Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020

II 116TH CONGRESS 2D SESSION S. 4572 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 SEPTEMBER 15, 2020 Mrs. GILLIBRAND 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 2020’’. 6 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4572 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 listed under paragraph 21 (4)(B). 22 ‘‘(B) Cancer of any type. 23 ‘‘(C) Chronic bronchitis. 24 ‘‘(D) Chronic obstructive pulmonary disease. 25 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4572 IS ‘‘(E) Constrictive bronchiolitis or obliterative 1 bronchiolitis. 2 ‘‘(F) Emphysema. 3 ‘‘(G) Granulomatous disease. 4 ‘‘(H) Interstitial lung disease. 5 ‘‘(I) Lymphoma. 6 ‘‘(J) Pleuritis. 7 ‘‘(K) Pulmonary fibrosis. 8 ‘‘(L) Sarcoidosis. 9 ‘‘(M) Any other disease with respect to which 10 final regulations have been prescribed under sub- 11 section (c)(3). 12 ‘‘(3) A veteran described in this paragraph is any vet- 13 eran who— 14 ‘‘(A) on or after August 2, 1990— 15 ‘‘(i) served as a member of the Armed 16 Forces in support of a military operation de- 17 scribed in paragraph (4); and 18 ‘‘(ii) was present for 15 or more cumu- 19 lative days in a country or territory listed under 20 subparagraph (B) of that paragraph; or 21 ‘‘(B) was awarded any of the following: 22 ‘‘(i) The Southwest Asia Service Medal. 23 ‘‘(ii) The Global War on Terrorism Expe- 24 ditionary Medal. 25 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4572 IS ‘‘(iii) A campaign medal in recognition of 1 service in any of the following: 2 ‘‘(I) Operation Enduring Freedom. 3 ‘‘(II) Operation Iraqi Freedom. 4 ‘‘(III) Operation Nomad Shadow. 5 ‘‘(IV) Operation New Dawn. 6 ‘‘(V) Operation Inherent Resolve. 7 ‘‘(VI) Operation Freedom’s Sentinel. 8 ‘‘(VII) Operation Odyssey Lightning. 9 ‘‘(VIII) Operation Pacific Eagle. 10 ‘‘(4) A military operation described in this paragraph 11 is— 12 ‘‘(A) any contingency operation (as defined in 13 section 101(a)(13) of title 10); or 14 ‘‘(B) any military operation in any of the fol- 15 lowing countries or territories: 16 ‘‘(i) Afghanistan. 17 ‘‘(ii) Bahrain 18 ‘‘(iii) Burkina Faso. 19 ‘‘(iv) Cameroon. 20 ‘‘(v) Chad. 21 ‘‘(vi) Diego Garcia. 22 ‘‘(vii) Djibouti. 23 ‘‘(viii) Egypt. 24 ‘‘(ix) Ethiopia. 25 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4572 IS ‘‘(x) Gabon. 1 ‘‘(xi) Ghana. 2 ‘‘(xii) Iraq. 3 ‘‘(xiii) Jordan. 4 ‘‘(xiv) Kenya. 5 ‘‘(xv) Kuwait. 6 ‘‘(xvi) Kyrgyzstan. 7 ‘‘(xvii) Libya. 8 ‘‘(xviii) Mali. 9 ‘‘(xix) Niger. 10 ‘‘(xx) Nigeria. 11 ‘‘(xxi) Oman 12 ‘‘(xxii) Pakistan. 13 ‘‘(xxiii) Philippines. 14 ‘‘(xxiv) Saudi Arabia. 15 ‘‘(xxv) Somalia. 16 ‘‘(xxvi) South Sudan. 17 ‘‘(xxvii) Sudan. 18 ‘‘(xxviii) Syria. 19 ‘‘(xxix) Tajikistan. 20 ‘‘(xxx) Tunisia. 21 ‘‘(xxxi) Turkey. 22 ‘‘(xxxii) United Arab Emirates. 23 ‘‘(xxxiii) Uzbekistan. 24 ‘‘(xxxiv) Yemen. 25 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4572 IS ‘‘(b) PROCESS TO ADD DISEASES THROUGH WRIT- 1 TEN PETITION.—(1) In the case that the Secretary re- 2 ceives a written petition from an interested party to add 3 a disease to the list of diseases specified in subsection 4 (a)(2), not later than 90 days after the date of receipt 5 of such petition, the Secretary shall request a determina- 6 tion by the National Academies of Sciences, Engineering, 7 and Medicine (referred to in this section as the ‘National 8 Academies’) with respect to whether there is a positive as- 9 sociation between— 10 ‘‘(A) the exposure of humans to one or more 11 covered toxins; and 12 ‘‘(B) the occurrence of the disease in humans. 