(a) Short title.—This Act may be cited as the “Comprehensive and Overdue Support for Troops of War Act of 2021” or the “COST of War Act of 2021”.

(b) Table of contents.—The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents.

(a) In general.—Section 1710(e) of title 38, United States Code, is amended—

(1) paragraph (1), by adding at the end the following new subparagraph:

“(G) Subject to paragraph (2), any veteran who participated in a toxic exposure risk activity while serving on active duty, active duty for training, or inactive duty training is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such toxic exposure risk activity.”; and

(2) in paragraph (2)(B)—

(A) by striking “or (F)” and inserting “(F), or (G)”; and

(B) by striking “service or testing” and inserting “service, testing, or activity”.

(b) Definitions.—Section 101 of such title is amended by adding at the end the following new paragraphs:

“(37) The term ‘toxic exposure’ includes the following:

“(A) A toxic exposure risk activity.

“(B) An exposure to a toxic or hazardous substance that is subject to regulation by the Occupational Safety and Health Administration.

“(38) The term ‘toxic exposure veteran’ means any veteran who—

“(A) carried out a toxic exposure risk activity; or

“(B) received or receives hospital care, medical services, or nursing home care pursuant to section 1710(e)(1) of this title.

“(39) The term ‘toxic exposure risk activity’ means any activity—

“(A) that requires a corresponding entry in the Individual Longitudinal Exposure Record of the veteran who carried out the activity; or

“(B) that the Secretary determines qualifies for purposes of section 1710(e)(1) of this title when taking into account what is reasonably prudent to protect the health of veterans.

“(40) The term ‘Individual Longitudinal Exposure Record’ includes any pilot program or other program used by the Department of Veterans Affairs or the Department of Defense to track how members of the Armed Forces or veterans have been exposed to various occupational or environmental hazards.”.

(a) In general.—Section 1710(e) of title 38, United States Code, as amended by section 101(a)(2)(A), is further amended—

(1) in paragraph (1), by adding at the end the following new subparagraph:

“(H) (i) Subject to paragraph (2), a covered veteran is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness.

“(ii) For purposes of this subparagraph, a covered veteran is a veteran who—

“(I) is eligible for inclusion in the Airborne Hazards and Open Burn Pit Registry; or

“(II) has been identified by the Secretary of Defense to have been possibly exposed, inside or outside the United States, during active duty, active duty for training, or inactive duty training, to an open burn pit.

“(iii) In this subparagraph:

“(I) The term ‘Airborne Hazards and Open Burn Pit Registry’ means the registry established by the Secretary under section 201 of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note).

“(II) The term ‘open burn pit’ has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note).”; and

(2) in paragraph (2)(B), as amended by section 101(a)(2)(A), by striking “or (G)” and inserting “(G), or (H)”.

(b) Effective date.—The amendments made by subsection (a) shall take effect on the date that is 90 days after the date of the enactment of this Act.

(a) In general.—Section 1710(e) of title 38, United States Code, as amended by section 102(a)(1), is further amended—

(1) in paragraph (1), by adding at the end the following new subparagraph:

“(I) Subject to paragraph (2), a veteran is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness if the veteran was awarded any of the following:

“(i) The Afghanistan Campaign Medal.

“(ii) The Armed Forces Expeditionary Medal.

“(iii) The Global War on Terrorism Expeditionary Medal.

“(iv) The Inherent Resolve Campaign Medal.

“(v) The Iraqi Campaign Medal.

“(vi) The Southwest Asia Service Medal.”; and

(2) in paragraph (2)(B), as amended by section 102(a)(2), by striking “or (H)” and inserting “(H), or (I)”.

(b) Effective date.—The amendments made by subsection (a) shall take effect on the date that is 90 days after the date of the enactment of this Act.

(a) In general.—The Secretary of Veterans Affairs shall conduct a study on the feasibility and advisability of furnishing hospital care and medical services to qualifying dependents of veterans described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 101(a)(1), for any illness or condition determined by the Secretary to be connected to a toxic exposure risk activity carried out by the veteran, as determined by the Secretary, notwithstanding that there is insufficient medical evidence to conclude that such illness or condition is attributable to such activity.

