30–262 PDF 

Calendar No. 446 

115TH CONGRESS REPORT " ! SENATE 2d Session 115–269 

MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND 

RELATED AGENCIES APPROPRIATION BILL, 2019 

JUNE 7, 2018.—Ordered to be printed 

Mr. BOOZMAN, from the Committee on Appropriations, 

submitted the following 

R E P O R T 

[To accompany S. 3024] 

The Committee on Appropriations reports the bill (S. 3024) making appropriations for military construction, the Department of 

Veterans Affairs, and related agencies for the fiscal year ending 

September 30, 2019, and for other purposes, reports favorably 

thereon and recommends that the bill do pass. 

Amounts in new budget authority 

Total of bill as reported to the Senate ....................$225,565,468,000 

Amount of 2018 appropriations ............................... 205,791,908,000 

Amount of 2019 budget estimate ............................ 224,608,740,000 

Bill as recommended to Senate compared to— 

2018 appropriations .......................................... ∂19,773,560,000 

2019 budget estimate ........................................ ∂956,728,000 
(2) 

C O N T E N T S 

Page 

Background: 

Purpose of the Bill ............................................................................................ 4 

Committee Recommendation ........................................................................... 4 

Overview and Summary of Bill ....................................................................... 4 

Title I: 

Military Construction: 

Items of Special Interest: 

Hearings .............................................................................................. 6 

Summary of Committee Recommendations ..................................... 6 

Reprogramming Guidelines ............................................................... 6 

Real Property Maintenance ............................................................... 7 

Incremental Funding ......................................................................... 7 

Other Matters ..................................................................................... 7 

Military Construction Overview ............................................................... 13 

Military Construction, Army .................................................................... 14 

Military Construction, Navy and Marine Corps ..................................... 16 

Military Construction, Air Force .............................................................. 17 

Military Construction, Defense-Wide ...................................................... 18 

Military Construction, Army National Guard ......................................... 18 

Military Construction, Air National Guard ............................................. 19 

Military Construction, Army Reserve ...................................................... 19 

Military Construction, Navy Reserve ...................................................... 19 

Military Construction, Air Force Reserve ............................................... 19 

North Atlantic Treaty Organization Security Investment Program ..... 20 

Department of Defense Base Closure Account ....................................... 20 

Family Housing Overview ........................................................................ 21 

Family Housing Construction, Army ....................................................... 21 

Family Housing Operation and Maintenance, Army ............................. 21 

Family Housing Construction, Navy and Marine Corps ........................ 21 

Family Housing Operation and Maintenance, Navy and Marine 

Corps ....................................................................................................... 22 

Family Housing Construction, Air Force ................................................. 22 

Family Housing Operation and Maintenance, Air Force ....................... 22 

Family Housing Operation and Maintenance, Defense-Wide ................ 23 

Department of Defense Family Housing Improvement Fund ............... 23 

Department of Defense Military Unaccompanied Housing Improvement Fund .............................................................................................. 23 

Administrative Provisions ........................................................................ 24 

Title II: 

Department of Veterans Affairs: 

Items of Special Interest: 

Hearings .............................................................................................. 26 

Summary of Committee Recommendations ..................................... 26 

Department Overview ........................................................................ 26 

Veterans Benefits Administration ........................................................... 30 

Compensation and Pensions .............................................................. 31 

Readjustment Benefits ....................................................................... 32 

Veterans Insurance and Indemnities ............................................... 33 

Veterans Housing Benefit Program Fund ........................................ 33 

Vocational Rehabilitation Loans Program Account ......................... 34 

Native American Veteran Housing Loan Program Account ........... 34 

General Operating Expenses, Veteran Benefits Administration ... 35 

Veterans Health Administration .............................................................. 37 

Medical Services ................................................................................. 42 
Page

3 

Title II—Continued 

Department of Veterans Affairs—Continued 

Veterans Health Administration—Continued 

Medical Community Care .................................................................. 62 

Medical Support and Compliance ..................................................... 63 

Medical Facilities ............................................................................... 63 

Medical and Prosthetic Research ...................................................... 64 

Medical Care Cost Recovery Collections .......................................... 67 

National Cemetery Administration .......................................................... 67 

Departmental Administration .................................................................. 68 

General Administration ..................................................................... 68 

Board of Veterans Appeals ................................................................ 68 

Information Technology Systems ...................................................... 69 

Office of Inspector General ................................................................ 72 

Construction, Major Projects ............................................................. 72 

Construction, Minor Projects ............................................................. 73 

Grants for Construction of State Extended Care Facilities ............ 74 

Grants for Construction of Veterans Cemeteries ............................ 75 

Administrative Provisions ........................................................................ 75 

Title III: 

Related Agencies: 

American Battle Monuments Commission: 

Salaries and Expenses ....................................................................... 79 

Foreign Currency Fluctuations ......................................................... 80 

United States Court of Appeals for Veterans Claims: Salaries and 

Expenses ................................................................................................. 80 

Department of Defense—Civil: Cemeterial Expenses, Army: 

Salaries and Expenses ....................................................................... 81 

Armed Forces Retirement Home: Trust Fund ........................................ 82 

Administrative Provision .......................................................................... 82 

Title IV: Overseas Contingency Operations .......................................................... 83 

Title V: General Provisions ..................................................................................... 85 

Program, Project, and Activity ............................................................................... 86 

Compliance With Paragraph 7, Rule XVI, of the Standing Rules of the 

Senate ................................................................................................................... 86 

Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules of the 

Senate ................................................................................................................... 88 

Compliance With Paragraph 12, Rule XXVI of the Standing Rules of the 

Senate ................................................................................................................... 89 

Budgetary Impact of Bill ......................................................................................... 90 

Military Construction Project Listing by Location ................................................ 91 

Overseas Contingency Operations .......................................................................... 106 

Comparative Statement of Budget Authority ........................................................ 108 
(4) 

BACKGROUND 

PURPOSE OF THE BILL

The Military Construction, Veterans Affairs, and Related Agencies appropriations bill provides necessary funding for the planning, design, construction, alteration, and improvement of military 

facilities worldwide. It also finances the cost of military family 

housing and the U.S. share of the NATO Security Investment Program. In addition, the bill provides funding, including environmental remediation, for base closures and realignments authorized 

by law. The bill provides resources to the Department of Veterans 

Affairs for veterans benefits and healthcare and funding for U.S. 

cemeteries and battlefield monuments both in the United States 

and abroad, including the American Battle Monuments Commission and Arlington National Cemetery. Additionally, the bill funds 

the U.S. Court of Appeals for Veterans Claims and the Armed 

Forces Retirement Homes. 

COMMITTEE RECOMMENDATION

The Committee recommends new budget authority totaling $225,565,468,000 for fiscal years 2019 and 2020 military construction, family housing, base closure, veterans healthcare and benefits, including fiscal year 2020 advance appropriations for veterans 

medical care and appropriated mandatories, and related agencies. 

This includes $122,706,761,000 in mandatory funding and 

$102,858,707,000 in discretionary funding. The table at the end of 

the report displays the Committee recommendation in comparison 

with the current fiscal year and the President’s fiscal year 2019 request. The following table shows total budget authority available 

for fiscal year 2019. 

APPROPRIATIONS FOR FISCAL YEAR 2019 

Budget request Senate recommendation 

New budget authority ..................................................................................... $224,608,740,000 $225,565,468,000 

Previous advances provided for fiscal year 2019 for medical care .............. 70,699,313,000 70,699,313,000 

Previous advances provided for fiscal year 2019 for appropriated 

mandatories ................................................................................................ 107,709,727,000 107,709,727,000 

Less advances provided for fiscal year 2020 for medical care .................... ¥75,550,600,000 ¥75,550,600,000 

Less advances provided for fiscal year 2020 for appropriated mandatories ¥121,296,429,000 ¥121,296,429,000 

Total appropriations for fiscal year 2019 ......................................... 206,170,751,000 207,127,479,000 

OVERVIEW AND SUMMARY OF BILL

The Military Construction, Veterans Affairs, and Related Agencies appropriations bill funds an array of programs that are vital 

to America’s military personnel and their families, and to the Na-
5 

tions’ veterans. For U.S. military forces and their families worldwide, the bill funds critical infrastructure, ranging from mission essential operational and training facilities, such as command and 

control centers, airfield improvements, and ranges, to key qualityof-life facilities, including barracks, family housing, child care centers, schools, and hospitals. 

For America’s 20 million veterans, the bill provides the necessary 

funding for veterans benefits and healthcare, from prescription 

drugs and clinical services to the construction of hospitals and 

other medical facilities throughout the Nation. 

The bill also funds veterans cemeteries in the United States and 

provides funding for four independent agencies—the American Battle Monuments Commission, the U.S. Court of Appeals for Veterans 

Claims, Arlington National Cemetery, and the Armed Forces Retirement Homes. 
(6) 

TITLE I 

MILITARY CONSTRUCTION 

ITEMS OF SPECIAL INTEREST

HEARINGS

The Subcommittee on Military Construction, Veterans Affairs, 

and Related Agencies held one hearing related to the fiscal year 

2019 military construction budget request. Witnesses included representatives of the Army, Navy, Marine Corps, Air Force, and the 

Office of the Secretary of Defense. 

SUMMARY OF COMMITTEE RECOMMENDATIONS

The fiscal year 2019 budget request for military construction and 

family housing totals $10,462,617,000. The Committee recommends 

$10,319,000,000, which is $143,617,000 below the President’s budget request. 

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) which has been specifically 

reduced by the Congress in acting on the budget request is considered to be a congressional interest item and as such, prior approval 

is required. Accordingly, no reprogrammings to an item specifically 

reduced below the threshold by the Congress are permitted. 

The reprogramming criteria that apply to military construction 

projects (25 percent of the funded amount or $2,000,000, whichever 

is less) continue to apply to new housing construction projects and 

to improvements over $2,000,000. 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, provided that such remediation 

requirements could not be reasonably anticipated at the time of the 

budget submission. 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. 

Furthermore, in instances where prior approval of a reprogramming request for a project or account has been received from the 

Committee, the adjusted amount approved becomes the new base 

for any future increase or decrease via below-threshold 

reprogrammings (provided that the project or account is not a congressional interest item as defined above). 
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In addition to these guidelines, the services are directed to adhere to the guidance for military construction reprogrammings and 

notifications, including the pertinent statutory authorities contained in Department of Defense [DOD] Financial Management 

Regulation 7000.14–R and relevant updates and policy memoranda. 

REAL PROPERTY MAINTENANCE

The Committee recommends a continuation of the following general rules for repairing a facility under ‘‘Operation and Maintenance’’ account funding: 

—Components of the facility may be repaired by replacement, 

and such replacement may be up to current standards or code. 

—Interior arrangements and restorations may be included as repair, but additions, new facilities, and functional conversions 

must be performed as military construction projects. 

—Such projects may be done concurrent with repair projects, as 

long as the final conjunctively funded project is a complete and 

usable facility. 

—The appropriate Service Secretary shall submit a 21-day notification prior to carrying out any repair project with an estimated cost in excess of $7,500,000. 

The Department is directed to continue to report on the real 

property maintenance backlog at all installations for which there 

is a requested construction project in future budget requests. This 

information is to be provided on the form 1390. In addition, for all 

troop housing requests, the form 1391 is to continue to show all 

real property maintenance conducted in the past 2 years and all future requirements for unaccompanied housing at that installation. 

INCREMENTAL FUNDING

In general, the Committee supports full funding for military construction projects. However, it continues to be the practice of the 

Committee to provide incremental funding for certain large 

projects, despite administration policy to the contrary, to enable the 

services to more efficiently allocate military construction dollars 

among projects that can be executed in the year of appropriation. 

Therefore, the Committee has recommended incremental funding 

for six projects. 

OTHER MATTERS

Military Construction Funding Initiatives.—The Committee is 

disappointed that military construction request levels do not reflect 

the level of investment needed to ensure both current and future 

force readiness. After years of deliberately ‘‘taking risk’’ by underfunding known military construction requirements, when the Department finally had the opportunity to take advantage of the significant resources provided under the 2018 budget agreement, the 

Department once again chose to ignore its growing list of infrastructure and construction needs. The fiscal year 2019 military construction budget request comprises less than 1.5 percent of the Department’s $686 billion total request. Continued underfunding of 

infrastructure requirements will yield disastrous results as facili-
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ties deteriorate and resources for repair or replacement are not 

available. 

In addition to the long list of deferred recapitalization and critical vulnerabilities, there are several multi-billion dollar high priority initiatives critical to rebuilding readiness and enabling joint 

warfighter capabilities that the Department has been tasked with 

funding and executing. For example, the Army has been tasked 

with funding a $17,000,000,000 modernization of Readiness Centers across the country. The Navy is taking steps to execute its 

Shipyard Infrastructure Optimization Plan, which will require a 

$21,000,000,000 investment over the next 20 years. The Air Force 

is undertaking a Ground Based Strategic Deterrent facility modernization. All of this competes with ongoing and upcoming platform beddown and facility upgrade projects. 

The Committee is concerned that reversing years of underfunding while simultaneously trying to accommodate the initiatives 

needed to provide ready and resilient installations that enable a 

platform for global operations is not viable without additional investment. The Committee urges the Secretary of Defense to ensure 

adequate funding for military construction in its planning, programming and budgeting processes. Further, the Committee directs 

the Secretary of each Service to provide an assessment at the time 

of submission of the fiscal year 2020 budget request identifying all 

military construction initiatives and targeted investments, such as 

the aforementioned, with a total estimated cost in excess of 

$1,000,000,000 and how the request ensures sufficient progress in 

buying down these infrastructure needs. 

The Committee also notes that major defense acquisition programs, particularly in the Air Force and Navy, do not adequately 

consider associated beddown and related infrastructure, which can 

result in late to need facilities, deferred recapitalization, and avoidable miscalculations in budget development. Therefore, the Committee also directs the Secretary of each Service to include in the 

above assessment expected military construction costs associated 

with new platform beddown by fiscal year, and process improvements to better identify these needs as well as obstacles in fully 

accounting for future projected infrastructure requirements. 

Energy Assurance.—The Committee recognizes DOD’s efforts to 

understand the vulnerability of its power generation, distribution, 

and storage systems on all of its military installations and to develop technologies, plans, and policies to mitigate its risks. However, the Committee remains concerned that DOD’s plan to ’island’ 

its military bases in an emergency is not a solution to addressing 

the hazards that exist outside the DOD property line, where 

vulnerabilities to civilian energy infrastructure pose a risk to 

troops, DOD civilians, and other mission-critical personnel living in 

the community. The Committee directs the Secretary to provide a 

report within 180 days of enactment of this act on the Department’s efforts to address risks to critical energy systems outside of 

DOD property. The report should assess the ability of military installations to develop and sustain relationships with public utilities 

regardless of leadership rotations; the necessary legal authorities to 

enter arrangements with private or public companies to make improvements to energy infrastructure outside of DOD property; 
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what, if any, plans exist for local military bases to provide excess 

base load power to communities during long-term emergencies; and 

the efficacy of appointing an executive agent charged with department-wide decisionmaking and funding of resiliency projects outside of DOD property. 

Joint Strike Fighter [JSF] Initial Joint Training Site.—The 2005 

Base Realignment and Closure [BRAC] Commission recommended 

Eglin Air Force Base [AFB], Florida, as an Initial Joint Training 

Site [IJTS] that teaches entry-level aviators and maintenance technicians how to safely operate and maintain the new Joint Strike 

Fighter [JSF] [F–35] aircraft. To implement the JSF IJTS, the Air 

Force, Navy, and Marines identified the need for a cantonment 

area, sufficient airspace, and ground targets to support 107 F–35 

Primary Assigned Aircraft [PAA] comprised of Air Force, Marine, 

and Navy variants. Development plans included training and maintenance facilities, hangars, dormitories, munitions storage and 

loading facilities as well as airfields, airspace and ground support 

to accommodate 107 PAA. The Committee is aware that since the 

selection of Eglin AFB as the site for JSF IJTS, the PAA has been 

reduced from 107 to 59 and that some Services conduct JSF training at installations other than Eglin AFB. The Committee is concerned that building construction, renovation and demolition may 

have already started to support the initial plan of 107 PAA and the 

full training mission. Therefore, the Committee directs the Secretary of Defense to report no later than 180 days after enactment 

of this act on the infrastructure plan supporting the JSF IJTS at 

Eglin AFB, to include completed facilities and associated capacity 

and current utilization, and how remaining infrastructure requirements have been adjusted to adapt to the reduced PAA and training mission. Additionally, the report should include the status of 

the Department’s compliance with the 2005 BRAC decision to establish Eglin AFB as the JSF IJTS and the rationale and impact 

of not fully implementing the decision. 

DOD Installation Energy Policy.—The Committee notes that 

DOD continues to take steps to increase installation energy efficiency and reduce overall energy consumption. However, more can 

be done bring down energy costs, and DOD must also ramp up its 

efforts to enhance energy security on its installations through a 

range of actions, to include exploring ways to mitigate potential 

vulnerabilities where installations draw from off-base energy 

sources. 

The Committee supports DOD’s investments in energy efficiency, 

renewable energy systems, and energy security, including through 

the Energy Resilience and Conservation Investment Program 

[ERCIP], however, is concerned that funding requested for the program has not increased since fiscal year 2014. This has resulted in 

a continued reduction of projects that can be undertaken, down to 

18 this year from 33 projects in fiscal year 2016. The Committee 

directs the Secretary of Defense to provide a report within 90 days 

of enactment detailing how DOD integrates and prioritizes ERCIP 

projects in the future years defense program and to certify whether 

there are unfunded requirements within the program. The Committee recommends an increase of $45,000,000 above the request 

for ERCIP and encourages the Department to prioritize funding for 
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energy-related projects, including renewable energy projects, to 

mitigate risk to mission-critical assets and promote energy security 

and efficiency at military installations. 

Defense Access Roads.—The Committee is concerned about the 

lack of future planning for Defense Access Roads [DAR] and transportation infrastructure needs as flooding on roads at domestic installations that are vital to military operations increases in frequency and severity. The Committee directs the Secretary of Defense, in consultation with the Secretary of Transportation, to establish a process for assessing the flood risk to defense access 

roads, with particular attention to communities that have experienced severe flooding from non-storm surge flooding and flooding 

due to storm surge. The Committee expects that process to be informed by the best available science regarding flood risk in the 

United States. Further, the Committee directs the Secretary of Defense to report no later than 90 days after enactment of this act 

on the national security risks of neglected DAR roads and projects 

affected by flooding due to storm surge, including what data and 

other appropriate information it is using to inform its risk and 

need assessment, and any relevant obstacles, to include legal, in 

carrying out such projects. 

Reserve Component Parity.—The Committee notes significant decreases in funding across the Reserve Component in the fiscal year 

2019 Military Construction request from the fiscal year 2018 level. 

While the Committee understands that critical demand fluctuates 

by year and ongoing large-scale initiatives can skew data, it is concerned that reliance on the Real Property Asset Database [RPAD] 

as a key criterion does not accurately reflect current and future infrastructure needs across the components based on evolving operational requirements. Furthermore, despite steps taken by the Department to improve oversight of its global real property portfolio, 

multiple reports by the Government Accountability Office have 

found deficiencies in its tracking of real property assets and leased 

facilities, further undermining the credibility of this data. Therefore, the Committee directs the Secretaries of each Service to provide a report within 90 days of enactment of this act on if and how 

each determines base ratios for respective Active and Reserve Component military construction funding allocations, to include what 

data is used, specifically the extent to which the RPAD is weighted, 

and how frequently these ratios are updated. 

Flight Line Infrastructure.—The Committee is concerned with 

the lack of sufficient flight line infrastructure and the potentially 

adverse impact it may have on aircraft and personnel. There are 

many examples throughout the Department where improvements 

in facilities and airfield infrastructure would save resources, and 

improve personnel and aircraft readiness. For example, at Laughlin 

Air Force Base, 82 percent of the T–1 fleet was unsheltered and 

damaged in a hail storm. The damaged aircraft were grounded, resulting in an 80 percent loss of T–1 pilot training production capability. At Al Dhafra Air Base, host nation sun shades are utilized 

to help protect F–22s from extreme heat and sunlight but are not 

always available. Adequate flight line infrastructure can help protect the Department’s assets from not only damage but resulting 

decreased mission accomplishment. The Committee recommends 
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the Secretary of Defense review flight line infrastructure for both 

minor and major revitalization and recapitalization opportunities. 

This could include simple infrastructure such as sun shelters that 

protect both personnel and equipment from extreme heat and inclement weather, to more elaborate construction and maintenance 

projects such as repairing drainage issues on flight lines to keep 

ramp areas useable during extended rainy periods and prevent aircraft from sitting in standing water. The Committee urges the Department to prioritize these projects in future budget submissions. 

Water Conservation on Military Installations.—Senate Report 

115–130 reiterated a directive from Senate Report 114–237 requesting the Secretary of Defense provide a report on water usage 

and conservation on military installations. The Committee notes 

that the report is currently overdue and directs the Secretary to 

provide the report no later than October 1, 2018. 

Federal, State and Local Intelligence Collaboration.—The Committee remains supportive of collaborative intelligence fusion centers that utilize National Guard facilities. These centers allow Federal, state, local, and tribal law enforcement officials to collaborate 

and share intelligence and threat information, and co-locating them 

with National Guard facilities offers opportunities for cost savings. 

The Committee urges the Department, the services, and the National Guard Bureau to prioritize needed workplace replacement 

projects, including Sensitive Compartmented Information Facility 

[SCIF] projects to conduct state and Federal intelligence analysis, 

in the fiscal year 2020 and future budget submissions. 

Major Range and Test Facility Base [MRTFB].—The Committee 

remains concerned about the lack of investment and sustainment 

in MRTFB facilities. These ranges, which include Army, Navy, Air 

Force and Defense Agency facilities are critical to developing and 

maintaining the Nation’s military technological superiority. In 

order to support development of emerging advanced technologies, 

test and training range infrastructure and instrumentation must 

be modernized. Senate Report 115–130 contained direction to the 

Secretary of Defense to submit a comprehensive MRTFB modernization plan within 180 days of enactment outlining a timetable 

and specific actions for repair, replacement and renovation of infrastructure, equipment and instrumentation at mission-critical facilities. The Committee looks forward to receiving this report. 

Family Housing Management.—The Committee is concerned that 

at times military families are faced with housing unit relocation or 

otherwise forced disposition due to untimely and mismanaged family housing renovations, particularly when service members and 

their families are in need of housing due to a permanent change 

of station. To understand the scale of this problem, the Committee 

directs the Department to assess the management of family housing renovations and identify any and all instances whereby military families have been relocated or forced to move from their assigned housing unit because of renovation or repair, specifically for 

government-controlled housing [owned and leased], with a focus on 

instances on duty stations outside the continental United States. 

The report should also include detailed data on wait times, identification of contributing factors, and potential mitigating solutions. 
12 

The Committee directs the Department to provide the report within 

120 days of enactment of this act. 

Simulation Center Planning Bays.—The Committee notes that 

combat maneuver simulation centers offer a valuable resource to 

train combat forces in real world situations while reducing cost, 

preserving equipment, enhancing training and decreasing risk to 

the warfighter. Military students utilize these centers, such as the 

Maneuver Center of Excellence and other educational posts, to augment their training and enhance readiness and should continue to 

do so at an increasing rate in the coming years. These centers often 

do not have the capacity for the entire unit to communicate, coordinate, and plan on site during their training. Therefore, the Committee encourages the Department to consider additional structures, such as covered planning bay areas, that could enhance the 

value of training by providing space to communicate, coordinate, 

and plan on site amidst the simulation training. As such, the Committee directs the Department to submit a report within 180 days 

of enactment of this Act assessing the value of having covered planning bay areas adjacent to or within current facilities that provide 

combat maneuver simulation training. The report should identify 

potential installations where these structures could be constructed 

adjacent to or within simulations centers. 

Information Technology Infrastructure for Military Construction 

Projects.—The Committee recognizes that information technology is 

an essential component in constructing modern facilities for military missions as well as planning for future requirements. Technological advancements can lead to increased productivity and efficiencies on energy and space, which impact military construction 

and modernization projects. For example, the Committee is aware 

of technology that can streamline historically compartmented classified networks through cross domain solutions. Not only does this 

drastically impact future productivity for the workforce but it could 

also yield substantial savings and efficiencies on space, energy, and 

HVAC requirements. The Committee urges the Services to utilize 

such cost cutting solutions early in the planning process to gain efficiencies and savings on military construction projects. 

Defense Workplace Facilities Improvements.—The Committee is 

concerned that continued constraints on the Defense budget in the 

face of increasing operational requirements is taking a serious toll 

on the Department’s aging and structurally deficient workplace facilities inventory. The parking garage at the National Maritime Intelligence Center [NMIC], which serves a workforce of approximately 3,700 personnel, continues to be certified as unsafe and 

structurally deficient. While $12,000,000 has already been spent on 

repairs in an effort to maintain the facility, the Committee remains 

concerned about the deficient operational status. A Navy commissioned engineering analysis validated the repairs as a stopgap 

measure because of the severity of the structural flaws, but needed 

investment continues to be deferred. In recognition of the fact that 

aging and structurally deficient workplace and support facility infrastructure has a significant impact on personnel safety and operational readiness, the Committee urges the Department and the 

services to prioritize needed workplace replacement projects, in-
13 

cluding the NMIC parking structure, in the fiscal year 2020 and future budget submissions. 

