House Report 118-528 - MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL, 2025

[House Report 118-528]
[From the U.S. Government Publishing Office]

Union Calendar No. 439

118th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 118-528

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

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
APPROPRIATIONS BILL, 2025

_______

May 28, 2024.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

Mr. Carter of Texas, from the Committee on Appropriations, submitted
the following

R E P O R T

together with

MINORITY VIEWS

[To accompany H.R. 8580]

The Committee on Appropriations submits the following
report in explanation of the accompanying bill making
appropriations for military construction, veterans affairs and
related agencies for the fiscal year ending September 30, 2025.

INDEX TO BILL AND REPORT

Page Number

Bill Report
Purpose of the Bill........................................
2
Summary of Committee Recommendation........................
2
Title I--Department of Defense
Military Construction.............................. 2
3
NATO Security Investment Program................... 9
15
Department of Defense Base Closure Account......... 10
16
Family Housing Construction and Operation and
Maintenance.................................... 10
16
Department of Defense Family Housing Improvement
Fund........................................... 12
18
Department of Defense Military Unaccompanied
Housing Improvement Fund....................... 12
18
Administrative Provisions.......................... 12
18
Title II--Department of Veterans Affairs
Veterans Benefits Administration................... 27
22
Veterans Health Administration..................... 31
29
National Cemetery Administration................... 36
58
Departmental Administration........................ 36
58
Administrative Provisions.......................... 45
65
Title III--Related Agencies
American Battle Monuments Commission............... 80
70
U.S. Court of Appeals for Veterans Claims.......... 81
71
Cemeterial Expenses, Army.......................... 81
72
Armed Forces Retirement Home....................... 82
72
Administrative Provision........................... 83
74
Title IV--General Provisions............................... 84
74

Purpose of the Bill

The Military Construction, Veterans Affairs, and Related
Agencies Appropriations bill funds the Department of Defense's
activities related to military construction; family housing
construction, maintenance, and oversight; and environmental
remediation at closed military bases. The bill also funds the
Department of Veterans Affairs, including programs to assist
veterans, such as disability and pension benefits, education,
healthcare, and insurance and loan programs. The bill funds
four related agencies that honor and respect the Nation's
veterans including the American Battle Monuments Commission;
Cemeterial Expenses, Army (including Arlington National
Cemetery); the U.S. Court of Appeals for Veterans Claims; and
the Armed Forces Retirement Home.

Summary of Committee Recommendation

The Committee recommends $378,643,794,000 in total budget
authority for the fiscal year 2025 programs and activities
funded in the bill. This is an increase of $49,395,186,000
above the fiscal year 2024 enacted level and $769,252,000 above
the President's request.
The bill includes $231,123,794,000 for mandatory programs
and $147,526,000,000 for discretionary programs.
The bill provides $17,957,000,000 for military construction
and family housing. This is $718,000,000 below the fiscal year
2024 enacted level and $411,321,000 above the budget request.
The bill provides $337,501,444,000 for fiscal year 2025 for
the Department of Veterans Affairs, which is an increase of
$30,196,000,000 above the fiscal year 2024 enacted level. Of
the total, $208,323,794,000 is provided for mandatory benefit
programs and $129,177,646,000 is provided for discretionary
programs.
Of the total for fiscal year 2025, $112,582,000,000 for
veterans' healthcare was advanced in the Consolidated
Appropriations Act, 2024 (P.L. 118-42).
For fiscal year 2026, the Committee recommendation includes
$131,439,000,000 in advance appropriations for the four
veterans' medical care accounts, and $22,800,000,000 for the
Cost of War Toxic Exposures Fund. The Committee recommendation
also includes $222,227,506,000 in advance appropriations for
mandatory benefits programs.
The Committee recommendation provides a total of
$385,354,000, which is $85,956,000 below the fiscal year 2024
enacted level and $500,000 above the budget request, for the
four Related Agencies: The American Battle Monuments
Commission, the U.S. Court of Appeals for Veterans Claims, Army
Cemeterial Expenses (including Arlington National Cemetery),
and the Armed Forces Retirement Home.
Advertising Contracts for Small Business.--The Committee
understands that, as the largest advertiser in the United
States, the Federal government should work to ensure fair
access to its advertising contracts for small disadvantaged
businesses and businesses owned by minorities and women. The
Committee directs each department and agency to include the
following information in its fiscal year 2026 budget
justification: Expenditures for fiscal year 2024 and expected
expenditures for fiscal year 2026, respectively, for (1) all
contracts for advertising services; and (2) contracts for the
advertising services of (I) socially and economically
disadvantaged small businesses concerns (as defined in section
8(a)(4) of the Small Business Act (15 U.S.C. 637(a)(4)); and
(II) women- and minority-owned businesses.

TITLE I

DEPARTMENT OF DEFENSE

Military Construction Overview

Appropriation, fiscal year 2024....................... $18,675,000,000
Budget request, fiscal year 2025...................... 17,545,679,000
Committee recommendation, fiscal year 2025............ 17,957,000,000
Change from enacted level......................... -718,000,000
Change from budget request........................ +411,321,000

Military construction accounts provide funds for new
construction, construction improvements, planning and design,
and host nation support. Projects funded by these accounts
include facilities for operations, training, readiness,
maintenance, research and development, supply, medical care,
and force protection as well as unaccompanied housing,
military-owned family housing, utilities infrastructure, and
land acquisition.

COMMITTEE DIRECTIVES

In addition to the notification and reporting requirements
for military construction programs contained in Title 10,
United States Code, the Committee's recommendations include
several provisions requiring the Department of Defense to
report on various aspects of military construction programs and
to provide notification to the Committee when certain actions
are taken. The Committee also retains prior approval authority
for any reprogramming of funds exceeding a specific threshold.
Reprogramming Guidelines.--The following reprogramming
guidelines apply for all military construction and family
housing projects. A project or account (including the sub-
elements of an account) that has been specifically reduced by
Congress in acting on the budget request is considered to be a
Congressional interest item and as such, prior approval is
required. Accordingly, no reprogramming to an item specifically
reduced below the threshold by Congress is permitted, except
that the Department may seek reprogramming for appropriated
increments.
The reprogramming criteria that applies to military
construction projects is 25 percent of the funded amount or
$6,000,000 and includes new housing construction projects and
improvements. To provide the Services the flexibility to
proceed with construction contracts without disruption or
delay, the costs associated with environmental hazard
remediation such as asbestos removal, radon abatement, lead-
based paint removal or abatement, and any other legislated
environmental hazard remediation may be excluded, if such
remediation requirements could not be reasonably anticipated at
the time of the budget submission. Reprogramming is a courtesy
provided to the Department and can be taken away if the
authority is abused. This exclusion applies to projects
authorized in this budget year as well as projects authorized
in prior years for which construction has not been completed.
Planning and design costs associated with military construction
and family housing projects may also be excluded from these
guidelines. In instances where prior approval for a
reprogramming request for a project or account has been
received from the Committees on Appropriations of both Houses
of Congress, the adjusted amount approved becomes the new base
for any future increase or decrease via below-threshold
reprogramming (provided that the project or account is not a
Congressional interest item as defined above).
In addition to these guidelines, the Services are directed
to adhere to the guidance for military construction
reprogramming actions and notifications, including the
pertinent statutory authorities contained in DOD Financial
Management Regulation 7000.14-R and relevant updates and policy
memoranda. The Committee further encourages the Office of the
Director of National Intelligence to use a format similar to
that used by the Office of the Secretary of Defense to submit
reprogramming requests.
Facilities Sustainment, Restoration and Modernization
(FSRM).--The Department is directed to continue describing on
form 1390 the backlog of FSRM requirements at installations
with future construction projects. For troop housing requests,
form 1391 should describe any FSRM conducted in the past two
years. Likewise, future requirements for unaccompanied housing
at the corresponding installation should be included.
Additionally, the forms should include English equivalent
measurements for projects presented in metric measurement.
Rules for funding repairs of facilities under the operation and
maintenance accounts are described below:
(1) components of the facility may be repaired by
replacement. Such replacement can be up to current
standards or codes;
(2) interior arrangements and restorations may be
included as repair;
(3) additions and new facilities, may be done
concurrently with repair projects as long as the final
conjunctively funded project is a complete and usable
facility; and (4) the appropriate Service Secretary
shall notify the appropriate committees 21 days prior
to carrying out any repair project with an estimated
cost in excess of $7,500,000.
Quarterly Summary of Notifications.--The Committee directs
the Services and the Office of the Secretary of Defense (on
behalf of itself and defense agencies) to continue to submit a
quarterly report listing all notifications that have been
submitted to the Committees during the preceding three-month
period.
Work in Progress or Planned (WIP) Curve.--The Committee
directs the Services and the Office of the Secretary of Defense
(on behalf of itself and defense agencies) to submit a WIP
curve for each project requested in a budget submission above
$90,000,000 with the form 1391 justification to the
congressional defense committees. The Committee also directs
the Secretary of Defense to report to the congressional defense
committees quarterly, beginning in the second quarter of fiscal
year 2024 and each quarter thereafter, of projects that remain
unawarded from the current and prior fiscal years and the
reasons for delay.
Transfer of Funds to and from the Foreign Currency
Fluctuations, Construction, Defense Account.--Committee directs
the Department of Defense to submit a quarterly report to the
Committees on Appropriations of both Houses of Congress on the
transfer of funds from military construction and family housing
accounts to the Foreign Currency Fluctuations, Construction,
Defense account. The report shall specify the amount
transferred to the Foreign Currency account from each military
construction and/or family housing account, and all other
accounts for which an appropriation is provided in this Act,
during the preceding fiscal quarter, and the amounts
transferred from the Foreign Currency account to the above
accounts during the same period. This report shall be submitted
no later than 30 days after the close of each fiscal quarter.
In addition, the Department shall notify the Committees on
Appropriations of both Houses of Congress within 7 days of
transferring any amount in excess of $10,000,000 to or from the
Foreign Currency account.
Bid Savings.--The Committee directs the Secretary of
Defense to submit 1002 reports on military construction bid
savings not later than 180 days after enactment of this Act,
and biannually thereafter, to the Committees on Appropriations
of both Houses of Congress.
Incremental Funding of Projects.--In general, the Committee
supports full funding for military construction projects if
they are executable. However, it continues to be the practice
of the Committee to provide incremental funding for certain
large projects to enable the Services to more efficiently
allocate military construction dollars among projects that can
be executed in the year of appropriation.
Unfunded Priority List (UPL) and Future Years Defense
Program (FYDP).--The Committee directs the Department of
Defense and Military Services, active and reserve components as
well as Combatant Commanders, as required by law, to submit a
UPL and FYDP to the congressional defense committees for
military construction projects no later than 10 days and 5
days, respectively, after the President's budget is submitted
to Congress.

ITEMS OF INTEREST

Advanced Manufacturing.--The Committee is encouraged by
reports that three-dimensional (3D) construction could provide
military civil engineers with a faster means of building
facilities which could reduce supply lines and the number of
personnel needed for construction and related activities. The
Department of Defense is encouraged to study, develop, and
utilize advanced manufacturing capabilities to the extent
practicable.
Barracks.--The Committee remains concerned about the
inadequate conditions of DOD unaccompanied housing and
continues to direct the Department to expeditiously address the
findings of the Government Accountability Office (GAO) report
entitled, ``Military Barracks: Poor Living Conditions Undermine
Quality of Life and Readiness'' (GAO-23-105797).
Building Materials.--The Committee supports the use by the
Department of a diversity of building materials, and directs
the Department to ensure selected building materials are
mature, cost effective, and advance the performance,
sustainability, reliability, and resiliency of DoD
infrastructure. The Committee believes that Federal resources
are best utilized when all materials can compete on their own
merits, allowing for the best solutions to address our
infrastructure challenges. The Committee further notes the need
for building materials and heating systems to undergo rigorous
testing, including in extreme temperature and conditions.
Camp Bull Simons Child Development Center.--The Committee
is concerned with the lack of affordable and accessible
childcare for servicemembers stationed at Camp Bull Simons and
Eglin Air Force Base. The Army and the Air Force stood up a
task force to review, and propose, solutions to construct a
child development center that would meet the needs of affected
families. The Committee directs the Secretaries of the Army and
the Air Force to provide a briefing within 30 days of filing
this report and every 60 days thereafter on the status of the
task force review and of the Departments' ongoing efforts to
find a solution to the childcare deficiencies for
servicemembers stationed at Camp Bull Simons and Eglin Air
Force Base
Demolition of Excess Infrastructure.--The bill includes
$75,000,000 for unspecified minor military construction for
demolition across the active and reserve components. The
Committee is concerned about the amount of excess and obsolete
infrastructure found on installations. While the Committee
understands the need to balance demolition with other
infrastructure needs, excess infrastructure can be costly to
maintain and diverts resources away from current requirements.
The Committee understands that recent technological
advancements of non-nuclear soil and asphalt density gauges
conform to American Society for Testing and Materials standards
and encourages the Department of Defense to continue exploring
the application of these innovative technologies in future
military construction projects.
Family Housing and CDC Heating and Air Conditioning.--The
Committee recognizes the Services' efforts to improve energy
efficiency through scheduled seasonal deactivation of air
conditioning and heating systems at its facilities. Certain
military installations, deactivate these systems in family
housing units and child development centers (CDC). The
Committee encourages the Department to examine its energy
conservation programs, including where family housing units and
CDCs may be excluded from air conditioning and heating
restrictions.
Infrastructure Needs to Support Alliance with the
Philippines.--The Committee notes the importance of the
recently reinvigorated alliance with the Philippines. To better
understand the Department of Defense's needs to support the
expanded alliance, the Committee directs the Secretary of
Defense to provide a report, not later than 180 days after the
date of the enactment of this Act, summarizing the plans for
military construction and associated infrastructure needs to
maximize the effectiveness of an enhanced posture in and
alliance with the Philippines.
Joint Civilian-Military Infrastructure in Alaska.--The
Committee notes the potential benefit of infrastructure that is
jointly used by both military and non-military users,
especially in remote locations. The Committee directs the
Assistant Secretary of Defense for Energy, Installations, and
Environment to provide a report within 180 days of enactment of
this Act detailing potential opportunities for joint-use
infrastructure investments in Alaska, strategies for maximizing
the utilization of existing infrastructure, and areas for
potential future investment to achieve cost savings and
operational efficiencies.
Laboratory Infrastructure.--The Committee is concerned that
aging laboratory infrastructure threatens the ability of
Services to maintain the advanced technology necessary to keep
ahead of U.S. adversaries across all domains. Accordingly, the
Committee provides an additional $75,000,000 for planning and
design for laboratory infrastructure projects. The Services are
directed to provide a spend plan not later than 90 days after
enactment of this Act regarding the use of these funds.
Linear Power Generation.--The Committee understands that
fuel agnostic linear generators can achieve over 50% net system
efficiency, are compatible with more than 22 fuel types, and
can house 2 megawatts of power in a standard 20-foot shipping
container. These systems can shift between different fuel types
in real-time without depleting fuel tanks or requiring hardware
changes. The committee encourages the DoD to invest in
scalable, fuel agnostic linear power generation as a means of
improving grid resiliency at military installations.
Mass Timber.--The Committee is aware that the use of cross
laminated timber and other mass timber products as a building
material has the potential to reduce costs, limit environmental
impact, and increase functionality of various military
structures. The Committee encourages the Department of Defense
to continue exploring the application of these innovative
technologies in future planning and design for military
construction projects.
Qatar.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to
the Committee on Appropriations, a report detailing the burden
sharing contributions by the State of Qatar to support the
United States military presence at Al Udeid Air Base and
elsewhere in Qatar, and joint operations between United States
and Qatari military forces. Such report shall include all host
country contributions, including facilities access,
construction and maintenance, operating costs, logistics
support, physical security, and any other financial or in-kind
contributions.
Resilient Military Installations.--The Committee supports
the Department's continued efforts to build lasting and
resilient military installations. These efforts include using
methods that update hurricane-resistant building codes for
bases, barracks, hospitals, and airfields and reviewing the
effect of severe drought and desertification and how these two
hazards affect installations and missions. The Committee
encourages the Department to continue investing in innovative
infrastructure projects to increase infrastructure resiliency
and reduce costs.
Remote Pacific Locations.--The Committee is aware of the
strategic importance of geographic remote Pacific locations,
yet the Department has failed to respond to direction included
in House Report 117-391 requesting a classified briefing on
military construction needs at Wake Island, Midway, Guam,
Tinian, the Republic of Marshall Islands, the Federated States
of Micronesia, the Republic of Palau, and other locations in
the Pacific Islands. The Committee directs the Assistant
Secretary of Defense for Sustainment, in conjunction with
USINDOPACOM and Services to promptly provide this briefing due
to the major infrastructure failures at Wake Island, unresolved
Mawar damage on Guam, the significant funds requested for
fiscal year 2025, and the significant planned investment for
these locations across the Future Years Defense Plan.
Transient Military Housing.--The Committee is concerned
about the shortcomings in the administration of transient
military housing within the Navy and Air Force. According to a
2021 GAO study, while significant differences exist in how the
services administer their respective programs, the Army's
transient housing program, which is administered by the
Assistant Secretary for Installations, Energy and Environment,
uses accepted industry accounting methods, has improved the
physical condition of Army lodging facilities at every Army
installation in the U.S., generates annual budget savings, and
has seen a dramatic increase in military traveler satisfaction.
The Committee directs both the Navy and Air Force to provide a
report, not later than 180 days after enactment of this Act, on
how both Services can effectively adopt the best practices of
the Army as they administer transient military housing. This
report should include whether both services should consider
transferring existing jurisdictions to most effectively
administer these critical programs.

Military Construction, Army

Appropriation, fiscal year 2024....................... $2,022,775,000
Budget request, fiscal year 2025...................... 2,311,157,000
Committee recommendation, fiscal year 2025............ 2,217,757,000
Change from enacted level......................... +194,982,000
Change from budget request........................ -93,400,000

The Committee recommends $2,217,757,000 for the Army in
fiscal year 2025, of which $87,100,000 is for the following
projects in the following amounts:

Within the total for Military Construction, Army, the
recommendation includes $334,738,000 for planning and design,
which is $10,000,000 above the budget request; and $186,119,000
for unspecified minor construction, which equal to the budget
request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Engineer Research & Development Center (ERDC).--The
Committee notes that U.S. Army Corp of Engineers' ERDC has
limited and outdated testing infrastructure that impacts its
mission to develop advanced airfield and pavement research
requirements related to high heat resistance and
sustainability. The Committee supports the development of the
Jet Engine Thrust Simulator (JETS) facility to further this
critical research and encourages the Army Futures Command and
ERDC to take steps to advance this important project.
Oahu Wildland Fire Center.--The Committee understands the
critical role the Army's wildland firefighters in Hawaii play
in preventing wildfires on Army training lands on Oahu and
assisting non-military partners during emergencies elsewhere on
the island. To better understand the condition of the Army's
existing facilities on Oahu, the Committee directs the
Assistant Secretary of the Army for Installations, Energy and
Environment to provide a report, not later than 90 days after
the date of the enactment of this Act, summarizing the
infrastructure investment needs to support these efforts.
Tobyhanna Army Depot.--The Committee views Tobyhanna Army
Depot as an advantageous location for the build-out of physical
space for future Army Materiel Command (AMC) manufacturing of
microelectronics, including semi-conductors. As such, the
Committee requests that the Army keep the Committee informed of
AMC construction needs at Tobyhanna Army Depot.
U.S. Indo-Pacific Command Pilot (USINDOPACOM).--The
recommendation includes $66,000,000 to for the pilot program
for minor military construction projects as established by the
Fiscal Year 2024 National Defense Authorization Act.

Military Construction, Navy and Marine Corps

Appropriation, fiscal year 2024....................... $5,531,369,000
Budget request fiscal year 2025....................... 4,540,899,000
Committee recommendation, fiscal year 2025............ 4,332,414,000
Change from enacted level......................... -1,198,955,000
Change from budget request........................ -208,485,000

The Committee recommends $4,332,414,000 or the Navy and
Marine Corps in fiscal year 2025, of which $70,480,000 is for
the following project in the following amount:

----------------------------------------------------------------------------------------------------------------
State Location Project Amount
----------------------------------------------------------------------------------------------------------------
FL..................................... Marine Corps Support Communications $4,300,000
Facility Blount Island. Infrastructure.
FL..................................... Naval Air Station Child Development Center. 6,900,000
Jacksonville.
FL..................................... Naval Air Station Hurricane Consolidated 10,600,000
Pensacola. (A) School Dorm.
FL..................................... Naval Station Mayport.... Waterfront Emergency 13,700,000
Power.
VA..................................... Fort Story............... Child Development Center. 2,000,000
VA..................................... Naval Air Station OCEANA. Unaccompanied Housing.... 16,000,000
VA..................................... Naval Air Station OCEANA. Child Development Center. 2,000,000
GU..................................... Guam..................... Guam Defense Access Roads 14,980,000
----------------------------------------------------------------------------------------------------------------

Within the total for Military Construction, Navy and Marine
Corps, the recommendation includes $877,946,000 for planning
and design, which is the same as the budget request; and
$233,620,000 for unspecified minor construction, which is equal
to the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Battle Damage Requirements in Shipyard Infrastructure
Optimization Program (SIOP).--As the Navy executes its 20-year,
$21 billion SIOP, it will make infrastructure improvements that
will last generations and support both peacetime and wartime
requirements, to include responding to battle damage. The
Committee directs the Naval Facilities Engineering Systems
Command and Naval Sea Systems Command to provide a joint report
within 180 days of the enactment of this Act (1) summarizing
the ability of existing shipyard infrastructure to support
wartime battle damage requirements, (2) how SIOP is
incorporating any shortfalls in meeting battle damage
requirements into its long-term infrastructure plan at the
naval public shipyards, and (3) any possible benefits of
coordinating these efforts with the U.S. Coast Guard's SIOP.
Drydocks.--The Committee recognizes the critical strategic
and logistics role public shipyards play in the security of the
nation. The Committee strongly supports efforts to modernize
and improve facilities at the Navy's four public shipyards,
including for the multi-mission dry dock (M2D2), and to address
the complex maintenance needs of the Navy's current and future
active fleet. The current modernization plans for Pearl Harbor
Naval Shipyard and Intermediate Maintenance Facility (IMF)
include converting Dry Dock 4 to focus on depot-level
maintenance for nuclear submarines. To better understand the
Navy's options for a floating dry dock at Pearl Habor Naval
Shipyard and IMF to address any infrastructure shortfalls, the
Committee directs the Assistant Secretary of the Navy for
Energy, Installations, and Environment to provide a report
within 180 days of enactment of this Act (1) detailing
potential locations for mooring a floating drydock, (2) a list
of the individual major military construction projects needed
to support a floating drydock, (3) the earliest a floating
drydock could be brought into service given the timelines
associated with the required military construction, and (4) how
a floating drydock would be used to ensure extra capacity for
potential crisis and conflict in the Indo-Pacific. The
Committee recognizes the importance of fleet maintenance on the
west coast to ensuring mission readiness in the Indo-Pacific
region and is aware the Navy is already facing maintenance
delays. The Committee encourages the Navy to avoid disruptions
to aircraft carrier maintenance, including during west coast
M2D2 construction.
Ground-Based Midcourse Defense Planning and Design.--The
Committee recognizes the need for an additional Ground-Based
Midcourse Defense capability, both in total number of ballistic
missile interceptors and sites from which those interceptors
can engage ballistic missile threats. The Committee directs the
Missile Defense Agency to bring planning and design of an
additional East Coast based Ground-Based Midcourse Defense
interceptor site to 35 percent complete.
Infrastructure Needs at Naval Air Station Corpus Christi.--
The Committee recognizes the unique importance of the Naval
Aviation Training Enterprise and is alarmed at the number of
the poor and failing facilities that the Navy identified in its
November 9, 2023 report to Congress, particularly at Naval Air
Station Corpus Christi. The Committee urges the Navy to address
the needs at Naval Air Station Corpus Christi, particularly as
related to construction and other improvements for
unaccompanied and family housing, child and youth development
centers, and quality of life projects for servicemembers and
their families.
Joint Base Pearl Harbor-Hickam Drinking and Wastewater
Infrastructure.--The Committee is concerned about wastewater
discharges from Joint Base Pearl Harbor-Hickam's aging
wastewater facility and the condition of the base's drinking
water systems. To help the Committee fully understand the long-
term infrastructure needs at the base, the Committee directs
the Assistant Secretary of the Navy for Energy, Installations,
and Environment, to provide a report within 120 days after
enactment of this Act summarizing: (1) any actions needed to
bring Joint Base Pearl Harbor-Hickam Infrastructure's
Installation Development Plan into compliance with Navy
regulations, (2) staffing needs for planning these military
construction projects, and (3) efforts to coordinate long-term
infrastructure needs with major tenants across the joint base.
Naval Aviation Training Enterprise.--The Committee notes
the importance of the Naval Aviation Training Enterprise and
encourages the Navy to prioritize infrastructure projects
within the coastal Naval Aviation Training Enterprise,
especially those that build, remodel, and restore unaccompanied
and family housing, child and youth development centers, and
quality of life projects for servicemembers and their families.
P-8 Parking Aprons at Naval Air Station Jacksonville.--The
Committee is concerned about the degradation of the P-8
Poseidon parking aprons at Naval Air Station Jacksonville and
its impact on the operational readiness of the aircraft.
Therefore, the Committee directs the Assistant Secretary of the
Navy for Energy, Installations, and Environment to provide a
report within 60 days of enactment detailing the plan to
recapitalize the P-8 parking apron infrastructure at Naval Air
Station Jacksonville.
Naval Air Station Pensacola B3260 Hangar.--Hurricane Sally
in 2020 caused hundreds of millions of dollars in damage to
numerous facilities at Naval Air Station Pensacola, forcing the
Navy to condemn a hangar used by the world-famous Blue Angels
flight demonstration squadron. The Committee directs the
Secretary of the Navy to provide a report detailing the status
of repairs to the hangar, as well as the necessary short- and
long-term investments required to properly address the damage
caused by Hurricane Sally, within 90 days of enactment of this
Act.
Port Improvements on Tinian Island.--The Committee notes
that the Department of the Navy has previously acknowledged the
critical nature of the Tinian Port Joint Area Development Plan
in the Commonwealth of the Northern Mariana Islands. The
Committee directs the Assistant Secretary of the Navy for
Energy, Installations, and Environment to provide a report, not
later than 180 days after the date of the enactment of this
Act, summarizing (1) the major and minor military construction
projects under consideration by the Department of the Navy to
support port operations on the Island of Tinian, (2) design
options to help maximize U.S. Marine Corps and U.S. Air Force
training capabilities on the Island of Tinian, (3) efforts to
coordinate the work and develop the requirements with the
Commonwealth Ports Authority of the Commonwealth of the
Northern Mariana Islands, and (4) actions the Navy can take to
accelerate these projects.
Unexploded Ordinance on Military Construction in Guam.--The
Committee continues to recognize the significant environmental,
planning, and construction activities on Guam and the impact
unexploded ordinance removal has on these projects. The
Committee directs the Assistant Secretary of the Navy for
Installations, Energy, and Environment within 180 days of
enactment to provide a report on efforts to address this issue
and to help keep construction projects on-time and on-budget.
United States Marine Corps Forces, Pacific Headquarters
Needs Assessment.--The Committee is concerned about the
condition of the infrastructure at Camp H. M. Smith, which was
built in 1942 and whose planned major upgrades have been
repeatedly delayed. The Committee directs the Deputy Commandant
for Installations and Logistics to provide a report within 180
days after enactment of this Act summarizing: (1) the Marine
Corps' current assessment of the condition of Marine Corps
Forces, Pacific Headquarters' infrastructure and (2) a plan for
addressing failed or failing infrastructure, to include a
detailed timeline, estimated cost, and specific projects that
must be completed to meet Operational Plan requirements.

