CHAPTER 11 - COMPENSATION FOR SERVICE-CONNECTED DISABILITY OR DEATH

Title 38 > CHAPTER 11

Sections (89)

“SEC. 601 SHORT TITLE; DEFINITIONS.

(“(a) Short Title.— This title may be cited as the ‘Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act of 2022’ or the ‘FASTER Presumption Act of 2022’.

(“(b) Definitions.— In this title, the terms ‘active military, naval, air, or space service’, ‘toxic exposure’, and ‘toxic-exposed veteran’ have the meanings given those terms in section 101 of title 38 , United States Code, as amended by section 102.

“SEC. 602 PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS FOR TOXIC-EXPOSED VETERANS AND VETERANS WHO REPORT TOXIC EXPOSURES AND OUTREACH PROGRAM FOR SUCH VETERANS AND CAREGIVERS AND SURVIVORS OF SUCH VETERANS.

(“(a) Publication of List of Resources.— Not later than one year after the date of the enactment of this Act [ Aug. 10, 2022 ], and annually thereafter, the Secretary of Veterans Affairs shall publish a list of resources of the Department of Veterans Affairs for— toxic-exposed veterans and veterans who report toxic exposure; families and caregivers of such veterans; and survivors of such veterans who are receiving death benefits under the laws administered by the Secretary. 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 exposures, including outreach with respect to benefits and support programs.

“SEC. 603 INCORPORATION OF TOXIC EXPOSURE SCREENING FOR VETERANS.

(“(a) In General.— Beginning not later than 90 days after the date of the enactment of this Act [ Aug. 10, 2022 ], the Secretary of Veterans Affairs shall incorporate a screening to help determine potential toxic exposures during active military, naval, air, or space service as part of a health care screening furnished by the Department of Veterans Affairs to veterans enrolled in the system of annual patient enrollment of the Department established and operated under section 1705 of title 38 , United States Code, to improve understanding by the Department of toxic exposures while serving in the Armed Forces.

(“(b) Timing.— The Secretary shall ensure that a veteran described in subsection (a) completes the screening required under such subsection not less frequently than once every five years.

(“(c) Determination of Questions.— The questions included in the screening required under subsection (a) shall be determined by the Secretary with input from medical professionals. At a minimum, the screening required under subsection (a) shall, with respect to a veteran, include— a question about the potential exposure of the veteran to an open burn pit; and a question regarding toxic exposures that are commonly associated with service in the Armed Forces. In this subsection, the term ‘open burn pit’ means an area of land that— is designated by the Secretary of Defense to be used for disposing solid waste by burning in the outdoor air; and does not contain a commercially manufactured incinerator or other equipment specifically designed and manufactured for the burning of solid waste.

(“(d) Print Material.— In developing the screening established under subsection (a), the Secretary shall ensure that print materials complementary to such screening that outline related resources for veterans are available at each medical center of the Department to veterans who may not have access to the internet.

(“(e) Screening Updates.— The Secretary shall consider updates to the content of the screening required under subsection (a) not less frequently than biennially to ensure the screening contains the most current information.

“SEC. 604 TRAINING FOR PERSONNEL OF THE DEPARTMENT OF VETERANS AFFAIRS WITH RESPECT TO VETERANS WHO REPORT TOXIC EXPOSURES.

(“(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 veterans of illnesses related to toxic exposures and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures.

(“(b) Benefits Personnel.— The Secretary shall incorporate 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 exposures. Training provided to processors under paragraph (1) shall be provided not less frequently than annually.”

§ 1101 Definitions

For the purposes of this chapter— The term “veteran” includes a person who died in the active military, naval, air, or space service. The term “period of war” includes, in the case of any veteran— any period of service performed by such veteran after November 11, 1918 , and before July 2, 1921 , if such veteran served in the active military, naval, air, or space service after April 5, 1917 , and before November 12, 1918 ; and any period of continuous service performed by such veteran after December 31, 1946 , and before July 26, 1947 , if such period began before January 1, 1947 . The term “chronic disease” includes— Anemia, primary Arteriosclerosis Arthritis Atrophy, progressive muscular Brain hemorrhage Brain thrombosis Bronchiectasis Calculi of the kidney, bladder, or gallbladder Cardiovascular-renal disease, including hypertension Cirrhosis of the liver Coccidioidomycosis Diabetes mellitus Encephalitis lethargica residuals Endocarditis Endocrinopathies Epilepsies Hansen’s disease Hodgkin’s disease Leukemia Lupus erythematosus, systemic Myasthenia gravis Myelitis Myocarditis Nephritis Organic diseases of the nervous system Osteitis deformans (Paget’s disease) Osteomalacia Palsy, bulbar Paralysis agitans Psychoses Purpura idiopathic, hemorrhagic Raynaud’s disease Sarcoidosis Scleroderma Sclerosis, amyotrophic lateral Sclerosis, multiple Syringomyelia Thromboangiitis obliterans (Buerger’s disease) Tuberculosis, active Tumors, malignant, or of the brain or spinal cord or peripheral nerves Ulcers, peptic (gastric or duodenal) and such other chronic diseases as the Secretary may add to this list. The term “tropical disease” includes— Amebiasis Blackwater fever Cholera Dracontiasis Dysentery Filiariasis Hansen’s disease Leishmaniasis, including kala-azar Loiasis Malaria Onchocerciasis Oroya fever Pinta Plague Schistosomiasis Yaws Yellow fever and such other tropical diseases as the Secretary may add to this list. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1118 , § 301; Pub. L. 94–433, title IV , §§ 401(2), (3), 404(1), Sept. 30, 1976 , 90 Stat. 1377 , 1378; Pub. L. 98–160, title VII, § 702(2) , Nov. 21, 1983 , 97 Stat. 1009 ; Pub. L. 100–322, title III, § 313 , May 20, 1988 , 102 Stat. 535 ; renumbered § 1101 and amended Pub. L. 102–83 , §§ 4(b)(1), (2)(E), 5(a), Aug. 6, 1991 , 105 Stat. 404–406 ; Pub. L. 116–283, div. A, title IX, § 926(a)(5) , Jan. 1, 2021 , 134 Stat. 3830 .)

“SEC. 1501 ESTABLISHMENT OF COMMISSION.

(“(a) Establishment of Commission.— There is hereby established a commission to be known as the Veterans’ Disability Benefits Commission (hereinafter in this title referred to as the ‘commission’).

(“(b) Membership.— The commission shall be composed of 13 members, appointed as follows: Two members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran who was awarded a decoration specified in paragraph (2). Two members appointed by the minority leader of the House of Representatives, at least one of whom shall be a veteran who was awarded a decoration specified in paragraph (2). Two members appointed by the majority leader of the Senate, at least one of whom shall be a veteran who was awarded a decoration specified in paragraph (2). Two members appointed by the minority leader of the Senate, at least one of whom shall be a veteran who was awarded a decoration specified in paragraph (2). Five members appointed by the President, at least three of whom shall be veterans who were awarded a decoration specified in paragraph (2). A decoration specified in this paragraph is any of the following: The Medal of Honor. The Distinguished Service Cross, the Navy Cross, or the Air Force Cross. The Silver Star. A vacancy in the Commission shall be filled in the manner in which the original appointment was made. The appointment of members of the commission under this subsection shall be made not later than 60 days after the date of the enactment of this Act [ Nov. 24, 2003 ].

(“(c) Period of Appointment.— Members of the commission shall be appointed for the life of the commission. A vacancy in the commission shall not affect its powers.

(“(d) Initial Meeting.— The commission shall hold its first meeting not later than 30 days after the date on which a majority of the members of the commission have been appointed.

(“(e) Meetings.— The commission shall meet at the call of the chairman.

(“(f) Quorum.— A majority of the members of the commission shall constitute a quorum, but a lesser number may hold hearings.

(“(g) Chairman.— The President shall designate a member of the commission to be chairman of the commission.

“SEC. 1502 DUTIES OF THE COMMISSION.

(“(a) Study.— The commission shall carry out a study of the benefits under the laws of the United States that are provided to compensate and assist veterans and their survivors for disabilities and deaths attributable to military service.

(“(b) Scope of Study.— In carrying out the study, the commission shall examine and make recommendations concerning the following: The appropriateness of such benefits under the laws in effect on the date of the enactment of this Act [ Nov. 24, 2003 ]. The appropriateness of the level of such benefits. The appropriate standard or standards for determining whether a disability or death of a veteran should be compensated.

(“(c) Contents of Study.— The study to be carried out by the commission under this section shall be a comprehensive evaluation and assessment of the benefits provided under the laws of the United States to compensate veterans and their survivors for disability or death attributable to military service, together with any related issues that the commission determines are relevant to the purposes of the study. The study shall include an evaluation and assessment of the following: The laws and regulations which determine eligibility for disability and death benefits, and other assistance for veterans and their survivors. The rates of such compensation, including the appropriateness of a schedule for rating disabilities based on average impairment of earning capacity. Comparable disability benefits provided to individuals by the Federal Government, State governments, and the private sector.

(“(d) Consultation With Institute of Medicine.— In carrying out the study under this section, the commission shall consult with the Institute of Medicine of the National Academy of Sciences with respect to the medical aspects of contemporary disability compensation policies.

“SEC. 1503 REPORT.

“Not later than October 1, 2007 , the commission shall submit to the President and Congress a report on the study. The report shall include the following: The findings and conclusions of the commission, including its findings and conclusions with respect to the matters referred to in section 1502(c). The recommendations of the commission for revising the benefits provided by the United States to veterans and their survivors for disability and death attributable to military service. Other information and recommendations with respect to such benefits as the commission considers appropriate.

“SEC. 1504 POWERS OF THE COMMISSION.

(“(a) Hearings.— The commission may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the commission considers advisable to carry out the purposes of this title.

(“(b) Information From Federal Agencies.— In addition to the information referred to in section 1502(c), the commission may secure directly from any Federal department or agency such information as the commission considers necessary to carry out the provisions of this title. Upon request of the chairman of the commission, the head of such department or agency shall furnish such information to the commission.

(“(c) Postal Services.— The commission may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.

(“(d) Gifts.— The commission may accept, use, and dispose of gifts or donations of services or property.

“SEC. 1505 PERSONNEL MATTERS.

(“(a) Compensation of Members.— Each member of the commission who is not an officer or employee of the United States shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5 , United States Code, for each day (including travel time) during which the member is engaged in the performance of the duties of the commission. All members of the commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.

(“(b) Travel Expenses.— The members of the commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the commission.

(“(c) Staff.— The chairman of the commission may, without regard to the civil service laws and regulations, appoint an executive director and such other personnel as may be necessary to enable the commission to perform its duties. The appointment of an executive director shall be subject to approval by the commission. The chairman of the commission may fix the compensation of the executive director and other personnel without regard to the provisions of chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.

(“(d) Detail of Government Employees.— Upon request of the chairman of the commission, the head of any Federal department or agency may detail, on a nonreimbursable basis, any personnel of that department or agency to the commission to assist it in carrying out its duties.

(“(e) Procurement of Temporary and Intermittent Services.— The chairman of the commission may procure temporary and intermittent services under section 3109(b) of title 5 , United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.

“SEC. 1506 TERMINATION OF COMMISSION.

“The commission shall terminate 60 days after the date on which the commission submits its report under section 1503.

“SEC. 1507 FUNDING.

(“(a) In General.— The Secretary of Veterans Affairs shall, upon the request of the chairman of the commission, make available to the commission such amounts as the commission may require to carry out its duties under this title.

(“(b) Availability.— Any sums made available to the commission under subsection (a) shall remain available, without fiscal year limitation, until the termination of the commission.”

§ 1102 Special provisions relating to surviving spouses

(a) No compensation shall be paid to the surviving spouse of a veteran under this chapter unless such surviving spouse was married to such veteran— before the expiration of fifteen years after the termination of the period of service in which the injury or disease causing the death of the veteran was incurred or aggravated; or for one year or more; or for any period of time if a child was born of the marriage, or was born to them before the marriage.

(b) Subsection (a) shall not be applicable to any surviving spouse who, with respect to date of marriage, could have qualified as a surviving spouse for death compensation under any law administered by the Secretary in effect on December 31, 1957 .

§ 1103 Special provisions relating to claims based upon effects of tobacco products

(a) Notwithstanding any other provision of law, a veteran’s disability or death shall not be considered to have resulted from personal injury suffered or disease contracted in the line of duty in the active military, naval, air, or space service for purposes of this title on the basis that it resulted from injury or disease attributable to the use of tobacco products by the veteran during the veteran’s service.

(b) Nothing in subsection (a) shall be construed as precluding the establishment of service connection for disability or death from a disease or injury which is otherwise shown to have been incurred or aggravated in active military, naval, air, or space service or which became manifest to the requisite degree of disability during any applicable presumptive period specified in section 1112 or 1116 of this title.

§ 1104 Cost-of-living adjustments

(a) In the computation of cost-of-living adjustments for fiscal years 1998 through 2013 in the rates of, and dollar limitations applicable to, compensation payable under this chapter, such adjustments shall be made by a uniform percentage that is no more than the percentage equal to the social security increase for that fiscal year, with all increased monthly rates and limitations (other than increased rates or limitations equal to a whole dollar amount) rounded down to the next lower whole dollar amount.

(b) For purposes of this section, the term “social security increase” means the percentage by which benefit amounts payable under title II of the Social Security Act ( 42 U.S.C. 401 et seq.) are increased for any fiscal year as a result of a determination under section 215(i) of such Act ( 42 U.S.C. 415(i) ).

§ 1110 Basic entitlement

For disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, air, or space service, during a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1119 , § 310; Pub. L. 101–508, title VIII, § 8052(a)(2) , Nov. 5, 1990 , 104 Stat. 1388–351 ; renumbered § 1110, Pub. L. 102–83, § 5(a) , Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 105–178, title VIII, § 8202(a) , June 9, 1998 , 112 Stat. 492 ; Pub. L. 105–206, title IX, § 9014(a) , July 22, 1998 , 112 Stat. 865 ; Pub. L. 116–283, div. A, title IX, § 926(a)(7) , Jan. 1, 2021 , 134 Stat. 3830 .)

§ 1111 Presumption of sound condition

For the purposes of section 1110 of this title , every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1119 , § 311; renumbered § 1111 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 .)

§ 1112 Presumptions relating to certain diseases and disabilities

(a) For the purposes of section 1110 of this title , and subject to the provisions of section 1113 of this title , in the case of any veteran who served for ninety days or more during a period of war— a chronic disease becoming manifest to a degree of 10 percent or more within one year from the date of separation from such service; a tropical disease, and the resultant disorders or disease originating because of therapy, administered in connection with such diseases, or as a preventative thereof, becoming manifest to a degree of 10 percent or more within one year from the date of separation from such service, or at a time when standard or accepted treatises indicate that the incubation period thereof commenced during such service; active tuberculous disease developing a 10 percent degree of disability or more within three years from the date of separation from such service; multiple sclerosis developing a 10 percent degree of disability or more within seven years from the date of separation from such service; Hansen’s disease developing a 10 percent degree of disability or more within three years from the date of separation from such service; shall be considered to have been incurred in or aggravated by such service, notwithstanding there is no record of evidence of such disease during the period of service.

(b) For the purposes of section 1110 of this title and subject to the provisions of section 1113 of this title , in the case of a veteran who is a former prisoner of war— a disease specified in paragraph (2) which became manifest to a degree of 10 percent or more after active military, naval, air, or space service shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of such disease during the period of service; and if the veteran was detained or interned as a prisoner of war for not less than thirty days, a disease specified in paragraph (3) which became manifest to a degree of 10 percent or more after active military, naval, air, or space service shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of such disease during the period of service. The diseases specified in this paragraph are the following: Psychosis. Any of the anxiety states. Dysthymic disorder (or depressive neurosis). Organic residuals of frostbite, if the Secretary determines that the veteran was detained or interned in climatic conditions consistent with the occurrence of frostbite. Post-traumatic osteoarthritis. Osteoporosis, if the Secretary determines that the veteran has post-traumatic stress disorder (PTSD). The diseases specified in this paragraph are the following: Avitaminosis. Beriberi (including beriberi heart disease). Chronic dysentery. Helminthiasis. Malnutrition (including optic atrophy associated with malnutrition). Pellagra. Any other nutritional deficiency. Cirrhosis of the liver. Peripheral neuropathy except where directly related to infectious causes. Irritable bowel syndrome. Peptic ulcer disease. Atherosclerotic heart disease or hypertensive vascular disease (including hypertensive heart disease) and their complications (including myocardial infarction, congestive heart failure and arrhythmia). Stroke and its complications.