Special Operations Command Planning and Design.—The Committee is aware of numerous recent reprogramming requests submitted by U.S. Special Operations Command [SOCOM]. The additional funds requested, and delayed project execution timelines, 

have largely been a result of poor planning and design fundamentals, such as contracting design-build when requirements necessitated design-bid-build. The committee is encouraged that SOCOM 

is evaluating its planning and budgeting process to ensure that 

projects requested are appropriately scoped and prepared for execution. It also recognizes that SOCOM manpower and infrastructure 

needs continue to increase in demand. The committee urges 

SOCOM to continue to work with the Army Corps of Engineers and 

Naval Facilities Engineering Command to ensure best practices are 

being followed. 

Fiscal Year 2018 Savings.—The Committee notes that the Department based certain project funding levels in the fiscal year 

2019 Budget Request on lower expected appropriations than were 

provided in Public Law 115–141. As a result, the fiscal year 2019 

requests for the Next NGA West Complex Phase 1 and Presidential 

Aircraft Recapitalization Complex exceed need. The Committee 

fully funds these projects as authorized in Public Law 115–91. 

Military Construction Funding Initiatives.—The bill includes 

funding for military construction initiatives to address important 

unfunded priorities included in the Department of Defense’s unfunded priority lists provided to Congress. This includes an additional $77,600,000 for the Army, $244,400,000 for the Navy and 

Marine Corps, $118,516,000 for the Air Force, $22,000,000 for the 

Army National Guard, $11,100,000 for the Air National Guard, 

$10,000,000 for the Army Reserve, and $14,400,000 for the Air 

Force Reserve. All additional funding is reserved for projects that 

were included in the unfunded priority lists submitted to Congress. 

Rescissions.—The Committee recommends an administrative provision rescinding prior year unobligated funds due primarily to 

project bid savings and the slow execution of projects. 

MILITARY CONSTRUCTION OVERVIEW

Appropriations, 2018 1 ........................................................................... $10,091,000,000 

Budget estimate, 2019 ........................................................................... 10,462,617,000 

Committee recommendation ................................................................. 10,319,000,000 

1Total excludes $920,981,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act and Public 

Law 115–96, Continuing Appropriations Act, Department of Defense Missile Defeat and Defense 

Enhancements Appropriations Act, 2018. 

MILITARY CONSTRUCTION ACCOUNTS—PROGRAM DESCRIPTION

The military construction appropriation provides for acquisition, 

construction, installation, and equipment of temporary or permanent public works, military installations, facilities, and real property for the Department of Defense. This appropriation also provides for facilities required as well as funds for infrastructure 

projects and programs required to support bases and installations 

around the world. 
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MILITARY CONSTRUCTION, ARMY

Appropriations, 2018 ............................................................................. $923,994,000 

Budget estimate, 2019 ........................................................................... 1,011,768,000 

Committee recommendation ................................................................. 1,021,768,000 

COMMITTEE RECOMMENDATION

The Committee recommends $1,021,768,000 for the Army for fis- cal year 2019. This amount is $97,774,000 above the fiscal year 

2018 enacted level and $10,000,000 above the budget request. Further detail of the Committee’s recommendation is provided in the 

State table at the end of this report. 

Army Training Schools.—The Committee is concerned about the 

impact of deferred investments in Army schoolhouses, especially 

those with aging facilities directly tied to warfighter training and 

readiness across the components. In particular, the Army Mountain 

Warfare School [AMWS], which directly supports the Army’s top 

priority of building and sustaining readiness, continues to see increased demand with insufficient and outdated space requirements, 

while deferred maintenance compounds challenges with its aging 

infrastructure. AMWS provides critical mountain warfare and cold 

weather operations training to support the creation of an agile and 

highly mobile force, but is nearly 40 years old and sited in a flood 

plain, and has been forced to cap attendance due to inadequate facilities, despite continual demand for throughput. Therefore, the 

Committee urges the Secretary of the Army to prioritize funding 

for ready-to-execute schoolhouse projects, in particular those that 

support the growing demand for mountaineering skills and training. 

Defense Laboratory Enterprise Facilities and Infrastructure.—The 

Committee remains concerned the unspecified minor military construction [UMMC] request is insufficient to support the Army Laboratories. As threats continue to emerge and construction costs continue to rise, outdated laboratory facilities lack the investment 

needed to deliver next generation capability to the U.S. military. 

While the Army can utilize funds from research, development, test 

and evaluation or operations and maintenance to fund laboratory 

projects, the higher UMMC threshold provided in Public Law 115– 

91 is intended to allow the services greater opportunity to keep up 

with threats that evolve faster than can be addressed through the 

normal military construction planning process. Therefore, an additional $10,000,000 is provided to supplement Army unspecified 

minor construction projects. The committee urges the Secretary of 

the Army to adequately prioritize UMMC projects that support the 

Army Laboratories to ensure that Army Science and Technology 

continue to lay the foundation for future capabilities. 

Army National Guard Readiness Center Investment.—The Committee remains concerned that the Department of the Army has 

not adequately prioritized funding to implement the ‘‘Affordable 

Readiness’’ strategy recommended by the 2014 Army National 

Guard Readiness Center Transformation Master Plan [RCTMP]. 

While the committee understands that the Army must balance 

these additional costs with existing infrastructure demands, the 

Committee also notes that the fiscal year 2019 Military Construction request for the Army National Guard was a 14 percent de-
15 

crease from the fiscal year 2018 request, representing its smallest 

portion of the Army military construction budget since 2008. Except for the fiscal year 2015 budget request, the funding level is at 

its lowest in the post-2001 era. The Committee urges the Army to 

provide additional funding for the Army National Guard in its future years defense program in order to expedite execution of the 

RCTMP. 

Army Pacific Readiness.—The Committee remains concerned 

about the risks that the Army, like the other military Services, has 

taken in funding infrastructure and the continued degradation 

these risks have on long-term readiness. The Committee is aware 

of the Army’s $2,600,000,000, 30-year plan to improve readiness in 

the Pacific by addressing critical shortfalls in aviation, operations, 

training, and munitions facilities at Schofield Barracks, Wheeler 

Army Airfield, and the Pohakuloa Training Area, in Hawaii. The 

Committee recognizes that the planned investment of $300,000,000 

over the future years defense program is important to meeting the 

Army’s short- and long-term readiness needs and ensuring that 

U.S. Army Garrison Hawaii remains a deployment platform from 

which soldiers in the state can continue to meet critical national 

defense missions across the Asia-Pacific region. The Committee 

urges the Army to continue to obligate funding toward its longrange plan to improve its readiness in the Pacific over the next several decades. 

Sunflower Army Ammunition Plant.—The Committee continues 

to urge the Army to proactively manage the environmental remediation of the former Sunflower Army Ammunition Plant [SFAAP]. 

The Committee is encouraged that the Army has addressed the 

need for improved communications with Sunflower Redevelopment, 

LLC [SRL] and supports regular stakeholder meetings and monthly 

conference calls with SRL to address questions or issues related to 

cleanup and redevelopment of the former SFAAP. The Committee 

expects the Army to continue its risk assessments and evaluations, 

consistent with applicable regulations and permit requirements, 

and to work with regulatory agencies to ensure all response sites 

are remediated to applicable and approved standards. The Committee further expects the Army to continue work in consultation 

and coordination with SRL and ensure SRL redevelopment priorities are synchronized with Army managed cleanup activities. 

Badger Army Ammunition Plant.—The Committee continues to 

urge the Army to accelerate, to the extent practicable and appropriate, its environmental remediation actions at the former Badger 

Army Ammunition Plant and directs the Army to hold regular public meetings to update and engage with local stakeholders and to 

integrate local priorities in its remediation plans and final groundwater remedy for the site and affected surrounding communities. 

The Committee supports the Army’s decision to work with the U.S. 

Geological Survey to review the current groundwater monitoring 

program and directs the Army to use the results of the review to 

improve the program to ensure that contaminated groundwater 

plumes are monitored and private drinking water wells are protected. The Committee recognizes that the Town of Merrimac, Wisconsin, acted in good faith to partner with the Army on the nowreversed plans to construct a municipal drinking water system, and 
16 

directs the Army to consider the construction of a such a system 

as a remedial alternative. 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

Appropriations, 2018 1 ........................................................................... $1,553,275,000 

Budget estimate, 2019 ........................................................................... 2,543,189,000 

Committee recommendation ................................................................. 2,222,522,000 

1Total excludes $201,636,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 

COMMITTEE RECOMMENDATION

The Committee recommends $2,222,522,000 for Navy and Marine 

Corps military construction for fiscal year 2019. This amount is 

$669,247,000 above the fiscal year 2018 enacted level and 

$320,667,000 below the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end 

of this report. 

Causeway, Boat Channel & Turning Basin.—The Committee 

notes that the work in progress curve submitted with the budget 

request shows that the Navy cannot execute the full request of 

$117,830,000 in fiscal year 2019. Therefore the Committee provides 

$60,000,000 for the first increment of this project. 

Naval Shipyard Modernization.—The committee is aware of the 

Shipyard Infrastructure Optimization Plan submitted to Congress 

in February 2018. The plan seeks to, among other requirements, 

assess existing facilities for efficiencies and address future infrastructure requirements at public shipyards. It also includes a master plan for each shipyard, including, but not limited to, capital 

equipment and facility investment requirements. The committee 

believes the Navy’s assessment of public shipyard dry dock capacity 

is particularly important, as it identifies 68 deferred maintenance 

availabilities under the status quo, 67 of which are restored upon 

making the public shipyard dry dock investments within the timeframe recommended by the plan. Accordingly, the Secretary of the 

Navy is urged to adequately prioritize the timely funding of public 

shipyard infrastructure, in particular dry dock and shore infrastructure necessary to support critical maintenance of surface and 

submarine fleets by public shipyards. 

Navy Strategic Laydown and Dispersal.—The Committee continues to recognize the inherent risk of natural and man-made hazards associated with the stationing of U.S. capital ships at major 

ports, and the Navy’s corresponding requirement for the strategic 

dispersal of its fleet in the Pacific and Atlantic to mitigate that 

risk. The Navy’s internal guidance on making decisions regarding 

strategic basing requires that the Navy consider strategic dispersal 

strategies and that these strategies be factored into homeporting 

decisions to limit the risk associated with natural disasters or manmade catastrophes. The Committee continues to believe that strategic dispersal should be a key consideration in expanding the fleet, 

and that, as a first step, the Navy should program military construction funding, to include planning and design funds, for necessary infrastructure to achieve strategic dispersal of its fleet, beginning with the budget request and future years defense program 

for fiscal year 2020. 
17 

MILITARY CONSTRUCTION, AIR FORCE

Appropriations, 2018 ............................................................................. $1,543,558,000 

Budget estimate, 2019 ........................................................................... 1,725,707,000 

Committee recommendation ................................................................. 1,495,423,000 

COMMITTEE RECOMMENDATION

The Committee recommends $1,495,423,000 for the Air Force in 

fiscal year 2019. This amount is $48,135,000 below the fiscal year 

2018 enacted level and $230,284,000 below the budget request. 

Further detail of the Committee’s recommendation is provided in 

the State table at the end of this report. 

Little Rock Air Force Base.—The Committee is concerned with 

the failed attempt to repair the runway at Little Rock AFB, Arkansas. Little Rock AFB, the nation’s tactical airlift Center of Excellence, has the world’s largest fleet of C–130 aircraft and is the largest C–130 training base in the world, training C–130 crews from 

the U.S. and 47 other nations. The contract to repair the base’s 

only runway, overseen by the Army Corps of Engineers [the Corps], 

was awarded in September 2014 and terminated in June 2017 due 

to problems with the project. Despite an estimated contract completion date of April 2017, the project was only one quarter complete 

when the Corps terminated the contract in June 2017. The Committee is concerned with the issues that led to termination of the 

contract, the coordination between the Air Force and the Corps, 

and ensuring a follow-on replacement project is adequately 

prioritized and funded. Prior Congressional inquiries have yielded 

conflicting and inconsistent information. Therefore, the Committee 

directs the Secretary of the Air Force to submit a report coordinated with the Corps no later than 90 days after enactment of this 

act providing the status on the cancelled project and replacement 

project, including what happened to the funding used for the original contract, a justification for the increase in cost for the new 

project, if any of the completed work from the cancelled project is 

salvageable, how the Air Force is resolving the issues that led to 

contract termination and ensuring, to the extent possible, that they 

are not repeated in follow-on contracts, and how and when a future 

project will be funded. Additionally, the Committee directs the Air 

Force to appoint a senior official who shall be responsible for the 

project and will provide quarterly project updates to the congressional defense committees. 

Air Force Ballistic Missile Facilities.—The Committee remains 

concerned with the deteriorating infrastructure of the ground-based 

intercontinental ballistic missile facilities at Malmstrom AFB, Montana; Minot AFB, North Dakota; and F.E. Warren AFB, Wyoming. 

The Missile Alert Facilities [MAF] at these bases are in advanced 

states of disrepair. In February 2018, the Air Force provided the 

Committee a study that highlighted the need to recapitalize the 

MAFs. Further, the Committee understands that Air Force Global 

Strike Command continues to be in the process of identifying, validating, and finalizing facility requirements, as well as analyzing 

commercial electrical power infrastructure to support the missile 

fields. The Committee directs the Secretary of the Air Force to provide compiled results as soon as they become available. 
18 

Air Force Space Rapid Capabilities Office.—The Committee notes 

that Air Force facilities supporting the space enterprise reorganization are lacking the secure compartmentalized information facility 

[SCIF] space needed to interact with all commercial partners, especially small business partners that may be developing cutting edge 

technology to aid the Air Force’s space capabilities. This includes 

both secure office/meeting spaces as well as secure hardware development, integration and testing spaces. Therefore, the Committee 

directs the Air Force to submit an analysis within 180 days of enactment of this Act detailing the SCIF needs for both secure office/ 

meeting spaces as well as secure hardware development, integration and testing spaces that could improve small business engagement with the Space RCO and the Space and Missile Systems Center. The analysis shall include a sample of current and would be 

business partners’ needs, as well as inputs from Space RCO, Space 

Command, and the Space and Missile Systems Center. 

MILITARY CONSTRUCTION, DEFENSE-WIDE

(INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018 1 ........................................................................... $2,811,513,000 

Budget estimate, 2019 ........................................................................... 2,693,324,000 

Committee recommendation ................................................................. 2,575,938,000 

1Total excludes $200,000,000 in emergency funding provided in Public Law 115–96, Continuing Appropriations Act, Department of Defense Missile Defeat and Defense Enhancements 

Appropriations Act, 2018. 

COMMITTEE RECOMMENDATION

The Committee recommends $2,575,938,000 for projects considered within the Defense-Wide account in fiscal year 2019. This 

amount is $235,575,000 below the fiscal year 2018 enacted level 

and $117,386,000 below the budget request. Further detail of the 

Committee’s recommendation is provided in the State table at the 

end of this report. 

Hydrant Fuel Systems in Support of Humanitarian Assistance 

and Disaster Relief Operations.—The Committee notes that the Department of Defense has a long history of successfully conducting 

urgently needed humanitarian assistance and disaster relief 

[HADR] missions. In recent years HADR missions have responded 

to major earthquakes, tsunamis, typhoons, hurricanes, floods, and 

the nuclear disaster in Fukushima, Japan. The Committee believes 

that hydrant fuel systems capable of supporting large scale fueling 

of heavy aircraft are an essential component of our HADR capability. The Committee continues to encourage the services and the 

Defense Logistics Agency to prioritize construction and enhancement of these systems in locations that serve as staging bases for 

HADR operations. 

MILITARY CONSTRUCTION, ARMY NATIONAL GUARD

Appropriations, 2018 1 ........................................................................... $220,652,000 

Budget estimate, 2019 ........................................................................... 180,122,000 

Committee recommendation ................................................................. 190,122,000 

1Total excludes $519,345,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 
19 

COMMITTEE RECOMMENDATION

The Committee recommends $190,122,000 for Military Construction, Army National Guard for fiscal year 2019. This amount is 

$30,530,000 below the fiscal year 2018 enacted level and 

$10,000,000 above the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end 

of this report. 

MILITARY CONSTRUCTION, AIR NATIONAL GUARD

Appropriations, 2018 ............................................................................. $171,491,000 

Budget estimate, 2019 ........................................................................... 129,126,000 

Committee recommendation ................................................................. 139,126,000 

COMMITTEE RECOMMENDATION

The Committee recommends $139,126,000 for Military Construction, Air National Guard for fiscal year 2019. This amount is 

$32,365,000 below the fiscal year 2018 enacted level and 

$10,000,000 above the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end 

of this report. 

MILITARY CONSTRUCTION, ARMY RESERVE

Appropriations, 2018 ............................................................................. $83,712,000 

Budget estimate, 2019 ........................................................................... 64,919,000 

Committee recommendation ................................................................. 64,919,000 

COMMITTEE RECOMMENDATION

The Committee recommends $64,919,000 for Military Construction, Army Reserve for fiscal year 2019. This amount is 

$18,793,000 below the fiscal year 2018 enacted level and equal to 

the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end of this report. 

MILITARY CONSTRUCTION, NAVY RESERVE

Appropriations, 2018 ............................................................................. $95,271,000 

Budget estimate, 2019 ........................................................................... 43,065,000 

Committee recommendation ................................................................. 43,065,000 

COMMITTEE RECOMMENDATION

The Committee recommends $43,065,000 for Military Construc- tion, Navy Reserve for fiscal year 2019. This amount is $52,206,000 

below the fiscal year 2018 enacted level and equal to the budget 

request. Further detail of the Committee’s recommendation is provided in the State table at the end of this report. 

MILITARY CONSTRUCTION, AIR FORCE RESERVE

Appropriations, 2018 ............................................................................. $73,535,000 

Budget estimate, 2019 ........................................................................... 50,163,000 

Committee recommendation ................................................................. 50,163,000 

COMMITTEE RECOMMENDATION

The Committee recommends $50,163,000 for Military Construction, Air Force Reserve for fiscal year 2019. This amount is 
20 

$23,372,000 below the fiscal year 2018 enacted level and equal to 

the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end of this report. 

NORTH ATLANTIC TREATY ORGANIZATION

SECURITY INVESTMENT PROGRAM

Appropriations, 2018 ............................................................................. $177,932,000 

Budget estimate, 2019 ........................................................................... 171,064,000 

Committee recommendation ................................................................. 171,064,000 

PROGRAM DESCRIPTION

The North Atlantic Treaty Organization [NATO] appropriation 

provides for the U.S. cost share of the NATO Security Investment 

Program for the acquisition and construction of military facilities 

and installations (including international military headquarters) 

and for related expenses for the collective defense of the NATO 

Treaty area. 

COMMITTEE RECOMMENDATION

The Committee recommends $171,064,000 for the North Atlantic 

Treaty Organization Security Investment Program for fiscal year 

2019. This amount is $6,868,000 below the fiscal year 2018 enacted 

level and equal to the budget request. 

DEPARTMENT OF DEFENSE BASE CLOSURE ACCOUNT

Appropriations, 2018 ............................................................................. $310,000,000 

Budget estimate, 2019 ........................................................................... 267,538,000 

Committee recommendation ................................................................. 277,538,000 

PROGRAM DESCRIPTION

Section 2711 of the National Defense Authorization Act for Fiscal 

Year 2014 (Public Law 112–239) consolidated the Base Closure Account 1990 and the Base Closure Account 2005 into a single Department of Defense Base Closure Account. The Base Closure Account provides for cleanup and disposal of property consistent with 

the four closure rounds required by the base closure acts of 1988 

and 1990, and with the 2005 closure round required by the Defense 

Base Closure and Realignment Act of 1990 (10 U.S.C. 2687 note). 

COMMITTEE RECOMMENDATION

The Committee recommends a total of $277,538,000 for the Department of Defense Base Closure Account for fiscal year 2019. 

This amount is $32,462,000 below the fiscal year 2018 enacted 

level and $10,000,000 above the budget request. Funds provided for 

fiscal year 2019 are for environmental cleanup and ongoing operations and maintenance. 

Perfluorooctane Sulfonate [PFOS] and Perfluorooctanoic Acid 

[PFOA].—The Committee has provided $10,000,000 in additional 

funds for identification, mitigation, and clean-up costs across the 

Department of Defense for PFOS and PFOA. DOD is directed to 

provide a spend plan for these additional funds to the Committee 

no later than 30 days after enactment of this act. 
21 

FAMILY HOUSING OVERVIEW

Appropriations, 2018 ............................................................................. $1,409,437,000 

Budget estimate, 2019 ........................................................................... 1,582,632,000 

Committee recommendation ................................................................. 1,582,632,000 

FAMILY HOUSING ACCOUNTS—PROGRAM DESCRIPTION

The Family Housing appropriation provides funds for military 

family housing construction activities, operation and maintenance, 

the Family Housing Improvement Fund, and the Homeowners Assistance Program. Construction accounts provide funding for new 

construction, improvements and the Federal Government share of 

housing privatization. Operation and maintenance accounts fund 

costs associated with the maintenance and leasing of military family housing, including utilities, services, management, and furnishings. 

COMMITTEE RECOMMENDATION

The Committee recommends $1,582,632,000 for Family Housing 

Construction, Operations and Maintenance, and the Department’s 

family housing improvement fund for fiscal year 2019. This amount 

is $173,195,000 above the fiscal year 2018 enacted level and equal 

to the budget request. 

FAMILY HOUSING CONSTRUCTION, ARMY

Appropriations, 2018 ............................................................................. $182,662,000 

Budget estimate, 2019 ........................................................................... 330,660,000 

Committee recommendation ................................................................. 330,660,000 

COMMITTEE RECOMMENDATION

The Committee recommends $330,660,000 for Army Family 

Housing Construction in fiscal year 2019. This amount is 

$147,998,000 above the fiscal year 2018 enacted level and equal to 

the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end of this report. 

FAMILY HOUSING OPERATION AND MAINTENANCE, ARMY

Appropriations, 2018 ............................................................................. $348,907,000 

Budget estimate, 2019 ........................................................................... 376,509,000 

Committee recommendation ................................................................. 376,509,000 

COMMITTEE RECOMMENDATION

The Committee recommends $376,509,000 for family housing operation and maintenance, Army for fiscal year 2019. This amount 

is $27,602,000 above the fiscal year 2018 enacted level and equal 

to the budget request. 

FAMILY HOUSING CONSTRUCTION, NAVY AND MARINE CORPS

Appropriations, 2018 ............................................................................. $83,682,000 

Budget estimate, 2019 ........................................................................... 104,581,000 

Committee recommendation ................................................................. 104,581,000 
22 

COMMITTEE RECOMMENDATION

The Committee recommends $104,581,000 for Family Housing 

Construction, Navy and Marine Corps. This amount is $20,899,000 

above the fiscal year 2018 enacted level and equal to the budget 

request. Further detail of the Committee’s recommendation is provided in the State table at the end of this report. 

FAMILY HOUSING OPERATION AND MAINTENANCE, NAVY AND

MARINE CORPS

Appropriations, 2018 ............................................................................. $328,282,000 

Budget estimate, 2019 ........................................................................... 314,536,000 

Committee recommendation ................................................................. 314,536,000 

COMMITTEE RECOMMENDATION

The Committee recommends $314,536,000 for family housing operation and maintenance, Navy and Marine Corps, in fiscal year 

2019. This amount is $13,746,000 below the fiscal year 2018 enacted level and equal to the budget request. 

Naval Support Activity Bahrain General and Flag Officers Quarters.—Public Law 115–141 provided $2,138,000 for the construction 

of on-base housing. The Committee understands that the Navy no 

longer intends to construct the housing facility, and is in the process of determining a suitable alternative. Therefore, the Committee 

rescinds $2,138,000 from the Navy Family Housing Construction 

account. Furthermore, the Committee is deeply concerned by the 

current off-base high cost lease and directs the Secretary of the 

Navy to keep the Committee apprised of progress on lease negotiation. 

FAMILY HOUSING CONSTRUCTION, AIR FORCE

Appropriations, 2018 ............................................................................. $85,062,000 

Budget estimate, 2019 ........................................................................... 78,446,000 

Committee recommendation ................................................................. 78,446,000 

COMMITTEE RECOMMENDATION

The Committee recommends $78,446,000 for Family Housing 

Construction, Air Force, in fiscal year 2019. This amount is 

$6,616,000 below the fiscal year 2018 enacted level and equal to 

the budget request. Further detail of the Committee’s recommendation is provided in the State table at the end of this report. 

FAMILY HOUSING OPERATION AND MAINTENANCE, AIR FORCE

Appropriations, 2018 ............................................................................. $318,324,000 

Budget estimate, 2019 ........................................................................... 317,274,000 

Committee recommendation ................................................................. 317,274,000 

COMMITTEE RECOMMENDATION

The Committee recommends $317,274,000 for family housing operation and maintenance, Air Force, in fiscal year 2019. This 

amount is $1,050,000 below the fiscal year 2018 enacted level and 

equal to the budget request. 
23 

FAMILY HOUSING OPERATION AND MAINTENANCE, DEFENSE-WIDE

Appropriations, 2018 ............................................................................. $59,169,000 

Budget estimate, 2019 ........................................................................... 58,373,000 

Committee recommendation ................................................................. 58,373,000 

COMMITTEE RECOMMENDATION

The Committee recommends $58,373,000 for family housing operation and maintenance, Defense-Wide, for fiscal year 2019. This 

amount is $796,000 below the fiscal year 2018 enacted level and 

equal to the budget request. 

DEPARTMENT OF DEFENSE FAMILY HOUSING IMPROVEMENT FUND

Appropriations, 2018 ............................................................................. $2,726,000 

Budget estimate, 2019 ........................................................................... 1,653,000 

Committee recommendation ................................................................. 1,653,000 

PROGRAM DESCRIPTION

The Family Housing Improvement Fund appropriation provides 

for the Department of Defense to undertake housing initiatives and 

to provide an alternative means of acquiring and improving military family housing and supporting facilities. This account provides 

seed money for housing privatization initiatives. 