(b) Elements of study.—The study required under subsection (a) shall—

(1) assess the impact of furnishing hospital care and medical services to qualifying dependents as described in such subsection on the ability of the Department of Veterans Affairs to furnish hospital care and medical services to veterans;

(2) assess the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection;

(3) estimate the resources required to furnish such care and services;

(4) assess any stress or other impact furnishing such care and services would have on the claims and appeals system of the Department;

(5) estimate the number of qualifying dependents who would be eligible for such care and services; and

(6) assess the feasibility of adjudicating claims for such care and services.

(c) Phased in application.—In conducting the study under subsection (a), the Secretary shall assess the feasibility and advisability of phasing in the furnishing of hospital care and medical services to qualifying dependents described in such subsection by the decade in which such toxic exposure risk activity occurred, starting with the most recent decade.

(d) Review of exposure cases regarding liability of Department of Defense.—In conducting the study under subsection (a), the Secretary shall—

(1) review known cases of toxic exposure on installations of the Department of Defense in the United States;

(2) explore the liability of the Department of Defense in each such case; and

(3) assess whether the Department of Defense should provide care and services relating to such toxic exposures under the TRICARE program.

(e) Report.—Not later than two years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a).

(f) Definitions.—In this section:

(1) HOSPITAL CARE AND MEDICAL SERVICES.—The terms “hospital care” and “medical services” have the meanings given those terms in section 1701 of title 38, United States Code.

(2) QUALIFYING DEPENDENT.—The term “qualifying dependent” means—

(A) a dependent of a veteran described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 101(a)(2) who resided with the veteran during the period in which, and on the installation at which, the veteran participated in a toxic exposure risk activity;

(B) an individual who was in utero of such a veteran or other qualifying dependent when the veteran participated in a toxic exposure risk activity; or

(C) a dependent of such a veteran who is not described in subparagraph (A) or (B) but who may have an illness or condition that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary.

(3) TRICARE PROGRAM.—The term “TRICARE program” has the meaning given that term in section 1072(7) of title 10, United States Code.

(a) Advisory committees, panels, and boards.—

(1) ESTABLISHMENT.—Chapter 11 of title 38, United States Code, is amended by adding at the end the following new subchapter:

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter is amended by adding at the end the following new items:

(b) Establishment of working group.—Not later than 120 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish the working group required by section 1174(a) of title 38, United States Code, as added by subsection (a).

(c) Conforming amendments.—Chapter 11 of title 38, United States Code, is amended—

(1) in section 1116—

(A) by striking subsections (b), (c), (d), and (e);

(B) by inserting after subsection (a) the following new subsection (b):

“(b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Comprehensive and Overdue Support for Troops of War Act of 2021 regarding a presumption of service connection based on exposure to an herbicide agent under this section is made pursuant to subchapter VII of this chapter, including with respect to assessing reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991 (Public Law 102–4).”; and

(C) by redesignating subsection (f) as subsection (c).

(2) in section 1116B(b)(2)(A), by inserting “pursuant to subchapter VII of this chapter,” before “the Secretary determines”; and

(3) in section 1118—

(A) by striking subsections (b) through (e); and

(B) by inserting after subsection (a) the following new subsection (b):

“(b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Comprehensive and Overdue Support for Troops of War Act of 2021 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter.”.

(a) In general.—Subchapter VI of chapter 11 of title 38, United States Code, is amended—

(1) by redesignating section 1165 as section 1166; and

(2) by redesignating the section 1164 that was added by section 5501(a)(1) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (Public Law 116–315) as section 1165.

(b) Conforming clerical amendments.—The table of sections at the beginning of such chapter is amended by striking the items relating to the section 1164 that was added by section 5501(a)(1) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (Public Law 116–315) and section 1165 and inserting the following new items:

“1165. Specialized teams to evaluate claims involving military sexual trauma.
“1166. Choice of sex of medical examiner for certain disabilities.”.

(a) In general.—Subchapter II of chapter 11 of title 38, United States Code, is amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 11 of such title is amended by inserting after the item relating to section 1118 the following new item:

“1119. Presumptions of toxic exposure.”.

