(a) Short title.—This Act may be cited as the “Honoring our Promise to Address Comprehensive Toxics Act of 2021” or the “Honoring our PACT Act of 2021”.

(b) References to title 38, United States Code.—Except as otherwise expressly provided, whenever in this title an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.

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

Sec. 1. Short title; references to title 38, United States Code; table of contents.

This title may be cited as the “Conceding Our Veterans’ Exposures Now And Necessitating Training Act” or the “COVENANT Act”.

(a) In general.—Section 1710(a)(2)(F) is amended by striking “who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e)” and inserting “in accordance with subsection (e), who is a toxic exposed veteran”.

(b) Definitions of toxic exposure and toxic exposed veteran.—Section 101 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, as defined in section 1710(e)(4) of this title.

“(B) An exposure to a substance, chemical, or airborne hazard specified in section 1119(b)(2).

“(38) The term ‘toxic exposed veteran’ means a veteran described in section 1710(e)(1) of this title.”.

(c) Definition of toxic exposure risk activity.—Section 1710(e)(4) is amended by adding at the end the following new subparagraph:

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

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

“(ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans.”.

(a) In general.—Section 1710(e), as amended by section 102(c), is further amended—

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

“(G) Subject to paragraph (2), a 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.

“(H) Subject to paragraph (2), a covered veteran (as defined in section 1119(c) of this title) is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness.”; and

(2) in paragraph (2)(B)—

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

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

(b) Resource assessment and report.—

(1) INITIAL ASSESSMENT AND REPORT.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—

(A) complete an assessment to determine—

(i) the personnel and material resources necessary to implement the amendments made by subsection (a); and

(ii) the total number of covered veterans, as such term is defined in section 1119(c) of title 38, United States Code (as added by section 301), who receive hospital care or medical services furnished by the Secretary under chapter 17 of such title, disaggregated by priority group specified in section 1705(a) of such title; and

(B) submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate an initial report containing the findings of the assessment completed under subparagraph (A), including a specific determination as to whether the Department has the personnel and material resources necessary to implement the amendments made by subsection (a).

(2) SUBSEQUENT REPORTS.—If the initial report submitted under paragraph (1)(B) contains a determination that the Department does not have the personnel or material resources necessary to implement the amendments made by subsection (a), beginning not later than 90 days after the submission of such initial report and every 90 days thereafter until the effective date specified in subsection (c), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a subsequent report containing an update to such determination.

(c) Effective date.—The amendments made by subsection (a) shall take effect on the date that is the earlier of the following:

(1) The date on which the Secretary submits a report under subsection (b) containing a determination that the Department has the personnel and material resources necessary to implement such amendments, and notifies the Law Revision Counsel of the House of Representatives of the submission of the report so the Law Revision Counsel may execute the amendments.

(2) The date that is 18 months after the date of the enactment of this Act.

This title may be cited as the “Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act” or the “FASTER Presumptions Act”.

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

(1) ESTABLISHMENT.—Chapter 11 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 inserting after the item relating to section 1165 the following new items:

(b) Conforming amendments.—Chapter 11 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 Honoring our Promise to Address Comprehensive Toxics 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 Honoring our Promise to Address Comprehensive Toxics 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 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 1165 the following new item:

“1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection.”.

(c) Application.—Section 1167 of title 38, United States Code, as added by subsection (a), shall apply with respect to presumptions of service connection established or modified on or after the date of the enactment of this Act, including pursuant to amendments made by this Act.

This title may be cited as the “Veterans Burn Pits Exposure Recognition Act”.

(a) In general.—Subchapter II of chapter 11 is amended by adding at the end the following new section:

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

“1119. Presumptions of toxic exposure.”.

(a) In general.—Subchapter VI of chapter 11, as amended by section 203 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 exposure risk activities.”.

(a) Short title.—This section may be cited as the “Mark Takai Atomic Veterans Healthcare Parity Act”.

(b) Enewetak Atoll.—Section 1112(c)(3)(B) 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.”.

(a) Short title.—This section may be cited as the “Palomares Veterans Act”.

(b) Palomares.—Section 1112(c)(3)(B), 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) Short title.—This section may be cited as the “Veterans Agent Orange Exposure Equity Act”.

(b) In general.—Section 1116, as amended by section 202, 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, Kampong 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.”.