COMMITTEE RECOMMENDATION

The Committee recommends $1,653,000 for the Family Housing 

Improvement Fund in fiscal year 2019. This amount is $1,073,000 

below the fiscal year 2018 enacted level and equal to the budget 

request. 

DEPARTMENT OF DEFENSE MILITARY UNACCOMPANIED HOUSING

IMPROVEMENT FUND

Appropriations, 2018 ............................................................................. $623,000 

Budget estimate, 2019 ........................................................................... 600,000 

Committee recommendation ................................................................. 600,000 

PROGRAM DESCRIPTION

The Military Unaccompanied Housing Improvement Fund appropriation provides for the Department of Defense to undertake housing initiatives and to provide an alternative means of acquiring and 

improving military unaccompanied housing and supporting facilities. This account provides seed money for housing privatization 

initiatives. 

COMMITTEE RECOMMENDATION

The Committee recommends $600,000 for the Military Unaccompanied Housing Improvement Fund in fiscal year 2019. This 

amount is $23,000 below the fiscal year 2018 enacted level and 

equal to the budget request. 
24 

ADMINISTRATIVE PROVISIONS

Sec. 101. The Committee includes a provision that restricts payments under a cost-plus-a-fixed-fee contract for work, except in 

cases of contracts for environmental restoration at base closure 

sites. 

Sec. 102. The Committee includes a provision that permits the 

use of funds for the hire of passenger motor vehicles. 

Sec. 103. The Committee includes a provision that permits the 

use of funds for defense access roads. 

Sec. 104. The Committee includes a provision that prohibits construction of new bases inside the continental United States for 

which specific appropriations have not been made. 

Sec. 105. The Committee includes a provision that limits the use 

of funds for purchase of land or land easements. 

Sec. 106. The Committee includes a provision that prohibits the 

use of funds to acquire land, prepare a site, or install utilities for 

any family housing except housing for which funds have been made 

available. 

Sec. 107. The Committee includes a provision that limits the use 

of minor construction funds to transfer or relocate activities among 

installations. 

Sec. 108. The Committee includes a provision that prohibits the 

procurement of steel unless American producers, fabricators, and 

manufacturers have been allowed to compete. 

Sec. 109. The Committee includes a provision that prohibits payments of real property taxes in foreign nations. 

Sec. 110. The Committee includes a provision that prohibits construction of new bases overseas without prior notification. 

Sec. 111. The Committee includes a provision that establishes a 

threshold for American preference of $500,000 relating to architect 

and engineering services for overseas projects. 

Sec. 112. The Committee includes a provision that establishes 

preference for American contractors for military construction in the 

United States territories and possessions in the Pacific, and on 

Kwajalein Atoll, or in countries bordering the Arabian Gulf. 

Sec. 113. The Committee includes a provision that requires notification of military exercises involving construction in excess of 

$100,000. 

Sec. 114. The Committee includes a provision that permits funds 

appropriated in prior years to be available for construction authorized during the current session of Congress. 

Sec. 115. The Committee includes a provision that permits the 

use of expired or lapsed funds to pay the cost of supervision for any 

project being completed with lapsed funds. 

Sec. 116. The Committee includes a provision that permits obligation of funds from more than 1 fiscal year to execute a construction project, provided that the total obligation for such project is 

consistent with the total amount appropriated for the project. 

Sec. 117. The Committee includes a provision that permits the 

transfer of funds from Family Housing Construction accounts to 

the DOD Family Housing Improvement Fund and from Military 

Construction accounts to the DOD Military Unaccompanied Housing Improvement Fund. 
25 

Sec. 118. The Committee includes a provision that provides 

transfer authority to the Homeowners Assistance Fund. 

Sec. 119. The Committee includes a provision that requires all 

acts making appropriations for military construction be the sole 

funding source of all operation and maintenance for family housing, 

including flag and general officer quarters, and limits the repair on 

flag and general officer quarters to $35,000 per unit per year without prior notification to the congressional defense committees. 

Sec. 120. The Committee includes a provision that provides authority to expend funds from the ‘‘Ford Island Improvement’’ account. 

Sec. 121. The Committee includes a provision that allows the 

transfer of expired funds to the Foreign Currency Fluctuation, Construction, Defense Account. 

Sec. 122. The Committee includes a provision that allows the reprogramming of military construction and family housing construction funds among projects and activities within the account in 

which they are funded. 

Sec. 123. The Committee includes a provision that prohibits the 

use of funds in this title for planning and design and construction 

of projects at Arlington National Cemetery. 

Sec. 124. The Committee includes a provision providing additional funds for unfunded military construction priorities. 

Sec. 125. The Committee includes a provision rescinding unobligated balances from various Military Construction accounts. 

Sec. 126. The Committee includes a provision defining the congressional defense committees. 

Sec. 127. The Committee includes a provision prohibiting the use 

of funds in this title to close or realign Naval Station Guantanamo 

Bay, Cuba. The provision is intended to prevent the closure or 

transfer of the installation out of the possession of the United 

States, and maintain the Naval Station’s long-standing regional security and migrant operations missions. 

Sec. 128. The Committee includes a provision regarding the consolidation or relocation of a U.S. Air Force RED HORSE Squadron 

outside of the United States. 

Sec. 129. The Committee includes a provision providing additional funding for Defense Access Roads. 

Sec. 130. The Committee includes a provision directing all 

amounts appropriated to military construction accounts be immediately available and allotted for the full scope of authorized 

projects. 
(26) 

TITLE II 

DEPARTMENT OF VETERANS AFFAIRS 

ITEMS OF SPECIAL INTEREST

HEARINGS

The Subcommittee on Military Construction, Veterans Affairs, 

and Related Agencies held one hearing related to the fiscal year 

2019 and 2020 Department of Veterans Affairs [VA] budget request. The subcommittee heard testimony from The Honorable 

Randy C. Reeves, Under Secretary for Memorial Affairs, National 

Cemetery Administration; The Honorable Jon J. Rychalski, Assistant Secretary for Management and Chief Financial Officer, Department of Veterans Affairs; Carolyn M. Clancy, M.D., Executive in 

Charge, Veterans Health Administration; and Mr. Thomas J. Murphy, Executive in Charge, Veterans Benefits Administration. 

SUMMARY OF COMMITTEE RECOMMENDATIONS

The Committee recommendation includes $195,569,404,000 for 

the Department of Veterans Affairs for fiscal year 2019, including 

$109,120,059,000 in mandatory spending and $86,449,345,000 in 

discretionary spending. The Committee also recommends 

$75,550,600,000 in advance appropriations for veterans medical 

care for fiscal year 2020 and $121,296,429,000 in advance appropriations for appropriated mandatories for fiscal year 2020. 

DEPARTMENT OVERVIEW

The Veterans Administration was established on July 21, 1930, 

as an independent agency by Executive Order 5398, in accordance 

with the act of July 3, 1930 (46 Stat. 1016). This act authorized the 

President to consolidate and coordinate Federal agencies specially 

created for or concerned with the administration of laws providing 

benefits to veterans, including the Veterans’ Bureau, the Bureau of 

Pensions, and the National Home for Disabled Volunteer Soldiers. 

On March 15, 1989, the Veterans Administration was elevated to 

Cabinet-level status as the Department of Veterans Affairs. 

VA’s mission is to serve America’s veterans and their families as 

their principal advocate in ensuring they receive the care, support, 

and recognition they have earned in service to the Nation. As of 

September 30, 2017, there were an estimated 20 million living veterans, with 19.9 million of them residing in the United States and 

Puerto Rico. There were an estimated 23.5 million dependents 

(spouses and dependent children) of living veterans in the United 

States and Puerto Rico, and there were 579,000 survivors of deceased veterans receiving VA survivor benefits in the United States 

and Puerto Rico. Thus, approximately 44 million people, or 13.4 
27 

percent of the total estimated resident population of the United 

States and Puerto Rico, were recipients or potential recipients of 

veterans benefits from the Federal Government. VA’s operating 

units include the Veterans Benefits Administration, Veterans 

Health Administration, National Cemetery Administration, and 

staff support offices. 

The Veterans Benefits Administration [VBA] provides an integrated program of nonmedical veterans benefits. VBA administers 

a broad range of benefits to veterans and other eligible beneficiaries through 56 regional offices; three Pension Management 

Centers; six Fiduciary Hubs; three Educational Regional Processing 

Offices; eight Regional Loan Centers; one Insurance Center; eight 

National Call Centers; and a records processing center in St. Louis, 

Missouri. The benefits provided include: compensation for serviceconnected disabilities; pensions for wartime, needy, and totally disabled veterans; vocational rehabilitation assistance; educational 

and training assistance; home buying assistance; estate protection 

services for veterans under legal disability; information and assistance through personalized contacts; and six life insurance programs. 

The Veterans Health Administration [VHA] develops, maintains, 

and operates a national healthcare delivery system for eligible veterans; carries out a program of education and training of 

healthcare personnel; conducts medical research and development; 

and furnishes health services to members of the Armed Forces during periods of war or national emergency. A system consisting of 

145 VA Hospitals; 24 Health Care Centers [HCC]; 199 Multi-Specialty Community-Based outpatient clinics; 544 Primary Care Community-Based outpatient clinics; 294 Outpatient Services Sites; 134 

community living centers; 120 domiciliary residential rehabilitation 

treatment programs [DRRTP]; 300 readjustment counseling vet 

centers; and 80 mobile vet centers is maintained to meet the VA’s 

medical mission. 

The National Cemetery Administration [NCA] provides for the 

interment of the remains of eligible deceased servicemembers and 

discharged veterans in any national cemetery with available grave 

space; permanently maintains these graves; provides headstones 

and markers for the graves of eligible persons in national and private cemeteries; administers the grant program for aid to States in 

establishing, expanding, or improving State veterans cemeteries; 

and provides certificates to families of deceased veterans recognizing their contributions and service to the Nation. In 2019, cemetery activities will encompass 139 national cemeteries (including 

four new national cemeteries), one national veterans’ burial 

ground, and 33 soldiers’ lots and monument sites. 

Staff support offices include the Office of Inspector General, 

Boards of Contract Appeals and Veterans Appeals, and General Administration offices, which support the Secretary, Deputy Secretary, Under Secretary for Benefits, Under Secretary for Health, 

Under Secretary for Memorial Affairs, and General Counsel. 

Aligning Veteran Benefits with Veteran Medical Care.—The Committee is concerned by reports that many veterans utilizing education benefits are not also registered for health benefits and are, 

therefore, not receiving adequate medical care for treatable condi-
28 

tions such as mental health and musculoskeletal ailments. Given 

the impact that untreated psychological and physical ailments can 

have on educational success, the Department is directed to submit 

to the Committees on Appropriations of both Houses of Congress 

a report within 180 days of enactment of this act, detailing the 

number of veterans enrolled in education benefits but not medical 

benefits and any disparities in educational outcomes between veterans utilizing medical benefits as compared to those who are not. 

Transitioning Servicemembers.—The ability of communities to 

build networks, including through public-private partnerships, to 

provide resources to servicemembers, veterans, and their families 

is critical for ensuring that transitioning service members and veterans have the support they need in their civilian lives. The Committee encourages the Department to provide support for such 

networked approaches, including through public-private partnerships. 

Study and Measures to Address Regrettable Losses.—The Committee is concerned that VA has failed to follow-up on repeated recommendations of the Office of Inspector General to review data on 

regrettable losses and consider implementing measures to reduce 

such losses. Given the staffing demands on the Department and 

the challenges it faces in recruiting personnel, VA should work to 

retain those staff who could have remained with the Department 

but left. The Secretary should work expeditiously to better understand why personnel leave the Agency and work to mitigate such 

losses. 

Contractor Accountability.—The Committee is concerned about 

the lack of transparency in the contract oversight process, as well 

as the lack of visibility into contractor performance. Whenever the 

Secretary provides notice to a contracted service provider that the 

service provider is failing to meet contractual obligations, VA must 

submit to the Appropriations Committees and the Committees on 

Veterans’ Affairs of the Senate and the House of Representatives 

notification of such failure. At a minimum, the notification should 

include: (1) an explanation of the reasons for providing such notice; 

(2) a description of the effect of such failure, including with respect 

to cost, schedule, and requirements; (3) a description of the actions 

taken by the Secretary to mitigate such failure; and, (4) a description of the actions taken by the contractor to address such failure. 

Contracting Fraud.—The Committee is concerned by continued 

incidents of willful misrepresentation of veteran or service-disabled 

veteran status for the purposes of winning Federal contract setasides and believes that a more effective disincentive is required to 

prevent this fraudulent behavior, which harms legitimate veteranowned and service-disabled veteran owned small businesses. The 

Committee encourages the Department, in consultation with relevant agency partners, to examine potential regulatory and legislative actions to more effectively prevent contracting fraud, including 

the possibility of expanding the current VA mandatory 5-year contracting debarment penalty to all Federal agencies. 

Financial Hardship and Bankruptcy.—The Committee continues 

to support VA programs that combat the root causes of veteran and 

dependent financial hardship, which is a known contributory factor 

to negative outcomes such as mental health issues, substance use 
29 

disorder, and suicide. For example, disability-related benefits not 

only honor the service and sacrifice of the veterans who receive 

them, but also help to replace lost wages and provide a critical 

source of economic well-being. The Committee continues to be concerned by an inequity in current bankruptcy law that results in the 

inclusion of VA and DOD disability benefits in the calculation of a 

debtor’s disposable income, while at the same time excluding Social 

Security disability benefits for non-veterans. The Committee hopes 

that this discrepancy between VA and Social Security disability 

benefits with regard to calculating a debtor’s disposable income can 

be resolved in the near future. 

Appeals Process.—The Committee directs the Secretary to ensure 

the Department is in full compliance with all requirements of the 

Veterans Appeals Improvement and Modernization Act of 2017 

(Public Law 115–55). Additionally, the Committee urges the Department to fully implement the GAO’s recommendations to better 

ensure the successful implementation of a new disability appeals 

process while attending to appeals in the current process. 

Public Private Partnerships.—The Committee is aware of the 

need to expand the Department’s research investment to leverage 

non-Federal initiatives which provide the opportunity for strong colocation of VA and university biomedical scientists for translational 

investigation which has high potential for precision medicine outcomes for wounded warriors and other high at risk veteran’s populations. The Committee notes the high concentration of VA research enterprises on the Nation’s two coasts. The Committee 

urges the Undersecretary for Health Affairs to expedite consideration of proposals for research complexes where there is multi-disciplinary investigation related to veterans and wounded warriors, 

including medicine, engineering and veterinary science. Such consideration should be timely to inform action in the fiscal year 2020 

budget. 

Improper Benefits.—The Department of Veterans Affairs [VA] 

currently uses the Social Security Administration’s [SSA] Death 

Master File [DMF] as a tool for reducing improper benefits. Following a Government Accountability Office [GAO] report that highlighted the DMF did not always reflect the most current and accurate data, SSA began to take steps to address these shortcomings. 

The Committee encourages the Department to explore the utilization of commercially available sources for obtaining the most accurate and extensive deceased data resources to identify, validate, 

and document deceased veterans in order to prevent improper payment of benefits. 

Security Risk Management.—The Committee understands the 

challenges associated with providing secure and accessible access to 

Department facilities. However, the Committee is concerned that 

the Department’s current risk management policies are not sufficient to ensure medical facilities are adequately protected. The Department is urged to, in coordination with the Interagency Security 

Committee, review and revise its current risk management process, 

and develop an oversight strategy that allows the Department to 

properly assess risk management programs in all VHA facilities. 

The Department is directed to submit a report to the Committees 

on Appropriations of both Houses of Congress no later than 180 
30 

days after enactment of this act detailing the findings of its review 

and the steps taken to develop the oversight strategy. 

Compensation Claims for Camp Lejeune Contaminated Water 

Veterans.—There is concern regarding the lack of consistency in the 

Department’s handling of disability compensation claims for veterans, former reservists, and former National Guard members who 

served at Marine Corps Base Camp Lejeune for no less than 30 

days (consecutive or nonconsecutive) between August 1, 1953 and 

December 31, 1987. VA established a presumption of service connection for eight diseases associated with exposure to contaminants 

in the water supply at Camp Lejeune during that period. The Department made the decision to subject nonpresumptive Camp 

Lejeune Contaminated Water [CLCW] exposure claims to a higher 

level of scrutiny than is applied to other exposure claims and did 

so without providing notice or an opportunity for public comment. 

In addition, no other toxic exposure claims require a positive medical opinion to warrant service connection. The evidentiary burden 

VA requires for CLCW nonpresumptive exposure claims is significantly greater than the standard used for Agent Orange or any 

other exposure claims. Furthermore, there currently exists a 

wealth of ‘‘competent medical evidence’’ specific to diseases related 

to exposure to contaminated water at Camp Lejeune, as published 

by the Agency for Toxic Substances and Disease Registry [ATSDR], 

the Institute of Medicine [IoM], and other government sanctioned 

medical experts. Nevertheless, the Department’s same Clinical 

Subject Matter Experts, who provide medical opinions, have routinely rejected ATSDR and IoM’s findings without providing any 

justification or explanation for doing so. 

The Department was directed to conduct a Special Focus Review 

for the CLCW claims process and submit the results of the review 

in the Explanatory Statement accompanying Public Law 115–141, 

the Consolidated Appropriations Act, 2018. The Committee looks 

forward to receiving this report in a timely manner. 

Community Wellness Programs.—Public Law 115–141, the Consolidated Appropriations Act, 2018, established a 2-year program 

for VA to award grants to nonprofit Veterans Services Organizations [VSOs] to upgrade, through construction and repair, VSO 

community facilities into health and wellness centers, and to promote and expand complementary and integrative wellness programs. Complementary and integrative wellness programs are increasingly being recognized as useful adjuncts to meet the needs of 

veterans who have experienced trauma. 

VETERANS BENEFITS ADMINISTRATION

Appropriations, 2018 ......................................................................... $107,038,649,000 

Advance Appropriations, 2019 ......................................................... 107,709,727,000 

Budget estimate, 2019 ...................................................................... 4,481,437,000 

Committee recommendation, 2019 ................................................... 4,568,858,000 

Budget estimate, advance appropriations, 2020 ............................. 121,296,429,000 

Committee recommendation, advance appropriations, 2020 ......... 121,296,429,000 

ADMINISTRATION OVERVIEW

The Veterans Benefits Administration is responsible for the payment of compensation and pension benefits to eligible service-con-
31 

nected disabled veterans, as well as education benefits and housing 

loan guarantees. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided $107,709,727,000 in 

advance appropriations for the Veterans Benefits Administration 

for fiscal year 2019. This included $95,768,462,000 for Compensation and pensions; $11,832,175,000 for Readjustment benefits; and 

$109,090,000 for Veterans insurance and indemnities. 

For fiscal year 2019, the Committee recommends an additional $1,410,332,000 for Compensation and Pensions as requested by the 

administration. Additionally, the Committee recommendation includes $200,612,000 for the Veterans Housing Benefit Program 

Fund administrative expenses; $39,000 for the Vocational Rehabilitation Loans Program account, with $396,000 for administrative 

expenses; $1,163,000 for the Native American Veteran Housing 

Loan Program account; $2,956,316,000 for General Operating Expenses, Veterans Benefits Administration account. The Committee recommendation also provides $121,296,429,000 

in advance appropriations for the Veterans Benefits Administration’s mandatory accounts for fiscal year 2020. 

COMPENSATION AND PENSIONS

(INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018 ............................................................................. $90,119,449,000 

Advance Appropriations, 2019 .............................................................. 95,768,462,000 

Budget estimate, 2019 ........................................................................... 1,410,332,000 

Committee recommendation, 2019 ....................................................... 1,410,332,000 

Budget estimate, advance appropriations, 2020 ................................. 107,119,807,000 

Committee recommendation, advance appropriations, 2020 .............. 107,119,807,000 

PROGRAM DESCRIPTION

Compensation is payable to living veterans who have suffered 

impairment of earning power from service-connected disabilities. 

The amount of compensation is based upon the impact of disabilities on a veteran’s earning capacity. Death compensation or dependency and indemnity compensation is payable to the surviving 

spouses and dependents of veterans whose deaths occur while on 

active duty or result from service-connected disabilities. A clothing 

allowance may also be provided for service-connected veterans who 

use a prosthetic or orthopedic device. In fiscal year 2019, the Department estimates it will obligate $92,477,647,000 for payments to 

4,850,289 veterans, 432,353 survivors, and 1,134 dependents receiving special benefits. 

Pensions are an income security benefit payable to needy wartime veterans who are precluded from gainful employment due to 

nonservice-connected disabilities which render them permanently 

and totally disabled. Public Law 107–103, the Veterans Education 

and Benefits Expansion Act of 2001, restored the automatic presumption of permanent and total nonservice connected disability 

for purposes of awarding a pension to veterans age 65 and older, 

subject to the income limitations that apply to all pensioners. 

Death pensions are payable to needy surviving spouses and children of deceased wartime veterans. The rate payable for both dis-
32 

ability and death pensions is determined on the basis of the annual 

income of the veteran or their survivors. In fiscal year 2019, the 

Department estimates that the Pensions program will provide benefits to 268,729 veterans and 199,972 survivors totaling 

$5,560,719,000. 

The Compensation and Pensions program funds certain burial 

benefits on behalf of eligible deceased veterans. These benefits provide the purchase and transportation costs for headstones and 

markers, graveliners, and pre-placed crypts; and provide partial reimbursement for privately purchased outer burial receptacles. In 

fiscal year 2019, the Department estimates the Compensation and 

Pensions program will obligate $261,943,000 providing burial benefits. This funding will provide 62,184 burial allowances, 34,089 burial plot allowances, 44,609 service-connected death awards, 497,644 

burial flags, 378,701 headstones or markers, 42,295 graveliners or 

reimbursement for privately purchased outer burial receptacles, 

and 310 caskets and urns for the internment of the remains of veterans without next of kin. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $95,768,462,000 for fiscal year 2019 for the Compensation and Pensions account. The Committee recommendation includes an additional $1,410,332,000 for Compensation and Pensions as requested. 

The Committee recommendation includes an advance appropriation of $107,119,807,000 for Compensation and pensions for fiscal 

year 2020. 

READJUSTMENT BENEFITS

Appropriations, 2018 ............................................................................. $13,708,648,000 

Advance Appropriations, 2019 .............................................................. 11,832,175,000 

Budget estimate, advance appropriations, 2020 ................................. 14,065,282,000 

Committee recommendation, advance appropriations, 2020 .............. 14,065,282,000 

PROGRAM DESCRIPTION

The Readjustment benefits appropriation finances the education 

and training of veterans and servicemembers under chapters 30, 

31, 32, 33, 34, 35, 36, 37, 39, 41, 42 and 43 of title 38, United 

States Code. These benefits include the All-Volunteer Force Educational Assistance Program (Montgomery GI bill) and the Post 9/ 

11 Educational Assistance Program. Basic benefits are funded 

through appropriations made to the readjustment benefits appropriation and by transfers from the Department of Defense. This account also finances vocational rehabilitation, specially adapted 

housing grants, specially adapted automobile grants for certain disabled veterans, and educational assistance allowances for eligible 

dependents of those veterans who died from service-connected 

causes or who have a total permanent service-connected disability, 

as well as dependents of servicemembers who were captured or 

missing in action. 
33 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $11,832,175,000 for the Readjustment Benefits account 

for fiscal year 2019. 

The Committee recommendation includes an advance appropriation of $14,065,282,000 for Readjustment benefits for fiscal year 

2020. 

VETERANS INSURANCE AND INDEMNITIES

Appropriations, 2018 ............................................................................. $120,338,000 

Advance Appropriations, 2019 .............................................................. 109,090,000 

Budget estimate, advance appropriations, 2020 ................................. 111,340,000 

Committee recommendation, advance appropriations, 2020 .............. 111,340,000 

PROGRAM DESCRIPTION

The Veterans insurance and indemnities appropriation consists 

of the former appropriations for military and naval insurance, applicable to World War I veterans; National Service Life Insurance, 

applicable to certain World War II veterans; servicemen’s indemnities, applicable to Korean conflict veterans; and veterans mortgage life insurance to individuals who have received a grant for 

specially adapted housing. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $109,090,000 for fiscal year 2019 for the Veterans Insurance and Indemnities account. 

The Committee recommendation includes an advance appropriation of $111,340,000 for Veterans insurance and indemnities for fiscal year 2020. 

VETERANS HOUSING BENEFIT PROGRAM FUND

Program account Administrative 

expenses 

Appropriations, 2018 ....................................................................................................... ............................ $178,626,000 

Budget estimate, 2019 ................................................................................................... ............................ 200,612,000 

Committee recommendation ........................................................................................... ............................ 200,612,000 

PROGRAM DESCRIPTION

The Veterans housing benefit program fund provides for all costs 

associated with VA’s direct and guaranteed housing loan programs, 

with the exception of the Native American veteran housing loan 

program. 

VA loan guaranties are made to servicemembers, veterans, reservists, and unremarried surviving spouses for the purchase of 

homes, condominiums, and manufactured homes, and for refinancing loans. VA guarantees part of the total loan, permitting the 

purchaser to obtain a mortgage with a competitive interest rate, 

even without a downpayment, if the lender agrees. VA requires a 

downpayment be made for a manufactured home. With a VA guaranty, the lender is protected against loss up to the amount of the 

guaranty if the borrower fails to repay the loan. 
34 

COMMITTEE RECOMMENDATION

The Committee recommends such sums as may be necessary for funding subsidy payments, and $200,612,000 for administrative expenses for fiscal year 2019. Bill language limits gross obligations 

for direct loans for specially adapted housing to $500,000. 

