★36–358 

116TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 116–63 

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND 

RELATED AGENCIES APPROPRIATIONS BILL, 2020 

MAY 15, 2019.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Ms. WASSERMAN SCHULTZ, from the Committee on Appropriations, 

submitted the following 

R E P O R T 

together with 

MINORITY VIEWS 

[To accompany H.R. 2745] 

The Committee on Appropriations submits the following report in 

explanation of the accompanying bill making appropriations for 

military construction, the Department of Veterans Affairs, and related agencies for the fiscal year ending September 30, 2020, and 

for other purposes. 

CONTENTS 

Page 

Purpose of the Bill ................................................................................................... 2 

Summary of Committee Recommendation ............................................................ 2 

Management and Oversight Initiatives ................................................................. 4 

Department of Defense: 

Military Construction ....................................................................................... 7 

NATO Security Investment Program .............................................................. 22 

Department of Defense Base Closure Account ............................................... 22 

Family Housing Construction and Operation and Maintenance .................. 23 

Department of Defense Family Housing Improvement Fund ....................... 26 

Department of Defense Military Unaccompanied Housing Improvement 

Fund ............................................................................................................... 26 

Administrative Provisions ................................................................................ 26 

Department of Veterans Affairs: 

Veterans Benefits Administration ................................................................... 29 

Veterans Health Administration ..................................................................... 35 

National Cemetery Administration ................................................................. 68 

Departmental Administration ......................................................................... 69 

Administrative Provisions ................................................................................ 79 


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Related Agencies: 

American Battle Monuments Commission ..................................................... 84 

U.S. Court of Appeals for Veterans Claims .................................................... 85 

Cemeterial Expenses, Army ............................................................................ 85 

Armed Forces Retirement Home ..................................................................... 86 

Administrative Provision ................................................................................. 86 

Department of Defense: 

Overseas Contingency Operations .................................................................. 86 

Administrative Provision ................................................................................. 87 

Department of Defense: 

Natural Disaster Relief .................................................................................... 87 

Administrative Provision ................................................................................. 88 

General Provisions ................................................................................................... 88 

House of Representatives Report Requirements: 

Statement of General Performance Goals and Objectives ............................ 89 

Rescissions ........................................................................................................ 89 

Transfer of Funds ............................................................................................. 89 

Disclosure of Earmarks and Congressionally Directed Spending Items ...... 91 

Ramseyer Rule .................................................................................................. 91 

Changes in Application of Existing Law ........................................................ 93 

Appropriations Not Authorized by Law .......................................................... 98 

Program Duplication ........................................................................................ 100 

Committee Hearings ........................................................................................ 100 

Full Committee Votes ...................................................................................... 101 

Comparison With the Budget Resolution ....................................................... 107 

Five-Year Projection of Outlays ...................................................................... 107 

Assistance to State and Local Governments .................................................. 107 

Comparative Statement of New Budget Authority ........................................ 108 

State and Country Project List ....................................................................... 120 

Overseas Contingency Operations Project List .............................................. 135 

Minority Views .................................................................................................. 137 

PURPOSE OF THE BILL

The purpose of the bill is to support our military and their families and provide the benefits and medical care that our Veterans 

have earned because of their service to our Nation. This is accomplished through the programs funded in the bill, which provide the 

facilities and infrastructure needed to house, treat, train, and equip 

our military personnel to defend this Nation, both in the United 

States and abroad; provide the housing and military community infrastructure that supports a good quality of life for them and their 

families; and allow the military to maintain an efficient and effective base structure. The quality of life for our servicemembers and 

their families is a key component of readiness. The bill also funds 

a wide variety of assistance programs for Veterans, including disability and pension benefits, healthcare in many different settings, 

educational assistance, and home loan and insurance programs. Finally, the bill funds four related agencies that provide support to 

our Nation’s heroes: the American Battle Monuments Commission, 

Cemeterial Expenses, Army (including Arlington National Cemetery), the United States Court of Appeals for Veterans Claims, and 

the Armed Forces Retirement Home. 

SUMMARY OF COMMITTEE RECOMMENDATION

The Committee recommends $231,349,814,000 in budget authority for the fiscal year 2020 programs and activities funded in the 

bill. The fiscal year 2020 recommendation is an increase of 

$22,588,146,000 above the fiscal year 2019 enacted level and 

$6,130,359,000 below the President’s request. Of the increase over 

the fiscal year 2019 enacted level, $12,507,301,000 is in mandatory 


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programs. Included in the total budget authority is 

$123,211,394,000 in mandatory budget authority and 

$108,138,420,000 in discretionary budget authority which includes 

$2,000,000,000 in emergency funding. 

The Committee recommendation highlights the continued commitment to our servicemembers and their families and to our Veterans. In discretionary budget authority, the bill is 10 percent over 

the fiscal year 2019 enacted level. The bill includes an increase in 

military construction, which is 2 percent above the fiscal year 2019 

level, and an increase in the Department of Veterans Affairs budget, which is 9 percent over the fiscal year 2019 level. While the 

Committee recommendation continues essential support for 

servicemembers and Veterans, it does not provide funds for projects 

or activities that lacked sufficient justification or were less missioncritical. Where it was prudent, the Committee recommendation rescinds prior year funding that is no longer needed for the purpose 

for which it was originally appropriated while leaving sufficient resources to close out contracts. Finally, the recommendation rescinds unobligated balances in certain military construction and 

VA accounts. 

The programs funded in the bill for the Department of Defense 

(DOD) address the priorities of the Department’s Agencies and the 

Services for the numerous facility challenges that they face. The 

funds provided support readiness improvements with new construction, family housing, and continued cleanup of military bases closed 

during previous Base Realignment and Closure rounds, support 

Combatant Commanders’ requirements where appropriate, and ensure that our military personnel and their families’ quality of life 

is preserved. 

The total recommended funding level for military construction 

and family housing, including base and Overseas Contingency Operations funding, including the European Reassurance Initiative, is 

$13,460,420,000 which is $2,207,000,000 above the fiscal year 2019 

enacted level and $7,625,759,000 below the budget request. The 

recommendation includes funding for Family Housing, funding for 

necessary construction on our bases, including barracks, health facilities and schools, and support for critical overseas investments as 

well as an additional $140,800,000 to address privatized family 

housing issues. The recommendation includes $921,420,000 for the 

European Deterrence Initiative and construction related to Overseas Contingency Operations, which helps ensure the protection of 

our allies and protects the warfighter. The recommendation also includes $2,000,000,000 to address the needs of military facilities 

damaged by Hurricanes Florence and Michael. The recommendation also includes $1,093,500,000 for the Services’ unfunded priorities that are more than 35 percent complete in design and can be 

executed in fiscal year 2020. 

The total funding level for fiscal year 2020 for the Department 

of Veterans Affairs is $217,467,894,000, an increase of 

$20,277,301,000 over the fiscal year 2019 enacted level. Of the 

total, $123,211,394,000 is provided for mandatory benefit programs 

and $94,256,500,000 is allocated to discretionary programs such as 

medical care, claims processing, and construction. In this bill, discretionary funding for the Department of Veterans Affairs is recommended at 9 percent over the fiscal year 2019 enacted level. For 


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fiscal year 2020, $75,550,600,000 for medical care has been appropriated in advance. 

In addition, the Committee recommendation includes 

$87,636,650,000 in advance appropriations for fiscal year 2021 for 

the four health care accounts of the Department and 

$129,509,505,000 in advance appropriations for mandatory benefits 

programs for fiscal year 2021. The Committee recommendation provides a total of $421,500,000 

for the four Related Agencies: the American Battle Monuments 

Commission (ABMC), the U.S. Court of Appeals for Veterans 

Claims, Arlington National Cemetery, and the Armed Forces Retirement Home. The recommendation is an increase of 

$175,900,000 over the budget request and $103,845,000 over the 

fiscal year 2019 enacted level. These funds are provided to achieve 

the level of services and facility maintenance that is necessary to 

properly ensure that these agencies are able to continue their missions of honoring the service and sacrifice of our servicemembers 

and Veterans. In addition, the recommendation includes funding 

for planning, design, and construction of the Southern Expansion 

at Arlington National Cemetery, in order to extend the life of the 

cemetery. 

MANAGEMENT AND OVERSIGHT INITIATIVES

The Committee believes the effective stewardship of taxpayer 

dollars is of the highest priority. In the interest of eliminating 

waste, fraud, and abuse in Federal programs, the Committee has 

and will continue to use public hearings, briefings, information requests, and reviews by the Government Accountability Office 

(GAO) and the Inspectors General to promote strong financial and 

program management, oversight and leadership at the Department 

of Defense (DOD), the Department of Veterans Affairs (VA), and 

Related Agencies under the jurisdiction of this bill. 

The fiscal year 2020 appropriations Act and the accompanying 

report address management challenges of the Federal agencies it 

funds, including directives to strengthen financial and program 

management, eliminate redundancy, and improve implementation 

and oversight of initiatives that support the mission of this bill. 

The Committee will use every means at its disposal to reduce mismanagement that results in waste, fraud, and abuse. 

Performance Measures.—The Committee directs each of the agencies funded by this Act to comply with title 31 of the United States 

Code, including the development of their organizational priority 

goals and outcomes such as performance outcome measures, output 

measures, efficiency measures, and customer service measures. 

Customer Service Standards.—The Committee emphasizes the 

importance of implementing proper customer service standards. 

Development of these standards includes providing significant services directly to the public, identifying and surveying target customers, establishing effective service standards and tracking internal performance against those standards. 

Department of Defense Military Family Housing.—Privatized 

housing has come under scrutiny over the last year with complaints of inadequate housing across the DOD enterprise due to 

lack of repairs, rodents, mold, cracks in walls and peeling paint. 

The military housing privatization initiative (MHPI) was estabVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR063.XXX HR063

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lished by Congress in 1996 as a tool to help DOD improve the quality of life for its servicemembers by improving the condition of their 

housing. MHPI is a public/private venture (PPV) where private sector developers may own, operate, maintain, improve and assume 

responsibility for military family housing. The private entity is responsible for managing the construction, renovation, and day-today maintenance and services for the community. The PPV housing 

may be located on or off government property and may be former 

military family housing. DOD has mandated that all military family housing in the United States be eventually privatized. The recommendation includes an additional $140,800,000 within Housing 

Support Costs under Family Housing Operation and Maintenance 

accounts for the Services. The funding is to increase the Services’ 

ability to provide oversight and management, and personnel to 

track current and future issues that may occur in military family 

housing. The Committee also includes report language directing 

DOD to submit various reports and maintain a maintenance database to track any issues that may be prevalent in the future. The 

Committee notes that the general welfare of a servicemember’s 

family contributes to the overall state of readiness for DOD. 

Department of Veterans Affairs (VA).—With the $217,467,894,000 

provided for VA in this bill, the increase in the number of Veterans 

seeking VA medical services, and the transformative initiatives VA 

is undertaking, the Committee believes it is important to strengthen its tools to monitor spending as well as the operating procedures 

of the VA workforce. The following initiatives demonstrate the 

Committee’s oversight focus: 

VA Electronic Health Record Modernization (EHRM).—After at 

least a decade of Congressional encouragement to DOD and VA to 

develop a single electronic health record (EHR), VA has completed 

a contract to acquire the same EHR that DOD is adopting. The bill 

includes $1,603,000,000 for the EHR contract entered in 2018, and 

continues strict quarterly reporting of timelines, performance milestones, costs, implementation, and change management. The bill 

also continues the requirement for GAO to review EHRM implementation so that Congress can be informed of any problems at a 

point where they can be promptly and economically addressed. 

Disability Claims and Appeals.—Thanks to the significant investments Congress has provided over the past eight years, VA has 

been able to hire the staff, acquire the technology, and change work 

processes necessary to reduce the disability claims backlog to an 

‘‘effective’’ zero. But as the number of claims continues to increase 

and the number of appeals skyrockets once claims are decided, VA 

again runs the risk of falling into serious claims and appeals backlogs. The Committee recognizes this threat and provides 

$25,000,000,000 above the Veterans Benefits Administration request to support staff overtime and digital claims scanning. The 

Committee hopes that with this additional investment and the recently passed legislation to reform the appeals process, Congress 

will have taken the necessary management action to prevent Veterans from enduring excessive waits to claim the disability benefits 

they deserve. 

Information Technology (IT).—The Committee continues to include bill language prohibiting obligation or expenditure of funds 

for information technology systems development until VA submits 


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to the Committees a certification of the amounts. 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. 

Stricter Control of Construction Funding.—The Committee continues to request 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 on 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. 

American Battle Monuments Commission (ABMC).—The Committee continues to provide funds to address the maintenance and 

repair needs of the American Battle Monuments around the world. 

The Committee directs ABMC to undertake these efforts in a 

proactive and timely manner, which will ensure that monuments 

do not fall into disrepair and require even greater investments to 

correct. 

Department of Defense Civil Cemeterial Expenses.—The Committee continues to provide $80,800,000 for Arlington National 

Cemetery to maintain current services and ensure that critical operations do not go unaddressed. Additionally, the Committee provides $131,000,000 for the Southern Expansion project, to expand 

cemetery capacity in a timely manner and extend the life of the 

cemetery into the 2050 timeframe. The bill also maintains an Administrative Provision permitting funds from concessions at Army 

National Military Cemeteries to be used to support activities at the 

Cemeteries. 

Armed Forces Retirement Home (AFRH).—The Committee provides increased funding to allow AFRH to address anticipated increases in costs such as personnel costs and contract inflation, as 

well as to address critical capital projects, particularly those affecting the health and safety of residents. This funding will allow 

AFRH to begin work on deferred maintenance projects, ensuring 

that AFRH is well-positioned to continue to improve its standing 

and increase revenue for the long term. The Committee notes efforts that are underway to stabilize the AFRH Trust Fund and reduce reliance on transfers from the General Fund, and directs 

AFRH to continue to make progress in improving AFRH’s sustainability. 


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TITLE I 

DEPARTMENT OF DEFENSE 

MILITARY CONSTRUCTION OVERVIEW

Fiscal year 2019 enacted level (including rescissions) .................... $10,332,000,000 

Fiscal year 2020 budget request ....................................................... 11,241,653,000 

Committee recommendation in the bill (including one rescission) 10,539,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 207,000,000 

Fiscal year 2020 budget request ................................................ (702,653,000) 

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. 

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 DOD to report on various aspects of military construction 

programs, or 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 DOD may seek reprogramming for appropriated increments. 

The reprogramming criteria that applies to military construction 

projects is one percent of the funded amount to include 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 DOD 

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 


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(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. 

Diversion of Military Construction Funds for a Border Wall.—On 

February 15, 2019, President Trump declared a National Emergency to use section 2808 of title 10, United States Code to bypass 

congressional intent and divert valuable military construction funding from previously approved national security projects to fund a 

border wall. Congress chose not to fund this wall in the Consolidated Appropriations Act, 2019 (P.L. 116–6). The Committee notes 

there is bipartisan opposition to the action taken by the President, 

as both the House and Senate voted to disapprove the President’s 

emergency declaration. Despite bipartisan congressional opposition, 

the fiscal year 2020 budget request for military construction included $7,200,000,000 to restore funding (up to $3,600,000,000) 

that would be diverted for the wall as well as provide the next installment of wall funding ($3,600,000,000). The Committee recommendation does not provide these requested funds. Also, the accompanying bill includes language that protects previously appropriated projects, as well as fiscal year 2020 projects included in this 

bill from being used as a source for wall funding. The Committee 

believes that Congress must assert its role as a co-equal branch of 

the Federal government and insist upon the regular appropriation 

of funds—funds this Committee has previously appropriated for 

disaster recovery, flood protection, and military base construction 

projects to maintain and improve military readiness. The Committee believes that military construction dollars should be used 

only for the purpose they are provided, which is to support DOD’s 

mission, servicemembers, and their families. 

Facilities Sustainment, Restoration and Modernization 

(FSRM).—DOD 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, new facilities, and functional conversions must 

be performed as military construction projects. Such projects 

may be done concurrently with repair projects as long as the 


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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. The 

Committee strongly encourages the Services and defense agencies to indicate the plant replacement value of the facility to 

be repaired on each such notification. 

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 over $25,000,000 with the 

form 1391 justification to the congressional defense committees. 

The Committee is concerned that there is an alarming amount of 

unawarded prior-year military construction projects, and therefore 

the Committee directs the Secretary of Defense to report to the 

congressional defense committees quarterly, beginning in the second quarter of fiscal year 2020 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.—The Committee directs DOD 

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, DOD shall 

notify the Committees on Appropriations of both Houses of Congress within seven days of transferring any amount in excess of 

$10,000,000 to or from the Foreign Currency account. 

Bid Savings.—The Committee has ascertained from cost variation notices required by 10 U.S.C. 2853 that DOD has canceled 

two projects that were previously appropriated military construction projects. The Committee’s recommendation, therefore, includes 

a rescission to the Military Construction, Defense-Wide account. 

The Committee directs the Secretary of Defense to continue to submit 1002 reports on military construction bid savings at the end of 

each fiscal quarter to the Subcommittees on Military Construction, 

Veterans Affairs, and Related Agencies 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 

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tion dollars among projects that can be executed in the year of appropriation. Therefore, the Committee recommendation includes 19 

projects that have been incrementally funded; however, the full authorization of the projects will be provided in the fiscal year 2020 

National Defense Authorization Act. 

Impacts of Climate Change and Investing in Multi-Hazard Resilient Defense Infrastructure.—The Committee is concerned by increasing magnitudes and frequencies of environmental shocks (e.g., 

hurricane-force winds, storm surge, and extreme rainfall) and longterm stresses (e.g., from sea level rise) on DOD facilities worldwide. 

Recent extreme weather and natural disasters, for example, Hurricane Michael in 2018 that heavily damaged Tyndall Air Force Base 

in Florida, illustrate the challenges facing DOD in mitigating and 

preparing for inevitable future disasters and improving the security 

and readiness of the Nation’s coastal military installations and the 

safety of military housing. The Committee supports the military’s 

continued focus on building lasting and resilient military installations, including methods that update hurricane-resistant building 

codes for bases, barracks, hospitals, and airfields. It also encourages continued consideration of severe drought and desertification 

as potential threats to military installations and missions. In addition to Department-wide initiatives, such as revised structure planning, conservation programs and modeling new installations with 

the threat of sea-level rise in mind, the Committee encourages 

DOD to prioritize investing in climate-sustainable infrastructure 

projects. Such investments have yielded positive results including 

increased resiliency and cost savings. The Committee urges DOD 

to collaborate with existing research universities with federally 

designated testing facilities to accelerate investments to assess 

DOD installation vulnerabilities at home and abroad and to develop and test resilient infrastructure and technologies capable of 

withstanding 200 mph winds and high levels of storm surge and 

flooding. Furthermore, the Committee directs the Secretary of Defense to report to the congressional defense committees no later 

than 180 days after enactment of this Act detailing DOD’s plans 

to develop lasting and resilient military installations, and what 

year these projects will appear in the Future Years Defense Plan. 

Hawaii Infrastructure Readiness Initiative.—The Committee recognizes the strategic and critical role the Hawaii Infrastructure 

Readiness Initiative (HIRI) plays in DOD’s strategic plans for the 

Indo-Pacific region. At the direction of Congress, United States 

Army Pacific (USARPAC) created the HIRI to address critical priorities established in USARPAC’s military construction submissions and major restoration and maintenance (R&M) programming 

requests. According to the Army’s analysis, 45 percent of the infrastructure in Hawaii is failed or failing, putting efforts to meet operational needs at risk. To fix this crisis, HIRI allocates between 

$50,000,000 and $150,000,000 per year through fiscal year 2030 to 

address major infrastructure needs, with a ten-year cost of 

$1,100,000,000. The program addresses several major facility and 

infrastructure deficiencies, including aviation maintenance facilities, operations facilities, tactical equipment maintenance facilities, 

Pohakuloa Training Area, West Loch Ammunition Storage, and 

base operations. The President’s Budget for fiscal year 2019 included funds for this critical initiative. The fiscal year 2020 budget 


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submission includes the West Loch Ammunition Storage Facility, a 

vital military construction project. Continued and consistent funding is needed at a time of growing national security needs in the 

Pacific. Therefore, the Committee directs the Secretary of the Army 

to certify that the Initiative’s plan for the next 10 fiscal years does 

not create gaps in funding that will result in inconsistent program 

implementation that could undermine the interconnected nature of 

HIRI’s projects. 

Strengthening our Alliances in the Indo-Pacific Area of Responsibility (AOR).—According to the National Defense Strategy, the 

United States is seeking to strengthen our alliances and partnerships in the Indo-Pacific AOR to include a networked security architecture capable of deterring aggression, maintaining stability 

and ensuring free access to common domains. This effort to rebalance toward the Pacific will include significant military construction requirements throughout the Indo-Pacific AOR. Therefore, the 

Committee directs the Service Secretaries to submit a report to the 

congressional defense committees no later than 180 days after enactment of this Act detailing (1) military construction requirements 

in the Indo-Pacific AOR over the next ten years, sorted by fiscal 

year, country and State and (2) efforts to coordinate these requirements across the Services. 

Adequate Childcare for Military Families.—The Committee is 

aware of the importance of helping military families secure adequate childcare for their children. DOD has argued that these 

childcare benefits help support their recruiting, retention and readiness goals, and that there is generally a high level of satisfaction 

among servicemembers who use DOD childcare services. However, 

the success of the program depends, in part, on ensuring adequate 

facilities for child development centers (CDCs) and School Age Care 

(SAC) Program facilities, preferably on military installations. Hearings before the Committee have noted a lack of facilities in some 

locations. Thus, the Committee directs the Service Secretaries to 

submit a report to the congressional defense committees no later 

than 180 days after enactment of this Act detailing (1) all installations that have CDCs and SAC facilities, (2) the physical condition 

of these facilities, and (3) the length of time military families must 

wait before enrolling their children into CDCs and SAC programs. 

Recycling of Tire Rubber.—The Committee is aware of recent advances in the use of waste tire rubber in asphalt, known as rubber 

modified asphalt (RMA), and encourages the Army to engage the 

research community and academia to study the potential benefits 

of rubber modified asphalt and to consider utilizing RMA on domestic military installations. 

Quality of Life (QOL) Projects Priority List.—The Committee 

notes the ongoing challenges that the lack of QOL projects, such as 

the lack of Childcare Development Centers (CDCs), creates a hardship to servicemembers and their families. The Committee is concerned that too often QOL projects are not included in budget submissions and this absence negatively impacts the QOL for 

servicemembers and their families. Given the demanding jobs that 

servicemembers must execute, creating unique solutions is required. The Committee notes that stable family life is a key component to mission readiness and retention. The Committee believes 

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ority amongst the Services. The recommendation includes an additional $11,000,000 in each of the Services’ planning and design accounts to support the Services preparation for construction of new 

CDCs at the most underserved military installation. Therefore, the 

Committee directs the Service Secretaries to submit a report to the 

congressional defense committees no later than 90 days after the 

enactment of this Act that provides a plan to provide address QOL 

shortfalls, with an emphasis on CDCs, and at what installations 

they are most needed for the fiscal year 2020 and in the FYDP. 

The report should include associated funding requirements for 

every installation with an emphasis on CDCs. Further, the Committee directs that the Secretary of Defense to create a unified list 

of needed QOL projects with an emphasis on CDCs across the enterprise which shall be submitted concurrently with the annual 

budget submission hereafter. 

Federally Recognized Tribes.—The Committee notes our Nation’s 

commitment to honoring treaty and trust obligations to Federally 

Recognized Tribes. While military operations and facility protection 

are important, upholding our commitments to Indian Country must 

be an equal priority. It has been observed that DOD has struggled 

to proactively engage with affected Tribes at the start of the planning process to ensure meaningful consultation can occur. Moreover, the Department does not identify sufficient funds to cover 

mitigation and alternatives should they be agreed upon. To understand the scale of this problem, the Committee directs the Secretary of Defense to provide the Committee a list of military construction projects related to mitigation and/or changes to projects 

were required within the past five years where consultation with 

a Federally Recognized Tribe, the outcome of each consultation, a 

list of all project modifications and/or mitigation requests made by 

the Tribe (or Tribes) in question for each project, the cost of each 

measure, and which modifications and or mitigations were adopted 

no later than 180 days after enactment of this Act. 

Securing Mission-Critical Infrastructure.—The Committee is 

aware that DOD is undertaking efforts to secure mission-critical infrastructure through modernization of industrial control systems at 

priority locations. Modernized electrical, mechanical, and hydraulic 

systems can improve energy management and reduce operating 

costs at DOD facilities. However, higher connectivity to these systems exposes exploitable vulnerabilities and increases the threat 

from potential cyberattacks. The Committee directs quarterly reports by DOD beginning in the first quarter of fiscal year 2020 

showing the steps the Department is taking to ensure that industrial control systems in ongoing and future military construction 

projects are secure. 

Other Transaction Authority.—The Committee is aware that the 

use of Other Transaction Authority provides a streamlined acquisition tool to accelerate project delivery. When leveraged appropriately, Other Transaction Authority also gives the Federal government greater access to innovative, state-of-the-art technology solutions from the commercial sector. DOD is encouraged, in consultation with the Corps of Engineers, to expand its use of Other 

Transaction Agreements to execute the Military Construction program. 


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High Performance and Sustainable Building Requirements.—The 

Committee recognizes that innovative technologies, including advanced wood products and recycled aerospace grade carbon fiber 

composite, have expanded the availability of materials with lower 

embodied energy for facilities that require exceptional durability 

and blast resistance. In addition, design techniques such as advanced framing contribute to lower material costs, increased energy 

efficiency, and reduced waste in facilities. Therefore, the Committee directs the Secretary of Defense to continue to utilize innovative renewable building materials, systems, and design techniques that support the requirements of UFC 1 200 02 and UFGS 

06 17 19. Furthermore, the Committee directs the Secretary of Defense to work with universities, public agencies, and experienced 

nonprofit organizations to develop a plan to expand the application 

of these innovative technologies in future military construction 

projects and report to the Committee no later than 90 days after 

enactment of this Act on how the Department will implement the 

plan. 

Defense Access Roads (DAR) Program.—The Committee is supportive of the DAR program as a vital mechanism in providing 

transportation infrastructure to domestic installations and additional funding from DOD for mission-critical, off-base transportation improvements. The Committee notes the expansion of DAR 

for the first time in fiscal year 2019, which made funds available 

to pay the cost of repairing and mitigating damage to infrastructure and highways by recurrent flooding and sea-level fluctuation 

if the Secretary determined that continued access to military installations were affected by flooding and projected sea-level fluctuation. The Services recently reported to Congress that there currently are no flood-prone locations creating a national security risk 

to transportation access for military installations and that DOD 

has the necessary means to address any flooding issues or risks 

(storm or non-storm surge) that may impact DOD missions for 

roads that meet DAR criteria. The Committee understands that 

there are numerous roadways providing transportation access to 

military installations that experience flooding and sea-level fluctuation and expects the Services to work with the local communities 

to certify these public roads that are hampering readiness for the 

military. 

Cyberspace Operations Facilities.—The Committee recognizes the 

importance of secure, up-to-date, and centralized cyberspace operations facilities at military installations because of the crucial role 

they play in securing information technology infrastructure. Therefore, the Secretary of Defense is directed to conduct a review of the 

condition of cyberspace operations facilities at military installations 

and submit the review and a plan to address the issues identified 

in the review by fiscal year to the congressional defense committees 

no later than 180 days after the enactment of this Act. 

HVAC Efficiency.—The Committee recognizes that the Federal 

Acquisition Regulation (48 C.F.R. Subpart 23.8) requires DOD, in 

servicing or replacing existing HVAC systems that use R–22, to 

give preference to alternatives that reduce overall risks to the environment, including stratospheric ozone depletion and global warming potential (GWP). Where feasible, DOD must use R–22 alternatives that have been approved by EPA as acceptable under its 


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Significant New Alternatives Policy (SNAP) program and that have 

lower GWP than R–22. Accordingly, the Committee instructs DOD 

to use such alternatives in servicing or replacing existing HVAC 

systems. The Committee believes that DOD’s replacement of R–22 

with alternatives that have a GWP lower than R–22, and are at 

least as energy efficient, will greatly reduce the overall environmental impacts of DOD operations. 

Access Control Points in Urban Areas.—The Committee supports 

accelerating funding for access control point projects to installations that face high-security risks to critical missions. Priority in 

allocating funds shall be given to access control points in heavily 

congested areas in large urban settings that place major transportation links at risk of incident closures. 