(c) Eligibility for hospital care and medical services.—Section 1710(e)(4), as amended by section 103, is further amended by striking subparagraph (A) and inserting the following new subparagraph:

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

“(i) performed covered service, as defined in section 1116(d) 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.”.

(d) Clerical amendments.—

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

(2) TABLE OF SECTIONS.—The table of sections at the beginning of chapter 11 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.”.

(a) Short title.—This section may be cited as the “Fair Care for Vietnam Veterans Act”.

(b) Additional diseases.—Section 1116(a)(2), 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 is amended by striking “became manifest—” and all that follows through the period at the end and inserting “became manifest to any degree at any time.”.

(b) Permanent extension of period of eligibility.—Such section is further amended—

(1) by striking subsection (b);

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

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

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

“(d) If a Persian Gulf veteran at a medical facility of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care personnel of the Department use a disability benefits questionnaire, or successor questionnaire, to identify Gulf War Illness.”.

(d) Expansion of definition of Persian Gulf veteran.—Subsection (f) of such section is amended by inserting “, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan,” after “operations”.

(e) Training.—Such section is further 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) Short title.—This section may be cited as the “Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act”.

(b) In general.—Subchapter II of chapter 11, as amended by section 303(a), is further amended by inserting after section 1119 the following new section:

(c) Clerical amendment.—The table of sections at the beginning of chapter 11, as amended by section 302(b), is further amended by inserting after the item relating to section 1119 the following new item:

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

(d) Conforming amendment.—Section 1113 is amended by striking “or 1118” each place it appears and inserting “1118, or 1120”.

(a) In general.—Subchapter II of chapter 73 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 Secretary in connection with hospital care, medical services, or nursing home care furnished to a veteran for an illness under section 1710(a)(2)(F) of title 38, United States Code, as amended by section 102; and

(2) is likely to be scientifically useful, as determined by the Secretary, in determining whether a positive association exists between the illness of the veteran and a toxic exposure.

(b) Consent of patients.—The Secretary shall ensure that the compilation and analysis of the clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, in a manner that is 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 House of Representatives and the Senate a report containing—

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

(2) an analysis of any such data;

(3) a description of the types and incidences of illnesses identified by the Secretary pursuant to such subsection;

(4) an explanation by the Secretary for the incidence of such illnesses and such alternate explanations for the incidence of such illnesses as the Secretary may consider reasonable; and

(5) a description of the views of the Secretary regarding the scientific validity of drawing conclusions from the incidence of such illnesses, as evidenced by the data compiled under subsection (a), regarding the existence of a positive association between such illness and a toxic exposure.

(d) Definitions.—In this section:

(1) The term “toxic exposure” has the meaning given that term in section 101 of title 38, United States Code.

(2) The term “illness” has the meaning given that term in section 1171 of such title, as added by section 202.

(a) Analysis on mortality in covered veterans.—

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

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

(A) Metrics of airborne exposures.

(B) The location and timing of any deployments of the veteran.

(C) The military occupational specialty of the veteran.

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

(E) The preexisting health status of the veteran, including with respect to asthma.

(F) Such personal information of the veteran as the Secretary may consider relevant, 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 involves—

(1) the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment; and

(2) the collection of detailed information on the covered veterans studied through medical records, administrative data, and other existing sources, including, with respect to the covered veterans—

(A) personal information, 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) STUDY.—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 toxic exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions.

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

(A) an analysis of results for mechanistic markers and clinically relevant outcomes; and

(B) a validation of any serum, tissue, or other biomarkers of toxic exposure, susceptibility, or effect with respect to the subjects of the study.

(d) Covered veteran defined.—In this section, the term “covered veteran” has the meaning given that term in section 1119(c) of title 38, United States Code, as added by section 302.

(a) Study.—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.

(b) Report.—Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a).

(a) Study.—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 under 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) Any military occupational speciality of the veteran.

(4) The gender of the veteran.

(5) Any type of cancer that the veteran has.

(c) Report.—Not later than two years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the study under subsection (a).

(a) Study.—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 103(a)(1), for any illness 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 is attributable to such activity.

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

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

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

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

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

(6) an assessment of 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 toxic 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 military installations of the Department of Defense located in the United States;

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

(3) assess whether the Secretary 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) The terms “hospital care” and “medical services” have the meanings given those terms in section 1701 of title 38, United States Code.

(2) The term “illness” has the meaning given that term in section 1171 of such title, as added by section 202.