Military Construction, Air Force

Appropriation, fiscal year 2024....................... $2,741,424,000
Budget request, fiscal year 2025...................... 3,187,126,000
Committee recommendation, fiscal year 2025............ 3,268,276,000
Change from enacted level......................... +526,852,000
Change from budget request........................ +81,150,000

The Committee recommends $3,268,276,000 for the Air Force
in fiscal year 2025, of which $299,000,000 is for the following
projects in the following amounts:

----------------------------------------------------------------------------------------------------------------
State Location Project Amount
----------------------------------------------------------------------------------------------------------------
AR..................................... Ebbing Air National Guard Academic Training Center. $70,000,000
Base.
CA..................................... Beale Air Force Base..... Multi-Doman Operations 53,000,000
Complex.
FL..................................... Tyndall Air Force Base... Fire Crash/Rescue Station 46,000,000
LA..................................... Barksdale Air Force Base. ADAL Child Development 22,000,000
Center.
NE..................................... Offutt Air Force Base.... Survivable Airborne 10,000,000
Operations Center.
UT..................................... Hill Air Force Base...... F-35 T-7A East Campus 28,000,000
Infrastructure.
TX..................................... JBSA-Lackland Air Force Military Training 70,000,000
Base. Classrooms/Dining
Facility 4.
----------------------------------------------------------------------------------------------------------------

Within the total for Military Construction, Air Force, the
recommendation includes $459,926,000 for planning and design,
which is $20,000,000 above the budget request; and $129,600,000
for unspecified minor construction, which is equal to the
request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Air Force Infrastructure Hardening.--The Committee remains
concerned with the hardening of aircraft hangers and shelters
on Pacific bases, as detailed in House Report 118-122, and
directs the Air Force to report to the Committee not later than
90 days after enactment of this Act on the use of funding
provided in prior fiscal years and plans for the use of funds
provided in this Act to this objective.
Ground Based Strategic Deterrent (GBSD) Infrastructure.--
The Committee is encouraged by the Air Force's future years
defense program expectations for military construction related
to the GBSD. The Committee requests that the Air Force continue
engaging with Congress on its infrastructure needs related to
the GBSD.
U.S. Space Forces Indo-Pacific Headquarters Study.--The
Committee is concerned that significant infrastructure
shortfalls on Joint Base Pearl Harbor-Hickam could negatively
impact Space Force Indo-Pacific's ability to carry out its role
as the Space Force Component to U.S. Indo-Pacific Command and
as the Joint Force Space Component Commander. The Committee
directs the Assistant Secretary of the Air Force for Energy,
Installations and Environment to provide a report within 180
days after enactment of this Act summarizing: (1) the
Department's assessment of the current Space Forces Indo-
Pacific's headquarters (2) the plan for addressing short-term
facility requirements in the next five years, to include a
detailed timeline, estimated cost, and specific projects, and
(3) the long-term plan for fully meeting operational capability
facility requirements for Space Forces Indo-Pacific.
Sentinel Workforce Lodging and Care.--The Committee remains
concerned about the Sentinel program's ability to identify,
hire and retain a skilled workforce. The Committee also notes
that the Sentinel program's needs include secondary
requirements associated with bringing in a large workforce for
an extended period of time to communities that may lack the
infrastructure to support such an influx, and encourages the
Air Force to identify industry partners who have demonstrated
experience in lodging and hospitality services for workforce in
remote locations.

Military Construction, Defense-Wide

Appropriation, fiscal year 2024....................... $3,161,782,000
Budget request, fiscal year 2025...................... 3,733,763,000
Committee recommendation, fiscal year 2025............ 3,500,083,000
Change from enacted level......................... +388,301,000
Change from budget request........................ -233,680,000

The Committee recommends $3,500,083,000 for Military
Construction, Defense-Wide, in fiscal year 2025, of which
$47,920,000 is for the following projects in the following
amounts:

Within the total for Military Construction, Defense-Wide,
the recommendation includes $395,131,000 for planning and
design, which is $27,920,000 above the budget request; and
$88,265,000 for unspecified minor construction, which is equal
to the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Energy Resilience and Conservation Investment Program
(ERCIP).--The Committee provides $636,000,000 for ERCIP
construction, the same as the budget request. The Committee
supports the Department's efforts to improve energy resilience,
contribute to mission assurance, save energy, and reduce energy
costs through ERCIP. The Committee encourages the Department to
continue using all available tools and authorities to ensure
the timely execution of ERCIP projects. Additionally, as the
Department works to achieve base energy independence, the
Committee encourages the Department to leverage new energy
technologies.
Special Operations Command Pacific (SOCPAC) Headquarters
Needs Assessment.--The Committee is aware that SOCPAC, has
personnel spread across Hawaii due to facility space
limitations at its primary headquarters at Camp H. M. Smith. To
better assess possible military construction projects that
could consolidate these locations, the Committee directs U.S.
Special Operations Command to provide a report within 180 days
after enactment of this Act summarizing: (1) the operational
impacts of having personnel spread across Hawaii, (2) SOCPAC's
total square foot and operational requirements for operations
on Oahu, and (3) construction options for overcoming facility
shortfalls.

Military Construction, Army National Guard

Appropriation, fiscal year 2024....................... $620,647,000
Budget request, fiscal year 2025...................... 362,129,000
Committee recommendation, fiscal year 2025............ 367,129,000
Change from enacted level......................... -253,518,000
Change from budget request........................ +5,000,000

The Committee recommends $367,129,000 for the Army National
Guard in fiscal year 2025.
Within the total for Military Construction, Army National
Guard, the recommendation includes $30,529,000 for planning and
design, which is $5,000,000 above the budget request; and
$45,000,000 for unspecified minor construction, which is equal
to the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Air National Guard

Appropriation, fiscal year 2024....................... $295,526,000
Budget request, fiscal year 2025...................... 190,792,000
Committee recommendation, fiscal year 2025............ 195,792,000
Change from enacted level......................... -99,734,000
Change from budget request........................ +5,000,000

The Committee recommends $195,792,000 for the Air National
Guard in fiscal year 2025, including $15,792,000 for planning
and design, which is $5,000,000 above the budget request; and
$40,200,000 for unspecified minor construction, which is equal
to the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.
Air National Guard Infrastructure.--The Committee
recognizes that some Aviation Support Facilities are not
configured to protect and maintain modern airframes and
encourages the Air National Guard to upgrade these facilities
using unspecified minor military construction funds, as
appropriate, to ensure current facilities are upgraded to
adequately support current airframes.

Military Construction, Army Reserve

Appropriation, fiscal year 2024....................... $151,076,000
Budget request, fiscal year 2025...................... 255,032,000
Committee recommendation, fiscal year 2025............ 265,032,000
Change from enacted level......................... +113,956,000
Change from budget request........................ +10,000,000

The Committee recommends $265,032,000 for the Army Reserve
in fiscal year 2025, of which $5,000,000 is for the following
projects in the following amounts:

Within the total for Military Construction, Army Reserve,
the recommendation includes $41,508,000 for planning and
design, which is $10,000,000 above the budget request; and
$3,524,000 for unspecified minor construction, which is equal
to the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Navy Reserve

Appropriation, fiscal year 2024....................... $51,291,000
Budget request, fiscal year 2025...................... 29,829,000
Committee recommendation, fiscal year 2025............ 67,329,000
Change from enacted level......................... +16,038,000
Change from budget request........................ +37,500,000

The Committee recommends $50,499,000 for the Navy Reserve
in fiscal year 2025, of which $37,500,000 is for the following
projects in the following amounts:

Within the total for Military Construction, Navy Reserve,
the recommendation includes $3,219,000 for planning and design,
which is equal to the budget request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

Military Construction, Air Force Reserve

Appropriation, fiscal year 2024....................... $331,572,000
Budget request, fiscal year 2025...................... 69,263,000
Committee recommendation, fiscal year 2025............ 50,499,000
Change from enacted level......................... -281,073,000
Change from budget request........................ -18,764,000

The Committee recommends $50,499,000 for the Air Force
Reserve in fiscal year 2025, which includes $3,798,000 for
planning and design, which is the $3,236,000 above the budget
request; and $701,000 for unspecified minor construction, which
is equal to the request.
Further detail of the Committee's recommendation is
provided in the State table at the end of this report.

North Atlantic Treaty Organization Security Investment Program

Appropriation, fiscal year 2024....................... $293,434,000
Budget request, fiscal year 2025...................... 433,864,000
Committee recommendation, fiscal year 2025............ 433,864,000
Change from enacted level......................... +140,430,000
Change from budget request........................ - - -

The North Atlantic Treaty Organization Security Investment
Program (NSIP) consists of annual contributions by North
Atlantic Treaty Organization (NATO) member countries to finance
the costs of construction needed to support the roles of the
major NATO commands.
The United States occasionally has been forced to
temporarily delay the authorization of projects due to
shortfalls in United States obligation authority. The Committee
directs the Secretary of Defense to notify the Committee within
14 days of the United States taking action to delay the
authorization of projects temporarily, or to temporarily
withhold funds from previously authorized projects, due to
shortfalls in U.S. obligation authority.

Department of Defense Base Closure Account

Appropriation, fiscal year 2024....................... $489,174,000
Budget request, fiscal year 2025...................... 447,961,000
Committee recommendation, fiscal year 2025............ 547,961,000
Change from enacted level......................... +58,787,000
Change from budget request........................ +100,000,000

The Committee recommends $547,961,000 for the Base Closure
account, which is $100,000,000 above the budget request. The
Committee continues to be concerned about the extent of per-
and polyfluoroalkyl substance (PFAS) contamination at closed
U.S. military installations and the Environmental Protection
Agency's announcement in April establishing PFAS drinking water
standards further highlights the urgency of this issue.
Therefore, the agreement includes an additional $50,000,000
above the budget request to increase the pace of cleanup at the
military installations affected by PFAS. The Committee
continues to recognize the Navy's efforts towards the
demolition and removal of non-historically designated buildings
and structures under Navy control where the sampling or
remediation of radiologically contaminated materials have been
the subject of substantiated allegations of fraud.

Family Housing Overview

Appropriation, fiscal year 2024....................... $1,970,751,000
Budget request, fiscal year 2025...................... 1,983,864,000
Committee recommendation, fiscal year 2025............ 2,013,864,000
Change from enacted level......................... +43,113,000
Change from budget request........................ +30,000,000

Family housing construction accounts provide funds for new
construction, construction improvements, the Federal
government's costs for family housing privatization projects,
and planning and design. The operation and maintenance accounts
provide funds to pay for maintenance and repair, furnishings,
management, services, utilities, leasing, interest, mortgage
insurance, and miscellaneous expenses.
Housing Oversight.--The Committee continues to be concerned
that Military Housing Privatization Initiative (MHPI) companies
are neglecting their responsibilities outlined in their
partnership agreements with the Services to provide adequate
and livable housing for servicemembers and their families.
Additionally, an April 2023 GAO report found significant
deficiencies in the Department's oversight of privatized
housing. Adequate and safe housing is paramount to military
readiness, recruitment, and retention, and as such the
Committee remains concerned about the unacceptable conditions
of some privatized military housing, including mold, lead
paint, poor water quality, and other health and safety issues.
The Committee provides an additional $30,000,000 above the
budget request to expand oversight of the entire housing
portfolio, including government-owned and controlled family
housing and privatized family and unaccompanied housing. The
Committee requests an expenditure plan detailing the planned
use of these funds within 30 days of enactment of this Act,
including the specific, additional oversight activities these
funds above the budget request will support.
The Committee is concerned that Servicemembers and their
families have developed respiratory diseases, lead poisoning,
and other health conditions as a result of these poor living
conditions. Not later than 120 days after enactment of this
Act, the Committee directs each Service to update its report to
the Committees on Appropriations of both Houses of Congress
detailing steps taken to improve the conditions of all MHPI
housing, including the current backlog of maintenance requests;
a summary of all MHPI tenant complaints; and an updated
performance review of each MHPI management company.
The Committee further directs the Services to provide a
briefing no later than 120 days after enactment of this Act
detailing steps being taken to improve the conditions of each
Service's privatized housing portfolio and to expeditiously
implement the recommendations issued in GAO's report, ``DOD Can
Further Strengthen Oversight of Its Privatized Housing
Program'' (GAO-23-105377). The Committee encourages the
Services to look at the feasibility and reasonability of
utilizing advanced technology to more quickly and accurately
improve housing inspections, such as utilizing aerial imagery
and probable weather analysis.

Family Housing Construction, Army

Appropriation, fiscal year 2024....................... $304,895,000
Budget request, fiscal year 2025...................... 276,647,000
Committee recommendation, fiscal year 2025............ 276,647,000
Change from enacted level......................... -28,248,000
Change from budget request........................ - - -

Family Housing Operation And Maintenance, Army

Appropriation, fiscal year 2024....................... $395,485,000
Budget request, fiscal year 2025...................... 475,611,000
Committee recommendation, fiscal year 2025............ 485,611,000
Change from enacted level......................... +90,126,000
Change from budget request........................ +10,000,000

Family Housing Construction, Navy and Marine Corps

Appropriation, fiscal year 2024....................... $277,142,000
Budget request, fiscal year 2025...................... 245,742,000
Committee recommendation, fiscal year 2025............ 245,742,000
Change from enacted level......................... -31,400,000
Change from budget request........................ - - -

Family Housing Operation And Maintenance, Navy and Marine Corps

Appropriation, fiscal year 2024....................... $373,854,000
Budget request, fiscal year 2025...................... 377,217,000
Committee recommendation, fiscal year 2025............ 387,217,000
Change from enacted level......................... +13,363,000
Change from budget request........................ +10,000,000

Family Housing Construction, Air Force

Appropriation, fiscal year 2024....................... $237,097,000
Budget request, fiscal year 2025...................... 221,549,000
Committee recommendation, fiscal year 2025............ 221,549,000
Change from enacted level......................... -15,548,000
Change from budget request........................ - - -

Family Housing Operation and Maintenance, Air Force

Appropriation, fiscal year 2024....................... $324,386,000
Budget request, fiscal year 2025...................... 326,250,000
Committee recommendation, fiscal year 2025............ 336,250,000
Change from enacted level......................... +11,864,000
Change from budget request........................ +10,000,000

Family Housing Operation and Maintenance, Defense-Wide

Appropriation, fiscal year 2024....................... $50,785,000
Budget request, fiscal year 2025...................... 52,156,000
Committee recommendation, fiscal year 2025............ 52,156,000
Change from enacted level......................... +1,371,000
Change from budget request........................ - - -

Department of Defense Family Housing Improvement Fund

Appropriation, fiscal year 2024....................... $6,611,000
Budget request, fiscal year 2025...................... 8,195,000
Committee recommendation, fiscal year 2025............ 8,195,000
Change from enacted level......................... +1,584,000
Change from budget request........................ - - -

Department of Defense Military Unaccompanied Housing Improvement Fund

Appropriation, fiscal year 2024....................... $496,000
Budget request, fiscal year 2025...................... 497,000
Committee recommendation, fiscal year 2025............ 497,000
Change from enacted level......................... +1,000
Change from budget request........................ - - -

Administrative Provisions

The bill includes a total of 33 administrative provisions,
33 of which were effective in fiscal year 2024.
The bill includes section 101 prohibiting the use of funds
for payments under a cost-plus-a-fixed-fee contract for
construction where cost estimates exceed $25,000. An exception
for Alaska is provided.
The bill includes section 102 permitting the use of
construction funds for the hire of passenger motor vehicles.
The bill includes section 103 permitting funds to be
expended on the construction of defense access roads under
certain circumstances.
The bill includes section 104 prohibiting construction of
new bases in the United States without a specific
appropriation.
The bill includes section 105 limiting the use of funds for
the purchase of land or land easements that exceed 100 percent
of value except under certain conditions.
The bill includes section 106 prohibiting the use of funds
to acquire land, prepare sites, or install utilities for family
housing except housing for which funds have been appropriated.
The bill includes section 107 limiting the use of minor
construction funds to relocate any activity from one
installation to another without prior notification.
The bill includes section 108 prohibiting the procurement
of steel unless American producers, fabricators, and
manufacturers have been allowed to compete.
The bill includes section 109 prohibiting the use of funds
to pay real property taxes in foreign nations.
The bill includes section 110 prohibiting the use of funds
to initiate a new installation overseas without prior
notification.
The bill includes section 111 establishing a preference for
United States architectural and engineering services where the
services are in Japan, NATO member countries, or countries
bordering the Arabian Sea.
The bill includes section 112 establishing a preference for
United States contractors for military construction in the
United States territories and possessions in the Pacific and on
Kwajalein Atoll, or countries bordering the Arabian Gulf,
except bids by Marshallese contractors for military
construction on Kwajalein Atoll.
The bill includes section 113 requiring the Secretary of
Defense to give prior notice to Congress of military exercises
where construction costs exceed $100,000.
The bill includes section 114 allowing funds appropriated
in prior years to be used for new projects authorized during
the current session of Congress.
The bill includes section 115 allowing the use of expired
or lapsed funds to pay the cost of associated supervision,
inspection, overhead, engineering and design on those projects
and on subsequent claims.
The bill includes section 116 providing that funds for
military construction projects are available until the end of
the fourth fiscal year following the fiscal year in which funds
are appropriated, subject to certain conditions.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 117 allowing for the transfer of
funds from Family Housing Construction accounts to the
Department of Defense Family Housing Improvement Fund and funds
from Military Construction accounts to the Department of
Defense Military Unaccompanied Housing Improvement Fund.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 118 providing transfer authority
to the Homeowners Assistance Program.
The bill includes section 119 requiring that funds in this
title be the sole source of all operation and maintenance for
flag and general officer quarter houses and limits the repair
on these quarters to $20,000 per unit annually without
notification.
The bill includes section 120 making funds in the Ford
Island Improvement Fund available until expended.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 121 allowing the transfer of
expired funds to the ``Foreign Currency Fluctuations,
Construction, Defense'' account.
The bill includes section 122 allowing the transfer of
funds in accordance with reprogramming guidelines.
The bill includes section 123 prohibiting the use of funds
for projects at Arlington National Cemetery.
The bill includes section 124 providing funds for certain
projects identified in the respective military department's
unfunded priority and cost to complete list for fiscal year
2025.
The bill includes section 125 directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
The bill includes section 126 extending the eligibility of
unobligated funding for fiscal year 2018, 2019, and 2020
projects that have not lapsed.
The bill includes section 127 defining the congressional
defense committees.
The bill includes section 128 providing additional funds
for planning and design for construction improvements to
laboratory facilities.
The bill includes section 129 providing additional funds
for the Air Force for expenses incurred as a result of natural
disasters.
The bill includes section 130 providing funds for planning
and design for child development centers.
The bill includes section 131 providing funds for planning
and design for barracks.
The bill includes section 132 providing funds for
unspecified minor construction for demolition.
The bill includes section 133 prohibiting funds from being
used to carry out the closure or realignment of Naval Station
Guantanamo Bay.

TITLE II

DEPARTMENT OF VETERANS AFFAIRS

Appropriation, fiscal year 2024\1\................... $307,305,393,000
Budget request, fiscal year 2025\1\.................. 337,425,926,000
Committee recommendation, fiscal year 2025\1\........ 337,501,440,000
Change from enacted level........................ +30,196,047,000
Change from budget request....................... +75,517,000

Fiscal year 2026 advance budget request.............. 376,466,506,000
Fiscal year 2026 Committee recommendation in the bill 376,466,506,000
Change from budget request....................... - - -

\1\All funding cited excludes amounts in the Medical Care Collections
Fund.

The Department of Veterans Affairs (VA) provides health
care for 9,000,000 veteran enrollees; disability compensation
benefits to an estimated 6,094,440 veterans and 562,448
survivors; pension benefits for an estimated 136,678 veterans
and 112,179 survivors; life insurance for more than 5,600,000
veterans, servicemembers and their families; educational
assistance for nearly 820,000 students; and interment of more
than 140,000 veterans and eligible family members in national
cemeteries. To serve adequately the nation's veterans, VA
employs more than 450,000 staff, making it one of the largest
Federal agencies in terms of employment.
Congressional Oversight of VA's Actions on Abortion.--The
bill prohibits funding to implement, administer, or otherwise
carry out the Department's illegal actions in the interim final
rule published September 9, 2022. The interim final rule
clearly violated Section 106 of the Veterans Health Care Act of
1992 (P.L. 102-585; Title 38 U.S.C. 1710 note). The Committee
directs the Department to provide a report within 30 days of
enactment, and every 180 days thereafter, to the Committee on
Appropriations of the United States House of Representatives
and the Committee on Appropriations of the United States Senate
containing the following information, disaggregated by State:
(1) the number of abortions the Department has provided in VA
facilities since September 9, 2022; (2) the number of abortions
performed elsewhere and funded by the Department since
September 9, 2022; (3) under which exception each abortion
provided or funded by the Department has qualified; (4) the
total amount expended on each abortion; and (5) the criteria
used and documentation required by the Department to determine
when an exception allowing for an abortion applies.
Veterans First Contracting Program.--The Committee
recognizes the tremendous value of the Veterans First
Contracting Program in assisting in the expansion and growth of
service-disabled veteran and veteran-owned small businesses.
Therefore, the Committee encourages VA to continue to expand
and make mandatory the training of contracting officers in the
requirements of the Veterans First Contracting Program, with
particular attention being paid to conducting the market
research necessary to ensure that service-disabled veteran and
veteran-owned small businesses, particularly women and minority
veteran-led small businesses, are awarded VA contracts when
appropriate.
Veterans in the Pacific.--The Committee directs the
Department to continue efforts to improve and expand access to
benefits, mental health, preventative and wellness programs,
and telehealth, among other programs. The Committee requests a
report not later than 90 days after enactment of this Act on
the progress made in the prior fiscal year on improving access
to such benefits and services.
Sexual Harassment and Sexual Assault Protections for VA
Beneficiaries and Employees.--The Committee directs the
Secretary to implement the recommendations laid out in GAO
Report 20-387.

VETERANS BENEFITS ADMINISTRATION

COMPENSATION AND PENSIONS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2024 enacted level....................... $161,850,524,000
Fiscal year 2025 enacted level....................... 182,310,515,000
Fiscal year 2025 budget year request................. 9,820,699,000
Committee 2025 budget year recommendation............ 9,820,699,000

Fiscal year 2026 advance appropriation request....... 204,481,753,000
Committee 2026 advance appropriation recommendation.. 204,481,753,000
Comparison with:
Fiscal year 2025 enacted level................... +22,171,238,0000
Fiscal year 2026 advance budget request.......... - - -

This appropriation provides funds for service-connected
compensation payments to an estimated 6,094,446 veterans and
562,448 survivors in fiscal year 2025. In addition, pension
payments will be funded for an estimated 150,678 veterans and
112,179 survivors. The average payment per compensation case
for veterans in fiscal year 2025 is estimated to be $24,307 and
pension payments are projected to be $14,063.
The appropriation includes authority to transfer funding
not to exceed $22,816,000 in fiscal year 2026 to General
Operating Expenses, Veterans Benefits Administration (VBA) and
Information Technology Systems. These funds are for the
administrative expenses of implementing cost-saving provisions
required by the Omnibus Budget Reconciliation Act of 1990 (P.L.
101-508), the Veterans' Benefits Act of 1992 (P.L. 102-568),
and the Veterans' Benefits Improvements Act of 1994 (P.L. 103-
446). The bill also continues to include language permitting
this appropriation to reimburse such sums as may be earned to
the Medical Care Collections Fund to help defray the operating
expenses of individual medical facilities for nursing home care
provided to pensioners.
The Committee recommendation includes $9,820,699,000 in
additional funding for fiscal year 2025 for a total of
$192,131,214,000 for the fiscal year, which includes the
advance appropriation provided in the prior fiscal year. For
fiscal year 2026, the Committee recommendation includes an
advance appropriation of $204,482,000,000.
Signing of Veteran Death Certificates.--The Committee is
concerned that the Veterans Administration is not signing death
certificates of all veterans who die of natural causes and who
have as their primary doctor a VA physician in a timely
fashion. The Committee directs the VA to work in consultation
with stakeholders to prepare a report within 45 days of passage
of FY25 Appropriations bill on the average time the VA takes to
sign a death certificate for a veterans family upon notice of
their passing, the average number of delays lasting longer than
72-hours over the last 5 years, the total number of refusals by
the VA to sign death certificates and the reasoning behind any
denial over the last 5 years, and solutions to ensure that a
speedy signature is done and received by the family of our
passed veterans. The agency should also transmit separate
copies of this report to the House and Senate Appropriations
Committees.
Ensuring VBA Access for Veterans.--The Committee is
concerned about closure of VBA offices in rural areas during
the pandemic. Physical VBA offices are crucial in rural areas
as veterans have more limited broadband access and
transportation options. Accordingly, the Committee directs VA
to report VBA offices at risk of closure 180 days prior to VBA
realignment, including analysis used as justification of
closure, necessary resources needed to prevent closure and the
projected realignment of VBA staffers to nearby facilities to
impacted congressional districts, as well as VA's corresponding
efforts to ensure continued services for impacted veterans in
the area.