13 ‘‘(2) For purposes of this subsection, the term ‘inter- 14 ested party’ includes a representative of— 15 ‘‘(A) a congressionally chartered veterans serv- 16 ice organization; 17 ‘‘(B) an organization that— 18 ‘‘(i) is described in section 501(c)(3) of the 19 Internal Revenue Code of 1986 and exempt 20 from taxation under section 501(a) of such 21 Code; 22 ‘‘(ii) serves veterans or members of the 23 Armed Forces; and 24 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4572 IS ‘‘(iii) has continuously operated for a pe- 1 riod of five years or more preceding the date of 2 the submittal of the written petition under 3 paragraph (1); 4 ‘‘(C) a collective bargaining agent for civilian 5 employees of the United States Government; 6 ‘‘(D) a nationally recognized medical associa- 7 tion; 8 ‘‘(E) the National Academies; or 9 ‘‘(F) a State or political subdivision of a State. 10 ‘‘(c) DETERMINATIONS BY NATIONAL ACADEMIES.— 11 (1) If the Secretary receives a determination described in 12 paragraph (2), not later than 180 days after receipt of 13 such determination, the Secretary shall— 14 ‘‘(A) publish in the Federal Register proposed 15 regulations to add the disease covered by the deter- 16 mination to the list of diseases specified in sub- 17 section (a)(2); 18 ‘‘(B) publish in the Federal Register, and sub- 19 mit to the Committee on Veterans’ Affairs of the 20 Senate and the Committee on Veterans’ Affairs of 21 the House of Representatives— 22 ‘‘(i) the decision of the Secretary not to 23 publish such proposed regulations; and 24 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4572 IS ‘‘(ii) the basis for such decision, including 1 specific medical science refuting the determina- 2 tion; or 3 ‘‘(C) publish in the Federal Register a decision 4 that insufficient evidence exists to take action under 5 subparagraph (A) or (B). 6 ‘‘(2) A determination described in this paragraph— 7 ‘‘(A) is a determination by the National Acad- 8 emies that there is a positive association between— 9 ‘‘(i) the exposure of humans to one or 10 more covered toxins; and 11 ‘‘(ii) the occurrence of the disease in hu- 12 mans; and 13 ‘‘(B) may be made pursuant to— 14 ‘‘(i) a request from the Secretary under 15 subsection (b); or 16 ‘‘(ii) an agreement between the Secretary 17 and the National Academies under section 3 of 18 the Presumptive Benefits for War Fighters Ex- 19 posed to Burn Pits and Other Toxins Act of 20 2020. 21 ‘‘(3)(A) Not later than 180 days after the date on 22 which the Secretary publishes any proposed regulations 23 under paragraph (1)(A) for a disease, the Secretary shall 24 prescribe final regulations for that disease. 25 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4572 IS ‘‘(B) Such regulations shall be effective on the date 1 of issuance. 2 ‘‘(d) REFERENCE TO NATIONAL ACADEMIES.—In the 3 case that the Secretary enters into an agreement with an- 4 other organization as described in section 3(h)(1) of the 5 Presumptive Benefits for War Fighters Exposed to Burn 6 Pits and Other Toxins Act of 2020, any reference in this 7 section to the National Academies shall be treated as a 8 reference to the other organization. 9 ‘‘(e) DEFINITIONS.—In this section: 10 ‘‘(1) The term ‘covered toxin’ includes the fol- 11 lowing: 12 ‘‘(A) Any toxic chemical or toxic fume. 13 ‘‘(B) Hazardous waste, mixed waste, solid 14 waste, or used oil (as those terms are defined 15 in section 1004 of the Solid Waste Disposal Act 16 (42 U.S.C. 6903)). 17 ‘‘(C) Radiological waste. 18 ‘‘(D) Any other carcinogen. 19 ‘‘(2) The term ‘veterans service organization’ 20 means an organization recognized by the Secretary 21 for the representation of veterans under section 22 5902 of this title.’’. 23 (b) EFFECTIVE DATE.— 24 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4572 IS (1) IN GENERAL.—The amendment made by 1 subsection (a) shall take effect on the date that is 2 180 days after the date of the enactment of this Act. 3 (2) WRITTEN PETITIONS.—With respect to a 4 written petition described in section 1119(b)(1) of 5 title 38, United States Code, as added by subsection 6 (a), that was received by the Secretary of Veterans 7 Affairs before the effective date described in para- 8 graph (1), the Secretary shall make a request of the 9 National Academies of Sciences, Engineering, and 10 Medicine under such section, as so added, not later 11 than 90 days after such effective date. 12 (c) CLERICAL AMENDMENT.