[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2718 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 2718

 To amend title 38, United States Code, to improve matters relating to 
  medical examinations for veterans disability compensation, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 5, 2023

Mr. Tester (for himself and Mr. Tillis) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to improve matters relating to 
  medical examinations for veterans disability compensation, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medical Disability Exam Improvement 
Act of 2023''.

SEC. 2. MODIFICATION OF ELIGIBILITY REQUIREMENTS FOR MEDICAL NEXUS 
              EXAMINATIONS FOR TOXIC EXPOSURE RISK ACTIVITIES.

    Section 1168(a)(1) of title 38, United States Code, is amended--
            (1) by striking ``with evidence of a disability and 
        evidence of participation in a toxic exposure risk activity'' 
        and inserting ``and expresses that such claim is associated 
        with a toxic exposure risk activity''; and
            (2) by striking ``and such evidence'' and inserting ``and 
        evidence of record before the Secretary''.

SEC. 3. SPECIFICATION OF ACCOUNTS FOR CERTAIN EXPENSES RELATING TO 
              MEDICAL EXAMINATIONS FOR VETERANS DISABILITY COMPENSATION 
              CLAIMS UNDER LAWS ADMINISTERED BY SECRETARY OF VETERANS 
              AFFAIRS.

    Section 5103A(d) of title 38, United States Code, is amended by 
adding at the end the following new paragraph:
    ``(3) Expenses of carrying out a medical examination or obtaining a 
medical opinion under paragraph (1), including payment for travel and 
incidental expenses under the terms and conditions set forth by section 
111 of this title for the examination or medical opinion, shall be 
reimbursed to the accounts available for the general operating expenses 
of the Veterans Benefits Administration and information technology 
systems from amounts available to the Secretary for payment of 
compensation and pensions.''.

SEC. 4. STUDY ON IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS COVERED 
              MEDICAL DISABILITY EXAMINATIONS IN RURAL AREAS.

    (a) Study Required.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
a study on access by rural veterans to covered medical disability 
examinations.
    (b) Elements.--
            (1) In general.--The study conducted under subsection (a) 
        shall include the following:
                    (A) A comparison of the average number of days to 
                complete covered medical disability examinations for 
                rural veterans compared to a national non-rural average 
                time to complete a covered medical disability 
                examinations, by either contractors or employees of the 
                Department.
                    (B) A root cause analysis of differences identified 
                pursuant to subparagraph (A).
                    (C) The plan of the Secretary for the following 
                year to improve access described in subsection (a), 
                which shall include a plan for the pursuit of a 
                commercial or industry-standard solution or technology 
                that could enable rural or housebound veterans to 
                receive examinations without traveling long distances.
            (2) National non-rural average defined.--For purposes of 
        paragraph (1)(A), the term ``national non-rural average'' means 
        the national average of all periods in the previous calendar 
        year--
                    (A) beginning on the date on which a contractor or 
                employee of the Department received a request from the 
                Secretary to conduct a covered medical disability 
                examination for a veteran who is not a rural veteran; 
                and
                    (B) ending on the date on which the examination was 
                completed.
    (c) Report on Study.--Not later than one year 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 findings of the 
Secretary with respect to the study completed under subsection (a).
    (d) Annual Report on Plans.--Not later than two years after the 
date of the enactment of this Act and not less frequently than once 
each year 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 evaluating the conduct of the 
plans of the Secretary to improve access described in subsection (a) 
and a new or revised plan for such improvement in the following year.