VOCATIONAL REHABILITATION LOANS PROGRAM ACCOUNT

Program account Administrative 

expenses 

Appropriations, 2018 ....................................................................................................... $30,000 $395,000 

Budget estimate, 2019 ................................................................................................... 39,000 396,000 

Committee recommendation ........................................................................................... 39,000 396,000 

PROGRAM DESCRIPTION

The Vocational Rehabilitation Loans Program account covers the 

cost of direct loans for vocational rehabilitation of eligible veterans 

and, in addition, includes administrative expenses necessary to 

carry out the direct loan program. Loans of up to $1,235 (based on 

the indexed chapter 31 subsistence allowance rate) are currently 

available to service-connected disabled veterans enrolled in vocational rehabilitation programs, as provided under 38 U.S.C. chapter 

31, 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. Virtually all loans are repaid in full and most 

in less than one year. 

COMMITTEE RECOMMENDATION

The Committee recommends $39,000 for program costs and $396,000 for administrative expenses for the Vocational Rehabilitation Loans Program account. The administrative expenses may be 

paid to the General Operating Expenses, Veterans Benefits Administration account. Bill language is included limiting program direct 

loans to $2,037,366. It is estimated VA will make 2,039 loans in fiscal year 2019, with an average amount of $999. 

NATIVE AMERICAN VETERAN HOUSING LOAN PROGRAM ACCOUNT

Appropriations, 2018 ............................................................................. $1,163,000 

Budget estimate, 2019 ........................................................................... 1,149,000 

Committee recommendation ................................................................. 1,163,000 

PROGRAM DESCRIPTION

The Native American veteran housing loan program is authorized by 38 U.S.C. chapter 37, section 3761 to provide direct loans 

to Native American veterans living on trust lands. The loans are 

available to purchase, construct, or improve homes to be occupied 

as veteran residences or to refinance a loan previously made under 

this program in order to lower the interest rate. The principal 

amount of a loan under this authority generally may not exceed 

$424,100; however, in some locations, this limit may be higher depending on median area home prices. Veterans pay a funding fee 

of 1.25 percent of the loan amount, although veterans with a serv-
35 

ice-connected disability are exempt from paying the fee. Before a 

direct loan can be made, the veteran’s tribal organization must sign 

a memorandum of understanding with VA regarding the terms and 

conditions of the loan. The Native American Veteran Housing Loan 

Program began as a pilot program in 1993 and was made permanent by Public Law 109–233, the Veterans Housing Opportunity 

and Benefits Act of 2006. 

COMMITTEE RECOMMENDATION

The Committee recommends $1,163,000 for administrative expenses associated with this program. This is equal to the fiscal 

year 2018 enacted level and $14,000 more than the budget request. 

GENERAL OPERATING EXPENSES, VETERANS BENEFITS

ADMINISTRATION

Appropriations, 2018 ............................................................................. $2,910,000,000 

Budget estimate, 2019 ........................................................................... 2,868,909,000 

Committee recommendation ................................................................. 2,956,316,000 

PROGRAM DESCRIPTION

The General Operating Expenses, Veterans Benefits Administration account provides funding for the Veterans Benefits Administration to administer entitlement programs such as service-connected disability compensation, education benefits, and vocational 

rehabilitation services. 

COMMITTEE RECOMMENDATION

The Committee recommends $2,956,316,000 for the General Operating Expenses, Veterans Benefits Administration account, which 

is $46,316,000 above the fiscal year 2018 enacted level and 

$87,407,000 above the budget request. The Committee has included 

bill language to make available through September 30, 2020, up to 

10 percent of the General Operating Expenses, Veterans Benefits 

Administration account. 

Disability Claims Processing.—The Committee has not only fully 

funded the budget request for claims processing in recent years, 

but has provided increases above the budget requests for hiring 

and training claims processors, bolstering the migration to electronic claims processing systems, and addressing the increasing 

backlog of appeals at the Board of Veterans Appeals. The Committee expects for the Department to utilize theses resources effectively to not only protect against a recurrence of a sizable disability 

backlog, but to also ensure that proper staffing and resources are 

being utilized to reduce the wait time and backlog of disability decisions on appeal and to meet the demand for other benefit programs. To that end, the Committee recommends an additional 

$87,407,000 for VBA, GOE to hire additional claims and appellate 

staff, as well as to increase staff for the Vocational Rehabilitation 

and Employment Program. The VBA may also use these resources 

to support increased resources for the Veterans Claims Intake Program [VCIP] to scan and convert paper files into digital records. 

The Committee will continue to require the Department to provide 

monthly updates on performance measures for each Regional Office. 
36 

Education Benefits.—The Committee is concerned about the levels of overpayments and improper payments being paid to GI Bill 

beneficiaries. The Committee directs VA to work with education 

stakeholders to ensure that veteran educational benefits are paid 

in a timely and accurate manner and that efforts to recoup any 

overpayments or improper payments is done fairly and in a manner 

that is not overly burdensome on student veterans and their families. The Committee further directs VA, in collaboration with the 

Department of Defense and Department of Education, to provide 

an interagency report on the development and continued implementation of the Principles of Excellence, oversight of institutions 

complying with the Principles, and appropriate and timely accountability measures for educational programs receiving Federal funding. Lastly, the Committee directs VA to continue to reform the 

compliance survey process to allow early detection of fraudulent 

marketing or predatory recruiting practices among institutions of 

higher learning and to codify a set of tools that is sufficiently agile 

enough to curtail the behavior of scamming institutions that are 

wasting the VA education benefits of service members and their 

families. 

Education Data Collection and Sharing.—The Committee believes that both students and VA should be able to make more evidence-based decisions when it comes to veterans’ education. The 

Committee directs VA to work with the Department of Education 

and Department of Defense to ensure that there is a comprehensive database or at a minimum, a set of data-sharing agreements 

in place between Federal entities involved in the administration of 

Federal resources related to veteran educational attainment. The 

Committee further directs VA, in collaboration with the Department of Education and Department of Defense, to provide an interagency report on data-sharing priorities, the development and implementation of subsequent data-sharing agreements, and the uses 

and effectiveness of the data shared. 

Gulf War Veterans Claims for Service-Connected Disability Compensation.—The Committee continues to be concerned by the Department’s high rates of denial of Gulf War veterans’ claims for 

undiagnosed illnesses and chronic multi-symptom illnesses. The 

Committee notes that according to the most recent VA data, 44 

percent of Gulf War veterans develop Gulf War illness, but only 26 

percent receive benefits. The Committee also notes that according 

to a 2016 GAO study, VA is still only approving 17 percent of Gulf 

War illness claims. To improve the accuracy and fairness of claims 

evaluation, the Committee directs the Department to adopt a single 

Disability Benefits Questionnaire [DBQ] for Gulf War illness. The 

Department is directed to submit to Committees on Appropriations 

of both Houses of Congress a report explaining the reasons for the 

high denial rate of claims, the Department’s actions to increase the 

number of approved claims, the Department’s efforts to ensure 

claims adjudicators are trained and held accountable for consistently following the Compensation and Pension manual, and the Department’s timeline for finalizing the required DBQ. 

Medical Disability Exams.—The Committee is concerned by recent reports indicating that contract physicians with revoked medical licenses have been performing medical disability examinations 
37 

on behalf of the Department. Consistent with statute, the Committee directs the Department to ensure that any non-VA physician 

contracted to conduct medical disability examinations must have a 

current unrestricted license to practice as a physician, and is not 

barred from practicing in any State, the District of Columbia, or a 

Commonwealth, Territory, or possession of the United States. 

VETERANS HEALTH ADMINISTRATION

Appropriations, 2018 1 ........................................................................... $70,296,454,000 

Advance appropriations, 2019 .............................................................. 70,699,313,000 

Budget estimate, 2019 2 ......................................................................... 3,127,369,000 

Committee recommendation, 2019 ....................................................... 2,740,000,000 

Budget estimate, advance appropriations, 2020 ................................. 75,550,600,000 

Committee recommendation, advance appropriations, 2020 .............. 75,550,600,000 

1Total excludes $89,392,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 2Total includes $1,900,000,000 requested in discretionary funding for the Mandatory Choice 

Program. 

ADMINISTRATION OVERVIEW

The Veterans Health Administration [VHA] is home to the 

United States’ largest integrated healthcare system consisting of 

145 VA Hospitals; 24 Health Care Centers [HCC]; 199 Multi-Specialty Community-Based outpatient clinics; 544 Primary Care Community-Based outpatient clinics; 294 Outpatient Services Sites; 134 

community living centers; 120 domiciliary residential rehabilitation 

treatment programs [DRRTP]; 300 readjustment counseling vet 

centers; and 80 mobile vet centers. 

The Department of Veterans Affairs Medical Care Collections 

Fund [MCCF] was established by the Balanced Budget Act of 1997 

(Public Law 105–33). In fiscal year 2004, Public Law 108–199 allowed the Department to deposit first-party and pharmaceutical copayments, 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 Parking Program provides funds for the construction, alteration, and acquisition (by purchase or lease) of parking garages at 

VA medical facilities authorized by 38 U.S.C. 8109. The Secretary 

is required under certain circumstances to establish and collect fees 

for the use of such garages and parking facilities. Receipts from the 

parking fees are to be deposited into the MCCF and are used for 

medical services activities. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided $70,699,313,000 in 

advance appropriations for VA’s medical care accounts for fiscal 

year 2019. This included $49,161,165,000 for Medical services, 

$8,384,704,000 for Medical community care, $7,239,156,000 for 

Medical support and compliance, and $5,914,288,000 for Medical 

facilities. The Committee also includes an Administrative Provision 

allowing the Department to carry forward into fiscal year 2019 certain amounts provided as an advance for fiscal year 2018. 

For fiscal year 2019, the Committee recommends an additional 

$750,000,000 for Medical services, $1,000,000,000 for Medical com-
38 

munity care, and $211,000,000 for Medical facilities. Additionally, 

the Committee recommendation includes $779,000,000 for Medical 

and prosthetic research. Medical care collections are expected to be 

$3,590,000,000. The Committee recommendation also provides 

$75,550,600,000 in advance appropriations for VA’s medical care 

accounts for fiscal year 2020. 

Allocations.—At the beginning of fiscal year 2018, without public 

notice, the Department considered fundamentally changing the 

manner in which Medical Service allocations were made to the Veterans Integrated Service Networks. Specifically, consideration was 

being given to converting almost $1,000,000,000 of Specific Purpose 

funding to General Purpose funding. After consultation with Congress regarding the unknown and potentially serious impacts the 

conversion could have to programs, such as the successful Housing 

and Urban Development–Veterans Affairs Supportive Services program, the Department ceased implementation and determined that 

conversion to General Purpose funding would not go forward in fiscal year 2018. In the Explanatory Statement accompanying Public 

Law 115–141, the Consolidated Appropriations Act of 2018, the Department was directed to consult with the Committees on Appropriations and the Committees on Veterans Affairs of both Houses 

of Congress before any future attempts are made to realign these 

funds and to propose such proposals in an annual budget submission. The Committee notes, that no such consultation has occurred 

and that the fiscal year 2019 budget submission did not reflect any 

conversion of funding. Therefore, the Committee directs that the 

Department not convert any Special Purpose funding to General 

Purpose funding in fiscal year 2019. 

Cross Government Credentialing of VA Healthcare Providers.—In 

order to better facilitate active recruitment of individuals who 

served in the healthcare field for the U.S. Armed Forces or while 

on duty with the U.S. Coast Guard, the Committee directs VA to 

establish coordinating relationships with the appropriate personnel 

divisions dealing with separating military personnel at the Departments of Defense and Homeland Security. As part of this coordination, the Department shall determine whether establishing a formal system for receiving advanced notice of separating members of 

the armed forces is feasible. The Committee further directs VHA to 

conduct an internal audit of its procedures for the recredentialing 

of providers when transferring within the VHA system. The Committee directs VHA to institute such policies and procedures to ensure the speedy and timely transfer of licensed personnel between 

facilities and to remove the unnecessary barrier of recredentialing 

triggered solely by a provider transferring facilities. 

National Intrepid Center of Excellence Satellite Strategic Basing.—The Committee recognizes the value of the National Intrepid 

Center of Excellence [NICoE] at Walter Reed National Military 

Center as a global leader in traumatic brain injury [TBI] care, research and education. In recent years, the NICoE has broadened its 

reach to service members and families by establishing a successful 

model of satellite centers, known as Intrepid Spirit Centers, which 

are located in highly populated military and defense communities. 

The Committee believes the Departments of Defense and Veterans 

Affairs can benefit from a similar model and joint project to serve 
39 

both the active and veteran populations in support of complementary and comprehensive recovery from the effects of TBI. The Committee directs the Departments to study the value and merit to establishing a joint DOD/VA, NICoE Intrepid Spirit Center that 

serves both the active duty and veteran populations for the mutual 

benefit and growth in treatment and care. The study will be reported to the Committees on Appropriations of both Houses of Congress no later than 180 days after enactment of this act, and include inputs from NICoE personnel and analysis regarding localities in geographically rural areas that may have existing DOD 

medical facilities that partner with the VA, academic institutions 

specializing in neurology and are distant from existing or planned 

NICoE satellite locations. 

Unmet Healthcare Benefits Concerning Veterans in the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, 

and Freely Associated States.—The Committee recognizes the challenges for veterans residing in the Commonwealth of the Northern 

Mariana Islands, American Samoa, Guam, and the Freely Associated States to access quality healthcare and is interested in exploring options to improve access and reduce overall costs. The Committee directs the Government Accountability Office to conduct a 

comparative analysis of delivering care to these veterans through 

the Department of Veterans Affairs Pacific Islands Health Care 

System [VAPIHCS] versus foreign medical facilities nearby, including the Philippines, Western Samoa, and New Zealand. The report 

should review the costs of providing care for these veterans, including travel and lodging costs in Hawaii and Guam; the medical outcomes and financial and psychological impacts of such referrals; 

and how veterans from other Pacific areas may reduce access to 

care for veterans residing in Hawaii. The report should also examine whether there is or needs to be existing administrative or legislative authority authorizing veteran care at foreign medical facilities. 

In addition, as VA works to transform its Community Care programs, the Committee directs the Secretary to provide the Committees on Appropriations of both Houses of Congress with a strategic 

plan to implement and improve the utilization of healthcare services for veterans in outlying areas through piloting the expansion 

of health services via telehealth or other community care providers 

within 180 days of enactment of this act. The plan should include 

an assessment of the number of veterans residing in outlying areas 

who have utilized services in the VAPIHCS facilities over the last 

three fiscal years and an average estimated cost for these veterans 

to access VA care; the estimated costs for providing telehealth services in outlying areas through a pilot program; identification of 

statutory authorities which may impede the necessary steps to implement such a plan and; recommendations for how VA can reduce 

burdensome restrictions under the Foreign Medical Program under 

its existing authorities. 

Furthermore, the Committee encourages the Department of Veterans Affairs to work with Federal and non-Federal partners, including the Departments of Defense, Interior, and Health and 

Human Services, non-VA healthcare facilities, and educational in-
40 

stitutions to leverage shared resources and improve access for delivery of care through collaboration. 

Prompt Payment.—The Committee remains committed to supporting VA’s efforts to ensure timely reimbursement for non-VA 

healthcare providers and facilities that provide necessary care for 

our veterans. As VA plans to award new Community Care Network 

contracts in 2018, the Committee encourages the Department to 

provide stronger oversight and improve timely payment to non-VA 

providers. The Committee also urges VA to facilitate the completion of all outstanding reimbursement as promptly as possible. 

Veterans Integrated Service Networks.—The Committee is aware 

that the Department intends to develop a plan to reorganize several regional Veterans Integrated Services Network [VISNs]. As 

the Department develops this reorganization plan, the Committee 

urges the Department to consider realignment strategies that keep 

whole States within the same VISN. 

Critical Need Occupations Staffing Model.—It is critical that the 

Veterans Health Administration develop a staffing model so that it 

can better understand, and more quickly address, its staffing needs 

in critical need occupations. The Committee remains concerned 

that after nearly 2 years, VA has failed to follow-up on repeated 

recommendations of the Office of Inspector General [OIG] regarding the development of staffing models for critical need occupations, 

as well as set forth milestones and a timetable for further critical 

need occupations’ staffing model development. The Committee recognizes that the Department has put forward some effort to move 

forward the process for creating a staffing model, but is disappointed with the pace. As such, the Committee directs VA to accelerate the creation of such a model so that veterans have access 

to the care they need. 

VHA Corporate Planning & Market Survey Functions.—Various 

documents published by VHA, such as the Blueprint for Excellence 

and the fiscal year 2016 Annual Restoring Trust in Veterans 

Health Care Report, recognize the need for creating a high-performing, integrated health network that includes VHA providers 

and facilities, other federally funded providers and facilities, and 

VHA-credentialed community providers and facilities. To date, VA 

has not articulated an overarching strategy to achieve such a goal, 

does not provide metrics to show progress towards achieving stated 

goals, and has no structure to identify accountable senior officials 

for such an effort. Further, the Department’s efforts in this area 

have been stymied by litigation, leading to further delays. The 

Committee recognizes that the complex and transformative nature 

of creating a system capable of serving veterans in the future requires direct and sustained VHA leadership involvement. To 

achieve this goal, the Committee directs VHA to form a corporate 

planning function patterned after high performing commercial 

health care delivery systems. Such function must include representation from VHA clinical leadership, and leaders from VHA offices 

that control, oversee, or manage facility investments, transition, facility operations, and organizational change, as well as the appropriate VA offices that are dedicated to the planning and procurement of capital infrastructure, whether built or leased by VA. The 

corporate planning function shall be responsible for planning and 
41 

implementing a high performing, integrated health network. The 

Department shall report to Congress no later than 180 days after 

enactment of this act detailing the corporate planning function and 

a plan to achieve a high-performing, integrated health network for 

the next 20 years. At a minimum, the plan shall clearly articulate 

VA’s vision of a future network, include goals VA is working towards to achieve the vision, Key Performance Indicators and other 

metrics VA will use to judge success, and an organizational chart 

detailing the corporate planning function’s direct reporting relationship to the Under Secretary of Health. The Committee recommends VA seek objective analysis and recommendations from organizations outside VA that have successfully created, implemented, or advised corporate planning functions at high-performing 

community health care systems. The Committee recommends VHA 

seek guidance from the leadership of the Department of Defense’s 

Military Health System Facility Shared Service. Additionally, the 

Committee understands that VHA is now conducting market surveys to examine how VHA can develop a high-performing network 

by looking at community health care supplies and VHA services 

and capabilities. The Committee directs VHA to report back the 

findings of these market surveys within 180 days of the completion 

of the surveys. 

Healthcare Fraud Prevention.—The Committee directs VA to 

evaluate the feasibility and advisability of utilizing health care 

fraud prevention initiatives to evaluate payments made to private 

sector providers and third party administrators to detect and prevent fraudulent billing by collecting data that evaluates trends, recognizes patterns consistent with potential fraud, and potentially 

uncover schemes or bad actors the Agency could not otherwise 

identify using only its own information. 

Retrofitting Facilities to Eliminate Barriers to Care for Women 

Veterans.—The Committee is concerned about VA’s lack of progress 

in addressing privacy and environment of care issues for women 

veterans, as highlighted in a 2016 GAO report. Therefore, not later 

than 180 days after enactment, the Committee directs VA to submit a report to the Committees on Appropriations and the Committees on Veterans Affairs of both Houses of Congress on the expenditures, including fixtures, materials, and other outfitting measures 

funded by major construction, minor construction, non-recurring 

maintenance, or other facilities accounts that provide for and enhance the privacy and environment of care for women veterans 

being treated. The report should further include a plan to address 

deficiencies in the environment of care for women veterans that 

serve as barriers to accessing the care that they have earned. 
42 

MEDICAL SERVICES

(INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018 1 ........................................................................... $46,849,538,000 

Advance appropriations, 2019 .............................................................. 49,161,165,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation, 2019 ....................................................... 750,000,000 

Budget estimate, advance appropriations, 2020 ................................. 48,747,988,000 

Committee recommendations, advance appropriations, 2020 ............ 51,411,165,000 

1Total excludes $11,075,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 

PROGRAM DESCRIPTION

The Medical Services account provides for medical services for eligible enrolled veterans and other beneficiaries in VA healthcare 

facilities, including VA medical centers and VA outpatient clinics. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $49,161,165,000 for fiscal year 2019 for the Medical 

Services account. The recommendation for fiscal year 2019 includes 

an additional $750,000,000 which is $750,000,000 above the budget 

request. The additional appropriation coupled with the advance appropriation provided for fiscal year 2019 provides the Department 

with total budget authority of $49,911,165,000 which is 

$3,061,627,000 above the fiscal year 2018 enacted amount. In addition, VA has the authority to retain co-payments and third-party 

collections, estimated to total $3,590,000,000 in fiscal year 2019. 

The Committee recommendation also includes an advance appropriation of $51,411,165,000 for Medical services for fiscal year 

2020. This is $2,663,177,000 above the budget request. The Administration’s budget proposed to consolidate the Medical Community 

Care account with the Medical Services account. The Medical Services account is used primarily for in-house VA medical care, while 

the Medical Community Care account funds non-VA care. The proposed consolidation of these accounts blurs the ability to readily 

identify how VA is executing funding between in-house care and 

non-VA care. However, according to the crosswalks contained in 

the justifications accompanying the budget submission, VA intended on allocating $14,419,786,000 to community care programs 

with the remaining $48,747,988,000 being utilized on traditional 

in-house VA care. This represented a proposed $413,177,000 reduction for services provided under the current Medical Services account. In order to continue to provide proper budgetary oversight 

of these two important functions, the Committee recommendation 

rejects the consolidation of these two accounts and adjusts the fiscal year 2020 advance appropriation for this account to better reflect current utilization rates. 

PREVENTING VETERANS HOMELESSNESS

The Committee remains strongly supportive of VA’s homeless 

prevention programs and as such the recommendation includes 

$1,888,534,000 to support these programs. This total includes an 

additional $130,000,000 over the current estimate of $320,000,000 
43 

for the Supportive Services for Veterans Families [SSVF] program 

and an additional $5,000,000 over the request for the Justice Outreach Homeless Prevention program. 

Limited Affordable Housing.—The Committee supports the continued efforts of the Department to shelter homeless veterans by 

providing case management services, housing grant assistance and 

access to low and no income housing opportunities, through programs such as the SSVF and HUD–VASH voucher programs. The 

Department is directed 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 the impacts of limited affordable 

housing opportunities on Department homelessness programs in 

rural communities and recommendations on how the Department 

may better partner with local housing entities to ensure rural access to housing services. 

In addition, the lack of affordable housing in many urban areas 

hindered efforts to reduce the homeless veterans population. Therefore, as part of the report, the Committee directs VA to include a 

section addressing the feasibility of piloting a demonstration 

through one of its existing programs to provide housing and supportive services to homeless veterans in high cost urban areas. 

Veterans Justice Outreach Program.—The goal of the Veterans 

Justice Outreach Program [VJO], authorized by section 2022 of 

title 38, United States Code, is to prevent homelessness, and avoid 

the unnecessary criminalization of mental illness and extended incarceration among veterans. This is accomplished by ensuring that 

eligible veterans encountered by police, and in jails or courts, have 

timely access to VA services including: mental health, substance 

abuse, and homeless programs. In 2017, the VJO program provided 

services to over 46,500 justice-involved veterans, supported 461 

Veterans Treatment Courts and other veteran-focused court programs, and partnered with legal providers to offer 158 pro-bono 

legal clinics to veterans on site at local VA hospitals. In order to 

assist in the success of this program, the Committee recommendation includes an additional $5,000,000 over the budget request for 

this program. 

Collaboration for Grant Per Diem Mix of Housing Services.—The 

Committee agrees with the goal of ending veteran homelessness by 

ensuring veterans’ access to permanent, affordable housing of their 

choice. However, the Committee recognizes that service-intensive 

transitional housing provided through the VA’s Grant Per Diem 

Program [GPD] is an important programmatic option, particularly 

in areas with low vacancy rates, limited housing stock, and high 

market rates, and that substance-free and service-intensive housing may be a critical step for veterans at risk of relapse into substance abuse. The most appropriate mix of housing services for veterans should be determined through a collaborative process including local housing partners, service providers, and the Department 

of Veterans Affairs. The Department should continue to make funding available for GPD beds based on a collaborative process with 

the local VA Medical Centers and the Continuums of Care. The Department is directed 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 the contingency and remediation 
44 

plan for veterans impacted by changes in availability or losses of 

awards of Grant Per Diem Program funds for current providers 

that serve rural or highly rural areas that would result in the loss 

of veterans’ access to transitional housing assistance. 

Veteran Homelessness in the Greater Los Angeles Region.—The 

Committee is concerned by reports that the population of veterans 

in Los Angeles experiencing homeless on any given night increased 

by 57 percent between from 2016 and 2017 from 3,071 to 4,828. 

Given the increasing homeless population, in many areas including 

the Greater Los Angeles Region, the Committee urges the Department to ensure that additional case management personnel and resources are being deployed to meet the recommended 25–1 case 

management staffing ratio. Within 30 days of enactment of this 

act, the Department shall provide to the Committees on Appropriations of both Houses of Congress a report outlining the cost and 

feasibility of contracting with local community-based agencies and 

non-profit organizations to provide additional case management 

services in regions where the Department does not meet is own 

case management ratio goals. 

