Senate Report 113-123 - VETERANS HEALTH AND BENEFITS IMPROVEMENT ACT OF 2013

[Senate Report 113-123]
[From the U.S. Government Publishing Office]

Calendar No. 258
113th Congress Report
SENATE
1st Session 113-123

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VETERANS HEALTH AND BENEFITS IMPROVEMENT ACT OF 2013

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December 9, 2013.--Ordered to be printed

_______

Mr. Sanders, from the Committee on Veterans' Affairs,
submitted the following

R E P O R T

together with

MINORITY VIEWS

[To accompany S. 944]

The Committee on Veterans' Affairs (hereinafter, ``the
Committee''), to which was referred the bill (S. 944), to amend
title 38, United States Code (hereinafter, ``U.S.C.''), to
require courses of education provided by public institutions of
higher education that are approved for purposes of the All-
Volunteer Force Educational Assistance Program and Post-9/11
Educational Assistance to charge veterans tuition and fees at
the in-State tuition rate, and for other purposes, having
considered the same, reports favorably thereon with an
amendment in the nature of a substitute, and an amendment to
the title, and recommends that the bill, as amended, do pass.

Introduction

On May 14, 2013, Committee Chairman Sanders introduced
S. 944, which would require courses of education provided by
public institutions of higher education that are approved for
purposes of the All-Volunteer Force Educational Assistance
Program and Post-9/11 Educational Assistance Program
(hereinafter, ``Post-9/11 GI Bill'') to charge veterans tuition
and fees at the in-State tuition rate. Ranking Member Burr is
an original cosponsor. The bill was referred to the Committee.
On January 31, 2013, Senator Murkowski introduced S. 200,
which would authorize the interment in national cemeteries
under the control of the National Cemetery Administration of
individuals who served in combat support of the Armed Forces in
the Kingdom of Laos between February 28, 1961, and May 15,
1975. Senators Begich and Whitehouse were later added as
cosponsors of the bill. The bill was referred to the Committee.
On February 7, 2013, Senator Toomey introduced S. 229, the
proposed Corporal Michael J. Crescenz Act of 2013. S. 229 would
designate the Department of Veterans Affairs (hereinafter,
``VA'' or ``the Department'') Medical Center at 3900 Woodland
Avenue in Philadelphia, Pennsylvania, as the ``Corporal Michael
J. Crescenz Department of Veterans Affairs Medical Center.''
Senator Casey is an original cosponsor. The bill was referred
to the Committee.
On February 7, 2013, Senator Boozman introduced S. 257, the
proposed GI Bill Tuition Fairness Act of 2013. S. 257 would
direct VA, for purposes of the educational assistance programs
administered by the Department, to disapprove courses of
education provided by public institutions of higher education
that do not charge tuition and fees for veterans at the same
rate that is charged for in-State residents, regardless of the
veteran's State of residence. Senators Durbin and Nelson are
original cosponsors of the bill. Senator Begich was later added
as a cosponsor of the bill. The bill was referred to the
Committee.
On February 13, 2013, Senator Tester introduced S. 294, the
proposed Ruth Moore Act of 2013. S. 294 would modify VA's
disability compensation evaluation procedure for veterans with
mental health conditions related to military sexual trauma
(hereinafter, ``MST''). Senators Baucus, Begich, Blumenthal,
Gillibrand, and Shaheen are original cosponsors of the bill.
Senators Baldwin, Bennet, Boxer, Cantwell, Collins, Durbin,
Feinstein, Harkin, Heinrich, Kaine, King, Klobuchar, Landrieu,
McCaskill, Merkley, Mikulski, Murkowski, Nelson, Schatz, Mark
Udall, Tom Udall, Warner, and Warren were later added as
cosponsors of the bill.
On February 28, 2013, Senator Blumenthal introduced S. 422,
the proposed Chiropractic Care Available to All Veterans Act of
2013. S. 422 would amend the VA Health Care Programs
Enhancement Act of 2001 to require the provision of
chiropractic care and services to veterans at all VA medical
centers and to expand access to such care and services.
Senators Brown, Grassley, Harkin, Moran, Schumer, Tester, and
Whitehouse are original cosponsors of the bill. Senators
Begich, Collins, King, Murkowski, and Murphy were later added
as cosponsors of the bill. The bill was referred to the
Committee.
On February 28, 2013, Senator Heller introduced S. 430, the
proposed Veterans Small Business Opportunity and Protection Act
of 2013. S. 430 would enhance treatment of certain small
business concerns for purposes of VA contracting goals and
preferences. Senator Manchin is an original cosponsor of the
bill. Senator Begich was later added as a cosponsor of the
bill. The bill was referred to the Committee.
On March 5, 2013, Senator Tester introduced S. 455, which
would authorize VA to transport individuals to and from its
facilities in connection with rehabilitation, counseling,
examination, treatment, and care. Senators Begich, Chambliss,
and Moran are original cosponsors of the bill. Senator Heitkamp
was later added as a cosponsor of the bill. The bill was
referred to the Committee.
On March 7, 2013, Ranking Member Burr introduced S. 492,
which would require States to recognize the military experience
of veterans when issuing licenses and credentials to veterans.
The bill was referred to the Committee.
On March 7, 2013, Ranking Member Burr introduced S. 495,
the proposed Careers for Veterans Act of 2013. S. 495 would
require Federal agencies to hire veterans and States to
recognize the military experience of veterans when issuing
licenses and credentials to veterans. Senators Boozman, Cornyn,
Heller, and Isakson are original cosponsors of the bill.
Senators Johanns and Rubio were later added as cosponsors of
the bill. The bill was referred to the Committee.
On March 11, 2013, Senator Brown introduced S. 515, which
would extend the Yellow Ribbon G.I. Education Enhancement
Program to cover recipients of the Marine Gunnery Sergeant John
David Fry Scholarship. The bill was referred to the Committee.
On March 11, 2013, Senator Durbin introduced S. 522, the
proposed Wounded Warrior Workforce Enhancement Act. S. 522
would require VA to award grants to establish, or expand upon,
master's degree or doctoral degree programs in orthotics and
prosthetics. Senators Blumenthal and Harkin are original
cosponsors of the bill. Senators Begich, Chambliss, and Murphy
were later added as cosponsors of the bill. The bill was
referred to the Committee.
On March 12, 2013, Ranking Member Burr introduced S. 529,
which would modify the commencement date of the period of
service at Camp Lejeune, North Carolina, for eligibility for
hospital care and medical services in connection with exposure
to contaminated water. Senators Hagan, Nelson, and Rubio are
original cosponsors of the bill. The bill was referred to the
Committee.
On March 13, 2013, Ranking Member Burr introduced S. 543,
the proposed VISN Reorganization Act of 2013. S. 543 would
direct the Secretary of Veterans Affairs to organize the
Veterans Health Administration (hereinafter, ``VHA'') into 12
geographically defined Veterans Integrated Service Networks
(hereinafter, ``VISNs''). Senator Coburn is an original
cosponsor of the bill. The bill was referred to the Committee.
On March 20, 2013, Senator Pryor introduced S. 629, the
proposed Honor America's Guard-Reserve Retirees Act of 2013.
S. 629 would honor as a veteran any person entitled to retired
pay for nonregular (Reserve) service or who, but for age, would
be so entitled. Senators Begich, Boozman, Franken, Grassley,
Harkin, Tim Johnson, Leahy, Tester, and Wyden are original
cosponsors of the bill. Senators Alexander, Cochran, Crapo,
Gillibrand, Heller, Hirono, Johanns, Klobuchar, Mikulski,
Murkowski, Rubio, Schatz, Sessions, Shaheen, and Thune were
later added as cosponsors of the bill. The bill was referred to
the Committee.
On April 9, 2013, Senator Heller introduced S. 674, the
proposed Accountability for Veterans Act of 2013. S. 674 would
require prompt responses from the heads of covered Federal
agencies when VA requests information necessary to adjudicate
claims for benefits under laws administered by the Department.
Senators Chambliss, Cochran, Cruz, Lee, Murkowski, Paul, Pryor,
Thune, Vitter, and Wicker were later added as cosponsors of
this bill. The bill was referred to the Committee.
On April 10, 2013, Senator Boozman introduced S. 695, the
proposed Veterans Paralympic Act of 2013. S. 695 would extend
the authorization of appropriations for VA to pay a monthly
assistance allowance to disabled veterans training or competing
for the Paralympics team, and the authorization of
appropriations for VA to provide assistance to the United
States Paralympics, Inc. Senator Begich is an original
cosponsor of the bill. Senators Brown, Harkin, Hirono, Isakson,
Johanns, Kirk, Moran, Murray, Nelson, and Tester were later
added as cosponsors of the bill. The bill was referred to the
Committee.
On April 16, 2013, Committee Chairman Sanders introduced
S. 735, the proposed Survivor Benefits Improvement Act of 2013.
S. 735 would improve benefits and assistance provided to
surviving spouses of veterans under laws administered by VA.
The bill was referred to the Committee.
On April 17, 2013, Senator Wyden introduced S. 748, the
proposed Veterans Pension Protection Act. S. 748 would require
VA to consider the resources of individuals applying for
pensions that were recently disposed of by such individuals for
less than fair market value when determining the eligibility of
such individuals for pension benefits. Ranking Member Burr and
Senators Blumenthal, Heller, McCaskill, and Tester are original
cosponsors of the bill. The bill was referred to the Committee.
On April 23, 2013, Ranking Member Burr introduced S. 778,
which would authorize the Secretary of Veterans Affairs to
issue cards to veterans that identify them as veterans. Senator
Begich is an original cosponsor of this bill. The bill was
referred to the Committee.
On April 25, 2013, Senator Donnelly introduced S. 832, the
proposed Improving the Lives of Children with Spina Bifida Act
of 2013. S. 832 would direct VA to carry out a 3-year pilot
program to assess the feasibility and advisability of providing
contracted case management services to individuals entitled to
VA benefits as children of Vietnam and Korean War veterans born
with spina bifida, and children of female Vietnam veterans born
with certain birth defects who live in a rural area and have no
access to such services through VA or otherwise. The bill was
referred to the Committee.
On April 25, 2013, Senator Tester introduced S. 845, which
would improve VA's Health Professional Educational Assistance
Program. Senator Moran is an original cosponsor of the bill.
Senators Begich and Blumenthal were later added as cosponsors
of the bill. The bill was referred to the Committee.
On April 25, 2013, Committee Chairman Sanders introduced
S. 852, the proposed Veterans' Health Promotion Act of 2013.
S. 852 would require VA to designate and operate at least one
center of innovation for complementary and alternative medicine
(hereinafter, ``CAM'') in health research, education, and
clinical activities in each of the VISNs. Senator Tester was
later added as a cosponsor of the bill. The bill was referred
to the Committee.
On May 7, 2013, Senator Heller introduced S. 868, the
proposed Filipino Veterans Promise Act. S. 868 would require
the Department of Defense (hereinafter, ``DOD'') to establish a
process for determining whether individuals who served in the
organized military forces of the Government of the Commonwealth
of the Philippines or in the Philippine Scouts while in the
service of the U.S. Armed Forces during World War II and who
are not included in the Missouri List are eligible for certain
benefits relating to their service. Senator Hirono is an
original cosponsor of the bill. Senator Begich was later added
as a cosponsor of the bill. The bill was referred to the
Committee.
On May 7, 2013, Senator Begich introduced S. 877, the
proposed Veterans Affairs Research Transparency Act of 2013.
S. 877 would require VA to allow public access to research of
the Department. Senators Blumenthal and Schatz were later added
as cosponsors of the bill. The bill was referred to the
Committee.
On May 7, 2013, Senator Boozman introduced S. 889, the
proposed Servicemembers' Choice in Transition Act of 2013.
S. 889 would modify the Transition Assistance Program
(hereinafter, ``TAP'') of DOD. Senators Manchin, Moran, and
Tester are original cosponsors of the bill. The bill was
referred to the Committee.
On May 8, 2013, Committee Chairman Sanders introduced
S. 894, which would extend expiring authority for work-study
allowances for individuals who are pursuing programs of
rehabilitation, education, or training under laws administered
by VA, and expand such authority to certain outreach services
provided through congressional offices. The bill was referred
to the Committee.
On May 9, 2013, Committee Chairman Sanders introduced
S. 927, the proposed Veterans' Outreach Act of 2013. S. 927
would require VA to carry out a demonstration project to assess
the feasibility and advisability of using State and local
government agencies and nonprofit organizations to increase
awareness of benefits and services for veterans and to improve
coordination of outreach activities relating to such benefits
and services. The bill was referred to the Committee.
On May 9, 2013, Committee Chairman Sanders introduced
S. 928, the proposed Claims Processing Improvement Act of 2013.
S. 928 would improve the processing of claims for compensation
under laws administered by VA. Senators Begich, Brown, Schumer,
and Tester were later added as cosponsors of the bill. The bill
was referred to the Committee.
On May 13, 2013, Senator Bennet introduced S. 930, which
would require VA, in cases of overpayments of educational
assistance under the Post-9/11 GI Bill, to deduct amounts for
repayment from the last months of educational assistance
entitlement. The bill was referred to the Committee.
On May 13, 2013, Senator Franken introduced S. 935, the
proposed Quicker Veterans Benefits Delivery Act of 2013. S. 935
would prohibit VA from requesting additional medical
examinations of veterans who have submitted sufficient medical
evidence provided by non-Department medical professionals and
modify VA's processing of certain claims for disability
compensation by veterans. The bill was referred to the
Committee.
On May 14, 2013, Senator Moran introduced S. 938, the
proposed Franchise Education for Veterans Act of 2013. S. 938
would allow eligible individuals to use VA veterans'
educational assistance benefits for franchise training. The
bill was referred to the Committee.
On May 14, 2013, Senator Blumenthal introduced S. 939,
which would treat certain misfiled documents as motions for
reconsideration of decisions by the Board of Veterans' Appeals
(hereinafter, ``BVA'' or ``the Board''). Senator Begich is an
original cosponsor of the bill. The bill was referred to the
Committee.
On May 23, 2013, Senator Merkley introduced S. 1039, the
proposed Spouses of Heroes Education Act. S. 1039 would expand
the Marine Gunnery Sergeant John David Fry scholarship to
include spouses of members of the Armed Forces who die in the
line of duty. Senator Heller is an original cosponsor of the
bill. Senators Baucus, Begich, Schatz, Tester, and Vitter were
later added as cosponsors of the bill. The bill was referred to
the Committee.
On May 9, 2013, the Committee held a hearing on pending
health care legislation. Testimony was offered by: Robert L.
Jesse, MD, PhD, Principal Deputy Under Secretary for Health,
VA; Rick Weidman, Executive Director for Policy and Government
Affairs, Vietnam Veterans of America; Wayne B. Jonas, MD,
President and Chief Executive Officer, Samueli Institute;
Heather Ansley, Esq., MSW, Vice President for Veterans Policy,
VetsFirst; Matt Gornick, Policy Director, National Coalition
for Homeless Veterans; and Thomas Bowman, Former Chief of
Staff, VA.
On June 12, 2013, the Committee held a hearing on pending
benefits legislation. Testimony was offered by: Curtis L. Coy,
Deputy Under Secretary for Economic Opportunity, Veterans
Benefits Administration, VA; Jeffrey Hall, Assistant
Legislative Director, Disabled American Veterans; Ian de
Planque, Deputy Legislative Director, The American Legion;
Colonel Robert F. Norton, USA (Ret.), Deputy Director,
Government Relations, Military Officers Association of America;
Ryan Gallucci, Deputy Director, National Legislative Service,
Veterans of Foreign Wars.

Committee Meeting

After carefully reviewing the testimony from the foregoing
hearings, the Committee met in open session on July 24, 2013,
to consider, among other legislation, an amended version of
S. 944, consisting of provisions from S. 944 as introduced and
provisions from the other legislation noted above. The
Committee voted, without dissent, to report favorably S. 944 as
amended.

Summary of S. 944 as Reported

S. 944, as reported (hereinafter, ``the Committee bill''),
consists of 74 sections, summarized below:

Section 1 provides a short title and table of contents.
Section 2 provides that certain references within the bill
are references to title 38, U.S.C.

TITLE I--SURVIVOR AND DEPENDENT MATTERS

Section 101 would extend the period for additional
dependency and indemnity compensation (hereinafter, ``DIC'')
for surviving spouses with dependent children to 3 years after
date of entitlement.
Section 102 would provide that remarriage after age 55 of a
surviving spouse shall not bar the furnishing of certain
benefits.
Section 103 would extend the marriage delimiting date for
surviving spouses of Persian Gulf War veterans to qualify for
death pension.
Section 104 would expand the Marine Gunnery Sergeant John
David Fry Scholarship to include surviving spouses of members
of the Armed Forces who die in the line of duty.
Section 105 would expand eligibility for the Yellow Ribbon
Program to beneficiaries of the Marine Gunnery Sergeant John
David Fry Scholarship.
Section 106 would authorize VA to provide benefits to
children, of certain Vietnam era veterans with covered service
in Thailand, born with spina bifida.
Section 107 would require VA to carry out a 3-year program
to provide assisted living, group home care, or similar
services to children with spina bifida.
Section 108 would require VA to carry out a 2-year program
to provide grief counseling services in group retreat settings
for surviving spouses of veterans who died while serving on
active duty.
Section 109 would require VA to conduct a program
evaluation of the Survivors' and Dependents' Educational
Assistance Program.

TITLE II--EDUCATION MATTERS

Section 201 would require VA to disapprove a course of
education provided by a public institution of higher learning
for purposes of Post-9/11 GI Bill and Montgomery GI Bill
(hereinafter, ``MGIB'') education benefits, if the institution
charges tuition and fees for that course for a covered
individual at a rate that is higher than the rate the
institution charges for tuition and fees for that course for
residents of the State in which the institution is located. The
public institution would be required to charge the in-State
tuition rate for Post-9/11 GI Bill and MGIB beneficiaries while
the individual is living in the State and enrolls in a course
of education within 3 years from discharge or release from
military service.
Section 202 would reauthorize certain options under VA's
Work-Study Program and expand the program to allow veterans to
work in congressional offices to conduct outreach and
assistance to servicemembers, veterans, and their families.
Section 203 would require the Government Accountability
Office (hereinafter, ``GAO'') to submit a report to Congress on
VA's processes for identifying and resolving incorrect payments
under the Post-9/11 GI Bill and MGIB.
Section 204 would decrease the amount of reporting fees
paid by VA to educational and training institutions in lieu of
other compensation for reports or certifications the
institution may be required to submit to VA.

TITLE III--HEALTH CARE MATTERS

SUBTITLE A--EXPANSION AND IMPROVEMENTS OF BENEFITS GENERALLY

Section 301 would require the increased provision of
chiropractic care and services to veterans at VA medical
centers and clinics.
Section 302 would amend the date of eligibility for
purposes of obtaining hospital care and medical services at VA
in connection with exposure to contaminated water at Camp
Lejeune, North Carolina, from January 1, 1957, to August 1,
1953.
Section 303 would provide VA with the authority to provide
counseling, care, and services to veterans, and certain other
servicemembers who may not have veteran status, who experienced
sexual trauma while serving on inactive duty for training.
Section 304 would extend the authority for VA to transport
individuals to and from VA facilities in connection with
vocational rehabilitation, counseling, examination, treatment,
or care.
Section 305 would direct VA to carry out a 2-year program
to assess the feasibility and advisability of promoting health
through the support of fitness center membership for veterans
determined to be overweight or obese and who reside more than
15 minutes driving distance from a VA fitness facility.
Section 306 would require VA to carry out a 3-year program
to assess the feasibility and advisability of promoting the
achievement of a healthy weight in veterans enrolled in VA
health care through the designation of VA fitness facilities
within VA medical centers and clinics.

SUBTITLE B--HEALTH CARE ADMINISTRATION

Section 311 would extend VA's Health Professional
Scholarship Program.
Section 312 would authorize funds to VA for the purpose of
developing partnerships with institutions of higher education
to ensure the availability of clinicians in orthotics and
prosthetics trained at the masters or doctoral level to meet
the needs of veterans receiving orthotic and prosthetic care.
Section 313 would change the name of the VA Medical Center
on 3900 Woodland Avenue in Philadelphia, PA, to the ``Corporal
Michael J. Crescenz Department of Veterans Affairs Medical
Center.''

SUBTITLE C--COMPLEMENTARY AND ALTERNATIVE MEDICINE

Section 321 would require VA to develop a plan to expand
research and education on and delivery of complementary and
alternative medicine to veterans.
Section 322 would require VA to carry out a 3-year program
to assess the feasibility and advisability of various
approaches for integrating the delivery of CAM services with
other health care services provided by VA. The program shall be
conducted at not fewer than 15 different VA medical centers.
Section 323 would direct VA to conduct a comprehensive
study of barriers encountered by veterans in accessing and
receiving complementary and alternative medicine and the
barriers encountered by providers in delivering such services.
Section 324 would require VA to establish a 3-year program
for the award of grants to public or private nonprofit entities
to assess the feasibility and advisability of using wellness
programs to complement the provision of mental health care to
veterans and family members eligible for VA counseling
services.

TITLE IV--ACCOUNTABILITY AND ADMINISTRATIVE IMPROVEMENTS

Section 401 would direct VA to reorganize VHA into
geographically defined VISNs. In addition, it directs VA to
ensure that each VISN provides high-quality health care to
veterans, increases efficiency in care delivery, implements
best practices, enhances collaboration with partner entities,
among other management functions. Finally, this section
requires VA, at least every 3 years, to review and assess VISN
structure and operations and submit review results to the
Committees on Veterans' Affairs.
Section 402 would require VA to establish not more than
four regional support centers within VHA to assess how
effectively and efficiently each VISN conducts outreach to
veterans who served in contingency operations; administers
programs for the benefit of women veterans; manages programs
that address homelessness among veterans; and consumes energy.
In addition, the regional support centers would assess the
quality of work performed within finance operations, compliance
related activities, and such other matters concerning the
operation and activities of each VISN as VA considers
appropriate.
Section 403 would require the establishment of a Commission
on Capital Planning for VA medical facilities.
Section 404 would require VA to establish a free, publicly-
available Web site that aggregates information on Department
research data files. VA would also be directed to require that
any final, peer-reviewed manuscript about VA-funded research be
submitted to a free, publicly-available Web site. Finally, the
VA-DOD Joint Executive Committee (hereinafter, ``JEC'') would
prepare recommendations for establishing a program for long-
term cooperation and data sharing to facilitate research.
Section 405 would require VA to include the amount
requested for outreach activities by the Office of Public and
Intergovernmental Affairs in its annual budget justification
materials submitted to Congress.
Section 406 would require GAO to submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives
a report on VA's advisory committees.

TITLE V--IMPROVEMENT OF PROCESSING OF CLAIMS FOR COMPENSATION

SUBTITLE A--CLAIMS BASED ON MILITARY SEXUAL TRAUMA

Section 501 would require VA in the case of a claim for
disability compensation based on a mental health condition
related to MST to treat an examination or opinion as being
necessary to make a decision on a claim if the evidence of
record does not contain a diagnosis or opinion by a mental
health professional that may assist in corroborating the
occurrence of a MST stressor.
Section 502 would require VA to assign, to each individual
seeking compensation for a disability based on MST, a case
representative officer who shall serve as a liaison between
such individual and VA and to provide advice and general
information to such individual on the claims process.
Section 503 would require VA to submit a report on the
current standard of proof for service-connection for covered
mental health conditions based on MST to the Committees on
Veterans' Affairs of the Senate and House of Representatives.
Section 504 would require VA to submit an annual report to
Congress on claims for disabilities based on post-traumatic
stress disorder (hereinafter, ``PTSD'') alleged to have been
incurred or aggravated by MST.

SUBTITLE B--AGENCY OF ORIGINAL JURISDICTION

Section 511 would require VA to establish a working group
to assess and develop recommendations for the improvement of
the employee work credit and work management systems of the
Veterans Benefits Administration (hereinafter, ``VBA'').
Section 512 would require VA to establish a task force to
assess the retention and training of claims processors and
adjudicators that are employed by VA and other departments and
agencies of the Federal government.
Section 513 would require VA to report to the Committees on
Veterans' Affairs of the Senate and House of Representatives on
VA attempts to obtain records from another department or agency
of the Federal government.
Section 514 would authorize VA to recognize representatives
of Indian tribes as individuals eligible to represent veterans
in the preparation, presentation, and prosecution of claims for
VA benefits.
Section 515 would require VA to carry out a 2-year program
to assess the feasibility and advisability of entering into
memoranda of understanding with local governments and tribal
organizations to improve the quality of disability compensation
claims and to provide claims submittal assistance to veterans
who may be eligible for disability compensation or pension
benefits.
Section 516 would require VA to submit a quarterly report
on VA efforts to eliminate the claims backlog.
Section 517 would require VA to submit a report on the use
of existing authorities to expedite benefit decisions and a
plan to increase the use of existing authorities to expedite
benefit decisions.
Section 518 would require VA to submit a report on the
provision of medical examinations for purposes of adjudicating
claims and a plan to prevent the ordering of unnecessary
medical examinations.

SUBTITLE C--BOARD OF VETERANS' APPEALS AND COURT OF APPEALS FOR
VETERANS CLAIMS

Section 521 would require the Court of Appeals for Veterans
Claims (hereinafter, ``CAVC'') to treat as timely filed a
document that expresses disagreement with a decision of the BVA
and an intent to appeal such decision to CAVC that is misfiled
with BVA or the agency of original jurisdiction (hereinafter,
``AOJ'') within 120 days of the BVA decision.
Section 522 would modify the filing period for a notice of
disagreement (hereinafter, ``NOD'') from 1 year to 180 days,
with a good cause exception.
Section 523 would require, with limited exceptions, that
any hearing before the BVA be conducted using video
teleconference technology.

TITLE VI--OUTREACH MATTERS

Section 601 would direct VA to carry out a 2-year program
that would competitively award grants to increase veterans'
awareness of benefits and services and improve coordination of
outreach activities between Federal, State and local agencies
and nonprofit organizations.
Section 602 would codify VA's authority to enter into
cooperative agreements and arrangements with State veterans'
agencies to carry out, improve, or enhance outreach activities
between VA and State veterans' agencies. VA would be required
to include such agreements and arrangements in its annual
report on outreach activities.
Section 603 would direct VA to establish an advisory
committee on national outreach activities composed of
individuals with backgrounds in: press relations, traditional
and new media marketing, shaping a brand image, and
communications. Veterans with press and public relations
experience would also be appointed to the maximum extent
practicable. The advisory committee would collaborate with the
Assistant Secretary of Public and Intergovernmental Affairs to
advise the Secretary on national outreach activities to ensure
VA is effectively communicating its benefits and services to
stakeholders. Advisory committee meetings would be required to
take place on VA-owned property and make use of teleconference
technology when practicable.
Section 604 would direct VA to establish an advisory board
at each VA health care system for purposes of enhancing and
improving local outreach activities. Advisory board membership
would be voluntary and would be composed of individuals with
backgrounds in: press relations, traditional and new media
marketing, shaping a brand image, and communications. Veterans
with press and public relations experience would also be
appointed to the maximum extent practicable. Each advisory
board would advise the director of the VA health care system,
in collaboration with VA employees of the health care system
and involved in press and public relations, on outreach
activities to ensure VA is effectively communicating its
benefits and services to local stakeholders, as well as to
explain policy changes or new programs at VA. Advisory boards
would be required to meet on VA-owned property and make use of
teleconference technology when practicable.
Section 605 would require VA to submit its report to
Congress on outreach activities annually, not biennially.

TITLE VII--EMPLOYMENT AND RELATED MATTERS

SUBTITLE A--EMPLOYMENT MATTERS

Section 701 would require Federal agencies to develop plans
to hire an aggregate of 15,000 veterans to existing vacancies
within 5 years using the Veterans' Recruitment Appointment
(hereinafter, ``VRA'') and the Veterans Employment
Opportunities Act (hereinafter, ``VEOA'') authorities.
Section 702 would, as a condition of receiving funding
through the Jobs for Veterans State Grants, require States to
recognize military experience when issuing licenses and
credentials to veterans. This section would require States to
issue licenses and credentials to certain veterans without
requiring such veterans to undergo further training.
Section 703 would require the Department of Labor
(hereinafter, ``DOL'') to compile a list of Internet Web sites
and applications that are beneficial for veterans in pursuit of
employment. This section would also require DOL to report to
the Veterans' Affairs Committees on the feasibility and
advisability of creating a single, unified employment portal.
Section 704 would improve the DOD's TAP by requiring DOL to
provide transitioning servicemembers with information regarding
disability-related employment and education protections.

SUBTITLE B--SMALL BUSINESS MATTERS

Section 711 would expand VA contracting goals and
preferences to include conditional ownership of small business
concerns if such small business concerns are 100 percent owned
by one or more veterans.
Section 712 would permit the surviving spouse of a veteran
owner of a small business, who is less than 100 percent
disabled and whose death is not a result of a service-connected
disability, to maintain the status of such small business
concern for up to 3 years following the death of such veteran.
Section 713 would permit the surviving spouse of a
servicemember, who owns at least 51 percent of a small business
concern and dies in the line of duty, to maintain the status of
such small business concern for up to 10 years following the
death of such servicemember.
Section 714 would require VA to consider small businesses,
licensed in a community property State, as if such small
business were licensed in a non-community property State if
such consideration would result in a greater ownership of such
small business concern for purposes of eligibility as a veteran
owned small business.

TITLE VIII--OTHER MATTERS

Section 801 would require VA to consider whether the
resources of individuals applying for pension were recently
disposed of for less than fair market value when determining
eligibility for pension benefits.
Section 802 would reauthorize certain funding for the
Office of National Veterans Sports Programs and Special Events.
This funding could be used for monthly subsistence allowances
for certain Paralympic athletes or other covered activities of
the Office of National Veterans Sports Programs and Special
Events.
Section 803 would authorize VA to plan, develop, manage,
and implement an integrated adaptive sports program for
disabled veterans and disabled members of the Armed Forces. In
carrying out this adaptive sports program, VA would be
authorized to award grants to the United States Olympic
Committee to plan, develop, manage, and implement an integrated
adaptive sports program for disabled veterans and disabled
members of the Armed Forces.
Section 804 would make effective date provisions consistent
with provisions for benefits eligibility of a veteran's child
based upon termination of remarriage by annulment.
Section 805 would extend the deadline by which VA has to
schedule a medical examination for a veteran in receipt of a
temporary disability rating for a severe mental disorder.
Section 806 would authorize VA to issue veteran
identification cards. Additionally, VA would be authorized to
work with national retail chains to ensure that such chains
recognize the card when offering reduced prices on
pharmaceuticals, consumer products, and services to veterans.
Section 807 would honor as veterans certain persons who
performed service in the reserve components of the Armed
Forces.
Section 808 would extend VA's authority to collect loan
guarantee fees.
Section 809 would direct VA, in consultation with DOD, to
review the process for determining whether certain individuals
have the requisite service requirements for purposes of
receiving specific Filipino veterans' benefits.
Section 810 would require VA, in consultation with DOD and
such agencies or individuals VA considers appropriate, to
submit a report to Congress on the extent to which Laotian
military forces provided combat support to the Armed Forces of
the United States between February 28, 1961, and May 15, 1975;
whether the current classification by the DOD Civilian/Military
Service Review Board is appropriate; and any recommendations
for legislative action.
Section 811 would require DOL, in consultation with VA, the
Small Business Administration, and other entities the Secretary
considers appropriate, to submit to Congress a report outlining
the benefits, services, and other assistance available to
veterans to obtain the training necessary to purchase and
operate a franchise; any known statistics about the number of
veterans who seek this type of training each year and complete
this type of training each year; and information regarding any
barriers encountered by veterans in obtaining that training.
Section 812 would limit the amount of awards and bonuses
payable to VA employees during fiscal year (hereinafter,
``FY'') 2014.

Background and Discussion

TITLE I--SURVIVOR AND DEPENDENT MATTERS

Sec. 101. Extension of initial period for increased dependency and
indemnity compensation for surviving spouses with children.

Section 101 of the Committee bill, which is derived from
S. 735, would extend the period for additional DIC for
surviving spouses with dependent children to 3 years after date
of entitlement.
Background. According to VA's most recent Annual Benefits
Report, there were nearly 350,000 surviving spouses receiving
DIC from VA. The May 2001 Program Evaluation of Benefits for
Survivors of Veterans with Service-Connected Disabilities
recommended increasing DIC by $250 per month for surviving
spouses with dependent children for the 5-year period after the
veteran's death due to evidence suggesting the need for an even
greater DIC benefit allowance for survivors with dependent
children.
In response, Congress enacted Public Law (hereinafter,
``P.L.'') 108-454, the Veterans Benefits Improvement Act of
2004, which amended section 1311 of title 38, U.S.C., to
authorize VA to pay a temporary $250 per month additional
benefit to a surviving spouse with one or more children below
the age of 18. However, this law only provided the additional
benefit for a 2-year period following entitlement.
Despite this additional benefit, recent data suggests many
surviving spouses are still struggling financially. Survivor
statistics reported in 2010 by the National Survey of Veterans
indicate that 44 percent of responding surviving spouses
reported income below $20,000. Low income survivors may be at
an even greater disadvantage when it comes to reestablishing
stability for their families.
Committee Bill. Section 101 of the Committee bill would
amend section 1311 of title 38 to provide for 3 years of
additional monthly DIC payments to surviving spouses with
dependent children. The Committee believes the increased length
of time a surviving spouse would receive additional monthly DIC
pursuant to the Committee bill would provide the additional
monetary support necessary to reestablish stability for
families of surviving spouses with children during the vital
period immediately following a veteran's death.

Sec. 102. Eligibility for dependency and indemnity compensation,
educational assistance, and housing loans for surviving spouses
who remarry after age 55.

Section 102 of the Committee bill, which is derived from
S. 735, would enable a surviving spouse to retain eligibility
for DIC, education assistance, and housing loans if the
surviving spouse remarries after age 55.
Background. Generally, the remarriage of a surviving spouse
bars the provision of VA benefits. P.L. 108-183, the Veterans
Benefits Act of 2003, allowed surviving spouses who remarried
after age 57 to retain eligibility for certain benefits
including DIC, educational assistance, and housing loans.
Other Federal benefit programs allow spouses to remarry at
age 55 and retain eligibility for benefits. For example,
section 1450 of title 10, U.S.C., allows surviving spouses of
military retirees to retain their DOD Survivor Benefit Plan
benefits if remarriage takes place after age 55. The same
applies for surviving spouses of Federal employees as a result
of section 8442 of title 5, U.S.C., receiving benefits as the
widow or widower of a Federal annuitant.
Committee Bill. Section 102 of the Committee bill would
amend section 103(d)(2) of title 38 to enable surviving spouses
who remarry after age 55 to retain eligibility for DIC,
education assistance, and housing loans. The Committee believes
this amendment would make eligibility standards for VA benefits
after remarriage consistent with other Federal benefit
programs.

Sec. 103. Extension of marriage delimiting date for surviving spouses
of Persian Gulf War veterans to qualify for death pension.

Section 103 of the Committee bill, which is derived from
S. 928, would extend the delimiting date for certain surviving
spouses of Persian Gulf War veterans to qualify for death
pension. This date, currently January 1, 2001, would be
extended to the date that is 10 years and 1 day after the date
on which the Persian Gulf War is terminated.
Background. Under current law, section 1541 of title 38,
U.S.C., pension benefits cannot be paid to a surviving spouse
of a Persian Gulf War veteran unless the claimant was married
to the veteran for at least 1 year immediately preceding the
veteran's death, a child was born of or before the marriage, or
the marriage occurred before January 1, 2001.
The Persian Gulf War, which began on August 2, 1990, has
not been terminated by Presidential proclamation or by law.
Part C of P.L. 102-25, the Persian Gulf War Veterans' Benefits
Act of 1991, established the Persian Gulf War as a period of
war for purposes of veterans' benefits. This same legislation
provided a delimiting date of January 1, 2001, for survivor
pension benefits' eligibility for certain surviving spouses.
Had the Persian Gulf War been terminated in 1991, this time
period would have been consistent with the time period applied
to surviving spouses of veterans of the Korean conflict and the
Vietnam era. Since the Persian Gulf War has not been terminated
by Presidential proclamation or by law, it is necessary to
update and extend the statutory delimiting date for purposes of
determining entitlement to survivor pension benefits provided
by section 1541 of title 38, U.S.C.
Committee Bill. Section 103 of the Committee bill would
amend section 1541(f)(1)(E) of title 38 by extending the
delimiting date for surviving spouses of Persian Gulf War
veterans to qualify for death pension to the date that is 10
years and 1 day after the date on which the Persian Gulf War is
terminated. This provision is consistent with the time period
provided for surviving spouses of other recent periods of war.

Sec. 104. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship.

Section 104 of the Committee bill, which is derived from
S. 1039, would expand the Marine Gunnery Sergeant John David
Fry Scholarship to include surviving spouses of members of the
Armed Forces who die in the line of duty.
Background. P.L. 111-32, the Supplemental Appropriations
Act of 2009, amended the Post-9/11 GI Bill to establish the
Marine Gunnery Sergeant John David Fry Scholarship for the
children of servicemembers who died in the line of duty after
September 10, 2001. Eligible children are entitled to 36 months
of benefits at the 100 percent level and may use the benefit
until their 33rd birthday.
Currently, surviving spouses of servicemembers who died in
the line of duty are only eligible to receive survivors' and
dependents' educational assistance (hereinafter, ``Chapter
35''). Chapter 35 benefits provide a spouse with $1,003 per
month as a full-time college student, which may leave the
spouse to find other sources of income or funding to offset the
high cost of education. Additionally, recipients of Chapter 35
do not receive a separate living allowance.
In March 2013, at a joint hearing of the House and Senate
Veterans' Affairs Committees, the Gold Star Wives of America
testified that many Federal education programs have been
increased and improved recently.
Committee Bill. Section 104 of the Committee bill would
amend subsection (b)(9) of section 3311 of title 38, U.S.C., to
expand the ability to receive the Marine Gunnery Sergeant John
David Fry Scholarship to surviving spouses, by inserting the
term ``or spouse'' after the word ``child.'' This section would
limit the entitlement of the surviving spouse to the date that
is 15 years after the date of the servicemember's death or the
date the surviving spouse remarries, whichever is earlier.
Section 103 would also require a surviving spouse, who is
entitled both under amended section 3311 and under Chapter 35,
to make an irrevocable election to receive educational
assistance under either amended section 3311 or Chapter 35.
Finally, a necessary conforming amendment would be made to
subsection (b)(4) of section 3321 of title 38, U.S.C.
The Committee believes this provision will enhance the
lives of surviving spouses and their families by alleviating
the hardships they may endure from losing a loved one.

Sec. 105. Expansion of Yellow Ribbon G.I. Education Enhancement
Program.

Section 105 of the Committee bill, which is derived from
S. 515, would extend eligibility for the Yellow Ribbon G.I.
Education Enhancement Program (hereinafter, ``Yellow Ribbon
Program'') to recipients of the Marine Gunnery Sergeant John
David Fry Scholarship.
Background. The Yellow Ribbon Program was established in
P.L. 110-252 and allows educational institutions to make
additional funds available without an additional charge to the
veteran's Post-9/11 GI Bill entitlement. Under the Yellow
Ribbon Program, VA can enter into agreements with institutions
of higher learning, where VA will match the amount of funds
contributed for a student's tuition and fees by such
educational institution, and issue payment directly to the
institution. This is especially helpful for veterans and
dependents who attend private schools that have higher tuition
rates or who attend public schools as a non-resident. The
Marine Gunnery Sergeant John David Fry Scholarship, codified at
section 3311(b)(9) and (f) of title 38, U.S.C., amended the
Post-9/11 GI Bill to include the children of servicemembers who
died in the line of duty after September 10, 2001. Eligible
children are entitled to up to 36 months of benefits at the 100
percent level and may use the benefits until their 33rd
birthday. A beneficiary entitled to the full Post-9/11 GI Bill
may participate in the Yellow Ribbon Program. However,
currently, children of deceased servicemembers who are using
Post-9/11 GI Bill benefits are ineligible to participate in the
Yellow Ribbon Program.
Committee Bill. Section 105 of the Committee bill would
amend subsection (a) of section 3317 of title 38, U.S.C., by
striking ``in paragraphs (1) and (2)'' and inserting ``in
paragraphs (1), (2), and (9)'' to enable recipients of the
Marine Gunnery Sergeant John David Fry Scholarship to
participate in the Yellow Ribbon Program.

Sec. 106. Benefits for children of certain Thailand service veterans
born with spina bifida.

Section 106 of the Committee bill, which is derived from
S. 735, would authorize VA to provide benefits to children, of
certain Vietnam era veterans with covered service in Thailand,
born with spina bifida.
Background. Exposure to certain herbicides, such as Agent
Orange, has been associated with a range of diseases ranging
from certain cancers to birth defects. Spina bifida is a
debilitating birth defect that can lead to physical
complications, neurological deficits, and inhibited executive
functions, to include planning, attention, and reasoning.
P.L. 104-204, the Department of Veterans Affairs and
Housing and Urban Development, and Independent Agencies
Appropriations Act of 1997, established benefits for children
of Vietnam veterans born with spina bifida, possibly as a
result of one or both parents' exposure to herbicides during
active service in Vietnam during the Vietnam era. These
benefits include health care services, vocational training and
rehabilitation services, and a monthly monetary allowance.
P.L. 108-183, the Veterans Benefits Act of 2003, extended
these benefits to the children of veterans who were exposed to
an herbicide agent during service in or near the Korean
demilitarized zone (hereinafter, ``DMZ'') during September 1,
1967, to August 31, 1971. Thus, under current law, 38 U.S.C.
1802 et seq., children with spina bifida of parents with
qualifying service in Vietnam or service in or near the Korean
demilitarized zone may be eligible for a variety of VA
benefits.
VA now recognizes that certain veterans of the Vietnam era
involved in activities on or near military bases in Thailand
may also have been exposed to herbicides, such as Agent Orange.
Absent a statutory change, children of a veteran whom VA
concedes was exposed to herbicides near military bases in
Thailand would not qualify for the benefits provided to
children with spina bifida whose parents were possibly exposed
to herbicides in Vietnam or certain areas of Korea.
Committee Bill. Section 106 of the Committee bill would
amend chapter 18 of title 38, U.S.C., by adding a new section
1822. This new section would authorize VA to provide to any
child of a veteran with covered service in Thailand, who is
suffering from spina bifida, the same health care services,
vocational training and rehabilitation services, and monetary
allowance currently required under subchapter I of chapter 18
to be provided to a child of a Vietnam veteran who is suffering
from spina bifida.
Providing benefits to these children whose parents have
covered service in Thailand would place them on an equal
footing with those children whose parents may have been exposed
to herbicides in Vietnam or near the Korean DMZ.

Sec. 107. Program on assisted living for children of Vietnam veterans
and certain Korea service veterans born with spina bifida.

Section 107 of the Committee bill, which is derived from
S. 832, would require VA to carry out a 3-year program to
provide assisted living, group home care, or similar services
to children with spina bifida.
Background. Under current law, section 1803 of title 38,
U.S.C., VA is authorized to provide or pay for nursing home
care for eligible children and adult children with spina
bifida, but is not authorized to provide care in less
restrictive settings, such as assisted living facilities or
group homes for persons with disabilities.
As a result of Committee oversight of VA's spina bifida
program, the Committee became aware of the need to clarify VA's
responsibility to provide health care to these beneficiaries.
VA's General Counsel, in its advisory opinion (VAOPGCADV 5-
2013), provided clarification of a number of VA's
responsibilities in providing care, including assistance with
activities of daily living in the beneficiary's home. However,
VA is not currently authorized to provide care in an assisted
living facility or group home or similar alternative residence.
Adult disabled beneficiaries with spina bifida who might be
able to live in such less restrictive and less expensive
settings can only be provided long-term care in their own homes
on a part-time basis or in nursing homes. During a roundtable
hosted by Committee staff on April 9, 2013, medical experts,
with experience in caring for children with spina bifida,
stated that children with spina bifida who require 24-hour care
could be better cared for in less restrictive settings than a
nursing home.
Committee Bill. Section 107 of the Committee bill would
direct VA to carry out a 3-year program to provide children
with spina bifida and entitlement to benefits under subchapters
I and III of chapter 18 of title 38 with assisted living, group
home care, or similar services instead of nursing home care.
This section also requires the Secretary to submit reports to
the Committees on Veterans' Affairs of the Senate and House of
Representatives detailing the operation of the program,
individuals covered by the program, costs and benefits of the
program, and any findings, conclusions, and recommendations the
Secretary may have about the program.
The Committee believes this section would expand the range
of care options available to children with spina bifida who
require a protective living environment with access to 24-hour
care. The Committee expects that adult disabled children with
spina bifida who are most likely to qualify for services under
the program are those whom VA has determined meet the criteria
for a Level III disability determination under section
3.814(d)(1)(iii) of title 38, Code of Federal Regulations
(hereinafter, ``C.F.R.''). Nursing home care may not always be
the best choice of care for children and adult children with
spina bifida. Further, according to the Market Survey of Long-
Term Care Costs: The 2012 MetLife Market Survey of Nursing
Home, Assisted Living, Adult Day Services, and Home Care Costs
(November 2012), assisted living care is less than half the
cost of nursing home care. The Committee recognizes changes in
health care delivery have occurred since the original law was
enacted and would authorize VA to evaluate the value of
providing alternative long-term care. Despite many of these
children requiring 24-hour care, they may be better cared for
in less restrictive settings than a nursing home.

Sec. 108. Program on grief counseling in retreat settings for surviving
spouses of members of the Armed Forces who die while serving on
active duty in the Armed Forces.

Section 108 of the Committee bill, which is derived from
S. 735, would require VA to carry out a 2-year program to
provide grief counseling services in group retreat settings for
surviving spouses of members of the Armed Forces who died while
serving on active duty.
Background. The Gold Star Wives of America provided
testimony on issues pertaining to surviving spouses at a joint
hearing of the Senate and House Veterans' Affairs Committee on
March 6, 2013. Among the issues discussed by the testimony was
the difficulty faced by new survivors in obtaining grief
counseling and locating grief support groups.
P.L. 111-163, the Caregivers and Veterans Omnibus Health
Services Act of 2010, required VA to conduct a pilot program on
providing reintegration and readjustment services in group
retreat settings to women veterans recently separated from
military service. The Committee is aware of positive feedback
provided by attendees and veterans service organizations
(hereinafter, ``VSO'') on this pilot program. VA's Report on
the Pilot Program on Counseling in Retreat Settings for Women
Veterans Newly Separated from Service in the Armed Forces
identified positive outcomes for attendees at the retreats:

Written feedback from the Veteran participants
immediately after the retreats was unanimously positive
for both years (see Appendix). Virtually every woman
Veteran identified some element of the curriculum that
was most useful to their current life readjustment. The
Vet Centers have received several letters from
satisfied Veterans expressing their gratitude for the
opportunity to participate in the retreat.
Additionally, the continuation of active group
interaction among various participants following the
retreat experience is indicative of a favorable
experience.

In testimony before the Committee on June 12, 2013, in
support of a provision in S. 735, now found in section 108 of
the Committee bill, the Veterans of Foreign Wars (hereinafter,
``VFW'') testified, ``VFW has heard positive stories from a
similar pilot program involving women veterans, and we are
happy to support the same goals for those who lost a loved one
on active duty.''
Committee Bill. Section 108 of the Committee bill would
require VA to carry out a 2-year program, at no less than six
events, to provide grief counseling services in group retreat
settings to surviving spouses of veterans who died while
serving on active duty.
This program would provide surviving spouses with
information and counseling on coping with grief, information
about VA benefits and services available to surviving spouse
and other information and counseling VA considers appropriate
to assist a surviving spouse with adjusting following the death
of a spouse. This section also requires VA to submit a report
to the Senate and House Committees on Veterans' Affairs
detailing the results of the program and recommendations for
the continuation or expansion of the program.
The Committee believes this program would assist in meeting
the needs of surviving spouses identified by the Gold Star
Wives in testimony before the Committee.

Sec. 109. Program evaluation on survivors' and dependents' educational
assistance authorities.

Section 109 of the Committee Bill, which is an original
provision, would require VA to conduct a program evaluation of
the Survivors' and Dependents' Educational Assistance Program
(hereinafter, ``DEA'').
Background. Under the DEA program, chapter 35 of title 38,
U.S.C., VA provides education benefits to the child or spouse
of: A veteran who died or is permanently and totally disabled
as the result of a service-connected disability; a veteran who
died from any cause while a permanent and total service-
connected disability was in existence; a servicemember missing
in action or captured in line of duty by a hostile force; a
servicemember forcibly detained or interned in line of duty by
a foreign government or power; or a servicemember who is
hospitalized or receiving outpatient treatment for a service-
connected permanent and total disability and is likely to be
discharged for that disability.
The purpose of this program, as stated in section 3500, is
to help these children ``in attaining the educational status
which they might normally have aspired to and obtained'' and to
provide these spouses with help ``in preparing to support
themselves and their families at a standard of living level to
which the veteran, but for the veteran's death or service
disability, could have expected to provide.'' Under this
program, an eligible child or spouse may receive up to 45
months of benefits, currently paid at the rate of $1,003 per
month.
In June 2000, the Klemm Analysis Group, Inc., released a
report entitled ``Program Evaluation of the Survivors' and
Dependents' Education Assistance Program.'' That report
assessed ``the extent to which DEA has met its statutory
intent, the educational needs of beneficiaries, and the
expectations of its stakeholders.'' In part, the report
contained a recommendation that the then-current monthly
allotment of $485 be increased to $778 per month. According to
the report, the increased amount of $778 ``would allow
virtually all DEA beneficiaries to attend the academic
institution of their choice.''
Another education program administered by VA, the Post-9/11
GI Bill, provides military personnel who have served on active
duty since September 11, 2001, with up to 36 months of
education benefits, including up to $18,077 per year for
tuition and fees, a monthly housing allowance, and a book
stipend. Generally, education benefits have been provided to
military personnel in order to encourage recruitment into the
military, to help retain servicemembers in the military, and to
help veterans readjust to civilian life after leaving the
military.
In 2009, P.L. 111-32, the Supplemental Appropriations Act
for Fiscal Year 2009, provided a small subset of the
individuals who are eligible for DEA, the children of
servicemembers who die in the line of duty after September 10,
2001, with eligibility for 36 months of benefits under the
Post-9/11 GI Bill. Also, section 104 of S. 944, as amended,
would allow another subset of DEA beneficiaries, spouses of
servicemembers who die in the line of duty after September 10,
2001, to be eligible for benefits under the Post-9/11 GI Bill.
The remainder of DEA beneficiaries would remain eligible for
only DEA, including the surviving spouses and children of those
who die after leaving the military from service-related
injuries and the spouses and children of veterans who are
permanently and totally disabled as a result of in-service
injuries.
In light of the different levels of benefits for various
categories of these children and spouses; the different
purposes of the programs to which they have access; and the
length of time since a full assessment of this program has been
conducted, the Committee believes it is necessary to examine
how effective the DEA program is at meeting its intended
purposes and how best to meet the needs of all categories of
children and spouses eligible for DEA.
Committee Bill. Section 109 of the Committee bill would
require VA to enter into a contract with an appropriate entity
to conduct a program evaluation of the DEA program and submit
to Congress a report on the results of that evaluation. This
section would take effect 1 year after the enactment of the
Committee bill.

TITLE II--EDUCATION MATTERS

Sec. 201. Approval of courses of education provided by public
institutions of higher learning for purposes of all-volunteer
force educational assistance program and Post-9/11 educational
assistance conditional on in-State tuition rate for veterans.

Section 201 of the Committee bill, which is derived from
S. 257 and S. 944, as introduced, would require public
educational institutions of higher learning to provide in-State
tuition for certain veterans who are within 3 years of date of
separation from service in the active military, naval, or air
service and their dependents.
Background. Section 3313 of title 38, U.S.C., authorizes VA
to pay in-State tuition and fees for veterans attending a
public educational institution using their Post-9/11 GI Bill
educational benefits. However, veterans may not always qualify
for in-State tuition rates.
Several States currently assist all or certain veterans by
recognizing them as in-State students for purposes of attending
a public educational institution, regardless of length of
residency in the State where the veteran is attending college.
Yet, many States require transitioning veterans to meet
stringent residency requirements before they can be considered
in-State residents. Federal law is currently silent on this
matter.
Recently-separated veterans may not be able to meet State
residency requirements where they wish to attend school because
they were stationed elsewhere during their military service,
and once enrolled, they may not be able to legally establish
residency because of their status as full-time students. The
Federal educational assistance provided to veterans by VA was
designed, in part, to help them develop the skills and
background necessary to make a successful transition from
military service to a civilian life and career.
Further, not being able to satisfy a State's residency
requirements can cause significant financial challenges for a
veteran. According to testimony from VFW before the Committee
in June 2013, ``VFW regularly hears from student-veterans who
confirm that financial uncertainty is the most significant
roadblock to persistence and graduation.'' Additionally, VFW
testified that having to pay out-of-State tuition ``forces
veterans to either drop out or find other ways to pay for
college through Federal financial aid programs, full time
employment or amassing student loan debt even when they make a
good faith effort to legally reside in a State and attend a
public school.''
Committee Bill. Section 201 of the Committee bill would
amend section 3679 of title 38, U.S.C., by adding a new
subsection (c) to require VA to disapprove courses of education
provided by public institutions of higher learning that do not
charge tuition and fees at no more than the in-State resident
rate for veterans within 3 years from discharge from a period
of at least 90 days service in the military, irrespective of
the veteran's current State of residence, if the veteran is
living in the State in which the institution is located while
pursuing that course of education. Pursuant to subsection (c),
this provision would apply to veterans using the educational
assistance programs administered by VA under chapters 30 and 33
of title 38, U.S.C., and to dependent beneficiaries using Post-
9/11 GI Bill benefits during the 3 years after the veteran's
discharge. As long as the veteran or dependent enrolls within 3
years after the veteran's discharge, the requirement to charge
no more than the in-State rate would apply for as long as the
individual remains continuously enrolled at the institution.
Subsection (c)(4) would permit a public educational institution
to require a covered individual to demonstrate an intent, by
means other than satisfying a physical presence requirement, to
eventually establish residency in that State or to meet
requirements unrelated to residency in order to be eligible for
the in-State tuition rate. The Committee bill also provides VA
discretion to waive the established requirements in a
circumstance where it is deemed appropriate in regards to
approval of a specific course of education. Any disapproval of
courses pursuant to these new requirements would apply only
with respect to benefits provided under chapters 30 and 33 of
title 38. This provision would apply to programs of education
that begin during academic terms after July 1, 2015.
The Committee intends to address the in-State tuition issue
by allowing those beneficiaries who are in a transitional
period to receive the in-State rate.

Sec. 202. Extension and expansion of authority for certain qualifying
work-study activities for purposes of the educational
assistance programs of the Department of Veterans Affairs.

Section 202 of the Committee bill, which is derived from
S. 894, would extend certain options under VA's work-study
program by 2 years and expand the program to allow participants
to conduct certain veterans' outreach and assistance activities
in congressional offices.
Background. Under current law, section 3485, of title 38,
U.S.C., VA's authority to allow certain options under its work-
study program expired on June 30, 2013. VA's work-study program
provides veterans participating in certain educational and
vocational and rehabilitation programs with the opportunity to
assist other veterans understand and access VA benefits. Under
the work-study program, veterans who are enrolled at least
three-fourths of full-time in certain VA programs, such as the
MGIB and the Post-9/11 GI Bill, may receive the greater of the
Federal or State minimum wage for veteran-related work in
certain VA facilities, educational institutions, State
veterans' homes, and other qualified work-study activities. In
FY 2012, this program assisted more than 10,000 veterans, who
received approximately $25.7 million in work-study payments.
Committee Bill. Section 202 of the Committee bill would
amend section 3485 of title 38, U.S.C., to extend certain
options under the work-study program to June 30, 2015.
This section would also create a subsection under section
3485 of title 38 to permit participants in VA's work-study
program to work in congressional offices. Such participants
would be limited to activities involving distribution of
information regarding VA benefits and services to other
veterans, dependents, and servicemembers, as well as
preparation of documents to assist in a claim for benefits.
This new authority would extend from June 30, 2013, to June 30,
2015.
This section would further require VA to submit a report to
Congress, no later than June 30 of 2014 and 2015. Such report
would include a description of the recipients of that year's
work-study allowances, all locations where work-study
activities were carried out, and a description of the outreach
conducted by VA to increase awareness of this program.
It is the Committee's intent to allow veterans to work in
congressional offices to assist other veterans with casework
issues, help congressional staff address the unique challenges
facing our newest generation of veterans, and develop the
knowledge and experience needed to successfully transition into
the civilian workforce.

Sec. 203. Report on debt management and collection.

Section 203 of the Committee bill, which is derived from
S. 930, would require GAO to report on processes used by VA to
identify and resolve cases of incorrect payments associated
with educational assistance under the MGIB and the Post-9/11 GI
Bill.
Background. An overpayment can occur when an individual
decreases credit hours or training time, or leaves school when
payment has already been processed. Currently, many educational
institutions in question will issue refunds to VA in accordance
with its internal policy, but any remaining amount due is the
responsibility of the veteran. When the debt is established, VA
will issue a notice to the veteran and require a response of
payment, establishment of a repayment plan, or request for
waiver. If no contact is made after 30 days of the notice, VA
will automatically begin to offset the debt from future VA
educational benefits. Continued non-contact will result in
notification to credit reporting agencies approximately 100
days after creation of debt and referral of the debt to the
Department of Treasury approximately 130 days after creation of
debt.
Many veterans are unaware of their debt and have often
reported not receiving notice from VA or receiving conflicting
information. This causes confusion that may lead to veterans
not paying their debt in time. The offset of future educational
benefits can also result in significant hardship for veterans
who depend on such funds to pay for their education.
Committee Bill. Section 203 of the Committee bill would
require GAO to submit to the appropriate committees of
Congress, not later than 2 years after the enactment of the
Committee bill, a report on the processes used by VA to
identify and resolve cases of incorrect payments associated
with educational assistance under the Post-9/11 GI Bill and the
MGIB.
The Committee believes a third party evaluation of VA's
debt management and collection process is needed to identify
current issues and possible solutions.

Sec. 204. Restoration of prior reporting fee multipliers.

Section 204 of the Committee bill, which is an original
provision, would decrease the amount of reporting fees paid by
VA to educational and training institutions.
Background. Section 3684(c) of title 38, U.S.C., provides
for the payment of reporting fees to educational and training
institutions based on the number of veterans or other eligible
students enrolled. The amount paid per eligible student is $12
or, in the case of an institution that accepts advance payments
from VA, $15 per student.
According to VA, as of July 2013, it has paid more than $30
billion in Post-9/11 GI Bill benefit payments, $13.5 billion of
which was in tuition to educational and training institutions,
for nearly one million beneficiaries since 2009. Further,
according to VA's FY 2014 budget submission to Congress, the
Post-9/11 GI Bill is the most used education benefit offered by
VA. The Post-9/11 GI Bill benefits paid by VA are expected to
increase approximately $1.2 billion in FY 2014 from FY 2013 and
to account for 86 percent of VA's total training and education
obligations.
The current fee payment structure was established in 2011
by section 204 of P.L. 111-377, the Post-9/11 Veterans
Educational Assistance Improvements Act of 2010. Previously,
the reporting fees paid to educational and training
institutions by VA was increased from $5 and $6 to $7 and $11,
respectively, in 1977 by section 304 of P.L. 95-202, the GI
Bill Improvements Act. In contrast, under the Federal Pell
Grant Program, institutions of higher learning receive $5 per
grant to administer and distribute Federal Pell awards.
Committee Bill. Section 204 of the Committee bill would
amend section 3684(c) to decrease the reporting fees paid by VA
to educational and training institutions from $12 and $15 to $7
and $11, respectively. This change would take effect on
enactment of the Committee bill.
The Committee is of the opinion that the tuition dollars
paid, and a lower reporting fee provided, to education and
training institutions is adequate in offsetting any overhead
created on the school's part in administering the benefit.
Further, the Committee believes the veteran-student services
provided under the work-study program authorized in section
3485 of title 38, U.S.C., can be used by schools to help
mitigate any difference between the amount of reporting fees
paid by VA and the costs incurred by the education and training
institution.

TITLE III--HEALTH CARE MATTERS

SUBTITLE A--EXPANSION AND IMPROVEMENTS OF BENEFITS GENERALLY

Sec. 301. Expansion of provision of chiropractic care and services to
veterans.

Section 301 of the Committee bill, which is derived from
S. 422, would expand the provision of chiropractic services at
VA medical facilities and expand the chiropractic services
available to veterans.
Background. In 2001, Congress acknowledged the importance
of offering chiropractic services at VA facilities and
established a program to provide such services to veterans
through P.L. 107-135, the Department of Veterans Affairs Health
Care Programs Enhancement Act of 2001, which included language
from H.R. 2792 as described in House Report 107-242.
The Department is long overdue in establishing a firm,
comprehensive policy to provide a full scope of chiropractic
services to veterans. Over the last 106 years, chiropractic
health science has become the third-largest physician level
health care profession in the world. Doctors of chiropractic
are licensed in all 50 States as health care service providers.
Understanding the availability and effectiveness of
chiropractic care, Congress directed VA to carry out a program
to provide chiropractic care and services to eligible veterans
at its medical centers and clinics. The law defined eligible
veterans to include all those enrolled under section 1705 of
title 38, U.S.C. Additionally, the legislation directed VA to
designate at least one site in each of VHA's geographic areas
including medical centers and clinics located in urban and
rural areas.
In 2009, VHA issued Directive 2009-059 that defined current
policy related to the provision of chiropractic care. Actions
required by this directive, set to expire on November 30, 2014,
included the requirement that each VISN director ensure at
least one facility in the VISN provide on-site chiropractic
care. Additionally, each facility director was required to
authorize the provision of patient evaluation and care, as well
as to ensure chiropractors as independent, licensed
practitioners, incorporate chiropractors into a health team;
and provide appropriate training to familiarize appropriate VHA
employees with chiropractic care.
A 2013 report by VA's Epidemiology Program of its Office of
Public Health entitled ``Analysis of VA Health Care Utilization
among Operation Enduring Freedom (OEF), Operation Iraqi Freedom
(OIF), and Operation New Dawn (OND) Veterans,'' identified
musculoskeletal ailments such as joint and back disorders as
the most common diagnoses of Operation Enduring Freedom
(hereinafter, ``OEF''), Operation Iraqi Freedom (hereinafter,
``OIF''), and Operation New Dawn (hereinafter, ``OND'')
veterans in treatment in VA facilities. The frequency of
possible diagnoses for such disorders among these veterans was
found to be approximately 58 percent.
Based on the frequency of possible diagnoses of
musculoskeletal ailments and the high rate of enrollment by
post-9/11 veterans, increased availability of chiropractic care
is necessary within VA medical facilities. According to the
Foundation for Chiropractic Progress, as of January 2012,
chiropractic care is available on-site at 45 VA facilities,
including at least one facility in each VISN. Eleven VISNs
contain only one such facility.
Committee Bill. Section 301 of the Committee bill would
amend Public Law 107-135 to require the chiropractic care
program be carried out at no fewer than two medical centers or
clinics in each VISN by no later than 2 years after the date of
enactment and no fewer than 50 percent of all medical centers
in each VISN by no later than 3 years after enactment.
Additionally, the Committee bill would expand the existing
chiropractic services available to veterans by amending
paragraph 6 of section 1701 of title 38, U.S.C., to include
chiropractic services on the list of available medical services
provided by VA. The section would also include chiropractic
services in the list of available rehabilitation and preventive
health services.