(c) Conforming amendment.—Section 1113 of such title is amended by striking “or 1118” each place it appears and inserting “1118, or 1119”.

(a) In general.—Subchapter II of chapter 11 of title 38, United States Code, as amended by section 301(a), is further amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 11 of such title, as amended by section 301(b), is further amended by inserting after the item relating to section 1119 the following new item:

“1120. Presumption of exposure to certain airborne hazards and substances from participation in contingency operations.”.

(c) Conforming amendment.—Section 1113 of such title, as amended by section 301, is amended by striking “or 1119” each place it appears and inserting “1119, or 1120”.

(a) In general.—Subchapter VI of chapter 11 of title 38, United States Code, as amended by title II of this Act, is further amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 11 of such title, as amended by title II of this Act, is further amended by inserting after the item relating to section 1167, as added by such title, the following new item:

“1168. Medical nexus examinations for toxic exposures.”.

Section 1112(c)(3)(B) of title 38, United States Code, is amended by adding at the end the following new clause:

“(v) Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980.”.

Section 1112(c)(3)(B) of title 38, United States Code, as amended by section 401, is further amended by adding at the end the following new clause:

“(vi) Onsite participation in the response effort following the collision of a United States Air Force B–52 bomber and refueling plane that caused the release of four thermonuclear weapons in the vicinity of Palomares, Spain, during the period beginning January 17, 1966, and ending March 31, 1967.”.

(a) In general.—Section 1116 of title 38, United States Code, as amended by section 201, is further amended—

(1) by striking “, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975” each place it appears and inserting “performed covered service”;

(2) by striking “performed active military, naval, or air service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975” each place it appears and inserting “performed covered service”; and

(3) by adding at the end the following new subsection:

“(d) In this section, the term ‘covered service’ means active military, naval, or air service—

“(1) performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975;

“(2) performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed;

“(3) performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969;

“(4) performed in Cambodia at Mimot or Krek, Kompon Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or

“(5) performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977.”.

(b) Eligibility for hospital care and medical services.—Section 1710(e)(4) is amended by amending subparagraph (A) to read as follows:

“(A) The term ‘Vietnam-era herbicide-exposed veteran’ means a veteran who—

“(i) performed covered service, as defined in section 1116(c) of this title; or

“(ii) the Secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period.”.

(c) Clerical amendments.—

(1) SECTION HEADING.—The heading for section 1116 is amended by striking and “the Republic of Vietnam” and inserting “certain locations”.

(2) TABLE OF SECTIONS.—The table of sections at the beginning of chapter 11 of such title is amended by striking the item relating to section 1116 and inserting the following new item:

“1116. Presumptions of service connection for diseases associated with exposure to certain herbicide agents; presumption of exposure for veterans who served in certain locations.”.

Section 1116(a)(2) of title 38, United States Code, as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 (Public Law 116–283), is further amended by adding at the end the following new subparagraphs:

“(L) Hypertension.

“(M) Monoclonal gammopathy of undetermined significance.”.

(a) Reduction in threshold of eligibility.—Subsection (a)(1) of section 1117 of title 38, United States Code, is amended by striking “became manifest—” and all that follows through the period at the end and inserting “became manifest to a degree of 10 percent or more at any time.”.

(b) Permanent extension of period of eligibility.—

(1) IN GENERAL.—Such section is amended by striking subsection (b).

(2) CONFORMING AMENDMENTS.—Such section, as amended by paragraph (1), is further amended—

(A) by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and

(B) in subsection (a)(2)(C), by striking “under subsection (d)” and inserting “under subsection (c)”.

(c) Establishing singular disability based questionnaire.—Such section, as amended by subsection (b), is further amended by inserting after subsection (c) the following new subsection (d):

“(d) The Secretary shall develop a Disability Benefits Questionnaire (DBQ), or successor questionnaire, such that if a Persian Gulf veteran presents with any one symptom associated with Gulf War Illness, use of such questionnaire is mandatory for health care personnel of the Department for the identification of Gulf War Illness.”.