(c) For the purposes of section 1110 of this title , and subject to the provisions of section 1113 of this title , a disease specified in paragraph (2) of this subsection becoming manifest in a radiation-exposed veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service, notwithstanding that there is no record of evidence of such disease during a period of such service. The diseases referred to in paragraph (1) of this subsection are the following: Leukemia (other than chronic lymphocytic leukemia). Cancer of the thyroid. Cancer of the breast. Cancer of the pharynx. Cancer of the esophagus. Cancer of the stomach. Cancer of the small intestine. Cancer of the pancreas. Multiple myeloma. Lymphomas (except Hodgkin’s disease). Cancer of the bile ducts. Cancer of the gall bladder. Primary liver cancer (except if cirrhosis or hepatitis B is indicated). Cancer of the salivary gland. Cancer of the urinary tract. Bronchiolo-alveolar carcinoma. Cancer of the bone. Cancer of the brain. Cancer of the colon. Cancer of the lung. Cancer of the ovary. For the purposes of this subsection: The term “radiation-exposed veteran” means (i) a veteran who, while serving on active duty, participated in a radiation-risk activity, or (ii) an individual who, while a member of a reserve component of the Armed Forces, participated in a radiation-risk activity during a period of active duty for training or inactive duty training. The term “radiation-risk activity” means any of the following: Onsite participation in a test involving the atmospheric detonation of a nuclear device (without regard to whether the nation conducting the test was the United States or another nation). The occupation of Hiroshima or Nagasaki, Japan, by United States forces during the period beginning on August 6, 1945 , and ending on July 1, 1946 . Internment as prisoner of war in Japan (or service on active duty in Japan immediately following such internment) during World War II which (as determined by the Secretary) resulted in an opportunity for exposure to ionizing radiation comparable to that of veterans described in clause (ii) of this subparagraph. Service in a capacity which, if performed as an employee of the Department of Energy, would qualify the individual for inclusion as a member of the Special Exposure Cohort under section 3621(14) of the Energy Employees Occupational Illness Compensation Program Act of 2000 ( 42 U.S.C. 7384 l (14)). Cleanup of Enewetak Atoll during the period beginning on January 1, 1977 , and ending on December 31, 1980 . 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 . Onsite participation in the response effort following the on-board fire and crash of a United States Air Force B–52 bomber that caused the release of four thermonuclear weapons in the vicinity of Thule Air Force Base, Greenland, during the period beginning January 21, 1968 , and ending September 25, 1968 . A radiation-exposed veteran who receives a payment under the provisions of the Radiation Exposure Compensation Act of 1990 ( 42 U.S.C. 2210 note) shall not be deprived, by reason of the receipt of that payment, of receipt of compensation to which that veteran is entitled by reason of paragraph (1), but there shall be deducted from payment of such compensation the amount of the payment under that Act.

§ 1113 Presumptions rebuttable

(a) Where there is affirmative evidence to the contrary, or evidence to establish that an intercurrent injury or disease which is a recognized cause of any of the diseases or disabilities within the purview of section 1112, 1116, 1117, 1118, or 1120 of this title, has been suffered between the date of separation from service and the onset of any such diseases or disabilities, or the disability is due to the veteran’s own willful misconduct, service-connection pursuant to section 1112, 1116, 1118, or 1120 of this title, or payments of compensation pursuant to section 1117 of this title , will not be in order.

(b) Nothing in section 1112, 1116, 1117, 1118, or 1120 of this title, subsection (a) of this section, or section 5 of Public Law 98–542 ( 38 U.S.C. 1154 note) shall be construed to prevent the granting of service-connection for any disease or disorder otherwise shown by sound judgment to have been incurred in or aggravated by active military, naval, air, or space service.

§ 1114 Rates of wartime disability compensation

(a) if and while the disability is rated 10 percent the monthly compensation shall be $123;

(b) if and while the disability is rated 20 percent the monthly compensation shall be $243;

(c) if and while the disability is rated 30 percent the monthly compensation shall be $376;

(d) if and while the disability is rated 40 percent the monthly compensation shall be $541;

(e) if and while the disability is rated 50 percent the monthly compensation shall be $770;

(f) if and while the disability is rated 60 percent the monthly compensation shall be $974;

(g) if and while the disability is rated 70 percent the monthly compensation shall be $1,228;

(h) if and while the disability is rated 80 percent the monthly compensation shall be $1,427;

(i) if and while the disability is rated 90 percent the monthly compensation shall be $1,604;

(j) if and while the disability is rated as total the monthly compensation shall be $2,673;

(k) if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs, or one foot, or one hand, or both buttocks, or blindness of one eye, having only light perception, has suffered complete organic aphonia with constant inability to communicate by speech, or deafness of both ears, having absence of air and bone conduction, or, in the case of a woman veteran, has suffered the anatomical loss of 25 percent or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy) or has received radiation treatment of breast tissue, the rate of compensation therefor shall be $96permonthforeachsuchlossorlossofuseindependentofanyothercompensationprovidedinsubsections(a)through(j)orsubsection(s)ofthissectionbutinnoeventtoexceed$3,327 per month; and in the event the veteran has suffered one or more of the disabilities heretofore specified in this subsection, in addition to the requirement for any of the rates specified in subsections ( l ) through (n) of this section, the rate of compensation shall be increased by $96permonthforeachsuchlossorlossofuse,butinnoeventtoexceed$4,667 per month;

(l) if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance, the monthly compensation shall be $3,327;

(m) if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both hands, or of both legs with factors preventing natural knee action with prostheses in place, or of one arm and one leg with factors preventing natural elbow and knee action with prostheses in place, or has suffered blindness in both eyes having only light perception, or has suffered blindness in both eyes, rendering such veteran so significantly disabled as to be in need of regular aid and attendance, the monthly compensation shall be $3,671;

(n) if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both arms with factors preventing natural elbow action with prostheses in place, has suffered the anatomical loss of both legs with factors that prevent the use of prosthetic appliances, or has suffered the anatomical loss of one arm and one leg with factors that prevent the use of prosthetic appliances, or has suffered the anatomical loss of both eyes, or has suffered blindness without light perception in both eyes, the monthly compensation shall be $4,176;

(o) if the veteran, as the result of service-connected disability, has suffered disability under conditions which would entitle such veteran to two or more of the rates provided in one or more subsections ( l ) through (n) of this section, no condition being considered twice in the determination, or if the veteran has suffered bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 60 percent or more disabling and the veteran has also suffered service-connected total blindness with 20/200 visual acuity or less, or if the veteran has suffered service-connected total deafness in one ear or bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 40 percent or more disabling and the veteran has also suffered service-connected blindness having only light perception or less, or if the veteran has suffered the anatomical loss of both arms with factors that prevent the use of prosthetic appliances, the monthly compensation shall be $4,667;

(p) in the event the veteran’s service-connected disabilities exceed the requirements for any of the rates prescribed in this section, the Secretary may allow the next higher rate or an intermediate rate, but in no event in excess of $4,667.Intheeventtheveteranhassufferedservice-connectedblindnesswith5/200visualacuityorlessand(1)hasalsosufferedbilateraldeafness(andthehearingimpairmentineitheroneorbothearsisserviceconnected)ratedatnolessthan30percentdisabling,theSecretaryshallallowthenexthigherrate,or(2)hasalsosufferedservice-connectedtotaldeafnessinoneearorservice-connectedanatomicallossorlossofuseofonehandoronefoot,theSecretaryshallallowthenextintermediaterate,butinnoeventinexcessof$4,667. In the event the veteran has suffered service-connected blindness, having only light perception or less, and has also suffered bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 10 or 20 percent disabling, the Secretary shall allow the next intermediate rate, but in no event in excess of $4,667.Intheeventtheveteranhassufferedtheanatomicallossorlossofuse,oracombinationofanatomicallossandlossofuse,ofthreeextremities,theSecretaryshallallowthenexthigherrateorintermediaterate,butinnoeventinexcessof$4,667. Any intermediate rate under this subsection shall be established at the arithmetic mean, rounded down to the nearest dollar, between the two rates concerned.

([(q) Repealed. Pub. L. 90–493, § 4(a) , Aug. 19, 1968 , 82 Stat. 809 .]

(r) Subject to section 5503(c) of this title , if any veteran, otherwise entitled to compensation authorized under subsection ( o ) of this section, at the maximum rate authorized under subsection (p) of this section, or at the intermediate rate authorized between the rates authorized under subsections (n) and ( o ) of this section and at the rate authorized under subsection (k) of this section, is in need of regular aid and attendance, then, in addition to such compensation— the veteran shall be paid a monthly aid and attendance allowance at the rate of $2,002;oriftheveteran,inadditiontosuchneedforregularaidandattendance,isinneedofahigherlevelofcare,suchveteranshallbepaidamonthlyaidandattendanceallowanceattherateof$2,983, in lieu of the allowance authorized in clause (1) of this subsection, if the Secretary finds that the veteran, in the absence of the provision of such care, would require hospitalization, nursing home care, or other residential institutional care. For the purposes of clause (2) of this subsection, need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran’s home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. The existence of the need for such care shall be determined by a physician employed by the Department or, in areas where no such physician is available, by a physician carrying out such function under contract or fee arrangement based on an examination by such physician. For the purposes of section 1134 of this title , such allowance shall be considered as additional compensation payable for disability.

(s) If the veteran has a service-connected disability rated as total, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or, (2) by reason of such veteran’s service-connected disability or disabilities, is permanently housebound, then the monthly compensation shall be $2,993. For the purpose of this subsection, the requirement of “permanently housebound” will be considered to have been met when the veteran is substantially confined to such veteran’s house (ward or clinical areas, if institutionalized) or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran’s lifetime.

(t) Subject to section 5503(c) of this title , if any veteran, as the result of service-connected disability, is in need of regular aid and attendance for the residuals of traumatic brain injury, is not eligible for compensation under subsection (r)(2), and in the absence of such regular aid and attendance would require hospitalization, nursing home care, or other residential institutional care, the veteran shall be paid, in addition to any other compensation under this section, a monthly aid and attendance allowance equal to the rate described in subsection (r)(2), which for purposes of section 1134 of this title shall be considered as additional compensation payable for disability. An allowance authorized under this subsection shall be paid in lieu of any allowance authorized by subsection (r)(1).

“SEC. 2 INCREASE IN RATES OF DISABILITY COMPENSATION AND DEPENDENCY AND INDEMNITY COMPENSATION.

(“(a) Rate Adjustment.— Effective on December 1, 2025 , the Secretary of Veterans Affairs shall increase, in accordance with subsection (c), the dollar amounts in effect on November 30, 2025 , for the payment of disability compensation and dependency and indemnity compensation under the provisions specified in subsection (b).

(“(b) Amounts To Be Increased.— The dollar amounts to be increased pursuant to subsection (a) are the following: Each of the dollar amounts under section 1114 of title 38 , United States Code. Each of the dollar amounts under section 1115(1) of such title. The dollar amount under section 1162 of such title. Each of the dollar amounts under subsections (a) through (d) of section 1311 of such title. Each of the dollar amounts under sections 1313(a) and 1314 of such title.

(“(c) Determination of Increase.— Each dollar amount described in subsection (b) shall be increased by the same percentage as the percentage by which benefit amounts payable under title II of the Social Security Act ( 42 U.S.C. 401 et seq.) are increased effective December 1, 2025 , as a result of a determination under section 215(i) of such Act ( 42 U.S.C. 415(i) ).

“SEC. 3 PUBLICATION OF ADJUSTED RATES.

“The Secretary of Veterans Affairs shall publish in the Federal Register the amounts specified in section 2(b), as increased under that section, not later than the date on which the matters specified in section 215(i)(2)(D) of the Social Security Act ( 42 U.S.C. 415(i)(2)(D) ) are required to be published by reason of a determination made under section 215(i) of such Act during fiscal year 2026.”

§ 1115 Additional compensation for dependents

Any veteran entitled to compensation at the rates provided in section 1114 of this title , and whose disability is rated not less than 30 percent, shall be entitled to additional compensation for dependents in the following monthly amounts: If and while rated totally disabled and— has a spouse but no child, $150;hasaspouseandoneormorechildren,$259 plus $75foreachchildinexcessofone;hasnospousebutoneormorechildren,$101 plus $75foreachchildinexcessofone;hasaparentdependentuponsuchveteranforsupport,then,inadditiontotheaboveamounts,$120 for each parent so dependent; notwithstanding the other provisions of this paragraph, the monthly payable amount on account of a spouse who is (i) a patient in a nursing home or (ii) blind, or so nearly blind or significantly disabled as to need or require the regular aid and attendance of another person, shall be $286foratotallydisabledveteranandproportionateamountsforpartiallydisabledveteransinaccordancewithparagraph(2)ofthissection;andnotwithstandingtheotherprovisionsofthisparagraph,themonthlyamountpayableonaccountofeachchildwhohasattainedtheageofeighteenyearsandwhoispursuingacourseofinstructionatanapprovededucationalinstitutionshallbe$240 for a totally disabled veteran and proportionate amounts for partially disabled veterans in accordance with paragraph (2) of this section. If and while rated partially disabled, but not less than 30 percent, in an amount having the same ratio to the amount specified in paragraph (1) of this section as the degree of disability bears to total disability. The amounts payable under this paragraph, if not a multiple of $1, shall be rounded down to the nearest dollar. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1121 , § 315; Pub. L. 86–499, § 1 , June 8, 1960 , 74 Stat. 165 ; Pub. L. 89–137, § 1(b) , Aug. 26, 1965 , 79 Stat. 576 ; Pub. L. 89–311, § 2(a) , (b), Oct. 31, 1965 , 79 Stat. 1154 , 1155; Pub. L. 91–376, § 2 , Aug. 12, 1970 , 84 Stat. 788 ; Pub. L. 92–328, title I, § 102 , June 30, 1972 , 86 Stat. 394 ; Pub. L. 93–295, title I, § 102 , May 31, 1974 , 88 Stat. 181 ; Pub. L. 94–71, title I, § 102 , Aug. 5, 1975 , 89 Stat. 396 ; Pub. L. 94–433, title I, § 102 , title IV, § 404(9)–(11), Sept. 30, 1976 , 90 Stat. 1375 , 1378; Pub. L. 95–117, title I, § 102 , Oct. 3, 1977 , 91 Stat. 1064 ; Pub. L. 95–479, title I, § 102 , Oct. 18, 1978 , 92 Stat. 1562 ; Pub. L. 96–128, title I, § 102 , Nov. 28, 1979 , 93 Stat. 983 ; Pub. L. 96–385, title I, § 102 , Oct. 7, 1980 , 94 Stat. 1529 ; Pub. L. 97–66, title I, § 102 , Oct. 17, 1981 , 95 Stat. 1027 ; Pub. L. 97–253, title IV , §§ 404(b), 405(c), Sept. 8, 1982 , 96 Stat. 803 ; Pub. L. 97–306, title I , §§ 102, 107, Oct. 14, 1982 , 96 Stat. 1430 , 1431; Pub. L. 98–223, title I, § 102 , Mar. 2, 1984 , 98 Stat. 38 ; Pub. L. 98–543, title I, § 102 , Oct. 24, 1984 , 98 Stat. 2736 ; Pub. L. 99–238, title I, § 102 , Jan. 13, 1986 , 99 Stat. 1766 ; Pub. L. 99–576, title I, § 102 , Oct. 28, 1986 , 100 Stat. 3251 ; Pub. L. 100–227, title I, § 102 , Dec. 31, 1987 , 101 Stat. 1553 ; Pub. L. 100–687, div. B, title XI, § 1102 , Nov. 18, 1988 , 102 Stat. 4123 ; Pub. L. 101–237, title I, § 102 , Dec. 18, 1989 , 103 Stat. 2063 ; Pub. L. 102–3, § 3 , Feb. 6, 1991 , 105 Stat. 8 ; renumbered § 1115 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 102–152, § 3 , Nov. 12, 1991 , 105 Stat. 986 ; Pub. L. 103–78, § 2 , Aug. 13, 1993 , 107 Stat. 768 ; Pub. L. 103–140, § 3 , Nov. 11, 1993 , 107 Stat. 1486 ; Pub. L. 105–98, § 3 , Nov. 19, 1997 , 111 Stat. 2156 ; Pub. L. 106–118, § 3 , Nov. 30, 1999 , 113 Stat. 1602 ; Pub. L. 107–94, § 3 , Dec. 21, 2001 , 115 Stat. 901 ; Pub. L. 107–330, title III, § 309(b) , Dec. 6, 2002 , 116 Stat. 2830 ; Pub. L. 108–454, title III, § 307(b) , Dec. 10, 2004 , 118 Stat. 3613 ; Pub. L. 109–111, § 2(b) , Nov. 22, 2005 , 119 Stat. 2363 ; Pub. L. 109–233, title V, § 502(3) , June 15, 2006 , 120 Stat. 415 ; Pub. L. 109–444, § 9(b) , Dec. 21, 2006 , 120 Stat. 3314 ; Pub. L. 109–461, title X , §§ 1005(b), 1006(b), Dec. 22, 2006 , 120 Stat. 3467 , 3468; Pub. L. 110–324, § 3(b) , Sept. 24, 2008 , 122 Stat. 3551 ; Pub. L. 111–37, § 3(b) , June 30, 2009 , 123 Stat. 1929 .)

§ 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) For the purposes of section 1110 of this title , and subject to section 1113 of this title — a disease specified in paragraph (2) of this subsection becoming manifest as specified in that paragraph in a veteran who performed covered service; and each additional disease (if any) that (i) the Secretary determines in regulations prescribed under this section warrants a presumption of service-connection by reason of having positive association with exposure to an herbicide agent, and (ii) becomes manifest within the period (if any) prescribed in such regulations in a veteran who performed covered service, and while so serving was exposed to that herbicide agent, shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of evidence of such disease during the period of such service. The diseases referred to in paragraph (1)(A) of this subsection are the following: Non-Hodgkin’s lymphoma becoming manifest to a degree of disability of 10 percent or more. Each soft-tissue sarcoma becoming manifest to a degree of disability of 10 percent or more other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma. Chloracne or another acneform disease consistent with chloracne becoming manifest to a degree of disability of 10 percent or more within one year after the last date on which the veteran performed covered service. Hodgkin’s disease becoming manifest to a degree of disability of 10 percent or more. Porphyria cutanea tarda becoming manifest to a degree of disability of 10 percent or more within a year after the last date on which the veteran performed covered service. Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) becoming manifest to a degree of disability of 10 percent or more. Multiple myeloma becoming manifest to a degree of disability of 10 percent or more. Diabetes Mellitus (Type 2). Parkinsonism. Bladder cancer. Hypothyroidism. Monoclonal gammopathy of undetermined significance. Hypertension. For purposes of this section, the term “herbicide agent” means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962 , and ending on May 7, 1975 .