Sec. 302. Modification of commencement date of period of service at
Camp Lejeune, North Carolina, for eligibility for hospital care
and medical services in connection with exposure to
contaminated water.

Section 302 of the Committee bill, which is derived from
S. 529, would change the start date for eligibility for
hospital care and medical services as a result of exposure to
contaminated water at Marine Corps Base Camp Lejeune
(hereinafter, ``Camp Lejeune''). The section would also direct
the Secretary to publish in the Federal Register any earlier
start date for eligibility for hospital care and medical
services provided under the law.
Background. P.L. 112-154, the Honoring America's Veterans
and Caring for Camp Lejeune Families Act of 2012, authorized VA
to provide hospital care and medical services to veterans and
their dependents exposed to toxic chemicals while living aboard
Camp Lejeune. Under the law, veterans and their dependents are
eligible for hospital care and medical services from VA if they
lived aboard Camp Lejeune between January 1, 1957, and December
31, 1987; were living on the base for at least 30 days; and
have one of fifteen diseases or conditions listed in the law.
The dates of service included in the law were derived from a
scientific review by the Agency for Toxic Substances and
Disease Registry (hereinafter, ``ATSDR''). That review
indicated the groundwater contamination likely began in 1957
and lasted until the Marine Corps shut down the last well in
1986. However, on January 16, 2013, Dr. Christopher Portier,
the Director of the National Center for Environmental Health
and ATSDR, wrote the VA Under Secretary for Benefits, Allison
Hickey, that the earliest month any toxic substance was found
in the drinking water aboard Camp Lejeune was August 1953.
Committee Bill. Subsection (a) of section 302 of the
Committee bill would amend section 1710(e)(1)(F) of title 38,
U.S.C., by striking January 1, 1957, and inserting August 1,
1953. This subsection would also authorize the Secretary to
specify an earlier date after consultation with ATSDR.
Subsection (b) would direct VA to publish in the Federal
Register any earlier date for the commencement of the period of
service at Camp Lejeune as specified in section 1710(e)(1)(F)
of title 38, U.S.C.
It is the Committee's intent that section 302 of the
Committee bill ensure VA's authority to provide care for those
who served aboard Camp Lejeune, as specified in section
1710(e)(1)(F) of title 38, U.S.C., keep pace with the current
scientific opinion from ATSDR.

Sec. 303. Expansion of eligibility for sexual trauma counseling and
treatment to veterans on inactive duty training.

Section 303 of the Committee bill, in an original
provision, would extend VA's authority to provide counseling,
care, and services to veterans, and certain other
servicemembers who may not have veteran status, who experienced
sexual trauma while serving on inactive duty for training.
Background. Under current law, section 1720D of title 38,
U.S.C., VA has the authority to provide counseling, care and
services to veterans who experienced sexual trauma while
serving on active duty or active duty for training.
Sexual assault in the military remains a serious problem.
DOD's Annual Report on Sexual Assault in the Military for FY
2012 estimated 26,000 servicemembers experienced unwanted
sexual contact, an increase of over 7,000 servicemembers since
2010. A study by the National Center for Post-traumatic Stress
Disorder and the Center for Health Care Evaluation estimated
that of all the veterans who receive VHA primary care or mental
health services, 15 percent of the women and 0.7 percent of the
men experienced sexual trauma while in the military.
A recent article entitled, ``Psycho-social Effects of
Trauma on Military Women Serving in the National Guard and
Reserves'' published in the Spring 2012 edition of Advances in
Social Work supports the conclusion that members of the
National Guard and Reserve experience significant challenges
accessing health care and support services, which may lead to
increased rates of mental health issues and even suicide. In
their work, they also noted, ``Female servicemembers serving in
the National Guard and Reserve components of the military have
unique challenges to reporting and seeking help for MST. They
often lack many of the resources that their active duty
counterparts receive.''
In June 2013, the Chairman of the Committee received a
piece of constituent correspondence which highlighted some of
the problems members of the National Guard and Reserve face
when dealing with the aftermath of a sexual assault. As a
former Sexual Assault Prevention and Response Coordinator, this
constituent had firsthand experience dealing with this issue.
In her assessment, the Department of Defense Sexual Assault
Response Program is broken. In particular, she wrote:

* * * Victims are unable to obtain medical or mental
assistance, because they do not fall under Title 10
status when the Sexual Assault occurred. This program
was not designed for Guardsmen or Reservists to have
Sexual Assaults only active duty members. Yes, that
sounds stupid, but look into the regulations, there is
no way for the military to get medical assistance for
these victims unless they, the leadership, puts the
victim back on Title 10. I experienced this with my
last sexual assault case. Another point of interest,
there is a timeline to report the sexual assault in
order for the victim to receive medical or mental
assistance. Generally, the victim needs mental
assistance long term.

Committee Bill. Section 303 of the Committee bill would
amend section 1720D of title 38, U.S.C., to provide VA with the
authority to provide counseling, care, and services to
veterans, and certain other servicemembers who may not have
veteran status, who experienced sexual trauma while serving on
inactive duty for training.
The Committee believes it is imperative that survivors of
sexual assault in the military, whether it is active duty
service or inactive service for duty training in the National
Guard and Reserve, have the opportunity to receive the care
necessary to confront and overcome the emotional and physical
consequences of these horrible experiences.

Sec. 304. Extension of sunset date regarding transportation of
individuals to and from facilities of Department of Veterans
Affairs and requirement of report.

Section 304 of the Committee bill, which is derived from
S. 455, would repeal the sunset date for the Veterans
Transportation Service initiative (hereinafter, ``VTS''), which
is set to expire January 10, 2014.
Background. For far too many veterans, a lack of affordable
transportation can be a barrier to needed health care services.
In rural areas, veterans are frequently required to travel
significant distances in order to access health care services
at VA medical facilities. VA clinics and Community Based
Outpatient Clinics play an important role in bringing care
closer to where veterans live. However, these facilities do not
eliminate some veterans' need to sometimes travel significant
distances for care especially for veterans living in rural
areas.
For years, the Disabled American Veterans (hereinafter,
``DAV'') has been providing free transportation services to
sick and disabled veterans through their transportation
network. These critical transportation services are coordinated
by nearly 190 DAV Hospital Service Coordinators throughout the
country. While DAV's services are critical to providing
transportation to many veterans, they do not serve all
veterans. As DAV states publicly, ``the DAV Transportation
Network is staffed by volunteers; therefore, it is unable to
cover every community.'' Additionally, volunteer drivers are
often not able to transport veterans with more serious health
needs, such as those requiring portable oxygen.
VA first launched VTS in 2010 to enhance transportation
services available to veterans. Through VTS, VA provided
funding to local VA facilities to be used for the hiring of
transportation coordinators and for the purchase of vehicles.
However, in the summer of 2012, the Office of General Counsel
(hereinafter, ``OGC'') determined VA did not have the authority
to provide such services and the program was put on hold.
In 2013, following OGC's decision, Congress added section
111A to title 38, U.S.C., in P.L. 112-260, the Dignified Burial
and Other Veterans' Benefits Improvement Act of 2012, to allow
VA to ``transport any person to or from a Department facility
or other place in connection with vocational rehabilitation,
counseling required by the Secretary pursuant to chapter 34 or
35 of this title, or for the purpose of examination, treatment,
or care.'' The intent of the program was to enhance
transportation services for veterans utilizing VA medical
facilities. Extending the program allows for its seamless
continuation and enables veterans to continue the receipt of
transportation service through VA, improving their access to
vocational rehabilitation and health care services.
Committee Bill. The Committee bill would extend the
authorization of this program under section 111A of title 38,
U.S.C., from January 10, 2014, to September 30, 2015, and would
set an authorization cap of $4 million for each fiscal year
2014 and 2015. The legislation would also require VA to report
to the Committees on Veterans' Affairs of the Senate and the
House of Representatives on the efforts to carry out the
program, the utilization of the program by covered veterans,
and the feasibility and advisability of the continuation of the
program.

Sec. 305. Program on health promotion for overweight and obese veterans
through support of fitness center memberships.

Section 305 of the Committee bill, which is derived from
S. 852, would create a pilot program for overweight and obese
veterans through the support of fitness center memberships. The
pilot program would run for 2 years to determine whether
providing support for veterans to access fitness centers
improves health and overall well-being among these veterans.
Background. Overweight and obese individuals are at risk
for a number of significant health problems. According to the
fact sheet published by the Weight Control Information Network
of the National Institute of Health (hereinafter, ``NIH'')
titled ``Do You Know Some of the Health Risks of Being
Overweight?'' updated in December 2012, these health problems
include increased risk for type 2 diabetes, high blood
pressure, heart diseases, stroke, cancer, sleep apnea,
osteoarthritis, fatty liver disease, and kidney disease. It
also acknowledges that losing as little as 5 percent of one's
body weight may lower the risk for several diseases and
suggests that to lose weight individuals should consider being
active for at least 5 hours each week.
By providing overweight and obese veterans opportunities to
access fitness facilities through full or partial subsidized
gym memberships, participating veterans may increase their
likelihood of losing weight and improving their overall health
through exercise. Additionally, while there is a limited cost
associated with providing fitness center memberships, these
costs may be far exceeded by the savings found through the
reduced health care costs of a healthier veteran population.
Committee Bill. Section 305 of the Committee bill would
establish a 2-year pilot program at ten unique locations no
later than 180 days after the effective date of section 305 to
assess the feasibility and advisability of promoting health
through the support of fitness center membership. The pilot
would be carried out through the National Center for Preventive
Health at ten facilities; five of which would provide the full
reasonable cost of a fitness center membership for covered
veterans and five of which would provide half of the reasonable
cost of a fitness center membership for covered veterans, up to
$50 per month. Section 305 would be effective 1 year after the
date of enactment.
Covered veterans would include any veteran who is enrolled
in VHA, determined by a VA clinician to be overweight or obese,
and resides in a location that is more than 15 minutes driving
distance from a fitness center at a VA facility that would
otherwise be available to the veteran for at least 8 hours per
day during 5 or more days per week. The number of covered
veterans who may participate in the pilot at each location
would not exceed 100.
Subsection (d) of section 305 requires that, when selecting
locations for the pilot, VA shall consider the feasibility and
advisability of selecting locations in rural areas, areas that
are not in close proximity to an active duty military
installation and areas in different geographic locations.
Subsection (g) requires VA to submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report on the activities carried out to
implement the pilot program, including outreach activities to
veterans and community organizations no later than 90 days
after the date of commencement of the pilot program. This
report shall then be submitted to Congress on a quarterly basis
thereafter. Additionally, VA shall submit a final report to
Congress on the findings and conclusions of the pilot program
and recommendations for the continuation or expansion of the
program no later than 180 days after the completion of the
pilot program.

Sec. 306. Program on health promotion for veterans through
establishment of Department of Veterans Affairs fitness
facilities.

Section 306 of the Committee bill, which is derived from
S. 852, would require VA to create a program on health
promotion through the establishment of VA fitness facilities.
This section would require VA to establish a pilot program to
assess the feasibility and advisability of such facilities.
Background. It can be difficult for some veterans to access
fitness facilities. For some veterans, barriers to accessing
such facilities can be financial while for others they are
geographic in nature. Certain areas may lack fitness facilities
while the fitness facilities in other areas, particularly urban
ones, can be cost prohibitive for veterans on fixed incomes.
A number of VA facilities have opened fitness facilities
for use by veterans. At some facilities, use of these
facilities is restricted to those veterans receiving physical
therapy or rehabilitation services. These facilities serve as
an important, no-cost resource for veterans interested in
staying healthy and active. Increasing the number of fitness
facilities at VA medical centers and clinics will increase the
number of veterans able to benefit from such resources.
Additionally, an increased number of veterans utilizing fitness
facilities could lead to a healthier veteran population with
lower overall health care costs.
Committee Bill. Section 306 of the Committee bill would
create a pilot program to assess the feasibility and
advisability of promoting health in covered veterans through
the establishment of fitness facilities within VA. Covered
veterans include any veteran who is enrolled in the system of
annual patient enrollment established under section 1705 of
title 38, U.S.C.
The pilot program would be carried out during a 3-year
period and would be carried out at no fewer than five VA
medical centers and five VA clinics. When selecting the pilot
sites, VA shall consider the feasibility and advisability of
selecting locations in rural areas, areas that are not in close
proximity to an active duty military installation, and areas in
different geographic locations. Expenses for the establishment
of fitness facilities in VA medical centers participating in
the pilot shall not exceed $60,000, while expenses for
participating VA clinics shall not exceed $40,000.
Subsection (f) of section 306 limits the expense of funds
through this pilot to repurposing of existing physical
facilities within VA and the purchase of fitness equipment and
supplies. Renovations of physical facilities allowed in this
section shall not be considered to infringe upon the delivery
of health care services to veterans.
No later than 90 days after the commencement of the pilot
program and quarterly thereafter, VA shall submit a report to
Congress on the activities carried out to implement the pilot
program, including outreach activities to veterans and
community organizations. Additionally, not later than 180 days
after the completion of the pilot, VA shall submit to Congress
a report on the pilot program detailing the findings and
conclusions as a result of the pilot and recommendations for
the continuation or expansion of the program.

SUBTITLE B--HEALTH CARE ADMINISTRATION

Sec. 311. Extension of Department of Veterans Affairs Health
Professional Scholarship Program.

Section 311 of the Committee bill, which is derived from
S. 845, would extend the VA's Health Professional Scholarship
Program (hereinafter, ``HPSP'') from December 31, 2014, to
December 31, 2019.
Background. Critical to VA's provision of high quality
health care to veterans is its ability to hire equally high
quality clinicians. To do this, VA must compete against the
nation's best hospitals and health systems. To that end,
Congress has provided VA with a variety of mechanisms to
attract and retain high quality providers. One such program is
the Health Professionals Educational Assistance Program
(hereinafter, ``HPEAP''), codified in section 7601 of title 38,
U.S.C., HPEAP consists of a scholarship program, a tuition
reimbursement program, the Selected Reserve member stipend
program, the employee incentive scholarship program, and the
education debt reduction program. The scholarship program,
codified in subchapter II of chapter 76, allows for the payment
of tuition of participants, the payment for other reasonable
educational expenses, and a stipend not to exceed $485 per
month.
Eligibility for the program, as defined in section 7612 of
title 38, U.S.C., includes individuals accepted for enrollment
or those currently enrolled as full-time students in a
qualifying field of education or training. Additionally,
current VA employees permanently assigned to a VA health care
facility shall be eligible to participate.
Most recently reauthorized through December 31, 2014, in
P.L. 111-163, the Caregivers and Veterans Omnibus Health
Services Act of 2010, HPSP was established in its current form
in 1988 through P.L. 100-322, the Veterans' Benefits and
Services Act of 1988. Qualified awardees must be pursuing a
degree designated by VA and remain a VA employee for the
duration of the scholarship award. Pursuant to section 7602(b)
of title 38, U.S.C., any applicant owing a service obligation
to any other entity to perform service after completion of the
course of study is ineligible to receive a scholarship under
VA's Scholarship Program.
Committee Bill. Section 311 of the Committee bill would
amend section 7619 of title 38, U.S.C., to extend VA's Health
Professional Scholarship Program for 5 additional years from
December 31, 2014, to December 31, 2019.

Sec. 312. Expansion of availability of prosthetic and orthotic care for
veterans.

Section 312 of the Committee bill, which is derived from
S. 522, would require VA to collaborate with institutions of
higher education for the establishment or expansion of advanced
degree programs in prosthetics and orthotics.
Background. Currently, veterans can access prosthetic and
orthotic services through all 152 VA medical centers. Roughly
one-third of these facilities include accredited VA Orthotic
and Prosthetic laboratories. The remaining locations provide
services through contracted and fee-based care, which account
for 90 percent of the total prosthetic and orthotic services
provided to veterans through VA.
In 2009, the decision was made by the American Board for
Certification in Orthotics, Prosthetics and Pedorthics and the
Board of Certification Accreditation International that a
master's degree would be the entry level of education required
for certification in these fields. While certified providers
were allowed to continue their practice, all new providers were
required to attain this education level for certification as of
2012.
Following over 10 years of war, there is an increased need
for prosthetics and orthotics services for the management of
complex injuries. Furthermore, as clinicians in the field
certified prior to this new degree requirement begin to retire,
they must be replaced with qualified professionals certified at
the master's degree level. Therefore, it is important for VA to
ensure a sufficient number of certified providers will be
available to provide orthotic and prosthetic care to veterans
in the years to come.
While the need for certified prosthetists and orthotists is
significant, only a small number of schools nationwide offer
master and doctoral programs in these fields. Therefore, a key
component to ensuring an adequate supply of certified
professionals available to serve veterans lies in VA's
collaboration with institutions of higher education for the
expansion and creation of education and training programs.
Committee Bill. Subsection (a) of section 312 would seek to
expand the availability of prosthetic and orthotic care for
veterans by requiring VA to collaborate with institutions of
higher education for the establishment or expansion of advanced
degree programs in prosthetics and orthotics.
Subsection (b) would require VA to develop and submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a plan for carrying out the collaboration required in
subsection (a). VA would be required to develop such a plan in
collaboration with veterans service organizations, institutions
of higher education with accredited degree programs in
prosthetics and orthotics, and representatives from the
prosthetics and orthotics field.
Ten million dollars would be authorized in subsection (c)
to be appropriated to VA for FY 2015, which would remain
available to be used until September 30, 2017.

Sec. 313. Corporal Michael J. Crescenz Department of Veterans Affairs
Medical Center.

Section 313 of the Committee bill, which is derived from
S. 229, would designate the VA medical center at 3900 Woodland
Avenue in Philadelphia, Pennsylvania, as the ``Corporal Michael
J. Crescenz Department of Veterans Affairs Medical Center.''
Background. Corporal Michael J. Crescenz was born in
Philadelphia, Pennsylvania, and served in the Vietnam War. A
rifleman with Company A, Corporal Crescenz acted selflessly to
protect his fellow soldiers in the face of challenge from the
North Vietnamese Army. He responded to firing from the enemy
that pinned down the lead squad and killed two point men by
putting himself in harm's way by leaving his position, taking a
nearby machine gun, running towards the enemy's bunkers and
killing the occupants. He then proceeded towards a third bunker
undeterred by the barrage of machine gun fire, where he killed
two more of the enemy and successfully cleared the way for his
comrades to advance. He valiantly continued towards a fourth
enemy bunker when he was fatally wounded by enemy machine gun
fire. Corporal Crescenz sacrificed his life in defense of his
fellow soldiers. His actions enabled his company to complete
its mission and defeat the enemy.
The Committee's Rules of Procedure (hereinafter,
``Committee Rules'') put forward the requirements for the
naming of Department facilities. According to those rules, a
facility may be named for an individual only if that individual
is deceased, and was a veteran who was instrumental to the
construction or operation of the facility, received the Medal
of Honor, or otherwise performed extraordinarily distinguished
military service; was a member of Congress who was directly
associated with such facility; an Administrator of Veterans
Affairs, Secretary of Veterans Affairs, Secretary of Defense or
of a branch of service, or a military or Federal civilian
official of comparable rank; or the Chairman and Ranking Member
agree the individual performed outstanding service for
veterans. Further, each member of Congress representing the
State in which the facility is located, and the State chapter
of each Congressionally-chartered VSO which has a national
membership of at least 500,000, must indicate in writing their
support for the naming proposal.
Committee Bill. Section 313 would name the VA medical
center located at 3900 Woodland Avenue in Philadelphia,
Pennsylvania, the ``Corporal Michael J. Crescenz Department of
Veterans Affairs Medical Center.''
Because all members of the Pennsylvania Congressional
delegation have expressed their support for naming this
facility in writing, and the Pennsylvania chapters of all VSOs
with national memberships of at least 500,000 individuals have
endorsed this facility being named in honor of Corporal Michael
J. Crescenz, this provision satisfies the Committee Rules
regarding the naming of VA facilities.

SUBTITLE C--COMPLEMENTARY AND ALTERNATIVE MEDICINE

Sec. 321. Expansion of research and education on and delivery of
complementary and alternative medicine to veterans.

Section 321 of the Committee bill, which is derived from
S. 852, would direct VA to develop a plan to expand research
and education on and delivery of CAM to veterans.
Background. In recent years, VA has worked to transform the
traditional practice of medicine to one that is patient-
centered, which involves a proactive approach to optimize
overall health and minimize risk. The approach is focused on
the overall well-being of individuals, rather than solely
disease management. To better meet the goals of providing
patient-centered care to veterans, VA created the Office of
Patient Centered Care and Cultural Transformation.
The Office of Patient Centered Care and Cultural
Transformation plays an important role in identifying best
practices for VA care, such as the movement toward patient-
centered care or the utilization of CAM therapies. However,
further research and education on, and the delivery and
integration of, CAM into the health care services provided to
veterans is necessary. It is important for VA to understand the
comparative effectiveness of various CAM therapies as well as
the various approaches for integrating CAM into traditional
health services. Finally, identifying barriers to receiving or
providing CAM therapies to veterans will allow VA to overcome
such barriers and improve delivery of CAM to veterans.
A variety of terms are used to describe therapies such as
acupuncture, massage therapy, and guided imagery. Particular
organizations and individuals have strong preferences and
rationales for the utilization of one particular terminology
over another. For the purposes of this legislation, the
utilization of the term ``complementary and alternative
medicine'' to describe these therapies should not be construed
to interject a position of this Committee in this debate.
Rather, this terminology is utilized to conform to the
terminology currently utilized by NIH. NIH currently defines
CAM as ``the term for medical products and practices that are
not part of standard care'' which is what ``medical doctors,
doctors of osteopathy, and allied health professionals, such as
nurses and physical therapists practice.'' This Committee
understands the fluidity of such terminology and encourages VA
to work in collaboration with other Federal government agencies
to ensure continuity of terminology throughout the Federal
government.
Committee Bill. Subsection (a) of section 321 would require
VA, within 6 months of the effective date of that section, to
develop a detailed plan to expand research and education on and
the delivery and integration of CAM services for veterans.
Subsection (b) of this section specifies that the plan shall
outline research on the comparative effectiveness of various
CAM services and strategies to integrate CAM services into
other health care services provided by the Department.
Additionally, the plan would outline education and training of
health care professionals in the Department on CAM services,
the appropriate uses of those services, and how such services
would be integrated into existing health care services for
veterans. Furthermore, the plan would require centers of
innovation at Department medical centers to carry out research,
education and clinical activities on CAM. Finally, the plan
would outline an approach for the identification or development
of metrics and outcome measures to evaluate the delivery of CAM
services as well as an approach to integrate and deliver CAM
services with other health care services provided by the
Department.
Subsection (c) of section 321 requires that VA, in creating
the plan, consult with the Director of the National Center on
CAM of the NIH; the Commissioner of Food and Drugs;
institutions of higher education, private research institutes,
and individual researchers who have extensive experience in
CAM; nationally recognized CAM providers; and other officials,
entities, and individuals who have experience in CAM as VA
deems appropriate. VA will consult with these parties in
developing the plan; identifying specific CAM services that are
promising or supported by research for veterans; identifying
barriers to the effective implementation and integration of CAM
services; and possible solutions to overcome such barriers.
Subsection (d) of section 321 would authorize the
appropriation of sums as may be necessary to carry out this
section. Subsection (e) of section 321 defines the term
``complementary and alternative medicine'' to have the meaning
given that term in regulations the Secretary shall prescribe
for purposes of this section, which to the degree practicable
will be consistent with the meaning given such term by the
Secretary of Health and Human Services. Because this Committee
seeks to align VA's terminology used to describe CAM services,
VA should follow any recommendations and actions by NIH and HHS
to revise said terminology. Subsection (f) of section 321
specifies that this section will become effective 1 year after
enactment.

Sec. 322. Program on integration of complementary and alternative
medicine within Department of Veterans Affairs medical centers.

Section 322 of the Committee bill, which is derived from
S. 852, would require VA to carry out a 3-year program to
assess the feasibility and advisability of integrating the
delivery of complementary and alternative medicine services
with other health care services provided by the Department for
veterans' mental health diagnoses, pain management, and chronic
illness. The program shall be carried out at not fewer than 15
VA medical centers.
Background. Currently, CAM is used in VA facilities
primarily for the purpose of pain management. Additionally,
according to VA/DOD Clinical Practice Guidelines for Management
of Post-Traumatic Stress, CAM therapies may be more acceptable
to patients ``reluctant to accept mental health labels or
interventions'' and have ``the added benefit of increasing
socialization'' because many of these therapies are practiced
in a group setting. CAM is also used to help individuals manage
stress and to promote general wellness.
According to the April 2011 edition of ``VA Research
Currents,'' a 2011 study conducted by VA's Health Care Analysis
and Information Group, showed the use of CAM has grown
substantially within VA over the last 10 years. VA's survey
noted that, out of 125 VA facilities nationwide that responded,
only 12 percent have an integrated medicine clinic where CAM is
provided. Integration of CAM services within VA's Patient
Aligned Care Teams (hereinafter, ``PACT'') is critical to
ensuring its utilization and in collaboration with other
primary care services. The integration of mental health
services as part of PACT is vital for the improved utilization
of these services and the reduction of stigma associated with
their use. CAM services may also benefit from such integration.
While CAM services are not currently available at every VA
facility, there is significant interest in expanding access to
such services for veterans. Of the remaining facilities that
participated in the 2011 survey that did not provide CAM
services at the time, half either indicated a desire to provide
CAM or were in the process of establishing a program. CAM
therapies provide an important alternative to veterans who
either do not respond to more conventional therapies as well as
for those interested in avoiding the use of prescription
medications. Such therapies can also be used in conjunction
with more conventional therapies to maximize veterans' health
and well-being. Additionally, CAM therapies may be utilized in
the treatment of seriously injured veterans--such as those
receiving care at VA's polytrauma centers--as well as veterans
receiving new, less acute diagnoses.
Committee Bill. Subsection (a) of section 322 would require
VA to carry out a program, through the Office of Patient
Centered Care and Cultural Transformation, to assess the
feasibility and advisability of integrating CAM services with
other health care services provided by the Department. Under
the program, CAM services would be provided for veterans with
mental health, chronic pain, or other chronic conditions. This
subsection specifies that, during the development of the
program, potential barriers to the integration of CAM services
into VA medical centers must be identified and resolved.
Subsections (b) and (c) require the program to be carried
out during a 3-year period at no fewer than 15 separate VA
medical centers. Subsection (c) requires that the program sites
include at least two VA medical centers designated by VA as
polytrauma centers. The medical centers chosen must include
locations in rural areas, areas that are not in close proximity
to an active duty military installation, and different
geographic locations.
Subsection (d) requires VA to, as part of the program,
provide covered CAM services to covered veterans. Subsection
(e) specifies that covered veterans shall include any veteran
who has a mental health condition diagnosed by a VA clinician,
experiences chronic pain, or has a chronic illness being
treated in a VA facility.
Subsection (f) defines covered services as those CAM
services selected by the Secretary. Under the program, those
covered CAM services shall be administered by clinicians hired
by VA who, to the extent possible, solely provide such
services. Covered services shall be included in the PACT
initiative of the Office of Patient Care Services, Primary Care
Program Office in coordination with the Office of Patient
Centered Care and Cultural Transformation. Covered services
would be available to veterans for the treatment of mental
health disorders, chronic pain, or other chronic conditions who
have or have not received traditional treatments from VA for
such conditions. Subsection (g) specifies that, in order to
participate in the program, veterans must voluntarily elect to
participate in consultation with a VA clinician.
Subsection (h) of this section requires VA to report to
Congress quarterly on the efforts to carry out the program; the
first report shall be submitted within 90 days of the start of
the program. The reports shall include a description of the
outreach conducted by VA to veterans and community
organizations to inform such individuals and organizations
about the program. No later than 180 days after the completion
of the program, VA would be required to report to Congress with
the findings, conclusions, and recommendations with respect to
the utilization and efficacy of CAM centers established under
the program, an assessment of the benefits of the program, and
the comparative effectiveness of various CAM therapies,
barriers identified, and recommendations for continuation or
expansion.
This section would take effect 1 year after the date of
enactment.

Sec. 323. Study of barriers encountered by veterans in receiving, and
administrators and clinicians in providing, complementary and
alternative medicine services furnished by the Department of
Veterans Affairs.

Section 323 of the Committee bill, which is derived from
S. 852, would direct VA to conduct a comprehensive study of
barriers encountered by veterans in receiving, and clinicians
in providing, CAM services at VA.
Background. The use of CAM services has increased
significantly, with particularly rapid growth in the past
decade. However, there remains a wide range of CAM therapies
available which could also be more widely utilized by VA. For
the expansion, utilization, and integration of CAM, it is
critical to understand the barriers encountered by patients in
receiving, and clinicians in providing, such services.
Committee Bill. Section 323 of the Committee bill requires
VA to enter into a contract with a qualified independent entity
or organization to carry out a study of the barriers
encountered by veterans in receiving CAM services from VA and
of clinicians and administrators in the provision of such
services. VA would be required to survey veterans who seek or
receive hospital or medical care furnished by VA, as well as
veterans who do not. Additionally, VA would administer the
survey to a representative sample of veterans from each VISN
and ensure the sample of veterans surveyed is of sufficient
size for the study results to be statistically significant.
Subsection (b) requires VA to also study the perceived
barriers associated with obtaining CAM services from VA; the
satisfaction of veterans with CAM in primary care; the degree
to which veterans are aware of eligibility requirements, and
the scope of services available under, CAM furnished by VA; the
effectiveness of outreach to veterans of the availability of
CAM; and such other barriers as VA considers appropriate.
Finally, VA would study the barriers to VA administrators and
clinicians involved in the provision of CAM services before and
after the introduction of such services at VA facilities.
Subsection (d) ensures that VA's head of the Centers for
Innovation as established under section 7330B of title 38,
U.S.C., and the National Research Advisory Council review the
results of the study conducted. In addition, the head of each
such division shall submit findings with respect to the study
to the Under Secretary for Health and to other pertinent
program offices within the Department with responsibilities to
health care services for veterans. Not later than 1 year after
the date of enactment, VA would submit a report on the status
of the implementation of this section to Congress.
Subsection (e) requires that, not later than 45 days after
the date of completion of the study, VA shall submit to
Congress a report on the study conducted with recommendations
for such administrative and legislative proposals as VA
considers appropriate. The findings of the National Research
Advisory Council and of the Under Secretary for Health shall be
included. Finally, subsection (f) authorizes $2 million to
carry out this section.

Sec. 324. Program on use of wellness programs as complementary approach
to mental health care for veterans and family members of
veterans.

Section 324 of the Committee bill, which is derived from
S. 852, would require VA to establish a 3-year program for the
award of grants to public or private nonprofit entities to
assess the feasibility and advisability of using wellness
programs to complement the provision of mental health care to
veterans and family members eligible for VA counseling
services.
Background. Traditionally, the mission of VHA has been the
treatment of disease and illness. Although VA offers tools and
information to help veterans and their families reach their
optimal health, more research is needed on the benefits of
wellness programs in conjunction with primary or mental health
care services.
Committee Bill. Section 324 of the Committee bill requires
VA to carry out a 3-year program through the award of grants to
public or private nonprofit entities to assess the feasibility
and advisability of using wellness programs to complement the
provision of mental health care to veterans and family members
eligible for counseling under section 1712A(a)(1)(C) of title
38, U.S.C. The pilot program would assess means of improving
coordination between Federal, State, local, and community
providers of health care in the provision of mental health
care; means of enhancing outreach, by and among providers of
health care on the mental health care services provided; and
means of using wellness programs of providers of health care as
complements to the provision by VA of mental health care to
veterans and family members.
Additionally, the program would address whether wellness
programs are effective in enhancing quality of life and well-
being; are effective in increasing the adherence of veterans to
the primary mental health services provided by VA; have an
impact on the sense of well-being of veterans who receive
primary mental health services through VA; and are effective in
encouraging veterans receiving health care from VA to adopt a
more healthy lifestyle.
A public or private nonprofit entity seeking the award of a
grant would be required to submit an application to VA. The
application shall include a plan to coordinate activities, to
the extent practicable, with Federal, State, and local
providers of services for veterans to enhance awareness by
veterans of benefits and health care services provided by VA,
outreach efforts to increase the use by veterans of services
provided by VA, and education efforts to inform veterans of
benefits of a healthy and active life style. In carrying out
the purposes prescribed by VA, a public or private nonprofit
entity awarded a grant would be permitted to use the award to
furnish services only to individuals specified in section
1712A(a)(1)(C) of title 38, U.S.C., which include veterans,
members of the Armed Forces, members of the reserves, and their
families.
Not later than 180 days after the commencement of the
program and every 180 days thereafter, VA would be required to
submit a report to Congress on the findings, conclusions, and
assessment of benefits of the program to veterans and their
family members during the 180 day period preceding the report.
A final report would be submitted by VA 180 days after the end
of the program.

TITLE IV--ACCOUNTABILITY AND ADMINISTRATIVE IMPROVEMENTS

Sec. 401. Administration of Veterans Integrated Service Networks.

Section 401 of the Committee bill, which is derived from
S. 543, would require VA to organize VHA into geographically
defined VISNs; establish an appropriate staffing model;
maintain a regional integrated health care system; identify and
reduce duplication of functions; work to achieve maximum
effectiveness in patient care and safety, graduate medical
education, and research; and assess the consolidation or
realignment with other VISNs or other entities. This section
requires VA to report at least annually to Congress on
employment at VISN headquarters. This section also requires VA
to report at least every 3 years on a review and assessment of
VISN structure and operations. Finally, this section requires
that VA either relocate leased VISN headquarters offices to VA
medical centers or notify Congress that the VISN will be
renewing a lease or engaging in a new lease.
Background. In order to provide the greatest access to VA
health care to veterans possible, VA's health care system
includes 152 VA medical centers and more than 1,400 outpatient
clinics, nursing homes, Vet Centers, and domiciliaries located
throughout the country. These facilities are organized into 21
regional networks, referred to as VISNs. Each of the 21 VISNs
has its own headquarters with a limited management structure to
manage and oversee the medical centers and other facilities
located within the regional network. These headquarters are
often located in leased commercial space.
In 1995, VA established VISNs in an effort to improve the
efficiency and effectiveness of care to veterans, by
decentralizing VA's budgetary, planning, and decisionmaking
functions to the VISN offices. Anticipated staffing for each
VISN office was expected to range between seven to ten full-
time equivalent employees, depending on the size and complexity
of the VISN. The specific role and expertise of VISN staff was
left to the discretion of each VISN. Similarly, the emphasis in
the VISN and the manner in which key functions would be
performed, such as medical facility oversight, was expected to
differ across VISNs.
Two published reports from the VA Office of Inspector
General (hereinafter, ``OIG'')--``Veterans Health
Administration, Audit of Financial Management and Fiscal
Controls for Veterans Integrated Service Network Offices'' and
``Veterans Health Administration, Audit of Management Control
Structures for Veterans Integrated Service Network Offices,''
both of which were published on March 27, 2012--raised concerns
about whether the VISNs are promoting efficient and effective
health care for veterans, as intended. According to the
reports, the VISNs' expenses had increased by more than 500
percent--from an estimated $26.7 million to over $164.9
million. The reports identified shortcomings in VISN oversight
including, among other things, failure to ensure compliance
with VA policies, and processes to improve the quality of
veterans' health care.
VA has acknowledged shortcomings in VISN operations. In a
Department response to the OIG's reports and concerns raised by
the Ranking Member, VA conducted an internal review to identify
and implement opportunities to improve efficiency across VISNs.
This review resulted in VA defining core VISN positions and key
functions and establishing a staffing model that accounts for
the specific health care needs of differing populations in the
VISN.
Committee Bill. Subsection (a) of section 401 of the
Committee bill would amend subchapter I of chapter 73 of title
38, U.S.C., by creating a new section 7310. Section 7310 would
detail the new requirements of VA and the corresponding VISNs.
Subsection (a) of section 7310 would require VA to organize
VHA in geographically defined VISNs. Subsection (b) would
require VA to establish and comply with a staffing model for
each VISN. Subsection (c) would require VISNs to coordinate
with other governmental, public, and private health care
organizations and practitioners, as appropriate, to meet
veterans' health care needs; oversee, manage, and take
responsibility for the VISNs' budget; use national metrics to
develop systems to provide effective, efficient, and safe
delivery of health care; and ensure high quality clinical
programs and services are provided. Subsection (d) of this new
section would require the VISNs to identify and reduce,
whenever practicable, the duplication of functions. Subsection
(e) would require each VISN to work to achieve maximum
effectiveness in patient care and safety, graduate medical
education, and research, and to assess consolidation or
realignment with other VISNs and other government and non-
government entities, as appropriate. Subsection (f) would
require that each VISN has only one headquarters office in a
location determined by the Secretary and co-located with a VA
medical center. This subsection would also require that VA
submit a report, not less frequently than once per year, on
employment at the VISN headquarters to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives. In these reports, VA would be required to
report on the number, title, and impact on the budget of
individuals employed at each VISN headquarters, including the
number of individuals employed by each VISN who are not
employed at the same location as the headquarters of the VISN.
Subsection (g) of this new section would require that VA
conduct a review and assessment of the structure and operations
of the VISNs every 3 years. Within 180 days of completion of
this triennial review, VA would be required to report to
Congress on this review and assessment and provide
recommendations for legislative or regulatory action to improve
the VISNs, as appropriate.
Subsection (b) of section 401 of the Committee bill would
authorize VA to relocate a leased VISN headquarters upon the
expiration of the lease so that such headquarters is co-located
with a medical center as required by the amended section
7310(f)(2) of title 38, U.S.C., or renew or enter into a lease
to keep such headquarters in a current location. Prior to
renewing or engaging in a new lease, VA would be required to
report to the Committees on Veterans' Affairs of the Senate and
the House of Representatives on the reasons for such renewal or
engagement. In these reports, VA would be required to provide a
list of VA medical centers in the VISNs with underutilized
buildings, the number of such buildings, and the total
underutilized square footage for each such medical center; the
cost of the current lease and the current square footage being
leased; and the cost of the new lease and the square footage to
be leased.
Subsection (c) of section 401 of the Committee bill would
clarify that nothing in new section 7310 would be construed to
require any change in the location or type of medical care or
service provided by a VA medical center or other facility that
provides direct care or services under a law administered by
the Department.
Subsection (d) of section 401 of the Committee bill would
establish an effective date for this section that is 1 year
after the date of enactment of the Committee bill.
The original intent behind the creation of the current VISN
structure was to improve the access to, quality of, and
efficiency of care to veterans through a ``patients first''
focus. The Committee is concerned VHA has significantly strayed
from the original concept behind the 1995 reorganization and
this provision is intended to return to that initial intent. It
is the Committee's objective that, in VA's review of the
current VISN structure, VA use the same metrics Dr. Kenneth W.
Kizer, former Under Secretary for Health, used to create the
original 22 VISNs. It is also the Committee's objective that
the functions of the VISN headquarters are returned back to Dr.
Kizer's original intent, in which the VISN headquarters served
as the budgetary, management, and planning unit for the
network.

Sec. 402. Regional support centers for Veterans Integrated Service
Networks.

Section 402 of the Committee bill, which is derived from
S. 543, would establish four regional support centers to assess
VISN efficiency and effectiveness in the areas of finance
operations and compliance activities, OEF/OIF/OND outreach,
women veterans' programs, homelessness, use of energy, and
other matters that the Secretary considers appropriate. The
centers would be co-located with medical centers when possible
and staffed with such employees as VA considers appropriate.
Background. According to Dr. Kizer's 1995 ``Vision for
Change,'' the blueprint for the current VISN organization, the
creation of 22 networks (later reduced to 21) would allow a
pooling of resources with improved cost management and
outcomes. The number and mix of network staffing would depend
on the region's needs but was expected to approximate the
proposed seven to ten full-time equivalent employees per
network. With increases in enrolled veterans and mandates for
care, network staff and functions have also increased but with
little oversight from VA. According to two published OIG
reports, ``Veterans Health Administration, Audit of Management
Control Structures for Veterans Integrated Service Network
Offices'' and ``Veterans Health Administration, Audit of
Financial Management and Fiscal Controls for Veterans
Integrated Service Network Offices,'' published March 27, 2012,
VHA lacks assurance that its VISNs are effectively managing
funds and resources. Consolidating oversight of selected VISN
functions to four regional support centers would strengthen
fiscal controls and allow more effective distribution of
resources.
Committee Bill. Subsection (a) of section 402 of the
Committee bill would amend subchapter I of chapter 73 of title
38, U.S.C., by creating a new section 7310A. Subsection (a) of
new section 7310A would require VA to establish four regional
support centers. The head of each regional support center would
report to the Under Secretary for Health. Functions of the
regional support centers as described in subsection (b) of new
section 7310A would include assessment of the quality of work
performed within finance operations and other compliance
related activities; outreach to veterans who served in OIF/OEF/
OND, or another contingency operation; women veterans'
programs; homelessness; use of energy; and other matters that
VA considers appropriate. Subsection (c) of new section 7310A
would authorize VA to hire such employees and contractors as
considered appropriate to carry out the functions of the
regional support centers. Subsection (d) of new section 7310A
would require the Department to co-locate the regional support
centers with a VA medical center or submit a report to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives detailing the reasons for not co-locating with
a VA medical center. The report would include a list of
underutilized buildings in the VISN region, the number of all
VHA buildings in such VISN, the total underutilized square
footage for each medical center in such VISN, and the cost of
the lease and the square footage to be leased.
Subsection (b) of section 402 of the Committee bill would
require initial staffing to be provided, to the degree
practicable, through transfer of employees from VISN
headquarters.
Subsection (d) of section 402 of the Committee bill would
specify that nothing in new section 7310A would be construed to
require any change in the location or type of medical care or
service provided by a VA medical center or facility that
provides direct care or services under a law administered by
the Department.
The Committee intends that the functions and the initial
staffing of the Regional Support Centers (hereinafter, ``RSC'')
will come from functions that the VISN headquarters have
currently been performing. With the creation of these RSCs, it
is not the Committee's intent to create another bureaucratic
level which VISN directors must move through to connect with
the Under Secretary of Health. The RSCs are intended to be the
information gathering arm of VHA to assess how the VISNs are
performing certain functions.

Sec. 403. Commission on Capital Planning for Department of Veterans
Affairs Medical Facilities.

Section 403 of the Committee bill would, in an original
provision, require the establishment of a Commission on Capital
Planning for VA medical facilities. Section 403 would also
require the Commission to report to VA and Congress, and would
require VA to report to Congress on the implementation of any
recommendations the Commission makes.
Background. VA operates the largest integrated health care
system in the nation. There are many mechanisms that VA
utilizes to deliver health care, including the construction or
lease of space for a clinic, sharing agreement with other
Federal agencies or local partners, or through contract with a
community provider. VA's capital asset programs have had a
number of issues that have impeded the Department's ability to
consistently provide high quality medical facilities.
Most recently, Congress has faced issues with the
authorization of VA's major medical facility lease requests.
Section 8104 of title 38, U.S.C., requires Congressional
authorization by law for any major medical facility
construction project that is anticipated to cost $10,000,000 or
above or any major medical facility lease that is anticipated
to have an average annual rent exceeding $1,000,000. In
accordance with the process laid out in section 8104 of title
38, VA is required to submit a list of major medical facility
construction projects and major medical facility leases that
require authorization, along with a detailed prospectus
including information on current and projected patient
demographics, utilization and workload; a detailed cost
estimate to construct or lease, activate, and staff the
facility; prioritization information with respect to other
projects the Department may be considering; a cost-benefit
analysis of alternatives considered; and an explanation of why
the proposed alternative is the most effective.
As Congress authorizes these projects, the Congressional
Budget Office (hereinafter, ``CBO'') is responsible for
estimating how legislation will impact spending and revenues
over the long term. In creating cost estimates for VA's major
medical facility lease program, CBO utilizes the Office of
Management and Budget (hereinafter, ``OMB'') Circular A-11,
Appendix B, which states, when agencies are authorized to
execute a capital lease ``budget authority will be scored in
the year in which the authority is first made available in the
amount of the net present value of the government's total
estimated legal obligations over the life of the contract.'' In
addition, it states for operating leases, budget authority:

is * * * obligated up front in the amount necessary to
cover the Government's legal obligations * * * [to
include] estimated total payments expected to arise
under the full term of the contract or, if the contract
includes a cancellation clause, an amount sufficient to
cover the lease payments for the first year plus an
amount sufficient to cover the costs associated with
cancellation of the contract.

Further, in each year that follows, sufficient budget authority
must be obligated for the annual lease payment and any
cancellation costs.
CBO historically has assumed these leases were short-term
contracts or renewals of leases on existing facilities. As
such, only a discretionary score for the first year of rent and
any special purpose improvements was assigned in compliance
with the OMB Circular's rules on scoring operating leases.
During the scoring process for VA's FY 2013 construction
request, CBO obtained additional information about the nature
of VA's Major Medical Facility Leasing Program, that led to the
conclusion that these leases were longer-term in nature, and
similar to major construction, financed by a third party. In
accordance with the guidelines set forth in the OMB Circular,
CBO assigned a mandatory score for the full 20-year cost of
each lease at the time of enactment.
Other program challenges have been identified by VA's
Construction Review Council (hereinafter, ``CRC''). In April
2012, VA established the CRC to serve as the single point of
oversight and performance for the planning, budgeting,
execution, and delivery of VA's real capital asset program. The
CRC reported that a number of challenges identified on a
project-by-project basis were not isolated incidents but were
indicative of systematic problems facing VA. Some of these
challenges include adequate development of project
requirements, design quality, timing and coordination of
funding with construction and activation schedules, and program
management. VA has recently taken steps to address these issues
but results remain to be seen.
VA is one of the largest property--holding agencies in the
Federal government, with 5,352 acres of land, 5,873 buildings,
and 149 million square feet of medical facilities and
administrative space. The average age of VA's medical
facilities is 60 years old and the Department's FY 2014 budget
request identified between $54 and $62 billion in construction
projects that the Department would like to complete in the next
10 years. In an April 2013 report entitled ``VA Construction:
Additional Actions Needed to Decrease Delays and Lower Costs of
Major Medical-Facility Projects,'' GAO reported that VA is
engaged in 50 major medical facility construction projects. In
addition, GAO reported that four of VA's largest medical-
facility construction projects were experiencing cost increases
and schedule delays, due to changing facility needs, other
unexpected factors, unclear roles and responsibilities for
construction management staff, delayed approval of change
orders, and complexities related to procurement and
installation of medical equipment.
Committee Bill. Section 403 of the Committee bill would
establish a Commission on Capital Planning for VA Medical
Facilities. The Commission would be composed of ten voting
members as follows:

- one would be appointed by the President;
- one would be appointed by the Administrator of General
Services;
- three would be appointed by the VA Secretary, the first
member being employed by VHA, the second member being employed
by VA's Office of Asset Enterprise Management, and the third
member being employed by VA's Office of Construction and
Facilities Management;
- one would be appointed by DOD from among employees of the
Army Corps of Engineers;
- one would be appointed by the majority leader of the
Senate;
- one would be appointed by the minority leader of the
Senate;
- one would be appointed by the Speaker of the House of
Representatives; and
- one would be appointed by the minority leader of the
House of Representatives.

All of the appointed members would have expertise in capital
leasing, construction, or health facility management planning.
In addition, the Commission would be assisted by ten non-voting
members, appointed by vote of a majority of members of the
Commission. Six members would be representatives of VSOs
recognized by VA and four members would be individuals from
outside VA with experience and expertise in matters relating to
management, construction, and leasing of capital assets.
The Commission would undertake a comprehensive evaluation
and assessment of various options for capital planning for VA
medical facilities, including an evaluation and assessment of
the mechanisms by which VA currently selects means for the
delivery of health care, whether by capital options such as
major construction, major medical facility leases, or multisite
care delivery, or by non-capital options such as sharing
agreements with DOD, the Indian Health Service (hereinafter,
``IHS''), and Federally Qualified Health Clinics under section
330 of the Public Health Service Act (42 U.S.C. 254b), contract
care, telemedicine, extended hours of care, or other means.
While conducting the evaluation, the Commission would consider:
the importance of access to health care through VA; limitations
and requirements applicable to construction and leasing for VA,
including costs as determined by both OMB and CBO; the nature
of capital planning for VA medical facilities in an era of
fiscal uncertainty; projected future fluctuations in the
population of veterans; and the extent to which VA was able to
meet the mandates of the Capital Asset Realignment for Enhanced
Services Commission.
Furthermore, the Commission would be required to address,
in a series of reports, ways to improve operations in the
following areas: VA's major medical facility lease program and
the Congressional lease authorization process; VA's management
process for its major medical facility construction program,
including processes relating to contract award and management,
project management, and processing of change orders; VA's
overall capital planning program for medical facilities,
including how VA determines whether to use non-capital or
capital means to expand health care access, how VA determines
the disposition of unutilized buildings, the effectiveness of
the facility master planning initiative, and how VA includes
sustainability in capital planning; and the current backlog of
construction projects of VA medical facilities, including an
identification of the most effective means to quickly secure
the most critical repairs required, including repairs relating
to facility condition deficiencies, structural safety, and
handicap accessibility.
VA would be required to report to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives on the feasibility and advisability of all
recommendations, implement each recommendation that was
considered feasible, and provide a description of the actions
that are being taken or any legislative action needed to
implement those recommendations considered feasible and
advisable.

Sec. 404. Public access to Department of Veterans Affairs research and
data sharing between Departments.

Section 404 of the Committee bill, which is derived from
S. 877, would direct VA to enhance public access to information
on VA's research data files and publications based on research
funded by VA. This section would also require that VA and DOD
jointly formulate recommendations for long-term cooperation and
data-sharing to facilitate research.
Background. A number of government agencies and departments
provide funding for research to advance health care, including
NIH and VA. The focus of this research varies across agencies
and departments, with VA assuming primary responsibility for
funding research to improve health care for our nation's
veterans.
VA maintains numerous data files that can be used in
research to improve veterans' health care. For example, VA
maintains data files on the cost of care veterans receive and
researchers may use those files to examine the cost
effectiveness of various treatments. However, many researchers,
including those from the Institute of Medicine (hereinafter,
``IOM''), face numerous obstacles in their attempts to access
those files. These obstacles may result in delays in
improvements of health care for veterans.
VA-funded research has contributed to numerous innovations
in veterans' health care. For example, in 2012, VA funded
research to develop new approaches for treating bomb blast-
related traumatic brain injury and restoring independence and
mobility for people with paralysis or loss of limbs. However,
many clinicians, veterans, and others may lack access to
information on these innovations since publications based on
this research are often only available through subscriptions to
various scholarly journals which may be cost prohibitive for
many. In contrast, the public has free access to publications
based on research funded by the NIH because researchers are
required to submit such publications to a free digital archive.
No such requirement currently exists for publications based on
VA-funded research.
Like VA, DOD maintains research data files and VA and DOD
have, in certain instances, shared their data for research on
topics of importance to both servicemembers and veterans. For
example, VA and DOD collaborated on research to determine why
certain servicemembers develop PTSD while others do not, which
has implications for the activities of both Departments.
Considerable additional research is needed to inform care and
services for servicemembers, veterans and their families. As a
result, it is imperative that the Departments minimize
unnecessary barriers researchers, including those from IOM,
have experienced when trying to access data for these purposes.
Committee Bill. Subsection (a) of section 404 of the
Committee bill would require VA to make information on VA data
files, including the contents of such files, and instructions
for how to access such files for use in research publicly
available on a VA Web site. Subsection (b) of section 404 would
require VA to ensure that manuscripts based on VA-funded
research are available for free to the public through a digital
archive established by VA or another executive agency,
consistent with available copyright law. This subsection would
also require VA, within 1 year of when VA begins ensuring that
publications are submitted to a digital archive, submit an
annual report on the implementation of this subsection during
the most recent 1-year period to the Committees on Veterans'
Affairs of the Senate and the House of Representatives.
Subsection (c) of section 404 of the Committee bill would
require that the VA and DOD Joint Executive Committee establish
a program for long-term cooperation and data-sharing to
facilitate research. Subsection (e) establishes the effective
date for section 404 as 1 year after the date of enactment of
the Committee bill.

Sec. 405. Budget transparency for outreach activities of Department of
Veterans Affairs.

Section 405 of the Committee bill, which is derived from
S. 927, would amend chapter 63 of title 38, U.S.C., by
requiring VA to include the amount requested for outreach
activities by the Office of Public and Intergovernmental
Affairs in its annual budget justification materials submitted
to Congress.
Background. In FY 2010, VA established the National
Outreach Office within the Office of Public and
Intergovernmental Affairs to standardize the administration of
outreach across its three administrations. Current law does not
require VA to include amounts requested for outreach activities
in the budget justification materials submitted to Congress. In
March 2011, the Committee held a hearing on VA's FY 2012 budget
request. In response to questions for the record following that
budget hearing, VA acknowledged its inability to extract the
total amount spent on outreach activities across the Department
for FYs 2010 and 2011, although VA was working on the ability
to do so for FY 2012. As for the budget submission from VA for
FY 2014, outreach expenditures were not included in the annual
budget submission to Congress, nor was VA able to provide the
information to the Committee through post-hearing questions.
Committee Bill. Section 405 of the Committee bill would
require VA to include, as part of its annual budget
justification materials for each FY, the amount requested for
outreach activities of the Office of Public and
Intergovernmental Affairs. Under this section, VA would be
required to include both the aggregate amount requested for
outreach activities and amounts requested for outreach
activities of the Office of the Secretary, VHA, VBA, and the
National Cemetery Administration. The Committee's intent in
requiring the inclusion of the amounts requested for outreach
activities in VA's budget justification materials is to
increase visibility of and justification for resources
requested for outreach activities.
Section 405 of the Committee bill would also require VA to
establish procedures to ensure the effective coordination and
collaboration of outreach activities throughout the Department.
Section 405 would require VA to review such procedures not less
frequently than once every 2 years and to submit a report to
Congress on the findings of these reviews.

Sec. 406. Comptroller General report on advisory committees of the
Department of Veterans Affairs.

Section 406 of the Committee bill, which is an original
provision, would require GAO to submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report on VA's advisory committees.
Background. The Federal Advisory Committee Act
(hereinafter, ``FACA'') created a formal process for
establishing, operating, overseeing, and terminating Federal
advisory committees. Advisory committees, whether created by
statute or Federal agencies, can provide valuable advice and
guidance on a variety of government programs.
VA maintains 24 Federal advisory committees. Fifteen of the
committees are required by statute, while the remaining nine
committees have been established by VA. According to GSA's
Committee Management Secretariat, VA's spending on advisory
committees over the last 10 years was $70,820,500. In FY 2012,
VA spent $6.3 million on advisory committees.
Committee Bill. Section 406 of the Committee bill would
require GAO to submit to the Committees on Veterans' Affairs of
the Senate and the House of Representatives a report on VA's
advisory committees. The report would include recommendations
or proposals for continuing, modifying, or terminating certain
advisory committees. This section would take effect on the date
1 year after the date of enactment.
The report may also include the purpose of each advisory
committee, the commencement date and anticipated termination
date, an estimated expense report detailing the anticipated
expenses in comparison to the actual expenses incurred by the
advisory committee during the three most recent FYs, and a
summary of the most recent meetings held by each advisory
committee.
The Committee's oversight responsibilities extend to all VA
programs and operations, including the effectiveness of
advisory committees.

TITLE V--IMPROVEMENT OF PROCESSING OF CLAIMS FOR COMPENSATION

SUBTITLE A--CLAIMS BASED ON MILITARY SEXUAL TRAUMA

Sec. 501. Medical examination and opinion for disability compensation
claims based on military sexual trauma.

Section 501 of the Committee bill, which is derived from
S. 294, would require a diagnosis or opinion by a mental health
professional to assist in corroborating the occurrence of a MST
stressor when no evidence of a marker has otherwise been found.
Background. Sexual assault in the military continues to be
a significant and dire problem. In DOD's Annual Report on
Sexual Assault in the Military from FY 2012, it was estimated
that 26,000 servicemembers experienced unwanted sexual contact
during the FY, an increase of over 7,000 servicemembers since
2010. The National Center for Posttraumatic Stress Disorder and
the Center for Health Care Evaluation estimated that, of all
the veterans who receive VHA primary care or mental health
services, 15 percent of the women and 0.7 percent of the men
experienced sexual trauma while in the military.
Under current law, section 5103A of title 38, U.S.C., VA
has a duty to assist claimants in obtaining the evidence
necessary to substantiate a claim for benefits. In certain
cases, this duty includes obtaining medical examinations or
medical opinions. The CAVC has interpreted this statute to
require VA to provide a medical examination when there is: (1)
competent evidence of a current disability or persistent or
recurrent symptoms of a disability; (2) evidence establishing
that an event, injury, or disease occurred in service or
establishing certain diseases manifesting during an applicable
presumptive period for which the claimant qualifies; (3) an
indication that the disability or persistent or recurrent
symptoms of a disability may be associated with the veteran's
service or with another service-connected disability; but (4)
insufficient competent medical evidence on file for the
Secretary to make a decision on the claim. McLendon v.
Nicholson, 20 Vet. App. 79 at 81 (2006). VA Training Letter 11-
05, Adjudicating Posttraumatic Stress Disorder Claims Based on
Military Sexual Trauma, issued December 2, 2011, and revised
June 17, 2013, provides information and guidelines on the
evidentiary standard necessary to schedule a medical
examination when adjudicating PTSD claims based on MST.
In order to satisfy the requirements of the second
criterion above, a veteran must have some evidence of a marker
in their service or post-service records. If the claimant is
unable to establish the presence of a marker to corroborate
their in-service stressor, VA may deny a medical examination.
The denial of a medical examination is of great significance in
these cases, because the opinion of a qualified examiner can be
considered credible supporting evidence of the occurrence of
the MST stressor. Patton v. West, 12 Vet. App. 272, 280 (1999);
see also VA training letter 11-05 issued December 2, 2011, and
revised June 17, 2013.
In conducting examinations, VA's best practice manual, Best
Practice Manual for Posttraumatic Stress Disorder (PTSD)
Compensation and Pension Examinations, suggests the need for a
more standard approach to the assessment and documentation of
PTSD. Other experts support this assertion. For example, IOM
identified use of a multimethod assessment approach that relies
in large part on standardized diagnostic assessment interviews
and psychometric testing as a best practice. Further, a recent
study published in the Journal of Traumatic Stress in December
2012 titled, Impact of Evidence-Based Standardized Assessment
on the Disability Clinical Interview for Diagnosis of Service-
Connected PTSD: A Cluster Randomized Sample, demonstrated
disability examinations would be improved through use of
evidence-based assessments. In summarizing the findings of
their work the authors noted, ``Our study indicates that
evidence-based, standardized disability assessment for PTSD
would enhance the clinician's determination of a PTSD diagnosis
and functional impairment and make the disability examination
process more reliable and accountable.''
Despite the evidence suggesting that the increased usage of
evidence-based assessments improves the quality of
examinations, an article by Jackson, et al. published in the
Journal of Traumatic Stress in October 2011 titled, Variation
in Practices and Attitudes of Clinicians Assessing PTSD-Related
Disabilities Among Veterans, suggests that few VA clinicians
actually follow best practices when conducting disability
examinations for PTSD. Specifically, of the surveyed mental
health professionals, 59 percent reported rarely or never using
testing and less than 1 percent reported that they routinely
used functional assessment scales.
The Committee wants to collect additional data about
whether or not VA is using consistent evidence-based
assessments in PTSD assessments based on MST. If not, the
Committee would be interested in VA's reasoning for not doing
so when credible outside studies, and in fact their own best
practices manual, suggest the adherence to these evidence-
based, standardized tests produce more consistent outcomes. The
Committee is concerned that the current wide variation in
practice styles, evidenced by the findings of Jackson, et al.,
produces different outcomes for similarly situated veterans and
undermines their perception of the fairness of the examination
and disability evaluation process.
Committee Bill. Section 501 of the Committee bill would
amend section 5103A of title 38, U.S.C., by adding a new
paragraph that would require VA to obtain a medical examination
or opinion when the evidence of record before the Department
contains competent evidence that the claimant has a current
disability or symptoms of one and indicates that the disability
may be associated with active duty, but does not contain a
diagnosis or opinion by a mental health professional that may
assist in corroborating the occurrence of a stressor based on
MST.
The Committee believes requiring VA to obtain medical
examinations and opinions for this unique category of claimants
will provide an additional opportunity for the claimant to
obtain evidence that may be used to corroborate the occurrence
of an in-service stressor. Because of the unique challenges of
documenting personal-assault claims, this category of claimants
requires distinct rules in order to assist in the evidentiary
development process.
Section 501 would also require VA to submit a report to the
Committees on Veterans' Affairs of the Senate and House of
Representatives on the number of examinations and opinions
conducted by VA pursuant to new paragraph (3) of section 5103A
of title 38, U.S.C., as added by the Committee bill. This
report will include the number of examinations conducted using
a standardized disability assessment and the number of
examinations conducted using a non-standardized clinical
interview.
The Committee believes adherence to best practices, which
includes the use of evidence-based, standardized tests, would
produce more consistent examination outcomes. As noted, the
Committee is concerned that the current wide variation in
practice styles could have a negative impact on a veteran's
perception of the fairness of the examination and disability
evaluation process. It is the Committee's intent that the
collection of data on the use of standardized disability
assessments provides the focused Congressional oversight
necessary to address these concerns.

Sec. 502. Case representative officers for military sexual trauma
support.

