COVENANT Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2368 To amend title 38, United States Code, to establish a presumption of service connection for illnesses associated with exposure to certain airborne haz- ards, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 5, 2021 Mrs. LURIA introduced the following bill; which was referred to the Committee on Veterans’ Affairs A BILL To amend title 38, United States Code, to establish a pre- sumption of service connection for illnesses associated with exposure to certain airborne hazards, 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. 3 This Act may be cited as the ‘‘Conceding Our Vet- 4 erans’ Exposures Now And Necessitating Training Act of 5 2021’’ or the ‘‘COVENANT Act of 2021’’. 6 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 2368 IH SEC. 2. PRESUMPTIONS OF SERVICE CONNECTION FOR ILL- 1 NESSES ASSOCIATED WITH EXPOSURE TO 2 CERTAIN AIRBORNE HAZARDS. 3 (a) SENSE OF CONGRESS.—It is the sense of Con- 4 gress that— 5 (1) as in past theaters of operation, Southwest 6 Asia and its supporting theaters of operation pose 7 numerous natural and manmade hazards that nega- 8 tively affect the health outcomes of individuals serv- 9 ing in these foreign environments; 10 (2) toxic exposures from burn pits, oil well 11 fires, and other regional airborne hazards increase 12 the potential for immediate and long-term illnesses 13 to emerge among members of the Armed Forces; 14 and 15 (3) legislation is necessary— 16 (A) to confront the scientific challenge of 17 producing clear associations between in-theater 18 toxic exposures and the illnesses confronting 19 veterans who served in Southwest Asia and be- 20 yond; 21 (B) to address the insufficient data hin- 22 dering the Secretary of Veterans Affairs, the 23 Secretary of Defense, and relevant partners 24 from reaching proactive determinations regard- 25 ing such associations; and 26 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 2368 IH (C) to improve evaluations associated with 1 claims for disability compensation that relate to 2 toxic exposure. 3 (b) PRESUMPTIONS OF SERVICE CONNECTION.— 4 (1) IN GENERAL.—Subchapter II of chapter 11 5 of title 38, United States Code, is amended by add- 6 ing at the end the following new section: 7 ‘‘§ 1119. Presumptions of service connection for ill- 8 nesses associated with exposure to cer- 9 tain airborne hazards 10 ‘‘(a) PRESUMPTIONS.—(1) For the purposes of sec- 11 tion 1110 of this title, and subject to section 1113 of this 12 title, an illness specified in subsection (d) becoming mani- 13 fest in a covered veteran to a degree of 10 percent or more 14 shall be considered to have been incurred in or aggravated 15 during active military, naval, or air service, notwith- 16 standing that there is no record of evidence of such illness 17 during a period of such service. 18 ‘‘(2) A covered veteran shall be presumed to have 19 been exposed to an airborne hazard specified in subsection 20 (e) during service of the covered veteran specified in sub- 21 section (f)(1) unless there is affirmative evidence to estab- 22 lish that the covered veteran was not exposed to any such 23 airborne hazard during such service. 24 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 2368 IH ‘‘(b) MEDICAL EXAMINATIONS AND OPINIONS.