MILITARY CONSTRUCTION, ARMY

Fiscal year 2019 enacted level ........................................................... $1,021,768,000 

Fiscal year 2020 budget request ....................................................... 1,453,499,000 

Committee recommendation in the bill ............................................ 1,132,499,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 110,731,000 

Fiscal year 2020 budget request ................................................ (321,000,000) 

The recommendation includes additional funding for the Army in 

section 124 under Administrative Provisions for projects on the 

Services Unfunded Priority lists as provided by the Office of the 

Secretary of Defense and submitted to Congress in priority order. 

Rapid Deployment Requirements.—The Committee is concerned 

that installations with rapid deployment requirements have insufficient rail and transport logistics infrastructure to efficiently move 

equipment in support of deployments, training operations, and 

evolving Army requirements. For example, Fort Bliss has only one 

railhead connection point for its deployment and redeployment activities. Therefore, the Secretary of the Army is directed to conduct 

a review of rail and transport logistics infrastructure and equipment deployment methods at installations with rapid deployment 

requirements and submit the review and a plan to address the 

issues identified in the review by fiscal year to the congressional 

defense committees no later than 90 days after the enactment of 

this Act. 

Access Control Points.—The Committee is aware that the Army 

has access control points (ACP) at military installations that do not 

meet current design criteria and U.S. Army Corps of Engineers 

standards as noted in House Report 115–673. Unfortunately, these 

concerns have not been addressed. Army installations are still encountering traffic backups, are operating at less than optimal efficiency and are vulnerable to hostile direct action and penetration 

attempts. Replacing an ACP is a military construction project that 

includes several discrete components, such as a visitor control center, gatehouses, canopy areas, guard booths, barriers, and cybersecurity and surveillance systems. Given that upgrading an ACP can 

take several years, the Committee directs the Army to both 

prioritize these important security projects in its construction program and to review the backlog of existing ACP projects to determine which can be accomplished sooner through smaller, incremental components within the minor construction account that 


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would enhance installation security and achieve U.S. Army Corps 

of Engineers Standards. 

Motor Pools.—In order to be able to deploy on command and conduct decisive full-spectrum operations, the Army must have wellmaintained and ready-to-deploy equipment. The readiness of this 

equipment relies on an effective, comprehensive maintenance program, which in turn, enhances and facilitates training and 

warfighting. This is particularly important for units that rely on 

armored vehicles as their primary weapons system. However, quality maintenance requires appropriately designed, sized, supplied, 

and staffed motor pools and maintenance facilities. The Committee 

requests a report on the condition, current and anticipated capacity 

requirements, and modernization needs of motor pools that support 

the rapid deployment of armored combat units within 90 days of 

enactment of this Act. The report should include information on recent upgrades and construction of motor pools, as well as planned 

investments included in the future years defense program. 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

Fiscal year 2019 enacted level ........................................................... $2,118,619,000 

Fiscal year 2020 budget request ....................................................... 2,805,743,000 

Committee recommendation in the bill ............................................ 2,205,771,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 87,152,000 

Fiscal year 2020 budget request ................................................ (599,972,000) 

The recommendation includes additional funding for the Navy 

and Marine Corps in section 124 under Administrative Provisions 

for projects on the Services Unfunded Priority lists as provided by 

the Office of Secretary of Defense and submitted to Congress in priority order. 

Navy Pier Replacement Master Plan.—The Committee is concerned that the Navy has not properly synchronized or prioritized 

pier replacement projects. Many of the current piers are in disrepair or in need of complete replacement. The Committee directs 

the Secretary of the Navy to provide to the congressional defense 

committees a report 90 days after enactment of this Act on pier replacement projects in the fiscal years defense plan for 2021–2025. 

Major Range and Test Infrastructure.—The Committee is aware 

of significant infrastructure and upgrades that are needed across 

the enterprise of Major Range and Test Facility bases (MRTFB) of 

the Department of Defense. Many MRTFBs have significant backlogs in infrastructure needs because they do not score well in the 

military construction prioritization process. The Committee is concerned that as new technologies are tested, there are not adequate 

facilities that will allow for successful testing, like with hypersonic 

weapons and other emerging technologies. Additionally, the Committee notes that DOD has not provided to the congressional defense committees an annual report, as required by section 2806 of 

the National Defense Authorization Act for Fiscal Year 2018, (P.L. 

115–91), on DOD laboratory construction needs. The Committee is 

also aware of a specific backlog of construction projects at Naval 

Air Station (NAS) Patuxent River. NAS Patuxent River has been 

pivotal in testing many new systems that support the fleet. The 

Aircraft Prototype Facility has enabled aircraft preparation and 

technology support to permit full-scale fabrication of advanced 


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structures. The third and final phase would directly support the 

Navy’s emphasis on rapid prototyping consistent with Maritime Accelerated Capabilities Office to capture innovation and speed solutions to the warfighters. The Navy expects that the facility is needed given current capacity constraints. The Committee is also aware 

that significant upgrades are needed to the Webster Outlying Field 

(WOLF) Air Traffic Control (ATC) tower to enable basic operational 

needs for the Navy test pilot program and UAV platforms. The current ATC was constructed in 1978 and needs urgent replacement. 

The Navy has included these projects in their FYDP. The Committee urges the Navy to keep these projects, as planned, and more 

broadly, better address the broader infrastructure needs at 

MRTFBs. 

The Strategic and Critical Role of Public Shipyards.—The Committee recognizes the strategic and critical role our public shipyards play in the national security of our Nation. However, our 

shipyards are in direct need of maintenance and upgrade. The National Defense Authorization Act for Fiscal Year 2018, (P.L. 115– 

91) included language directing DOD to create a Shipyard Infrastructure Optimization Plan. This plan included recommendations 

and future year projects that would help to restore our public shipyards to support our fleet around the world. The Committee directs 

the Secretary of Defense no later than 180 days after enactment of 

this Act to submit to congressional defense committees a prioritized 

list of projects to be constructed under the Shipyard Infrastructure 

Optimization Plan necessary for national security requirements 

over the next ten years. 

MILITARY CONSTRUCTION, AIR FORCE

Fiscal year 2019 enacted level ........................................................... $1,440,323,000 

Fiscal year 2020 budget request ....................................................... 2,179,230,000 

Committee recommendation in the bill ............................................ 1,588,730,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 148,407,000 

Fiscal year 2019 budget request ................................................ (590,500,000) 

The recommendation includes additional funding for the Air 

Force in section 124 under Administrative Provisions for projects 

on the Services Unfunded Priority lists as provided by the Office 

of the Secretary of Defense and submitted to Congress in priority 

order. 

F–35 Beddown and 21st Century Installation.—The current estimate for F–35 beddown at Tyndall Air Force Base is $350,000,000. 

It is the understanding of the Committee that the Air Force is still 

determining what additional facilities would be required for the additional three squadrons. The Committee believes that it would not 

be prudent to have 5th generation air assets like the F–35 housed 

in inappropriate hangars that fail to protect the aircraft from the 

elements. Therefore, the Committee directs the Air Force to provide 

a detailed timeline by fiscal year, location and costs of necessary 

facilities, including estimates for hurricane-related military construction at Tyndall Air Force Base and the F–35 aircraft delivery 

timeline, by base to the congressional defense committees no later 

than 60 days after enactment of this Act. 

F–22 Rebasing.—Hurricane Michael caused catastrophic damage 

to the Tyndall Air Force Base and dislocated the 43rd Fighter 


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Squadron. It is the understanding of the Committee that the Air 

Force has the opportunity to restructure F–22 Raptor rebasing for 

long-term health and readiness. The current estimate for the relocation of F–22s is $150,000,000 for additional facilities required at 

existing F–22 bases to support the formal training unit and operational squadron. The Committee directs the Secretary of the Air 

Force to provide by cost, location and fiscal year the necessary military construction projects no later than 60 days after enactment of 

this Act. 

Air Traffic Control Towers.—The Committee is concerned that 

the Department of the Air Force’s ATC Towers have been neglected 

over the years, and funding for military construction has been deferred to the out years of budget submissions. Many of the air towers are deteriorating and antiquated, creating significant life, safety, and health concerns. In some cases, towers have developed extensive mold issues and contain health risks related to the use of 

asbestos and lead-based paint. Additionally, obstructed views in 

some cases prevent 100 percent positive visual control of aircraft 

landing and taxiing on the airfield. The Committee urges the Department of the Air Force to prioritize funding for these towers in 

a much timelier manner. The Committee believes that these towers 

are valuable national security assets that the Department of the 

Air Force should maintain in a manner that will ensure their vital 

role in protecting United States national security interests. 

Air Force Dormitories.—The Committee is concerned with the 

condition of dormitories at numerous Air Force bases around the 

country, especially at those in cities with large military populations. The Committee, therefore, directs the Secretary of the Air 

Force to submit a report to the congressional defense committees 

detailing the process and formulas it uses to prioritize its infrastructure renovation and upgrade projects no later than 60 days 

after enactment of this Act. 

Offutt Air Force Base.—The Committee continues to have concerns on the impacts of recent flooding at Offutt Air Force Base. 

The Committee is committed to ensuring United States Strategic 

Command, the 55th Wing, and the Nebraska National Guard receive the necessary funding to return Offutt Air Force Base to fully 

mission capable. The unique facilities and assets at Offutt Air 

Force Base are a cornerstone of our national security and provide 

many one-of-a-kind capabilities, thereby guaranteeing the Nation’s 

airborne intelligence gathering superiority, survivable nuclear command and control, and the effectiveness of our strategic deterrent. 

Air Education and Training Command (AETC).—The Committee 

recognizes the importance of adequate facilities for basic military 

training, flying training, and the other training missions of the 

AETC. Outdated and inadequate AETC facilities, including dormitories, harm the Department of the Air Force’s ability to recruit, 

train, and retain Airmen and increase operations and maintenance 

costs. The Committee urges the Department of the Air Force to 

prioritize funding for AETC facility design, construction, and construction improvements because of the critical role training plays 

in force readiness for future threats to U.S. national security. 

Air Education and Training Command Drainage Projects.—The 

Committee recognizes the adverse impact that flooding and other 

infrastructure challenges have had on AETC facilities, equipment, 


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operations, and training. The Committee also recognizes the steps 

that the Air Force has taken to begin mitigating the damage 

through multi-year projects. The Committee supports these efforts 

and urges the Secretary of the Air Force to prioritize these projects. 

MILITARY CONSTRUCTION, DEFENSE-WIDE

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2019 enacted level ........................................................... $2,550,728,000 

Fiscal year 2020 budget request ....................................................... 2,504,190,000 

Committee recommendation in the bill ............................................ 2,025,799,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (524,929,000) 

Fiscal year 2020 budget request ................................................ (478,391,000) 

Transfer of Funds.—The accompanying bill provides transfer authority to the Secretary of Defense to allow the transfer of funds 

to such appropriations of DOD available for military construction 

or family housing as the Secretary may designate. The recommendation includes a reduction of $10,000,000 from 

the contingency construction account. The recommendation includes a rescission of $45,055,000 from 

unobligated balances in section 125 under Administrative Provisions. 

Excess Inventory of Infrastructure.—The Committee recognizes 

the issue of excess inventory within DOD and encourages the Department to consider a Military Installation Savings Commission 

(MISC). This would create a focus on integrating and consolidating 

functions, outsourcing services, assisting in the transition of 

underused facilities to higher economic use, and provision of the 

necessary resources for successful outcomes in affected communities. 

Investment in Renewable Energy Systems.—The Committee supports the military’s continued investment in renewable energy systems, including the use and application of solar energy for mobility 

and resilience capabilities at defense military installations including military bases, barracks, hospitals, and airfields. Such investments have yielded positive results such as increased resiliency 

and cost-savings. The Committee encourages DOD to prioritize 

funding for renewable energy-related projects, including solar, to 

mitigate risk to mission-critical assets and to promote energy security and efficiency at military installations. Accordingly, the Committee requests a report no later than 180 days after enactment of 

this Act detailing DOD’s plans for further development of renewable energy systems at military installations and a timeline and 

goals for increased utilization. 

Natural Disasters and Military Installations Resiliency.—The 

Committee supports the military’s continued focus on building lasting and resilient military installations, including methods that update hurricane-resistant building codes for bases, barracks, hospitals, and airfields. It further considers the impact of severe 

drought and desertification as high potential instability areas and 

how these two hazards impact bases and missions. In addition to 

Department-wide initiatives such as revised structure planning, 

conservation programs and modeling new installations with the 

threat of sea-level rise in mind, the Committee encourages DOD to 

prioritize investing in climate-sustainable infrastructure projects. 


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Such investments have yielded positive results like increased resiliency and cost-savings. Accordingly, the Committee requests a report no later than 180 days after enactment of this Act detailing 

DOD’s plans to further develop lasting and resilient military installations. 

Energy Conservation.—The Committee commends DOD’s forward 

posture on the need to improve energy resilience, improve mission 

assurance, save energy, and reduce energy costs. DOD must continue to increase the integration of alternative energy sources, particularly through renewable sources, throughout military facilities 

and installations. Energy resilience is critical to mission assurance 

for military units that perform cyber and intelligence, surveillance, 

and reconnaissance functions, missions vitally important to America’s complex global engagements. The Committee directs the Secretary of Defense to provide a report no later than 90 days after 

enactment of this Act on DOD’s strategy to increase energy conservation efforts and on energy cost savings, improved unit readiness, and opportunities for return on investments of existing and 

planned projects. 

Rhine Ordnance Barracks Medical Center Replacement.—The 

Committee fully understands the strategic importance of this hospital. In the Consolidated Appropriations Act, 2018 (P.L. 115–141) 

the Committee directed the Director of the Defense Health Agency 

to report to the congressional defense committees: (1) specific 

changes in German energy law that affected the energy study; (2) 

what United States sources of energy the new German energy laws 

incorporate; (3) what United States sources are no longer able to 

be used in Germany; (4) what effect the changes in law have on 

other military construction projects, construction costs and current 

utilities contracts in the region; and (5) what effect this delay may 

have on other aspects of the Rhine Ordnance Barracks Medical 

Center Replacement Project. In addition to this requirement, the 

Committee directed the Director of the Defense Health Agency to 

provide to the congressional defense committees (1) an updated 

form 1391 to include a WIP curve; (2) the total amount of funding 

for the utility plant that is within the military construction program; and (3) a list of other of appropriations, if any, that are being 

used for utility costs. This report has not yet been received by the 

Committee. In addition to the prior reporting requirement, the 

Committee directs the Director of the Defense Health Agency to 

provide the total amount of funding that has been obligated of the 

$50,095,000 requested in the original form 1391 for the central utility plant and the percentages of Russian-exported natural gas and 

domestically-sourced natural gas that will be used at the utility 

plant no later than 90 days after enactment of this Act. We need 

to ensure our military installations are not compromised, as well 

as ensure energy security through diversification of fuel sources. 

DOD Installation Energy Policy.—DOD installation energy use 

accounts for nearly a quarter of all Federal government energy consumption. In fiscal year 2015, according to DOD’s Annual Energy 

Management Report, the Department spent $3,900,000 on installation energy. While DOD has made great strides in increasing installation energy efficiency and reducing overall energy consumption, more needs to be done to bring down the energy costs 

throughout the Department. DOD must also ramp up its efforts to 


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enhance energy security on its installations through a range of actions, including investing in renewable energy and smart technology that can shield mission-critical operations from disruptions 

to the power grid. According to a January 2017 report commissioned by the Pew Charitable Trusts (Power Begins at Home: Assured Energy for U.S. Military Bases), DOD could enhance energy 

security on installations and save hundreds of millions of dollars 

annually by investing in microgrids and renewable energy systems, 

and by increasing energy efficiency on military bases. The report 

found that microgrid power systems are more reliable than the 

stand-alone diesel generators typically used for backup power and 

could save $8,000,000 to $20,000,000 over a 20-year period. The report also found that DOD could save as much as $1,000,000,000 a 

year simply by increasing the use of commercially available energy 

efficiency measures in its facilities. The Committee notes that military installations in Hawaii are among those at the forefront of 

DOD’s efforts to increase energy efficiency and security, including 

projects to develop net-zero energy military housing and installation facilities, upgrade and retrofit systems to improve energy and 

water efficiency and demonstrate microgrid technology. The Committee supports DOD’s investments in energy efficiency, renewable 

energy systems, and energy security, and provides $190,000,000 for 

the Energy Resilience and Conservation Program, an increase of 

$40,000,000 above the request. 

Information Technology Infrastructure for Military Construction 

Projects.—In the fiscal year 2019 conference agreement, the Committee directed the Secretary of Defense to report to the Committee 

no later than 60 days after enactment on how the Department is 

incorporating technology advancements and working with industry 

partners to gain efficiencies and savings on military construction 

projects. The Committee directs the Secretary to provide a status 

on the fiscal year 2019 directive. 

MILITARY CONSTRUCTION, ARMY NATIONAL GUARD

Fiscal year 2019 enacted level ........................................................... $190,122,000 

Fiscal year 2020 budget request ....................................................... 210,819,000 

Committee recommendation in the bill ............................................ 210,819,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 20,697,000 

Fiscal year 2020 budget request ................................................ – – – 

The recommendation includes additional funding for the Army 

National Guard in section 124 under Administrative Provisions for 

projects on the Services Unfunded Priority lists as provided by the 

Office of the Secretary of Defense and submitted to Congress in priority order. 

Army National Guard Readiness Centers Investment.—The Committee remains concerned by the failure of the Army to prioritize 

investment in Army National Guard Readiness Centers. These facilities are critical infrastructure in the protection of the homeland 

and in responding to domestic emergencies. Their deteriorating 

conditions are detrimental to the readiness of the Army Guard and 

present significant safety concerns. The Committee encourages the 

Army to accelerate investments in Readiness Centers within the 

fiscal year 2020 FYDP to include the $1,200,000,000 for the Army 

National Guard Transformation Plan. 


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MILITARY CONSTRUCTION, AIR NATIONAL GUARD

Fiscal year 2019 enacted level ........................................................... $129,126,000 

Fiscal year 2020 budget request ....................................................... 165,971,000 

Committee recommendation in the bill ............................................ 115,971,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (13,155,000) 

Fiscal year 2020 budget request ................................................ (50,000,000) 

The recommendation includes additional funding for the Air National Guard in section 124 under Administrative Provisions for 

projects on the Services Unfunded Priority lists as provided by the 

Office of the Secretary of Defense and submitted to Congress in priority order. 

Puerto Rico Construction.—The Committee is concerned that the 

Department has yet to obligate supplemental funding provided by 

Congress to assist Puerto Rico in recovering from the devastating 

Hurricane Maria. The Committee believes hurricane-related damage should be addressed prior to new construction, and as such, the 

recommendation does not include funding for Air National Guard 

projects at the Luis Munoz-Marin International Airport. However, 

the Committee expects the Department to submit these projects for 

consideration in the future. 

Dannelly Field Environmental Impact Statement (EIS) and 

Record of Decision (ROD).—The Committee encourages the Department to maintain its schedule for finalizing the EIS and ROD for 

Dannelly Field and to ensure future projects are not delayed. 

MILITARY CONSTRUCTION, ARMY RESERVE

Fiscal year 2019 enacted level ........................................................... $64,919,000 

Fiscal year 2020 budget request ....................................................... 60,928,000 

Committee recommendation in the bill ............................................ 60,928,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (3,991,000) 

Fiscal year 2020 budget request ................................................ – – – 

MILITARY CONSTRUCTION, NAVY RESERVE

Fiscal year 2019 enacted level ........................................................... $43,065,000 

Fiscal year 2020 budget request ....................................................... 54,955,000 

Committee recommendation in the bill ............................................ 54,955,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 11,890,000 

Fiscal year 2020 budget request ................................................ – – – 

MILITARY CONSTRUCTION, AIR FORCE RESERVE

Fiscal year 2019 enacted level ........................................................... $38,063,000 

Fiscal year 2020 budget request ....................................................... 59,750,000 

Committee recommendation in the bill ............................................ 59,750,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 21,687,000 

Fiscal year 2020 budget request ................................................ – – – 

The recommendation includes additional funding for the Air 

Force Reserve in section 124 under Administrative Provisions for 

projects on the Services Unfunded Priority lists as provided by the 

Office of the Secretary of Defense and submitted to Congress in priority order. 

Air Force Reserve Hangars.—The Committee is concerned that 

many of the Air Force Reserve hangars that were damaged during 

the record-breaking 2017 hurricane season are unsafe, antiquated, 


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and do not provide adequate protection of Air Force Reserve air assets. For example, hangars located at Homestead Air Reserve Base 

have become wholly inadequate due to constrained military construction budgets and devastating storm damage and are putting 

equipment and air assets at risk. The Committee is concerned that 

this could be a problem throughout the Air Force Reserve enterprise with the recent reductions to DOD’s construction accounts. 

Therefore, the Secretary of the Air Force is directed to conduct a 

risk assessment on Air Force Reserve hangars damaged by natural 

events throughout the Air Force Reserve enterprise and develop a 

plan to update these facilities in the fiscal years 2021–2025 FYDP. 

This assessment shall be submitted to the congressional defense 

committees no later than 60 days after enactment of this Act. 

NORTH ATLANTIC TREATY ORGANIZATION SECURITY INVESTMENT

PROGRAM

Fiscal year 2019 enacted level ........................................................... $171,064,000 

Fiscal year 2020 budget request ....................................................... 144,040,000 

Committee recommendation in the bill ............................................ 172,005,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 941,000 

Fiscal year 2020 budget request ................................................ 27,965,000 

The North Atlantic Treaty Organization Security Investment 

Program (NSIP) consists of annual contributions by NATO member 

countries. The program finances the costs of construction needed to 

support the roles of the major NATO commands. The investments 

cover facilities such as airfields, fuel pipelines and storage, harbors, 

communications and information systems, radar and navigational 

aids, and military headquarters, both within NATO Nations and 

for ‘‘out of area’’ operations such as Afghanistan. 

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. 

The recommendation includes an increase of $27,965,000 for the 

NATO Security Investment Program (NSIP) for fiscal year 2020 to 

continue to assure our partner Nations and provide support against 

Russian aggression. 

DEPARTMENT OF DEFENSE BASE CLOSURE ACCOUNT

Fiscal year 2019 enacted level ........................................................... $342,000,000 

Fiscal year 2020 budget request ....................................................... 278,526,000 

Committee recommendation in the bill ............................................ 398,526,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 56,526,000 

Fiscal year 2020 budget request ................................................ 120,000,000 

The recommendation provides an additional $60,000,000 for the 

Navy to accelerate environmental remediation at installations 

closed under previous Base Closure and Realignment rounds. Furthermore, the Navy shall provide to the Committee a spend plan 

for these additional funds no later than 60 days after enactment 

of this Act. 


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Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid 

(PFOA).—The Committee is concerned about the extent of PFOS/ 

PFOA contamination at United States military installations. While 

this bill only covers military installations funded through the Base 

Realignment and Closure (BRAC) account that are affected by 

PFOS/PFOA, the issue is not limited to the Defense Department 

and affects many communities across the Nation. The Committee 

is encouraged by the Environmental Protection Agency’s (EPA) announced plan to evaluate the need for a maximum contaminant 

level, as provided by the Safe Drinking Water Act, as well as designate these chemicals as hazardous substances under the Comprehensive Environmental Response, Compensation, and Liability 

Act, and urges the Department and affected communities to work 

closely with EPA. The Committee directs the Department to keep 

it apprised of new findings of PFOS/PFOA at BRAC sites and provides additional funds in this bill for the continued review of sites 

contaminated by PFOS/PFOA. Furthermore, the recommendation 

provides an additional $60,000,000 above the budget request to address PFOS and PFOA cleanup. 

FAMILY HOUSING OVERVIEW

Fiscal year 2019 enacted level ........................................................... $1,582,632,000 

Fiscal year 2020 budget request ....................................................... 1,324,002,000 

Committee recommendation in the bill ............................................ 1,464,802,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 117,830,000 

Fiscal year 2020 budget request ................................................ 140,800,000 

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 Support Costs.—The recommendation includes an additional $140,800,000 within Housing Support Costs under Family 

Housing Operation and Maintenance accounts for the Services. The 

additional funds were identified by the Services on the Unfunded 

Priority list submitted to Congress by the Service Secretaries. The 

funding is to increase the Services’ ability to provide oversight and 

management, and personnel to track current and future issues that 

may occur in military family housing. 

Military Privatized Housing.—The Committee is concerned about 

the ability of the Department to readily assess the quality of its 

privatized housing. The quality of military housing is a key component of military readiness and quality of life. The National Defense 

Authorization Act for Fiscal Year 1996 (P.L. 104–106) allowed DOD 

to work with the private sector to build and renovate military housing. The Committee’s oversight work has identified potentially unsafe conditions at privatized military housing throughout the Nation, ranging from electrical issues to mold, which undermines the 

congressionally-authorized privatized housing initiative. The Committee urges DOD to work with the private contractor management 

companies to prioritize funding for mold remediation in military 

housing in a timelier manner. The Committee believes that the 


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health of our servicemembers is of the utmost importance, and substandard living conditions negatively impact the ability to recruit 

and retain servicemembers, to the detriment of United States national security interests. In addition, DOD had to conduct extensive 

work to obtain an overview status report about these facilities since 

they do not feed into standard defense installations systems. Further, the Committee directs the Service Secretaries to submit a report to the congressional defense committees no later than 180 

days after enactment of this Act detailing (1) how the Services 

monitor privatized facilities at a national level and (2) any planned 

upgrades to this system to improve transparency. 

Privatized Housing-Safety and Health Threat Reporting.—The 

Committee expects DOD and the Services to establish and maintain procedures for ensuring response and remediation efforts to 

safety and health threats in military housing managed by private 

sector property management companies. The Committee expects 

privatized housing companies chosen by the Department to be 

knowledgeable, professionally trained, and capable of performing 

the proper response for the safety and health threats. The Services 

should constantly review the competency of repair personnel and 

contractors. The Committee notes that military personnel and family members are by their very nature temporary tenants of base 

housing. They are often not in a particular housing unit or building 

long enough to undertake a lengthy administrative process with a 

landlord. Rather than relying on the temporary tenants for much 

of the overall oversight of the safety and health aspects of 

privatized base housing, the Committee believes that the Services 

must fully shoulder this responsibility as the only reliable, longterm stewards of living standards in privatized base quarters. The 

Committee also urges DOD to take the necessary steps to ensure 

that families who have suffered as a result of negligent maintenance that resulted in issues such as mold, asbestos, radon, faulty 

electrical wiring, rodent and insect infestations, gas leaks and 

other safety and health threats are made whole when there has 

been failure of performance by contractors. Additionally, the Committee directs DOD to take immediate action when servicemembers 

or base housing residents experience the onset of physical or mental ailments, or disabilities caused or suspected to be caused by 

negligent property maintenance and management. Furthermore, 

the Committee directs DOD and the Services to establish and 

maintain procedures for tenant reporting of safety and health 

threats in military family housing managed by private contractors, 

that include the following: (1) active outreach on how to file a complaint or make a maintenance request, (2) a record-keeping and reporting system of housing complaints and maintenance requests 

that are reviewable by Department leadership and available to 

Members of Congress upon request, and (3) provide the annual reports regarding the status of remediation requests and efforts acted 

upon by private contractors, and should be reviewable by base commanders, DOD leadership, and submitted to the congressional defense committees annually. 

Tenant Rights.—The Committee is aware that DOD is creating 

a process to assist servicemembers with their tenant rights while 

living in base housing, and simultaneously renegotiating department leases with private housing providers. The Committee directs 


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the Department to provide a report no later than 60 days after enactment of this Act, and then every quarter, regarding the status 

of the tenant contracts, leases with private housing providers and 

overall implementation measures that were taken to improve quality of housing for servicemembers. 

Foreign Currency Savings and Sub-Account Transfers.—The 

Committee directs that savings in family housing operation and 

maintenance accounts from foreign currency re-estimates be used 

to maintain and repair existing family housing units. The Comptroller is directed to report to the Committees on Appropriations of 

both Houses of Congress on how these savings are allocated 90 

days after enactment of this Act. In addition, the Committee directs the Services and Defense agencies to notify the Committees 

on Appropriations of both Houses of Congress within 30 days of a 

transfer of funds between sub-accounts within the family housing 

construction and family housing operation and maintenance accounts, if such transfer is in excess of 10 percent of the funds appropriated to the sub-account to which the funds are being transferred. Notifications to the Committees shall indicate the sub-accounts and amounts that are being used to source the transfer. 