(b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 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 ).

(c) For purposes of establishing service connection for a disability or death resulting from exposure to a herbicide agent, including a presumption of service-connection under this section, a veteran who performed covered service, 1 shall be presumed to have been exposed during such service to an herbicide agent containing dioxin or 2,4-dichlorophenoxyacetic acid, and may be presumed to have been exposed during such service to any other chemical compound in an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service.

(d) In this section, the term “covered service” means active military, naval, air, or space service— performed in the Republic of Vietnam during the period beginning on January 9, 1962 , and ending on May 7, 1975 ; 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; performed in Laos during the period beginning on December 1, 1965 , and ending on September 30, 1969 ; 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 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 .

“SEC. 631 DEFINITIONS.

“In this subtitle: The term ‘Armed Forces’ means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard. The term ‘descendant’ means, with respect to an individual, the biological child or grandchild of that individual. The term ‘toxic exposure’ means a condition in which an individual inhaled or ingested an agent determined to be hazardous to the health of the individual or the agent came in contact with the skin or eyes of the individual in a manner that could be hazardous to the health of the individual. The term ‘veteran’ has the meaning given that term in section 101 of title 38 , United States Code.

“SEC. 632 NATIONAL ACADEMY OF MEDICINE ASSESSMENT ON RESEARCH RELATING TO THE DESCENDANTS OF INDIVIDUALS WITH TOXIC EXPOSURE.

(“(a) In General.— Not later than 180 days after the date of the enactment of this Act [ Dec. 16, 2016 ], the Secretary of Veterans Affairs shall seek to enter into an agreement with the National Academy of Medicine under which the National Academy of Medicine conducts an assessment on scientific research relating to the descendants of individuals with toxic exposure. If the Secretary is unable within the period prescribed in paragraph (1) to enter into an agreement described in such paragraph with the National Academy of Medicine on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate organization that— is not part of the Federal Government; operates as a not-for-profit entity; and has expertise and objectivity comparable to that of the National Academy of Medicine. If the Secretary enters into an agreement with another organization as described in subparagraph (A), any reference in this section to the National Academy of Medicine shall be treated as a reference to the other organization.

(“(b) Elements.— The assessment conducted pursuant to the agreement entered into under subsection (a) shall include the following: A scientific review of the scientific literature regarding toxicological and epidemiological research on descendants of individuals with toxic exposure. An assessment of areas requiring further scientific study relating to the descendants of veterans with toxic exposure. An assessment of the scope and methodology required to conduct adequate scientific research relating to the descendants of individuals with toxic exposure, including— the types of individuals to be studied, including veterans with toxic exposure and the descendants of those veterans; the number of veterans and descendants described in subparagraph (A) to be studied; the potential alternatives for participation in such a study, including whether it would be necessary for participants to travel in order to participate; the approximate amount of time and resources needed to prepare and conduct the research; and the appropriate Federal agencies to participate in the research, including the Department of Defense and the Department of Veterans Affairs. The establishment of categories, including definitions for each such category, to be used in assessing the evidence that a particular health condition is related to toxic exposure, such as— sufficient evidence of a causal relationship; sufficient evidence of an association; limited or suggestive evidence of an association; inadequate or insufficient evidence to determine whether an association exists; and limited or suggestive evidence of no association. An analysis of— the feasibility of conducting scientific research to address the areas that require further study as described under paragraph (2); the value and relevance of the information that could result from such scientific research; and for purposes of conducting further research, the feasibility and advisability of accessing additional information held by a Federal agency that may be sensitive. An identification of a research entity or entities with— expertise in conducting research on health conditions of descendants of individuals with toxic exposure; and an ability to conduct research on those health conditions to address areas requiring further scientific study as described under paragraph (2).

(“(c) Report.— The agreement entered into under subsection (a) shall require the National Academy of Medicine to submit, not later than 2 years after entering into such agreement, to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives— the results of the assessment conducted pursuant to such agreement, including such recommendations as the National Academy of Medicine considers appropriate regarding the scope and methodology required to conduct adequate scientific research relating to the descendants of veterans with toxic exposure; and a determination regarding whether the results of such assessment indicate that it is feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, including an explanation of the basis for the determination.

(“(d) Certification.— Not later than 90 days after receiving the results of the assessment and determination under subsection (c), 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 certification of the understanding of the Secretary, based on such results and determination, regarding the feasibility of conducting further research regarding health conditions of descendants of veterans with toxic exposure that is expressed by such results and determination. The certification submitted under paragraph (1) shall include an explanation of the basis for the certification.

“SEC. 633 ADVISORY BOARD ON RESEARCH RELATING TO HEALTH CONDITIONS OF DESCENDANTS OF VETERANS WITH TOXIC EXPOSURE WHILE SERVING IN THE ARMED FORCES.

(“(a) Establishment.— Unless the Secretary of Veterans Affairs certifies under section 632(d) that the results of the assessment and determination under section 632(c) indicate that it is not feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, not later than 180 days after receiving such results and determination, the Secretary shall establish an advisory board (in this section referred to as the ‘Advisory Board’) to advise the Secretary in the selection of a research entity or entities under section 634, advise such entity or entities in conducting research under such section, and advise the Secretary with respect to the activities of such entity or entities under such section.

(“(b) Membership.— The Secretary, in consultation with the National Academy of Medicine, the Director of the National Institute of Environmental Health Sciences, and such other heads of Federal agencies as the Secretary determines appropriate— shall select not more than 13 voting members of the Advisory Board, of whom— not less than two shall be members of organizations exempt from taxation under section 501(c)(19) of the Internal Revenue Code of 1986 [ 26 U.S.C. 501(c)(19) ]; not less than two shall be descendants of veterans with toxic exposure while serving as members of the Armed Forces; and not less than seven shall be health professionals, scientists, or academics who are not employees of the Federal Government and have expertise in— birth defects; developmental disabilities; epigenetics; public health; the science of environmental exposure or environmental exposure assessment; the science of toxic substances; or medical and research ethics; and may select not more than two nonvoting members who are employees of the Federal Government and who are otherwise described in subparagraph (A)(iii). The Secretary shall select a Chair from among the members of the Advisory Board selected under paragraph (1)(A). Each member of the Advisory Board shall serve a term of 2 or 3 years as determined by the Secretary. At the end of the term of a member of the Advisory Board, the Secretary may reselect the member for another term, except that no member may serve more than 4 consecutive terms.

(“(c) Duties.— The Advisory Board shall— advise the Secretary in the selection of a research entity or entities to conduct research under section 634 from among those identified under section 632(b)(6); advise such entity or entities and assess the activities of such entity or entities in conducting such research; develop a research strategy for such entity or entities based on, but not limited to, the results of the assessment conducted under section 632; advise the Secretary with respect to the activities of such entity or entities under section 634; submit recommendations to be included by such entity or entities in the report under section 634(d)(2)(C); and not less frequently than semiannually, meet with the Secretary and representatives of such entity or entities on the research conducted by such entity or entities under section 634.

(“(d) Meetings.— The Advisory Board shall meet at the call of the Chair, but not less frequently than semiannually.

(“(e) Compensation.— The members of the Advisory Board shall serve without compensation.

(“(f) Expenses.— The Secretary of Veterans Affairs shall determine the appropriate expenses of the Advisory Board.

(“(g) Personnel.— The Chair may, without regard to the civil service laws and regulations, appoint an executive director of the Advisory Board, who shall be a civilian employee of the Department of Veterans Affairs, and such other personnel as may be necessary to enable the Advisory Board to perform its duties. The appointment of an executive director under paragraph (1) shall be subject to approval by the Advisory Board. The Chair may fix the compensation of the executive director and other personnel without regard to the provisions of chapter 51 and subchapter III of chapter 53 of title 5, United States Code, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.

“SEC. 634 RESEARCH RELATING TO HEALTH CONDITIONS OF DESCENDANTS OF VETERANS WITH TOXIC EXPOSURE WHILE SERVING IN THE ARMED FORCES.

(“(a) In General.— Unless the Secretary of Veterans Affairs certifies under section 632(d) that the results of the assessment and determination under section 632(c) indicate that it is not feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, not later than 1 year after receiving such results and determination, the Secretary shall (in consultation with the advisory board established under section 633 (in this section referred to as the ‘Advisory Board’)) enter into an agreement with one or more research entities identified under section 632(b)(6) (excluding an entity of the Department of Veterans Affairs) to conduct research on health conditions of descendants of veterans with toxic exposure while serving as members of the Armed Forces (in this section referred to as the ‘research entity or entities’).

(“(b) Research.— To the extent included in the research strategy developed by the Advisory Board under section 633(c)(3), the research entity or entities shall conduct research on health conditions of descendants of veterans with toxic exposure while serving as members of the Armed Forces. In conducting research under paragraph (1), the research entity or entities may study any veteran, at the election of the veteran, identified under section 632(b)(3)(A) as a type of individual to be studied in order to conduct adequate scientific research relating to the descendants of veterans with toxic exposure. In conducting research under paragraph (1), the research entity or entities shall assess, using the categories established under section 632(b)(4), the extent to which a health condition of a descendant of a veteran is related to the toxic exposure of the veteran while serving as a member of the Armed Forces.

(“(c) Availability of Records.— The Secretary of Defense, the Secretary of Veterans Affairs, and the head of each Federal agency identified under section 632(b)(3)(E) shall make available to the research entity or entities records held by the Department of Veterans Affairs, the Department of Defense, the Armed Forces, that Federal agency, or any other source under the jurisdiction of any such Federal agency or the Armed Forces, as appropriate, that the research entity or entities determine are necessary to carry out this section. The Secretary of Veterans Affairs, the Secretary of Defense, and the head of each Federal agency identified under section 632(b)(3)(E) shall jointly establish a mechanism for access by the research entity or entities to records made available under paragraph (1).

(“(d) Annual Report.— Not later than 1 year after commencing the conduct of research under this section, and not later than September 30 each year thereafter, each research entity with which the Secretary has entered into an agreement under subsection (a) shall, in consultation with the Advisory Board, submit to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a report on the functions of such entity under this section during the year preceding the submittal of the report. Each report submitted under paragraph (1) shall include the following: A summary of the research efforts that have been completed during the year preceding the submittal of the report and that are ongoing as of the date of the submittal of the report. A description of any findings made during such year in carrying out such research efforts. Recommendations for administrative or legislative action made by the Advisory Board based on such findings, which may include recommendations for further research under this section. Upon the request of any organization exempt from taxation under section 501(c)(19) of the Internal Revenue Code of 1986 [ 26 U.S.C. 501(c)(19) ], the Secretary of Veterans Affairs may transmit to such organization a copy of a report received by the Secretary under paragraph (1).”

§ 1116A Presumptions of service connection for veterans who served offshore of the Republic of Vietnam

(a) Service Connection.— For the purposes of section 1110 of this title , and subject to section 1113 of this title , a disease covered by section 1116 of this title becoming manifest as specified in that section in a veteran who, during active military, naval, or air service, served offshore of the Republic of Vietnam during the period beginning on January 9, 1962 , and ending on May 7, 1975 , shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of evidence of such disease during the period of such service.

(b) Exposure.— A veteran who, during active military, naval, or air service, served offshore of the Republic of Vietnam during the period beginning on January 9, 1962 , and ending on May 7, 1975 , shall be presumed to have been exposed during such service to an herbicide agent unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service.

(c) Effective Date of Award.— Except as provided by paragraph (2), the effective date of an award under this section shall be determined in accordance with section 5110 of this title . Notwithstanding subsection (g) of section 5110 of this title , the Secretary shall determine the effective date of an award based on a claim under this section for an individual described in subparagraph (B) by treating the date on which the individual filed the prior claim specified in clause (i) of such subparagraph as the date on which the individual filed the claim so awarded under this section. An individual described in this subparagraph is a veteran, or a survivor of a veteran, who meets the following criteria: The veteran or survivor submitted a claim for disability compensation on or after September 25, 1985 , and before January 1, 2020 , for a disease covered by this section, and the claim was denied by reason of the claim not establishing that the disease was incurred or aggravated by the service of the veteran. The veteran or survivor submits a claim for disability compensation on or after January 1, 2020 , for the same condition covered by the prior claim under clause (i), and the claim is approved pursuant to this section.

(d) Determination of Offshore.— Notwithstanding any other provision of law, for purposes of this section, the Secretary shall treat a location as being offshore of Vietnam if the location is not more than 12 nautical miles seaward of a line commencing on the southwestern demarcation line of the waters of Vietnam and Cambodia and intersecting the following points: Points Geographic Names Latitude North Longitude East At Hon Nhan Island, Tho Chu Archipelago Kien Giang Province 9°15.0′ 103°27.0′ At Hon Da Island southeast of Hon Khoai Island Minh Hai Province 8°22.8′ 104°52.4′ At Tai Lon Islet, Con Dao Islet in Con Dao-Vung Toa Special Sector 8°37.8′ 106°37.5′ At Bong Lai Islet, Con Dao Islet 8°38.9′ 106°40.3′ At Bay Canh Islet, Con Dao Islet 8°39.7′ 106°42.1′ At Hon Hai Islet (Phu Qui group of islands) Thuan Hai Province 9°58.0′ 109°5.0′ At Hon Doi Islet, Thuan Hai Province 12°39.0′ 109°28.0′ At Dai Lanh point, Phu Khanh Province 12°53.8′ 109°27.2′ At Ong Can Islet, Phu Khanh Province 13°54.0′ 109°21.0′ At Ly Son Islet, Nghia Binh Province 15°23.1′ 109° 9.0′ At Con Co Island, Binh Tri Thien Province 17°10.0′ 107°20.6′

(e) Herbicide Agent.— In this section, the term “herbicide agent” has the meaning given that term in section 1116(a)(3) of this title .

§ 1116B Presumption of herbicide exposure for certain veterans who served in Korea

(a) Presumption of Service-Connection.— For the purposes of section 1110 of this title , and subject to section 1113 of this title , a disease specified in subsection (b) that becomes manifest as specified in that subsection in a veteran described in paragraph (2) shall be considered to have been incurred or aggravated in the line of duty in the active military, naval, or air service, notwithstanding that there is no record of evidence of such disease during the period of such service. A veteran described in this paragraph is a veteran who, during active military, naval, or air service, served in or near the Korean Demilitarized Zone (DMZ), during the period beginning on September 1, 1967 , and ending on August 31, 1971 .

(b) Diseases.— A disease specified in this subsection is— a disease specified in paragraph (2) of subsection (a) of section 1116 of this title that becomes manifest as specified in that paragraph; or any additional disease that— pursuant to subchapter VII of this chapter, the Secretary determines in regulations warrants a presumption of service-connection by reason of having positive association with exposure to an herbicide agent; and becomes manifest within any period prescribed in such regulations.

(c) Herbicide Agent.— For purposes of this section, the term “herbicide agent” has the meaning given such term in section 1821(d) of this title .

§ 1117 Compensation for disabilities occurring in Persian Gulf War veterans

(a) The Secretary may pay compensation under this subchapter to a Persian Gulf veteran with a qualifying chronic disability that became manifest to any degree at any time. For purposes of this subsection, the term “qualifying chronic disability” means a chronic disability resulting from any of the following (or any combination of any of the following): An undiagnosed illness. A medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms. Any diagnosed illness that the Secretary determines in regulations prescribed under subsection (c) warrants a presumption of service-connection.

(b) Whenever the Secretary determines under section 1118(c) 1 of this title that a presumption of service connection previously established under this section is no longer warranted— a veteran who was awarded compensation under this section on the basis of the presumption shall continue to be entitled to receive compensation under this section on that basis; and a survivor of a veteran who was awarded dependency and indemnity compensation for the death of a veteran resulting from the disease on the basis of the presumption before that date shall continue to be entitled to receive dependency and indemnity compensation on that basis. This subsection shall cease to be effective on September 30, 2011 .

(c) The Secretary shall prescribe regulations to carry out this section. Those regulations shall include the following: A description of the period and geographical area or areas of military service in connection with which compensation under this section may be paid. A description of the illnesses for which compensation under this section may be paid. A description of any relevant medical characteristic (such as a latency period) associated with each such illness.

(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, designed to identify Gulf War Illness, in addition to any other diagnostic actions the personnel determine appropriate.

(e) A disability for which compensation under this subchapter is payable shall be considered to be service connected for purposes of all other laws of the United States.

(f) For purposes of this section, the term “Persian Gulf veteran” means a veteran who served on active duty in the Armed Forces in the Southwest Asia theater of operations, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, during the Persian Gulf War.

(g) For purposes of this section, signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multisymptom illness include the following: Fatigue. Unexplained rashes or other dermatological signs or symptoms. Headache. Muscle pain. Joint pain. Neurological signs and symptoms. Neuropsychological signs or symptoms. Signs or symptoms involving the upper or lower respiratory system. Sleep disturbances. Gastrointestinal signs or symptoms. Cardiovascular signs or symptoms. Abnormal weight loss. Menstrual disorders.