(d) Training.—Such section is amended by adding at the end the following new subsection:

“(i) (1) The Secretary shall take such actions as may be necessary to ensure that health care personnel of the Department are appropriately trained to effectively carry out this section.

“(2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1).”.

(a) In general.—Subchapter II of chapter 11 of title 38, United States Code, as amended by section 302(a), is further amended by inserting after section 1120 the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 11 of title 38, United States Code, as amended by section 302(b), is further amended by inserting after the item relating to section 1120 the following new item:

“1120A. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins.”.

(c) Conforming amendment.—Section 1113 of such title, as amended by section 302, is further amended by striking “or 1120” each place it appears and inserting “1120, or 1120A”.

(a) In general.—Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of such subchapter is amended by inserting after the item relating to section 7330C the following new item:

“7330D. Coordination of toxic exposure research.”.

(a) In general.—The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that—

(1) is obtained by the Department of Veterans Affairs in connection with hospital care, medical services, and nursing home care furnished under section 1710(a)(2)(F) of title 38, United States Code; and

(2) is likely to be scientifically useful in determining the association, if any, between the medical condition of a veteran and a toxic exposure.

(b) Consent of patients.—Compilation and analysis by the Secretary of clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, consistent with the informed consent of the veteran and in compliance with all applicable Federal law.

(c) Annual report.—Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing—

(1) the data compiled under subsection (a);

(2) an analysis of such data;

(3) a description of the types and incidences of medical conditions identified by the Department under such subsection;

(4) the explanation of the Secretary for the incidence of such medical conditions and other explanations for the incidence of such conditions as the Secretary considers reasonable; and

(5) the views of the Secretary on the scientific validity of drawing conclusions from the incidence of such medical conditions, as evidenced by the data compiled under subsection (a), regarding any association between such conditions and a toxic exposure.

(d) Toxic exposure defined.—In this section, the term “toxic exposure” has the meaning given that term in section 101(37) of title 38, United States Code.

(a) Analysis.—

(1) IN GENERAL.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, in coordination with the Secretary of Defense, shall conduct an updated analysis of total and respiratory disease mortality in covered veterans.

(2) ELEMENTS.—The analysis required by paragraph (1) shall include, to the extent practicable, the following:

(A) Metrics of airborne exposures.

(B) The location and timing of deployments.

(C) The military occupational specialty.

(D) The Armed Force in which the veteran served.

(E) Pre-existing health status, including with respect to asthma.

(F) Relevant personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity.

(b) Epidemiological study.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct an epidemiological study of covered veterans that uses the following:

(1) Improved spatio-temporal estimates of ambient air pollution exposures using advances in retrospective exposure assessment.

(2) Detailed information on the study subjects obtained through medical records, administrative data, and other existing sources, that include—

(A) personal characteristics, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity;

(B) deployment history, including locations, periods, and number of deployments;

(C) biospecimen data; and

(D) supplementary health status and outcomes data, including imaging and physiological parameters.

(c) Toxicology study.—

(1) IN GENERAL.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall conduct a toxicology study to include variability to replicate exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions.

(2) ELEMENTS.—The study required under paragraph (1) shall—

(A) analyze the study results for mechanistic markers and clinically relevant outcomes; and

(B) validate serum, tissue, and other biomarkers of exposure, susceptibility, or effect.

(d) Covered veteran defined.—In this section, the term “covered veteran” means any veteran who—

(1) on or after August 2, 1990, served on active duty in—

(A) Bahrain;

(B) Iraq;

(C) Kuwait;

(D) Oman;

(E) Qatar;

(F) Saudi Arabia;

(G) Somalia; or

(H) the United Arab Emirates; or

(2) on or after September 11, 2001, served on active duty in—

(A) Afghanistan;

(B) Djibouti;

(C) Egypt;

(D) Jordan;

(E) Lebanon;

(F) Syria; or

(G) Yemen.

The Secretary of Veterans Affairs shall conduct an epidemiological study on the health trends of veterans who served in the Armed Forces after September 11, 2001.

