Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021

II 117TH CONGRESS 1ST SESSION S. 952 To amend title 38, United States Code, to provide for a presumption of service connection for certain diseases associated with exposure to toxins, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 24, 2021 Mrs. GILLIBRAND (for herself and Mr. RUBIO) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs A BILL To amend title 38, United States Code, to provide for a presumption of service connection for certain diseases associated with exposure to toxins, and for other pur- poses. 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. 3 This Act may be cited as the ‘‘Presumptive Benefits 4 for War Fighters Exposed to Burn Pits and Other Toxins 5 Act of 2021’’. 6 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 952 IS SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR CER- 1 TAIN DISEASES ASSOCIATED WITH EXPO- 2 SURE TO BURN PITS AND OTHER TOXINS. 3 (a) IN GENERAL.—Subchapter II of chapter 11 of 4 title 38, United States Code, is amended by adding at the 5 end the following new section: 6 ‘‘§ 1119. Presumption of service connection for cer- 7 tain diseases associated with exposure to 8 burn pits and other toxins 9 ‘‘(a) PRESUMPTION OF SERVICE CONNECTION.—(1) 10 For the purposes of section 1110 of this title, and subject 11 to section 1113 of this title, a disease specified in para- 12 graph (2) becoming manifest in a veteran described in 13 paragraph (3) shall be considered to have been incurred 14 in or aggravated during active military, naval, or air serv- 15 ice, notwithstanding that there is no record of evidence 16 of such disease during the period of such service. 17 ‘‘(2) The diseases specified in this paragraph are the 18 following: 19 ‘‘(A) Asthma that was diagnosed after service 20 in a country or territory for which a medal described 21 in paragraph (3) was awarded. 22 ‘‘(B)(i) Head cancer of any type. 23 ‘‘(ii) Neck cancer of any type. 24 ‘‘(iii) Respiratory cancer of any type. 25 ‘‘(iv) Gastrointestinal cancer of any type. 26 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 952 IS ‘‘(v) Reproductive cancer of any type. 1 ‘‘(vi) Lymphoma cancer of any type. 2 ‘‘(vii) Lymphomatic cancer of any type. 3 ‘‘(viii) Kidney cancer. 4 ‘‘(ix) Brain cancer. 5 ‘‘(x) Melanoma. 6 ‘‘(C) Chronic bronchitis. 7 ‘‘(D) Chronic obstructive pulmonary disease. 8 ‘‘(E) Constrictive bronchiolitis or obliterative 9 bronchiolitis. 10 ‘‘(F) Emphysema. 11 ‘‘(G) Granulomatous disease. 12 ‘‘(H) Interstitial lung disease. 13 ‘‘(I) Pleuritis. 14 ‘‘(J) Pulmonary fibrosis. 15 ‘‘(K) Sarcoidosis. 16 ‘‘(L) Any other disease listed under subsection 17 (a)(2) of section 1116 of this title or for which a 18 presumption of service connection is warranted pur- 19 suant to regulations prescribed under section sub- 20 section (b)(1) of such section. 21 ‘‘(M) Any other disease with respect to which 22 final regulations have been prescribed under sub- 23 section (c)(3). 24 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 952 IS ‘‘(3) A veteran described in this paragraph is any vet- 1 eran who on or after August 2, 1990, was awarded any 2 of the following: 3 ‘‘(A) The Afghanistan Campaign Medal. 4 ‘‘(B) The Armed Forces Expeditionary Medal. 5 ‘‘(C) The Armed Forces Reserve Medal with M- 6 device. 7 ‘‘(D) The Armed Forces Service Medal. 8 ‘‘(E) The Global War On Terrorism Expedi- 9 tionary Medal. 10 ‘‘(F) The Inherent Resolve Campaign Medal. 11 ‘‘(G) The Iraqi Campaign Medal. 12 ‘‘(H) The Southwest Asia Service Medal. 13 ‘‘(b) PROCESS TO ADD DISEASES THROUGH WRIT- 14 TEN PETITION.—(1) In the case that the Secretary re- 15 ceives a written petition from an interested party to add 16 a disease to the list of diseases specified in subsection 17 (a)(2), not later than 90 days after the date of receipt 18 of such petition, the Secretary shall request a determina- 19 tion by the National Academies of Sciences, Engineering, 20 and Medicine (referred to in this section as the ‘National 21 Academies’) with respect to whether there is a positive as- 22 sociation between— 23 ‘‘(A) the exposure of humans to one or more 24 covered toxins; and 25 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 952 IS ‘‘(B) the occurrence of the disease in humans. 