—(1) 1 If a covered veteran submits to the Secretary a claim for 2 disability compensation for a diagnosed illness not speci- 3 fied in subsection (d) that includes an assertion that the 4 illness is related to airborne hazard exposure (regardless 5 of whether such assertion identifies a particular airborne 6 hazard specified in subsection (e)) or open burn pit expo- 7 sure, and the evidence of record is insufficient to establish 8 service connection for the illness, the Secretary shall pro- 9 vide to the covered veteran a medical examination and ob- 10 tain a medical opinion under section 5103A of this title 11 to determine whether the illness is at least as likely as 12 not caused by an airborne hazard specified in subsection 13 (e). 14 ‘‘(2) In carrying out paragraph (1), if the diagnosed 15 illness for which a claim is submitted involves a sign or 16 symptom specified in section 1117(g) of this title, the Sec- 17 retary shall ensure that— 18 ‘‘(A) the medical examination provided pursu- 19 ant to such paragraph includes an evaluation of each 20 corresponding body part or system that relates to 21 the sign or symptom; and 22 ‘‘(B) the sign or symptom is considered in mak- 23 ing the determination under such paragraph. 24 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 2368 IH ‘‘(3) In providing the Secretary with a medical opin- 1 ion pursuant to paragraph (1), a medical provider shall 2 consider— 3 ‘‘(A) the total potential exposure to airborne 4 hazards through any service of the covered veteran 5 specified in subsection (f)(1) and the synergistic ef- 6 fect of combined airborne hazards, including air- 7 borne hazards that involve exposure through inhala- 8 tion, dermal exposure, or ingestion; and 9 ‘‘(B) the medical evidence and scientific report- 10 ing available at the time of the determination under 11 paragraph (1). 12 ‘‘(c) RELATIONSHIP TO PRESUMPTIONS FOR ILL- 13 NESSES ASSOCIATED WITH SERVICE IN PERSIAN 14 GULF.—A determination that a presumption of service 15 connection is not warranted pursuant to this section shall 16 not preclude the Secretary from— 17 ‘‘(1) determining that a presumption of service 18 connection is warranted pursuant to section 1118 of 19 this title; or 20 ‘‘(2) paying compensation to the veteran (or de- 21 pendency and indemnity compensation to a survivor 22 of the veteran) pursuant to section 1117 of this title. 23 ‘‘(d) ILLNESSES.—The illnesses specified in this sub- 24 section are the following: 25 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 2368 IH ‘‘(1) Asthma that was diagnosed after a period 1 of service specified in subsection (f)(1). 2 ‘‘(2)(A) Head cancer of any type. 3 ‘‘(B) Neck cancer of any type. 4 ‘‘(C) Respiratory cancer of any type. 5 ‘‘(D) Gastrointestinal cancer of any type. 6 ‘‘(E) Reproductive cancer of any type. 7 ‘‘(F) Lymphoma cancer of any type. 8 ‘‘(G) Lymphomatic cancer of any type. 9 ‘‘(H) Kidney cancer. 10 ‘‘(I) Brain cancer. 11 ‘‘(J) Melanoma. 12 ‘‘(3) Chronic obstructive pulmonary disease. 13 ‘‘(4) Chronic bronchitis. 14 ‘‘(5) Constrictive bronchiolitis or obliterative 15 bronchiolitis. 16 ‘‘(6) Emphysema. 17 ‘‘(7) Granulomatous disease. 18 ‘‘(8) Interstitial lung disease. 19 ‘‘(9) Pleuritis. 20 ‘‘(10) Pulmonary fibrosis. 21 ‘‘(11) Sarcoidosis. 22 ‘‘(12) Rhinitis. 23 ‘‘(13) Sinusitis. 24 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 2368 IH ‘‘(e) AIRBORNE HAZARDS.