READJUSTMENT BENEFITS

Fiscal year 2024 enacted level....................... $8,827,352,000
Fiscal year 2025 enacted level....................... 13,399,805,000
Fiscal year 2025 budget year request................. 2,657,656,000
Committee 2025 budget year recommendation............ 2,657,656,000

Fiscal year 2026 advance appropriation request....... 17,614,235,000
Committee 2026 advance appropriation recommendation.. 17,614,235,000
Comparison with:
Fiscal year 2025 enacted level................... +4,214,430,000
Fiscal year 2026 advance budget request.......... - - -

This appropriation finances the education and training of
veterans and servicemembers through the Post-9/11 GI Bill and
the All-Volunteer Force Educational Assistance Program. In
addition, certain disabled veterans are provided with
vocational rehabilitation, specially adapted housing grants,
and grants for automobiles with approved adaptive equipment.
This account also finances educational assistance allowances
for eligible dependents of veterans who died from service-
connected causes or have a total and permanent service-
connected disability, as well as dependents of servicemembers
who were captured or are missing in action.
The Committee recommendation includes an advance
appropriation of $17,614,235,000 for fiscal year 2026.
GI Bill Comparison Tool.--The Committee emphasizes the
importance of providing veterans with the necessary information
to make informed decisions when selecting institutions of
higher education. The Committee urges the Department to
continue to monitor and assess the effectiveness of the GI
comparison tool, including usage metrics, the frequency that
caution flags are checked and updated, and technical
performance.
GI Bill Apprenticeships and On-the-Job-Training.--The
Committee directs VA to take additional actions to promote
awareness and increased utilization of apprenticeships and on-
the-job training [OJT] programs, including continued
coordination and support to State Approving Agencies [SAAs] and
programs which may incentivize increased participation by
employers. The Committee directs additional support and
resources be provided to SAAs for the purpose of establishing
partnerships between industry and institutes of higher
education. The Department is encouraged to explore options to
expand the program in the future, while ensuring proper
oversight of SAA contracts.
Post 9/11 GI Bill Books & Supplies Stipend.--The Committee
acknowledges the increasing need for technology for education
as coursework and class materials continue to shift from
physical to virtual. Additionally, the Committee recognizes
that the books and supply stipend has not been adjusted for
inflation in 15 years. The Committee directs the Secretary to
evaluate the need to increase the books and supplies stipend
from the current rate of $1,000 per year to a higher inflation
adjusted level.
Skills and Certifications.--The Committee recognizes the
importance of expanding job opportunities for veterans after
their discharge and encourages VA to work with other Federal
agencies and State licensing bureaus, as appropriate, to
evaluate the transferability of DoD skills and certifications,
including mechanical skills and certifications, to state
certifications to aid in transition to civilian employment. The
Committee directs the Secretary to partner with the appropriate
agencies outreach effort and use this information to inform VA
transition programs and advise the Secretary of Defense of any
changes needed to DoD Credentialing Programs to aid in smooth
transition to civilian employment within 90 days of enactment
of this act.
Technology for Student Veterans.--The Committee understands
during the pandemic the importance of remote learning
technologies, such as computers and routers for internet
access, were widely used so students could continue their
studies. House Report 118-122 directed a report within 180 days
of enactment of this Act, on the cost, feasibility, and
advisability of ensuring student veterans have access to the
technologies needed to be successful in school. The Committee
is looking forward to receiving this report.
Transition Coordination.--The Committee encourages VA, in
consultation with the Departments of Defense and Labor, to
coordinate efforts and resources to ensure veterans have a
successful transition to civilian life. This includes sharing
information on community resources, including nonprofits and
Veterans Service Organizations, that are available to veterans
and their families. The Committee also urges VA to explore
options for veterans to access hands-on job placement services
that connect them directly with employers, including those
offered through successful state and local programs. A report
shall be submitted to the Appropriations Committees on these
efforts within 60 days of enactment of the Act.
VET TEC Pilot Program.--The Committee expects the
Department to fund the program, if authorized, at $45,000,000
for fiscal year 2025, and encourages it to take steps to expand
access by including additional providers, particularly in areas
of the country where the initiative is not currently available
or only allowing access to online courses, as well as to help
train and employ women veterans and veterans with disabilities.
Veteran Transition Assistance Grant Program (VTAG).--The
Committee continues to support VTAG and is looking forward to
examining the program's success.
Biomanufacturing Training.--The Committee directs the
Department to engage with an institution of higher education
with expertise in and simulated Current Good Manufacturing
Practice facilities for the provision of biomanufacturing
training to consider the establishment of a pilot program to
provide targeted, hands-on, industrial biomanufacturing
training for veterans, transitioning service members, and
military spouses.
Financial Hardship and Bankruptcy.--The Committee continues
to support VA programs that combat the root causes of veteran
and dependent financial hardship, which is a known contributory
factor to negative outcomes such as mental health issues,
substance use disorder, and suicide. The Committee continues to
be concerned by an inequity in current bankruptcy law that
results in the inclusion of VA and DoD disability benefits in
the calculation of a debtor's disposable income, while at the
same time excluding Social Security disability benefits for
non-veterans.

VETERANS INSURANCE AND INDEMNITIES

Fiscal year 2024 enacted level........................ $133,827,000
Fiscal year 2024 enacted level........................ 135,119,000
Fiscal year 2025 budget year request.................. 0
Committee 2025 budget year recommendation............. 0

Fiscal year 2026 advance appropriation request........ 131,518,000
Committee 2026 advance appropriation recommendation... 131,518,000
Comparison with:......................................
Fiscal year 2025 enacted level.................... - - -
Fiscal year 2026 advance budget request........... - - -

The Veterans Insurance and Indemnities appropriation is
made up of the former appropriations for military and naval
insurance, applicable to World War I veterans; national service
life insurance (NSLI), applicable to certain World War II
veterans; servicemember's indemnities, applicable to Korean
Conflict veterans; and veterans mortgage life insurance,
applicable to individuals who have received a grant for
specially adapted housing.
For fiscal year 2026, the Committee recommendation includes
an advance appropriation of $131,518,000.

VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
Limitation on
direct loans for Administrative
Program Account specially adapted Expenses
housing loans
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2024.......................... - - - ($500,000) $316,742,419
Budget request est., fiscal year 2025.................... - - - (500,000) 319,596,460
Committee recommendation, fiscal year 2025............... - - - (500,000) 319,596,460
Change from enacted level............................ - - - - - - +2,854,2041
Change from budget request........................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------

The purpose of the home loan guaranty program is to
facilitate the extension of mortgage credit on favorable terms
by private lenders to eligible veterans. This appropriation
provides for all costs, with the exception of the Native
American Veterans Housing Loan Program, of the Department's
direct and guaranteed loans programs.
The Committee recommendation includes $319,596,460 for
fiscal year 2025 for administrative expenses to carry out the
Veterans Housing Loan Program.
VA Home Loan Program.--The Committee has been made aware of
a pending settlement that would prohibit listing brokers from
making offers of compensation to buyer brokers on a Multiple
Listing Service, and could potentially disadvantage veterans
utilizing the home loan under current rules. The Committee
directs VA to study its current policy of prohibiting borrowers
from paying fees or commissions to a real estate agent and
determine whether this policy negatively impacts veterans when
buying a home. The Department is directed to report these
findings to the committee within 120 days of enactment.
Home Loan Income Verification.--The Committee understands
that as directed by House Report 116-63, VA has clarified that
nothing in VA statutes or regulations specifically prohibits a
veteran whose income is derived from state-legalized cannabis
activities from obtaining a certificate of eligibility for VA
home loan benefits. The Committee understands that VA is
working to improve communication with eligible lending
institutions to reduce confusion among lenders and borrowers on
this matter.

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

----------------------------------------------------------------------------------------------------------------
Limitation on Administrative
Program Account direct loans Expenses
----------------------------------------------------------------------------------------------------------------
Appropriation, fiscal year 2024.......................... $78,337 ($2,026,000) $460,698
Budget request, fiscal year 2025......................... 64,431 (1,563,660) 493,868
Committee recommendation, fiscal year 2024............... 64,431 (1,563,660) 493,898
Change from enacted level............................ -13,906 (-462,340) +33,170
Change from budget request........................... - - - - - - - - -
----------------------------------------------------------------------------------------------------------------

This appropriation covers the subsidy cost of direct loans
for vocational rehabilitation of eligible veterans and includes
administrative expenses necessary to carry out the direct loan
program. Loans of up to $1,530 (based on indexed chapter 31
subsistence allowance rate) are available to service-connected
disabled veterans enrolled in vocational rehabilitation
programs when the veteran is temporarily in need of additional
assistance.
The Committee recommendation includes $64,431 for fiscal
year 2025 for administrative expenses to carry out the
Vocational Rehabilitation Direct Loan program. It is estimated
that the Department will make 1,559 loans in fiscal year 2025.

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

Administrative expenses:
Appropriation, fiscal year 2024....................... $2,718,546
Budget request, fiscal year 2025...................... 5,845,241
Committee recommendation, fiscal year 2025............ 5,845,241
Change from enacted level......................... +3,126,695
Change from budget request........................ - - -

The Native American Veteran Housing Loan Program, as
authorized by title 38 United States Code, chapter 37,
subchapter V, provides the Secretary authority to make direct
housing loans to Native American veterans for the purpose of
purchasing, constructing, or improving dwellings on trust
lands, including Hawaiian Home Lands. These loans are available
to purchase, construct, or improve homes to be occupied as
veterans' residences.
The Committee recommendation includes $5,845,241 for fiscal
year 2025 for administrative expenses for the Native American
Veteran Housing Loan Program, and $75,000,000, to remain
available until expended, for the principal amount of direct
loans pursuant to subchapter V of chapter 37 of title 38,
United States Code, to remain available until expended.

GENERAL OPERATING EXPENSES, VETERANS BENEFITS ADMINISTRATION

Appropriation, fiscal year 2024....................... $3,899,000,000
Budget request, fiscal year 2025...................... 4,035,000,000
Committee recommendation, fiscal year 2025............ 4,035,000,000
Change from enacted level......................... +136,000,000
Change from budget request........................ - - -

The General Operating Expenses, Veterans Benefits
Administration (VBA) account provides funding for VBA to
administer entitlement programs such as service-connected
disability compensation, education benefits, and vocational
rehabilitation services.
The Committee recommendation includes $4,899,000,000 for
fiscal year 2025 for General Operating Expenses, VBA. These
resources will fully fund VA's request for fiscal year 2025 and
improve VBA's ability to address compensation and benefit
claims. The bill makes available through September 30, 2026, up
to ten percent of these funds.
Benefits Usage.--The Committee encourages VA to include
veteran benefit usage into its annual suicide prevention
report, including usage of disability compensation, education
and employment, home loan and foreclosure assistance benefits,
as well as participation in housing and food security programs.
Additional data may enable a better understanding of the
correlation between benefit use and suicide and allow for more
effective programs to assist veterans.
Compensation and Pension Exams.--The Committee understands
the important role of contractors in providing medical
disability exams. These exams are necessary for Veterans to
receive the benefits that they have earned. Therefore, the
Committee directs VA to apply standard timeliness and quality
performance metrics across contract providers and VHA providers
to ensure quality exams for all Veterans. Further, VA is
directed to report to the Committee on the impact on VHA
healthcare wait times before committing additional VHA
providers to the delivery of medical disability exams.
Digitizing Veteran Records.--The Committee commends the
efforts of VBA, in partnership with the National Archives and
Records Administration, to address the backlog of veterans'
records requests by creating digital copies of records that
currently exist only in hardcopy form at the National Personnel
Records Center (NPRC). The Committee strongly encourages VBA to
continue its efforts to create digital copies of veterans'
records housed at NPRC. The Committee requests VA update the
analyses required by House Report 117-391 on resources needed
to digitize all hard copy-only veteran records at NPRC not
later than 90 days after enactment of this Act.
Equitable Relief.--The Committee understands VA is working
to implement new systems and protocols to eliminate instances
of administrative error. However, as VA enacts system-wide
reforms, ending equitable relief for veterans who were deemed
eligible for benefits in error would place an unfair burden on
veterans and their families. The Secretary is directed to
continue to grant or extend equitable relief to eligible
veterans initially deemed eligible in instances of
administrative error. Not later than April 1, 2025, the
Secretary is directed to submit to the Committees on
Appropriations of both Houses of Congress a report containing a
statement as to the disposition of each case recommended to the
Secretary for equitable relief under section 503 of title 38,
United States Code during the preceding calendar year.
Information for Toxic-Exposed Veterans.--The Committee
encourages VA to ensure resources and materials provided by VA
to toxic-exposed veterans be made available in the most
commonly spoken languages in the United States, as required by
the Veterans and Family Information Act (P.L. 117-62).
Military Sexual Trauma (MST).--The Committee is frustrated
by the findings of the August 2021 OIG Report titled
``Improvements Still Needed in Processing Military Sexual
Trauma Claims'' which found VBA has failed to ensure all claims
processors handling MST-related claims have received
specialized MST training. The Committee urges VBA to prioritize
specialized MST training for claims processors, and to continue
to involve MST survivors in the development of specialized
training. The Committee additionally remains concerned that
veterans suffering from a mental health disorder as a result of
sexual trauma during service have different standards of
evidence based on their diagnosis. The Committee recognizes
that evidence in personnel files is rare, no matter the
resulting condition following MST, and therefore, the Committee
urges VA to support the extension of the relaxed evidentiary
standard to all those suffering from mental health disorders as
a result of MST. The Committee requests that the Secretary
submit a report to the Committees on Appropriations of both
Houses of Congress, no later than 180 days after enactment of
this Act, outlining the status of MST backlogs. Further, the
Committee urges VA to continue to report to Congress on
information relating to claims for disabilities incurred or
aggravated by MST, as provided by section 113 of the Jeff
Miller and Richard Blumenthal Veterans Health Care and Benefits
Improvement Act of 2016 (P.L. 114-315).
Toxic Exposure Claims.--The Committee recognizes that an
increase in claims and associated workload increases is
continued to be expected as a result of enactment of the
Honoring our Promise to Address Comprehensive Toxics Act (PACT
Act) and encourages the Department to implement thorough and
special training protocols to ensure accuracy and efficiency in
the claims adjudication process.
Mileage Reimbursements Kiosks.--The Committee is concerned
with the removal of mileage reimbursement kiosks and requests
the Department to report to the Committee on Appropriations on
the recent removal of mileage reimbursement kiosks from several
VA facilities, which have been replaced by the online
Beneficiary Travel Self Service System. The report shall
include the circumstances leading to the removal of kiosks as
well as the effects on veterans who rely on them. Additionally,
any future plans for travel reimbursement will be detailed.
Over-The-Counter-Hearing Aids.--The Committee notes that
over 2.7 million veterans are compensated for hearing loss and
tinnitus, and noise exposure during military service being a
major factor. The Committee encourages VA to reassess its
current model for hearing aids. The lower cost of over-the-
counter (OTC) hearing aids has the potential to reduce
financial strain on VA's budget, freeing up resources to invest
in other critical areas of veteran care and support. The
Committee requests a report within 180 days of the bill's
passage on VA hearing service access and cost savings from
implementing OTC hearing aids for veterans receiving audiology
treatment. OTC hearing aids present a cost-effective
alternative, potentially enhancing access and alleviating
financial pressure on the VA healthcare system.

Veterans Health Administration (VHA)

The Department operates the largest integrated medical care
delivery system in the United States, providing care at nearly
1,300 health care facilities, including 171 medical centers and
more than 1,100 outpatient sites to more than 9,000,000
veterans enrolled in the VA health care program.
Funding for veterans' health care, VA research, and the
Veterans Health Administration is provided through five
discretionary accounts and the mandatory Cost of War Toxic
Exposures Fund. The discretionary accounts are Medical
Services, Medical Community Care, Medical Support and
Compliance, Medical Facilities, and Medical and Prosthetic
Research.
For fiscal year 2025, the President's Budget requested a
total of $134,037,000,000 for veterans' medical care, including
funding for medical care for the treatment of conditions
related to toxic exposures.
In fiscal year 2025, VA will collect an estimated
$4,389,678,000 in the Medical Care Collections Fund.
The Committee provides $923,514,000 for Medical and
Prosthetic Research for fiscal year 2025, $55,514,000 above the
requested level.
The Committee provides $131,439,000,000, the total amount
requested, in advance for fiscal year 2026. This request of
discretionary advance appropriations is in conjunction with the
Toxic Exposures Fund advance appropriations request of
$22,800,000,000 billion in 2026.
Air Ambulance Services.--The Committee remains concerned
that changes to the reimbursement rates for ground and air
ambulance services may negatively impact the ability of
veterans to access emergency medical services, particularly in
rural and underserved areas, and commends the Department for
delaying the implementation of its final rule Change in Rates
that VA Pays for Special Modes of Transportation, 88 Fed. Reg.
10032, until February 16, 2025. The Committee directs the
Department to delay implementation of the final rule until at
minimum September 30, 2025, and urges the Department not to
expend funds for any change in rates for travel by ground
ambulance or for rotor wing and fixed wing air ambulance
emergency or non-emergency transport without first engaging
with industry stakeholders, to identify both an appropriate
level of reimbursement and an effective contracting process for
emergency air and ground services that does not jeopardize
access to ambulance services for veteran beneficiaries. The
Committee also requests that the Department submit a report
within 180 days to the Committee detailing its discussions and
efforts to ensure continued access for veterans to emergency
health care transportation, and to report back to the Committee
with its findings.
Beneficiary Travel.--The Committee continues to hear from
veterans frustrated with the system and the inability of VA
staff to assist them. The Department is directed to ensure the
new system is user-friendly and staff are trained and available
to provide the required assistance.
Community Care Expansion.--The Committee continues to
strongly support the Department's efforts to expand veterans'
access to timely, high-quality health care in their communities
through the Veterans Community Care Program (VCCP) authorized
under the MISSION Act. The Committee is pleased that the budget
request includes robust funding for community care and urges
the Department to continue increasing veterans' usage of
community providers to supplement VA direct care as needed. The
Committee remains concerned by reports of excessive wait times
for care at many VA facilities, as exemplified by the recent
issues at the Atlanta VA Medical Center that led to a
leadership change. It is unacceptable that veterans continue to
face delays and barriers to receiving the care they have
earned. The Committee believes that leveraging community
partnerships is essential to addressing these access challenges
and that care delivery decisions should be based on clinical
need and veteran preference, not simply defaulting to VA
facilities. The Committee directs the Department to submit a
report no later than 90 days after enactment of this Act
detailing efforts to reduce wait times by expanding community
care utilization in areas with access challenges, in accordance
with the MISSION Act, and towards ensuring the MISSION Act is
fully implemented as intended.
Dispute Resolution.--The Committee urges VA to ensure that
veterans are advised of their rights to contest VA billing
charges and determinations and of the step-by-step process for
disputes. VA should ensure this information is available online
and in publicly accessible areas at each VA medical center, and
that it is made available in English, Spanish, and the eight
other most commonly spoken languages in the United States.
Equitable Care for Veterans.--As the VHA considers policies
that would remove anesthesiologists from the surgical care
team, the Committee requests a report detailing how the VHA
intends to ensure that Veterans, particularly PACT Act
Veterans, will not receive a lower standard of care than non-
Veterans in the same state or jurisdiction.
Essential Medical Devices.--The United States'
manufacturing capacity for essential medical devices is at
serious risk due to organized efforts by Chinese manufacturers
to enter the U.S. market in response to inflationary pressures
faced by U.S.-based manufacturers, distributors, and providers.
The current shift toward purchasing Chinese-made medical
devices is drastic and occurring at a pace that will leave U.S.
hospitals dependent on Chinese supplied devices. The Committee
urges VA to purchase essential medical devices, like needles
and syringes, from U.S. manufacturers or allied trading
partners. The Committee directs VA to submit a report to the
Committee on Appropriations no later than 90 days after
enactment of this Act on the percentage of Chinese made devices
for the 96 device medical countermeasures published by the Food
and Drug Administration in 2020. The report should also include
specific recommendations on how the VA can reduce its
dependency on Chinese medical devices, increase the domestic
supply chain, while safeguarding against shortages.
Native Hawaiian, Pacific Islander and United States-
Affiliated Pacific Islander (NHPIUSAPI) Veterans Health.--The
Committee continues to support the VA Center for NHPIUSAPIs.
The Committee encourages VA to partner with universities in the
Pacific region focusing on issues unique to the NHPISAPI
community.
Timeliness of Care at VA Facilities.--The Committee
recognizes the critical need for quality and timely health care
for veterans. To ensure this is provided, the Committee directs
the Secretary to submit a detailed report to Congress within
180 days of the enactment of this legislation regarding the
average waiting periods experienced by veterans seeking health
care services through VA hospitals. This report should
encompass data collected from various VA healthcare facilities
nationwide, including to the extent possible non-VHA operated
clinics, analyzing both the duration veterans wait from initial
contact to their first appointment and any subsequent waits for
further medical treatments. The data presented in this report
should be broken out by state to facilitate a clear
understanding of regional disparities and target improvements
effectively. The directive aims to ensure transparency and
accountability in the administration of veteran healthcare
services, and to facilitate legislative or administrative
measures to enhance the efficiency and effectiveness of the VA
health system.

MEDICAL SERVICES

Fiscal year 2024 enacted level...................... $70,969,795,000
Fiscal year 2025 enacted level...................... 71,000,000,000
Fiscal year 2025 budget year request................ 71,000,000,000
Committee 2025 budget year recommendation........... 0

Fiscal year 2026 advance appropriation request...... 75,039,000,000
Committee 2026 advance appropriation recommendation. 75,039,000,000
Comparison with:
Fiscal year 2025 enacted level.................. +4,039,000,000
Fiscal year 2026 advanced budget request........ - - -

The bill includes $75,039,000,000 for advance fiscal year
2026 funding for Medical Services. The Committee has included
bill language to make $2,000,000,000 of the Medical Services
advance appropriation for fiscal year 2026 available through
September 30, 2027.
Allocation of Health Funding.--The Committee continues to
request a report each year, no later than 30 days after VA
allocates the medical services appropriation to the VISNs, that
identifies: (1) the amount of general purpose funding that is
allocated to each VISN; (2) the amount of funding that is
retained by central headquarters for specific purposes, with
amounts identified for each purpose; and (3) the amount of
funding that is retained by each VISN before allocating it to
the medical centers, identifying separately the amounts
retained for purposes such as network operations, network
initiatives, and emergencies.
Changes in Funding Requirements Due to Modeling.--The
Committee expects VA to continue to include in the sufficiency
letter required by section 117(d) of title 38, United States
Code, which is due to the Congress on July 31 of each year, a
description of any changes exceeding $250,000,000 in funding
requirements for the Medical Services account resulting from
the spring recalculation of the Enrollee Healthcare Projection
Model.
Support for FAS Veterans.--Since the passage of the
Consolidated Appropriations Act, 2024 (Public Law 118-42), VA
is no longer restricted from providing services to veterans
residing in the Freely Associated States (FAS), including
direct care from VA providers, telehealth, and care through
contracts with community providers; shipping medications to the
FAS; and reimbursing veterans for travel from their home
countries to the United States. To determine how VA implements
these new authorities, the Committee directs VA within 60 days
of enactment of this Act to provide the Committee with the
estimated cost and the plan for implementing this law in fiscal
year 2025.

CANCER AND RARE DISEASES

Cancer Screening at Veterans Affairs Medical Centers.--The
Department is encouraged to ensure its healthcare providers
screen for the numerous types of cancers that veterans
experience so they can receive the best possible care.
Creutzfeldt-Jakob Disease (CJD) Monitoring.--The Committee
continues to urge VA to utilize reference data from existing
medical records of veterans to determine the percentage of
veterans who have more frequent or unexplained symptoms
associated with CJD compared to the civilian population. This
data could be helpful in clarifying the extent and specifics of
the medical issues suffered by veterans from exposure to CJD.
Dermatological Care for Veterans.--The Committee is
concerned by recent research studies, including those by the
National Institutes of Health and the Journal of American
Academy of Dermatology, regarding the increased risk of skin
cancers in Veterans. Servicemembers' increased UV radiation
exposure, lack of sun protective measures, and over two decades
of deployments to regions in close equatorial proximity have
placed veterans at higher risk for melanoma and other skin
cancers. Veterans are also more likely to be diagnosed with
advanced-stage skin cancers than the civilian population due to
less frequent skin checks and access to specialized care. The
Committee directs VA to submit a report to the Committee no
later than 180 days after the enactment of this Act on
veterans' access to dermatology screening, dermatologic
preventative care, and trained Mohs micrographic surgeons.
Lung Precision Oncology Program.--The Committee commends VA
for launching the Lung Precision Oncology Program and its
effort to expand access to lung cancer screening for veterans
and accelerate the science on lung cancer prevention,
detection, and treatment. The Committee is interested in the
program's success since being launched and directs the
Department to report to the Committee within 180 days of
enactment of this Act regarding the program's efficacy.
Expanding Lung Cancer Screening for Veterans.--The
Committee recognizes the importance of early detection and
timely diagnosis of cancers and directs the Department to
review and update its approach to lung cancer screening to
optimize veterans access to screenings given the unique risk
factors and evolving demographics for this patient population.
As part of this update, the Committee encourages the Department
to issue a request for information and corresponding public
docket to receive information and recommendations regarding the
latest lung cancer research, data, and clinical best practices
to inform the updates to the Department's lung cancer screening
guidelines and update lung cancer screening guidelines to
address those exposed to toxic hazards. The Department is
directed to provide a report to the Committee on Appropriations
within 120 days of enactment of this Act regarding the steps it
is taking to optimize lung cancer screening for veterans.
Digital Pathology.--The Committee recognizes the Veterans
Affairs (VA) healthcare system for its efforts to modernize and
enhance diagnostic capabilities using digital pathology. The
utilization of digital pathology technology represents a
transformative approach to pathology services that will improve
efficiency and advance the quality of care provided to our
nation's veterans. Digitization provides high-resolution
imaging, aiding pathologists in achieving more accurate and
timely diagnoses, crucial for effective treatment. Notably, the
use of digital pathology fosters the required VA collaborative
environment that allows for expert consultations across VA
facilities, even in the most remote settings, ensuring veterans
receive the best possible care regardless of location. The
transition to digital pathology streamlines laboratory
workflows, reducing turnaround times for pathology reports and
enhancing overall operational efficiency within VA medical
facilities, and eliminates the need for physical transportation
of glass slides, reducing the risk of loss or damage and
optimizing resource utilization within the VA healthcare
system. The cycle of cancer care for our Nation's Veterans
begins with diagnosis and staging from a pathologist. By moving
our VA pathology labs to a digital format, it expedites this
care cycle which is critical when it comes to a cancer
diagnosis.
Molecular Diagnostics and Precision Oncology.--The
Committee recommendation includes $215,433,000 for Precision
Oncology, and $55,090,000 for molecular diagnostics which are
equal to budget request. VA is encouraged to continue to
provide information to clinicians on the value of using
molecular diagnostics for cancer patients and on how to
contribute tissue specimens to a repository started among the
Department, Department of Defense, and the National Institute
of Health. Over 60 forms of cancer disproportionately impact
military service members and most are rare, defined as fewer
than six new cases per 100,000 Americans per year.
The Committee requests an update, no later than 60 days
after the enactment of this Act, describing how these funds
will be used to enhance the use of molecular diagnostics,
including information on the use of specific types of molecular
diagnostics, such as microarray, whole exome, whole genome, and
RNA-Seq which the Department is providing to cancer patients
and their frequency of use, as well as detailed policy for
data-sharing practices for cancer cell lines and models with
the external research community.
Metabolic Disease.--The Committee recommends that to ensure
access to advanced care for all veterans, the VA Innovation
Ecosystem (IE) include in its fiscal year 2025 portfolio
activities expanding the VA healthcare system's infrastructural
reach to enrolled veterans residing in geographically
underserved areas, including rural and highly rural. The
Committee would like IE to engage industry with community
stakeholders to co-develop transformative, highly deployable,
mobile, and scalable advanced MRI-based solutions to identify,
stratify, and manage the highly prevalent metabolic disease
burden in the VA population.

