[House Report 115-133]
[From the U.S. Government Publishing Office]


115th Congress    }                                    {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {       115-133

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

 
  TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE TREATMENT OF 
MEDICAL EVIDENCE PROVIDED BY NON-DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
 PROFESSIONALS IN SUPPORT OF CLAIMS FOR DISABILITY COMPENSATION UNDER 
  THE LAWS ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS, AND FOR 
                             OTHER PURPOSES

                                _______
                                

  May 19, 2017.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 1725]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1725) to amend title 38, United States Code, to 
improve the treatment of medical evidence provided by non-
Department of Veterans Affairs medical professionals in support 
of claims for disability compensation under the laws 
administered by the Secretary of Veterans Affairs, and for 
other purposes, having considered the same, report favorably 
thereon with amendments and recommend that the bill as amended 
do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     7
Advisory Committee Statement.....................................     7
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Statement on Duplication of Federal Programs.....................     7
Disclosure of Directed Rulemaking................................     7
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill as Reported.............     8

                               AMENDMENT

    The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. REPORT ON PROGRESS OF DEPARTMENT OF VETERANS AFFAIRS 
                    ACCEPTABLE CLINICAL EVIDENCE INITIATIVE.

  (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a report on the progress of the 
Acceptable Clinical Evidence initiative of the Department of Veterans 
Affairs in reducing the necessity for in-person disability examinations 
and other efforts to comply with the provisions of section 5125 of 
title 38, United States Code.
  (b) Contents of Report.--The report required by subsection (a) shall 
include the following:
          (1) The number of claims eligible for the Acceptable Clinical 
        Evidence initiative during the period beginning on the date of 
        the commencement of the initiative and ending on the date of 
        the submittal of the report, disaggregated by fiscal year.
          (2) The total number of claims eligible for the Acceptable 
        Clinical Evidence initiative that required a medical examiner 
        of the Department to supplement the evidence with information 
        obtained during a telephone interview with a claimant.
          (3) Information on any other initiatives or efforts of the 
        Department to further encourage the use of private medical 
        evidence and reliance upon reports of a medical examination 
        administered by a private physician if the report is 
        sufficiently complete to be adequate for the purposes of 
        adjudicating a claim.
          (4) The anticipated impact on the timeline and accuracy of a 
        decision on a claim for benefits under chapter 11 or 15 of 
        title 38, United States Code, if the Secretary were prohibited 
        from requesting a medical examination in the case of a claim in 
        support of which a claimant submits medical evidence and a 
        medical opinion provided by a private physician that is 
        competent, credible, probative, and otherwise adequate for the 
        purpose of making a decision on that claim.
          (5) Recommendations on how the Department can measure, track, 
        and prevent the ordering of unnecessary medical examinations 
        when the provision by a claimant of a medical examination 
        administered by a private physician in support of a claim for 
        benefits under chapter 11 or 15 of title 38, United States 
        Code, is adequate for the purpose of making a decision on that 
        claim.

SEC. 2. ANNUAL REPORT ON SUBMITTAL OF PRIVATE MEDICAL EVIDENCE IN 
                    SUPPORT OF CLAIMS FOR DEPARTMENT OF VETERANS 
                    AFFAIRS BENEFITS.

  Not later than March 1 of fiscal years 2018 through 2024, the 
Secretary of Veterans Affairs shall submit to Congress a report that 
includes, for the calendar year preceding the year in which the report 
is submitted, the following for each regional office of the Department 
of Veterans Affairs:
          (1) The number of times a veteran who submitted private 
        medical evidence in support of a claim for compensation or 
        pension under the laws administered by the Secretary was 
        scheduled for an examination performed by Department personnel 
        because the private medical evidence submitted was determined 
        to be unacceptable.
          (2) The most common reasons why private medical evidence 
        submitted in support of claims for benefits under the laws 
        administered by the Secretary was determined to be 
        unacceptable.
          (3) The types of disabilities for which claims for benefits 
        under the laws administered by the Secretary were mostly 
        commonly denied when private medical evidence was submitted.

    Amend the title so as to read:
    A bill to direct the Secretary of Veterans Affairs to 
submit certain reports relating to medical evidence submitted 
in support of claims for benefits under the laws administered 
by the Secretary.

                          PURPOSE AND SUMMARY

    H.R. 1725, as amended, the ``Quicker Veterans Benefits 
Delivery Act of 2017,'' was introduced by Representative 
Timothy J. Walz, Ranking Member of Committee on Veterans' 
Affairs, on March 24, 2017. The purpose of H.R. 1725, as 
amended, is to help VA reduce the number of unnecessary and 
duplicative disability examinations. H.R. 1725, as amended, 
would require VA to submit to submit: (1) a report to Congress 
on the progress of the VA's Acceptable Clinical Evidence 
initiative in reducing the necessity for in-person disability 
examinations within 180 days of enactment; and, (2) an annual 
report to Congress regarding claims for which VA determined the 
private medical evidence was unacceptable, with such 
information containing in the report to be disaggregated by 
regional office.

