S.Amdt. 5517

1. Adds SEC. 1041. ESTABLISHMENT OF REGISTRY OF MEMBERS AND FORMER MEMBERS OF THE ARMED FORCES EXPOSED IN THE LINE OF DUTY TO OCCUPATIONAL AND ENVIRONMENTAL HEALTH CHEMICAL HAZARDS at the end of subtitle D of title X

   Adds a section

   In S. 3001 · Placed on Calendar Senate

   (2) if the Secretary determines that such an initiative is in the national interest, take appropriate actions to coordinate with the Federal Aviation Administration to achieve the type certification for such aircraft required by section 21.27 of title 14, Code of Federal Regulations.

   Inserted: SEC. 1041. ESTABLISHMENT OF REGISTRY OF MEMBERS AND FORMER MEMBERS OF THE ARMED FORCES EXPOSED IN THE LINE OF DUTY TO OCCUPATIONAL AND ENVIRONMENTAL HEALTH CHEMICAL HAZARDS.

   Inserted: (a) Establishment.--The Secretary of Defense shall establish and administer a registry of members and former members of the Armed Forces who were exposed in the line of duty to occupational and environmental health chemical hazards in concentrations that exceed the military exposure guidelines to assist in the provision of care to such members and former members.

   Inserted: (b) Registration.--

   Inserted: (1) In general.--Except as provided in paragraph (2), for every member and former member of the Armed Forces who requests to be included in the registry required by subsection (a), the Secretary shall--

   Inserted: (A) register such member or former member in such registry; and

   Inserted: (B) collect such information about such member or former member as the Secretary considers appropriate for purposes of establishing and administering such registry.

   Inserted: (2) Exclusion.--The Secretary may exclude from the registry required by subsection (a) individuals for whom the Secretary has evidence that indicates that such individual is not a member or former member of the Armed Forces who was exposed in the line of duty to an occupational and environmental health chemical hazard in a concentration that exceeded the military exposure guidelines.

   Inserted: (c) Notification.--In the case that the Secretary learns that a member or former member of the Armed Forces may have been exposed in the line of duty to an occupational and environmental health chemical hazard in a concentration that exceeds the military exposure guidelines for such hazard, the Secretary shall--

   Inserted: (1) notify of such exposure--

   Inserted: (A) such member or former member;

   Inserted: (B) the commanding officer of the unit to which such member or former member belonged at the time of such exposure; and

   Inserted: (C) in the case of a member of the National Guard, the Adjutant General of the State concerned; and

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   Inserted: (2) inform such member or former member that such member or former member may request to be included in the registry required by subsection (a).

   Inserted: (d) Examination.--The Secretary shall give each individual in the registry required by subsection (a) a complete physical and medical examination.

   Inserted: (e) Military Exposure Guidelines Defined.--In this section, the term "military exposure guidelines" means the military exposure guidelines specified in the January 2002 Chemical Exposure Guidelines for Deployed Military Personnel, United States Army Center for Health Promotion and Preventive Medicine Technical Guide 230 (or any successor technical guide that establishes military exposure guidelines for the assessment of the significance of field exposures to occupational and environmental health chemical hazards during deployments).

   Inserted: SEC. 1042. SCIENTIFIC REVIEW OF ASSOCIATION OF HEALTH EFFECTS WITH EXPOSURE TO OCCUPATIONAL AND ENVIRONMENTAL HEALTH CHEMICAL HAZARDS THAT EXCEED MILITARY EXPOSURE GUIDELINES.

   Inserted: (a) Agreement.--

   Inserted: (1) In general.--The Secretary of Defense shall seek to enter into an agreement with the Institute of Medicine of the National Academies for the Institute of Medicine to perform the services covered by this section.

   Inserted: (2) Timing.--The Secretary shall seek to enter into the agreement described in paragraph (1) not later than two months after the date of the enactment of this Act.

   Inserted: (b) Review of Scientific Evidence.--Under an agreement between the Secretary of Defense and the Institute of Medicine under this section, the Institute of Medicine shall, for each health effect reported in the registry established in section 1041(a) with respect to exposure to an occupational and environmental health chemical hazard listed in the military exposure guidelines, review and summarize the scientific evidence, and assess the strength thereof, concerning the association between the health effect and the exposure to such occupational and environmental health chemical hazard in a concentration that exceeds the military exposure guidelines.

   Inserted: (c) Scientific Determinations Concerning Health Effects.--

   Inserted: (1) In general.--For each health effect reviewed under subsection (b), the Institute of Medicine shall determine (to the extent that available scientific data permit meaningful determinations)--

   Inserted: (A) whether a statistical association with the occupational and environmental health chemical hazard exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association;

   Inserted: (B) the increased risk of the health effect among those exposed to occupational and environmental health chemical hazards in the line of duty; and

   Inserted: (C) whether there exists a plausible biological mechanism or other evidence of a causal relationship between the occupational and environmental health chemical hazard and the health effect.

   Inserted: (2) Discussion and reasoning.--The Institute of Medicine shall include in its reports under subsection (f) a full discussion of the scientific evidence and reasoning that led to its conclusions under this subsection.

   Inserted: (d) Recommendations for Additional Scientific Studies.--

   Inserted: (1) In general.--The Institute of Medicine shall make any recommendations it has for additional scientific studies to resolve areas of continuing scientific uncertainty relating to exposure to occupational and environmental health chemical hazards.