Section 502 of the Committee bill, which is derived from
S. 294, would require VA to assign, to each individual seeking
compensation for a disability based on MST, a case
representative officer who shall serve as a liaison between
such individual and VA and provide advice and general
information to such individual on the claims process.
Background. According to VA's FY 2014 budget justification
materials, VHA has a specialized organizational structure to
provide oversight of MST-related services. Every facility,
whether regional or national, has a designated MST Coordinator
that serves as the point of contact for all MST-related issues,
including staff education and training, monitoring of MST-
related screening, referral, treatment, and outreach to
veterans. This position can be full-time or assigned as a
collateral duty in addition to the many other responsibilities
and functions being performed by the coordinators.
Additionally, each VISN has a MST point of contact to monitor
and ensure national and VISN-level policies are consistently
applied. This role is a collateral position, but the person
must be provided adequate protected time to fulfill their
duties. Finally, the MST Support Team at the national level,
which monitors MST screening and treatment, oversees and
expands MST-related education and training, promotes best
practices in the field, and develops policy recommendations.
VBA also has employees dedicated to providing support and
services to veterans and MST survivors. Every VA regional
office (hereinafter, ``RO'') has at least one designated Women
Veterans Coordinator (hereinafter, ``WVC'') to assist veterans,
both male and female, with their claims resulting from MST.
WVCs also assist in coordinating any required health care for
individuals by serving as a liaison with the Women Veterans
Program Manager located at the local VA medical center. Other
duties performed by WVCs include conducting outreach and
briefings on VA benefits and services.
The challenges faced by MST survivors in applying for
benefits are well documented. In testimony presented on July
19, 2013, before the House Committee on Veterans' Affairs,
Subcommittee on Health, DAV, on behalf of the four veterans
organizations comprising The Independent Budget Veterans
Service Organizations (IBVSOs) stated, 86.5 percent of sexual
assaults in the military go unreported, ``meaning that official
documentation of many assaults may not exist,'' according to
DOD's Sexual Assault Prevention and Response Office. DAV
further stated, ``[p]rior to the new records retention laws
passed in the 2011 National Defense Authorization Act (NDAA),
the services routinely destroyed all evidence and investigation
records in sexual assault cases after 2 to 5 years, leaving
gaping holes in MST-related claims filed prior to 2012.'' Also,
``VA [has] acknowledged that due to the personal and sensitive
nature of the MST stressors in these cases, victims often fail
to report or document the trauma of sexual assault. If the MST
event subsequently leads to post-service PTSD symptoms and a
veteran files a claim for disability, the available evidence is
often insufficient to establish the occurrence of a stressor
event.''
VBA issued a training letter on December 2, 2011, titled,
Adjudicating Posttraumatic Stress Disorder Claims Based on
Military Sexual Trauma, in order to improve the accuracy,
consistency, and timeliness of MST claims decisions. The
training letter clarified the types of evidence that may be
used to support a PTSD claim based on MST, including examples
to aid adjudicators in applying a liberal interpretation of
requirements. Moreover, VHA undertook a 1-time mandatory
training on MST for all VHA mental health providers and primary
care providers in January 2012. However, a December 2012, OIG
report, Review of Combat Stress in Women Veterans Receiving VA
Health Care and Disability Benefits, found that VBA does not
fully assess all available data for MST-related claims, which
leads to inconsistency in the adjudication of MST claims.
Therefore, more training is warranted to ensure that all VA MST
coordinators, representatives, and adjudicators have the
comprehensive knowledge base and skills to assist veterans who
have suffered from sexual assault in obtaining benefits and
services.
Although VA has coordinators and resources for veterans to
consult and has developed regulations and procedures setting
forth more liberal evidentiary requirements, there is a need
for veterans to have a personal representative that specializes
in and concentrates on providing advice and general information
on the claims process specifically related to claims based on
MST. Currently, VBA MST coordinators may also perform many
other functions and serve in this role as a collateral
assignment. The Committee envisions this personal liaison can
assist veterans and their representatives in understanding the
unique evidentiary requirements for claims based on MST and the
challenges potentially faced as a result of lack of official
documentation to ensure the veteran is provided the treatment
and benefits to which they are entitled. For this to occur, VBA
must develop a more robust specialized organizational structure
to provide oversight of MST-related benefits.
Committee Bill. Section 502 of the Committee bill would
require VA to assign, to each individual seeking compensation
for a disability based on MST, a case representative officer
who shall serve as a liaison between such individual, or his or
her authorized representative, and VA and provide advice and
general information to such individual on the claims process.
The case representative officer must be competent and
knowledgeable about the claims adjudication process and all
applicable authorities, policies and procedures related to MST.
As determined by the Secretary, each case representative
officer would be limited to an appropriate number of cases.
This section would sunset VA's ability to assign case
representative officers on December 31, 2018. However, case
representative officers would be allowed to continue duties for
cases already assigned.
This section would also require VA to make available to
authorized representatives, agents and attorneys any relevant
materials used to train case representative officers. VA's
Advisory Committee on Women Veterans would be required to
identify mechanisms to enhance coordination between VBA and VHA
in the provision of benefits and services based on MST.
Finally, this section would require VA to submit an annual
report to Congress regarding MST case representative officers.
The report would include a description of training on claims
for benefits based on MST for case representative officers and
VBA staff, efforts to coordinate activities and assistance
provided to individuals who seek care or benefits for MST, and
whether or not case representative officers met the
requirements specified in this section.
The Committee's intent is to complement and enhance the
duties of existing WVCs and MST Coordinators within VBA in
order to better serve the needs of veterans who have suffered
MST and ensure they are provided the treatment and benefits to
which they are entitled.

Sec. 503. Report on standard of proof for service-connection of mental
health conditions related to military sexual trauma.

Section 503 of the Committee bill, which is derived from
S. 294, would require VA to submit a report on the current
standard of proof for service-connection for covered mental
health conditions based on MST to the Committees on Veterans'
Affairs of the Senate and House of Representatives.
Background. Under current law, section 501 of title 38,
U.S.C., VA has the authority to prescribe regulations governing
the nature and extent of proof and evidence necessary to
establish entitlement to benefits. Further, VA is required by
section 1154(a) of title 38, U.S.C., to ``include in the
regulations pertaining to service-connection of disabilities''
provisions requiring ``due consideration'' of the places,
types, and circumstances of a veteran's service. Based on this
authority, VA has promulgated regulations, found at section
3.304(f) of title 38, C.F.R., providing for the evidentiary
development and adjudication of PTSD claims including unique
requirements for PTSD claims based on an in-service personal
assault.
A number of veterans service organizations continue to
assert that the standard of proof required by VA for PTSD
claims based on an in-service personal assault is inappropriate
given the unique circumstances surrounding MST. In testimony
presented on July 12, 2013, for the Committee's hearing on
pending legislation, DAV stated that ``[a]n absence of
documentation of military sexual trauma in the personnel or
military unit records of injured individuals prevents or
obstructs adjudication of claims for disabilities for this
deserving group of veterans injured during their service, and
may prevent their care by VA once they become veterans.'' At
the same hearing, the VFW presented testimony stating
``[c]urrent regulations put a disproportionate burden on the
veteran to produce evidence of MST--often years after the event
and in an environment which is often unfriendly--in order to
prove service-connection for mental health disorders.''
Committee Bill. Section 503 of the Committee bill would
require VA to submit a report on the current standard of proof
for service-connection, under chapter 11 of title 38, U.S.C.,
for covered mental health conditions based on MST to the
Committees on Veterans' Affairs of the Senate and House of
Representatives. The report must include any recommendations
the Secretary considers appropriate to improve the adjudication
of claims for compensation based on MST. The report required by
section 503 of the Committee bill must be submitted to the
Committees no later than 90 days after enactment.
The Committee believes continued and focused oversight,
such as the reporting requirement included in this section,
will allow the Committee to make more informed decisions about
what future Congressional action, if any, may be necessary to
ensure survivors of MST receive the benefits to which they are
entitled.

Sec. 504. Reports on claims for disabilities incurred or aggravated by
military sexual trauma.

Section 504 of the Committee bill, which is derived from
S. 294, would require VA to submit an annual report to Congress
on claims for disabilities based on PTSD alleged to have been
incurred or aggravated by MST.
Background. VA's efforts to improve the adjudication of
PTSD claims based on MST remains an issue of concern to the
Committee. In DOD's Annual Report on Sexual Assault in the
Military from FY 2012, it was estimated that 26,000
servicemembers experienced unwanted sexual contact, an increase
of over 7,000 servicemembers since 2010. Other data, such as
VA's universal screening program, indicate 1 in 5 women
receiving health care at VA report experiencing MST.
The Independent Budget for the Department of Veterans
Affairs for Fiscal Year 2014, which is a comprehensive budget
and policy document coauthored by AMVETS, DAV, Paralyzed
Veterans of America (hereinafter, ``PVA''), and VFW, discussed
the need for improvement with regards to the adjudication of
PTSD claims based on MST, demonstrating the continued concern
of veterans service organizations with this issue. The
Committee has also received testimony from other veterans
service organizations and advocacy groups stressing the need
for continued oversight of VA efforts to improve the
adjudication of PTSD claims based on MST.
VA also remains focused on ensuring the proper adjudication
of PTSD claims based on MST. In testimony for the Committee's
hearing on pending legislation on June 12, 2013, VA indicated
``[t]he Under Secretary for Benefits has spearheaded VBA's
efforts to ensure that these claims are adjudicated
compassionately and fairly, with sensitivity to the unique
circumstances presented by each individual claim.''
Additionally, the testimony outlined a number of steps VA has
taken in an effort to improve the adjudication of such claims.
For example, VBA developed and issued Training Letter 11-05,
Adjudicating Posttraumatic Stress Disorder Claims Based on
Military Sexual Trauma, and following its issuance provided
targeted training to a number of employees involved in the
adjudication of claims based on MST.
Committee Bill. Section 504 of the Committee bill would
require VA to submit an annual report to Congress on claims for
disabilities based on PTSD alleged to have been incurred or
aggravated by MST. This section would require VA to submit the
first report no later than December 1, 2014, and continue the
annual submissions through 2018.
Section 504 of the Committee bill would require each report
to contain specific information on the adjudication of PTSD
claims based on MST. Specifically, the report would include (1)
the number and percentage of claims submitted by each gender
that were approved and denied; (2) the rating percentage
assigned for claims that were approved disaggregated by gender;
(3) the three most common reasons for denials; and (4) the
number of denials based on the failure of a veteran to report
for a medical examination. VA would also be required to report
this same information for claims that were resubmitted after a
denial in a previous adjudication. Finally, the annual report
required by section 504 of the Committee bill would be required
to include the number of claims pending and on appeal and the
average number of days from submission to completion of a claim
during the past fiscal year.
The Committee recognizes VA's ongoing efforts to improve
the adjudication of PTSD claims based on MST. However, the
Committee believes continued oversight, such as the reporting
requirements of this section, will allow the Committee to make
more informed decisions about what future Congressional action,
if any, may be necessary to ensure survivors of MST receive the
benefits to which they are entitled.

SUBTITLE B--AGENCY OF ORIGINAL JURISDICTION

Sec. 511. Working group to improve employee work credit and work
management systems of Veterans Benefits Administration in an
electronic environment.

Section 511 of the Committee bill, which is derived from
S. 928, would require VA to establish a working group to assess
and develop recommendations for the improvement of VBA's
employee work credit and work management systems in an
electronic environment.
Background. VBA employee production standards are measured
through the work credit system, which is VBA's foundation for
managing work and evaluating performance. The work credit
system identifies how much an employee can reasonably do with a
certain level of accuracy, and in conjunction with the work
management system, projects the number of employees needed to
process the current claims inventory.
Significant amounts of time and energy have been devoted to
VBA's work credit and work management systems. Congress has
continually played a role in efforts to improve the manner in
which VBA measures and manages work. Most recently, section 226
of P.L. 110-389, the Veterans' Benefits Improvement Act of
2008, required VA to conduct a study on VBA's employee work
credit and work management system.
Despite these efforts, recent testimony indicates
significant challenges continue to confront VBA's work credit
and work management systems. The American Federation of
Government Employees (hereinafter, ``AFGE'') at a March 20,
2013, hearing of the House Committee on Veterans' Affairs
stated, ``Despite the mandate of Public Law 110-389 and
corroboration by IBM, [Veterans Benefits Management System
(hereinafter, ``VBMS'')] has still not conducted a
comprehensive, evidence-based, scientifically designed time
motion study to determine how long certain tasks should take
for employees to complete.'' They continued, ``When employees
work under achievable performance standards, accuracy,
production, and morale will all increase.'' Efforts to ensure
the work credit and work management systems accurately reflect
current operations is vital given VBA's transformation to an
electronic claims processing system.
Furthermore, VA's resource allocation model is extremely
underdeveloped. Under Secretary for Benefits, Allison Hickey,
admitted as much at a March 2013 House Committee on Veterans'
Affairs hearing on VA's plans for employee training,
accountability, and workload management to improve disability
claims. In response to a question from Rep. Brownley, General
Hickey responded:

I'll tell you, we have been looking at the staffing
issue. I think I described earlier in the hearing here,
but I'll--we had a resource allocation model that
frankly, from my perspective, doesn't make any sense. I
think that our resource allocation model ought to be
built around the demand of veterans. It ought to be
veteran-centric from that perspective. This resource
allocation model years ago was established, and so
we're in the process of redoing that now. We're looking
at what's the right--what's the right mix of [veterans
service representatives (hereinafter, ``VSRs'')] to
raters in this new environment. That's important to
note, too. Because the nature of the work will change
in a new, transformed VBA. What's the right mix of VSRs
to raters? Is there a new structure, is there a new
career ladder that needs to be built into there to
allow us to move forward? And I still do believe--so we
do have a--the answer to your question is yes, we're
looking at that right now. I don't have a clear,
defined answer for you right now because we're
thrashing through it as we speak.

The Committee's opinion is that VA's work credit and work
management systems should be the foundation upon which the
claims system resides. Merely altering processes or
implementing information technology solutions will not allow VA
to truly transform the claims system unless they build upon a
sound work management and resource allocation foundation. VA
has provided some evidence that it agrees with this assessment.
According to a response provided by VA to a request for
information from the majority staff of the Committee, VA
outlined an ongoing capacity analysis. The goals of the
capacity analysis project are to:

1. Collect and validate data on employee activities through
a time and motion study and data available in ASPEN to have a
more expansive and substantive basis for managing employee time
and other resources;
2. Quantify the level of repetition that is avoidable and
consequently can be minimized or eliminated by implementing new
initiatives;
3. Establish empirical relationships between staffing
ratios (VSR to [rating veterans service representatives
(hereinafter, ``RVSR'')], etc.), staffing tenure, and
productivity levels; and
4. Develop a Resource Allocation Model based on capacity.
Future efforts in the capacity analysis project will examine
capacity reflecting the impact of VBMS, the new organizational
model, and other transformation initiatives.

Committee Bill. Section 511 of the Committee bill would
require VA to establish a working group to assess and develop
recommendations for the improvement of VBA's employee work
credit and work management systems in an electronic
environment. The working group would be comprised of claims
system stakeholders including the Secretary or his designee, VA
compensation and pension employees, including VSRs, RVSR, and
decision review officers who are also recommended by labor
organizations, and at least three representatives from three
different VSOs.
Section 511 of the Committee bill charges the working group
with assessing and developing recommendations on how to improve
the employee work credit and work management systems in the new
electronic claims environment. These recommendations would
include development of a scientific data based methodology to
be used in revising the work credit system. The Committee bill
also requires the working group to develop recommendations for
a schedule by which VA would make necessary revisions to the
work credit and work management systems. Finally, the working
group is charged with making recommendations on improving VBA's
resource allocation model. Given the significant amount of time
and energy that has been devoted to VBA's work credit and work
management systems, there is no need to replicate previous
efforts. Rather, section 511 of the Committee bill requires the
working group to review the findings and conclusions of
previous studies in order to leverage past efforts in
conducting their assessment and developing recommendations.
The Secretary retains the authority to implement the
working group recommendations he considers appropriate. The
working group and VA would be required to submit two reports to
Congress. The first is required no later than 180 days after
the establishment of the work group and would provide an update
on the progress of the working group. Then, no later than 1
year after the establishment of the working group, VA must
submit a report to Congress on the methodology and schedule VA
has decided to implement as a result of the working group's
recommendations.
VA is currently undertaking a major transformation of its
claims processing systems in order to eliminate the claims
backlog and improve the timeliness and accuracy of claims
decisions. The work credit, work management, and resource
allocation models are critical components of the claims
process. The shortcomings in these systems are believed to
contribute to claims processing delays. However, VA has not
completed a thorough re-examination and overhaul of these
systems.
The Committee is of the opinion that, before transformation
can be successful, there must be corresponding changes and
improvements to the way VA projects the workload of employees
and the number of employees it needs to process its inventory.
VA cannot simply transform its processing method, it must
transform the nature by which it measures productivity and
allocates its resources. As a result, a scientific, empirical
study is needed to develop production standards that reasonably
reflect employee production with a high level of accuracy. It
is the Committee's intent that the requirements of the
Committee bill build upon ongoing VA efforts and to ensure the
work credit and management systems and the resource allocation
model are incorporated into VA's transformation efforts.

Sec. 512. Task force on retention and training of Department of
Veterans Affairs claims processors and adjudicators.

Section 512 of the Committee bill, which is derived from
S. 928, would require VA to establish a task force to assess
the retention and training of claims processors and
adjudicators that are employed by VA and other departments and
agencies of the Federal government.
Background. VA is in the midst of implementing a
transformation plan designed to help VA meet its goal of
eliminating the claims backlog and improving the accuracy of
decisions to 98 percent in 2015. The three major components of
the transformation plan are people, process, and technology.
According to VA's Strategic Plan to Eliminate the Compensation
Claims Backlog, ``VBA's employees are the key to Transformation
success'' and ``VBA is changing how its workforce is organized
and trained to decide disability compensation claims.''
Every time a highly-qualified employee leaves VA, whether
it is a rating veterans service representative or a decision
review officer, VA loses a valuable resource. In order to
replace these employees, VA puts new hires through an intensive
8-week Challenge Training program, which is designed to prepare
employees for claims processing positions. AFGE, in testimony
before the House Committee on Veterans' Affairs on June 2,
2011, noted that ``It is widely acknowledged that it takes at
least 2 to 3 years for new hires to get close to `full
production.''' According to statistics provided to the
Committee, VBA's employee attrition rate was 6.2 percent in FY
2012. Certain ROs, such as Chicago and Indianapolis, had
attrition rates in excess of 10 percent. The delay caused by
the loss of an employee and time spent preparing a new employee
to become proficient at processing claims is extremely costly.
To support VA's goal of processing all claims within 125 days
and at 98 percent quality in 2015, VA must become more
productive and do a better job of not only training but also
retaining its claims processing workforce.
VA is not the only Federal agency that has faced
significant challenges in providing timely claims decisions.
According to the Social Security Administration's (hereinafter,
``SSA'') Office of Inspector General, SSA had a disability
claims hearing backlog of approximately 817,000 cases as of
September 2012. At the end of FY 2012, the Office of Personnel
Management (hereinafter, ``OPM'') had 41,176 Federal retirement
claims pending. In order to successfully combat the backlog of
any type of claim, these agencies need a strategy to maintain
long-term employees with the skills, education, and training
necessary to help them process claims in a timely and accurate
manner.
Veterans and transitioning servicemembers can serve as a
valuable source of personnel for these agencies. According to
the Bureau of Labor Statistics, as of July 2013 the
unemployment rate among all veterans was 6.4 percent. Among
Post-9/11 veterans, this number was higher at 7.7 percent. In
recognition of the need for increased veterans' employment,
President Obama issued Executive Order (hereinafter, ``E.O.'')
13518, Employment of Veterans in the Federal Government, in
November 2009, which established an interagency Veterans
Employment Initiative to promote the recruitment and retention
of veterans in the Federal workforce. According to a July 2012
White House press release, since its inception, this initiative
has resulted in 200,000 new veteran hires and at least 25,000
new Reservists in the Federal workforce. While this initiative
may have helped employ additional veterans in the Federal
government, a similar program has not been established that
promotes, trains, and employs veterans and recently separated
servicemembers specifically for Federal claims processing and
adjudication positions.
Committee Bill. Section 512 of the Committee bill would
require VA to establish a task force to assess the retention
and training of claims processors and adjudicators that are
employed by VA and other agencies of the Federal government.
The task force would be comprised of the Secretary or a
designee, the Director of OPM or a designee, the Commissioner
of Social Security or a designee, an individual who represents
an organization authorized to represent veterans under section
5902 of title 38, U.S.C., and other individuals the Secretary
considers appropriate.
Section 512 of the Committee bill requires the task force
to (1) identify the key skills required by claims processors
and adjudicators to perform their duties in the various claims
processing and adjudication positions throughout the Federal
government; (2) identify reasons for employee attrition from
claims processing positions; (3) coordinate with educational
institutions to develop training and programs of education for
servicemembers to prepare them for employment in claims
processing and adjudication positions in the Federal
government; (4) identify and coordinate with DOD and VA offices
located throughout the United States to provide information
about, and promotion of, available claims processing positions
to servicemembers transitioning to civilian life and to
veterans with disabilities; and (5) establish performance
measures to evaluate the effectiveness of the task force. Not
later than 1 year after the date of the establishment of the
task force, it would be required to develop a government-wide
strategic and operational plan for promoting employment of
veterans in claims processing positions in the Federal
government. Following the establishment of performance measures
to assess the strategic plan, it would also be required to
assess the implementation of the plan and revise as necessary.
This section would also require VA to submit to Congress,
not later than 1 year after the establishment of the task
force, a report on the strategic plan developed by the group. A
second report would be required to be submitted to Congress,
not later than 120 days after the termination of the task force
that assesses the implementation of the strategic plan
developed by the group. The task force established under this
section shall terminate not later than 2 years after the date
on which the task force is established.
The Committee believes a plan similar to that developed and
implemented by E.O. 13518 could improve the hiring and
retention of transitioning servicemembers and veterans for the
Federal government's claims processing workforce and assist in
addressing the pending claims at VA and other Federal agencies.

Sec. 513. Reports on requests by the Department of Veterans Affairs for
records of other Federal agencies.

Section 513 of the Committee bill, which is derived from
S. 674, would require VA to report on attempts to obtain
records from another department or agency of the Federal
government.
Background. Under current law, section 5103A of title 38,
U.S.C., VA has a duty to assist claimants in obtaining evidence
necessary to substantiate a claim for benefits. This duty to
assist requires VA to obtain certain Federal records if
relevant to a claim for benefits. VA asserts that the
collection of Federal records is a contributing factor to the
claims backlog. In testimony before the Committee on March 13,
2013, VA's Under Secretary for Benefits, Allison Hickey,
stated:

Three out of five times that we have an old claim it's
because of this issue. We need data from [the
Department of Defense (DOD)] in terms of the complete
medical history of that member when they leave service
in order for us to decide a claim. We also need their
complete personnel records in order to know what their
character of service is. Without those we must ask.

VA's testimony on section 103 of S. 928, which sought to
streamline Federal record requests, submitted for the
Committee's June 12, 2013, hearing on pending legislation also
supports the assertion that delays in the collection of Federal
records contribute to the claims backlog. VA's testimony noted,
``past efforts to obtain records from other government agencies
have significantly delayed adjudication of pending disability
claims.''
Despite VA's assertions, other evidence indicates agencies
are providing requested records in a timely manner. For
example, testimony submitted for the Committee's June 12, 2013,
hearing on pending legislation by SSA and the National Archives
and Records Administration (hereinafter, ``NARA'') indicated
these agencies are providing requested records to VA in a
timely manner. NARA testified that, ``[d]uring the first 35
weeks of fiscal year 2013 NPRC [National Personnel Records
Center] responded to nearly 218,000 requests from the VA.''
According to NARA's testimony, the average response time for
these requests was 2.2 workdays. SSA's testimony stated that it
responded to VA's nearly 33,000 requests for medical evidence
in FY 2012 in, on average, less than a week. In the first
quarter of FY 2013, SSA received 9,600 requests for medical
evidence from VA. Testimony indicated, on average, SSA
continued to respond to those requests in less than a week.
DOD has also provided information on its response to VA's
requests for records. In May of this year, DOD asserted that
only 4 percent of claims in the backlog were waiting for a
response from the Department. VA has been unable to provide the
Committee with data on the status of requests for DOD records
and the impact delivery of requested records are having on the
timely adjudication of compensation claims. In response to a
post-hearing question for the record from Ranking Member Burr
requesting ``relevant statistics on the number of claims
considered backlogged solely because VA has not received
relevant evidence,'' VA responded that it was ``unable to
determine accurately how many requests for DOD records are
pending with DOD.''
Further, VA has provided limited justification for a
legislative proposal contained in its FY 2014 budget
submission, which seeks to amend the statutory duty to assist
and streamline Federal record requests. In fact, in testimony
on S. 694 provided for the Committee's June 12, 2013, hearing
on pending legislation, VA opposed efforts to facilitate faster
response times noting that ``adequate measures are already in
place to facilitate expeditious transfer of records from the
identified covered agencies.''
Committee Bill. Section 513 of the Committee bill would
require VA to report on attempts to obtain records from another
department or agency of the Federal government.
The report required by section 513 of the Committee bill
would require VA to report by department or agency the number
of requests made for records, the types of records requested,
the number of requests made before receipt of each record, the
amount of time between the initial request and receipt of each
record, and the number of times receipt of a requested record
occurs following adjudication of the claim for which the record
was sought. VA would also have to report on efforts to expedite
the delivery of requested records and any recommendations for
administrative or legislative action the Secretary considers
appropriate to support this goal. VA would have to submit the
first report required by section 513 of the Committee bill no
later than 180 days after enactment. It would then be required
to submit reports every 180 days for a period of approximately
2\1/2\ years following enactment.
The Committee believes VA must track the information
required by section 513 of the Committee bill in order to
understand what actions may be necessary to comply with its
duty to assist and to improve, if necessary, the processes by
which it collects Federal records. The reports required under
section 513 of the Committee bill would also allow the
Committee to continue its oversight and continued evaluation of
whether legislative action may be necessary to speed the
collection of Federal records as required by VA's duty to
assist.

Sec. 514. Recognition of representatives of Indian tribes in the
preparation, presentation, and prosecution of claims under laws
administered by the Secretary of Veterans Affairs.

Section 514 of the Committee bill, which is derived from
S. 928, would authorize VA to recognize representatives of
Indian tribes as individuals eligible to represent veterans in
the preparation, presentation, and prosecution of claims for VA
benefits.
Background. Section 5902 of title 38, U.S.C., describes the
guidelines for VA recognition of representatives of
organizations that can assist veterans in preparing,
presenting, and prosecuting claims for VA benefits. Section
5902(a)(1) describes the organizations that these individuals
may represent as ``the American National Red Cross, the
American Legion, the Disabled American Veterans, the United
Spanish War Veterans, the Veterans of Foreign Wars, and such
other organizations as the Secretary may approve.'' Section
14.628 of title 38, C.F.R., describes the categories of
organizations that can be recognized by VA, including national
organizations, organizations created by State governments to
serve veterans, or regional or local organizations that
primarily deliver Federal or State services or benefits to
veterans, dependents, and survivors. Section 14.628 also
describes the process that organizations must complete in order
to be recognized. Section 14.629 of title 38, C.F.R., describes
the process that representatives of recognized organizations
must complete in order to be recognized to assist veterans in
preparing, presenting, and prosecuting claims for VA benefits.
VA has recognized that distance and a lack of awareness
have been major barriers to the receipt of services and
benefits for Native American veterans. Furthermore, tribal
lands tend to be located in rural or highly rural areas, far
removed from VA clinics and ROs. In light of this challenge, VA
began the Tribal Veterans Representatives (hereinafter,
``TVR'') program in 2001 to improve awareness and receipt of
benefits and services in tribal lands. TVRs are identified and
funded by tribal governments and receive training from VA in
order to provide appropriate information to veterans about
benefits and services available to them. TVRs also assist
veterans to complete benefits and health care applications.
Several TVRs have been able to complete the recognition
process, through their membership in a recognized Veterans
Service Organization, but not through their employment by a
tribal government for the purpose of serving veterans.
Although some tribal governments, such as the Navajo
Nation, the Rosebud Sioux Tribe, and the Fort Peck Assiniboine
and Sioux Tribes have established Veterans Departments or
Veterans Offices within the structure of their government, none
fit within the framework described in section 14.629 of title
38, C.F.R. As such, none have been recognized.
Committee Bill. Section 514 of the Committee bill would
amend section 5902 of title 38 by inserting the term ``Indian
tribes'' as defined in section 450b of title 25, U.S.C. This
amendment would clarify that tribal veterans organizations are
eligible entities for VA recognition. This will allow
representatives of these organizations to go through the
process outlined in section 14.629 of title 38, C.F.R., to be
recognized by VA and to be able to prepare, present, and
prosecute VA claims on behalf of veterans. It is the intent of
the Committee that VA affords tribal veterans organizations the
same clear opportunity to complete the recognition process as
is offered to State, County, and veterans service
organizations.

Sec. 515. Program on participation of local and tribal governments in
improving quality of claims for disability compensation
submitted to Department of Veterans Affairs.

Section 515 of the Committee bill, which is derived from
S. 928, would create a 2-year program on collaboration with
State, local, and tribal governments to improve the quality of
claims for disability compensation.
Background. Although VA, State and local governments, and
tribal governments all seek to ensure eligible veterans are
obtaining the benefits to which they are entitled, coordination
among these entities can be limited. VA currently serves the
health care needs of American Indians and Alaska Natives under
a memorandum of understanding (hereinafter, ``MOU'') with the
IHS and sharing agreements between VHA and Federally recognized
tribal governments. The approach of collaborating with IHS and
tribal governments through memoranda of understandings and
sharing agreements has shown some promise. However,
coordination between VBA and Federally recognized tribal
governments is much more limited.
Furthermore, VBA has recognized the importance of
soliciting a variety of stakeholders in their effort to ensure
the timely and accurate delivery of benefits. According to
information provided to the Committee in February 2013, five VA
ROs had memorandums of understanding with State departments of
veterans affairs or equivalent organizations. VA also indicated
numerous ROs are in the process of initiating similar
agreements with their respective State and local service
organizations. These formalized partnerships can help increase
the use of electronic claims submission tools, more efficiently
retrieve and process copies of military medical records, and
execute comprehensive outreach activities to the veterans'
community. For example, an agreement between the Seattle RO and
the Washington State Department of Veterans Affairs included
goals such as maximizing the number of claims submitted using
the Fully Developed Claims process, committing to professional
development of State service officers, and increasing the
number of Washington veterans enrolled in the eBenefits system.
Committee Bill. Section 515 of the Committee bill would
require VA to establish and implement a 2-year program to study
the feasibility and advisability of entering into MOUs with
State and local governments and tribal organizations in the
provision of certain benefits to veterans. VA would be required
to enter into MOUs with at least two tribal organizations and
at least ten State or local governments. However, VA could use
existing MOUs to fulfill these requirements.
It is the Committee's intent that this program seek to
improve the quality of claims submitted for compensation and
provide assistance to veterans in submitting such claims. The
Committee believes VA needs to continue to expand its strong
working relationships and collaborative efforts with local
organizations in order to help veterans and their families
access the benefits they have earned.

Sec. 516. Quarterly reports on progress of Department of Veterans
Affairs in eliminating backlog of claims for compensation that
have not been adjudicated.

Section 516 of the Committee bill, which is derived from
S. 928, would require VA to submit a quarterly report on VA
efforts to eliminate the claims backlog.
Background. VA has set a goal of eliminating the
compensation claims backlog in 2015 and improving decision
accuracy to 98 percent. As of August 24, 2013, VA's Monday
Morning Workload Report indicated the compensation and pension
rating bundle stood at 760,820 pending claims with 471,650 or
62 percent pending for over 125 days and considered part of the
backlog. The Monday Morning Workload Report and other publicly
available information, such as the information provided by
ASPIRE, provide a wealth of claims production data. However,
similar data related to projected claims production is limited.
At a Committee hearing on VA's budget request on April 15,
2013, Chairman Sanders asked Secretary Shinseki, ``What
benchmarks have you set that VA must meet to make sure that VA
achieves those goals?'' In response, Secretary Shinseki and
Under Secretary for Benefits Allison Hickey provided
information on the historical claims situation and some of the
steps the Department has taken, such as fielding of the VBMS,
in an attempt to meet VA's claims processing goal. However,
neither witness identified tangible benchmarks that must be met
in order for VA to eliminate the compensation claims backlog,
provide decisions within 125 days, and improve decision
accuracy to 98 percent in 2015.
VA has provided some limited projections in its budget
justification materials and a document titled ``Department of
Veterans Affairs (VA) Strategic Plan to Eliminate the
Compensation Claims Backlog'' (hereinafter, ``Strategic Plan'')
dated January 25, 2013. For example, VA budget justification
materials include estimates of future claims receipts and
production for FYs 2013 and 2014. However, these materials do
not contain projections for FY 2015, which is the time period
VA has established for recognizing its claims processing goal.
VA's Strategic Plan also includes some information on the
benchmarks and milestones that must be met in order for VA to
reach its claims processing goal. For example, exhibits 5 and 6
of the Strategic Plan include the estimated change in claims
received, claims produced under the transformation initiatives,
timing of the initiatives, and expected elimination of the
backlog prior to the end of FY 2015. However, it is unclear
when these projections were made and whether they continue to
serve as the Department's expectations. The Committee's
assumption is that such expectations and projections should
continue to evolve to reflect changing conditions such as
actual receipts. Further, it is not clear to the Committee that
VA is utilizing these expectations as benchmarks by which they
measure progress toward reaching its claims processing goal.
Committee Bill. Section 516 of the Committee bill would
require VA to submit a quarterly report, beginning no later
than 90 days after enactment through calendar year 2015, to the
Committees on Veterans' Affairs of the Senate and House of
Representatives on VA efforts to eliminate the backlog of
claims.
The report is required to include for each month through
calendar year 2015 a projection of the number of claims
completed, the number of claims received, the number of claims
backlogged at the end of the month, the number of claims
pending at the end of the month, the number of appeals pending
at the end of the month, and a description of the status of the
implementation of initiatives designed to address the backlog.
The report must also project the accuracy of disability
decisions for each quarter. In addition to projected data, the
report required by section 516 of the Committee bill would
include for each month through calendar year 2015 the number of
claims completed, the number of claims received, the number of
claims backlogged at the end of the month, the number of claims
pending at the end of the month, the number of appeals pending
at the end of the month, and a description of the status of the
implementation of initiatives designed to address the backlog.
The report would also include the actual accuracy of disability
decisions for the most recently completed quarter. Section 516
of the Committee bill would also require VA to report
significant information on VA's appellate workload. The report
required by this section must also be made available to the
public.
The Committee believes this section would provide Congress
with increased visibility of VA's efforts to eliminate the
claims backlog. Our intent is not to burden VA with reporting
requirements. In fact, much of the information required by
section 516 of the Committee bill is already publicly
available. Rather, by requiring VA to report information on
both projected and actual production, Congress would be able to
more quickly assess VA's progress in meeting its claims
processing goal, and if necessary, respond accordingly.

Sec. 517. Reports on use of existing authorities to expedite benefits
decisions.

Section 517 of the Committee bill, which is derived from
S. 935, would require VA to submit a report on the use of
temporary, intermediate, and provisional rating decisions and a
plan to increase the use of existing authorities to expedite
benefit decisions.
Background. Generally, VA provides decisions on disability
claims, regardless of the number of claimed disabilities within
the claim, in one decision. However, under current law, VA has
the authority in certain situations to provide partial or
temporary decisions. Section 1156 of title 38, U.S.C., provides
VA with the authority to issue temporary disability ratings in
certain situations. For example, section 1156 requires VA to
provide temporary disability ratings to veterans with service-
connected disabilities that require hospital treatment or
observation for a period in excess of 21 days. These temporary
disability ratings reflect the non-permanent nature of the
disability while providing VA with the ability to address the
immediate needs of veterans during the prescribed periods
warranting such a decision.
Intermediate rating decisions are another tool that allows
VA to provide partial decisions. The VBA Adjudication
Procedures Manual Rewrite, M21-1MR (Manual), Part III, Subpart
iv, Chapter 6.A.1.a., outlines the criteria for use of
intermediate rating decisions. The manual requires adjudicators
to ``Make an intermediate rating decision if the record
contains sufficient evidence to grant any claim at issue,
including service connection at a noncompensable level.'' This
type of decision would allow VA to award benefits on one or
more claimed disabilities while continuing to process other
claimed disabilities within the application for benefits.
In April of this year, VA announced an initiative to
expedite claims decisions for veterans who have waited 1 year
or longer. Under this initiative, VA is making provisional
decisions on certain claims. These decisions are based on the
evidence of record at the time of the decision. VA claims this
initiative provides veterans with a decision on their claims
more quickly, rather than waiting until all evidence has been
gathered.
As demonstrated by these examples, VA has a number of
authorities and initiatives that provide it with flexibility in
determining the most appropriate manner by which to issue
decisions on claimed disabilities. However, there is limited
evidence detailing VA's use of such authorities and the
resulting impacts on VA claimants. For example in 2010, VA
piloted the Quick Pay initiative at the St. Petersburg RO.
According to VA, the intent of the initiative was to fast-track
payments to veterans who submitted evidence sufficient to
decide all or part of a claim. However, this initiative has
subsequently ended with little explanation. PVA has given some
attention to VA efforts to utilize existing authorities to
expedite benefit decisions. In an April 2013 policy paper
titled ``Confronting the VA Claims Backlog,'' PVA described VA
efforts such as the Quick Pay initiative and provided pros and
cons for the various efforts.
Some stakeholders have argued that VA should provide
decisions when it has sufficient evidence to make a decision on
a claimed condition rather than wait to make a decision on the
complete claim. The Committee, however, is unaware of efforts
beyond PVA's work to evaluate the effectiveness of such an
approach or to plan for the increased use of existing
authorities to expedite benefit decisions while ensuring there
are no unintended consequences to claimants.
Committee Bill. Section 517 of the Committee bill would
require VA to submit, within 180 days after enactment, a report
to the Senate and House Committees on Veterans' Affairs on the
use of temporary, intermediate, and provisional rating
decisions.
Section 517 requires VA to report the number of temporary
and intermediate rating decisions issued during FYs 2011, 2012,
and 2013. The report must also include a description of any
obstacles that prevent the use of these existing authorities to
issue temporary or intermediate rating decisions and a
description of the Quick Pay Disability initiative, including
the rationale for not expanding the initiative beyond pilot
program status.
The report would also include information on VA's
initiative to expedite compensation claims decisions for
veterans who have waited 1-year or longer for a decision. The
report required by section 517 would include: (1) the number of
provisional rating decisions issued by VA during the
initiative; (2) the number of provisional decisions that
involved a claim granted, a claim denied, and a claim granted
or denied in part; (3) a statement of reasons claims with
sufficient evidence to rate were not completed before the
commencement of the initiative; (4) the average number of days
to issue a provisional rating; (5) the number of provisional
decisions issued for Category 1 and Category 2 claims; (6) the
number of rating decisions received and issued, by each RO,
that involved a brokered claim; (7) the number of provisional
rating decisions to which the veteran requested that the
provisional decision become final in order to appeal such
decision; (8) the number provisional rating decisions as to
which the veteran requested an appeal after the expiration of
the 1-year period beginning on the date of notification of the
provisional rating decision; and (9) an assessment of the
accuracy of decisions provided during the Oldest Claims First
initiative.
Section 517 would also require VA to submit, within 180
days after enactment, to the Senate and House Committees on
Veterans' Affairs a plan to increase the use of temporary or
intermediate rating decisions to expedite benefits decisions
when sufficient evidence exists to grant any issue within the
claim. In the plan required by section 517, VA must address a
number of issues including (1) how it would overcome obstacles
that prevent the use of temporary or intermediate rating
decisions; (2) how it would ensure that appropriate claimant
populations benefit from the use of temporary or intermediate
rating decisions; (3) how best to provide for the use of
temporary or intermediate rating decisions; (4) how to prevent
the use of temporary or intermediate rating decisions in lieu
of a final rating decision when a final rating decision could
be made with little or no additional claim development; and (5)
any administrative or legislative recommendations necessary to
increase the use of temporary or intermediate rating decisions.
It is the Committee's intent that VA considers all of the
existing legislative authorities available to expedite or
provide decisions on issues within a claim during its
transformation of the disability claims system.

Sec. 518. Reports on Department disability medical examinations and
prevention of unnecessary medical examinations.

Section 518 of the Committee bill, which is derived from
S. 935, would require VA to submit a report on the provision of
medical examinations for purposes of adjudicating claims and a
plan to prevent the ordering of unnecessary medical
examinations.
Background. Under current law, section 5125 of title 38,
U.S.C., in establishing eligibility for benefits, VA may accept
a report of a medical examination conducted by a private
physician if sufficiently complete to be adequate for purposes
of adjudicating a claim.
Despite this authority, the Committee frequently hears
assertions that VA often dismisses private medical evidence and
orders VA medical examinations despite sufficient private
medical evidence, which could be used to make a decision on a
claim.
VSOs have consistently testified before the Committee on
claims where VA had ordered a medical examination when the
evidence presented by a private medical provider should be
adequate for rating purposes. For example on March 13, 2013,
Joseph Violante, Legislative Director of DAV stated:

We hear from the field, from our people, that in some
cases where the medical evidence is sufficient to be
rated, the fact that it comes in from a private
physician triggers an unnecessary examination.

In other cases, veterans have their claims remanded by the
Board of Veterans' Appeals, because the RO failed to obtain a
medical examination or opinion when necessary to decide a
claim. This occurs more frequently for veterans who have not
filed the claim within 1 year of leaving service. Veterans who
file a claim within 1 year of service may receive extensive
examinations affecting systems for which no complaint of
disability is alleged.
VA has also acknowledged efficiencies may be recognized by
reducing the unnecessary ordering of medical examinations. For
example, last year, VA launched the Acceptable Clinical
Evidence (hereinafter, ``ACE'') initiative to help alleviate
the need for VA administered medical examinations. This
initiative allows VA medical providers to perform assessments
without an in-person examination when sufficient information
already exists. The ACE initiative enables a VA medical
provider to complete a Disability Benefits Questionnaire by
reviewing existing medical evidence and supplementing such
evidence with information obtained during a telephone interview
with the veteran. VA reports that this initiative has reduced
the average time is takes to complete a Disability Benefits
Questionnaire from 25 days to 8 days.
In evaluating claims for disabilities involving the
musculoskeletal system, section 4.40 of title 38, C.F.R.,
(Functional loss) requires an assessment of the impact of the
disability on the performance of ``the normal working movements
of the body with normal excursion, strength, speed,
coordination and endurance.'' Following the court's decision in
DeLuca v. Brown, 8 Vet. App. 202 (1995), VA developed a medical
examination which evaluates the effect of repetitive motion on
normal working movements, by having the claimant perform an
activity three times in the examining physician's office.
During oversight visits, VA physicians have consistently
indicated to staff that the ``three repetition requirement''
does not provide a scientifically sound basis for evaluating
the effect of repetitive motion on ``normal working
movements,'' such as those performed during a normal 8-hour
work day. Physicians have complained about the time it takes to
perform repetitive motion actions on joints for which no
disability is alleged.
Committee Bill. Section 518 of the Committee bill would
require VA to submit, within 180 days after enactment, a report
on the provision of medical examinations for purposes of
adjudicating claims and a plan to prevent the ordering of
unnecessary medical examinations. There are two distinct
reporting requirements contained in section 518 of the
Committee bill.
The first reporting requirement requires VA to provide
information on the furnishing of general medical and specialty
medical examinations. The report must include the number of
general medical examinations furnished by VA during the FY 2009
through FY 2012. The report must also include the number of
specialty medical examinations furnished by VA during the same
time period. Additionally, the report must include a summary of
medical and scientific studies that provide a basis for
determining that three repetitions of a joint movement is
adequate to assess the effect of repetitive motion on
functional loss when assessing range of motion during joint
examinations. The report must identify all examination reports
used for evaluation of compensation and pension disability
claims which require measurements of repeated ranges of motion
testing. Finally, the report would include the number of
examinations for FY 2012 that required such measurements, the
average amount of time taken to perform the three repetitions
of movement method for each joint, a discussion of whether
there are more efficient and effective methods of testing range
of motion, and recommendations on whether to continue the
practice of measuring functional impairment by using the three
repetitions of movement method.
The second reporting requirement requires VA to provide a
report on VA efforts to reduce the need for in-person
disability examinations and use of the authority provided by
section 5125 of title 38. This report would contain information
on the ACE initiative. It would also contain information on any
other efforts to further encourage the use of medical evidence
provided by a private health care provider and the reliance
upon reports of a medical examination or a medical opinion
administered by a private physician if such report is
sufficiently complete to be adequate for the purposes of
adjudicating a claim for service-connection. Under this second
requirement, VA would also have to submit a plan to measure,
track, and prevent the ordering of unnecessary medical
examinations and actions to eliminate requests for medical
examinations when the record contains medical evidence and/or
opinions provided by a private health care provider that is
adequate for purposes of making a decision on a claim.
It is the Committee's intent that VA continue to ensure
medical examinations are appropriate and used efficiently.
Further, Congress has provided authority to allow VA to accept
private medical evidence and take actions consistent with this
authority to improve the timeliness and accuracy of claims
decisions.

SUBTITLE C--BOARD OF VETERANS' APPEALS AND COURT OF APPEALS FOR
VETERANS CLAIMS

Sec. 521. Treatment of certain misfiled documents as a notice of appeal
to the Court of Appeals for Veterans Claims.

Section 521 of the Committee bill, which is derived from
S. 939, would treat as timely filed a document that expresses
disagreement with a decision of the BVA and an intent to appeal
such decision to the CAVC, that is misfiled with the BVA or an
AOJ within 120 days of the Board's decision.
Background. Under current law, if a claimant disagrees with
a Board decision, the claimant has the option, under section
7103 of title 38, U.S.C., to ask the Board for reconsideration
or to appeal to the Court pursuant to section 7266 of title 38.
Pursuant to section 7266, an appeal to the Court must be filed
with the Court within 120 days after notice of the Board
decision is mailed to the claimant. Appellants are sometimes
confused by this process and incorrectly send the Notice of
Appeal (hereinafter, ``NOA'') to one of VA's offices. If that
happens and the NOA is not forwarded to the Court within the
120-day window, the appeal may eventually be dismissed by the
Court as untimely.
In Posey v. Shinseki, 23 Vet. App. 406 (2010), the Court
discussed the problem that occurs when claimants mistakenly
send their notification of disagreement with a decision of the
Board to VA instead of the Court. The Court suggested that VA
be held accountable for properly receiving and forwarding NOAs.
Judge Hagel's concurring opinion included this observation:

It has become clear to me that VA somewhat routinely
holds correspondence from claimants that it determines,
sometime after receipt, are Notices of Appeal to this
Court. As a result, in far too many cases, the Court
receives the Notice of Appeal from VA only after the
120-day appeal period has expired, permitting the
Secretary to then move to dismiss the appeals for lack
of jurisdiction.

There is a certain level of protection for claimants in the
event an appeal is not timely filed, because the Court has the
discretion to exercise equitable tolling. In Rickett v.
Shinseki, 26 Vet. App. 210 (March 12, 2013) (en banc), the
Court set forth four factors it must consider when assessing
whether equitable tolling is warranted when a veteran files an
NOA outside of the 120-day period. First, the veteran must have
misfiled his NOA in a timely manner; second, the veteran must
have expressed a clear intent to appeal to the Court; third,
the Secretary must have been on notice of the intent to seek
further review of the claim; and fourth, the veteran must have
exercised due diligence in preserving his or her legal rights.
Regarding the due diligence provision, the claimant must have
had some reason for believing the place he or she submitted the
NOA was appropriate for obtaining judicial review.
Additionally, the claimant must have taken actions to correct
the mistake after learning of his or her misfiling of the NOA.
The Court granted equitable tolling to the veteran in Rickett
because his NOA was misfiled with VA's Office of the General
Counsel within the 120-day period, it expressed his intent to
appeal the Board decision, it put VA on notice of his intent,
and he filed an NOA with the Court the same day he was informed
of his prior filing error.
While the criteria outlined in Rickett identify when
equitable tolling is available, they do place a burden on the
veteran to prove that he or she exercised due diligence to a
level acceptable by the Court. According to the Annual Report
of the United States Court of Appeals for Veterans Claims for
Fiscal Year 2012, 44 percent of the 3,649 appeals filed with
the Court were without representation at the time of filing.
Without representation, these veterans can be at a disadvantage
when it comes to understanding all the steps they need to
fulfill in order to show the Court they have exercised the due
diligence necessary for the Court to apply equitable tolling.
Committee Bill. Section 521 of the Committee bill would
amend section 7266 of title 38 by adding a new subsection
providing that a notice of appeal mistakenly sent to the AOJ or
the Board, instead of the Court, within 120 days after the date
of a final decision of the Board, would be considered timely
filed.
The Committee bill is consistent with the Court's decision
in Rickett because it requires the NOA to have been filed with
the Board or AOJ within 120 days, thereby putting VA on notice.
It also requires an expression of disagreement with the Board's
decision and a clear intent to seek review of the Board's
decision. The Committee bill, however, in cases of misfiling
places responsibility on VA to forward a veteran's misfiled NOA
to the Court in a timely manner. If VA fails to do so, the
claimant is not prejudiced as a result of VA's inaction.
Nothing in the Committee bill is intended to limit the
Court's ability to provide other equitable relief, otherwise
available, to claimants described in this section.

Sec. 522. Modification of filing period for notice of disagreement to
initiate appellate review of decisions of Department of
Veterans Affairs.

Section 522 of the Committee bill, which is derived from
S. 928, would modify the filing period for an NOD from 1 year
to 180 days and provides a good cause exception in the event an
NOD is not filed in a timely manner.
Background. Under current law, section 7105(b) of title 38,
U.S.C., a claimant has 1 year to file an NOD after the date on
which VA mails notice of an initial decision on a claim for
benefits. This means that, in some circumstances, VA must wait
a full year to determine if a claimant disagrees with a
decision on a claim for benefits. If a claimant waits until the
end of the 1-year period to file an NOD, VA is often required
to re-develop the record to ensure the evidence of record is
current. Data from VA supports the conclusion that post-NOD
development delays the resolution of the claim. In FY 2011,
2012 and through August 31, 2013, where the AOJ received an NOD
more than 180 days after the date the decision was mailed, it
took, on average, 46.5 additional days to decide the claim. In
FY 2012, 76 percent of NODs were filed within 180 days. This
data indicates a 1-year period to file an NOD is not necessary
in the majority of cases, and instead can result in unnecessary
delays in a veteran receiving a decision.
Committee Bill. Section 522 of the Committee bill would
amend section 7105(b) of title 38, U.S.C., by modifying the
filing period for an NOD from 1 year to 180 days. The provision
would also permit the electronic filing of NODs. As a
protective measure for veterans, VA would be authorized to
grant good cause exceptions under a new paragraph (3)(A).
VA has experience implementing good cause exceptions. For
example, section 7105(d)(3) provides appellants with an
opportunity to extend the time period to file a substantive
appeal for ``good cause shown.'' VA has promulgated regulations
to implement this requirement at section 30.303 of title 38,
C.F.R. Further, both the Board and CAVC have developed a body
of case law related to the interpretation of ``good cause''
provisions. For these reasons, the Committee chose to use a
term that is currently used within VA's appellate process. It
is the Committee's intent that VA rely upon this previous
experience with and usage of good cause exceptions in
implementing section 522 of the Committee bill. In the event
good cause is shown, the NOD will be treated as timely if filed
within 186 days after the initial 180-day period ends.
Section 522 of the Committee bill would apply to claims
filed after the date of enactment. The Committee believes
modifying the period in which a veteran has to file an NOD will
allow VA to more quickly finalize the administrative processing
of claims not being appealed and focus additional resources on
the processing of both pending claims and appeals.

Sec. 523. Determination of manner of appearance for hearings before
Board of Veterans' Appeals.

Section 523 of the Committee bill, which is derived from
S. 928, would require with limited exceptions that any hearing
before BVA be conducted using video teleconference technology.
Background. Under current law, section 7107(d) of title 38,
if an individual appeals to the Board, the individual may
request a hearing before BVA at the BVA's principal location in
Washington, DC, or at a VA facility in the area of the
appellant's local RO (called field hearings or travel Board
hearings). Currently, field hearings may be conducted through
voice or voice and picture transmission with Board members
sitting in Washington, DC.
According to the Fiscal Year 2012 Annual Report of the
Board of Veterans' Appeals, in FY 2012, the Board issued 44,300
decisions and conducted 12,334 hearings, forty percent of which
were via video teleconference technology. The Board also
conducted its first video hearings with appellants in Guam and
American Samoa, which eliminated significant travel burdens on
appellants residing in those areas. Furthermore, the Board
reported that, in FY 2012, 26 percent of appellants who were
scheduled for a travel board hearing did not report to the
appointment. Hearings utilizing video teleconference technology
would allow for greater flexibility for the Board when
appellants fail to attend the scheduled hearing.
According to VA's testimony at the Committee's hearing on
pending legislation on June 12, 2013, the Board is well-
positioned to respond to the Committee bill. For example, much
of the Board's video teleconference hearing equipment was
recently upgraded; the Board has expanded its video
teleconference capacity; and the Board successfully implemented
its new virtual hearing docket, which provides electronic
tracking and scheduling of all hearings. Further, VA's
testimony indicated significant time savings result from the
use of video teleconference technology. VA's testimony noted in
FY 2012 video conference hearings, on average, were held nearly
100 days quicker than in-person hearings.
The Committee is also cognizant of the importance
appellants and veterans service organizations place on the
right of appellants to have an in-person hearing. Although VA's
testimony indicated historical data shows no statistical
difference in the allowance rate of appeals based on the type
of hearing, the Committee included an exception in the
Committee bill to protect an appellant's right to an in-person
hearing.
Committee Bill. Section 523 of the Committee bill would
amend section 7107 of title 38 to provide, with limited
exceptions, that any hearing before the BVA be conducted using
video teleconference technology.
Subsection (d)(2) of the amended section 7107 outlines the
limited exceptions. First, it provides the appellant with an
absolute right to request that a hearing be held in-person.
Second, in-person hearings may be conducted as BVA considers
appropriate. For example, if judges are participating in
previously scheduled travel and have the opportunity to conduct
hearings, this provision would not limit BVA's ability to
schedule such in-person hearings as it considers appropriate in
ensuring appellants are provided with hearing opportunities in
a timely manner.
The amendments made by section 523 of the Committee bill
would apply to cases received by BVA pursuant to NODs submitted
on or after the date of enactment. The Committee believes this
provision would reduce hearing wait times, reduce travel time,
allow existing resources to be utilized on issuing decisions,
enable the Board to serve more veterans, and promote more
efficient operations at BVA.

TITLE VI--OUTREACH MATTERS

Sec. 601. Program to increase coordination of outreach efforts between
the Department of Veterans Affairs and Federal, State, and
local agencies and nonprofit organizations.

Section 601 of the Committee bill, which is derived from
S. 927, would require VA to carry out a 2-year demonstration
project on coordinating with State and local government
agencies and nonprofit organizations to increase veteran
awareness of VA benefits and services.
Background. Under section 527 of title 38, U.S.C., VA is
authorized to gather information for the purposes of planning
and evaluating its programs. Similarly, chapter 63 of title 38,
U.S.C., authorizes VA to conduct various outreach activities
across each of its three administrations to ensure veterans and
eligible dependents are aware and informed of VA benefits and
services.
According to an October 18, 2010, report entitled
``National Survey of Veterans'' prepared by Westat, nearly 60
percent of veterans did not understand or were not fully aware
of the benefits and services available to them. VA is required
to report its outreach activities every 2 years, beginning in
2008, under section 6308 of title 38, U.S.C. Despite this
requirement, Congress did not receive the December 1, 2012,
outreach report by the date required in law. Continued inaction
demonstrates to the Committee that the report is not a priority
and consequently nor is the management of VA outreach
activities.
Inadequate attention to outreach activities negatively may
affect how well benefits and services are utilized. VSOs have
called into question the amount of emphasis VA ascribes to its
outreach activities. On June 12, 2013, The American Legion
testified that only a fraction of the 22 million veterans in
America use the services available to them. Likewise, DAV's
testimony noted dozens of other veterans organizations are also
engaged in continual outreach to veterans across the country,
reaching hundreds of thousands of veterans each year. The need
to improve VA outreach activities in order to better inform,
educate, and assist veterans in availing themselves of earned
benefits and services was also echoed by Military Officers
Association of America (hereinafter, ``MOAA''), VFW, Iraq and
Afghanistan Veterans of America (hereinafter, ``IAVA''), PVA,
and the National Governors Association.
It is important to recognize that not all veterans have
been captured by VA outreach activities in recent years, which
by and large have targeted the newest generation of veterans.
Similarly, awareness among National Guard and Reserve
components present a distinct challenge. National Guard and
Reserve members transition from active-duty to civilian life,
often on multiple occasions as a result of numerous
deployments. Transition in and out of active-duty military
service leaves some Guard and Reserve members unaware and
unclear of their status as a veteran. As a result of
insufficient awareness, Guard and Reserve members leave active-
duty with no or limited understanding of their veterans'
benefits. When members of the Armed Forces, past and present,
exit the military their primary focus is on a return to family,
friends, communities, and careers. Veterans' benefits and
enrollment in VA health care may not typically be at the
forefront of most of their minds after leaving active-duty.
Moreover, factors such as youth, military culture, and stigma
still inhibit some exiting servicemembers from proactively
seeking VA health care, especially in the area of mental
health.
In a 2009 study entitled ``All Volunteer Force: From
Military to Civilian Service'' conducted by Civic Enterprises,
a consulting firm to nonprofits, a veteran from the wars in
Iraq and Afghanistan asserted, ``Recognize our usefulness. We
are not charity cases. We are an American asset.'' Community
work and volunteerism taps into this willingness to serve for
the greater good. Psychologists have suggested this type of
interaction between veterans and community can be therapeutic,
noting a sense of well-being is correlated with social
engagement. In April 2012, the Center for a New American
Security published, ``Well After Service: Veteran Reintegration
and American Communities'' and reported that successful
Federal, State, and local collaborations were found to leverage
resources, mitigate needless duplication of services, and
enhance the community's culture of support by developing a
network of outreach opportunities to reach and serve veterans.
Outreach activities need to be more prevalent. Current
outreach activities at the Federal, State, and local levels do
little to foster collaboration and cooperation. Competitive
grants are a viable alternative to current efforts. Community-
based organizations must complement VA outreach activities, not
supplant them.
Committee Bill. Section 601 of the Committee bill would
require VA to establish a 2-year program to competitively award
grants to eligible State and local government entities, as well
as nonprofit community-based organizations. The program would
require VA to evaluate grant proposals by eligible entities for
activities that improve coordination and collaboration of
outreach activities related to veterans' benefits and services
across Federal, State, and local assets. Eligible entities
would be required to submit grant proposals that provide
sufficient documentation in support of either current or
planned outreach activities that increase coordination of
benefits and services for veterans. Likewise, grant proposals
under consideration would also be required to provide
sufficient documentation in support of outreach activities that
improve collaboration between VA and Federal, State, and local
government and nonprofit providers of health care and benefit
services for veterans.
It is the intent of the Committee for grant proposals under
the program to be thoroughly evaluated by VA for the purpose of
increasing awareness and accessibility of benefits and services
for veterans. Grant proposal submissions under this program
should be reviewed by the Department in support of improving VA
strategy, development, and reassessment of its outreach
activities. Under the program, VA would have greater visibility
of outreach activities administered outside of VA, allowing the
Department to examine and assess grant proposals for
effectiveness. VA would be able to also identify opportunities
for greater collaboration of outreach activities, in order to
leverage all applicable local outreach activities that reach,
inform, and assist more veterans and their family members. It
is the intent of the Committee for grants awarded under this
program to be widespread.
It is also the intent of the Committee for information
obtained under the program to render VA a snapshot of various
veteran populations across the country, especially at locations
where the Federal government has limited presence in and around
a community. As a result, VA should be better able to identify
localized activities that effectively augment its own outreach
activities. Furthermore, it is intent of the Committee for
information submitted with grant proposals to offer VA greater
insight into the changing trends of effective outreach across
the country. The program would award grants for a 2-year
period, with an option to extend the program an additional 2
years. An authorized appropriation of $2.5 million for FY 2015
and FY 2016 would fund the program.

Sec. 602. Cooperative agreements between Secretary of Veterans Affairs
and States on outreach activities.

Section 602 of the Committee bill, which is derived from
S. 927, would authorize VA to enter into cooperative veterans
outreach agreements and arrangements with State agencies and
departments.
Background. Currently, all fifty States have some form of
State veterans' service for administering benefits and services
for veterans. Each State, including the District of Columbia,
America Samoa, Guam, Northern Mariana Islands, Puerto Rico, and
the U.S. Virgin Islands, is represented in the National
Association of State Directors of Veterans Affairs. The way a
State administers its State veterans' services differs by
jurisdiction, while some States have agencies or services,
others have commissions or boards, but all are recognized by VA
as State Departments of Veterans Affairs (hereinafter,
``SDVA'').
Nationally, States provide the second largest amount of
services to veterans. Combined, State veterans' services
administered benefits and services amounting to over $6 billion
in 2012. Support for veterans and their family members
continues to swell despite State budget constraints. State
veterans' services tend to work with the various veterans'
organizations to raise awareness among veterans about the many
benefits and services offered by Federal and State governments,
regardless of a veteran's age, gender, era of service, military
branch, or circumstance of exiting the service.
Having benefits and services for veterans that are offered
at both the Federal and State level is not a new development.
However, as recent as January 2012, VA had no formal
partnership between States. VA also lacked a formal partnership
with the National Association of State Directors of Veterans
Affairs (hereinafter, ``NASDVA''). In February 2012, VA signed
an MOU with NASDVA to maintain effective communications between
the two organizations, to exchange ideas and information, to
identify changes or new requirements, and to allow for
continuous reevaluation to identify complementary and redundant
programs. In March 2013, the NASDVA testified before the
Committee regarding the need to increase interaction between
Federal and State governments. Later in April 2013, the
Massachusetts Department of Veterans' Services testified before
the Committee about how better collaboration between Federal
and State governmental assets could benefit veterans who
traditionally do not use VA. For example, the Massachusetts
Secretary of Veterans' Services indicated how his organization
was able to produce an information technology solution that was
made possible by a $1 million Federal grant provided through
P.L. 111-5, the American Recovery and Reinvestment Act
(hereinafter, ``ARRA''), which greatly increased the
accessibility of benefits and services among veterans living in
Massachusetts. The result demonstrated how collaboration
between the Federal government and a State government can
successfully increase access and availability of benefits and
services for veterans and their family members.
Committee Bill. Section 602 would amend chapter 63 of title
38, U.S.C., by granting VA authority to proactively engage with
State partners to ensure outreach activities by the Department
reach and impact veterans. Under this section, VA would also be
directed to report agreements and arrangements entered into
with States in its annual report required under chapter 63 of
title 38, U.S.C. It is the intent of the Committee for VA to
furnish its outreach report annually, thereby ensuring VA is
more proactive in engaging State veterans' services. Regardless
of where veterans reside, they should have similar access to
Federal and State benefits and services. Federal and State
governments should work together to increase communication and
collaboration to achieve this goal. By codifying the authority
and requiring agreements and arrangements reached between VA
and States to be included in the annual outreach report, the
Committee intends for VA to improve its reporting of activities
and findings associated with all outreach activities while also
identifying the collaborations and cooperation between VA and
SDVAs.

Sec. 603. Advisory committee on outreach activities of Department of
Veterans Affairs.

Section 603 of the Committee bill, which is derived from
S. 927, would authorize VA to establish an advisory committee
on outreach activities.
Background. According to an October 18, 2010, report issued
by Westat entitled ``National Survey of Veterans,'' nearly 60
percent of veterans did not understand or were not fully aware
of the benefits and services available to them. The Office of
Public and Intergovernmental Affairs is responsible for
evaluating and planning VA outreach activities and on April 24,
2013, Assistant Secretary Sowers testified before the Committee
regarding current efforts. According to written testimony, VA
outreach activities rest upon three pillars: centralized
planning with decentralized execution; leveraging technology;
and maximizing partnerships. Moreover, VA is required to
biennially report its outreach activities under section 6308 of
title 38, U.S.C., and required to submit the report to Congress
by December 1st of each even-numbered year.
Congress relies on the submission of the outreach report to
evaluate and assess VA operations and oversight of such
activities. VSOs have also called into question the amount of
emphasis VA ascribes to its outreach activities. On June 12,
2013, The American Legion testified that only a fraction of the
22 million veterans in America use the services available to
them. Likewise, DAV's testimony noted dozens of other veterans
organizations are also engaged in continual outreach to
veterans across the country, reaching hundreds of thousands of
veterans each year. The need to improve VA outreach activities
in order to better inform, educate, and assist veterans in
availing themselves of earned benefits and services was also
echoed by MOAA, VFW, IAVA, PVA, and the National Governors
Association.
VA advisory committees provide an alternative, outside-
looking-in perspective. Advisory committees offer VA an
independent assessment and evaluation of a wide variety of its
programs for veterans. VA has 15 advisory committees
established by statute; each independently authorized under
title 38, U.S.C. Furthermore, VA has nine non-statutory
advisory committees, which operate under the Federal Advisory
Committee Act and assess specific policies or programs. The
general purpose of an advisory committee is to advise the
Secretary on issues related to a specified objective and scope
of activity, as well as offer policy or program
recommendations.
Committee Bill. Section 603 of the Committee bill would
require VA to establish an advisory committee on national
outreach activities. The advisory committee would be comprised
of individuals selected by the Secretary who are well-regarded
in their respective fields of public relations, communications,
and marketing. Also under this section, the Assistant Secretary
for Public and Intergovernmental Affairs would be directed to
consult with the advisory committee not less than quarterly on
matters relating to the duties of the Advisory Committee. The
advisory committee should submit a review of its activities and
findings for inclusion in the outreach report required under
section 6308 of title 38, U.S.C. Furthermore, it is the intent
of the Committee for the Office of Public and Intergovernmental
Affairs to maintain proactive collaboration with the advisory
committee regarding all national outreach activities to ensure
VA is strategically and effectively informing, engaging, and
evaluating national outreach activities. Finally, the advisory
committee will terminate on October 1, 2015.

