TEAM Act of 2020

II Calendar No. 602 116TH CONGRESS 2D SESSION S. 4393 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 JULY 30, 2020 Mr. TILLIS (for himself, Mrs. BLACKBURN, Ms. MCSALLY, and Mrs. CAPITO) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs DECEMBER 8, 2020 Reported by Mr. MORAN, with an amendment [Strike out all after the enacting clause and insert the part printed in italic] 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 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 4393 RS SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1 (a) SHORT TITLE.—This Act may be cited as the 2 ‘‘Toxic Exposure in the American Military Act of 2020’’ 3 or the ‘‘TEAM Act of 2020’’ 4 (b) TABLE OF CONTENTS.—The table of contents for 5 this Act is as follows: 6 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. Consultation, testing, and treatment for certain veterans who received hazardous duty pay or were exposed to toxic substances. Sec. 102. Permanent reauthorization of authority of Secretary of Veterans Af- fairs to prescribe regulations providing that a presumption of service connection is warranted for a disease associated with exposure to a herbicide agent. 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. Analysis of results of consultation, testing, and treatment of veterans for disabilities related to exposure to toxic substances. Sec. 204. Report to evaluate and identify groups at-risk of 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. Portal for access by veterans to individual longitudinal exposure record. Sec. 304. Training of personnel of Department of Veterans Affairs on illnesses related to exposure to toxic substances. VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6411 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 4393 RS SEC. 2. DEFINITIONS. 1 In this Act: 2 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV- 3 ICE.—The term ‘‘active military, naval, or air serv- 4 ice’’ has the meaning given that term in section 5 101(24) of title 38, United States Code. 6 (2) TOXIC SUBSTANCE.—The term ‘‘toxic sub- 7 stance’’ has the meaning given that term in section 8 1720J(i) of such title, as added by section 101(a). 9 TITLE I—EXPANSION OF HEALTH 10 CARE AND BENEFITS FOR 11 VETERANS EXPOSED TO 12 TOXIC SUBSTANCES 13 SEC. 101. CONSULTATION, TESTING, AND TREATMENT FOR 14 CERTAIN VETERANS WHO RECEIVED HAZ- 15 ARDOUS DUTY PAY OR WERE EXPOSED TO 16 TOXIC SUBSTANCES. 17 (a) IN GENERAL.—Subchapter II of chapter 17 of 18 title 38, United States Code, is amended by adding at the 19 end the following new section: 20 ‘‘§ 1720J. Consultation, testing, and treatment of vet- 21 erans for exposure to toxic substances 22 ‘‘(a) IN GENERAL.—The Secretary shall furnish to 23 covered veterans— 24 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 4393 RS ‘‘(1) covered consultation and testing regarding 1 the exposure of those veterans to toxic substances; 2 and 3 ‘‘(2) treatment for any illness relating to such 4 exposure diagnosed under subsection (b)(2), subject 5 to approval by the Under Secretary for Health. 6 ‘‘(b) COVERED CONSULTATION AND TESTING.—For 7 purposes of this section, covered consultation and testing 8 is— 9 ‘‘(1) consultation with a primary care physician 10 or other treating physician to determine whether the 11 covered veteran has an illness related to exposure to 12 a toxic substance while serving in the Armed Forces; 13 ‘‘(2) diagnosis by such physician of any illness 14 related to exposure to a toxic substance; and 15 ‘‘(3) any medical testing necessary to carry out 16 paragraphs (1) and (2), including a referral to a 17 specialist physician. 18 ‘‘(c) COVERED VETERANS.—For purposes of this sec- 19 tion, a covered veteran is a veteran who— 20 ‘‘(1) received hazardous duty incentive pay 21 under section 351 of title 37 for more than one day; 22 or 23 ‘‘(2) has been identified by the Secretary of De- 24 fense to have been possibly exposed, inside or out- 25 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 4393 RS side the United States, during service in the Armed 1 Forces, to— 2 ‘‘(A) an open burn pit; 3 ‘‘(B) a toxic substance; or 4 ‘‘(C) a site at which members of the 5 Armed Forces were potentially exposed to a 6 toxic substance, as indicated in a database 7 shared by the Department of Defense and the 8 Department of Veterans Affairs. 