Leasing Reporting Requirements.—The Secretary of Defense is directed to report to the Committees on Appropriations of both 

Houses of Congress quarterly on the details of all new or renewed 

domestic leases entered into during the previous quarter that exceeds the cost threshold set by 10 U.S.C. 2828(b)(2), including certification that less expensive housing was not available for lease. 

For foreign leases, the Department is directed to (1) perform an 

economic analysis on all new leases or lease/contract agreements 

where more than 25 units are involved; (2) report the details of 

new or renewed lease agreements that exceed the cost threshold 

set by 10 U.S.C. 2828(e)(1) 21 days before entering into such an 

agreement; and (3) base leasing decisions on the economic analysis. 

FAMILY HOUSING CONSTRUCTION, ARMY

Fiscal year 2019 enacted level ........................................................... $330,660,000 

Fiscal year 2020 budget request ....................................................... 141,372,000 

Committee recommendation in the bill ............................................ 141,372,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (189,288,000) 

Fiscal year 2020 budget request ................................................ – – – 

FAMILY HOUSING OPERATION AND MAINTENANCE, ARMY

Fiscal year 2019 enacted level ........................................................... $376,509,000 

Fiscal year 2020 budget request ....................................................... 357,907,000 

Committee recommendation in the bill ............................................ 407,907,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 31,398,000 

Fiscal year 2020 budget request ................................................ 50,000,000 

FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS

Fiscal year 2019 enacted level ........................................................... $104,581,000 

Fiscal year 2020 budget request ....................................................... 47,661,000 

Committee recommendation in the bill ............................................ 47,661,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (56,920,000) 

Fiscal year 2020 budget request ................................................ – – – 


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FAMILY HOUSING OPERATION AND MAINTENANCE, NAVY AND

MARINE CORPS

Fiscal year 2019 enacted level ........................................................... $314,536,000 

Fiscal year 2020 budget request ....................................................... 317,870,000 

Committee recommendation in the bill ............................................ 377,470,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 62,934,000 

Fiscal year 2020 budget request ................................................ 59,600,000 

FAMILY HOUSING CONSTRUCTION, AIR FORCE

Fiscal year 2019 enacted level ........................................................... $78,446,000 

Fiscal year 2020 budget request ....................................................... 103,631,000 

Committee recommendation in the bill ............................................ 103,631,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 25,185,000 

Fiscal year 2020 budget request ................................................ – – – 

FAMILY HOUSING OPERATION AND MAINTENANCE, AIR FORCE

Fiscal year 2019 enacted level ........................................................... $317,274,000 

Fiscal year 2020 budget request ....................................................... 295,016,000 

Committee recommendation in the bill ............................................ 326,216,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 8,942,000 

Fiscal year 2020 budget request ................................................ 31,200,000 

FAMILY HOUSING OPERATION AND MAINTENANCE, DEFENSE-WIDE

Fiscal year 2019 enacted level ........................................................... $58,373,000 

Fiscal year 2020 budget request ....................................................... 57,000,000 

Committee recommendation in the bill ............................................ 57,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (1,373,000) 

Fiscal year 2020 budget request ................................................ – – – 

DEPARTMENT OF DEFENSE FAMILY HOUSING IMPROVEMENT FUND

Fiscal year 2019 enacted level ........................................................... $1,653,000 

Fiscal year 2020 budget request ....................................................... 3,045,000 

Committee recommendation in the bill ............................................ 3,045,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 1,392,000 

Fiscal year 2020 budget request ................................................ – – – 

DEPARTMENT OF DEFENSE MILITARY UNACCOMPANIED HOUSING

IMPROVEMENT FUND

Fiscal year 2019 enacted level ........................................................... $600,000 

Fiscal year 2020 budget request ....................................................... 500,000 

Committee recommendation in the bill ............................................ 500,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (100,000) 

Fiscal year 2020 budget request ................................................ – – – 

Administrative Provisions 

The bill retains 27 provisions that were in effect in fiscal year 

2019. The administrative provisions included in the bill are as follows: 

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. 


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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 within the Central Command area of responsibility, 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 supervision for any project being 

completed with lapsed funds. 

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. 


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(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 $15,000 per year 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. 

(INCLUDING TRANSFER OF FUNDS)

The bill includes section 122 allowing the transfer of funds 

among projects and activities in accordance with the reprogramming guidelines. 

The bill includes section 123 prohibiting the use of funds for 

projects at Arlington National Cemetery. 

The bill includes section 124 providing additional funds for various military construction accounts and requires a spend plan for 

each. 

(RESCISSION OF FUNDS)

The bill includes section 125 rescinding funds from prior appropriations Acts. 

The bill includes section 126 defining the congressional defense 

committees. 

The bill includes section 127 directing all amounts appropriated 

to Military Construction (all accounts) be immediately available 

and allotted for the full scope of the authorized project. 

TITLE II 

DEPARTMENT OF VETERANS AFFAIRS 

Fiscal year 2019 enacted level 1 (Including one rescission) ........ $197,190,593,000 

Fiscal year 2020 budget request 1 ................................................. 216,148,394,000 

Committee recommendation in the bill 1 (Including one rescission) .............................................................................................. 217,467,894,000 

Comparison with: 

Fiscal year 2019 enacted ........................................................ 20,277,301,000 

Fiscal year 2020 budget request ............................................ 1,319,500,000 

Fiscal year 2021 advance budget request ..................................... 217,146,155,000 

Fiscal year 2021 Committee recommendation in the bill ........... 217,146,155,000 

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

The Department of Veterans Affairs (VA) serves approximately 

41,350,000 people—19,500,000 Veterans and 23,900,000 family 

members and dependents who may be eligible for certain VA benefits. To serve adequately the Nation’s Veterans, VA employs more 

than 377,000 people, making it one of the largest federal agencies 

in terms of employment. 


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VETERANS BENEFITS ADMINISTRATION (VBA) 

COMPENSATION AND PENSIONS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2020 enacted level ....................................................... $109,017,152,000 

Fiscal year 2021 advance budget request ..................................... 116,801,316,000 

Fiscal year 2021 Committee recommendation in the bill ........... 116,801,316,000 

Comparison with: 

Fiscal year 2020 enacted level ............................................... 7,784,164,000 

Fiscal year 2021 budget request ............................................ – – – 

This appropriation will provide funds for service-connected compensation payments to an estimated 5,477,000 Veterans, survivors, 

and dependents in 2020. In addition, pension payments will be 

funded for 444,000 Veterans and their survivors. The average payment per compensation case for Veterans in 2020 is estimated at 

$18,883 and pension payments are projected at $13,619. 

The appropriation includes authority to transfer funding not to exceed $18,147,000 in 2021 to General Operating Expenses, Veterans Benefits Administration 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). These cost-saving provisions include verifying pension income against Internal Revenue Service 

(IRS) and Social Security Administration (SSA) data; establishing 

a match with SSA to obtain verification of Social Security numbers; 

and applying the VA pension cap for Medicaid-eligible single Veterans and surviving spouses alone in Medicaid-covered nursing 

homes. 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. 

Performance Measures.—Based on the findings of the Government Accountability Office (GAO) report entitled, ‘‘Better Measures 

Needed to Assess Regional Office Performance in Processing 

Claims’’ (GAO 19–15), the Committee directs the Under Secretary 

for Benefits to: (1) implement a new measure to assess regional offices’ performance and accuracy to better target resources to lowperforming offices; (2) clarify how Veterans Services Representatives should handle claims when they identify an error; (3) evaluate 

its policy for regional office communication with Veterans Service 

Organizations (VSOs) to ensure that it is clear, that it aligns with 

practice, and that it meets the communication needs of VSOs; and 

(4) develop and implement a mechanism to obtain periodic feedback 

from congressional caseworkers on their communication with regional offices regarding claims and needed information or support. 

The Committee requests a report on the Department’s efforts no 

later than 60 days after enactment of this Act. 

Pro-bono Legal Services.—The Committee recognizes an unmet 

need for holistic programs that offer pro-bono legal services to Veterans and their dependents. The Committee acknowledges existing 

VA initiatives that guide Veterans during benefit-related interactions with administrative agencies and believes that public landVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00029 Fmt 6659 Sfmt 6602 E:\HR\OC\HR063.XXX HR063

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grant university law schools are suited to complement existing 

agency efforts in underserved areas. 

READJUSTMENT BENEFITS

Fiscal year 2020 enacted level ....................................................... $14,065,282,000 

Fiscal year 2021 advance budget request ..................................... 12,578,965,000 

Fiscal year 2021 Committee recommendation in the bill ........... 12,578,965,000 

Comparison with: 

Fiscal year 2020 enacted level ............................................... (1,486,317,000) 

Fiscal year 2021 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. Supplemental 

education benefits are also provided to certain Veteran members of 

the Selected Reserve and are funded through transfers from DOD. 

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. Almost 80 percent of the funds in the account support the Post-9/11 

GI Bill. 

VetSuccess on Campus (VSOC).—The Committee recognizes the 

tremendous value of counseling in assisting the transition of Veterans from military service to academic life. Therefore, the Committee encourages VBA to continue to expand the availability of 

services through the VSOC program to additional sites, with particular attention to geographic regions without current access to 

VSOC programs. 

Transition Coordination.—The Committee believes that VA, in 

consultation with the Departments of Labor and Defense, should 

further coordinate efforts and resources to ensure Veterans have a 

successful transition to civilian life. This includes sharing information on community resources, including nonprofits and VSOs, that 

are available to the Veteran and their family as they depart the 

service. The Committee also urges the Secretary to use the Veteran 

treatment courts system to educate Veterans on job training and 

small business services offered by the Department (and in partnership with the Small Business Administration and the Department 

of Labor). 

Gender-Specific Women Veteran Case Management.—The Committee recognizes traditional Veteran services were primarily designed for men and do not always meet the needs of women Veterans. Women Veterans struggling with the acclimation to civilian 

and community life often find themselves in at-risk circumstances 

that may differ from those of men, and therefore women Veterans 

require specialized interventions and programming. The Committee 

encourages the Department to work with the Department of Defense and the Department of Labor to provide robust gender-specific case management services for women Veterans transitioning 

from military service. 


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VETERANS INSURANCE AND INDEMNITIES

Fiscal year 2020 enacted level ........................................................... $111,340,000 

Fiscal year 2020 budget year request ............................................... 17,620,000 

Fiscal year 2020 budget year Committee recommendation in the 

bill .................................................................................................... 17,620,000 

Fiscal year 2021 advance budget request ......................................... 129,224,000 

Fiscal year 2021 Committee recommendation in the bill ............... 129,224,000 

Comparison with: 

Fiscal year 2020 enacted level ................................................... 17,884,000 

Fiscal year 2021 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. 

The amount provided will enable the Department to transfer 

funding to the service-disabled Veterans insurance fund and transfer additional amounts for payments for policies under the Veterans mortgage life insurance program. These policies are identified under the Veterans Insurance and Indemnities appropriation 

since they provide insurance to service-disabled Veterans unable to 

qualify under basic NSLI. 

VETERANS HOUSING BENEFIT PROGRAM FUND PROGRAM ACCOUNT

Program account 

Limitation on 

direct loans for 

specially adapted 

housing loans 

Administrative 

expenses 

Fiscal year 2019 enacted level ........................................................ – – – ($500,000) $200,612,000 

Fiscal year 2020 budget request est. .............................................. – – – (500,000) 200,377,391 

Committee recommendation est. in the bill .................................... – – – (500,000) 200,377,391 

Comparison with: 

Fiscal year 2019 enacted level ............................................... – – – – – – (234,609) 

Fiscal year 2020 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 Federal Credit Reform Act of 1990 (P.L. 101–508) requires budgetary resources to be available prior to incurring a direct loan obligation or a loan guaranty commitment. In addition, 

the bill requires all administrative expenses of a direct or guaranteed loan program to be funded through a program account. Loan 

guaranties are made to servicemembers, Veterans, reservists, and 

single surviving spouses for the purchase of homes, condominiums, 

and manufactured homes and for refinancing loans. The Department guarantees part of the total loan, permitting the purchaser 

to obtain a mortgage with a competitive interest rate, even without 

a down payment if the lender agrees. The Department requires 

that a down payment be made for a manufactured home. With a 

Department guaranty, the lender is protected against loss, up to 

the amount of the guaranty, if the borrower fails to repay the loan. 


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Home Loan Income Verification.—The Committee is aware of the 

Department’s denial of home loan guarantees to Veterans solely on 

the basis of the Veteran’s documented income being derived from 

state-legalized cannabis activities. The Committee is concerned 

that the Department has never publicly stated its position on this 

matter, hindering Veterans’ ability to fully understand and consider how employment decisions could affect future eligibility for 

earned benefits. The Committee therefore directs VA to publicly 

clarify its position on this matter no later than 180 days after the 

enactment of this Act. 

Home Loan Utilization.—The Committee notes with concern that 

Veterans significantly under-utilize their available Home Loan 

Benefit from the Department of Veterans Affairs. Therefore, VA is 

directed to provide a report no later than 180 days after enactment 

of this Act determining the reasons for this under-utilization, along 

with recommendations to improve its use and effectiveness. 

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

Program account Limitation on 

direct loans 

Administrative 

expenses 

Fiscal year 2019 enacted level ........................................................ $39,000 ($2,037,000) $396,000 

Fiscal year 2020 budget request ..................................................... 57,729 (2,008,232) 401,880 

Committee recommendation in the bill ............................................ 57,729 (2,008,232) 401,880 

Comparison with: 

Fiscal year 2019 enacted level ............................................... 18,729 (28,768) 5,880 

Fiscal year 2020 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 $1,260 (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. Repayment is made in 

monthly installments, without interest, through deductions from 

future payments of compensation, pension, subsistence allowance, 

educational assistance allowance, or retirement pay. Most loans are 

repaid in full in less than one year. The Federal Credit Reform Act 

of 1990 (P.L. 101–508) requires budgetary resources to be available 

prior to incurring a direct loan obligation. 

It is estimated that the Department will make 1,970 loans in fiscal year 2020, with an average amount of $1,019. 

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM

Administrative expenses: 

Fiscal year 2019 enacted level ........................................................... $1,163,000 

Fiscal year 2020 budget request ....................................................... 1,163,000 

Committee recommendation in the bill ............................................ 1,186,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 23,000 

Fiscal year 2020 budget request ................................................ 23,000 

The Native American Veteran Housing Loan Program, as authorized by title 38 United States Code, chapter 37, subchapter V, provides the Secretary with 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. Native Hawaiians, Alaska Natives, and Native 


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Americans enroll in the military at higher rates than non-Natives. 

These loans are available to purchase, construct, or improve homes 

to be occupied as Veterans’ residences. 

GENERAL OPERATING EXPENSES, VETERANS BENEFITS

ADMINISTRATION

Fiscal year 2019 enacted level ........................................................... $2,956,316,000 

Fiscal year 2020 budget request ....................................................... 3,000,000,000 

Committee recommendation in the bill ............................................ 3,025,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 68,684,000 

Fiscal year 2020 budget request ................................................ 25,000,000 

The General Operating Expenses, Veterans Benefits Administration account provides funding for VBA to administer entitlement 

programs such as service-connected disability compensation, education benefits, and vocational rehabilitation services. 

The bill makes available through September 30, 2021, up to ten 

percent of these funds. The Committee provides $3,025,000,000 for the General Oper- ating Expenses, VBA account, which is $25,000,000 above the Administration request. The Committee provides these additional 

funds for hiring additional claims and appellate staff, digital scanning of health records, and overtime pay. 

Equitable Relief.—The Committee reiterates that it 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, 2020, the Secretary shall submit to the Committees 

a report containing a statement as to the disposition of each case 

recommended to the Secretary for equitable relief under 38 U.S.C 

503 during the preceding calendar year. 

Military Sexual Trauma (MST) claims.—The 2018 Inspector 

General’s report that found that almost half of denied MST-related 

claims were not properly adjudicated in accordance with VBA policies. The Committee is concerned that efforts to address the massive claim backlog caused VBA leadership to lose focus regarding 

these sensitive claims, abandoning appropriate and ongoing training, case audits, and specialized processors for MST-related claims. 

The Committee directs VA to report to the Committee by October 

31, 2019, on implementation of the Inspector General’s recommendations, and to consult with the Committee prior to any 

changes in the system for handling MST-related claims. The Committee is 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, 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. 

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 


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Richard Blumenthal Veterans Health Care and Benefits Improvement Act of 2016 (P.L. 114–315). 

Transition Assistance.—The Committee is aware of VA’s efforts 

to expand Veterans education connection centers at medical centers 

and outpatient clinics, such as the one established at the Louis 

Stokes Veterans Medical Center in Cleveland, Ohio. As directed in 

fiscal year 2019, the Committee continues to encourage VA to explore opportunities for education connection centers at VA Medical 

Centers with a high need. Furthermore, the Committee directs VA 

to provide the Committee with a report detailing: (1) the current 

education connection centers project, (2) an explanation of how the 

center currently benefits Veterans it serves and, (3) its potential 

plans to expand the number of education connection centers. In addition, this report should include an action plan with a detailed 

timeline for possible further expansion to one education connection 

center in at least ten of the 21 Veterans Integration Service Networks (VISN) within the next three years, projected timelines for 

implementation of this expansion effort, an analysis of projected 

added benefit to Veterans under the expansion, as well as potential 

funding costs and needs. The fiscal year 2019 report has not yet 

been submitted to the Committee, thus the Committee requires VA 

to provide a briefing to the Committee no later than 30 days after 

enactment of this Act on how they will produce this report in a 

timely manner. 

Outreach to Remote Locations.—The Committee directs VBA to 

improve access and outreach to Veterans living in remote and underserved areas, such as the Commonwealth of the Northern Mariana Islands, by increasing staff presence in these areas. Veterans 

living in these areas, particularly elderly and disabled Veterans 

who may have difficulty accessing VBA services via the internet or 

phone, should have an opportunity to speak and obtain assistance, 

in-person, with VBA staff. 

Weatherization and Other Benefits.—The Committee recognizes 

the importance of housing stability for Veterans and encourages 

VA to increase its outreach efforts to make Veterans aware of the 

Department of Energy’s Weatherization Assistance Program, Department of Housing and Urban Development grants, and similar 

programs in conjunction with existing Veterans Benefit Administration programs as Veterans start the claims submission process. 

The Committee urges VA to take steps to inform Veterans about 

benefits beyond traditional Veterans benefits and incorporate this 

information into education and outreach materials when Veterans 

utilize the VA Home Loan program or housing assistance programs. 

GI Bill Benefits.—The Committee recognizes the GI Bill is an 

earned benefit from service with limits, so it is critical Veterans 

have the information they need to make informed decisions. They 

need better information not just on colleges, but on outcomes of the 

programs that will prepare them well for their civilian careers. 

Currently, all public Federal databases lack program level data 

that would allow potential students to compare the outcomes of 

specific programs across institutions. Therefore, the Committee encourages VA to work with other Federal agencies and the private 

sector to provide program level information on Veterans on the GI 

Bill Comparison Tool or other Federal databases including, but not 


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limited to, graduation rates, total cost, time to completion, and percent of graduates employed in the field and post-graduate salaries. 

Providing such information would empower Veterans to choose 

both the college and program that is best for them by considering 

outcomes of other Veterans in the specific programs they are considering. 

VETERANS HEALTH ADMINISTRATION (VHA) 

The Department operates the largest Federal medical care delivery system in the country, with 143 hospitals, 119 residential rehabilitation treatment programs, 134 nursing homes, 300 Vet Centers, 80 mobile Vet Centers, and 728 outpatient clinics. Approximately 7,000,000 patients will be treated in 2020. 

The Veterans Health Administration budget is comprised of five 

accounts: Medical Services, Medical Community Care, Medical Support and Compliance, Medical Facilities, and Medical and Prosthetic Research. For the first four accounts, the Administration has 

requested total resources for fiscal year 2021 of $87,636,650,000 in 

direct appropriations to fund the four advance appropriations of the 

VHA. The Committee provides an additional $4,809,360,000 for the 

first four accounts for fiscal year 2020, which is $189,160,000 over 

the budget request. In addition, VA will receive an estimated 

$3,912,000,000 in the Medical Care Collections Fund in fiscal year 

2020. The Committee also provides $840,000,000 for medical and 

prosthetic research. 

MEDICAL SERVICES

Fiscal year 2019 enacted level ........................................................... $49,911,165,000 

Fiscal year 2020 enacted level ........................................................... 51,411,165,000 

Fiscal year 2020 budget year request ............................................... – – – 

Committee 2020 budget year recommendation ................................ 169,160,000 

Fiscal year 2021 advance appropriation request ............................. 56,158,015,000 

Committee 2021 advance appropriation recommendation .............. 56,158,015,000 

Comparison with: 

Fiscal year 2020 enacted level ................................................... 4,746,850,000 

Fiscal year 2021 budget request ................................................ – – – 

This appropriation provides for medical services of eligible Veterans and beneficiaries in Department medical centers, outpatient 

clinic facilities, contract hospitals, State homes, and outpatient programs on a fee basis. VA also supports hospital and outpatient care 

through the private sector for certain dependents and survivors of 

Veterans under DOD civilian health and medical programs. 

The bill provides the request of $56,158,015,000 for advance fiscal year 2021 funding. The Committee has included bill language 

to make available through September 30, 2022, $1,500,000,000 of 

the Medical Services advance appropriation for fiscal year 2021. 

The Committee provides an additional $169,160,000 to be available 

for fiscal year 2020; of which $35,000,000 shall be for gender-specific care for women; $30,000,000 shall be for suicide prevention, 

$20,000,000 shall be for Whole Health initiatives; $40,000,000 shall 

be for homelessness initiatives; $17,000,000 shall be for other initiatives specified by the Committee; and $27,160,000 shall be to reimburse the Medical Care account for the April 2019 reprogramming to the Information Technology (IT) Systems account to support the John S. McCain III, Daniel K. Akaka, and Samuel R. 

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grated Outside Networks (MISSION) Act of 2018 (P.L. 115–182) 

implementation. The Committee directs that as of the date of enactment of this Act, all reprogramming requests from the Department to the Committees on Appropriations of both Houses of Congress to support the MISSION Act may come from the Medical 

Community Care account only, and not from the Medical Services 

account. 

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. 

Caregivers Program.—The caregivers program provides an unprecedented level of benefits to families with Veterans seriously injured in the line of duty in post-9/11 service. These benefits include 

stipends paid directly to the family caregiver, enrollment for the 

family member in the VA Civilian Health and Medical Program 

(CHAMPVA), an expanded respite benefit, and mental health treatment. The Committee provides the request of $705,219,000 for the 

caregivers. The Committee also continues the requirement from the 

fiscal year 2018 conference report on quarterly reporting on obligations for the caregivers program. 

Allocation of Health Funding.—The Committee continues to be 

concerned that the process VA uses to allocate the health services 

appropriation through the VISNs and from them to the medical 

centers may shortchange the ultimate users because of excessive 

funding retained at headquarters or at the VISNs. 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. 

MENTAL HEALTH

The Committee provides $9,452,633,000 for mental health programs, which is $30,000,000 above the budget request. Of the 

amounts provided for mental health programs in fiscal year 2020, 

$1,526,059,000 shall be used for suicide prevention and treatment 

programs. Specifically, $221,764,000 shall be used for suicide prevention outreach. With the additional funds, the Committee directs 

the Department to implement suicide safety plans that address 

parking lot suicides and expand the Coaching Into Care Program 

to better help Veterans, their family members, and other loved 

ones find the appropriate services at their local VA facilities and/ 

or in their community. The Department should also engage with 

VSOs to help remove the stigma that is associated with seeking 

mental healthcare. Furthermore, VA is directed to remove barriers 

that impact a Veteran when trying to receive mental healthcare. 

The Committee also directs VA to implement a twenty-first century 


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outreach program that incorporates social media and other electronic means to reach Veterans before they are at a crisis point. 

In addition, the Committee directs VA to engage with DOD to 

help servicemembers transition from active duty to civilian life to 

ensure that mental health needs are addressed throughout the 

transition process. 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. 

Mental Health Services.—Women Veterans are twice as likely to 

commit suicide than women in the general population. To address 

this alarming trend, the Committee directs VA to take aggressive 

steps to improve mental health services for women Veterans and 

ensure that women’s mental health needs, which often differ from 

men in prevalence and expression, are met. 

PREVENTS Initiative.—The Committee is aware of efforts to coordinate Veteran suicide prevention efforts under the Presidential 

Task Force established under the PREVENTS Initiative. A primary 

focus of these efforts is to engender collaboration across public and 

private sectors to end the national tragedy of suicide, including the 

use of public-private partnerships. This is a strategy the Committee has supported and believes vital to address critical mental 

health issues in our Veteran population. VA has awarded grants as 

part of an existing public-private pilot program in six states and 

the District of Columbia to address the causes and contributing factors that lead to suicides among our Veteran populations. Because 

firearms were used in nearly 70 percent of all Veteran suicide 

deaths, an important focus of the pilot program includes the safe 

storage of firearms. The Committee provides an additional 

$3,000,000 above the request to continue and broaden this initiative. 

Post-traumatic Growth Programs.—The Committee recognizes 

there is a shortage of adequate, timely, and effective mental health 

care available to Veterans across the United States. As the Department continues to highlight Veterans’ mental healthcare and suicide prevention as a key priority, there is an opportunity to explore 

effective alternative treatments focused on the area of post-traumatic growth. The Committee encourages the establishment of a 

pilot program to study the effectiveness and benefits of nonprofit 

post-traumatic growth programs to determine the outcomes of such 

programs in contrast to traditional models of mental healthcare, 

the possible integration of such nonprofit programs into mental 

healthcare programs provided by the Department, and the budgetary impacts of such integration. The Secretary shall submit a report no later than 180 days after enactment of this Act, detailing 

the feasibility of such a pilot program and the metrics required to 

determine the value of post-traumatic growth programs. 

Improving the Veterans Crisis Line (VCL).—The Committee continues to monitor the VCL to ensure Veterans are receiving appropriate clinical care. To support this critical care, the Committee instructs the Secretary to ensure that Federal funding for the VCL 

is utilized to make any necessary improvements to VCL’s operations in order to best meet the needs of Veterans seeking assistance. This includes, but is not limited to, ensuring appropriate 


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staffing for call centers and back-up centers, providing necessary 

training for VCL staff, and ensuring that staff are able to appropriately and effectively respond to the needs of Veterans needing 

assistance through the VCL. 

The Committee has repeated 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. 

Community Clinic Mental Health Services.—The Committee remains concerned that in-person mental healthcare is not available 

to all Veterans who require this care. VA is encouraged to ensure 

critical in-person mental health services are available at facilities 

that currently are not served, even on a temporary basis. 

Post-Traumatic Stress Disorder (PTSD) Service Dogs.—The Committee recognizes the positive role that service, guide, and hearing 

dogs have played in mitigating Veterans’ disabilities and providing 

assistance and rehabilitation. The Energy and Water, Legislative 

Branch, and Military Construction and Veterans Affairs Appropriations Act, 2019 (P.L. 115–244) urged VA to prioritize support of 

veterinary healthcare and other benefits for service dogs for 

wounded warriors. The Committee also noted that VA is currently 

engaged in a study to assess the potential therapeutic effectiveness 

of service dogs in the treatment of PTSD and that the study will 

be completed in June 2019. The Committee is interested in the possibility of providing service dogs to Veterans with a mental health 

mobility disorder related to post-traumatic stress or traumatic 

brain injury. According to the Department of Veterans Affairs, as 

many as 20 percent of those who served in Iraq or Afghanistan are 

diagnosed with post-traumatic stress. This disorder can cause debilitating symptoms in Veterans, leading to depression, social isolation, and suicide. Studies demonstrate that service dogs provide 

support to Veterans by mitigating their disability, allowing for professional and social reintegration. Currently, waiting lists for service dogs average between 18 and 24 months, with intensive compulsory training costing an average of $25,000 per service dog, which 

makes this an expensive option for Veterans. The Committee looks 

forward to this study and will address this issue as the bill moves 

through the process. 

Public-Private Partnerships.—The Committee is concerned by the 

alarming number of suicides committed by Veterans each day. 