Sec. 604. Advisory boards on outreach activities of Department of
Veterans Affairs relating to health care.

Section 604 of the Committee bill, which is derived from
S. 927, would require VA to establish an Advisory Board
(hereinafter, ``AB'') on outreach activities at each health
care system.
Background. A report prepared by Westat in 2010 entitled
``National Survey of Veterans'' showed nearly 60 percent of
veterans did not understand or were not fully aware of their
benefits and services. VA is required to report its outreach
activities every 2 years, beginning in 2008, under section 6308
of title 38, U.S.C. Despite the requirement, Congress did not
receive the December 1, 2012, outreach report from the
Department until July 22, 2013. This inability to submit a
biennial report to Congress by the date required in law
demonstrates the report is not a priority and consequently nor
is the management of VA outreach activities.
Congress relies on the submission of the outreach report to
evaluate and assess VA outreach activities. On April 24, 2013,
organizations supporting veterans and their families testified
on the lack of emphasis placed upon outreach activities at VA.
VSOs have also called into question the amount of emphasis VA
ascribes to outreach activities. On June 12, 2013, The American
Legion testified that only a fraction of the 22 million
veterans in America use the services available to them.
Likewise, DAV's testimony noted dozens of other veterans
organizations also engage in continual outreach activities to
complement VA efforts, and in doing so reach hundreds of
thousands of veterans each year. Moreover, in written testimony
submitted to the Committee for the June 12th hearing, a real
need to improve VA outreach activities in order to better
inform, educate, and assist veterans in availing themselves of
earned benefits and services was echoed by MOAA, VFW, IAVA,
PVA, and the National Governors Association.
VHA consists of 21 VISNs. Some VISNs may have a few medical
centers located in and around a major urban setting. In such a
case, one medical center will be designated a parent facility
and the relationship between these few medical centers is
referred to as a health care network. Moreover, VA Central
Office has not recommended that a communications position be
included as part of each VISN's core staff. Without a core
position designated at the VISN level, communications and other
outreach is done in a piecemeal approach across a network.
Individual medical centers do a variety of local outreach
activities. However, the cross-pollination between medical
center outreach activities with a VA RO or with network Vet
Centers is not common.
Committee Bill. Section 604 of the Committee bill would
require VA to establish an AB at each health care system. An AB
would be comprised of local individuals who are well-regarded
in their respective fields of public relations, communications,
and marketing. Members would also include VA employees involved
in press and public relations strategy and veterans who have
experience in those fields as well. This section would also
require the director of a health care system to collaborate
with the activities of the AB. It is the intent of this section
to have collaborative planning at each health care system for
purposes of comprehensive and effective outreach activities at
the local level. Furthermore, it is the intent of this
Committee that collaboration between the director, press and
public relations staff at VA health care systems, and the AB on
outreach activities ensures VA is strategically and effectively
informing, engaging, and continually evolving outreach
activities at the local level.
In addition, any AB established under this section would
terminate 3 years after the date specified in subsection (h).
Finally, this section shall take effect on a date that is 1
year after the date of enactment.

Sec. 605. Modification of requirement for periodic reports to Congress
on outreach activities of the Department of Veterans Affairs.

Section 605 of the Committee bill, which is derived from
S. 927, would amend current law to require VA submit to
Congress an outreach report annually instead of biennially.
Background. Under current law, section 6308 of title 38,
U.S.C., VA is required to submit a report to Congress on the
outreach activities carried out by the Department not later
than December 1 of every even-numbered year beginning in 2008.
The report requires VA to provide a description of the outreach
activities during the preceding FYs of the biennial plan
required under section 6302 of this title. In addition, the
report required under section 6308 of title 38 must include
recommendations for the improvement and streamlining of
outreach activities of the Department.
Committee Bill. Under section 605, VA would be required to
submit the outreach report annually. By requiring the biennial
report to be submitted annually, it is the intent of this
Committee to increase the emphasis placed upon outreach
activities at VA and hold the Department accountable.

TITLE VII--EMPLOYMENT AND RELATED MATTERS

SUBTITLE A--EMPLOYMENT MATTERS

Sec. 701. Employment of veterans with the Federal government.

Section 701 of the Committee bill, which is derived from
S. 495, would require Federal agencies to develop plans to hire
an aggregate of 15,000 veterans to existing vacancies within 5
years using the VRA and VEOA authorities.
Background. According to the United States Bureau of Labor
Statistics, the unemployment rate for Gulf War-era II veterans
was 9.9 percent in 2012. Although this represented a decline of
2.2 percent from 2011, newly-separated veterans are still
entering the toughest civilian labor market in a generation.
Specifically, recently separated veterans are facing hurdles
transitioning their military skillsets to civilian employment
or identifying occupations, in which they are interested, that
lead to long-term employment.
Since FY 2007, the Federal executive branch has increased
the number of veterans it employs from 462,282 to 567,314 in FY
2011. This represents a 22.7 percent increase, or 105,032
additional hires over 5 years. These overall increases have
been contained mostly within two Federal agencies: DOD and VA.
Over the same 5-year period, DOD and VA were responsible for
the hiring of 89,555 additional veterans, while the rest of the
Federal executive branch was responsible for only 15,015
collectively.\1\
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\1\Information on Federal executive branch hiring of veterans was
compiled from the OPM report ``Employment of Veterans in the Federal
Executive Branch Fiscal Year 2007'' and ``Employment of Veterans in the
Federal Executive Branch Fiscal Year 2011.''
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Federal agencies have several special appointing
authorities for veterans to allow Federal hiring managers to
quickly employ qualified veterans. These authorities allow the
Federal government to retain veterans who received extensive
training while in the military. Section 4214 of title 38,
U.S.C., establishes VRA authority by which agencies can, if
they wish, appoint eligible veterans without competition to
positions at any grade level through General Schedule 11 or
equivalent. VRA appointees are hired under excepted
appointments to positions that are otherwise in the competitive
service. After 2 years of satisfactory service, the agency must
convert the veteran to career or career-conditional
appointment, as appropriate.
Additionally, VEOA, as amended by section 511 of P.L. 106-
117, the Veterans Millennium Health Care Act, provides that
agencies must allow preference eligible or other eligible
veterans to apply for positions announced under merit promotion
procedures when the agency is recruiting from outside its own
workforce. A VEOA-eligible who competes under merit promotion
procedures and is selected will be given a career or career-
conditional appointment. Both VRA and VEOA provide Federal
hiring managers with the tools to quickly and easily hire
eligible veterans, while also providing veterans with the
certainty that if they work hard their positions will be
converted into career appointments.
In FY 2011, DOD and VA were responsible for slightly more
than 80 percent of the 47,093 total full-time permanent new
veteran hires across the Federal executive branch. During that
time, DOD and VA hired 37,792 veterans in total to full-time
permanent positions. Further, DOD and VA used VRA or VEOA to
hire 22,676, or 60 percent, of those positions. In contrast,
for that same period, the other Federal agencies hired 9,301
veterans to new full-time permanent positions, with only 2,088
of those using VRA or VEOA.\2\
---------------------------------------------------------------------------
\2\Information on Federal executive branch hiring of veterans was
compiled from the OPM report ``Employment of Veterans in the Federal
Executive Branch Fiscal Year 2011.''
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Committee Bill. Section 701 of the Committee bill would
amend section 4214 of title 38, U.S.C., by directing Federal
agencies, in consultation with the Director of OPM, to develop
a plan to hire 15,000 qualified veterans during a 5-year period
starting on the enactment of the Committee bill.
Specifically, section 701 of the Committee bill requires
the Director of OPM to ensure these plans result in appointment
of no fewer than 15,000 qualified covered veterans in total
using VRA or VEOA. For the purposes of calculating whether
Federal agencies have hired 15,000 qualified covered veterans,
those veterans hired under either VRA or VEOA by DOD or VA will
be excluded. Furthermore, only those veterans hired under VEOA
to a full-time and permanent position will count towards the
total.
The section would require each agency to annually report to
Congress, during the 5-year period of this requirement,
information on the pay or grade level of appointments, and
whether the appointments are converted to permanent
appointments. Also, no later than 180 days after the date of
enactment of the Committee bill, the Director of OPM must
report to Congress on the development of a plan to carry out
this section.
The Committee has confidence that both DOD and VA
understand the skills that veterans provide to their workforce,
which is evident by the large numbers of veterans hired and
retained annually. By implementing this requirement, other
Federal agencies will have to proactively identify talented
veterans and include them into their workforces. Once Federal
hiring managers become more familiar with hiring veterans and
understand the unique skillsets and qualifications veterans
developed during their military service, the Committee believes
Federal agencies will be more proactive in hiring veterans.

Sec. 702. State recognition of military experience of veterans in
issuing licenses and credentials to veterans.

Section 702 of the Committee bill, which is derived from
S. 495, would, as a condition of receiving funding through the
Jobs for Veterans State Grants (hereinafter, ``JVSG'') program,
require States to recognize military experience when issuing
licenses and credentials to veterans. This section would
require States to issue licenses and credentials to certain
veterans without requiring such veterans to undergo further
training.
Background. Section 4102A(c) of title 38, U.S.C., provides
the conditions for the receipt of funds for States
participating in the JVSG program. The JVSG helps veterans find
employment by providing employment services through funding for
Disabled Veterans' Outreach Program (hereinafter, ``DVOP'')
specialists and Local Veterans' Employment Representatives
(hereinafter, ``LVERs''). DVOPs and LVERs are State employees
whose salaries and benefits are funded through formula grants
to the States. DVOPs provide intensive services to veterans and
LVERs focus on outreach to employers.
States are primarily responsible for issuing occupational
licenses and credentials required to perform certain
occupations. It is unknown the exact number of unique licenses
or credentials issued by States: for example, according to
information provided by The American Legion, the State of
Illinois issues more than 200 occupational licenses while other
States may issue as few as 40. Additionally, there may be as
many as 4,000 national certifications that are recognized by
employers or States. These varying State requirements make it
difficult for veterans, who have transitioned from active duty
to civilian life with extensive training, to navigate the labor
market after they separate from the military. For those
veterans who want to pursue an occupation related to their
Military Occupational Specialty (hereinafter, ``MOS''), they
may have the requisite experience and training, but many times
are unable to prove that fact to the State agencies charged
with issuing the required license or credential.
Without the appropriate documentation or the State's
ability to fully evaluate the training servicemembers received,
many States will require veterans to retake training as if they
have no existing experience. Since 2011, according to The
American Legion, at least 27 States have taken legislative
action to make it easier for veterans to obtain the license or
credentials they are qualified for based on previous
experience. One example of these efforts is North Carolina
House Bill 799 (Session Law 2012-196. Passed July 24, 2012),
which requires North Carolina occupational licensing boards to
issue veterans licenses if: (1) the veteran has completed
equivalent military training, (2) has been active in the
occupation for 2 out of the last 5 years, (3) has not committed
any act that would be grounds for refusal, and (4) pays the
applicable fees. Other States including Colorado, Oklahoma, and
Washington have all passed laws that require the appropriate
State agency to take military training and experience into
account when evaluating whether to issue a license. However,
even with these improvements, many States lack fully developed
programs that could easily improve the job prospects of
veterans.
Committee Bill. Section 702 of the Committee bill would
amend section 4102A(c)(9) of title 38, U.S.C., by requiring as
a condition of receipt of JVSG funds that States establish a
program to administer an examination to each veteran seeking a
license or credential issued by the State in order to evaluate
competency and, if passed, forego additional training. A
veteran would qualify for the requisite license or credential
if the veteran: (1) receives a satisfactory score on the
examination, as determined by the State; (2) has been awarded
an MOS that is ``substantially equivalent or exceeds the
requirements of the State;'' (3) has engaged in active practice
of the occupation for 2 out of the last 5 years; and (4) pays
any customary and usual fees.
Additionally, the section allows the Secretary of Labor to
waive the examination requirement if the State certifies that:
(1) the State already takes into account previous military
training when issuing licenses and credentials; (2) the State
permits veterans to satisfy training or testing requirements
through examination; or (3) for any credential or license for
which a veteran is unable to completely satisfy the
requirements through the examination, the State must
substantially reduce the training time required to satisfy such
requirement.
In the Committee's opinion, this requirement gives States
the flexibility to meet the mandate while at the same time
achieving the goal of easing the burden veterans' face when
transitioning skills from the military into the civilian
workforce. States have the authority to develop examinations
that meet their differing standards in order to ensure that
veterans who pass them are experienced and knowledgeable about
the occupational area the examination covers.

Sec. 703. Report on unified government Internet portal for veterans on
jobs available through the Federal government.

Section 703 of the Committee bill, which is derived from
S. 495, would require DOL to compile a list of Internet Web
sites and applications that are beneficial for veterans in
pursuit of employment. This section would also require DOL to
report to the Veterans' Affairs Committees on the feasibility
and advisability of creating a single, unified employment
portal.
Background. There has been a proliferation of both public
and private sector job search engines targeted at veterans.
Federal agencies, individual companies, and trade associations
have independently developed products; these products vary in
effectiveness based on the algorithm used or other variables.
Although there are many effective programs, those that are less
effective can lead to confusion and frustration for veterans
seeking to identify occupations based on their military
experience.
Many of the currently available products have an MOS
translator, which evaluates the information provided by the
veteran to determine which civilian occupations are related to
the veteran's military experience. Fewer products also contain
the ability for companies to directly post jobs or allow the
company to search for veterans with a specific MOS. The ability
to have employers directly post jobs is more effective in
linking veterans with potential employers versus those products
that only aggregate job openings from other Web sites. Veterans
using sites that only aggregate job postings often find
listings that are duplicated or no longer exist. The products
currently used at DOL-funded workforce offices do not contain
both the capability of using an MOS translator and listing job
openings posted directly from employers.
Committee Bill. Section 703 of the Committee bill would
require the Secretary of Labor, in consultation with the
Secretary of Veterans Affairs and Secretary of Defense, to
identify Internet Web sites and applications that assist
veterans seeking employment. Specifically, the Secretary of
Labor should identify Web sites and applications that match
veterans seeking employment with available jobs based on skills
acquired in the Armed Forces, and permit employers to post
information on available jobs.
Further, the section requires the Secretary of Labor to
submit a report to Congress on the feasibility and advisability
of creating a single, unified Internet-based employment portal
for the Federal government. The report should include
information on the potential cost, needed collaboration with
other Federal agencies, and the utilization of the portal by
veterans.
This section would take effect 1 year after the date of
enactment.
The Committee believes it is important that DOL has a full
understanding of Internet Web sites and applications that are
currently available by other Federal agencies and the private
sector. With this understanding, DOL can better disseminate
that information to workforce centers or the veteran population
at large. The Committee also believes that assessing whether or
not there should be a single Federal government Internet Web
site for veteran employment is imperative. The continual
development of veteran employment products and portals by
Federal agencies are often duplicative, ineffective in
assisting veterans, or a poor value to taxpayers.

Sec. 704. Information on disability-related employment and education
protections in Transition Assistance Program.

Section 704 of the Committee bill, which is derived from
S. 889, would improve TAP by requiring DOL to provide
transitioning servicemembers with information regarding
disability-related employment and education protections.
Background. Current law, section 1144 of title 10, U.S.C.,
requires the Secretary of Labor to establish and maintain TAP
in order to provide servicemembers separating from the Armed
Forces with counseling, assistance with identifying or
obtaining employment and training opportunities, and other
related information. TAP is delivered via a partnership between
DOD, DOL's Veterans' Employment and Training Service, VA, the
Small Business Administration, and Department of Homeland
Security. TAP includes a wide variety of employment-related
training lessons and VA benefits briefing. Under current law,
and pursuant to section 221 of the VOW to Hire Heroes Act of
2011 (Public Law 112-56; 38 U.S.C. 4100 note), participation in
TAP is mandatory for all servicemembers transitioning from
active duty, with certain limited exceptions.
Committee Bill. Section 704 of the Committee bill would
amend section 1144(b) of title 10, U.S.C., by adding an
additional paragraph that would require the Secretary of Labor
to provide information, during TAP, about disability-related
employment and education protections. TAP is a critical
resource for servicemembers separating from the Armed Forces.
DOD, VA, and DOL have made significant efforts to revise TAP to
make the program focused and responsive to individual needs and
modular in order to allow individuals to be assessed for
specific needs and subsequently receive training in those
areas. Nevertheless, the Committee finds that transitioning
servicemembers are not receiving sufficient information
regarding disability-related employment and education
protections available to veterans. As a result, veterans with
service-connected disabilities may not be aware of their
protections as they seek meaningful employment after leaving
military service.

SUBTITLE B--SMALL BUSINESS MATTERS

Sec. 711. Expansion of contracting goals and preferences of Department
of Veterans Affairs to include conditionally owned small
business concerns 100 percent owned by veterans.

Section 711 of the Committee bill, which is derived from
S. 495, would expand VA contracting goals and preferences to
include conditional ownership of small business concerns if
such small business concerns are 100 percent owned by one or
more veterans.
Background. Under current law, section 8127 of title 38,
U.S.C., VA is required to establish contracting goals for
Veteran Owned Small Businesses (hereinafter, ``VOSB'') and
Service Disabled Veteran Owned Small Businesses (hereinafter,
``SDVOSB''). Further, the section grants VA authority to use
certain contracting preferences to meet the established goals
and requires a VOSB and SDVOSB to be certified by VA prior to
being awarded a contracting preference under the section.
Committee Bill. Section 711 of the Committee bill would
amend section 8127(l) of title 38, U.S.C., by redefining the
term ``small business concern owned and controlled by
veterans'' to include conditional ownership of small business
concerns 100 percent owned by one or more veterans.
VOSBs and SDVOSBs have been denied verification by VA
because the veteran owners, despite owning 100 percent of the
company, have established rights of first refusal or other
riders into their operating agreements. The Committee believes
companies wholly owned by veterans should be entitled to
contracting preferences regardless of issues related to
transfer or termination. This section of the Committee bill
will ensure veterans are able to establish operating agreements
and small business concerns that protect their economic
interests.

Sec. 712. Modification of treatment under contracting goals and
preferences of Department of Veterans Affairs for small
businesses owned by veterans of small businesses after death of
disabled veteran owners.

Section 712 of the Committee bill, which is derived from
S. 430 and S. 495, would permit the surviving spouse of a
veteran owner of a small business, who is less than 100 percent
disabled and whose death is not a result of a service-connected
disability, to maintain the status of such small business
concern for up to 3 years following the death of such veteran.
Background. Under current law, section 8127(h) of title 38,
U.S.C., if the death of a veteran causes a small business to be
less than 51 percent owned by one or more veterans, the
surviving spouse may be treated as if the surviving spouse is
the veteran under limited circumstances for up to 10 years for
the purpose of receiving contracting preferences from VA.
Specifically, the spouse can only retain the status as an
SDVOSB if, following the death of the veteran owner, the spouse
acquires ownership rights of at least 51 percent and the
veteran had a service-connected disability rated as 100 percent
disabling or if the veteran died as a result of a service-
connected condition.
For spouses not covered by section 8127(h), the small
business concern immediately loses the SDVOSB designation, thus
precluding them from benefiting from future VA procurement
preferences.
Committee Bill. Section 712 of the Committee bill would
amend section 8127(h) of title 38, U.S.C., by providing that
the surviving spouse may retain the SDVOSB designation for a
period of up to 3 years in cases where the veteran had a
service-connected disability rated at less than 100 percent or
who did not die as a result of a service-connected condition.
The Committee is concerned that surviving spouses may be
forced to quickly sell the company or go out of business
following the death of a disabled veteran if the small business
loses the SDVOSB designation immediately upon death of the
veteran. The 3-year period will provide adequate time for the
surviving spouse to evaluate what course of action is
appropriate for the small business following the death of the
veteran.

Sec. 713. Treatment of businesses after deaths of servicemember-owners
for purposes of Department of Veterans Affairs contracting
goals and preferences.

Section 713 of the Committee bill, which is derived from
S. 430 and S. 495, would permit the surviving spouse of a
servicemember who owns at least 51 percent of a small business
concern and dies in the line of duty to maintain the status of
such small business concern for up to 10 years following the
death of such servicemember.
Background. Current law, section 8127 of title 38, U.S.C.,
requires VA to establish contracting goals for VOSBs and
SDVOSBs. Further, the section grants VA authority to use
certain contracting preferences to meet established goals and
requires a VOSB or SDVOSB to be certified as eligible by VA
prior to being awarded a contract under this section. To be
eligible, a former servicemember must be a veteran as defined
by section 101(2) of title 38, U.S.C. A servicemember who is
wounded in action, upon discharge, will meet the statutory
definition of a veteran and become eligible for certain VA
contracting preferences. Current law provides, under section
8127(h) of title 38, U.S.C., that if a wounded veteran
establishes eligibility and is certified as an SDVOSB, the
surviving spouse can retain the designation for VA contracting
preferences if the veteran dies and is rated as 100 percent
disabled or dies as a result of a service-connected disability.
However, if a servicemember dies on active duty in the line of
duty, he or she will never have the ability to apply for the
SDVOSB designation, and any surviving spouse or dependent would
not be viewed as an SDVOSB for the purposes of VA contracting
following the servicemember's death.
Additionally, according to DOD, since September 11, 2001,
6,742 servicemembers have died in the line of duty while
serving in Iraq or Afghanistan. Further, of those
servicemembers, at least 690 were members of the Army National
Guard, Army Reserves, or Marine Corps Reserves.
Committee Bill. Section 713 of the Committee bill would
amend section 8127 of title 38, U.S.C., by inserting a new
subsection (i). The new subsection would provide that, if a
member of the Armed Forces dies in the line of duty while on
active duty and owned at least 51 percent of a small business
prior to his or her death, the surviving spouse or dependent,
who acquired the ownership rights of the small business, will
be treated as a service-disabled veteran for the purposes of
SDVOSB certification and VA contracting preferences.
Surviving spouses may retain the SDVOSB designation until
the date they remarry, the date they no longer own and control
51 percent of the small business, or the date that is 10 years
after the death of the servicemember. Dependents may retain the
designation until they no longer own and control 51 percent of
the small business or the date which is 10 years after the
death of the servicemember.
SDVOSB contracting goals and preferences are designed to
help service-disabled veterans lead productive and fulfilling
lives after their military service by recognizing the sacrifice
of those who were wounded in service to their country. The
Committee believes extending the SDVOSB designation to
surviving spouses and dependents, who have lost family members
in the line of duty, is a small recognition of their sacrifice
and may assist them in successfully operating their businesses.

Sec. 714. Special rule for treatment under contracting goals and
preferences of Department of Veterans Affairs of small business
concerns licensed in community property States.

Section 714 of the Committee bill, which is derived from
S. 495, would require VA to consider small businesses, licensed
in a community property State, as if such small business were
licensed in a non-community property State if such
consideration would result in a greater ownership of such small
business concern for purposes of eligibility as a veteran-owned
small business.
Background. In community property States, married persons
are considered to own their property, assets, and income
jointly. In the event of divorce, the individuals will be
entitled to half ownership of any asset or property acquired or
established during the divorce. Currently, there are nine
community property States: Arizona, California, Idaho,
Louisiana, Nevada, New Mexico, Texas, Washington, and
Wisconsin.
For the purposes of certifying as an SDVOSB or VOSB, under
section 8127 of title 38, U.S.C., veteran small business owners
must demonstrate they unconditionally own and control at least
51 percent of a small business to be eligible. This includes
the requirement that a veteran has the ability to sell the
small business without any limitations. Veterans who are
married and reside in a community property State have been
denied certification because VA believes their States'
community property laws preclude the veterans from
unconditional ownership and control. VA's denials are based on
the assumption that, if a veteran were to divorce while
residing in a community property State, the veteran would
automatically lose his or her controlling interest because the
spouse is entitled to half of the company.
Committee Bill. Section 714 of the Committee bill would
amend section 8127 of title 38, U.S.C., by establishing a
special rule for community property States. Specifically, the
rule would require VA to assess the degree of ownership by an
individual of a small business in a community property State,
and also assess what that degree of ownership would be if the
small business had been licensed in a non-community property
State. If VA determines the individual would have a greater
degree of ownership in the non-community property State, the
Secretary shall treat the small business as if it was licensed
in a non-community property State.
The Committee believes VA should evaluate a small business
based on current control and ownership, not on issues that may
arise in the future. If a veteran loses majority ownership or
no longer has unconditional control, the veteran has a legal
obligation to report such a change to VA. If, due to those
changes, the veteran or the small business is no longer
eligible, VA has the authority to revoke the designation or
require the veteran owner to make the needed modifications to
the operating agreement. Section 714 of the Committee bill
ensures veterans are not put at a disadvantage solely based on
the State wherein their small business is licensed.

TITLE VIII--OTHER MATTERS

Sec. 801. Consideration by Secretary of Veterans Affairs of resources
disposed of for less than fair market value by individuals
applying for pension.

Section 801 of the Committee bill, which is derived from
S. 748, would create a 3-year look-back period and a maximum 3-
year penalty period for purposes of determining eligibility for
VA pension benefits, by allowing VA to consider the resources
of individuals applying for pension that were recently disposed
of for less than fair market value.
Background. Under current law, sections 1513 and 1521 of
title 38, U.S.C., pension benefits are provided to veterans of
a period of war who meet service requirements and are
permanently and totally disabled from non-service-connected
disabilities or veterans who meet service requirements and are
65 years of age or older. Under section 1541 of title 38,
U.S.C., surviving spouses of veterans of a period of war who
meet service requirements or were receiving compensation or
retirement pay for a service-connected disability at the time
of a veteran's death are eligible for pension benefits. Certain
children of veterans of a period of war are also eligible to
receive pension benefits under section 1542 of title 38, U.S.C.
In addition to these basic pension benefits, an increased
pension is provided to veterans and surviving spouses with a
dependent child or children under sections 1521 and 1541 of
title 38, U.S.C. Increased pension is also available for
veterans and surviving spouses who need assistance with the
activities of daily living. This increased benefit is commonly
referred to as aid and attendance.
VA's pension program is a need-based program and, in
addition to service and disability requirements, veterans,
surviving spouses, and children must meet income and net worth
requirements in order to qualify for pension benefits. The net
worth limitations of VA's pension program are provided by
sections 1522 and 1543 of title 38, U.S.C. Currently, VA
calculates net worth at the time of application and would not
consider assets disposed of or transferred prior to application
as part of the claimant's net worth.
In May 2012, the GAO issued a report outlining a number of
weaknesses in VA's pension program. GAO-12-540, ``Veterans'
Pension Benefits: Improvements Needed to Ensure Only Qualified
Veterans and Survivors Receive Benefits, May 2012.'' One of the
weaknesses identified by the report was the ability of
claimants to transfer assets prior to application for VA
pension benefits. As a result of this weakness, veterans or
other claimants without financial need are able to obtain a
need-based benefit. Also of significant concern to the
Committee is the growing industry of organizations, identified
by GAO's investigation and report, marketing financial products
and services in order to qualify claimants for VA pension
benefits.
The GAO report also identified financial products and
services marketed by these organizations that may be harmful to
veterans or other pension beneficiaries. One example referenced
by GAO involved an organization that provided a financial plan
that included a deferred annuity for an 86-year-old veteran.
Payments from this deferred annuity would not have been
generated until after the life expectancy of the veteran. This
example highlights the potential harmful impacts of the
products and services being offered by some of these
organizations. Individual Members of the Committee have and
continue to work with members of the consumer protection
community, including the Consumer Financial Protection Bureau,
the National Association of Insurance Commissioners and the
Federal Trade Commission, to address these issues. Despite this
ongoing engagement, the practices and prevalence of these
organizations remain of significant concern to the Committee.
Committee Bill. Section 801 of the Committee bill would
amend section 1522 of title 38, U.S.C., in subsection (a) by
adding at the end a new paragraph which would create a 3-year
look-back period and a maximum 3-year penalty period for
purposes of determining eligibility for need-based pension
benefits provided by VA to veterans of a period of war.
Specifically, this new paragraph would require VA to deny
or discontinue the payment of pension benefits if a veteran, or
the veteran's spouse, disposed of covered resources for less
than fair market value during a 3-year look-back period. This
new paragraph would define a covered resource as any resource
that was part of the corpus of a veteran's estate, or a veteran
and spouse if married, that VA considers could reasonably have
been used for the veteran's maintenance. VA may also consider
the transfer of an asset, including transfers to an annuity,
trust or other financial instruments or investments, as a
disposal of a covered resource for less than fair market value
if it reduces the corpus of a veteran's estate that could
reasonably have been used for the veteran's maintenance.
The look-back period provided by this new paragraph would
be 36 months before the date the veteran applied for pension
or, if later, the date on which a veteran or the veteran's
spouse disposed of covered resources for less than fair market
value. The penalty period would begin on the first day of the
first month in or after which covered resources were disposed
of for less than fair market value and does not occur during
another period of pension ineligibility.
The penalty period would be calculated by dividing the
total, cumulative uncompensated value of the portion of covered
resources, which VA determines would reasonably have been
consumed for the veteran's maintenance, that were disposed of
during the look-back period by the maximum monthly pension that
is payable to a veteran under section 1513 or 1521 of title 38,
U.S.C. This maximum amount would include the maximum amount of
increased pension payable because of family members. However,
it would not include any amount of pension payable because a
veteran is in need of regular aid and attendance or is
permanently housebound. The penalty period derived by this
calculation would be rounded down to the nearest whole number
and may not exceed 36 months. The Committee believes using a
generic divisor (in this paragraph the maximum amount of
monthly pension payable to a veteran), in each of the
calculations contemplated by the Committee bill, would reduce
the impact of implementing this provision on VA's already
burdened claims processing system.
The Committee bill would also amend section 1522 of title
38, U.S.C., in subsection (b) by adding at the end a new
paragraph that would create a 3-year look-back period and a
maximum 3-year penalty period for purposes of determining
eligibility for increased pension benefits as a result of a
dependent child.
The Committee bill would further amend section 1522 of
title 38, U.S.C., by adding a new subsection (c). New
subsection (c)(1) would prohibit VA from denying or
discontinuing pension benefits to a veteran if all resources
transferred for less than fair market value were returned to
the individual who disposed of such resources. It would also
provide that partial returns could be used to reduce a penalty
period by taking into account a partial return of resources. It
would also create an exception to the denial or discontinuance
of pension benefits if it would create an undue hardship.
Previous testimony from the bill's sponsor, Senator Wyden,
on similar legislation at a Committee legislative hearing on
June 27, 2012, provides insight into the purpose of new
subsection (c): ``We also didn't want to inadvertently punish
veterans who were misled by the false or inaccurate promises,
so we've included specific waiver authority to address this.''
The Committee continues to agree with this statement and
believes the improper practices identified by GAO in its May
2012 report warrant an undue hardship exception for veterans
who disposed of covered resources as the result of deceptive or
unfair trade practices or other inappropriate action on the
part of an individual or organization marketing and selling
financial products and services.
Further, new subsection (c) would require VA to notify
veterans upon application for pension or increased pension
about the look-back and penalty period and to obtain necessary
information from the veteran to determine whether a penalty
period is necessary. It would also provide VA with the
authority to take such actions at other times VA considers
appropriate.
The Committee bill would also amend section 1543 of title
38, U.S.C., by inserting three new paragraphs that would create
a 3-year look-back period and a maximum 3-year penalty period
for purposes of determining eligibility for need-based pension
benefits provided by VA to a surviving spouse or surviving
child. These three new paragraphs would apply the same
restrictions on the disposal of covered resources to surviving
spouses and children that would apply to veterans.
The amendments made by section 801 of the Committee bill
would become effective 1 year after the date of enactment and
would apply to payments of pension and increased pension
applied for or eligibility redeterminations made after such
date. Further, a disposal of covered resources prior to the
effective date would not be grounds for a reduction in pension.
The purpose of this effective date is to ensure veterans are
aware of the changes and are not negatively impacted by a
transfer made prior to the effective date of this provision.
The Committee bill would require an annual report,
beginning not later than 30 months after the date of enactment,
through 2018. This report would be submitted to the Veterans'
Affairs Committees of the Senate and the House of
Representatives and the Senate Select Committee on Aging and
would include the number of individuals who applied for and who
received pension under chapter 15 of title 38, U.S.C.; the
number of individuals denied pension or who had pension
discontinued as a result of section 801 of the Committee bill;
a description of any trends resulting from enactment of this
section of the Committee bill; and any other information VA
considers appropriate.

Sec. 802. Office of National Veterans Sports Programs and Special
Events.

Section 802 of the Committee bill, which is derived from
S. 695, would reauthorize authority for the Office of National
Veterans Sports Programs and Special Events to provide monthly
subsistence allowances for certain Paralympic athletes and
allow VA to allocate unnecessary funds to the program at large.
Background. In 2005, the United States Olympic Committee
(hereinafter, ``USOC'') entered into a memorandum of
understanding with VA to increase interest in and access to
Paralympic sports programs for veterans with physical
disabilities by coordinating the activities between the two
entities.
Then, in order to provide adaptive sports program
opportunities to an even greater number of veterans and
servicemembers, Congress passed and the President signed into
law P.L. 110-389, the Veterans' Benefits Improvement Act of
2008. Section VII of this law established the VA Paralympic
program: to promote the lifelong health of disabled veterans
and disabled members of the Armed Forces through regular
participation in physical activity and sports; to enhance the
recreation activities provided by VA by promoting disabled
sports from the local level through elite levels and by
creating partnerships among organizations specializing in
supporting, training, and promoting programs for disabled
veterans; to provide training and support to national and local
organizations to provide Paralympic sports training to disabled
veterans and disabled members of the Armed Forces in their own
communities; and to provide support to the United States
Paralympics, Inc., to increase the participation of disabled
veterans and disabled members of the Armed Forces in sports of
qualifying programs and events.
In order to meet the above-mentioned objectives of the
program, current law, section 322 of title 38, U.S.C., requires
the Office of National Veterans Sports Programs and Special
Events to facilitate and encourage participation by disabled
veterans in Paralympic sporting programs and events. The Office
is also required, to the extent feasible, to cooperate with
U.S. Paralympics, Inc., and its partners to promote the
participation of disabled servicemembers and veterans in
sporting events sponsored by the United States Paralympics,
Inc., and its partners.
Finally, current law, section 322(d)(4), authorizes $2
million for direct use, in the form of monthly stipends, by
certain veterans training for the Paralympics. As of June 2013,
more than 110 disabled veterans had qualified for the monthly
stipends.
Committee Bill. Section 802 of the Committee bill would
extend authorization for $2 million in yearly funding through
2018 to support veterans training for the Paralympics. Current
law would be modified to allow VA to absorb any funding that
goes unused by Paralympic athletes to carry out the activities
of the Office of National Veterans Sports Programs and Special
Events. Additionally, it would remove the requirement to
partner with U.S. Paralympics, but would continue to allow VA
to partner with USOC as VA considers appropriate. The Committee
believes these modifications would provide VA with flexibility
in administering the program.
Finally, this section would substitute ``United States
Olympic Committee'' for ``United States Paralympics'' in each
place it appears in section 322 of title 38, U.S.C., because
the USOC dissolved the U.S. Paralympics.

Sec. 803. Adaptive sports programs for disabled veterans and members of
the Armed Forces through United States Olympic Committee.

Section 803 of the Committee bill would reauthorize VA's
adaptive sports programs for servicemembers and veterans and
clarify VA's authority to award grants to USOC for the purposes
of such programs, and strengthen the reporting requirements for
grantees and subgrantees.
Background. Under current law, section 521A of title 38,
U.S.C., VA is authorized to award grants to U.S. Paralympics,
Inc., to plan, manage, and implement an integrated adaptive
sports program for disabled servicemembers and veterans. Under
this authority, VA is authorized to provide up to $8 million in
yearly grants to U.S. Paralympics, Inc. VA awarded $7.5 million
in FY 2010, $7.8 million in FY 2011, and $8.0 million in FY
2012 through this authority.
P.L. 110-389, the Veterans' Benefits Improvement Act of
2008, required GAO to review the integrated adaptive sports
program authorized in section 521A. The resulting report,
Veterans Paralympics Program: Improved Reporting Needed to
Ensure Grant Accountability, focused largely on the lack of
accurate record keeping that would allow for a proper
evaluation of these programs. GAO noted: ``Regular reporting of
relevant, reliable, and timely information and regular
monitoring are necessary for an entity to run and control its
operations.''
In addition to their failure to keep appropriate accounting
records, GAO's review revealed that VA and the U.S. Paralympics
provided unreliable data on key operational facts, such as the
number of participants in the program, and were unsure as to
whether all the tasks and activities agreed to in subgrantee
contracts were fulfilled. Additionally, many subgrantees seemed
to be unaware that Federal funding was required to be monitored
separately in order to comply with allowable uses.
Committee Bill. Like section 802 of the Committee bill,
section 803 would substitute ``United States Olympic
Committee'' for ``United States Paralympics'' in each place it
appears in section 521A of title 38, U.S.C., because the USOC
dissolved the U.S. Paralympics.
In order to address concerns noted in the above-mentioned
GAO report, section 803 of the Committee bill would increase
reporting requirements for grantees and subgrantees. The
Committee bill would also require a follow-up evaluation by GAO
if VA continues to provide grants to the USOC. The Committee
believes these changes will lead to better overall management
of these programs, so that the greatest number of veterans and
servicemembers are provided with the best possible adaptive
sports opportunities.
Section 803 of the Committee bill would reauthorize $8
million in yearly appropriations for VA's adaptive sports
programs for an additional 2 years. However, it would also
provide VA with more latitude in administering the integrated
adaptive sports program by allowing, but not requiring, VA to
award grants to USOC. VA would be authorized to use the
authorized funding to plan, develop, manage, and implement an
adaptive sports program, which could include both VA-managed
sporting activities and sporting opportunities made available
through the award of grants to USOC. The Committee believes VA
is capable of administering certain recreational activities for
veterans, as evidenced by its management of the Golden Age
Games, the National Veterans Wheelchair Games, and the Winter
Sports Clinic, and should be permitted to directly spend these
funds in circumstances where that would be the most effective
means of providing adaptive sporting opportunities.

Sec. 804. Making effective date provision consistent with provision for
benefits eligibility of a veteran's child based upon
termination of remarriage by annulment.

Section 804 of the Committee bill, which is derived from
S. 928, would make the effective date provisions of section
5110 of title 38 consistent with current law providing for
regained recognition of a veteran's child for purposes of VA
benefits.
Background. P.L. 101-508, The Omnibus Budget Reconciliation
Act of 1990, eliminated from section 103(e) of title 38 a
provision under which a veteran's child whose marriage was
terminated by death or divorce regained recognition as the
veteran's child. However, no corresponding amendment was made
to the effective date provisions in section 5110(l), which
continues to provide an effective date for recognition of a
veteran's child upon termination of such child's marriage by
death or divorce. Because of the amendments made by P.L. 101-
508 this effective date provision is not consistent with the
regained recognition of a veteran's child for benefits
purposes.
Committee Bill. Section 804 of the Committee bill would
amend section 5110(l) of title 38 by removing the effective
date provisions for an award or increase of benefits based upon
recognition of a child upon termination of the child's marriage
by death or divorce. This amendment would make this effective
date provision consistent with provisions of section 103(e)
providing for regained recognition of a veteran's child for
benefits purposes.

Sec. 805. Extended period for scheduling of medical exams for veterans
receiving temporary disability ratings for severe mental
disorders.

Section 805 of the Committee bill, which is derived from
S. 928, would extend the deadline by which VA has to schedule a
medical examination for a veteran in receipt of a temporary
disability rating for a severe mental disorder.
Background. Under current law, section 1156 of title 38,
U.S.C., VA is required to assign a temporary disability rating
to a veteran if such veteran, as a result of a highly stressful
in-service event, has a mental disorder that was severe enough
to result in his or her discharge or release from active duty.
As required by section 1156 of title 38, for these veterans, VA
must schedule a medical examination within 6 months of the
veteran's separation or discharge from active duty. The
temporary disability rating issued under the authority of
section 1156 remains in effect until a rating decision is
issued following the required medical examination.
In testimony before the Committee on June 12, 2013, VA
testified that:

[A]n examination a mere 6 months after discharge may
lead to premature conclusions regarding the severity,
stability, and prognosis of a Veteran's mental
disorder. Six months is a relatively short period of
treatment, and the stresses of active-duty trauma and
the transition to civilian life may not fully have
manifested themselves after 6 months. An examination
conducted up to 18 months after discharge is more
likely to reflect an accurate evaluation of the
severity, stability, and prognosis of a Veteran's
mental disorder.

Committee Bill. Section 805 of the Committee bill would
amend section 1156 of title 38, U.S.C., by extending the
deadline by which VA has to schedule a medical examination for
veterans in receipt of a temporary disability rating as the
result of a severe mental disorder from 6 to 18 months after
discharge or release from active duty.

Sec. 806. Authority to issue Veterans ID Cards.

Section 806 of the Committee bill, which is derived from
S. 778, would authorize VA to provide those who have served in
the military with a photo identification card indicating their
veteran status.
Background. Many retailers across the country offer special
discounts to active duty servicemembers, military retirees, and
veterans. To receive such discounts, a veteran or servicemember
frequently is required to show proof of military service or
veteran status. However, only active duty servicemembers and
military retirees are issued a DOD identification card
indicating their status. Without enrolling in the VA health
care system, a former servicemember who did not retire from the
military may not have a photo identification card proving he or
she is a veteran.
Committee Bill. Subsection (a) of section 806 of the
Committee bill would authorize VA to issue a Veterans ID Card
to any former servicemember, regardless if he or she is
enrolled in or receives benefits from VA. This section would
not bestow any benefits from VA, but would provide a veteran
with the ability to obtain photo identification indicating
their status as a veteran. Subsection (b) of section 806 of the
Committee bill would authorize VA to work with national retail
chains that offer discounts on pharmaceuticals, consumer
products, and services to veterans to ensure the identification
cards issued under subsection (a) are recognized as valid proof
of veteran status.

Sec. 807. Honoring as veterans certain persons who performed service in
the reserve components of the Armed Forces.

Section 807 of the Committee bill, which is derived from
S. 629, would recognize the service of certain persons in the
reserve components of the Armed Forces by honoring them as
veterans.
Background. Under current law, section 101(2) of title 38,
U.S.C., for purposes of determining eligibility for benefits
administered by VA, a veteran is defined as ``a person who
served in the active military, naval, or air service, and who
was discharged or released therefrom under conditions other
than dishonorable.'' As such, a member of the reserve
components who is eligible for retirement pay, or in receipt of
retired pay, who did not have qualifying active duty service,
is not recognized as a veteran for purposes of eligibility for
certain VA benefits. This has led to some confusion as to
whether an individual who served in the reserves, but did not
have qualifying active duty service, should be referred to as a
``veteran'' for purposes other than determining eligibility for
VA benefits.
Committee Bill. Section 807 of the Committee bill would, in
a non-codified provision, honor as a veteran those individuals
who are entitled under chapter 1223 of title 10, U.S.C., to
retired pay for irregular service or who would be entitled to
retired pay, but for age. Section 807 would ensure those who
are honored as ``veterans'' under this section would not be
entitled to any benefit by reason of such recognition.

Sec. 808. Extension of authority for Secretary of Veterans Affairs to
issue and guarantee certain loans.

Section 808 of the Committee bill would extend VA's
authority to levy a loan guaranty fee for certain subsequent
guaranteed housing loans.
Background. Under VA's home loan guaranty program, VA may
guarantee a loan made to eligible servicemembers, veterans,
reservists, and certain un-remarried surviving spouses for the
purchase (or refinancing) of houses, condominiums, and
manufactured homes.
Section 3729(b)(2) of title 38, U.S.C., sets forth a loan
fee table that lists funding fees, expressed as a percentage of
the loan amount, for different types of loans.
Committee Bill. Section 808 of the Committee bill would
amend the fee schedule set forth in section 3729(b)(2) of title
38 by extending VA's authority to collect certain fees.
Specifically, the section would amend subparagraphs (A), (B),
(C), and (D) of section 3729(b)(2) by striking ``October 1,
2017'' in each place it appears and inserting ``October 1,
2018.''

Sec. 809. Review of determination of certain service in Philippines
during World War II.

Section 809 of the Committee bill, which is derived from
S. 868, would require VA to review the process used to
determine whether certain individuals served in support of the
Armed Forces during World War II.
Background. P.L. 111-5, the ARRA authorized the payment of
a one-time, lump-sum benefit to eligible World War II
Philippine Veterans. The deadline to apply for this benefit was
February 16, 2010.
Veterans who served before July 1, 1946, in the organized
military forces of the Government of the Commonwealth of the
Philippines, while such forces were in the service of the Armed
Forces of the United States; members of the organized guerrilla
forces under commanders appointed, designated, or subsequently
recognized by the Commander-in-Chief, Southwest Pacific Area,
or other competent authority in the Army of the United States;
and individuals who served in the Philippine Scouts under
Section 14 of the Armed Forces Voluntary Recruitment Act of
1945 were all eligible to apply for the benefit.
As of September 1, 2013, 18,841 claims for benefits under
ARRA were granted; 24,846 claims were denied; and 65 claims
were pending. 4,538 appeals of denied claims were received--
just 61 were still pending. No appeals were overturned by the
Board of Veterans' Appeals.
Because of the difficulty in verifying eligible service,
Filipino veteran advocates have expressed concern that the
process for determining eligibility is flawed. Recognizing
these concerns, in October 2012, the White House Initiative on
Asian Americans and Pacific Islanders created the Filipino
Veterans Equity Compensation Fund Interagency Working Group
(hereinafter, ``IWG'') to analyze the process faced by Filipino
veterans in demonstrating eligibility for the lump sum benefit.
The IWG found the U.S. Army's process to determine service is
appropriate.
Committee Bill. Section 809 of the Committee bill would
require VA to review the process used to determine whether
Filipino veterans served in support of the Armed Forces during
World War II. VA would be required to consult DOD and military
historians during this review and submit a report to the
Committees on Veterans' Affairs of the Senate and House of
Representatives detailing findings, actions taken, or
recommendations for legislative action.
The Committee recognizes the actions already undertaken in
this area. However, given the advanced age of veterans who
might be eligible for the benefit, it is appropriate to make
certain that all avenues for reviewing the process by which
eligibility is determined have been exhausted.

Sec. 810. Report on Laotian military support of Armed Forces of the
United States during Vietnam War.

Section 810 of the Committee bill, which is derived from
S. 200, would require VA, in consultation with DOD and such
agencies or individuals VA considers appropriate, to submit a
report to Congress on the extent to which Laotian military
forces provided combat support to the Armed Forces of the
United States between February 28, 1961, and May 15, 1975;
whether the current classification by the DOD Civilian/Military
Service Review Board is appropriate; and any recommendations
for legislative action.
Background. Due to American involvement in South-East Asia
in the 1960s, Laos became a focal point for both American and
North Vietnamese operations. Due to the limited ability of
formal Laotian forces to stop cross border threats and stymie
North Vietnamese supply lines, the U.S. began to train and
supply Hmong guerillas in Laos.\3\ The Hmong ``Special
Guerrilla Units'' were trained by members of the Central
Intelligence Agency (hereinafter, ``CIA''). This effort by the
CIA became known as the CIA's ``Secret War.''\4\ The Hmong were
primarily responsible for interrupting communist supply lines
and rescuing downed pilots.\5\ Given the secrecy that
surrounded the program, establishing concrete figures for the
number of Hmong guerillas who fought along-side American forces
during this period is challenging. One estimate claims it was
in the tens of thousands.\6\ Casualties amongst this cohort
mounted rapidly. A source indicates that by 1975, 100,000 Hmong
had been killed.\7\ After the fall of Saigon and the takeover
of Laos by communist forces, the CIA stopped all further
assistance to the Hmong. This discontinuation of support by the
CIA effectively left the Hmong to fend for themselves.\8\ Those
who remained sought refuge in neighboring Thailand, while
others fled to the U.S.
---------------------------------------------------------------------------
\3\Tim Weiner, Gen. Vang Pao's Last War, New York Times Magazine,
May 11, 2008. http://www.nytimes.com/2008/05/11/magazine/11pao-
t.html?pagewanted=all&_r=0
\4\John Prados, Laos: The Geneva Protocol and the Not-So-Secret
War, Vietnam Veterans of America. http://www.vva.org/veteran/0207/
laos.html
\5\William Lloyd-George, The CIA's `Secret War', The Diplomat,
February 25, 2011.http://thediplomat.com/2011/02/25/the-cia%E2%80%99s-
secret-war/?all=true
\6\Weiner.
\7\Lloyd-George.
\8\Weiner.
---------------------------------------------------------------------------
Consequently, over the years, concern over the treatment of
the Hmong has been expressed. In recent years, members of
Congress have argued for interment rights at national
cemeteries for these individuals. During the 113th Congress,
Senator Murkowski introduced S. 200 that would grant certain
burial benefits to former Hmong guerillas who qualify. Although
rare, the United States has granted certain benefits to other
groups who have assisted American war efforts including certain
Filipino veterans who served under American command during
World War II.
However, given the protracted covert nature of events in
South-East Asia during the Cold War, questions have been raised
about the ability to verify and document individuals' claims
about participation as well as whether or not these individuals
acted in accordance with norms associated with the law of armed
conflict. Recognizing the difficulty of answering these
questions, the Committee developed a compromise proposal to get
a better understanding of the Hmong involvement in American
operations during the Vietnam War.
Committee Bill. Section 810 would require VA to submit to
Congress a report documenting the extent to which Laotian
military forces provided combat support to the Armed Forces of
the U.S. between February 28, 1961, and May 15, 1975. This
report requires consultation with DOD and any other agencies or
individuals VA considers appropriate in order to determine
whether the current classification by the DOD Civilian/Military
Service Review Board is fitting and if further legislative
action is necessary.

Sec. 811. Report on assistance for veterans in obtaining training on
purchasing and operating a franchise.

Section 811 of the Committee bill, which is derived from
S. 938, would require DOL, in consultation with VA, the Small
Business Administration (hereinafter, ``SBA'') and other
entities the Secretary considers appropriate, to submit to
Congress a report outlining the benefits, services, and other
assistance available to veterans to obtain the training
necessary to purchase and operate a franchise; any known
statistics about the number of veterans who seek and complete
this type of training each year; and information regarding any
barriers encountered by veterans in obtaining such training.
Background. A March 2012 report by SBA entitled, ``Veteran-
owned Businesses and their Owners-Data from the Census Bureau's
Survey of Business Owners,'' found that in 2007 there were 2.45
million businesses with majority ownership by veterans.
Committee Bill. Section 811 of the Committee bill requires
DOL, VA, and SBA to submit to Congress a report, not later than
1 year after the effective date, on the assistance available to
veterans to obtain training necessary to purchase and operate a
franchise.
The Committee's intent is to gain a better understanding of
the assistance available to veterans who have interest in
owning and operating a franchise. There are currently several
programs administered by SBA that can assist veterans who are
interested in entrepreneurship and franchising. This report to
Congress should identify any gaps that may exist and what
further assistance may be needed to help veterans receive the
training they need to own and operate a franchise.

Sec. 812. Limitation on aggregate amount of bonuses payable to
personnel of the Department of Veterans Affairs during fiscal
year 2014.

Section 812 of the Committee bill, which is an original
provision, would limit the amount of bonuses payable to VA
employees under chapter 45, chapter 53, and other provisions of
title 5, U.S.C.
Background. Under current law, chapter 45, chapter 53, and
other provisions of title 5, U.S.C., VA has the authority to
provide bonuses to certain employees. For example, chapter 45
of title 5 provides VA with authority to grant cash awards to
employees in recognition of performance. Chapter 53 of title 5
provides VA with authority to issue performance awards to
members of the senior executive service (hereinafter, ``SES'').
Given the current fiscal environment, it is vitally
important these bonuses are carefully considered. In 2011, OPM
issued a Memorandum for Heads of Executive Departments and
Agencies, Guidance on Awards for Fiscal Years 2011 and 2012,
providing budgetary limits on individual awards granted during
FYs 2011 and 2012. In setting these limits, OPM noted:

When the President made the decision to propose a 2-
year pay freeze beginning in January 2011, he directed
the Office of Personnel Management (OPM) and the Office
of Management and Budget (OMB) to evaluate the system
of performance awards and incentives for cost and
effectiveness. Consistent with previous Government
Accountability Office reviews of Federal agencies' use
of awards and incentives, we have identified a number
of concerning trends. In many cases, awards are broadly
and inconsistently allocated and some Federal employees
have come to expect awards as part of their
compensation. At the same time, recent survey results
show that a large number of both agency managers and
employees do not perceive the current employee
performance management/award systems to be fair or
accurately reflect differences in performance levels.

The oversight of the cost and effectiveness of performance
awards continues to be an area of emphasis for the Committee
and for VA. For example, in April 2013, VA announced it would
withhold 2012 bonuses for VBA senior officials stating savings
would be used to assist in reducing the backlog of pending
disability claims. However, the announcement failed to discuss
the amount of bonuses withheld or how the savings would be used
to reduce the backlog of pending claims. Additionally, Congress
also provided limits for performance awards and bonuses to VA
employees for FY 2013 in P.L. 112-249, which, in part, limited
the amount of awards and bonuses VA could pay to $395 million.
Committee Bill. Section 812 of the Committee bill would
limit the aggregate amount of incentive and performance awards
payable to VA employees under chapter 45, chapter 53 and other
provisions of title 5, U.S.C., to $368 million.
The Committee recognizes the importance awards and bonuses
play in hiring and retaining talented employees. For this
reason, the Committee provided an aggregate cap in order to
provide the Secretary flexibility in the administration of VA's
incentives and awards programs.

Committee Bill Cost Estimate

In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the CBO, estimates that enactment of
the Committee bill would, relative to current law, increase
discretionary spending by $4 million in fiscal year 2014 and by
$170 million over the 2014--2018 period, but would not affect
direct spending or revenues. Enactment of the Committee bill
would not affect the budgets of State, local, or tribal
governments.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:

Congressional Budget Office,
Washington, DC, November 12, 2013.
Hon. Bernard Sanders,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.

Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 944, the Veterans
Health and Benefits Improvement Act of 2013.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Douglas W. Elmendorf,
Director.

Enclosure.

S. 944--Veterans Health and Benefits Improvement Act of 2013

Summary: S. 944 would expand health services offered by the
Department of Veterans Affairs (VA), increase certain fees for
guaranteeing home loans, enhance education benefits, and make
other changes to compensation and employment benefits. In
total, CBO estimates that implementing the bill would have a
discretionary cost of $171 million over the 2014-2018 period,
assuming appropriation of the specified and estimated amounts.
In addition, CBO estimates that enacting the bill would
decrease net direct spending by $94 million over the 2014-2023
period; therefore, pay-as-you-go procedures apply to the bill.
Enacting S. 944 would not affect revenues.
S. 944 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal government: The estimated
budgetary impact of S. 944 is summarized in Table 1. The costs
of this legislation fall within budget function 700 (veterans'
benefits and services).

Table 1.--Estimated Budgetary Effects of S.944, the Veterans Health and Benefits Improvement Act of 2013
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------
2014 2015 2016 2017 2018 2014-2018
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level..................................... -5 80 38 36 24 173
Estimated Outlays................................................. -5 73 42 36 25 171

CHANGES IN DIRECT SPENDINGa

Estimated Budget Authority........................................ -1 -4 13 15 -193 -170
Estimated Outlays................................................. -1 -4 13 15 -193 -170
----------------------------------------------------------------------------------------------------------------
aIn addition to the changes in direct spending shown above, enacting S.944 would have effects beyond 2018 (see
Table 3). CBO estimates that enacting S.944 would decrease net direct spending by $94 million over the 2014-
2023 period.

Basis of estimate: For this estimate, CBO assumes that the
legislation will be enacted in 2014, that the necessary amounts
will be appropriated for each year, and that outlays will
follow historical spending patterns for similar programs.

Spending subject to appropriation

CBO estimates that implementing S. 944 would have a
discretionary cost of $171 million over the 2014-2018 period,
assuming appropriation of the specified and estimated amounts
(see Table 2 for details).
Health Care. Title III would expand the provision of
complementary and alternative health care, prosthetics and
orthotics, and chiropractic care at the VA. Other provisions in
this title would provide veterans with transportation to and
from VA health care facilities and expand eligibility for
health care benefits to certain veterans previously stationed
at Camp Lejeune, North Carolina. CBO estimates that
implementing title III would cost $53 million over the 2014-
2018 period, assuming appropriation of the estimated amounts.

Table 2.--Estimated Changes in Spending Subject to Appropriation Under S.944
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------
2014 2015 2016 2017 2018 2014-2018
----------------------------------------------------------------------------------------------------------------
HEALTH CARE

Complementary and Alternative Medicine
Estimated Authorization Level................................. 0 8 6 7 * 21
Estimated Outlays............................................. 0 7 6 7 * 20
Prosthetic and Orthotic Care
Authorization Level........................................... 0 10 0 0 0 10
Estimated Outlays............................................. 0 9 1 * * 10
Transportation Benefits
Authorization Level........................................... 4 4 0 0 0 8
Estimated Outlays............................................. 4 4 * * * 8
Chiropractic Care
Estimated Authorization Level................................. 0 * * 4 4 8
Estimated Outlays............................................. 0 * * 4 4 8
Expand Eligibility for Camp Lejeune Health Benefits
Estimated Authorization Level................................. 2 2 1 1 0 6
Estimated Outlays............................................. 2 2 1 1 * 6
Pilot Program for Health Promotion
Estimated Authorization Level................................. 0 1 * * * 1
Estimated Outlays............................................. 0 1 * * * 1
---------------------------------------------
Subtotal, Health Care
Estimated Authorization Level............................. 6 25 7 12 4 54
Estimated Outlays......................................... 6 23 8 12 4 53

SURVIVORS AND DEPENDENTS BENEFITS

Grief Counseling
Estimated Authorization Level................................. 0 2 4 2 0 8
Estimated Outlays............................................. 0 2 4 2 * 8
Spina Bifida Benefits
Estimated Authorization Level................................. 0 * 1 1 1 3
Estimated Outlays............................................. 0 * 1 1 1 3
---------------------------------------------
Subtotal, Survivors and Dependents Benefits
Estimated Authorization Level............................. 0 2 5 3 1 11
Estimated Outlays......................................... 0 2 5 3 1 11

ACCOUNTABILITY AND ADMINISTRATIVE IMPROVEMENTS

Regional Support Centers for VISNs
Estimated Authorization Level................................. 0 1 2 2 2 7
Estimated Outlays............................................. 0 1 2 2 2 7
Commission on Capital Planning
Estimated Authorization Level................................. 2 2 1 0 0 5
Estimated Outlays............................................. 2 2 1 * * 5
Public Access to VA Research and Data Sharing
Estimated Authorization Level................................. 0 1 1 1 1 4
Estimated Outlays............................................. 0 1 1 1 1 4
Budget Transparency
Estimated Authorization Level................................. * * 0 0 0 1
Estimated Outlays............................................. * * 0 0 0 1
---------------------------------------------
Subtotal, Accountability and Administrative Improvements
Estimated Authorization Level............................. 2 4 4 3 3 17
Estimated Outlays......................................... 2 4 4 3 3 17

PROCESSING CLAIMS OF COMPENSATION

Medical Examinations for Military Sexual Trauma
Estimated Authorization Level................................. 0 2 2 2 2 8
Estimated Outlays............................................. 0 2 2 2 2 8
Working Group
Estimated Authorization Level................................. * * 0 0 0 1
Estimated Outlays............................................. * * 0 0 0 1
Task Force
Estimated Authorization Level................................. * * 0 0 0 1
Estimated Outlays............................................. * * 0 0 0 1
---------------------------------------------
Subtotal, Processing Claims of Compensation
Estimated Authorization Level............................. * 2 2 2 2 10
Estimated Outlays......................................... * 2 2 2 2 10

OUTREACH

Outreach Coordination
Authorization Level........................................... 0 3 3 0 0 5
Estimated Outlays............................................. 0 3 3 0 0 5
Advisory Board
Estimated Authorization Level................................. 0 1 1 1 0 3
Estimated Outlays............................................. 0 1 1 1 * 3
---------------------------------------------
Subtotal, Outreach
Estimated Authorization Level............................. 0 4 4 1 0 8
Estimated Outlays......................................... 0 4 4 1 * 8

OTHER PROVISIONS

Asset Look-Back for Disability Pensions
Estimated Authorization Level................................. 0 7 7 7 7 28
Estimated Outlays............................................. 0 7 7 7 7 28
VA Support of Paralympic Program
Authorization Level........................................... 10 10 2 2 2 26
Estimated Outlays............................................. 10 10 2 2 2 26
Limitations on Bonuses
Estimated Authorization Level................................. -25 0 0 0 0 -25
Estimated Outlays............................................. -25 0 0 0 0 -25
Long-Term Solution
Estimated Authorization Level................................. 0 15 * * * 15
Estimated Outlays............................................. 0 10 3 1 1 15
Issuance of Vet Cards
Estimated Authorization Level................................. 0 3 3 3 3 12
Estimated Outlays............................................. 0 3 3 3 3 12
Reports
Estimated Authorization Level................................. * 6 2 1 * 9
Estimated Outlays............................................. * 6 2 * * 8
---------------------------------------------
Subtotal, Other Provisions
Estimated Authorization Level............................. -15 41 14 13 12 65
Estimated Outlays......................................... -15 36 17 13 13 64
---------------------------------------------
Total Changes to Spending Subject to Appropriation
Estimated Authorization Level............................. -5 80 38 36 24 173
Estimated Outlays......................................... -5 73 42 36 25 171
----------------------------------------------------------------------------------------------------------------
Notes: VISN = Veteran Integrated Service Network; VA = Department of Veterans Affairs; * = between 0 and
$500,000.
Components may not sum to totals because of rounding.

