117TH CONGRESS 1ST SESSION S. 927 To improve the provision of health care and other benefits from the Depart- ment of Veterans Affairs for veterans who were exposed to toxic sub- stances, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 23, 2021 Mr. TILLIS (for himself, Ms. HASSAN, Mr. MORAN, Ms. KLOBUCHAR, Mrs. BLACKBURN, Ms. BALDWIN, and Mrs. CAPITO) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs A BILL To improve the provision of health care and other benefits from the Department of Veterans Affairs for veterans who were exposed to toxic substances, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Toxic Exposure in the American Military Act’’ or the 5 ‘‘TEAM Act’’. 6 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 927 IS (b) TABLE OF CONTENTS.—The table of contents for 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. Sec. 2. Definitions. TITLE I—EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO TOXIC SUBSTANCES Sec. 101. Expansion of health care eligibility for certain individuals exposed to open burn pits and other toxic substances. Sec. 102. Expansion of health care eligibility for veterans awarded certain med- als. Sec. 103. Presumptions of service connection for diseases associated with expo- sure to certain toxic substances. TITLE II—RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES Sec. 201. Establishment of Toxic Exposure Review Commission. Sec. 202. Agreement with National Academies of Sciences, Engineering, and Medicine concerning the exposure of humans to toxic sub- stances. Sec. 203. Collection, analysis, and report on treatment of veterans for medical conditions related to exposure to toxic substances. TITLE III—IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS REGARDING EXPOSURES TO TOXIC SUB- STANCES Sec. 301. Publication of list of resources of Department of Veterans Affairs for veterans exposed to toxic substances and outreach program for such veterans and caregivers and survivors of such veterans. Sec. 302. Incorporation of toxic exposure questionnaire during primary care ap- pointments. Sec. 303. Training of health care personnel of Department of Veterans Affairs on illnesses related to exposure to toxic substances. SEC. 2. DEFINITIONS. 3 In this Act: 4 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV- 5 ICE.—The term ‘‘active military, naval, or air serv- 6 ice’’ has the meaning given that term in section 101 7 of title 38, United States Code. 8 (2) OPEN BURN PIT.—The term ‘‘open burn 9 pit’’ has the meaning given that term in section 10 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 927 IS 201(c) of the Dignified Burial and Other Veterans’ 1 Benefits Improvement Act of 2012 (Public Law 2 112–260; 38 U.S.C. 527 note). 3 (3) TOXIC SUBSTANCE.—The term ‘‘toxic sub- 4 stance’’ has the meaning given that term in subpara- 5 graph (G)(iii) of section 1710(e)(1) of such title, as 6 added by section 101(a)(1). 7 TITLE I—EXPANSION OF HEALTH 8 CARE AND BENEFITS FOR 9 VETERANS EXPOSED TO 10 TOXIC SUBSTANCES 11 SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 12 CERTAIN INDIVIDUALS EXPOSED TO OPEN 13 BURN PITS AND OTHER TOXIC SUBSTANCES. 14 (a) EXPANSION OF HEALTH CARE ELIGIBILITY.— 15 (1) IN GENERAL.—Section 1710(e) of title 38, 16 United States Code, is amended— 17 (A) in paragraph (1), by adding at the end 18 the following new subparagraph: 19 ‘‘(G)(i) Subject to paragraph (2), a covered individual 20 is eligible for hospital care, medical services, and nursing 21 home care under subsection (a)(2)(F) for any illness. 22 ‘‘(ii) For purposes of this subparagraph, a covered 23 individual is an individual who— 24 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 927 IS ‘‘(I) is eligible for inclusion in the Airborne 1 Hazards and Open Burn Pit Registry; or 2 ‘‘(II) has been identified by the Secretary of 3 Defense to have been possibly exposed, inside or out- 4 side the United States, during active duty, active 5 duty for training, or inactive duty training, to— 6 ‘‘(aa) an open burn pit; 7 ‘‘(bb) a toxic substance; or 8 ‘‘(cc) a site included in a database main- 9 tained by the Department of Defense and 10 shared with the Department of Veterans Affairs 11 to serve as the central portal for exposure-re- 12 lated data that compiles, collates, presents, and 13 provides available occupational and environ- 14 mental exposure information to support the 15 needs of the Department of Defense and the 16 Department of Veterans Affairs. 