While the Committee appreciates the important work being done 

by the Department to combat suicide and improve mental health 

among Veterans, more can and must be done. The Committee recommends the Department actively seek out public-private partnerships, in particular with research universities, teaching hospitals, 

and other partners, to expand upon its existing efforts related to 

suicide prevention, PTSD, traumatic brain injury (TBI), and substance use disorders. The Secretary shall report to the Committee 

no later than 60 days after enactment of this Act on the status of 

creating public-private partnerships related to suicide prevention, 

PTSD, TBI, and substance use disorders. Of the funds appropriated 

for mental health programs in fiscal year 2020, no less than 

$5,000,000 shall be appropriated to expand the public-private partnerships. 


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Law Enforcement Liaison.—The Committee appreciates VHA’s 

past efforts in working to educate the law enforcement community 

regarding the unique issues facing Veterans, especially those returning from combat operations. Such education is invaluable in 

cases where Veterans are determined to be an immediate threat to 

themselves or others. In such instances, it is imperative that the 

Veteran’s needs be addressed in an expeditious, humane, and respectful manner. The Committee, therefore, directs VA to implement a program that would designate a VA liaison to work with 

local law enforcement to address such circumstances and to submit 

a report to the Committees on Appropriations of both Houses of 

Congress detailing its efforts no later than 60 days after enactment 

of this Act. 

Non-Citizen Veteran Outreach.—The Committee is concerned 

about the level of awareness regarding mental health services by 

at-risk, non-citizen Veterans. The Committee therefore urges VA to 

conduct more aggressive outreach targeting this group of Veterans 

to offer mental health and other early intervention services, drug 

and alcohol services, and mental health counseling, and directs the 

Department to submit a report to Congress no later than 60 days 

after the enactment of this Act. 

Cultural Competency Training.—The Committee welcomes the 

Secretary’s commitment to addressing mental health in the Veteran population. The Committee also recognizes the importance of 

the National Center for PTSD at VA in promoting better prevention, diagnoses, and treatment of PTSD. Consistent with findings 

from the VA National Center for PTSD, the Committee recognizes 

that some groups of Veterans, including African-Americans and 

Latinos, are more likely to develop PTSD. As such, the Committee 

directs the Veterans Health Administration in coordination with 

the VA National Center for PTSD to provide a report no later than 

180 days after enactment of this Act detailing whether cultural 

competency training is provided to healthcare professionals serving 

Veterans of color, and at what stage(s) in their career; and analyzing whether minority Veterans receive quality and culturally appropriate care. This report shall also include recommendations on 

how to address the unique mental health needs of minority Veterans, and disparities, whether perceived or real, in the care they 

receive. 

National Academies of Sciences.—A survey conducted by the National Academies of Sciences, Engineering, and Medicine in 2017 

found that while the Department of Veterans Affairs provides mental healthcare to Veterans of the Iraq and Afghanistan Wars of 

comparable or superior quality to other providers, substantial 

needs remain unmet. The Committee strongly encourages the implementation of the Academy’s recommendations, including the development of a comprehensive five-year strategic plan for mental 

health services. Moreover, the plan should address how VA will become a high-reliability organization that provides accessible, highquality, and integrated mental healthcare services while also providing explicit attention to the unique needs of women Veterans 

within the VA system. 

Adverse Childhood Experiences (ACEs).—ACEs exist within the 

Veterans population at a substantially higher rate than the general 

public. These experiences correlate with significant negative health 


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outcomes, including on behavioral, mental and physical health. The 

Committee encourages VA to track ACEs among Veterans and target individualized treatment. To ensure appropriate treatment 

from the moment a Veteran enters VA, it is critical that VA coordinate with the Department of Defense to obtain information on 

ACEs from servicemembers and provide a seamless transition in 

care. 

Mental Health Pilot Program.—The Committee urges VA to implement a comprehensive medication selection, adherence, compliance and digital education pilot program for Veterans suffering 

from mental health issues, including PTSD and the long-term sideeffects of increased exposure to TBI, through the utilization of cutting-edge, off-the-shelf technology and pharmacy management protocols to reduce suicide, relapse and hospital visits. 

Agritherapy.—An increasing number of States now have programs that assist Veterans in starting farms, and many Veterans 

turning to farming suffer from PTSD. The benefits of agritherapy 

have been reported in the news media; however, limited research 

and insufficient opportunities exist to offer the benefits of 

agritherapy to those suffering from PTSD. The Department is encouraged to work with the Department of Agriculture on providing 

agritherapy programs to Veterans. 

Mental Health Data on Asian Pacific American Veterans.—The 

Committee recognizes the lack of mental health data specific to 

Asian Pacific American Veterans. The Committee directs the Department to submit a report within 90 days after enactment of this 

Act on its data collection efforts. 

SUICIDE PREVENTION OUTREACH

The Committee remains concerned that 14 of the 20 Veterans 

who commit suicide each day are not using VA services. The Committee urges VA to develop and implement a strategy to conduct 

outreach to this Veteran population and report to the House Committee on Appropriations 90 days after enactment of this Act. 

VetsCorps.—Existing suicide prevention efforts are failing to 

reach the majority of Veterans in need. The Committee directs the 

Department to create a pilot program, carried out over a two-year 

period, establishing a VetsCorps. This Corps, comprised of Veterans themselves, will conduct outreach and recruitment to bring 

in Veterans who have not been served by the Department and connect them with available programs and services. The VetsCorps 

will be designed to reach Veterans wherever they are and provide 

a personal connection to VA. 

Furthermore, the Committee encourages the Department to facilitate peer-to-peer Veteran support networks within VetsCorps for 

Veterans who are trained in suicide prevention and crisis intervention to help other Veterans transition from military service to civilian life. The pilot program shall be carried out at no fewer than 

six sites, targeted to regions with low rates of VA utilization and 

including at least one rural and one urban site. At the conclusion 

of the pilot program, the Department shall report to Congress on 

the effectiveness of the pilot program at reaching Veterans, particularly those in need, and increasing utilization of VA services 

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isting outreach efforts. The Committee provides $5,000,000 for this 

pilot program. 

Suicide Prevention Paid Media GAO Report.—The Committee is 

concerned with the findings of the GAO report entitled, ‘‘Improvements Needed in Suicide Prevention Media Outreach Campaign 

Oversight and Evaluation’’ (GAO–19–66), which found that VHA 

had only spent $57,000 of its $6,200,000 fiscal year 2018 budget for 

suicide prevention paid media as of September 2018. In accordance 

with the GAO report, the Committee recommends that the Office 

of Suicide Prevention and Mental Health (OSPMH) establish targets for its metrics to improve its evaluation of the effectiveness of 

its suicide prevention media outreach campaign. Further, the Committee directs that OSPMH provide the Committee with an expenditure plan on how it intends to effectively use fiscal year 2020 suicide prevention outreach funds no later than 30 days after enactment of this Act. 

Social Media Contact.—The Committee recognizes the incidence 

of mental illness within the Veteran community, and the Committee encourages the Department to investigate the use of technology, specifically social media database algorithms, to detect and 

identify, via indirect contact such as social media, Veterans who 

are at risk of harming themselves or others. Once these individuals 

are identified, the Department would use indirect means of communication to interact with the troubled individual to provide help 

and support in the hope of preventing tragedy. 

GRIT Suicide Prevention Mobile Application.—The Committee 

supports the Department’s current efforts to use twenty-first century technology to promote social connectedness in order to prevent 

Veteran suicides. The Department, in collaboration with technology 

organizations, is developing mobile applications and online platforms in an effort to reach more Veterans, such as the Getting Results in Transition (GRIT) mobile application for transitioning 

servicemembers and Veterans. The Committee directs the Department to continue its efforts to work with technology organizations 

to develop and implement innovative platforms to prevent Veteran 

suicide. 

HOMELESS ASSISTANCE

The Committee provides $1,858,534,000 for VA homeless assistance programs, an increase of $40,000,000 above the budget request. Additionally, an estimated $7,465,430,000 is provided for 

homeless Veterans treatment costs. These programs include the 

Homeless Providers Grant and Per Diem, the Domiciliary Care for 

Homeless Veterans, the Supportive Services for Low Income Veterans and Families, and the Department of Housing and Urban 

Development-Department of Veterans Affairs Supported Housing 

(HUD–VASH) programs. Within this total, the bill includes 

$380,000,000 for the Supportive Services to Veteran Families program. 

Homeless Patient Aligned Care Teams (H–PACT) Expansion.— 

The Committee directs the Secretary to submit to the Committees 

on Appropriations of both Houses of Congress within 180 days of 

enactment of this Act a report on (1) the benefits of expanding the 

H–PACT program; (2) the expansion to additional locations, including rural areas; and (3) additional services to improve the program. 


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HUD–VASH Program.—The Committee continues to support the 

HUD–VASH program and reminds the Department to continue to 

provide the annual report on distribution of HUD–VASH vouchers 

as requested in House Report 115–188. Furthermore, the Committee requests that this annual report also identify how many 

HUD–VASH vouchers are given to women Veterans with children, 

women Veterans without children, male Veterans with children, 

and male Veterans without children in each State. The report 

should also include the number of HUD–VASH vouchers distributed to Veterans in rural, suburban, and urban areas per State. 

The Committee believes that an annual report with this information will be an important data point over time to assess the success 

of VA’s efforts to combat Veteran homelessness. 

HUD–VASH Case Management.—The Committee recognizes the 

value and impact of the HUD–VASH program, which serves Veterans experiencing homelessness. 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. Due to the joint nature of HUD–VASH funding, the Committee recommends that VA’s budget for case managers be increased commensurate with any increases in HUD’s budget for new 

vouchers. 

Legal Assistance for the Supportive Services for Veteran Families 

(SSVF) Program.—The Committee notes that university law 

schools are willing to work with Veterans on a pro-bono basis to 

provide legal assistance. This can result in additional benefits such 

as training law students in Veteran disability law and legal skills 

critical to providing advocacy within the VA system and inspiring 

next-generation lawyers to serve Veterans in practice. The Committee encourages the 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 encouraged to establish one or more pilot 

projects to partner SSVF grantees with university law schools in 

rural areas to enhance legal assistance to Veterans. 

Homeless Women Veterans.—The Committee is concerned with 

the growing number of women Veterans identified as homeless or 

unstably housed and strongly encourages the Department to complete an analysis of programs that provide assistance to women 

Veterans to identify the areas in which such programs are failing 

to meet the needs of such women. Therefore, no later than 180 

days after enactment of this Act, the Committee directs the Department to submit a report on the analyses to the Committees on Appropriations of both Houses of Congress. 

Homeless Veterans Near the United States-Mexico Border.—The 

Committee notes that there may be homeless Veterans living near 

the United States-Mexico border who, historically, may not have 

been counted in point-in-time homeless surveys. The Committee directs VA to work with HUD to develop strategies and recommendations for addressing Veteran homelessness near the United StatesMexico border and to take into account these undercounted Veterans when awarding HUD–VASH vouchers. The Committee appreciates VA’s efforts to implement strategies and make recommendations to decrease Veteran homelessness on the border, 

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minder, data sharing, improving the accuracy of data, and contracting case management in rural areas. The Committee directs 

VA to work with HUD to submit a report to Congress detailing the 

effectiveness of these measures in addressing Veteran homelessness on the United States-Mexico border no later than 60 days 

after enactment of this Act. 

Underemployment of Veterans.—The Committee is encouraged by 

the historically low rates of unemployment and homelessness 

among Veterans. The Committee urges the Secretary to develop a 

strategy to address underemployment, which includes partnerships 

with non-governmental organizations, the private sector, and appropriate Federal agencies, which ensures that the job skills Veterans gain during active duty service are fully realized in professional workplaces. 

STAFFING ISSUES

Mental Health Professionals Hiring.—The Committee recognizes 

the growing need for mental health professionals and in particular 

the need for mental health professionals at VA facilities. Therefore, 

the Committee directs the Department to prioritize hiring mental 

health professionals. 

Medical Staff Retention.—The Committee expects VA to continue 

to report every six months on the number of all clinical staff directly responsible for patient care who have left VA, including a 

summary of the principal reasons explaining their departure, and 

the steps being taken to mitigate the principal reasons providers 

leave. The data should be aggregated at the VISN level and should 

also include the percentage of staff in primary care versus specialty 

care and mental health care, and the percentage of medical staff 

at each facility who complete an exit survey upon their departure. 

Exit surveys should be conducted anonymously, including through 

the use of a location that allows for privacy, is not directly visible 

by another employee, and does not require the departing employee 

to input any personally identifiable data. In addition, the Committee directs VA to submit a separate report, no later than 90 

days after enactment of this Act, on efforts to recruit and hire medical officers and nurses within VHA, as well as any impediments 

to such efforts. The report should include the resources provided for 

these efforts and recommendations for relevant legislation. 

Hiring and Credentialing.—The Committee is concerned if the 

VA hiring and credentialing process may contribute to longer wait 

times for Veterans seeking healthcare. The Committee requests VA 

to report on the average length of time to fill a healthcare provider 

slot at a representative sample of medical centers, including: the 

time it takes the resource board to approve the hire of a new position; the time it takes to post the job announcement; how long the 

interview process takes; and the length of time for credentialing; as 

well as any internal VA goals that exist for the time each step in 

the process should take. The report should also describe how often 

a healthcare provider reaches the credentialing process phase of 

the process, but exits the process because of another opportunity 

outside VA. This report should be provided to the Committee no 

later than 60 days after enactment of this Act. 

Unfilled Positions.—The number of unfilled positions at VA has 

steadily grown and is at present nearly 49,000 system-wide. These 


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unfilled positions include VHA physicians and mental health professionals, and the lack of these professionals negatively impacts 

the delivery of care for Veterans at VHA medical centers and 

CBOCs across the country. VHA facilities have been forced to provide care with fewer staff than are medically necessary to properly 

care for our Nation’s Veterans. As a result, The Committee is concerned that the significant number of vacancies will lead to longer 

waits for Veterans going without service. Section 505 of the MISSION Act required VA to post data on unfilled positions and the 

Committee expects VA to comply with this mandate. Therefore, the 

Committee expects VA to actively recruit and hire full-time professionals to fill these system-wide vacancies with the resources provided from the Committee. The Committee directs the Secretary of 

Veterans Affairs to provide a quarterly report to the Committees 

on Appropriations of both Houses of Congress detailing hiring initiatives and system-wide progress on hiring and specifically what 

actions are being taken to fill physician positions and mental 

health provider positions. Finally, the Committee directs the Secretary to include in this report an analysis of the amount of care 

and services carried out by non-Department facilities because of 

unfilled VA positions and how much money that has cost taxpayers. 

ACCESS FOR RURAL VETERANS

Office of Rural Health (ORH).—The Committee provides $270,000,000 to improve access and quality of care for the more 

than 3,000,000 enrolled Veterans residing in rural and highly rural 

areas. ORH improves access and quality of care for enrolled Veterans residing in geographically rural areas. Developing evidencebased policies and innovative practices to bring healthcare to rural 

areas is key to serving Veterans in geographically remote areas, including remote facilities in Hawaii, many of whom would otherwise 

need to travel by air to reach their nearest VA facility. In addition 

to providing healthcare services, ORH’s important work includes 

identifying barriers to healthcare delivery in rural areas and implementing new ways to deliver healthcare and services to Veterans 

in these locations. 

Operating Plan.—The Committee directs the Office of Rural 

Health to submit to the Committee no later than 30 days after enactment of this Act an operating plan for fiscal year 2020 funding, 

as well as the fiscal year 2021 funding provided in advance by this 

Act. 

Hard-to-Reach Veterans.—The Committee directs VA to submit a 

report providing an analysis of the hardest-to-reach rural Veterans, 

the barriers to accessing these Veterans, and next steps to address 

the needs of these Veterans, no later than 120 days after enactment of this Act. 

Rural Transportation Barriers.—The Committee recognizes that 

many Veterans in rural areas face significant transportation barriers, such as limited transit options or long distances without the 

capability to drive, to attending in person appointments. While the 

Committee recognizes the important work of VSOs and the existence of the Veterans Transportation Program, a rural transportation gap still exists. Of the funds provided for ORH, $5,000,000 

shall be for a pilot program in which VA provides grants to State 


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Veterans Affairs Agencies and VSOs to provide transportation to 

VA appointments for Veterans who live in rural areas. Further, the 

Committee directs the Secretary to submit a report concurrent with 

the President’s Budget Request for fiscal year 2021 that assesses 

the viability of this pilot grant program, an analysis of rural transportation needs, and whether there is sufficient need to increase its 

funding level to reach additional rural Veterans. 

Rural Health Resource Centers.—Given the important role ORH’s 

Rural Health Resource Centers play in expanding access to care, 

the Committee encourages VA to continue considering expanding 

these centers. ORH has played a major role in VA’s overall strategy 

to combat opioid abuse by funding pilot programs through the 

Rural Health Initiative focused on pain coaching and modalities 

that increase Veterans’ access to alternatives to opioid-centered 

pain management. The Committee recommends that as ORH considers expansion, combatting the opioid epidemic and non-opioid 

pain management in rural areas remain key components of its 

focus. 

Lack of Rural Health Providers.—The Committee notes persistent issues for VA health facilities in rural areas in recruiting 

and retaining health providers in the face of national provider 

shortages and a highly competitive environment. The Committee 

encourages VA to continue to consider expanded use of physician 

assistants, through both physical facilities and expanded access to 

telehealth services, to address the rural health provider gap. The 

Committee directs VA to submit a report, no later than 90 days 

after enactment of this Act, providing an update on VA hiring 

needs in rural areas and VA plans to address the provider gap in 

rural areas to the Committees on Appropriations of both Houses of 

Congress. 

Telehealth in Rural Areas.—The Committee is encouraged by recent efforts by VA with regard to investment in telehealth programs. The Committee acknowledges the recent report submitted 

by VA outlining their collaborative efforts with several other Federal agencies on this issue. However, the report fails to provide an 

adequate explanation of the specific plan/strategy that VA will pursue to provide telehealth access to the 33 percent of Veterans who 

reside in rural areas nationwide. Additionally, the Committee remains concerned that not enough is being done to expand access 

to those Veterans in rural areas with limited broadband internet 

access. The Committee directs the Secretary and ORH, to elaborate 

with specificity on measures to expand capabilities of telehealth to 

these regions, and continue collaborating with the Department of 

Health and Human Services, which has dedicated programs specifically for rural hospital access, and the Department of Agriculture, 

which has dedicated programs specifically for rural broadband access, as well as continued participation with the President’s Rural 

Prosperity Task Force. The Committee also encourages VA to consider partnerships with state and local governments to ensure VA 

and medical facility inclusion in ongoing broadband expansion 

projects. The Committee directs the Department to submit a report 

to the Committee on the cross collaboration of departments and 

programs in regards to a specific plan and/or strategy to expand 

telehealth in rural areas, no later than 60 days after enactment of 

this Act. 


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Telehealth For Mental Health.—The Committee recognizes the 

strides made by the Department to reach rural communities with 

telehealth solutions. The Committee encourages further development and implementation of telemedicine to treat Veterans with 

mental health issues in rural communities. Telemedicine should be 

used to its maximum capabilities by VA. 

GENDER-SPECIFIC CARE FOR WOMEN

The number of women Veterans using VHA services has increased 22 percent in four years from 423,642 women Veterans in 

2014 to 517,241 in 2018. The increased number of women using 

VHA services necessitates the greater need to provide and expand 

VA’s gender-specific services to women Veterans. The bill provides 

$581,514,000 for gender-specific care for women, which is 

$35,000,000 above the request. VA is directed to continue redesigning its women’s healthcare delivery system and facilities to ensure women receive equitable, timely, and high-quality healthcare. Of the amount provided, no less than $35,000,000 shall be used 

to implement women’s healthcare programs, and VA is directed to 

provide an expenditure plan detailing how the additional funding 

will be spent no later than 90 days after enactment of this Act. The 

Committee further requires quarterly briefings on the expenditure 

of these funds. The Committee directs VA to provide greater resources at VA Central Office and in the field for Mental Health to 

support the new Women’s Mental Health initiatives and directs 

funding to be provided for three new staff for the Women’s Mental 

Health section in the Office of Mental Health and Suicide Prevention. The Committee directs funding for the education of primary 

care providers and women-specific programs, including weight loss 

and pain management, and for the education of peer navigators. 

The Department is further directed to prioritize hiring women primary care providers and psychologists for women’s clinics out of 

the Medical Services appropriation. 

Additionally, the Committee directs that Women’s Health Program Managers be full-time jobs and not be tasked with supplemental responsibilities outside of their specified job descriptions. 

Gender-Specific Women Veterans’ Healthcare.—The Committee 

remains concerned that VA is not adequately addressing the health 

needs of women veterans, including obstetrics, gynecological care, 

and treatment for gender-specific conditions and diseases. The 

Committee urges VA to continue its efforts to expand access to care 

in these areas and ensure women veteran health needs, which 

often differ from men, are met. 

Access to Gender-Specific Care for Women.—The Committee expects VA to improve care for women Veterans by monitoring 

women Veterans’ access to gender-specific care services under current and future community care contracts. The monitoring should 

include an examination of appointment scheduling and completion 

times, driving times to appointments, and reasons appointments 

could not be scheduled with community providers. VA must provide 

women Veterans equitable access to the same healthcare services 

and programs as male Veterans, including VA’s specialized services 

for substance use disorders, homelessness and treatment for PTSD 

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erans, and the Committee expects VHA will expand the list of inspection requirements for facility staff to ensure compliance with 

the womens health handbook. It is also important to ensure proper 

coordination of care for women patients with complex care needs 

who must frequently access gender-specific healthcare services in 

the community. This is especially important for women Veterans 

with war-related injuries and/or service conditions who are at higher risk for poor outcomes. 

Women Medical Staff.—The Committee continues to support the 

hiring of more women healthcare professionals in order to provide 

women Veterans greater opportunities to choose the gender of their 

healthcare provider. 

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 should a physician determine or risk factors warrant screening before age 40. The Committee supports this effort 

to ensure that the care women Veterans receive is consistent with 

the private sector and will continue to monitor the Department’s 

implementation of this policy. The Department should closely follow ongoing debate within the scientific community on breast cancer screening and mammography coverage to provide Veterans the 

best care possible. The recommendation includes bill language to 

ensure VA maintains this policy through fiscal year 2024. 

Childbirth Data.—The Committee directs VA to provide a report 

no later than 180 days after enactment of this Act identifying the 

number of women Veterans participating in the VA healthcare system who have given birth in the five most recent years for which 

data are available, how many of the pregnancies were high risk, 

the number of complications related to the mother or baby, and the 

number of maternal mortalities that occurred. 

Maternity Care Benefits, Survey, and Education Campaign.—The 

Committee requests a report on the following data related to VA 

maternity care benefits: the number of eligible women Veterans 

and actual utilization from each of the last 10 years in each VISN, 

to the extent that data are available; the number of Veterans who 

receive prenatal care and have births at a VA facility, and the 

number of Veterans who receive prenatal care-related services 

through contracted non-VA providers; information on the transition 

from VA to non-VA providers and how medical records are returned to VA once a woman is postpartum, particularly if she has 

an underlying medical condition; the number of maternity care coordinators in each VISN and specific data on minimum employment requirements and caseload. The Committee also directs VHA 

to develop a patient survey to collect feedback from women Veterans who utilize the maternity care benefit, including their satisfaction with VA maternity care benefits; whether the benefit met 

their needs; the patient’s interaction with the maternity care coordinator; and whether there were barriers to care, providers, or specific services related to the maternity care benefit. Further, the 

Committee encourages VHA to develop an education campaign publicizing the maternity care benefit, including clarifying who is eligible, what the benefit covers and does not cover, and any cost sharing that may be required with the benefit. The education campaign 


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materials should be easy for patients to understand and be easily 

accessible online and at each center for women’s health, medical 

center and CBOC. 

Women’s Health Transition Training.—Women are the fastest 

growing subgroup of Veterans, yet fewer women Veterans seek 

services and support from the Department than men. The Committee expresses its support for the expansion of the Veterans Affairs Women’s Health Transition Training Pilot Program and programs similar to it to better support the increasing numbers of 

women who leave the military and enter the Veterans Affairs support system. 

Personal Hygiene Products.—The Committee is concerned that 

not all VA facilities have committed to VHA Directive 1330.01(2) 

with regards to personal hygiene products, specifically menstrual 

hygiene products, being available in public female, unisex, and 

family restrooms at no charge. The Committee directs VHA to submit a report no later than 180 days after enactment of this Act on 

the distribution and accessibility of these products across all VA facilities. 

Maternal Mental Health Services.—An estimated one out of seven 

new mothers experience postpartum depression. The Committee requests a report on the maternal mental health services available 

to women Veterans at each VISN through VHA and the MISSION 

Act. The report should include mental health support services for 

women Veterans who: have miscarried; had a stillborn baby; who 

have had challenges related to fertility; have or have had a highrisk pregnancy; or have postpartum depression. The report should 

also specifically address if women Veterans are screened for 

postpartum depression, as well as how many women mental health 

professionals are available in each VA medical facility. 

PHARMACY ISSUES

Drug Pricing Report.—Rising drug prices are a significant cost 

driver in healthcare. However, VA receives substantial discounts 

when purchasing prescription drugs. Common sense approaches 

such as using lower-cost generic drugs, providing care from expert 

pharmacists and making drug companies compete for business can 

help drive down the cost of healthcare. The Committee is interested 

in VA’s spending on prescription drugs. The Committee directs the 

Secretary of Veterans Affairs to submit a report to the Committee 

on Appropriations of both Houses of Congress no later than 120 

days after enactment of this Act. The report should include 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. If data is unavailable, the report should provide a detailed explanation of why. 

PRESCRIPTION DRUG ABUSE

Opioid Abuse.—As the reports of increasing numbers of opioid 

overdoses roil the Nation, the Committee is pleased that VA has 

taken an aggressive posture in reducing the volume of opioid prescriptions it dispenses and is turning to alternative approaches to 

pain relief, including the use of complementary medicine tools. The 

VA Opioid Safety Initiative, begun in 2013, has resulted in a 25 


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percent reduction in the number of Veterans prescribed opioids for 

pain relief and the rate of overdose among Veterans prescribed a 

prescription opioid has been cut in half. The Committee encourages 

VA to continue the challenging effort to reduce opioid use among 

Veterans, half of whom suffer from chronic pain. The bill provides 

$396,924,000 for opioid treatment and prevention efforts, of which 

$54,054,000 is provided for activities authorized by the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114–198). 

Opioid Safety Initiative.—The Committee recognizes that VHA 

has made progress in addressing opioid safety for Veterans through 

its Opioid Safety Initiative (OSI). The Committee requests VHA to 

provide an impact study of OSI’s effectiveness and challenges no 

later than 90 days after enactment of this Act. 

Opioid Therapy Risk Report.—The Committee urges VA to ensure that all VA providers who prescribe opioids use VA’s Opioid 

Therapy Risk Report tool consistently, including prior to initiating 

opioid therapy, to ensure safe prescribing and to help prevent diversion, abuse, and double-prescribing. The Committee also urges 

VA to further improve the timeliness of data available in the tool 

to allow a provider to have real-time access to data. It is critical 

that VA clinicians have access to a patient’s opioid therapy history 

from outside providers to ensure safe pain management care, as 

many Veterans also seek care from providers in the community 

who may prescribe them medication. 

Naloxone.—Public health agencies have appropriately highlighted the risk of overdose from doses of opioids greater than 90 

morphine milligram equivalents (MME) per day. The Committee is 

concerned about the hundreds of millions of prescriptions each year 

of immediate release (IR) lower MME opioids, such as hydrocodone 

and oxycodone. These opioids are commonly associated with abuse, 

are a common pathway to addiction, and present a risk of overdose. 

Some States have limited the prescribing of these IR opioids. An 

alternative approach might be to assess the benefit of co-prescribing naloxone with IR and extended release opioids. Prescribers, including dentists and other primary care providers, have 

an opportunity to become more attuned to the risks of all opioids 

through the consideration of co-prescribing naloxone with each 

opioid prescription. The Committee awaits the report for the Veterans Health Administration to develop a strategy to test this hypothesis, execute a pilot program and assess the benefit for enacting such a policy for Veteran patients, as directed in House Report 

115–673. 

Opioid Treatment Alternatives.—The Committee notes that the 

United States is grappling with an opioid epidemic. Some areas, 

such as Appalachia, are disproportionately hard-hit by this crisis. 