1 ‘‘(2) For purposes of this subsection, the term ‘inter- 2 ested party’ includes a representative of— 3 ‘‘(A) a congressionally chartered veterans serv- 4 ice organization; 5 ‘‘(B) an organization that— 6 ‘‘(i) is described in section 501(c)(3) of the 7 Internal Revenue Code of 1986 and exempt 8 from taxation under section 501(a) of such 9 Code; 10 ‘‘(ii) serves veterans or members of the 11 Armed Forces; and 12 ‘‘(iii) has continuously operated for a pe- 13 riod of five years or more preceding the date of 14 the submittal of the written petition under 15 paragraph (1); 16 ‘‘(C) a collective bargaining agent for civilian 17 employees of the United States Government; 18 ‘‘(D) a nationally recognized medical associa- 19 tion; 20 ‘‘(E) the National Academies; or 21 ‘‘(F) a State or political subdivision of a State. 22 ‘‘(c) DETERMINATIONS BY NATIONAL ACADEMIES.— 23 (1) If the Secretary receives a determination described in 24 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 952 IS paragraph (2), not later than 180 days after receipt of 1 such determination, the Secretary shall— 2 ‘‘(A) publish in the Federal Register proposed 3 regulations to add the disease covered by the deter- 4 mination to the list of diseases specified in sub- 5 section (a)(2); 6 ‘‘(B) publish in the Federal Register, and sub- 7 mit to the Committee on Veterans’ Affairs of the 8 Senate and the Committee on Veterans’ Affairs of 9 the House of Representatives— 10 ‘‘(i) the decision of the Secretary not to 11 publish such proposed regulations; and 12 ‘‘(ii) the basis for such decision, including 13 specific medical science refuting the determina- 14 tion; or 15 ‘‘(C) publish in the Federal Register a decision 16 that insufficient evidence exists to take action under 17 subparagraph (A) or (B). 18 ‘‘(2) A determination described in this paragraph— 19 ‘‘(A) is a determination by the National Acad- 20 emies that there is a positive association between— 21 ‘‘(i) the exposure of humans to one or 22 more covered toxins; and 23 ‘‘(ii) the occurrence of the disease in hu- 24 mans; and 25 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 952 IS ‘‘(B) may be made pursuant to— 1 ‘‘(i) a request from the Secretary under 2 subsection (b); or 3 ‘‘(ii) an agreement between the Secretary 4 and the National Academies under section 3 of 5 the Presumptive Benefits for War Fighters Ex- 6 posed to Burn Pits and Other Toxins Act of 7 2021. 8 ‘‘(3)(A) Not later than 180 days after the date on 9 which the Secretary publishes any proposed regulations 10 under paragraph (1)(A) for a disease, the Secretary shall 11 prescribe final regulations for that disease. 12 ‘‘(B) Such regulations shall be effective on the date 13 of issuance. 14 ‘‘(d) REFERENCE TO NATIONAL ACADEMIES.—In the 15 case that the Secretary enters into an agreement with an- 16 other organization as described in section 3(h)(1) of the 17 Presumptive Benefits for War Fighters Exposed to Burn 18 Pits and Other Toxins Act of 2021, any reference in this 19 section to the National Academies shall be treated as a 20 reference to the other organization. 21 ‘‘(e) DEFINITIONS.—In this section: 22 ‘‘(1) The term ‘covered toxin’ includes the fol- 23 lowing: 24 ‘‘(A) Any toxic chemical or toxic fume. 25 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 952 IS ‘‘(B) Hazardous waste, mixed waste, solid 1 waste, or used oil (as those terms are defined 2 in section 1004 of the Solid Waste Disposal Act 3 (42 U.S.C. 6903)). 4 ‘‘(C) Radiological waste. 5 ‘‘(D) Any other carcinogen. 6 ‘‘(2) The term ‘veterans service organization’ 7 means an organization recognized by the Secretary 8 for the representation of veterans under section 9 5902 of this title.’’. 10 (b) EFFECTIVE DATE.— 11 (1) IN GENERAL.—The amendment made by 12 subsection (a) shall take effect on the date that is 13 180 days after the date of the enactment of this Act. 14 (2) WRITTEN PETITIONS.—With respect to a 15 written petition described in section 1119(b)(1) of 16 title 38, United States Code, as added by subsection 17 (a), that was received by the Secretary of Veterans 18 Affairs before the effective date described in para- 19 graph (1), the Secretary shall make a request of the 20 National Academies of Sciences, Engineering, and 21 Medicine under such section, as so added, not later 22 than 90 days after such effective date. 23 (c) CLERICAL AMENDMENT.—The table of sections 24 at the beginning of chapter 11 of title 38, United States 25 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 952 IS Code, is amended by inserting after the item relating to 1 section 1118 the following new item: 2 ‘‘1119. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins.’’. (d) CONFORMING AMENDMENT.—Section 1113 of 3 such title is amended by striking ‘‘or 1118’’ each place 4 it appears and inserting ‘‘1118, or 1119’’. 