Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022
Public Law 117-168
The following are excerpts, highlighted in red, from the final legislation and/or conference report which contain references to and studies for The National Academies of Sciences, Engineering, and Medicine. (Pound signs [##] between passages denote the deletion of unrelated text.)
S3373 Kaine (D-Va.) 08/04/22
Enrolled (finally passed both houses)
To improve the Iraq and Afghanistan Service Grant and the Children of Fallen Heroes Grant.
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SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE; TABLE OF CONTENTS
(a) SHORT TITLE.—This Act may be cited as the “Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022” or the “Honoring our PACT Act of 2022”.
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“SUBCHAPTER VII—Determinations relating to presumptions of service connection based on toxic exposure
Ҥ1171.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—
“(1) .—under section 1172 of this title—
“(A) the Secretary provides—
“(i) public notice regarding what formal evaluations the Secretary plans to conduct; and
“(ii) the public an opportunity to comment on the proposed formal evaluations;
“(B) the working group established under subsection (b) of such section provides—
“(i) 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;
“(ii) recommendations to the Secretary on corrections needed in the Individual Longitudinal Exposure Record to better reflect veterans and dependents described in clause (i); and
“(iii) recommendations to the Secretary regarding which cases of possible toxic exposure should be reviewed;
“(2) 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
“(3) the Secretary issues regulations under section 1174 of this title.
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Ҥ1173.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:
“(1) Scientific evidence, based on the review of available scientific literature, including human, toxicological, animal, and methodological studies, and other factors.
“(2) Claims data, based on the review of claim rate, grant rate, and service connection prevalence, and other factors.
“(3) .—Other factors the Secretary determines appropriate, such as—
“(A) the level of disability and mortality caused by the health effects related to the case of toxic exposure being evaluated;
“(B) the quantity and quality of the information available and reviewed;
“(C) the feasibility of and period for generating relevant information and evidence;
“(D) whether such health effects are combat- or deployment-related;
“(E) the ubiquity or rarity of the health effects; and
“(F) any time frame during which a health effect must become manifest.
“(c) CONDUCT OF EVALUATIONS (1) .—The Secretary shall ensure that each formal evaluation under subsection (a)—
“(A) reviews scientific evidence in a manner that—
“(i) conforms to principles of scientific and data integrity;
“(ii) is free from suppression or distortion of scientific or technological findings, data, information, conclusions, or technical results; and
“(B) (i) 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
“(ii) 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.
“(2) .—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:
“(A) The ‘sufficient’ category, where the evidence is sufficient to conclude that a positive association exists.
“(B) 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.
“(C) 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.
“(D) 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.
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Ҥ1176.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 (1) The Secretary shall seek to enter into a five-year agreement with the Academies to perform the services covered by this section.
“(2) 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.
“(3) 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—
“(1) 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;
“(2) the increased risk of the disease among those reporting toxic exposures during active military, naval, air, or space service;
“(3) 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
“(4) 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 (1) 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.
“(2) .—In making recommendations under paragraph (1), the Academies shall consider—
“(A) the scientific information that is available at the time of the recommendation;
“(B) the value and relevance of the information that could result from additional studies; and
“(C) the cost and feasibility of carrying out such additional studies.
“(g) REPORTS (1).— (A) 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.
“(B) The report submitted under subparagraph (A) shall include the following:
“(i) The determinations described in subsection (d).
“(ii) A full explanation of the scientific evidence and reasoning that led to such determinations.
“(iii) Any recommendations of the Academies under subsection (f).
“(2) 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 (1) .—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—
“(A) is not part of the Federal Government;
“(B) operates as a not-for-profit entity; and
“(C) has expertise and objectivity comparable to that of the Academies.
“(2) 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.
(b) REPORTS AND BRIEFINGS
(1) REPORT.—
(A) IN GENERAL.—Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the implementation of, and recommendations for, subchapter VII of chapter 11 of title 38, United States Code, as added by subsection (a).
(B) CONSULTATION.—The Secretary shall develop the report under subparagraph (A) in consultation with organizations recognized by the Secretary for the representation of veterans under section 5902 of such title and any other entity the Secretary determines appropriate.
(2) BRIEFING.—On a quarterly basis during the two-year period beginning on the date of the enactment of this Act, the Secretary shall provide to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a briefing on the implementation of subchapter VII of chapter 11 of such title, as added by subsection (a).
(c) INDEPENDENT ASSESSMENT
(1) AGREEMENT.—The Secretary shall seek to enter into an agreement with the National Academies of Science, Engineering, and Medicine (in this subsection referred to as the “Academies”) before the date that is 90 days after the date of the enactment of this Act to perform the services set forth under paragraph (2).
(2) ASSESSMENT.—
(A) IN GENERAL.—Under an agreement between the Secretary and the Academies under paragraph (1), the Academies shall conduct an assessment of the implementation by the Department of Veterans Affairs of the process established under subchapter VII of chapter 11 of title 38, United States Code, as added by subsection (a).