9 ‘‘(d) CONSULTATION.—A covered veteran is eligible 10 under this section for three consultations each year unless 11 a treating physician for such veteran determines that more 12 consultations are necessary under subsection (b)(1). 13 ‘‘(e) PROVISION OF SERVICES.—Covered consultation 14 and testing and treatment may be provided under this sec- 15 tion at facilities of the Department or under contract ar- 16 rangements with the Department for such services. 17 ‘‘(f) DETERMINATIONS RELATING TO TREATMENT.— 18 (1) When determining whether to approve eligibility for 19 treatment under subsection (a)(2), the Under Secretary 20 for Health shall give heavy weight to the diagnosis by the 21 treating physician under subsection (b)(2). 22 ‘‘(2) The Under Secretary shall support any denial 23 of eligibility under subsection (a)(2) with specific scientific 24 evidence. 25 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 4393 RS ‘‘(3) Determinations by the Under Secretary under 1 subsection (a)(2) shall be made not later than five busi- 2 ness days after a request for approval has been made by 3 the treating physician under subsection (b)(2). 4 ‘‘(g) INFORMATION AND TRAINING.—The Secretary 5 shall provide information and training on eligibility for 6 services under this section and the services covered under 7 this section to— 8 ‘‘(1) health care providers of the Department; 9 ‘‘(2) health care providers providing services 10 under this section under contract arrangements; and 11 ‘‘(3) covered veterans. 12 ‘‘(h) COPAYMENT.—A covered veteran is not required 13 to pay a copayment for covered consultation and testing 14 or treatment under this section. 15 ‘‘(i) DEFINITIONS.—In this section: 16 ‘‘(1) The term ‘open burn pit’ has the meaning 17 given that term in section 201(c) of the Dignified 18 Burial and Other Veterans’ Benefits Improvement 19 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 20 note). 21 ‘‘(2) The term ‘toxic substance’ means a toxi- 22 cant or a toxin. 23 ‘‘(3) The term ‘toxicant’ means any substance 24 that can injure or kill humans, animals, or plants 25 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 4393 RS and that is produced by humans or is a by-product 1 of human activities. 2 ‘‘(4) The term ‘toxin’ means any substance that 3 can injure or kill humans, animals, or plants and 4 that is produced naturally. 5 ‘‘(5) The team ‘treatment’ means any com- 6 monly accepted medical treatment practiced by the 7 medical community at large.’’. 8 (b) CLERICAL AMENDMENT.—The table of sections 9 at the beginning of subchapter II of chapter 17 of such 10 title is amended by adding at the end the following new 11 item: 12 ‘‘1720J. Consultation, testing, and treatment of veterans for exposure to toxic substances.’’. SEC. 102. PERMANENT REAUTHORIZATION OF AUTHORITY 13 OF SECRETARY OF VETERANS AFFAIRS TO 14 PRESCRIBE REGULATIONS PROVIDING THAT 15 A PRESUMPTION OF SERVICE CONNECTION 16 IS WARRANTED FOR A DISEASE ASSOCIATED 17 WITH EXPOSURE TO A HERBICIDE AGENT. 18 (a) IN GENERAL.—Section 1116 of title 38, United 19 States Code, is amended by striking subsection (e). 20 (b) EFFECTIVE DATE.—Subsection (a) of this section 21 and subsections (b) through (d) of section 1116 of such 22 title shall take effect on the date of the enactment of this 23 Act. 24 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 4393 RS SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR 1 DISEASES ASSOCIATED WITH EXPOSURE TO 2 CERTAIN TOXIC SUBSTANCES. 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. Presumptions of service connection for dis- 7 eases associated with exposure to certain 8 toxic substances 9 ‘‘(a) PRESUMPTIONS OF SERVICE CONNECTION.—(1) 10 For purposes of section 1110 of this title, and subject to 11 section 1113 of this title, each disease specified in para- 12 graph (2) becoming manifest as specified in that para- 13 graph shall be considered to have been incurred in or ag- 14 gravated by service referred to in that paragraph, notwith- 15 standing that there is no record of evidence of such disease 16 during the period of such service. 