5 SEC. 3. AGREEMENT WITH THE NATIONAL ACADEMIES OF 6 SCIENCES, ENGINEERING, AND MEDICINE 7 CONCERNING THE EXPOSURE OF HUMANS TO 8 BURN PITS AND OTHER TOXINS. 9 (a) AGREEMENT.— 10 (1) IN GENERAL.—The Secretary of Veterans 11 Affairs shall seek to enter into an agreement with 12 the National Academies of Sciences, Engineering, 13 and Medicine (referred to in this section as the ‘‘Na- 14 tional Academies’’) to perform the services covered 15 by this section. 16 (2) TIMING.—The Secretary shall seek to enter 17 into the agreement described in paragraph (1) not 18 later than 60 days after the date of the enactment 19 of this Act. 20 (b) REVIEWS OF SCIENTIFIC EVIDENCE.— 21 (1) IN GENERAL.—Under an agreement be- 22 tween the Secretary and the National Academies, 23 the National Academies shall review and summarize 24 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 952 IS the scientific evidence, and assess the strength there- 1 of, concerning the association between the exposure 2 of humans to covered toxins and each disease sus- 3 pected to be associated with such exposure. 4 (2) REVIEWS UPON REQUEST.—Under an 5 agreement between the Secretary and the National 6 Academies under this section, the National Acad- 7 emies shall conduct a review described in paragraph 8 (1) in response to each request made by the Sec- 9 retary under section 1119(b)(1) of title 38, United 10 States Code, as added by section 2(a). 11 (c) SCIENTIFIC DETERMINATIONS CONCERNING DIS- 12 EASES.— 13 (1) IN GENERAL.—For each disease reviewed 14 under subsection (b), the National Academies shall 15 determine (to the extent that available scientific data 16 permit meaningful determinations) whether there is 17 a positive association between the exposure of hu- 18 mans to one or more covered toxins and the occur- 19 rence of the disease in humans, taking into account 20 the strength of the scientific evidence and the appro- 21 priateness of the statistical and epidemiological 22 methods used to detect the association. 23 (2) SUBMISSIONS FOR REVIEWS UPON RE- 24 QUEST.—Under an agreement between the Secretary 25 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 952 IS and the National Academies under this section, not 1 later than 270 days after the date on which the Sec- 2 retary transmits a request to the National Acad- 3 emies with respect to a disease under section 4 1119(b)(1) of title 38, United States Code, as added 5 by section 2(a), the National Academies shall submit 6 to the Secretary the determination made with re- 7 spect to that disease under paragraph (1). 8 (d) RECOMMENDATIONS FOR ADDITIONAL SCI- 9 ENTIFIC STUDIES.— 10 (1) IN GENERAL.—Under an agreement be- 11 tween the Secretary and the National Academies 12 under this section, the National Academies shall 13 make any recommendations it has for additional sci- 14 entific studies to resolve areas of continuing sci- 15 entific uncertainty relating to the exposure of hu- 16 mans to covered toxins. 17 (2) CONSIDERATIONS.—In making rec- 18 ommendations for additional scientific studies, the 19 National Academies shall consider— 20 (A) the scientific information that is avail- 21 able at the time of the recommendation; 22 (B) the value and relevance of the informa- 23 tion that could result from additional studies; 24 and 25 VerDate Sep 11 2014 20:11 Apr 17, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S952.IS S952 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 952 IS (C) the feasibility of carrying out such ad- 1 ditional studies. 2 (e) SUBSEQUENT REVIEWS.—Under an agreement 3 between the Secretary and the National Academies under 4 this section, the National Academies shall— 5 (1) conduct as comprehensive a review as is 6 practicable of the evidence referred to in subsection 7 (b)(1) that became available since the last review of 8 such evidence under this section; and 9 (2) make determinations and estimates on the 10 basis of the results of such review and all other re- 11 views conducted for the purposes of this section. 12 (f) REPORTS.— 13 (1) INITIAL REPORT.— 14 (A) IN GENERAL.—Under an agreement 15 between the Secretary and the National Acad- 16 emies under this section, not later than 540 17 days after the date of the enactment of this 18 Act, the National Academies shall submit to the 19 Secretary and the Committee on Veterans’ Af- 20 fairs of the Senate and the Committee on Vet- 21 erans’ Affairs of the House of Representatives 22 a report [Text truncated for display. Full text available on Congress.gov.]