Complementary and Alternative Medicine. Several sections of
the title would allow VA greater authority to provide
complementary and alternative medicine to veterans at its
medical facilities. Those sections would take effect 1 year
after enactment. Complementary medicine generally refers to
using a non-mainstream approach together with conventional
medicine; alternative medicine refers to using a non-mainstream
approach in place of conventional medicine. In total, CBO
estimates that implementing these sections would cost $20
million over the 2014-2018 period.
Section 322 would establish a 3-year program to assess the
feasibility of integrating complementary and alternative
medicine at 15 VA Medical Centers. Based on costs for
implementing other pilot programs of similar scope (such as
using meditation for veterans with Post Traumatic Stress
Disorder), CBO expects that developing and operating the
program would require two additional full time employees at
each of the 15 facilities to engage in research, training, and
assessment of the program. CBO estimates that the annual cost
per person for those employees would be $120,000 in 2014. In
total, the estimated cost for those employees would be $12
million over the 5-year period.
CBO expects that the use of complementary and alternative
medicine would partially displace the use of traditional care
(emergency care, primary care, and physical therapy) but would
lead to greater use of medical services on balance, than under
current law. Specifically, CBO estimates that the cost to
deliver medical services, after adjusting for the expected
reduction in usage of traditional health care services, would
increase by roughly $1 million annually during the 3-year pilot
program. Thus, in total, implementing section 322 would cost
$15 million over the 2014-2018 period, assuming appropriation
of the necessary amounts.
Section 323 would authorize the appropriation of $2 million
in 2015 for a study of the use of alternative medicine at the
VA. CBO estimates the cost for this study would be $2 million
over the 2014-2018 period, assuming appropriation of the
specified amount.
Section 324 would establish a 3-year program to assess the
value of wellness programs at the VA. Wellness programs may
include a number of services, such as disease management and
assistance in losing weight or stopping smoking. This section
would allow VA to provide grants to public and private entities
to assess the use of such programs as part of the mental health
care provided to veterans and their families. Based on similar
programs at the VA, such as the demonstration project for Post
Traumatic Stress Disorder and the pilot program to provide
lifestyle coaching by telephone, CBO estimates this program
would cost $3 million over the 2014-2018 period.
Prosthetic and Orthotic Care. Section 312 would authorize
the appropriation of $10 million in 2015 to expand prosthetic
and orthotic care at the VA. CBO estimates this expansion would
cost $10 million through 2018, with most of the outlays falling
in 2015, assuming appropriation of the specified amount.
Transportation Benefits. Section 304 would authorize the
appropriation of $4 million in 2014 and 2015 for VA to hire
professional drivers to provide transportation to veterans
receiving medical care, educational counseling, and vocational
rehabilitation at VA facilities. Under current law, VA's
authority to hire professional drivers expires on January 10,
2014. This section would extend that authority through
September 30, 2015. CBO estimates that implementing this
section would cost $8 million over the 2014-2018 period,
assuming appropriation of the specified amounts.
Chiropractic Care. Section 301 would require VA to expand
the availability of chiropractic care at its medical centers.
VA currently has about 40 chiropractors providing care at 39 VA
Medical Centers (VAMCs). This section would require VA to
provide such care at 42 VAMCs by 2016 and at 76 VAMCs by 2017.
Based on the level of service provided at the VAMCs that
currently provide chiropractic care, CBO estimates that VA
would require three additional chiropractors in 2016, growing
to 41 additional chiropractors in 2017. CBO also assumes that
the use of chiropractic care would partially displace the use
of traditional care (emergency care, primary care, and physical
therapy). Based on an average cost per chiropractor of about
$115,000 in 2012 and adjusting for inflation, CBO estimates
that implementing section 301 would result in an increase in
costs totaling $8 million over the 2014-2018 period, assuming
appropriation of the necessary amounts.
Expand Eligibility for Camp Lejeune Health Benefits.
Section 302 would extend VA health benefits to former military
members who were stationed at Camp Lejeune, North Carolina,
between 1953 and 1956 and to their dependents whose health was
affected by exposure to environmental contaminants while
residing on the base.
Under current law, all veterans stationed at Camp Lejeune
between 1957 and 1987 are eligible for VA health benefits.
Spouses and children are also eligible for health care if they
have certain health conditions that may be related to exposure
to environmental contaminants (that is, leukemia, lung, kidney,
or breast cancer). Under this section, CBO estimates that about
300 additional veterans and dependents would become eligible
for health care benefits. Based on participation and other
factors in similar programs, we estimate that about half of
them would apply and be approved to use the benefit, resulting
in estimated costs of $6 million over the 2014-2018 period,
assuming appropriation of the necessary amounts.
Pilot Program for Health Promotion. Effective 1 year after
enactment, section 306 would require VA to carry out a 3-year
pilot program to assess the feasibility of establishing fitness
facilities in select VA medical facilities. This section would
require VA to establish fitness facilities in up to five
medical centers at a maximum cost of $60,000 per location and
five outpatient clinics at a maximum cost of $40,000 per
location. Adding a small cost for maintenance and reporting
requirements, CBO estimates that this pilot program would cost
$1 million over the 2014-2018 period, assuming the availability
of appropriated funds.
Survivors and Dependents Benefits. Title I includes two
provisions that would provide assistance to survivors and
dependents of veterans. The provisions discussed below would be
effective 1 year after the date of enactment. CBO estimates
that implementing those provisions would cost $11 million over
the 2014-2018 period, assuming appropriation of the estimated
amounts.
Grief Counseling. Section 108 would require VA to establish
a 2-year pilot program for grief counseling in retreat settings
for surviving spouses and children of veterans who die while
serving on active duty. The provision would require that those
services be provided through at least six separate retreats.
Based on an existing pilot program that provides counseling in
retreat settings for female veterans, CBO estimates that the
six retreats would cost $8 million over the 2014-2018 period,
assuming appropriation of the necessary amounts.
Spina Bifida Benefits. Section 106 would expand eligibility
for benefits related to spina bifida to include the children of
veterans who served in Thailand between January 9, 1962, and
May 7, 1975, and who may have been exposed to herbicide agents.
Those children would be eligible for health care and certain
other benefits from VA similar to those provided to children
with spina bifida of veterans who served in Vietnam. Based on
information from VA about the current population of children
receiving health benefits for spina bifida relative to the
number of servicemembers who served in Vietnam, and on
information about the number of veterans who served in
Thailand, CBO estimates that roughly 30 people per year would
take advantage of the health care benefits, at an estimated
cost of $32,000 per beneficiary in 2014. Adjusting for
inflation, CBO estimates that providing health benefits to this
population would cost $3 million over the 2014-2018 period. The
other benefits provided under this provision are discussed in
the section of the estimate titled ``Direct Spending.''
Accountability and Administrative Improvements. Title IV
would require the VA to establish regional support offices for
medical care, assess capital planning for medical facilities,
and improve data sharing and budget transparency. CBO estimates
that implementing title IV would cost $17 million over the
2014-2018 period, assuming appropriation of the estimated
amounts.
Regional Support Centers for VISNs. Section 402 would
require VA to establish up to four regional support centers,
starting in 2015, to assess the delivery of medical services
within Veterans Integrated Service Networks (VISNs). Based on
information from VA regarding staff resources at existing rural
support offices, which evaluate the provision of VA health
services, CBO estimates that five employees would be needed to
operate each new regional center. CBO assumes half of the
initial support center staff would be transferred from VA
headquarters. Based on information on relocation expenses from
the General Services Administration, we estimate that
relocation costs would total $20,000 per person. In total, CBO
estimates that implementing section 402 would cost $7 million
over the 2014-2018 period for transferring existing staff,
compensating additional staff, and leasing office space for the
VISN regional support centers.
Commission on Capital Planning. Section 403 would create a
commission of 10 voting, and 10 nonvoting members to evaluate
and provide recommendations for capital planning for VA medical
facilities. The commission--which would terminate 2\1/2\ years
after its initial meeting--would consist of veterans, federal
employees, and representatives of veteran service organizations
with knowledge of construction and leasing of capital assets.
Nonfederal employees on the commission would be compensated
based on the Executive Pay Schedule.
While section 403 specifies that federal employees may be
detailed to the commission without further reimbursement, CBO
anticipates that other employees would cover the regular duties
of the commission members in their absence, thereby resulting
in costs for overtime hours for some employees. CBO estimates
that five federal employees would work part time for the
commission at a cost of $42,000 each per year, 15 nonfederal
employees would work part time at a cost of $23,000 each year,
and five additional federal staff would work full time at a
cost of $210,000 each per year. In total, CBO estimates that
the cost for staff and travel reimbursements for the commission
would be $5 million over the 2014-2018 period.
Public Access to VA Research and Data Sharing. Section 404
would require VA to provide access on their Web site to all of
the data files used for research by VA and to submit an annual
report on the use of that data. This section would also require
VA to create a digital archive of all publications that use
data from VA, and to make that archive available on its Web
site. Based on input from VA on the costs of establishing and
maintaining a data archive, CBO estimates that implementing
section 404 would cost $4 million over the 2014-2018 period,
assuming an effective date of 2015.
Budget Transparency. Section 405 would require VA to
include in its annual budget justification a statement of the
amounts the agency is requesting for outreach as a whole and
for each individual administration within the agency. CBO
estimates that compiling that data would cost about $1 million
over the 2014-2018 period.
Processing Claims of Compensation. Title V would require VA
to provide medical examinations for all veterans identifying
military sexual trauma as the basis for their claim for
disability compensation and to form a working group and task
force to review VA's claims process. CBO estimates that
implementing title V would cost $10 million over the 2014-2018
period, assuming appropriation of the estimated amounts.
Medical Examinations for Military Sexual Trauma. Section
501 would require VA to include a medical examination as part
of the adjudication process on disability claims based on
military sexual trauma (MST) and to provide a report on the
number of MST claims submitted to VA. Under current law, VA can
deny a claim without an examination based on the evidence
presented for the claim.
VA receives about 4,000 claims per year that are based on
MST. Assuming a similar trend over the 2014-2023 period, and
given the approximately 50 percent denial rate for MST, CBO
expects that enacting this provision would require VA to
provide about 1,900 examinations to veterans who would
otherwise not be eligible. Based on a cost per exam of about
$1,000, CBO estimates that providing such examinations would
cost about $8 million over the 2014-2018 period. CBO also
estimates that enacting this provision would increase mandatory
spending for veterans disability compensation. That estimate is
discussed below, under the ``Direct Spending'' heading.
Working Group. Section 511 would require VA to establish a
working group to provide recommendations for improving the
employee work credit and work management systems of the
Veterans Benefits Administration. The working group would
include individuals assigned by the Secretary who have
knowledge about the claims review process. The working group
would be required to submit a report with findings and
recommendations within a year from date of creation of the
group. CBO estimates that implementing section 511 would cost
$1 million over the 2014-2018 period.
Task Force. Section 512 would require VA to establish a
task force, composed of federal employees and certain members
of the public, to assess the retention and training of claims
processors and adjudicators employed by VA and other federal
agencies. The task force would last no longer than 2 years and
would be required to submit a report to the Congress. The
provision would not authorize compensation for members of the
task force. CBO estimates that the administrative costs of
implementing section 512 would amount to $1 million over the
2014-2018 period.
Outreach. Effective in 2015, title VI would assess and
improve VA's outreach efforts. CBO estimates that implementing
title VI would cost $8 million through 2018, assuming
appropriation of the estimated amounts.
Outreach Coordination. Section 601 would require VA to
carry out a program to assess the feasibility of using State
and local governments and nonprofit agencies to increase
veterans' awareness of available benefits and services and to
improve coordination of outreach activities among VA, States,
and local governments regarding veterans' benefits. The
provision would authorize $2.5 million for each of 2015 and
2016 to provide grants to State and local governments and non-
profit agencies to carry out the program. CBO estimates that
implementing section 601 would cost $5 million over the 2014-
2018 period.
Advisory Board. Section 604 would require VA to create an
advisory board on outreach practices at every Veterans
Integrated Service Network and any subdivisions of those
networks (46 locations in total). Those boards would be
authorized for 3 years. Membership on the boards would be
largely composed of knowledgeable individuals from the private
sector, but would include a small number of employees of VA.
CBO expects that duties related to the advisory board would be
a small part of their duties for the VA employees. Members from
the private sector would serve without compensation. CBO
estimates that staff and administrative costs for the advisory
boards would total $3 million over the 2014-2018 period.
Other Provisions. Other provisions would have differing
effects on discretionary cost. CBO estimates that implementing
those requirements would have a net cost of $64 million over
the 2014-2018 period, assuming appropriation actions consistent
with the bill.
Asset Look-Back for Disability Pensions. Section 801 would
authorize VA to conduct a review of the financial records of
all applicants for pensions. The review would cover the 3 years
preceding each application. This look-back would determine if
the applicant disposed of any assets or resources for less than
fair market value. Individuals who were found to have disposed
of such assets would be ineligible to receive pensions for up
to 3 years, depending on the value of the assets involved. This
provision would affect only those individuals applying for
veterans' or survivors' pension benefits starting in 2015.
Based on information from VA on the time needed to process
a pension claim, CBO estimates that to implement this
provision, VA would eventually hire about 70 additional
employees to maintain the current processing times. VA reports
that under this provision, most of the hiring of additional
employees would take place in 2015. At an average cost of about
$100,000 per employee, CBO estimates that implementing section
801 would cost $28 million over the 2014-2018 period. The
savings from reduced spending for pension benefits are
discussed below, under ``Direct Spending.''
VA Support of Paralympic Program. Sections 802 and 803
would extend, through 2018, two programs related to VA's
authority to support the United States Olympic Committee (USOC)
Paralympic Program. Those programs are scheduled to expire on
December 31, 2013. The first program would authorize VA to
provide an allowance to certain veterans for any month in which
they are in training for a USOC event or are residing at the
USOC training center. Under section 802, $2 million would be
authorized annually to provide the monthly allowances through
the Office of National Veterans Sports and Special Events.
The second program would authorize VA to make grants to the
USOC to plan, develop, manage, and implement the Paralympic
Program for disabled veterans and disabled members of the armed
services. Section 803 would authorize VA to provide $8 million
in grant money in 2014 and 2015 to the USOC for those purposes.
Together, CBO estimates that implementing sections 802 and
803 would cost $26 million over the 2014-2018 period, assuming
appropriation of the authorized amounts.
Limitations on Bonuses. Section 812 would limit to $370
million the amount that VA could pay in awards and bonuses to
VA employees in 2014. Over the 2008-2012 period, VA paid an
average of $395 million each year in awards and bonus payments
to employees. Assuming such payments will continue at that
level, CBO estimates that implementing section 812 would reduce
discretionary spending for pay and performance by $25 million
over the 2014-2018 period, assuming appropriation actions
consistent with the bill.
Long-Term Solution (LTS). To help VA transition from paper-
based to electronic claims processing for Post-9/11 GI Bill
benefits, VA has developed and deployed (on a limited basis)
the LTS--VA's automated claims processing system. As described
below under ``Direct Spending,'' sections 104 and 105 would
modify programs offered under the Post-9/11 GI Bill. Benefits
under that program are paid from a mandatory spending account.
To implement those changes, VA would need to modify the LTS to
electronically process the claims of affected individuals.
Modifying the LTS would cost $15 million over the 2014-2018
period, CBO estimates.
Issuance of Vet Cards. Effective 1 year after enactment,
section 806 would allow VA to issue identification cards (Vet
Cards) to all veterans enrolled in the VA health care system or
receiving educational assistance, compensation, or a pension
through the VA. Under current law, VA issues Veterans
Identification Cards (VICs) to certain eligible veterans. VA
reports that 8.5 million VICs were issued through 2012. After
adjusting for the number of VICs issued under current law and
the anticipated participation rate, CBO estimates that under
this provision about 1.5 million new cards would be issued each
year at a cost of $2 per card. Thus, CBO estimates that
implementing this proposal would cost $12 million over the
2014-2018 period.
Reports. S. 944 would require VA to complete reports by
various deadlines. CBO estimates that those provisions,
collectively, would cost about $8 million over the 2014-2018
period.
State Certifications and Licensing. As a condition of
receiving grants from the Department of Labor (DOL) to provide
employment services to veterans, section 702 would require
States to establish programs to facilitate the provision of
State-issued licenses and credentials to veterans with certain
qualifications. The section also would allow States to receive
waivers from having to establish such programs as long as those
States certify to DOL that they:

Take into consideration previous military training
for the purposes of issuing licenses or credentials;
Allow veterans to completely satisfy through
examination any training or testing requirement for a license
or credential for which they have received military training;
and
Reduce the required training time for such
licenses or credentials for veterans unable to completely
satisfy that requirement through examination.

Based on information from DOL, CBO estimates that most
States would receive waivers and that implementing this
provision would cost the federal government less than $500,000
over the 2014-2018 period.
Jobs Portal. Section 703 would require DOL to identify Web
sites and online tools that would match veterans seeking
employment with available jobs based on the skills those
veterans acquired while serving in uniform. DOL then would be
required to assess the feasibility and costs of creating a
single Internet-based portal that would provide those Web sites
and online tools to all veterans seeking employment. CBO
estimates that identifying those Web sites and online tools,
conducting the feasibility and cost analysis, and then
reporting those findings to the Congress would cost less than
$500,000 over the 2014-2018 period.
Transition Assistance Program (TAP). Under current law,
servicemembers receive pre-separation counseling through TAP to
help prepare them for the transition from military service.
Section 704 would require DOL to incorporate into its existing
TAP curriculum information about protections for disabled
individuals, such as those provided by the Americans with
Disabilities Act and the Rehabilitation Act of 1973. Based on
information from DOL, CBO estimates that revising TAP's
curriculum and updating handout materials would cost less than
$500,000 over the 2014-2018 period.
Employment of Veterans in the Federal Government. Section
701 would require that at least 15,000 qualified veterans be
appointed to positions in the federal government over the 5-
year period beginning on the date of enactment. Because recent
hiring trends are consistent with that goal, CBO estimates that
implementing this requirement would probably have no budgetary
impact.

Direct spending

S. 944 contains provisions that would modify several
mandatory spending programs; some of those provisions would
increase direct spending, and others would decrease it. CBO
estimates that, on net, enacting S. 944 would decrease direct
spending by $94 million over the 2014-2023 period (see Table
3).
Fees for Guaranteed Loans. Under its Home Loan program, VA
provides lenders guarantees on mortgages made to veterans;
those guarantees enable veterans to get better loan terms, such
as lower interest rates or smaller down payments. The loan
guarantees promise lenders a payment of up to 25 percent of the
outstanding loan balance (subject to some limitations on the
original loan amount) in the event that a veteran defaults on a
guaranteed loan. Section 808 would increase some of the fees
that VA charges veterans for providing those guarantees. By
partially offsetting the costs of subsequent defaults, those
fees lower the subsidy cost of the guarantees.\1\
---------------------------------------------------------------------------
\1\Under the Federal Credit Reform Act of 1990, the subsidy cost of
a loan guarantee is the net present value of estimated payments by the
government to cover defaults and delinquencies, interest subsidies, or
other expenses, offset by any payments to the government, including
origination fees, other fees, penalties, and recoveries on defaulted
loans. Such subsidy costs are calculated by discounting those expected
cash flows using the rate on Treasury securities of comparable
maturity. The resulting estimated subsidy costs are recorded in the
budget when the loans are disbursed.
---------------------------------------------------------------------------
Under current law, the up-front fee varies on the basis of
the size of the down payment and whether the veteran has
previously used the loan-guarantee benefit. Borrowers who are
members of the reserve component pay an additional fee of 0.25
percent of the loan amount. Veterans who receive compensation
for service-connected disabilities are exempt from paying the
fee. The current fees are:

2.15 percent of the loan amount for loans with no
down payment,
1.50 percent of the loan amount for loans with a 5
percent down payment,
0.75 percent of the loan amount for loans with a
10 percent down payment,
3.30 percent of the loan amount for all loans if
the veteran has used the guarantee benefit in the past.

Those fees are scheduled to decline on October 1, 2017, to 1.40
percent, 0.75 percent, 0.50 percent, and 1.25 percent,
respectively.
Under section 808, that scheduled fee reduction would be
delayed by 7 months, until May 1, 2018. Continuing the fees at
their current level for that period would increase collections
by VA in 2018, thereby lowering the subsidy cost of the loan
guarantees. Based on program data from VA, CBO estimates that
enacting section 808 would reduce direct spending by $206
million in 2018.

Table 3.--Estimated Changes in Direct Spending Under S.944
----------------------------------------------------------------------------------------------------------------
Outlays by fiscal year, in millions of dollars--
----------------------------------------------------------------------------------
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2014-2018 2014-2023
----------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING

Fees for Guaranteed Loans.... 0 0 0 0 -206 0 0 0 0 0 -206 -206
Marine Gunnery Sergeant John 0 0 24 25 24 24 23 23 24 25 73 192
David Fry Scholarship.......
In-State Tuition for Post-9/ 0 -6 -13 -13 -14 -15 -16 -16 -17 -17 -46 -127
11 GI Bill Beneficiaries....
Medical Examinations for 1 2 3 5 6 7 8 10 11 12 17 65
Military Sexual Trauma......
Additional Assistance for 0 4 5 5 5 5 6 6 6 6 19 48
Surviving Spouses...........
Reporting Fees............... -4 -4 -4 -4 -4 -4 -4 -4 -4 -5 -22 -44
Asset Look-Back for 0 -2 -3 -4 -5 -5 -5 -5 -5 -5 -14 -39
Disability Pensions.........
Expansion of the Yellow 0 * 1 1 1 1 1 1 1 1 4 10
Ribbon GI Education
Enhancement Program.........
Extension and Expansion of 2 2 0 0 0 0 0 0 0 0 4 4
Work-Study Program..........
Spina Bifida Benefits........ 0 * * * * * * * * * 1 3
----------------------------------------------------------------------------------
Total Changes............ -1 -4 13 15 -193 13 13 15 16 17 -170 -94
----------------------------------------------------------------------------------------------------------------
Notes: Components may not sum to totals because of rounding; * = between -$500,000 and $500,000.

Marine Gunnery Sergeant John David Fry Scholarship. Under
current law, when servicemembers die in the line of duty while
serving in an active-duty status, certain children of those
servicemembers become entitled to education benefits under both
the Marine Gunnery Sergeant John David Fry Scholarship (Fry
Scholarship) and the Survivors' and Dependents' Education
Assistance Program (DEAP). However, surviving spouses become
entitled to education benefits under the DEAP only. Beginning 2
years after the date of enactment, section 104 would expand the
eligibility criteria of the Fry Scholarship to include spouses.
The Fry Scholarship entitles qualifying recipients to education
benefits under the Post-9/11 GI Bill. Those benefits include
the payment of in-State tuition and fees for beneficiaries
attending public schools, a monthly housing allowance, and a
stipend to pay for books and supplies. DEAP currently provides
education benefits to qualifying recipients at a maximum rate--
for full-time students--of $987 per month.
Based on information from VA and DOD, CBO estimates that
under S. 944 approximately 1,800 spouses per year would elect
to receive education benefits under the Fry Scholarship rather
than the DEAP over the 2016-2023 period. Each of those spouses
would receive, on average, about $15,700 in Fry Scholarship
benefits in 2016 and, after cost-of-living increases, about
$21,000 in 2023, CBO estimates. Under DEAP, we estimate that
each of those spouses would have received about $4,600 in
benefits in 2016 and, after cost-of-living increases, about
$5,400 in benefits in 2023. After accounting for the
interactive effects of section 201 (discussed immediately
below), CBO estimates that this change in eligibility would
increase direct spending by $192 million over the 2014-2023
period. In addition, implementing this section would increase
discretionary costs. Those costs are discussed in the
``Spending Subject to Appropriation'' section of the estimate
under the subheading ``Long-Term Solution.''
In-State Tuition for Post-9/11 GI Bill Beneficiaries.
Effective July 1, 2015, section 201 would require the Secretary
of Veterans Affairs to approve, for the purposes of education
benefits provided under the Montgomery GI Bill and Post-9/11 GI
Bill programs, only certain public institutions of higher
education. Institutions could only be approved if they charge
tuition and fees at no more than the in-State rate to veterans
who enroll within 3 years of separation from service on active
duty. In order to qualify for the in-State rate, dependents
also would need to enroll within 3 years from when the
servicemember from whom they derived their eligibility
separated from active duty. As long as the veteran or dependent
remained continuously enrolled, institutions would have to
continue to offer the in-State rate. Institutions that choose
not to comply with those conditions would no longer be approved
to participate in Montgomery GI Bill or Post-9/11 GI Bill
programs.
Under current law, VA pays up to the actual net cost of in-
State tuition and fees for individuals who are eligible for the
full Post-9/11 GI Bill benefit. Students attending public
institutions where nonresident tuition and fees exceed the
maximum amount payable may be eligible for additional
assistance under the Yellow Ribbon GI Education Enhancement
Program (YRP). When an institution enters into a YRP agreement
with VA, it agrees to cover a portion of the student's tuition
shortfall. VA then matches the institution's contribution to
further reduce or eliminate the student's out-of-pocket
expenses.
CBO expects that all affected institutions would comply
with the requirements of this provision. Based on information
from VA, CBO estimates that under the bill approximately 3,400
veterans and dependents would no longer require YRP assistance
to help cover the costs of non-resident tuition and fees. Under
current law, CBO estimates that those veterans will receive
about $3,900 each in YRP assistance in 2015 and, after taking
into consideration annual increases in tuition costs, $4,900
each by 2023. In total, the reduction in YRP assistance would
decrease direct spending by $127 million over the 2014-2023
period, CBO estimates. In addition, implementing this section
would increase discretionary costs. Those costs are discussed
above in the section titled ``Long-Term Solution'' under
``Spending Subject to Appropriation.''
Medical Examinations for Military Sexual Trauma. Section
501 would require VA to provide a medical exam in order to make
a decision on a claim of disability based on military sexual
trauma (MST). Under current law, VA can deny a claim without an
examination based on the evidence presented for the claim. VA
generally places Post Traumatic Stress Disorder (PTSD) or
mental disorder claims resulting from MST in one of three
categories: (1) veterans who have enough substantiated
information via examination and reports to grant a claim of
service connection because of MST; (2) veterans who do not have
enough information to grant a service-connection claim, but
whose file contains enough information to grant an examination;
or (3) veterans who do not have enough substantiated
information to provide an examination, and who therefore
receive an automatic denial of benefits. The third category is
the 1 that would be affected by section 501. According to VA,
about half of all claims for PTSD or mental disorders because
of MST are denied because they lack substantiation.
VA receives about 340 claims per month that are based on
MST (about 4,000 annually), and about one-half of those are
denied. Of those claims that are denied, about one-quarter
involved an examination (the second category above) and three-
quarters did not (the third category above). Assuming a similar
pattern over the 2014-2023 period, CBO expects that enacting
this provision would require VA to provide an additional
roughly 1,400 examinations per year to veterans who would
otherwise not be eligible. Based on discussions with VA, CBO
expects that 10 percent of the new examinations would result in
new accessions to the compensation rolls per year, meaning
about 140 new accessions. The costs of providing those
examinations are discussed in the ``Spending Subject to
Appropriation'' section of the estimate under the subheading
``Medical Examinations for Military Sexual Trauma.''
Including adjustments for mortality, CBO expects that under
this provision about 140 additional veterans would receive
payments in 2014, increasing to a total of about 1,320
recipients in 2023. The average disability rate for a new claim
in 2012 for PTSD or a mental disorder was 40 percent or $7,464
annually. After accounting for inflation, CBO estimates that
enacting section 501 would increase direct spending by about
$65 million over the 2014-2023 period.
Additional Assistance for Surviving Spouses. Under section
101, surviving spouses who are eligible for Dependency and
Indemnity Compensation (DIC) and have 1 or more children under
age 18 would have their monthly DIC payment increased by about
$320 for up to 3 years from the date that the survivor becomes
eligible for DIC. That amount would increase annually with
inflation. Under current law, surviving spouses who fit those
criteria are eligible for 2 years of such additional payments.
This extension would become effective on September 30, 2014,
and would apply to all eligible surviving spouses receiving the
additional payments on or after the enactment date of this
bill. The additional payments would end sooner if all of the
surviving spouse's children reached age 18 before the end of
the 2-year period.
Based on information from VA, about 25,800 surviving
spouses began receiving DIC in 2012. Assuming a similar pattern
over the 2014-2023 period, and accounting for mortality and the
fact that about 5 percent of all DIC accessions have a
dependent under 18, CBO estimates that about 1,280 surviving
spouses with children under the age of 18 would receive an
additional year of $250 payments in 2015. Assuming that the
ratio of new surviving spouses to surviving spouses with
children under the age of 18 remains the same over the 10-year
period and that survivors begin receiving payments uniformly
over the year, CBO estimates that enacting section 101 would
increase direct spending for DIC by $48 million over the 2014-
2023 period.
Reporting Fees. VA pays reporting fees to institutions that
provide education or training to veterans using VA education
benefits. Those fees are paid at a rate of $12 per calendar
year for each eligible enrolled veteran or $15 in cases where
educational institutions assume temporary custody of education
assistance checks until the time of registration. Section 204
would reduce the amount of those fees to $7 and $11,
respectively. Based on current levels of spending for these
fees, CBO estimates that change would decrease direct spending
by $44 million over the 2014-2023 period.
Asset Look-Back for Disability Pensions. Section 801 would
authorize VA to conduct a review of the financial records of
all applicants for pensions. The review would cover the 3 years
preceding each application. This look-back would determine if
the applicant disposed of any assets or resources for less than
fair market value. This provision would only affect those
individuals applying for veterans' or survivors' pension
benefits in 2015 or later.
Based on information from VA and the Government
Accountability Office about the income and resources of most
pension applicants, CBO expects that less than 1 percent of all
eligible veterans or survivors have disposed of assets that
would disqualify them from eligibility within the 3-year
window. Therefore, CBO estimates that in 2015, about 200
veterans and 140 survivors would be disqualified from
eligibility because of the review and that a similar pattern
would continue over the 2014-2023 period. Such individuals
would be disqualified, on average, for 3 years. CBO estimates
an average veteran's pension rate will be about $9,800 in 2015
and an average survivor's pension rate will be about $6,300.
After accounting for inflation and mortality, CBO estimates
that enacting section 801 would decrease direct spending by $39
million over the 2014-2023 period.
Those estimated savings would occur whether or not VA hires
additional personnel; however, CBO expects VA to do so to
maintain the current processing time for applications. The
costs for those additional employees are discussed in the
``Spending Subject to Appropriation'' section of the estimate.
Expansion of the Yellow Ribbon GI Education Enhancement
Program (YRP). Under current law, dependents receiving
education benefits under the Fry Scholarship are not eligible
for YRP assistance (a description of the YRP can be found under
``In-State Tuition for Post-9/11 GI Bill Beneficiaries'').
Section 105 would expand YRP eligibility to Fry Scholarship
recipients starting July 1, 2015. Based on information from VA,
and assuming that sections 104 and 201 are concurrently
enacted, CBO estimates that about 250 children and spouses each
year would benefit from this provision, with each receiving an
average of about $4,600 in YRP assistance. Thus, enacting this
provision would increase direct spending by $10 million over
the 2014-2023 period, CBO estimates. In addition, implementing
this section would increase discretionary costs. Those costs
are discussed in the ``Spending Subject to Appropriation''
section of the estimate under the subheading ``Long-Term
Solution.''
Extension and Expansion of Work-Study Program. Veterans
using their educational benefits on a full-time or three-
quarters-time basis may be eligible to receive a work-study
allowance for performing VA-related work on school campuses and
at other qualifying locations. Those veterans are paid the
federal minimum wage or their State's minimum wage, whichever
is greater. VA's authority to pay work-study allowances to
certain veterans performing outreach services, providing
hospital and domiciliary care to veterans in State homes, or
performing activities at national or State veterans' cemeteries
expired on June 30, 2013. Section 202 would extend that
authority through June 30, 2015. Assuming the legislation is
enacted near the beginning of 2014, VA's authority to pay work-
study allowances for about 400 positions would be interrupted
for several months.
The section also would expand the work-study program to
include certain activities performed in the offices of Members
of Congress. That authority would also expire on June 30, 2015.
Based on information from VA, CBO estimates that about 700
veterans each year would benefit from the extension and
expansion of these work-study programs and that each would be
paid, on average, about $2,800 annually. Over the 2014-2023
period, enacting this provision would increase direct spending
by $4 million, CBO estimates.
Spina Bifida Benefits. Starting 1 year after enactment,
section 106 would expand eligibility for benefits related to
spina bifida to include the children of veterans who served in
Thailand between January 9, 1962, and May 7, 1975, and who may
have been exposed to an herbicide agent. Those children would
be eligible for a monetary allowance and certain other benefits
from VA similar to those provided to children with spina bifida
of veterans who served in Vietnam. Based on information from VA
about the current population of children receiving benefits for
spina bifida relative to the number of servicemembers who
served in Vietnam, and information about the number of veterans
who served in Thailand, CBO estimates that about 30 individuals
per year would receive a monetary allowance under this
provision. With an average allowance of $700 per month, CBO
estimates that enacting section 106 would increase direct
spending by $3 million over the 2014-2023 period. Section 106
would also provide health care for those eligible individuals.
The cost of that care is discussed in the ``Spending Subject to
Appropriation'' section of the estimate.
Pay-As-You-Go Considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. S. 944 would modify several programs that provide
benefits to veterans. The net changes in outlays that are
subject to those pay-as-you-go procedures are shown in the
following table.

Table 4.--CBO Estimate of Pay-As-You-Go Effects for S.944 as ordered reported by the Senate Committee on
Veterans' Affairs on July 24, 2013
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------------------------------
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2014-2018 2014-2023
----------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT

Statutory Pay-As-You-Go -1 -4 13 15 -193 13 13 15 16 17 -170 -94
Impact......................
----------------------------------------------------------------------------------------------------------------

Estimated impact on State, local, and tribal governments:
S. 944 contains no intergovernmental mandates as defined in
UMRA, but it would place additional conditions on States for
participating in voluntary federal programs. The bill would
require public institutions of higher education to charge
certain veterans no more than in-State tuition and fees
regardless of State of residency in order for veterans enrolled
in those institutions to be eligible to use their VA education
benefits at those institutions. In addition, the bill would
require States to comply with new standards for licensing
professionals. Any costs incurred by those institutions or
governments would be incurred voluntarily.
Estimated impact on the private sector: This bill contains
no new private-sector mandates as defined in UMRA.
Estimate prepared by: Federal costs: Ann E. Futrell, Bill
Ma, David Newman, and Dwayne Wright; Impact on State, local,
and tribal governments: Lisa Ramirez-Branum; Impact on the
private sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.

Regulatory Impact Statement

In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee has made an
evaluation of the regulatory impact that would be incurred in
carrying out S. 944. The Committee finds that S. 944 would not
entail any regulation of individuals or businesses or result in
any impact on the personal privacy of any individuals and that
the paperwork resulting from enactment would be minimal.

Tabulation of Votes Cast in Committee

In compliance with paragraph 7 of rule XXVI of the Standing
Rules of the Senate, the following is a tabulation of votes
cast in person or by proxy by Members of the Committee on
Veterans' Affairs at its July 24, 2013, meeting. Three
amendments were offered to S. 944 by Members of the Committee.
An amendment by Ranking Member Burr would have required
that, prior to establishing any fitness facility under section
306 that requires the construction of a facility, all projects
in the Strategic Capital Investment Planning project list for
fiscal year 2014 must have been completed. This amendment was
not agreed to.
Ranking Member Burr's second amendment would require the
addition of a prohibition on benefits for disqualifying conduct
under a new process related to Filipino Veterans. This
amendment was agreed to by voice vote.
Senator Boozman's amendment sought to amend adaptive sports
programs for disabled veterans and members of the Armed Forces
through the USOC. This amendment was not agreed to.
S. 944 as amended, and as subsequently amended during the
markup, was agreed to by voice vote and ordered reported to the
Senate.

Agency Report

On May 9, 2013, Robert L. Jesse, M.D., Ph.D., Principal
Deputy Under Secretary for Health, Veterans Health
Administration, Department of Veterans Affairs, and on June 12,
2013, Curtis L. Coy, Deputy Under Secretary for Economic
Opportunity, Veterans Benefits Administration, appeared before
the Committee and submitted testimony on various bills
incorporated into the Committee bill. In addition, on
September 11 and September 13, 2013, VA provided views on
various bills incorporated into the Committee bill. Excerpts
from both the testimony and Department views are reprinted
below:

STATEMENT OF ROBERT L. JESSE, M.D., Ph.D., PRINCIPAL DEPUTY UNDER
SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT
OF VETERANS AFFAIRS

Good Morning Chairman Sanders, Ranking Member Burr, and
Members of the Committee. Thank you for inviting me here today
to present our views on several bills that would affect
Department of Veterans Affairs (VA) benefits programs and
services. Joining me today is Susan Blauert, Deputy Assistant
General Counsel.
We do not yet have cleared views on sections 4, 10, 11, or
12 of S. 131, S. 287, section 3 of S. 522, S. 800, S. 832,
S. 845, S. 851, S. 852, or the draft bill described as ``The
Veterans Affairs Research Transparency Act of 2013.'' Also, we
do not have estimated costs associated with implementing
S. 131, S. 422, S. 455, or S. 825. We will forward the views
and estimated costs to you as soon as they are available.

* * * * * * *

S. 229, CORPORAL MICHAEL J. CRESCENZ ACT OF 2013

S. 229 would designate the Department of VAMC located at
3900 Woodland Avenue in Philadelphia, Pennsylvania, as the
``Corporal Michael J. Crescenz Department of Veterans Affairs
Medical Center.'' VA defers to Congress in the naming of this
facility.

* * * * * * *

S. 422 CHIROPRACTIC CARE AVAILABLE TO ALL VETERANS ACT OF 2013

S. 422 would require VA to establish programs for the
provision of chiropractic care and services at not fewer than
75 medical centers by not later than December 31, 2014, and at
all VAMCs by not later than December 31, 2016. Currently, VA is
required (by statute) to have at least one site for such
program in each VHA geographic services area.
Section 3(a) would amend the statutory definition of
``medical services'' in section 1701 of chapter 17, U.S.C., to
include chiropractic services. Subsection (b) would amend the
statutory definition of ``rehabilitative services'' in that
same section to include chiropractic services. Finally,
subsection (c) would amend the statutory definition of
``preventive health services'' in that same section to include
periodic and preventive chiropractic examinations and services.
The bill would also make technical amendments needed to
effect these substantive amendments.
In general, VA supports the intent of S. 422, but believes
the decision to provide on-site or fee care should be
determined based on existing clinical demands and business
needs. Chiropractic care is available to all Veterans and is
already part of the standard benefits package.
As VA increases the number of VA sites providing on-site
chiropractic care, we will be able to incrementally assess
demand for chiropractic services and usage, and to best
determine the need to add chiropractic care at more sites.
Currently, VA does not have an assessment that would
support providing on-site chiropractic care at all VAMCs by the
end of 2016. Such a mandate could potentially be excessive,
given the availability of resources for on-site chiropractors
and non-VA care to meet the current need for services. VA does
not object to sections 3(a) and (b) as those changes reflect
VA's consideration of chiropractic care as properly part of
what should be considered medical and rehabilitative services.
VA, however, cannot support section 3(c) for lack of a
conclusive consensus on the use of chiropractic care as a
preventative intervention.

S. 455 TRANSPORTATION IN CONNECTION WITH REHABILITATION, COUNSELING,
EXAMINATION, TREATMENT, AND CARE

S. 455 would make permanent VA's broad authority to
transport individuals to and from VA facilities in connection
with vocational rehabilitation, counseling, examination,
treatment, or care. That authority currently will expire on
January 10, 2014. This authority has allowed VA to operate the
Veterans Transportation Program which uses paid drivers to
complement the Volunteer Transportation Network, which uses
volunteer drivers. The Volunteer Transportation Network
supported by Veterans Service Organizations, especially the
Disabled American Veterans, is invaluable; however, with
increasing numbers of transportation-disadvantaged Veterans,
there simply are not enough volunteers to serve the level of
need. Furthermore, volunteer drivers are generally precluded
from transporting Veterans who are not ambulatory, require
portable oxygen, have undergone a procedure involving sedation,
or have other clinical issues. Also, some volunteers, for valid
reasons, are reluctant to transport non-ambulatory or very ill
Veterans. Paid drivers have resulted in better access to VA
health care, often for those for whom travel is the most
difficult.
VA thus supports enactment of this bill, and proposed a
five-year extension of this authority in the FY 2014
President's Budget. The budget assumes savings of $19.2 million
in FY 2014 and $102.7 million over five years. As a technical
matter, we suggest the bill's insertion of a new section 111A
be changed to instead reflect the intent to replace the
existing section 111A with the revised version.

S. 522, WOUNDED WARRIOR WORKFORCE ENHANCEMENT ACT

S. 522, the Wounded Warrior Workforce Enhancement Act,
would direct VA to establish two grant award programs. Section
2 of the bill would require VA to award grants to institutions
to: (1) establish a master's or doctoral degree program in
orthotics and prosthetics, or (2) expand upon an existing
master's degree program in such area. This section would
require VA to give a priority in the award of grants to
institutions that have a partnership with a VAMC or clinic or a
DOD facility. Grant awards under this provision must be at
least $1 million and not more than $1.5 million. Grant
recipients must either be accredited by the National Commission
on Orthotic and Prosthetic Education or demonstrate an ability
to meet such accreditation requirements if receiving a grant.
VA would be required to issue a request for proposals for
grants not later than 90 days after the date of enactment of
this provision.
In addition to the two purposes noted above, grantees would
be authorized to use grants under this provision to train
doctoral candidates and faculty to permit them to instruct in
orthotics and prosthetics programs, supplement the salary of
faculty, provide financial aid to students, fund research
projects, renovate buildings, and purchase equipment. Not more
than half of a grant award may be used for renovating
buildings. Grantees would be required to give a preference to
Veterans who apply for admission in their programs.
VA does not support enactment of section 2 of this bill. We
believe VHA has adequate training capacity to meet the
requirements of its health care system for recruitment and
retention of orthotists and prosthetists. VA offers one of the
largest orthotic and prosthetic residency programs in the
Nation. In FY 2013, VA allocated $837,000 to support 19
Orthotics/Prosthetics residents at 10 VAMCs. The training
consists of a year-long post masters residency, with an average
salary of $44,000 per trainee. In recent years, VA has expanded
the number of training sites and the number of trainees.
Moreover, recruitment and retention of orthotists and
prosthetists has not been a challenge for VA. Nationally, VA
has approximately 240 orthotic and prosthetic staff; there are
currently only seven positions open and being actively
recruited.
Much of the specialized orthotic and prosthetic capacity of
VA is met through contract mechanisms. VA contracts with more
than 600 vendors for specialized orthotic and prosthetic
services. Through both in-house staffing and contractual
arrangements, VA is able to provide state-of-the-art
commercially-available items ranging from advanced myoelectric
prosthetic arms to specific custom fitted orthoses.
We also note the bill would not require these programs to
affiliate with VA or send their trainees to VA as part of a
service obligation. We also have technical concerns about the
language in section 2, subsection (e). Specifically, the
language directs the appropriators to provide funding ($15
million) in only one fiscal year, FY 2014, which would expire
after three fiscal years. This subsection contemplates that
unobligated funds would be returned to the General Fund of the
Treasury immediately upon expiration. Under 31 U.S.C. section
1553(a), expired accounts are generally available for 5 fiscal
years following expiration for the purpose of paying
obligations incurred prior to the account's expiration and
adjusting obligations that were previously unrecorded or under
recorded. If the unobligated balance of these funds were
required to be returned to the Treasury immediately upon
expiration, then VA would be unable to make obligation
adjustments to reflect unrecorded or under recorded
obligations. A bookkeeping error could result in an
Antideficiency Act violation. Accordingly, we recommend the
deletion of paragraph (2) of subsection (e). Further, we
recommend that the words ``for obligation'' be deleted from
paragraph (e)(1) of section 2 because they are superfluous.
Last, we note that 90 days after the date of enactment of this
provision is not enough time for VA to prepare a request for
proposals for these grants.
VA is unable to provide views on section 3 at this time,
but will provide views for the record at a future time.

S. 529 MODIFICATION OF CAMP LEJEUNE ELIGIBILITY

Public Law 112-154 provided authority for VA to provide
hospital services and medical care to Veterans and family
members who served on active duty or resided at Camp Lejeune
for no less than 30 days from January 1, 1957, to December 31,
1987, for care related to 15 illnesses specified in the public
law. S. 529 would modify the commencement date of the period of
service at Camp Lejeune, North Carolina for eligibility under
1710(e)(1)(F) from January 1, 1957, to August 1, 1953, or to
such earlier date as the Secretary, in consultation with the
Agency for Toxic Substances and Disease Registry (ATSDR),
specifies.
VA supports this change due to information provided in the
scientific studies conducted by ATSDR. We do not believe this
change would result in substantial additional costs.
VA also recommends that the Committee consider including
language to simplify the administrative eligibility
determination process and thereby relieve some of the burden
from the Veteran and family member. Other special eligibility
authorities included participation by DOD to determine exposure
while on active duty. The current statute for Camp Lejeune
Veterans and family members does not include this provision. VA
recommends including a requirement for DOD to determine if the
Veteran or family member met the 30-day presence requirement on
Camp Lejeune.

S. 543 VISN REORGANIZATION ACT OF 2013

Section 2 of S. 543 would require VHA to consolidate its 21
Veterans Integrated Service Networks (VISN) into 12
geographically defined VISNs, would require that each of the 12
VISN headquarters be co-located with a VAMC, and would limit
the number of employees at each VISN headquarters to 65 full-
time equivalent employees (FTEE). VA opposes section 2 for the
following reasons.
By increasing the scope of responsibility for each VISN
headquarters while reducing the number of employees at each,
the legislation would impede VA's ability to implement national
goals. Currently, VISN headquarters are capable of providing
assistance to supplement resource needs at facilities and are
able to support transitions in staff within local facilities
when there are personnel changes; with a responsibility for
oversight of more facilities and fewer staff, the VISN
headquarters would lose the opportunity to provide this
essential service when needed. VHA has reviewed each VISN
headquarters and is working with each to streamline operations,
create efficiencies internal to each VISN, and realign
resources. This will achieve savings without the negative
impact of the restructuring proposed in S. 543.
The requirement in section 2 that VISN budgets be balanced
at the end of each fiscal year may have unintended
consequences. Currently, each VISN balances its accounts at the
end of each fiscal year. Sometimes this is achieved by
providing additional resources from VHA. These resources may be
needed for a number of reasons, including greater-than-
anticipated demand, a national disaster or emergency, new legal
requirements enacted during the year, and other factors. Under
S. 543, VA may lose the flexibility to supplement VISNs with
additional resources, potentially compromising patient care.
Section 2 would also require VA to identify and reduce
duplication of functions in clinical, administrative, and
operational processes and practices in VHA. We are already
doing this by identifying best practices and consolidating
functions, where appropriate. Further, section 2 describes how
the VISNs should be consolidated but fails to articulate
clearly the flow of leadership authority. Consequently, S. 543
would blur the lines of authority from VHA Central Office,
regions, and VISNs to medical centers, which could actually
impede oversight and create confusion.
Additionally, the original VISN boundaries were drawn
carefully based on the health needs of the local population. By
contrast, the proposed combination of VISNs does not account
for the underlying referral patterns within each VISN. For
example, it is unclear why VISNs 19 and 20 should be
consolidated. This would produce a single Network responsible
for overseeing 12 States, 15 VA health care systems or medical
centers, and a considerable land mass, while VISN 6 would
continue to oversee three States and eight health care systems
or medical centers. VA would appreciate the opportunity to
review the Committee's criteria for determining these
boundaries.
Finally, section 2 seems to assume that locating the
management function away from a medical center represents an
inefficient organizational approach. That assumption is not
valid in all cases. Currently, six VISNs (1, 2, 3, 20, 21, and
23) are co-located with a VAMC. The legislation's requirement
for co-location with a VAMC would require either construction
to expand existing medical centers, using resources that would
otherwise be devoted to patient care to cover administrative
costs, or would require the removal of certain clinical
functions to create administrative space for VISN staff in at
least nine VISNs.
As a result, Veterans potentially would be forced to travel
to different locations for services or would be unable to
access new services that would have been available had
construction resources not been required to modify existing
facilities to accommodate VISN staff. While section four States
that nothing in the bill shall be construed to require any
change in the location or type of medical care or service
provided by a VA medical center, the reality is that requiring
co-location would necessitate this result.
VA also does not support section 3 of S. 543. Section 3
would require VA to create up to four regional support centers
to ``assess the effectiveness and efficiency'' of the VISNs.
Section 3 identifies a number of functions to be organized
within the four regional support centers including:

Financial quality assurance;
Operation Enduring Freedom/Operation Iraqi
Freedom/Operation New Dawn outreach;
Women's Veterans programs assessments;
Homelessness effectiveness assessments;
Energy assessments; and
Other functions as the Secretary deems
appropriate.

Certain services are more appropriately organized as
national functions rather than regional ones. For example,
regional functions addressing homelessness and women Veterans
issues would duplicate existing national services. The current
structure (VISN accountability and national oversight) ensures
accountable leadership oversight that is proximate to health
care services provided to Veterans at VA facilities. By
contrast, S. 543 would create competing oversight entities.
In addition, the functions listed in section 3 may not be
the most appropriate ones for consolidation. VHA has created
seven Consolidated Patient Account Centers to achieve superior
levels of sustained revenue cycle management, established
national call centers to respond to questions from Veterans and
their families, and is assessing consolidation of claims
payment functions to achieve greater efficiencies and accuracy.
We believe these types of functions are more appropriate to
move off-station. S. 543 appears to contemplate a reduction in
the FTEE associated with regional management but in practice,
the proposed regional support centers are likely to increase
overall staffing needs, resulting in a diversion of resources
from patient care. If each of the four regional support centers
is 110 FTEE, a realistic assumption given the scope of
responsibilities identified in the legislation, the proposed
model would result in overall growth of regional staff compared
with VHA's current plans.
Currently, it is not possible to identify costs for the
proposed legislation; however, it is expected that the
requirement to collocate functions with Medical Centers will
result in costlier clinical leases. Additionally, the proposed
VA Central Office, VISN, and Regional Support Center structure
will result in increased FTEE requirements.

* * * * * * *

Mr. Chairman, this concludes my statement. Thank you for
the opportunity to appear before you today. I would be pleased
to respond to questions you or the other Members may have.
------

STATEMENT OF CURTIS L. COY, DEPUTY UNDER SECRETARY FOR ECONOMIC
OPPORTUNITY, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF
VETERANS AFFAIRS

Good morning, Mr. Chairman and Members of the Committee. I
am pleased to be here today to provide the views of the
Department of Veterans Affairs (VA) on pending legislation
affecting VA's programs, including the following: Sections 101,
102 and 103 of S. 6, S. 200, S. 257, S. 262, S. 294, S. 373,
S. 430, sections 5, 6, 7, and 8 of S. 495, S. 514, S. 515,
S. 572, S. 629, S. 674, S. 690, S. 695, S. 705, S. 748, S. 893,
S. 894, S. 922, sections 103, 104, 201, 202, 301, 302, 303,
304, and 305 of S. 928, and S. 939. VA has not had time to
develop cost estimates for S. 514 and S. 894 and but will work
to provide them. VA has not had time to develop views and costs
on the other sections of S. 928. I cannot address today views
and costs on S. 735, S. 778, S. 819, S. 863, S. 868, S. 889,
S. 927, certain sections of S. 928, S. 930, S. 932, S. 935,
S. 938, S. 944, S. 1039, S. 1042, and S. 1058, but, with your
permission, we will work to provide that information. Other
legislative proposals under discussion today would affect
programs or laws administered by the Department of Labor (DOL),
Department of Homeland Security (DHS), Department of Defense
(DOD), the Office of Personnel Management (OPM), and the
General Services Administration (GSA). Respectfully, we defer
to those Departments' views on those legislative proposals.
Accompanying me this morning are Thomas Murphy, Director,
Compensation Service, Veterans Benefits Administration; Richard
Hipolit, Assistant General Counsel; and John Brizzi, Deputy
Assistant General Counsel.

* * * * * * *

S. 200

S. 200 would establish eligibility for interment in a
national cemetery for any individual who: (1) the Secretary of
Veterans Affairs determines served in combat support of the
Armed Forces in Laos during the period beginning on
February 28, 1961, and ending on May 15, 1975; and (2) at the
time of death was a U.S. citizen or lawfully admitted alien.
Section 401 of Public Law 95-202 authorizes the Secretary
of Defense to determine whether the service of members of
civilian or contractual groups shall be considered active duty
for the purposes of all laws administered by VA. The DOD
Civilian/Military Service Review Board advises the Secretary of
Defense in determining if civilian service in support of the
U.S. Armed Forces during a period of armed conflict is
equivalent to active military service for VA benefits. VA
provides burial and memorial benefits to individuals deemed
eligible by reason of active military service established by
the Secretary of Defense.
VA does not support this bill because it would bypass the
statutorily mandated process established under section 401 of
Public Law 95-202 that promotes consistency in evaluation of
various types of service. The established process under Public
Law 95 202 ensures that determinations regarding individuals or
groups who did not serve in the Armed Forces are based on
adequate information regarding the nature of the operations of
the U.S. Armed Forces at the relevant times and locations and
the nature of the support provided by the individuals or groups
in question.
Further, VA relies on DOD to determine the circumstances of
an individual's service and when such service was rendered,
and, for purposes of this bill, VA would have to rely on DOD to
make determinations such as whether such service was ``in
combat support of the Armed Forces.'' VA is not equipped to
make those determinations on a case-by-case basis. Yet the bill
makes no provision for DOD involvement in the process. In
addition, it is unclear how ``combat support'' would be defined
and documented for purposes of implementing this bill.
If the assumption is made that the impacted population
would be small, no significant cemetery construction or
interment costs would be associated with this legislation.

S. 257

S. 257, the ``GI Bill Tuition Fairness Act of 2013,'' would
amend section 3679 of title 38, United States Code, to direct
VA, for purposes of the educational assistance programs
administered by the Secretary, to disapprove courses of
education provided by public institutions of higher education
that do not charge tuition and fees for Veterans at the same
rate that is charged for in-State residents, regardless of the
Veteran's State of residence. The bill does not address whether
tuition and fee rates for Servicemembers or other eligible
beneficiaries of the GI Bill affect the approval status of a
program of education. S. 257 would apply to educational
assistance provided after August 1, 2014. In the case of a
course of education in which a Veteran or eligible person (such
as a spouse or dependent who is eligible for education
benefits) is enrolled prior to August 1, 2014, that is
subsequently disapproved by VA, the Department would treat that
course as approved until the Veteran or eligible person
completes the course in which the individual is enrolled. After
August 1, 2018, any disapproved course would be treated as
such, unless the Veteran or eligible person receives a waiver
from VA. While VA is sympathetic to the issue of rising tuition
costs, it is difficult to endorse the proposed legislation
until we know more about the impact.
VA cannot predict what reductions in offerings by
educational institutions would result from this requirement.
In-State tuition rules are set by individual States, and are
undoubtedly driven by overall fiscal factors and other policy
considerations. Additionally, the bill creates ambiguity since
it is unclear whether institutions that charge out-of-state
tuition and fees to other eligible persons for a course of
education, but that charge in-State tuition to Veterans in the
same course, would also be disapproved.
VA estimates approximately 11.8 percent of Yellow Ribbon
participants attended public institutions since the program's
inception. Of those, an estimated 80.6 percent were Veterans
during the 2012 fall enrollment period. VA applied these
percentages to the total amount of Yellow Ribbon benefits paid
in FY 2012 and projected through FY 2023, assuming growth
consistent with the overall chapter 33 program. Based on those
projections, VA estimates that enactment of S. 257 would result
in benefit savings to VA's Readjustment Benefits account of
$2.3 million in the first year, $70.3 million over 5 years, and
$179.9 million over 10 years. VA estimates there would be no
additional GOE administrative costs required to implement this
bill.

* * * * * * *

S. 294

Section 2(a) of S. 294, the ``Ruth Moore Act of 2013,''
would add to 38 U.S.C. Sec. 1154 a new subsection (c) to
provide that, if a Veteran alleges that a ``covered mental
health condition'' was incurred or aggravated by military
sexual trauma (MST) during active service, VA must ``accept as
sufficient proof of service-connection'' a mental health
professional's diagnosis of the condition together with
satisfactory lay or other evidence of such trauma and the
professional's opinion that the condition is related to such
trauma, provided that the trauma is consistent with the
circumstances, conditions, or hardships of such service,
irrespective of whether there is an official record of
incurrence or aggravation in service. Service connection could
be rebutted by ``clear and convincing evidence to the
contrary.'' In the absence of clear and convincing evidence to
the contrary, and provided the claimed MST is consistent with
the circumstances, conditions, and hardships of service, the
Veteran's lay testimony alone would be sufficient to establish
the occurrence of the claimed MST. The provision would define
the term ``covered mental health condition'' to mean Post
Traumatic Stress Disorder (PTSD), anxiety, depression, ``or
other mental health diagnosis described in the current
version'' of the American Psychiatric Association Diagnostic
and Statistical Manual of Mental Disorders that VA ``determines
to be related to military sexual trauma.'' The bill would
define MST to mean ``psychological trauma, which in the
judgment of a mental health professional, resulted from a
physical assault of a sexual nature, battery of a sexual
nature, or sexual harassment which occurred during active
military, naval, or air service.''
Section 2(b) would require VA, for a 5-year period
beginning with FY 2014, to submit to Congress an annual report
on claims covered by new section 1154(c) that were submitted
during the fiscal year. Section 2(b) would also require VA to
report on the: (1) number and percentage of covered claims
submitted by each sex that were approved and denied; (2) rating
percentage assigned for each claim based on the sex of the
claimant; (3) three most common reasons for denying such
claims; (4) number of claims denied based on a Veteran's
failure to report for a medical examination; (5) number of
claims pending at the end of each fiscal year; (6) number of
claims on appeal; (7) average number of days from submission to
completion of the claims; and (8) training provided to Veterans
Benefits Administration (VBA) employees with respect to covered
claims.
Section 2(c) would make proposed section 1154(c) applicable
to disability claims ``for which no final decision has been
made before the date of the enactment'' of the bill.
VA is committed to serving our Nation's Veterans by
accurately adjudicating claims based on MST in a thoughtful and
caring manner, while fully recognizing the unique evidentiary
considerations involved in such an event. Before addressing the
specific provisions of S. 294, it would be useful to outline
those efforts, which we believe achieve the intent behind the
bill. The Under Secretary for Benefits has spearheaded VBA's
efforts to ensure that these claims are adjudicated
compassionately and fairly, with sensitivity to the unique
circumstances presented by each individual claim.
VA is aware that, because of the personal and sensitive
nature of the MST stressors in these cases, it is often
difficult for the victim to report or document the event when
it occurs. To remedy this, VA developed regulations and
procedures specific to MST claims that appropriately assist the
claimant in developing evidence necessary to support the claim.
As with other PTSD claims, VA initially reviews the Veteran's
military service records for evidence of the claimed stressor.
VA's regulation also provides that evidence from sources other
than a Veteran's service records may corroborate the Veteran's
account of the stressor incident, such as evidence from mental
health counseling centers or statements from family members and
fellow Servicemembers. Evidence of behavior changes, such as a
request for transfer to another military duty assignment, is
another type of relevant evidence that may indicate occurrence
of an assault. VA notifies Veterans regarding the types of
evidence that may corroborate occurrence of an in-service
personal assault and asks them to submit or identify any such
evidence. The actual stressor need not be documented. If
minimal circumstantial evidence of a stressor is obtained, VA
will schedule an examination with an appropriate mental health
professional and request an opinion as to whether the
examination indicates that an in-service stressor occurred. The
mental health professional's opinion can establish occurrence
of the claimed stressor.
With respect to claims for other disabilities based on MST,
VA has a duty to assist in obtaining evidence to substantiate a
claim for disability compensation. When a Veteran files a claim
for mental or physical disabilities other than PTSD based on
MST, VBA will obtain a Veteran's service medical records, VA
treatment records, relevant Federal records identified by the
Veteran, and any other relevant records, including private
records, identified by the Veteran that the Veteran authorizes
VA to obtain. VA must also provide a medical examination or
obtain a medical opinion when necessary to decide a disability
claim. VA will request that the medical examiner provide an
opinion as to whether it is at least as likely as not that the
current symptoms or disability are related to the in-service
event. This opinion will be considered as evidence in deciding
whether the Veteran's disability is service-connected.
VBA has also placed a primary emphasis on informing VA
regional office (RO) personnel of the issues related to MST and
providing training in proper claims development and
adjudication. VBA developed and issued Training Letter 11-05,
Adjudicating Posttraumatic Stress Disorder Claims Based on
Military Sexual Trauma, in December 2011. This was followed by
a nationwide broadcast on MST claims adjudication. The
broadcast focused on describing the range of potential markers
that could indicate occurrence of an MST stressor and the
importance of a thorough and open-minded approach to seeking
such markers in the evidentiary record. In addition, the VBA
Challenge Training Program, which all newly hired claims
processors are required to attend, now includes a module on MST
within the course on PTSD claims processing. VBA also provided
its designated Women Veterans Coordinators with updated
specialized training. These employees are located in every VA
RO and are available to assist both female and male Veterans
with their claims resulting from MST.
VBA worked closely with the Veterans Health Administration
(VHA) Office of Disability Examination and Medical Assessment
to ensure that specific training was developed for clinicians
conducting PTSD compensation examinations for MST-related
claims. VBA and VHA further collaborated to provide a training
broadcast targeted to VHA clinicians and VBA raters on this
very important topic, which aired initially in April 2012 and
has been rebroadcast numerous times.
Prior to these training initiatives, the grant rate for
PTSD claims based on MST was about 38 percent. Following the
training, the grant rate rose and at the end of February 2013
stood at about 52 percent, which is roughly comparable to the
approximate 59-percent grant rate for all PTSD claims.
In December 2012, VBA's Systematic Technical Accuracy
Review team, VBA's national quality assurance office, completed
a second review of approximately 300 PTSD claims based on MST.
These claims were denials that followed a medical examination.
The review showed an overall accuracy rate of 86 percent, which
is roughly the same as the current national benefit entitlement
accuracy level for all rating-related end products.
In addition, VBA's new standardized organizational model
has now been implemented at all of our ROs. It incorporates a
case-management approach to claims processing. VBA reorganized
its workforce into cross-functional teams that give employees
visibility of the entire processing cycle of a Veteran's claim.
These cross-functional teams work together on one of three
segmented lanes: express, special operations, or core. Claims
that predictably can take less time flow through an express
lane (30 percent); those taking more time or requiring special
handling flow through a special operations lane (10 percent);
and the rest of the claims flow through the core lane (60
percent). All MST-related claims are now processed in the
special operations lane, ensuring that our most experienced and
skilled employees are assigned to manage these complex claims.
The Under Secretary for Benefits' efforts have dramatically
improved VA's overall sensitivity to MST-related PTSD claims
and have led to higher current grant rates. However, she
recognized that some Veterans' MST-related claims were decided
before her efforts began. To assist those Veterans and provide
them with the same evidentiary considerations as Veterans who
file claims today, VBA in April 2013 advised Veterans of the
opportunity to request that VA review their previously denied
PTSD claims based on MST. Those Veterans who respond will
receive review of their claims based on VA's heightened
sensitivity to MST and a more complete awareness of evidence
development. VBA will also continue to work with VHA medical
professionals to ensure they are aware of their critical role
in processing these claims.
Through VA's extensive, recent, and ongoing actions, we are
ensuring that MST claimants are given a full and fair
opportunity to have their claim considered, with a practical
and sensitive approach based on the nature of MST. As noted
above, VA has recognized the sensitive nature of MST-related
PTSD claims and claims based on other covered mental health
conditions, as well as the difficulty inherent in obtaining
evidence of an in-service MST event. Current regulations
provide multiple means to establish an occurrence, and VA has
initiated additional training efforts and specialized handling
procedures to ensure thorough, accurate, and timely processing
of these claims.
VA's regulations reflect the special nature of PTSD.
Section 3.304(f) of title 38 Code of Federal Regulations,
currently provides particularized rules for establishing
stressors related to personal assault, combat, former prisoner-
of-war status, and fear of hostile military or terrorist
activity. These particularized rules are based on an
acknowledgement that certain circumstances of service may make
the claimed stressor more difficult to corroborate.
Nevertheless, they require threshold evidentiary showings
designed to ensure accuracy and fairness in determinations as
to whether the claimed stressor occurred. Evidence of a
Veteran's service in combat or as a prisoner of war generally
provides an objective basis for concluding that claimed
stressors related to such service occurred. Evidence that a
Veteran served in an area of potential military or terrorist
activity may provide a basis for concluding that stressors
related to fears of such activity occurred. In such cases, VA
also requires the opinion of a VA or VA-contracted mental
health professional, which enables VA to ensure that such
opinions are properly based on consideration of relevant facts,
including service records, as needed. For PTSD claims based on
a personal assault, lay evidence from sources outside the
Veteran's service records may corroborate the Veteran's account
of the in-service stressor, such as statements from law
enforcement authorities, mental health counseling centers,
family members, or former Servicemembers, as well as other
evidence of behavioral changes following the claimed assault.
Minimal circumstantial evidence of a stressor is sufficient to
schedule a VA examination and request that the examiner provide
an opinion as to whether the stressor occurred. We recognize
that some victims of sexual assault may not have even this
minimal circumstantial evidence, and we are committed to
addressing the problem.
As VA has continued its close review of this legislation as
part of an Administration-wide focus on the critical issue of
MST, we would like to further consider whether statutory
changes could also be useful, while continuing to carry forward
the training, regulatory, and case review efforts described
above. VA would like to follow up with the Committee on the
results of this review, and of course are glad to meet with you
or your staff on this critical issue.
VA does not oppose section 2(b).
Section 2(c) does not define the term ``final decision.''
As a result, it is unclear whether the new law would be
applicable to an appealed claim in which no final decision has
been issued by VA or, pursuant to 38 U.S.C. Sec. 7291, by a
court.
Benefit costs are estimated to be $135.9 million during the
first year, $2.0 billion for 5 years, and $7.1 billion over 10
years.