CAREGIVER SUPPORT PROGRAM

Caregivers Program.--The Committee provides $2,913,000,000,
as requested, for the caregivers program. The Committee
continues to require quarterly reporting on obligations for
this program.
Caregiver Assistance Eligibility.--The Committee recognizes
the important role of family caregivers in supporting the
health and wellness of veterans. The Committee directs VA to
report to the Committee on Appropriations within 180 days of
enactment of this Act on the feasibility, including cost
estimates, of expanding eligibility for the Program of
Comprehensive Assistance for Family Caregivers and the Program
of General Caregiver Support Services to include veterans with
lower continuous care needs and disability ratings.

CENTERS OF EXCELLENCE

Epilepsy Center of Excellence.--The Committee encourages
the Department to ensure that all veterans with epilepsy are
comprehensively evaluated at a VHA Epilepsy Center of
Excellence to identify drug-resistant epilepsy patients who may
be candidates for FDA-approved non-drug therapies.
Neurology Centers of Excellence.--The Committee recognizes
the increasing number of veterans affected by neurologic
conditions, including but not limited to: epilepsy, headache,
multiple sclerosis, and Parkinson's disease, and therefore
provides $76,800,000 for the Neurology Centers of Excellence.
This includes $26,800,000 for the Epilepsy Centers, $28,000,000
for the Headache Centers, $6,000,000 for the Multiple Sclerosis
Centers, and $16,000,000 for the Parkinson's Disease, Research,
Education and Clinical Centers.
The Neurology Centers of Excellence provide essential
innovative clinical care, education, and research efforts
focused on these conditions. The Committee applauds the
Department for recent investments into the headache, multiple
sclerosis, and Parkinson's disease centers and acknowledges the
advancement and expansion the Centers have begun. The Committee
encourages further investment and collaboration of the Centers
across disciplines and directs the Department to allocate
robust funding for the Neurology Centers of Excellence for
maintenance and expansion. The Committee also directs the
Department to provide a report to the Committees on
Appropriations of both Houses of Congress on the use and
allocation of funds for each Center within 120 days of
enactment of this Act. Additionally, the Department should
provide a report to the Committees on Appropriations of both
Houses of Congress no later than 180 days of enactment of this
Act detailing associations between neurological disorders and
military exposures, including open burn pits.

COLLABORATIONS AND PARTNERSHIPS

Academic Collaborations at Community Based Outpatient
Clinics (CBOC).--The Committee encourages VA to expand academic
collaborations with CBOCs, as they provide valuable patient
care and access to services that can be strengthened by
collaboration with educational institutions. Through clinical
traineeships and research fellowships, emerging health
professionals can gain a better understanding of veterans'
specific healthcare needs, improve patient outcomes, advance
specialized research, and increase the talented workforce
pipeline. VA is encouraged to consider including public
academic medical centers in CBOC collaborations.
Whole Family Care Partnerships.--The Committee is aware of
the efforts of private organizations to support veterans and
their families and recognizes that they can sometimes provide
services, such as counseling and wellness programs, for the
families of veterans that the Department cannot. Recognizing
that Congress, the Department, and private organizations share
the same goal of supporting veterans, the Committee directs the
Department to build upon its existing partnerships and seek
opportunities to establish new ones. The Committee is
particularly interested partnerships related to mental health,
including the mental health of veterans' families, and provides
up to $2,500,000 to increase outreach to this in-need
underserved population.

DENTAL CARE

Dental Care.--The recommendation includes $2,975,647,000,
as requested, to provide dental care for veterans. The
Committee requests that the fiscal year 2026 budget
justification include information on the role, resources, and
staffing required for the Assistant Under Secretary of Health
for Dentistry and the Office of Dentistry.
Dental Care Report.--House Report 118-122 directed the
Department to submit a report within 180 days of enactment to
assess the state of VA's oral health care program and its
ability to meet the needs of current and future veterans. The
Committee is looking forward to receiving this report.
Veterans Oral Health.--The Committee understands that
veterans may experience a large oral disease burden, and
therefore an integrated and whole-person approach is needed to
prevent and manage oral disease in this population, which may
also enable cost savings in VA Health Care at large. The
Committee looks forward to receiving the report on the
Department's assessment of its oral healthcare program and its
ability to meet current and future needs as required by House
Report 118-122.

DIABETES CARE

Improving Standards of Care for Diabetic Foot Ulcers.--One
in four veterans in the United States suffers from diabetes.
The VA health system treats about 115,000 diabetic foot ulcers
(DFUs) per year, and about 40 percent of patients afflicted
with the condition die within five years. DFUs are frequently
recurrent and require specialized wound care technology to
achieve optimal outcomes. To provide effective DFU care to the
VA population, the Department is encouraged to examine
alternatives to current standards of care for DFU treatment.
The Committee requests a report, no later than 180 days after
enactment of this Act, on tissue-based products proven in
clinical trials to treat hard-to-heal wounds, specifically
those with proven efficacy in tissue regeneration and anti-
inflammatory and anti-bacterial properties. This report should
review each product's shelf life, storage requirements, source
materials, and sizing options.
Reducing Type 2 Diabetes in Veterans.--The Committee
commends the Department for actively engaging with industry
partners in a pilot study using telehealth to provide
individualized ketogenic nutrition programs and medical support
to reduce the incidence of diabetes in VA patients. The
Committee applauds the effectiveness of the study at reducing
patient dependence on diabetes medication and the clinical
improvements achieved by Veterans engaged individualized
ketogenic nutrition programs. The Committee is aware of
existing plans within the Department to expand ketogenic
diabetes telehealth services beyond the pilot study to address
the healthcare needs of veterans living with Type 2 diabetes.
The Committee encourages the Department to sustain and expand
industry partnerships and programs focused on ketogenic
diabetes telehealth services to support the health and quality
of life of our Nation's veterans.

EMERGING AND NOTABLE HEALTHCARE ISSUES

Dialysis.--Over 18,000 veterans receive dialysis through
the National Dialysis Services Contract. The Committee
appreciates the Department's commitment to ensure care is not
disrupted or diminished for the veterans who receive treatment.
The Committee looks forward to working with the Department to
utilize a value-based dialysis payment model.
Needle Stick Injuries.--The Committee remains interested in
the Department's efforts to reduce or eliminate needlestick
injury among caregivers and staff at VA facilities. The
Committee encourages VA to use the most-up-to-date needle
destruction technology.
Nuclear Medicine Quality Improvements.--The Committee notes
that the Nuclear Regulatory Commission (NRC) has confirmed
nuclear medicine extravasations can result in radiation-safety-
significant doses to patients and is engaged in rulemaking to
require medical event reporting of extravasations. The
Committee encourages VA nuclear medicine facilities to monitor
injection quality, image extravasations, conduct dosimetry, and
notify patients when large extravasations occur.
Pressure Injuries.--The Committee recognizes the
Department's efforts to reduce pressure injuries among veterans
and its willingness to enhance the existing standard of care.
Further understanding of the VA Approved Enterprise Standard
(VAAES) Skin Template, and its interplay with pressure injury
statistics, notably within the spinal cord trauma population,
is of interest to the Committee. As such, the Committee
requests a briefing from VA on this issue within 120 days of
enactment of this Act aimed at advancing a comprehensive
understanding and effective implementation of improvements to
pressure injury care across VA and includes outside stakeholder
input and participation from clinicians and researchers.
Rideshare Program.--The Committee recognizes the success of
VA's temporary rideshare authority and is interested in
expanding transportation services for veterans. The Committee
is looking forward to the report as requested in House Report
118-122.
Veterans Transportation.--The Committee supports the
Department's programs that provide veterans with transportation
to VA medical facilities and make it easier for veterans to
receive medical care and encourages VA to explore options to
strengthen and sustain the Volunteer Transportation Network,
such as increased funding to recruit and retain drivers and
provide vehicle maintenance.

HEALTHCARE TECHNOLOGIES

Bioelectronic Medicine for Veterans.--The Committee
recognizes that Bioelectronic Medicine has the potential to
harness the body's electrical signaling to advance treatments
that save lives and lower medical expenditures. Accelerating
studies, additional data collection, and the development and
adoption of novel applications for Bioelectronic Medicine
combined with machine learning and artificial intelligence (AI)
can address challenging and expensive diseases by personalizing
treatments and improving therapy delivery. The Committee
encourages the Department to ensure that combined Bioelectronic
Medicine and AI technologies are available to veterans.
Medical Image Exchange.--The Committee applauds VA
facilities in 17 of 18 VISNs that have deployed a modern
software platform that supports bi-directional exchange of
medical images, diagnostic reports, and other clinical data
between VA facilities, community providers, and federal
partners. VA is directed to expand this software's connections
to Indian and tribal health clinics and work with the
Department of Defense to expedite connections with military
treatment facilities.
Migraine Prevention and Treatment.--The Committee
recognizes approximately one in three servicemembers experience
severe headaches and migraines and encourages the Department to
ensure neuromodulation devices with FDA-indication for migraine
prevention and treatment are available to veterans and to
educate clinicians and veterans on such devices.
Respiratory Illness.--The Committee is aware of emerging
technology that uses existing x-ray imaging equipment to derive
four-dimensional models of lung function, which helps to
identify respiratory illnesses and accompanying loss of lung
function earlier than was previously feasible. The Committee is
looking forward to learning about the program's efficacy in the
required report as requested in House Report 118-122.

HOMELESS ASSISTANCE PROGRAMS

The Committee provides $3,210,276,000 for VA homeless
assistance programs, an increase of $96,746,000 above the
fiscal year 2024 enacted level and equal to the budget request.
An estimated $12,007,323,000 is provided for homeless veterans
treatment costs, an increase of $820,715,000 above the fiscal
year 2024 level.
Programs to assist homeless veterans include the Homeless
Providers Grant and Per Diem (GPD), Health Care for Homeless
Veterans (HCHV), the Domiciliary Care for Homeless Veterans,
the Supportive Services for Low Income Veterans and Families
(SSVF), Veterans Justice Outreach Homeless Prevention (VJO),
Compensated Work Therapy, and the Department of Housing and
Urban Development-Department of Veterans Affairs Supported
Housing (HUD-VASH) programs.
Healthcare for Homeless Veterans.--The Committee notes the
benefits of the Homeless Patient Aligned Care Team (HPACT)
program and encourages VA to expand this program to additional
sites, including rural areas, and to consider additional
services to improve the program. The Committee directs the
Department to explore options to expand this program to
additional sites, including cost estimates, with its fiscal
year 2026 budget request.
HUD-VASH Case Management.--The Committee recognizes the
value and impact of the HUD-VA Supportive Housing (VASH)
program, which serves veterans experiencing homelessness and
pairs each HUD affordable housing voucher designated for
veterans with intensive case management from VA to assist with
benefits and income, mental healthcare, recovery services, and
permanent housing stability. Case management services are
critically important to the function of the program, and public
housing authorities rely on VA Medical Centers' referrals to
house veterans. Existing requirements mandate that a veteran
must receive VA case management services to receive a HUD-VASH
voucher. The inadequacy of staff for case management has
contributed to the ongoing underutilization of HUD-VASH
vouchers. Therefore, the Committee directs an increase in
staffing for case management services to continue to improve
the rate of lease referrals and to account for increased
staffing costs and recent expansions in eligibility.
Recovery-Oriented Care.--The Committee notes the National
Center for Homelessness Among Veterans' development of housing
models that promote recovery-oriented care for veterans
experiencing or at risk of homelessness. The Committee is
looking forward to receiving the report on the program's
effectiveness as requested in House Report 118-122.
Veterans Councils.--The Committee is aware of the
importance of Veterans Councils and their mission to assist
homeless prevention actions, and their assistance to at-risk,
impoverished, and veterans of all ages and terms of service.
Supportive Housing for Veterans with Serious Mental
Illness.--The Committee encourages VA to build upon the
tangible achievements of the HUD-VASH program and explore
whether a new model of vouchers could provide housing
opportunities for low-income veterans experiencing serious
mental illness who seek healthcare services from VA.
Legal Assistance for the Supportive Services for Veteran
Families Program.--The Committee continues to encourage the
Supportive Services for Veteran Families [SSVF] program to work
with grantees to expand their legal service offerings,
particularly in rural areas where access to private legal
assistance can be limited. Within funds provided, the
Department is further encouraged to pilot projects to partner
SSVF grantees with university law schools in rural areas or
within underserved populations to enhance legal assistance to
veterans.
Cost of Care for Veterans' Homes.--The Committee is
concerned with the current reimbursement rate for state and
non-profit run Veterans Homes. The Committee recognizes that
the costs associated with Veterans Homes are substantial due to
the high acuity level of the veteran population served, and
that current VHA rates are inconsistent with the current cost
of care. The Committee requests a report, no later than 90 days
following enactment of this Act, outlining how current
reimbursement rates are calculated, how VHA makes locality
adjustments, how VHA works to reduce the cost of prescription
drugs for veterans in homes, and recommended legislative
changes for Congress to consider.
Tiny Homes.--The Committee notes the success of the tiny
home village model by multiple veterans service organizations
(VSOs) and encourages VA, in coordination with the Department
of Housing and Urban Development to support this work and
facilitate the creation of additional villages of tiny homes
villages within the VA's existing Grant and Per-Diem (GPD)
program.
Veterans At-Risk of Homelessness Data.--The Committee notes
that homelessness data may currently undercount women veterans
with children. The Committee directs VA to work with the
Department of Housing and Urban Development's Continuums of
Care to include data on veterans at-risk of homelessness within
Section 5: Veterans Experiencing Homelessness of the Annual
Homelessness Assessment Report (AHAR) to Congress. The
Committee commends the progress made by the Supportive Services
for Veteran Families Program but encourages data collection on
women veterans with children who may not meet the VA's
definition of homelessness but are homeless for parts of the
year and remain at-risk.

INTIMATE PARTNER VIOLENCE ASSISTANCE PROGRAM

Intimate Partner Violence Program (IPV).--The Committee
continues to support VA's efforts to expand its IPV program,
which provides a holistic approach that involves understanding,
recognizing and responding to the effects of all types of
trauma, with the ultimate goals to end violence, prevent
further violence, and promote healthy relationships

MENTAL HEALTH PROGRAMS

The Committee provides $16,380,187,000 for mental health
programs. Of the total, $3,161,426,000 is for suicide
prevention and treatment programs, including $582,554,000 for
suicide prevention outreach and $306,683,000 for the Veterans
Crisis Line.
The Committee continues to direct the Department to focus
on efforts to address parking lot suicides and connect veterans
to care.
The Department is directed to provide a report to the
Committee, no later than 90 days after enactment of this Act,
identifying a detailed expenditure plan for all suicide
outreach and treatment programs and how VA is meeting the
Committee's directives.
AANHPI Veterans.--The Committee understands that Asian
American, Native Hawaiian, and Pacific Islander (AANHPI)
veterans have a lower use of VA and non-VA mental health
services and requests a report Committee not later 180 days
after enactment of this Act on reasons for such lower
utilization and ways improve access of AANHPI veterans to
mental health care and increase outreach to such veterans,
especially for those in harder-to-reach populations, including
rural communities and English-as-a-second-language households.
Faith Based Digital Applications Impact on Mental Health.--
The Committee understands that recent data has shown that the
use of digital, faith-based applications can have a measurable
impact on mental health and wellness. The Committee directs VA
to conduct a study on the effectiveness of such applications
and requests a report on findings within 180 days of enactment
of this Act.
Agritherapy.--The Committee supports efforts to train
veterans in agricultural vocations, while also tending to
behavioral and mental health needs with behavioral healthcare
services and treatments from licensed providers. The Department
is urged to consider including agritherapy as a Complementary
and Alternative Medicine therapy.
Improving Depression Treatment with Precision Medicine.--
The Committee recognizes that depression is one of the most
common conditions associated with military service and combat
service. Further, the risk of suicide increases with this
diagnosis each time a veteran tries and fails a medication. The
Committee is encouraged by ongoing VA-sponsored genetic testing
research to aid in depression treatment selection; however,
veterans still have less access than Medicare beneficiaries to
precision medicine tools. The Committee directs VHA to ensure
the procurement of pharmacogenomic tests for use in the
treatment of depression if they have been shown to improve
health outcomes of veterans in clinical trials.
Military Sexual Assault.--The Committee recommends that all
veterans seeking treatment services are screened for sexual
assault using an evidence-based screening tool in order to
successfully treat those who have experienced assault.
Modeling and Simulation Treatment of PTSD.--The committee
commends the Department of Veterans Affairs for its innovative
implementation of immersive technology to improve Veterans'
health care experiences. The Committee is aware that modeling
and simulation technology has enabled the development of
innovative and immersive therapies, which can extend trauma
management therapy protocol. The Committee requests that VA to
provide a report with 90 days of enactment of this Act
regarding the results of the study. Immersive technology is
currently being used in VA Medical Centers and Facilities
across all 50 states American Samoa, Guam, and Puerto Rico.
Immersive technologies have proven effective in treating
Veterans with difficult-to-treat post-traumatic stress
disorder, depression, stress, and anxiety.
Veterans Crisis Line (VCL).--The Committee provides funding
to support the VCL, as requested, and continues to monitor the
VCL to ensure veterans are receiving appropriate clinical care.
To support this critical care, the Committee encourages VA to
utilize funds provided by the bill to ensure appropriate
staffing for call centers and back-up centers, provide
necessary training for VCL staff, and ensure that staff are
able to appropriately and effectively respond to the needs of
veterans. The Committee maintains bill language requiring the
VCL to: (1) provide to individuals who contact the hotline
immediate assistance from a trained professional; and (2) to
adhere to all requirements of the American Association of
Suicidology.

MILITARY TOXIC EXPOSURE RESEARCH PROGRAM

The bill includes $59,000,000, as requested, for research
on military environmental exposures. The Committee supports
efforts to improve diagnosis and treatment of conditions
resulting from toxic exposures and appreciates the work of the
Health Outcomes Military Exposures (HOME) program, the Office
of Research and Development, and other VA program offices to
increase attention to this issue.
The Committee encourages the Department to continue
research on the effects of and treatments for veterans exposed
to toxins, such as Agent Orange, open burn pits, PFAS,
radiation, and asbestos, during the course of their active-duty
service. The Committee also urges the Department to utilize
reference data from existing medical records to determine how
veterans who served in areas where toxins were dispersed may
have more frequent or unexplained diseases compared to the
civilian population.
Airborne Hazards and Burn Pits Center of Excellence.--The
Committee provides $15,165,000 and continues to support the
Airborne Hazards and Burn Pits Center of Excellence on
diagnoses, mitigation, and treatment of conditions related to
airborne hazards and burn pits.
Colorectal Cancer Screening.--The Committee recognizes that
early detection with screening is the most effective tool
available to help prevent thousands of cancer deaths and that
catching cancers in earlier stages when they are most treatable
saves lives as well as provides a cost savings for the patient
and the system. The Committee urges the Department of Veterans
Affairs to review its policy related to colorectal cancer
screening and take action to align it with the nationally
recognized guideline recommendations from the United States
Preventive Services Task Force (USPSTF), National Comprehensive
Care Network, and the American Cancer Society. Furthermore, the
Committee requests a briefing by the Department of Veteran
Affairs no later than 6 months after enactment of this act to
receive an update on the alignment of the colorectal screening
options available to veterans.
Service-Connected Colorectal Cancer.-- Colorectal cancer is
the fourth most common cancer diagnosis among our nation's
veterans. More information is needed to determine why
colorectal cancer is so prevalent among the veteran population,
and if their service, including exposure to burn pits, played a
role. The Committee requests the Department to report to the
Committee, no later than 180 days after enactment of the Act,
on the prevalence of colorectal cancer among veterans and the
potential effect of exposures to burn pits and other
environmental hazards during military service.

OPIOID PREVENTION AND TREATMENT PROGRAM

The bill includes $713,049,000 for opioid treatment and
prevention efforts, which is $2,316,000 below the fiscal year
2024 enacted level. Of the total, $254,487,000 is provided for
activities authorized by the Comprehensive Addiction and
Recovery Act of 2016 (P.L. 114-198).
Fentanyl Abuse Education.--The Committee recognizes the
alarming rise in fentanyl overdoses as part of the opioid
epidemic that is impacting our service members. The Committee
urges the VA to prioritize comprehensive education and
awareness initiatives for veterans on fentanyl abuse, alongside
support programs aimed at reducing substance use. The Committee
directs VA provide a report within 180 days of enactment on
effectiveness of the ongoing initiatives.
Nonaddictive Opioid Alternatives.--The Committee remains
concerned about the continued use of opioids in the veteran
population. The Committee requests that the Department to
provide a report to the Committee no later than 60 days after
enactment of this act on veterans' access to non-opioid pain
relief medications. The report should include: (1) steps the
Department will take to ensure that coverage, cost-sharing, and
access are not an impediment to veterans receiving these
medications; (2) what actions need to be taken to ensure
Tricare beneficiaries have access to prescriptions for
nonaddictive opioid alternatives for both acute and chronic
pain; and (3) how the Department will support continued and
expanded education to providers on nonaddictive opioid
alternatives.
Improvements to Opioid Management in the Military Health
System.--The Committee is concerned that the Department of
Veterans Affairs (VA) Pharmacy Benefits Management (PBM)
Services has not conducted a class review of the opioid
analgesics therapeutic class since 2017 and has not undertaken
such a review following the Department of Defense and
Department of Veterans Affairs' joint publication of the
guideline titled ``VA/DoD Clinical Practice Guideline for the
Use of Opioids in the Management of Chronic Pain, 2022''. The
Committee encourages the VA PBM to evaluate the opioid
analgesics therapeutic class annually, and in connection with
that evaluation, consider the FDA-approved labels of
therapeutics in this class as such labels may evolve from time
to time, the value of consistent coverage positions across
formularies that may be accessed by beneficiaries of the
Veterans Health Administration, real-world evidence and health
economics and outcomes research pertaining to therapeutics in
this class, and the extent to which VA national formulary
coverage aligns with, and enables, any applicable clinical and
public health guidelines or reports.

PHARMACEUTICAL ISSUES

Drug Pricing Report.--The Committee remains interested in
information regarding VA drug pricing and appreciates VA
providing a report as requested in previous fiscal years on
VA's spending on prescription drugs. The Committee encourages
VA to conduct this analysis annually and requests robust and
routine updates to Congress, including updated information for
fiscal year 2025 on prescription drug prices (net of rebates)
paid by VA for the ten most frequently prescribed drugs and the
ten highest-cost drugs for VA. In addition, the report should
include total annual costs to VA for all prescription drugs. As
VA has noted that country of origin information on drugs and
active pharmaceutical ingredients is not yet available on a
national level, the Committee urges the VA's National
Acquisition Center to work with the Food and Drug
Administration to track this data and establish a national
database for such information.
Medication Optimization for Veterans.--The Committee
commends VA's work to implement a National Pharmacogenomics
Program to ensure all eligible veterans have access to
appropriate, evidenced-based pharmacogenomic testing, and that
VA has a robust and highly trained healthcare professional
workforce to help veterans who have undergone pharmacogenomic
testing. The Committee provides $41,300,000, as requested, for
this work.
Prescription Drug Quality.--The availability of safe and
effective prescription drugs has significant implications for
the health of veterans, the workload of VHA personnel, and
federal spending. The U.S. experiences over three drug recalls
a day, and production of most drugs and active pharmaceutical
ingredients (API) has shifted to China and India. VHA is one of
the largest purchasers of pharmaceuticals in the U.S. but has
no way to distinguish between higher- and lower-quality
pharmaceutical manufacturers. Currently, the Uniformed Services
University of the Health Sciences' (USUHS) Center for Health
Services Research (CHSR) is piloting a system to evaluate the
quality of drug products for essential medicines and develop a
scoring tool for potential use in Department of Defense
procurement. The Committee encourages the Department to explore
a potential partnership with USUHS and work to develop a
strategy for the use of drug quality scoring in VA procurement.
The Committee directs the Department to report to the
Committees on Appropriations of both Houses of Congress not
later than 180 days after enactment of this Act and annually
thereafter on the progress of this effort.
Novel Program for Optimizing Pain Management.--The
Committee recognizes the balance between supporting access to
care for veterans with pain and the veteran's risk of
developing dependency for prescription pain medication. The
Committee supports the implementation of a process improvement
initiative that will reduce the risk of tolerance, dependence,
misuse, addiction, and diversion of prescription pain
medication by establishing more precise and effective
prescribing guidelines to ensure veterans receive appropriate
care. The Committee expects VA to deploy an innovative clinical
decision support tool to evaluate and interpret the acute and
chronic pain management needs for military veterans, their
dependents, and/or employees of VA. The Committee supports the
use of a novel care model that is available to those receiving
treatment through traditional VHA hospitals/clinics and those
utilizing Care in the Community. Such model should enable
better value, a better standard of care, and seek to
significantly reduce VA spending on pharmacy and behavioral
health services. The Committee requests VA to provide a report
within 180 days on its plans for the model and how it intends
to phase in its use across VHA over the next several years.
Pharmaceutical On-dose Tracking and Tracing Technologies.--
The Committee is committed to providing veterans safe and
reliable medication. Track and trace systems are increasingly
being implemented as a technological solution to secure
pharmaceutical supply chains. These systems offer the potential
to minimize reimbursement fraud, facilitate fast market
recalls, and help identify medicine shortages. The Committee
looks forward to receiving the report requested in House Report
117-391, especially regarding solutions to prevent counterfeit
medicines from entering the VA supply chain.
Weight Loss and Weight Management Tools.--According to the
Centers for Disease Control and Prevention, nearly 35 percent
of American adults are obese. VA estimates that 78 percent of
veterans are overweight or obese. The Committee continues to
encourage the Department to ensure veterans have access to
evidence-based weight management interventions, including
prescription medications.
Pain.--The Committee recognizes the balance between
supporting access to care for veterans with pain and the
veteran's risk of developing dependency for prescription pain
medication. The Committee supports the implementation of a
process improvement initiative that will reduce the risk of
tolerance, dependence, misuse, addiction, and diversion of
prescription pain medication by establishing more precise and
effective prescribing guidelines to ensure veterans receive
appropriate care and provides up to $5,000,000 for this
purpose. The Committee expects VA to deploy an innovative
clinical decision support tool to evaluate and interpret the
acute and chronic pain management needs for military veterans,
their dependents, and/or employees of VA. The Committee
supports the use of a novel care model that is available to
those receiving treatment through traditional VHA hospitals/
clinics and those utilizing Care in the Community. Such model
should enable better value, a better standard of care, and seek
to significantly reduce VA spending on pharmacy and behavioral
health services. The Committee requests the Department to
provide a report within 180 days on its plans for the model and
how it intends to phase in its use across VHA over the next
several years.

