Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
This bill establishes a presumption of service-connection for specified diseases associated with exposure to burn pits (an area used for burning solid waste in open air without equipment) and other toxins by veterans who were awarded specified medals on or after August 2, 1990. Under a presumption of service-connection, specific conditions diagnosed in certain veterans are presumed to have been caused by the circumstances of their military service. Health care benefits and disability compensation may then be awarded.
Under the bill, if the Department of Veterans Affairs (VA) receives a written petition to add a disease to the list, the VA must request a determination by the National Academies of Sciences, Engineering, and Medicine with respect to whether there is a positive association between the exposure of humans to a covered toxin and the occurrence of the disease in humans.
The bill makes disability or death of certain employees from specified diseases compensable as a work injury. Specifically, such employees are those who were employees of the Department of State, the Department of Defense, or an element of the intelligence community on or after August 2, 1990, and carried out job responsibilities for at least 30 days during a contingency operation.
To amend title 38, United States Code, to provide for a presumption of 
  service connection for certain diseases associated with exposure to 
                    toxins, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Presumptive Benefits for War 
Fighters Exposed to Burn Pits and Other Toxins Act of 2021''.

SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR CERTAIN DISEASES 
              ASSOCIATED WITH EXPOSURE TO BURN PITS AND OTHER TOXINS.