* * * * * * *

S. 430

Section 2 of S. 430, the ``Veterans Small Business
Opportunity and Protection Act of 2013,'' would expand the
scope of the ``surviving spouse'' exception associated with
VA's Veteran-owned small business (VOSB) acquisition program
established by 38 U.S.C. Sec. 8127. This program requires that
VA verify the ownership and control of VOSBs by Veterans in
order for the VOSB to participate in VA acquisitions set aside
for these firms.
Currently, an exception in the law is provided for certain
surviving spouses to stand in the place of a deceased service-
disabled spouse owner for verification purposes if the Veteran
owner had a service-connected disability rated as 100 percent
disabling or died as a result of a service-connected disability
for a limited period of time. Section 2 would continue to
provide that if the deceased Veteran spouse had a service-
connected disability rated as 100 percent disabling or died as
a result of a service-connected disability, the surviving
spouse owner could retain verified service-disabled Veteran-
owned small business (SDVOSB) status for VA's program for a
period of 10 years. In addition, a surviving spouse of a
deceased Veteran with any service-connected disability,
regardless of whether the Veteran died as a result of the
disability, could retain verified SDVOSB status for VA's
program for a period of 3 years. VA supports this provision.
Section 3 of S. 430 would add a separate, new provision to
38 U.S.C. Sec. 8127 to enable the surviving spouse or dependent
of an servicemember killed in the line of duty who acquires 51
percent or greater ownership rights of the servicemember's
small business to stand in place of the deceased servicemember
for purposes of verifying the small business as one owned and
controlled by Veterans in conjunction with VA's VOSB set-aside
acquisition program also created by 38 U.S.C. Sec. 8127. This
status would continue, for purposes of a surviving spouse,
until the earlier of the re-marriage of the surviving spouse,
the relinquishment of ownership interest such that the
percentage falls below 51 percent, or 10 years. With respect to
dependent status, this would continue until the dependent holds
less than 51 percent ownership interest or 10 years, whichever
occurs earlier. VA supports this provision but recommends
clarifying the term ``dependent,'' as appropriate, to ensure
the individual is one having legal capacity to contract with
the Federal government. VA stands ready to work with the
Committee to address this issue. VA estimates no additional
appropriations would be required to implement this bill if
enacted.

S. 492

S. 492, which would require conditioning certain DOL grants
upon States establishing programs to recognize military
experience in its licensing and credentialing programs. This
bill affects programs or laws administered by DOL.
Respectfully, we defer to that Department's views on this bill.

S. 495

Section 5 of S. 495, ``Careers for Veterans Act of 2013,''
would add a new definition to 38 U.S.C. Sec. 8127, VA's VOSB
set-aside acquisition program, to clarify that any small
business concern owned exclusively by Veterans would be deemed
to be unconditionally owned by Veterans. VA supports this
provision.
Section 6 of the bill essentially duplicates the extension
of surviving spouse status previously discussed in conjunction
with section 2 of S. 430. VA supports this provision. Section 7
of this bill essentially duplicates the provisions of section 3
of S. 430. Again, VA supports this provision subject to the
caveat that ``dependent'' be more specifically defined. Last,
section 8 of this bill would add a new subsection to 38 U.S.C.
Sec. 8127 that would eliminate consideration of State community
property laws in verification examinations with respect to
determinations of ownership percentage by the Veteran or
Veterans of businesses located in States with community
property laws. VA supports this provision. VA estimates that no
additional appropriations would be required to implement the
provisions of sections 5 through 8 of S. 495.
Section 2 affects programs or laws administered by OPM and
sections 3 and 4 affect programs or laws administered by DOL.
Respectfully, we defer to those Departments for views on those
sections of S. 495.

* * * * * * *

S. 515

S. 515 would amend title 38, United States Code, to permit
a recipient of the Marine Gunnery Sergeant John David Fry
Scholarship (available to a child of an individual who, on or
after September 11, 2001, dies in the line of duty while
serving on active duty) to be eligible for the ``Yellow Ribbon
G.I. Education Enhancement Program'' (Yellow Ribbon Program),
under the Post-9/11 Educational Assistance Program (Post-9/11
GI Bill). The Yellow Ribbon Program is available to Veterans
and transfer-of-entitlement recipients receiving Post-9/11 GI
Bill benefits at the 100% benefit level attending school at a
private institution or as a non-resident student at a public
institution. The Program provides payment for up to half of the
tuition-and-fee charges that are not covered by the Post-9/11
GI Bill, if the institution enters into an agreement with VA to
pay or waive an equal amount of the charges that exceed Post-9/
11 GI Bill coverage. This bill would take effect at the
beginning of the academic year after the date of enactment.
VA supports S. 515, but has some concerns, expressed below,
that we believe should be addressed. The enactment of this
proposed legislation would require programming changes to VA's
Long Term Solution computer processing system. Obviously
development funding is not available in VA's fiscal year 2013
budget for the changes that would be necessitated by enactment
of this legislation. If funding is not made available to
support them, manual processes would be required, which could
result in some decrease in timeliness and accuracy of Post-9/11
GI Bill claims. The effective date for the proposed legislation
would be the first academic year after enactment, which is also
problematic. VA estimates that it would require one year from
date of enactment to make the system changes necessary to
implement this bill.
VA estimates that if S. 515 were enacted, the costs to the
Readjustment Benefits account would be $609 thousand in the
first year, $3.6 million over 5 years, and $8.4 million over 10
years. There are no additional FTE or GOE costs associated with
this proposal.

* * * * * * *

S. 629

S. 629, the ``Honor America's Guard-Reserve Retirees Act of
2013,'' would add to chapter 1, title 38, United States Code, a
provision to honor as Veterans, based on retirement status,
certain persons who performed service in reserve components of
the Armed Forces but who do not have service qualifying for
Veteran status under 38 U.S.C. Sec. 101(2). The bill provides
that such persons would be ``honored'' as Veterans, but would
not be entitled to any benefit by reason of the amendment.
Under 38 U.S.C. Sec. 101(2), Veteran status is conditioned
on the performance of ``active military, naval, or air
service.'' Under current law, a National Guard or Reserve
member is considered to have had such service only if he or she
served on active duty, was disabled or died from a disease or
injury incurred or aggravated in line of duty during active
duty for training, or was disabled or died from any injury
incurred or aggravated in line of duty or from an acute
myocardial infarction, a cardiac arrest, or a cerebrovascular
accident during inactive duty training. S. 629 would eliminate
these service requirements for National Guard or Reserve
members who served in such a capacity for at least 20 years.
Retirement status alone would make them eligible for Veteran
status.
VA recognizes that the National Guard and Reserves have
admirably served this country and in recent years have played
an even greater role in our Nation's overseas conflicts.
Nevertheless, VA does not support this bill because it
represents a departure from active service as the foundation
for Veteran status. This bill would extend Veteran status to
those who never performed active military, naval, or air
service, the very circumstance which qualifies an individual as
a Veteran. Thus, this bill would equate longevity of reserve
service with the active service long ago established as the
hallmark for Veteran status.
VA estimates that there would be no additional benefit or
administrative costs associated with this bill if enacted.

S. 674

S. 674, the ``Accountability for Veterans Act of 2013,''
would require responses within a fixed period of time from the
heads of covered Federal agencies when the Secretary of
Veterans Affairs requests information necessary to adjudicate
claims for benefits under laws administered by the Secretary.
Covered agencies would include the Department of Defense (DOD),
the Social Security Administration (SSA), and the National
Archives and Records Administration (NARA).
The bill would require covered agencies to provide VA with
requested Federal records within 30 days or submit to VA the
reason why records cannot be obtained within 30 days, along
with an estimate as to when the records could be furnished. If
VA does not receive the records within 15 days after the
estimated date, then VA would resubmit such request and the
agency must, within 30 days, furnish VA with the records or
provide an explanation of why the records have not been
provided and an estimate of when the records will be provided.
The bill would also require VA to provide notices to the
claimant regarding the status of the records requests and to
submit a semiannual report to the Senate and House Committees
on Veterans' Affairs regarding the progress of records requests
for the most recent 6-month period.
VA appreciates this effort to accelerate the response times
when VA requests records from Federal agencies that are
necessary to adjudicate disability claims. However, VA opposes
this bill because adequate measures are already in place to
facilitate expeditious transfer of records from the identified
covered agencies.
Under a recent Memorandum of Understanding (MOU) between VA
and DOD, DOD provides VA, at the time of a Servicemember's
discharge, a 100-percent-complete service treatment and
personnel record in an electronic, searchable format. As this
MOU applies to the 300,000 annually departing Active Duty,
National Guard, and Reserve Servicemembers, it represents a
landmark measure that will significantly contribute to VA's
efforts to achieve its 125-day goal to complete disability
compensation claims.
VA also continues to work with SSA to enhance information
sharing through SSA's Web-based portal, Government to
Government Services Online (GSO). VA and SSA officials confer
weekly to develop strategies to allow VA to more quickly obtain
SSA medical records needed for VA claims. As a result, SSA is
now directly uploading electronic medical records into VBA's
electronic document repository at several regional offices
(RO). These improvements are reducing duplication and
streamlining the records transmittal and review processes. VA
will continue with a phased nationwide deployment of this
initiative for our new paperless processing system, beginning
with the San Juan Regional Office.
VA is also concerned about the requirement to notify the
claimant of the status of records requests. Although these
extra administrative steps would provide additional information
to claimants, they also require more work of claims processors
and thus reduce claims processing capacity in ROs. VA wishes to
concentrate its resources on eliminating the disability claims
backlog.
There are no mandatory costs associated with this proposal.
The discretionary costs associated with this bill cannot be
determined, given the speculative nature of estimating what
additional actions would be required of other Federal agencies.

* * * * * * *

S. 695

S. 695 would amend section 322 of title 38, United States
Code, to extend for 5 years (through FY 2018) the yearly $2
million appropriations authorization for VA to pay a monthly
assistance allowance to disabled Veterans who are invited to
compete for a slot on, or have been selected for, the U.S.
Paralympic Team in an amount equal to the monthly amount of
subsistence allowance that would be payable to the Veteran
under chapter 31, title 38, United States Code, if the Veteran
were eligible for and entitled to rehabilitation under such
chapter. S. 695 also would amend section 521A of title 38 to
extend for 5 years (through FY 2018) VA's appropriations
authorization, with amounts appropriated remaining available
without fiscal year limitation, for grants to United States
Paralympics, Inc. (now the United States Olympic Committee) to
plan, develop, manage, and implement an integrated adaptive
sport program for disabled Veterans and disabled members of the
Armed Forces. These Paralympic programs have experienced
ongoing improvement and expansion of benefits to disabled
Veterans and disabled Servicemembers, to include 115 Veterans
qualifying for the monthly assistance allowance, and over 1,900
Paralympic grant events with over 16,000 Veteran participants
during FY 2012. Under current law, both authorities will expire
at the end of FY 2013.
VA supports extension of these authorities, but recommends
further revisions, to improve the accessibility and equity of
these programs, by extending monthly assistance allowances to
disabled Veterans who are invited to compete for a slot on, or
have been selected for, the United States Olympic Team (not
just the Paralympic Team) or Olympic and Paralympic teams
representing the American Samoa, Guam, Puerto Rico, the
Northern Mariana Islands, and the U.S. Virgin Islands, by
authorizing grants to those Olympic and Paralympic sports
entities, and by clarifying that the current authority to award
grants is to promote programs for all adaptive sports and not
just Paralympic sports.
VA estimates there would be no costs associated with
implementing this bill.

* * * * * * *

S. 748

S. 748, the ``Veterans Pension Protection Act,'' would
amend sections 1522 and 1543 of title 38, United States Code,
to establish in VA's pension programs a look-back and penalty
period of up to 36 months for those claimants who dispose of
resources for less than fair market value that could otherwise
be used for their maintenance.
Subsection (a) would amend the net worth limitations
applicable to Veteran's pension in section 1522 of title 38,
United States Code. If a Veteran (or a Veteran's spouse)
disposes of assets before the date of the Veteran's pension
claim, VA currently does not generally consider those assets as
part of the Veteran's net worth, so long as the transfer was a
gift to a person or entity other than a relative living in the
same household. As amended, section 1522 would provide that
when a Veteran (or Veteran's spouse) disposes of ``covered
resources'' for less than fair market value on or after the
beginning date of a 36-month look-back period, the disposal may
result in a period of ineligibility for pension. In such cases,
the law would provide for a period of ineligibility for pension
beginning the first day of the month in or after which the
resources were disposed of and which does not occur in any
other period of ineligibility.
Subsection (a) would also provide a method for calculating
the period of ineligibility for pension resulting from a
disposal of covered resources at less than fair market value.
The period of ineligibility, expressed in months, would be the
total uncompensated value of all applicable covered resources
disposed of by the Veteran (or the Veteran's spouse) divided by
the maximum amount of monthly pension that would have been
payable to the Veteran under section 1513 or 1521 without
consideration of the transferred resources.
This subsection would also give VA authority to promulgate
regulations under which VA would consider a transfer of an
asset, including a transfer to an annuity, trust, or other
financial instrument or investment, to be a transfer at less
than fair market value, if the transfer reduced the Veteran's
net worth for pension purposes and VA determines that, under
all the circumstances, the resources would reasonably be
consumed for maintenance.
Subsection (a) would also provide that VA shall not deny or
discontinue payment of pension under sections 1513 and 1521 or
payment of increased pension under subsections (c), (d), (e),
or (f) of section 1521 on account of a child based on the
penalty and look-back periods established by sections (a)(2) or
(b)(2) of the bill if: (1) the claimant demonstrates to VA that
the resources disposed of for less than fair market value have
been returned to the transferor; or (2) VA determines that the
denial would work an undue hardship.
Finally, subsection (a) would require VA to inform Veterans
of the asset transfer provisions of the bill and obtain
information for making determinations pertaining to such
transfers.
VA supports in principle the look-back and penalty-period
provisions of subsection (a), but cannot support the bill as
written because of the manner in which the length of the
penalty period would be calculated. Our reading of the bill
indicates that the method used to calculate the penalty period
in proposed section 1522(a)(2)(E)(i), ``the total, cumulative
uncompensated value of all covered resources,'' could be
unnecessarily punitive because VA might have determined that
only a small portion of the covered resources should have been
used for the Veteran's maintenance. VA has similar concerns
with language in proposed section 1522(b)(2)(E)(i).
VA proposes, as an alternative, that the dividend under
proposed section 1522(a)(2)(E)(i) be, ``the total, cumulative
uncompensated value of the portion of the covered resources so
disposed of by the veteran (or the spouse of the veteran) on or
after the look-back date described in subparagraph (C)(i), that
the Secretary determines would reasonably have been consumed
for the Veteran's maintenance;.'' We propose that similar
language be used in section 1522(b)(2)(E)(i).
Apart from the concerns expressed regarding the method for
calculating the penalty period, VA supports this subsection of
the bill, which would clarify current law by prescribing that
pension applicants cannot create a need for pension by gifting
assets that the applicant could use for the applicant's own
maintenance. It would also clarify that an applicant cannot
restructure assets during the 36-month period preceding a
pension application through transfers using certain financial
products or legal instruments, such as annuities and trusts. A
2012 Government Accountability Office study found that there is
a growing industry that markets these products and instruments
to vulnerable Veterans and survivors, potentially causing them
harm. Subsection (a) would amend the law in a manner that will
authorize VA's implementation of necessary program integrity
measures.
Subsection (b) of S. 748 would amend the net worth
limitations applicable to survivor's pension in section 1543 of
title 38, United States Code. Subsection (b) of the bill would
apply to surviving spouses and surviving children the same
restrictions pertaining to disposal of covered resources at
less than fair market value as would be applied to Veterans
under subsection (a). This subsection would also provide that
if the surviving spouse transferred assets during the Veteran's
lifetime that resulted in a period of ineligibility for the
Veteran, VA would apply any period of ineligibility remaining
after the Veteran's death to the surviving spouse.
As with subsection (a), VA supports in principle the look
back and penalty period provisions of subsection (b), but
cannot support the bill as written because of the manner in
which the length of the penalty period would be calculated. VA
has the same concerns with the methodology language in proposed
sections 1543(a)(2)(E)(i) and (b)(2)(E)(i) as expressed above
pertaining to sections 1522(a)(2)(E)(i) and (b)(2)(E)(i).
VA opposes carrying over a penalty based on a transfer of
assets made during the Veteran's lifetime to a pension claim
filed by a surviving spouse because it could be potentially
punitive. Under proposed paragraph (a)(2)(C) of section 1543,
VA would apply the same 36-month look-back period to surviving
spouses that it applies to Veterans. If the Veteran died soon
after his or her pension claim was filed and the surviving
spouse filed a claim for pension within 36 months of the
Veteran's pension claim, VA would evaluate resource transfers
that the surviving spouse made during the Veteran's lifetime
under section 1543(a)(2)(C). However, if the surviving spouse
did not claim pension until many years after the Veteran's
pension claim or many years after the Veteran's death, under
proposed section 1543(a)(2)(F), VA would apply the remainder of
any penalty period assessed the Veteran based on a spouse's
pre-death transfer of assets. In applying a penalty period
based on a very old transaction to a new pension claim, this
provision could be viewed as imposing a much longer look-back
period for surviving spouses than that proposed for Veterans.
Because VA will evaluate the surviving spouse's claim for
pension on its own merits, VA proposes that the penalty-period
carry-over provisions be eliminated.
Subsection (c) would provide that the amendments to section
1522(a)(2), (b)(2), and (c), and section 1543(a)(2), (a)(4),
(b)(2), and (c) prescribed in the bill would take effect one
year after the date of enactment and would apply to
applications filed after the effective date as well as to any
pension redetermination occurring after the effective date.
Subsection (d) provides for annual reports from VA to
Congress, beginning not later than two years after the date of
enactment, as to: (1) the number of individuals who applied for
pension; (2) the number of individuals who received pension;
and (3) the number of individuals whose pension payments were
denied or discontinued because covered resources were disposed
of for less than fair market value.
VA would not oppose inclusion of subsections (c) and (d) if
the bill were amended as we recommend.
We lack sufficient data to estimate benefit or
administrative costs associated with this proposal.

* * * * * * *

S. 894

S. 894 would amend section 3485(a)(4) of title 38, United
States Code, extending for 3 years (through June 30, 2016) VA's
authority to provide work-study allowances for certain already-
specified activities. Under current law, the authority is set
to expire on June 30, 2013.
Public Law 107-103, the ``Veterans Education and Benefits
Expansion Act of 2001,'' established a 5-year pilot program
under section 3485(a)(4) that expanded qualifying work-study
activities to include outreach programs with State Approving
Agencies, an activity relating to the administration of a
National Cemetery or a State Veterans' Cemetery, and assisting
with the provision of care to Veterans in State Homes.
Subsequent public laws extended the period of the pilot program
and, most recently, section 101 of Public Law 111-275, the
``Veterans' Benefits Act of 2010,'' extended the sunset date
from June 30, 2010 to June 30, 2013.
S. 894 also would add a provision to section 3485(a) that
would authorize for a 3-year period from June 30, 2013 to
June 30, 2016, work-study activities to be carried out at the
offices of Members of Congress for such Members. Work-study
participants would distribute information about benefits and
services under laws administered by VA and other appropriate
governmental and non-governmental programs to Servicemembers,
Veterans, and their dependents. Work-study participants would
also prepare and process papers and other documents, including
documents to assist in the preparation and presentation of
claims for benefits under laws administered by VA.
Finally, S. 894 would require VA, not later than June 30
each year beginning with 2014 and ending with 2016, to submit a
report to Congress on the work-study allowances paid during the
most recent 1-year period for qualifying work-study activities.
Each report would include a description of the recipients of
the allowances, a list of the locations where qualifying work-
study activities were carried out and a description of the
outreach conducted by VA to increase awareness of the
eligibility of such work-study activities for work-study
allowances.
VA does not oppose legislation that would extend the
current expiration date of the work-study provisions to
June 30, 2016. However, we would prefer that the legislation
provide a permanent authorization of the work-study activities,
rather than extending repeatedly for short time periods.
VA has no objection to work-study participants conducting
and promoting the outreach activities and services contemplated
by the bill. We also have no objection to work-study
participants assisting in the preparation and processing of
papers and other documents, ``including documents to assist in
the preparation and presentation of claims for VA benefits''
under the proposed new section. However, work-study
participants would be subject to the limitations found in
chapter 59 of title 38 on representing claimants for VA
benefits.
VA does not oppose submitting annual reports to Congress
regarding the work-study program.

* * * * * * *

S. 928

S. 928, the ``Claims Processing Improvement Act of 2013''
would amend title 38, United States Code, to improve the
processing of claims for compensation under laws administered
by the Secretary of VA, and for other purposes. VA will provide
later for the record its views on sections 101,102, 104, 105,
106, and 203 of the draft bill.
Currently, section 5103A(c)(2) of title 38, United States
Code, requires VA, when requesting records on a claimant's
behalf from a Federal department or agency, to continue to
request records until VA obtains them or it is reasonably
certain that such records do not exist or that further efforts
to obtain them would be futile. VA is rarely able to determine
with certainty that particular records do not exist or that
further efforts to obtain them would be futile. Under current
law, VA regional offices experience significant challenges and
delays in their attempts to obtain certain non-VA Federal
records, particularly service treatment records for National
Guard and Reserve members who have been activated. While VA is
currently working with other Federal agencies to improve the
process of procuring non-VA Federal records, past efforts to
obtain records from other government agencies have
significantly delayed adjudication of pending disability
claims.
Section 103 of this draft bill would provide that, when VA
attempts to obtain records from a Federal department or agency
other than a component of VA itself, it shall make not fewer
than two attempts to obtain the records, unless the records are
obtained or the response to the first request makes evident
that a second request would be futile. Section 103 would also
ensure that if any relevant record requested by VA from a
Federal department or agency before adjudication is later
provided, the relevant record would be treated as though it was
submitted as of the date of the original filing of the claim.
This provision would streamline the process for obtaining non-
VA Federal records, would further balance the responsibilities
of VA and Veterans to obtain evidence in support of a claim,
and would allow VA to better address its pending inventory of
disability claims. Section 103 would provide a more feasible
and realistic standard in this time of limited resources and
burgeoning claim inventory, which would help ensure valuable
resources are focused most effectively on what will make a
difference for faster more accurate adjudications of Veterans'
claims.
VA supports section 103 of this bill, which is similar to
one of VA's legislative proposals in the FY 2014 budget
submission.
No benefit costs or savings would be associated with this
section.
Section 104 would amend section 5902(a)(1) of title 38,
United States Code, to include ``Indian tribes'' with the
American National Red Cross, the American Legion, the Disabled
American Veterans, the United Spanish War Veterans, and the
Veterans of Foreign Wars as an enumerated organization whose
representatives may be recognized by the Secretary in the
preparation, presentation, and prosecution of claims under laws
administered by the Secretary.
VA does not support section 104 of S. 928. With the
exception of the American National Red Cross, which provides
services generally as a charitable organization, the
organizations listed in current section 5902(a)(1) have as a
primary purpose serving Veterans. Indian tribes are not
charitable organizations, nor do they have as a primary purpose
serving Veterans; therefore, VA does not believe Indian tribes
should be named among these organizations in the statute. Under
this bill as drafted, all Indian tribes, regardless of their
size, capability, and resources to represent VA claimants,
would essentially receive similar treatment as organizations
recognized by VA for the purpose of providing representation to
VA claimants. In other words, under section 14.629(a) of title
38, Code of Federal Regulations, Indian tribes could certify to
VA that certain members are qualified to represent claimants
before VA for the purpose of obtaining VA accreditation for
those members, despite the tribes not meeting all the
requirements for recognition under section 14.628 of title 38,
Code of Federal Regulations.
Pursuant to the authority granted in section 5902(a), VA
has established in section 14.628 of title 38, Code of Federal
Regulations, the requirements for recognition of organizations
to assist claimants in the preparation, presentation, and
prosecution of claims under laws administered by the Secretary.
Under this regulation, the organization must, among other
requirements, have as a primary purpose serving veterans,
demonstrate a substantial service commitment to Veterans, and
commit a significant portion of its assets to Veterans'
services. VA believes these are necessary characteristics of an
organization whose representatives will be recognized in
providing such assistance to Veterans. Indian tribes
necessarily engage in a much broader scope of governance
activities and operations and, therefore, generally do not have
the Veteran-specific focus that is common to the organizations
(save for the American Red Cross) recognized pursuant to
section 5902(a)(1) of title 38, United States Code, and the VA
regulations implementing that statute.
Currently, a member of an Indian tribe may request
accreditation to assist Veterans in the preparation,
presentation, and prosecution of claims for VA benefits as an
agent or attorney under section 14.629(b) of title 38, Code of
Federal Regulations, or as a representative of a currently
recognized Veterans Service Organization. Thus, a member of an
Indian tribe may be individually recognized by the Secretary to
assist Veterans despite ``Indian tribes'' not being included
among the enumerated organizations in section 5902(a)(1) of
title 38, United States Code.
Section 201 of the bill would amend section 7105(b)(1) of
title 38, United States Code, to require persons seeking
appellate review of a VA decision to file a notice of
disagreement (NOD) within 180 days from the date VA mails such
decision to the claimant. Currently, persons challenging a
decision of a VA agency of original jurisdiction (AOJ) have one
year from the date the AOJ mails the decision to initiate an
appeal to the Board of Veterans' Appeals (Board) by filing a
NOD. This provision would reduce the time period for initiating
appellate review from one year to 180 days.
The intent behind this provision is to allow VA to more
quickly resolve claims and appeals. Currently, VA must wait up
to one year to determine if a claimant disagrees with a
decision on a claim for benefits. If a claimant waits until the
end of the 1-year period to file a NOD, VA is often required to
re-develop the record to ensure the evidence of record is up to
date. Data support the conclusion that such late-term
development delays the resolution of the claim. If the period
in which to file a NOD were reduced, VA could more quickly
finalize the administrative processing of claims not being
appealed and focus resources on the processing of new claims
and appeals. Accordingly, adoption of this proposal would allow
VA to more actively manage cases and work toward a faster
resolution of claims and appeals.
Because most claimants are able to quickly determine if
they are satisfied with VA's decision on their claims and
because the NOD is a relatively simple document, enactment of
this provision would not adversely affect claimants for VA
benefits. The average filing time for NODs demonstrates that
most claimants file their NOD shortly after receiving notice of
VA's decision, and, consequently, claimants would not be
adversely affected by this amendment.
VA supports this provision. VA submitted a similar proposal
with the FY 2014 budget request. While this proposal is clearly
a step in the right direction, VA believes that further changes
are needed in what currently is an extraordinarily lengthy and
cumbersome appellate process in order to provide Veterans with
timely resolution of their appeals. VA believes there is a need
to further shorten the timeframe for Veterans to initiate
appellate review to 60 days. Data show that most appeals are
filed within the first 30 days following notice to a claimant
of VA's decision on a claim. We therefore believe this 60-day
time period would still protect Veterans' rights to appeal VA's
decisions while bringing the appeal filing period more in line
with that of Federal district courts and the Social Security
Administration, which allows 60 days for appeal of the initial
agency decision.
This proposal has no measurable monetary costs or savings.
However, VA estimates that enactment of the proposal would
result in more expeditious adjudication of claims because VA
would not have to wait one year from the date of an adverse
decision to determine whether a claimant intended to file an
appeal. Under this proposal, VA would have to wait only 180
days for such determination and could therefore more timely
process the appeal.
Section 202 would allow for greater use of video conference
hearings by the Board, while still providing Veterans with the
opportunity to request an in-person hearing if they so elect.
This provision would apply to cases received by the Board
pursuant to a NOD submitted on or after the date of the
enactment of the Act. VA fully supports section 202 as drafted,
as this provision would potentially decrease hearing wait times
for Veterans, enhance efficiency within VA, and better focus
Board resources toward issuing more final decisions.
The Board has historically been able to schedule video
conference hearings more quickly than in-person hearings,
saving valuable time in the appeals process for Veterans who
elect this type of hearing. In FY 2012, on average, video
conference hearings were held almost 100 days sooner than in-
person hearings. Section 202 would allow both the Board and
Veterans to capitalize on these time savings by giving the
Board greater flexibility to schedule video conference hearings
than is possible under the current statutory scheme.
Historical data also shows that there is no statistical
difference in the ultimate disposition of appeals based on the
type of hearing selected. Veterans who had video conference
hearings had an allowance rate for their appeals that was
virtually the same as Veterans who had in-person hearings, only
Veterans who had video conference hearings were able to have
their hearings scheduled much more quickly. Section 202 would,
however, still afford Veterans who want an in-person hearing
with the opportunity to specifically request one.
Enactment of section 202 could also lead to more final
decisions for Veterans as a result of increased productivity at
the Board. Time lost due to travel and time lost in the field
due to appellants failing to show up for their hearing would be
greatly reduced, allowing Veterans Law Judges (VLJs) to better
focus their time and resources on issuing decisions. The time
saved for VLJs could translate into additional final Board
decisions for Veterans.
Major technological upgrades to the Board's video
conference hearing equipment over the past several years have
resulted in the Board being well-positioned for the enactment
of section 202. These upgrades include the purchase of high-
definition video equipment, a state-of-the art digital audio
recording system, implementation of a virtual hearing docket,
and significantly increased video conference hearing capacity.
These upgrades also include expanding the video conferencing
system to other strategic satellite sites in the continental
United States, Puerto Rico, Guam, American Samoa, and the
Philippines to support Veterans living in remote areas. Section
202 would allow the Board to better leverage these important
technological enhancements.
In short, section 202 would result in shorter hearing wait
times, better focus Board resources on issuing more decisions,
and provide maximum flexibility for both Veterans and VA, while
fully utilizing recent technological improvements. VA therefore
strongly endorses this proposal.
Section 301 of the bill would extend the authority
currently provided by section 315(b) of title 38, United States
Code, to maintain the operations of VA's Manila RO from
December 31, 2013, to December 31, 2014. Maintaining an RO in
the Philippines has two principal advantages. First, it is more
cost effective to maintain the facility in Manila than it would
be to transfer its functions and hire equivalent numbers of
employees to perform those functions on the U.S. mainland.
Because the Manila RO employs mostly foreign nationals who
receive a lower rate of pay than U.S. Government employees,
transferring that office's responsibilities to a U.S. location
would result in increased payroll costs. Second, VA's presence
in Manila significantly enhances its ability to manage
potential fraud. In an FY 2002 study of Philippine benefit
payments, the VA Inspector General stated: ``VA payments in the
Philippines represent significant sums of money. That, coupled
with extreme poverty and a general lack of economic
opportunity, fosters an environment for fraudulent activity.''
Relocation of claims processing for VA benefits arising from
Philippine service would result in less control of potential
fraud. VA would lose the expertise the Manila staff applies to
these claims and would need time to develop such expertise at a
mainland site. Relocation would also diminish the RO's close
and effective working relationship with the VHA's Outpatient
Clinic, which is essential for the corroboration of the
evidentiary record. Based on these factors, VA could not
maintain the same quality of service to the beneficiaries and
the U.S. Government if claims processing were moved outside of
the Philippines.
VA supports this provision and submitted a similar proposal
with the FY 2014 budget request. VA's version of the proposal
would extend operating authority for 2 years rather than 1
year.
There would be no significant benefits costs or savings
associated with this proposal.
Section 302 of the draft bill would amend section
1156(a)(3) of title 38, United States Code, to extend from 6
months to 18 months the deadline after separation or discharge
from active duty by which VA must schedule a medical
examination for certain Veterans with mental disorders.
Section 1156(a)(3) currently requires VA to schedule a
medical examination not later than 6 months after the date of
separation or discharge from active duty for each 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.'' However, an
examination a mere six months after discharge may lead to
premature conclusions regarding the severity, stability, and
prognosis of a Veteran's mental disorder. Six months is a
relatively short period of treatment, and the stresses of
active-duty trauma and the transition to civilian life may not
fully have manifested themselves after 6 months. An examination
conducted up to 18 months after discharge is more likely to
reflect an accurate evaluation of the severity, stability, and
prognosis of a Veteran's mental disorder.
VA supports section 302 of the bill, which is identical to
one of VA's legislative proposals in the FY 2014 budget
submission.
This provision will not result in cost savings or benefits.
Section 303 of the draft bill would amend section
1541(f)(1)(E) of title 38, United States Code, to extend
eligibility for death pension to certain surviving spouses of
Persian Gulf War Veterans who were married for less than 1
year; had no child born of, or before, the marriage; and were
married on or after January 1, 2001.
Section 1541 authorizes the payment of pension to the
surviving spouse of a wartime Veteran who met certain service
requirements or of a Veteran who was entitled to receive
compensation or retirement pay for a service-connected
disability when the Veteran died. Section 1541(f) prohibits the
payment of such a pension unless: (1) the surviving spouse was
married to the Veteran for at least 1 year immediately
preceding the Veteran's death; (2) a child was born of the
marriage or to the couple before the marriage; or (3) the
marriage occurred before a delimiting date specified in section
1541(f)(1). The current delimiting date applicable to a
surviving spouse of a Gulf War Veteran is January 1, 2001.
Section 303 would eliminate those restrictions and extend that
delimiting date.
The Persian Gulf War Veterans' Benefits Act of 1991
established the delimiting marriage date of January 1, 2001,
when pension eligibility was initially extended to surviving
spouses of Veterans of the Gulf War. However, due to the
duration of the Gulf War, this date is no longer consistent
with the other marriage delimiting dates in section 1541(f)(1).
Generally, these delimiting dates are set for the day following
10 years after the war or conflict officially ended, (e.g., the
Korean War officially ended on January 31, 1955; the applicable
delimiting date is February 1, 1965). As provided in section
101(33) of title 38, United States Code, the official Persian
Gulf War period, which began on August 2, 1990, is still
ongoing and will end on a date to be prescribed by Presidential
proclamation or law. Revising the marriage delimiting date for
surviving spouses of Gulf War Veterans to 10 years and 1 day
after the end of the war as prescribed by Presidential
proclamation or law would make that delimiting date consistent
with the other dates in section 1541(f)(1) and would prevent
any potentially incongruous results in death pension claims
based on Gulf War service compared to claims based on other
wartime service. Furthermore, because the Gulf War has not yet
ended, the language in this amendment would ensure that a
standing 10-year qualifying period will be in place for
surviving spouses seeking pension based on Gulf War service.
VA supports section 303 of the bill, which is identical to
one of VA's legislative proposals in the FY 2014 budget
submission.
There would be no significant benefit costs or savings
associated with this proposal.
Section 304 of the draft bill would amend section 5110(l)
of title 38, United States Code, to make the effective date
provision consistent with section 103(e), which provides: ``The
marriage of a child of a veteran shall not bar recognition of
such child as the child of the veteran for benefit purposes if
the marriage is void, or has been annulled by a court with
basic authority to render annulment decrees unless the
Secretary determines that the annulment was secured through
fraud by either party or collusion.'' Section 103(e) implies
that a child's marriage that is not void and has not been
annulled does bar recognition of the child as a child of the
Veteran for VA benefit purposes, even if the marriage was
terminated by death or divorce. In fact, section 8004 of the
Omnibus Budget Reconciliation Act of 1990 repealed a prior
provision in section 103(e) that ``[t]he marriage of a child of
a veteran shall not bar the recognition of such child as the
child of the veteran for benefit purposes if the marriage has
been terminated by death or has been dissolved by a court with
basic authority to render divorce decrees unless the Veterans'
Administration determines that the divorce was secured through
fraud by either party or collusion.''
Nevertheless, no amendment has been made to the
corresponding effective date provision in section 5110(l),
which still provides an effective date for an award or increase
in benefits ``based on recognition of a child upon termination
of the child's marriage by death or divorce.'' Section 304 of
the bill would delete that provision from section 5110(l) and
make section 5110(l) consistent with section 103(e).
VA supports section 304 of the bill, which is identical to
one of VA's legislative proposals in the FY 2014 budget
submission.
There would be no costs or savings associated with this
technical amendment.
Section 305 of the draft bill would amend section 704(a) of
the Veterans Benefits Act of 2003, Public Law 108-183, which
authorizes VA to provide for the conduct of VA compensation and
pension examinations by persons other than VA employees by
using appropriated funds other than mandatory funds
appropriated for the payment of compensation and pension. In
accordance with section 704(b), VA exercises this authority
pursuant to contracts with private entities. However, under
section 704(c), as amended by section 105 of the Veterans'
Benefits Improvement Act of 2008, by section 809 of the
Veterans' Benefits Act of 2010, and by section 207 of the VA
Major Construction Authorization and Expiring Authorities
Extension Act of 2012, this authority will expire on
December 31, 2013.
Section 305(a) of the bill would extend VA's authority to
provide compensation and pension examinations by contract
examiners for another year. The continuation of this authority
is essential to VA's ability to continue to provide prompt and
high-quality medical disability examinations for our Veterans.
If this authority is allowed to expire, VA will not be able to
provide contracted disability examinations to Veterans in need
of examinations. Extending the authority for another year would
enable VA to effectively utilize supplemental and other
appropriated funds to respond to increasing demands for medical
disability examinations. Contracting for examinations is
essential to VA's objective of ensuring timely adjudication of
disability compensation claims and allows the VHA to better
focus its resources on providing needed heath care to Veterans.
Section 305(b) of the bill would require VA to provide to
the House and Senate Committees on Veterans' Affairs a report
within 180 days of enactment of the bill. The report would have
to include extensive information regarding medical exams
furnished by VA from FY 2009 to FY 2012. Similarly, section
305(c) would require VA to provide a report to the same
committees in the same timeframe regarding Acceptable Clinical
Evidence.
VA supports section 305(a) of this bill and submitted a
similar proposal with the FY 2014 budget request. VA's version
of the proposal would extend operating authority for five years
rather than one year.
VA does not oppose the reporting requirements of sections
305(b) and 305(c); however, one year rather than 180 days would
provide adequate time to compile the data needed to comply with
the detailed reporting requirements and to adequately
coordinate review of the report before submission.
No benefit or administrative costs would result from
enactment of this provision.

S. 939

Section 1 of this draft bill would amend section 7103 of
title 38, United States Code, to provide that the Board of
Veterans' Appeals (Board) or Agency of Original Jurisdiction
(AOJ) shall treat any document received from a person adversely
affected by a decision of the Board expressing disagreement
with that Board decision as a motion for reconsideration when
that document is submitted to the Board or AOJ not later than
120 days after the date of the Board decision and an appeal
with the United States Court of Appeals for Veterans Claims
(Veterans Court) has not been filed. The section would further
explain that a document will not be considered as a motion for
reconsideration if the Board or AOJ determines that the
document expresses an intent to appeal the decision to the
Court and forwards the document to the Court in time for
receipt before the appeal filing deadline. As explained below,
VA has several concerns with the draft legislation.
Proposed new section 7103(c)(1) would state that a document
filed within 120 days of a Board decision that ``expresses
disagreement with such decision'' shall be treated as a motion
for reconsideration. We believe this draft standard would prove
too vague and would result in an excessive amount of
uncertainty for reviewers determining how to classify a piece
of correspondence. The Board and AOJ receive a significant
amount of correspondence on a regular basis. The fact that a
piece of correspondence is received at the Board or AOJ after a
Board decision does not necessarily mean that the appellant
intends to challenge that Board decision, nor does it
necessarily indicate an expression of disagreement with a Board
decision. An appellant could be contacting VA to challenge a
Board decision by way of a motion to vacate the decision, a
motion to revise the decision based on clear and unmistakable
error, or a motion for reconsideration--all types of motions
that imply some level of disagreement. Additionally, an
appellant could be contacting VA after a Board decision to file
a new claim, reopen an old claim, check on the status of a
claim, or simply express a generalized complaint, without
intending to initiate an appeal. In order for Board or AOJ
correspondence reviewers to be able to properly identify an
appellant's intent from a piece of correspondence, it is not
unreasonable to require the appellant to articulate the purpose
of his or her correspondence and the result he or she is
seeking. Allowing an appellant to seek reconsideration by
merely expressing disagreement with a final Board decision
would not provide reviewers with sufficient ability to
distinguish whether the appellant is seeking a motion for
reconsideration or some other legitimate action, such as a
motion to vacate a Board decision or a motion to challenge
based on clear and unmistakable error. This broad standard
would, in turn, result in greater uncertainty and delay in an
already heavily burdened system while benefiting few Veterans.
The current proposal's broad language will likely lead to
reconsideration rulings in cases where the appellant was not
seeking further appellate review and would occupy limited
adjudicative resources, thus delaying the claims of other
Veterans.
Under section 20.1001(a) of title 38, Code of Federal
Regulations, a motion for reconsideration must ``set forth
clearly and specifically the alleged obvious error, or errors,
of fact or law in the applicable decision, or decisions, of the
Board or other appropriate basis for requesting
Reconsideration.'' Further, the discretion of the Chairman or
his delegate to grant reconsideration of an appellate decision
is limited to the following grounds: (a) upon allegation of
obvious error of fact or law; (b) upon discovery of new and
material evidence in the form of relevant records or reports of
the service department concerned; or (c) upon allegation that
an allowance of benefits by the Board has been materially
influenced by false or fraudulent evidence submitted by or on
behalf of the appellant. Although VA construes all claimants'
filings liberally, under these governing regulations, a
document that expresses general disagreement with a Board
decision would not be construed a motion for reconsideration.
The draft legislation would, however, require VA to
consider such general statements of dissatisfaction or
disagreement to be motions for reconsideration, thereby
considerably broadening and weakening the standard required to
render a Board decision nonfinal. This could cause confusion
among correspondence reviewers. In fact, the standard
contemplated by the draft legislation would be lower than the
standard used to determine whether a document is a notice of
disagreement (NOD) with an AOJ decision, pursuant to section
20.201 of title 38, Code of Federal Regulations.
Moreover, the language of proposed new section 7103(c)(1)
indicates that the lower standard would only apply to documents
submitted within the 120-day period for appeal to the Veterans
Court. This would essentially result in two standards being
applied to motions for reconsideration based on whether the
appellant submits the motion before or after the 120-day appeal
period. Such different standards would understandably result in
confusion in determining whether a document is a
reconsideration motion.
Proposed new section 7103(c)(2) indicates that VA will not
treat a submitted document as a motion for reconsideration if
VA determines that the document expresses an intent to appeal
the Board decision to the Veterans Court and forwards that
document to the court, and the court receives the document
within the statutory deadline to appeal the Board decision. The
draft legislation appears to make VA's determination of whether
a document is a motion for reconsideration or a notice of
appeal (NOA) to the Veterans Court partially contingent upon
whether VA forwards the document to the court and the court
timely receives it. Yet court decisions have found equitable
tolling may apply in situations where VA timely received a
misfiled NOA, but the Veterans Court did not timely receive it.
The bill would give VA the authority to potentially take away a
course of action from an appellant. The legislation would
essentially provide VA with the authority to determine whether
a document is an NOA based in part on whether VA can timely
forward the document to the Veterans Court. This would prevent
an appellant who timely misfiled an NOA with VA from having an
opportunity to have the court determine whether equitable
tolling applies and whether the court will accept the misfiled
submission as timely. Further, an appellant may have been
seeking to file a motion for reconsideration with the Board.
However, if VA determines that a document is an NOA instead of
a motion for reconsideration, VA may inadvertently prevent an
appellant from having the Board consider his or her motion for
reconsideration. Consequently, the proposed legislation would
pose a number of legal and practical difficulties.

Mr. Chairman, this concludes my statement. Thank you for
the opportunity to appear before you today. I would be pleased
to respond to questions you or the other Members may have.
------

Enclosure:
VA Views

S. 422, CHIROPRACTIC CARE AVAILABLE TO ALL VETERANS ACT OF 2013

VA provided views on S. 422 in our testimony on May 9,
2013. In general, VA supports the intent of S. 422, but
believes the decision to provide on-site or fee care should be
determined based on existing clinical demands and business
needs. Chiropractic care is available to all Veterans and is
already part of the standard benefits package. As VA increases
the number of VA sites providing on-site chiropractic care, we
will be able to incrementally assess demand for chiropractic
services and usage, and to best determine the need to add
chiropractic care at more sites.
Currently, VA does not have an assessment that would
support providing on-site chiropractic care at all VAMCs by the
end of 2016. Such a mandate could potentially be excessive,
given the availability of resources for on-site chiropractors
and non-VA care to meet the current need for services. VA does
not object to sections 3(a) and (b) as those changes reflect
VA's consideration of chiropractic care as properly part of
what should be considered medical and rehabilitative services.
VA, however, cannot support section 3(c) for lack of a
conclusive consensus on the use of chiropractic care as a
preventative intervention. VA estimates the costs associated
with S. 422 to be $4.99 million in FY 2014; $26.8 million over
five years; and $59 million over ten years.

S. 522, WOUNDED WARRIOR WORKFORCE ENHANCEMENT ACT

Section 3 of S. 522 would require VA to award a $5 million
grant to an institution to: (1) establish the Center of
Excellence in Orthotic and Prosthetic Education (the Center)
and (2) improve orthotic and prosthetic outcomes by conducting
orthotic and prosthetic-based education research. Under the
bill, grant recipients must have a robust research program;
offer an education program that is accredited by the National
Commission on Orthotic and Prosthetic Education in cooperation
with the Commission on Accreditation of Allied Health Education
Programs; be well recognized in the field of orthotics and
prosthetics education; and have an established association with
a VA medical center or clinic and a local rehabilitation
hospital. This section would require VA to give priority in the
grant award to an institution that has, or is willing and able
to enter into: (1) a memorandum of understanding with VA, the
Department of Defense (DOD), or other Government agency; or (2)
a cooperative agreement with a private sector entity. The
memorandum or agreement would provide resources to the Center
or assist with the Center's research. VA would be required to
issue a request for proposals for grants not later than 90 days
after the date of enactment of this provision.
VA does not support section 3 because VA would not have
oversight of the Center and there would be no guarantee of any
benefit to VA or Veterans. Further, we believe that a new
Center is unnecessary. DOD has an Extremity Trauma and
Amputation Center of Excellence (EACE), and VA works closely
with EACE to provide care and conduct scientific research to
minimize the effect of traumatic injuries and improve outcomes
of wounded Veterans suffering from traumatic injury. VA also
has six Research Centers of Excellence that conduct research
related to prosthetic and orthotic interventions, amputation,
and restoration of function following trauma:

1. Center of Excellence for Limb Loss Prevention and
Prosthetic Engineering in Seattle, WA.
2. Center of Excellence in Wheelchairs and Associated
Rehabilitation Engineering in Pittsburgh, PA.
3. Center for Functional Electrical Stimulation in
Cleveland, OH.
4. Center for Advanced Platform Technology (APT) in
Cleveland, OH.
5. Center for Neurorestoration and Neurotechnology in
Providence, RI.
6. Maryland Exercise and Robotics Center of Excellence
(MERCE) in Baltimore, MD.

These centers provide a rich scientific environment in
which clinicians work closely with researchers to improve and
enhance care. They are not positioned to confer terminal
degrees for prosthetic and orthotic care/research but they are
engaged in training and mentoring clinicians and engineers to
develop lines of inquiry that will have a positive impact on
amputee care. Finally, the requirement to issue a request for
proposals within 90 days of enactment would be very difficult
to meet as VA would first need to promulgate regulations prior
to being able to issue the RFP.
VA estimates that sections 2 (views previously provided)
and 3 of S. 522 would cost $160,000 in FY 2014 and $21.7
million over 5 years.

* * * * * * *

S. 832, IMPROVING THE LIVES OF CHILDREN WITH SPINA BIFIDA
ACT OF 2013

Section 2 of S. 832 would require VA to carry out a three-
year pilot program to assess the feasibility and advisability
of furnishing children of Vietnam Veterans and certain Korea
service Veterans born with spina bifida and children of women
Vietnam Veterans born with certain birth defects with case
management services under a national contract with a third
party. The Secretary would have the option to extend the
program for an additional 2 years.
Under the bill, a covered individual is any person who is
entitled to health care under chapter 18 of title 38 and who
lives in a rural area and does not have access to case
management services. The Secretary would be responsible for
determining the appropriate number of covered individuals to
participate in the pilot. S. 832 would require VA to provide
these individuals with coordination and management of needed
health care, monetary, and general care services authorized
under Chapter 18; transportation services; and such other
services as the Secretary considers appropriate. The bill would
also require the Secretary to inform all covered individuals of
the services available under the pilot program and to submit
preliminary and final reports to the Senate and House
Committees on Veterans Affairs.
VA supports section 2 of the bill but notes that VA already
has authority to provide case management services, and
currently reimburses beneficiaries for case management services
by an approved provider. Support of section 2 of S. 832 is
contingent on appropriation of any additional funds for
services beyond what are currently provided by VA. See 38
U.S.C. Sec. 1803(c)(1)(A). In addition, VA is reviewing the
viability of providing case management via contract to increase
access to these services to all covered beneficiaries,
including those in rural areas. As this beneficiary population
ages into adulthood, increased case management and care
coordination services are needed to meet their unique health
care challenges, and a systematic approach to offering these
services may better serve this group of beneficiaries.
In addition, VA has several technical comments to the bill
language. As noted above, section 2(e)(2) would require VA to
provide ``transportation services'' to all covered individuals
in the program. These services could include transportation for
both health care purposes and personal purposes such as for
vacations etc. The services could also include transportation
for visiting family and friends and for those providing health
care and other services to the covered individuals. It is
unclear whether the Committee intends to require VA to provide
the full extent of transportation services described above and
not permit VA to limit transportation services provided. If
this is not the case, we recommend that the Committee clearly
authorize VA to limit the scope of transportation services by
adding ``as the Secretary considers appropriate'' after
``transportation services'' in section 3(e)(2).
As noted above, section 2(e)(1) would require VA to provide
``[c]oordination and management of needed health care,
monetary, and general care services authorized under chapter 18
of title 38, United States Code.'' The reference to ``monetary,
and general care services'' is confusing. The term ``health
care'' is already defined in chapter 18, and that definition
does not include monetary and general care services. It is
unclear whether monetary and general care services are intended
to be services in addition to what is included in the
definition of ``health care.'' If so, we recommend revising
this provision to read: ``[c]oordination and management of
needed health care authorized under chapter 18 of title 38,
United States Code, and monetary and general care services.''
We further recommend defining the terms ``monetary services''
and ``general care services.'' Finally, we note that section
2(a) would require VA to enter into ``a national contract with
a third party entity'' to carry out the pilot program while
section 2(f)(2) would require VA to enter into ``contracts''
for the same purpose. It may be possible to provide these
services through a national contract but in case that is not
feasible, we would prefer the flexibility to enter into
contracts regionally as needed. Accordingly, we recommend
replacing the words ``a national contract with a third party
entity'' in section 2(a) with the words ``contracts with third
party entities.''
VA estimates the total costs for section 2, including case
management, care coordination and oversight, to be $3.024
million in FY 2014; $15.98 million over five years; and $36.97
million over ten years.
Section 3 of S. 832 would require VA to carry out a three-
year pilot program to assess the feasibility and advisability
of providing assisted living, group home care, and similar
services in lieu of nursing home care to covered individuals.
The Secretary would have the option to extend the pilot for an
additional two years. Section 3(d) of the bill would require VA
to provide covered individuals with assisted living, group home
care, or such other similar services; transportation services;
and such other services as the Secretary considers appropriate.
The bill would also direct the Secretary to provide covered
individuals with notice of the services available under the
pilot; to consider contracting with appropriate providers of
these services; and to determine the appropriate number of
covered individuals to be enrolled in the pilot and criteria
for enrollment. Section 3 of the bill would also specify
preliminary and final reporting requirements.
VA does not support section 3 of the S. 832. The provision
would extend benefits to spina bifida beneficiaries beyond what
VA is authorized to provide to Veterans, including service-
connected veterans. Service-connected Veterans who need
assisted living, group home care, and similar services are
equally deserving of receiving these benefits.
VA is unable to develop an accurate cost estimate at this
time; however, we have several technical comments to the bill
language. Section 3(a) would require VA to commence carrying
out this program not later than 180 days after enactment of
this Act. This would not be sufficient time because VA would be
required to issue regulations, including a notice and public
comment period, prior to carrying out this program. In
particular, regulations would be required to define assisted
living and group home care, to designate what services are
similar to assisted living and group home care, and to identify
any other services appropriate for the care of covered
individuals under the pilot program. Finally, VA would be
required by regulation to establish the criteria for enrollment
of the appropriate number of covered individuals.
By requiring VA to carry out the program of providing
assisted living, group home care, or similar services to
covered individuals ``in lieu of nursing home care,'' VA could
only provide these services if the spina bifida beneficiary
would otherwise need nursing home care. We question whether
many spina bifida beneficiaries who need nursing home care
could be provided care instead in assisted living facilities,
group homes or similar institutions. The Committee may wish to
consider deleting the reference to ``in lieu of nursing home
care.''
Section 3(b) defines ``covered individuals'' for purposes
of this section to be spina bifida beneficiaries who are
entitled to health care under subchapter I or III of chapter 18
of title 38, United States Code. This would include many
beneficiaries who do not need assisted living, group home care,
or similar services. The scope of services that VA is required
to provide under this program includes services that could be
useful to these beneficiaries even if they do not need assisted
living, group home care, or similar services. These services
include transportation services and such other services as the
Secretary considers appropriate for the care of covered
individuals under the program. This section thus could be
interpreted to require VA to provide these additional services
to covered beneficiaries even if they are not in need of
assisted living, group home care, or similar services in lieu
of nursing home care. If the Committee intends this program to
be for only spina bifida beneficiaries who need care in
assisted living facilities, group homes or similar
institutions, we recommend amending the definition of covered
individual to require that they be determined to need assisted
living, group home care, or similar services.
As noted above, section 3(d)(2) would require VA to provide
``transportation services'' to all covered individuals in the
program. These services could include transportation for both
health care purposes and personal purposes such as for
vacations. The services could also include transportation for
visiting family and friends and for those providing health care
and other services to the covered individuals. It is unclear
whether the Committee intends to require VA to provide the full
extent of transportation services described above and not
permit VA to limit transportation services provided. If this is
not the case, we recommend that the Committee clearly authorize
VA to limit the scope of transportation services by adding ``as
the Secretary considers appropriate'' after ``transportation
services.''
Section 3(g) would limit funding for this program to
amounts appropriated or otherwise made available before the
date of enactment of this Act. This would severely limit
funding for the program. We suggest deleting ``before the date
of enactment of this Act.''
Finally, this section does not provide for what happens to
covered beneficiaries who are in assisted living when the pilot
ends, who have no place else to go, and who have insufficient
personal funds to stay in their current location. Although VA
does not support section 3 of S. 832, if enacted we recommend
authorizing VA to continue providing assisted living, group
home care, or similar services to those who had received these
services prior to the completion of the program to avoid
adverse impact on this population.

S. 845, TO IMPROVE THE PROFESSIONAL EDUCATIONAL
ASSISTANCE PROGRAM

VA supports S. 845, which would amend 38 U.S.C. Sec. 7619
by eliminating the December 31, 2014 sunset date for the Health
Professionals Scholarship Program (HPSP). The HPSP authorizes
VA to provide tuition assistance, a monthly stipend, and other
required education fees for students pursing education/training
that would lead to an appointment in a healthcare profession.
This program will help VA meet future need for health care
professionals by obligating scholarship recipients to complete
a service obligation at a VA health care facility after
graduation and licensure/certification.
Extending this program for an additional five years would
allow VA to offer additional scholarships to satisfy
recruitment and retention needs for critical health care
providers. The regulation development process is lengthy,
involving legal review and public comment, and VHA anticipates
that final HPSP regulations will be published by early 2014. If
HPSP expires in December 2014, the program would be in
operation for less than one academic year.
VA estimates that this bill would cost $850,000 in FY 2014
and $23.73 million over five years.

* * * * * * *

S. 852, VETERANS HEALTH PROMOTION ACT OF 2013

Section 2 of S. 852, the Veterans Health Promotion Act of
2013 would require VA, acting through the Director of the
Office of Patient Centered Care for Cultural Transformation
(OPCC&CT), to operate at least one center of innovation for
complementary and alternative medicine (CAM) in health
research, education and clinical activities in each VISN.
Section 3 of the bill would require VA to establish a 3-
year pilot program through OPCC&CT to assess the feasibility
and advisability of establishing CAM centers within VA medical
centers to promote the use and integration of such services for
mental health diagnoses and pain management. The pilot would
operate in no fewer than 15 separate medical centers and would
provide voluntary CAM services to Veterans with a mental health
condition diagnosed by a VA clinician or a pain condition for
which the Veteran has received a pain management plan from a VA
clinician. Section 3 would also impose quarterly and final
reporting requirements.
VA supports sections 2 and 3 of S. 852. CAM practices
already are widespread within VA, although with significant
variation. According to the National Institute of Health (NIH)
National Center for Complementary and Alternative Medicine
(NCCAM), defining CAM is difficult. Thus, VA recommends using
the term ``Integrative Health'' (IH) instead. In addition,
because IH impacts the entire spectrum of healthcare and
involves practitioners across healthcare professions and all
points of care, VA recommends that the legislation not limit
the provision of care to clinicians who provide IH services
exclusively.
VA supports an integrated implementation of sections 2 and
3 that could build on the existing infrastructure within VHA
and OPCC&CT that could include: (1) Expanding the capacity of
existing VHA OPCC&CT Centers of Innovation to serve as National
Integrative Health Centers of Innovation to develop and
implement innovative clinical activities and systems of care,
serve as regional learning centers, and work collaboratively
with the identified pilot sites; (2) Creating additional sites
of innovation (i.e., one in each VISN) that could develop
specific models for the delivery of Integrative Health,
including CAM; (3) Expanding the OPCC&CT Field Implementation
Teams and educational initiatives to include IH and IH coaching
to support the implementation of these sites/pilot projects;
(4) Creating a national strategy and to address any barriers to
implementation identified through the pilot and Centers of
Innovation; and (5) Developing an evaluation strategy to assess
impact.
These pilots would also operate in conjunction with
existing initiatives, including the Mental Health Innovations
Committee, the VA/DOD Health Executive Council's Pain
Management Work Group, VHA's National Pain Office, and IH pilot
projects being undertaken at three Polytrauma Centers by
OPCC&CT and the Physical Medicine and Rehabilitation Service
National Program Office. Building on these pilots, VA
recommends the legislation specify a total of ``up to five''
pilot projects at Designated Polytrauma Centers rather than
five. The funding source for this proposed legislation is
unclear, and implementation of sections 2 and 3 would be
problematic without additional funding.
Section 4 of S. 852 would require VA to carry out a 3-year
pilot program through the award of grants to public or private
nonprofit entities to assess the feasibility and advisability
of using wellness programs to complement the provision of
mental health care to veterans and family members eligible for
counseling under 38 U.S.C. 1712A(a)(1)(C). Grantees would be
required to periodically report to the Secretary, and VA in
turn would report to Congress every 180 days during the pilot
period.
VA supports section 4 but recommends that contracts be used
instead of grants, because of the limited ability to fund
grants within existing VA funding authority. In addition, VA
uses the term ``well-being'' instead of wellness because well-
being is a broader concept that incorporates whole person
health, inclusive of mind, body and spirit.
As a component of the pilots identified in section 3 of
S. 852, VA would pilot at up to five sites the use of wellness
programs as a complementary approach to mental health care.
This would be accomplished by training peers, volunteers, and
patient advocates as IH coaches who will link Veterans to
community organizations that can provide support focused on the
Veterans' health and well-being, including self-development and
spirituality, concepts that until recently were not associated
with traditional medical care in the United States.
Section 5 of S. 852 would require VA to carry out a 2-year
pilot program through the National Center for Preventive Health
to assess the feasibility and advisability of promoting health
in covered Veterans through support for fitness center
membership. Covered Veterans would be defined as any Veteran
who is determined by a VA clinician to be overweight or obese
at the commencement of the pilot and who resides more than 15
minutes driving distance from a fitness center at a VA facility
that would otherwise be open to the public for at least 8
hours, 5 days a week. The program would be piloted at no less
than ten VA medical centers. VA would cover the full reasonable
cost of a fitness center membership at a minimum of five
locations; VA would cover half of the reasonable membership
costs at a minimum of five other locations.
Section 6 of S. 852 would require VA to carry out a 3-year
pilot program to assess the feasibility and advisability of
promoting health in covered Veterans through the establishment
of VA fitness facilities at no fewer than five VA medical
centers and five VA outpatient clinics. Covered Veterans would
include any Veteran enrolled under 38 U.S.C. 1705. In selecting
locations, VA would consider rural areas and areas not in close
proximity to an active duty military installation. Section 6
would set a $60,000 cap on spending for a fitness facility at a
VA medical center and a $40,000 cap on spending for a facility
at an outpatient clinic. Under the bill, VA could not assess a
fee for use of the facilities.
VA strongly supports the intent of sections 5 and 6 to
support physical activity interventions for overweight or obese
and all Veterans because of the substantial evidence that
physical activity has significant health benefits and is an
important component of weight management and other chronic
disease self-management strategies, but does not support the
provisions as drafted.
VA is committed to providing effective physical fitness
education, training, and support for all Veterans to enhance
their health and well-being. VA has a number of programs
available for Veterans, both young and old, that encourage
regular physical activity. The Gerofit program is an example of
an effective physical activity intervention for frail elderly
Veterans. A new program has been developed to reach overweight/
obese Veterans in the MOVE! Weight Management Program who
receive care in outpatient clinics. This program uses
telehealth technology to provide group sessions, led by a
physical activity specialist at a VA medical center, to
multiple outpatient clinic sites simultaneously.
Costs for this bill are still under development, but we
believe it could be challenging to implement the programs in
this Bill on a system-wide scale. Constructing space in medical
centers and outpatient clinics for fitness centers may not be
feasible in many locations. As noted above, we are committed to
encouraging physical activity and VA will continue to develop
cost effective and innovative ways to support active, healthy
lifestyles for all Veterans.
Section 7 of S. 852 would require VA to enter into a
contract to study the barriers encountered by Veterans in
receiving CAM from VA. Specifically, VA would study the
perceived barriers associated with obtaining CAM, the
satisfaction of Veterans with CAM in primary care, the degree
to which Veterans are aware of eligibility for and scope of CAM
services furnished by VA, and the effectiveness of outreach to
Veterans about CAM. The head of specified VA departments would
be required to review the results of the study and to submit
findings to the Under Secretary for Health.
VA supports section 7 of the bill. The current healthcare
system supports conventional approaches to prevention and
disease care. Barriers exist and need to be addressed in order
to optimize and incentivize health and well-being. VA would
coordinate research activities around the design, diffusion,
and evaluation of IH. The creation and diffusion of the IH
initiative will be informed by Veterans and VA healthcare team
end users. VA recommends studies in two areas of focus: (1)
Veteran and healthcare team end users, and (2) system
properties. With respect to the first area, VA could ascertain
from Veterans VHA healthcare team end users their experiences
with IH and the real and perceived barriers to IH. With respect
to the second area of focus, VA could study the current VHA
system and other barriers (laws, policies, business practices,
workload capture, credentialing and privileging, etc.) that
support or impede the delivery of IH.
Findings of a comprehensive report would inform
recommendations for system changes and program design and
implementation. VA would coordinate and oversee the writing,
approval process, and dissemination of the report. VA estimates
the requirements of this section would cost approximately
$2,000,000.
Section 8 would define the term ``complementary and
alternative medicine'' to have the meaning in 38 U.S.C. 7330B,
as added by section 2 of the bill. As stated in sections 2 and
3 above, VA recommends using the term Integrative Health
instead of CAM.
VA is working to develop a complete cost estimate for this
bill. As noted in the views, fully implementing an enterprise
wide system of integrative health and complementary alternative
medicine is complex and would include multiple types of
clinicians, clinical practices and new products and services.
On a smaller scale, the same is true for pilot sites. VA is
analyzing the multiple components that would go into the full
cost estimate and will provide to the Committee upon completion
of this analysis.