(h) If the Secretary determines with respect to a medical research project sponsored by the Department that it is necessary for the conduct of the project that Persian Gulf veterans in receipt of compensation under this section or section 1118 of this title participate in the project without the possibility of loss of service connection under either such section, the Secretary shall provide that service connection granted under either such section for disability of a veteran who participated in the research project may not be terminated. Except as provided in paragraph (2), notwithstanding any other provision of law any grant of service-connection protected under this subsection shall remain service-connected for purposes of all provisions of law under this title. Paragraph (1) does not apply in a case in which— the original award of compensation or service connection was based on fraud; or it is clearly shown from military records that the person concerned did not have the requisite service or character of discharge. The Secretary shall publish in the Federal Register a list of medical research projects sponsored by the Department for which service connection granted under this section or section 1118 of this title may not be terminated pursuant to paragraph (1).

(i) 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. 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).

“SEC. 1603 AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES.

(“(a) Purpose.— The purpose of this section is to provide for the National Academy of Sciences, an independent nonprofit scientific organization with appropriate expertise, to review and evaluate the available scientific evidence regarding associations between illnesses and exposure to toxic agents, environmental or wartime hazards, or preventive medicines or vaccines associated with Gulf War service.

(“(b) Agreement.— The Secretary of Veterans Affairs shall seek to enter into an agreement with the National Academy of Sciences for the Academy to perform the activities covered by this section. The Secretary shall seek to enter into the agreement not later than two months after the date of enactment of this Act [ Oct. 21, 1998 ].

(“(c) Identification of Agents and Illnesses.— Under the agreement under subsection (b), the National Academy of Sciences shall— identify the biological, chemical, or other toxic agents, environmental or wartime hazards, or preventive medicines or vaccines to which members of the Armed Forces who may have been exposed by reason of service in the Southwest Asia theater of operations during the Persian Gulf War or, after September 11, 2001 , in another Post-9/11 Global Theater of Operations; and identify the illnesses (including diagnosed illnesses and undiagnosed illnesses) that are manifest in such members. In identifying illnesses under paragraph (1)(B), the Academy shall review and summarize the relevant scientific evidence regarding illnesses among the members described in paragraph (1)(A) and among other appropriate populations of individuals, including mortality, symptoms, and adverse reproductive health outcomes among such members and individuals.

(“(d) Initial Consideration of Specific Agents.— In identifying under subsection (c) the agents, hazards, or preventive medicines or vaccines to which members of the Armed Forces may have been exposed for purposes of the first report under subsection (i), the National Academy of Sciences shall consider, within the first six months after the date of enactment of this Act [ Oct. 21, 1998 ], the following: The following organophosphorous pesticides: Chlorpyrifos. Diazinon. Dichlorvos. Malathion. The following carbamate pesticides: Proxpur. Carbaryl. Methomyl. The carbamate pyridostigmine bromide used as nerve agent prophylaxis. The following chlorinated hydrocarbon and other pesticides and repellents: Lindane. Pyrethrins. Permethrins. Rodenticides (bait). Repellent (DEET). The following low-level nerve agents and precursor compounds at exposure levels below those which produce immediately apparent incapacitating symptoms: Sarin. Tabun. The following synthetic chemical compounds: Mustard agents at levels below those which cause immediate blistering. Volatile organic compounds. Hydrazine. Red fuming nitric acid. Solvents. Uranium. The following ionizing radiation: Depleted uranium. Microwave radiation. Radio frequency radiation. The following environmental particulates and pollutants: Hydrogen sulfide. Oil fire byproducts. Diesel heater fumes. Sand micro-particles. Diseases endemic to the region (including the following): Leishmaniasis. Sandfly fever. Pathogenic escherechia coli. Shigellosis. Time compressed administration of multiple live, ‘attenuated’, and toxoid vaccines. The consideration of agents, hazards, and medicines and vaccines under paragraph (1) shall not preclude the Academy from identifying other agents, hazards, or medicines or vaccines to which members of the Armed Forces may have been exposed for purposes of any report under subsection (i). Not later than six months after the date of enactment of this Act [ Oct. 21, 1998 ], the Academy shall submit to the designated congressional committees a report specifying the agents, hazards, and medicines and vaccines considered under paragraph (1).

(“(e) Determinations of Associations Between Agents and Illnesses.— For each agent, hazard, or medicine or vaccine and illness identified under subsection (c), the National Academy of Sciences shall determine, to the extent that available scientific data permit meaningful determinations— whether a statistical association exists between exposure to the agent, hazard, or medicine or vaccine and the illness, taking into account the strength of the scientific evidence and the appropriateness of the scientific methodology used to detect the association; the increased risk of the illness among human or animal populations exposed to the agent, hazard, or medicine or vaccine; and whether a plausible biological mechanism or other evidence of a causal relationship exists between exposure to the agent, hazard, or medicine or vaccine and the illness. The Academy shall include in its reports under subsection (i) a full discussion of the scientific evidence and reasoning that led to its conclusions under this subsection.

(“(f) Review of Potential Treatment Models for Certain Illnesses.— Under the agreement under subsection (b), the National Academy of Sciences shall separately review, for each chronic undiagnosed illness identified under subsection (c)(1)(B) and for any other chronic illness that the Academy determines to warrant such review, the available scientific data in order to identify empirically valid models of treatment for such illnesses which employ successful treatment modalities for populations with similar symptoms.

(“(g) Recommendations for Additional Scientific Studies.— Under the agreement under subsection (b), the National Academy of Sciences shall make any recommendations that it considers appropriate for additional scientific studies (including studies relating to treatment models) to resolve areas of continuing scientific uncertainty relating to the health consequences of exposure to toxic agents, environmental or wartime hazards, or preventive medicines or vaccines associated with service described in subsection (c)(1)(A). In making recommendations for additional studies, the Academy shall consider the available scientific data, the value and relevance of the information that could result from such studies, and the cost and feasibility of carrying out such studies.

(“(h) Subsequent Reviews.— Under the agreement under subsection (b), the National Academy of Sciences shall conduct on a periodic and ongoing basis additional reviews of the evidence and data relating to its activities under this section. As part of each review under this subsection, the Academy shall— conduct as comprehensive a review as is practicable of the evidence referred to in subsection (c) and the data referred to in subsections (e), (f), and (g) that became available since the last review of such evidence and data under this section; and make determinations under the subsections referred to in subparagraph (A) on the basis of the results of such review and all other reviews previously conducted for purposes of this section.

(“(i) Reports.— Under the agreement under subsection (b), the National Academy of Sciences shall submit to the committees and officials referred to in paragraph (6) periodic written reports regarding the Academy’s activities under the agreement. The first report under paragraph (1) shall be submitted not later than 18 months after the date of enactment of this Act [ Oct. 21, 1998 ]. That report shall include— the determinations and discussion referred to in subsection (e); the results of the review of models of treatment under subsection (f); and any recommendations of the Academy under subsection (g). Reports shall be submitted under this subsection at least once every two years, as measured from the date of the report under paragraph (2). In any report under this subsection (other than the report under paragraph (2)), the Academy may specify an absence of meaningful developments in the scientific or medical community with respect to the activities of the Academy under this section during the 2-year period ending on the date of such report. In each report under this subsection submitted after the date of the enactment of this paragraph [ Oct. 13, 2010 ], any determinations, results, and recommendations as described in paragraph (2) shall be submitted separately as follows: For the Southwest Asia theater of operations for the period of the Persian Gulf War ending on September 11, 2001 . For the Post-9/11 Global Theaters of Operations for the period of the Persian Gulf War beginning on September 11, 2001 . Reports under this subsection shall be submitted to the following: The designated congressional committees. The Secretary of Veterans Affairs. The Secretary of Defense.

(“(j) Sunset.— This section shall cease to be effective on October 1, 2015 .

(“(k) Alternative Contract Scientific Organization.— If the Secretary is unable within the time period set forth in subsection (b) to enter into an agreement with the National Academy of Sciences for the purposes of this section on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for purposes of this section with another appropriate scientific organization that is not part of the Government, operates as a not-for-profit entity, and has expertise and objectivity comparable to that of the National Academy of Sciences. If the Secretary enters into an agreement with another organization under this subsection, any reference in this section and section 1118 of title 38 , United States Code (as added by section 1602(a)), to the National Academy of Sciences shall be treated as a reference to such other organization.

(“(l) Definitions.— In this section: The term ‘Persian Gulf War’ has the meaning given that term in section 101(33) of title 38 , United States Code. The term ‘Post-9/11 Global Theater of Operations’ means Afghanistan, Iraq, and any other theater of operations for which the Global War on Terrorism Expeditionary Medal is awarded for service.

“[SEC. 1604

Repealed. Pub. L. 111–275, title VIII, § 806(b)(3) , Oct. 13, 2010 , 124 Stat. 2893 .]

“SEC. 1605 DEFINITIONS.

“In this title [enacting section 1118 of this title , amending this section and section 1113 of this title , and enacting this note and provisions set out as a note under section 101 of this title ]: The term ‘toxic agent, environmental or wartime hazard, or preventive medicine or vaccine associated with Gulf War service’ means a biological, chemical, or other toxic agent, environmental or wartime hazard, or preventive medicine or vaccine that is known or presumed to be associated with service in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, whether such association arises as a result of single, repeated, or sustained exposure and whether such association arises through exposure singularly or in combination. The term ‘designated congressional committees’ means the following: The Committees on Veterans’ Affairs and Armed Services of the Senate. The Committees on Veterans’ Affairs and National Security [now Armed Services] of the House of Representatives. The term ‘Persian Gulf War’ has the meaning given that term in section 101(33) of title 38 , United States Code.”

“SEC. 102 FINDINGS.

“The Congress makes the following findings: During the Persian Gulf War, members of the Armed Forces were exposed to numerous potentially toxic substances, including fumes and smoke from military operations, oil well fires, diesel exhaust, paints, pesticides, depleted uranium, infectious agents, investigational drugs and vaccines, and indigenous diseases, and were also given multiple immunizations. It is not known whether these servicemembers were exposed to chemical or biological warfare agents. However, threats of enemy use of chemical and biological warfare heightened the psychological stress associated with the military operation. Significant numbers of veterans of the Persian Gulf War are suffering from illnesses, or are exhibiting symptoms of illness, that cannot now be diagnosed or clearly defined. As a result, many of these conditions or illnesses are not considered to be service connected under current law for purposes of benefits administered by the Department of Veterans Affairs. The National Institutes of Health Technology Assessment Workshop on the Persian Gulf Experience and Health, held in April 1994, concluded that the complex biological, chemical, physical, and psychological environment of the Southwest Asia theater of operations produced complex adverse health effects in Persian Gulf War veterans and that no single disease entity or syndrome is apparent. Rather, it may be that the illnesses suffered by those veterans result from multiple illnesses with overlapping symptoms and causes that have yet to be defined. That workshop concluded that the information concerning the range and intensity of exposure to toxic substances by military personnel in the Southwest Asia theater of operations is very limited and that such information was collected only after a considerable delay. In response to concerns regarding the health-care needs of Persian Gulf War veterans, particularly those who suffer from illnesses or conditions for which no diagnosis has been made, the Congress, in Public Law 102–585 [see Short Title of 1992 Amendments note under section 101 of this title ], directed the establishment of a Persian Gulf War Veterans Health Registry, authorized health examinations for veterans of the Persian Gulf War, and provided for the National Academy of Sciences to conduct a comprehensive review and assessment of information regarding the health consequences of military service in the Persian Gulf theater of operations and to develop recommendations on avenues for research regarding such health consequences. In Public Law 103–210 [see Tables for classification], the Congress authorized the Department of Veterans Affairs to provide health care services on a priority basis to Persian Gulf War veterans. The Congress also provided in Public Law 103–160 (the National Defense Authorization Act for Fiscal Year 1994) [see Tables for classification] for the establishment of a specialized environmental medical facility for the conduct of research into the possible health effects of exposure to low levels of hazardous chemicals, especially among Persian Gulf veterans, and for research into the possible health effects of battlefield exposure in such veterans to depleted uranium. In response to concerns about the lack of objective research on Gulf War illnesses, Congress included research provisions in the National Defense Authorization Act for Fiscal Year 1995 [ Pub. L. 103–337 , see Tables for classification], which was passed by the House and Senate in September 1994. This legislation requires the Secretary of Defense to provide research grants to non-Federal researchers to support three types of studies of the Gulf War syndrome. The first type of study will be an epidemiological study or studies of the incidence, prevalence, and nature of the illness and symptoms and the risk factors associated with symptoms or illnesses. This will include illnesses among spouses and birth defects and illnesses among offspring born before and after the Gulf War. The second group of studies shall be conducted to determine the health consequences of the use of pyridostigmine bromide as a pretreatment antidote enhancer during the Persian Gulf War, alone or in combination with exposure to pesticides, environmental toxins, and other hazardous substances. The final group of studies shall include clinical research and other studies on the causes, possible transmission, and treatment of Gulf War syndrome, and will include studies of veterans and their spouses and children. Further research and studies must be undertaken to determine the underlying causes of the illnesses suffered by Persian Gulf War veterans and, pending the outcome of such research, veterans who are seriously ill as the result of such illnesses should be given the benefit of the doubt and be provided compensation benefits to offset the impairment in earnings capacities they may be experiencing.

“SEC. 103 PURPOSES.

“The purposes of this title [see Short Title of 1994 Amendments note under section 101 of this title ] are— to provide compensation to Persian Gulf War veterans who suffer disabilities resulting from illnesses that cannot now be diagnosed or defined, and for which other causes cannot be identified; to require the Secretary of Veterans Affairs to develop at the earliest possible date case assessment strategies and definitions or diagnoses of such illnesses; to promote greater outreach to Persian Gulf War veterans and their families to inform them of ongoing research activities, as well as the services and benefits to which they are currently entitled; and to ensure that research activities and accompanying surveys of Persian Gulf War veterans are appropriately funded and undertaken by the Department of Veterans Affairs.

“SEC. 104 DEVELOPMENT OF MEDICAL EVALUATION PROTOCOL.

(“(a) Uniform Medical Evaluation Protocol.— The Secretary of Veterans Affairs shall develop and implement a uniform and comprehensive medical evaluation protocol that will ensure appropriate medical assessment, diagnosis, and treatment of Persian Gulf War veterans who are suffering from illnesses the origins of which are (as of the date of the enactment of this Act [ Nov. 2, 1994 ]) unknown and that may be attributable to service in the Southwest Asia theater of operations during the Persian Gulf War. The protocol shall include an evaluation of complaints relating to illnesses involving the reproductive system. If such a protocol is not implemented before the end of the 120-day period beginning on the date of the enactment of this Act [ Nov. 2, 1994 ], the Secretary shall, before the end of such period, submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report as to why such a protocol has not yet been developed. The Secretary shall ensure that the evaluation under the protocol developed under this section is available at all Department medical centers that have the capability of providing the medical assessment, diagnosis, and treatment required under the protocol. The Secretary may enter into contracts with non-Department medical facilities for the provision of the evaluation under the protocol. In the case of a veteran whose residence is distant from a medical center described in subparagraph (A), the Secretary may provide the evaluation through a Department medical center described in that subparagraph and, in such a case, may provide the veteran the travel and incidental expenses therefor pursuant to the provisions of section 111 of title 38 , United States Code. If the Secretary is unable to diagnose the symptoms or illness of a veteran provided an evaluation, or if the symptoms or illness of a veteran do not respond to treatment provided by the Secretary, the Secretary may use the authority in sections 1703A, 8111, and 8153 of title 38, United States Code, in order to provide for the veteran to receive diagnostic tests or treatment at a non-Department medical facility that may have the capability of diagnosing or treating the symptoms or illness of the veteran. The Secretary may provide the veteran the travel and incidental expenses therefor pursuant to the provisions of section 111 of title 38 , United States Code. The Secretary shall request from each non-Department medical facility that examines or treats a veteran under this paragraph such information relating to the diagnosis or treatment as the Secretary considers appropriate. In each year after the implementation of the protocol, the Secretary shall enter into an agreement with the National Academy of Sciences under which agreement appropriate experts shall review the adequacy of the protocol and its implementation by the Department of Veterans Affairs.

(“(b) Relationship to Other Comprehensive Clinical Evaluation Protocols.— The Secretary, in consultation with the Secretary of Defense, shall ensure that the information collected through the protocol described in this section is collected and maintained in a manner that permits the effective and efficient cross-reference of that information with information collected and maintained through the comprehensive clinical protocols of the Department of Defense for Persian Gulf War veterans.

(“(c) Case Definitions and Diagnoses.— The Secretary shall develop case definitions or diagnoses for illnesses associated with the service described in subsection (a)(1). The Secretary shall develop such definitions or diagnoses at the earliest possible date.

“SEC. 105 OUTREACH TO PERSIAN GULF VETERANS.

(“(a) In General.— The Secretary of Veterans Affairs shall implement a comprehensive outreach program to inform Persian Gulf War veterans and their families of the medical care and other benefits that may be provided by the Department of Veterans Affairs and the Department of Defense arising from service in the Persian Gulf War.

(“(b) Newsletter.— The outreach program shall include a newsletter which shall be updated and distributed at least semi-annually and shall be distributed to the veterans listed on the Persian Gulf War Veterans Health Registry. The newsletter shall include summaries of the status and findings of Government sponsored research on illnesses of Persian Gulf War veterans and their families, as well as on benefits available to such individuals through the Department of Veterans Affairs. The newsletter shall be prepared in consultation with veterans service organizations. The requirement under this subsection for the distribution of the newsletter shall terminate on December 31, 2003 .