17 ‘‘(iii) In this subparagraph: 18 ‘‘(I) The term ‘Airborne Hazards and Open 19 Burn Pit Registry’ means the registry established by 20 the Secretary under section 201 of the Dignified 21 Burial and Other Veterans’ Benefits Improvement 22 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 23 note). 24 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 927 IS ‘‘(II) The term ‘open burn pit’ has the meaning 1 given that term in section 201(c) of the Dignified 2 Burial and Other Veterans’ Benefits Improvement 3 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 4 note). 5 ‘‘(III) The term ‘toxic substance’ means a toxi- 6 cant or a toxin. 7 ‘‘(IV) The term ‘toxicant’ means any substance 8 that can injure or kill humans, animals, or plants 9 and that is produced by humans or is a by-product 10 of human activities. 11 ‘‘(V) The term ‘toxin’ means any substance 12 that can injure or kill humans, animals, or plants 13 and that is produced naturally.’’; and 14 (B) in paragraph (2)(B), by striking ‘‘or 15 (F)’’ and inserting ‘‘(F), or (G)’’. 16 (2) EFFECTIVE DATE.—The amendments made 17 by paragraph (1) shall take effect on the date that 18 is 90 days after the date of the enactment of this 19 Act. 20 (b) DETERMINATIONS OF EXPOSURE.— 21 (1) IN GENERAL.—The Secretary of Veterans 22 Affairs shall, to the extent practicable, establish and 23 maintain a mechanism by which veterans may deter- 24 mine whether or not they have been possibly exposed 25 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 927 IS to an open burn pit or toxic substance described in 1 subclause (II) of subparagraph (G)(ii) of section 2 1710(e)(1) of title 38, United States Code, as added 3 by subsection (a)(1), for purposes of being consid- 4 ered as covered individuals under such subpara- 5 graph. 6 (2) APPROVAL OF SECRETARY.—Any deter- 7 mination made under paragraph (1) shall be subject 8 to the approval of the Secretary. 9 (3) APPEALS.—The Secretary shall establish a 10 mechanism for appealing a decision made by the 11 Secretary under paragraph (2). 12 (c) REPORT.— 13 (1) IN GENERAL.—Not later than 30 days after 14 the date on which the Secretary of Defense identifies 15 the individuals described in subparagraph (G)(ii)(II) 16 of section 1710(e)(1) of title 38, United States 17 Code, as added by subsection (a)(1), the Secretary 18 of Defense, in consultation with the Secretary of 19 Veterans Affairs, shall submit to the appropriate 20 committees of Congress a report. 21 (2) ELEMENTS.—The report required by para- 22 graph (1) shall include the following: 23 (A) The duty locations or units of the indi- 24 viduals described in paragraph (1), or other in- 25 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 927 IS formation on groups to which such individuals 1 belong. 2 (B) The evidence considered in identifying 3 individuals who were possibly exposed to an 4 open burn pit, toxic substance, or site as de- 5 scribed in subparagraph (G)(ii)(II) of section 6 1710(e)(1) of title 38, United States Code, as 7 added by subsection (a)(1). 8 (C) The criteria used to determine whether 9 an individual was so exposed. 10 (3) APPROPRIATE COMMITTEES OF CON- 11 GRESS.—In this subsection, the term ‘‘appropriate 12 committees of Congress’’ means— 13 (A) the Committee on Veterans’ Affairs 14 and the Committee on Armed Services of the 15 Senate; and 16 (B) the Committee on Veterans’ Affairs 17 and the Committee on Armed Services of the 18 House of Representatives. 19 SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 20 VETERANS AWARDED CERTAIN MEDALS. 21 (a) IN GENERAL.—Section 1710(e) of title 38, 22 United States Code, as amended by section 101(a)(1), is 23 further amended— 24 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 927 IS (1) in paragraph (1), by adding at the end the 1 following new subparagraph: 2 ‘‘(H) Subject to paragraph (2), a veteran is eligible 3 for hospital care, medical services, and nursing home care 4 under subsection (a)(2)(F) for any illness if the veteran 5 was awarded any of the following: 6 ‘‘(i) The Armed Forces Service Medal. 7 ‘‘(ii) The Afghanistan Campaign Medal. 8 ‘‘(iii) The Global War on Terrorism Expedi- 9 tionary Medal. 10 ‘‘(iv) The Inherent Resolve Campaign Medal. 11 ‘‘(v) The Iraq Campaign Medal. 12 ‘‘(vi) The Southwest Asia Service Medal.’’; and 13 (2) in paragraph (2), by striking ‘‘or (G)’’ and 14 inserting ‘‘(G), or (H)’’. 15 (b) EFFECTIVE DATE.—The amendments made by 16 subsection (a) shall take effect on the date that is 90 days 17 after the date of the enactment of this Act. 18 SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR 19 DISEASES ASSOCIATED WITH EXPOSURE TO 20 CERTAIN TOXIC SUBSTANCES. 