S. 877, THE VETERANS AFFAIRS RESEARCH TRANSPARENCY ACT OF 2013

S. 877, the ``Veterans Affairs Research Transparency Act of
2013,'' would permit public access to research results on VA
Web sites. Specifically, the bill would require VA to make
available data files that contain information on research, data
dictionaries on data files for research, and instructions how
to access such files. Under the bill, VA would also be required
to create a digital archive of peer-reviewed manuscripts that
use such data. Finally, the bill would direct VA to submit to
the Senate and House Committees on Veterans Affairs annual
reports that include the number, title, authors, and manuscript
information for each publication in the digital archive.
VA supports the objectives of this bill but does not
believe that legislation is needed to achieve them. Key
elements of S. 877 are already covered by the February 22, 2013
memorandum from the Office of Science and Technology Policy
(OSTP) regarding ``Increasing Access to the Results of
federally Funded Scientific Research.'' Efforts are already
underway to coordinate governmentwide compliance with the OSTP
memorandum.
VA believes that transparency is most effectively
accomplished using PubMed Central, an archive maintained by the
NIH. VHA Office of Research and Development is negotiating with
NIH with the objective of disseminating published findings
using this vehicle. Using this common platform to disseminate
VA funded research would be more cost-effective and would
better serve the needs of the Federal and non-Federal research
community.
VA estimates the costs associated with this bill to be
$107,518 in FY 2014; $1.46 million over five years, and $8.8
million over ten years for the entire research program.
------

Enclosure:
VA Views

* * * * * * *

S. 735

S. 735, the ``Survivor Benefits Improvement Act of 2013,''
would amend title 38, United States Code, to improve benefits
and assistance provided to surviving spouses of Veterans under
laws administered by the Secretary of VA and for other
purposes.
Section 2 of this bill would amend section 1311 of title
38, United States Code, by extending, from 2 to 5 years, the
period for increased dependency and indemnity compensation
(DIC) for surviving spouses with children. VA supports the
extended period of eligibility, subject to Congress identifying
the appropriate offsets. The bill extends the with-children
increase period by 3 additional years. Benefits costs
associated with section 2 are estimated to be $5.6 million
during the first year, $72.1 million for 5 years, and $199.3
million over 10 years.
Section 3 of S. 735 would extend eligibility for DIC, heath
care, and home loan guaranty benefits to surviving spouses who
remarry after age 55. Currently, such benefits may be granted
to surviving spouses who remarry after age 57. VA supports this
provision because it would make consistent VA's provision of
benefits and health care to surviving spouses. Under section
103(d)(2)(b) of title 38, United States Code, remarriage after
age 55 is not a bar to health care benefits. On December 16,
2003, Congress enacted the Veterans Benefits Act of 2003, which
for the first time gave certain surviving spouses the right to
retain VA benefits after remarriage. Prior law required VA to
terminate those benefits upon remarriage regardless of the age
of the surviving spouse.
There will be no additional costs for health care as, under
section 103(d)(2)(b) of title 38, United States Code,
remarriage after age 55 is not a bar to health care benefits.
Regarding costs associated with home loans, the provision would
produce negligible estimated subsidy costs over 10 years
because of a very small change expected in loan volume. We do
not currently have an estimate of the costs associated with
additional DIC eligibility.
Section 4 of S. 735 would provide benefits to children of
certain Thailand service Veterans born with spina bifida. The
Spina Bifida Health Benefits Program was originally enacted for
the birth of children with spina bifida to Vietnam Veterans
based on evidence of an increased incidence of spina bifida
among Veterans exposed to herbicides. The program was later
expanded to include the children with spina bifida of certain
Veterans whom the Veterans Benefits Administration (VBA)
determined had been exposed to herbicides in Korea. The
proposed bill would incorporate language from Subchapter I of
Chapter 18 regarding spina bifida benefits for children of
Vietnam Veterans and from Subchapter II, section 1821,
regarding spina bifida benefits for children of Veterans with
covered service in Korea. The covered service in this proposed
bill is defined as ``active military, naval, or air service in
Thailand, as determined by the Secretary in consultation with
the Secretary of Defense, during the period beginning on
January 9, 1962, and ending on May 7, 1975,'' in which an
individual ``is determined by the Secretary, in consultation
with the Secretary of Defense, to have been exposed to a
herbicide agent during such service in Thailand.'' The proposed
bill goes on to define ``herbicide agent'' as ``a chemical in a
herbicide used in support of United States and allied military
operations in Thailand, as determined by the Secretary in
consultation with the Secretary of Defense, during the period
beginning on January 9, 1962, and ending on May 7, 1975.''
VA supports section 4, pending congressional funding, which
would provide benefits for this population similar to the
benefits offered to those eligible under the Spina Bifida
Health Care Benefits Program. However, there are several
aspects that may limit its application. The benefit it seeks to
provide to children of Veterans with Thailand service is based
on the premise that the parent Veteran was exposed to the
herbicide Agent Orange with its carcinogenic element dioxin,
and that this contributed to the spina bifida. Veterans with
service in Vietnam from January 9, 1962, to May 7, 1975, are
presumed exposed to this herbicide based on section 1116 of
title 38, United States Code. Veterans with service in certain
units located on the Korean demilitarized zone (DMZ) from
April 1, 1968, to August 31, 1971, are also given the
presumption of exposure under section 3.307(a)(6)(iv) of title
38, Code of Federal Regulations. This presumption is the basis
for the child's spina bifida benefits. However, there is no
presumption of Agent Orange exposure for service in Thailand,
and DOD has stated that only commercial herbicides were used
within the interiors of military installations in Thailand. As
a result, there is some question as to how the proposed bill's
``covered service'' in Thailand would be applied.
Although there is no applicable presumption of herbicide
exposure for purposes of identifying ``covered service'' in
Thailand, there is some evidence supporting the possibility
that tactical herbicides, such as Agent Orange, may have been
used on the fenced-in perimeters of Thailand air bases during
the Vietnam War. Some evidence for this is found in the 1973
DOD document ``CHECO Report: Base Defense in Thailand,'' which
emphasizes the security role of herbicides within the fenced-in
perimeters, but does not specifically identify the herbicide
type. As a result, VA has given the benefit of the doubt to
those Veterans who walked the perimeters as dog handlers or
security guards and has acknowledged their exposure on a direct
facts-found occupational basis. This is not the same as a legal
presumption of exposure. These Veterans would be the only ones
currently recognized as having the ``covered service'' that is
referred to in the proposed legislation. General service in
Thailand is not considered by VA to be the ``covered service''
involved with this legislation.
VA estimates that medical-care costs associated with this
section would be $3.14 million in fiscal year (FY) 2014; $17.81
million over 5 years; and $56.73 million over 10 years.
Benefits costs associated with this section of the bill are
estimated to be $1.8 million during the first year, $9.4
million for 5 years, and $19.8 million over 10 years.
Section 5 of S. 735 would require VA, not later than 6
months after the date of enactment, to conduct a pilot program
to assess the feasibility of providing grief counseling
services in a group retreat setting to surviving spouses of
Veterans who die while serving on active duty in the Armed
Forces. The pilot program would be carried out by the
Readjustment Counseling Service (RCS). Participation would be
at the election of the surviving spouse. The pilot program
would be carried out at not fewer than six locations, including
three locations where surviving spouses with dependent children
are encouraged to bring their children, and three locations
where surviving spouses with dependent children are not
encouraged to bring their children. Services provided under the
pilot would include information and counseling on coping with
grief, information about benefits and services available to
surviving spouses under laws administered by VA, and other
information considered appropriate to assist a surviving spouse
with adjusting to the death of a spouse.
VA supports the concept of providing readjustment
counseling in retreat settings. Initial results from similar
retreat-based pilot programs operated by RCS found participants
were able to reduce symptoms and maintain a higher quality of
life after the retreat. The retreats proposed in section 5 have
the potential for similar results; however, a permissive or
discretionary authority to operate such a program would be
preferable to a mandatory pilot authority. Such authority would
permit VA to determine eligible cohort participation based on
criteria such as local demand and available funding.
We estimate that the cost of the pilot would be
approximately $512,730.

S. 778

S. 778 would grant VA the authority to issue a card, known
as a ``Veterans ID Card,'' to a Veteran that identifies the
individual as a Veteran and includes a photo and the name of
the Veteran. The issuance of the card would not be premised on
receipt of any VA benefits nor enrollment in the system of
annual patient enrollment for VA health care established under
section 1705(a) of title 38, United States Code. The card could
be used by Veterans to identify themselves as Veterans in order
to secure pharmaceuticals and consumer products offered by
retailers to Veterans at reduced prices.
VA understands and appreciates the purpose of this bill, to
provide Veterans a practical way to show their status as
Veterans to avail themselves of the many special programs or
advantages civic-minded businesses and organizations confer
upon Veterans. However, VA does not support this bill. The same
benefit to Veterans can best be achieved by VA and DOD working
with the States, the District of Columbia, and United States
territories to encourage programs for them to issue such
identification cards. Those entities already have the
experience and resources to issue reliable forms of
identification.
VA is working with States on these efforts. For example, VA
and the Commonwealth of Virginia launched a program to allow
Veterans to obtain a Virginia Veteran's ID Card from its
Department of Motor Vehicles (DMV). The program will help
thousands of Virginia Veterans identify themselves as Veterans
and obtain retail and restaurant discounts around the State. On
May 30, 2012, the program was launched in Richmond, and a DMV
``2 Go'' mobile office was present to process Veterans'
applications for the cards.
Virginia Veterans may apply for the cards in person at any
Virginia DMV customer service center, at a mobile office, or
online. Each applicant presents an unexpired Virginia driver's
license or DMV-issued ID card, a Veterans ID card application,
his or her DOD Form DD-214, DD-256, or WD AGO document, and
$10. The card, which does not expire, is mailed to the Veteran
and should arrive within a week. In the meantime, the temporary
Veterans ID card received at the time of the in-person
application can be used as proof of Veteran status.
Other jurisdictions can use this model to establish similar
programs without creating a new program within VA that may not
be cost-efficient. It is not known whether enough Veterans
would request the card to make necessary initial investments in
information technology and training worthwhile.
In addition, a VA-issued card could create confusion about
eligibility. Although the card would not by itself establish
eligibility, there could nonetheless be misunderstandings by
Veterans that a Government benefit is conferred by the card. As
the Committee knows, entitlement to some VA benefits depends on
criteria other than Veteran status, such as service connection
or level of income. Confusion may also occur because the
Veterans Health Administration (VHA) issues identification
cards to Veterans who are eligible for VA health care. Having
two VA-issued cards would pose the potential for confusion.
It is difficult to predict how many Veterans would apply
for such a card. Therefore, VA cannot provide a reliable cost
estimate for S. 778.

* * * * * * *

S. 868

S. 868, the ``Filipino Veterans Promise Act,'' would
require the Secretary of Defense, in consultation with the
Secretary of VA, to establish a process to determine whether
individuals claiming certain service in the Philippines during
World War II are eligible for certain benefits despite not
being on the so-called ``Missouri List.'' This bill affects
programs and laws administered by DOD. Respectfully, we defer
to that Department's views on this bill.

S. 889

S. 889, the ``Servicemembers' Choice in Transition Act of
2013,'' would amend section 1144 of title 10, United States
Code, to improve the Transition Assistance Program (TAP). The
current law does not stipulate any requirements for TAP beyond
pre-separation counseling and the Department of Labor (DOL)
Employment Workshop.
S. 889 would mandate the following additions to TAP
providing: (1) information on disability-related employment and
education protection; (2) an overview of available education
benefits; and (3) testing to determine academic readiness for
post-secondary education. The deadline for implementation of
these provisions would be April 1, 2015. The bill would also
require a feasibility study by VA on providing the instruction
of pre-separation counseling (described in subsection (b) of
section 1142 of title 10, United States Code) at overseas
locations, no later than 270 days after the date of the
enactment.
VA appreciates the strong interest and support from the
Committee to ensure that separating Servicemembers are given
full and effective engagement on their employment and training
opportunities, as well as other VA benefits they have earned.
However, VA does not support this legislation. The passage of
the Veterans Opportunity to Work (VOW) to Hire Heroes Act (VOW
Act) of 2011 and the introduction of the President's Veterans
Employment Initiative (VEI) satisfy the intent underlying
S. 889. VA believes those efforts should be afforded an
opportunity to be fully implemented and assessed before any
further legislation concerning TAP is enacted. Allowing
agencies to proceed under current plans will provide greater
flexibility in implementing improvements and making adjustments
based on accurate data analysis during assessment. VA will be
pleased to brief the Committee on the improvements and
enhancements that are currently being implemented as part of
the Administration's VEI.
VA and Federal agency partners including DOD, DOL,
Department of Education, Office of Personnel Management (OPM),
and the Small Business Administration (SBA), are currently
working to develop a plan for the implementation of an enhanced
TAP curriculum, known as Transition GPS (Goals, Plans,
Success), which was developed under the Administration's VEI.
Current components of the Transition GPS curriculum include
mandatory pre-separation counseling, service-delivered modules,
enhanced VA benefits briefings, a DOL Employment Workshop, and
Servicemember-selected tracks focused on technical training,
higher education, and entrepreneurship opportunities. With the
implementation of the Capstone event by the end of FY 2013, the
Transition GPS curriculum will take approximately 7 to 8 days
to complete.
VA has primary responsibility in the development and
delivery of the VA benefits briefings and the Career Technical
Training Track, and additional responsibilities to support
partner agencies in the development of curriculum of the higher
education track, the entrepreneurship track, and the Capstone
event. The Capstone event is intended to serve as a
standardized end-of-career experience to validate, verify, and
bolster transition training and other services to prepare for
civilian career readiness, including those delivered throughout
the entire span of a Servicemember's career, from accession to
post-military civilian life.
The VA Benefits I and II Briefings are part of the current
Transition GPS Curriculum. During the VA Benefits I Briefing,
information is provided on VA education benefits, as well as
identifying the forms and documentation necessary to access
those education benefits. The VA Benefits I Briefing also
provides information on all other benefits and services offered
by VA. The Benefits II Briefing provides an in-depth overview
of VA's disability compensation process, VA health care, and
navigation of the eBenefits portal, a one-stop, self-service
tool providing access to all benefits information.
Testing to determine academic readiness for post-secondary
education for any member who plans to use educational
assistance under title 38 does not play a role in how VA
determines eligibility and disburses VA education benefits. VA
does not agree that this type of testing should be a part of
Transition GPS, since Servicemembers who are interested in
pursuing post-secondary education already go through an
application process in order to determine readiness and
acceptance to accredited schools, universities, or colleges.
The final determination for one's acceptance to post-secondary
education is the responsibility of the academic institutions.
VA believes the intent of this amendment is already being met
under the revised Transition GPS. As part of the new process,
Servicemembers receive pre-separation counseling by a
representative within their respective Service, where they may
receive additional guidance on appropriate next steps to
include planning for a post-secondary education.
This legislation would also mandate providing information
on disability-related employment and education protections. As
VA does not have oversight on employment and education
protections, we defer to our agency partners (e.g., DOL and
Department of Education) regarding the extent to which they
address these topic areas during Transition GPS.
Because pre-separation counseling is the responsibility of
DOD, the feasibility study on the implementation of subsection
(b) of section 1142 of title 10, United States Code, would be a
new requirement for VA and would necessitate agreements and
information sharing between VA and DOD to finalize within 270
days after enactment.
We note that the Transition GPS curriculum is new and still
being evaluated for effectiveness and efficiency. VA is in the
process of fine tuning delivery and content to best meet
Servicemembers' needs, and additional legislation at this stage
may hinder those efforts. For these reasons, VA does not
support the feasibility study.
VA estimates that, if S. 889 were enacted, costs for the
first year would be $8.2 million (including salary, benefits,
travel, rent, supplies, training, equipment, and other services
[including curriculum development]), $40.6 million over 5
years, and $86.5 million over 10 years. VA estimates that IT
costs for the first year would be $0.3 million (including the
IT equipment for FTE, installation, maintenance, and IT
support) $0.9 million over 5 years, and $2.0 million over 10
years.

S. 894

S. 894 would extend, through June 30, 2016, the Secretary's
authority to pay allowances for certain qualifying work-study
activities performed by certain individuals pursuing programs
of education. This bill would also amend section 3485(a)(4) of
title 38, United States Code, to add a new subparagraph to add
to the list of qualifying work-study activities certain
activities performed at the offices of Members of Congress.
Finally, this bill would require VA to submit annual reports to
Congress regarding the work-study allowances paid under section
3485(a). VA provided views for this bill at the June 12, 2013,
hearing.
VA estimates that, if enacted, benefit costs for S. 894
would be $572,000 during FY 2013 and $7.4 million for the 3-
year period beginning on June 30, 2013, and ending on June 30,
2016. There are no additional FTE or GOE cost requirements
associated with this legislation.

* * * * * * *

S. 927

S. 927, the ``Veterans Outreach Act of 2013,'' would
require VA to carry out a demonstration project to assess the
feasibility and advisability of using State and local
government agencies and nonprofit organizations to increase
outreach to Veterans regarding VA benefits and services. VA
would require additional resources, such as manpower, funds,
and space, to administer the mandated grant program, comply
with the reporting requirements, and support the advisory
committee called for in section 5 of the bill. In addition, VA
has several recommendations and concerns regarding particular
bill language. Because of the central role of outreach in
ensuring that Veterans know of the benefits they have earned
and the role of outreach throughout the myriad missions of VHA,
VBA, and the National Cemetery Administration, we would benefit
from meeting with the Committee to discuss ongoing outreach
efforts and the ideas represented in this bill.
Section 2 of S. 927 would require VA to conduct a
demonstration project to increase coordination of outreach
efforts between VA and Federal, State, and local agencies and
nonprofit organizations. In the absence of a requirement for
specific appropriations dedicated to the implementation of the
bill, VA requests that, in section 2(a), ``shall'' be replaced
with ``may.''
Section 2(a)(2) lists ``nonprofit providers of health care
and benefits services for veterans'' as an entity with which VA
would coordinate outreach activities. VA would like for the
bill to have broad reach but would like to discuss with the
Committee the different types of entities this language could
cover.
Section 2(c)(3) would require the Secretary to ``consider
where the projects will be carried out'' and a number of other
factors. VA recommends the considerations of section 2(c)(3) be
deleted and that VA be directed to include appropriate project
criteria, such as location and other factors, in VA
implementing regulations. VA is concerned that, under section
2(c)(5), which would limit awards to a single State entity to
20 percent of all grant amounts awarded in a fiscal year,
limitations would only be established for State entities while
local and nonprofit entities would not be subject such
limitations. VA recommends including all eligible grantees in
this paragraph. Similarly, under section 2(d), the 50 percent
matching funds requirement would only apply to States while
county, municipal, and nonprofit entities would not have this
burdensome requirement. VA recommends including all eligible
grantees in this subsection as well. Essentially, there should
be one standard: matching funds should be required for all
entities or no such requirement should exist. VA already
submits a consolidated biennial report on outreach activities,
and therefore recommends that, rather than requiring the annual
report as prescribed by section 2(e), the biennial report
already submitted address the grants called for in this
proposed legislation.
Section 3 would provide for cooperative agreements between
the Secretary and States on outreach activities. VA already has
an existing Memorandum of Agreement through the National
Association of State Directors of Veterans Affairs that
encompasses the intent of this legislation. Therefore, VA
recommends removing this section.
Section 4 would provide for specific budget reporting
requirements for VA's outreach activities. VA administrations
currently plan and track outreach budgets without a
Congressionally-mandated requirement in order to report to VA's
Office of Public and Intergovernmental Affairs (OPIA). However,
the language of section 4 would require additional collection
and coordination that could represent additional expenditures
for VA. Additional manpower would be required to plan,
coordinate, track, and report all outreach budget activities
throughout VA. VA would be glad to discuss the requirements of
this section with the Committee.
Section 5 would establish an advisory committee on outreach
activities in VA. Additional resources would be required to
manage, plan, coordinate, support, and report on an outreach
advisory committee's activities. In addition, VA already has
several committees, such as the Advisory Committee on Minority
Veterans, the Advisory Committee on Women Veterans, and the
Research Advisory Committee on Gulf War Veterans' Illnesses,
which look at outreach as a component of their charters. Should
this additional advisory committee be established, VA believes
that the quarterly consultation and reporting requirements
contemplated by section 5(d) and (e) are excessive. Most VA
committees already meet two to three times annually. VA
recommends instead a biannual meeting requirement.
Section 6 would require each VA medical center to establish
an advisory board on outreach activities. VA does not support
this section of S. 927 as it would require 152 additional
advisory boards, each one being a potential distracter to
mission workload.
VA is unable to estimate the costs of this bill, as they
would depend upon the scope of the grant program which, in
turn, would depend upon amounts appropriated for such grants.

S. 928

Section 101 of S. 928, the ``Claims Processing Improvement
Act of 2013,'' would establish a working group to improve the
employee work credit and work management systems of VBA. Not
later than 90 days after the date of the enactment of this Act,
VA would establish a working group to assess and develop
recommendations for the improvement of the employee work credit
and work management systems of VBA. The work group would be
comprised of VA adjudicators, labor representatives, and
individuals from Veterans Service Organizations (VSOs). The
working group would develop a data-based methodology to be used
in revising the employee work credit system and a schedule by
which revisions to such system would be made, and would assess
and develop recommendations for improvement of the resource
allocation model. In carrying out its duties, the working group
would review the findings and conclusions of the Secretary
regarding previous studies of the employee work credit and work
management systems of VBA.
Within 180 days following establishment of the working
group, VA would submit a progress report to Congress. Within 1
year following the establishment of the working group, VA would
submit a report to Congress detailing the methodology and
schedule developed by the working group.
VA does not support section 101. VA is fully aware of the
need to improve its work credit and work management systems,
but does not believe it necessary to legislate a formal working
group to carry out an improvement plan. VA benefited from the
Center for Naval Analyses report, mandated by section 226,
Public Law 110-389, which revealed needed improvements of VA's
work credit and management system. It is vital that VA continue
to improve its evolving claims processing system, including the
enhancement of the Veterans Benefits Management System (VBMS)
to incorporate advanced workload management functionalities.
VBA's planned future State includes development of VBMS
workload management capabilities that are entirely electronic.
The workload management capabilities of VBMS are being
developed in two steps. Currently, a working group is building
the design requirements that will provide managers with the
tools and reporting capabilities to manage their workload most
effectively at the regional office level. Second, a national
work queue will be developed, to include the capability of
routing claims automatically through a pre-determined model,
which will route claims based on VBA's priorities and the skill
levels of our employees, essentially matching claims processors
with the ``next best claim'' to work based on their skill
levels and areas of expertise, as well as national workload
management policies.
As VBA moves toward the full integration of the entire
claims process in VBMS, the capability to capture transactional
data will allow VA to move from a points-based work credit
system dependent on employee-user input to a system that can
automatically capture employees' transactions, activities,
claims completions, and timeliness, enabling VBA to measure
performance against standards that truly reflect the desired
outcome of timely and accurate completion of claims. VBA
recognizes the importance of assessing the impact of our
transformational initiatives on employees' job requirements and
appropriately adjusting the work credit system. VBA established
a new team in April 2013 to work in concert with VBMS
programmers to ensure the requirements and functionality for
employee work-credit is incorporated into VBMS and that a
system is established that measures and manages the work
production of employees in accordance with actions required by
the updated claims process.
No mandatory or discretionary costs are associated with
this section of the bill.
Section 102 of the bill would establish a task force on
retention and training of claims processors and adjudicators
who are employed by VA and other Federal agencies and
departments. The task force would be comprised of the VA
Secretary, Director of OPM, Commissioner of the Social Security
Administration, a representative from a VSO, and other
individuals from institutions as the Secretary considers
appropriate. The duties of the task force would include:

(1) Identifying key skills required by claims processors
and adjudicators to perform the duties of claims processors and
adjudicators in the various claims processing and adjudication
positions throughout the Federal government;
(2) Identifying reasons for employee attrition from claims
processing positions;
(3) No later than 1 year after establishment of the task
force, developing a Government-wide strategic and operational
plan for promoting employment of Veterans in claims processing
positions in the Federal government;
(4) Coordinating with educational institutions to develop
training and programs of education for members of the Armed
Forces to prepare such members for employment in claims
processing and adjudication positions in the Federal
government;
(5) Identifying and coordinating offices of DOD and VA
located throughout the United States to provide information
about, and promotion of, available claims processing positions
to members of the Armed Forces transitioning to civilian life
and to Veterans with disabilities;
(6) Establishing performance measures to assess the plan
developed under paragraph (3), assessing the implementation of
such plan, and revising such plan as the task force considers
appropriate; and
(7) Establishing performance measures to evaluate the
effectiveness of the task force.

No later than 1 year after the date of the establishment of
the task force, VA would be required to submit to Congress a
report on the plan developed by the task force. Not later than
120 days after the termination of the task force, the Secretary
would be required to submit to Congress a report that assesses
the implementation of the plan developed by the task force.
VA does not support section 102 because VA already has
systems and programs in place to achieve the goals of the bill.
As VA's claims processes evolve, VA continues to identify
critical skills needed by adjudicators. Establishing a task
force to address concerns at this stage would be premature and
counterproductive as VA implements, modifies, and enhances its
transformational initiatives and automated processing systems.
With regard to development of a Government-wide strategic
and operational plan for promoting employment of Veterans in
claims processing positions in the Federal government, VA
defers to OPM. However, 73 percent of VBA's hires this year
have been Veterans, and over 51 percent of VBA's current
workforce is Veterans. Our attrition rate in disability claims
processing positions was only 6 percent last year and 4 percent
this fiscal year through June 30. VA currently utilizes tools
in regional offices that capture reasons for attrition when
employees leave Federal service. This information is used for
succession planning and future hiring at the local level.
Over the last several years, VBA has developed competency
models for claims processing positions. The models describe the
knowledge, skills and abilities necessary for these jobs. VBA
is in the process of linking the models to training.
The linked models will guide supervisors and employees as
they develop training plans to improve capabilities and/or
remediate skill deficits. Training to develop claims processing
skill requires practical application using VA systems and
processes that closely guard Veterans' privacy. Effective
training requires close evaluation achievable only by experts
in claims processing, such as is conducted within VA.
Educational institutions are unlikely to provide meaningful
development of claims processor skills in Veterans.
The requirement to coordinate with educational institutions
to develop training and programs for members of the Armed
Forces seems to contradict the rules in section 3680A of title
38, United States Code, which prohibits VA from approving
programs of education where more than 85 percent of the
students enrolled are in receipt of VA education benefits.
Additionally, VA has concerns that the intent of providing
specific training for employment for claims processing
positions may actually limit their employment opportunities as
their training would be specific to a position and not an
industry or general career field.
VA has partnered with other Federal agencies to include
DOD, Department of Education, DOL, SBA, and OPM to develop a
process through redesign of the TAP in order to achieve the
President's intent for a ``career-ready military.'' The
redesign provides training to enable transitioning
Servicemembers to meet Career Readiness Standards by
translating military skills into Federal or private work
opportunities and better prepare Servicemembers in making a
successful transition from military to civilian life. VA is
also responsible for delivering the Career Technical Training
Track (CTTT) which assists Servicemembers in developing a plan
for a technical career after departing the military. The CTTT
is a 16-hour course targeted toward Servicemembers who may not
choose a 4-year education option and who are seeking rapid
employment. As part of the redesign efforts of TAP, VA partners
with DOD and the Military Services in implementing a Capstone
event to verify Servicemembers are career ready when departing
the military. VA will provide support in the development of a
Military Life Cycle, which will incorporate Career Readiness
Standards throughout an individual's military career versus
during the last few months prior to separation.
There are no mandatory or discretionary costs associated
with this section.
Section 105 of S. 928 would mandate a pilot program to
assess the feasibility and advisability of entering into
memorandums of understanding with local governments and tribal
organizations, to include at least two tribal organizations and
10 State or local governments, for the purpose of improving the
quality of claims submitted and assisting Veterans who may be
eligible for disability compensation in submitting claims.
While VA supports efforts to enhance service and benefits
delivery to all categories of Veterans to include those of
tribal organizations, the rationale and intent behind this
section of the bill is unclear. Therefore, VA does not support
this section. A pilot is unnecessary given that VA regularly
conducts outreach to tribal organizations. Further, VA works
closely with State and local governments, which employ claims
representatives to assist Veterans and their family members
with filing claims. VA regularly trains State and county
personnel to ensure they are equipped to assist Veterans in
their communities.
Costs cannot be accurately estimated without understanding
the scope of this provision. However, it is anticipated that
additional discretionary funds would be needed to administer
the program and to train the local governments and tribal
organizations to accurately discuss VA benefit programs and
assist with claims.
Section 106 of the bill would require VA, not later than 90
days after the date of the enactment of this Act and not less
frequently than quarterly thereafter through calendar year
2015, to submit to the Senate and House Committees on Veterans'
Affairs a report on the backlog of claims. The report would
include the following elements:

(1) For each month through calendar year 2015, a projection
of the following:

a. The number of claims completed;
b. The number of claims received;
c. The number of claims backlogged at the end of the
month;
d. The number of claims pending at the end of the
month; and
e. A description of the status of the implementation
of initiatives carried out by the Secretary to address
the backlog.

(2) For each quarter through calendar year 2015, a
projection of the average accuracy of disability determinations
for compensation claims that require a disability rating (or
disability decision);
(3) For each month during the most recently completed
quarter, the following:

(4) For the most recently completed quarter, an assessment
of the accuracy of disability determinations for compensation
claims that require a disability rating (or disability
decision).

VA does not oppose section 106. Although various data
elements from this bill are already publicly available and/or
provided to Congress on a regular basis, this section of the
bill would formalize the transmission of specific performance
data.
No mandatory or discretionary costs are associated with
this section.

S. 930

S. 930 would add a new subsection to section 5314 of title
38, United States Code, to delay the recovery of overpayments
made by VA to individuals receiving Post-9/11 GI Bill benefits
until their last payment or payments under that program. This
new provision would not apply to individuals, who either
completed the program of education for which the debt was made
or failed to attend class during the two academic semesters
following the creation of the overpayment. VA would be
authorized to charge interest on the amount of indebtedness so
that the delayed payment actuarially would be equal to the
amount as if the debt were paid immediately. The new subsection
would apply to all debts created after the date of enactment
and would expire 9 years after the date of enactment.
VA does not support this bill. It would require VA to delay
the collection of debts by making deductions from the last
payment or payments due to beneficiaries. VA would not be able
to project when Post-9/11 GI Bill beneficiaries would use their
benefits for the last time and the amount of the last payment.
As a result, it would be difficult to determine when the debt
should be recouped. Furthermore, withholding some or all the
payments due to a Veteran for his/her final enrollment may
place undue financial burden on the Veteran during his/her last
school term, potentially putting at risk the Veteran's ability
to complete his or her program and graduate. If an overpayment
remains after the final payment has been withheld, that
overpayment would be the responsibility of the Veteran and
would be subject to collection through the Treasury Offset
Program if the Veteran is unable to pay out of pocket.
This legislation would not apply to individuals who fail to
attend classes in a manner consistent with ``normal pursuit''
of a program of education during the next two academic
semesters after such overpayment. It is not clear what is meant
by ``normal pursuit'' as individuals may pursue training on a
part-time basis and may take short breaks in training periods.
Furthermore, the proposed legislation directs VA to charge the
individual interest for debts that must be collected. It is not
clear whether interest would accrue from the date the
overpayment is created or the date VA begins collection due to
non-pursuit of training. It is also unclear whether the debt
should be deferred if the individual resumes ``normal pursuit''
after the debt collection process is initiated.
VA does not believe that the potential benefits gained by
deferring some Veteran debts would outweigh the increased
burden Veterans may face to repay large amounts out-of-pocket
(as there will be little to no benefits remaining) or the
burden placed on VA to administer this provision. Moreover,
this legislation conflicts with the intended spirit of the
Improper Payment Elimination and Recovery Act of 2010 and the
Debt Collection Improvement Act of 1996, both of which speak to
proper identification and recovery of Federal debts.
S. 930 would be effective on the date of enactment;
however, its implementation would require extensive changes to
VA's collection process, including labor-intensive systems
changes. Thus, VA would need at least 18 months from the date
of enactment to develop and/or amend systems to account for
this change, train personnel on the change, and inform
beneficiaries.
VA estimates that enactment of S. 930 would result in
benefits costs to VA of $233 million during the first year,
$1.3 billion over 5 years, and $2.4 billion over 10 years.

* * * * * * *

S. 935

S. 935, the ``Quicker Veterans Benefits Delivery Act of
2013,'' would revise statutes pertaining to adjudications and
payment of disability benefits.
Section 2 of this bill would prohibit VA from requesting a
medical examination when the claimant submits medical evidence
or an opinion from a non-VA provider that is competent,
credible, probative, and adequate for rating purposes. Section
3 would add a third level of pre-stabilization rates under
section 4.28 of title 38, Code of Federal Regulations, that can
be assigned to recently discharged Veterans. Currently, pre-
stabilization rates include a 50-percent and 100-percent
evaluation. This bill proposes to add a 30-percent evaluation.
In addition, the bill would create a new ``temporary minimum
disability rating.'' The bill would authorize such a rating for
a Veteran who has one or more disabilities not already covered
under the current temporary-rating scheme and ``submits a claim
for such disability that has sufficient evidence to support a
minimum disability rating.'' Under section 4, VA would be
authorized to issue benefits payments prior to the month for
which such payments are issued. Currently, VA issues benefits
payments on the first of the month for the previous month's
entitlement.
VA does not support S. 935. VA appreciates the intent of
the provisions, which seek to provide benefits to Veterans more
expeditiously. However, as written, these provisions are, in
some respects, unnecessary, unclear, and problematic to
implement.
Section 2 of the bill is duplicative of existing law. This
section prohibits VA from requesting a medical examination when
evidence that is submitted is adequate for rating purposes.
Section 5103A(d)(2) of title 38, United States Code, notes that
an examination or opinion is only required when the record does
not contain sufficient medical evidence to make a decision.
Furthermore, section 5125 of title 38, United States Code,
explicitly notes that private examinations may be sufficient,
without conducting additional VA examinations, for adjudicating
claims. VA regulations are consistent with these statutory
requirements. Therefore, this section is unnecessary and
duplicative. VA is already allowed to adjudicate a claim
without an examination if evidence is provided by the claimant
that is adequate for rating purposes. There are no costs
associated with section 2.
VA does not support section 3. The intent of this provision
and how it would be implemented are unclear. The existing pre-
stabilization rates, 50 percent and 100 percent, are used to
compensate Veterans with severe injuries that are unstable and
which materially impair employability. The criteria for when
the proposed 30-percent evaluation would be used are not
specified. However, generally, a rating of 30 percent indicates
that an individual is able to participate in the examination
process and is capable of employment. Because the Veteran would
be required to be re-examined and re-evaluated between 6 and 12
months after discharge, this provision would inconvenience
Veterans as well as require additional work on the part of
claims adjudicators and medical examiners.
To the extent the bill would create a whole new category of
claimants eligible to receive a temporary minimum disability
rating, VA does not support this provision. It is unclear how
this would be implemented (i.e., whether the term ``temporary
minimum disability rating'' refers to the proposed 30 percent
pre-stabilization rating or whether it refers to the current
minimum compensable schedular rating of 10 percent.
Additionally, it is unclear what is meant by the requirement
that the claimant submit ``sufficient evidence to support a
minimum disability rating.'' If interpreted to mean that the
claimant need only submit evidence of a current disability to
be assigned a temporary rating of 30 percent, such a practice
would likely result in frequent overpayments that would later
need to be adjusted. Likewise, a Veteran with multiple
disabilities would often be undercompensated. In general,
establishing temporary ratings means that cases will need to be
processed twice, which is not an efficient use of resources.
Subsection (c), which directs that cases with pre-stabilization
ratings or temporary minimum disability ratings not be counted
in the backlog of disability claims, raises questions about how
these cases would be tracked and counted in VA's workload and
concern about data integrity. VA is unable to provide costs for
section 3, as the provision is unclear. Additional information
concerning the criteria that would create entitlement would be
required to determine costs.
VA does not support section 4 of the bill, as its intent is
unclear, and it could create significant administrative burdens
and costs for VA. This provision would authorize the Secretary
to certify benefit payments so that payments will be delivered
``before the first day of the calendar month for which such
payments are issued.'' VA is already authorized to make
payments prior to the first of the month whenever the first day
of the calendar month falls on a Saturday, Sunday, or legal
public holiday. The payment VA makes on or near the first of
the month is payment for the prior month's entitlement. If the
intent of section 4 is to permit VA to make this payment prior
to the first of the month irrespective of whether that date
falls on a weekend or holiday, we recommend replacing the
phrase ``for which such payments are issued'' with the phrase
``in which such payments would otherwise be issued.'' However,
if the intent is to authorize VA to deliver disability payments
a full month in advance, such a change in procedure would raise
several concerns. For a Veteran with an award that is currently
ongoing, an additional month of mandatory funding would be
required, as an extra payment would need to be made to advance
payments to a month-in-advance status. Additionally, paying
benefits in advance significantly increases the chances for
overpayment of benefits and directly conflicts with the spirit
of the Debt Collection Improvement Act and the Improper Payment
Elimination and Recovery Improvement Act. Current processing
allows VA to prevent payments from being released if a Veteran
becomes ineligible during the month. For example, if a Veteran
student drops out of school or passes away during the month, VA
is able to amend his or her benefit award and prevent payment
from being released. Paying in advance would eliminate VA's
ability to prevent this type of improper payment. Paying
benefits prior to the month in which they are earned would
potentially result in increased overpayments.
Absent clarification as discussed above, VA opposes this
section of the bill, as it potentially would create an
administrative burden and significant costs in the
reprogramming of VA's computer systems. The systems used by VA
do not currently allow prospective payments, and this section
would create the need to reprogram multiple applications.
For section 4, if the intent of the proposed bill is to
release benefit payments on the last day of the month for which
they are due, rather than the first of the following month, as
is the current practice, VA sees little impact to our internal
processes or Office of Information Technology (OIT)
applications. This change would require that our schedule of
operations be modified by at least 1 business day to send our
bulk payment files to the Department of the Treasury earlier in
the month so payments could be delivered (by mail or
electronically) on the last business day of the month rather
than the first of the following month. The Department of the
Treasury does not anticipate this potential change would be an
issue with regards to processing and releasing VA benefit
payments.
However, if the intent of section 4 is to issue payments in
advance of when they are due, VA OIT systems would require
significant modifications, which would take longer than the 90-
day period allowed to implement this section. For example, if
the intent is that payment for July be received prior to July 1
(e.g., June 30), rather than August 1, the current
functionality that generates the recurring or monthly payment
files would require significant changes. VBA has ten separate
OIT payment applications that produce a recurring or monthly
payment file that would need to be modified. Changes of this
nature would require significant OIT funding that is not
budgeted and re-prioritization of planned OIT initiatives.
If the intent of section 4 is to release benefit payments
on the last day of the month for which they are due, rather
than the first of the following month as is the current
practice, there are no benefit costs or savings associated with
section 4. While this provision would impact the timing of
outlays, it would not affect obligations. If the intent of
section 4 is to issue payments in advance of when they are due,
there would be costs, including costs associated with the
increased chances of overpayments. However, more information
would be required to calculate the benefit costs in this
scenario.

S. 938

S. 938, the ``Franchise Education for Veterans Act of
2013,'' would amend title 38 United States Code, to allow
Veterans who are eligible for educational assistance under the
All-Volunteer Force Educational Assistance Program (chapter 30)
or the Post-9/11 Educational Assistance Program (chapter 33)
and no longer on active duty, to pursue training and receive
educational assistance for franchise training. The amount of
educational assistance payable under this program shall be,
within any 12-month period in which training is pursued, the
sum of the fees assessed by the training establishment, a
monthly housing stipend for each month of training pursued
equal to the monthly amount of the basic allowance for a
Servicemember with dependents in pay grade E-5 residing in
military housing within the zip code area of the training
establishment, and a monthly stipend in the amount equal to $83
for each month of training for books, supplies, equipment, and
other educational costs or $15,000, whichever is less.
VA supports the intent of S. 938; however, we cannot
support this bill due to significant administrative impacts and
a need for further refinement in order to make this policy
executable and supportable. We are unclear how VA would
determine that the franchise training pursued by the Veteran
would result in the establishment of a franchise. Franchise
training times vary depending on what the franchise business
requirements are (e.g., Meineke may be 4 weeks, whereas 7-
Eleven may be 2-4 weeks). VA would have to establish ways to
measure the franchise training and conduct adequate oversight
to ensure compliance that is necessary for the State Approving
Agencies (SAA) to approve the training programs. It is unclear
whether any limitations should be established as to when VA
should approve the individual pursuit of the franchise
training. For example, it is unclear whether VA would need to
ensure the individual who desires to open a business first
provide business plans or proof of funding in order to
establish the franchise.
Due to the need to develop regulations to provide rules to
administer this new benefit type, provide training to the SAAs
who will approve the training, and provide training to the
field offices on processing, VA recommends that this provision
become effective at the beginning of a fiscal year but no
earlier than 12 months from date of enactment.
VA estimates that benefit costs associated with enactment
of S. 938 would be $1.5 million in the first year, $7.5 million
over 5 years, and a total of $15.0 million over 10 years.

S. 944

S. 944, the ``Veterans' Educational Transition Act of
2013,'' would amend section 3679 of title 38, United States
Code, by adding a new subsection at the end. The new subsection
would require VA to disapprove any course offered by a public
institution of higher education that does not charge Veterans
and eligible dependents pursuing a course of education with
educational assistance under the All-Volunteer Force
Educational Assistance Program (chapter 30) or the Post-9/11
Educational Assistance Program (chapter 33), in-State tuition,
and fees, regardless of their State of residence.
Under this legislation, a ``covered individual'' would be a
Veteran who was discharged or released from a period of no less
than 180 days of service in the active military, naval, or air
service less than 2 years before the date of enrollment in the
course concerned, or an individual who is entitled to
assistance under section 3311(b)(9) or 3319 of title 38 by
virtue of such individual's relationship to a covered Veteran.
S. 944 would apply to educational assistance provided for
pursuit of programs of education during academic terms that
begin after July 1, 2015.
While VA is sympathetic to the issue of rising educational
costs, we cannot endorse this legislation until we know more
about the impact. VA is concerned that possible reductions in
course offerings could be the result from this requirement,
which could negatively impact Veterans' educational choices.
In-State tuition rules are set by individual States and are
undoubtedly driven by overall fiscal factors and other policy
considerations.
Enactment of S. 944 may result in cost savings for VA
because the Department would no longer make Yellow Ribbon
program payments to public institutions of higher learning--
these schools would either charge in-State tuition, negating
the need to make up the difference between in-State and out-of-
state tuition, or the school would cease to be approved for VA
education benefit participation. However, as noted above, it is
difficult to project the effect of this legislation on the
courses offered by public educational institutions, so students
may choose not to use their benefits at all because of reduced
educational choices.
VA estimates that benefit savings to the Readjustment
Benefits account would be $70.2 million over 5 years and $206.2
million over 10 years.
VA estimates that there would be no additional GOE
administrative costs required to implement this amendment.

S. 1039

S. 1039, the ``Spouses of Heroes Education Act,'' would
amend the Post-9/11 GI Bill (chapter 33 of title 38, United
States Code) to expand the Marine Gunnery Sergeant John David
Fry scholarship to include spouses of members of the Armed
Forces who die in the line of duty. Currently, only children of
Servicemembers who die in the line of duty while serving on
active duty in the Armed Forces are eligible for such education
benefits.
This bill would make spouses eligible for education
benefits under chapter 33 for 15 years from the date of the
Servicemember's death, or the date on which the spouse
remarries, whichever comes first.
A surviving spouse who establishes chapter 33 eligibility
based on this bill and is also eligible for education benefits
under the Dependents' Educational Assistance (chapter 35)
program would have to make an irrevocable election with respect
to receipt of educational assistance (under one program only).
S. 1039 also would amend section 3321(b)(4) of title 38 to
specify that the period of eligibility for a child entitled to
Post-9/11 GI Bill educational assistance under the Marine
Gunnery Sergeant John David Fry scholarship expires 15 years
after the child's eighteenth birthday.
VA supports S. 1039, subject to Congress identifying
appropriate offsets for the benefit costs. If enacted, this
legislation would offer eligible surviving spouses more
generous monetary benefits than they are currently eligible to
receive. Currently, a surviving spouse of a Servicemember who
dies in the line of duty may receive education benefits under
chapter 35, which include a 20-year delimiting date, 45 months
of entitlement, and a current full-time monthly rate of $987.
Under this legislation, eligible spouses would receive full
tuition and fees at a public institution (or the maximum amount
payable at private institutions), a housing allowance, and a
books and supplies stipend of up to $1,000.
Since the benefits are greater under chapter 33 than under
chapter 35, VA anticipates surviving spouses would elect to
receive benefits under chapter 33. As a consequence, this would
decrease the number of chapter 35 beneficiaries.
VA estimates that, if enacted, S. 1039 would result in
benefit costs to VA of $10.3 million during the first year,
$67.7 million for 5 years, and $163.9 million over 10 years. No
administrative or personnel costs to VA are associated with
this bill. VA IT costs are estimated to be $9.3 million. These
costs include enhancements to the Post-9/11 GI Bill Long-Term
Solution. If these IT enhancements could not be implemented,
manual processing of claims would be required, which would
result in an overall decrease in timeliness and accuracy in
processing Post-9/11 GI Bill claims. We estimate that VA would
need one year from date of enactment to implement this change.

* * * * * * *

MINORITY VIEWS OF RANKING MEMBER
HON. RICHARD BURR

On July 24, 2013, the Senate Committee on Veterans' Affairs
(hereinafter, ``the Committee'') voted, by voice vote, to
approve S. 944, as amended, the Veterans Health and Benefits
Improvement Act of 2013 (hereinafter, ``the Committee bill'').
While I agreed with a number of the provisions included in the
Committee bill, I have concerns about Title VI, which included
items addressing the Department of Veterans Affairs
(hereinafter, ``VA'') outreach efforts. In these supplemental
views, I will outline a number of my concerns and unresolved
questions.
On April 24, 2013, the Senate Committee on Veterans'
Affairs convened a hearing entitled, ``Call to Action: VA
Outreach and Community Partnerships,'' to examine VA outreach
activities and efforts to expand community partnerships. One of
the main issues discussed was the lack of coordination between
VA, state and local governments, and private entities. These
non-VA organizations have been effective in identifying the
needs of veterans in their local areas, and providing services
that are either difficult for VA to provide or are outside of
VA's primary responsibilities. VA testified that they are
reevaluating how they coordinate with outside groups, and are
educating VA medical centers and Regional Offices about how to
best leverage existing local capabilities. I believe that this
should be the focus of the Committee's efforts when trying to
improve VA's outreach.
Section 601 of the Committee bill would establish a pilot
program to provide grants to state and local governments or
nonprofit organizations to increase veterans' awareness of
benefits and services and improve coordination of outreach
activities between Federal, state and local agencies and
nonprofit organizations. While I believe that further
coordination between VA and other providers is needed, I do not
believe the testimony provided during the April 24 hearing
indicated a grant program was required. The Committee bill is
vague as to what projects the Secretary of Veterans Affairs
should award grants to, yet authorizes $5 million over a two
year period for that purpose.
What was clear from the outreach hearing was that state
governments, local governments, and nonprofit entities are
already providing a number of services, yet VA is completely
unaware of their existence. To my mind, this underscores the
need for greater oversight of VA's current outreach activities;
including a full accounting of the amount of money VA currently
spends enterprise-wide. During the hearing, I asked Assistant
Secretary for Public and Intergovernmental Affairs Tommy Sowers
for this information, and have yet to get a response. Providing
grants to those already assisting veterans may bolster a few of
their services, but it places the onus, not on VA, but on
outside groups to coordinate their efforts with VA. It will
likely not fix the underlying issues identified at the hearing.
Before we proceed any further legislatively on the outreach
pilot, I believe, the Committee needs a better understanding
of: (1) the types of projects to be provided by the section;
(2) whether these projects, funded by the pilot, will duplicate
existing services; (3) how funding additional projects outside
of VA will improve VA's outreach efforts; and (4) what specific
steps VA is taking to coordinate with outside groups?
Finally, I would like to mention my apprehension with
establishing advisory committees on outreach activities at both
VA Central Office and at VA medical centers. Previously
established advisory committees at VA have not demonstrated
their effectiveness. While I hope the additional advisory
committees are successful in forging relationships, I believe
that real change that leads to better outreach and coordination
will need to be derived from strong leadership at VA Central
Office, individual VA medical centers, and VA Regional Offices.

Changes in Existing Law

In compliance with paragraph 12 of Rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman).

Title 10. Armed Forces

* * * * * * *

Subtitle A. General Military Law

* * * * * * *

Part II. Personnel

* * * * * * *

Chapter 58. Benefits and Services for Members Being Separated or
Recently Separated

* * * * * * *

SEC. 1144. EMPLOYMENT ASSISTANCE, JOB TRAINING ASSISTANCE, AND OTHER
TRANSITIONAL SERVICES: DEPARTMENT OF LABOR

* * * * * * *

(b) * * *

* * * * * * *

(9) Provide information about disability-related
employment and education protections.

* * * * * * *

Title 38. Veterans' Benefits

* * * * * * *

Part I. General Provisions

* * * * * * *

Chapter 1. General

* * * * * * *

SEC. 103. SPECIAL PROVISIONS RELATING TO MARRIAGES

* * * * * * *

(d)(1) * * *
(2)(A) * * *
[(B) The remarriage after age 57 of the surviving spouse of
a veteran shall not bar the furnishing of benefits specified in
paragraph (5) to such person as the surviving spouse of the
veteran. Notwithstanding the previous sentence, the remarriage
after age 55 of the surviving spouse of a veteran shall not bar
the furnishing of benefits under section 1781 of this title to
such person as the surviving spouse of the veteran.]
(B) The remarriage after age 55 of the surviving spouse of
a veteran shall not bar the furnishing of benefits specified in
paragraph (5) to such person as the surviving spouse of the
veteran.

* * * * * * *

(5) [Paragraphs (2)(A)] Paragraphs (2) and (3) apply with
respect to benefits under the following provisions of this
title:

* * * * * * *

SEC. 111A. TRANSPORTATION OF INDIVIDUALS TO AND FROM DEPARTMENT
FACILITIES

(a) * * *
(1) * * *
(2) The authority granted by paragraph (1) shall
expire on [the date that is one year after the date of
the enactment of this section] September 30, 2015.
(b) * * *
(c) Funding.--There is hereby authorized to be appropriated
for each of fiscal years 2014 and 2105 for the Department,
$4,000,000 to carry out this section.

* * * * * * *

Chapter 3. Department of Veterans Affairs

* * * * * * *

SEC. 322. OFFICE OF NATIONAL VETERANS SPORTS PROGRAMS AND SPECIAL
EVENTS

* * * * * * *

(b) * * *

* * * * * * *

(4) [shall, to the extent feasible,] may cooperate
with the [United States Paralympics, Inc.,] United
States Olympic Committee and its partners to promote
the participation of disabled veterans and disabled
members of the Armed Forces in [sporting] paralympic
events sponsored by the [United States Paralympics,
Inc.,] United States Olympic Committee and its
partners;

* * * * * * *

(d) Monthly assistance allowance.--
(1) Subject to the availability of appropriations for
such purpose, the Secretary may provide a monthly
assistance allowance to a veteran with a disability
invited by the [United States Paralympics, Inc.,]
United States Olympic Committee to compete for a slot
on, or selected for, the Paralympic Team for any month
in which the veteran is training or competing in any
event sanctioned by the [United States Paralympics,
Inc.,] United States Olympic Committee or who is
residing at a [United States Paralympics, Inc.,] United
States Olympic Committee training center.

* * * * * * *

(4) (A) There is authorized to be appropriated to
carry out this subsection $2,000,000 for each of fiscal
years 2010 through [2013] 2018.
(B) Any amounts appropriated or otherwise made
available to carry out this subsection that the
Secretary determines are unnecessary to carry out this
subsection may be used by the Secretary to carry out
this section.

* * * * * * *

Chapter 5. Authority and Duties of the Secretary

SEC.

SUBCHAPTER I. GENERAL AUTHORITIES

* * * * * * *

SUBCHAPTER II. SPECIFIED FUNCTIONS

* * * * * * *

[521A. ASSISTANCE FOR UNITED STATES PARALYMPICS, INC.]

521A. ADAPTIVE SPORTS PROGRAMS FOR DISABLED VETERANS AND MEMBERS OF THE
ARMED FORCES THROUGH THE UNITED STATES OLYMPIC
COMMITTEE.

* * * * * * *

Subchapter II. Specified Functions

* * * * * * *

[SEC. 521A. ASSISTANCE FOR UNITED STATES PARALYMPICS, INC.]

SEC. 521A. ADAPTIVE SPORTS PROGRAMS FOR DISABLED VETERANS AND MEMBERS
OF THE ARMED FORCES THROUGH THE UNITED STATES
OLYMPIC COMMITTEE

[(a) Authorization to Provide Assistance.--The Secretary
may award grants to the United States Paralympics, Inc., to
plan, develop, manage, and implement an integrated adaptive
sports program for disabled veterans and disabled members of
the Armed Forces.]
(a) Adaptive Sports Program.--(1) The Secretary may plan,
develop, manage, and implement an integrated adaptive sports
program for disabled veterans and disabled members of the Armed
Forces.
(2) The Secretary may award grants to the United States
Olympic Committee to carry out paragraph (1).
(b) Oversight by Secretary.--As a condition of receiving a
grant under this section, the [United States Paralympics,
Inc.,] United States Olympic Committee shall permit the
Secretary to conduct such oversight of the use of grant funds
as the Secretary determines is appropriate. The [United States
Paralympics, Inc.,] United States Olympic Committee shall be
responsible for the use of grant funds provided under this
section.
(c) Application Requirement.--
(1) Before the Secretary may award a grant to the
[United States Paralympics, Inc.,] United States
Olympic Committee under this section, the [United
States Paralympics, Inc.,] United States Olympic
Committee shall submit to the Secretary an application
that describes the activities to be carried out with
the grant, including information on specific measurable
goals and objectives to be achieved using grant funds.
(2) The application shall include--
(A) a detailed description of all
partnerships referred to in paragraph (3) at
the national and local levels that will be
participating in such activities and the amount
of grant funds that the [United States
Paralympics, Inc.,] United States Olympic
Committee proposes to make available for each
of such partnerships; [and]
(B) for any fiscal year for which a grant is
sought, the amount of private donations
received by the [United States Paralympics,
Inc.,] United States Olympic Committee expected
to be expended to support operations during
that fiscal year[.] ; and
(C) a statement that includes a detailed
description of--
(i) the anticipated personnel,
travel, and administrative costs that
will be paid for by the United States
Olympic Committee with funds provided
under this section;
(ii) the financial controls
implemented by the United States
Olympic Committee, including methods to
track expenditures of funds provided
under this section;
(iii) the performance metrics to be
used by the United States Olympic
Committee to evaluate the effectiveness
of the activities to be carried out
with the funds provided under this
section; and
(iv) the anticipated personnel,
travel, and administrative costs that
will be paid for by subgrantees with
funds provided under this section.
(3) Partnerships referred to in this paragraph are
agreements between the [United States Paralympics,
Inc.,] United States Olympic Committee and
organizations with significant experience in the
training and support of disabled athletes and the
promotion of disabled sports at the local and national
levels. Such organizations may include Disabled Sports
USA, Blaze Sports, Paralyzed Veterans of America, and
Disabled American Veterans. The agreements shall detail
the scope of activities and funding to be provided by
the [United States Paralympics, Inc.,] United States
Olympic Committee to the partner.
(d) Use of Funds.--
(1) The [United States Paralympics, Inc., with the
assistance] United States Olympic Committee, with the
assistance and cooperation of the Secretary and the
heads of other appropriate Federal and State
departments and agencies and partnerships referred to
in subsection (c)(3), shall use a grant under this
section to reimburse grantees with which the [United
States Paralympics, Inc., has entered] United States
Olympic Committee has entered into a partnership under
subsection (c) for the direct costs of recruiting,
supporting, equipping, encouraging, scheduling,
facilitating, supervising, and implementing the
participation of disabled veterans and disabled members
of the Armed Forces in the activities described in
paragraph (3) by supporting a program described in
paragraph (2).

* * * * * * *

(4) A grant made under this section may include, at
the discretion of the Secretary, an amount for the
administrative expenses of the [United States
Paralympics, Inc.] United States Olympic Committee, but
not to exceed five percent of the amount of the grant.
(5) Funds made available by the [United States
Paralympics, Inc.,] United States Olympic Committee to
a grantee under subsection (c) may include an amount
for administrative expenses, but not to exceed ten
percent of the amount of such funds.

* * * * * * *

(g) Authorization of Appropriations.--There is authorized
to be appropriated $8,000,000 for each of fiscal years 2010
through [2013] 2015 to carry out this section. Amounts
appropriated pursuant to this subsection shall remain available
without fiscal year limitation.
(h) Separate Accounting.--The Department shall have a
separate line item in budget proposals of the Department for
funds to be appropriated to carry out this section. Funds
appropriated to carry out this section shall not be commingled
with any other funds appropriated to the Department , except
that funds appropriated to carry out this section may be used
by the Department to carry out subsections (a), (b), and (c) of
section 322 of this title.
(i) Limitation on Use of Funds.--Except as provided in
paragraphs (4) and (5) of subsection (d), funds appropriated to
carry out this section may not be used to support or provide
services to individuals who are not disabled veterans or
disabled members of the Armed Forces.
(j) Annual report to Secretary.--
(1) As a condition of receiving a grant under this
section, the [United States Paralympics, Inc.,] United
States Olympic Committee shall agree that by not later
than 60 days after the last day of a fiscal year for
which a grant is provided under this section, the
[United States Paralympics, Inc.,] United States
Olympic Committee shall submit to the Secretary a
report setting forth in detail the use of the grant
funds during that fiscal year, including the number of
veterans who participated in the integrated adaptive
sports program, including any programs carried out
through a partnership under subsection (c)(3), and the
administrative expenses of the integrated adaptive
sports program.
(2) * * *
(3) For any fiscal year after fiscal year 2010, the
eligibility of the [United States Paralympics, Inc.,]
United States Olympic Committee to receive a grant
under this section shall be contingent upon the
submission of the report under paragraph (1) for the
preceding fiscal year.
(k) Annual Report to Congress.--For any fiscal year during
which the Secretary provides assistance under this section, the
Secretary shall submit to Congress a report on the use of funds
provided under this section.
(l) Comptroller General Report.--(1) Not later than two
years after the date of the enactment of the Veterans Health
and Benefits Improvement Act of 2013, the Comptroller General
of the United States shall submit to Congress a report on the
use of grants, if any, awarded to the United States Olympic
Committee, under this section during the two-year period
preceding the report.
(2) The report required under paragraph (1) shall contain
the following:
(A) An assessment of how the Department, the United
States Olympic Committee, and subgrantees of the United
States Olympic Committee, have provided adaptive sports
opportunities to veterans and members of the Armed
Forces through grants awarded under this section.
(B) An assessment of how the Department oversees the
use of funds provided under this section by the United
States Olympic Committee and subgrantees of the United
States Olympic Committee.
(C) A description of the benefit provided to veterans
and members of the Armed Forces through programs and
activities developed through grants awarded under this
section.
(m) [(l)] Termination.--The Secretary may only provide
assistance under this section during fiscal years 2010 through
[2013] 2015.

* * * * * * *

Part II. General Benefits

* * * * * * *

Chapter 11. Compensation for Service-Connected Disability or Death

* * * * * * *

Subchapter VI. General Compensation Provisions

* * * * * * *

SEC. 1156. TEMPORARY DISABILITY RATINGS

(a) Assignment of Temporary Ratings.--(1) * * *

* * * * * * *

(3) 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] 18 months after the
separation or discharge of such veteran from active duty.

* * * * * * *

Chapter 13. Dependency and Indemnity Compensation for Service-Connected
Deaths

* * * * * * *

Subchapter II. Dependency and Indemnity Compensation

* * * * * * *

SEC. 1311. DEPENDENCY AND INDEMNITY COMPENSATION TO A SURVIVING SPOUSE

* * * * * * *

(f)(1) * * *
(2) Dependency and indemnity compensation shall be
increased under this subsection only for months occurring
during the [two-year] three-year period beginning on the date
on which entitlement to dependency and indemnity compensation
commenced.

