TEAM Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8506 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 HOUSE OF REPRESENTATIVES OCTOBER 2, 2020 Mr. BILIRAKIS (for himself, Mr. DAVID P. ROE of Tennessee, Mr. WENSTRUP, Mr. BOST, and Mr. MAST) introduced the following bill; which was re- ferred 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 of 2020’’ 5 or the ‘‘TEAM Act of 2020’’. 6 (b) TABLE OF CONTENTS.—The table of contents for 7 this Act is as follows: 8 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 8506 IH 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. Sense of Congress on portal for access by veterans to Individual Lon- gitudinal Exposure Record. Sec. 304. Training of health care personnel of Department of Veterans Affairs on illnesses related to exposure to toxic substances. 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 101 5 of title 38, United States Code. 6 (2) OPEN BURN PIT.—The term ‘‘open burn 7 pit’’ has the meaning given that term in section 8 201(c) of the Dignified Burial and Other Veterans’ 9 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 8506 IH Benefits Improvement Act of 2012 (Public Law 1 112–260; 38 U.S.C. 527 note). 2 (3) TOXIC SUBSTANCE.—The term ‘‘toxic sub- 3 stance’’ has the meaning given that term in subpara- 4 graph (G)(iv) of section 1710(e)(1) of such title, as 5 added by section 101(a). 6 TITLE I—EXPANSION OF HEALTH 7 CARE AND BENEFITS FOR 8 VETERANS EXPOSED TO 9 TOXIC SUBSTANCES 10 SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 11 CERTAIN INDIVIDUALS EXPOSED TO OPEN 12 BURN PITS AND OTHER TOXIC SUBSTANCES. 13 (a) IN GENERAL.—Section 1710(e) of title 38, 14 United States Code, is amended— 15 (1) in paragraph (1), by adding at the end the 16 following new subparagraph: 17 ‘‘(G)(i) Subject to paragraph (2), a covered individual 18 is eligible for hospital care, medical services, and nursing 19 home care under subsection (a)(2)(F) for any illness. 20 ‘‘(ii) For purposes of this subparagraph, a covered 21 individual is an individual who— 22 ‘‘(I) is eligible for inclusion in the Airborne 23 Hazards and Open Burn Pit Registry; or 24 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 8506 IH ‘‘(II) has been identified by the Secretary of 1 Defense to have been possibly exposed, inside or out- 2 side the United States, during active duty, active 3 duty for training, or inactive duty training, to— 4 ‘‘(aa) an open burn pit; 5 ‘‘(bb) a toxic substance; or 6 ‘‘(cc) a site included in a database main- 7 tained by the Department of Defense and 8 shared with the Department of Veterans affairs 9 to serve as the central portal for exposure-re- 10 lated data that compiles, collates, presents, and 11 provides available occupational and environ- 12 mental exposure information to support the 13 needs of the Department of Defense and the 14 Department of Veterans Affairs. 15 ‘‘(iii) A covered individual shall be enrolled in the sys- 16 tem of annual patient enrollment of the Department in 17 the priority group under subsection (a)(6) of section 1705 18 of this title. 19 ‘‘(iv) In this subparagraph: 20 ‘‘(I) The term ‘Airborne Hazards and Open 21 Burn Pit Registry’ means the registry established by 22 the Secretary under section 201 of the Dignified 23 Burial and Other Veterans’ Benefits Improvement 24 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 8506 IH Act of 2012 (Public Law 112–260; 38 U.S.C. 527 1 note). 2 ‘‘(II) The term ‘open burn pit’ has the meaning 3 given that term in section 201(c) of the Dignified 4 Burial and Other Veterans’ Benefits Improvement 5 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 6 note). 7 ‘‘(III) The term ‘toxic substance’ means a toxi- 8 cant or a toxin. 9 ‘‘(IV) The term ‘toxicant’ means any substance 10 that can injure or kill humans, animals, or plants 11 and that is produced by humans or is a by-product 12 of human activities. 13 ‘‘(V) The term ‘toxin’ means any substance 14 that can injure or kill humans, animals, or plants 15 and that is produced naturally.’’; and 16 (2) in paragraph (2)(B), by striking ‘‘or (F)’’ 17 and inserting ‘‘(F), or (G)’’. 18 (b) EFFECTIVE DATE.—The amendments made by 19 subsection (a) shall take effect on the date that is 90 days 20 after the date of the enactment of this Act. 21 (c) DETERMINATIONS OF EXPOSURE.— 22 (1) IN GENERAL.—The Secretary of Veterans 23 Affairs shall, to the extent practicable, establish and 24 maintain a mechanism by which veterans may deter- 25 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 8506 IH mine whether or not they have been possibly exposed 1 to an open burn pit or toxic substance described in 2 subparagraph (G)(ii)(II) of section 1710(e)(1) of 3 title 38, United States Code, as added by subsection 4 (a), for purposes of being considered as covered vet- 5 erans under such subparagraph. 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 (d) 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), the Secretary, in 18 consultation with the Secretary of Veterans Affairs, 19 shall submit to the appropriate committees of Con- 20 gress 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 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 8506 IH 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). 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), is fur- 23 ther amended— 24 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 8506 IH (1) in paragraph (1), by adding at the end the 1 following new subparagraph: 2 ‘‘(H)(i) 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. 13 ‘‘(ii) A veteran described in clause (i) shall be enrolled 14 in the system of annual patient enrollment of the Depart- 15 ment in the priority group under subsection (a)(6) of sec- 16 tion 1705 of this title.’’; and 17 (2) in paragraph (2), by striking ‘‘or (G)’’ and 18 inserting ‘‘(G), or (H)’’. 19 (b) EFFECTIVE DATE.—The amendments made by 20 subsection (a) shall take effect on the date that is 90 days 21 after the date of the enactment of this Act. 22 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 8506 IH 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 suffi- 22 cient evidence of positive association with exposure 23 to a toxic substance; and 24 ‘‘(B) becomes manifest within the period, if 25 any, prescribed in such regulations in a veteran who 26 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 8506 IH 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 sufficient evidence of positive association 8 with exposure to the toxic substance, notwithstanding that 9 there is no record of evidence of such exposure, if the Sec- 10 retary determines based on one or more of the factors set 11 forth in subparagraph (B) that a presumption of exposure 12 is warranted. 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 sufficient evi- 22 dence of positive association exists between the exposure 23 of humans to a toxic substance and the occurrence of a 24 disease in humans, the Secretary shall prescribe regula- 25 VerDate Sep 11 2014 22:08 Nov 02, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8506.IH H8506 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 8506 IH tions providing that a presumption of service connection 1 is warranted for that disease 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 wh [Text truncated for display. 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