    (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:
``Sec. 1119. Presumption of service connection for certain diseases 
              associated with exposure to burn pits and other toxins
    ``(a) Presumption of Service Connection.--(1) For the purposes of 
section 1110 of this title, and subject to section 1113 of this title, 
a disease specified in paragraph (2) becoming manifest in a veteran 
described in paragraph (3) shall be considered to have been incurred in 
or aggravated during active military, naval, or air service, 
notwithstanding that there is no record of evidence of such disease 
during the period of such service.
    ``(2) The diseases specified in this paragraph are the following:
            ``(A) Asthma that was diagnosed after service in a country 
        or territory for which a medal described in paragraph (3) was 
        awarded.
            ``(B)(i) Head cancer of any type.
            ``(ii) Neck cancer of any type.
            ``(iii) Respiratory cancer of any type.
            ``(iv) Gastrointestinal cancer of any type.
            ``(v) Pancreatic cancer of any type.
            ``(vi) Reproductive cancer of any type.
            ``(vii) Lymphoma cancer of any type.
            ``(viii) Lymphomatic cancer of any type.
            ``(ix) Kidney cancer.
            ``(x) Brain cancer.
            ``(xi) Melanoma.
            ``(C) Chronic bronchitis.
            ``(D) Chronic obstructive pulmonary disease.
            ``(E) Constrictive bronchiolitis or obliterative 
        bronchiolitis.
            ``(F) Emphysema.
            ``(G) Granulomatous disease.
            ``(H) Interstitial lung disease.
            ``(I) Pleuritis.
            ``(J) Pulmonary fibrosis.
            ``(K) Sarcoidosis.
            ``(L) Any other disease listed under subsection (a)(2) of 
        section 1116 of this title or for which a presumption of 
        service connection is warranted pursuant to regulations 
        prescribed under section subsection (b)(1) of such section.
            ``(M) Any other disease with respect to which final 
        regulations have been prescribed under subsection (c)(3).
    ``(3) A veteran described in this paragraph is any veteran who on 
or after August 2, 1990, was awarded any of the following:
            ``(A) The Afghanistan Campaign Medal.
            ``(B) The Armed Forces Expeditionary Medal.
            ``(C) The Armed Forces Reserve Medal with M-device.
            ``(D) The Armed Forces Service Medal.
            ``(E) The Global War On Terrorism Expeditionary Medal.
            ``(F) The Inherent Resolve Campaign Medal.
            ``(G) The Iraqi Campaign Medal.
            ``(H) The Southwest Asia Service Medal.
    ``(b) Process To Add Diseases Through Written Petition.--(1) In the 
case that the Secretary receives a written petition from an interested 
party to add a disease to the list of diseases specified in subsection 
(a)(2), not later than 90 days after the date of receipt of such 
petition, the Secretary shall request a determination by the National 
Academies of Sciences, Engineering, and Medicine (referred to in this 
section as the `National Academies') with respect to whether there is a 
positive association between--
            ``(A) the exposure of humans to one or more covered toxins; 
        and
            ``(B) the occurrence of the disease in humans.
    ``(2) For purposes of this subsection, the term `interested party' 
includes a representative of--
            ``(A) a congressionally chartered veterans service 
        organization;
            ``(B) an organization that--
                    ``(i) is described in section 501(c)(3) of the 
                Internal Revenue Code of 1986 and exempt from taxation 
                under section 501(a) of such Code;
                    ``(ii) serves veterans or members of the Armed 
                Forces; and
                    ``(iii) has continuously operated for a period of 
                five years or more preceding the date of the submittal 
                of the written petition under paragraph (1);
            ``(C) a collective bargaining agent for civilian employees 
        of the United States Government;
            ``(D) a nationally recognized medical association;
            ``(E) the National Academies; or
            ``(F) a State or political subdivision of a State.
    ``(c) Determinations by National Academies.--(1) If the Secretary 
receives a determination described in paragraph (2), not later than 180 
days after receipt of such determination, the Secretary shall--
            ``(A) publish in the Federal Register proposed regulations 
        to add the disease covered by the determination to the list of 
        diseases specified in subsection (a)(2);
            ``(B) publish in the Federal Register, and submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives--
                    ``(i) the decision of the Secretary not to publish 
                such proposed regulations; and
                    ``(ii) the basis for such decision, including 
                specific medical science refuting the determination; or
            ``(C) publish in the Federal Register a decision that 
        insufficient evidence exists to take action under subparagraph 
        (A) or (B).
    ``(2) A determination described in this paragraph--
            ``(A) is a determination by the National Academies that 
        there is a positive association between--
                    ``(i) the exposure of humans to one or more covered 
                toxins; and
                    ``(ii) the occurrence of the disease in humans; and
            ``(B) may be made pursuant to--
                    ``(i) a request from the Secretary under subsection 
                (b); or
                    ``(ii) an agreement between the Secretary and the 
                National Academies under section 3 of the Presumptive 
                Benefits for War Fighters Exposed to Burn Pits and 
                Other Toxins Act of 2021.
    ``(3)(A) Not later than 180 days after the date on which the 
Secretary publishes any proposed regulations under paragraph (1)(A) for 
a disease, the Secretary shall prescribe final regulations for that 
disease.
    ``(B) Such regulations shall be effective on the date of issuance.
    ``(d) Reference to National Academies.--In the case that the 
Secretary enters into an agreement with another organization as 
described in section 3(h)(1) of the Presumptive Benefits for War 
Fighters Exposed to Burn Pits and Other Toxins Act of 2021, any 
reference in this section to the National Academies shall be treated as 
a reference to the other organization.
    ``(e) Definitions.--In this section:
            ``(1) The term `covered toxin' includes the following:
                    ``(A) Any toxic chemical or toxic fume.
                    ``(B) Hazardous waste, mixed waste, solid waste, or 
                used oil (as those terms are defined in section 1004 of 
                the Solid Waste Disposal Act (42 U.S.C. 6903)).
                    ``(C) Radiological waste.
                    ``(D) Any other carcinogen.
            ``(2) The term `veterans service organization' means an 
        organization recognized by the Secretary for the representation 
        of veterans under section 5902 of this title.''.
    (b) Effective Date.--
            (1) In general.--The amendment made by subsection (a) shall 
        take effect on the date that is 180 days after the date of the 
        enactment of this Act.
            (2) Written petitions.--With respect to a written petition 
        described in section 1119(b)(1) of title 38, United States 
        Code, as added by subsection (a), that was received by the 
        Secretary of Veterans Affairs before the effective date 
        described in paragraph (1), the Secretary shall make a request 
        of the National Academies of Sciences, Engineering, and 
        Medicine under such section, as so added, not later than 90 
        days after such effective date.
    (c) Clerical Amendment.--The table of sections at the beginning of 
chapter 11 of title 38, United States Code, is amended by inserting 
after the item relating to section 1118 the following new item:

``1119. Presumption of service connection for certain diseases 
                            associated with exposure to burn pits and 
                            other toxins.''.
    (d) Conforming Amendment.--Section 1113 of such title is amended by 
striking ``or 1118'' each place it appears and inserting ``1118, or 
1119''.

SEC. 3. AGREEMENT WITH THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, 
              AND MEDICINE CONCERNING THE EXPOSURE OF HUMANS TO BURN 
              PITS AND OTHER TOXINS.

    (a) Agreement.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        seek to enter into an agreement with the National Academies of 
        Sciences, Engineering, and Medicine (referred to in this 
        section as the ``National Academies'') to perform the services 
        covered by this section.
            (2) Timing.--The Secretary shall seek to enter into the 
        agreement described in paragraph (1) not later than 60 days 
        after the date of the enactment of this Act.
    (b) Reviews of Scientific Evidence.--
            (1) In general.--Under an agreement between the Secretary 
        and the National Academies, the National Academies shall review 
        and summarize the scientific evidence, and assess the strength 
        thereof, concerning the association between the exposure of 
        humans to covered toxins and each disease suspected to be 
        associated with such exposure.
            (2) Reviews upon request.--Under an agreement between the 
        Secretary and the National Academies under this section, the 
        National Academies shall conduct a review described in 
        paragraph (1) in response to each request made by the Secretary 
        under section 1119(b)(1) of title 38, United States Code, as 
        added by section 2(a).
    (c) Scientific Determinations Concerning Diseases.--
            (1) In general.--For each disease reviewed under subsection 
        (b), the National Academies shall determine (to the extent that 
        available scientific data permit meaningful determinations) 
        whether there is a positive association between the exposure of 
        humans to one or more covered toxins and the occurrence of the 
        disease in humans, taking into account the strength of the 
        scientific evidence and the appropriateness of the statistical 
        and epidemiological methods used to detect the association.
            (2) Submissions for reviews upon request.--Under an 
        agreement between the Secretary and the National Academies 
        under this section, not later than 270 days after the date on 
        which the Secretary transmits a request to the National 
        Academies with respect to a disease under section 1119(b)(1) of 
        title 38, United States Code, as added by section 2(a), the 
        National Academies shall submit to the Secretary the 
        determination made with respect to that disease under paragraph 
        (1).
    (d) Recommendations for Additional Scientific Studies.--
            (1) In general.--Under an agreement between the Secretary 
        and the National Academies under this section, the National 
        Academies shall make any recommendations it has for additional 
        scientific studies to resolve areas of continuing scientific 
        uncertainty relating to the exposure of humans to covered 
        toxins.
            (2) Considerations.--In making recommendations for 
        additional scientific studies, the National Academies shall 
        consider--
                    (A) the scientific information that is available at 
                the time of the recommendation;
                    (B) the value and relevance of the information that 
                could result from additional studies; and
                    (C) the feasibility of carrying out such additional 
                studies.
    (e) Subsequent Reviews.--Under an agreement between the Secretary 
and the National Academies under this section, the National Academies 
shall--
            (1) conduct as comprehensive a review as is practicable of 
        the evidence referred to in subsection (b)(1) that became 
        available since the last review of such evidence under this 
        section; and
            (2) make determinations and estimates on the basis of the 
        results of such review and all other reviews conducted for the 
        purposes of this section.
    (f) Reports.--
            (1) Initial report.--
                    (A) In general.--Under an agreement between the 
                Secretary and the National Academies under this 
                section, not later than 540 days after the date of the 
                enactment of this Act, the National Academies shall 
                submit to the Secretary and the Committee on Veterans' 
                Affairs of the Senate and the Committee on Veterans' 
                Affairs of the House of Representatives a report on the 
                activities of the National Academies under the 
                agreement.
                    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:
                            (i) The determinations described in 
                        subsection (c)(1).
                            (ii) An explanation of the scientific 
                        evidence and reasoning that led to such 
                        determinations.
                            (iii) Any recommendations of the National 
                        Academies under subsection (d).
            (2) Periodic updates.--Under an agreement between the 
        Secretary and the National Academies under this section, not 
        less frequently than once every two years, the National 
        Academies shall submit to the Secretary and the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives an updated report on 
        the activities of the National Academies under the agreement.
    (g) Limitation on Authority.--The authority to enter into 
agreements under this section shall be effective for a fiscal year to 
the extent that appropriations are available.
    (h) Alternative Contract Scientific Organization.--
            (1) In general.--If the Secretary is unable within the 
        period prescribed in subsection (a)(2) to enter into an 
        agreement with the National Academies on terms acceptable to 
        the Secretary, the Secretary shall seek to enter into such an 
        agreement with another appropriate scientific organization 
        that--
                    (A) is not part of the Government;
                    (B) operates as a not-for-profit entity; and
                    (C) has expertise and objectivity comparable to 
                that of the National Academies.
            (2) Treatment.--If the Secretary enters into an agreement 
        with another organization as described in paragraph (1), any 
        reference in this section, section 4, and section 1119 of title 
        38, United States Code, as added by section 2(a), to the 
        National Academies shall be treated as a reference to the other 
        organization.
    (i) Covered Toxin Defined.--In this section, the term ``covered 
toxin'' has the meaning given that term in section 1119(e) of title 38, 
United States Code, as added by section 2(a).
    (j) Authorization of Appropriations.--There are authorized to be 
appropriated to the Department of Veterans Affairs such sums as may be 
necessary to carry out this section.