17 ‘‘(2) A disease specified in this paragraph is any dis- 18 ease that— 19 ‘‘(A) the Secretary determines in regulations 20 prescribed under this section warrants a presump- 21 tion of service connection by reason of having a posi- 22 tive association with exposure to a toxic substance; 23 and 24 ‘‘(B) becomes manifest within the period, if 25 any, prescribed in such regulations in a veteran who 26 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 4393 RS was exposed to that toxic substance during active 1 military, naval, or air service. 2 ‘‘(3)(A) For purposes of this subsection, the Sec- 3 retary may presume that a veteran who has a disease spec- 4 ified in paragraph (2) was exposed to the toxic substance 5 for which the Secretary has determined under paragraph 6 (2)(A) warrants a presumption of service connection by 7 reason of having a positive association with exposure to 8 the toxic substance, notwithstanding that there is no 9 record of evidence of such exposure, if the Secretary deter- 10 mines based on one or more of the factors set forth in 11 subparagraph (B) that a presumption of exposure is war- 12 ranted. 13 ‘‘(B) The factors set forth in this subparagraph are 14 as follows: 15 ‘‘(i) The duty location of the veteran. 16 ‘‘(ii) The length of service of the veteran. 17 ‘‘(iii) Such other factors as the Secretary con- 18 siders appropriate. 19 ‘‘(b) DETERMINATIONS RELATING TO DISEASES.— 20 (1) Whenever the Secretary determines, on the basis of 21 sound medical and scientific evidence, that a positive asso- 22 ciation exists between the exposure of humans to a toxic 23 substance and the occurrence of a disease in humans, the 24 Secretary shall prescribe regulations providing that a pre- 25 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 4393 RS sumption of service connection is warranted for that dis- 1 ease for purposes of this section. 2 ‘‘(2) In making determinations under paragraph (1), 3 the Secretary shall take into account— 4 ‘‘(A) reports received by the Secretary from the 5 National Academies of Sciences, Engineering, and 6 Medicine under section 202(g) of the Toxic Expo- 7 sure in the American Military Act of 2020; and 8 ‘‘(B) all other sound medical and scientific in- 9 formation and analyses available to the Secretary. 10 ‘‘(3)(A) In evaluating any report, information, or 11 analysis for purposes of making such determinations, the 12 Secretary shall consider only scientific studies that are 13 valid in accordance with contemporary scientific stand- 14 ards. 15 ‘‘(B) The Secretary may define the standards de- 16 scribed in subparagraph (A) for purposes of that subpara- 17 graph. 18 ‘‘(c) RESPONSE TO REPORTS BY THE NATIONAL 19 ACADEMIES OF SCIENCES, ENGINEERING, AND MEDI- 20 CINE.—(1) Not later than 60 days after the date on which 21 the Secretary receives a report from the National Acad- 22 emies of Sciences, Engineering, and Medicine under sec- 23 tion 202(g) of the Toxic Exposure in the American Mili- 24 tary Act of 2020, the Secretary shall determine whether 25 VerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 4393 RS a presumption of service connection is warranted for each 1 disease covered by the report. 2 ‘‘(2) If the Secretary determines under paragraph (1) 3 that a presumption of service connection is warranted for 4 a disease, the Secretary shall, not later than 60 days after 5 making the determination, issue proposed regulations set- 6 ting forth the determination. 7 ‘‘(3)(A) If the Secretary makes a determination de- 8 scribed in subparagraph (B), the Secretary shall, not later 9 than 60 days after making the determination, publish in 10 the Federal Register a notice of the determination. 11 ‘‘(B) A determination described in this subparagraph 12 is a determination by the Secretary under paragraph (1) 13 that— 14 ‘‘(i) a presumption of service connection is not 15 warranted for a disease; and 16 ‘‘(ii)(I) sufficient evidence of an association ex- 17 ists bet [Text truncated for display. 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