POST-TRAUMATIC STRESS DISORDER CARE

National Center for Post-traumatic Stress Disorder.--
Recognizing the importance of VA's National Center for PTSD in
promoting better prevention, diagnoses and treatment of PTSD,
the Committee provides $42,000,000 for the Center, as
requested.
Service Dogs for Veterans' Mental Health.--The Committee
recognizes the positive role that service, guide, and hearing
dogs have played in mitigating veterans' disabilities and
providing assistance and rehabilitation. In House Report 118-
122, the Committee encouraged VA to expand the number of pilot
sites to include medical centers that primarily serve veterans
in rural areas and in states with few VA medical facilities.
Within 180 days of enactment of this Act, the Department is
directed to report on ongoing efforts to expand the number of
pilot sites and recommendations to help alleviate financial
burdens on non-profits to implement the program, including
potential partnerships with Department of Defense medical
schools.
Women Veteran PTSD Research and Treatment.--The Committee
recognizes the effects of PTSD may manifest differently between
men and women. The Committee also notes that more women are
using the VA system than ever before and over 30% of new VHA
users are women. The Committee encourages the Department to
continue and expand its research on the effects of PTSD and to
ensure specific research on women veterans is included in these
efforts. The Committee also encourages that commensurate number
of women veterans relative to the total women veteran
population are utilized in research studies pertaining to PTSD.
New Treatments for PTSD.--The Committee is aware of
privately funded research regarding potential new treatments
for PTSD and encourages the Department to monitor these efforts
and review the results of existing and future clinical trials.
Women Veterans Network.--The Committee continues to support
the role of Women Veterans Network (WoVeN), a national peer
support network for women veterans managed by the National
Center for PTSD-Women's Health Sciences Division, and provides
up to $3,000,000 for peer support programs for women veterans.

RURAL HEALTH

Office of Rural Health (ORH).--The bill includes
$337,455,000 for rural health, which is equal to the budget
request, to improve access and quality of care for the more
than 3,000,000 enrolled veterans residing in rural and highly
rural areas.
Rural Veterans Transportation Program.--The Committee
encourages the Office of Rural Health to use $10,000,000 for
the continued partnership between the Veterans Transportation
Program an the Office of Rural Health to continue to provide
transportation to VA appointments for veterans who live in
rural areas. Further, the Committee directs the Secretary to
submit a report with the President's Budget Request for FY2026
that assesses the transportation challenges faced by rural
veterans.
Office of Rural Health Operating Plan.--The Committee
directs the Office of Rural Health to submit no later than 30
days after enactment of this Act an operating plan for fiscal
year 2025 funding, as well as for the fiscal year 2026 funding
provided in advance by this Act.
Rural Access Network for Growth Enhancement (RANGE).--The
RANGE Program provides case management and treatment services
to mentally ill veterans in rural areas. The bill includes
sufficient funding to maintain three new centers of the RANGE
Program, as authorized by the Sgt. Ketchum Rural Veterans
Mental Health Act of 2021 (P.L. 117-21).
Transportation Challenges.--The Committee recognizes the
transportation challenges and barriers to care that rural and
remote veterans face and directs the Office of Rural Health to
increase efforts to improve transportation mobility for
veterans, to allocate funding to enhance rural access and
transportation services, and continue to consider utilizing
accessible autonomous electric vehicles to overcome these
challenges.

SUBSTANCE-USE DISORDER CARE

The bill includes $263,881,000 for Substance-Use Disorder
(SUD) efforts to ensure veterans can receive timely SUD
specialty services.
Jason Simcakoski Memorial and PROMISE Act Implementation.--
The Committee supports the continued implementation of the
Jason Simcakoski Memorial and Promise Act, Title IX of the
Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-
198), including updating therapy and pain management
guidelines, strengthening provider education and training, and
improving patient advocacy.
Medication-Assisted Treatments.--The Committee encourages
VA to increase education among its primary care practitioners,
and on the diagnosis and treatment of alcohol use disorders
with FDA-approved medication-assisted treatments and
counseling, as clinically indicated.
Tobacco Harm Reduction.--The Committee is concerned that
smoking rates among U.S. military veterans is significantly
higher than among the civilian population, finding that 27% of
Iraq and Afghanistan combat veterans use tobacco products daily
versus 11.5% of their civilian counterparts. The Committee is
aware of the Department's smoking cessation program but is
concerned that there is no publicly available information
regarding the success of the program. The Committee is also
aware that if the success rate of the tobacco cessation program
reflects that of the civilian population, then over 90% of
veteran participants are likely to continue use of combustible
cigarettes. The Committee directs the Department to coordinate
with the Food and Drug Administration (FDA) to incorporate into
the Department's smoking cessation program, information about
FDA-authorized tobacco products that have been determined to be
less harmful than continued cigarette smoking, such as heated
tobacco products, to help reduce cigarette use amongst the
veteran community.

SUICIDE PREVENTION

Lethal Means Safety Collaboration.--The Committee notes
that VA has been called to partner with the Departments of
Defense, Health and Human Services, Homeland Security, Justice,
and the Office of Emergency Medical Services within the
Department of Transportation to create and implement a
coordinated approach for improving lethal means safety. The
Committee looks forward to the report required by House Report
117-391 on this coordinated approach and VA's plans to
incorporate the coordinated approach into the Department's
existing lethal means safety initiatives.
Lethal Means Safety Training.--To ensure that every
employee who regularly interacts with veterans is prepared to
have a conversation that could save a veteran's life, the
Committee continues to urge VA to implement mandatory lethal
means safety trainings for all VA employees who regularly
interact with veterans in their work, compensation and pension
examiners, employees of Veterans Centers and vocational
rehabilitation facilities, community care providers, and family
caregivers to the extent practicable.
Firearm Lockbox Program.--The Committee supports VA's
efforts to address veteran suicide prevention, and the firearm
lockbox program is a critical element. As VA implements this
program, the Committee is concerned that funding limitations
may impact the scope and reach of this initiative within the
broader National Strategy for Preventing Veteran Suicide. The
Committee provides $3,000,000 above the request to expand the
firearms safety elements of the lockbox program to increase
awareness and enable greater distribution of firearms safe
storage devices. The Committee encourages VA to ensure that
access to firearms storage resources for Veterans is included
in training for employees of the Veterans Crisis Line.
Predictive Modeling and Analytics for Veterans Suicide
Prevention.--The Committee continues to be concerned by the
alarming number of veterans dying by suicide each day. The
Committee encourages the Department to utilize its Recovery
Engagement and Coordination for Health--Veterans Enhanced
Treatment (REACH VET) program, for predictive modeling and
analytics to support early detection of suicidal ideations, and
continue to utilize improved technologies to expand its
efforts.
Suicide Prevention Coordinators.--The Committee recognizes
the importance of Suicide Prevention Coordinators, who follow
up with and coordinate care for veterans who have been directly
referred to them by responders at the Veterans Crisis Line, and
directs VA to fully staff suicide prevention coordinator
positions. To better support coordinators, the Committee
encourages the Department to incorporate enterprise-wide and
interactive technology. The Committee directs the Secretary to
outline in the next budget request how VA medical facilities
are using this technology, total program cost, and schedule to
implement an enterprise-wide solution.
Zero Suicide Initiative.--The Committee expects the
Department to prioritize efforts to combat veteran suicide and
looks forward to receiving the report requested in House Report
118-122.
Suicide Prevention Reporting.--The Committee directs VA to
incorporate full veteran benefit usage in its annual suicide
prevention report to demonstrate the relationship between VA
benefits and veterans who die by suicide. The report shall
contain detailed usage of benefits the same way VA reports on
veteran interactions with VHA. Additionally, the Committee
directs VA to provide annual utilization reports on community
grants for suicide prevention.
Veteran Resiliency, Suicide Prevention and Response.--The
Committee notes that death by suicide in our veteran population
remains an alarming crisis. Tragically, 18 to 24 Veterans die
by suicide daily. The Department's data demonstrates that
veterans suicide rates have increased over the last 20 years.
The Committee encourages VA to modernize current suicide
prevention models to better ensure they are reaching at risk
veterans.

TELEHEALTH AND CONNECTED CARE

The bill includes $6,398,020,000 for teleheath and
connected care, which includes home telehealth, home telehealth
prosthetics, and clinic-based telehealth.
VA is encouraged to leverage newly gained telehealth
capacity to address backlogs for disability exams and
healthcare appointments when appropriate. The Committee further
directs VA to continue to implement plans to improve veteran
and provider satisfaction, increase awareness of the telehealth
program, and enhance adoption of telehealth by veterans and
providers.
VA Telehealth Benefits.--VA Telehealth Services are
transforming how Veteran's access high-quality VA care by
making it easier for veterans to connect with health
specialists from across the country. Not later than 180 days
after the enactment of this Act, the Secretary of Veterans
Affairs shall submit a report to the Committees on
Appropriations of both Houses of Congress a report on the wait
times for VA telehealth services and the active public-private
partnerships that enable and enhance telehealth access to
Veterans. The report shall include an update on obligations of
public-private partnerships (P3s) included in the VA Mission
Act of 2018.

WHOLE HEALTH

The Committee recommendation includes $119,289,000 Whole
Health, as requested, which is $11,441,000 above the fiscal
year 2024 enacted level. The Committee supports the Whole
Health model of care and the expansion of Whole Health to all
VA facilities.
Continued Support and Expansion of Whole Health.--Since FY
2021, the Committee has consistently praised the Veterans
Administration (VA) Whole Health System, citing its ability to
provide efficient and effective patient-centered, integrative
care to veterans, especially those who are struggling with
opioid use disorder and chronic pain. In light of independent
evaluations from the National Academy of Sciences and VA, which
have demonstrated both dramatic increases in program
participation and decreases in total healthcare costs among
enrolled Veterans, the Committee has provided $34,300,000 in
additional funding since FY 2022 to help expand Whole Health to
all VA health facilities nationwide. In response to ``VA's
Report to Congress on Continued Support and Expansion for Whole
Health'' submitted in March 2023, the Committee includes
$119,300,000 which is $11,400,000 above the FY 24 enacted level
to support the continued expansion of Whole Health. Further,
the Committee requests a report from the VA no later than 90
days following enactment of the Act regarding the status of the
program's expansion efforts to date and, if applicable, an
increased cost estimate.
Adaptive Sports.--As requested, the bill provides
$30,542,000, for National Veterans Sports Programs, including
$16,500,000 for adaptive sports programs and up to $5,000,000
equine therapy.
Creative Arts Therapies.--The Committee continues to
acknowledge the effective use of creative arts therapies and
arts and humanities partnerships in treating veterans with
traumatic brain injuries and psychological health conditions
and provides up to $5,000,000 to do so.
Equine Assisted Therapy Services.--The Department should
utilize funding provided for equine therapy to conduct a
comprehensive program evaluation to ensure the continued
effectiveness of equine assisted therapy and services in
addressing the mental health needs of veterans that participate
in these programs, including through the systematic assessment
and tracking of mental health issues and symptoms, and the
measurement of key outcomes, such as functional improvement in
veterans' different life domains. The Committee directs the
Department to provide a report to the Committees on the
feasibility and cost associated with expanding access to
recreational therapy options, such as equine assisted therapy
and services, to all veterans enrolled in VA care within 180
days of enactment of this Act.
Creative Arts Therapies.--The Committee continues to
acknowledge the effective use of creative arts therapies and
arts and humanities partnerships in treating veterans with
traumatic brain injuries and psychological health conditions
and provides up to $5,000,000 to do so.
Produce Prescription.--Studies have shown veterans
experience obesity and chronic diet-related comorbidities at
higher levels compared to the U.S. population. VHA has the
potential to play an important role in alleviating diet-related
disease through produce prescriptions. The Committee provides
up to $2,000,000 for VA facilities to partner directly with
organizations to develop and implement local VA produce
prescription programs and pursue strategies for patient
education and outreach. The Committee looks forward to the
report requested in House Report 118-122 on this issue.
Medically Tailored Meals.--The Committee recognizes the
ability for VA to provide food to veterans in both inpatient
and non-inpatient settings under existing statutory authority.
The Committee requests that medically tailored meals and food
be provided, when VA providers deem it to be appropriate, in
order to support a healthy food-as-medicine component and as
part of a comprehensive care plan for veterans with at least
one chronic health condition.
Food Service Guidelines.--The Committee encourages VA to
explore goals supports the goal set forth in the National
Strategy on Hunger, Nutrition, and Health to update and
implement government-wide the Food Service Guidelines for
Federal Facilities. The Committee provides $1,000,000 to the
Veterans Health Administration to implement the Food Service
Guidelines across its food service facilities within one year
or sooner of the date of enactment of this Act. The Committee
requests within two years or sooner of the date of enactment of
this Act a report that includes a baseline and final assessment
of how the Veterans Health Administration's food purchasing and
food service practices align with the Food Service Guidelines;
an evaluation of the implementation strategy including
associated costs and customer feedback; and recommendations for
changes to procurement or other laws that would facilitate
ongoing implementation of the Food Service Guidelines.

WOMEN VETERANS HEALTH CARE

The recommendation includes a total of $1,323,444,000, as
requested, to support care for women, the Office of Women's
Health and programmatic efforts, including the childcare
initiative. Within this amount, VA is encouraged to continue
hiring women primary care providers and increase the number of
peer support specialists for women veterans.
Care for Women.--The Committee recognizes that women are
the fastest growing cohort within the veteran community. The
number of women veterans using VHA services has more than
tripled since 2001, growing from 159,810 in 2001 to more than
600,000 today. The increased number of women using VHA services
necessitates a greater investment of resources to provide and
expand VA's services to women veterans and ensure women
veterans' health needs, which often differ from men, are met.
Breast Cancer Screening Guidelines.--The Committee commends
VA's decision to offer breast cancer screening and mammography
to eligible women veterans beginning at age 40. However, the
Department should be prepared to offer screening to eligible
younger women veterans, especially women at higher risk for
breast cancer, should a physician determine medical necessity,
or risk factors warrant, screening before age 40. The Committee
supports this effort to ensure that women veterans have access
to and receive adequate and timely care and requests an update
on the departments implementation of this policy no later than
60 days after enactment of this Act.
Maternal and Infant Health Outcomes for Women Veterans.--
The Committee directs the Department to provide a report within
180 days of enactment of this Act regarding the incidence of
birth defects, miscarriage, stillbirth, and maternal morbidity
and mortality that can be related to military service and
provide recommendations to raise awareness and improve maternal
and infant health outcomes.
Maternity Healthcare and Coordination Programs.--The
Committee is pleased that to coordinate prenatal and postpartum
care provided in the community, the Department has established
maternity healthcare and coordination programs, which have been
successful in ensuring that veterans can receive high-quality,
appropriate care and robust support during and after pregnancy.
The Committee supports these programs and encourages VA to
continue to ensure veterans have access to high-quality, well-
coordinated care, and robust services and directs VA to
continue to implement the Protecting Moms Who Served Act (P.L.
117-69).
Women's Veteran Initiative.--The Committee supports
continued efforts to identify and address unique issues
experienced by women veterans.
Women's Health Research and Innovation.--The Committee is
aware of a new joint collaborative to improve women's health
research for service members and veterans that will develop a
roadmap to close pressing research gaps specific to women who
served in the military. Of the areas of research that will
benefit women veterans, the Committee notes that 80 percent of
patients diagnosed with an autoimmune disease are women. The
Committee encourages VA to engage with experts who are
researching autoimmune diseases in women veterans, including
myalgic encephalomyelitis/chronic fatigue syndrome and Gulf War
Illness, to better understand sex-based differences in disease
diagnosis and treatment. The Committee requests a detailed
report within 180 days of filing this report of how the
Department will execute the Executive Order, what research gaps
will be prioritized, and how it will engage with nationally
recognized experts on diseases that impact women veterans.

WORKFORCE AND STAFFING ISSUES

Expanding Recruitment.--The Committee recognizes the
challenge VA has in the recruitment and retention of
clinicians. To help VA better keep pace with other providers
and continue to train its workforce to improve their service to
veterans, the Committee urges VA to explore potential options
to enhance recruitment and retention, such as expanding
benefits to relocate to underserved VA medical facilities and
expanding reimbursement to clinicians for Continuing
Professional Education, regardless of individual specialty or
board certification.
Expedited Hiring Authority.--The Committee strongly
encourages the Department to focus hiring efforts on converting
clinical trainees to full VA employment immediately upon
completion of their residencies through the utilization of the
expedited hiring authority granted to the VA by Title 38.
Homeless Veterans Caseworkers.--The Committee requests that
the Department evaluate staffing needs for caseworkers for
homeless veterans and veterans at risk of homelessness and
evaluate the potential benefits and effectiveness of
contracting for caseworkers in the annual Staffing Report.
Respiratory Therapists.--The Committee remains concerned
with gaps in coverage of respiratory therapists at VA,
particularly as additional veterans become eligible under the
PACT Act. The Committee encourages VA to evaluate staffing
needs for respiratory therapists using a validated data system,
and to report to the Committee within 180 days of enactment of
this Act on gaps in staffing for respiratory therapists.
Staffing Report.--The Committee looks forward to the annual
comprehensive report required by the Joint Explanatory
Statement accompanying the Consolidated Appropriations Act,
2022 (P.L. 117-103) on the Department's plan to address
critical workforce issues.
VA/HHS Collaboration on Health Workforce Shortages.--The
Committee continues to encourage VA to work with the Department
of Health and Human Services (HHS) to explore ways the agencies
can work together, such as by creating a taskforce, to increase
the availability of providers, including in the behavioral
health workforce and among physicians specializing in cancer,
spinal cord, and neuropsychiatric conditions. This
collaboration is urged to examine VA's recruitment challenges,
review programs that could enhance recruitment and retention,
and to think creatively on how other Federal agencies like HHS
can identify and address provider shortages. VA also is
encouraged to consult with the Department of Defense to explore
recruiting those who have left military service.
VA Physician Pay.--The Committee understands that one of
the biggest hurdles in retaining health care professionals
within VA health care system is the agency's ability to compete
with market pay rates. The Committee encourages VA to explore
opportunities in which VA can better compete with market pay
rates and increase pay opportunities for physicians and other
identified health care professionals.
Staffing at Richard A. Pittman Community-Based Outpatient
Clinic.--The Committee celebrates the recent opening of the
Richard A. Pittman Community-Based Outpatient Clinic in San
Joaquin County, California. The Committee recognizes the
crucial role this clinic has in expanding primary care and
specialty health care services to veterans across California's
Central Valley. The Committee recommends the Department work
with all relevant partners to ensure full-staffing requirements
at all levels are met and sustained within the first six months
of seeing patients.

MEDICAL COMMUNITY CARE

Fiscal year 2024 enacted level....................... $30,342,023,000
Fiscal year 2025 enacted level....................... 20,382,000,000
Fiscal year 2025 budget year request................. - - -
Committee 2025 budget year recommendation............ - - -

Fiscal year 2026 advance appropriation request....... 34,000,000,000
Committee 2026 advance appropriation recommendation.. 34,000,000,000
Comparison with:
Fiscal year 2025 enacted level................... +13,618,000,000
Fiscal year 2025 advance budget request.......... - - -

The Committee recommendation includes an advance
appropriation of $34,000,000,000 for fiscal year 2026 for
Medical Community Care, of which $2,000,000,000 is available
until September 30, 2027.
Dystonia.--The Committee continues to note the connection
between traumatic brain injury (TBI) and dystonia. The
Committee requests a report within 90 days of enactment of this
Act on efforts to pursue collaborative opportunities with the
dystonia stakeholder community and related federal agencies.
Third-Party Payments and Reimbursements.--The Committee
continues to direct VA to provide comprehensive reports on a
quarterly basis detailing the amount owed to outside providers
for every state, outstanding payments over six months, the
corrective actions being implemented to address these
outstanding balances, and the average time for repayment.
Community Pharmacies.--In the previous fiscal year, the
Committee requested a report on the feasibility and
advisability of expanding the use of community pharmacies,
including an assessment of cost, veteran access, and effect on
rural delivery. The Committee looks forward to receiving this
report and working with VA to expand healthcare access to
veterans.
Ground Ambulance Providers.--The Committee is concerned
that the Department is inadvertently disadvantaging veterans in
connection to reimbursement for ground ambulance services.
Specifically, under the Community Care Program, ground
ambulance providers are required to notify VA and seek approval
for payment within 72-hours. By contrast, veterans have a 30-
day window to notify VA of their receipt of emergency treatment
in a non-VA facility. This results in ground ambulance provider
claims being denied and the burden falls upon the veterans to
seek reimbursement. The Committee directs the Department to
provide a briefing within 90 days of enactment of this Act
regarding how the Department and its respective VISNs could
reduce the financial burden on veterans by reducing the number
of ground ambulance service claims that are denied for failure
to meet the 72-hour notification requirement but ultimately
comply with the VA's coverage rules.
Long-Term Care for Veterans with Severe Traumatic Brain
Injury (TBI).--The Committee continues to note the increasing
prevalence of deployment-related traumatic brain injuries. This
increase continues to demonstrate the longstanding need for
providing adequate long-term specialty care for Veterans
suffering from severe TBIs. The Committee is encouraged by the
Department's progress in using agreements with non-VA providers
to ensure all Veterans receive such long-term specialty care in
their communities and directs the Department to continue
entering into such agreements, to educate case managers on all
tools available to provide veterans with long-term specialty
care outside the VA system, and to provide quarterly updates to
Congress on the Department's progress on providing access to
long-term care to veterans with severe TBIs.

MEDICAL SUPPORT AND COMPLIANCE

Fiscal year 2024 enacted level........................ $10,750,000,000
Fiscal year 2025 enacted level........................ 11,800,000,000
Fiscal year 2025 budget year request.................. 0
Committee 2025 budget year recommendation............. 0

Fiscal year 2026 advance appropriation request........ 12,700,000,000
Committee 2026 advance appropriation recommendation... 12,700,000,000
Comparison with:
Fiscal year 2025 enacted level.................... +900,000
Fiscal year 2026 advance budget request........... - - -

The Committee recommendation includes an advance
appropriation of $12,700,000,000 for fiscal year 2026 for
Medical Support and Compliance, of which $350,000,000 shall
remain available through September 30, 2027.

MEDICAL FACILITIES

Fiscal year 2024 enacted level........................ $8,949,485,000
Fiscal year 2025 enacted leve......................... 9,400,000,000
Fiscal year 2025 budget year request.................. 0
Committee 2025 budget year recommendation,............ 0

Fiscal year 2026 advance appropriation request........ 9,700,000,000
Committee 2026 advance appropriation recommendation... 9,700,000,000
Comparison with:
Fiscal year 2025 enacted level.................... +300,000,000
Fiscal year 2026 advance budget request........... - - -

The Committee recommendation includes an advance
appropriation of $9,700,000,000, for fiscal year 2026 for
Medical Facilities, of which $500,000,000 shall remain
available until September 30, 2027.
Community-Based Outpatient Clinic in Bakersfield,
California.--The Committee remains disappointed that the new
Bakersfield CBOC remains unbuilt more than a decade after
Congress authorized this facility in fiscal year 2010 through
Public Law 111-82. The Committee directs the Secretary to
expeditiously execute Lease No. 36C10F20L0008 and, unless
prevented by an order issued by a federal or state court,
commence construction of the CBOC by no later than September
30, 2025, as provided in the lease. Furthermore, the Committee
directs the Secretary to provide monthly reports to the
Committees on Appropriations of both Houses of Congress on the
CBOC 's progress until completion and activation.
Medical Center Services.--The Committee reminds the
Department to ensure it consults with a wide variety of
stakeholders regarding any changes to services, hours, and
staffing prior to making changes and to ensure veterans are not
negatively affected.
Spend Plan.--The Committee expects VA to provide, no later
than 30 days after enactment of this Act, an expenditure plan
detailing the planned use of the funds provided. The Committee
understands that some of the projects planned for fiscal year
2025 may not be ready within that timeframe, requiring an
adjustment to the spending plan. The Committee requests a
quarterly update of the plan if the funding for any single
project changes by more than $3,000,000 during that time
period.
Use of Autonomous Robots.--In House Report 118-122 the
Committee encouraged VA to consider autonomous robots during
the planning for new construction or modernization of VA
hospitals and requested the VA report to the Committee not
later than 180 days after the enactment of the Act on the use
of robots at VA hospitals, including current use and potential
benefits from expanded use in the future. The Committee looks
forward to receiving this report.
Viruses and Bacteria.--The Committee encourages VA to
explore initiating a pilot program that would evaluate how
commercial, off-the-shelf, sensor-integrated autonomous UV
technologies can reduce the transmission of viruses and
bacteria in VA facilities. The Committee requests a report from
VA on its efforts within 90 days of an enactment of this Act.
VA--Water Conservation at Medical Centers and Clinics.--The
Committee is aware that hospital laboratories account for
approximately 15% of the total hospital water usage. There have
been advancements in laboratory equipment which operate with
zero water input or connection to the municipal water systems.
The Committee encourages the Assistant Under Secretary for
Health for Support (AUSH-S) to consider water efficiency and
zero water systems where feasible for VA Medical Centers and
Community Based Outpatient Clinics when modernizing VA
facilities and medical equipment. In addition, the Committee
requests the AUSH-S to provide a report to the Committee within
180 days of enactment on the plans to implement laboratory
systems that have no to little impact on the water suppl in the
communities they reside.
Veterans Integrated Service Network Distribution.--The
Committee is interested in learning how the Veterans Integrated
Services Network (VISN) (1) determines patient service
catchment areas (2) assesses where to build new VA medical
centers, and (3) plans the distribution of VA medical centers
and outpatient clinics compared to the number of veterans in
each area. The Committee requests the Department to provide a
report within 180 days of enactment, that details the criteria
used to determine how various types of medical facilities
including VAMCs and CBOCs are distributed, and the distribution
of VA medical facilities given the number of veterans in each
location. Further, the report should include information on how
many communities nationwide exist where veterans utilize a VAMC
not within their home state.
Women Veterans Healthcare Facilities.--The Committee
recognizes that some women veterans who routinely use VA
primary care and women's health services have experienced
childhood or military sexual trauma which makes them
uncomfortable with male healthcare providers. The Committee
also acknowledges the Department's efforts to revise care
standards to align with women veterans' preferences for care,
including women-only care environments. The Committee requests
a report within 120 days of enactment of this Act on the needs,
utilization patterns, and preferences of women veterans, and
any planned steps, including recommendations on facility
modifications, to meet those needs.
Food Pantry Program.--The Committee recognizes the success
of the VA food pantry program in easing veteran access to
quality food and reducing stigma around veteran food
insecurity. The Committee understands that VA collaborates with
nonprofit organizations to identify potential VA medical
centers with the need and capacity for enrolling this program
and encourages VA to ensure that at least one VA medical center
in a dense urban area offers food on-site. The Committee
directs VA to identify the additional funds necessary to scale
up the food pantry program.