(“(c) Toll-Free Number.— The outreach program shall include establishment of a toll-free telephone number to provide Persian Gulf War veterans and their families information on the Persian Gulf War Veterans Health Registry, health care and other benefits provided by the Department of Veterans Affairs, and such other information as the Secretary considers appropriate. Such toll-free telephone number shall be established not later than 90 days after the date of the enactment of this Act [ Nov. 2, 1994 ].

“SEC. 107 EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN OF PERSIAN GULF WAR VETERANS.

(“(a) Evaluation Program.— Subject to subsection (c), the Secretary of Veterans Affairs shall conduct a program to evaluate the health status of spouses and children of Persian Gulf War veterans. Under the program, the Secretary shall provide for the conduct of diagnostic testing and appropriate medical examinations of any individual— who is the spouse or child of a veteran who— is listed in the Persian Gulf War Veterans Registry established under section 702 of Public Law 102–585 [set out in a note under section 527 of this title ]; and is suffering from an illness or disorder; who is apparently suffering from, or may have suffered from, an illness or disorder (including a birth defect, miscarriage, or stillbirth) which cannot be disassociated from the veteran’s service in the Southwest Asia theater of operations; and who, in the case of a spouse, has granted the Secretary permission to include in the Registry relevant medical data (including a medical history and the results of diagnostic testing and medical examinations) and such other information as the Secretary considers relevant and appropriate with respect to such individual.

(“(b) Duration of Program.— The program shall be carried out during the period beginning on November 1, 1994 , and ending on December 31, 2003 .

(“(c) Funding Limitation.— The amount spent for the program under subsection (a) may not exceed $2,000,000.

(“(d) Contracting.— The Secretary may provide for the conduct of testing and examinations under subsection (a) through appropriate contract arrangements, including fee arrangements described in section 1703 of title 38 , United States Code.

(“(e) Standard Protocols and Guidelines.— The Secretary shall seek to ensure uniform development of medical data through the development of standard protocols and guidelines for such testing and examinations. If such protocols and guidelines have not been adopted before the end of the 120-day period beginning on the date of the enactment of this Act [ Nov. 2, 1994 ], the Secretary shall, before the end of such period, submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report as to why such protocols and guidelines have not yet been developed.

(“(f) Entry of Results in Registry.— The results of diagnostic tests, medical histories, and medical examinations conducted under subsection (a) shall be entered into the Persian Gulf War Veterans Health Registry.

(“(g) Outreach.— The Secretary shall conduct such outreach activities as the Secretary determines necessary for the purposes of the program. In conducting such outreach activities, the Secretary shall advise that medical treatment is not available under the program.

(“(h) Use Outside Department of Standard Protocols and Guidelines.— The Secretary shall— make the standard protocols and guidelines developed under this section available to any entity which requests a copy of such protocols and guidelines; and enter into the registry the results of any examination of the spouse or child of a veteran who served in the Persian Gulf theater which a licensed physician certifies was conducted using those standard protocols and guidelines.

(“(i) Report to Congress.— Not later than July 31, 1999 , the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on activities with respect to the program, including the provision of services under subsection (d).

(“(j) Definitions.— For purposes of this section, the terms ‘child’ and ‘spouse’ have the meanings given those terms in paragraphs (4) and (31), respectively, of section 101 of title 38 , United States Code.

“SEC. 109 SURVEY OF PERSIAN GULF VETERANS.

(“(a) In General.— The Secretary of Veterans Affairs may carry out a survey of Persian Gulf veterans to gather information on the incidence and nature of health problems occurring in Persian Gulf veterans and their families.

(“(b) Coordination With Department of Defense.— Any survey under subsection (a) shall be carried out in coordination with the Secretary of Defense.

(“(c) Persian Gulf Veteran.— For purposes of this section, a Persian Gulf veteran is an individual who served on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War as defined in section 101(33) of title 38 , United States Code.

“SEC. 110 AUTHORIZATION FOR EPIDEMIOLOGICAL STUDIES.

(“(a) Study of Health Consequences of Persian Gulf Service.— If the National Academy of Sciences includes in the report required by section 706(b) of the Veterans Health Care Act of 1992 ( Public Law 102–585 ) [set out in a note under section 527 of this title ] a finding that there is a sound basis for an epidemiological study or studies on the health consequences of service in the Persian Gulf theater of operations during the Persian Gulf War and recommends the conduct of such a study or studies, the Secretary of Veterans Affairs is authorized to carry out such study.

(“(b) Oversight.— The Secretary shall seek to enter into an agreement with the Medical Follow-Up Agency (MFUA) of the Institute of Medicine of the National Academy of Sciences for (A) the review of proposals to conduct the research referred to in subsection (a), (B) oversight of such research, and (C) review of the research findings. If the Secretary is unable to enter into an agreement under paragraph (1) with the entity specified in that paragraph, the Secretary shall enter into an agreement described in that paragraph with another appropriate scientific organization which does not have a connection to the Department of Veterans Affairs. In such a case, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives, at least 90 days before the date on which the agreement is entered into, notice in writing identifying the organization with which the Secretary intends to enter into the agreement.

(“(c) Access to Data.— The Secretary shall enter into agreements with the Secretary of Defense and the Secretary of Health and Human Services to make available for the purposes of any study described in subsection (a) all data that the Secretary, in consultation with the National Academy of Sciences and the contractor for the study, considers relevant to the study.

(“(d) Authorization.— There are authorized to be appropriated to the Department such sums as are necessary for the conduct of studies described in subsection (a).”

§ 1118 Presumptions of service connection for illnesses associated with service in the Persian Gulf during the Persian Gulf War

(a) For purposes of section 1110 of this title , and subject to section 1113 of this title , each illness, if any, described in paragraph (2) shall be considered to have been incurred in or aggravated by service referred to in that paragraph, notwithstanding that there is no record of evidence of such illness during the period of such service. An illness referred to in paragraph (1) is any diagnosed or undiagnosed illness that— the Secretary determines in regulations prescribed under this section to warrant a presumption of service connection by reason of having a positive association with exposure to a biological, chemical, or other toxic agent, environmental or wartime hazard, or preventive medicine or vaccine known or presumed to be associated with service in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War; and becomes manifest within the period, if any, prescribed in such regulations in a veteran who served on active duty in that theater of operations during that war and by reason of such service was exposed to such agent, hazard, or medicine or vaccine. For purposes of this subsection, a veteran who served on active duty in the Southwest Asia theater of operations during the Persian Gulf War and has an illness described in paragraph (2) shall be presumed to have been exposed by reason of such service to the agent, hazard, or medicine or vaccine associated with the illness in the regulations prescribed under this section unless there is conclusive evidence to establish that the veteran was not exposed to the agent, hazard, or medicine or vaccine by reason of such service. For purposes of this section, signs or symptoms that may be a manifestation of an undiagnosed illness include the signs and symptoms listed in section 1117(g) of this title .

(b) The Secretary shall ensure that any determination made on or after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter.

§ 1119 Presumptions of toxic exposure

(a) Consideration of Records.— If a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and a toxic exposure that occurred during active military, naval, air, or space service, the Secretary may, in adjudicating such claim, consider— any record of the veteran in an exposure tracking record system; and if no record of the veteran in an exposure tracking record system indicates that the veteran was subject to a toxic exposure during active military, naval, air, or space service, the totality of the circumstances of the service of the veteran.

(b) Presumption of Specific Toxic Exposure for Members Who Served in Certain Locations.— The Secretary shall, for purposes of section 1110 and chapter 17 of this title, presume that any covered veteran was exposed to the substances, chemicals, and airborne hazards identified in the list under paragraph (2) during the service of the covered veteran specified in subsection (c)(1), unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. The Secretary shall— establish and maintain a list that contains an identification of one or more such substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate for purposes of this section; and determine, using procedures consistent with section 1172 of this title and through the conduct of a formal evaluation under section 1173 of this title , whether to establish an end date for a covered veteran to qualify for presumptions of exposure under this section, if appropriate, but in no case establish an end date earlier than the last day of the period specified in section 101(33) for the Persian Gulf War. Beginning not later than two years after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, and not less frequently than once every two years 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 identifying any additions or removals to the list under paragraph (2) during the period covered by the report.

(c) Definitions.— In this section: The term “covered veteran” means any veteran who— on or after August 2, 1990 , performed active military, naval, air, or space service while assigned to a duty station in, including airspace above— Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; or United Arab Emirates; or on or after September 11, 2001 , performed active military, naval, air, or space service while assigned to a duty station in, including airspace above— Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; Uzbekistan; or any other country determined relevant by the Secretary. The term “exposure tracking record system”— means any system, program, or pilot program used by the Secretary of Veterans Affairs or the Secretary of Defense to track how veterans or members of the Armed Forces have been exposed to various occupational or environmental hazards; and includes the Individual Longitudinal Exposure Record, or successor system. The term “toxic exposure risk activity” has the meaning given such term in section 1710(e)(4) of this title .

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

(a) Presumption of Service Connection.— For the purposes of section 1110 of this title , and subject to section 1113 of this title , a disease specified in subsection (b) becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service, notwithstanding that there is no record of evidence of such disease during the period of such service.

(b) Diseases Specified.— The diseases specified in this subsection are the following: Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). The following types of cancer: Head cancer of any type. Neck cancer of any type. Respiratory cancer of any type. Gastrointestinal cancer of any type. Reproductive cancer of any type. Lymphoma cancer of any type. Kidney cancer. Brain cancer. Melanoma. Pancreatic cancer. Chronic bronchitis. Chronic obstructive pulmonary disease. Constrictive bronchiolitis or obliterative bronchiolitis. Emphysema. Granulomatous disease. Interstitial lung disease. Pleuritis. Pulmonary fibrosis. Sarcoidosis. Chronic sinusitis. Chronic rhinitis. Glioblastoma. Any other disease for which the Secretary determines, pursuant to regulations prescribed under subchapter VII that a presumption of service connection is warranted based on a positive association with a substance, chemical, or airborne hazard identified in the list under section 1119(b)(2) of this title .

(c) Covered Veteran Defined.— In this section, the term “covered veteran” has the meaning given that term in section 1119(c) of this title .

§ 1121 Basic entitlement

The surviving spouse, child or children, and dependent parent or parents of any veteran who died before January 1, 1957 as the result of injury or disease incurred in or aggravated by active military, naval, or air service, in line of duty, during a period of war, shall be entitled to receive compensation at the monthly rates specified in section 1122 of this title . ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1122 , § 321; Pub. L. 92–197, § 6 , Dec. 15, 1971 , 85 Stat. 662 ; Pub. L. 94–433, title IV, § 404(12) , Sept. 30, 1976 , 90 Stat. 1378 ; renumbered § 1121 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 .)

§ 1122 Rates of wartime death compensation

(a) The monthly rates of death compensation shall be as follows: Surviving spouse but no child, $87;Survivingspousewithonechild,$121 (with $29foreachadditionalchild);Nosurvivingspousebutonechild,$67; No surviving spouse but two children, $94(equallydivided);Nosurvivingspousebutthreechildren,$122 (equally divided) (with $23foreachadditionalchild,totalamounttobeequallydivided);Dependentparent,$75; Both dependent parents, $40 each.

(b) The monthly rate of death compensation payable to a surviving spouse or dependent parent under subsection (a) of this section shall be increased by $79 if the payee is (1) a patient in a nursing home or (2) blind, or so nearly blind or significantly disabled as to need or require the regular aid and attendance of another person.

§ 1131 Basic entitlement

For disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, air, or space service, during other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1122 , § 331; Pub. L. 101–508, title VIII, § 8052(a)(3) , Nov. 5, 1990 , 104 Stat. 1388–351 ; renumbered § 1131, Pub. L. 102–83, § 5(a) , Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 105–178, title VIII, § 8202(b) , June 9, 1998 , 112 Stat. 492 ; Pub. L. 105–206, title IX, § 9014(a) , July 22, 1998 , 112 Stat. 865 ; Pub. L. 116–283, div. A, title IX, § 926(a)(10) , Jan. 1, 2021 , 134 Stat. 3830 .)

§ 1132 Presumption of sound condition

For the purposes of section 1131 of this title , every person employed in the active military, naval, air, or space service for six months or more shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1122 , § 332; renumbered § 1132 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 116–283, div. A, title IX, § 926(a)(11) , Jan. 1, 2021 , 134 Stat. 3830 .)

§ 1133 Presumptions relating to certain diseases

(a) For the purposes of section 1131 of this title , and subject to the provisions of subsections (b) and (c) of this section, any veteran who served for six months or more and contracts a tropical disease or a resultant disorder or disease originating because of therapy administered in connection with a tropical disease, or as a preventative thereof, shall be deemed to have incurred such disability in the active military, naval, air, or space service when it is shown to exist within one year after separation from active service, or at a time when standard and accepted treatises indicate that the incubation period thereof commenced during active service.

(b) Service-connection shall not be granted pursuant to subsection (a), in any case where the disease or disorder is shown by clear and unmistakable evidence to have had its inception before or after active military, naval, air, or space service.

(c) Nothing in this section shall be construed to prevent the granting of service-connection for any disease or disorder otherwise shown by sound judgment to have been incurred in or aggravated by active military, naval, air, or space service.

§ 1134 Rates of peacetime disability compensation

For the purposes of section 1131 of this title , the compensation payable for the disability shall be that specified in section 1114 of this title . ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1123 , § 334; Pub. L. 92–328, title I, § 108(a) , June 30, 1972 , 86 Stat. 396 ; renumbered § 1134 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 .)

§ 1135 Additional compensation for dependents

Any veteran entitled to compensation at the rates provided in section 1134 of this title , and whose disability is rated not less than 30 percent, shall be entitled to additional monthly compensation for dependents as provided in section 1115 of this title . ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1123 , § 335; Pub. L. 92–328, title I, § 108(b) , June 30, 1972 , 86 Stat. 396 ; Pub. L. 98–543, title I, § 112(a) , Oct. 24, 1984 , 98 Stat. 2740 ; renumbered § 1135 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 .)

[§ 1136 Vacant]

§ 1137 Wartime presumptions for certain veterans

For the purposes of this subchapter and subchapter V of this chapter and notwithstanding the provisions of sections 1132 and 1133 of this subchapter, the provisions of sections 1111, 1112, and 1113 of this chapter shall be applicable in the case of any veteran who served in the active military, naval, air, or space service after December 31, 1946 . (Added Pub. L. 89–358, § 7(a) , Mar. 3, 1966 , 80 Stat. 27 , § 337; amended Pub. L. 93–295, title II, § 205 , May 31, 1974 , 88 Stat. 183 ; renumbered § 1137 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 116–283, div. A, title IX, § 926(a)(13) , Jan. 1, 2021 , 134 Stat. 3830 .)

§ 1141 Basic entitlement

The surviving spouse, child or children, and dependent parent or parents of any veteran who died before January 1, 1957 , as the result of injury or disease incurred in or aggravated by active military, naval, air, or space service, in line of duty, during other than a period of war, shall be entitled to receive compensation as hereinafter provided in this subchapter. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1123 , § 341; Pub. L. 92–197, § 6 , Dec. 15, 1971 , 85 Stat. 662 ; Pub. L. 94–433, title IV, § 404(18) , Sept. 30, 1976 , 90 Stat. 1379 ; renumbered § 1141, Pub. L. 102–83, § 5(a) , Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 116–283, div. A, title IX, § 926(a)(14) , Jan. 1, 2021 , 134 Stat. 3830 .)

§ 1142 Rates of peacetime death compensation

For the purposes of section 1141 of this title , the monthly rates of death compensation payable shall be those specified in section 1122 of this title . ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1124 , § 342; Pub. L. 93–295, title II, § 206(a) , May 31, 1974 , 88 Stat. 183 ; renumbered § 1142 and amended Pub. L. 102–83, § 5(a) , (c)(1), Aug. 6, 1991 , 105 Stat. 406 .)

[§ 1143 Vacant]

§ 1151 Benefits for persons disabled by treatment or vocational rehabilitation

(a) Compensation under this chapter and dependency and indemnity compensation under chapter 13 of this title shall be awarded for a qualifying additional disability or a qualifying death of a veteran in the same manner as if such additional disability or death were service-connected. For purposes of this section, a disability or death is a qualifying additional disability or qualifying death if the disability or death was not the result of the veteran’s willful misconduct and— the disability or death was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by the Secretary, either by a Department employee or in a Department facility as defined in section 1701(3)(A) of this title , and the proximate cause of the disability or death was— carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or an event not reasonably foreseeable; or the disability or death was proximately caused (A) by the provision of training and rehabilitation services by the Secretary (including by a service-provider used by the Secretary for such purpose under section 3115 of this title ) as part of an approved rehabilitation program under chapter 31 of this title, or (B) by participation in a program (known as a “compensated work therapy program”) under section 1718 of this title .