SEC. 4. ACCESS OF THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND 
              MEDICINE TO INFORMATION FROM FEDERAL AGENCIES.

    (a) In General.--Upon request by the National Academies of 
Sciences, Engineering, and Medicine (referred to in this section as the 
``National Academies''), the head of any Federal agency with relevant 
information shall provide to the National Academies information in the 
possession of the agency that the National Academies determines useful 
in conducting a review under section 3(b).
    (b) Federal Agency Defined.--In this section, the term ``Federal 
agency'' means any agency as that term is defined in section 551 of 
title 5, United States Code.

SEC. 5. PRESUMPTION RELATING TO PERSONAL INJURY OF CERTAIN FEDERAL 
              EMPLOYEES.

    (a) In General.--Section 8102 of title 5, United States Code, is 
amended by adding at the end the following:
    ``(c)(1) In this subsection, the term `covered employee' means an 
employee of the Department of State, the Department of Defense, or an 
element of the intelligence community (as defined in section 3 of the 
National Security Act of 1947 (50 U.S.C. 3003)) who, on or after August 
2, 1990, carried out the job responsibilities of the employee for not 
fewer than 30 total days in a country or territory while the United 
States was conducting a contingency operation (as defined in section 
101 of title 10) in that country or territory.
    ``(2) Disability or death from a disease described in paragraph (2) 
of such section suffered by a covered employee is deemed to have 
resulted from personal injury sustained while in the performance of the 
duty of the covered employee, whether or not the covered employee was 
engaged in the course of employment when the disability or disability 
resulting in death occurred.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date that is 180 days after the date of enactment of 
this Act.
                                 <all>
Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
To amend title 38, United States Code, to provide for a presumption of service connection for certain diseases associated with exposure to toxins, and for other purposes.
Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
Rep. Ruiz, Raul