—The airborne hazards 1 specified in this subsection are the following: 2 ‘‘(1) Particulate matter, including the following: 3 ‘‘(A) PM-10. 4 ‘‘(B) PM-2.5. 5 ‘‘(2) Polycyclic aromatic hydrocarbons (PAHs), 6 including the following: 7 ‘‘(A) Acenaphthene. 8 ‘‘(B) Acenaphthylene. 9 ‘‘(C) Anthracene. 10 ‘‘(D) Benzo(a)anthracene. 11 ‘‘(E) Benzo(a)pyrene. 12 ‘‘(F) Benzo(b)fluoroanthene. 13 ‘‘(G) Benzo(g,h,i)perylene. 14 ‘‘(H) Benzo(k)fluoroanthene. 15 ‘‘(I) Chrysene. 16 ‘‘(J) Dibenze(a,h)anthracene. 17 ‘‘(K) Fluoranthene. 18 ‘‘(L) Fluorene. 19 ‘‘(M) Indeno(1,2,3-cd)pyrene. 20 ‘‘(N) Naphthalene. 21 ‘‘(O) Phenanthrene. 22 ‘‘(P) Pyrene. 23 ‘‘(3) Volatile organic compounds, including the 24 following: 25 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 2368 IH ‘‘(A) Acetone. 1 ‘‘(B) Acrolein. 2 ‘‘(C) Benzene. 3 ‘‘(D) Carbon disulfide. 4 ‘‘(E) Chlorofluoromethane. 5 ‘‘(F) Chloromethane. 6 ‘‘(G) Ethylbenzene. 7 ‘‘(H) Hexane. 8 ‘‘(I) Hexachlorobutadiene. 9 ‘‘(J) M/p-Xylene. 10 ‘‘(K) Methylene chloride. 11 ‘‘(L) Pentane. 12 ‘‘(M) Propylene. 13 ‘‘(N) Styrene. 14 ‘‘(O) Toluene. 15 ‘‘(4) Toxic organic halogenated dioxins and 16 furans (dioxins), including the following: 17 ‘‘(A) 1,2,3,4,6,7,8-HPCDD. 18 ‘‘(B) 1,2,3,4,6,7,8-HPCDF. 19 ‘‘(C) 1,2,3,4,7,8,9-HPCDF. 20 ‘‘(D) 1,2,3,4,7,8-HXCDD. 21 ‘‘(E) 1,2,3,4,7,8-HXCDF. 22 ‘‘(F) 1,2,3,6,7,8-HXCDD. 23 ‘‘(G) 1,2,3,6,7,8-HXCDF. 24 ‘‘(H) 1,2,3,7,8,9-HXCDD. 25 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 2368 IH ‘‘(I) 1,2,3,7,8,9-HXCDF. 1 ‘‘(J) 1,2,3,7,8-PECDD. 2 ‘‘(K) 1,2,3,7,8-PECDF. 3 ‘‘(L) 2,3,4,6,7,8-HXCDF. 4 ‘‘(M) 2,3,4,7,8-PECDF. 5 ‘‘(N) 2,3,7,8-TCDD. 6 ‘‘(O) 2,3,7,8-TCDF. 7 ‘‘(P) Octachlorodibenzodioxin. 8 ‘‘(Q) Octachlorodibenzofuran. 9 ‘‘(5) Any other airborne hazard determined rel- 10 evant by the Secretary. 11 ‘‘(f) DEFINITIONS.—In this section: 12 ‘‘(1) The term ‘covered veteran’ means any vet- 13 eran who— 14 ‘‘(A) on or after August 2, 1990, per- 15 formed active military, naval, or air service 16 while assigned to a duty station in— 17 ‘‘(i) Bahrain; 18 ‘‘(ii) Iraq; 19 ‘‘(iii) Kuwait; 20 ‘‘(iv) Oman; 21 ‘‘(v) Qatar; 22 ‘‘(vi) Saudi Arabia; 23 ‘‘(vii) Somalia; or 24 ‘‘(viii) United Arab Emirates; or 25 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 2368 IH ‘‘(B) on or after September 11, 2001, per- 1 formed active military, naval, or air service 2 while assigned to a duty station in— 3 ‘‘(i) Afghanistan; 4 ‘‘(ii) Djibouti; 5 ‘‘(iii) Egypt; 6 ‘‘(iv) Jordan; 7 ‘‘(v) Lebanon; 8 ‘‘(vi) Syria; 9 ‘‘(vii) Yemen; 10 ‘‘(viii) Uzbekistan; 11 ‘‘(ix) the Philippines; or 12 ‘‘(x) any other country determined rel- 13 evant by the Secretary. 14 ‘‘(2) The term ‘illness’ means a disease or other 15 condition that affects the health of an individual on 16 a basis other than an acute or transient basis. 17 ‘‘(3) The term ‘open burn pit’ has the meaning 18 given such term in section 201(c) of the Dignified 19 Burial and Other Veterans’ Benefits Improvement 20 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 21 note), except that the area of land may be located 22 in any country specified in paragraph (1) or deter- 23 mined relevant by the Secretary pursuant to such 24 paragraph. 25 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 2368 IH ‘‘(g) EFFECTIVE DATE OF AWARD.—The effective 1 date of an award under this section shall be determined 2 in accordance with section 5110 of this title, except that 3 such date may not be earlier than the date of the enact- 4 ment of this Act.’’