SEC. 5. IMPROVEMENTS TO TRAINING FOR PROCESSING MEDICAL DISABILITY 
              EXAMINATIONS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall require 
additional training for employees of the Department of Veterans Affairs 
who order or review covered medical disability examinations.
    (b) Training Requirements.--The training required under subsection 
(a) shall include the following:
            (1) Instruction on how to assess whether a covered medical 
        disability examination is adequate for purposes of adjudicating 
        the particular claim for a benefit under chapter 11 or 15 of 
        title 38, United States Code, for which the examination was 
        ordered by the Department.
            (2) Instruction on how to assess whether a covered medical 
        disability examination is necessary for purposes of 
        adjudicating the particular claim for a benefit under chapter 
        11 or 15 of title 38, United States Code, for which the 
        examination was ordered by the Department.
            (3) Review of relevant statutes, judicial decisions, 
        regulations, and policies of the Department regarding covered 
        medical disability examinations, including, at a minimum--
                    (A) the duty to assist;
                    (B) the relevance of causation compared to other 
                evidentiary standards in covered medical disability 
                examinations;
                    (C) the required elements of a covered medical 
                disability examination, with an emphasis on the 
                requirement for reasoned analysis to support medical 
                opinions; and
                    (D) the relevance of a lack of a statutory or 
                regulatory presumption of service-connection in covered 
                medical disability examinations.
    (c) Frequency.--The Secretary shall ensure that each employee of 
the Department who orders or uses a covered medical disability 
examination to evaluate a claim for a benefit under chapter 11 or 15 of 
title 38, United States Code, completes training that incorporates the 
requirements of subsection (b) not less frequently than once each year.
    (d) Modification of Reports.--
            (1) Board of veterans' appeals.--Section 7101(d)(2) of 
        title 38, United States Code, is amended--
                    (A) in subparagraph (F), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in subparagraph (G), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(H) a summary of recurring issues that the Chairman 
        believes could be resolved by better training for employees of 
        the Department, increased oversight, or clarification from 
        either the Department or Congress.''.
            (2) United states court of appeals for veterans claims.--
        Section 7288(b) of title 38, United States Code, is amended by 
        adding at the end the following new paragraph:
            ``(16) A summary of recurring issues that the chief judge 
        of the Court believes could be resolved by better training for 
        employees of the Department, increased oversight, or 
        clarification from either the Department or Congress.''.
    (e) Definition of Covered Medical Disability Examination.--In this 
section, the term ``covered medical disability examination'' means a 
medical examination or medical opinion that the Secretary determines 
necessary for the purposes of adjudicating a benefit under chapter 11 
or 15 of title 38, United States Code, regardless of whether conducted 
by an employee or a contractor of the Department.

SEC. 6. REVIEW AND PRIORITY PROCESSING OF CLAIMS WITH INADEQUATE OR 
              UNNECESSARY EXAMINATIONS.

    (a) Review.--Not later than 1 year after the date of the enactment 
of this Act and not less frequently than once every calendar month 
thereafter, the Secretary of Veterans Affairs shall review a 
statistically significant sample of all covered medical disability 
examinations completed during the previous calendar month.
    (b) Further Sample Requirements.--Under each review required by 
subsection (a), the Secretary shall ensure the review includes--
            (1) a statistically significant sample of covered medical 
        disability examinations completed by employees of the 
        Department of Veterans Affairs; and
            (2) a statistically significant sample of covered medical 
        disability examinations completed by each contractor that 
        provides such examinations for the Department.
    (c) Analysis.--Under each review required by subsection (a), the 
Secretary shall analyze--
            (1) the sample specified in subsection (b)(1) and identify 
        the percentage of examinations that were adequate for purposes 
        of adjudicating the particular claim for a benefit under 
        chapter 11 or 15 of title 38, United States Code, for which the 
        examination was ordered by the Department;
            (2) the sample specified in subsection (b)(2) and identify 
        the percentage of examinations that were adequate for purposes 
        of adjudicating the particular claim for a benefit under 
        chapter 11 or 15 of title 38, United States Code, for which the 
        examination was ordered by the Department; and
            (3) the overall sample specified in subsection (a) and 
        identify the percentage of examinations that were necessary for 
        purposes of adjudicating the particular claim for a benefit 
        under chapter 11 or 15 of title 38, United States Code, for 
        which the examination was ordered by the Department.
    (d) Priority Processing.--If during a review under subsection (a) 
the Secretary finds any covered medical disability examination to be 
not adequate or not necessary for adjudicating a claim of a claimant, 
the Secretary may provide such claimant--
            (1) another examination on a priority basis; and
            (2) priority processing for the entirety of impacted claim.
    (e) Covered Medical Disability Examination Defined.--In this 
section, the term ``covered medical disability examination'' means a 
medical examination or medical opinion that the Secretary determines 
necessary for the purposes of adjudicating a benefit under chapter 11 
or 15 of title 38, United States Code, regardless of whether conducted 
by an employee or a contractor of the Department.

SEC. 7. MECHANISM FOR CONTRACTORS CONDUCTING DISABILITY EXAMINATIONS 
              UNDER CERTAIN DEPARTMENT OF VETERANS AFFAIRS PILOT 
              PROGRAM TO TRANSMIT MEDICAL EVIDENCE INTRODUCED BY 
              CLAIMANTS DURING EXAMINATIONS.

    Section 504 of the Veterans' Benefits Improvements Act of 1996 
(Public Law 104-275; 38 U.S.C. 5101 note) is amended--
            (1) by redesignating subsections (d) and (e) as subsection 
        (e) and (f), respectively; and
            (2) by inserting after subsection (c) the following new 
        subsection (d):
    ``(d) Mechanism for Transmittal of Evidence Introduced by 
Applicants During Examinations.--The Secretary shall establish a 
mechanism whereby a health care professional can transmit to the 
Secretary, evidence introduced by the applicant during a medical 
examination or in conjunction with such examination.''.
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