   Inserted: (2) Considerations.--In making recommendations for further study, the Institute of Medicine shall consider the following:

   Inserted: (A) The scientific information that is currently available.

   Inserted: (B) The value and relevance of the information that could result from additional studies.

   Inserted: (C) The cost and feasibility of carrying out such additional studies.

   Inserted: (e) Subsequent Reviews.--The agreement under subsection (a) shall require the Institute of Medicine--

   Inserted: (1) to periodically conduct as comprehensive a review as is practicable of the evidence referred to in subsection (b) that has become available since the last review of such evidence under this section; and

   Inserted: (2) to make its determinations and estimates on the basis of the results of such review and all other reviews conducted for the purposes of this section.

   Inserted: (f) Reports.--

   Inserted: (1) Reports to congress.--

   Inserted: (A) In general.--The agreement under subsection (a) shall require the Institute of Medicine to submit, not later than the end of the 18-month period beginning on the date of the enactment of this Act and not less frequently than once every two years thereafter, to the appropriate committees of Congress a report on the activities of the Institute of Medicine under the agreement.

   Inserted: (B) Contents.--The report described in paragraph (1) shall include the following:

   Inserted: (i) The determinations and discussion referred to in subsection (c).

   Inserted: (ii) Any recommendations of the Institute of Medicine under subsection (d).

   Inserted: (2) Reports to secretary of defense.--The agreement under subsection (a) shall require the Institute of Medicine, in the case that the Institute of Medicine makes any conclusive determination under subsection (c)(1) with respect to any health effect studied under subsection (b), to submit, not later than 30 days after the date of such determination, to the Secretary of Defense a report describing such determination.

   Inserted: (g) Limitation on Authority.--The agreement under this section shall be effective for a fiscal year to the extent that appropriations are available to carry out the agreement.

   Inserted: (h) Sunset.--This section shall cease to be effective 10 years after the last day of the fiscal year in which the Institute of Medicine submits to the Secretary of Defense the first report under subsection (f).

   Inserted: (i) Alternative Contract Scientific Organization.--

   Inserted: (1) In general.--If the Secretary of Defense is unable within the time period prescribed in subsection (a)(2) to enter into an agreement described in subsection (a)(1) with the Institute of Medicine on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate scientific organization that--

   Inserted: (A) is not part of the Government;

   Inserted: (B) operates as a not-for-profit entity; and

   Inserted: (C) has expertise and objectivity comparable to that of the Institute of Medicine.

   Inserted: (2) Treatment.--If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this section to the Institute of Medicine shall be treated as a reference to the other organization.

   Inserted: (j) Definitions.--In this section:

   Inserted: (1) Appropriate committees of congress.--The term "appropriate committees of Congress" means--

   Inserted: (A) the Committee on Armed Services and the Committee on Health, Education, Labor, and Pensions of the Senate; and

   Inserted: (B) the Committee on Armed Services and the Committee on Energy and Commerce of the House of Representatives.

   Inserted: (2) Military exposure guidelines.--The term "military exposure guidelines" means the military exposure guidelines specified in the January 2002 Chemical Exposure Guidelines for Deployed Military Personnel, United States Army Center for Health Promotion and Preventive Medicine Technical Guide 230 (or any successor technical guide that establishes military exposure guidelines for the assessment of the significance of field exposures to occupational and environmental health chemical hazards during deployments).

   Inserted: SEC. 1043. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO OCCUPATIONAL AND ENVIRONMENTAL HEALTH CHEMICAL HAZARDS.

   Inserted: (a) Authorized Inpatient Care.--Section 1710(e) of title 38, United States Code, is amended--

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

   Inserted: "(F) A veteran who was exposed in the line of duty to an occupational and environmental health chemical hazard in a concentration that exceeds the military exposure guidelines is eligible (subject to paragraph (2)) for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disability, notwithstanding that there is insufficient medical evidence to conclude that such disability may be associated with such exposure.";

   Inserted: (2) in paragraph (2), by adding at the end the following:

   Inserted: "(C) In the case of a veteran described in paragraph (1)(F), hospital care, medical services, and nursing home care may not be provided under subsection (a)(2)(F) with respect to--

   Inserted: "(i) a disability that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than an exposure described in paragraph (1)(F); or

   Inserted: "(ii) a health effect for which the National Academy of Sciences, in a report issued in accordance with section 1042 of the National Defense Authorization Act for Fiscal Year 2009, has determined that there is limited or suggestive evidence of the lack of a positive association between occurrence of the health effect in humans and exposure to an occupational and environmental health chemical hazard listed in the military exposure guidelines."; and

   Inserted: (3) in paragraph (4), by adding at the end the following:

   Inserted: "(C) The term 'military exposure guidelines' means the military exposure guidelines specified in the January 2002 Chemical Exposure Guidelines for Deployed Military Personnel, United States Army Center for Health Promotion and Preventive Medicine Technical Guide 230 (or any successor technical guide that establishes military exposure guidelines for the assessment of the significance of field exposures to occupational and environmental health chemical hazards during deployments).".

   Inserted: (b) Technical Amendment.--Section 1710(e)(4) is amended in the matter before subparagraph (A) by striking "For purposes of this subsection--" and inserting "In this subsection:".

   Original wording

   At the end of subtitle D of title X, insert the following:

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As printed