21 (a) IN GENERAL.—Subchapter II of chapter 11 of 22 title 38, United States Code, is amended by adding at the 23 end the following new section: 24 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 927 IS ‘‘§ 1119. Presumptions of service connection for dis- 1 eases associated with exposure to certain 2 toxic substances 3 ‘‘(a) PRESUMPTIONS OF SERVICE CONNECTION.—(1) 4 For purposes of section 1110 of this title, and subject to 5 section 1113 of this title, each disease specified in para- 6 graph (2) becoming manifest as specified in that para- 7 graph shall be considered to have been incurred in or ag- 8 gravated by service referred to in that paragraph, notwith- 9 standing that there is no record of evidence of such disease 10 during the period of such service. 11 ‘‘(2) A disease specified in this paragraph is any dis- 12 ease that— 13 ‘‘(A) the Secretary determines in regulations 14 prescribed under this section warrants a presump- 15 tion of service connection by reason of having a posi- 16 tive association with exposure to a toxic substance; 17 and 18 ‘‘(B) becomes manifest within the period, if 19 any, prescribed in such regulations in a veteran who 20 was exposed to that toxic substance during active 21 military, naval, or air service. 22 ‘‘(3)(A) For purposes of this subsection, the Sec- 23 retary may presume that a veteran who has a disease spec- 24 ified in paragraph (2) was exposed to the toxic substance 25 for which the Secretary has determined under paragraph 26 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 927 IS (2)(A) warrants a presumption of service connection by 1 reason of having a positive association with exposure to 2 the toxic substance, notwithstanding that there is no 3 record of evidence of such exposure, if the Secretary deter- 4 mines based on one or more of the factors set forth in 5 subparagraph (B) that a presumption of exposure is war- 6 ranted. 7 ‘‘(B) The factors set forth in this subparagraph are 8 as follows: 9 ‘‘(i) The duty location of the veteran. 10 ‘‘(ii) The length of service of the veteran. 11 ‘‘(iii) Such other factors as the Secretary con- 12 siders appropriate. 13 ‘‘(b) DETERMINATIONS RELATING TO DISEASES.— 14 (1) Whenever the Secretary determines, on the basis of 15 sound medical and scientific evidence, that a positive asso- 16 ciation exists between the exposure of humans to a toxic 17 substance and the occurrence of a disease in humans, the 18 Secretary shall prescribe regulations providing that a pre- 19 sumption of service connection is warranted for that dis- 20 ease for purposes of this section. 21 ‘‘(2) In making determinations under paragraph (1), 22 the Secretary shall take into account— 23 ‘‘(A) reports received by the Secretary from the 24 National Academies of Sciences, Engineering, and 25 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 927 IS Medicine under section 202(g) of the Toxic Expo- 1 sure in the American Military Act; and 2 ‘‘(B) all other sound medical and scientific in- 3 formation and analyses available to the Secretary. 4 ‘‘(3)(A) In evaluating any report, information, or 5 analysis for purposes of making such determinations, the 6 Secretary shall consider only scientific studies that are 7 valid in accordance with contemporary scientific stand- 8 ards. 9 ‘‘(B) The Secretary may define the standards de- 10 scribed in subparagraph (A) for purposes of that subpara- 11 graph. 12 ‘‘(c) RESPONSE TO REPORTS BY THE NATIONAL 13 ACADEMIES OF SCIENCES, ENGINEERING, AND MEDI- 14 CINE.—(1) Not later than 60 days after the date on which 15 the Secretary receives a report from the National Acad- 16 emies of Sciences, Engineering, and Medicine under sec- 17 tion 202(g) of the Toxic Exposure in the American Mili- 18 tary Act, the Secretary shall determine whether a pre- 19 sumption of service connection is warranted for each dis- 20 ease covered by the report. 21 ‘‘(2) If the Secretary determines under paragraph (1) 22 that a presumption of service connection is warranted for 23 a disease, the Secretary shall, not later than 60 days after 24 VerDate Sep 11 2014 03:55 Apr 13, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S927.IS S927 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 927 IS making the determination, issue proposed regulations set- 1 ting forth the determination. 2 ‘‘(3)( [Text truncated for display. 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