MEDICAL AND PROSTHETIC RESEARCH

Appropriation, fiscal year 2024....................... $943,000,000
Budget request, fiscal year 2025...................... 868,000,000
Committee recommendation, fiscal year 2025............ 923,514,000
Change from enacted level......................... -19,486,000
Change from budget request........................ +55,514,000

The Committee recommendation includes $923,514,000 for
Medical and Prosthetic Research, available through September
30, 2026, which is $19,486,000 below the fiscal year 2024
level. The Committee appreciates the Department's plans to
focus on critical research areas that include environmental
exposures, traumatic brain injury, cancer and precision
oncology, and mental health.
In addition to this appropriation, resources from other
sources, including appropriations from the medical care
accounts, reimbursements from DOD, grants from the National
Institutes of Health, private sources, and voluntary
organizations, support the Department's researchers. The total
amount estimated available for fiscal year 2025 is
$1,437,400,000.
Limb Loss.--The Committee commends the Department's work
with veterans living with limb loss, particularly its support
of programs that engage amputees to become certified peer
visitors for other veterans. Over the past year, this program
has trained veterans to become certified peer visitors and re-
certified many to continue to provide peer support. In
addition, veterans with amputations have been able to benefit
from over 250 registered support groups nationwide. While these
programs have touched the lives of veterans across the country
in the last year, there are still many veterans who have not
benefited from these and other support programs because they
have not grown to keep pace with the number of veteran amputees
across the country. The Committee encourages the Department to
consider expanding its certified peer visitor program in fiscal
year 2025 to meet the needs of all veterans. In addition, the
Committee requests a report no later than 90 days after
enactment of this act on the feasibility, advisability, and
cost estimate of expanding amputee services and educational
opportunities for individuals who have received
osseointegration surgery and are using osseointegration
prosthetic technology.
Advanced Platform Technology (APT) Center.--The Committee
applauds the Department for progress being made to provide
veterans with new assistive and restorative technologies that
address sensory, motor, or cognitive deficits, as well as limb
loss. The APT Center has effectively utilized a partnership
model to leverage local and national research expertise to
drive progress in diverse areas including artificial lung
development, wound healing, and neural connected sensory
prosthesis. The Committee continues to support the APT Center's
efforts.
Endometriosis.--The Committee directs the Department to
ensure its research program adequately addresses the unique
needs and concerns of veterans with endometriosis. The
Committee further directs VA to prioritize endometriosis
research to expand basic, clinical, and translational research
into the mechanics of endometriosis, identify early diagnostic
markets, and develop new treatment methods.
Metastatic Cancer Research.--The Committee supports the
Department's work to achieve therapeutic advances and extend
the life of metastatic cancer survivors, including through
clinical trials that treat patients with diverse types of
cancer, demographics, and genetics, and recognizes more studies
are required to develop a comprehensive understanding of this
complex process. The 2018 Department of Defense report to
Congress on the Metastatic Cancer Task Force noted there are
few active duty servicemembers with metastatic cancer because
they are medically retired prior to metastasis. However, the
Department's FY25 budget justification notes that there were
more than 51,000 new cases among veterans in 2017. The
Committee directs the Department to assess the likelihood that
service in the military, including types of service, affect
veterans' likelihood of a metastatic cancer diagnosis and
continue to increase veterans participation in clinical trials.
The Committee requests that the FY26 budget justification
include an update on its progress on this issue.
Gulf War Illness Studies.--The Committee recommends the
Department continue to conduct epidemiological studies
regarding the prevalence of Gulf War Illness, morbidity, and
mortality in Persian Gulf War veterans and the development of
effective treatments, preventions, and cures. The Department is
encouraged to make the findings of all research conducted by or
for the Executive Branch publicly available as soon as possible
and continue to publish disease-specific mortality data related
specifically to Persian Gulf War veterans. The Committee
continues to encourage the Department to utilize the term
``Gulf War Illness,'' as recommended by the Institute of
Medicine. The Committee appreciates the Department's work to
strengthen the training of primary, specialty, and mental
healthcare providers on effective assessment, diagnosis, and
clinical management of Gulf War Illness.
Herbicide-Related Toxic Exposure Research.--To understand
the residual effects of Agent Orange, dioxins, and other
herbicide-related toxic exposures, the Committee urges the
Department to utilize reference data from existing medical
records of veterans who served in Vietnam, Thailand, Guam, the
Northern Mariana Islands, America Samoa, and other geographic
areas where these toxic substances were dispersed to determine
the percentage who have frequent or unexplained diseases
compared to the civilian population.
National Intrepid Center of Excellence (NICoE).--The
Committee recognizes the high-quality mental health care and
neurological research being conducted at the NICoE and directs
the Department to expand its work with NICoE to strengthen VA's
research capacity. The Committee continues to encourage the
Department to pursue new collaborative initiatives with NICoE,
consider public academic medical centers as partners in such
efforts, and assist DOD-wide efforts to optimize research to
implement solutions and deliver better health outcomes for
veterans.
Research Using Animals.--The Department is directed to
include in any report to Congress describing animal research
approved under section 247 in division A of the Consolidated
Appropriations Act, 2024 (P.L. 118-42), submitted after the
date of filing of this report, details on the specific
alternatives to animals that were considered, why those
alternatives were not chosen, and an explanation for why these
animal subjects were the only viable option for this research.
The Committee looks forward to the Department fully
implementing its plan to eliminate the research conducted using
canines, felines, or non-human primates by 2026, as directed in
Public Law 118-42 and directs the Department to not approve any
new animal research that would not be complete before 2026.
Kidney Disease.--The Committee applauds VA's focus on
ensuring that veterans with kidney disease are provided access
to the best medical care available. The value of testing for
APOL1 in kidney disease patients is well documented and the
Committee encourages VA to continue screening for kidney
diseases for veterans, including rare and genetic, and
encourages VA to prioritize funding for staffing for genetic
kidney disease clinical trials at qualified VA sites. Further,
the Committee urges the Department to focus resources on
clinical trials for kidney disease in high-risk populations.
The Department is directed to provide a report to the Committee
no later than 90 days after enactment of this act on its
efforts in this area. The report should include: (1) current
funding levels for clinical trials related to APOL1; (2)
details on ongoing trials, including the number of veterans in
each trial and the trial location; and (3) funding for APOL1
research over the past 3 years.
PFAS Registry.--The Committee directs the Secretary of
Veterans Affairs to (1) establish and maintain a registry for
eligible individuals who may have been exposed to per- and
polyfluoroalkyl substances due to the environmental release of
aqueous film-forming foam on military installations to meet the
requirements of military specification MIL-F-24385F; (2)
develop a public information campaign to inform eligible
individuals about the registry, including how to register and
the benefits of registering; and (3) periodically notify
eligible individuals of significant developments in the study
and treatment of conditions associated with exposure to PFAS.
Wearable Monitoring Devices.--The Committee urges the
Department to initiate a research program focused on the
application of platform agnostic wearable medical devices
wearables in transitioning veterans from inpatient to
outpatient care. This program will study the efficacy of
wearable hardware in continuous health monitoring, aiming to
enhance patient outcomes and optimize care as veterans
reintegrate into daily life outside the hospital. The research
will explore the adaptability of these devices in varied living
environments, ensuring veterans receive the same level of care
they would within the hospital setting. The Committee urges the
Department to deliver a comprehensive research report detailing
the feasibility of utilizing such devices, findings, potential
improvements in healthcare delivery, and recommendations for
wide scale implementation, within 180 days of enactment of this
Act.
Wound Dressings.--The Committee is interested in effective
advanced treatments for wound care, including fentonite. The
Committee understands advanced methods can be used for various
wounds such as diabetic ulcers, venous ulcers, burns, and
pressure wounds and can lead to improved outcomes while
reducing long-term costs. The Committee requests that VA to
provide a report within 90 days of enactment of this Act on its
findings.

Medical Care Collections Fund

The Department of Veterans Affairs Medical Care Collections
Fund (MCCF) was established by the Balanced Budget Act of 1997
(P.L. 105-33). The Department deposits first-party and pharmacy
co-payments, third-party insurance payments and enhanced-use
collections, long-term care co-payments, Compensated Work
Therapy Program collections, Compensation and Pension Living
Expenses Program collections, and Parking Program fees into the
MCCF. The Department uses these funds for medical care and
services to veterans. The estimate of fees that will be
collected in fiscal year 2025 is $4,400,000,000.

National Cemetery Administration

Appropriation, fiscal year 2024....................... $480,000,000
Budget request, fiscal year 2025...................... 495,000,000
Committee recommendation, fiscal year 2025............ 495,000,000
Change from enacted level......................... +15,000,000
Change from budget request........................ - - -

The Committee recommends $495,000,000 for fiscal year 2025,
which is $15,000,000 above the fiscal year 2024 enacted level.
NCA should prioritize maintaining the current level of services
at existing cemeteries and activating new cemeteries to
increase burial access. In addition, the bill includes language
making ten percent of the total available until September 30,
2026.
Medallions on Headstones.--The Committee is concerned with
the decision to remove medallions from headstones honoring the
First Special Service Forces (FSSF). The Committee requests a
report on its decision to remove medallions from headstones in
cemeteries honoring members of the FSSF. This report should
include a justification of the National Cemetery
Administration's directive leading to the removal as well as a
plan for apologies to the families of FSSF soldiers affected.

Departmental Administration

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2024....................... $475,000,000
Budget request, fiscal year 2025...................... 457,000,000
Committee recommendation, fiscal year 2024............ 457,000,000
Change from enacted level......................... -18,000,000
Change from budget request........................ - - -

The General Administration account provides funds for the
Office of the Secretary, the General Counsel, six Assistant
Secretaries, and two Department-level staff offices.
The Committee recommendation includes $457,000,000 for
General Administration, a decrease of $18,000,000 below the
fiscal year 2024 enacted level.
The Committee has included bill language to make available
through September 30, 2026, up to ten percent of these funds
and to permit the transfer of funds in this account to the
General Operating Expenses, Veterans Benefits Administration
account.
Additional Budgetary Information.--The Committee continues
its request that items described in previous House reports
continue to be included in the budget justifications submitted
each year. Further, the Committee directs VA to include in its
budget justification materials a table for each account that
shows a five-year funding history for requested and enacted
levels.
Data Governance Analytics.--The Committee continues to
support the work carried out by VA's Office of Enterprise
Integration for the continuous improvement of veterans' access
and outcomes throughout their lifetimes, as outlined in VA Data
Strategy. VA, as a learning enterprise, should manage,
integrate, and consolidate its various data sources to ensure
its data of highest quality and is used to support operational
decision making. As such, the Committee encourages OEI to
further coordinate enterprise-wide efforts to manage VA data as
a strategic asset, in order to enhance veterans' insights and
to strengthen VA's delivery of services and benefits to
veterans, their families, survivors, and caregivers. Of the
funds provided, $3,250,000 shall be for the Office of
Enterprise Integration to further coordinate enterprise-wide
efforts of managing VA data as a strategic asset, in order to
enhance veterans' insights and to strengthen VA's delivery of
services and benefits to veterans, their families, survivors,
and caregivers.
Data on Women and Minority Veterans.--The Committee
continues to recommend that, when applicable, the Secretary of
Veterans Affairs display information in the annual report(s)
submitted to Congress separately or women veterans and minority
veterans.
Federal Bureau of Investigation's National Instant Criminal
Background Check System.--The Committee directs the Department
to provide a report on the impact and implementation status of
section 413 of division A of the Consolidated Appropriations
Act, 2024 (Public Law 118-42), which prohibits the Department
from submitting a veteran or beneficiary's name to the FBI's
National Instant Criminal Background Check System (NICS) list
without a judge's consent.
Office of Resolution Management, Diversity, and Inclusion
(ORMDI).--The Committee recommendation does not include any
funds for diversity, equity, and inclusion programs, projects,
or activities for ORMDI.
Quarterly Financial Information Reports.--The bill includes
an administrative provision that extends the requirement for
submission of the quarterly financial information required in
the fiscal year 2017 bill and conference report.
COVID-19 Vaccine Requirements.--The Committee is concerned
about remaining COVID-19 vaccine requirements for VA employees.
The Department shall produce a report on any remaining
requirements for VA employees to receive the COVID-19
vaccination to continue employment. The report should
prioritize scientific justification from peer reviewed research
published in the last calendar year from the date of enactment.
Staff Relocations Within VA.--The bill continues the
administrative provision requiring written notification 15 days
prior to organizational changes that result in the transfer of
25 or more full-time equivalent staff from one organizational
unit of the Department to another.
Supporting Minority and Disadvantaged Contractors.--The
Committee reiterates the reporting requirement included in
House Report 117-81 on this topic and looks forward to
receiving the requested report.
Transparency and Accountability in Disciplinary Actions.--
The Committee is aware that the House Veterans Affairs
Committee has been alerted to allegations of sexual harassment
and other misconduct by credible whistleblowers who have not
trusted the VA's internal investigations process. From 2014 to
2016, the House Veterans Affairs Committee reviewed more than
200 settlements. In 96% of these settlements, the disciplinary
action proposed or taken against the employee did not appear on
their permanent record form. The Committee is concerned that
this practice has weakened accountability within the VA. The
Committee encourages the VA to complete its investigations
against employees credibly accused of misconduct. Further, it
encourages the VA to notate any investigation and its findings
in resigning or retiring employees.
Delays With Board of Veterans Appeals.--The Committee is
concerned about ongoing delays veterans and their families
experience before the Board of Veterans Appeals, often causing
years-long wait times for final adjudication and resolution of
claims. Within the funds provided, the Committee urges VA to
prioritize hiring the staff necessary to allow the efficient
processing of the Board's current inventory of cases.

BOARD OF VETERANS APPEALS

Appropriation, fiscal year 2024....................... $287,000,000
Budget request, fiscal year 2025...................... 267,000,000
Committee recommendation, fiscal year 2025............ 267,000,000
Change from enacted level......................... -20,000,000
Change from budget level.......................... - - -

The Committee recommendation includes $267,000,000 for the
Board of Veterans Appeals, which is $20,000,000 below fiscal
year 2024 enacted level. Ten percent of this funding is
available through September 30, 2026.
VA Board of Appeals Backlog.--Congress has provided
significant funding increases to enable VA to hire the staff,
acquire the technology, and change work processes necessary to
significantly reduce the appeals backlog. The Committee is
concerned that despite these investments, the Board of
Veterans' Appeals has not adequately addressed the backlog of
veterans waiting for a decision and that the inventory of
pending appeals cannot be depleted with the Board of Veterans'
Appeals' current policies and procedures. The Committee directs
the Secretary to prioritize the processing of appeals and to
submit a plan no later than 90 days after the enactment of this
legislation detailing a strategy to clear the backlog of cases
within 36 months.

INFORMATION TECHNOLOGY SYSTEMS

(INCLUDING TRANSFER OF FUNDS)

Appropriation, fiscal year 2024....................... $6,401,000,000
Budget request, fiscal year 2025...................... 6,231,680,000
Committee recommendation, fiscal year 2025............ 6,231,680,000
Change from enacted level......................... -169,320,000
Change from budget request........................ - - -

The Committee recommendation includes $6,231,680,000 for
Information Technology Systems, which is $169,320,000 below the
fiscal year 2024 enacted amount. Within the account total, the
Committee allocates $1,686,245,270 for pay and associated
costs; $4,544,475,000 for operations and maintenance; and
$118,900,000 for activations.
The bill makes available three percent of pay and
associated costs and five percent of operations and maintenance
funds until September 30, 2026. All development funds are
available until September 30, 2026.
The Committee continues bill language permitting the
transfer of funding among the three subaccounts upon approval
of the Committees on Appropriations of both Houses of Congress.
The bill also continues language allowing for the
reprogramming of funds among development projects upon approval
by the Committees on Appropriations of both Houses of Congress.
The Committee continues to include bill language limiting
the funds available for information technology systems
development to the projects and in the amounts specified in the
report. The bill limits the amount of funds that can be
transferred into the IT account to ten percent of the total of
either the source or destination account. The bill contains
language that permits the reprogramming of funds among
development projects upon prior notification to, and approval
by, the Committees on Appropriations of both Houses of
Congress.
The Committee expects the Office of Information and
Technology (OIT) to continue to provide an IT expenditure
report to the Committees on Appropriations of both Houses of
Congress on a monthly basis. This report should include a
comparison to the project costs included in the development
funding chart above and provide an explanation for any
differences in excess of $3,000,000.
Small Business IT Security Partners.--The Committee urges
the Office of Information Technology to increase utilization of
small businesses in implementing IT security programs,
including in the areas of secure storage and encryption.

VETERANS ELECTRONIC HEALTH RECORD

Appropriation, fiscal year 2024....................... $1,334,142,000
Budget request, fiscal year 2025...................... 894,000,000
Committee recommendation, fiscal year 2025............ 894,000,000
Change from enacted level......................... -440,142,000
Change from budget request........................ - - -

The bill includes $894,000,000, as requested, for Veterans
Electronic Health Record, which is $440,142,000 below the
enacted level. This reduction reflects deferred deployments and
focus on current site optimization, sustaining infrastructure,
and supporting 6 live sites. It also assumes costs for
activities related to the development and rollout of VA's
Electronic Health Record Modernization (EHRM) initiative, the
associated contractual costs, and the salaries and expenses of
employees hired under titles 5 and 38, United States Code.
Within the total, the bill includes $375,000,000 for the
electronic health record contract; $191,009,000 for
infrastructure readiness; and $327,890,000 for program
management. Funding is made available for three fiscal years.
This account is intended to be the single source of funding
within VA for the electronic health record effort. No authority
is provided for funds from other VA accounts to be transferred
into this account nor for funds from this account to be
transferred out to other accounts.
The Committee continues to direct the Department to manage
this initiative in the Office of the Deputy Secretary and
provide monthly briefings on program implementation, including
updates on progress resolving outstanding issues, and to
provide quarterly updates to review timelines, performance
milestones, implementation, and change management progress. The
Government Accountability Office is directed to continue
quarterly performance reviews of EHRM deployment and to report
to the Committees on each quarter.
Future Deployments.--The Committee has been encouraged by
EHRM's rollout at Captain James A. Lovell Federal Health
Community Center. However, the Committee is concerned that the
Department did not include funding for future deployments in
this year's request. The Committee requests a report that
outlines the Department's plan to schedule deployments,
potential shortcomings that could hinder deployments, and
actions VA will take to execute a schedule within 90 days of
enactment of this Act.
Contractor Accountability.--The Committee expects the
Department to hold its contractors accountable. The Department
is expected to work closely with Oracle Cerner to resolve
usability problems and dramatically improve training to ensure
that when deployments restart the new system can be adopted
easily by clinicians and healthcare staff.
Life-Cycle Cost Estimate.--The Committee continues to
require that at least annually the Department provide a report
to the Committee on Appropriation that compares current
estimated costs to the revised Life Cycle Cost Estimate to the
estimate provided by the Institute for Defense Analyses.

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2025....................... $296,000,000
Budget request, fiscal year 2026...................... 296,000,000
Committee recommendation, fiscal year 2026............ 296,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -

The Committee recommendation includes $296,000,000 for
fiscal year 2025 for the Office of the Inspector General, which
is equal to the budget request. The bill makes up to ten
percent of this funding available until September 30, 2026.
The Committee continues to request robust oversight of the
Electronic Health Record Modernization initiative and medical
community care claims.
VA Claims Backlog.--OIG is encouraged to continue to review
VA's work to address the claims backlog and report to the
Committee about such efforts. This report should analyze how
VA's partnership with the National Archives and Records
Administration to digitally scan all paper-based military
personnel files has helped address and resolve the backlog as
well as any changes in wait times and size of the claims
backlog.

CONSTRUCTION, MAJOR PROJECTS

Appropriation, fiscal year 2024....................... $961,218,560
Budget request, fiscal year 2025...................... 2,069,000,000
Committee recommendation, fiscal year 2025............ 2,069,000,000
Change from enacted level......................... +1,107,781,000
Change from budget request........................ - - -

The Committee recommendation includes $2,069,000,000 for
Construction, Major Projects for fiscal year 2025, of which
$1,265,300,000 shall remain available until September 30, 2029,
and of which $803,700,000 shall remain available until
expended. In addition, the Committee supports the Department's
plan to allocate $1,403,110,000 to support major construction
projects in West Los Angeles, CA, Dallas, TX, and Denver, CO.
As required by language that is in permanent law, all major
construction projects costing more than $100,000,000 must be
managed by a non-VA government entity, such as the Army Corps
of Engineers. While the Committee no longer duplicates this
language, the Committee intends to continue its oversight of
the quality of the outside entity management and expects to
receive quarterly briefings on each of the large construction
projects.
Construction Reports.--The Committee continues to request
that VA provide quarterly briefings on the progress and cost of
each facility managed by an outside entity. Several additional
bill language provisions are included to enhance the
Committee's capacity to conduct oversight of VA's facility
construction efforts including: (1) no funding greater than
$7,000,000 may be reprogrammed between construction projects
unless approved by the Committees on Appropriations of both
Houses of Congress; (2) any change to the scope of a
construction project is prohibited without the approval of the
Committees; and (3) VA must report any bid savings of
$5,000,000 or more on projects as soon as they are identified.
The Committee does not provide transfer authority between
twelve VA appropriations and for funds to be transferred to
major or minor construction to be made available for five
years.
The chart below reflects the Committee's recommendation for
Major Construction projects.

CONSTRUCTION, MAJOR PROJECTS
[In thousands of dollars]
------------------------------------------------------------------------
Project Amount
------------------------------------------------------------------------
Veterans Health Administration (VHA)
West Los Angeles, CA--Build New Critical Care Center 1,344,810
Central Utility Plant, Demolition and Renovations to
Building 500
Dallas, TX--Clinical Expansion for Mental Health, 13,300
Expansion of Parking Facilities and Land Acquisition
Advanced Planning and Design--Various Stations....... 278,409
Asbestos............................................. 1,000
Claims Analysis--Various Stations.................... 500
Construction & Facilities Management Staff--Various 213,000
Stations............................................
Hazardous Waste--.................................... 1,000
Non-Departmental Federal Entity Project Management 134,481
Support--Various Stations...........................
Total, VHA....................................... 1,986,500
National Cemetery Administration (NCA)
Denver, CO--Fort Logan National Cemetery--Gravesite 45,000
Expansion........................................... 30,000
Total, NCA....................................... 75,000
General Administration/Staff Offices
Department Advance Planning and Design Fund for Major 7,500
Construction........................................
Total, Major Construction........................ 2,069,000
------------------------------------------------------------------------

To enhance the Committee's capacity to conduct oversight on
VA's facility construction efforts, several administrative
provisions are continued in the bill: (1) No funding amount
greater than $7,000,000 may be reprogrammed between
construction projects unless approved by the Committees on
Appropriations of both Houses of Congress; (2) any change to
the scope of a construction project is not permitted without
the approval of the Committees; and (3) VA must report any bid
savings of $5,000,000 or more on projects as soon as they are
identified.

CONSTRUCTION, MINOR PROJECTS

Appropriation, fiscal year 2024....................... $692,000,000
Budget request, fiscal year 2025...................... 380,453,000
Committee recommendation, fiscal year 2025............ 380,453,000
Change from enacted level......................... -311,547,000
Change from budget request........................ - - -

The Committee recommendation includes $380,453,000 for
Construction, Minor Project for fiscal year 2025, of which
$342,408,000 shall remain available until September 30, 2029,
and $38,045,000 shall remain available until expended.
In addition, the Committee supports the Department's plan
to allocate $307,000,000 from the Recurring Expenses
Transformational Fund.
Greater Los Angeles Healthcare System's Master Plan.--The
Committee continues to encourage the VA to engage with the
Principal Developer Team responsible for the Greater Los Angles
Health Care System's Master Plan and support the
operationalization of the Master Plan, as appropriate.

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Appropriation, fiscal year 2024....................... $171,000,000
Budget request, fiscal year 2025...................... 141,000,000
Committee recommendation, fiscal year 2025............ 156,000,000
Change from enacted level......................... -15,000,000
Change from budget request........................ - - -

The Committee recommendation includes $156,000,000 for
fiscal year 2025 for Grants for Construction of State Extended
Care Facilities, which is $15,000,000 below the fiscal year
2024 level. A grant may not exceed 65 percent of the total cost
of the project. The bill makes this funding available until
expended.
State Veterans Home Construction Grant Program.--The
Committee remains concerned about compliance with State
Veterans Home Construction Grant Program (SHCGP) projects that
are subject to Build America, Buy America Act (BABAA)
requirements. The Committee is aware that three USDVA State
Veterans Home Construction Grant Program projects in Idaho. The
Committee urges the Secretary to ensure it consults with the
affected stakeholders to ensure veterans are not negatively
affected.

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Appropriation, fiscal year 2024....................... $60,000,000
Budget request, fiscal year 2025...................... 60,000,000
Committee recommendation, fiscal year 2025............ 60,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -

The Committee recommendation includes $60,000,000 for
Grants for Construction of Veterans Cemeteries, which is equal
to the budget request. The bill makes this funding available
until expended.
Grants For Construction of Veterans Cemeteries.--The
Committee applauds the Department's efforts to improve Veterans
Cemeteries through the Grants for Construction of Veterans
Cemeteries. Within 60 days of the enactment of this Act, the
Committee requires a report on the impact of the grants from
January 1, 2021, to include information on all outstanding
projects and statistics on state usage of the grants program.