(B) ELEMENTS.—The assessment conducted under subparagraph (A) shall include the following:
(i) An assessment of the Department’s implementation of the process established under subsection (a) to determine whether the process is in accordance with current scientific standards for assessing the link between exposure to environmental hazards and the development of health outcomes,
(ii) assess whether the criteria is fair and consistent, and
(iii) provide recommendations for improvements to the process.
(3) REPORT.—Not later than one year after the date on which the Secretary enters into an agreement under paragraph (1), 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 on the findings of the Academies pursuant to such agreement.
(4) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZATION.—
(A) IN GENERAL.—If the Secretary is unable within the time period prescribed in paragraph (1) to enter into an agreement with the Academies for the purposes of this subsection on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for the purposes of this subsection with another appropriate scientific organization that—
(i) is not part of the Federal Government;
(ii) operates as a not-for-profit entity; and
(iii) has expertise and objectivity comparable to that of the Academies.
(B) TREATMENT.—If the Secretary enters into an agreement with another organization as described in subparagraph (A), any reference in this subsection to the Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization.
(d) CONFORMING AMENDMENTS.—Chapter 11 is amended—
(1) .—in section 1116—
(A) by striking subsections (b), (c), (d), and (e);
(B) by inserting after subsection (a) the following new subsection (b):
“(b) The Secretary shall ensure that any determination made on or after the date of the enactment of the 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) by redesignating subsection (f) as subsection (c);
(2) in section 1116B(b)(2)(A), by inserting “pursuant to subchapter VII of this chapter,” before “the Secretary determines”; and
(3) .—in section 1118—
(A) by striking subsections (b) through (e); and
(B) by inserting after subsection (a) the following new subsection (b):
“(b) The Secretary shall ensure that any determination made on or after the date of the enactment of the 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.
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SEC. 506. STUDY ON HEALTH EFFECTS OF WASTE RELATED TO MANHATTAN PROJECT ON CERTAIN VETERANS
(a) STUDY.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for the conduct of a study on the health trends of veterans who, while serving in the active military, naval, air, or space service—
(1) participated in activities relating to the Manhattan Project (including activities relating to covered waste) in connection with such service; or
(2) resided at or near, as determined by the Secretary, the locations described in subsection (b).
(b) COVERED LOCATIONS.—The locations described in this subsection are the following locations:
(1) .—In the county of St. Louis, Missouri, the following:
(A) Coldwater Creek, Missouri.
(B) The St. Louis Airport Site, Missouri.
(C) The West Lake Landfill.
(2) Oak Ridge, Tennessee.
(3) Hanford, Washington.
(4) Any other location that is proximate to covered waste, as determined by the Secretary.
(c) ELEMENTS.—The study under subsection (a) shall assess, with respect to each veteran included in the study, the following:
(1) The age, sex, and race of the veteran.
(2) The period and location of exposure to covered waste.
(3) Any type of cancer, or other illness associated with toxic exposure, that the veteran has.
(4) A comparison of the overall health condition of the veteran, including any illness of the veteran identified pursuant to paragraph (3), with the overall health condition of past and present civilian populations residing at the same location of exposure, as determined by the Secretary.
(d) REPORT.—Not later than three years after the date of the enactment of this Act, 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 on the study under subsection (a) and include in such report an analysis of the data available and data reliability.
(e) DEFINITIONS.—In this section:
(1) ACTIVE MILITARY, NAVAL, AIR, OR SPACE SERVICE; TOXIC EXPOSURE.—The terms “active military, naval, air, or space service” and “toxic exposure”
have the meanings given those terms in section 101 of title 38, United States Code, as added by section 102(b).
(2) COVERED WASTE.—The term “covered waste” means any waste arising from activities carried out in connection with the Manhattan Project.
(3) ILLNESS.—The term “illness” has the meaning given that term in section 1171 of title 38, United States Code, as added by section 202.
(4) TOXIC EXPOSURE.—The term “toxic exposure” has the meaning given such term in section 101 of title 38, United States Code, as amended by section 102(b).
SEC. 507. STUDY ON TOXIC EXPOSURE AND MENTAL HEALTH OUTCOMES
(a) STUDY REQUIRED.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for the conduct of a study of veterans to assess possible relationships between toxic exposures experienced during service in the Armed Forces and mental health conditions, including chronic multisymptom illness, traumatic brain injury, post-traumatic stress disorder, depression, episodes of psychosis, schizophrenia, bipolar disorder, suicide attempts, and suicide deaths.
(b) ELEMENTS.—For each veteran included in the study under subsection (a), the following information shall be collected and assessed:
(1) Age.
(2) Sex.
(3) Race and ethnicity.
(4) Period and length of service in the Armed Forces.
(5) The military occupational specialty or specialties of the veteran.
(6) History of toxic exposure during service in the Armed Forces.
(7) Any diagnosis of chronic multisymptom illness.
(8) Any diagnosis of a mental health or cognitive disorder.
(9) Any history of suicide attempt or suicidality.
(10) If the veteran died by suicide.
(11) Any confounding traumatic experiences that could affect a veteran's mental health.
(c) REPORT.—Not later than three years after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report containing the findings of the National Academies of Sciences, Engineering, and Medicine with respect to the study conducted under subsection (a).
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