(a) In general.—The Secretary of Veterans Affairs shall conduct a study on the incidence of cancer in veterans to determine trends in the rates of the incidence of cancer in veterans.

(b) Elements.—The study required by subsection (a) shall assess, with respect to each veteran included in the study, the following:

(1) The age of the veteran.

(2) The period of service and length of service of the veteran in the Armed Forces.

(3) The military occupational speciality or specialties of the veteran.

(4) The gender of the veteran.

(5) The type or types of cancer that the veteran has.

In this title, the terms “active military, naval, or air service”, “toxic exposure”, and “toxic exposure veteran” have the meanings given those terms in section 101 of title 38, United States Code.

(a) Publication of list of resources.—

(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for—

(A) toxic exposure veterans;

(B) families and caregivers of toxic exposure veterans; and

(C) survivors of toxic exposure veterans (or who would be toxic exposure veterans were the veterans alive) who are receiving death benefits under the laws administered by the Secretary.

(2) UPDATE.—The Secretary shall periodically update the list published under paragraph (1).

(b) Outreach.—The Secretary shall develop, with input from the community, an informative outreach program for veterans on illnesses that may be related to toxic exposure, including outreach with respect to benefits and support programs.

(a) In general.—The Secretary of Veterans Affairs shall incorporate a clinical questionnaire to help determine potential toxic exposures during active military, naval, or air service as part of the initial screening conducted for an appointment of a veteran with a primary care provider of the Department of Veterans Affairs to improve understanding by the Department of toxic exposures of veterans while serving in the Armed Forces.

(b) Determination of questions.—The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals.

(a) Health care personnel.—The Secretary of Veterans Affairs shall provide to health care personnel of the Department of Veterans Affairs education and training to identify, treat, and assess the impact on toxic exposure veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures.

(b) Benefits personnel.—

(1) IN GENERAL.—The Secretary shall establish a training program for processors of claims under the laws administered by the Secretary who review claims for disability benefits relating to service-connected disabilities based on toxic exposure.

(2) ANNUAL TRAINING.—Training provided to processors under paragraph (1) shall be provided not less frequently than annually.

(a) Short title.—This section may be cited as the “SFC Heath Robinson Burn Pit Transparency Act”.

(b) Quarterly notifications.—

(1) IN GENERAL.—On a quarterly basis, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report on each reported case of burn pit exposure by a covered veteran reported during the previous quarter.

(2) ELEMENTS.—Each report submitted under paragraph (1) shall include, with respect to each reported case of burn pit exposure of a covered veteran included in the report, the following:

(A) Notice of the case, including the medical facility at which the case was reported.

(B) Notice of, as available—

(i) the enrollment status of the covered veteran with respect to the patient enrollment system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code;

(ii) a summary of all health care visits by the covered veteran at the medical facility at which the case was reported that are related to the case;

(iii) the demographics of the covered veteran, including age, sex, and race;

(iv) any non-Department of Veterans Affairs health care benefits that the covered veteran receives;

(v) the Armed Force in which the covered veteran served and the rank of the covered veteran;

(vi) the period in which the covered veteran served;

(vii) each location that the covered veteran reported as being a location at which the veteran was exposed to toxic airborne chemicals and fumes from an open burn pit;

(viii) the medical diagnoses of the covered veteran and the treatment provided to the veteran; and

(ix) whether the covered veteran is registered in the Airborne Hazards and Open Burn Pit Registry.

(3) PROTECTION OF INFORMATION.—The Secretary shall ensure that the reports submitted under paragraph (1) do not include the identity of covered veterans or contain other personally identifiable data.

(c) Annual report on cases.—

(1) IN GENERAL.—Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, in collaboration with the Secretary of Defense, shall submit to the appropriate congressional committees a report detailing the following:

(A) The total number of covered veterans.

(B) The total number of claims for disability compensation under chapter 11 of title 38, United States Code, approved and the total number denied by the Secretary of Veterans Affairs with respect to a covered veteran, and for each such denial, the rationale of the denial.

(C) A comprehensive list of—

(i) the conditions for which covered veterans seek treatment; and

(ii) the locations that the covered veterans reported as being locations at which the veterans were exposed to toxic airborne chemicals and fumes from open burn pits.