                  BACKGROUND AND NEED FOR LEGISLATION

    VA may afford medical examinations to veterans seeking 
disability benefits, but there may be a long wait time before 
VA can schedule such examinations. In such cases, the veteran 
may wish to submit private medical evidence in support of their 
claim for disability benefits. There may also be cases in which 
the veteran simply prefers to submit private medical evidence 
in support of his or her claim, regardless of the timeliness of 
scheduling an examination with a VA medical professional.
    Section 1525 of title 38, U.S.C., currently authorizes VA 
to accept a report of medical examination administered by a 
private physician, if such report is sufficiently complete and 
is adequate for the purpose of adjudicating the veteran's claim 
for disability benefits. However, the law does not require VA 
to accept such a report.
    In 2013, VA developed the Acceptable Clinical Evidence 
Initiative (ACE), which gives VA the option to review a 
veteran's existing medical records and determine if additional 
medical information is necessary to adjudicate a disability 
claim. The purpose of ACE is to expedite the disability ratings 
process by eliminating the wait time to schedule and conduct an 
in-person examination. If the Department determines that the 
veteran's existing medical records contain sufficient evidence 
to decide the claim, VA may decide such claim without ordering 
a new disability examination.
    During the April 5, 2017, Subcommittee on Disability 
Assistance and Memorial Affairs hearing, The American Legion 
testified that it had documented many instances of VA 
scheduling unnecessary and duplicative examinations with a VA 
physician, even though the veteran had already submitted 
sufficient medical evidence from a private physician to decide 
the claim. These duplicative examinations add unnecessary 
delays to the disability claims process. Moreover, reducing the 
number of disability examinations conducted by VA physicians 
would allow such medical professionals to devote more resources 
to providing care for our nation's veterans and improve the 
timeliness for those VA compensation examinations conducted by 
VA physicians.
    H.R. 1725, as amended, seeks to reduce the number of 
unnecessary disability examinations by requiring additional 
information be provided to Congress regarding VA's use of 
private medical evidence in support of claims for disability 
compensation.

                                HEARINGS

    On April 5, 2017, the Subcommittee on Disability Assistance 
and Memorial Affairs conducted a legislative hearing on various 
bills introduced during the 115th Congress, including H.R. 
1725.
    The following witnesses testified:

          The Honorable Mike Bost, U.S. House of 
        Representatives; The Honorable Julia Brownley, U.S. 
        House of Representatives; The Honorable Jim Banks, U.S. 
        House of Representatives; The Honorable Jack Bergman, 
        U.S. House of Representatives; The Honorable David G. 
        Valadao, U.S. House of Representatives; Ms. Beth 
        Murphy, Director, Compensation Service, Veterans 
        Benefits Administration, U. S. Department of Veterans 
        Affairs, accompanied by Dr. Ralph L. Erickson, Chief 
        Consultant for Post Deployment Health Service, Veterans 
        Health Administration, U. S. Department of Veterans 
        Affairs; Ms. Patricia Watts, Director, Legislative and 
        Regulatory Service, National Cemetery Administration, 
        U. S. Department of Veterans Affairs; Mr. Zachary 
        Hearn, Deputy Director, Veterans Affairs and 
        Rehabilitation Division, The American Legion; Mr. Rick 
        Weidman, Executive Director, Policy and Government 
        Affairs, Vietnam Veterans of America; Mr. Patrick 
        Murray, Associate Director, National Legislative 
        Service, Veterans of Foreign Wars; Mr. LeRoy Acosta, 
        Assistant National Legislative Director, Disabled 
        American Veterans; and, Mr. John B. Wells, Executive 
        Director, Military-Veterans Advocacy, Inc.

    Statements for the record were submitted by:

          The Honorable Timothy J. Walz, U.S. House of 
        Representatives and the Paralyzed Veterans of America

                       SUBCOMMITTEE CONSIDERATION

    On April 27, 2017, the Subcommittee on Disability 
Assistance and Memorial Affairs met in open markup session, a 
quorum being present, and favorably forwarded to the full 
Committee H.R. 1725, as amended. During consideration of H.R. 
1725, the following amendment in the nature of a substitute was 
considered and adopted by voice vote:
    An amendment in the nature of a substitute offered by Ms. 
Esty of Connecticut that retained provisions that would require 
VA submit: (1) a report to Committees on Veterans' Affairs of 
the House of Representatives and the Senate on the progress on 
the Acceptable Clinic Evidence Initiative; and, (2) annual 
reports to Congress on the treatment of private medical 
evidence provided by non-VA medical professionals in support of 
claims for disability compensation. The amendment in the nature 
of a substitute removed the provisions that would have mandated 
VA accept reports of private physician examinations, if such 
reports were sufficiently complete for the purpose of 
adjudicating a claim for veterans benefits.