* * * * * * *

Chapter 15. Pension for Non-Service-Connected Disability or Death or
for Service

* * * * * * *

Subchapter II. Veterans' Pensions

* * * * * * *

Non-Service-Connected Disability Pension

* * * * * * *

SEC. 1522. NET WORTH LIMITATION

(a)(1) The Secretary shall * * *
(2)(A) If a veteran otherwise eligible for payment of
pension under section 1513 or 1521 of this title or the spouse
of such veteran disposes of covered resources for less than
fair market value on or after the look-back date described in
subparagraph (C)(i), the Secretary shall deny or discontinue
the payment of pension to such veteran under section 1513 or
1521 of this title, as the case may be, for months during the
period beginning on the date described in subparagraph (D) and
equal to the number of months calculated as provided in
subparagraph (E).
(B)(i) For purposes of this paragraph, a covered resource
is any resource that was a part of the corpus of the estate of
the veteran or, if the veteran has a spouse, the corpus of the
estates of the veteran and of the veteran's spouse, that the
Secretary considers that under all the circumstances, if the
veteran or spouse had not disposed of such resource, it would
be reasonable that the resource (or some portion of the
resource) be consumed for the veteran's maintenance.
(ii) For purposes of this paragraph, the Secretary may
consider, in accordance with regulations the Secretary shall
prescribe, a transfer of an asset (including a transfer of an
asset to an annuity, trust, or other financial instrument or
investment) a disposal of a covered resource for less than fair
market value if such transfer reduces the amount in the corpus
of the estate of the veteran or, if the veteran has a spouse,
the corpus of the estates of the veteran and of the veteran's
spouse, that the Secretary considers, under all the
circumstances, would be reasonable to be consumed for the
veteran's maintenance.
(C)(i) The look-back date described in this clause is a
date that is 36 months before the date described in clause
(ii).
(ii) The date described in this clause is the date on which
the veteran applies for pension under section 1513 or 1521 of
this title or, if later, the date on which the veteran (or the
spouse of the veteran) disposes of covered resources for less
than fair market value.
(D) The date described in this subparagraph is the first
day of the first month in or after which covered resources were
disposed of for less than fair market value and which does not
occur in any other period of ineligibility under this
paragraph.
(E) The number of months calculated under this subparagraph
shall be equal to--
(i) the total, cumulative uncompensated value of the
portion of covered resources so disposed of by the
veteran (or the spouse of the veteran) on or after the
look-back date described in subparagraph (C)(i) that
the Secretary determines would reasonably have been
consumed for the veteran's maintenance; divided by
(ii) the maximum amount of monthly pension that is
payable to a veteran under section 1513 or 1521 of this
title, including the maximum amount of increased
pension payable under such sections on account of
family members, but not including any amount of pension
payable under such sections because a veteran is in
need of regular aid and attendance or is permanently
housebound,
rounded down, in the case of any fraction, to the nearest whole
number, but shall not in any case exceed 36 months.
(b)(1) The Secretary shall deny or discontinue the payment
of increased pension under subsection (c), (d), (e), or (f) of
section 1521 of this title on account of a child when the
corpus of such child's estate is such that under all the
circumstances, including consideration of the veteran's and
spouse's income, and the income of the veteran's children, it
is reasonable that some part of the corpus of such child's
estate be consumed for the child's maintenance. During the
period such denial or discontinuance remains in effect, such
child shall not be considered as the veteran's child for
purposes of this chapter.
(2)(A) If a veteran otherwise eligible for payment of
increased pension under subsection (c), (d), (e), or (f) of
section 1521 of this title on account of a child, the spouse of
the veteran, or the child disposes of covered resources for
less than fair market value on or after the look-back date
described in subparagraph (C)(i), the Secretary shall deny or
discontinue payment of such increased pension for months during
the period beginning on the date described in subparagraph (D)
and equal to the number of months calculated as provided in
subparagraph (E).
(B)(i) For purposes of this paragraph, a covered resource
is any resource that was a part of the corpus of the estate of
the child that the Secretary considers that under all the
circumstances, if the veteran, the spouse of the veteran, or
the child had not disposed of such resource, it would be
reasonable that the resource (or some portion of the resource)
be consumed for the child's maintenance.
(ii) For purposes of this paragraph, the Secretary may
consider, in accordance with regulations the Secretary shall
prescribe, a transfer of an asset (including a transfer of an
asset to an annuity, trust, or other financial instrument or
investment) a disposal of a covered resource for less than fair
market value if such transfer reduces the amount in the corpus
of the estate of the child that the Secretary considers, under
all the circumstances, would be reasonable to be consumed for
the child's maintenance.
(C)(i) The look-back date described in this clause is a
date that is 36 months before the date described in clause
(ii).
(ii) The date described in this clause is the date on which
the veteran applies for payment of increased pension under
subsection (c), (d), (e), or (f) of section 1521 of this title
on account of a child or, if later, the date on which the
veteran, the spouse of the veteran, or the child disposes of
covered resources for less than fair market value.
(D) The date described in this subparagraph is the first
day of the first month in or after which covered resources were
disposed of for less than fair market value and which does not
occur in any other period of ineligibility under this
paragraph.
(E) The number of months calculated under this subparagraph
shall be equal to--
(i) the total, cumulative uncompensated value of the
portion of the covered resources so disposed of by the
veteran, the spouse of the veteran, or the child on or
after the look-back date described in subparagraph
(C)(i) that the Secretary determines would reasonably
have been consumed for the child's maintenance; divided
by
(ii) the maximum amount of increased monthly pension
that is payable to a veteran under subsection (c), (d),
(e), or (f) of section 1521 of this title on account of
a child,
rounded down, in the case of any fraction, to the nearest whole
number, but shall not in any case exceed 36 months.
(c)(1)(A) The Secretary shall not deny or discontinue
payment of pension under section 1513 or 1521 of this title or
payment of increased pension under subsection (c), (d), (e), or
(f) of section 1521 of this title on account of a child by
reason of the application of subsection (a)(2) or (b)(2) of
this section to the disposal of resources by an individual--
(i) if--
(I) a satisfactory showing is made to the
Secretary (in accordance with regulations
promulgated by the Secretary) that all
resources disposed of for less than fair market
value have been returned to the individual who
disposed of the resources; or
(II) the Secretary determines, under
procedures established by the Secretary in
accordance with subparagraph (B), that the
denial or discontinuance of payment would work
an undue hardship; or
(ii) to the extent that any portion of the resources
disposed of for less than fair market value have been
returned to the individual who disposed of the
resources.
(B) Undue hardship would be worked by the denial or
discontinuance of payment for purposes of subparagraph
(A)(i)(II) if the denial or discontinuance of payment would
deprive the individual during the period of denial or
discontinuance--
(i) of medical care such that the individual's life
or health would be endangered;
(ii) of necessary food or clothing, or other
necessities of life; or
(iii) on such other basis as the Secretary shall
specify in the procedures required by subparagraph
(A)(i)(II).
(C) If payment of pension or increased pension that would
otherwise be denied or discontinued by reason of the
application of subsection (a)(2) or (b)(2) is denied or
discontinued only in part by reason of the return of resources
as described in subparagraph (A)(ii), the period of the denial
or discontinuance as determined pursuant to subparagraph (E) of
subsection (a)(2) or (b)(2), as applicable, shall be
recalculated to take into account such return of resources.
(2) At the time a veteran applies for pension under section
1513 or 1521 of this title or increased pension under
subsection (c), (d), (e), or (f) of section 1521 of this title
on account of a child, and at such other times as the Secretary
considers appropriate, the Secretary shall--
(A) inform such veteran of the provisions of
subsections (a)(2) and (b)(2) providing for a period of
ineligibility for payment of pension under such
sections for individuals who make certain dispositions
of resources for less than fair market value, including
the exception for hardship from such period of
ineligibility;
(B) obtain from such veteran information which may be
used in determining whether or not a period of
ineligibility for such payments would be required by
reason of such subsections; and
(C) provide such veteran a timely process for
determining whether or not the exception for hardship
shall apply to such veteran.

* * * * * * *

Subchapter III. Pensions to Surviving Spouses and Children

* * * * * * *

Other Periods of War

SEC. 1541. SURVIVING SPOUSES OF VETERANS OF A PERIOD OF WAR

* * * * * * *

(f) No pension shall be paid under this section to a
surviving spouse of a veteran unless the spouse was married to
the veteran--
(1) before (A) December 14, 1944, in the case of a
surviving spouse of a Mexican border period or World
War I veteran, (B) January 1, 1957, in the case of a
surviving spouse of a World War II veteran, (C)
February 1, 1965, in the case of a surviving spouse of
a Korean conflict veteran, (D) May 8, 1985, in the case
of a surviving spouse of a Vietnam era veteran, or (E)
[January 1, 2001] the date that is 10 years and one day
after the date on which the Persian Gulf War was
terminated, as prescribed by Presidential proclamation
or by law, in the case of a surviving spouse of a
veteran of the Persian Gulf War;

* * * * * * *

SEC. 1543. NET WORTH LIMITATION

(a)(1) * * *

* * * * * * *

(2)(A) If a surviving spouse otherwise eligible for payment
of pension under section 1541 of this title disposes of covered
resources for less than fair market value on or after the look-
back date described in subparagraph (C)(i), the Secretary shall
deny or discontinue the payment of pension to such surviving
spouse under section 1541 of this title for months during the
period beginning on the date described in subparagraph (D) and
equal to the number of months calculated as provided in
subparagraph (E).
(B)(i) For purposes of this paragraph, a covered resource
is any resource that was a part of the corpus of the estate of
the surviving spouse that the Secretary considers that under
all the circumstances, if the surviving spouse had not disposed
of such resource, it would be reasonable that the resource (or
some portion of the resource) be consumed for the surviving
spouse's maintenance.
(ii) For purposes of this paragraph, the Secretary may
consider, in accordance with regulations the Secretary shall
prescribe, a transfer of an asset (including a transfer of an
asset to an annuity, trust, or other financial instrument or
investment) a disposal of a covered resource for less than fair
market value if such transfer reduces the amount in the corpus
of the estate of the surviving spouse that the Secretary
considers, under all the circumstances, would be reasonable to
be consumed for the surviving spouse's maintenance.
(C)(i) The look-back date described in this clause is a
date that is 36 months before the date described in clause
(ii).
(ii) The date described in this clause is the date on which
the surviving spouse applies for pension under section 1541 of
this title or, if later, the date on which the surviving spouse
disposes of covered resources for less than fair market value.
(D) The date described in this subparagraph is the first
day of the first month in or after which covered resources were
disposed of for less than fair market value and which does not
occur in any other period of ineligibility under this
paragraph.
(E) The number of months calculated under this subparagraph
shall be equal to--
(i) the total, cumulative uncompensated value of the
portion of the covered resources so disposed of by the
surviving spouse on or after the look-back date
described in subparagraph (C)(i) that the Secretary
determines would reasonably have been consumed for the
surviving spouse's maintenance; divided by
(ii) the maximum amount of monthly pension that is
payable to a surviving spouse under section 1541 of
this title, including the maximum amount of increased
pension payable under such section on account of a
child, but not including any amount of pension payable
under such section because a surviving spouse is in
need of regular aid and attendance or is permanently
housebound,
rounded down, in the case of any fraction, to the nearest whole
number, but shall not in any case exceed 36 months.
(3) [(2)] The Secretary shall * * *
(4)(A) If a surviving spouse otherwise eligible for payment
of increased pension under subsection (c), (d), or (e) of
section 1541 of this title on account of a child or the child
disposes of covered resources for less than fair market value
on or after the look-back date described in subparagraph
(C)(i), the Secretary shall deny or discontinue payment of such
increased pension for months during the period beginning on the
date described in subparagraph (D) and equal to the number of
months calculated as provided in subparagraph (E).
(B)(i) For purposes of this paragraph, a covered resource
is any resource that was a part of the corpus of the estate of
the child that the Secretary considers that under all the
circumstances, if the surviving spouse or the child had not
disposed of such resource, it would be reasonable that the
resource (or some portion of the resource) be consumed for the
child's maintenance.
(ii) For purposes of this paragraph, the Secretary may
consider, in accordance with regulations the Secretary shall
prescribe, a transfer of an asset (including a transfer of an
asset to an annuity, trust, or other financial instrument or
investment) a disposal of a covered resource for less than fair
market value if such transfer reduces the amount in the corpus
of the estate of the child that the Secretary considers, under
all the circumstances, would be reasonable to be consumed for
the child's maintenance.
(C)(i) The look-back date described in this clause is a
date that is 36 months before the date described in clause
(ii).
(ii) The date described in this clause is the date on which
the surviving spouse applies for payment of increased pension
under subsection (c), (d), or (e) of section 1541 of this title
on account of a child or, if later, the date on which the
surviving spouse (or the child) disposes of covered resources
for less than fair market value.
(D) The date described in this subparagraph is the first
day of the first month in or after which covered resources were
disposed of for less than fair market value and which does not
occur in any other period of ineligibility under this
paragraph.
(E) The number of months calculated under this clause shall
be equal to--
(i) the total, cumulative uncompensated value of the
portion of the covered resources so disposed of by the
surviving spouse (or the child) on or after the look-
back date described in subparagraph (C)(i) that the
Secretary determines would reasonably have been
consumed for the child's maintenance; divided by
(ii) the maximum amount of increased monthly pension
that is payable to a surviving spouse under subsection
(c), (d), or (e) of section 1541 of this title on
account of a child,
rounded down, in the case of any fraction, to the nearest whole
number, but shall not in any case exceed 36 months.
(b)(1) The Secretary shall * * *
(2)(A) If a child otherwise eligible for payment of pension
under section 1542 of this title or any person with whom such
child is residing who is legally responsible for such child's
support disposes of covered resources for less than fair market
value on or after the look-back date described in subparagraph
(C)(i), the Secretary shall deny or discontinue the payment of
pension to such child under section 1542 of this title for
months during the period beginning on the date described in
subparagraph (D) and equal to the number of months calculated
as provided in subparagraph (E).
(B)(i) For purposes of this paragraph, a covered resource
is any resource that was a part of the corpus of the estate of
the child or the corpus of the estate of any person with whom
such child is residing who is legally responsible for such
child's support that the Secretary considers that under all the
circumstances, if the child or person had not disposed of such
resource, it would be reasonable that the resource (or some
portion of the resource) be consumed for the child's
maintenance.
(ii) For purposes of this paragraph, the Secretary may
consider, in accordance with regulations the Secretary shall
prescribe, a transfer of an asset (including a transfer of an
asset to an annuity, trust, or other financial instrument or
investment) a disposal of a covered resource for less than fair
market value if such transfer reduces the amount in the corpus
of the estate described in clause (i) that the Secretary
considers, under all the circumstances, would be reasonable to
be consumed for the child's maintenance.
(C)(i) The look-back date described in this clause is a
date that is 36 months before the date described in clause
(ii).
(ii) The date described in this clause is the date on which
the child applies for pension under section 1542 of this title
or, if later, the date on which the child (or person described
in subparagraph (B)) disposes of covered resources for less
than fair market value.
(D) The date described in this clause is the first day of
the first month in or after which covered resources were
disposed of for less than fair market value and which does not
occur in any other period of ineligibility under this
paragraph.
(E) The number of months calculated under this clause shall
be equal to--
(i) the total, cumulative uncompensated value of the
portion of the covered resources so disposed of by the
child (or person described in subparagraph (B)) on or
after the look-back date described in subparagraph
(C)(i) that the Secretary determines would reasonably
have been consumed for the child's maintenance; divided
by
(ii) the maximum amount of monthly pension that is
payable to a child under section 1542 of this title,
rounded down, in the case of any fraction, to the nearest whole
number, but shall not in any case exceed 36 months.
(c)(1)(A) The Secretary shall not deny or discontinue
payment of pension under section 1541 or 1542 of this title or
payment of increased pension under subsection (c), (d), or (e)
of section 1541 of this title on account of a child by reason
of the application of subsection (a)(2), (a)(4), or (b)(2) of
this section to the disposal of resources by an individual--
(i) if--
(I) a satisfactory showing is made to the
Secretary (in accordance with regulations
promulgated by the Secretary) that all
resources disposed of for less than fair market
value have been returned to the individual who
disposed of the resources; or
(II) the Secretary determines, under
procedures established by the Secretary in
accordance with subparagraph (B), that the
denial or discontinuance of payment would work
an undue hardship; or
(ii) to the extent that any portion of the resources
disposed of for less than fair market value have been
returned to the individual who disposed of the
resources.
(B) Undue hardship would be worked by the denial or
discontinuance of payment for purposes of subparagraph
(A)(i)(II) if the denial or discontinuance of payment would
deprive the individual during the period of denial or
discontinuance--
(i) of medical care such that the individual's life
or health would be endangered;
(ii) of necessary food or clothing, or other
necessities of life; or
(iii) on such other basis as the Secretary shall
specify in the procedures required by subparagraph
(A)(i)(II).
(C) If payment of pension or increased pension that would
otherwise be denied or discontinued by reason of the
application of subsection (a)(2), (a)(4), or (b)(2) is denied
or discontinued only in part by reason of the return of
resources as described in subparagraph (A)(ii), the period of
the denial or discontinuance as determined pursuant to
subparagraph (E) of subsection (a)(2), (a)(4), or (b)(2), as
applicable, shall be recalculated to take into account such
return of resources.
(2) At the time a surviving spouse or child applies for
pension under section 1541 or 1542 of this title or increased
pension under subsection (c), (d), or (e) of section 1541 of
this title on account of a child, and at such other times as
the Secretary considers appropriate, the Secretary shall--
(A) inform such surviving spouse or child of the
provisions of subsections (a)(2), (a)(4), and (b)(2),
as applicable, providing for a period of ineligibility
for payment of pension or increased pension under such
sections for individuals who make certain dispositions
of resources for less than fair market value, including
the exception for hardship from such period of
ineligibility;
(B) obtain from such surviving spouse or child
information which may be used in determining whether or
not a period of ineligibility for such payments would
be required by reason of such subsections; and
(C) provide such surviving spouse or child a timely
process for determining whether or not the exception
for hardship shall apply to such surviving spouse or
child.

* * * * * * *

Chapter 17. Hospital, Nursing Home, Domiciliary, and Medical Care

* * * * * * *

Subchapter I. General

SEC. 1701. DEFINITIONS

* * * * * * *

(6) * * *

* * * * * * *

(H) Chiropractic services.
(7) * * *
(8) The term ``rehabilitative services'' means such
professional, counseling, chiropractic, and guidance
services and treatment programs as are necessary to
restore, to the maximum extent possible, the physical,
mental, and psychological functioning of an ill or
disabled person.
(9) * * *
(A) * * *

* * * * * * *

(F) periodic and preventive chiropractic
examinations and services;
(G) [(F)] immunizations against infectious
disease;
(H) [(G)] prevention of musculoskeletal
deformity or other gradually developing
disabilities of a metabolic or degenerative
nature;
(I) [(H)] genetic counseling concerning
inheritance of genetically determined diseases;
(J) [(I)] routine vision testing and eye care
services;
(K) [(J)] periodic reexamination of members
of likely target populations (high-risk groups)
for selected diseases and for functional
decline of sensory organs, together with
attendant appropriate remedial intervention;
and
(L) [(K)] such other health-care services as
the Secretary may determine to be necessary to
provide effective and economical preventive
health care.

* * * * * * *

Subchapter II. Hospital, Nursing Home, or Domiciliary Care and Medical
Treatment

SEC. 1710. ELIGIBILITY FOR HOSPITAL, NURSING HOME, AND DOMICILIARY CARE

* * * * * * *

(e)(1)(A) * * *

* * * * * * *

(F) Subject to paragraph (2), a veteran who served on
active duty in the Armed Forces at Camp Lejeune, North
Carolina, for not fewer than 30 days during the period
beginning on [January 1, 1957,] August 1, 1953 (or such earlier
date for the commencement of exposure to contaminated water at
Camp Lejeune as the Secretary, in consultation with the Agency
for Toxic Substances and Disease Registry, shall specify), and
ending on December 31, 1987, is eligible for hospital care and
medical services under subsection (a)(2)(F) for any of the
following illnesses or conditions, notwithstanding that there
is insufficient medical evidence to conclude that such
illnesses or conditions are attributable to such service:

* * * * * * *

SEC. 1720D. COUNSELING AND TREATMENT FOR SEXUAL TRAUMA

(a)(1) The Secretary shall operate a program under which
the Secretary provides counseling and appropriate care and
services to veterans who the Secretary determines require such
counseling and care and services to overcome psychological
trauma, which in the judgment of a mental health professional
employed by the Department, resulted from a physical assault of
a sexual nature, battery of a sexual nature, or sexual
harassment which occurred while the veteran was serving on
active duty [or active duty for training] , active duty for
training, or inactive duty training.

* * * * * * *

Chapter 18. Benefits for Children of Vietnam Veterans and Other
Veterans

SEC.

* * * * * * *

[SUBCHAPTER III. CHILDREN OF CERTAIN KOREA SERVICE VETERANS BORN WITH
SPINA BIFIDA]

SUBCHAPTER III. CHILDREN OF CERTAIN KOREA AND THAILAND SERVICE VETERANS
BORN WITH SPINA BIFIDA

1821. BENEFITS FOR CHILDREN OF CERTAIN KOREA SERVICE VETERANS BORN WITH
SPINA BIFIDA.

1822. BENEFITS FOR CHILDREN OF CERTAIN THAILAND SERVICE VETERANS BORN
WITH SPINA BIFIDA.

* * * * * * *

Subchapter III. Children of Certain Korea and Thailand Service Veterans
Born with Spina Bifida

* * * * * * *

SEC. 1822. BENEFITS FOR CHILDREN OF CERTAIN THAILAND SERVICE VETERANS
BORN WITH SPINA BIFIDA

(a) Benefits Authorized.--The Secretary may provide to any
child of a veteran of covered service in Thailand who is
suffering from spina bifida the health care, vocational
training and rehabilitation, and monetary allowance required to
be paid to a child of a Vietnam veteran who is suffering from
spina bifida under subchapter I of this chapter as if such
child of a veteran of covered service in Thailand were a child
of a Vietnam veteran who is suffering from spina bifida under
such subchapter.
(b) Spina Bifida Conditions Covered.--This section applies
with respect to all forms and manifestations of spina bifida,
except spina bifida occulta.
(c) Veteran of Covered Service in Thailand.--For purposes
of this section, a veteran of covered service in Thailand is
any individual, without regard to the characterization of that
individual's service, who--
(1) served in the active military, naval, or air
service in Thailand, as determined by the Secretary in
consultation with the Secretary of Defense, during the
period beginning on January 9, 1962, and ending on May
7, 1975; and
(2) is determined by the Secretary, in consultation
with the Secretary of Defense, to have been exposed to
a herbicide agent during such service in Thailand.
(d) Herbicide Agent.--For purposes of this section, the
term ``herbicide agent'' means a chemical in a herbicide used
in support of United States and allied military operations in
Thailand, as determined by the Secretary in consultation with
the Secretary of Defense, during the period beginning on
January 9, 1962, and ending on May 7, 1975.

* * * * * * *

Subchapter IV. General Provisions

SEC. 1831. DEFINITIONS

In this chapter:
(1) * * *
(A) * * *

* * * * * * *

(B) For purposes of [subchapter III of this
chapter] section 1821 of this title, an
individual, regardless of age or marital
status, who--
(i) is the natural child of a veteran
of covered service in Korea (as
determined for purposes of [section
1821 of this title] that section); and
(ii) * * *
(C) For purposes of section 1822 of this
title, an individual, regardless of age or
marital status, who--
(i) is the natural child of a veteran
of covered service in Thailand (as
determined for purposes of that
section); and
(ii) was conceived after the date on
which that veteran first entered
service described in subsection (c) of
that section.

* * * * * * *

Part III. Readjustment and Related Benefits

* * * * * * *

Chapter 33. Post-9/11 Educational Assistance

* * * * * * *

Subchapter II. Educational Assistance

SEC. 3311. EDUCATIONAL ASSISTANCE FOR SERVICE IN THE ARMED FORCES
COMMENCING ON OR AFTER SEPTEMBER 11, 2001:
ENTITLEMENT

(a) * * *
(b) * * *

* * * * * * *

(9) An individual who is the child or spouse of a
person who, on or after September 11, 2001, dies in
line of duty while serving on active duty as a member
of the Armed Forces.

* * * * * * *

(f) * * *
(1) * * *
(2) Limitation.--The entitlement of an individual to
assistance under subsection (a) pursuant to paragraph
(9) of subsection (b) because the individual was a
spouse of a person described in such paragraph shall
expire on the earlier of--
(A) the date that is 15 years after the date
on which the person died; and
(B) the date on which the individual
remarries.
(3) Election on receipt of certain benefits.--A
surviving spouse entitled to assistance under
subsection (a) pursuant to paragraph (9) of subsection
(b) who is also entitled to educational assistance
under chapter 35 of this title may not receive
assistance under both this section and such chapter,
but shall make an irrevocable election (in such form
and manner as the Secretary may prescribe) under which
section or chapter to receive educational assistance.
(4) [(2)] Definition of child.--For purposes of that
paragraph, the term ``child'' includes a married
individual or an individual who is above the age of
twenty-three years.

* * * * * * *

SEC. 3317. PUBLIC-PRIVATE CONTRIBUTIONS FOR ADDITIONAL EDUCATIONAL
ASSISTANCE

(a) Establishment of Program.--In instances where the
educational assistance provided pursuant to section
3313(c)(1)(A) does not cover the full cost of established
charges (as specified in section 3313), the Secretary shall
carry out a program under which colleges and universities can,
voluntarily, enter into an agreement with the Secretary to
cover a portion of those established charges not otherwise
covered under section 3313(c)(1)(A), which contributions shall
be matched by equivalent contributions toward such costs by the
Secretary. The program shall only apply to covered individuals
described [in paragraphs (1) and (2)] in paragraphs (1), (2),
and (9) of section 3311(b).

* * * * * * *

Subchapter III. Administrative Provisions

SEC. 3321. TIME LIMITATION FOR USE OF AND ELIGIBILITY FOR ENTITLEMENT

* * * * * * *

(b) * * *

* * * * * * *

(4) Applicability to children of deceased members.
The period during which [an individual] a child
entitled to educational assistance by reason of section
3311(b)(9) may use [such individual's] such child's
entitlement expires at the end of the 15-year period
beginning on the date of [such individual's] such
child's eighteenth birthday.

* * * * * * *

Chapter 34. Veterans Educational Assistance

* * * * * * *

Subchapter IV. Payments to Eligible Veterans; Veteran-Student Services

* * * * * * *

SEC. 3485. WORK-STUDY ALLOWANCE

(a)(1) * * *

* * * * * * *

(4) * * *
(A) The outreach services program under chapter 63 of
this title as carried out under the supervision of a
Department employee or, during the period preceding
[June 30, 2013] June 30, 2015, outreach services to
servicemembers and veterans furnished by employees of a
State approving agency.
(B) * * *
(C) The provision of hospital and domiciliary care
and medical treatment under chapter 17 of this title,
including, during the period preceding [June 30, 2013]
June 30, 2015, the provision of such care to veterans
in a State home for which payment is made under section
1741 of this title.
(D) * * *
(E) * * *
(F) During the period preceding [June 30, 2013] June
30, 2015, an activity relating to the administration of
a national cemetery or a State veterans' cemetery.

* * * * * * *

(J) * * *
(K) During the period beginning on June 30, 2013, and
ending on June 30, 2015, the following activities
carried out at the offices of Members of Congress for
such Members:
(i) The distribution of information to
members of the Armed Forces, veterans, and
their dependents about the benefits and
services under laws administered by the
Secretary and other appropriate governmental
and nongovernmental programs.
(ii) The preparation and processing of papers
and other documents, including documents to
assist in the preparation and presentation of
claims for benefits under laws administered by
the Secretary.

* * * * * * *

Chapter 36. Administration of Educational Benefits

* * * * * * *

Subchapter I. State Approving Agencies

* * * * * * *

SEC. 3679. DISAPPROVAL OF COURSES

(a) * * *
(b) * * *
(c)(1) Notwithstanding any other provision of this chapter
and subject to paragraphs (3) through (6), the Secretary shall
disapprove a course of education provided by a public
institution of higher learning to a covered individual pursuing
a course of education with educational assistance under chapter
30 or 33 of this title while living in the State in which the
public institution of higher learning is located if the
institution charges tuition and fees for that course for the
covered individual at a rate that is higher than the rate the
institution charges for tuition and fees for that course for
residents of the State in which the institution is located,
regardless of the covered individual's State of residence.
(2) For purposes of this subsection, a covered individual
is any individual as follows:
(A) A veteran who was discharged or released from a
period of not fewer than 90 days of service in the
active military, naval, or air service less than three
years before the date of enrollment in the course
concerned.
(B) An individual who is entitled to assistance under
section 3311(b)(9) or 3319 of this title by virtue of
such individual's relationship to a veteran described
in subparagraph (A).
(3) If after enrollment in a course of education that is
subject to disapproval under paragraph (1) by reason of
paragraph (2)(A) or (2)(B) a covered individual pursues one or
more courses of education at the same public institution of
higher learning while remaining continuously enrolled (other
than during regularly scheduled breaks between courses,
semesters or terms) at that institution of higher learning, any
course so pursued by the covered individual at that institution
of higher learning while so continuously enrolled shall also be
subject to disapproval under paragraph (1).
(4) It shall not be grounds to disapprove a course of
education under paragraph (1) if a public institution of higher
learning requires a covered individual pursuing a course of
education at the institution to demonstrate an intent, by means
other than satisfying a physical presence requirement, to
establish residency in the State in which the institution is
located, or to satisfy other requirements not relating to the
establishment of residency, in order to be charged tuition and
fees for that course at a rate that is equal to or less than
the rate the institution charges for tuition and fees for that
course for residents of the State.
(5) The Secretary may waive such requirements of paragraph
(1) as the Secretary considers appropriate.
(6) Disapproval under paragraph (1) shall apply only with
respect to educational assistance under chapters 30 and 33 of
this title.

* * * * * * *

Subchapter II. Miscellaneous Provisions

* * * * * * *

SEC. 3684. REPORTS BY VETERANS, ELIGIBLE PERSONS, AND INSTITUTIONS;
REPORTING FEE

* * * * * * *

(c) The Secretary may pay to any educational institution,
or to the sponsor of a program of apprenticeship, furnishing
education or training under either this chapter or chapter 31,
34, or 35 of this title, a reporting fee which will be in lieu
of any other compensation or reimbursement for reports or
certifications which such educational institution or joint
apprenticeship training committee is required to submit to the
Secretary by law or regulation. Such reporting fee shall be
computed for each calendar year by multiplying [$12] $7 by the
number of eligible veterans or eligible persons enrolled under
this chapter or chapter 31, 34, or 35 of this title, or [$15]
$11 in the case of those eligible veterans and eligible persons
whose educational assistance checks are directed in care of
each institution for temporary custody and delivery and are
delivered at the time of registration as provided under section
3680(d)(4) of this title, during the calendar year. * * *

* * * * * * *

Chapter 37. Housing and Small Business Loans

* * * * * * *

Subchapter III. Administrative Provisions

* * * * * * *

SEC. 3729. LOAN FEE

* * * * * * *

(b) Determination of Fee.--(1) * * *
(2) The loan fee table referred to in paragraph (1) is as
follows:

LOAN FEE TABLE
------------------------------------------------------------------------
Active
Type of loan duty Reservist Other
veteran obligor
------------------------------------------------------------------------
(A)(i) Initial loan described in 2.00 2.75 NA
section 3710(a) to purchase or
construct a dwelling with 0-down, or
any other initial loan described in
section 3710(a) other than with 5-down
or 10-down (closed before January 1,
2004).................................
(A)(ii) Initial loan described in 2.20 2.40 NA
section 3710(a) to purchase or
construct a dwelling with 0-down, or
any other initial loan described in
section 3710(a) other than with 5-down
or 10-down (closed on or after January
1, 2004, and before October 1, 2004)..
(A)(iii) Initial loan described in 2.15 2.40 NA
section 3710(a) to purchase or
construct a dwelling with 0-down, or
any other initial loan described in
section 3710(a) other than with 5-down
or 10-down (closed on or after October
1, 2004, and before [October 1, 2017]
May 1, 2018)..........................
(A)(iv) Initial loan described in 1.40 1.65 NA
section 3710(a) to purchase or
construct a dwelling with 0-down, or
any other initial loan described in
section 3710(a) other than with 5-down
or 10-down (closed on or after
[October 1, 2017] May 1, 2018)........
(B)(i) Subsequent loan described in 3.30 3.30 NA
section 3710(a) to purchase or
construct a dwelling with 0-down, or
any other subsequent loan described in
section 3710(a) (closed before
[October 1, 2017] May 1, 2018)........
(B)(ii) Subsequent loan described in 1.25 1.25 NA
section 3710(a) to purchase or
construct a dwelling with 0-down, or
any other subsequent loan described in
section 3710(a) (closed on or after
[October 1, 2017] May 1, 2018)........
(C)(i) Loan described in section 1.50 1.75 NA
3710(a) to purchase or construct a
dwelling with 5-down (closed before
[October 1, 2017] May 1, 2018)........
(C)(ii) Loan described in section 0.75 1.00 NA
3710(a) to purchase or construct a
dwelling with 5-down (closed on or
after [October 1, 2017] May 1, 2018)..
(D)(i) Initial loan described in 1.25 1.50 NA
section 3710(a) to purchase or
construct a dwelling with 10-down
(closed before [October 1, 2017] May
1, 2018)..............................
(D)(ii) Initial loan described in 0.50 0.75 NA
section 3710(a) to purchase or
construct a dwelling with 10-down
(closed on or after [October 1, 2017]
May 1, 2018)..........................
(E) Interest rate reduction refinancing 0.50 0.50 NA
loan..................................
(F) Direct loan under section 3711..... 1.00 1.00 NA
(G) Manufactured home loan under 1.00 1.00 NA
section 3712 (other than an interest
rate reduction refinancing loan)......
(H) Loan to Native American veteran 1.25 1.25 NA
under section 3762 (other than an
interest rate reduction refinancing
loan).................................
(I) Loan assumption under section 3714. 0.50 0.50 0.50
(J) Loan under section 3733(a)......... 2.25 2.25 2.25
------------------------------------------------------------------------

* * * * * * *
Chapter 41. Job Counseling, Training, and Placement Service for
Veterans

* * * * * * *

SEC. 4102A. ASSISTANT SECRETARY OF LABOR FOR VETERANS' EMPLOYMENT AND
TRAINING; PROGRAM FUNCTIONS; REGIONAL
ADMINISTRATORS

* * * * * * *

[(9)(A) As a condition of a grant or contract under
which funds are made available to a State in order to
carry out section 4103A or 4104 of this title for any
program year, the Secretary may require the State--
[(i) to demonstrate that when the State
approves or denies a certification or license
described in subparagraph (B) for a veteran the
State takes into consideration any training
received or experience gained by the veteran
while serving on active duty in the Armed
Forces; and
[(ii) to disclose to the Secretary in writing
the following:
[(I) Criteria applicants must satisfy
to receive a certification or license
described in subparagraph (B) by the
State.
[(II) A description of the standard
practices of the State for evaluating
training received by veterans while
serving on active duty in the Armed
Forces and evaluating the documented
work experience of such veterans during
such service for purposes of approving
or denying a certification or license
described in subparagraph (B).
[(III) Identification of areas in
which training and experience described
in subclause (II) fails to meet
criteria described in subclause (I).
[(B) A certification or license described in this
subparagraph is any of the following:
[(i) A license to be a nonemergency medical
professional.
[(ii) A license to be an emergency medical
professional.
[(iii) A commercial driver's license.
[(C) The Secretary shall share the information the
Secretary receives under subparagraph (A)(ii) with the
Secretary of Defense to help the Secretary of Defense
improve training for military occupational specialties
so that individuals who receive such training are able
to receive a certification or license described in
subparagraph (B) from a State.
[(D) The Secretary shall publish on the Internet
website of the Department available to the public--
[(i) any guidance the Secretary gives the
Secretary of Defense with respect to carrying
out this section; and
[(ii) any information the Secretary receives
from a State pursuant to subparagraph (A).]
(9)(A) As a condition of a grant or contract under
which funds are made available to a State under
subsection (b)(5) in order to carry out section 4103A
or 4104 of this title, the State shall--
(i) establish a program under which the State
administers an examination to each veteran
seeking a license or credential issued by the
State and issues such license or credential to
such veteran without requiring such veteran to
undergo any training or apprenticeship if the
veteran--
(I) receives a satisfactory score on
completion of such examination, as
determined by the State;
(II) has been awarded a military
occupational specialty that is
substantially equivalent to or exceeds
the requirements of the State for the
issuance of such license or credential;
(III) has engaged in the active
practice of the occupation for which
the veteran is seeking such license or
credential for at least two of the five
years preceding the date of
application; and
(IV) pays any customary or usual fees
required by the State for such license
or credential; and
(ii) submit each year to the Secretary a
report on the exams administered under clause
(i) during the most recently completed 12-month
period that includes, for the period covered by
the report the number of veterans who completed
an exam administered by the State under clause
(i) and a description of the results of such
exams, disaggregated by occupational field.
(B) The Secretary may waive the requirement under
subparagraph (A) that a State establish a program
described in that subparagraph as a condition of a
grant or contract if the State certifies to the
Secretary that the State--
(i) takes into account previous military
training for the purposes of issuing licenses
or credentials;
(ii) permits veterans to completely satisfy
through examination any training or testing
requirements for a license or credential with
respect to which a veteran has previously
completed military training; and
(iii) for any credential or license for which
a veteran is unable to completely satisfy such
requirements through examination, the State
substantially reduces training time required to
satisfy such requirement based on the military
training received by the veteran.
(C) Not less frequently than once each year, the
Secretary shall submit to Congress and the Secretary of
Defense a report summarizing the information received
by the Secretary under subparagraph (A)(ii).

* * * * * * *

Chapter 42. Employment and Training of Veterans

* * * * * * *

SEC. 4214. EMPLOYMENT WITHIN THE FEDERAL GOVERNMENT

* * * * * * *

(b)(1) * * *

* * * * * * *

(4)(A) The requirement under this paragraph is in addition
to the appointment of qualified covered veterans under the
authority under paragraph (1) by the Department of Veterans
Affairs and the Department of Defense.
(B) The head of each agency, in consultation with the
Director of the Office of Personnel Management, shall develop a
plan for exercising the authority specified in subparagraph (C)
during the five-year period beginning on the date of the
enactment of the Veterans Health and Benefits Improvement Act
of 2013.
(C) The authority specified in this subparagraph is the
authority as follows:
(i) The authority under paragraph (1).
(ii) The authority available to the agency concerned
under the Veterans Employment Opportunities Act of 1998
(Public Law 105-339) and the amendments made by that
Act.
(D) The Director of the Office of Personnel Management
shall ensure that under the plans developed under subparagraph
(B) agencies shall appoint to existing vacancies not fewer than
15,000 qualified covered veterans during the five-year period
beginning on the date of the enactment of the Veterans Health
and Benefits Improvement Act of 2013. For purposes of complying
with this subparagraph, an appointment pursuant to the
authority referred to in subparagraph (C)(ii) shall not count
toward the number required by this subparagraph unless the
appointment is to a vacancy in a full-time, permanent position.

* * * * * * *

(d) The Office of Personnel Management shall be responsible
for the review and evaluation of the implementation of this
section and the activities of each agency to carry out the
purpose and provisions of this section. The Office shall
periodically obtain (on at least an annual basis) information
on the implementation of this section by each agency and on the
activities of each agency to carry out the purpose and
provisions of this section. The information obtained shall
include specification of the use and extent of appointments
made by each agency under subsection (b) of this section
(including, during the 5-year period beginning on the date of
the enactment of the Veterans Health and Benefits Improvement
Act of 2013, the development and implementation by each agency
of the plan required under subsection (b)(4), which shall
include information regarding the grade or pay level of
appointments by the agency under the plan and whether the
appointments are, or are converted to, career or career-
conditional appointments) and the results of the plans required
under subsection (c) of this section.
(e)(1) The Office of Personnel Management shall submit [to
the Congress] to the appropriate committees of Congress
annually a report on activities carried out under this section.
Each such report shall include the following information with
respect to each agency:
(A) The number of appointments made under subsection
(b) of this section since the last such report and the
grade levels in which such appointments were made
(including, during the 5-year period beginning on the
date of the enactment of the Veterans Health and
Benefits Improvement Act of 2013, the development and
implementation by the agency of the plan required under
subsection (b)(4), which shall include information
regarding the grade or pay level of appointments by the
agency under the plan and whether the appointments are,
or are converted to, permanent appointments).

* * * * * * *

(3) In this subsection, the term ``appropriate committees
of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Homeland Security and Governmental Affairs
of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Oversight and Government Reform of the
House of Representatives.

* * * * * * *

Part IV. General Administrative Provisions

* * * * * * *

Chapter 51. Claims, Effective Dates, and Payments

* * * * * * *

Subchapter I. Claims

* * * * * * *

SEC. 5103A. DUTY TO ASSIST CLAIMANTS

* * * * * * *

(d) * * *

* * * * * * *

(3)(A) In the case of a claim for disability
compensation based on a mental health condition related
to military sexual trauma, the Secretary shall treat an
examination or opinion as being necessary to make a
decision on a claim for purposes of paragraph (1) if
the evidence of record before the Secretary, taking
into consideration all information and lay or medical
evidence (including statements of the claimant)--
(i)(I) contains competent evidence that the
claimant has a current disability, or
persistent or recurrent symptoms of disability;
and
(II) indicates that the disability or
symptoms may be associated with the claimant's
active military, naval, or air service; but
(ii) does not contain a diagnosis or opinion
by a mental health professional that may assist
in corroborating the occurrence of a military
sexual trauma stressor related to a diagnosable
mental health condition.
(B) In this paragraph, the term ``military sexual
trauma'' shall have the meaning specified by the
Secretary for purposes of this paragraph, and shall
include ``sexual harassment'' (as so specified).

* * * * * * *

Subchapter II. Effective Dates

SEC. 5110. EFFECTIVE DATES OF AWARDS

* * * * * * *

(l) The effective date of an award of benefits to a
surviving spouse based upon a termination of a remarriage by
death or divorce[, or of an award or increase of benefits based
on recognition of a child upon termination of the child's
marriage by death or divorce,] shall be the date of death or
the date the judicial decree or divorce becomes final, if an
application therefor is received within one year from such
termination.

* * * * * * *

Chapter 59. Agents and Attorneys

* * * * * * *

SEC. 5902. RECOGNITION OF REPRESENTATIVES OF ORGANIZATIONS

(a)(1) The Secretary may recognize representatives of the
American National Red Cross, the American Legion, the Disabled
American Veterans, the United Spanish War Veterans, the
Veterans of Foreign Wars, and such other organizations as the
Secretary may approve , including Indian tribes (as defined in
section 4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b)), in the preparation,
presentation, and prosecution of claims under laws administered
by the Secretary.

* * * * * * *

Chapter 63. Outreach Activities

SEC.

* * * * * * *

6306. USE OF OTHER AGENCIES.

6306A. COOPERATIVE AGREEMENTS WITH STATES.

6307. OUTREACH FOR ELIGIBLE DEPENDENTS.

6308. [BIENNIAL] ANNUAL REPORT TO CONGRESS.

6309. BUDGET TRANSPARENCY.

* * * * * * *

SEC. 6306A. COOPERATIVE AGREEMENTS WITH STATES

(a) In General.--The Secretary may enter into cooperative
agreements and arrangements with various State agencies and
State departments to carry out this chapter and to otherwise
carry out, coordinate, improve, or enhance outreach activities
of the Department and the States.
(b) Report.--The Secretary shall include in each report
submitted under section 6308 of this title a description of the
agreements and arrangements entered into by the Secretary under
subsection (a).

* * * * * * *

SEC. 6308. [BIENNIAL] ANNUAL REPORT TO CONGRESS

(a) Report required.--The Secretary shall, not later than
December 1 of every [even-numbered] year (beginning in 2008),
submit to Congress a report on the outreach activities carried
out by the Department.
(b) Content.--Each report under this section shall include
the following:
(1) A description of the implementation during the
preceding fiscal year of the current [biennial] plan
under section 6302 of this title.
(2) Recommendations for legislative and
administrative action for the improvement or more
effective administration of the outreach activities of
the Department.
(3) Recommendations that such administrative actions
as may be taken--
(A) to maximize resources for outreach
activities of the Department; and
(B) to focus outreach efforts on activities
that are proven to be more effective.

SEC. 6309. BUDGET TRANSPARENCY

(a) Budget Requirements.--In the budget justification
materials submitted to Congress in support of the Department
budget for a fiscal year (as submitted with the budget of the
President under section 1105(a) of title 31), the Secretary
shall include a separate statement of the amount requested for
such fiscal year for activities of the Office of Public and
Intergovernmental Affairs as follows:
(1) For outreach activities of the Department in
aggregate.
(2) For outreach activities of each element of the
Department specified in subsection (b)(1).
(b) Procedures for Effective Coordination and
Collaboration.--(1) Not later than 180 days after the date of
the enactment of the Veterans Health and Benefits Improvement
Act of 2013, the Secretary shall establish and maintain
procedures for the Office of Public and Intergovernmental
Affairs to ensure the effective coordination and collaboration
of outreach activities of the Department between and among the
following:
(A) Office of the Secretary.
(B) Veterans Health Administration.
(C) Veterans Benefits Administration.
(D) National Cemetery Administration.
(2) The Secretary shall--
(A) beginning after the date on which the Secretary
establishes procedures under paragraph (1), not less
frequently than once every two years conduct a review
of the procedures established and maintained under
paragraph (1) to ensure that such procedures meet the
requirements of such paragraph;
(B) make such modifications to such procedures as the
Secretary considers appropriate based upon reviews
conducted under subparagraph (A) in order to better
meet such requirements; and
(C) not later than 45 days after completing a review
under subparagraph (A), submit to Congress a report on
the findings of such review.

* * * * * * *

Part V. Boards, Administrations, and Services

Chapter 71. Board of Veterans' Appeals

* * * * * * *

SEC. 7105. FILING OF NOTICE OF DISAGREEMENT AND APPEAL

* * * * * * *

(b)(1) Except in the case of simultaneously contested
claims, notice of disagreement shall be filed within [one year]
180 days from the date of mailing of notice of the result of
initial review or determination. Such notice, and appeals, must
be in writing and be filed with the activity which entered the
determination with which disagreement is expressed (hereinafter
referred to as the ``agency of original jurisdiction''). A
notice of disagreement postmarked or transmitted by electronic
means before the expiration of the [one-year] 180-day period
will be accepted as timely filed.
(2) * * *
(3) A notice of disagreement not filed within the time
prescribed by paragraph (1) shall be treated by the Secretary
as timely filed if--
(A) the Secretary determines that the claimant, legal
guardian, or other accredited representative, attorney,
or authorized agent filing the notice had good cause
for the lack of filing within such time; and
(B) the notice of disagreement is filed not later
than 186 days after the expiration of the period
prescribed by paragraph (1).

* * * * * * *

SEC. 7106. ADMINISTRATIVE APPEALS

Application for review on appeal may be made within the
[one-year period prescribed in section 7105] period described
in section 7105(b)(1) of this title by such officials of the
Department as may be designated by the Secretary. An
application entered under this paragraph shall not operate to
deprive the claimant of the right of review on appeal as
provided in this chapter.

SEC. 7107. APPEALS: DOCKETS; HEARINGS

(a)(1) Except as provided in paragraphs (2) and (3) and [in
subsection (f)] in subsection (g), each case received pursuant
to application for review on appeal shall be considered and
decided in regular order according to its place upon the
docket.

* * * * * * *

[(d)(1) An appellant may request that a hearing before the
Board be held at its principal location or at a facility of the
Department located within the area served by a regional office
of the Department.
[(2) A hearing to be held within an area served by a
regional office of the Department shall (except as provided in
paragraph (3)) be scheduled to be held in accordance with the
place of the case on the docket under subsection (a) relative
to other cases on the docket for which hearings are scheduled
to be held within that area.
[(3) A hearing to be held within an area served by a
regional office of the Department may, for cause shown, be
advanced on motion for an earlier hearing. Any such motion
shall set forth succinctly the grounds upon which the motion is
based. Such a motion may be granted only--
[(A) if the case involves interpretation of law of
general application affecting other claims;
[(B) if the appellant is seriously ill or is under
severe financial hardship; or
[(C) for other sufficient cause shown.
[(e)(1) At the request of the Chairman, the Secretary may
provide suitable facilities and equipment to the Board or other
components of the Department to enable an appellant located at
a facility within the area served by a regional office to
participate, through voice transmission or through picture and
voice transmission, by electronic or other means, in a hearing
with a Board member or members sitting at the Board's principal
location.
[(2) When such facilities and equipment are available, the
Chairman may afford the appellant an opportunity to participate
in a hearing before the Board through the use of such
facilities and equipment in lieu of a hearing held by
personally appearing before a Board member or panel as provided
in subsection (d). Any such hearing shall be conducted in the
same manner as, and shall be considered the equivalent of, a
personal hearing. If the appellant declines to participate in a
hearing through the use of such facilities and equipment, the
opportunity of the appellant to a hearing as provided in such
subsection (d) shall not be affected.]
(d)(1) Except as provided in paragraph (2), a hearing
before the Board shall be conducted through picture and voice
transmission, by electronic or other means, in such a manner
that the appellant is not present in the same location as the
members of the Board during the hearing.
(2)(A) A hearing before the Board shall be conducted in
person upon the request of an appellant.
(B) In the absence of a request under subparagraph (A), a
hearing before the Board may also be conducted in person as the
Board considers appropriate.
(e)(1) In a case in which a hearing before the Board is to
be held as described in subsection (d)(1), the Secretary shall
provide suitable facilities and equipment to the Board or other
components of the Department to enable an appellant located at
an appropriate facility within the area served by a regional
office to participate as so described.
(2) Any hearing conducted as described in subsection (d)(1)
shall be conducted in the same manner as, and shall be
considered the equivalent of, a personal hearing.
(f)(1) In a case in which a hearing before the Board is to
be held as described in subsection (d)(2), the appellant may
request that the hearing be held at the principal location of
the Board or at a facility of the Department located within the
area served by a regional office of the Department.
(2) A hearing to be held within an area served by a
regional office of the Department shall (except as provided in
paragraph (3)) be scheduled to be held in accordance with the
place of the case on the docket under subsection (a) relative
to other cases on the docket for which hearings are scheduled
to be held within that area.
(3) A hearing to be held within an area served by a
regional office of the Department may, for cause shown, be
advanced on motion for an earlier hearing. Any such motion
shall set forth succinctly the grounds upon which the motion is
based. Such a motion may be granted only--
(A) if the case involves interpretation of law of
general application affecting other claims;
(B) if the appellant is seriously ill or is under
severe financial hardship; or
(C) for other sufficient cause shown.
(g) [(f)] Nothing in this section shall preclude the
screening of cases for purposes of--

* * * * * * *

Chapter 72. United States Court of Appeals for Veterans Claims

* * * * * * *

Subchapter II. Procedure

* * * * * * *

SEC. 7266. NOTICE OF APPEAL

* * * * * * *

(e)(1) If a person adversely affected by a final decision
of the Board, who has not filed a notice of appeal with the
United States Court of Appeals for Veterans Claims under
subsection (a), misfiles a document with the Board or the
agency of original jurisdiction referred to in section
7105(b)(1) of this title that expresses disagreement with such
decision and a clear intent to seek review of such decision by
the United States Court of Appeals for Veterans Claims, not
later than 120 days after the date of such decision, such
document shall be treated as timely filed under subsection (a).
(2) The treatment of misfiled documents under
paragraph (1) does not limit equitable relief that may
be otherwise available to a person described in that
paragraph.

Chapter 73. Veterans Health Administration--Organization and Functions

SEC.

SUBCHAPTER I. ORGANIZATION

7301. FUNCTIONS OF VETERANS HEALTH ADMINISTRATION: IN GENERAL.

* * * * * * *

7310. VETERANS INTEGRATED SERVICE NETWORKS.

7310A. REGIONAL SUPPORT CENTERS FOR VETERANS INTEGRATED SERVICE
NETWORKS.

Subchapter I. Organization

* * * * * * *

SEC. 7310. VETERANS INTEGRATED SERVICE NETWORKS

(a) Organization.--(1) The Secretary shall organize the
Veterans Health Administration in geographically defined
Veterans Integrated Service Networks.
(2) Each Veterans Integrated Service Network shall be
organized in consideration of the following:
(A) The size of the veteran population of the region
of the network.
(B) The complexity of the medical needs of the
veterans in such region.
(C) Patient referral patterns.
(D) The availability of a full continuum of health
care services.
(E) The ability of the Department to furnish health
care efficiently.
(F) Partnerships with non-Department health care
entities.
(b) Staffing Model.--(1) The Secretary shall establish a
staffing model for each Veterans Integrated Service Network
that--
(A) is appropriate for the mission and
responsibilities of the Veterans Integrated Service
Network; and
(B) accounts for the specific health care needs of
differing populations in the Veterans Integrated
Service Network.
(2) The Secretary shall ensure that each Veterans
Integrated Service Network complies with the staffing model
established by the Secretary under paragraph (1) for such
Veterans Integrated Service Network.
(c) Integrated Health Care System.--The Secretary shall
ensure that each Veterans Integrated Service Network maintains
a regional integrated healthcare system by--
(1) implementing alliances with such other
governmental, public, and private health care
organizations and practitioners as the Secretary
considers appropriate to meet the needs of veterans in
the Network;
(2) providing oversight and management of, and taking
responsibility for, a regional budget for the
activities of the Veterans Health Administration in the
geographic area of the Network that is--
(A) aligned with the budget guidelines of the
Department and the Veterans Health
Administration;
(B) balanced at the end of each fiscal year;
and
(C) sufficient to provide high-quality health
care to veterans within the region and to meet
any unique needs of the veterans of the region;
(3) using national metrics to develop systems to
provide effective, efficient, and safe delivery of
health care; and
(4) ensuring high-quality clinical programs and
services are rendered in and through--
(A) the medical centers and outpatient
clinics of the Department that are located in
the Network; and
(B) other non-Department clinical or health
care delivery settings located in the Network.
(d) Reduction in Duplicate Functions.--The Secretary shall
ensure that the Veterans Integrated Service Networks identify
and reduce, whenever practicable, the duplication of functions
in clinical, administrative, and operational processes and
practices of the Veterans Health Administration.
(e) Collaboration and Cooperation.--The Secretary shall
ensure that each Veterans Integrated Service Network--
(1) works to achieve maximum effectiveness in patient
care and safety, graduate medical education, and
research; and
(2) assesses the consolidation or realignment of
institutional functions, including capital asset,
safety, and operational support functions, in
collaboration and cooperation with other Veterans
Integrated Service Networks and the following offices
or entities within the geographical area of the
Network:
(A) The offices of the Veterans Benefits
Administration and the National Cemetery
Administration.
(B) The offices, installations, and
facilities of the Department of Defense,
including the offices, installations, and
facilities of each branch of the Armed Forces
and the reserve components of the Armed Forces.
(C) The offices, installations, and
facilities of the Coast Guard.
(D) Offices of State and local agencies that
have a mission to provide assistance to
veterans.
(E) Medical schools and other affiliates.
(F) Offices of Congress, offices of State and
local elected officials, and other government
offices.
(G) Federal, State, and local emergency
preparedness organizations.
(H) Community and nonprofit organizations.
(I) Such other entities of the Federal
Government as the Secretary considers
appropriate.
(f) Headquarters.--(1) The Secretary shall ensure that each
Veterans Integrated Service Network has only one headquarters
office.
(2) The location of a headquarters office for a Veterans
Integrated Service Network shall be determined by the Secretary
and co-located with a Department of Veterans Affairs medical
center.
(3)(A) The Secretary may employ or contract for the
services of such full time equivalent employees and contractors
at the headquarters of each Veterans Integrated Service Network
as the Secretary considers appropriate in accordance with the
staffing models established under subsection (b).
(B) Not later than December 31 each year, 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 employment at the headquarters of
Veterans Integrated Service Networks during the most recently
completed fiscal year.
(C) Each report submitted under subparagraph (B) shall
include the following for the year covered by the report:
(i) The number of individuals employed at each
headquarters of a Veterans Integrated Service Network.
(ii) The number of individuals employed by the
Veterans Health Administration in each Veterans
Integrated Service Network who are not employed at the
same location as the headquarters of the Network.
(iii) The title for each position of employment at a
headquarters of a Veterans Integrated Service Network.
(iv) The title for each position of employment with
the Veterans Health Administration in each Veterans
Integrated Service Network that is not at the same
location as the headquarters of the Network.
(v) An assessment of the impact on the budget of the
Department by the employment of individuals at the
headquarters of the Veterans Integrated Service
Networks.
(g) Triennial Structure Review, Reassessment, and Report.--
(1) Beginning three years after the date of the enactment of
this section and not less frequently than once every three
years thereafter, the Secretary shall conduct a review and
assessment of the structure and operations of the Veterans
Integrated Service Networks in order to identify
recommendations--
(A) for streamlining and reducing costs associated
with the operation of each headquarters of a Veterans
Integrated Service Network; and
(B) for reducing costs of health care within the
Veterans Health Administration.
(2) Not later than 180 days after conducting a review and
assessment under paragraph (1), the Secretary shall submit to
the Committee of Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a report on such review and assessment, which shall include
such recommendations for legislative or administrative action
as the Secretary considers appropriate to improve the Veterans
Integrated Service Networks.

SEC. 7310A. REGIONAL SUPPORT CENTERS FOR VETERANS INTEGRATED SERVICE
NETWORKS

(a) Establishment.--The Secretary shall establish not more
than four regional support centers within the Veterans Health
Administration to assess the effectiveness and efficiency of
the Veterans Integrated Service Networks. The head of each
regional support center shall report to the Under Secretary of
Health.
(b) Functions.--The functions of the regional support
centers established under subsection (a) are as follows:
(1) To assess the quality of work performed within
finance operations and other compliance related
activities of the Veterans Integrated Service Networks.
(2) To assess how effectively and efficiently each
Veterans Integrated Service Network conducts outreach
to veterans who served in Operation Enduring Freedom,
Operation Iraqi Freedom, Operation New Dawn, or any
other contingency operation (as that term is defined in
section 101 of title 10).
(3) To assess how effectively and efficiently each
Veterans Integrated Service Network conducts programs
for the benefit of women veterans.
(4) To assess how effectively and efficiently each
Veterans Integrated Service Network conducts programs
that address homelessness among veterans.
(5) To assess how effectively and efficiently each
Veterans Integrated Service Network consumes energy.
(6) To assess such other matters concerning the
operations and activities of the Veterans Integrated
Service Networks as the Secretary considers
appropriate.
(c) Staff.--The Secretary may hire such employees and
contractors as the Secretary considers appropriate to carry out
the functions of the regional support centers.
(d) Location of Regional Support Centers.--(1) Except as
provided in paragraph (2), the location of each regional
support center established under subsection (a) shall be
determined by the Secretary and co-located with a medical
center of the Department.
(2) The Secretary may choose a location for a regional
support center established under subsection (a) that is not co-
located with a medical center of the Department if the
Secretary submits to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives, before entering into a contract for a location
that is not co-located with a medical center, a report
describing the reasons for choosing a location for the regional
support center that is not co-located with a medical center of
the Department. Such report shall include the following:
(A) A list of medical centers of the Department in
the Veterans Integrated Service Network of the regional
support center with underutilized buildings, the number
of all Veterans Health Administration buildings in such
Network, and the total underutilized square footage for
each medical center of the Department in such Network.
(B) The estimated cost of such lease (the annual
amount of rent, the total cost over the life of the
lease, and the total cost per square foot) and the
square footage to be leased.

* * * * * * *

Chapter 76. Health Professionals Educational Assistance Program

* * * * * * *

Subchapter II. Scholarship Program

* * * * * * *

SEC. 7619. EXPIRATION OF PROGRAM

The Secretary may not furnish scholarships to new
participants in the Scholarship Program after [December 31,
2014] December 31, 2019.

* * * * * * *

Part VI. Acquisition and Disposition of Property

* * * * * * *

Chapter 81. Acquisition and Operation of Hospital and Domiciliary
Facilities; Procurement and Supply; Enhanced-use Leases of Real
Property

* * * * * * *

Subchapter II. Procurement and Supply

* * * * * * *

SEC. 8127. SMALL BUSINESS CONCERNS OWNED AND CONTROLLED BY VETERANS:
CONTRACTING GOALS AND PREFERENCES

* * * * * * *

(h) Treatment of Businesses After Death of Veteran-Owner.--
(1) * * *
(2) * * *

* * * * * * *

[(C) The date that is ten years after the date of the
veteran's death.]
(C) The date that--
(i) in the case of a surviving spouse of a
veteran with a service-connected disability
rated as 100 percent disabling or who dies as a
result of a service-connected disability, is 10
years after the date of the veteran's death; or
(ii) in the case of a surviving spouse of a
veteran with a service-connected disability
rated as less than 100 percent disabling who
does not die as a result of a service-connected
disability, is three years after the date of
the veteran's death.
(3) Paragraph (1) only applies to a surviving spouse of a
veteran with a service-connected disability [rated as 100
percent disabling or who dies as a result of a service-
connected disability.] .
(i) Treatment of Businesses After Death of Servicemember-
Owner.--(1) If a member of the Armed Forces owns at least 51
percent of a small business concern and such member is killed
in line of duty in the active military, naval, or air service,
the surviving spouse or dependent child of such member who
acquires such ownership rights in such small business concern
shall, for the period described in paragraph (2), be treated as
if the surviving spouse or dependent child were a veteran with
a service-connected disability for purposes of determining the
status of the small business concern as a small business
concern owned and controlled by veterans for purposes of
contracting goals and preferences under this section.
(2) The period referred to in paragraph (1) is the period
beginning on the date on which the member of the Armed Forces
dies and ending on the date as follows:
(A) In the case of a surviving spouse, the earliest
of the following dates:
(i) The date on which the surviving spouse
remarries.
(ii) The date on which the surviving spouse
relinquishes an ownership interest in the small
business concern and no longer owns at least 51
percent of such small business concern.
(iii) The date that is ten years after the
date of the member's death.
(B) In the case of a dependent child, the earliest of
the following dates:
(i) The date on which the surviving dependent
child relinquishes an ownership interest in the
small business concern and no longer owns at
least 51 percent of such small business
concern.
(ii) The date that is ten years after the
date of the member's death.
(j) [(i)] Priority for Contracting Preferences.-- * * *

* * * * * * *

(k) [(j)] Applicability of Requirements to Contracts.--(1)
* * *

* * * * * * *

(l) [(k)] Annual Reports.-- * * *

* * * * * * *

(m) [(l)] Definitions.--In this section:

* * * * * * *

(2) * * *
(A)(i) not less than 51 percent of which is
unconditionally owned by one or more veterans
or, in the case of a publicly owned business,
not less than 51 percent of the stock of which
is unconditionally owned by one or more
veterans; and
(ii) the management and daily business
operations of which are controlled by one or
more veterans; or
(B) not less than 51 percent of which is
unconditionally owned by one or more veterans
with service-connected disabilities that are
permanent and total who are unable to manage
the daily business operations of such concern
or, in the case of a publicly owned business,
not less than 51 percent of the stock of which
is unconditionally owned by one or more such
veterans.
(3) The term ``unconditionally owned'' includes, with
respect to ownership of a small business concern,
conditional ownership of such small business concern if
such business concern is 100 percent owned by one or
more veterans.
(n) Special Rule for Community Property States.--Whenever
the Secretary assesses, for purposes of this section, the
degree of ownership by an individual of a small business
concern licensed in a community property State, the Secretary
shall also assess what that degree of ownership would be if
such small business concern had been licensed in a State other
than a community property State. If the Secretary determines
that such individual would have had a greater degree of
ownership of the small business concern had such small business
concern been licensed in a State other than a community
property State, the Secretary shall treat, for purposes of this
section, such small business concern as if it had been licensed
in a State other than a community property State.

* * * * * * *

Department of Veterans Affairs Health Care Programs Enhancement Act of
2001

(Public Law 107-135; 115 Stat. 2459; 38 U.S.C. 1710 note)

* * * * * * *

Title II. Other Matters

* * * * * * *

SEC. 204. PROGRAM FOR PROVISION OF CHIROPRACTIC CARE AND SERVICES TO
VETERANS.

(a) * * *

* * * * * * *

(c) Location of Program.--(1) The program shall be carried
out at sites designated by the Secretary for purposes of the
program. The Secretary shall designate at least one site for
such program in each geographic service area of the Veterans
Health Administration. The sites so designated shall be medical
centers and clinics located in urban areas and in rural areas.
(2) The program shall be carried out at not fewer than two
medical centers or clinics in each Veterans Integrated Service
Network by not later than one year after the effective date
specified in section 301(c) of the Veterans Health and Benefits
Improvement Act of 2013, and at not fewer than 50 percent of
all medical centers in each Veterans Integrated Service Network
by not later than two years after such effective date.

* * * * * * *