Further, in order to better inform the Committee regarding 

HUD–VASH case management, not later than 120 days after enactment of this act, the Secretary shall submit to the Committees 

on Appropriations of both Houses of Congress a report that details 

the current ratio of HUD–VASH case managers to veterans serviced; steps taken to recruit and retain case managers for this program; a list of VA Medical Centers where HUD–VASH cases are 

being contracted out; and, efforts currently underway to assist 

HUD–VASH case management in highly rural areas. 

TELEHEALTH SERVICES

The Committee recommendation includes an additional 

$30,000,000 to expand VA’s telehealth capabilities. The Department of Veterans Affairs along with the Department of Defense 

have long been leaders in the field of emerging technology and 

medicine. For VA, telehealth creates a bridge between rural and 

urban centers—providers at an urban site can diagnose and provide a care plan for veterans hundreds of miles away, allowing, VA 

to expand the resources of one facility by connecting those providers to providers in another area. Through telehealth, the Department has the means and flexibility to provide care to veterans 

who do not have easy access to a VA hospital or access to a VA 

hospital staffed with the care they need. 

Telehealth is not only allowing the Department to expand access 

to care in areas where services are limited, but telehealth also allows care to be provided more effectively and efficiently for veterans closer to home and also through direct in-home access. While 

VA is once again leading the healthcare industry in the expansion 

of in-home telehealth and remote patient monitoring services, these 

services are often limited by the lack of broadband service in remote and rural areas. In order to better leverage other Federal 

partners, the Department is directed to provide a report to the 

Committee on Appropriations of both Houses of Congress by January 31, 2019, regarding ongoing collaborations VA has with other 

Federal agencies in targeting remote and rural areas with veteran 
45 

populations in order to ensure that grant programs administered 

by other Federal agencies maximize coverage areas to veterans. 

The Committee is also aware telehealth has a potential for significant cost savings and cost avoidance for the Department, and 

the Department is urged to maintain its focus on this type of care, 

not only to better serve veterans, but also to be a good steward of 

its financial resources. In order to ensure cost effectiveness and 

faster deployment of telehealth platforms, the Committee urges the 

Department to take advantage of commercial-off-the-shelf technology solutions when appropriate. 

MENTAL HEALTH/PREVENTING VETERANS SUICIDE

National Center for Post-Traumatic Stress Disorder.—The National Center for Post-Traumatic Stress Disorder [NCPTSD] is the 

Federal Government’s foremost center of expertise on evidencebased treatment of post-traumatic stress. The Committee continues 

to support the mission and work of the NCPTSD and has provided 

$40,000,000 to continue the center’s advancement of the clinical 

care and social welfare of America’s veterans who have experienced 

trauma or suffer from PTSD through research, education, and 

training in the science, diagnosis, and treatment of PTSD and 

stress-related disorders. The Committee supports the priorities for 

NCPTSD as described in the Congressional budget submission, and 

directs the Department to provide an assessment of the additional 

full time staff needed to carry out those priorities, as well as a hiring plan. Additionally, no later than 30 days after enactment of 

this act, the Department is directed to submit to the Committees 

on Appropriations of both Houses of Congress its plan for ensuring 

that all community care mental health providers receive information about NCPTSD and its consultation program. 

PTSD Treatment at VA Facilities.—Advances in evidenced-based 

clinical treatments stemming from recent brain research have significantly increased the ability to treat veterans experiencing posttraumatic stress. However, the availability of all levels of care remains inconsistent throughout the VA system. Therefore, no later 

than 180 days after enactment of this act, the Department is directed to submit to the Committees on Appropriations of both 

Houses of Congress an itemized cost estimate for the establishment 

of specialized out-patient PTSD programs, specialized intensive 

PTSD programs, and residential PTSD treatment program at every 

level two or above VA facility. 

Mental Health Staffing.—The Committee recognizes the importance of maintaining the appropriate number of mental health staff 

members at the Department of Veterans Affairs to provide veterans 

timely, effective, high-quality care. Therefore, the Committee urges 

the Department of Veterans Affairs to sufficiently fund its Mental 

Health Hiring Initiative in order to reach the recommended staffing ratio of 7.72 mental health outpatient staff to 1,000 veterans. 

Although the Committee is aware that the Department of Veterans 

Affairs currently seeks to increase the number of mental healthcare 

providers by 1,000 staff members. The Department is directed to 

keep the Committee apprised on a quarterly basis on meeting its 

hiring goals. 
46 

Suicide Prevention.—The Committee recognizes that preventing 

suicide among the veteran population requires a comprehensive 

and consistent effort to enhance the quality, continuity, and integration of mental healthcare. The Committee commends the Department for strengthening its focus on suicide prevention and 

urges the Department to increase support for primary care-mental 

health integration and recovery models, expand telemental health 

services, build on the success of evidence-based psychotherapy initiatives, and guide treatment decisions by measuring the outcomes 

of interventions. Additionally, the Committee recommends VHA develop a veterans suicide prevention strategy that is focused on preventing suicide by increasing focus on ‘‘upstream’’ prevention based 

interventions in order to more appropriately target interventions 

with veterans before they are at a crisis point. Interventions should 

be data-driven and executed in general areas of large veteran populations in the community as well as populations of at-risk veterans. 

The new strategy should include training for all VA employees who 

interact with veterans, not only those in the medical community, 

including chaplains, attorneys, law enforcement, and volunteers. 

The Department should also engage non-VA sectors such as employers, first responders, and the healthcare industry to ensure 

that all sectors are working across systems for suicide prevention. 

Sleep Disorders.—The Committee recognizes the importance of 

sleep, including its impacts on PTSD, traumatic brain injury, and 

mental health. The Committee supports VA considering all treatment options for these conditions, including ensuring proper sleep 

health. The Committee continues to recommend the Department 

assign a program manager for sleep disorders, including sleep 

apnea, that affect at least 200,000 veterans of the Persian Gulf 

War and Operations Iraqi Freedom and Enduring Freedom. The 

Department is directed to submit a report to the Committees on 

Appropriations of both Houses of Congress no later than 90 days 

after enactment of this act on the status of this recommendation. 

Trauma Management.—The Committee encourages the Secretary 

to consider establishing a Trauma Management Therapy pilot program utilizing 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 in treating PTSD. 

Mental Health/Suicide Prevention Best Practice Review.—The 

Committee is concerned that despite significant focus, addition of 

new programs, and increased funding, veterans suicide statistics 

are not changing. The Committee supports the Department’s Research efforts to synthesize information about successful practices 

and initiatives across the Department, and would like this effort to 

be expanded. As such, the Committee directs the Department to 

provide a report to the Committees on Appropriations of both 

Houses of Congress within 90 days after enactment, including: 

—A complete list of all current and planned mental health and 

suicide prevention programs available to veterans within the 

VA and through community partnerships; 
47 

—For each program, the annual amount of funding and number 

of veterans served; 

—The number of veterans receiving treatment in each program 

who ultimately committed suicide; 

—The metrics used by the Department to track the efficacy of its 

mental health programs, including how those metrics are 

tracked longitudinally; 

—Recommendations for additional metrics for VHA to better 

measure the efficacy of each mental health program; 

—The impacts of local mental health and suicide prevention programs in rural communities; and 

—Recommendations on how the Department may better partner 

with local communities to ensure rural access to mental health 

and suicide prevention programs. 

Further, if the VA does not have a Veterans Suicide Coordinator, 

the Committee directs the establishment of the roll. That position 

will be responsible for tracking metrics on suicides among veterans, 

annually reporting trends, and providing feedback to VHA that can 

be used to adjust programming for veterans’ mental health and suicide prevention to ensure funds are going to the most effective programs. 

OPIOID REDUCTION AND SAFETY INITIATIVES

To continue to build upon opioid reduction efforts and safety ini- tiatives, Committee recommendation includes $400,025,000 for 

Opioid Prevention and Treatment programs at the VA. This includes $348,000,000 for prevention and treatment programs, 

$18,000,000 above the budget request and $52,025,000 to continue 

implementation of the Comprehensive Addiction and Recovery Act 

of 2016. The additional resources are to be used to strengthen VA’s 

Opioid Safety Initiative as well as to develop programs aimed at 

ensuring that non-VA providers treating veterans through the community care programs are informed and in compliance with all VA 

standards for opioid safety and prescription guidelines. 

Office of Patient Advocate.—The Committee urges the Department to prioritize continued implementation of the reforms made 

to the patient advocacy program as required by the Jason 

Simcakoski Memorial and Promise Act (Title IX, Public Law 114– 

198). The Committee believes that the law’s establishment of the 

Office of Patient Advocacy will ensure that patient advocates are 

independent of local facility management, truly work on behalf of 

veterans, and are properly trained according to national standards. 

Accordingly, within 30 days of enactment, the Committee directs 

VA to provide a report on its progress implementing the relevant 

sections of Public Law 114–198, including progress on patient advocate training at each VAMC and any outstanding recommendations 

included in the Inspector General’s March 2017 audit of the patient 

advocacy program’s fiscal year 2015 operations [VA OIG 15–05379– 

146]. 

Improvement of Opioid Safety Initiative.—The Committee supports VA’s Opioid Safety Initiative [OSI] and encourages continued 

implementation at all VA medical facilities, as directed under Title 

IX of Public Law 114–198, the Jason Simcakoski Memorial and 

Promise Act. The Committee believes that it is imperative that all 
48 

VA providers who prescribe opioids continue to consistently use the 

Opioid Therapy Risk Report tool under the OSI, including prior to 

initiating opioid therapy, to ensure safe prescribing, and to help 

prevent diversion, abuse, and double-prescribing. Under Public 

Law 114–198, the Department must continue implementation of 

mandatory use of such tool for all providers prior to initiating 

opioid therapy for a patient to assess the risk for adverse outcomes; 

routine and random drug tests standards; provider use of the tool 

to access the State Prescription Drug Monitoring Program [PDMP]; 

and inclusion of information identifying when health care providers 

access the tool and the most recent urine drug test for each veteran. The Committee also urges VA to further improve the timeliness of data available in the tool to allow a provider to have realtime access to data on a patient who was prescribed opioid therapy 

by another facility, in another State, or by mail order to prevent 

overprescribing and abuse potential. Public Law 114–198 requires 

the Department to ensure VA providers can access information in 

the State PDMP including by seeking to enter into memoranda of 

understanding with States to allow shared access of such information between VA and the States. This is critical to ensure safe pain 

management care, as many veterans also seek care from providers 

in the community who may prescribe them medication. The Department must also include such information in the Opioid Therapy 

Risk Report tool and require VA providers to disclose certain veteran information to State controlled substance or PDMPs. The Department is directed to submit an updated report to the Committees on Appropriations of both Houses of Congress no later than 

180 days after enactment of this act assessing compliance with 

mandatory provider use of the tool and utilization of and reporting 

to State PDMPs. The report must also include an assessment of the 

feasibility of improving the tool to allow for real-time tracking and 

feasibility of implementing an indication for use linked to opioid 

prescriptions in the tool to support oversight of safe opioid prescribing. 

Opioid Therapy Clinical Practice Guidelines and Training.—The 

Committee believes that continued and robust implementation and 

dissemination of the updated 2017 VA/DoD Clinical Practice Guideline [CPG] for Management of Opioid Therapy for Chronic Pain, as 

required under Public Law 114–198, is critical to ensure that clinicians have routine access to the most updated information to help 

inform safe and quality care and improve pain management for 

veterans. In addition, to ensure that all providers have access to 

most recent scientific evidence, it is critical for opioid prescribing 

guidance to be as up to date and as consistent as possible across 

Federal agencies. As such, the Committee directs the Department 

to continue to routinely coordinate and consult with the Centers for 

Disease Control and Prevention and other relevant groups and 

Federal agencies on continued implementation and compliance with 

the CPG and latest scientific recommendations. As part of continued efforts to enhance safe pain management and education across 

the Department, the Committee directs the VA to ensure that all 

clinicians, including pharmacists, receive guidance on assessing the 

risks and benefits of critical drug interactions with opioids when a 

pharmacists overrides such interaction under section 913 of Public 
49 

Law 114–198. The Committee further directs VA to provide a report within 180 days after enactment of this act on implementation 

of the new CPG, including education and training of providers as 

well as certification from the new pain management teams at each 

facility that all health care professionals responsible for coordinating and overseeing pain management therapy utilize the updated CPG. 

Opioid Control Procedures.—The Committee is aware a recent 

GAO report recommended that the Under Secretary for Health 

should ensure that VAMCs have established an additional control 

procedure, such as an alternate controlled substance coordinator or 

a pool of extra inspectors, to help coordinators meet their responsibilities and prevent missed inspections. The Committee urges the 

Secretary to fully implement these recommendations to improve 

oversight of the controlled substance inspection program and to 

document its progress. The Committee directs the Secretary to provide annual updates on its progress regarding its adoption of the 

GAO recommendations. 

Community Care Opioid Safety.—The Committee recognizes that 

VA has made important progress increasing opioid safety and reducing overprescribing within the VA health care system. However, 

the Department has not made comparable progress implementing 

opioid safety reforms in VA community care programs. The Committee believes that the July 2017 VA Office of Inspector General 

report on opioid prescribing in VA community care programs provides further evidence that veterans receiving opioid therapy from 

community care providers, including through the VA Choice program, are at significant risk. The Office of Inspector General found 

that contract providers are not subject to many of the opioid safety 

reforms included in Public Law 114–198, the Jason Simcakoski Memorial and Promise Act, and implemented at VA [VA OIG 17– 

01846–316]. Specifically, community care providers are not aware 

of and thus, not complying with, VA opioid therapy and safe prescribing protocols. Furthermore, VA is not consistently tracking 

opioid prescriptions from community care programs due to significant information exchange gaps between VA and non-VA providers. 

To ensure community care providers follow the same safe opioid 

prescribing standards and have access to the same up-to-date pain 

care information as VA practitioners, the Committee directs the 

Department to implement the recommendations in the OIG report, 

including ensuring that community care providers review the safe 

opioid prescribing guidelines and Opioid Safety Initiative protocols 

and implementing a process to provide community care providers 

a complete up-to-date list of medications and medical history of the 

veteran during non-VA care consults. The Committee further directs the Department to provide a progress report on implementation of such recommendations within 180 days after enactment of 

this act. 

Complementary and Integrative Health.—Expanding access to 

comprehensive pain management and complementary and integrative health [CIH] services is vital to improving the delivery of highquality care for our veterans, especially those struggling with cooccurring conditions like chronic pain, mental health and substance 

use disorders. The Committee urges robust implementation of VA’s 
50 

plan to expand the scope of research, education, delivery, and integration of CIH into the health care services provided to veterans. 

In addition, as required under section 932 of Public Law 114–198, 

VA must continue to prioritize implementation of the pilot program 

at VA medical centers, including polytrauma rehabilitation centers, 

to assess the feasibility and advisability and delivery using 

wellness-based programs to complement pain management and related health care services. The Committee has been concerned with 

previous reports of VA’s dangerous opioid prescription practices at 

facilities, including at the Tomah VA Medical Center in Wisconsin, 

where such practices led to the tragic death of Marine veteran 

Jason Simcakoski in 2014. While the Committee supports the 

progress being made to reduce misuse and abuse of opioids and to 

improve pain care, the Committee believes that consideration of 

VISNs or medical centers with a history of or current prescription 

rates of opioids that are in conflict with or are inconsistent with 

the standards of appropriate and safe care should be given priority. 

The Committee encourages the Department to continue to expand 

access to CIH services as part of the VA’s Whole Health System approach and directs VA to report to the Committee on the progress 

of the 18 flagship facilities being launched to effectuate this effort. 

Implementation of VA Participation in State Prescription Drug 

Monitoring Programs.—Within 90 days of enactment, VA shall submit a report to the Committees on Appropriations of both Houses 

of Congress regarding implementation of the VA Prescription Data 

Accountability Act of 2017 (Public Law 115–144) that requires VA 

to participate in State Prescription Drug Monitoring Programs. The 

report shall indicate progress in participation broken out by VISN 

and healthcare system, identify with specificity impediments to 

participation in particular State Prescription Drug Monitoring Programs and establish benchmarks and timeframes for full participation. Not later than February 1, 2020, VA shall submit an update 

report to the Committees identifying progress toward full participation during calendar year 2019. The committee also encourages VA, 

to the maximum extent permitted by law, to share prescription 

drug information with other Federal medical facilities that may 

serve veterans, including DOD medical facilities and Indian Health 

Service facilities. 

LONG-TERM CARE

Long-Term Care.—The bill provides $9,024,330,000 as requested 

by the Department for long-term care. This includes the 

$6,168,524,000 for institutional care and $2,855,806,000 for non-institutional care. The Committee supports the Department’s efforts 

to broaden veterans’ options regarding non-institutional long-term 

care support and services. As the Department realigns these programs under the Medical Community Care account, the Committee 

encourages VA to continue to prioritize veterans’ preferences in receiving home based services. The Committee notes the positive results of pilot programs such as the Veterans Independence Program, a veterans-directed Home and Community Based Services 

[HCBS] grant program originally created as a pilot administered 

jointly by VA and the Department of Health and Human Services 

[HHS]. The Committee encourages enhanced cooperation with HHS 
51 

to expand and grow these programs. The Department is directed 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 the cost avoidance associated with various non-institutional 

care programs. The report should include information on the demand for HCBS among the veteran population, the number of veterans currently being served by each program under HCBS, and 

the Department’s plans to expand the size and scope of HCBS. 

Given the success of current HCBS pilot programs, the Department 

should include a cost analysis of growing the existing pilot programs prior to national expansion to leverage coordination with 

HHS, in addition to detail regarding the Department’s efforts to coordinate with HHS on HCBS in future years. Given that mandatory eligibility for certain types of care is associated with disability 

levels adjudicated by VBA, this report should also include recommendations for modernizing the claims process for veterans requiring long-term care. 

Home-Based Primary Care.—The Committee supports the collaboration between VA and the Indian Health Service [IHS] and 

collaboration by Federal agencies with Tribes to expand access to 

care for Native veterans, including the recent expansion of evidence-based home-based primary care [HBPC] programs at 14 VA 

medical centers. This expansion is designed to reach new populations of American Indian veterans living in rural reservation 

communities, which are served by medical facilities operated directly by the IHS or by Tribes and Tribal organizations with funding provided by the IHS. The Committee urges the Secretary to increase funding within the Office of Rural Health to expand HBPC 

programs to additional American Indian reservations and to other 

rural areas. Furthermore, the Secretary should continue to improve 

planning coordination with other Federal healthcare organizations. 

Planning efforts should take into account conducting a populationbased needs assessment and allowing sufficient time to develop 

trusting relationships with Native veterans, Tribal health and social service personnel, IHS and Tribal community health representatives, and Tribal communities. Planning efforts should also consider availability of IHS and Tribal resources for patients, as well 

as identify potential opportunities for co-management to prevent 

unintended duplication of effort, over-prescribing of medications, 

and other inefficiencies. 

RURAL HEALTHCARE

Office of Rural Health.—Veterans residing in rural and remote 

areas face unique barriers to receiving high-quality mental health, 

primary healthcare, and specialty care services. While enhanced 

community care programs offer veterans increased flexibility to obtain care close to home, often this same gap in services exists in 

the private market in rural and remote communities. Over the past 

9 years, the Office of Rural Health and its Rural Health Initiative 

has played a critical role in assisting VA in its efforts to increase 

access to care. Therefore the Committee recommendation includes 

$270,000,000 for the Office of Rural Health [ORH] and the Rural 

Health Initiative. This is $20,000,000 above the budget request. 
52 

Through collaborations with other VA program offices, Federal 

partners, State partners, and rural communities, ORH works to optimize the use of available and emerging technologies, establish 

new access points to care, and employ strategies to increase 

healthcare options for all rural veterans. Currently, ORH identifies 

and implements initiatives that support rural clinics and rural 

home-based primary care, address barriers to access and quality of 

healthcare delivery in rural areas, develop workforce recruitment 

and retention initiatives, and accelerate and expand telehealth. 

ORH also operates Rural Health Resource Centers and works with 

Federal and non-Federal community partners to share resources 

and expand access to care for rural veterans. Given the important 

role these centers play in increasing access, the Committee encourages the Department to increase the number of these centers. Any 

expansion should also emphasize increasing access to healthcare 

for women veterans, treating traumatic brain injuries, and the recruitment and retention of healthcare providers to serve rural and 

remote areas. 

Rural Health Continuity of Care.—The Committee notes the Access Received Closer to Home [ARCH] pilot program was highly 

successful in some areas in providing healthcare services to veterans who live in the rural and highly rural States in which it operated, such as in northern Maine and in Kansas. During the pilot, 

VISN analysis demonstrated that more than 90 percent of veterans 

who received medical care through ARCH were ‘‘completely satisfied’’ with their care and cited significantly shortened travel and 

wait times to receive care. Furthermore, the Committee is pleased 

the Department has made efforts to provide continuous, ARCH-like 

access to rural healthcare in northern Maine through the use of 

provider agreements. As the Department transitions away from the 

Choice Program to a reformed community care program, the Committee directs the Secretary to sustain continuity of care for rural 

veterans through provider agreements, based on previous models 

such as the ARCH program, to ensure veterans do not experience 

a lapse in existing healthcare access during the transition to the 

new community care program and any resulting integrated networks. The Committee continues to support enabling the Department to enter into provider agreements with non-VA long-term 

care providers, including skilled nursing facilities, in lieu of the 

current onerous Federal contracting requirements. 

VA/Clergy Partnership for Rural Veterans.—The Committee supports the continuation of the efforts of the Department’s Community Clergy Training to Support Rural Veterans Mental Health Initiative. The Committee urges the Department to increase the financial resources made available in order to increase accessibility of 

this initiative to rural communities. Further, the Committee directs 

the Department to provide a report to the Committees on Appropriations of both Houses of Congress, no later than 180 days after 

enactment, on the participation rate of rural communities in this 

program and recommendations on how the Department may better 

partner with local faith-based organizations as well as the Department of Defense, in conjunction with the ‘‘Strong Bonds’’ program, 

to ensure access for veterans as well as total force servicemembers. 
53 

Rural Recruitment.—To improve recruitment and retention initiatives for healthcare providers in rural and highly rural areas the 

Committee urges the Department to conform with the recommendations contained in GAO report GAO–181–24. Specifically, 

that the VHA: 

—Develop and implement a process to accurately count all physicians providing care at each medical center, including physicians not employed by VHA; 

—Develop and issue guidance to the VAMCs on determining appropriate staffing levels for all mission-critical physician occupations; 

—Ensure that when multiple offices issue similar productivity 

data on physician occupations, any methodological differences 

are clearly communicated and guidance is provided on how to 

interpret and reconcile the data; 

—Establish a system-wide method to share information about 

physician trainees to help fill vacancies across VAMCs; and 

—Conduct a comprehensive, system-wide evaluation of the physician recruitment and retention strategies used by VAMCs to 

determine their overall effectiveness, identify and implement 

improvements, ensure coordination across VHA offices, and establish an ongoing monitoring process. 

Nurse Advice Line.—Last year, the Committee directed the Department to pursue a pilot program for a nurse advice line targeting rural areas and highly rural areas with a large percentage 

of veterans. The pilot was to be based on and improve upon the 

nurse advice line implemented by DOD for beneficiaries under the 

TRICARE program. No later than 30 days after enactment of this 

act, the Department is directed to submit to the Committees on Appropriations of both Houses of Congress a report detailing where 

the pilot was established and the progress made in implementing 

the directive. The reports shall also contain information on utilization of the pilot, to include a description of the individuals who 

benefitted from advice; a description of any impediments in carrying out, or encountered by individuals accessing, the pilot program; a description of any cost savings to the Department, and an 

assessment of the feasibility and advisability of expanding the pilot 

program to more veterans. 

CAREGIVERS

The Committee recommendation includes $860,828,000 for the 

VA’s Caregivers Program, $364,796,000 above the current estimate 

submitted with the budget request. The Committee expects VA to 

dedicate this funding to the program and not to divert the resources to other areas and notes that notification should be provided to the Committee of any reprogramming of this funding. In 

order to ensure proper budgetary oversight, the Department is directed to report to the Committees on Appropriations quarterly obligations for the Caregivers Program. 

Caregivers.—The Committee notes the robust usage of the post9/11 Caregiver program with its more than 21,000 approved applications, as well as the consistent reviews by caregiver families noting that the program’s stipend, respite care, formal training, and 

support structure are critical components to its success. Given the 
54 

demonstrated success of the program, the Committee encourages 

the VA to ensure that the Caregiver coordinators at each Medical 

Center are fully resourced and, to the maximum extent possible, 

assigned designated Caregiver duties as their chief and only responsibility. The Department is also encouraged to work with the 

Department of Defense in order to develop and share best practices. 

Many caregivers for severely wounded veterans are working dramatically reduced hours outside the home or have left the workforce completely, often leading to financial hardship. This reduction 

in outside earnings results in difficulties meeting financial obligations, including student loan debt held by the caregiver. The Committee directs the VA to survey all caregivers currently in the program to identify the number possessing outstanding student loan 

debt and to develop a plan to monitor this issue, by developing 

methods to capture this data routinely. The Department shall report to the Committees on Appropriations of both Houses of Congress within 120 days of enactment of this act survey results and 

details for future monitoring. 

WOMEN VETERANS HEALTHCARE

Women Veterans.—Women represent 15.5 percent of today’s active duty force and 19 percent of our National Guard and Reserves. 