(b) Where an individual is, on or after December 1, 1962 , awarded a judgment against the United States in a civil action brought pursuant to section 1346(b) of title 28 or, on or after December 1, 1962 , enters into a settlement or compromise under section 2672 or 2677 of title 28 by reason of a disability or death treated pursuant to this section as if it were service-connected, then (except as otherwise provided in paragraph (2)) no benefits shall be paid to such individual for any month beginning after the date such judgment, settlement, or compromise on account of such disability or death becomes final until the aggregate amount of benefits which would be paid but for this subsection equals the total amount included in such judgment, settlement, or compromise. In the case of a judgment, settlement, or compromise covered by paragraph (1) that becomes final on or after the date of the enactment of this paragraph and that includes an amount that is specifically designated for a purpose for which benefits are provided under chapter 21 or 39 of this title (hereinafter in this paragraph referred to as the “offset amount”), if such judgment, settlement, or compromise becomes final before the date of the award of benefits under chapter 21 or 39 for the purpose for which the offset amount was specifically designated— the amount of such award shall be reduced by the offset amount; and if the offset amount is greater than the amount of such award, the excess amount received pursuant to the judgment, settlement or compromise, shall be offset against benefits otherwise payable under this chapter.

(c) A qualifying additional disability under this section shall be treated in the same manner as if it were a service-connected disability for purposes of the following provisions of this title: Chapter 21, relating to specially adapted housing. Chapter 39, relating to automobiles and adaptive equipment.

§ 1152 Persons heretofore having a compensable status

The death and disability benefits of this chapter shall, notwithstanding the service requirements thereof, be granted to persons heretofore recognized by law as having a compensable status, including persons whose claims are based on war or peacetime service rendered before April 21, 1898 . ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1124 , § 352; renumbered § 1152, Pub. L. 102–83, § 5(a) , Aug. 6, 1991 , 105 Stat. 406 .)

§ 1153 Aggravation

A preexisting injury or disease will be considered to have been aggravated by active military, naval, air, or space service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1124 , § 353; renumbered § 1153, Pub. L. 102–83, § 5(a) , Aug. 6, 1991 , 105 Stat. 406 ; Pub. L. 116–283, div. A, title IX, § 926(a)(15) , Jan. 1, 2021 , 134 Stat. 3830 .)

§ 1154 Consideration to be accorded time, place, and circumstances of service

(a) The Secretary shall include in the regulations pertaining to service-connection of disabilities (1) additional provisions in effect requiring that in each case where a veteran is seeking service-connection for any disability due consideration shall be given to the places, types, and circumstances of such veteran’s service as shown by such veteran’s service record, the official history of each organization in which such veteran served, such veteran’s medical records, and all pertinent medical and lay evidence, and (2) the provisions required by section 5 of the Veterans’ Dioxin and Radiation Exposure Compensation Standards Act ( Public Law 98–542 ; 98 Stat. 2727 ).

(b) In the case of any veteran who engaged in combat with the enemy in active service with a military, naval, air, or space organization of the United States during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. The reasons for granting or denying service-connection in each case shall be recorded in full.

“Section 1

This Act [amending this section, enacting provisions set out as notes under this section, and amending provisions set out as notes under this section and section 1116 of this title ] may be cited as the ‘Veterans’ Dioxin and Radiation Exposure Compensation Standards Act’.

“Sec. 2

The Congress makes the following findings: Veterans who served in the Republic of Vietnam during the Vietnam era and veterans who participated in atmospheric nuclear tests or the American occupation of Hiroshima or Nagasaki, Japan, are deeply concerned about possible long-term health effects of exposure to herbicides containing dioxin or to ionizing radiation. There is scientific and medical uncertainty regarding such long-term adverse health effects. In section 102 of Public Law 97–22 [see Tables for classification], the Congress responded to that uncertainty by authorizing priority medical care at Veterans’ Administration [now Department of Veterans Affairs] facilities for any disability of a veteran who may have been so exposed (even though there is insufficient medical evidence linking such disability with such exposure) unless the disability is found to have resulted from a cause other than the exposure. The Congress has further responded to that medical and scientific uncertainty by requiring, in section 307 of Public Law 96–151 [set out as a note under section 1116 of this title ] and section 601 of Public Law 98–160 [set out below], the conduct of thorough epidemiological studies of the health effects experienced by veterans in connection with exposure both to herbicides containing dioxin and (if not determined to be scientifically infeasible) to radiation, and by requiring in Public Law 97–414 [see Tables for classification], the development of radioepidemiological tables setting forth the probabilities of causation between various cancers and exposure to radiation. There is some evidence that most types of leukemia, malignancies of the thyroid, female breast, lung, bone, liver, and skin, and polycythemia vera are associated with exposure to certain levels of ionizing radiation. As of the date of the enactment of this Act [ Oct. 24, 1984 ], there are sixty-six federally sponsored research projects being conducted relating to herbicides containing dioxin, at a cost to the Federal Government in excess of $130,000,000and,asof1981,federallysponsoredresearchprojectsrelatingtoionizingradiationwerecostingtheFederalGovernmentmorethan$115,000,000. The initial results of one project—an epidemiological study, conducted by the United States Air Force School of Aerospace Medicine, of the health status of the ‘Ranch Hand’ veterans who carried out the loading and aerial spraying of herbicides containing dioxin in Vietnam and in the process came into direct skin contact with such herbicides in their most concentrated liquid form—were released on February 24, 1984 , and contained the conclusion ‘that there is insufficient evidence to support a cause and effect relationship between herbicide exposure and adverse health in the Ranch Hand group at this time’. The ‘film badges’ which were originally issued to members of the Armed Forces in connection with the atmospheric nuclear test program have previously constituted a primary source of dose information for veterans (and survivors of veterans) filing claims for Veterans’ Administration [now Department of Veterans Affairs] disability compensation or dependency and indemnity compensation in connection with exposure to radiation. These film badges often provide an incomplete measure of radiation exposure, since they were not capable of recording inhaled, ingested, or neutron doses (although the Defense Nuclear Agency currently has the capability to reconstruct individual estimates of such doses), were not issued to most of the participants in nuclear tests, often provided questionable readings because they were shielded during the detonation, and were worn for only limited periods during and after each nuclear detonation. Standards governing the reporting of dose estimates in connection with radiation-related claims for Veterans’ Administration [now Department of Veterans Affairs] disability compensation vary among the several branches of the Armed Forces, and no uniform minimum standards exist. The Veterans’ Administration [now Department of Veterans Affairs] has not promulgated permanent regulations setting forth specific guidelines, standards, and criteria for the adjudication of claims for Veterans’ Administration disability compensation based on exposure to herbicides containing dioxin or to ionizing radiation. Such claims (especially those involving health effects with long latency periods) present adjudicatory issues which are significantly different from issues generally presented in claims based upon the usual types of injuries incurred in military service. It has always been the policy of the Veterans’ Administration [now Department of Veterans Affairs] and is the policy of the United States, with respect to individual claims for service connection of diseases and disabilities, that when, after consideration of all evidence and material of record, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of a claim, the benefit of the doubt in resolving each such issue shall be given to the claimant.

“Sec. 3

The purpose of this Act is to ensure that Veterans’ Administration [now Department of Veterans Affairs] disability compensation is provided to veterans who were exposed to ionizing radiation in connection with atmospheric nuclear tests or in connection with the American occupation of Hiroshima or Nagasaki, Japan, for all disabilities arising after that service that are connected, based on sound scientific and medical evidence, to such service (and that Veterans’ Administration dependency and indemnity compensation is provided to survivors of those veterans for all deaths resulting from such disabilities).”

“Sec. 5

(a) In carrying out the responsibilities of the Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs] under section 1154(a)(2) [formerly 354(a)(2)] of title 38, United States Code, and in order to promote consistency in claims processing and decisions, the Administrator shall prescribe regulations to— establish guidelines and (where appropriate) standards and criteria for the resolution of claims for benefits under laws administered by the Veterans’ Administration [now Department of Veterans Affairs] where the criteria for eligibility for a benefit include a requirement that a death or disability be service connected and the claim of service connection is based on a veteran’s exposure during service in connection with such veteran’s participation in atmospheric nuclear tests or with the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946 , to ionizing radiation from the detonation of a nuclear device; and ensure that, with respect to those claims, the policy of the United States described in section 2(13) [set out above] is carried out.

(“(b) The guidelines required to be established in regulations prescribed under this section shall include guidelines governing the evaluation of the findings of scientific studies relating to the possible increased risk of adverse health effects of exposure to ionizing radiation. Those guidelines shall require that, in the evaluation of those studies, the Administrator [now Secretary] shall take into account whether the results are statistically significant, are capable of replication, and withstand peer review. The evaluations described in subparagraph (A) shall be made by the Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs] after receiving the advice of the Scientific Council of the Veterans’ Advisory Committee on Environmental Hazards (established under section 6). Those evaluations shall be published in the notice section of the Federal Register. The standards and criteria required to be established in regulations prescribed under this section shall include provisions governing the use in the adjudication of individual claims of the Administrator’s [now Secretary’s] evaluations made under subparagraph (B). In prescribing regulations under this section, the Administrator [now Secretary] (after receiving the advice of the Advisory Committee and of the Scientific Council of the Veterans’ Advisory Committee on Environmental Hazards regarding the diseases described in subparagraph (B)) shall make determinations, based on sound medical and scientific evidence, with respect to each disease described in subparagraph (B) as to whether service connection shall, subject to division (ii) of this subparagraph, be granted in the adjudication of individual cases. In making determinations regarding such diseases, the Administrator shall give due regard to the need to maintain the policy of the United States with respect to the resolution of contested issues as set forth in section 2(13) [set out above]. The Administrator shall set forth in such regulations such determinations, with any specification (relating to exposure or other relevant matter) of limitations on the circumstances under which service connection shall be granted, and shall implement such determinations in accordance with such regulations. If the Administrator [now Secretary] makes a determination, pursuant to this subparagraph, that service connection shall be granted in the case of a disease described in subparagraph (B), the Administrator shall specify in such regulations that, in the adjudication of individual cases, service connection shall not be granted where there is sufficient affirmative evidence to the contrary or evidence to establish that an intercurrent injury or disease which is a recognized cause of the described disease has been suffered between the date of separation from service and the onset of such disease or that the disability is due to the veteran’s own willful misconduct. With regard to each disease described in subparagraph (B), the Administrator [now Secretary] shall include in the regulations prescribed under this section provisions specifying the factors to be considered in adjudicating issues relating to whether or not service connection should be granted in individual cases and the circumstances governing the granting of service connection for such disease. The diseases referred to in subparagraph (A) are those specified in section 2(5) [set out above] and any other disease with respect to which the Administrator [now Secretary] finds (after receiving and considering the advice of the Scientific Council established under section 6(d)(2)) that there is sound scientific or medical evidence indicating a connection to exposure to ionizing radiation, in the case of a veteran who was exposed to ionizing radiation in connection with such veteran’s participation in an atmospheric nuclear test or with the American occupation of Hiroshima or Nagasaki, Japan, before July 1, 1946 . The regulations prescribed under this section shall include— specification of the maximum period of time after exposure to such ionizing radiation for the development of those diseases; and a requirement that a claimant filing a claim based upon a veteran’s exposure to ionizing radiation from the detonation of a nuclear device may not be required to produce evidence substantiating the veteran’s exposure during active military, naval, or air service if the information in the veteran’s service records and other records of the Department of Defense is not inconsistent with the claim that the veteran was present where and when the claimed exposure occurred.

(“(c) The Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs] shall develop the regulations required by this section (and any amendment to those regulations) through a public review and comment process in accordance with the provisions of section 553 of title 5 , United States Code. That process may include consideration by the Administrator of the recommendations of the Veterans’ Advisory Committee on Environmental Hazards and the Scientific Council thereof (established under section 6) with respect to the proposed regulations, and that process shall include consideration by the Administrator of the recommendations of the Committee and the Council with respect to the final regulations and proposed and final amendments to such regulations. The period for public review and comment shall be completed not later than ninety days after the proposed regulations or proposed amendments are published in the Federal Register. Not later than one hundred and eighty days after the date of the enactment of this Act [ Oct. 24, 1984 ], the Administrator [now Secretary] shall develop and publish in the Federal Register a proposed version of the regulations required to be prescribed by this section. Not later than three hundred days after the date of the enactment of this Act [ Oct. 24, 1984 ], the Administrator [now Secretary] shall publish in the Federal Register the final regulations (together with explanations of the bases for the guidelines, standards, and criteria contained therein) required to be prescribed by this section.

“Sec. 6

(a) The advisory committee referred to in subsections (b) and (c) of section 5, to be known as the Veterans’ Advisory Committee on Environmental Hazards (hereinafter in this section referred to as the ‘Committee’) shall consist of nine members appointed by the Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs] after requesting and considering recommendations from veteran organizations, including— six individuals (of whom none may be members of the Armed Forces on active duty or employees of the Veterans’ Administration [now Department of Veterans Affairs] or the Department of Defense and not more than three may be employees of other Federal departments or agencies), appointed, after requesting and considering the recommendations of the heads of Federal entities with particular expertise in biomedical and environmental science, including— three individuals who are recognized medical or scientific authorities in fields pertinent to understanding the health effects of exposure to ionizing radiation; and three individuals who are recognized medical or scientific authorities in fields, such as epidemiology and other scientific disciplines, pertinent to determining and assessing the health effects of exposure to ionizing radiation in exposed populations; and three individuals from the general public, including at least one disabled veteran, having a demonstrated interest in and experience relating to veterans’ concerns regarding exposure to ionizing radiation.

(“(b) The Committee shall include, as ex officio, nonvoting members, the Chief Medical Director and the Chief Benefits Director of the Veterans’ Administration [now Under Secretary for Health and Under Secretary for Benefits of the Department of Veterans Affairs], or their designees.

(“(c) The Committee shall submit to the Administrator [now Secretary] any recommendations it considers appropriate for administrative or legislative action.

(“(d) The six members of the Committee described in subsection (a)(1) shall, in addition to serving as members of the Committee, constitute a Scientific Council of the Committee (hereinafter in this section referred to as the ‘Council’). The Council shall have responsibility for evaluating scientific studies relating to possible adverse health effects of exposure to ionizing radiation. The Council shall make findings and evaluations regarding pertinent scientific studies and shall submit to the Committee, the Administrator [now Secretary], and the Committees on Veterans’ Affairs of the Senate and House of Representatives directly periodic reports on such findings and evaluations.

(“(e) The Administrator [now Secretary] shall designate one of the members to chair the Committee and another member to chair the Council.

(“(f) The Administrator [now Secretary] shall determine the terms of service and pay and allowances of members of the Committee, except that a term of service of any member may not exceed three years. The Administrator may reappoint any member for additional terms of service.

(“(g) The Administrator [now Secretary] shall provide administrative support services and fiscal support for the Committee.

“Sec. 7

(a) In connection with the duties of the Director of the Defense Nuclear Agency, as Department of Defense Executive Agent for the Nuclear Test Personnel Review Program, relating to the preparation of radiation dose estimates with regard to claims for Veterans’ Administration [now Department of Veterans Affairs] disability compensation and dependency and indemnity compensation under chapters 11 and 13, respectively, of title 38, United States Code— the Secretary of Defense shall prescribe guidelines (and any amendment to those guidelines) through a public review and comment process in accordance with the provisions of section 553 of title 5 , United States Code— specifying the minimum standards governing the preparation of radiation dose estimates in connection with claims for such compensation, making such standards uniformly applicable to the several branches of the Armed Forces, and requiring that each such estimate furnished to the Veterans’ Administration [now Department of Veterans Affairs] and to any veteran or survivor include information regarding all material aspects of the radiation environment to which the veteran was exposed and which form the basis of the claim, including inhaled, ingested, and neutron doses; and the Secretary of Health and Human Services, through the Director of the National Institutes of Health, shall— conduct a review of the reliability and accuracy of scientific and technical devices and techniques (such as ‘whole body counters’) which may be useful in determining previous radiation exposure; submit to the Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs] and the Committees on Veterans’ Affairs of the House of Representatives and the Senate, not later than July 1, 1985 , a report regarding the results of such review, including information concerning the availability of such devices and techniques, the categories of exposed individuals as to whom use of such devices and techniques may be appropriate, and the reliability and accuracy of dose estimates which may be derived from such devices and techniques; and enter into an interagency agreement with the Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs] for the purpose of assisting the Administrator in identifying agencies or other entities capable of furnishing services involving the use of such devices and techniques.

(“(b) The Administrator of Veterans’ Affairs [now Secretary of Veterans Affairs], in resolving material differences between a radiation dose estimate, from a credible source, submitted by a veteran or survivor and a radiation dose estimate prepared and transmitted by the Director of the Defense Nuclear Agency, shall provide for the preparation of a radiation dose estimate by an independent expert, who shall be selected by the Director of the National Institutes of Health and who shall not be affiliated with the Defense Nuclear Agency, and the Administrator shall provide for the consideration of such independent estimate in connection with the adjudication of the claim for Veterans’ Administration [now Department of Veterans Affairs] compensation.”

§ 1155 Authority for schedule for rating disabilities

The Secretary shall adopt and apply a schedule of ratings of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. The schedule shall be constructed so as to provide ten grades of disability and no more, upon which payments of compensation shall be based, namely, 10 percent, 20 percent, 30 percent, 40 percent, 50 percent, 60 percent, 70 percent, 80 percent, 90 percent, and total, 100 percent. The Secretary shall from time to time readjust this schedule of ratings in accordance with experience. However, in no event shall such a readjustment in the rating schedule cause a veteran’s disability rating in effect on the effective date of the readjustment to be reduced unless an improvement in the veteran’s disability is shown to have occurred. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1125 , § 355; Pub. L. 98–223, title I, § 101(c) , Mar. 2, 1984 , 98 Stat. 38 ; renumbered § 1155 and amended Pub. L. 102–83 , §§ 4(b)(1), (2)(E), 5(a), Aug. 6, 1991 , 105 Stat. 404–406 ; Pub. L. 102–86, title I, § 103(a) , Aug. 14, 1991 , 105 Stat. 414 .)