—The table of sections 13 at the beginning of chapter 11 of title 38, United States 14 Code, is amended by inserting after the item relating to 15 section 1118 the following new item: 16 ‘‘1119. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins.’’. (d) CONFORMING AMENDMENT.—Section 1113 of 17 such title is amended by striking ‘‘or 1118’’ each place 18 it appears and inserting ‘‘1118, or 1119’’. 19 SEC. 3. AGREEMENT WITH THE NATIONAL ACADEMIES OF 20 SCIENCES, ENGINEERING, AND MEDICINE 21 CONCERNING THE EXPOSURE OF HUMANS TO 22 BURN PITS AND OTHER TOXINS. 23 (a) AGREEMENT.— 24 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 11 •S 4572 IS (1) IN GENERAL.—The Secretary of Veterans 1 Affairs shall seek to enter into an agreement with 2 the National Academies of Sciences, Engineering, 3 and Medicine (referred to in this section as the ‘‘Na- 4 tional Academies’’) to perform the services covered 5 by this section. 6 (2) TIMING.—The Secretary shall seek to enter 7 into the agreement described in paragraph (1) not 8 later than 60 days after the date of the enactment 9 of this Act. 10 (b) REVIEWS OF SCIENTIFIC EVIDENCE.— 11 (1) IN GENERAL.—Under an agreement be- 12 tween the Secretary and the National Academies, 13 the National Academies shall review and summarize 14 the scientific evidence, and assess the strength there- 15 of, concerning the association between the exposure 16 of humans to covered toxins and each disease sus- 17 pected to be associated with such exposure. 18 (2) REVIEWS UPON REQUEST.—Under an 19 agreement between the Secretary and the National 20 Academies under this section, the National Acad- 21 emies shall conduct a review described in paragraph 22 (1) in response to each request made by the Sec- 23 retary under section 1119(b)(1) of title 38, United 24 States Code, as added by section 2(a). 25 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 12 •S 4572 IS (c) SCIENTIFIC DETERMINATIONS CONCERNING DIS- 1 EASES.— 2 (1) IN GENERAL.—For each disease reviewed 3 under subsection (b), the National Academies shall 4 determine (to the extent that available scientific data 5 permit meaningful determinations) whether there is 6 a positive association between the exposure of hu- 7 mans to one or more covered toxins and the occur- 8 rence of the disease in humans, taking into account 9 the strength of the scientific evidence and the appro- 10 priateness of the statistical and epidemiological 11 methods used to detect the association. 12 (2) SUBMISSIONS FOR REVIEWS UPON RE- 13 QUEST.—Under an agreement between the Secretary 14 and the National Academies under this section, not 15 later than 270 days after the date on which the Sec- 16 retary transmits a request to the National Acad- 17 emies with respect to a disease under section 18 1119(b)(1) of title 38, United States Code, as added 19 by section 2(a), the National Academies shall submit 20 to the Secretary the determination made with re- 21 spect to that disease under paragraph (1). 22 (d) RECOMMENDATIONS FOR ADDITIONAL SCI- 23 ENTIFIC STUDIES.— 24 VerDate Sep 11 2014 07:04 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S4572.IS S4572 kjohnson on DSK79L0C42PROD with BILLS 13 •S 4572 IS (1) IN GENERAL.—Under an agreement be- 1 tween the Secretary and the National Academies 2 under this section, the National Academies shall 3 make any recommendations it has for additional sci- 4 entific studies to resolve areas of continuing sci- 5 entific uncertainty relating to the exposure of hu- 6 mans to covered toxins. 7 (2) CONSIDERATIONS.—In making recommen- 8 dations for additional scientific studies, the National 9 Academies shall consider— 10 (A) the scientific information that is avail- 11 able at the time of the recommendation; 12 (B) the value and relevance of the informa- 13 tion that could result from additional studies; 14 and 15 (C) the feasibility of carrying out such ad- 16 ditional s [Text truncated for display. Full text available on Congress.gov.]