COST OF WAR TOXIC EXPOSURES FUND

Fiscal year 2024 enacted level........................ - - -
Fiscal year 2025 enacted level........................ - - -
Fiscal year 2025 budget year request.................. - - -
Committee 2025 budget year recommendation............. - - -
Fiscal year 2025 advance appropriation request........ 22,800,000,000
Committee 2026 advance appropriation recommendation... 22,800,000,000
Comparison with:
Fiscal year 2024 enacted level.................... - - -
Fiscal year 2025 advance budget request........... +22,800,000,000

The bill provides $22,800,000,000 for the Cost of War Toxic
Exposures Fund (TEF) for advance funding for fiscal year 2026
for veterans medical care related to toxic exposures.
Section 103 Expansion.--The Committee requests a briefing
on how many new enrollments the Department has taken in since
section 103 expanded, metrics on staffing and work flow
efficiency, and any new findings that may impact future budget
requests.

Administrative Provisions

The bill includes 61 administrative provisions, of which 57
were in effect in fiscal year 2024 and 4 are new. The
administrative provisions included in the bill are as follows:

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 201 allowing for the transfer of
funds among three mandatory appropriations. The Administration
proposal to modify this provision is not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 202 allowing the Department to
transfer funding among the four medical appropriations accounts
in fiscal year 2025. The Administration proposal to modify this
provision is not adopted.
The bill includes section 203 allowing for salaries and
expenses funds to be used for hire of passenger vehicles, lease
of facilities or land, and purchase of uniforms.
The bill includes section 204 providing that only funding
in ``Construction, Major Projects'' and ``Construction, Minor
Projects'' can be used for the purchase of any site for any new
hospital or home or to construct any new hospital or home.
The bill includes section 205 requiring the Department to
be reimbursed for medical services it provides to any person
not defined as a beneficiary to ensure the Department is
receiving payment for all medical services provided.
The bill includes section 206 allowing for the use of funds
appropriated in fiscal year 2025 for ``Compensation and
Pensions'', ``Readjustment Benefits'', and ``Veterans Insurance
and Indemnities'' for payment of accrued obligations recorded
in the last quarter of fiscal year 2024.
The bill includes section 207 allowing for the use of
fiscal year 2025 funds to pay prior year obligations resulting
from implementation of sections 3328(a), 3334, and 3712(a) of
title 31, United States Code.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 208 allowing the Department to
use surplus earnings from the national service life insurance,
U.S. Government life insurance, and veterans' special life
insurance program to administer these programs.
The bill includes section 209 allowing enhanced-use lease
proceeds deducted for administrative expenses that were
incurred in a prior fiscal year to be available until expended.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 210 limiting the amount of
reimbursement the Office of Resolution Management, Diversity
and Inclusion, the Office of Employment Discrimination
Complaint Adjudication, and the Alternative Dispute Resolution
function within the Office of Human Resources and
Administration can charge other offices and accounts of the
Department for services provided.
The bill includes section 211 requiring the Department to
collect current and accurate third-party reimbursement
information for the purposes of third-party insurance
collections. If persons receiving care or medical services do
not disclose this information, the Department is allowed to
bill them reasonable charges for services provided.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 212 allowing the Department to
use enhanced-use lease funds for construction and alteration of
medical facilities.
The bill includes section 213 allowing the Department to
use the Medical Services appropriation for expenses related to
the broader mission of medical care to veterans.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 214 allowing the Department to
transfer Medical Care Collections to the ``Medical Services''
and ``Medical Community Care'' accounts to be used for veterans
medical care and makes those funds available until expended.
The bill includes section 215 allowing veterans who reside
in Alaska to obtain medical services from medical facilities
supported by the Indian Health Service or tribal organizations,
and provides for reimbursement for those services from VA.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 216 allowing the Department to
transfer the proceeds received from the transfer of real
property deposited into the VA Capital Asset Fund to the Major
and Minor Construction appropriations accounts and makes those
funds available until expended.
The bill includes section 217 requiring the Secretary to
submit quarterly reports to the Committees on Appropriations of
both Houses of Congress on the financial status of the
Department of Veterans Affairs.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 218 prohibiting the Department
from increasing total resources of the Information Technology
appropriation by more than ten percent by transferring funding
from the other VA accounts and requires the Department to
receive approval from the Committees on Appropriations of both
Houses of Congress before such transfer. The Administration
proposal to modify this provision is not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 219 providing up to $594,828,000
of fiscal year 2025 funds for transfer to the Joint DOD-VA
Medical Facility Demonstration Fund. Additional funding may be
transferred from these accounts upon written notification to
the Committees on Appropriations of both Houses of Congress.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 220 permitting the transfer of
$664,625,000 of fiscal year 2025 funding appropriated for
medical accounts to the Joint DOD-VA Medical Facility
Demonstration Fund for the operation of facilities designated
as combined Federal medical facilities.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 221 permitting the transfer of
funds deposited in the Medical Care Collections Fund to the
Joint DOD-VA Medical Facility Demonstration Fund for facilities
designated as combined Federal medical facilities.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 222 directing that a minimum of
$15,000,000 shall be transferred from the four medical care
appropriations to the Department of Defense/Department of
Veterans Affairs Health Care Sharing Incentive Fund, to be
available until expended.
The bill includes section 223 requiring the Secretary to
notify the Committees on Appropriations of both Houses of
Congress of all bid savings when identified in Major
Construction projects that total at least $5,000,000 or five
percent of the programmed amount of the project. The
Administration proposal to delete this provision is not
adopted.
The bill includes section 224 prohibiting the original
scope of work for a Major Construction project from being
increased above the scope specified for that project in the
original justification data provided to Congress unless
approved by the Committees on Appropriations of both Houses of
Congress. The Administration proposal to delete this provision
is not adopted.
The bill includes section 225 requiring a quarterly report
from each VBA regional office on pending disability claims,
both initial and supplemental; error rates; the number of
claims processing personnel; corrective actions taken; training
programs; and review team audit results. In addition, the bill
requires quarterly reporting on pending appeals at VBA, as well
as BVA. The Administration proposal to delete this provision is
not adopted.
The bill includes section 226 requiring advance written
notification to the Committees on Appropriations of both Houses
of Congress 15 days prior to organizational changes which
result in the transfer of 25 or more full-time equivalent staff
from one organizational unit to another. The Administration
proposal to delete this provision is not adopted.
The bill includes section 227 requiring the Secretary to
provide, on a quarterly basis to the Committees on
Appropriations of both Houses of Congress, notification of any
single national outreach and awareness marketing campaign in
which obligations exceed $1,000,000. The Administration
proposal to delete this provision is not adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 228 permitting the transfer to
``Medical Services'' from any discretionary program except
``General Operating Expenses, Veterans Benefits
Administration'' upon approval of the Committees on
Appropriations of both Houses of Congress. This provision is
intended to give VA flexibility as it administers the changes
to its traditional healthcare program and the MISSION Act. The
Administration proposal to modify this provision is not
adopted.

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 229 permitting the transfer of
funds between the ``Board of Veterans Appeals'' and ``General
Operating Expenses, Veterans Benefits Administration'' upon
approval of the Appropriations Committees on Appropriations of
both Houses of Congress. The Administration proposal to modify
this provision is not adopted.
The bill includes section 230 prohibiting the reprogramming
of funds exceeding $7,000,000 among the Major Construction
projects unless the Committees on Appropriations of both Houses
of Congress approve the request. The Administration proposal to
modify this provision is not adopted.
The bill includes section 231 requiring the Secretary to
ensure that the toll-free suicide hotline provides immediate
assistance from a trained professional and adheres to all
requirements of the American Association of Suicidology. The
Administration request to delete this provision is not adopted.
The bill includes section 232 requiring VA to use the
mammography screening guidelines announced by the Secretary on
May 10, 2017, through January 1, 2024. The Administration
request to delete this provision is not adopted.
The bill includes section 233 allowing the use of Medical
Services funding for assisted reproductive technology treatment
and adoption reimbursement for veterans and their spouses.
The bill includes section 234 prohibiting any funds from
being used in a manner that is inconsistent with statutory
limitations on outsourcing.
The bill includes section 235 pertaining to exceptions for
Indian- or Native Hawaiian-owned businesses contracting with
VA.
The bill includes section 236 directing the elimination
over a series of years of the use of Social Security numbers in
VA programs.
The bill includes section 237 referencing the provision in
the Continuing Appropriations and Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act,
2017, and Zika Response and Preparedness Act (P.L. 114-223)
pertaining to certification of marriage and family therapists.
The Administration request to delete this provision is not
adopted.
The bill includes section 238 which prohibits funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account. The
Administration request to delete this provision is not adopted.
The bill includes section 239 permitting funding to be used
in fiscal years 2025 and 2026 to carry out and expand the
childcare pilot program authorized by section 205 of the
Caregivers and Veterans Omnibus Health Services Act of 2010
(P.L. 111-163).
The bill includes section 240 prohibiting VA from using
funds to enter into an agreement to resolve a dispute or claim
with an individual that would restrict the individual from
speaking to Members of Congress or their staff on any topic,
except those required to be kept secret in the interest of
national defense or the conduct of foreign affairs. The
Administration request to delete this provision is not adopted.
The bill includes section 241 referencing language in the
Continuing Appropriations and Military Construction, Veterans
Affairs, and Related Agencies Appropriations Act, 2017, and
Zika Response and Preparedness Act (P.L. 114-223) requiring
certain data to be included in budget justifications for major
construction projects. The Administration request to delete
this provision is not adopted.
The bill includes section 242 prohibiting the use of funds
to deny the Inspector General timely access to information
unless a provision of law expressly refers to the Inspector
General and expressly limits such access.
The bill includes section 243 prohibiting funding from
being used in a manner that would increase wait times for
veterans at medical facilities. The Administration request to
delete this provision is not adopted.
The bill includes section 244 prohibiting the use of funds
in fiscal year 2025 to convert any program that received
specific purpose funds in fiscal year 2024 to a general
purpose-funded program without the approval of the Committees
on Appropriations of both Houses of Congress at least 30 days
prior to any such action. The Administration request to delete
this provision is not adopted.
The bill includes section 245 regarding verification of
service for coastwise merchant seamen.
The bill includes section 246 regarding the use of canines,
felines, and non-human primates in VA research.
The bill includes section 247 regarding staffing ratios.
The bill includes section 248 to allow fiscal year 2025 and
2026 ``Medical Community Care'' funds to be used to cover
obligations that would have otherwise been paid by the Veterans
Choice Fund.
The bill includes section 249 allowing obligations and
expenditures applicable to the ``Medical Services'' account in
fiscal years 2017 through 2019 for aid to state homes to remain
in the ``Medical Community Care'' account for such fiscal
years.
This bill includes section 250 specifying an amount from
the four medical care accounts for gender-specific care for
women. The administration request to delete this provision is
not adopted.
The bill includes section 251 regarding a community-based
outpatient clinic in Bakersfield, California.
The bill includes section 252 requiring quarterly reports
on the status of the ``Veterans Medical Care and Health Fund,''
established to execute section 8002 of the American Rescue Plan
(P.L. 117-2).
The bill includes section 253 establishing a timeline for
construction in accordance with a lease.
The bill includes section 254 regarding the use of
unobligated balances to support construction projects in the
CHIP-IN program.
The bill includes section 255 prohibiting federal funding
for abortions except in cases of incest, rape, or life of the
mother and prohibiting federal funding to implement the
Department of Veterans Affairs' Interim Final Rule on abortion.
The bill includes section 256 prohibiting federal funding
for hormone therapies or surgeries for gender-affirming care.
The bill includes section 257 permitting certain flags to
be flown over VA facilities.
The bill includes section 258 prohibiting federal funding
for administering, implementing, or enforcing the final rule
issued by the Secretary of Veterans Affairs related to special
modes of transportation (88 Fed. Reg. 10032).
This bill includes section 259 prohibiting federal funds
for carrying out the Coronavirus Disease 2019 Vaccination for
Veterans Health Administration Health Care Personnel (VHA
Directive 11903).
This bill includes section 260 prohibiting federal funds
for providing services to individuals who are unlawfully
present in the United States and are not eligible for health
care under laws administered by the Secretary of Veterans
Affairs.
This bill includes section 261 prohibiting the Secretary of
Veterans Affairs to use federal funding to report a person who
is deemed mentally incapacitated, mentally incompetent, or to
be experiencing an extended loss of consciousness who has been
adjudicated as a mental defective, without the order or finding
a judge, magistrate, or other judicial authority that a person
is in danger to himself or herself or others.

TITLE III

RELATED AGENCIES

American Battle Monuments Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $158,630,000
Budget request, fiscal year 2025...................... 89,520,000
Committee recommendation, fiscal year 2025............ 90,020,000
Change from enacted level......................... -68,610,000
Change from budget request........................ +500,000

The recommendation includes $90,020,000 for Salaries and
Expenses of the American Battle Monuments Commission (ABMC).
Identifying Improperly Buried Servicemembers.--The
Committee recommendation includes an additional $500,000 for
ABMC to award a contract for the purpose of researching and
identifying American-Jewish servicemembers buried at American
military cemeteries who were buried under markers incorrectly
representing their religion and heritage. The research should
also include identifying surviving next of kin of these
servicemembers. The ABMC should prioritize making an award to
an organization with a demonstrated capability and expertise in
conducting such research and identification activities. The
Committee requests a report within 180 days of enactment of
this Act on progress towards identifying incorrect markers for
American-Jewish servicemembers, timeline for completion, and
expected future funding requirements.
ABMC Mission.--The Committee requests that ABMC submit to
the Committee on Appropriations a report not later than 90 days
after enactment of the Act on the role of remembrance
activities including facilitating flower orders for families of
the fallen in its mission and the reason for any changes to
that role and in its mission over time.
National Memorial Day Parade.--The National Memorial Day
Parade is the largest Memorial Day event in the nation. The
Committee encourages American Battle Monuments Commission to
partner with relevant stakeholders, including the National
Parks Service, the city of Washington D.C., and non-profit
stakeholders to support a sustainable path forward for this
important American tradition.

FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

The recommendation includes such sums as necessary for the
Foreign Currency Fluctuations Account (FCFA). The Foreign
Currency Fluctuations account addresses exchange rate
imbalances between the U.S. Dollar, the European Euro, and
other foreign currencies. If exchange rates change at time of
expenditure, funds from FCFA are transferred to Salaries and
Expenses.

CAPITAL PROGRAM

Appropriation, fiscal year 2024....................... $44,000,000
Budget request, fiscal year 2025...................... - - -
Committee recommendation, fiscal year 2025............ - - -
Change from enacted level......................... - - -
Change from budget request........................ - - -

The recommendation includes no funds as requested for the
Capital Program Account.

United States Court of Appeals for Veterans Claims

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $47,200,000
Budget request, fiscal year 2025...................... 47,300,000
Committee recommendation, fiscal year 2025............ 47,300,000
Change from enacted level......................... +100,000
Change from budget request........................ - - -

The recommendation includes $47,300,000 for Salaries and
Expenses for the United States Court of Appeals for Veterans
Claims.

Department of Defense--Civil

Cemeterial Expenses, Army

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $98,800,000
Budget request, fiscal year 2025...................... 105,514,000
Committee recommendation, fiscal year 2025............ 105,514,000
Change from enacted level......................... +5,634,000
Change from budget request........................ - - -

The recommendation includes $105,514,000 for Salaries and
Expenses for Arlington National Cemetery, which is equal to the
fiscal year 2025 budget request.
Virtual Tours.--The Committee appreciates the efforts to
improve the interactive tools available to Arlington National
Cemetery (ANC) visitors and understands that the ANC is
currently working to supplement the visitor experience through
the creation of a three-dimensional virtual tour utilizing
ground level, interactive, 360-degree perspective, with key
interactive information about every internment. The Committee
encourages the ANC to continue engaging with stakeholders to
explore virtual tour technologies for potential use in the
future.

CONSTRUCTION

Appropriation, fiscal year 2024....................... $88,600,000
Budget request, fiscal year 2025...................... 42,000,000
Committee recommendation, fiscal year 2026............ 42,000,000
Change from enacted level......................... -46,600,000
Change from budget request........................ - - -

The recommendation includes $42,000,000 to complete the
Southern Expansion, to remain available until expended. The
Committee reminds the Army to include status updates in its
required quarterly reports on funds obligated, including
previously appropriated funds, and funds remaining for the
Southern Expansion project, as well as any remaining unfunded
needs to complete the project.

Armed Forces Retirement Home

TRUST FUND

The recommendation includes a total of $69,520,000 for the
Armed Forces Retirement Home (AFRH) Trust Fund, including
$1,000,000 for capital projects and $25,000,000 from the
general fund of the Treasury.
Redevelopment of AFRH Washington, DC Campus.--The Committee
notes that the Armed Forces Retirement Home (AFRH) announced
its decision to terminate the RFP from 2018 for the mixed-use
development project of 80 acres of the Home's Washington, DC
campus in October, 2023. To date, AFRH has not provided
congressional stakeholders or other affected parties with
support for its explanation of the decision to terminate the
redevelopment initiative, which is a central element of the
AFRH Master Plan and a critical step toward providing a
dedicated source of revenue to support the long-term
sustainability of the AFRH, including the Washington, DC
campus. The Committee has historically expressed concern about
the use of the General Fund to support the AFRH and has
directed the AFRH to increase revenues and stabilize the Trust
Fund for the long term. The decision by the AFRH to terminate
the project without consultation or communication with the
Committee is concerning and undermines the long-term viability
of the Washington, DC campus and, more importantly, the well-
being of the resident veterans in its care. The Committee
directs the Department to conduct and provide to the Committee,
within 90 days of enactment of this Act, a detailed evaluation
of the AFRH decision and justification to terminate the mixed-
use redevelopment project at the AFRH Washington, DC campus.
Such report shall address the following: (1) terms of the
negotiated agreement AFRH claims could not be finalized, (2)
the economic analysis upon with AFRH relied for its termination
decision, and (3) the specific ``significant changes in
economic conditions'' cited by AFRH for its termination
decision in the fiscal year 2025 budget submission. The
Committee further directs AFRH to provide the Committee its
plan for achieving in a timely fashion a dedicated source of
revenue to support AFRH operations, including specific
milestones and costs associated with such plan.
General Fund.--The Committee continues to be concerned
about the use of the General Fund to support the AFRH and
directs it to make progress to increase revenues and stabilize
the Trust Fund for the long term.
Land Redevelopment.--The Committee reminds AFRH of the
direction in the joint explanatory statement accompanying the
Consolidated Appropriations Act, 2024 (Public Law 118-42) to
provide a briefing on the options for and timelines associated
with the future use of the 80-acre master planned parcel.

OPERATION AND MAINTENANCE

Appropriation, fiscal year 2024....................... $43,060,000
Budget request, fiscal year 2025...................... 43,520,000
Committee recommendation, fiscal year 2025............ 43,520,000
Change from enacted level......................... +460,000
Change from budget request........................ - - -

The Committee makes these operation and maintenance funds
available until September 30, 2026, as requested, to provide
AFRH greater ability to respond to emergency situations and
ensure stable operations.

CAPITAL PROGRAM

Appropriation, fiscal year 2024....................... $8,940,000
Budget request, fiscal year 2025...................... 1,000,000
Committee recommendation, fiscal year 2025............ 1,000,000
Change from enacted level......................... -7,940,000
Change from budget request........................ - - -

Capital Maintenance Spending Plan.--The Committee directs
AFRH to provide, no later than 30 days after enactment of this
Act, an expenditure plan detailing the planned use of the funds
provided for construction and renovation. The Committee
continues to direct AFRH to prioritize completing projects that
are currently underway.

MAJOR CONSTRUCTION

Appropriation, fiscal year 2024....................... $- -
Budget request, fiscal year 2025...................... 31,000,000
Committee recommendation, fiscal year 2025............ 31,000,000
Change from enacted level......................... +31,000,000
Change from budget request........................ - - -

The Committee reminds AFRH to provide quarterly reports on
the status of this construction project, including obligations
of funds, anticipated timelines, and any changes to the overall
cost of the project.

Administrative Provision

The bill includes section 301 permitting funds from
concessions at Army National Military Cemeteries to be used to
support activities at the Cemeteries.

TITLE IV

GENERAL PROVISIONS

The bill includes a total of 22 provisions; 12 were in
effect in fiscal year 2024 and 10 are new:
The bill includes section 401 prohibiting the obligation of
funds beyond the current fiscal year unless expressly so
provided.
The bill includes section 402 prohibiting the use of funds
for programs, projects, or activities not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
The bill includes section 403 encouraging all departments
and agencies funded in this Act to expand the use of ``E-
Commerce'' technologies and procedures.
The bill includes section 404 specifying the Congressional
committees that are to receive all reports and notifications.
The bill includes section 405 prohibiting the transfer of
funds to any instrumentality of the United States Government
without authority from an appropriations Act.
The bill includes section 406 prohibiting any funds in this
Act to be used for a project or program named for an individual
serving as a Member, Delegate, or Resident Commissioner of the
United States House of Representatives.
The bill includes section 407 requiring all reports
submitted to Congress to be posted on official websites of the
submitting agency.
The bill includes section 408 prohibiting the use of funds
to establish or maintain a computer network unless such network
blocks the viewing, downloading, and exchanging of pornography,
except for law enforcement investigation, prosecution, or
adjudication activities.
The bill includes section 409 prohibiting the use of funds
for payment of first-class travel by an employee of the
executive branch.
The bill includes section 410 prohibiting the use of funds
in this Act for any contract where the contractor has not
complied with E-Verify requirements.
The bill includes section 411 prohibiting the use of funds
in this Act to construct facilities on military installations
that do not meet resiliency standards.
The bill includes section 412 prohibiting the use of funds
in this Act for the renovation, expansion, or construction of
any facility in the continental United States for the purposes
of housing any individual who has been detained at the United
States Naval Station, Guantanamo Bay, Cuba.
The bill includes section 413 prohibiting the use of funds
to support or defeat legislation pending before Congress.
The bill includes section 414 prohibiting the use of funds
to implement Executive Order 13985, Executive Order 14035,
Executive Order 14091 regarding diversity, equity, and
inclusion activities.
The bill includes section 415 prohibiting the use of funds
to promote or advance Critical Race Theory or any concept
associated with Critical Race Theory.
The bill includes section 416 prohibiting discrimination
based on religious beliefs related to marriage.
The bill includes section 417 prohibiting federal funding
for Diversity, Equity, and Inclusion training or
implementation.
The bill includes section 418 prohibiting federal funding
for enforcing COVID-19 mask mandates.
This bill includes section 419 prohibiting federal funding
for administering, implementing, or enforcing Executive Order
No. 14057 of December 8, 2021.
The bill includes section 420 prohibiting federal funding
for implementing Executive Order No. 13990, Executive Order No.
14408, Section 6 of Executive Order No. 14013, Executive Order
No. 14030, Executive No. 14082, and Executive No. 14096
regarding climate initiatives.
The bill includes section 421 prohibiting the Department of
Veterans Affairs from purchasing computers, printers, software,
or hardware needed for an office environment from the People's
Republic of China or entities that contribute to the defense
industry of the Chinese Communist Party.
The bill includes section 422 establishing a ``Spending
Reduction Account'' in the bill.

House of Representatives Reporting Requirements

The following items are included in accordance with various
requirements of the Rules of the House of Representatives:

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

Pursuant to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, the following is a statement of
general performance goals and objectives for which this measure
authorizes funding:
The Committee on Appropriations considers program
performance, including a program's success in developing and
attaining outcome-related goals and objectives, in developing
funding recommendations.

RESCISSION OF FUNDS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following statements are
submitted describing the rescissions in the accompanying bill:
The bill does not contain any rescission of funds from
amounts appropriated by prior Acts.

TRANSFER OF FUNDS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following statements are
submitted describing the transfer of funds provided in the
accompanying bill.
Language is included under Title I to allow for the
transfer of funds from Family Housing, Construction accounts to
the Department of Defense Family Housing Improvement Fund and
funds from Military Construction accounts to the Department of
Defense Military Unaccompanied Housing Improvement Fund.
Language is included under Title I to provide transfer
authority from the BRAC account to the Homeowners Assistance
Program.
Language is included under Title I to allow the transfer of
expired funds to the ``Foreign Currency Fluctuations,
Construction, Defense'' account.
Language is included under Title II to transfer not to
exceed $22,816,224 in fiscal year 2026 from Compensation and
Pensions to General Operating Expenses, Veterans Benefits
Administration and Information Technology Systems. These funds
are for the administrative costs of implementing cost-savings
proposals required by the Omnibus Budget Reconciliation Act of
1990 and the Veterans' Benefits Act of 1992. Language is also
included transferring funds to the Medical Care Collections
Fund to augment funding of medical facilities for nursing home
care provided to pensioners.
Language is included under Title II to permit the transfer
of funds from General Administration to General Operating
Expenses, Veterans Benefits Administration.
Language is included under Title II to permit the transfer
of funds between Information Technology Systems development
projects and among the three sub-accounts identified in bill
language subject to the approval of the Committee.
Language is included under Title II to provide authority
for the Department of Veterans Affairs for any funds
appropriated in 2025 for Compensation and Pensions,
Readjustment Benefits, and Veterans Insurance and Indemnities
to be transferred among those three accounts.
Language is included under Title II to transfer funds among
the Medical Services, Medical Community Care, Medical Support
and Compliance, and Medical Facilities accounts, subject to
approval by the Committee.
Language is included under Title II to permit the funds
from three life insurance funds to be transferred to General
Operating Expenses, Veterans Benefits Administration and
Information Technology Systems for the costs of administering
such programs.
Language is included under Title II to permit funding up to
$150,655,581 to be transferred to General Administration and
Information Technology Systems from any funds appropriated in
fiscal year 2025 to reimburse three headquarters offices for
services provided.
Language is included under Title II to transfer certain
funds derived from enhanced-use leasing activities to the
Construction, Major Projects and Construction, Minor Projects
accounts.
Language is included under Title II to allow the transfer
of funds from the Medical Care Collections Fund to the Medical
Services and Medical Community Care accounts.
Language is included under Title II to allow the transfer
of funds from the Capital Asset Fund to the Construction, Major
Projects and Construction, Minor Projects accounts.
Language is included under Title II to allow the transfer
of funds from various accounts to the Information Technology
Systems account in an aggregate amount not to exceed ten
percent of the account appropriation, subject to approval by
the Committee.
Language is included under Title II to allow the transfer
of funds provided for the Department of Veterans Affairs in
fiscal year 2025 to the Joint Department of Defense-Department
of Veterans Affairs Medical Facility Demonstration Fund.
Language is included under Title II allowing fiscal year
2026 medical care funding to be transferred to the Joint
Department of Defense-Department of Veterans Affairs Medical
Facility Demonstration fund.
Language is included under Title II permitting funds
deposited to the Medical Care Collections Fund for healthcare
provided at a combined Federal medical facility to be
transferred to the Joint Department of Defense-Department of
Veterans Affairs Medical Facility Demonstration Fund.
Language is included under Title II to the Department of
Veterans Affairs that would transfer no less than $15,000,000
for the DOD-VA Health Care Sharing Incentive Fund as authorized
by section 8111(d) of title 38, United States Code.
Language is included under Title II that permits the
transfer from all discretionary accounts except General
Operating Expenses, Veterans Benefits Administration, to
Medical Services, subject to approval by the Committee.
Language is included under Title II that permits transfer
of funds between General Operating Expenses, Veterans Benefits
Administration and the Board of Veterans Appeals, subject to
approval by the Committee.

DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS

The following table is submitted in compliance with clause
9 of rule XXI, and lists the congressional earmarks (as defined
in paragraph (e) of clause 9) contained in the bill or in this
report. Neither the bill nor the report contain any limited tax
benefits or limited tariff benefits as defined in paragraphs
(f) or (g) of clause 9 of rule XXI.

COMPLIANCE WITH RULE XIII, CL. 3(E) (RAMSEYER RULE)

In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, 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 italics, existing law in which no change
is proposed is shown in roman):
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, the Committee notes that the
accompanying bill does not propose to repeal or amend a statute
or part thereof.

CHANGES IN THE APPLICATION OF EXISTING LAW

Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
Language is included in various parts of the bill to
continue ongoing activities that require annual authorization
or additional legislation, which to date have not been enacted.
Language is included in various parts of the bill to place
limitations on the use of funds in the bill or change existing
limitations and which might, under some circumstances, be
construed as changing the application of existing law.
Language is included in various parts of the bill to allow
the Secretary of Defense to exceed certain limitations upon
notification to the Committee.
Language is included in various parts of the bill to allow
funding to be used for official reception and representation
expenses.
Language is included in various parts of the bill to enable
various appropriations to remain available for more than one
year for some programs for which the basic authority
legislation does not presently authorize such extended
availability.
Language is included in various parts of the bill to permit
the transfer of funds to other accounts.
Language is included under Title I to prohibit payments for
cost plus-a-fixed-fee contracts under certain circumstances.
Language is included in various parts of the bill to allow
funds to be used for the hire of passenger motor vehicles.
Language is included under Title I to allow advances to the
Federal Highway Administration, Department of Transportation
under certain circumstances. Language is included under Title I
to prohibit the use of funds to begin construction of new bases
without specific appropriations.
Language is included under Title I to prohibit the use of
funds for purchase of land or land easements under certain
circumstances.
Language is included under Title I to prohibit the use of
funds for land acquisition, site preparation, and utility
installation for family housing unless funds have been made
available in annual appropriations Acts.
Language is included under Title I to prohibit the use of
minor construction funds to transfer an activity between
installations without prior notification.
Language is included under Title I to prohibit the use of
funds for the procurement of steel for any activity if American
steel producers have been denied the opportunity to compete for
such steel procurements.
Language is included under Title I to prohibit the use of
funds to pay real property taxes in any foreign nation.
Language is included under Title I to prohibit the use of
funds to initiate a new installation overseas without prior
notification.
Language is included under Title I to limit the use of
funds for architect and engineer contracts under certain
circumstances.
Language is included under Title I to limit the use of
funds for awarding contracts to foreign contractors under
certain circumstances.
Language is included under Title I to require the
Department of Defense to notify the appropriate committees of
Congress of any proposed military exercises under certain
circumstances.
Language is included under Title I to allow prior year
construction funding to be available for currently authorized
projects.
Language is included under Title I to allow payment for the
cost associated with supervision, inspection, overhead,
engineering and design on family housing or military
construction projects that are being completed with expired or
lapsed funds.
Language is included under Title I to allow funds to be
expended on military construction projects for four fiscal
years after enactment under certain circumstances.
Language is included under Title I to allow construction
funds to be transferred to Housing Improvement Funds.
Language is included under Title I to allow for the
transfer of BRAC funds to the Homeowners Assistance Program.
Language is included under Title I to limit funds for the
operation and maintenance of family housing to those provided
in this appropriation and to limit amounts expended on repairs
of general and flag officer quarters under certain
circumstances.
Language is included under Title I to allow funds in the
Ford Island Improvement Account to be available until expended
for certain purposes.
Language is included under Title I to allow for the
transfer of expired funding to the Foreign Currency Fluctuation
Account under certain circumstances.
Language is included under Title I to prohibit funds from
being used for projects at Arlington Cemetery.
Language is included under Title I directing all amounts
appropriated to Military Construction (all accounts) be
immediately available and allotted for the full scope of the
authorized project.
Language is included under Title I providing funds for
unfunded requirements requested by the Services and Combatant
Commanders.
Language is included under Title I allowing unobligated
funds from prior appropriations acts for fiscal years 2018,
2019, and 2020 to be obligated under certain circumstances.
Language is included under Title I defining the
congressional defense committees.
Language is included under Title I providing funds for
military laboratory facilities.
Language is included under Title I providing funds for
natural disasters.
Language is included under Title I providing funds for
child development centers planning and design.
Language is included under Title I providing funds for
barracks planning and design.
Language is included under Title I providing funds for
demolition.
Language is included under Title I prohibiting funds to
close Naval Station Guantanamo Bay, Cuba.
Language is included under Title II providing for the
reimbursement to the Department of Defense for the costs of
verseas employee mail.
Language is included under Title II to require that the
Secretary of Veterans Affairs establish a priority for
treatment of Veterans who are service-connected disabled, lower
income, or have special needs.
Language is included under Title II to require that the
Secretary of Veterans Affairs give priority funding of basic
medical benefits to priority groups 1 through 6.
Language is included under Title II to allow the Secretary
of Veterans Affairs to dispense prescription drugs from VHA
facilities to enrolled Veterans with privately written
prescriptions at no additional cost to the Department.
Language is included under Title II requiring the Secretary
to ensure sufficient funding is available for the acquisition
of prosthetics designed for women Veterans.
Language is included under Title II requiring sufficient
funding is available for prosthetic research specifically for
female Veterans and for toxic exposure research.
Language is included under Title II to require approval of
a transfer between development projects in the Information
Technology Systems account.
Language is included under Title II prohibiting funding in
the Veterans Electronic Health Record account from being
obligated in a manner inconsistent with deployment schedules.
Language is included under Title II establishing time
limitations and reporting requirements concerning the
obligation of Major Construction funds, limiting the use of
funds, allowing the use of funds for program costs, and
allowing for the reimbursement to the ``General
Administration'' account for the salaries and expenses of the
Office of Construction and Facilities Management employees.
Language is included under Title II to allow Minor
Construction funds to be used to repair non-medical facilities
damaged by natural disaster or catastrophe.
Language is included under Title II permitting transfers
between mandatory and discretionary accounts, limiting and
providing for the use of certain funds, funding administrative
expenses associated with life insurance programs from excess
program revenues, allowing reimbursement from enhanced-use
leases and for certain services, requiring notification of
construction bid savings, limiting reprogramming amount of
major construction projects, restricting changes in the scope
of major construction projects, requiring disclosure of
insurance and income information, allowing a recovery audit
collection program, allowing Veterans in the State of Alaska to
use Indian Health Service facilities under certain conditions,
requiring quarterly reports on the Department's financial
status, performance measures, and data, allowing medical
services funds for recreational and funeral expenses, and
requiring notification of organizational changes that transfer
25 or more employees rom one VA organizational unit to another.
Language is included under Title II requiring notification
of any single national outreach and awareness marketing
campaign in which obligations exceed $1,000,000.
Language is included under Title II requiring the Secretary
to maintain certain requirements in operating the toll-free
suicide hotline.
Language is included under Title II prohibiting funds from
being used in contravention of certain breast cancer screening
guidance.
Language is included under Title II to allow covered
veterans and their spouses or partners, under certain
conditions, to receive assisted reproductive technology
services and adoption reimbursement.
Language is included under Title II pertaining to
exceptions for Indian-or Native Hawaiian-owned businesses
contracting with the Department.
Language is included under Title II directing the
elimination of using Social Security account numbers to
identify individuals in all information systems of the
Department.
Language is included under Title II pertaining to
certification of marriage and family therapists.
Language is included under Title II prohibiting funds from
being used to transfer funding from the Filipino Veterans
Equity Compensation Fund to any other VA account.
Language is included under Title II permitting funds to
carry out and expand the childcare program.
Language is included under Title II prohibiting funds to
enter into an agreement to resolve a dispute or claim with an
individual that would restrict the individual from speaking to
Members of Congress or their staff.
Language is included under Title II requiring certain data
to be included in budget justifications for major construction
projects.
Language is included under Title II prohibiting the
Inspector General from being denied timely access to
information.
Language is included under Title II prohibiting funding to
be used in a manner that would increase wait times for Veterans
who seek medical care.
Language is included under Title II prohibiting the use of
funds in fiscal year 2024 to convert any program that received
specific purpose funding in fiscal year 2023 to a general
purpose-funded program.
Language is included under Title II prohibiting the use of
dogs or cats as part of the conduct of any study.
Language is included under Title II allowing for funds
within the Medical Community Care account to be used for
expenses that would have otherwise been payable from the
Veterans Choice Fund.
Language is included under Title II allowing for
obligations and expenditures applicable to the Medical Services
account in fiscal years 2017 through 2019 for aid to state
homes to remain in the Medical Community Care account for such
fiscal years.
Language is included under Title II providing for a certain
amount within the medical care accounts to be made available
for gender-specific care and programmatic efforts to deliver
care for women veterans.
Language is included under Title II rescinding unobligated
balances in the ``Recurring Expenses Transformational Fund.''
Language is included under Title II requiring quarterly
reports on the status of the Veterans Medical Care and Health
Fund.
Language is included under Title II allowing the use of
unobligated balances for CHIP-In construction projects.
Language is included under Title II to require an expenditure
plan for funds made available in the Fiscal Responsibility Act
of 2023 (P.L. 118-5).
Language is included under Title II prohibiting federal
funding for abortions except in cases of incest, rape, or life
of the mother and prohibiting federal funding for implementing
the Department of Veterans Affairs Interim Final Rule on
abortion.
Language is included under Title II regarding funding for
hormone therapies or surgeries for gender-affirming care.
Language is included under Title II permitting certain
flags to be flown at VA facilities. Language is included under
Title II prohibiting the use of funds to implement 88. Fed.
Reg. 10032.
Language is included under Title II prohibiting the use of
funds to carry out VHA Directive 1193.01.
Language is included prohibiting the use of to provide any
services to any individual unlawfully present in the United
States who is not eligible for health care under the laws
administered by the Secretary of Veterans Affairs.
Language is included under Title II prohibiting the
Secretary of Veterans Affairs from reporting who is deemed
mentally incapacitated, mentally incompetent, or experiencing
an extended loss of consciousness as mental defective under 18
U.S.C (d)(4) or (g)(4).
Language is included under Title III, United States Court
of Appeals for Veterans Claims, Salaries and Expenses, to
permit the use of funds for a pro bono program.
Language is included under Title III, Cemeterial Expenses,
Army, Salaries and xpenses, to permit the use of funds for
parking maintenance and repairs.
Language is included under Title III, Armed Forces
Retirement Home to permit payment from the general fund of the
Treasury to the Trust Fund.
Language is included under Title III to allow for the use
of concession fees.
Language is included under Title IV prohibiting funding
beyond the current fiscal year unless expressly so provided.
Language is included under Title IV to limit the use of
funds for Federal entities when they are not in compliance with
Federal law relating to risk assessment, the protection of
private property rights, or unfunded mandates.
Language is included under Title IV providing funding to
expand the use of ``E Commerce'' technologies and procedures.
Language is included under Title IV specifying the
Congressional committees that are to receive all reports and
notifications.
Language is included under Title IV prohibiting the
transfer of funds to any instrumentality of the United States
Government without authority from an appropriations Act.
Language is included under Title IV prohibiting the use of
funds for a project or program named for an individual serving
as a Member, Delegate, or Resident Commissioner of the United
States House of Representatives.
Language is included under Title IV requiring all reports
submitted to the Congress to be posted on the official public
website of that agency.
Language is included under Title IV prohibiting funds from
being used to maintain or establish a computer network unless
such network blocks the viewing, downloading, and exchanging of
pornography.
Language is included under Title IV prohibiting funds from
being used to pay for first-class travel in violation of
Federal regulations.
Language is included under Title IV prohibiting funds from
being used to execute a contract for goods or services where a
contractor has not complied with Executive Order 12989.
Language is included under Title IV prohibiting the use of
funds in this Act to construct facilities on military
installations that do not meet resiliency standards.
Language is included under Title IV prohibiting funds to
build or house detainees at Naval Station Guantanamo Bay, Cuba.
Language is included under Title IV prohibiting funds for
executive orders related to diversity, equity, and inclusion.
Language is included under Title IV prohibiting use of
funds to directly or indirectly influence an appropriation
mattered pending before Congress, other than to communicated
with Members of Congress as described in 18 U.S.C 1913.
Language is included under Title IV prohibiting use of
funds to carry Executive Order 13985, Executive Order 14035, or
Executive Order 14091.
Language is included under Title IV prohibiting funds to
teach or promote Critical Race Theory.
Language is included under Title IV prohibiting
discrimination based on religious beliefs related to marriage.
Language is included under Title IV prohibiting Diversity,
Equity, and Inclusion training or implementation.
Language is included under Title IV prohibiting use of
funds to enforce COVID-19 mask mandates.
Language is included under Title IV prohibiting use of
funds to administer, implement, or enforce Executive Order
14057.
Language is included under Title IV prohibiting use of
funds to implement Executive Order 13990, Executive Order
14008, Executive Order 14013, Executive Order 14030, Executive
Order 14057, Executive Order 14082, and Executive Order 14096.
Language is included under Title IV prohibiting use of
funds to purchases various IT related equipment from China.
Language is included under Title IV regarding a Spending
Reduction Account.

APPROPRIATIONS NOT AUTHORIZED BY LAW

Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of
the House of Representatives, the following table lists the
appropriations in the accompanying bill which are not
authorized by law for the period concerned:

[dollars in thousands]
----------------------------------------------------------------------------------------------------------------
Appropriations
Last year of Authorization in last year Appropriations
Agency/program authorization level of in this bill
authorization
----------------------------------------------------------------------------------------------------------------
Military Construction, Army..................... 2024 1,912,289 2,022,775 2,217,757
Military Construction, Navy and Marine Corps.... 2024 5,310,740 5,531,369 4,332,414
Military Construction, Air Force................ 2024 3,151,314 2,741,424 3,268,276
Military Construction, Defense-Wide............. 2024 3,198,571 3,161,782 3,500,083
Military Construction, Army National Guard...... 2024 732,078 620,647 367,129
Military Construction, Air National Guard....... 2024 361,265 295,526 0
Military Construction, Army Reserve............. 2024 234,076 151,076 265,032
Military Construction, Navy Reserve............. 2024 66,291 51,291 67,329
Military Construction, Air Force Reserve........ 2024 346,572 331,572 50,499
North Atlantic Treaty Organization Security 2024 343,434 293,434 433,864
Investment Program.............................
Family Housing Construction, Army............... 2024 316,284 304,895 276,647
Family Housing Operation and Maintenance, Army.. 2024 385,485 395,485 485,611
Family Housing Construction, Navy and Marine 2024 277,142 277,142 245,742
Corps..........................................
Family Housing Operation and Maintenance, Navy 2024 363,854 373,854 387,217
and Marine Corps...............................
Family Housing Construction, Air Force.......... 2024 264,097 237,097 221,549
Family Housing Operation and Maintenance, Air 2024 314,386 324,386 336,250
Force..........................................
Family Housing Operation and Maintenance, 2024 50,785 50,785 52,156
Defense-Wide...................................
Department of Defense Family Housing Improvement 2024 6,611 6,611 8,195
Fund...........................................
Department of Defense Military Unaccompanied 2024 496 496 497
Housing Improvement Fund.......................
Base Realignment and Closure Account............ 2024 539,174 489,174 539,174
Dept. of Veterans Affairs, Major Construction... done each yr .............. 961,219 2,069,000
Armed Forces Retirement Home.................... 2024 77,000 77,000 100,520
----------------------------------------------------------------------------------------------------------------

PROGRAM DUPLICATION

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, no provision of this bill 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.

COMPARISON WITH THE BUDGET RESOLUTION

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and Section 308(a)(1)(A) of the
Congressional Budget Act of 1974 (P.L. 93-344), as amended, the
following table compares the levels of new budget authority
provided in the bill with the appropriate allocations under
section 302(b) of the Budget Act:

[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
302(b) Allocation This Bill
---------------------------------------------------------------
Budget Budget
Authority Outlays Authority Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
allocations to its subcommittees: Subcommittee
on Military Construction, Veterans Affairs, and
Related Agencies
Discretionary............................... 147,520 .............. 147,520 \1\144,158
Mandatory................................... .............. .............. 221,926 \1\218,333
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.

FIVE-YEAR OUTLAY PROJECTIONS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(B) of the Congressional Budget Act of 1974 (P.L. 93-
344), as amended, the following table contains five-year
projections associated with the budget authority provided in
the accompanying bill as provided to the Committee by the
Congressional Budget Office.

[In millions of dollars]
------------------------------------------------------------------------
Outlays
------------------------------------------------------------------------
Projection of outlays associated with the recommendation:
2025................................................... \1\212,745
2026................................................... 123,898
2027................................................... 18,224
2028................................................... 5,790
2029 and future years.................................. 5,530
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(C) of the Congressional Budget Act of 1974 (P.L. 93-
344), as amended, the Congressional Budget Office has provided
the following estimates of new budget authority and outlays
provided by the accompanying bill for financial assistance to
State and local governments.

[In millions of dollars]
------------------------------------------------------------------------
Budget Authority Outlays
------------------------------------------------------------------------
Financial assistance to State and 276 \1\269
local governments for 2025.......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

COMMITTEE HEARINGS

Pursuant to clause 3(c)(6) of rule XIII of the Rules of the
House of Representatives, the following hearings were used to
develop or consider the Military Construction, Department of
Veterans Affairs, and Related Agencies Appropriations Act,
[2025]:
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on March
20, 2024, entitled ``Oversight Hearing--Quality of Life in the
Military''. The Subcommittee received testimony from:
Sergeant Major Michael A. Weimer, U.S. Army
Master Chief Petty Officer James A. Honea, U.S. Navy
Sergeant Major Carlos A. Ruiz, U.S. Marine Corps
Chief Master Sergeant David A. Flossi, U.S. Air Force
Chief Master Sergeant John F. Bentivegna, U.S. Space
Force
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on May 1,
2024, entitled ``Budget Hearing--Fiscal Year 2025 Request for
Army Military Construction and Family Housing''. The
Subcommittee received testimony from:
The Honorable Rachel Jacobson, Assistant Secretary of
the Army, Installations, Energy, and Environment
Department of Veterans Affairs
Lieutenant General Kevin Vereen, Deputy Chief of
Staff G9, Installation Management Command
The Subcommittee on Military Construction, Department
of Veterans Affairs, and Related Agencies held a
hearing on April 16, 2024, entitled ``Budget Hearing--
Fiscal Year 2024 Request for the Department of Veterans
Affairs''. The Subcommittee received testimony from:
The Honorable Denis McDonough, Secretary, Department
of Veterans Affairs
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
11, 2024, entitled ``Budget Hearing--Fiscal Year 2025 Request
for Navy and Marine Corps Military Construction and Family
Housing''. The Subcommittee received testimony from:
The Honorable Meredith Berger, Assistant Secretary of
the Navy, Energy, Installations, and Environment
Vice Admiral Jeffrey T. Jablon, Deputy Chief of Naval
Operations, Fleet Readiness, and Logistics, N4, Office
of the Chief of Naval Operations
Lieutenant General Edward D. Banta, Deputy
Commandant, Installations and Logistics, United States
Marine Corps
The Subcommittee on Military Construction, Department of
Veterans Affairs, and Related Agencies held a hearing on April
17, 2023, entitled ``Budget Hearing--Fiscal Year 2025 Request
for Air Force and Space Force Military Construction and Family
Housing''. The Subcommittee received testimony from:
Dr. Ravi I. Chaudhary, Assistant Secretary of the Air
Force, Energy, Installations, and Environment,
Department of the Air Force
Mr. Bruce Hollywood, Associate Chief Operations
Officer, Office of the Chief Operations Officer, United
States Space Force
Brigadier General Brian S. Hartless, Air Force
Director of Civil Engineers, Deputy Chief of Staff for
Logistics, Engineering and Force Protection, United
States Air Force

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY

The following table provides a detailed summary, for each
Department and agency, comparing the amounts recommended in the
bill with amounts enacted for fiscal year 2024 and budget
estimates presented for fiscal year 2025.

MINORITY VIEWS

The fiscal year 2025 Military Construction, Veterans
Affairs, and Related Agencies (MilCon-VA) bill funds critical
military construction, family housing, and quality of life
improvements and enhancements for our brave men and women in
uniform and their families. The bill also funds a wide variety
of assistance programs for veterans, including disability and
pension benefits, healthcare services, educational assistance,
and home loan and insurance programs they have earned through
their service to our country. It also funds the American Battle
Monuments Commission, Armed Forces Retirement Home, Arlington
National Cemetery, and the Court of Appeals for Veterans
Claims.
The fiscal year 2025 MilCon-VA bill, together with funds
provided in the fiscal year 2024 bill through advance
appropriations and the Fiscal Responsibility Act of 2023 (FRA),
provides $380.3 billion for fiscal year 2025, an increase of
$33.5 billion above current funding levels. Of this amount,
discretionary funding for programs such as veterans' health
care and military construction totals $147.5 billion, a
decrease of $6.4 billion below current funding levels. The bill
also provides advance funding of $376.5 billion for fiscal year
2026, including $23 billion through the Cost of War Toxic
Exposures Fund (TEF) for veterans medical care.
We thank Chairman Carter and his staff for their work in
keeping a professional process in place and engaging in
respectful debate on difficult issues, in spite of clear policy
differences. While we appreciate the efforts made to
accommodate Democratic priorities, the funding levels and
significant policy riders in the MilCon-VA bill are not
workable or sustainable.

MILITARY CONSTRUCTION

The bill funds military construction at $18 billion, which
is $718 million below the fiscal year 2024 enacted level. Since
2021, this committee has built on the progress from the
previous year and continued to increase investments in military
construction. This bill backtracks on that progress. In a time
when we have a recruitment and retention issue, the condition
of military facilities has a direct impact on the quality of
life of our servicemembers and their families. We need to be
strongly investing in infrastructure that supports quality of
life--including child development centers, gyms, barracks,
family housing, among others, to better the lives of our
servicemembers and their families.
We are pleased that the bill includes Ranking Member
Wasserman Schultz's request to provide $30 million in dedicated
funding to expand the oversight of the housing portfolio at the
Department of Defense, including government-owned and
controlled family housing and privatized family and
unaccompanied housing. We appreciate Chairman Carter's shared
commitment to this oversight and ensuring privatized housing
providers are held accountable. The wellbeing of servicemembers
and their families is of utmost importance, and we continue to
hear unacceptable reports of poor housing conditions, slow
response times, and indifference towards requests for
assistance.
Additionally, we are pleased to see $50 million in
dedicated funding for PFAS remediation and cleanup. The
Environmental Protection Agency announced its final rule in
April 2024 for certain PFAS under the Safe Drinking Water Act
that sets limits on PFOS and PFOA at 4 parts per trillion,
which will have a significant impact on DOD's PFAS remediation
efforts within the Base Closure Account. However, the bill does
not include additional, dedicated funding for military
installation climate change and resilience projects, which is a
cut of $30 million from the current level. It also includes
$100 million for natural disasters, and while we appreciate
Chairman Carter including this funding in the bill, it is a cut
of $50 million from the enacted level. Providing funding for
resiliency to harden military construction on the front end
will save taxpayer dollars on the back end to build back after
natural disasters, and we hope we can work together on these
issues moving forward.

DEPARTMENT OF VETERANS AFFAIRS

The current version of the bill funds the Department of
Veterans Affairs at $337.5 billion in total mandatory and
discretionary resources, which is $30 billion above the enacted
level and $75.5 million above the budget request. The bill
provides $112.5 billion for the four medical care accounts,
equal to the budget request. Combined with the $24.5 billion
provided for medical care through the TEF in the Fiscal
Responsibility Act, a total of $137 billion is available for
medical care in 2025. The bill further provides $131 billion in
discretionary advance appropriations for medical care. Combined
with the $22.8 billion provided in advance appropriations for
medical care through the TEF, the bill provides $154 billion in
total advance appropriations for 2026 for medical care, equal
to the request.
The bill would have been improved if the amendments offered
by Ranking Member Wasserman Schultz and Congresswoman Lee were
adopted to strike the partisan riders included in the bill that
prohibit VA from implementing its rule on abortion; prohibit VA
from submitting a beneficiary's name to the National Instant
Criminal Background Check System based on VA's appointment of a
fiduciary, preventing VA from protecting veterans and those
around them; prohibit VA from flying Pride flags at its
facilities; prohibit VA from providing hormone therapy or
surgical treatment for gender affirming care; create a license
to discriminate against LGBTQI+ people under the guise of
religious liberty; prohibit the enforcement of any covid-19
mask mandate or the vaccine requirement for health care
personnel; prohibit the implementation of clean energy or
climate change executive orders; prohibit VA from providing
financial services to Immigration and Customs Enforcement;
prohibit the influencing of congressional action aimed to
prevent VA from providing technical assistance; prohibit funds
related to Guantanamo Bay that are not germane to the bill; and
prohibit VA from implementing Diversity, Equity, and Inclusion
(DEI) executive orders, any DEI programs or training, or any
concept related to Critical Race Theory. These riders only
further politicize this bill, and take away from the focus of
veterans, servicemembers, and their families.
This subcommittee has a long-standing tradition of
bipartisanship, and we will work in good faith with our
colleagues as we proceed through the appropriations process
with the hope of restoring bipartisan priorities in this bill.
By working together, we can best address the needs of our
Nation's military and its veterans and reach an agreement on
the Military Construction, Veterans Affairs, and Related
Agencies bill for FY 2025.

Rosa DeLauro.
Debbie Wasserman Schultz.