§ 1156 Temporary disability ratings

(a) Assignment of Temporary Ratings.— For the purpose of providing disability compensation under this chapter to veterans, the Secretary shall assign a temporary disability rating to a veteran as follows: To a veteran who— was discharged or released from active duty not more than 365 days before the date such veteran submits a claim for disability compensation under this chapter; has one or more disabilities for which a rating of total is not immediately assignable— under the regular provisions of the schedule of ratings; or on the basis of individual unemployability; and has one or more— severe disabilities that result in substantially gainful employment not being feasible or advisable; or healed, unhealed, or incompletely healed wounds or injuries that make material impairment of employability likely. To a veteran who, as a result of a highly stressful in-service event, has a mental disorder that is severe enough to bring about the veteran’s discharge or release from active duty. To a veteran who has a service-connected disability that requires hospital treatment or observation in a Department of Veterans Affairs or approved hospital for a period in excess of 21 days. To a veteran who has a service-connected disability that has required convalescent care or treatment at hospital discharge (regular discharge or release to non-bed care) or outpatient release that meets the requirements of regulations prescribed by the Secretary. With respect to a veteran described in paragraph (1)(A), the Secretary may assign a temporary disability rating to such veteran regardless of whether such veteran has obtained a medical examination or a medical opinion concerning such veteran’s disability. With respect to a veteran described in paragraph (1)(B), the Secretary shall schedule a medical examination for such veteran not later than six months after the separation or discharge of such veteran from active duty.

(b) Termination of Temporary Disability Ratings.— Except as provided in paragraph (2), a temporary disability rating assigned to a veteran under this section shall remain in effect as follows: For a veteran who is assigned a temporary disability rating under subsection (a)(1)(A), until the later of the date that is— 12 months after the date of discharge or release from active duty; or provided in regulations prescribed by the Secretary. For a veteran who is assigned a temporary disability rating under subsection (a)(1)(B), until the date on which a rating decision is issued to such veteran following the medical examination scheduled under subsection (a)(3). For a veteran who is assigned a temporary disability rating under subsection (a)(1)(C), until the later of the date that is— the last day of the month in which the veteran is discharged from the hospital as described in such subsection (a)(1)(C); or provided in regulations prescribed by the Secretary. For a veteran who is assigned a temporary disability rating under subsection (a)(1)(D), until the date that is provided in regulations prescribed by the Secretary. The Secretary may extend a temporary disability rating assigned to a veteran under subsection (a) beyond the applicable termination date under paragraph (1) if the Secretary determines that such an extension is appropriate.

(c) Regulations.— The Secretary shall prescribe regulations to carry out the provisions of this section.

(d) Construction.— Nothing in this section shall be construed to preclude the Secretary from providing a temporary disability rating under an authority other than this section.

§ 1157 Combination of certain ratings

The Secretary shall provide for the combination of ratings and pay compensation at the rates prescribed in subchapter II of this chapter to those veterans who served during a period of war and during any other time, who have suffered disability in line of duty in each period of service. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1125 , § 357; renumbered § 1157 and amended Pub. L. 102–83 , §§ 4(b)(1), (2)(E), 5(a), Aug. 6, 1991 , 105 Stat. 404–406 .)

§ 1158 Disappearance

Where a veteran receiving compensation under this chapter disappears, the Secretary may pay the compensation otherwise payable to the veteran to such veteran’s spouse, children, and parents. Payments made to such spouse, child, or parent under the preceding sentence shall not exceed the amounts payable to each if the veteran had died from service-connected disability. ( Pub. L. 85–857 , Sept. 2, 1958 , 72 Stat. 1125 , § 358; Pub. L. 86–212 , Sept. 1, 1959 , 73 Stat. 436 ; Pub. L. 94–433, title IV, § 404(21) , Sept. 30, 1976 , 90 Stat. 1379 ; renumbered § 1158 and amended Pub. L. 102–83 , §§ 4(b)(1), (2)(E), 5(a), Aug. 6, 1991 , 105 Stat. 404–406 .)

§ 1159 Protection of service connection

Service connection for any disability or death granted under this title which has been in force for ten or more years shall not be severed on or after January 1, 1962 , except upon a showing that the original grant of service connection was based on fraud or it is clearly shown from military records that the person concerned did not have the requisite service or character of discharge. The mentioned period shall be computed from the date determined by the Secretary as the date on which the status commenced for rating purposes. (Added Pub. L. 86–501, § 1 , June 10, 1960 , 74 Stat. 195 , § 359; amended Pub. L. 87–825, § 6 , Oct. 15, 1962 , 76 Stat. 950 ; renumbered § 1159 and amended Pub. L. 102–83 , §§ 4(b)(1), (2)(E), 5(a), Aug. 6, 1991 , 105 Stat. 404–406 .)

§ 1160 Special consideration for certain cases of loss of paired organs or extremities

(a) Where a veteran has suffered— impairment of vision in one eye as a result of service-connected disability and impairment of vision in the other eye as a result of non-service-connected disability not the result of the veteran’s own willful misconduct and— the impairment of vision in each eye is rated at a visual acuity of 20/200 or less; or the peripheral field of vision for each eye is 20 degrees or less; the loss or loss of use of one kidney as a result of service-connected disability and involvement of the other kidney as a result of non-service-connected disability not the result of the veteran’s own willful misconduct; deafness compensable to a degree of 10 percent or more in one ear as a result of service-connected disability and deafness in the other ear as the result of non-service-connected disability not the result of the veteran’s own willful misconduct; the loss or loss of use of one hand or one foot as a result of service-connected disability and the loss or loss of use of the other hand or foot as a result of non-service-connected disability not the result of the veteran’s own willful misconduct; or permanent service-connected disability of one lung, rated 50 percent or more disabling, in combination with a non-service-connected disability of the other lung that is not the result of the veteran’s own willful misconduct, the Secretary shall assign and pay to the veteran the applicable rate of compensation under this chapter as if the combination of disabilities were the result of service-connected disability.

(b) If a veteran described in subsection (a) of this section receives any money or property of value pursuant to an award in a judicial proceeding based upon, or a settlement or compromise of, any cause of action for damages for the non-service-connected disability described in such subsection, the increase in the rate of compensation otherwise payable under this section shall not be paid for any month following a month in which any such money or property is received until such time as the total of the amount of such increase that would otherwise have been payable equals the total of the amount of any such money received and the fair market value of any such property received.

§ 1161 Payment of disability compensation in disability severance cases

The deduction of disability severance pay from disability compensation, to the extent required by section 1212(d) of title 10 , shall be made at a monthly rate not in excess of the rate of compensation to which the former member would be entitled based on the degree of such former member’s disability as determined on the initial Department rating. (Added Pub. L. 91–241 , May 7, 1970 , 84 Stat. 203 , § 361; amended Pub. L. 94–433, title IV, § 404(23) , Sept. 30, 1976 , 90 Stat. 1379 ; Pub. L. 98–160, title VII, § 702(4) , Nov. 21, 1983 , 97 Stat. 1009 ; renumbered § 1161 and amended Pub. L. 102–83 , §§ 4(a)(3), (4), 5(a), Aug. 6, 1991 , 105 Stat. 404 , 406; Pub. L. 110–181, div. A, title XVI, § 1646(c) , as added Pub. L. 110–389, title I, § 103(a)(2) , Oct. 10, 2008 , 122 Stat. 4148 .)

§ 1162 Clothing allowance

(a) Eligibility Requirements.— The Secretary, under regulations which the Secretary shall prescribe, shall pay a clothing allowance of $716 1 per year to each veteran who— because of a service-connected disability, wears or uses a prosthetic or orthopedic appliance (including a wheelchair) which the Secretary determines tends to wear out or tear the clothing of the veteran; or uses medication which— a physician has prescribed for a skin condition which is due to a service-connected disability; and the Secretary determines causes irreparable damage to the veteran’s outergarments.

(b) Continuous Nature of Payments.— Payments made to a veteran under subsection (a) shall continue on an automatically recurring annual basis until the earlier of the following: The date on which the veteran elects to no longer receive such payments. The date on which the Secretary determines the veteran is no longer eligible pursuant to subsection (c).

(c) Reviews of Claims.— The Secretary shall, in accordance with this subsection, conduct reviews of a claim on which a clothing allowance for a veteran under subsection (a) is based to determine the continued eligibility of the veteran for such allowance. The Secretary shall prescribe standards for determining whether a claim for a clothing allowance is based on a veteran’s wearing or use of a prosthetic, orthopedic appliance (including a wheelchair), or medication whose wear or tear or irreparable damage on a veteran’s outergarments or clothing is as likely as not subject to no change for the duration of such wearing or use. If the Secretary determines, pursuant to standards prescribed under paragraph (2), that a claim for a clothing allowance is based on wear or tear or irreparable damage that is as likely as not subject to no change, the veteran shall continue to be deemed eligible for receipt of a clothing allowance under this section until the Secretary— receives notice under subparagraph (B); or finds otherwise under subparagraph (C) or (D). The Secretary shall require a veteran who is receiving a clothing allowance under subsection (a), based on the wearing or use of a prosthetic, orthopedic appliance (including a wheelchair), or medication, to notify the Secretary when the veteran terminates the wearing or use of such a prosthetic, orthopedic appliance, or medication. For each veteran who is receiving a clothing allowance under subsection (a), based on the wearing or use of a prosthetic, orthopedic appliance (including a wheelchair), or medication, the Secretary shall periodically review the veteran’s Department records for evidence that the veteran has terminated the wearing or use of such a prosthetic, orthopedic appliance, or medication. If a veteran who is receiving a clothing allowance under subsection (a), based on the wearing or use of a prosthetic, orthopedic appliance (including a wheelchair), or medication, has received such clothing allowance beyond the prescribed or intended lifespan of such prosthetic, orthopedic appliance, or medication, the Secretary may periodically request the veteran to attest to continued usage. If the Secretary determines that a claim for a clothing allowance under subsection (a) does not meet the requirements of paragraph (3)(A), then the Secretary may require the veteran to recertify the veteran’s continued eligibility for a clothing allowance under this section periodically, but not more frequently than once each year. When reviewing a claim under this subsection, the Secretary shall evaluate the evidence presented by the veteran and such other relevant evidence as the Secretary determines appropriate.

(d) Determination Regarding Continued Eligibility.— If the Secretary determines, as the result of a review of a claim conducted under subsection (c), that the veteran who submitted such claim no longer meets the requirements specified in subsection (a), the Secretary shall— provide to the veteran notice of such determination that includes a description of applicable actions that may be taken following the determination, including the actions specified in section 5104C of this title ; and discontinue the clothing allowance based on such claim.

§ 1163 Trial work periods and vocational rehabilitation for certain veterans with total disability ratings

(a) The disability rating of a qualified veteran who begins to engage in a substantially gainful occupation after January 31, 1985 , may not be reduced on the basis of the veteran having secured and followed a substantially gainful occupation unless the veteran maintains such an occupation for a period of 12 consecutive months. For purposes of this section, the term “qualified veteran” means a veteran who has a service-connected disability, or service-connected disabilities, not rated as total but who has been awarded a rating of total disability by reason of inability to secure or follow a substantially gainful occupation as a result of such disability or disabilities.

(b) The Secretary shall make counseling services described in section 3104(a)(2) of this title and placement and postplacement services described in section 3104(a)(5) of this title available to each qualified veteran (whether or not the veteran is participating in a vocational rehabilitation program under chapter 31 of this title).

(c) In the case of each award after January 31, 1985 , of a rating of total disability described in subsection (a)(2) of this section to a veteran, the Secretary shall provide to the veteran, at the time that notice of the award is provided to the veteran, a statement providing— notice of the provisions of this section; information explaining the purposes and availability of and eligibility for, and the procedures for pursuing, a vocational rehabilitation program under chapter 31 of this title; and a summary description of the scope of services and assistance available under that chapter. After providing the notice required under paragraph (1) of this subsection, the Secretary shall offer the veteran the opportunity for an evaluation under section 3106(a) of this title .

§ 1164 Presumptions of service-connection for Coronavirus Disease 2019

(a) Presumptions Generally.— For purposes of laws administered by the Secretary and subject to section 1113 of this title , if symptoms of Coronavirus Disease 2019 (in this section referred to as “COVID–19”) described in subsection (d) manifest within one of the manifestation periods described in paragraph (2) in an individual who served in a qualifying period of duty described in subsection (b)— infection with severe acute respiratory syndrome coronavirus 2 (in this section referred to as “SARS–CoV–2”) shall be presumed to have occurred during the qualifying period of duty; COVID–19 shall be presumed to have been incurred during the qualifying period of duty; and if the individual becomes disabled or dies as a result of COVID–19, it shall be presumed that the individual became disabled or died during the qualifying period of duty for purposes of establishing that the individual served in the active military, naval, or air service. The manifestation periods described in this paragraph are the following: During a qualifying period of duty described in subsection (b), if that period of duty was more than 48 continuous hours in duration. Within 14 days after the individual’s completion of a qualifying period of duty described in subsection (b). An additional period prescribed under subparagraph (B). If the Secretary determines that a manifestation period of more than 14 days after completion of a qualifying period of service is appropriate for the presumptions under paragraph (1), the Secretary may prescribe that additional period by regulation. A determination under clause (i) shall be made in consultation with the Director of the Centers for Disease Control and Prevention.

(b) Qualifying Period of Duty Described.— A qualifying period of duty described in this subsection is— a period of active duty performed— during the national emergency declared by the President under the National Emergencies Act ( 50 U.S.C. 1601 et seq.); and before the date that is three years after the date of the enactment of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020; or training duty under title 10 or full-time National Guard duty (as defined in section 101 of title 10 ), performed under orders issued on or after March 13, 2020 — during the national emergency declared by the President under the National Emergencies Act ( 50 U.S.C. 1601 et seq.); and before the date that is three years after the date of the enactment of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020.

(c) Application of Presumptions for Training Duty.— When, pursuant to subsection (a), COVID–19 is presumed to have been incurred during a qualifying period of duty described in subsection (b)(2)— COVID–19 shall be deemed to have been incurred in the line of duty during a period of active military, naval, or air service; and where entitlement to benefits under this title is predicated on the individual who was disabled or died being a veteran, benefits for disability or death resulting from COVID–19 as described in subsection (a) shall be paid or furnished as if the individual was a veteran, without regard to whether the period of duty would constitute active military, naval, or air service under section 101 of this title .

(d) Symptoms of COVID–19.— For purposes of subsection (a), symptoms of COVID–19 are those symptoms that competent medical evidence demonstrates are experienced by an individual affected and directly related to COVID–19.

(e) Medical Examinations and Opinions.— If there is a question of whether the symptoms experienced by an individual described in paragraph (1) of subsection (a) during a manifestation period described in paragraph (2) of such subsection are attributable to COVID–19 resulting from infection with SARS–CoV–2 during the qualifying period of duty, in determining whether a medical examination or medical opinion is necessary to make a decision on the claim within the meaning of section 5103A(d) of this title , a qualifying period of duty described in subsection (b) of this section shall be treated as if it were active military, naval, or air service for purposes of section 5103A(d)(2)(B) of this title .

§ 1165 Choice of sex of medical examiner for certain disabilities

(a) In General.— The Secretary shall ensure that a veteran who requires a medical examination from a covered medical provider in support of a claim for compensation under this chapter for a mental or physical health condition that resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment may designate the sex of the medical provider who provides such medical examination.

(b) Covered Medical Providers.— For purposes of this section, a covered medical provider is any medical provider who is employed by the Department or is under any contract with the Department to provide a medical examination or a medical opinion when such an examination or opinion is necessary to make a decision on a claim.

(c) Notice.— Before providing any medical examination for a veteran in support for a claim described in subsection (a), the Secretary shall notify the veteran of the veteran’s rights under subsection (a).

§ 1166 Claims involving military sexual trauma

(a) Processing.— The Secretary shall establish specialized teams to process claims for compensation for a covered mental health condition based on military sexual trauma experienced by a veteran during active military, naval, air, or space service. A peer support specialist of the Department— shall not be responsible for providing any assistance to a veteran regarding a claim described in paragraph (1), other than counseling services, guidance, and support, pursuant to duties determined by the Under Secretary for Health; and shall not participate in the adjudication of such a claim.

(b) Referrals to MST Coordinators.— The Secretary shall include, in forms for claims described in subsection (a), an option for a veteran to elect to be referred to a military sexual trauma coordinator of the Veterans Health Administration at the facility of the Department nearest to the residence of such veteran.

(c) Training.— The Secretary shall ensure that members of teams established under subsection (a) are trained to identify markers indicating military sexual trauma. The Secretary shall ensure that peer support specialists of the Department receive annual training on how to provide peer support regarding military sexual trauma. The Secretary shall provide annual training, regarding the processing of claims described in subsection (a), to the following individuals: Military sexual trauma coordinators of the Veterans Health Administration. Peer support specialists of the Department.

(d) Definitions.— In this section: The term “covered mental health condition” means post-traumatic stress disorder, anxiety, depression, or other mental health diagnosis described in the current version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association that the Secretary determines to be related to military sexual trauma. The term “military sexual trauma” means, with respect to a veteran, a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment during active military, naval, air, or space service.

“SECTION 1 SHORT TITLE.