(3) 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 103(a)(1), 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 that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary.

(4) The term “toxic exposure” has the meaning given that term in section 101 of such title, as added by section 102(b).

(5) The term “toxic exposure risk activity” has the meaning given that term in section 1710(e)(4) of such title, as added by section 103(a)(3).

(6) The term “TRICARE program” has the meaning given that term in section 1072 of such title.

(a) Short title.—This title may be cited as the “Toxic Exposure in the American Military Act” or the “TEAM Act”.

(b) Definitions.—In this title, the terms “active military, naval, or air service”, “toxic exposure”, and “toxic exposed 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 exposed veterans, including with respect to—

(i) disability compensation under chapter 11 of title 38, United States Code; and

(ii) hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title;

(B) caregivers of toxic exposed veterans who are participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title; and

(C) survivors of toxic exposed veterans 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 exposed 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) STANDARD CLAIMS PROCESSOR TRAINING CURRICULUM.—

(A) CURRICULUM.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a standard training curriculum 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, including employees who adjudicate such claims.

(B) MATTERS INCLUDED.—The Secretary shall ensure that the training under subparagraph (A) includes the following explanations with respect to claims relating to toxic exposure:

(i) A lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist.

(ii) The claims adjudicator shall always consider whether direct service connection is applicable and request, as needed, an advisory medical opinion pursuant to section 1168 of title 38, United States Code, as added by section 303.

(iii) The claims adjudicator shall always review and consider the Individual Longitudinal Exposure Record program of the Department of Veterans Affairs pursuant to section 1119 of such title, as added by section 302, but a lack of such information is not by itself sufficient to determine that such exposure did not occur or sufficient to deny the claim.

(C) PROVISION OF TRAINING.—The Secretary shall—

(i) provide training under subparagraph (A) to each employee described in such subparagraph not less frequently than annually; and

(ii) using the Systematic Technical Accuracy Review program, or such successor program, conduct a nationwide, quarterly, randomized review of the quality of adjudication of claims relating to toxic exposure.

(2) STANDARD MEDICAL EXAMINER TRAINING CURRICULUM.—

(A) CURRICULUM.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a standard medical training curriculum for medical providers who conduct examinations and provide opinions pursuant to section 1168 of title 38, United States Code, as added by section 303, regardless of whether the provider is an employee of the Department or a contractor.

(B) STANDARDIZED APPROACH.—The Secretary shall ensure that the curriculum established under subparagraph (A)—

(i) provides a standardized approach to conducting and providing examinations and opinions in accordance with such section 1168; and

(ii) instructs medical providers to consider, when conducting an examination or providing an opinion—

(I) relevant medical and scientific literature;

(II) the proximity, intensity, and frequency of exposure of the individual to the identified toxic exposure;

(III) medically unexplained chronic multisymptom illnesses; and

(IV) all competent and credible evidence of record.

(a) Establishment of registry.—

(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—

(A) establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances (in this section referred to as “PFAS”) due to the environmental release of aqueous film-forming foam (in this section referred to as “AFFF”) on military installations to meet the requirements of military specification MIL–F–24385F;

(B) include any information in such registry that the Secretary determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to PFAS associated with AFFF;

(C) develop a public information campaign to inform eligible individuals about the registry, including how to register and the benefits of registering; and

(D) periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to PFAS.

(2) COORDINATION.—The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense in carrying out paragraph (1).

(b) Reports.—

(1) INITIAL REPORT.—Not later than two years after the date on which the registry under subsection (a) is established, the Secretary of Veterans Affairs shall submit to Congress an initial report containing the following:

(A) An assessment of the effectiveness of actions taken by the Secretary of Veterans Affairs and the Secretary of Defense to collect and maintain information on the health effects of exposure to PFAS.

(B) Recommendations to improve the collection and maintenance of such information.

(C) Using established and previously published epidemiological studies, recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to exposure to PFAS.

(2) FOLLOWUP REPORT.—Not later than five years after submitting the initial report under paragraph (1), the Secretary of Veterans Affairs shall submit to Congress a followup report containing the following:

(A) An update to the initial report submitted under paragraph (1).

(B) An assessment of whether and to what degree the content of the registry established under subsection (a) is current and scientifically up to date.

(3) INDEPENDENT SCIENTIFIC ORGANIZATION.—The Secretary of Veterans Affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs (1) and (2).