Accordingly, women veterans are enrolling in VA healthcare at 

record levels, with the number of women veterans using VA 

healthcare tripling since 2001. With the upward trend of women 

serving in all branches of the Armed Forces, the Department must 

continue to aggressively expand efforts that address the current 

barriers to gender-specific healthcare services and plan accordingly 

for the type and length of the treatment needs of women veterans. 

The Committee continues to believe VA must be poised to address 

the changing demographic of today’s and tomorrow’s veterans in 

order to fulfill its mission. Toward this end, the Committee recommendation includes an additional $20,000,000 over the budget 

request for fiscal year 2019 to support gender-specific healthcare 

services. The Committee also encourages the Department to consider a mobile healthcare pilot program, prioritizing rural and high 

need areas, to provide gender-specific services, awareness of benefits, and outreach to women veterans utilizing mobile healthcare 

infrastructure. This innovative model is designed to fill the current 

gap in gender-specific services as VA works to expand infrastructure and hire the needed staff for specialty care. 

Female Primary Care and Mental Health Care Providers.—The 

Committee urges VA to make every effort to hire more women 

healthcare professionals and offer all women veterans the opportunity to choose the gender of their primary care and mental 

healthcare providers. 

Intimate Partner Violence Program.—The VA Intimate Partner 

Violence Program expands VA’s screening, prevention, and intervention services to veterans and strengthens collaboration with 

community partners as well as the Caregivers Support Program 

and VA programs to address homelessness. The program focuses on 

developing a culture of safety and adopts a holistic, trauma-informed, veteran-centered approach to services and support for 
55 

those veterans involved in a domestic violence situation. In recent 

years, VHA has run this program using general funds, and at 

times, the program has lapsed due to a lack of funds. The Committee directs the Department to fully resource this program at 

$17,000,000 in fiscal year 2019 and include it as a program of interest with budget detail in the justifications accompanying the fiscal year 2020 budget submission. 

OTHER ITEMS OF INTEREST

Adaptive Sports.—The Committee recommendation includes 

$16,000,000 for adaptive sports programs. The Adaptive Sports 

Grant Program helps connect veterans with disabilities to sports 

programs and remains one of the most popular programs among 

veterans. Originally established to assist with training for 

Paralympic athletes, the program now supports veterans of all levels. The Committee recognizes that veterans have shown marked 

improvements in mental and physical health from participating in 

adaptive sports and recreational therapy and that veterans have 

expressed the need for these activities to be included in the 

healthcare services VA offers. The Committee also recognizes that 

adaptive sports and recreational therapy provide a low-cost alternative to other healthcare services that produce similar health outcomes. Therefore, the Committee requests that the Department 

provide a feasibility assessment for the cost of expanding the grant 

program to include recreational and lifelong sports, such as openocean swimming, surfing, outrigger canoeing, hunting, and fishing, 

as well as any legal barriers to expansion. 

The Adaptive Sports Grants Program currently awards a limited 

number of grants for equine therapy, mostly related to physical disabilities. Therefore, of the increase provided, $1,500,000 should be 

used by VA to increase its use of these grants for the purpose of 

equine therapy targeted to mental health issues. 

Equine Therapy.—The Committee recommends that the Department utilize funding to conduct a comprehensive program evaluation to ensure the continued effectiveness of equine therapy in addressing the mental health needs of veterans that participate in 

these programs, including through the systematic assessment and 

tracking of mental health issues and symptoms, and the measurement of key outcomes, such as functional improvement in veterans’ 

different life domains. 

Cancer Treatment.—The Committee seeks to ensure that veterans have access to the highest quality cancer care available. The 

Committee, therefore, applauds the ongoing collaborative efforts between VA medical centers and NCI-designated comprehensive cancer centers. The Committee supports 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 is also pleased that VA is engaged with the NCI 

and VA Interagency Group to Accelerate Trials Enrollment partnership, which will improve access to certain clinical trials at a 

number of VA facilities. The Committee understands that initiating 

new clinical trials is a resource-intensive process requiring experi-
56 

enced coordination staff with specialized expertise in data management and regulatory compliance. To improve its own capacity to coordinate a full range of cancer clinical trials with non-VA organizations, the Committee encourages VA to provide resources for coordination staff and continue to develop partnerships with non-VA 

organizations that have initiated pilot clinical trials programs. The 

Committee also requests a report, within 90 days of enactment of 

this act, which provides an overview of VA’s credentialing process 

for non-VA clinical trial coordinators and recommendations, if any, 

to improve this process. 

Inpatient Drug Rehabilitation Report.—The Secretary of Veterans Affairs, no later than 120 days after enactment, shall submit 

to Congress a report that includes: (1) the number of VA inpatient 

drug rehabilitation beds per VA Medical Center; (2) Number of occurrences, per VA Medical Center, that the VA furnished inpatient 

drug rehabilitation care in the community in previous 24 months; 

and, (3) specific demographic data on addicted veterans. 

Beneficiary Travel.—The Committee is concerned about the allocation of beneficiary travel to VISNs where unconventional modes 

of travel, such as air, are the primary means for veterans to visit 

a VA hospital. The Committee directs the Secretary to conduct a 

review of the beneficiary travel program for VISNs that have exhausted available funds in the first or second quarter of the fiscal 

year. In conducting the review, the Secretary shall consider whether the traditional mileage reimbursement model remains appropriate for VISNs that serve the non-contiguous states and other 

rural, highly rural, and remote areas. The Secretary shall also report on the types of clinical services for which veterans are traveling and seeking reimbursement, and determine whether telemedicine could reduce the need for such travel and, if so, a plan 

to make those services available. Finally, the report shall assess 

how the beneficiary travel allocation in impacted VISNs affects 

timely reimbursements for veterans and what, if any, chilling effect 

delayed reimbursements have on veterans choosing to seek care. 

This report should be provided to the Committees on Appropriations of both Houses of Congress no later than 180 days after enactment of this act. 

Blood products.—The Committee is concerned about the safety of 

blood products being transfused to veterans at VA medical facilities 

given the aging and medically fragile populations being treated. 

Therefore, the Committee urges VA to request that all blood product providers use FDA-approved pathogen reduction technology, 

where available, before providing blood products for transfusion at 

VHA medical facilities, including VA medical centers, outpatient 

clinics, community-based outpatient clinics, and community living 

centers. 

Orthotics & Prosthetics Workforce.—The Committee is concerned 

about the sustainability of the orthotics and prosthetics workforce 

treating veterans, particularly with retirements in an aging workforce and the lack of availability of advanced degree programs necessary to train new professionals. Reports indicate that up to 20 

percent of the field’s 7,100 clinicians nationwide are either past retirement age or within 5 years of retiring. The Committee recognizes the contributions made by the VHA’s Orthotic and Prosthetic 
57 

Residency Program to provide rotation opportunities through the 

VA system, but acknowledges this program alone is inadequate to 

ensure a sustainable workforce for the future, especially in light of 

the skill set necessary to provide the increasingly complex, stateof-the-art orthotics and prosthetics care for Iraq and Afghanistan 

war veterans. The Committee directs the VHA to explore cost effective opportunities to grow the workforce pipeline in order to ensure 

the future orthotic and prosthetic workforce required by the nation’s new generation of veterans and report findings to the Committees on Appropriations of both Houses of Congress within 180 

days of enactment. 

Sepsis Screening.—Sepsis is a major cause of mortality among 

veterans with spinal cord injury. The Committee believes that the 

Department, through its Center for Clinical Management Research 

and its Spinal Cord Injuries and Disorders Centers, can help improve the VA’s diagnosis and management of Sepsis. The Committee urges the Department to provide a report on its costs related to sepsis management and how it has incorporated latest improvements in sepsis screening and diagnostics, including biomarker testing, across its healthcare facilities. 

Veterans Exposed to Open Burn Pits and Airborne Hazards.—In 

order to provide full and effective medical care it is essential for 

the Department to better understand the impacts exposure during 

service has had on the health of veterans. Therefore the Committee 

includes $5,000,000 for VHA clinical proposals, developed in conjunction with research, focusing on post-deployment health for veterans exposed to airborne hazards and open burn pits. Additionally, the Committee directs the Secretary to provide an assessment 

of the process by which veterans are informed by both VA and community care providers about the Airborne Hazards and Open Burn 

Pit Registry and their eligibility for registering. The assessment 

should include an analysis of the process by which VA or community care providers for veterans who may be suffering the effects 

of exposure to airborne hazards are connected to the VA experts at 

the Airborne Hazards Center of Excellence for additional resources 

and assistance. 

The Committee is aware that the Department may be undertaking an effort to consolidate several health registries at the VA. 

In order to better understand the impacts this might have, the Department is directed to submit a report to the Committees on Appropriations of both Houses of Congress no later than 60 days after 

enactment of this act outlining the number and type of registries 

being consolidated. The report should also include how such consolidation will affect implementation of the recommendations included in the National Academies of Sciences, Engineering, and 

Medicine’s Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry for improving the registry. 

Hospice Care.—From 1964 to 1975, more than nine million Americans served in the armed services, with more than one-third of 

them having served in Vietnam. As these Vietnam-era veterans 

age, many of them are facing unique end-of-life challenges related 

to their combat experience that standard hospice care and palliative services are not fully equipped to address. These challenges in-
58 

clude psychological and post-traumatic stress disorders, a history of 

substance abuse, and neurological conditions resulting from toxic 

chemical exposure. While the VA provides hospice care and palliative services to qualified veterans, the Committee is aware that 

many non-profit organizations are developing programs designed to 

meet the specific end-of-life care needs for Vietnam-era veterans. 

The Committee also recognizes that such an approach could be beneficial to Iraq and Afghanistan combat veterans in the future. 

The Committee supports the findings of the feasibility study on 

hospice care protocols tailored to the unique needs of combat veterans, including Vietnam-era veterans, as required in fiscal year 

2018. Therefore, the VA is urged to deploy a pilot program to develop the techniques, best practices and support mechanisms to 

serve these veterans and to further implement the findings of the 

feasibility study. The Department is encouraged to engage nonprofit hospice and palliative care providers with Vietnam veterancentric programs. The Department is directed 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 this effort. 

Veterans Transportation Service.—In order to ensure the Veterans Transportation Service [VTS] is improving veterans’ access to 

healthcare and VA’s ability to provide quality care in a cost effective manner, the Department is directed to submit a report to the 

Committees on Appropriations of both Houses of Congress no later 

than 90 days after enactment of this act outlining the progress 

made on these metrics. At a minimum, the report should include 

analysis of the healthcare costs impacted by non-emergency medical transportation, the impact of VTS on missed appointment rates 

at facilities utilizing the program, and VTS impact on health outcomes for veterans. 

Center for Compassionate Innovation.—The Committee understands that VA has been operating a Center for Compassionate Innovation. The Center’s stated purpose is to explore emerging therapies targeted to enhance veteran physical and mental well-being 

when other treatments have not been successful. The Committee 

encourages VA to always be testing and researching new and innovative treatments that may benefit veterans’ lives. To more fully 

understand these treatments, the Committee directs VA to report 

within 180 days of the enactment of this act with a description of 

the proposals the Center received in fiscal year 2018 and the cost 

and disposition of such proposals. Further, the Committee directs 

VA to report on the actions the Department took regarding the 

data or results gleaned from these treatments and whether they 

have been utilized by the Department to determine the efficacy of 

the treatments. 

Physician Assistants.—The Committee is concerned that VA has 

failed to utilize existing authorities to hire and retain Physician 

Assistants [PAs]. As such, the Committee directs VA to accelerate 

the rollout of competitive pay for PAs, and develop a plan on how 

to better utilize the Health Professional Scholarship Program and 

Education Debt Reduction Program. In addition, the Committee believes VA would benefit from the creation of a staffing plan on how 

to utilize PAs within the Department and directs the Agency to develop such a model. 
59 

Healthcare Workforce.—The Committee remains concerned with 

VHA’s ability to recruit and retain quality physicians. Accordingly, 

the Committee directs the Department to fully comply with GAO’s 

recommendations to improve staffing, recruitment, and retention 

strategies for physicians. 

The Committee is aware of the ongoing challenges facing the VA 

Caribbean Healthcare System as a result of the devastating 2017 

hurricane season. The Committee directs the Department to formulate a strategy to address the physician shortages currently facing 

the VA Caribbean Healthcare System. The Department is directed 

to submit a report to the Committees on Appropriations of both 

Houses of Congress no later than 180 days after enactment of this 

act assessing the VA Caribbean Healthcare System’s emergency response to Hurricanes Irma and Maria and identifying areas for improvement. 

Licensed Professional Mental Health Counselors and Marriage 

and Family Therapists.—The Committee directs VA to work with 

the Office of Personnel Management [OPM] to create an Occupational Series for Licensed Professional Mental Health Counselors 

[LPMHCs] and Marriage and Family Therapists [MFTs]. The Committee also directs VA to create a staffing plan for LPMHCs and 

MFTs to fill open positions and assess LPMHC and MFT shortages. 

Rehabilitation Therapy Outcomes.—The Committee believes that 

rehabilitation therapy outcomes might be improved if VA collected 

functional status data that includes; functional status and improvement; effectiveness and efficiency of treatment; and patient satisfaction. The Committee encourages VA to pilot the collection of 

such data and compare outcomes with a control group for which 

such data is not collected and monitored. 

Canadian Forces Base Gagetown.—The Committee is aware that 

many National Guard veterans engaged in training activities at 

Canadian Forces Base [CFB] Gagetown in the 1950s and 1960s. 

The Committee is also aware that Veterans Affairs Canada approved one-time, lump sum payments to eligible veterans exposed 

to Agent Orange and other defoliants who served at CFB 

Gagetown, and that American veterans who served there between 

June 20 and June 24, 1964, are currently eligible for an Agent Orange Registry Health Exam from the Veterans Health Administration. The Committee urges the Department to establish and maintain a health registry for American veterans who were stationed or 

underwent training at CFB Gagetown between 1956 and 2006 and 

who have subsequently experienced health problems which may be 

attributed to Agent Orange or other defoliants. The Committee further urges the Department to commission an independent study 

tasked with investigating the linkage between service at CFB 

Gagetown and the development of health problems and disease associated with exposure to Agent Orange. 

VA Special Mode Transportation.—The Committee is concerned 

that blinded veterans are being denied transportation assistance 

because their disability is not considered ‘‘non-ambulatory.’’ The 

Committee directs VA to review this policy and report back to the 

Committee regarding the circumstance under which a denial of 

transportation assistance would be issued. 
60 

Emergency Ambulance Reimbursement.—The Committee is concerned that the Department’s medical documentation requirements 

for emergency ambulance services claims are resulting in veterans 

receiving bills for expenses properly borne by the VA. For example, 

the Committee is aware that the Health Insurance Portability and 

Accountability Act [HIPAA] frequently prevents ambulance providers from gathering the required medical information for submission to the VA for reimbursement. The Committee therefore urges 

the Department to take any necessary actions to process such 

claims using the ‘‘prudent layperson’’ standard, as utilized by other 

Federal health insurance programs such as Medicare and Medicaid. 

The Department is directed to provide a brief to the Committees 

on Appropriations of both Houses of Congress no later than 90 days 

after enactment of this act to update the Committees on this effort. 

VA Transplant Centers.—The VA National Transplant Program 

currently maintains 13 VA transplant centers [VATCs] across the 

United States and performs approximately 300 organ transplants 

per year, with significant differences in volume and types of transplants being performed at the 13 facilities. 

The Committee is very concerned with the inconsistent volume 

of transplants being performed at the 13 VATCs. High volume, particularly for complex procedures, is associated with better outcomes, and research has demonstrated that there is strong evidence for a volume-mortality relationship for hospitals and physicians. 

The Committee also acknowledges the Office of Special Counsel’s 

[OSC] report released in January 2018, which noted that VA failed 

to address conflicting information regarding the availability of 

transplant care in the community and the coverage of organ harvesting and donor care through the CHOICE Program. 

Therefore, the Committee directs the Secretary of the VA to deliver a report to the Committees on Appropriations of both Houses 

of Congress not later than 180 days after the enactment of this Act 

that addresses the following issues: 

—The fully burdened annual cost of the Department’s National 

Transplant Program over the previous five fiscal years, including a per year cost breakdown for maintaining and operating 

each transplant center; 

—A detailed accounting, by transplant center, of the number of 

transplants, by organ type, performed over the previous five 

fiscal years by month, indicating whether or not those were 

performed at a VATC or at a non-VA facility, and the average 

cost to the Department of performing each type of organ transplant; 

—For those transplants performed at a non-VA facility, a listing 

of the statutory authority by which the transplants were covered by the VA; 

—A detailed accounting of the travel and lodging costs associated 

with transporting veterans and authorized support members to 

each of the Department’s transplant centers for pre-operative, 

operative, and post-operative care for the previous five fiscal 

years with a per year breakdown; 

—VA’s policy regarding the Veteran and his or her support member when travel has been authorized, to include per diem rates, 
61 

dwelling options and travel allowances for visiting home during treatment; and 

—A cost comparison by organ type of the average cost to perform 

an organ transplant, to include pre- and post-operative care, 

for the Department versus the Centers for Medicare & Medicaid Services. 

The Committee directs the Secretary of the VA to provide this information from the previous fiscal year to the House and Senate 

Appropriations Committees and Veterans Affairs Committees, on 

an annual basis, no later than 60 days after the end of the fiscal 

year. 

Pilot Program for Agritherapy.—An increasing number of States 

now have programs that assist veterans in starting farms, and 

many veterans turning to farming also 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. Therefore, 

the Department is urged to consider agritherapy for inclusion 

among VA’s Complementary and Alternative Medicine therapies. 

Additionally, the Committee directs no less than $4,000,000, made 

available through the Office of Rural Health, toward a pilot program to train veterans in agricultural vocations while also tending 

to behavioral and mental health needs with behavioral healthcare 

services and treatments from licensed providers at no fewer than 

three locations. The pilot locations may be sites that currently have 

an operational construct to train veterans for agricultural vocations 

and have the potential to expand operations that tend to veterans 

medical needs while creating a pathway to employment in agriculture related fields. 

Hepatitis C.—The Department is directed to continue its quarterly updates to the Committees on Appropriations of both Houses 

of Congress detailing the expenditures and obligations of funding 

hepatitis C treatment, the number of veterans treated, the number 

of veterans deemed cured, the projection of spending, the number 

of new starts for drug treatment, and number of veterans who have 

been cured. 

Colorectal Cancer Screening.—In the explanatory statement accompanying Public Law 115–141, the Department was directed to 

offer all 7 colorectal cancer screening strategies recommended by 

the United States Preventive Services Task Force and adopted by 

the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measures, which are used by 

more than 90 percent of U.S. health plans to measure performance. 

The Committee reminds the Department that it is to report to the 

Committees on Appropriations no later than June 23, 2018 if it determines that it is unable to comply with this directive. 

Lovell FHCC.—The Committee recognizes the innovative collaboration between VA and DOD at the Captain James A. Lovell Federal Health Care Center Demonstration Project, established in 

2010 under Public Law 111–84. Given the unique nature of this 

joint facility, the Committee notes that the Lovell Federal Health 

Care Center has significant potential to improve access, quality, 

and cost-effectiveness of healthcare delivery to veterans, service 

members, and their families. The Committee also recognizes that 
62 

the important work of this integration effort must go on even as 

the two Departments continue to roll out their respective EHR programs. Therefore, the Committee directs the Department to provide, within 90 days of enactment, a comprehensive assessment of 

the status of integration efforts at Lovell FHCC, including an update on how to address ongoing challenges related to workforce 

planning and electronic health record and information technology 

systems integration, as well as an assessment of whether the model 

of a joint facility can be replicated in other parts of the country. 

MEDICAL COMMUNITY CARE

Appropriations, 2018 ............................................................................. $9,828,294,000 

Advance appropriations, 2019 .............................................................. 8,384,704,000 

Budget estimate, 2019 ........................................................................... 500,000,000 

Committee recommendation, 2019 ....................................................... 1,000,000,000 

Budget estimate, advance appropriations, 2020 ................................. 14,419,786,000 

Committee recommendation, advance appropriations, 2020 .............. 10,758,399,000 

PROGRAM DESCRIPTION

The Medical Community Care account provides for medical services for eligible enrolled veterans and other beneficiaries that is 

purchased from and provided by non-Department of Veterans Affairs facilities and providers, including contract hospitals, State 

homes, and outpatient services. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $8,384,704,000 for fiscal year 2019 for the Medical Community Care account. The recommendation for fiscal year 2019 includes an additional $1,000,000,000. The additional appropriation 

coupled with the advance appropriation provided for fiscal year 

2019 provides the Department with total budget authority of 

$9,384,704,000. 

The Committee recommendation also includes an advance appropriation of $10,758,399,000 for Medical community care for fiscal 

year 2020. 

VETERANS CHOICE FUND

Appropriations, 2018 ............................................................................. ........................... 

Budget estimate, 2019 ........................................................................... $1,900,000,000 

Committee recommendation, 2019 ....................................................... ........................... 

PROGRAM DESCRIPTION

The Choice Fund was created in Public Law 113–146, the legislation establishing the Choice program and providing mandatory 

funding for it. 

COMMITTEE RECOMMENDATION

The Committee recommendation does not provide any funding for 

the Veterans Choice Fund. Since its inception, the authorizers have 

provided nearly $20,000,000,000 in mandatory funding, a significant portion of which was designated as an emergency requirement, to support the Choice program. The account has never received discretionary funding. The Committee also notes the House 
63 

of Representatives and the United States Senate recently passed 

the VA MISSION Act of 2018, which provided an additional mandatory appropriation of $5,200,000,000. 

MEDICAL SUPPORT AND COMPLIANCE

Appropriations, 2018 1 ........................................................................... $6,754,480,000 

Advance appropriations, 2019 .............................................................. 7,239,156,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation, 2019 ....................................................... ........................... 

Budget estimate, advance appropriation, 2020 ................................... 7,106,150,000 

Committee recommendation, advance appropriation, 2020 ............... 7,239,156,000 

1Total excludes $3,209,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 

PROGRAM DESCRIPTION

The Medical Support and Compliance account provides funds for 

management, security, and administrative expenses within the VA 

healthcare system, in addition to providing costs associated with 

the operation of VA medical centers and clinics, VISN offices, and 

the VHA Central Office in Washington, DC. This appropriation also 

covers Chief of Staff and Facility Director operations, quality of 

care oversight, legal services, billing and coding activities, procurement, financial management, security, and human resource management. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $7,239,156,000 for fiscal year 2019 for the Medical Support and Compliance account. 

The Committee recommendation also includes an advance appropriation of $7,239,156,000 for Medical support and compliance for 

fiscal year 2020. 

MEDICAL FACILITIES

Appropriations, 2018 1 ........................................................................... $6,141,880,000 

Advance appropriations, 2019 .............................................................. 5,914,288,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation, 2019 ....................................................... 211,000,000 

Budget estimate, advance appropriation, 2020 ................................... 5,276,676,000 

Committee recommendation, advance appropriation, 2020 ............... 6,141,880,000 

1Total excludes $3,209,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 

PROGRAM DESCRIPTION

The Medical Facilities account provides funds for the operation 

and maintenance of the VA healthcare system’s vast capital infrastructure. This appropriation provides for costs associated with 

utilities, engineering, capital planning, leases, laundry, 

groundskeeping, housekeeping, facility repair, and property disposition and acquisition. 

COMMITTEE RECOMMENDATION

In fiscal year 2018, the Committee provided an advance appropriation of $5,914,288,000 for fiscal year 2019 for the Medical Facilities account. The recommendation for fiscal year 2019 includes 
64 

an additional $211,000,000 which is $211,000,000 above the budget 

request. The additional appropriation coupled with the advance appropriation provided for fiscal year 2019 provides the Department 

with total budget authority of $6,125,288,000 which is $16,592,000 

below the fiscal year 2018 enacted amount. 

For any VA renovation project for which energy systems are involved, the committee encourages the VA to use energy related Energy Savings Performance Contracting and Utility Energy Service 

Contracting in concert with appropriated funds to leverage more investment from the private sector. 

VA Chapels.—The Committee has provided significant investment for the upkeep and maintenance of Department infrastructure. The Department owns and is responsible for maintaining a 

variety of structures to include chapels and other facilities to tend 

to the spiritual needs of veterans. The Committee encourages the 

Secretary to prioritize funding for maintenance and renovation of 

such sites owned by the Department. 

Facility Assessments.—The Committee supports VA’s efforts to 

obtain analysis that provides a more holistic view of VA facilities 

and thereby allows the Department to make more informed, data 

driven decisions about its facilities and buildings. The Committee 

recognizes that annual analysis and benchmarking across the Department’s facilities will provide an invaluable tool for long-term 

system-wide planning, needs identification, and cost management 

for the Department. Therefore, the Committee encourages the Department to utilize an independent, third-party to provide facilities 

analysis, benchmarking and recommendations for all VHA hospitals, nursing homes, domiciliary facilities, and other necessary facilities. 

MEDICAL AND PROSTHETIC RESEARCH

Appropriations, 2018 ............................................................................. $722,262,000 

Budget estimate, 2019 ........................................................................... 727,369,000 

Committee recommendation ................................................................. 779,000,000 

PROGRAM DESCRIPTION

The Medical and Prosthetic Research account provides funds for 

medical, rehabilitative, and health services research. Medical research supports basic and clinical studies that advance knowledge 

leading to improvements in the prevention, diagnosis, and treatment of diseases and disabilities. Rehabilitation research focuses 

on rehabilitation engineering problems in the fields of prosthetics, 

orthotics, adaptive equipment for vehicles, sensory aids and related 

areas. Health services research focuses on improving the effectiveness and economy of the delivery of health services. 