“This Act may be cited as the ‘MST Claims Coordination Act’.

“SEC. 2 VETERANS HEALTH ADMINISTRATION AND VETERANS BENEFITS ADMINISTRATION COORDINATION FOR CERTAIN CLAIMS ARISING FROM MILITARY SEXUAL TRAUMA.

(“(a) Coordinated Provision of Materials.— During or immediately after each covered event, and together with each covered document, in a claim for compensation arising from military sexual trauma experienced by a covered individual, the Under Secretary for Benefits of the Veterans Benefits Administration, in coordination with the Under Secretary for Health of the Veterans Health Administration, shall provide, to the covered individual— outreach letters; information on the Veterans Crisis Line; information on how to make an appointment with a mental health provider; and other information on available resources relating to military sexual trauma (including information on military sexual trauma coordinators of the Veterans Health Administration, mental health providers trained in military sexual trauma issues, and peer support specialists). Materials described in paragraph (1) may be provided electronically.

(“(b) Automatic Notification System.— In a claim for compensation arising from military sexual trauma experienced by a veteran, if the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs under section 1705 of title 38 , United States Code, and consents to the notification system under this subsection, the Under Secretary for Benefits shall automatically notify the Under Secretary for Health shortly before the veteran— participates in any covered event; or receives any covered document.

(“(c) Implementation Deadline.— The Secretary of Veterans Affairs shall implement this Act not later than 18 months after the date of the enactment of this Act [ Dec. 27, 2022 ].

(“(d) Definitions.— In this section: The term ‘compensation’ has the meaning given that term in section 101 of title 38 , United States Code. The term ‘covered document’ means a determination (including a rating determination) that the Secretary of Veterans Affairs provides to the claimant in connection with a claim for compensation. The term ‘covered event’ includes, with respect to a claim for compensation— a medical examination under section 5103A of title 38 , United States Code; a hearing before the Board of Veterans’ Appeals under section 7107 of such title; and any other event determined relevant by the Secretary of Veterans Affairs. The term ‘covered individual’ means a former member of the Armed Forces (as that term is defined in section 1720D of title 38 , United States Code) who elects to receive materials under subsection (a). The term ‘military sexual trauma’ has the meaning given that term in section 1166 of title 38 , United States Code. The term ‘Veterans Crisis Line’ means the toll-free hotline for veterans established under section 1720F(h) of title 38 , United States Code.”

§ 1167.11 Another section 1167 is set out after section 1168 Outreach pursuant to changes in presumptions of service connection

(a) In General.— Whenever a law, including through a regulation or Federal court decision or settlement, establishes or modifies a presumption of service connection, the Secretary shall— identify all claims for compensation under this chapter that— were submitted to the Secretary; were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and might have been evaluated differently had the establishment or modification been applicable to the claim; and pursuant to subsection (b), conduct outreach to the claimants.

(b) Outreach.— The Secretary shall conduct outreach to inform claimants identified under subsection (a) that they may submit a supplemental claim in light of the establishment or modification of a presumption of service connection described in subsection (a). Outreach under paragraph (1) shall include the following: The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to file a supplemental claim. The Secretary shall notify, in writing or by electronic means, veterans service organizations of the ability of such veterans to file a supplemental claim. The Secretary shall contact each claimant identified under subsection (a) in the same manner that the Department last provided notice of a decision.

§ 1168 Medical nexus examinations for toxic exposure risk activities

(a) Medical Examinations and Medical Opinions.— Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall— provide the veteran with a medical examination under section 5103A(d) of this title ; and obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under subparagraph (A)) as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. When providing the Secretary with a medical opinion under paragraph (1)(B) for a veteran, the health care provider shall consider— the total potential exposure through all applicable military deployments of the veteran; and the synergistic, combined effect of all toxic exposure risk activities of the veteran. The requirement under paragraph (2)(B) shall not be construed as requiring a health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and airborne hazards identified in the list under section 1119(b)(2) of this title .

(b) Exception.— Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence.

(c) Toxic Exposure Risk Activity Defined.— In this section, the term “toxic exposure risk activity” has the meaning given that term in section 1710(e)(4) of this title .

§ 1167.11 Another section 1167 is set out preceding section 1168 Mental health consultations

(a) In General.— Not later than 30 days after the date on which a veteran submits to the Secretary a claim for compensation under this chapter for a service-connected disability relating to a mental health diagnosis, the Secretary shall offer the veteran a mental health consultation to assess the mental health needs of, and care options for, the veteran.

(b) Availability.— The Secretary shall— offer a veteran a consultation under subsection (a) without regard to any previous denial or approval of a claim of that veteran for a service-connected disability relating to a mental health diagnosis; and ensure that a veteran offered a mental health consultation under subsection (a) may elect to receive such consultation during the one-year period beginning on the date on which the consultation is offered or during such longer period beginning on such date as the Secretary considers appropriate.

(c) Rule of Construction.— A consultation provided to a veteran under this section shall not be construed as a determination that any disability of such veteran is service-connected for the purposes of any benefit under the laws administered by the Secretary.

§ 1171 Procedures to determine presumptions of service connection based on toxic exposure; definitions

(a) Procedures.— The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby— under section 1172 of this title — the Secretary provides— public notice regarding what formal evaluations the Secretary plans to conduct; and the public an opportunity to comment on the proposed formal evaluations; the working group established under subsection (b) of such section provides— advice to the Secretary on toxic-exposed veterans and cases in which veterans who, during active military, naval, air, or space service, may have experienced a toxic exposure or their dependents may have experienced a toxic exposure while the veterans were serving in the active military, naval, air, or space service; recommendations to the Secretary on corrections needed in the Individual Longitudinal Exposure Record to better reflect veterans and dependents described in clause (i); and recommendations to the Secretary regarding which cases of possible toxic exposure should be reviewed; the Secretary provides for formal evaluations of such recommendations under section 1173 of this title and takes into account reports received by the Secretary from the National Academies of Sciences, Engineering, and Medicine under section 1176 of this title ; and the Secretary issues regulations under section 1174 of this title .

(b) Definitions.— In this subchapter: The term “illness” includes a disease or other condition affecting the health of an individual, including mental and physical health. The term “Individual Longitudinal Exposure Record” means the data system maintained under section 996 of title 10 .

§ 1172 Annual notice and opportunity for public comment

(a) Notice Required.— Not less frequently than once each year, the Secretary shall publish in the Federal Register notice of the formal evaluations that the Secretary plans to conduct pursuant to section 1173 of this title . Each notice published under subparagraph (A) shall include, for each formal evaluation referred to in the notice, an explanation as to why the military environmental exposures and adverse health outcomes that are the subject of the formal evaluation were chosen by the Secretary for formal evaluation under section 1173 of this title . With each notice published under paragraph (1), the Secretary shall seek public comment on the military environmental exposures and adverse health outcomes that are the subject of the formal evaluations referred to in the notice. The Secretary shall— consider all public comment received under subparagraph (A); and publish in the Federal Register a response to the comments received under subparagraph (A). For each notice published under paragraph (1), the Secretary shall hold an open meeting for members of the public to voice their comments in response to the notice. To help evaluate presumptions of service connection, the Secretary shall, not less frequently than quarterly, collaborate with, partner with, and give weight to the advice of veterans service organizations and such other stakeholders as the Secretary considers appropriate. Failure to include a military environmental exposure or adverse health effect in a Federal Register notice published pursuant to subsection (a) shall not preclude the Secretary from initiating a formal evaluation of such exposure or health effect.

(b) Working Group.— The Secretary shall establish a working group within the Department (in this section referred to as the “Working Group”). The Working Group shall include personnel of the Veterans Health Administration and the Veterans Benefits Administration. The Secretary shall consult with, and seek the advice of, the Working Group with respect to cases in which— a veteran may have, during active military, naval, air, or space service, experienced a toxic exposure; or a dependent of a veteran may have experienced a toxic exposure during the active military, naval, air, or space service of the veteran.

(c) Assessments.— The Working Group shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, air, or space service, including by conducting ongoing surveillance and reviewing such exposure described in scientific literature, media reports, information from veterans, and information from Congress. The assessments under paragraph (1) shall cover suspected and known toxic exposures occurring during active military, naval, air, or space service, including by identifying and evaluating new and emerging toxic exposures that are not recognized under existing presumptions of service connection. The Working Group may conduct an assessment under paragraph (1) in response to a comment received under paragraph (2) or (3) of subsection (a). The Working Group shall, in consultation with the Secretary of Defense, on a periodic basis, assess the Individual Longitudinal Exposure Record to ensure the accuracy of data collected.

(d) Development of Recommendations.— Following an assessment of a case of the toxic exposure of veterans that occurred during active military, naval, air, or space service under subsection (c), or their dependents, the Working Group may develop a recommendation for formal evaluation under section 1173 of this title to conduct a review of the health effects related to the case of exposure if the Working Group determines that the research may change the current understanding of the relationship between an exposure to an environmental hazard and adverse health outcomes in humans. Upon receipt of evidence suggesting that previous findings regarding the periods and locations of exposure covered by an existing presumption of service connection are no longer supported, the Working Group may nominate such evidence for formal evaluation under section 1173 of this title to modify the periods and locations.

(e) Reports by the Working Group.— Not less frequently than once each year, the Working Group shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives, and make publicly available, a report on— recommendations developed under subsection (d), if any; and recommendations for such legislative or administrative action as the Working Group considers necessary for the Working Group to be more effective in carrying out the requirements of this section.

(f) Responses by Secretary.— In response to each report submitted under subsection (e), the Secretary shall, not later than 30 days after receiving the report, initiate a formal evaluation pursuant to section 1173 of this title .

§ 1173 Formal evaluation of recommendations

(a) Formal Evaluations.— The Secretary shall establish a process to conduct a formal evaluation with respect to each recommendation made by the Working Group under section 1172 of this title .

(b) Evidence, Data, and Factors.— The Secretary shall ensure that each formal evaluation under subsection (a) covers the following: Scientific evidence, based on the review of available scientific literature, including human, toxicological, animal, and methodological studies, and other factors. Claims data, based on the review of claim rate, grant rate, and service connection prevalence, and other factors. Other factors the Secretary determines appropriate, such as— the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated; the quantity and quality of the information available and reviewed; the feasibility of and period for generating relevant information and evidence; whether such health effects are combat- or deployment-related; the ubiquity or rarity of the health effects; and any time frame during which a health effect must become manifest.

(c) Conduct of Evaluations.— The Secretary shall ensure that each formal evaluation under subsection (a)— reviews scientific evidence in a manner that— conforms to principles of scientific and data integrity; is free from suppression or distortion of scientific or technological findings, data, information, conclusions, or technical results; and evaluates the likelihood that a positive association exists between an illness and a toxic exposure while serving in the active military, naval, air, or space service; and assesses the toxic exposures and illnesses and determines whether the evidence supports a finding of a positive association between the toxic exposure and the illness. In carrying out paragraph (1)(B)(ii), a formal evaluation under subsection (a) shall include reviewing all relevant data to determine the strength of evidence for a positive association based on the following four categories: The “sufficient” category, where the evidence is sufficient to conclude that a positive association exists. The “equipoise and above” category, where the evidence is sufficient to conclude that a positive association is at least as likely as not, but not sufficient to conclude that a positive association exists. The “below equipoise” category, where the evidence is not sufficient to conclude that a positive association is at least as likely as not, or is not sufficient to make a scientifically informed judgment. The “against” category, where the evidence suggests the lack of a positive association.

(d) Recommendation for Establishing a Presumption of Service Connection.— Not later than 120 days after the date on which a formal evaluation is commenced, the element of the Department that conducts the evaluation shall submit to the Secretary a recommendation with respect to establishing a presumption of service connection for the toxic exposure and illness, or modifying an existing presumption of service connection, covered by the evaluation.

§ 1174 Regulations regarding presumptions of service connection based on toxic exposure

(a) Action Upon Recommendation.— Not later than 160 days after the date on which the Secretary receives a recommendation to establish or modify a presumption of service connection under section 1173 of this title — if the Secretary determines, in the discretion of the Secretary, that the presumption, or modification, is warranted, the Secretary shall— commence issuing regulations in accordance with the provisions of subchapter II of chapter 5 of title 5 (commonly referred to as the Administrative Procedures Act) setting forth the presumption or commence revising regulations to carry out such modification; and include in such regulations any time frame during which a health effect must become manifest; or if the Secretary determines, in the discretion of the Secretary, that the presumption, or modification, is not warranted, the Secretary shall publish in the Federal Register a notice of the determination, including the reasons supporting the determination.

(b) Removal of Presumption.— The Secretary may— issue a regulation to remove an illness from a presumption of service connection previously established pursuant to a regulation issued under subsection (a); and issue a regulation to remove a presumption of service connection established pursuant to title IV of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 if the Secretary concludes that evidence suggests the lack of a positive association between the disease and the toxic exposure. Under subparagraph (A)(ii), the Secretary shall not consider the lack of evidence as sufficient to support a decision for removal of a presumption. Whenever an illness is removed from regulations pursuant to paragraph (1), or the periods and locations of exposure covered by a presumption of service connection are modified under subsection (a)— a veteran who was awarded compensation under chapter 11 of this title for such illness on the basis of the presumption provided under such regulations before the effective date of the removal or modification shall continue to be entitled to receive compensation on that basis; a survivor of a veteran who was awarded dependency and indemnity compensation under chapter 13 of this title for the death of a veteran resulting from such illness on the basis of such presumption shall continue to be entitled to receive dependency and indemnity compensation on such basis; and no veteran or survivor covered under subparagraph (A) or (B) shall have their compensation reduced solely because of the removal of an illness pursuant to paragraph (1).

§ 1175 Authority to modify process; congressional oversight

(a) In General.— The Secretary may modify the process under which the working group established under subsection (b) of section 1172 of this title conducts assessments under such section, the Secretary conducts formal evaluations under section 1173 of this title , and issues regulations under section 1174 of this title if— such evaluations cover the evidence, data, and factors required by subsection (b) of such section 1173; and a period of 180 days has elapsed following the date on which the Secretary submits the notice under subsection (b) regarding the modification.

(b) Notice.— If the Secretary proposes to modify the process under which the working group established under subsection (b) of section 1172 of this title conducts assessments under such section, the process under which the Secretary conducts formal evaluations under section 1173 of this title , or issues regulations under section 1174 of this title , 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 notice of the proposed modifications containing the following: A description of the proposed modifications. A description of any exceptions to the requirements of such sections that are proposed because of limited available scientific evidence, and a description of how such evaluations will be conducted.

§ 1176 Agreement with National Academies of Sciences, Engineering, and Medicine concerning toxic exposures

(a) Purpose.— The purpose of this section is to provide for the National Academies of Sciences, Engineering, and Medicine (in this section referred to as the “Academies”), an independent nonprofit scientific organization with appropriate expertise that is not part of the Federal Government, to review and evaluate the available scientific evidence regarding associations between diseases and toxic exposures.

(b) Agreement.— The Secretary shall seek to enter into a five-year agreement with the Academies to perform the services covered by this section. The Secretary shall seek to enter into an agreement described in paragraph (1) not later than 60 days after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022. An agreement under this section may be extended in five-year increments.

(c) Review of Scientific Evidence.— Under an agreement between the Secretary and the Academies under this section, the Academies shall review and summarize the scientific evidence, and assess the strength thereof, concerning the association between toxic exposures during active military, naval, air, or space service and each disease suspected to be associated with such exposure in the human population.

(d) Scientific Determinations Concerning Diseases.— For each disease reviewed under subsection (c), the Academies shall determine, to the extent that available scientific data permit meaningful determinations— whether an association exists between toxic exposures and the occurrence of the disease, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association; the increased risk of the disease among those reporting toxic exposures during active military, naval, air, or space service; whether there exists a plausible biological mechanism or other evidence of a positive association between the toxic exposure and the occurrence of the disease; and determine the strength of evidence for a positive association based on categories furnished under section 1173 of this title .

(e) Cooperation of Federal Agencies.— The head of each relevant Federal agency, including the Secretary of Defense, shall cooperate fully with the Academies in performing the services covered by this section.

(f) Recommendations for Additional Scientific Studies.— Under an agreement between the Secretary and the Academies under this section, the Academies shall make any recommendations for additional scientific studies to resolve areas of continuing scientific uncertainty relating to toxic exposures. In making recommendations under paragraph (1), the Academies shall consider— the scientific information that is available at the time of the recommendation; the value and relevance of the information that could result from additional studies; and the cost and feasibility of carrying out such additional studies.

(g) Reports.— Under an agreement between the Secretary and the Academies under this section, not later than one year after the date of the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, the Academies shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives an initial report on the activities of the Academies under the agreement. The report submitted under subparagraph (A) shall include the following: The determinations described in subsection (d). A full explanation of the scientific evidence and reasoning that led to such determinations. Any recommendations of the Academies under subsection (f). Under an agreement between the Secretary and the Academies under this section, not less frequently than once every two years after the date on which the initial report is submitted under paragraph (1)(A), the Academies shall submit to the Secretary, 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 Academies under the agreement.

(h) Alternative Contract Scientific Organization.— If the Secretary is unable within the time period prescribed in subsection (b)(2) to enter into an agreement with the Academies for the purposes of this section on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for the purposes of this section with another appropriate scientific organization that— is not part of the Federal Government; operates as a not-for-profit entity; and has expertise and objectivity comparable to that of the Academies. If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this subchapter to the Academies shall be treated as a reference to the other organization.