                        COMMITTEE CONSIDERATION

    On May 17, 2017, the Full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 1725, as 
amended, reported favorably to the House of Representatives by 
voice vote. During consideration of the bill, the following 
amendment to the Subcommittee Print of H.R. 1725, was 
considered and agreed to by voice vote:
    An amendment offered by Mr. Walz of Minnesota that 
specified that the requirement that VA issue annual reports to 
Congress on the treatment of private medical evidence provided 
by non-VA medical professions in support of claims for 
disability compensation be submitted for fiscal years 2018 
through 2024.

                            COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the recorded 
votes on the motion to report the legislation and amendments 
thereto. There were no recorded votes taken on amendments or in 
connection with ordering H.R. 1725, as amended, reported to the 
House. A motion by Ranking Member Timothy Walz of Minnesota to 
report H.R. 1725, as amended, favorably to the House of 
Representatives was agreed to by voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the objectives for this 
legislation are to provide Congress informationon the use of 
private medical evidence in support of claims for veterans 
disability benefits.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 1725, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
1725, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 1725, as amended, provided by the Director of the 
Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 17, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1725, a bill to 
direct the Secretary of Veterans Affairs to submit certain 
reports relating to medical evidence submitted in support of 
claims for benefits under the laws administered by the 
Secretary.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Dwayne M. 
Wright.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 1725--A bill to direct the Secretary of Veterans Affairs to submit 
        certain reports relating to medical evidence submitted in 
        support of claims for benefits under the laws administered by 
        the Secretary

    H.R. 1725 would require the Department of Veterans Affairs 
(VA) to submit several reports to the Congress regarding the 
use of private medical evidence in lieu of a VA-provided 
examination for purposes of establishing eligibility for 
disability compensation or pension. CBO estimates that 
implementing H.R. 1725 would cost less than $500,000 to prepare 
those reports over the 2018-2022 period; such spending would be 
subject to the availability of appropriated funds.
    Section 1 would require VA to submit a report detailing the 
progress of the Acceptable Clinical Evidence initiative--a VA 
initiative created to allow the department to accept private 
medical evidence to support an eligible individual's claim for 
disability compensation or pension--and recommendations on how 
VA can best use private medical evidence in its claims process. 
That report would be due within 180 days of enactment of the 
bill.
    Section 2 would require annual reports on disability 
examinations requested each year by VA because the private 
medical evidence submitted was deemed unacceptable by the 
department. Those reports would document the number of cases 
where private evidence was found to be unacceptable, the most 
common reasons why such evidence was unacceptable, and the most 
common disabilities for which private medical evidence was 
deemed unacceptable.
    Enacting H.R. 1725 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 1725 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 1725 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Dwayne M. 
Wright. The estimate was approved by Theresa Gullo, Assistant 
Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1725, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
1725, as amended.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1725, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 1725, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 1725, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                   DISCLOSURE OF DIRECTED RULEMAKING

    Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), 
the Committee estimates that H.R. 1725, as amended, contains no 
directed rule making that would require the Secretary to 
prescribe regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1--Report on progress of Department of Veterans Affairs 
        Acceptable Clinical Evidence initiative

    Section 1 would require VA to, not later than 180 days 
after the date of enactment: submit to the Committees on 
Veterans' Affairs of the House of Representatives and the 
Senate a report on the progress of VA's Acceptable Clinical 
Evidence initiative in reducing the necessity for in-person 
disability examinations. Such report must include: (1) the 
number of claims eligible for the Acceptable Clinical Evidence 
initiative; (2) the number of claims eligible for the 
Acceptable Clinical Evidence initiative that required a VA 
medical examiner to supplement the evidence with information 
obtained during a telephone interview with the claimant; (3) 
information on VA's other efforts to encourage the use of 
private medical evidence; (4) the anticipated impact on 
processing claims for veterans benefits if VA were prohibited 
from requesting a medical examination when a claimant submits 
medical evidence and a medical opinion provided by a private 
physician that is adequate for the purpose of making a decision 
on the claim; and, (5) recommendations on how VA can measure, 
track, and prevent the ordering of unnecessary medical 
examinations.

Section 2--Annual report on submittal of private medical evidence in 
        support of claims for Department of Veterans Affairs benefits

    Section 2 would require VA to, not later than March 1 of 
each year for seven years after the date of enactment, submit 
to Congress a report that includes for the preceding calendar 
year, the following information disaggregated by each regional 
office: (1) the number of times a veteran who submitted private 
medical evidence in support of a claim for compensation or 
pension was scheduled for an examination conducted by a VA 
medical provider because the private medical evidence submitted 
was determined to be unacceptable, (2) the most common reasons 
why private medical evidence submitted in support of claims for 
veterans benefits was determined to be unacceptable, and (3) 
the types of disabilities for which claims for veterans 
benefits were most commonly denied when private medical 
evidence was submitted.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]