The Committee, therefore, encourages VA to ensure pain treatment 

alternatives to opioids, such as chiropractic care, are available to 

Veterans where they are most needed. Further, the Committee encourages VA to integrate such treatments into VA’s medical centers 

or clinics to be provided by VA staff, or on a contract basis where 

needed. 

Pain University.—The Committee recognizes the excellent and 

inspiring work from the Tomah VA facility in Tomah, Wisconsin, 

which has successfully implemented a program called Pain University. The program seeks to incorporate alternative medicine, such 


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as acupuncture and meditation, to reduce Veterans’ reliance on 

prescription pain medications, which have a higher likelihood of addiction leading to substance abuse. The Pain University program 

was recognized as a gold status program by VHA in 2016 for its 

work. The Committee encourages VHA to continue to expand implementation of the Pain University program to other VA clinics so 

more Veterans have access to non-addictive pain management 

therapies. 

Substance Use Disorder (SUD) Study.—As the Committee supports VA’s ongoing work to reduce substance use disorder among 

Veterans, the Committee is concerned VA has yet to report on the 

number and proportion of Veterans with substance use disorder, 

broken down by age, including a breakdown by state, and additionally include available demographic data, as requested in House Report 115–673. The report deadline was 120 days after passage and 

VA should consider this report a priority. The Committee directs 

VA to provide a status update on this study 15 days after this report is filed. 

Opioid Safety and SUD.—The Committee urges VA to implement 

a comprehensive medication selection, adherence, compliance and 

internet-based education pilot program related to opioid safety and 

substance use disorder in order to provide assistance for at-risk 

Veterans. Using off-the-shelf technology, such as smart pill bottles, 

internet-based technologies, and bi-lateral text messaging, VA can 

reduce suicide, relapse, and hospital visits. 

Military Sexual Assault Screening.—In 2016, it was estimated 

that 14,900 servicemembers, both men and women, were sexually 

assaulted, usually more than once. One in four women and one in 

three men were assaulted by someone in their chain of command. 

Due to this high prevalence, it is important to ensure that all those 

who are victims are identified and receive proper treatment. The 

Committee is concerned about the high prevalence of sexual assault 

among servicemembers, both men and women, during their service. 

The Committee is concerned that the effects from this assault persist once servicemembers return home and can manifest in mental 

health disorders such as depression, PTSD, substance use disorders, eating disorders, and anxiety. Because military sexual trauma is prevalent, the Committee recommends that all Veterans 

seeking treatment services are screened for sexual assault using 

evidence-based screening tools in order to successfully treat those 

who have experienced assault. 

Behavioral Health and Substance Use Screening.—The Committee is aware of the high prevalence of mental illness and substance abuse among Veterans, particularly PTSD, depression, anxiety, and alcohol and opioid abuse. The Committee strongly recommends that all Veterans seeking treatment services in a VA facility be screened for the listed illnesses, at a minimum annually, 

using evidence-based assessment tools. 

Substance Abuse Among Women.—In recent years, rates of problematic substance use among women Veterans have been increasing. While men have greater rates of addiction than women, many 

women Veterans have characteristics that make them more prone 

to substance use disorders than men, including past trauma (physical and sexual). As such, the Committee recommends that the Department ensures women Veterans have timely access to a full 


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spectrum of integrated substance abuse treatment services, from 

detoxification to rehabilitation. Additionally, the Department 

should increase the availability of gender-specific substance use 

disorder programming and ensure all programming venues comply 

with the environment of care standards for women’s privacy and 

safety. 

WHOLE HEALTH INITIATIVE

Traditionally, Veteran medical providers have focused on the 

physical symptoms of Veterans, zeroing in on their diseases and 

ailments. However, VA is working to shift this focus by moving to 

a whole health model, which is a holistic look at the many areas 

of life that can affect a Veteran’s health, including their work environment, relationships, diet, sleep patterns, and more. Whole 

Health is an approach to healthcare that empowers and enables 

the Veteran to take charge of their health and well-being and live 

their life to the fullest. The Committee is extremely pleased with 

the Whole Health model of care. The recommendation provides 

$20,000,000 above the request to expand the use of the Whole 

Health model. 

Interactive Patient Care.—The Committee is impressed by the remarkable work that the Office of Patient Centered Care and Cultural Transformation is doing to approach Veterans’ health with a 

holistic effort. Early data indicates that Veterans who are using 

Whole Health are using less opioids and derive greater satisfaction 

and meaning in their lives. Yet, only 18 Flagship Whole Health facilities exist that are implementing the Whole Health System. The 

Committee is concerned that only one-third of VA Medical Centers 

have implemented the Whole Health initiative through interactive 

patient care, a model that empowers patients and educates them 

on the care they receive. Interactive patient care implementation 

has shown increases in patient satisfaction and improvement in 

quality and safety outcomes. Therefore, the Committee directs VA 

to expand use of interactive patient care through use of a national 

contract to ensure coordination and standardization of field implementation of the Whole Health initiative. Furthermore, the Committee directs the Department to submit a report to Congress on 

the outcomes derived from the Whole Health System and the resources needed to expand the Whole Health System across all 

VISNs. The report shall be submitted no later than 180 days after 

enactment of this Act. 

Interactive Patient Care Outside VA Medical Centers (VAMCs).— 

The Committee understands that several VAMCs are implementing 

the Whole Health model through interactive patient care, but the 

Committee is concerned how the Department will ensure the Whole 

Health model is sustained when the Veteran is outside of the VA 

inpatient setting. To achieve success, VA must facilitate the Veteran’s care team’s ability to provide the same consistent and collaborative patient engagement and interactive patient care outside 

of VAMCs and enable the Veteran and the Veteran’s care team to 

be actively involved in the Veteran’s Whole Health Plan. The Committee directs the Department to leverage technology to facilitate 

management and adaptations of the Veterans Whole Health Plan, 

ongoing communication, and awareness of additional VA services to 

support fulfillment of the Whole Health Plan. 


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Creative Arts Therapies.—The Committee acknowledges the effective use of creative arts therapies in treating Veterans with traumatic brain injuries and psychological health conditions. The Committee supports the integration of the arts and creative arts therapies provided by VA’s Office of Patient Care and Cultural Transformation through the Whole Health initiative and encourages VA’s 

continued partnerships with healing arts providers. The Committee 

strongly supports the Secretary in continuing to expand these innovative programs throughout the Veterans Healthcare Networks 

and provides an additional $5,000,000 to do so. 

OTHER HEALTH ISSUES

Central Alabama Veterans Health Care System (CAVHCS).—The 

Committee calls the Department’s attention to the urgent need to 

improve the care provided at and the management of CAVHCS. 

The Department is directed to immediately and fully correct deficiencies and problems at CAVHCS and ensure VA Southeast Network (VISN 7) is focused on providing appropriate and additional 

assistance to the system. The Committee directs the Department to 

develop a plan to resolve these problems and to submit the plan 

by August 1, 2019, to the Committees on Appropriations of both 

Houses of Congress. In addition, the Department is directed to submit quarterly reports describing implementation of the plan and 

improvements made for Veterans in central Alabama. The Committee further directs the Department to develop a plan to address 

urgent needs at other VA healthcare systems with poor or failing 

grades and to submit the report to the Committees on Appropriations of both Houses of Congress within 90 days after enactment 

of this Act. 

Hepatitis C Virus (HCV) Outreach and Testing.—The Committee 

is pleased with VA’s significant progress in reaching and treating 

Veterans who have lived with HCV for years, and it continues to 

dedicate resources towards the goal of screening and treating Veterans who are disproportionately affected by the disease. The Committee notes that the prevalence of Hepatitis C is higher among 

servicemembers, but that prevalence data for the cohort at greatest 

risk, Vietnam Era Veterans, remains unknown. VA is encouraged 

to work with other stakeholders and VSOs to conduct an outreach 

testing campaign that establishes the prevalence number for this 

cohort while evaluating point-of-care testing opportunities that can 

reach Veterans outside of the VA system. Furthermore, the Secretary is urged to implement a pilot program to evaluate the benefits of providing access to rapid point-of-care outreach testing for 

Hepatitis C for Vietnam and Vietnam-era Veterans utilizing enhanced eligibility criteria that would make such services available 

to all honorably discharged servicemembers who served between 

February 28, 1961, and May 7, 1975. 

Lung Cancer Screening.—The Committee continues to note with 

concern that Veterans at high risk of developing lung cancer do not 

have access to lung cancer screening programs that are available 

to Medicare beneficiaries. The Committee encourages the Department to expand access to lung cancer screening for high-risk Veterans by developing a VA Centers of Excellence for Lung Cancer 

program. 


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Cancer Moonshot Contribution.—The Committee supports the 

Beau Biden Cancer Moonshot Initiative and the Department’s contribution utilizing advances in genomic science to provide targeted 

treatment to Veterans. The Department has identified prostate 

cancer, triple-negative breast cancer, and colorectal cancer as areas 

of priority. Due to the prevalence of various skin cancers among 

servicemembers, the Committee directs that skin cancer be included as a priority as well. 

Colorectal Cancer Screening.—The Committee reminds VA of the 

direction in the Statement of Managers accompanying the Consolidated Appropriations Act, 2018 (P.L. 115–141) that directed the 

Department to offer all seven colorectal cancer screening strategies 

recommended by the United States Preventive Services Task Force 

or to notify the Committee if it is not using all seven approaches. 

Prostate Cancer.—Prostate cancer is the most frequently detected 

cancer among Veterans, with an estimated 10,000 new cases diagnosed annually. Unfortunately, early detection is not yet an exact 

science. Although prostate biopsies are the standard of care, they 

often miss detecting cancer. This fear of missed cancer often leads 

to multiple, invasive biopsies, many of which may be unnecessary. 

Recent biotechnology advancements within the emerging field of 

prostate cancer biomarkers have hastened the detection of prostate 

cancer and curbed the financial costs associated with unnecessary 

repeat diagnostic procedures. The Committee encourages VA to accelerate the adoption of such technologies within VHA, particularly 

for biomarker tests on the Federal supply schedule, to help rule out 

false-negative biopsy concerns and alleviate financial and mental 

anguish for Veterans. 

Rare Cancers.—The Committee is pleased by the December 2017 

signing of the collaboration agreement between the Department, 

the John P. Murtha Cancer Center at Walter Reed National Military Medical Center, and the National Cancer Institute focused on 

improving cancer care for common cancers affecting 

servicemembers and Veterans. However, the Committee remains 

concerned about the need for a better understanding of, and treatment options for, rare cancers. There are 55 cancers that disproportionately affect those serving in the military and 67 percent of 

them are rare. Of the 396 total cancers, 374 are rare and few treatment options are available. Servicemembers are uniquely exposed 

to carcinogens, including asbestos, industrial solvents, nuclear radiation, depleted uranium, lead, fuels, polychlorinated biphenyls, and 

components of Chemical Agent Resistance Coating, all hazards that 

may increase the risk of cancer for servicemembers and Veterans. 

Therefore, the Committee directs the Department to issue a report 

no later than 90 days after enactment of this Act on how the collaboration between the Department, the John P. Murtha Cancer 

Center at Walter Reed National Military Medical Center, and the 

National Cancer Institute will address rare cancer, including molecular subtyping, systemic research and development gaps, and inadequacies in targeted treatment options. 

Nuclear Medicine Quality Improvements.—The Committee is 

aware of evidence demonstrating the prevalence of extravasations 

in nuclear medical procedures. Extravasations of diagnostic radiopharmaceuticals negatively affect the sensitivity and quantification 

of nuclear medicine scans. Extravasations can affect disease stagVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00053 Fmt 6659 Sfmt 6602 E:\HR\OC\HR063.XXX HR063

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ing and treatment assessment, result in unnecessary invasive procedures and additional radiation exposure, and lead to higher costs 

for patients and payers. As America’s largest integrated healthcare 

system, the VAMC should lead by example in acting to reduce medical errors and medical waste. The Committee encourages VAMCs 

to monitor injection quality and develop a physician/patient reporting system to disclose when extravasations occur. No later than 90 

days after the enactment of this Act, VHA shall provide to the 

Committees on Appropriations of both Houses of Congress a report 

on efforts to monitor injection quality and reduce the incidence of 

extravasations. 

Pressure Ulcer Prevention.—The Committee remains concerned 

about the incidence of facility-acquired pressure ulcers and the associated $1,300,000,000 to $3,600,000,000 in annual costs for the 

treatment of hospitalized patients with pressure ulcers in VA facilities. The Committee understands that significant health benefits 

and cost savings may be possible through non-invasive innovative 

biometric sensor technologies that have produced promising results 

in the early detection of pressure ulcers. The Committee looks forward to receiving the report from VA, as requested in House Report 115–673, presenting the steps VHA is taking in this area, including the status of technologies VA has assessed. However, the 

Committee believes more can be done to reduce the rate of facilityacquired pressure ulcers that affect thousands of Veterans each 

year. The Committee directs the Secretary to continue prioritizing 

wound care by executing a pilot program to reduce the incidence 

of pressure ulcers in VA facilities. The Committee provides 

$2,000,000 for the purpose of carrying out a pressure ulcer prevention pilot program. The Committee encourages VA to consider pilot 

sites with a clinical and research focus on wound care, and locations with higher incidence rates of pressure ulcers, such as sites 

that serve patient populations with limited mobility and spinalcord injury. 

Pressure Ulcer Transparency.—The Committee acknowledges the 

need to better analyze and prevent hospital-acquired pressure ulcers/injuries, as well as associated complications, in the VA 

healthcare system. To date, inadequate information is available to 

measure the incidence rates and impact of pressure ulcers/injuries 

at VHA facilities. Department of Health and Human Services data 

demonstrates growing rates of fatal hospital-acquired pressure ulcers/injuries nationwide, and research published by the National 

Institutes of Health shows more than one-third of Veterans with 

spinal cord injuries report costly pressure ulcer/injuries annually. 

The Committee directs VHA to conduct an assessment of the Department’s efforts to (1) monitor the incidence and impact of unintended Hospital-Acquired Conditions; (2) reduce the incidence of 

pressure ulcers/injuries and Surgical Site Infections; and (3) expand public reporting on U.S. Centers for Medicare and Medicaid 

Services hospital comparisons to include total pressure ulcer/injury 

incidence at VA medical centers. The Committee further instructs 

VHA to incorporate never-event reduction protocols into existing 

best practices for its Veterans healthcare providers. VHA has 

adopted healthcare transparency as a strategy to enhance public 

trust and to help Veterans make informed choices about their 


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healthcare and therefore, the Committee encourages the Department to continue its efforts in transparency. 

Wheelchairs.—The Committee encourages the Department to 

work with Veterans who are eligible to receive a wheelchair to determine the best options for restoring their maximum achievable 

mobility and function for daily life. 

Food as Medicine.—The Committee recognizes the value of proper nutrition and food’s effect on health. Patients with three or more 

chronic conditions represent 35 percent of Veterans receiving VA 

care and account for 65 percent of VHA costs. Additionally, 78 percent of Veterans receiving VA care are overweight and 41 percent 

are obese. The Committee continues to urge VHA to be proactive 

in promoting wellness and disease prevention by providing evidence-based nutritional services. The Committee directs VA to provide a status update on current practices as well as a plan to expand nutritional education and means to increase access to nutritional foods for Veterans 15 days after this report is filed. 

Long-Term Care.—The Committee is aware of the aging Veteran 

population and supports long-term care that focuses on facilitating 

Veteran independence, enhancing quality of life, and supporting 

the family members of Veterans. The Committee supports homeand community-based care, residential settings, nursing homes, 

geriatric services, and advanced care planning for Veterans and 

their families. Multiple chronic conditions, life-limiting illness, or 

disability associated with disease, aging, or injury can be factors of 

consideration. The Committee acknowledges that the Veteran population faces unique health risks and that each Veteran requires 

an individualized approach to care. 

Hospice Care for Veterans.—The Energy and Water, Legislative 

Branch, and Military Construction and Veterans Affairs Appropriations Act, 2019 (P.L. 115–244) urged VA to undertake a pilot program to develop techniques, best practices, and support mechanisms to improve end-of-life care for combat Veterans and Vietnamera Veterans. Due to the lack of meaningful advancement toward 

addressing the unique needs of Vietnam Veterans, VA is directed 

to carry out this pilot program and to engage nonprofit hospice and 

palliative care providers with Vietnam Veteran-centric programs in 

implementing the pilot program. The Committee is aware that organizations such as the nonprofit National Partnership for Hospice 

Innovation are developing programs designed to meet the specific 

end-of-life care needs for Vietnam-era Veterans and strongly reiterates that such an approach could be beneficial to Iraq, Afghanistan, 

and Syria combat Veterans in the future. The Committee directs 

VA to provide to the Committees on Appropriations for both 

Houses of Congress an update, no later than 30 days after enactment of this Act, on the status of this pilot program. 

VA Affiliation With Minority Medical Schools.—The Committee is 

pleased with the Department’s improvements to its academic affiliation activities with minority medical schools. For the purposes of 

enhancing training initiatives, improving patient care, and providing educational opportunities for our Nation’s Veterans, the 

Committee urges VHA and the Office of Academic Affiliations to 

maintain this ongoing commitment to minority health professions 

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Minority Veteran Care.—The Committee acknowledges the Department’s efforts to streamline data collection practices through a 

working group and other initiatives. The Committee notes that the 

Veteran population is becoming increasingly diverse. According to 

VA’s Center for Minority Veterans, more than one-third of Veterans will come from minority groups by the year 2040. The Committee also acknowledges that the Department currently has a 

working group, which has the goal of developing streamlined data 

collection processes. Accordingly, the Committee directs the Secretary to provide a report no later than 180 days after enactment 

of this Act that details how VA can restructure its data collection 

practices to more accurately and consistently capture data on the 

race and ethnicity of Veterans across its various systems. This report shall take into consideration that the Department is in the 

midst of an acquisition of a new electronic health record system 

that will combine the Department’s current data collecting programs and make recommendations of how implementation of this 

new program can help improve data collection on Veterans. 

Freely Associated States (FAS) Veterans’ Access.—The Committee 

is concerned about impediments to VA healthcare access for FAS 

Veterans. Veterans in the FAS must travel hundreds to thousands 

of miles to the nearest VA medical center in Guam or Hawaii, in 

some circumstances at their own expense, to get healthcare. For 

those who are able to travel to seek care, the collective costs are 

magnified by lost wages resulting from missed days at work and 

childcare costs, as well as time away from families. Given the significant time, resources, and high costs for travel for some Veterans, including airfare, transportation, and lodging, many FAS 

Veterans are never able to access the VA health services they have 

earned through their military service. As VA works to transform its 

Community Care programs, the Committee directs VA, no later 

than 90 days after enactment of this Act, to provide a report that 

assesses options for improving access to VA healthcare for FAS 

Veterans. The report should include the number of Veterans residing in the FAS who have utilized services in VA Pacific Islands 

Health Care System facilities over the last three fiscal years, the 

extent of travel benefits offered to Veterans and eligibility requirements for the benefits, an average estimated personal cost for an 

FAS Veteran to access VA care, the estimated costs for providing 

telehealth services in FAS through a pilot program, and recommendations for how VA can reduce burdensome restrictions 

under the Foreign Medical Program using existing authorities. Furthermore, the Committee encourages VA to work with Federal and 

non-Federal partners, including the Departments of Defense, Interior, and Health and Human Services, as well as non-VA 

healthcare facilities and educational institutions, to leverage 

shared resources and improve access for delivery of care through 

collaboration. 

VA Healthcare Expansion.—The Committee directs VA to increase access to direct VA care for Veterans living in remote and 

underserved areas, such as the Commonwealth of the Northern 

Mariana Islands, by increasing the number of full-time, dedicated, 

VA medical and mental health providers in these areas. 

FAS Data Collection.—The Committee remains concerned about 

the challenges to accessing quality healthcare for Veterans residing 


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in outlying areas, such as the Northern Mariana Islands and the 

Freely Associated States. The Committee is aware of potential obstacles in data collection to account for the number of Veterans residing in these areas. The Committee seeks to understand the data 

limitations that may exist, and how VA can improve data collection 

from the outlying areas to help inform the development of proposals to ensure that health needs of Veterans, including Pacific Island Veterans, are met. The Committee looks forward to receiving 

the strategic plan as requested in Conference Report 115–929 to 

improve the utilization of healthcare services of Veterans in outlying areas. In addition, the Secretary is directed to provide the 

Committees on Appropriations of both Houses of Congress with information regarding VA’s process for informing Veterans in the outlying areas about enrollment in the Foreign Medical Program and 

if the Department discloses information about potential barriers 

Veterans may face in utilizing services and other VA benefits in 

outlying and remote areas. 

Dialysis Services.—The Committee understands that VA has a 

long history of providing dialysis services through community dialysis providers under the Nationwide Dialysis Services contracts 

when VA is unable to directly provide such care. Today, approximately 15,000 Veterans receive timely access to high-quality dialysis services through these national dialysis contracts. The Committee will monitor the Department’s transition to the Community 

Care Network (CCN) contracts when an adequate network of dialysis providers is available in the CCN. The Committee expects VA 

will ensure that care is not disrupted or diminished for the Veterans who receive treatment through experienced providers under 

the Nationwide Dialysis Services contracts. 

Healthcare-Associated Infection (HAI) Reduction.—The Committee is concerned with improving the quality of healthcare for 

Veterans and their family members, including by reducing the incidence of HAIs and methicillin-resistant Staphylococcus aureus 

(MRSA) infections. According to the Centers for Disease Control 

and Prevention, roughly one in thirty-one hospital patients has at 

least one HAI at any given time. HAIs are associated with roughly 

99,000 deaths per year and contribute billions of dollars annually 

to the total cost of healthcare. Within medical treatment facilities, 

medical gowns, bed linens, and other textiles and hard surfaces 

such as bed-rails, work stations, and trays are major vectors for 

these types of infections. Therefore, the Committee directs the Department to submit a report no later than 180 days after enactment of this Act to the Committees on Appropriations of both 

Houses of Congress on the rate of incidence of HAIs within all medical care facilities under its jurisdiction; recommend means of reducing the incidence of HAIs at such facilities; and consider infection reduction functionality in procurement decisions regarding textiles and hard-surface items. The Committee further encourages 

the Department to use evidence-based tools to significantly reduce 

the incidence of HAIs. 

Creutzfeldt-Jakob Disease Monitoring.—Veterans and their dependents who resided at United States Military bases in Germany, 

Belgium, and the Netherlands for six months or more from 1980 

through 1990, and Veterans and their dependents who resided at 

United States Military bases in Greece, Turkey, Spain, Portugal, 


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and Italy for six months or more from 1980 through 1996 are 

barred from donating blood due to their potential exposure during 

their military service to beef that was infected with bovine 

spongiform encephalopathy, resulting in possible infection of 

Creutzfeldt-Jakob Disease (CJD), a human prion disease. The Committee is committed to understanding the residual impacts of CJD 

within the Veteran community. The Committee urges the Department to reference data from existing medical records of Veterans 

to determine the percentage of Veterans from the above referenced 

subgroup that have more frequent or unexplained symptoms associated with CJD compared to the civilian population. This body of 

data could be helpful in clarifying the extent and specifics of the 

medical issues suffered by Veterans from exposure to CJD. 

Artificial Intelligence And Machine Learning.—The Committee 

directs the Secretary to submit a report to the Committees on Appropriations of both Houses of Congress no later than 180 days 

after enactment of this Act on how the Department is utilizing artificial intelligence and machine learning to improve healthcare services to Veterans. 

Prosthetics.—The Committee is concerned about the proposed 

regulation regarding prosthetic and orthotic providers and strongly 

encourages the Department to allow Veterans to choose the best 

provider for their needs. 

Tobacco Use Among Veterans.—A 2018 government study found 

almost 30 percent of Veterans are smokers. Interventions for Veterans are critical to reduce tobacco use and lead to improved health 

outcomes. Women Veterans are uniquely impacted by the effects of 

tobacco use, including difficulty getting pregnant, early menopause, 

osteoporosis, cervical cancer, and breast cancer. The Committee encourages VA to continue promoting cessation and evidence-based 

tobacco interventions for our Veterans. 

Burn Pits.—The Committee continues to support VA’s work 

through the Airborne Hazards and Burn Pits Center of Excellence 

on diagnoses, mitigation, and treatment of conditions related to airborne hazards and burn pits. The Committee continues to encourage VA to partner with the Department of Defense, institutes of 

higher learning, and other public and private entities to carry out 

this initiative and provides an additional $5,000,000 for the Center. 

Jason Simcakoski Memorial and PROMISE Act Implementation.—The Committee supports robust funding to support the continued implementation of the Jason Simcakoski Memorial and 

Promise Act, which passed as 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. 

VSO Wellness Pilot Program.—The Committee is concerned that 

VA is taking too much time to implement the VSO Wellness pilot 

program, authorized in Section 252 of the Consolidated Appropriations Act, 2018 (P.L. 155–141). This is a priority of the Committee, 

and the Department is directed to implement the pilot program expeditiously. The Committee directs VA to provide a status update 

on the pilot program no later than 14 days after the report is filed. 

Health Videos for Veterans.—Hospitals and physicians’ offices 

around the country are currently utilizing health videos in their 

lobbies, waiting rooms, and exam rooms to supplement and reinVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00058 Fmt 6659 Sfmt 6602 E:\HR\OC\HR063.XXX HR063

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force the medical care, advice, and instruction physicians are providing. The Committee notes that educational resources, such as 

these could result in cost savings and quality of life improvement 

for Veterans. The Committee encourages VHA, where possible, to 

have health videos available to Veterans and directs the Secretary 

to develop a plan to implement educational video systems within 

VHA. 

MEDICAL COMMUNITY CARE

Fiscal year 2019 enacted level ....................................................... $9,384,704,000 

Fiscal year 2020 enacted level ....................................................... 10,758,399,000 

Fiscal year 2020 budget year request ........................................... 4,521,400,000 

Committee 2020 budget year recommendation ............................ 4,521,400,000 

Fiscal year 2021 advance appropriation request ......................... 17,131,179,000 

Committee 2021 advance appropriation recommendation .......... 17,131,179,000 

Comparison with: 

Fiscal year 2020 enacted level ............................................... 6,372,780,000 

Fiscal year 2021 advance budget request ............................. – – – 

The Medical Community Care account was created in the Surface 

Transportation and Veterans Health Care Choice Improvement Act 

of 2015 (P.L. 114–41). Per the MISSION Act of 2018, all community care programs are consolidated into one community care program. For fiscal year 2021, the bill provides $17,131,179,000, of 

which $2,000,000,000 is available until September 30, 2022. The Committee provides $4,521,400,000 for an additional amount 

for fiscal year 2020 as requested in the budget request. 

Third-Party Payments and Reimbursements.—The Committee 

is concerned about the timeliness of reimbursements by VA to private healthcare/third-party providers. The Committee remains concerned that VA has created an inefficient process that must be reformed. As VA continues the MISSION Act implementation, the 

Committee believes VA must further prioritize efficient and prompt 

payment to community providers to ensure timely access to quality 

care. Delays in processing of such payments undermines the ability 

to recruit and retain private healthcare providers to service our 

Nation’s Veterans, especially among rural communities. Therefore, 

no later than 90 days after enactment of this Act and then on a 

quarterly basis, the Secretary shall provide the Committees on Appropriations of both Houses of Congress a comprehensive report detailing the amount owed to outside providers for every State. The 

report shall include outstanding payments over six months old and 

the corrective actions being implemented to address these outstanding balances as well as average time for repayment. Furthermore, this report will include a comprehensive plan to prevent this 

issue from reoccurring in the future. 

Choice Program Third-Party Payments and Reimbursements.— 

The Committee recognizes the massive undertaking it took to develop and implement the Veterans Choice Program and the difficulties that patients and providers have experienced in dealing with 

the third-party administrators of the program. The Committee 

awaits the fiscal year 2019 report, as requested in House Report 

115–673, on the effectiveness of the programs with third-party administrators. 

Transportation to Community Care Providers.—The Committee is 

concerned with the lack of access to transportation for Veterans 

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ments due to disability, illness, or financial hardships. Veterans 

who live in both rural and urban areas experience a lack of consistent and efficient travel, especially access to medical care. As VA 

continues to implement the Veterans Community Care Program, 

transportation to medical care and services in the community will 

be an even bigger obstacle for Veterans moving forward. The Committee urges VA to prioritize transportation assistance for Veterans 

who live in both rural and urban areas, and encourages VA to work 

with state, regional and local groups, local VSOs, and nonprofits on 

transportation assistance programs and provide direct transportation services for Veterans who have limited access to transportation networks. 

