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


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

======================================================================



 
          VETERANS HEALTH AND BENEFITS IMPROVEMENT ACT OF 2013

                                _______
                                

                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\
---------------------------------------------------------------------------
    \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.''
---------------------------------------------------------------------------
    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.''
---------------------------------------------------------------------------
    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:

          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.

    (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

           *       *       *       *       *       *       *


    (c) Conditions for receipt of funds.--

           *       *       *       *       *       *       *

          [(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.

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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.

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Part VI. Acquisition and Disposition of Property

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

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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) 
* * *

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    (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.

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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.

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