COMMITTEE RECOMMENDATION

The Committee recommends $779,000,000 for the Medical and 

Prosthetic Research account. This is $56,738,000 above the fiscal 

year 2018 enacted level and $51,631,000 above the budget request. 

The Committee remains highly supportive of this program, and 

recognizes its importance both in improving healthcare services to 

veterans and recruiting and retaining high quality medical professionals in the Veterans Health Administration. 
65 

Through the Department’s research and development program, 

VA has implemented a comprehensive research agenda to develop 

new treatments and tools for clinicians to ease the physical and 

psychological pain of men and women returning from war zones, to 

improve access to VA healthcare services, and to accelerate discoveries and applications, especially for neurotrauma, sensory loss, 

amputation, polytrauma, and related prosthetic needs. The Committee encourages VA to continue its research into developing novel 

approaches to restoring veterans with amputation, central nervous 

system injuries, loss of sight or hearing, or other physical and cognitive impairments to full and productive lives. 

VA 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 service members, the Committee directs that skin cancer be included 

as well. 

Enewetak Atoll Registry Research.—The Committee is aware that 

thousands of veterans served on the Enewetak Atoll to clean up the 

island following its use for nuclear weapons testing. The Committee is also aware of many instances of veterans who conducted 

the cleanup suffering serious health problems, such as brittle 

bones, cancers, and birth defects in their children. The Committee 

urges the Department to study whether there is a connection between certain illnesses and the potential exposure of individuals to 

radiation related to service at Enewetak Atoll between January 1, 

1977, and December 31, 1980. 

Veterans Exposed to Open Burn Pits and Airborne Hazards.—The 

Committee directs the Secretary to provide an assessment of the 

process by which veterans are informed by both VA and community 

care providers about the Airborne Hazards and Open Burn Pit Registry and their eligibility for registering. The assessment should include an analysis of the process by which VA or community care 

providers for veterans who may be suffering the effects of exposure 

to airborne hazards are connected to the VA experts at the Airborne Hazards Center of Excellence for additional resources and 

assistance. 

The Committee is also concerned about the need for a better understanding of and treatment options for rare cancers disproportionately impacting those who have served in the military. The 

Committee encourages the Department to support research to 

evaluate the health status of service members from their time of 

deployment to Iraq and Afghanistan over many years to determine 

their incidence of chronic diseases including cancers that tend not 

to show up for decades. The Committee further encourages the Department to establish a collaboration with the Department of Defense to examine the impact of rare cancers on those who serve and 

fund research in delivering treatments for rare cancers that take 

a platform-agnostic approach to developing new therapeutics. 

Development of Veteran-Specific Therapies.—The Committee recognizes that commercial firms have expressed challenges with researching and developing veteran-specific therapies in light of the 
66 

nature of service-connected diseases and the relatively small population served. However, the Committee believes it is increasingly 

important for VA to better understand and develop treatment options for veteran-specific afflictions in order to fulfill its promise to 

provide timely access to care. The Committee directs VA, where 

practicable, to leverage appropriate research toward development 

of veteran-specific therapies and to use existing contracting authorities to work with commercial firms to deliver treatments that 

provide relief for veterans with service-connected diseases. 

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 

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 

as recognized by the Institute of Medicine [IOM]—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 Multi-symptom Illness [CMI] 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. 

VA/Department of Energy Computing Collaboration.—As requested, the Committee includes $27,000,000 for VA to collaborate 

with the Department of Energy through the Advanced Computational and Translational Initiatives for Veterans and the Million 

Veterans Program Cohort—Computational Health Analytics for 

Medical Precision to Improve Outcomes Now [MVP–CHAMPION] 

programs. The Committee encourages VA to take advantage of the 

unique high-performance resources offered by the Department of 

Energy Laboratories to address their most pressing issues in veteran health data. Important research collaborations, such as the 

MVP–CHAMPION project, have already collected protected 

healthcare data for 23 million veterans and is helping researchers 

better understand the role genes play in our health. The Committee encourages VA to continue leveraging the high performance 

computer facilities available through its partnership with the Department of Energy. 
67 

MEDICAL CARE COST RECOVERY COLLECTIONS

MEDICAL CARE COLLECTION FUND

Appropriations, 2018 ............................................................................. $2,507,000,000 

Budget estimate, 2019 ........................................................................... 3,590,000,000 

Committee recommendation ................................................................. 3,590,000,000 

MEDICAL CARE COLLECTION FUND—REVENUES APPLIED

Appropriations, 2018 .............................................................................¥$2,507,000,000 

Budget estimate, 2019 ........................................................................... ¥3,590,000,000 

Committee recommendation ................................................................. ¥3,590,000,000 

PROGRAM DESCRIPTION

The Medical Care Collection Fund [MCCF] was established by 

the Balanced Budget Act of 1997 (Public Law 105–33). In fiscal 

year 2004, Public Law 108–199 allowed the Department of Veterans Affairs to deposit first-party and pharmacy co-payments; 

third-party insurance payments and enhanced-use collections; longterm care co-payments; Compensated Work Therapy Program collections; and Parking Program fees into the MCCF. The Secretary 

of Veterans Affairs has the authority to transfer funds from the 

MCCF to the Medical Services account. 

COMMITTEE RECOMMENDATION

The Committee recommendation includes the authority to retain 

co-payments and third-party collections, estimated to total 

$3,590,000,000 in fiscal year 2019. 

NATIONAL CEMETERY ADMINISTRATION

Appropriations, 2018 ............................................................................. $306,193,000 

Budget estimate, 2019 ........................................................................... 315,836,000 

Committee recommendation ................................................................. 315,836,000 

ADMINISTRATION OVERVIEW

The National Cemetery Administration was established in accordance with Public Law 93–94, the National Cemeteries Act of 

1973. It has a four-fold mission: to provide for the interment in any 

national cemetery of the remains of eligible deceased 

servicemembers and discharged veterans, together with their 

spouses and certain dependents, and permanently maintain their 

graves; to provide headstones for, and to mark graves of, eligible 

persons in national, State, and private cemeteries; to administer 

the grant program for aid to States in establishing, expanding, or 

improving State veterans cemeteries; and to administer the Presidential Memorial Certificate Program. 

COMMITTEE RECOMMENDATION

The Committee recommends $315,836,000 for the National Cemetery Administration. This is an increase of $9,643,000 above the 

fiscal year 2018 enacted level and equal to the budget request. 

The Committee has included bill language to make available 

through September 30, 2020, up to 10 percent of the National Cemetery Administration appropriation. 
68 

DEPARTMENTAL ADMINISTRATION

Appropriations, 2018 1 ........................................................................... $6,508,439,000 

Budget estimate, 2019 ........................................................................... 8,135,377,000 

Committee recommendation ................................................................. 7,746,670,000 

1Total excludes $4,088,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 

ADMINISTRATION OVERVIEW

Departmental Administration provides for the administration of 

veterans benefits through the Veterans Benefits Administration, 

the executive direction of the Department, several top level supporting offices, the Board of Contract Appeals, and the Board of 

Veterans Appeals. 

COMMITTEE RECOMMENDATION

The Committee recommends $7,746,670,000 for Departmental 

Administration. The amount is composed of $365,976,000 for General administration; $174,748,000 for the Board of Veterans Appeals; $4,184,571,000 for Information technology systems; 

$800,000,000 for the Electronic Health Record; $192,000,000 for the 

Office of the Inspector General; $1,127,486,000 for Construction, 

major projects; $706,889,000 for Construction, minor projects; 

$150,000,000 for Grants for construction of State extended care facilities; and $45,000,000 for Grants for the construction of State 

veterans cemeteries. 

GENERAL ADMINISTRATION

(INCLUDING TRANSFER OF FUNDS)

Appropriations, 2018 ............................................................................. $335,891,000 

Budget estimate, 2019 ........................................................................... 367,629,000 

Committee recommendation ................................................................. 365,976,000 

PROGRAM DESCRIPTION

The General Administration account provides funding for the Office of the Secretary, six assistant secretaries, and three independent staff offices. 

COMMITTEE RECOMMENDATION

The Committee recommends $365,976,000 for General Administration. This amount is $30,085,000 above the fiscal year 2018 enacted level and $1,653,000 below the budget request. The Committee has included bill language to make available through September 30, 2020, up to 10 percent of the General Administration 

appropriation. 

BOARD OF VETERANS APPEALS

Appropriations, 2018 ............................................................................. $161,048,000 

Budget estimate, 2019 ........................................................................... 174,748,000 

Committee recommendation ................................................................. 174,748,000 
69 

PROGRAM DESCRIPTION

As set forth in section 7101(a) of title 38 United States Code, the 

Board of Veterans Appeals is responsible for making final decisions 

on claims for veterans benefits presented to the Board for appellate 

review. The vast majority of the Board’s workload derives from 

benefit claims initiated by the Veterans Benefits Administration’s 

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 the Regional Office determination, he or she may appeal to the Board for a final agency decision. The Board adjudicates 

appeals covering all areas of veterans benefits, including: service 

connection, increased disability ratings, total disability ratings, 

pensions, insurance benefits, educational benefits, home loan guaranties, vocational rehabilitation, waivers of indebtedness, fee basis 

medical care, and dependency and indemnity compensation. 

COMMITTEE RECOMMENDATION

The Committee recommends $174,748,000 for the Board of Veterans Appeals, which is $13,700,000 above fiscal year 2018 enacted 

level and equal to the budget request. The Committee has included 

bill language to make available through September 30, 2020, up to 

10 percent of the Board of Veterans Appeals appropriation. 

INFORMATION TECHNOLOGY SYSTEMS

Appropriations, 2018 ............................................................................. $4,055,500,000 

Budget estimate, 2019 ........................................................................... 4,184,571,000 

Committee recommendation ................................................................. 4,184,571,000 

PROGRAM DESCRIPTION

The Information Technology [IT] Systems appropriation, along 

with reimbursements, funds the costs of all IT staff salaries and 

expenses, the operations and maintenance of all existing information technology systems, and the development of new projects and 

programs designed to improve the delivery of service to veterans. 

This appropriation also funds the costs associated with the Office 

of Information and Technology which oversees the functions highlighted above. 

COMMITTEE RECOMMENDATION

The Committee recommends $4,184,571,000 for the Information 

Technology Systems account. This amount is $129,071,000 above 

the fiscal year 2018 enacted level and equal to the budget request. 

The Committee recommendation includes $1,243,220,000 for staff 

salaries and expenses, $2,560,780,000 for operation and maintenance of existing programs, and $380,571,000 for program development. 

The Committee has appropriated the Information Technology 

Systems account as three subaccounts. This funding structure enhances the Committee’s ability to ensure funds are executed in a 

manner consistent with the Department’s budget submission. The 

Committee has provided sufficient flexibility within the subaccounts by way of authorized carryover amounts and reprogramming authority to give the Office of Information Technology as 
70 

much flexibility as possible to accomplish its mission and goals, 

while ensuring proper accountability and oversight. The Committee 

will continue to work with the Department to ensure the IT 

projects currently underway, as well as the projects planned for the 

future, have the resources needed for success. 

INFORMATION TECHNOLOGY DEVELOPMENT PROJECTS 

[In thousands of dollars] 

Project Fiscal year 2019 

budget request 

Committee 

recommendation 

Clinical Applications 

Access and Billing ................................................................................................. 5,891 5,891 

My HealtheVet ........................................................................................................ 10,300 10,300 

Health Data Interoperability .................................................................................. 13,000 13,000 

Registries ............................................................................................................... 3,228 3,228 

Subtotal Clinical Applications ........................................................................... 32,419 32,419 

Health Management Platform 

Digital Health Platform .......................................................................................... 15,682 15,682 

Community Care ..................................................................................................... 25,303 25,303 

Patient Record System ........................................................................................... 14,300 14,300 

Purchased Care ...................................................................................................... 9,076 9,076

Telehealth ............................................................................................................... 6,030 6,030 

Subtotal Health Management Platform ............................................................ 70,391 70,391 

Benefits Systems 

Benefits Appeals .................................................................................................... 2,500 2,500

Education Benefits ................................................................................................. 37,830 37,830 

Veterans Customer Experience .............................................................................. 47,564 47,564 

Veterans Benefits Management ............................................................................. 10,000 10,000 

Benefits Systems ................................................................................................... 31,721 31,721 

Subtotal Benefits Systems ................................................................................ 129,615 129,615 

Memorial Affairs 

Memorials Automation ........................................................................................... 18,800 18,800 

Subtotal Memorial Affairs ................................................................................. 18,800 18,800 

Other IT Systems 

Human Resources .................................................................................................. 12,600 12,600 

Financial and Acquisition Management Modernization ........................................ 65,971 65,971 

Subtotal Other IT Systems ................................................................................ 78,571 78,571 

Cyber Security ................................................................................................................. 17,000 17,000 

Information/Infrastructure Management 

Data Integration and Management ....................................................................... 33,715 33,715 

Subtotal Information/Infrastructure Management ............................................ 33,715 33,715 

Total IT Development ......................................................................................... 380,511 380,511 

Scheduling System.—For more than 15 years, the Department 

has struggled to modernize the current patient scheduling system 

and the Committee remains concerned about the lack of progress. 

While the Department has made upgrades to the VistA scheduling 

system, these modifications only provide a more user friendly viewing environment and do not address more functional problems with 

the current system. The Committee understands that a scheduling 

system solution will be a component of the new Electronic Health 
71 

Record [EHR] program and that VA plans to deploy this new system over a 10 year period, with the first deployment to begin within the next 18 months. While the Committee supports VA’s efforts 

to replace the antiquated EHR system currently in place and upgrade the deficient infrastructure in the field to handle the new 

functionality, it is concerning that many hospitals will not see functional modernization of the current scheduling system for another 

10 years. The Committee understands that VA is conducting pilot 

programs involving commercial off-the-shelf solutions scheduling 

systems to assess if they provide substantial value over its current 

interim systems and whether the benefits of deploying off-the-shelf 

technology outweighs costs during the decade-long deployment plan 

to modernize the entire EHR is implemented. The Committee believes that the Department must provide an interim solution for 

those hospitals and clinics that fall toward the end of the deployment schedule to improve veteran access to care, shorten veteran 

wait times, allow the VA to track and manage patient progress 

throughout the care continuum, and improve resource utilization 

across the VA healthcare system. Therefore the Committee directs 

the Department to submit a scheduling modernization plan no later 

than 60 days after enactment of this act, describing plans and costs 

of utilizing off-the-shelf technology as an interim solution during 

EHR modernization. 

Enhancing Local Control of Information Technology Needs.—The 

Committee is concerned that local facilities and VISN leadership do 

not have the ability to quickly address IT issues causing the disruption of patient care. Further, that they do not have the ability 

to utilize the technologies they have identified as enhancing patient 

experience, due to centralization of IT resources. VA is therefore directed to produce a report on the methods by which information 

technology funds are allocated to the VISNs and to facilities, and 

any plans to increase local control. 

VETERANS ELECTRONIC HEALTH RECORD

Appropriations, 2018 ............................................................................. $782,000,000 

Budget estimate, 2019 ........................................................................... 1,207,000,000 

Committee recommendation, 2019 ....................................................... 800,000,000 

PROGRAM DESCRIPTION

The Veterans Electronic Health Record account funds all activities related to the acquisition, implementation, preparation, development, interface, management, rollout, and maintenance of a new 

electronic health record. The EHR solution and implementation 

will include program management; an enterprise-wide EHR system; change management; training; testing; deployment services; 

sustainment and other solutions encompassing the entire range of 

EHR requirements. 

COMMITTEE RECOMMENDATION

The Committee recommends $800,000,000 for the Veterans Electronic Health Record. This is $18,000,000 above the fiscal year 

2018 enacted level and $407,000,000 below the budget request. In 

July 2017, the Secretary announced that Cerner Corporation, 

which had participated in the DOD EHR acquisition, had received 
72 

the sole source contract to develop the VA EHR. In support of this 

effort, the Committee appropriated $782,000,000 in fiscal year 

2018, with the expectation that award of a contract was imminent, 

however, execution of a contract became delayed, with the contract 

not being awarded until May 2018. 

It is incumbent on the Department to present detailed justifications, including schedules and costs with any acquisition of this 

size and magnitude. Yet, the Department’s justifications accompanying the budget submission lacked even the most basic of detail. While the Committee remains supportive of replacing the VA’s 

current EHR with the same being acquired by DOD, the Department must address how delays in contracting, as well as slippage 

in timelines, including DOD’s deployment schedule of MHS Genesis, will impact budgetary needs for fiscal year 2019 and beyond. 

VA/DOD Interoperability.—As VA and DOD plan to deploy the 

same EHR, VA must remain committed to working towards assuring continued VA/DOD interoperability. The Committee directs VA 

and DOD to maintain clear and agreed-upon metrics and goals for 

interoperability, to establish clear timeframes for meeting those 

goals, to ensure clinician feedback is sought and considered as the 

respective electronic medical record systems are modernized, and to 

update the VA/DOD Interagency Program Office guidance to reflect 

agreed-upon metrics and goals. The need for well-functioning, upto-date electronic health record technology is absolutely critical. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $164,000,000 

Budget estimate, 2019 ........................................................................... 172,054,000 

Committee recommendation ................................................................. 192,000,000 

PROGRAM DESCRIPTION

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 Department of Veterans Affairs programs and operations. 

COMMITTEE RECOMMENDATION

The Committee recommends $192,000,000 for the Office of Inspector General. This is $28,000,000 above the fiscal year 2018 enacted level and $19,946,000 above the budget request. The Committee has included bill language to make available through September 30, 2020, up to 10 percent of the Office of the Inspector 

General appropriation. 

CONSTRUCTION, MAJOR PROJECTS

Appropriations, 2018 ............................................................................. $512,430,000 

Budget estimate, 2019 ........................................................................... 1,127,486,000 

Committee recommendation ................................................................. 1,127,486,000 

PROGRAM DESCRIPTION

The Construction, Major Projects account provides for constructing, altering, extending, and improving any of the facilities 

(including parking projects) under the jurisdiction or for the use of 

VA, including planning, architectural and engineering services, 
73 

needs assessment, and site acquisition where the estimated cost of 

a project is more than the amount set forth in 38 U.S.C. 

8104(a)(3)(A). Proceeds realized from Enhanced Use Lease activities may be deposited into the Construction, Major Projects and 

Construction, Minor Projects accounts. 

COMMITTEE RECOMMENDATION

The Committee recommends an appropriation of $1,127,486,000 for the construction of major projects. This is $615,056,000 above 

the fiscal year 2018 enacted level and equal the budget request. 

The following table reflects the President’s budget request for 

major construction projects and the corresponding Committee recommendations. 

MAJOR CONSTRUCTION PROJECTS 

[In thousands of dollars] 

Location and description Fiscal year 2019 

budget request 

Committee 

recommendation 

Veterans Health Administration [VHA]: 

St. Louis (JB), MO: Medical Facility Improvements and Cemetery Expansion ...... 34,400 34,400 

Canandaigua, NY: Construction and Renovation .................................................. 190,000 190,000 

Dallas, TX: Spinal Cord Injury ............................................................................... 135,686 135,686 

North Chicago, IL: Renovate Building 4 ................................................................ 6,000 6,000 

Oklahoma City, OK: New Surgical Intensive Care Unit ......................................... 10,800 10,800 

Advance Planning Fund ......................................................................................... 95,000 95,000 

Asbestos ................................................................................................................. 15,000 15,000 

Major Construction Staff ....................................................................................... 27,500 27,500 

Hazardous Waste ................................................................................................... 26,200 26,200

Judgment Fund ....................................................................................................... 25,000 25,000 

Non–Departmental Federal Entity Project Management Support .......................... 38,700 38,700 

Seismic Corrections Initiative ................................................................................ 400,000 400,000 

Total VHA ........................................................................................................... 1,004,286 1,004,286 

National Cemetery Administration [NCA]: 

Ohio Western Reserve, OH: Gravesite Expansion, Phase 3 ................................... 29,000 29,000 

Great Lakes, MI: Gravesite Expansion, Phase 2 ................................................... 35,200 35,200 

Cape Canaveral, FL: Gravesite Expansion Phase 2 .............................................. 38,000 38,000 

Advance Planning Fund ......................................................................................... 10,000 10,000 

NCA Land Acquisition Fund ................................................................................... 5,000 5,000 

Total NCA ........................................................................................................... 117,200 117,200 

General Administration—Staff Offices, Advance Planning Fund .................................. 6,000 6,000 

Total Construction, Major Projects .................................................................... 1,127,486 1,127,486 

CONSTRUCTION, MINOR PROJECTS

Appropriations, 2018 1 ........................................................................... $342,570,000 

Budget estimate, 2019 ........................................................................... 706,889,000 

Committee recommendation ................................................................. 706,889,000 

1Total excludes $4,088,000 in emergency funding provided in Public Law 115–123, the Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018. 

PROGRAM DESCRIPTION

The Construction, Minor Projects account provides for constructing, altering, extending, and improving any of the facilities 

(including parking) under the jurisdiction or for the use of VA, including planning, assessment of needs, architectural and engineer-
74 

ing services, and site acquisition, where the estimated cost of a 

project is equal to or less than $20,000,000. Public Law 106–117, 

the Veterans Millennium Health Care and Benefits Act of 1999, 

gave VA authority to make capital contributions from minor construction in enhanced-use leases. Proceeds realized from enhanceduse lease activities may be deposited into the Construction, Major 

Projects and Construction, Minor Projects accounts. 

COMMITTEE RECOMMENDATION

The Committee recommends $706,889,000 for minor construction. This is $364,319,000 above the fiscal year 2018 enacted level 

and equal to the budget request. The recommendation includes $449,149,000 for the Veterans 

Health Administration, $171,820,000 for the National Cemetery 

Administration, $46,820,000 for the Veterans Benefits Administration, and $39,100,000 for staff offices and the Office of Information 

Technology. The Department is directed to provide an expenditure 

plan to the Committees on Appropriations of both Houses of Congress no later than 30 days after enactment of this act for the 

amount appropriated for minor construction. 

GRANTS FOR CONSTRUCTION OF STATE EXTENDED CARE FACILITIES

Appropriations, 2018 ............................................................................. $110,000,000 

Budget estimate, 2019 ........................................................................... 150,000,000 

Committee recommendation ................................................................. 150,000,000 

PROGRAM DESCRIPTION

This account is used to provide grants to assist States in acquiring or constructing 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. The grant may not exceed 

65 percent of the total cost of the project. Public Law 102–585 

granted permanent authority for this program, and Public Law 

106–117 provided greater specificity in directing VA to prescribe 

regulations for the number of beds for which grant assistance may 

be furnished. This program has been a successful partnership between States and VA in meeting the long-term care needs of elderly veterans for decades. 

COMMITTEE RECOMMENDATION

The Committee recommends $150,000,000 for Grants for construction of State extended care facilities. This is equal to the 

budget request. 

State Extended Care Facility Construction.—The Committee is 

concerned that VA continues to approve new grants for State home 

construction projects without adequate resources to fulfill the Federal cost share. In fiscal year 2018, VA budgeted only $90,000,000 

towards an outstanding list of 57 approved projects in 25 States 

valued at $639,000,000. Recognizing this disparity, the Congress 

provided a one-time appropriation of $575,000,000 in fiscal year 

2018 to assist VA in resolving its backlog. The Committee directs 

VA to provide an update within 180 days of enactment of this act 

on the execution of those funds, that specifically addresses the pro-
75 

jected schedule of execution by priority group, including estimated 

completion dates for each project, as well as actions the Department will take to prevent future backlogs. 

GRANTS FOR CONSTRUCTION OF VETERANS CEMETERIES

Appropriations, 2018 ............................................................................. $45,000,000 

Budget estimate, 2019 ........................................................................... 45,000,000 

Committee recommendation ................................................................. 45,000,000 

PROGRAM DESCRIPTION

Public Law 105–368 amended title 38 U.S.C. 2408 and established authority to provide aid to States for establishment, expansion, and improvement of State veterans cemeteries, which are operated and permanently maintained by the States. This statutory 

change increased the maximum Federal share from 50 percent to 

100 percent in order to fund construction costs and initial equipment expenses when the cemetery is established. States remain responsible for providing the land and for paying all costs related to 

operation and maintenance of the cemeteries, including the costs 

for subsequent equipment purchases. 

COMMITTEE RECOMMENDATION

The Committee recommends $45,000,000 for Grants for construction of State veterans cemeteries. This is equal to the budget request. 

ADMINISTRATIVE PROVISIONS

(INCLUDING TRANSFERS AND RESCISSIONS OF FUNDS)

Sec. 201. The Committee includes a provision which outlines 

transfer authority and responsibilities for the Veterans Benefits 

Administration. 

Sec. 202. The Committee includes a provision which outlines 

transfer authority and responsibilities for the Veterans Health Administration. 

Sec. 203. The Committee includes a provision which outlines the 

use of funds appropriated for salaries and expenses. 

Sec. 204. The Committee includes a provision mandating that 

only construction funds may be used for land procurement or the 

construction of any new hospital or home. 

Sec. 205. The Committee includes a provision allowing for reimbursements to the Medical Services account. 

Sec. 206. The Committee includes a provision allowing for payments of prior year obligations. 

Sec. 207. The Committee includes a provision which allows for 

the use of funds for prior year obligations. 

Sec. 208. The Committee includes a provision which allows for 

payments from the National Service Life Insurance Fund. 

Sec. 209. The Committee includes a provision which outlines the 

use of funds from enhanced-use lease proceeds. 

Sec. 210. The Committee includes a provision which provides for 

funds for the Office of Resolution Management, the Office of Employment Discrimination Complaint Adjudication, the Office of Ac-
76 

countability and Whistleblower Protection, and the Office of Diversity and Inclusion. 