(D) Identification of any illnesses relating to exposure to open burn pits that formed the basis for the Secretary to award benefits, including entitlement to service connection or an increase in disability rating.

(E) The total number of covered veterans who died after seeking care for an illness relating to exposure to an open burn pit.

(F) Any updates or trends with respect to the information described in subparagraphs (A), (B), (C), (D), and (E) that the Secretary determines appropriate.

(2) MATTERS INCLUDED IN FIRST REPORT.—The Secretary shall include in the first report under paragraph (1) information specified in subsection (b)(2) with respect to reported cases of burn pit exposure made during the period beginning January 1, 1990, and ending on the day before the date of the enactment of this Act.

(d) Comptroller General report.—Not later than 180 days after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the appropriate congressional committees a report containing an assessment of the effectiveness of any memorandum of understanding or memorandum of agreement entered into by the Secretary of Veterans Affairs with respect to—

(1) the processing of reported cases of burn pit exposure; and

(2) the coordination of care and provision of health care relating to such cases at medical facilities of the Department of Veterans Affairs and at non-Department facilities.

(e) Definitions.—In this section:

(1) The term “Airborne Hazards and Open Burn Pit Registry” means the registry established by the Secretary of Veterans Affairs under section 201 of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note).

(2) The term “appropriate congressional committees” means—

(A) the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and

(B) The Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives.

(3) The term “covered veteran” means a veteran who presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces.

(4) The term “open burn pit” has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note).

(5) The term “reported case of burn pit exposure” means each instance in which a veteran presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces.

In this title:

(1) INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.—The term “Individual Longitudinal Exposure Record” has the meaning given that term in section 101(40) of title 38, United States Code, as added by section 101(b).

(2) TOXIC EXPOSURE.—The term “toxic exposure” has the meaning given that term in section 101(37) of such title, as so added.

(a) In general.—Not later than 60 days after the date of the enactment of this Act, the Secretary of Defense shall enter into a contract with an independent research entity described in subsection (b) to carry out a comprehensive study of the development of the Individual Longitudinal Exposure Record to evaluate—

(1) the quality of the location data, occupational and environmental exposure data, and health surveillance data; and

(2) whether a member of the Armed Forces can be reasonably assured that any toxic exposure experienced by the member during service in the Armed Forces will be accurately reflected in the Individual Longitudinal Exposure Record of the member.

(b) Independent research entity described.—An independent research entity described in this subsection is a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a).

(a) In general.—Not later than one year after the date on which the Individual Longitudinal Exposure Record achieves full operation capability, as determined by the Secretary of Defense, and every 180 days thereafter, the Secretary of Defense shall, in consultation with the Secretary of Veterans Affairs, submit to the appropriate committees of Congress a report on the data quality of the databases of the Department of Defense that provide the information presented in the Individual Longitudinal Exposure Record and the usefulness of the Individual Longitudinal Exposure Record in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs.

(b) Elements.—Each report required by subsection (a) shall include, for the period covered by the report, the following:

(1) An identification of toxic exposures that may not be fully captured by the current systems of the Department of Defense for environmental and occupational health monitoring, and recommendations for how to improve those systems.

(2) An analysis of the quality of the location data used by the Department of Defense in determining toxic exposures of members of the Armed Forces and veterans, and recommendations for how to improve the quality of that location data.

(c) Appropriate committees of Congress defined.—In this section, the term “appropriate committees of Congress” means—

(1) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and

(2) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives.

(a) In general.—The Secretary of Defense and the Secretary of Veterans Affairs shall provide a means for members of the Armed Forces and veterans to update their records as necessary to reflect a toxic exposure by such member or veteran in the Individual Longitudinal Exposure Record.

(b) Evidence.—

(1) IN GENERAL.—To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, must provide such evidence as the Secretary of Defense and the Secretary of Veterans Affairs jointly consider sufficient.

(2) REGULATIONS.—The Secretary of Veterans Affairs shall prescribe by regulation the evidence considered sufficient under paragraph (1).