MEDICAL SUPPORT AND COMPLIANCE

Fiscal year 2019 enacted level ....................................................... $7,239,156,000 

Fiscal year 2020 enacted level ....................................................... 7,239,156,000 

Fiscal year 2020 budget year request ........................................... 98,800,000 

Committee 2020 budget year recommendation ............................ 98,800,000 

Fiscal year 2021 advance appropriation request ......................... 7,914,191,000 

Committee 2021 advance appropriation recommendation .......... 7,914,191,000 

Comparison with: 

Fiscal year 2020 enacted level ............................................... 675,035,000 

Fiscal year 2021 advance budget request ............................. – – – 

The Medical Support and Compliance appropriation funds the expenses of management and administration of the Department’s 

healthcare system, including financial management, public health 

and environmental hazard, quality and performance management, 

medical inspection, human research oversight, training programs 

and continuing education, security, volunteer operations, and 

human resources. 

The bill provides $7,914,191,000 in advance fiscal year 2021 

funding. The Committee has included bill language to make available through September 30, 2022, $150,000,000 of the Medical Support and Compliance appropriation for fiscal year 2021. The Committee provides $98,880,000 for an additional amount 

for fiscal year 2020 as requested in the budget request. 

MEDICAL FACILITIES

Fiscal year 2019 enacted level ....................................................... $6,004,468,000 

Fiscal year 2020 enacted level ....................................................... 6,141,880,000 

Fiscal year 2020 budget year request ........................................... – – – 

Committee 2020 budget year recommendation ............................ 20,000,000 

Fiscal year 2021 advance appropriation request ......................... 6,433,265,000 

Committee 2021 advance appropriation recommendation .......... 6,433,265,000 

Comparison with: 

Fiscal year 2020 enacted level ............................................... 291,385,000 

Fiscal year 2021 advance budget request ............................. – – – 

The Medical Facilities appropriation provides funds for the operation and maintenance of the Department’s healthcare system’s 

capital infrastructure. Included under this heading are provisions 

for costs associated with utilities, engineering, capital planning, 

leases, laundry, groundskeeping, garbage, housekeeping, facility repair, and property disposition and acquisition. 

The bill provides $6,433,265,000 in advance fiscal year 2021 

funding. The Committee has included bill language to make available through September 30, 2022, $250,000,000 of the advance 

Medical Facilities appropriation for fiscal year 2021. 


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The Committee provides $20,000,000 as an additional amount 

above the non-recurring maintenance (NRM) fiscal year 2020 appropriation of $1,175,581,000 for women’s health and mental 

health NRM projects. Within the additional NRM funding for mental health, the Committee directs VA to prioritize construction to 

increase the number of beds available for overnight mental health 

treatment for Veterans. 

Spending 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 2020 

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. 

Facility Expansion.—The Committee continues to support an expansion of the number of clinics available to Veterans. To help accomplish this, the Committee encourages VA to identify CBOC facilities, with a priority in underserved, rural, and remote areas, for 

facility expansion opportunities in order to accommodate additional 

patients and provide enhanced services, thereby reducing the need 

for Veterans to travel long distances for care. VA is encouraged to 

look at existing CBOCs that are operating at full capacity, have a 

proven record of delivering services, and have community support 

to expand the facility. Additionally, the Committee urges VA to 

continue to explore the potential benefits of placing VA clinics on 

military installations located in areas with high Veteran populations and where nearby VA infrastructure is overburdened. 

Community-Based Outpatient Clinic in California.—The Committee is encouraged by the issuance of a lease for a new community-based outpatient clinic in Bakersfield, California, and directs 

the Department to expeditiously finalize this project and continue 

to provide regular updates as directed in House Report 114–497. 

Operating Room Patient Safety and Fire Prevention.—The Committee is concerned that operating room fires have been increasing 

and encourages the Department to look at technology that can 

mitigate risks of fires. The Committee directs of the funds provided 

not less than $1,000,000 shall be utilized by the Department to 

carry out a pilot project that tests and validates operating room fire 

safety technology at multiple VHA medical facilities and report 

back to the Committee on the status of the pilot within 90 days of 

enactment of this Act. Furthermore, the Committee directs the Department to provide an annual report concurrent with the budget 

submission to the Committees on Appropriations of both Houses of 

Congress, on the number of operating room fire events, data showing the total number of tort claims, the amount per claim, and the 

total amount of these claims, paid by the Department of the Treasury’s Judgment Fund or any other taxpayer-funded sources as a result of VA operating room fires and safety issues and VHA’s effort 

to reduce the risk of operating room fires utilizing available technology. 

Strategic Analytics for Improvement and Learning (SAIL).—The 

Committee directs the Secretary to quarterly address and provide 

the Committees on Appropriations of both Houses of Congress material on failing VA facilities as defined by VA’s SAIL data. The 


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quarterly update will include the current state of failing facilities 

and any steps or improvements that are in place. 

Facility Transformations.—The Committee directs the Department to report on specific measures it takes to track and prioritize 

both the physical and cultural transformation within VA medical 

facilities to better serve women Veterans. The Committee is concerned that VA has failed to keep up with a growing population of 

women Veterans who need equitable access to medical care. When 

one in four women Veterans report having experienced unwanted 

sexual attention while serving, it is concerning that the very system intended to address their trauma is failing to foster a safe environment for them. VA’s own 2015 Study of Barriers for Women 

Veterans to VA Health Care noted that women Veterans experienced unwanted sexual attention at VA facilities. The President’s 

Budget for Fiscal Year 2020 identifies the need to upgrade facilities 

to better serve women Veterans, such as separate entrances and 

parking accommodations that will take several years to implement. 

VA’s construction priority list was established over decades and 

contains billions of urgently needed repairs. The 2019 VA Strategic 

Capital Investment Planning Process (SCIP) list of construction 

projects had approximately $120,000,000 in unfunded facilities improvements for women Veterans. The Committee directs the Department to prioritize funding for medical facilities to accommodate 

women Veterans. 

Use of Smart Technologies.—The Committee is interested in the 

potential use of new and innovative devices, systems, and networks 

to improve the operation and management of VA facilities, such as 

energy, traffic control, perimeter security and access control systems, and encourages the Department to work with industry leaders to develop a demonstration project that could be adapted by a 

variety of VA facilities. 

Medical Facilities Realignment.—The Committee remains concerned that VA medical care realignments are being approached in 

an ad hoc manner by each individual VISN rather than on a comprehensive basis by VA Central Office. Moreover, such an approach 

may lead to inequitable and inefficient distribution of medical resources throughout the Nation. Before VA makes any decision to 

relocate, close, or diminish services at an existing facility, or proceeds with any such realignment already underway, consideration 

must be given to the impact such action would have on Veterans, 

especially tribal Veterans or Veterans in rural or highly rural 

areas. The Committee directs VA to adhere to a clear and transparent process that engages all parties from the onset and is consistent with a national realignment strategy. Since the conference 

report for the Consolidated Appropriations Act, 2016 (P.L. 114– 

113), the Committees have suspended the proposed realignment of 

services in VISN 23 until a report was transmitted to the Committees, and that report has not been received. The Department is 

again directed to comply with the request for the report and meanwhile suspend the proposed realignment of services in VISN 23 

until such time as the Department transmits to the Committee a 

report that outlines the following: (1) a national realignment strategy that includes a detailed description of realignment plans within 

each VISN; (2) an explanation of the process by which those plans 

were developed and coordinated within each VISN; (3) a cost 


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versus benefit analysis of each realignment, including the cost of 

replacing VHA services with contract or other outsourced services; 

(4) an analysis of how any realignment will impact tribal, rural, 

and highly rural Veteran healthcare within each VISN; and (5) an 

analysis of how any realignment will impact access to, enrollment 

in, and the capacity of VA PTSD and Residential Rehabilitation 

Treatment Program services within each VISN and nationally. 

War Related Illness and Injury Study Centers (WRIISC).—The 

Committee is concerned that research and clinical trials are urgently needed to develop effective treatments for Veterans exposed 

to toxic environmental hazards, such as burn pits. Cost effective 

models for rapid development of new treatments for Gulf War Illness using computational models, research funding through DOD’s 

Congressionally Directed Medical Research Program (CDMRP), and 

clinical experts in environmental medicine have proven effective in 

partnership with VA medical centers. The Committee notes the Department’s extensive discussions of adding additional WRIISC 

sites, and directs the Secretary to establish a WRIISC focused on 

toxic environmental exposures to leverage research funding 

through the CDMRP and clinical partnerships. 

Women Veterans Health Facilities.—The Committee is concerned 

about the harassment women Veterans have had to endure at VA 

healthcare facilities. The Committee requests VHA to conduct a 

feasibility study of establishing women-only clinics in each VISN no 

later than 180 days after enactment of this Act. 

MEDICAL AND PROSTHETIC RESEARCH

Fiscal year 2019 enacted level ........................................................... $779,000,000 

Fiscal year 2020 budget request ....................................................... 762,000,000 

Committee recommendation in the bill ............................................ 840,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 61,000,000 

Fiscal year 2020 budget request ................................................ 78,000,000 

This appropriation provides for medical, rehabilitative, and 

health services research. The bill provides $840,000,000 available 

through September 30, 2021. The Committee recognizes the importance of the research conducted by VA for Veterans’ quality of life 

and health and provides $78,000,000 above the request and 

$61,000,000 above fiscal year 2019 for these activities. 

Medical research is an important aspect of the Department’s programs, providing complete medical and hospital services for Veterans. The prosthetic research program is also essential in the development and testing of prosthetic, orthopedic, and sensory aids 

for the purpose of improving the care and rehabilitation of eligible 

disabled Veterans, including amputees, paraplegics, and the blind. 

The health services research program provides unique opportunities to improve the effectiveness and efficiency of the healthcare delivery system. Budgetary resources from a number of areas, including appropriations from the medical care accounts, reimbursements 

from DOD, grants from the National Institutes of Health, private 

proprietary sources, and voluntary organizations, provide support 

for the Department’s researchers. Estimated fiscal year 2020 research resources beyond the research account are $1,217,000,000. 

National Center for Post-traumatic Stress Disorder Research.— 

The National Center for PTSD sets the VA agenda for research and 


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education on PTSD, with seven research divisions located at VA facilities. The Center also conducts education and training and coordinates the VA National PTSD Brain Bank. The Committee provides $40,000,000 for the Center in fiscal year 2020, which includes 

$10,000,000 for the coordination of the VA National PTSD Brain 

Bank. The Committee encourages the National Center to use funding for the Brain Bank to accelerate the discovery of novel therapeutic targets for the treatment of PTSD utilizing post-mortem 

brain datasets, cell-based and other models for target identification 

and validation. 

Modeling and Simulation Treatment of PTSD.—As a mechanism 

to explore treatments for PTSD, the Committee is aware that the 

use of modeling and simulation technology has enabled the development of innovative and immersive therapies, which can extend 

trauma management therapy protocol. The Committee encourages 

the establishment of a Trauma Management Therapy pilot program that utilizes exposure therapy involving virtual reality in 

combination with group therapy for the treatment of individuals 

with symptoms relating to PTSD. The Secretary shall submit a report to the Committees on Appropriations of both Houses of Congress no later than 180 days after enactment of this Act, detailing 

the feasibility of such a pilot program and the metrics required to 

determine the value of exposure therapy utilizing therapeutic virtual environments using real-time modeling and simulation training to treat PTSD. 

Dystonia.—The Committee notes the connection between traumatic brain injury and the onset of dystonia. The Committee continues to urge VA to pursue collaboration with stakeholders to advance critical research on dystonia. 

Cannabis Research.—The Committee recognizes that continued 

focus on the discovery of treatment alternatives for Veterans diagnosed with various conditions, such as chronic pain and PTSD, is 

essential to reducing the number of Veteran suicides. For this reason, the Energy and Water, Legislative Branch, and Military Construction and Veterans Affairs Appropriations Act, 2019 (P.L. 115– 

244) urged VA to utilize funds to prioritize investments in research 

on the efficacy and safety of cannabis usage among the Veteran 

population for medicinal purposes and submit a report to the Committee no later than 180 days after enactment of that Act. The report has yet to be submitted to the Committee, therefore the Committee directs VA to provide a status update of this outstanding report no later than 15 days after the report is filed. 

Access to Clinical Trials.—The Committee applauds the ongoing 

collaborative efforts between VA medical centers and NCI-designated comprehensive cancer centers that will allow Veterans to 

have access to the highest quality cancer care available, including 

cutting-edge clinical trials. The Committee is concerned that States 

with large Veteran populations are not able to access these treatments. The Committee directs VA to expand these efforts, especially as they relate to providing Veterans access to 

groundbreaking new treatments through clinical trials led by academic cancer centers, as well as the linking of VA oncology care 

with national research databases involving patients at multiple 

academic cancer centers. The Committee commends the work of the 

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erate Trials Enrollment) in providing NCI funding for VA health 

centers, which have already established clinical trials partnerships 

with academic cancer centers. The Committee is concerned, however, that this partnership does not include certain States with 

large Veteran populations. To address this need, the Committee directs VA to provide up to $5,000,000 to support the establishment 

of partnerships between VA hospitals and NCI-designated facilities 

that allow for Veterans to access cancer clinical trials at VA health 

centers. 

Exposure to Herbicide-Related Toxins.—Veterans have frequently 

expressed long-held concerns that toxic exposure during their military service is related to adverse health conditions. The Committee 

is committed to understanding the residual impacts of Agent Orange/Dioxin and other herbicide-related toxic exposures among Veterans who served in Vietnam, Thailand, Guam, the Northern Mariana Islands, America Samoa, and all other geographic areas where 

these toxic substances were dispersed. The Committee urges the 

Department to reference data from existing medical records of Veterans to determine the percentage of Veterans from the above referenced subgroup that have more frequent or unexplained diseases 

compared to the civilian population. This body of data could be 

helpful in clarifying the extent and specifics of the medical issues 

suffered by Veterans from exposure to herbicides. 

Female Prosthetics Research.—The Committee strongly supports 

robust funding for medical and prosthetic research. Recognizing 

that approximately six percent of wounded Veterans returning 

from Iraq and Afghanistan are amputees, and the number of Veterans accessing VA healthcare for prosthetics and sensory aids continues to increase, this funding greatly enhances Veterans’ quality 

of life. However, there is an acute need for research specializing in 

female prosthetics, as most prostheses are designed to fit male Veterans. Since three percent of military amputees are female, the 

Committee directs VA to prioritize medical and prosthetic research 

to adequately address prosthetics meant for women. 

Neural-Enabled Prosthetics.—The Committee understands the 

uniqueness of limb trauma injuries sustained by servicemembers in 

combat. Traumatic injury or neurological diseases can also significantly alter or impair the lifestyle of the individual and their caregivers. The Committee encourages VA to fund research that will 

design and develop technology to offset the effects of limb amputation, orthopedic injury and disease, neuropathic pain, and other 

neurodegenerative diseases. The Committee directs $25,000,000 for 

VA to prioritize and fund extramural research that accelerates 

functional recovery and rehabilitation of sensorimotor function 

through engineering of wirelessly activated implantable biomedical 

technologies capable of focal stimulation inside nerves and that is 

personalized to the needs of the patient. 

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 Committee is concerned by the lack of 

public availability of the findings of all research conducted by or for 

the Executive Branch relating to the health consequences of military service in the Persian Gulf theater of operations during the 


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Persian Gulf War, and by the lack of coordination by the Department in ensuring the public availability of this information. The 

Committee urges the Department to publish disease-specific mortality data related specifically to Persian Gulf War Veterans. The 

Committee remains concerned by VA’s ever-evolving terminology 

for the signature adverse health outcome of the Persian Gulf War, 

recognized by the Institute of Medicine (IOM) as Gulf War Illness, 

and encourages the Department to utilize the term, Gulf War Illness, as IOM has recommended. The Committee continues to urge 

the Secretary to consider revising and updating the Clinical Practice Guideline for Chronic Multisymptom Illness consistent with 

the July 2011 Veterans Health Initiative, Caring for Gulf War Veterans, in that it cannot be reliably ascribed to any known psychiatric disorder, and to focus on recent Gulf War Illness treatment 

research findings and ongoing Gulf War Illness treatment research 

direction. Furthermore, the Committee once again encourages VA 

to strengthen the training of primary, specialty, and mental 

healthcare providers on the Gulf War Illness case definitions recommended by IOM. 

Public Access to Scientific Data.—This Committee commends the 

Department on issuing its Policy and Implementation Plan for Public Access to Scientific Publications and Digital Data from Research 

Funded by the Department of Veterans Affairs on July 23, 2015. 

The Committee urges VA to continue its efforts towards full implementation of the plan and requires an update on progress made be 

included in its fiscal year 2021 budget request. 

Ultrasound Guided Regional Anesthesia for Opioid Reduction.— The Committee continues to be concerned about the use of opioids 

to address pain in the VA Healthcare System. The Committee is 

aware of several protocols being tested in non-VA hospitals, such 

as Alternatives to Opioids in the Emergency Department, Enhanced Recovery After Surgery, and the Perioperative Surgical 

Medical Home. The Committee encourages VA as part of its opioid 

prevention efforts to provide VA clinicians with resources to study 

and potentially adopt these and other ultrasound guided regional 

anesthesia protocols to reduce the number of opioids prescribed and 

used to treat Veterans’ acute and urgent pain. 

NICoE Collaboration.—The Committee recognizes the high-quality mental health care and neurological research being conducted 

at Walter Reed National Intrepid Center of Excellence (NICoE). 

The Committee directs the Department of Veterans Affairs to 

strengthen its collaboration with NICoE so VA researchers and 

health professionals can learn from NICoE’s important work and 

contribution to the health community. The Committee directs VA 

to submit a report no later than 120 days after enactment of this 

Act to the Committees on Appropriations of both Houses of Congress on existing collaborative efforts between VA and NICoE and 

the expansion of such collaborations. 

Collaboration on Precision Medicine.—The Committee supports 

expanding the reach of the Department’s research program, such as 

by partnering with non-federal entities and initiatives and co-locating VA and university biomedical scientists, and encourages the 

Department to expeditiously seek opportunities for collaboration on 

precision medicine and other multi-disciplinary research for wounded warriors and other at-risk Veterans. 


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Hyperbaric Therapy.—The Committee supports continued study 

of the use of hyperbaric oxygen treatments for Veterans suffering 

from post-traumatic stress disorder. 

Drug Development for Depression and Suicide Prevention.—Depression, post-traumatic stress disorder, and suicide threaten to 

reach epidemic proportions among America’s Veteran warfighters. 

Recent National Institute of Mental Health clinical trials investigating the use of intravenous Scopolamine to treat depression 

have shown potentially promising initial results to address this 

issue and the potential to assist in the prevention of suicide. The 

Committee encourages the Department to look at all drug development to build upon current research efforts to prevent depression 

and suicides. 

Rapid Cerebral Therapeutic Hypothermia.—Veterans who suffer 

from brain injury frequently experience long-term cognitive effects. 

Evidence has demonstrated that immediate cooling of the brain following traumatic injury can reduce brain damage and improve outcomes. The Committee supports the research of rapid cerebral 

therapeutic hypothermia to lessen the long-term effects of traumatic brain injuries. 

Parkinson’s Disease Research.—Parkinson’s Disease Research, 

Education and Clinical Centers (PADRECCs) allow for approximately 110,000 United States Veterans diagnosed with Parkinson’s 

disease to receive specialized, multidisciplinary care of the highest 

quality, leading to improved quality of life and improved health 

outcomes. The six PADRECCs located throughout the United 

States have expanded care through a National Consortium that offers specialized Parkinson’s disease and movement disorder specialty care in 51 Consortium Centers to Veterans who cannot travel 

to a PADRECC. The mission of the PADRECCs is to support quality of life by providing comprehensive medical and surgical care to 

Veteran patients with Parkinson’s disease and other movement disorders, advancing investigation into the cause and cure for Parkinson’s disease, and enhancing understanding of the disorder through 

education and research. The Committee strongly supports Parkinson’s disease research and encourages the Department to increase 

funding to PADRECCs to allow the Centers to address the growing 

and complex needs of the population, while continuing to provide 

specialized, multidisciplinary care to Veterans diagnosed with Parkinson’s disease and other movement disorders. 

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 2020 is $3,912,000,000. 

MCCF Third-Party Billing.—Congress remains concerned over 

potential discrepancies in VA’s billing process. Procedures to provide for correct billing and prompt collection must improve at VA. 


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Therefore, the Department shall submit to Congress a quarterly report identifying the amount of third-party health billings that were 

owed to VA in the previous quarter and the amount collected. The 

report shall include billings and collections data for both large 

claims (greater than $1,000) and small claims (equal to or less than 

$1,000). In addition, the first quarter report shall include current 

efforts underway to increase VA’s efficiency, accuracy, and collection process, as well as what management practices are in place to 

provide proper oversight of the billing process, including appeals, 

so as to eliminate unnecessary and duplicative functions. 

NATIONAL CEMETERY ADMINISTRATION

Fiscal year 2019 enacted level ........................................................... $315,836,000 

Fiscal year 2020 budget request ....................................................... 329,000,000 

Committee recommendation in the bill ............................................ 329,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 13,164,000 

Fiscal year 2020 budget request ................................................ – – – 

The National Cemetery Administration (NCA) was established in 

accordance with the National Cemeteries Act of 1973 (P.L. 93–43). 

It has a fourfold mission: to provide for the interment of, in any 

national cemetery with available grave space, the remains of eligible deceased servicemembers and discharged Veterans, together 

with their spouses and certain dependents, and to permanently 

maintain their graves; to provide headstones for, and to mark 

graves of eligible persons in National, State and Tribal, and private 

cemeteries; to administer the grant program for aid to States and 

tribal governments in establishing, expanding, or improving State 

and tribal government Veterans’ cemeteries; and to administer the 

Presidential Memorial Certificate Program. This appropriation will 

provide for the operation and maintenance of 144 operational national cemeteries, 11 cemeteries transferred from the Department 

of the Army, and 33 other cemeterial installations. 

The bill includes language making ten percent of the total available until September 30, 2021. 

Rural Cemetery Access.—In House Report 112–94 and House Report 115–188 the Committee expressed concern that NCA is not 

adequately serving the Nation’s Veterans in rural areas. The Committee continues to be concerned that there are geographic pockets 

in the country that are not being served, as VA has failed to meet 

its goals of having access for all Veterans to a burial option within 

75 miles of a Veteran’s home. The Committee has previously requested a report on this issue and in fiscal year 2018 requested 

that GAO examine this issue as well. The Committee remains interested and looks forward to this report no later than 60 days 

after enactment of this Act. 


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DEPARTMENTAL ADMINISTRATION

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2019 enacted level ........................................................... $355,897,000 

Fiscal year 2020 budget request ....................................................... 369,200,000 

Committee recommendation in the bill ............................................ 369,200,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 13,303,000 

Fiscal year 2020 budget request ................................................ – – – 

The General Administration account provides funds for the Office 

of the Secretary, seven Assistant Secretaries, and three independent staff offices. The Committee has included bill language to 

make available through September 30, 2021, 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. Included in this funding is $22,000,000 for the Office of 

Accountability and Whistleblower Protection. This office was previously funded out of reimbursements, and the recommendation 

provides a direct funding source to ensure its independence from 

Department leadership. 

VA Five Year Development Plan (VFYDP).—The Committee is 

very pleased that the Department has provided a VFYDP in its fiscal year 2020 budget. The Committee looks forward to continued 

annual review of the VFYDP in VA budget submissions. 

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. 

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. 

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. 

Performance Bonuses.—The Committee feels it is important to 

know how VA is allocating its resources with regard to performance 

bonuses. Therefore, the Committee directs VA to submit a report, 

no later than 90 days after enactment of this Act, which provides 

the aggregate total of VA performance bonuses covering the five 

most recent fiscal years for which the data is available. The data 

should be divided between bonuses for Senior Executive Service 

(SES) staff and non-SES staff. The report should also include the 

percentage of SES and non-SES employees who received a bonus 

and the average dollar amount of the bonuses by grade covering 

the same time period. The report, however, should not include any 

personally identifiable information. 

Financial Management Business Transformation (FMBT).—The 

Committee provides $11,900,000 in this account as well as 

$66,000,000 in the Information Technology Systems account for 


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FMBT. An additional $107,000,000 will be provided from the VA 

customer offices through the Franchise Fund. The current legacy financial management system is over 30 years old, and its imminent 

failure presents significant risks to VA. In the fiscal year 2018 conference report, VA was directed to provide the Committee, on a 

quarterly basis, a report that compares actual progress on the financial management system to the performance benchmarks and 

timeline provided in the first report. The Committee continues to 

expect the Department to continue this quarterly report throughout 

fiscal year 2020. 

Whistleblower Protection.—The Committee reiterates that the 

purpose of the Department of Veterans Affairs Accountability and 

Whistleblower Protection Act of 2017 (P.L. 115–41), was to increase 

accountability and the integrity of Veterans services and care. Public Law 115–41 is not a retaliatory tool for management to use 

against employees or a means of discrimination against employees 

who are also Veterans. In order for this legislation to work as intended, it must be applied consistently and as intended, which is 

why the Department of Defense and Labor, Health and Human 

Services, and Education Appropriations Act, 2019 and Continuing 

Appropriations Act, 2019 (P.L. 115–245) directed the Secretary of 

Veterans Affairs to provide a report on this matter. Unfortunately, 

the Committee has yet to receive a report, which is concerning as 

the congressional intent was to receive information on the application of such authorities to employees organized by wage grade, an 

assessment of whether such authorities are being disproportionately applied to lower wage grades, as well as the information on 

the frequency of appeals. In addition, the report was to include demographic data on overall VA workforce terminations since fiscal 

year 2016. Therefore, the Committee directs the Secretary of Veterans Affairs to provide a status update on this report 15 days 

after the filing of this report. 

Small, Minority- and Women-Owned Businesses.—The Committee recognizes the need for the Department to continue to meet 

its goals for contracting with minority, disadvantaged, and womenowned businesses. The Committee is concerned that in fiscal years 

2016 and 2017, the Department missed its prime contracting goals 

for women-owned businesses, and businesses in HUBZones. In fiscal year 2016, the Department missed all of its subcontracting 

goals for women-owned businesses, small disadvantaged businesses, service-disabled Veteran-owned businesses, and businesses 

in HUBZones. Therefore, the Committee directs the Department to 

prioritize awarding contracts to contractors that consistently execute approved small business subcontracting plans. The Committee 

further urges the Department to prioritize minority-owned and disadvantaged contractors and subcontractors. The Committee directs 

the Department to submit a report, no later than 180 days after 

enactment of this Act and annually thereafter, detailing the number of contractors that submitted a small business subcontracting 

plan during the fiscal year. This report shall include an analysis 

detailing which contractors successfully implemented subcontracting plans and recommendations on how the Department could 

better achieve its prime and subcontracting goals for small businesses. 


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Advertising With Small and Disadvantaged Businesses.—The 

Committee notes 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 

the Department to include the following information concurrent 

with the fiscal year 2021 budget request: Expenditures for fiscal 

year 2020 and expected expenditures for fiscal year 2021, respectively, for (1) all contracts for advertising services; and (2) contracts 

for the advertising services of (i) socially and economically disadvantaged small business 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. 

Data on Women and Minority Veterans.—The Committee recognizes the lack of data specific to women and minority Veterans 

made available to Congress by the Department. The Committee 

recommends, when applicable, the Secretary of Veterans Affairs 

display information in the annual report(s) submitted to Congress 

separately for women Veterans and minority Veterans. 

Mail Management.—The Committee notes the GAO report titled, 

‘‘VA: Actions Needed to More Effectively Manage Outgoing Mail’’ 

(GAO–17–581), and requests the Department provide a report on 

the potential costs and benefits of centralizing its mail management system no later than 180 days after enactment of this Act. 

The report should include information on innovative information 

technology platforms that could result in savings and increased efficiency. 

BOARD OF VETERANS’ APPEALS

Fiscal year 2019 enacted level ........................................................... $174,748,000 

Fiscal year 2020 budget request ....................................................... 182,000,000 

Committee recommendation in the bill ............................................ 182,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 7,252,000 

Fiscal year 2020 budget request ................................................ – – – 

The bill makes ten percent of this funding available through September 30, 2021. 