. 5 (2) CLERICAL AMENDMENT.—The table of con- 6 tents at the beginning of chapter 11 of title 38, 7 United States Code, is amended by inserting after 8 the item relating to section 1118 the following new 9 item: 10 ‘‘1119. Presumptions of service connection for illnesses associated with exposure to certain airborne hazards.’’. (3) IMPLEMENTATION DEADLINE.—The Sec- 11 retary of Veterans Affairs shall implement the 12 amendments made by this subsection by not later 13 than 18 months after the date of the enactment of 14 this Act. 15 (c) RELATIONSHIP TO PRESUMPTIONS FOR ILL- 16 NESSES ASSOCIATED WITH SERVICE IN THE PERSIAN 17 GULF.—Subchapter II of chapter 11 of title 38, United 18 States Code, is further amended— 19 (1) in section 1117, by adding at the end the 20 following new subsection: 21 ‘‘(i) A denial or termination of compensation paid to 22 a veteran pursuant to this section shall not preclude the 23 Secretary from determining that a presumption of service 24 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 2368 IH connection is warranted pursuant to section 1119 of this 1 title.’’; and 2 (2) in section 1118, by adding at the end the 3 following new subsection: 4 ‘‘(f) A determination that a presumption of service 5 connection is not warranted pursuant to this section shall 6 not preclude the Secretary from determining that a pre- 7 sumption of service connection is warranted pursuant to 8 section 1119 of this title.’’. 9 (d) PENDING CASES.— 10 (1) AUTHORITY TO STAY.—The Secretary may 11 stay a claim described in paragraph (2) until the 12 date on which the Secretary commences the imple- 13 mentation of section 1119 of title 38, United States 14 Code (as added by subsection (b)). 15 (2) CLAIMS DESCRIBED.—A claim described in 16 this subparagraph is a claim for disability compensa- 17 tion that is pending at the Veterans Benefits Admin- 18 istration, the Board of Veterans’ Appeals, the Court 19 of Appeals for Veterans Claims, or the Court of Ap- 20 peals for the Federal Circuit, on or after the date 21 of the enactment of this Act and before the date on 22 which the Secretary commences the implementation 23 of such section 1119 and that relates to— 24 VerDate Sep 11 2014 21:37 Jun 07, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2368.IH H2368 pbinns on DSKJLVW7X2PROD with BILLS 13 •HR 2368 IH (A) the service and illnesses covered by 1 such section 1119; or 2 (B) the service covered by such section 3 1119 and a diagnosed illness asserted in the 4 claim to be related to airborne hazard exposure, 5 regardless of whether such assertion identifies a 6 particular airborne hazard, or open burn pit ex- 7 posure. 8 (e) STANDARD MEDICAL TRAINING CURRICULUM.— 9 (1) CURRICULUM.—Not later than 180 days 10 after the date of the enactment of this Act, the Sec- 11 retary of Veterans Affairs shall establish a standard 12 medical training curriculum for all medical providers 13 conducting examinations and providing opinions 14 under section 1119(b) of title 38, United States 15 Code (as added by subsection (b)), that provides a 16 standardized approach to conducting and providing 17 examinations and opinions in accordance with such 18 section. 19 (2) ELEMENTS.—The Secretary shall include in 20 the curriculum under paragraph (1) an [Text truncated for display. Full text available on Congress.gov.]