(c) Recommendations for additional exposures To be included.—Not later than five years after the date of the enactment of this Act, and every five years thereafter, the Secretary of Veterans Affairs, in consultation with the Secretary of Defense and the Administrator of the Environmental Protection Agency, shall submit to Congress recommendations for additional chemicals with respect to which individuals exposed to such chemicals should be included in the registry established under subsection (a).

(d) Eligible individual defined.—In this section, the term “eligible individual” means any individual who, on or after a date specified by the Secretary of Veterans Affairs through regulations, served or is serving in the Armed Forces at a military installation where AFFF was used or at another location of the Department of Defense where AFFF was used.

(a) Establishment.—The Secretary of Veterans Affairs shall establish and maintain a special record to be known as the Fort McClellan Health Registry (in this section referred to as the “Registry”).

(b) Contents.—Except as provided in subsection (c), the Registry shall include the following information:

(1) A list containing the name of each individual who, while serving as a member of the Armed Forces, was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, and who—

(A) applies for care or services from the Department of Veterans Affairs under chapter 17 of title 38, United States Code;

(B) files a claim for compensation under chapter 11 of such title on the basis of any disability which may be associated with such service;

(C) dies and is survived by a spouse, child, or parent who files a claim for dependency and indemnity compensation under chapter 13 of such title on the basis of such service;

(D) requests from the Secretary a health examination under subsection (d); or

(E) receives from the Secretary a health examination similar to the health examination referred to in subparagraph (D) and requests inclusion in the Registry.

(2) Relevant medical data relating to the health status of, and other information that the Secretary considers relevant and appropriate with respect to, each individual described in paragraph (1) who—

(A) grants to the Secretary permission to include such information in the Registry; or

(B) at the time the individual is listed in the Registry, is deceased.

(c) Individuals submitting claims or making requests before date of enactment.—If in the case of an individual described in subsection (b)(1) the application, claim, or request referred to in such subsection was submitted, filed, or made before the date of the enactment of this Act, the Secretary shall, to the extent feasible, include in the Registry such individual's name and the data and information, if any, described in subsection (b)(2) relating to the individual.

(d) Examinations.—Upon the request of a veteran who was stationed at Fort McClellan, Alabama, at any time during the period beginning January 1, 1935, and ending on May 20, 1999, the Secretary shall provide the veteran with a health examination (including any appropriate diagnostic tests) and consultation and counseling with respect to the results of the examination and the tests.

(e) Outreach.—

(1) ONGOING OUTREACH TO INDIVIDUALS LISTED IN REGISTRY.—The Secretary shall, from time to time, notify individuals listed in the Registry of significant developments in research on the health consequences of potential exposure to a toxic substance or environmental hazard related to service at Fort McClellan.

(2) EXAMINATION OUTREACH.—The Secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations (including any diagnostic tests) and consultation and counseling services under subsection (d).

(f) Consultation.—The Secretary of Veterans Affairs shall consult with the Secretary of Defense to acquire information maintained by the Secretary of Defense that the Secretary of Veterans Affairs considers necessary to establish and maintain the Registry.

(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 determine—

(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 they experience during service in the Armed Forces will be accurately reflected in the Individual Longitudinal Exposure Record of the member.

(b) Independent research entity.—The entity described in this subsection is an independent research entity that is a not-for-profit entity or a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a).

(c) 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, as added by section 102(b).

(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 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 exposure events that may not be fully captured by the current systems of the Department of Defense for environmental, occupational, and 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 if necessary.

(c) Definitions.—In this section:

(1) APPROPRIATE COMMITTEES OF CONGRESS.—The term “appropriate committees of Congress” means—

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

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

(2) TOXIC EXPOSURE.—The term “toxic exposure” has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b).

(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) PROVISION OF EVIDENCE.—To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, shall provide such evidence as the Secretary of Defense and the Secretary of Veterans Affairs jointly consider necessary.

(2) BENEFIT OF THE DOUBT.—In reviewing evidence provided under paragraph (1), the Secretary of Defense and the Secretary of Veterans Affairs shall give the benefit of the doubt to the member of the Armed Forces or veteran who provided the evidence, as the case may be, in a manner that is equivalent to the benefit of the doubt required under section 5107(b) of title 38, United States Code.

(3) REGULATIONS.—The Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall prescribe by regulation the evidence considered necessary under paragraph (1).

(c) 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, as added by section 102(b).