The Board of Veterans’ Appeals (BVA) is the component of VA 

responsible for making final decisions on behalf of the Secretary for 

the thousands of claims for Veterans’ benefits that are presented 

to BVA for appellate review. The majority of BVA’s workload derives from the benefit claims initiated at VBA regional offices. The 

appellate process has multiple steps, most of which occur at the 

local regional office level. If a Veteran is not satisfied with a regional office determination, he or she may appeal to BVA for a final 

agency decision. BVA adjudicates appeals covering all areas of Veterans’ benefits, but most of the workload concerns appeals for Veterans’ disability compensation or pension benefits. On February 19, 

2019, VA implemented the new legislative framework that modernized the claims and appeals process and provided greater choice to 

Veterans by providing them three options for claims and appeals: 

(1) a supplemental claim; (2) a higher-level review; or (3) a direct 

appeal to the Board of Veterans’ Appeals. VA decided 85,000 cases 

in fiscal year 2018, which was a record level by 25,000 cases, and 


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was VA’s best year since 2009 for efficiencies. VA is on pace to exceed the 2019 goal of 90,050 decisions. 

The bill also provides the $4,100,000 as requested in the Information Technology Systems budget to support phase three of the 

Appeals Modernization initiative. The initiative will convert the 

Board’s 1980s-era case control and locator system to a new, automated integrated community developed suite that is used to process initial disability claims. 

INFORMATION TECHNOLOGY SYSTEMS

(INCLUDING TRANSFER OF FUNDS)

Fiscal year 2019 enacted level ........................................................... $4,103,000,000 

Fiscal year 2020 budget request ....................................................... 4,343,000,000 

Committee recommendation in the bill ............................................ 4,343,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 240,000,000 

Fiscal year 2020 budget request ................................................ – – – 

The Information Technology (IT) Systems account supports IT 

services such as systems development and performance, operations 

and maintenance, information protection, and customer support. 

The program permits the effective and efficient delivery of Veterans’ healthcare services and benefits programs. 

Within the account total, the Committee allocates in bill language $1,204,238,000 for pay and associated costs, which is equal 

to the budget request; $2,737,482,000 for operations and maintenance, which is equal to the request; and $401,280,000 for development, which is equal to the request. The bill makes available three 

percent of pay and associated costs and five percent of operations 

and maintenance funds until September 30, 2021. All development 

funds are available until September 30, 2021. 

The bill provides $66,000,000 to continue the Financial Management Business Transformation (in addition to the $11,900,000 provided for FMBT in the General Administration account and the 

$107,000,000 provided out of the Franchise Fund), $36,785,000 for 

the supply chain management modernization, and $6,000,000 for 

the VA Center for Innovation to improve existing programs or inform decisions about new programs. 

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 contains language allowing for the reprogramming of 

funds among development projects upon prior notification to, and 

approval by, the Committees on Appropriations of both Houses of 

Congress. The bill continues to include language indicating that 

funds for development are available only for the projects and in the 

amounts specified in the report accompanying the Act. 

The chart below reflects the Committee’s recommendation for 

each development project. This chart will serve as the Department’s approved list of development projects, and all requested 

changes are subject to the reprogramming guidelines as outlined in 

the accompanying Act. 


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INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS 

(In thousands of dollars) 

Project Committee Recommendation 

Clinical Applications ...................................................................................................................................... $32,910 

Health Management Platforms ...................................................................................................................... 80,690 

Benefits Systems ............................................................................................................................................ 136,823 

Memorial Affairs ............................................................................................................................................. 13,877 

Other IT Systems ............................................................................................................................................ 100,480 

Cybersecurity .................................................................................................................................................. 16,600 

Information/Infrastructure Management ........................................................................................................ 19,900 

Total All Development ........................................................................................................................... 401,280 

The Committee expects the Office of Information Technology to 

continue to provide an IT expenditure report to the Committees on 

Appropriations of both Houses of Congress on a monthly basis. 

This report shall include a comparison to the project costs included 

in the development funding chart above and provide an explanation 

for any differences in excess of $1,000,000. 

Information Technology National Standards.—The Committee 

encourages the Veterans Health Administration to vigilantly pursue the Department of Veterans Affairs national IT goals and do 

all that is necessary to maintain needed national standards in IT 

while at the same time meeting short-term local IT needs of individual VA Medical Centers, including maintaining up-to-date security systems and security infrastructure. VHA should solicit, review, and respond in a timely fashion to short-term IT requests 

from its Medical Centers. The Committee supports keeping on 

track with beneficial national IT plans and standards, but the 

Committee also supports serving Veterans well on location in the 

short run. Long-term IT sync and short-term outstanding service 

should both be a part of VHA’s management strategy. 

VETERANS ELECTRONIC HEALTH RECORD (EHR)

Fiscal year 2019 enacted level ........................................................... $1,107,000,000 

Fiscal year 2020 budget request ....................................................... 1,603,000,000 

Committee recommendation in the bill ............................................ 1,603,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 496,000,000 

Fiscal year 2020 budget request ................................................ – – – 

The Veterans Electronic Health Record is a unified account designed to manage the effort to develop an interoperable electronic 

health record system that will access seamlessly the records of Veterans in the VA system and those of the Department of Defense 

and of community providers. The VA system is the same as the one 

chosen by DOD and is planned to be rolled out with the same 

timeline and geographic areas as DOD in order to realize cost efficiency savings. 

Within the total funding, the bill provides $1,106,500,000 for the 

electronic health record contract, $161,800,000 for program management, and $334,700,000 for infrastructure support. Funding is 

made available for three years because of the uncertainty of the 

timing of obligations in this substantial new effort. 

The recommendation includes a rescission of $70,000,000 from 

unobligated balances in section 250 under Administration Provisions. 


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The Department has committed in future years to provide approximately 30 percent of the total cost of this ten-year project. The 

Committee expects that this pledge will be maintained even if 

there are changes in the Department’s leadership. 

The bill does not include the transfer language requested by the 

Administration. 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 to this account or for funds from this account to be transferred to other accounts. Consistent with the effort to centralize financial management of the development of the electronic health 

record, the Committee continues to direct the Department to manage this effort at the headquarters level in the Office of the Deputy 

Secretary. 

The bill language for this account continues to require the Secretary to submit a report quarterly to the Committees on Appropriations of both Houses of Congress detailing obligations, expenditures, and deployment strategy by facility. In addition, bill language is included requiring notice to the Committees on Appropriations of both Houses of Congress on any changes to the deployment 

schedule. The Committee repeats the fiscal year 2019 directive for 

GAO to perform quarterly performance reviews of the VA electronic 

health record deployment. It is expected that this quarterly reporting will provide the Committees and VA with timely information 

to properly oversee this effort and address important issues. Furthermore, the Committee directs VA to provide quarterly reporting 

on EHRM obligations. 

Medical Records Portability.—The Committee supports Veterans 

having real-time, seamless, and portable access to all of their medical records and urges VA to develop, as part of EHRM, the means 

by which Veterans can have secure, portable access to their own 

medical records. 

Cybersecurity Implementation.—The Committee is concerned 

about the pace at which implementation of cybersecurity best practices are occurring at the Department, especially as VA and DOD 

continue to integrate electronic health information. The Committee 

directs the Department to identify for the Committee steps it has 

taken to protect data and patient records across physical, virtual, 

and mobile networks and the devices and systems attached to these 

networks. If such review warrants, the Department should consider 

a layered defensive strategy that includes perimeter security, segmentation within the data center to increase lateral security, and 

data and application protections. The Committee also urges VA to 

ensure that patient records being transferred from DOD to VA 

have the same level of security and data-level protections as provided by DOD. 

Informatics.—In conjunction with the implementation of the 

EHRM program, the Committee recommends that VA continue to 

develop and implement, within the Veterans Health Administration, a comprehensive enterprise interoperability and intelligence 

strategy in order to benefit from advances in the health information technology marketplace for utilization by both Office of Information Technology and Informatics purposes. Such a strategy 

should include modernized enterprise data and analytics capabilities, a clinical interoperability platform, and open-application proVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00074 Fmt 6659 Sfmt 6602 E:\HR\OC\HR063.XXX HR063

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gram interfaces leveraging community healthcare interoperability 

standards. 

Cybersecurity.—Recognizing the cybersecurity challenges of sharing data between the Military Healthcare System GENESIS and 

the VA EHRM initiative, the Committee urges the Department to 

explore and invest in modern, software-defined networking and hybrid cloud technologies to ensure that its EHRM network and IT 

infrastructure will effectively support the Cerner implementation 

and its subsequent use. 

Open Architecture.—The Committee encourages VA to ensure the 

new EHR initiative provides an open architecture that allows a 

governance and oversight process for administering access and support to deploy third-party applications, components, and application programming interfaces to ensure longevity of the EHR platform and requests information on the EHRM architecture be included in quarterly reports. 

Clinical Workflow Challenges.—The Committee is concerned 

about the significant amount of time clinicians spend on the current electronic health record documentation in their treatment of 

Veterans, as well as their inability to easily incorporate such information from within the Veterans’ continuum of care, particularly 

the community care environment. This administrative burden also 

means clinicians have less time to spend providing care to each patient and fewer patients are seen in a given day, resulting in long 

wait times for Veterans. VA’s ongoing efforts with EHRM and 

interoperability with the Department of Defense provide an opportunity to assess innovative technologies’ ability to solve this challenge. The EHRM technology must enhance clinicians’ efficacy so 

they can spend more time with patients. The Committee commends 

the Department’s efforts to involve clinicians at all stages of the 

EHRM rollout and encourages the continued collaboration with clinicians to ensure the most efficient workflow solutions are developed with clinician input. 

Health Navigator.—Section 731 of the National Defense Authorization Act for Fiscal Year 2018 (P.L. 115–91) required the Secretary of Defense to conduct a pilot program to improve health outcomes and patient experience for beneficiaries with complex medical conditions. The Committee believes that VA should conduct a 

similar pilot. VA is encouraged to conduct this pilot in a VA Region 

where it can operate in tandem with DOD’s rollout of the EHR 

platform and the Defense Health Agency’s pilot project as directed 

in Section 731 of Public Law 115–91. 

OFFICE OF INSPECTOR GENERAL

Fiscal year 2019 enacted level ........................................................... $192,000,000 

Fiscal year 2020 budget request ....................................................... 207,000,000 

Committee recommendation in the bill ............................................ 222,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 30,000,000 

Fiscal year 2020 budget request ................................................ 15,000,000 

The Office of Inspector General (OIG) was established by the Inspector General Act of 1978 and is responsible for the audit, investigation, and inspection of all VA programs and operations. The 

overall operational objective is to focus available resources on areas 

that would help improve services to Veterans and their beneficiaries, assist managers of Department programs to operate ecoVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00075 Fmt 6659 Sfmt 6602 E:\HR\OC\HR063.XXX HR063

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nomically in accomplishing program goals, and to prevent and 

deter recurring and potential fraud, waste, and inefficiencies. 

The bill makes up to ten percent of this funding available until 

September 30, 2021. The Committee provides an additional $15,000,000 above the 

budget request to ensure robust oversight by OIG of MISSION Act 

and EHRM implementation. 

CONSTRUCTION, MAJOR PROJECTS

Fiscal year 2019 enacted level ........................................................... $1,127,486,000 

Fiscal year 2020 budget request ....................................................... 1,235,200,000 

Committee recommendation in the bill ............................................ 1,235,200,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... 107,714,000 

Fiscal year 2020 budget request ................................................ – – – 

The Construction, Major Projects appropriation provides for constructing, altering, extending, and improving any of the facilities 

under the jurisdiction or for the use of VA, including planning, architectural and engineering services, assessments, and site acquisition where the estimated cost of a project is more than $20,000,000. 

The Committee recommendation makes all but $480,000,000 of 

these funds available for a five-year period. 

In past years, this appropriations bill repeated language that is 

in permanent law requiring that all major construction projects 

costing more than $100,000,000 be managed by a non-VA government entity such as the Army Corps of Engineers. Because this 

policy is now well-established, the Committee no longer feels a 

need to duplicate the language. However, the Committee intends to 

continue its oversight of the quality of the outside entity management and will continue to receive quarterly briefings on each of the 

large construction projects. 

The chart below reflects the Committee’s recommendation for 

Major Construction projects. 

CONSTRUCTION, MAJOR PROJECTS 

(In thousands of dollars) 

Location Description Committee 

Recommendation 

VHA: 

New York, NY, Manhattan VAMC .................................... Flood Recovery ................................................. 150,000 

Bay Pines, FL .................................................................. Inpatient/Outpatient Improvements ................. 30,000 

San Juan, PR .................................................................. Seismic Corrections—Building #1 .................. 30,000 

San Diego, CA ................................................................. SCI & Seismic Corrections .............................. 20,000 

Reno, NV ......................................................................... Correct Seismic Deficiencies & Expand Clinical Services Building.10,000 

Louisville, KY ................................................................... New Medical Facility ........................................ 410,000 

West Los Angeles, CA ..................................................... Build New Critical Care Center ....................... 25,000 

Alameda, CA .................................................................... Outpatient Clinic & National Cemetery ........... 26,000 

Advance Planning and Design Fund .............................. Various Locations ............................................ 72,000 

Asbestos: ......................................................................... Various Locations ............................................ 12,000 

Major Construction Staff: ............................................... Various Locations ............................................ 88,700 

Judgment Fund: .............................................................. Various Locations ............................................ 25,000 

Non-Dept. Fed. Entity Project Management Support ...... Various Locations ............................................ 120,000 

Seismic Corrections: ....................................................... Various Locations ............................................ 35,000 

Total VHA ............................................................... .......................................................................... 1,053,700 

National Cemetery Admin. (NCA): 

Bayamon, PR ................................................................... Replacement Cemetery (Morovis) .................... 10,000 

Riverside, CA ................................................................... Gravesite Expansion & Cemetery Improvements.3,000 


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CONSTRUCTION, MAJOR PROJECTS—Continued 

(In thousands of dollars) 

Location Description Committee 

Recommendation 

Elmira, NY ....................................................................... Western New York Cemetery ............................ 10,000 

Houston, TX ..................................................................... Gravesite Expansion ........................................ 34,000 

Bourne, MA ...................................................................... Massachusetts Phase 4 Expansion ................. 32,000 

Dallas, TX ........................................................................ Dallas National Cemetery Expansion .............. 28,000 

Advance Planning and Design Fund .............................. .......................................................................... 35,000 

NCA Land Acquisition ..................................................... .......................................................................... 20,000 

Total, NCA .............................................................. .......................................................................... 172,000 

General Admin.: .............................................................. Staff Offices Advance Planning Fund ............. 9,500 

Major Construction Total ....................................... .......................................................................... 1,235,200 

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. 

Budget Justification Documents.—The Committee reminds the 

Department of the requirement in section 258 of Division A of the 

Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act (P.L. 114–223) regarding specific materials to be included in Major Construction budget justification 

documents for fiscal year 2017 and each fiscal year thereafter. 

Joint VA and U.S. Army Corps of Engineers Projects.—The Committee is concerned the Department projects under management of 

the United States Army Corps of Engineers (USACE) may experience unecessary administrative delays during the initial transitional phase between projects being authorized and appropriated 

by Congress and an interagency agreement being signed by VA and 

USACE. Accordingly, no later than 60 days after enactment of this 

Act, the Committee directs VA to provide monthly updates on all 

current and subsequent VA construction projects worth more than 

$100,000,000, and jointly managed by VA and USACE. Regular reports for certain projects may be submitted on a quarterly basis if 

the Department and Committee come to an agreement that more 

frequent reports are not necessary. 

Research Facilities Infrastructure Report.—In fiscal year 2006, 

the Committee directed VA to conduct a comprehensive review of 

its research facilities and report to Congress on the deficiencies 

found and suggestions for correction. VA released its initial review 

in 2012, and recently completed Phase II assessments of a subset 

of those facilities. The Committee directs VA to submit the completed Phase II research facilities infrastructure report updates to 

the Committees on Appropriations of both Houses of Congress no 

later than October 1, 2019. 


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CONSTRUCTION, MINOR PROJECTS

Fiscal year 2019 enacted level ........................................................... $649,514,000 

Fiscal year 2020 budget request ....................................................... 398,800,000 

Committee recommendation in the bill ............................................ 421,117,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... (228,397,000) 

Fiscal year 2020 budget request ................................................ 22,317,000 

The Construction, Minor Projects appropriation provides for constructing, altering, extending, and improving any of the facilities 

under the jurisdiction of, or for the use of, the Department, including planning, assessment of needs, architectural and engineering 

services, and site acquisition, where the estimated cost of a project 

is equal to or less than $20,000,000. 

As with the Major Construction account, the Committee recommendation makes these funds available for a five-year period. 

Within the amounts provided, the Committee directs $22,317,000 

for the construction related to expanding gender-specific care for 

women and mental health programs. 

The recommendation includes $150,000,000 in additional funding 

in section 243 under Administration Provisions for minor construction projects. 

Construction of Housing for Rural Homeless Veterans.—The Department has made great efforts to find suitable housing for homeless Veterans and their families. The Committee encourages more 

non-traditional efforts to eliminate Veteran homelessness. For example, some cities and towns have started pilot programs using 

‘‘Micro’’ or ‘‘Tiny Homes’’ to help deal with homelessness. The Committee encourages VA to continue its efforts to house homeless Veterans and their families and explore the feasibility of providing 

‘‘Tiny Homes’’. 

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Fiscal year 2019 enacted level ........................................................... $150,000,000 

Fiscal year 2020 budget request ....................................................... 90,000,000 

Committee recommendation in the bill ............................................ 150,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... – – – 

Fiscal year 2020 budget request ................................................ 60,000,000 

This appropriation provides grants to assist States to construct 

State home facilities, for furnishing domiciliary or nursing home 

care to Veterans, and to expand, remodel, or alter existing buildings for furnishing domiciliary, nursing home, or hospital care to 

Veterans in State homes. A grant may not exceed 65 percent of the 

total cost of the project. The bill makes this funding available until 

expended. 

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Fiscal year 2019 enacted level ........................................................... $45,000,000 

Fiscal year 2020 budget request ....................................................... 45,000,000 

Committee recommendation in the bill ............................................ 45,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... – – – 

Fiscal year 2020 budget request ................................................ – – – 

This program provides grants to assist States and tribal governments with the establishment, expansion, and improvement of Veterans’ cemeteries that are operated and permanently maintained 


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by the States and tribal governments. Grants under this program 

fund up to 100 percent of construction costs and the initial equipment expenses when the cemetery is established. State and tribal 

governments remain responsible for providing the land and for paying all costs related to the operation and maintenance of the State 

cemeteries, including the costs for subsequent equipment purchases. The bill makes this funding available until expended. 

ADMINISTRATIVE PROVISIONS

The bill includes 52 administrative provisions, of which 47 were 

in effect in fiscal year 2019 in some form and 5 are new provisions. 

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 2020. 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 2020 for ‘‘Compensation and Pensions’’, ‘‘Readjustment Benefits’’, and ‘‘Veterans Insurance and Indemnities’’ 

for payment of accrued obligations recorded in the last quarter of 

fiscal year 2019. 

The bill includes section 207 allowing for the use of fiscal year 

2020 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 the Department to obligate 

enhanced-use lease proceeds for administrative expenses that were 

incurred in a prior fiscal year during the year funds are received. 


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(INCLUDING TRANSFER OF FUNDS)

The bill includes section 210 limiting the amount of reimbursement the Office of Resolution Management, the Office of Employment Discrimination Complaint Adjudication, and the Office of Diversity and Inclusion 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 Veterans Health 

Administration. 

(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. 


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(INCLUDING TRANSFER OF FUNDS)

The bill includes section 219 providing up to $314,409,000 of fiscal year 2020 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 $322,931,000 of fiscal year 2020 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 


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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 budget request 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 budget request 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 delete 

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 restricting funds from being used to 

close certain medical facilities in the absence of a national realignment strategy. The Administration request to delete this provision 

is not adopted. 

The bill includes section 233 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 234 permanently allowing the use of 

Medical Services funding for assisted reproductive technology treatment and adoption reimbursement for Veterans and their spouses 

if the Veteran has a service-connected disability that results in 

being unable to procreate without such fertility treatment. 

The bill includes section 235 prohibiting any funds from being 

used in a manner that is inconsistent with statutory limitations on 

outsourcing. 

The bill includes section 236 pertaining to exceptions for Indianor Native Hawaiian-owned businesses contracting with VA. The 

Administration request to delete this provision is not adopted. 

The bill includes section 237 directing the elimination over a series of years of the use of Social Security numbers in VA programs. 

The Administration request to delete this provision is not adopted. 

The bill includes section 238 referencing the provision in the 

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fairs, 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 239 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 240 permitting funding to be used in fiscal years 2020 and 2021 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 241 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 242 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 243 providing $1,000,000,000 to be 

available until expended for VA infrastructure needs, of which 

$850,000,000 is for seismic improvement projects and seismic management activities and $150,000,000 is for Minor Construction. 

This funding is not made available until VA provides and the Committees on Appropriations of both Houses of Congress approve a 

detailed expenditure plan. 

The bill includes section 244 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 Administration request to delete this provision is not adopted. 

The bill includes section 245 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 246 prohibiting the use of funds in fiscal 

year 2020 to convert any program that received specific purpose 

funds in fiscal year 2019 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 247 eliminating category D or E pain 

testing on dogs. 

The bill includes section 248 prohibiting the closure of the CBOC 

in Bainbridge, New York until the Secretary submits a completed 

market area assessment to the Committees on Appropriations of 

both Houses of Congress. 


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The bill includes section 249 requiring the Department to update 

the Planning and Activating CBOC handbook every five years and 

provide guidance and training to employees on each update of the 

handbook. 

(INCLUDING RESCISSION OF FUNDS)

The bill includes section 250 rescinding $70,000,000 of unobligated fiscal year 2019 funding for the Veterans Electronic Health 

Record account. 

The bill includes section 251 extending the VSO wellness pilot 

program authorized in section 252 of the Consolidated Appropriations Act, 2018 (P.L. 155–141) until 2022. 

TITLE III 

RELATED AGENCIES 

Funds under Title III support the agencies that honor and respect the service of our Nation’s heroes. Though it may be a smaller title of the bill, the agencies funded under Title III are the public face of America’s commitment to our servicemembers and Veterans. The American Battle Monuments Commission and Arlington 

Cemetery commemorate those who made the ultimate sacrifice, 

while the Armed Forces Retirement Home and the United States 

Court of Appeals for Veterans Claims are critical parts of keeping 

our promise to serve those who served our Nation. 

The Committee is disappointed that these agencies are kept 

largely flat funded in their requests by the Office of Management 

and Budget (OMB), despite the very real needs of these agencies. 

The Committee expects OMB to provide budget requests that properly reflect the needs of these agencies, not to shortchange these 

critical agencies under the guise of fiscal responsibility. 

AMERICAN BATTLE MONUMENTS COMMISSION

SALARIES AND EXPENSES

The recommendation includes $104,000,000 for Salaries and Expenses of the ABMC, an increase of $28,900,000 above the request 

to support ABMC’s unfunded requirements for high-priority 

projects. 

The Committee notes the significant maintenance needs of the 

American Battle Monuments around the world, which are specifically designed to honor our fallen servicemembers. The Committee 

directs ABMC to emphasize maintaining and repairing these monuments and memorials in a proactive and timely manner that honors the service, achievements, and sacrifices of the United States 

Armed Forces. 

World War I Memorial Preservation.—The Committee supports 

the preservation and rehabilitation of World War I memorials 

across the country and in Europe to honor the more than four million men and women who bravely served the United States and 

fought to preserve our freedom. 


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FOREIGN CURRENCY FLUCTUATIONS ACCOUNT

The recommendation includes such sums as necessary for the 

Foreign Currency Fluctuations Account. 

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

SALARIES AND EXPENSES

The recommendation includes $35,400,000 for Salaries and Expenses for the United States Court of Appeals for Veterans Claims 

(the Court). The Consolidated Appropriations Act, 2018 (P.L. 115– 

141) included bill language requiring a feasibility study before the 

purchase of a new courthouse. The study has not been completed, 

and the Committee does not support the Court using the requested 

fiscal year 2020 funds for this purpose. Instead, the Committee directs the Court to use the $800,000 to address its growing caseload. 

Caseload.—The Committee is concerned about indications of a 

growing caseload at the Court, particularly as the Court has now 

received authority to hear class action litigation. While reforms 

have recently been enacted that may slow this increase, the Committee acknowledges that the Court may need additional resources 

in the future, potentially including additional judges, to meet the 

caseload needs. 

DEPARTMENT OF DEFENSE CIVIL CEMETERIAL EXPENSES, ARMY

SALARIES AND EXPENSES

The recommendation includes $80,800,000 for Salaries and Expenses for Arlington National Cemetery (the Cemetery), which is 

$10,000,000 above the fiscal year 2020 budget request. The Committee has provided this additional $10,000,000 to maintain current services, as was previously identified as a need during the fiscal year 2019 cycle. 

CONSTRUCTION

The recommendation includes $131,000,000 for planning and design and construction of Southern Expansion to remain available 

until expended. 

Southern Expansion.—The recommendation includes 

$131,000,000 for planning and design and construction of Southern 

Expansion to remain available until expended. This will complete 

the anticipated $350,000,000 cost of the Southern Expansion and 

road realignments to extend the life of the cemetery. The Committee provides this funding to ensure that the life of our Nation’s 

most prestigious cemetery is extended into the 2050 timeframe. 

Updated Interment Policy.—The Committee notes that the National Defense Authorization Act for Fiscal Year 2019 (P.L. 115– 

232) required the Secretary of the Army to revise criteria for interment at Arlington National Cemetery to preserve the Cemetery as 

an active burial ground well into the future. The Committee understands that the Secretary is currently reviewing proposals and 

notes that it will be following closely to ensure that the Cemetery 

can continue to live up to its mission to honor those who have 

served. 


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ARMED FORCES RETIREMENT HOME

TRUST FUND

The recommendation includes $70,300,000 for the Armed Forces 

Retirement Home (AFRH), an increase of $6,000,000 above the requested amount, although $22,000,000 of the total is provided from 

the general fund of the Treasury, and not the Trust Fund. The 

Committee provides this increase to keep pace with anticipated 

personnel costs and contract cost inflation, as well as to support urgently needed capital maintenance and other improvements, in 

particular, infrastructure related to the health and safety of AFRH 

residents. The Committee understands that deferred maintenance 

projects are in critical need of attention, and provides this funding 

as a clear statement of priorities for future budget requests. 

General Fund.—The Committee has previously expressed concern 

about the use of the General Fund to support the work of AFRH. 

The Committee is pleased that efforts are underway to increase 

revenues and stabilize the AFRH Trust Fund for the long term, 

and directs AFRH to continue to make progress in this area and 

report to the Committee on its further initiatives to improve sustainability and maintain the high-quality services provided to 

AFRH residents. 

Land Redevelopment.—The Committee understands that AFRH 

has issued a request for proposals to redevelop the 80-acre master 

planned parcel on the Washington campus, and looks forward to 

seeing the selection process conducted in a fair, open, and transparent manner without undue outside influence. AFRH is directed 

to report to the Committee on the status of the selection process 

and resulting lease negotiations. 

Administrative Provision 

The bill includes one provision that was in effect in fiscal year 

2019. The administrative provision included in the bill is as follows: 

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 

OVERSEAS CONTINGENCY OPERATIONS 

DEPARTMENT OF DEFENSE

Fiscal year 2019 enacted level ........................................................... $921,000,000 

Fiscal year 2020 budget request ....................................................... 9,844,526,000 

Committee recommendation in the bill ............................................ 921,000,000 

Comparison with: 

Fiscal year 2019 enacted level ................................................... – – – 

Fiscal year 2020 budget request ................................................ (8,923,526,000) 

The recommendation includes Overseas Contingency Operations 

for military construction projects and planning and design related 

to the European Deterrence Initiative (EDI). 


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MILITARY CONSTRUCTION, ARMY

The recommendation includes $156,860,000 for Army military 

construction and planning and design for Overseas Contingency 

Operations and European Deterrence Initiative projects. 

The recommendation does not include $88,500,000 as requested 

for the High-Value Detention Facility replacement at Guantanamo 

Bay, Cuba. 

The recommendation does not include $7,200,000,000 for a border wall as requested by the Administration. 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

The recommendation includes $281,576,000 for Navy and Marine 

Corps military construction and planning and design for European 

Deterrence Initiative projects. 

MILITARY CONSTRUCTION, AIR FORCE

The recommendation includes $436,564,000 for Air Force military construction and planning and design for European Deterrence 

Initiative projects. 

MILITARY CONSTRUCTION, DEFENSE-WIDE

The recommendation includes $46,000,000 for Defense-Wide 

Overseas Contingency Operations and planning and design for European Deterrence Initiative projects. 

ADMINISTRATIVE PROVISION

The bill includes one provision that was in effect in fiscal year 

2019. 

The bill includes section 401 that designates that funding shall 

be available only if the President so designates all amounts and 

transmits such designations to Congress. 

TITLE V 

NATURAL DISASTER RELIEF 

DEPARTMENT OF DEFENSE

Fiscal year 2019 enacted level ............................................... – – – 

Fiscal year 2020 budget request ........................................... $9,200,000,000 

Committee recommendation in the bill ................................ 2,300,000,000 

Comparison with: 

Fiscal year 2019 enacted level ....................................... 2,300,000,000 

Fiscal year 2020 budget request .................................... (6,900,000,000) 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

The recommendation includes $1,210,948,000 for Navy and Marine Corps military construction and planning and design for damages related to Hurricanes Florence and Michael. 

MILITARY CONSTRUCTION, AIR FORCE

The recommendation includes $1,035,752,000 for Air Force military construction and planning and design for damages related to 

Hurricanes Florence and Michael and 2019 flooding. 


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MILITARY CONSTRUCTION, ARMY NATIONAL GUARD

The recommendation includes $50,000,000 for Army National 

Guard military construction and planning and design for damages 

related to Hurricanes Florence and Michael. 

MILITARY CONSTRUCTION, ARMY RESERVE

The recommendation includes $3,300,000 for Army Reserve military construction and planning and design for damages related to 

Hurricanes Florence and Michael. 

ADMINISTRATIVE PROVISION

The bill includes one new Administrative Provision. 

The bill includes section 501 that designates that funding shall 

be available only if the President so designates all amounts and 

transmits such designation to Congress and requires a spend plan. 

TITLE VI 

GENERAL PROVISIONS 

The bill includes a total of 14 provisions: 11 provisions that are 

effective in fiscal year 2019: 

The bill includes section 601 prohibiting the obligation of funds 

beyond the current fiscal year unless expressly so provided. 

The bill includes section 602 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 603 encouraging all departments and 

agencies funded in this Act to expand the use of ‘‘E-Commerce’’ 

technologies and procedures. 

The bill includes section 604 specifying the Congressional committees that are to receive all reports and notifications. 

The bill includes section 605 prohibiting the transfer of funds to 

any instrumentality of the United States Government without authority from an appropriations Act. 

The bill includes section 606 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 607 requiring all reports submitted to 

the Congress to be posted on official websites of the submitting 

agency. 

The bill includes section 608 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 609 prohibiting the use of funds for payment of first-class travel by an employee of the executive branch. 

The bill includes section 610 prohibiting the use of funds in this 

Act for any contract where the contractor has not complied with EVerify requirements. 


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The bill includes section 611 prohibiting the use of funds in this 

Act by the Department of Defense or the Department of Veterans 

Affairs for the purchase or lease of a new vehicle except in accordance with Presidential Memorandum—Federal Fleet Performance, 

dated May 24, 2011. 

The bill includes section 612 prohibiting the use of funds in this 

Act and previous Acts for the construction of a wall, barrier, fence, 

or road along the Southern border of the United States or a road 

to provide access to a wall, barrier, or fence constructed along the 

Southern border of the United States. 

The bill includes section 613 prohibiting childcare centers, agencies, or providers to employ an individual convicted of a sex offense, 

an offense involving a child victim, or a violent crime. 

The bill includes section 614 prohibiting funds to be used to replace or diminish the quality of care provided by the TRICARE program. 

HOUSE OF REPRESENTATIVES REPORT 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. 

RESCISSIONS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the House 

of Representatives, the following table lists the rescissions in the 

accompanying bill: 

DEPARTMENT/ACTIVITY

AMOUNTS RECOMMENDED FOR RESCISSION

Department of Defense, Military Construction, Defense-Wide 

(Sec. 125) ......................................................................................... $45,055,000 

Department of Veterans Affairs, Departmental Administration, 

Veterans Electronic Health Record (Sec. 250) .............................. $70,000,000 

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 that allows transfer of funds from ‘‘Military 

Construction, Defense-Wide’’ to other military construction accounts and family housing. 

Language is included 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 


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Construction accounts to the Department of Defense Military Unaccompanied Housing Improvement Fund. 

Language is included to provide transfer authority from the 

BRAC account to the Homeowners Assistance Program. 

Language is included to allow the transfer of expired funds to the 

‘‘Foreign Currency Fluctuations, Construction, Defense’’ account. 

Language is included to allow the transfer of funds among 

projects and activities in accordance with reprogramming guidelines. 

Language is included to transfer not to exceed $18,147,000 in fiscal year 2021 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 to permit the transfer of funds from General Administration to General Operating Expenses, Veterans Benefits Administration. 

Language is included 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 to provide authority for the Department of 

Veterans Affairs for any funds appropriated in 2020 for Compensation and Pensions, Readjustment Benefits, and Veterans Insurance 

and Indemnities to be transferred among those three accounts. 

Language is included to transfer funds among the Medical Services, Medical Community Care, Medical Support and Compliance, 

and Medical Facilities accounts. 

Language is included 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 to permit funding up to $67,891,000 to be 

transferred to General Administration and Information Technology 

Systems from any funds appropriated in fiscal year 2020 to reimburse four headquarters offices for services provided. 

Language is included to transfer certain funds derived from enhanced-use leasing activities to the Construction, Major Projects 

and Construction, Minor Projects accounts. 

Language is included to transfer funds from the Medical Care 

Collections Fund to the Medical Services and Medical Community 

Care accounts. 

Language is included to allow the transfer of funds from the Capital Asset Fund to the Construction, Major Projects and Construction, Minor Projects accounts. 

Language is included 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 to allow the transfer of funds in fiscal year 

2020 provided for the Department of Veterans Affairs to the Joint 


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Department of Defense-Department of Veterans Affairs Medical 

Facility Demonstration Fund. 

Language is included allowing fiscal year 2021 medical care 

funding to be transferred to the Joint Department of Defense-Department of Veterans Affairs Medical Facility Demonstration fund. 

Language is included 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 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 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 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

Neither the bill nor the report contains any Congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

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 italic, 

existing law in which no change is proposed is shown in roman): 

SECTION 220 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS ACT, 2019 

øSEC. 220. Of the amounts appropriated to the Department of 

Veterans Affairs which become available on October 1, 2019, for 

‘‘Medical Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support 

and Compliance’’, and ‘‘Medical Facilities’’, up to $307,609,000, plus 

reimbursements, may be transferred to the Joint Department of 

Defense—Department of Veterans Affairs Medical Facility Demonstration Fund, established by section 1704 of the National Defense Authorization Act for Fiscal Year 2010 (Public Law 111–84; 

123 Stat. 3571) and may be used for operation of the facilities designated as combined Federal medical facilities as described by section 706 of the Duncan Hunter National Defense Authorization Act 

for Fiscal Year 2009 (Public Law 110–417; 122 Stat. 4500): Provided, That additional funds may be transferred from accounts designated in this section to the Joint Department of Defense—DeVerDate Sep 11 2014 22:05 May 17, 2019 Jkt 036401 PO 00000 Frm 00091 Fmt 6659 Sfmt 6601 E:\HR\OC\HR063.XXX HR063

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partment of Veterans Affairs Medical Facility Demonstration Fund 

upon written notification by the Secretary of Veterans Affairs to 

the Committees on Appropriations of both Houses of Congress.¿ 

TITLE 38, UNITED STATES CODE 

* * * * * * * 

PART II—GENERAL BENEFITS 

* * * * * * * 

CHAPTER 17—HOSPITAL, NURSING HOME, 

DOMICILIARY, AND MEDICAL CARE 

SUBCHAPTER I—GENERAL 

Sec. 

1701. Definitions. 

* * * * * * * 

SUBCHAPTER II—HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND 

MEDICAL TREATMENT 

* * * * * * * 

1720J. Provision of assisted reproductive technology or adoption reimbursements for 

certain disabled veterans. 

* * * * * * * 

SUBCHAPTER II—HOSPITAL, NURSING HOME, OR 

DOMICILIARY CARE AND MEDICAL TREATMENT 

* * * * * * * 

§ 1720J. Provision of assisted reproductive technology or 

adoption reimbursements for certain disabled veterans 

(a) PROVISION OF SERVICES.—Subject to the availability of appropriations, the Secretary may provide— 

(1) fertility counseling and treatment using assisted reproductive technology to a covered veteran or the spouse of a covered 

veteran; or 

(2) adoption reimbursement to a covered veteran. 

(b) LIMITATIONS.—Amounts made available for the purposes specified in subsection (a) are subject to the requirements for funds contained in section 508 of division H of the Consolidated Appropriations Act, 2017 (Public Law 115–31). 

(c) DEFINITIONS.—In this section: 

(1) The term ‘‘adoption reimbursement’’ means reimbursement 

for the adoption-related expenses for an adoption that is finalized after the date of the enactment of this section under the 

same terms as apply under the adoption reimbursement program of the Department of Defense, as authorized in Department of Defense Instruction 1341.09, including the reimbursement limits and requirements set forth in such instruction, as 

in effect on the date of the enactment of this section. 

(2) The term ‘‘assisted reproductive technology’’ means benefits relating to reproductive assistance provided to a member of 


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the Armed Forces who incurs a serious injury or illness on active duty pursuant to section 1074(c)(4)(A) of title 10, as described in the memorandum on the subject of ‘‘Policy for Assisted Reproductive Services for the Benefit of Seriously or Severely Ill/Injured (Category II or III) Active Duty Service Members’’ issued by the Assistant Secretary of Defense for Health Affairs on April 3, 2012, and the guidance issued to implement 

such policy, as in effect on the date of the enactment of this section, including any limitations on the amount of such benefits 

available to such a member, except that— 

(A) the periods regarding embryo cryopreservation and 

storage set forth in part III(G) and in part IV(H) of such 

memorandum shall not apply; and 

(B) such term includes embryo cryopreservation and storage without limitation on the duration of such 

cryopreservation and storage. 

(3) The term ‘‘covered veteran’’ means a veteran who has a 

service-connected disability that results in the inability of the 

veteran to procreate without the use of fertility treatment. 

* * * * * * * 

SECTION 252 OF THE MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS ACT, 2018 

SEC. 252. øThe Secretary may carry out a 2-year pilot program¿ 

During the period preceding October 1, 2022, the Secretary of Veterans Affairs may carry out a 2-year pilot program making grants 

to nonprofit veterans services organizations recognized by the Secretary in accordance with section 5902 of title 38, United States 

Code, to upgrade, through construction and repair, VSO community 

facilities into health and wellness centers and to promote and expand complementary and integrative wellness programs: Provided, 

That no single grant may exceed a total of $500,000: Provided further, That the Secretary may not provide more than 20 grants during the 2-year pilot program: Provided further, That the recipient 

of a grant under this section may not use the grant to purchase 

real estate or to carry out repair of facilities leased by the recipient 

or to construct facilities on property leased by the recipient: Provided further, That the Secretary ensures that the grant recipients 

use grant funds to construct or repair facilities located in at least 

10 different geographic locations in economically depressed areas or 

areas designated as highly rural that are not in close proximity to 

Department of Veterans Affairs medical centers: Provided further, 

That the Secretary shall report to the Committees on Appropriations of both Houses of Congress no later than 180 days after enactment of this Act, on the grant program established under this 

section. 

CHANGES IN 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. 


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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 costplus-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. 


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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 allow for transfer of funds 

among projects and activities in accordance with reprogramming 

guidelines. 

Language is included under Title I to prohibit funds to be used 

for projects at Arlington Cemetery. 

Language is included under Title I providing additional funds for 

Military Construction, Army. 

Language is included under Title I providing additional funds for 

Military Construction, Navy and Marine Corps. 

Language is included under Title I providing additional funds for 

Military Construction, Air Force. 

Language is included under Title I providing additional funds for 

Military Construction, Army National Guard. 

Language is included under Title I providing additional funds for 

Military Construction, Air National Guard. 

Language is included under Title I providing additional funds for 

Military Construction, Air Force Reserve. 

Language is included under Title I defining the congressional defense committees. 

Language is included under Title I to require funds appropriated 

shall be immediately available and allotted to contract for the full 

scope of authorized projects. 

Language is included under Title II providing for the reimbursement to the Department of Defense for the costs of overseas 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. 


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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. 

Language is included until Title II requiring the Secretary to ensure sufficient funding is available for the acquisition of prosthetics 

designed for women Veterans. 

Language is included until Title II specifies funding for genderspecific care for women. 

Language is included under Title II to require approval of a 

transfer between development projects in the Information Technology Systems account. 

Language is included prohibiting funding in the Veterans 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, allowing medical services funds for recreational and funeral expenses, and requiring notification of organizational changes that 

transfer 25 or more employees from one VA organizational unit to 

another. 

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 to close hospitals, domiciliaries, or clinics, or conduct environmental assessment or diminish services in the Veterans Integrated 

Service Network 23 as part of a realignment of VA services until 

the Secretary provides a report that includes a national realignment strategy, a cost benefit analysis, and an inventory of buildings with historic designation. 

Language is included under Title II to allow covered veterans 

and their spouses, 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. 


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Language is included in Title II directing the elimination of 

using Social Security account numbers to identify individuals in all 

information systems of the Department. 

Language is included in Title II pertaining to certification of 

marriage and family therapists. 

Language is included in 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 in Title II permitting funds to carry out 

and expand the child care program. 

Language is included in 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 in Title II requiring certain data to be included in budget justifications for major construction projects. 

Language is included until Title II providing funding for infrastructure improvements. 

Language is included in Title II prohibiting the Inspector General timely access to information. 

Language is included in Title II prohibiting funding to be used 

that would increase wait times for veterans who seek medical care. 

Language is included in Title II prohibiting the use of funds in 

fiscal year 2020 to convert any program that received specific purpose funding in fiscal year 2019 to a general purpose-funded program. 

Language is included under Title II prohibiting the use of dogs 

as part of the conduct of any study. 

Language is included under Title II prohibiting the closure of a 

certain community-based outpatient clinic until the Secretary completes a market area assessment. 

Language is included under Title II requiring the Secretary to 

update the ‘‘Planning and Activating Community Based Outpatient 

Clinics’’ handbook. 

Language is included under Title II extending the duration of the 

VSO pilot program. 

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 Expenses, 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 providing Overseas Contingency Operations funding with an emergency designation. 

Language is included under Title IV providing funds with emergency designation, for Overseas Contingency Operations and European Defense Initiative for the Army. 

Language is included under Title IV providing funds with emergency designation, for Overseas Contingency Operations and European Defense Initiative for the Navy and Marine Corps. 


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Language is included under Title IV providing funds with emergency designation, for Overseas Contingency Operations and European Defense Initiative for the Air Force. 

Language is included under Title IV providing funds with emergency designation, for Overseas Contingency Operations and European Defense Initiative for the Defense Agencies. 

Language is include under Title V providing Natural Disaster 

Relief funding with an emergency designation. 

Language is included under Title V providing funds with an 

emergency designation, for hurricane damages sustained by the 

Navy and Marine Corps. 

Language is included under Title V providing funds with an 

emergency designation, for hurricane damages sustained by the Air 

Force. 

Language is included under Title V providing funds with an 

emergency designation, for hurricane damages sustained by the 

Army National Guard. 

Language is included under Title V providing funds with an 

emergency designation, for hurricane damages sustained by the 

Army Reserve. 

Language is included under Title VI 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 VI to prohibit the use of funds 

for a project or program named for a serving Member of the United 

States Congress. 

Language is included under Title VI 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 VI prohibiting funds from being 

used to pay for first class travel in violation of federal regulations. 

Language is included under Title VI 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 VI prohibiting funds from being 

used by the Department of Defense or the Department of Veterans 

Affairs for the purchase or lease of a new vehicle except in accordance with Presidential Memorandum Federal Fleet Performance, 

dated May 24, 2011. 

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: 


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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. 

COMMITTEE HEARINGS

In compliance with Sec. 103(i) of H. Res. 6 (116th Congress) the 

following hearings were used to develop the fiscal year 2020 Military Construction, Department of Veterans Affairs, and Related 

Agencies Appropriations Bill: 

Date Title of Hearing Witnesses 

Feb. 7, 2019 ............................. Quality of Life in the 

Military Hearing.

Sergeant Major Daniel A. Dailey, Sergeant Major of the Army; 

Master Chief Petty Officer Russell Smith, Master Chief Petty 

Officer of the Navy; Sergeant Major Ronald L. Green, Sergeant Major of the Marine Corps; and Chief Master Sergeant Kaleth O. Wright, Chief Master Sergeant of the Air 

Force 

Feb. 13, 2019 ........................... Veterans Long Term Care 

and Health Challenges Hearing.

Dr. Teresa Boyd, ADUSH for Clinical Operations; and Dr. Scotte 

R. Hartronft, Acting Executive Director, VA Office of Geriatrics & Extended Care 

Feb. 26, 2019 ........................... VA General Oversight 

Hearing.

The Honorable Robert Wilkie, Secretary of Veterans Affairs; 

and Richard A. Stone, M.D. Executive in Charge, Veterans 

Health Administration 

Feb. 27, 2019 ........................... The President’s 2019 

National Emergency 

Declaration Circumventing Congress to 

Build a Border Wall & 

its Effect on Military 

Construction and 

Readiness.

The Honorable Robert H. McMahon, Assistant Secretary of Defense for Sustainment; Mr. Robert G. Salesses, Deputy Assistant Secretary of Defense for Homeland Defense Integration and DSCA; Mr. Alex A. Beehler, Assistant Secretary of 

the Army Installations, Energy and Environment; The Honorable Phyllis L. Bayer, Assistant Secretary of the Navy Energy, Installations and Environment; and The Honorable 

John W. Henderson, Assistant Secretary of the Air Force Installations, Environment and Energy 

Feb. 28, 2019 ........................... Female Veterans Access 

to VA Hearing.

Dr. Patricia Hayes, Chief Consultant, Women’s Health Services; 

and Dr. Susan McCutcheon, National MH Director, Family 

Svc/Women’s MH/MST 

Mar. 6, 2019 ............................ Electronic Health Record 

Modernization and Information Technology 

Oversight Hearing.

James M. Byrne, General Counsel, Performing the Duties of 

the Deputy Secretary; James P. Gfrerer, Assistant Secretary 

for Information and Technology and Chief Information Officer; and John Windom, Executive Director, OEHRM 

Mar. 7, 2019 ............................ VA Whole Health, Mental 

Health and Homelessness Hearing.

Dr. Tracy Gaudet, Director, Office of Patient Centered Care 

(10NE), VHA; Dr. David Carroll, Executive Director, Mental 

Health Operations; and Dr. Roger Casey, Director, Education-Dissemination, National Center on Homelessness 

Mar. 12, 2019 .......................... Related Agencies Hearing.Secretary William M. Matz Jr., American Battle Monuments 

Commission; Ms. Karen Durham-Aguilera, Executive Director, Department of the Army, Arlington National Cemetery; 

Stephen T. Rippe, Chief Executive Officer, Armed Forces Retirement Home; and Chief Judge Robert N. Davis, United 

States Court of Appeals for Veterans Claims 

Mar. 13, 2019 .......................... Veterans Affairs Office 

of Inspector General 

Hearing.

The Honorable Michael J. Missal, Inspector General 


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Date Title of Hearing Witnesses 

Mar. 26, 2019 .......................... Military Installations and 

BRAC Budget Hearing.

The Honorable Robert H. McMahon Assistant Secretary of Defense for Sustainment; Lieutenant General Gwen Bingham, 

Assistant Chief for Installations Management; Vice Admiral 

Dixon R. Smith, Deputy Chief of Naval Operations, Fleet 

Readiness and Logistics; Major General Vincent A. 

Coglianese, Marine Corps Installations Command/Assistant 

Deputy Commandant, Installations & Logistics (Facilities); 

and Brigadier General John J. Allen, Air Force Director of 

Civil Engineers, Deputy Chief of Staff for Logistics, Engineering & Force Protection 

Mar. 27, 2019 .......................... Veterans Affairs FY 2020 

Budget Hearing.

The Honorable Robert Wilkie Secretary of Veterans Affairs; Dr. 

Paul R. Lawrence, Under Secretary for Benefits; Richard A. 

Stone, M.D. Executive in Charge, Veterans Health Administration; and Jon Rychalski, Assistant Secretary for Management and Chief Financial Officer 

Apr. 2, 2019 ............................. Members Day Hearing .... The Honorable Anthony Brindisi; The Honorable Salud O. 

Carbajal; The Honorable Gilbert Ray Cisneros; The Honorable Neal P. Dunn, The Honorable Daniel T. Kildee; The 

Honorable Gregorio Kilili Camacho Sablan; and The Honorable Glenn Thompson 

Apr. 2, 2019 ............................. Public Witness Hearing .. Ms. Heather L. Ansley, Associate Executive Director of Government Affairs, Paralyzed Veterans of America, Washington, 

D.C.; Ms. Joy J. Ilem, National Legislative Director, Disabled 

Veterans of America, Washington, D.C.; and Mr. Patrick D. 

Murray, National Legislative Service, Veterans of Foreign 

Wars, Washington, D.C. 

FULL COMMITTEE VOTES


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BUDGETARY IMPACT OF THE FY 2020 MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS BILL

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET

OFFICE PURSUANT TO SEC. 308(A), PUBLIC LAW 93–344, AS AMENDED

[IN MILLIONS OF DOLLARS]

COMPARISION WITH 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 requires the report accompanying a bill providing new 

budget authority to contain a statement comparing the levels in the 

bill to the suballocations submitted under section 302(b) of the Act 

for the most recently agreed to concurrent resolution on the budget 

for the applicable fiscal year. 

[In millions of dollars] 

302(b) Allocation This Bill 

Budget 

Authority Outlays Budget Authority Outlays 

Comparison of amounts in the bill with Committee allocations 

to its subcommittees: Subcommittee on Military Construction, 

Veterans Affairs, and Related Agencies 

General Purpose Discretionary .............................................. 105,217 99,500 106,138 1 99,219 

Mandatory ............................................................................. 114,950 114,775 114,950 1 114,775 

1 Includes outlays from prior-year budget authority. 

NOTE—Consistent with the funding recommended in the bill for overseas contingency operations/global war on terrorism, in accordance

with section 251(b)(2) of the Balanced Budget and Emergency Deficit Control Act of 1985, and after the bill is reported to the House, the 

Chairman of the Committee on the Budget will provide a revised section 302(a) allocation reflecting an additional $921,000,000 in discretionary budget authority and $7,000,000 in associated outlays. That new allocation will eliminate the technical difference prior to Floor consideration. 

In addition, the amounts in this report do not include $2,300,000,000 in discretionary budget authority and $23,000,000 in associated outlays from funding designated as being for emergency requirements pursuant to section 251 of the Balanced Budget and Emergency Deficit 

Control Act of 1985. Consistent with the Congressional Budget Act of 1974, in the House of Representatives such funding does not count 

against the Committee’s allocation. 

FIVE-YEAR PROJECTION OF OUTLAYS

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the House 

of Representatives and in compliance with section 308(a)(1)(B) of 

the Congressional Budget and Impoundment Control Act of 1974 

(Public Law 93–344), as amended, the following table contains fiveyear projections 

[In millions of dollars] 

Projection of outlays associated with the recommendation: 

2020 ........................................................................................................................ .................... .................... 1 128,782 

2021 ........................................................................................................................ .................... .................... .................... 7,442 

2022 ........................................................................................................................ .................... .................... .................... 5,680 

2023 ........................................................................................................................ .................... .................... .................... 3,322 

2024 and future years ............................................................................................ .................... .................... .................... 3,298 

1 Excludes outlays from prior-year budget authority. 

FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the House 

of Representatives and in accordance with section 308(a)(1)(C) of 

the Congressional Budget Act of 1974, as amended, the Congressional Budget Office has provided the following estimates of new 

budget authority and 


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[In millions of dollars] 

Budget 

Authority Outlays 

Financial assistance to State and local governments for 2020 .................................................... 260 1 47 

1 Excludes outlays from prior-year budget authority. 

COMPARATIVE STATEMENT OF NEW BUDGET AUTHORITY AND STATE

LIST

The following is a complete listing, by title, State and country, 

of the Committee’s recommendations for military construction and 

family housing projects, including Overseas Contingency Operations projects: 


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MINORITY VIEWS 

As reported by the Committee, the Military Construction, Veterans Affairs, and Related Agencies Appropriations bill for fiscal 

year 2020 provides a total of $231,349,814,000 in budget authority. 

Of this amount, $123,211,394,000 is for mandatory programs and 

$108,438,000,000 is for discretionary programs. The discretionary 

funding total includes $2,300,000,000 in emergency funds. The bill 

also includes $87,636,650,000 in advance appropriations for the Department of Veterans Affairs’ health care accounts and 

$129,509,505,000 in advance appropriations for mandatory veterans’ benefits programs for fiscal year 2021. Unfortunately, due to 

concerns about spending levels and numerous policy provisions contained in the bill, we are unable to support the bill as written at 

this time. 

We are troubled that the Majority party’s budget framework does 

not reflect a bipartisan, bicameral agreement. That framework puts 

the Federal government on track to add nearly $2,000,000,000,000 

in deficits over 10 years, while the national debt is already more 

than $22,000,000,000,000. In addition, the Majority supports more 

than twice as much additional funding in fiscal year 2020 for nondefense programs as for defense programs. 

We need to come together with the Senate and the Administration to reach an agreement on the topline funding level before we 

allocate funding among the various appropriations bills. We should 

see how the Military Construction and Veterans Affairs bill fits 

into the larger picture before moving forward. 

In addition to overall funding concerns, Republican Members of 

the Committee were disappointed by several policy provisions and 

funding decisions made within the bill. These positions could prevent this bill from being signed into law, and House Republicans 

will continue to work to address these issues as the appropriations 

process continues. 

Of particular concern is Section 612, which limits the President’s 

use of military construction funds. It is an unnecessary restriction 

on the President’s ability and responsibility to respond to national 

emergencies. We believe we must provide the President with the 

tools to address the humanitarian and security crisis on our Southern border. 

The facts are undeniable, and the strain on the system is 

unsustainable. Record-breaking numbers of people, primarily from 

Central American countries but also from other countries around 

the world, are coming through Mexico to the Southern border. Unauthorized border crossings are now at a 12-year high, and the system is overwhelmed by unaccompanied children and family units. 

More than 109,000 people came to the border in April alone, compared to approximately 400,000 in all of 2018. 


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138 

Recognizing the bipartisan concern about using previously appropriated military construction funds for border security projects and 

well aware of the indisputable need to reinvest in our military’s 

readiness and infrastructure, Republican Members of the Committee supported Subcommittee Ranking Member Rep. John 

Carter’s amendment to provide $7,200,000,000 in emergency funding for border security projects. The amendment provided the same 

amount the President requested in the fiscal year 2020 budget request and would have transferred funds to the Department of 

Homeland Security to implement the Border Security Improvement 

Plan. 

While the amendment was defeated, we continue to believe the 

Committee will need to address the President’s request and provide 

funding for border security and humanitarian needs before the fiscal year 2020 appropriations cycle concludes. 

The bill also does not continue the current prohibition on the 

transfer of detainees at Guantanamo Bay, Cuba, to the United 

States, nor does it provide funding for a new detention facility at 

Guantanamo Bay. We believe the prohibition on transferring detainees to the United States and the new funding are needed. We 

must not bring the world’s most dangerous terrorists to American 

soil, and the Service men and women guarding the detainees at 

Guantanamo Bay must have the safest possible work environment. 

Despite our disagreements over the issues discussed above, we 

appreciate the Majority’s willingness to address Member priorities 

in the bill and report and to include Minority Committee Members 

in the development of the bill. The Subcommittee has a long-standing tradition of bipartisanship, and we will continue to work in 

good faith with our colleagues as we proceed through the appropriations process. By working together, we can best address the 

needs of our Nation’s military and its Veterans and reach an agreement on funding for the Military Construction, Veterans Affairs, 

and Related Agencies for the next fiscal year. 

KAY GRANGER. 

JOHN R. CARTER. 

Æ 


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