Sec. 211. The Committee includes a provision which requires disclosure of third-party reimbursement information. 

Sec. 212. The Committee includes a provision which allows for 

the transfer of revenue derived from enhanced-use leases into the 

construction accounts. 

Sec. 213. The Committee includes a provision which outlines authorized uses for Medical Services account funds. 

Sec. 214. The Committee includes a provision which allows funds 

in the Medical Care Collection Fund to be transferred into the 

Medical Services and Medical Community Care accounts. 

Sec. 215. The Committee includes a provision which allows eligible veterans in the State of Alaska to obtain medical care services. 

Sec. 216. The Committee includes a provision which allows for 

the transfer of funds into the construction accounts. 

Sec. 217. The Committee includes a provision requiring the Secretary of Veterans Affairs to submit quarterly financial reports. 

Sec. 218. The Committee includes a provision outlining transfer 

authority for the Information Technology Systems account. 

Sec. 219. The Committee includes a provision allowing for the 

transfer of funds from certain accounts to the Joint Department of 

Defense/Department of Veterans Affairs Medical Facility Demonstration Fund, as authorized by Public Law 111–84. 

Sec. 220. The Committee includes a provision allowing for the 

transfer of funds from certain advance appropriation accounts to 

the Joint Department of Defense/Department of Veterans Affairs 

Medical Facility Demonstration Fund, as authorized by Public Law 

111–84. 

Sec. 221. The Committee includes a provision allowing for the 

transfer of certain funds deposited in the Medical Care Collections 

Fund to the Joint Department of Defense/Department of Veterans 

Affairs Medical Facility Demonstration Fund, as authorized by 

Public Law 111–84. 

Sec. 222. The Committee includes a provision directing a minimum of $15,000,000 be transferred from Medical Services, Medical 

Support and Compliance, and Medical Facilities to the Department 

of Defense/Department of Veterans Affairs Health Care Sharing Incentive Fund, as authorized by section 8111 of title 38, United 

States Code. 

Sec. 223. The Committee includes a provision prohibiting funds 

available to the Department in this or any other act from being 

used to replace the current system by which VISNs select and contract for diabetes monitoring supplies and equipment. 

Sec. 224. The Committee includes a provision requiring notification of all bid savings for major construction projects. 

Sec. 225. The Committee includes a provision restricting scope 

increases for major construction projects above that specified in the 

original project justification. 

Sec. 226. The Committee includes a provision requiring the Department to submit reports relating to the Veterans Benefits Administration on claims processing at Regional Offices. 
77 

Sec. 227. The Committee includes a provision requiring VA to notify the Committee 15 days prior to any organizational changes 

within VA of 25 or more FTE. 

Sec. 228. The Committee includes a provision requiring the Secretary to report to the Committees each quarter about any single 

national outreach and awareness marketing campaign exceeding 

$2,000,000. 

Sec. 229. The Committee includes a provision permitting the 

transfer to the Medical Services account of fiscal year discretionary 

2019 appropriated funds. 

Sec. 230. The Committee includes a provision permitting the 

transfer of funds between GOE, VBA and BVA. 

Sec. 231. The Committee includes a provision prohibiting the reprogramming of funds in excess of $7,000,000 among major construction projects or programs. 

Sec. 232. The Committee includes a provision mandating certain 

professional standards for the veterans crisis hotline. 

Sec. 233. The Committee includes a provision restricting funds 

from being used to close certain medical facilities in the absence of 

a national realignment strategy. 

Sec. 234. The Committee includes a provision requiring VA to 

use the mammography screening guidelines announced by the Secretary on May 10, 2017. 

Sec. 235. The Committee includes a provision 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. 

Sec. 236. The Committee includes a provision rescinding funds. 

Sec. 237. The Committee includes a provision prohibiting any 

funds to be used to contract out any functions performed by more 

than 10 employees without a fair competition process. 

Sec. 238. The Committee includes a provision pertaining to Native Hawaiian small businesses. 

Sec. 239. The Committee includes a provision directing the discontinuation of the usage of social security numbers with the Department of Veterans Affairs. 

Sec. 240. The Committee includes a provision pertaining to the 

certification of marriage and family therapists. 

Sec. 241. The Committee includes a provision prohibiting the 

transfer of funds from the Filipino Veterans Equity Compensation 

Fund to any other VA account. 

Sec. 242. The Committee includes a provision regarding a 

childcare program. 

Sec. 243. The Committee includes a reference to a provision in 

the 2017 appropriations act identifying information which may be 

used to verify the status of coastwise merchant seamen who served 

during World War II for the purposes of eligibility for medals, ribbons, or other military decorations. 

Sec. 244. The Committee includes a provision ensuring particular 

ratios of veterans to full-time employment equivalents within any 

VA program of rehabilitation. 
78 

Sec. 245. The Committee includes a provision prohibiting funds 

to be used to restrict an individual’s ability to speak with a Member of Congress or his or her staff. 

Sec. 246. The Committee includes a provision requiring certain 

data to be included in the budget justifications for the Construction, Major account. 

Sec. 247. The Committee includes a provision prohibiting the use 

of canines in VA research unless: the scientific objectives of the 

study can only be met by using canines; the study has been directly 

approved by the Secretary; and the study is consistent with the revised VA canine research policy document released in December, 

2017. 

Sec. 248. The Committee includes a provision providing $2,000,000,000 to be available until expended for VA infrastructure 

needs, of which $1,000,000,000 is for Medical Facilities for non-recurring maintenance; $500,000,000 is for Minor Construction; and 

$500,000,000 is for Major Construction. This funding is not made 

available until VA provides and the Committees approve a detailed 

expenditure plan. 

Sec. 249. The Committee includes a provision prohibiting the use 

of funds to interfere with the ability of veterans to participate in 

State-approved medicinal marijuana programs or deny service to 

such veterans. 
(79) 

TITLE III 

RELATED AGENCIES 

AMERICAN BATTLE MONUMENTS COMMISSION

OVERVIEW

The American Battle Monuments Commission [ABMC] was established by Congress in 1923 and is responsible for the following: 

designing, constructing, operating, and maintaining permanent 

American cemeteries in foreign countries; establishing and maintaining U.S. military memorials, monuments, and markers where 

American Armed Forces have served overseas since April 6, 1917, 

the date of the United States entry into World War I, and within 

the United States when directed by public law; and controlling the 

design and construction of permanent U.S. military monuments 

and markers by other U.S. citizens and organizations, both public 

and private, and encouraging their maintenance. ABMC administers, operates, and maintains 26 permanent American military 

cemeteries, 29 Federal memorial, monuments, and markers, and 8 

non-Federal memorials located in 15 foreign countries, the U.S. 

Commonwealth of the Northern Mariana Islands, the British Dependency of Gibraltar, and the United States of America. 

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $79,000,000 

Budget estimate, 2019 ........................................................................... 75,100,000 

Committee recommendation ................................................................. 81,000,000 

COMMITTEE RECOMMENDATION

The Committee recommends $81,000,000 for the Salaries and Expenses account. This amount is $2,000,000 above the fiscal year 

2018 enacted level and $5,900,000 above the budget request. The 

recommendation includes an additional $5,900,000 to bolster the 

Commission’s maintenance and infrastructure program, including 

the interpretive program. The additional funds will restore the reduction proposed in the budget request for this program and provide additional funds to accelerate the Commission’s 5-year plan, 

not only to maintain the cemeteries and monuments honoring 

America’s war dead, but also to preserve and communicate these 

veterans’ stories of courage and sacrifice. 

Nisei Veterans.—The Committee recognizes the legacy of the 

100th Infantry Battalion which, with the 442nd Regiment and Military Intelligence Service, became one the most decorated military 

units of the Second World War. The Committee is aware of the existence of exhibits and memorials dedicated to the 100th Infantry 

Battalion/442nd Regiment. However, the Committee believes it is 
80 

increasingly important to memorialize the important part they, and 

all Nisei veterans, have played in our country’s history. 

Not later than 90 days after enactment of this act, the American 

Battle Monuments Commission shall conduct a feasibility study to 

determine the viability of establishing a national memorial in recognition of the 100th Infantry Battalion/442nd Regiment. In conducting the feasibility study, ABMC shall consider the importance 

of telling the story of the 100th Infantry Battalion/442nd Regiment 

in the context of the contributions of all Nisei veterans and associated units during the Second World War, and the ability to adequately reach audiences, including Americans of Japanese ancestry, with the story of these Nisei veterans through existing exhibits 

and memorials. 

National Memorial Cemetery of the Pacific Visitor Center.—The 

Committee is aware that the American Battle Monuments Commission prepared preliminary designs for a new visitors center at the 

National Memorial Cemetery of the Pacific, also known as the 

‘‘Punchbowl.’’ The Committee understands that the Punchbowl is 

the resting place of more than 13,000 Soldiers and sailors who died 

during the Second World War and that a new visitor center would 

enhance the story of Pacific Theatre of the Second World War by 

giving context to the headstones and columbaria through interpretive exhibits and other displays. Not later than 90 days after enactment of this act, the Committee directs the American Battle Monuments Commission to report on the status of this project, including 

what, if any, funding has been programmed in its future years’ 

budgets. 

FOREIGN CURRENCY FLUCTUATIONS

The Committee includes in the accompanying act, as proposed by 

the administration, such sums as necessary for the Foreign Currency Fluctuations account. Funding the account in this manner allows the Commission to maintain cemeteries regardless of the volatility of foreign currency fluctuations. 

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

OVERVIEW

The United States Court of Appeals for Veterans Claims was established by the Veterans’ Judicial Review Act of 1988. The Court 

is an independent judicial tribunal with exclusive jurisdiction to review decisions of the Board of Veterans Appeals. It has the authority to decide all relevant questions of law; interpret constitutional, 

statutory, and regulatory provisions; and determine the meaning or 

applicability of the terms of an action by the Secretary of Veterans 

Affairs. It is authorized to compel action by the Secretary. It is authorized to hold unconstitutional or otherwise unlawful and set 

aside decisions, findings, conclusions, rules, and regulations issued 

or adopted by the Secretary of Veterans Affairs, the Board of Veterans Appeals, or the Chairman of the Board that are found to be 

arbitrary or capricious. The Court’s principal office location is 

Washington, DC; however, it is a national court, empowered to sit 

anywhere in the United States. 
81 

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $33,600,000 

Budget estimate, 2019 ........................................................................... 107,455,000 

Committee recommendation ................................................................. 34,955,000 

COMMITTEE RECOMMENDATION

The Committee recommends $34,955,000 for the U.S. Court of 

Appeals for Veterans Claims. This amount is $1,355,000 above the 

fiscal year 2018 enacted level and $72,500,000 below the budget request. Public Law 115–141 included funding for a feasibility study 

regarding a new courthouse. This study is not complete, therefore, 

the Committee does not include the funds requested for a new 

courthouse. 

DEPARTMENT OF DEFENSE—CIVIL

CEMETERIAL EXPENSES, ARMY

OVERVIEW

The Secretary of the Army is responsible for the administration, 

operation, and maintenance of Arlington National Cemetery [ANC] 

and the Soldiers’ and Airmen’s Home National Cemetery. In addition to its principal function as a national cemetery, Arlington 

hosts more than 3,000 public wreath laying ceremonies, approximately 100 distinguished visitor honors wreath laying ceremonies, 

and approximately 4,000,000 visitors annually. 

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $80,800,000 

Budget estimate, 2019 ........................................................................... 70,800,000 

Committee recommendation ................................................................. 80,800,000 

COMMITTEE RECOMMENDATION

The Committee recommends $80,800,000 for the Salaries and Expenses account. This amount is equal to the fiscal year 2018 enacted level and $10,000,000 above the budget request. 

The Committee remains concerned that ANC’s operating account 

has been held artificially flat for a number of years, and this action 

is beginning to have deleterious effects on the Cemetery’s performance and ability to meet its mission. 

Arlington performs over 7,000 burial services each year for veterans and family members and an average of 27–30 each weekday. 

With this heavy workload, ANC cannot be under-resourced, and accordingly, the Committee has provided an additional $10,000,000 to 

correct this problem. 

This Committee remains unwavering in its support for the Cemetery and the successful completion of the Cemetery’s truly unique 

and honored mission. Accordingly, the Secretary of the Army is 

again directed to include this increase in the Cemetery’s baseline 

budget and ensure future budget requests provide ample resources 

for Arlington National Cemetery. 
82 

CONSTRUCTION

Appropriations, 2018 ............................................................................. $167,000,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation, 2019 ....................................................... 56,600,000 

ARMED FORCES RETIREMENT HOME

TRUST FUND

OVERVIEW

Appropriations, 2018 ............................................................................. $64,300,000 

Budget estimate, 2019 ........................................................................... 64,300,000 

Committee recommendation ................................................................. 64,300,000 

COMMITTEE RECOMMENDATION

The Committee recommends authority to expend $64,300,000 

from the Armed Forces Retirement Home Trust Fund to operate 

and maintain the Armed Forces Retirement Home—Washington, 

DC, and the Armed Forces Retirement Home—Gulfport, Mississippi. 

ADMINISTRATIVE PROVISION

Sec. 301. The Committee includes a provision making available 

funds as authorized by 10 U.S.C. 4727. 
(83) 

TITLE IV 

OVERSEAS CONTINGENCY OPERATIONS 

DEPARTMENT OF DEFENSE 

The Committee recommends title IV, Overseas Contingency Operations, for military construction projects related to the Global 

War on Terrorism and the European Reassurance Initiative that 

were requested by the Administration in the Fiscal Year 2019 

Overseas Contingency Operations budget request. 

MILITARY CONSTRUCTION, ARMY

The Committee recommends $192,250,000 for ‘‘Military Construction, Army’’, as requested in the Fiscal Year 2019 Overseas Contingency Operations budget request, for military construction and 

planning and design in support of Overseas Contingency Operations and the European Reassurance Initiative. 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS

The Committee recommends $227,320,000 for ‘‘Military Construction, Navy and Marine Corps’’, as requested in the Fiscal Year 

2019 Overseas Contingency Operations budget request, for military 

construction and planning and design in support of the European 

Reassurance Initiative. 

MILITARY CONSTRUCTION, AIR FORCE

The Committee recommends $414,800,000 for ‘‘Military Construction, Air Force’’, as requested in the Fiscal Year 2019 Overseas 

Contingency Operations budget request, for military construction 

and planning and design in support of Overseas Contingency Operations and the European Reassurance Initiative. 

MILITARY CONSTRUCTION, DEFENSE-WIDE

The Committee recommends $87,050,000 for ‘‘Military Construction, Defense-Wide’’, as requested in the Fiscal Year 2019 Overseas 

Contingency Operations budget request, for planning and design in 

support of the European Reassurance Initiative. 

ADMINISTRATIVE PROVISIONS

SEC. 401. The Committee includes a provision which provides the 

contingent emergency designation for the Overseas Contingency 

Operations accounts. 

SEC. 402. The agreement includes section 402 which requires the 

Department of Defense to provide a future year defense program 
84 

for European Deterrence/Reassurance Initiative to the congressional defense committees. 
(85) 

TITLE V 

GENERAL PROVISIONS 

Sec. 501. The Committee includes a provision that prohibits the 

obligation of funds beyond the current fiscal year unless expressly 

so provided. 

Sec. 502. The Committee includes a provision that prohibits 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. 

Sec. 503. The Committee includes a provision that encourages 

the expansion of E-commerce technologies and procedures. 

Sec. 504. The Committee includes a provision that specifies the 

congressional committees that are to receive all reports and notifications. 

Sec. 505. The Committee includes a provision that limits funds 

from being transferred from this appropriations measure to any instrumentality of the United States Government without authority 

from an appropriations act. 

Sec. 506. The Committee includes a provision regarding the posting of congressional reports on agency Web sites. 

Sec. 507. The Committee includes a provision 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. 

Sec. 508. The Committee includes a provision prohibiting the use 

of funds for the payment of first-class travel by an employee of the 

executive branch. 

Sec. 509. The Committee includes a provision prohibiting the use 

of funds in this act for any contract where the contractor has not 

complied with E–Verify requirements. 

Sec. 510. The Committee includes a provision 511 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. 

Sec. 511. The Committee includes a provision limiting the construction of facilities in the United States, its territories, or possessions for the purposes of housing individuals detained at 

Guanta ́namo Bay, Cuba. 
(86) 

PROGRAM, PROJECT, AND ACTIVITY 

In fiscal year 2019, for purposes of the Balanced Budget and 

Emergency Deficit Control Act of 1985 (Public Law 99–177) or the 

Balanced Budget and Emergency Deficit Control Reaffirmation Act 

of 1987 (Public Law 100–119), the following information provides 

the definition of the term ‘‘program, project, and activity’’ for departments, agencies and programs under the jurisdiction of the 

Military Construction and Veterans Affairs, and Related Agencies 

subcommittee. The term ‘‘program, project, and activity’’ shall include the most specific level of budget items identified in the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2019, the House and Senate Committee reports, and 

the conference report and accompanying joint explanatory statement of managers of the committee of conference. 

If a sequestration order is necessary, in implementing the Presidential order, departments, and agencies shall apply any percentage reduction required for fiscal year 2019 pursuant to the provisions of Public Law 99–177 or Public Law 100–119 to all items 

specified in the justifications submitted to the Committees on Appropriations of the Senate and House of Representatives in support 

of the fiscal year 2019 budget estimates, as amended, for such departments and agencies, as modified by congressional action, and 

in addition, for the Department of Defense, Military Construction, 

the definition shall include specific construction locations as identified in the explanatory notes. 

COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE 

STANDING RULES OF THE SENATE 

Paragraph 7 of rule XVI requires that Committee reports accompanying general appropriations bills identify each recommended 

amendment which proposes an item of appropriation which is not 

made to carry out the provisions of an existing law, a treaty stipulation, or an act or resolution previously passed by the Senate during that session. 

The Committee recommends funding for the following programs 

which currently lack authorization: 

Title I: Department of Defense 

Military Construction, Army 

Military Construction, Navy and Marine Corps 

Military Construction, Air Force 

Military Construction, Defense-Wide 

Military Construction, Army National Guard 

Military Construction, Air National Guard 

Military Construction, Army Reserve 

Military Construction, Navy Reserve 

Military Construction, Air Force Reserve 
87 

North Atlantic Treaty Organization Security Investment Program 

Department of Defense Base Closure Account 

Family Housing Operation and Maintenance, Army 

Family Housing Operation and Maintenance, Navy and Marine 

Corps 

Family Housing Operation and Maintenance, Air Force 

Family Housing Operation and Maintenance, Defense-Wide 

Family Housing Construction, Army 

Family Housing Construction, Navy and Marine Corps 

Family Housing Construction, Air Force 

Department of Defense Family Housing Improvement Fund 

Department of Defense Military Unaccompanied Housing Improvement Fund 

Title II: Department of Veterans Affairs 

Veterans Benefits Administration 

Veterans Health Administration 

National Cemetery Administration 

Departmental Administration 

Title III: Related Agencies 

American Battle Monuments Commission 

U.S. Court of Appeals for Veterans Claims 

Cemeterial Expenses, Army 

Armed Forces Retirement Home 
88 

COMPLIANCE WITH PARAGRAPH 7(c), RULE XXVI OF THE 

STANDING RULES OF THE SENATE 

Pursuant to paragraph 7(c) of rule XXVI, on June 7, 2018, the 

Committee ordered favorably reported a bill (S. 3024) making appropriations for military construction, the Department of Veterans 

Affairs, and related agencies for the fiscal year ending September 

30, 2019, and for other purposes, provided, that the bill be subject 

to amendment and that the bill be consistent with its budget allocation, and provided that the Chairman of the Committee or his 

designee be authorized to offer the substance of the original bill as 

a Committee amendment in the nature of a substitute to the House 

companion measure, by a recorded vote of 31–0, a quorum being 

present. The vote was as follows: 

Yeas Nays 

Chairman Shelby 

Mr. McConnell 

Mr. Alexander 

Ms. Collins 

Ms. Murkowski 

Mr. Graham 

Mr. Blunt 

Mr. Moran 

Mr. Hoeven 

Mr. Boozman 

Mrs. Capito 

Mr. Lankford 

Mr. Daines 

Mr. Kennedy 

Mr. Rubio 

Mrs. Hyde-Smith 

Mr. Leahy 

Mrs. Murray 

Mrs. Feinstein 

Mr. Durbin 

Mr. Reed 

Mr. Tester 

Mr. Udall 

Mrs. Shaheen 

Mr. Merkley 

Mr. Coons 

Mr. Schatz 

Ms. Baldwin 

Mr. Murphy 

Mr. Manchin 

Mr. Van Hollen 
89 

COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE 

STANDING RULES OF THE SENATE 

Paragraph 12 of rule XXVI requires that Committee reports on 

a bill or joint resolution repealing or amending any statute or part 

of any statute include ‘‘(a) the text of the statute or part thereof 

which is proposed to be repealed; and (b) a comparative print of 

that part of the bill or joint resolution making the amendment and 

of the statute or part thereof proposed to be amended, showing by 

stricken-through type and italics, parallel columns, or other appropriate typographical devices the omissions and insertions which 

would be made by the bill or joint resolution if enacted in the form 

recommended by the committee.’’ 

In compliance with this rule, changes in existing law proposed to 

be made by the bill are shown as follows: existing law to be omitted 

is enclosed in black brackets; new matter is printed in italic; and 

existing law in which no change is proposed is shown in roman. 

CONSOLIDATED APPROPRIATIONS ACT, 2018, 

PUBLIC LAW 115–141 

DIVISION J—MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATIONS ACT, 

2018 

* * * * * * * 

TITLE II 

DEPARTMENT OF VETERANS AFFAIRS 

ADMINISTRATIVE PROVISIONS

* * * * * * * 

ø(INCLUDING TRANSFER OF FUNDS)

SEC. 220. Of the amounts appropriated to the Department of 

Veterans Affairs which become available on October 1, 2018, for 

‘‘Medical Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support 

and Compliance’’, and ‘‘Medical Facilities’’, up to $306,378,000, 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—Department 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.¿ Repealed. 
90 

BUDGETARY IMPACT OF BILL 

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 

308(a), PUBLIC LAW 93–344, AS AMENDED 

[In millions of dollars] 

Budget authority Outlays 

Committee 

allocation 

Amount 

in bill 

Committee 

allocation 

Amount 

in bill 

Comparison of amounts in the bill with the subcommittee 

allocation for 2019: Subcommittee on Military Construction and Veterans Affairs, and Related Agencies: 

Mandatory .................................................................... 109,472 109,472 109,086 1 109,086 

Discretionary ................................................................ 97,086 98,007 90,261 1 90,261 

Security ............................................................... 10,319 11,240 NA NA 

Nonsecurity ......................................................... 86,767 86,767 NA NA 

Projections of outlays associated with the recommendation: 

2019 ............................................................................. ...................... ...................... ...................... 2 114,799 

2020 ............................................................................. ...................... ...................... ...................... 5,486 

2021 ............................................................................. ...................... ...................... ...................... 5,216 

2022 ............................................................................. ...................... ...................... ...................... 3,202 

2023 and future years ................................................ ...................... ...................... ...................... 3,590 

Financial assistance to State and local governments for 

2019 ................................................................................. NA 277 NA 2 59 

1 Includes outlays from prior-year budget authority. 

2 Excludes outlays from prior-year budget authority. 

NA: Not applicable. 

NOTE.—Consistent with the funding recommended in the bill for overseas contingency operations and in accordance with subparagraph 

(A)(ii) of section 251(b)(2) of the BBEDCA of 1985, the Committee anticipates that the Budget Committee will provide, at the appropriate 

time, a 302(a) allocation for the Committee on Appropriations reflecting an upward adjustment of $921,000,000 in budget authority plus the 

associated outlays. 
91 

MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION 

[In thousands of dollars] 

Installation and project Budget 

estimate 

Committee 

recommendation 

Committee 

recommendation 

compared to 

budget estimate 

ALABAMA 

ARMY: 

ANNISTON ARMY DEPOT: 

WEAPON MAINTENANCE SHOP .................................................. 5,200 5,200 ........................

TOTAL, ALABAMA .................................................................. 5,200 5,200 ........................

ALASKA 

AIR FORCE: 

EIELSON AFB: 

F–35 AIRCRAFT MAINTENANCE UNIT ADMIN FACILITY ............. 6,800 6,800 ........................

F–35 CONVENTIONAL MUNITIONS MAINTENANCE FACILITY ..... 15,500 15,500 ........................

F–35A CATM RANGE ................................................................ 19,000 19,000 ........................

F–35A SCHOOL AGE FACILITY .................................................. 22,500 22,500 ........................

DEFENSE-WIDE: 

CLEAR AFS: 

LONG RANGE DISCRIM RADAR SYS COMPLEX PHASE 2 .......... 174,000 174,000 ........................

FORT GREELY: 

MISSILE FIELD #1 EXPANSION ................................................. 8,000 8,000 ........................

JOINT BASE ELMENDORF-RICHARDSON: 

OPERATIONS FACILITY REPLACEMENT ...................................... 14,000 14,000 ........................

ARMY NATIONAL GUARD: 

JOINT BASE ELMENDORF-RICHARDSON: 

UNITED STATES PROPERTY & FISCAL OFFICE .......................... 27,000 27,000 ........................

TOTAL, ALASKA ..................................................................... 286,800 286,800 ........................

ARIZONA 

AIR FORCE: 

LUKE AFB: 

F–35A AIRCRAFT MAINTENANCE UNIT FACILITY ...................... 23,000 23,000 ........................

F–35A SQUAD OPS #6 ............................................................. 17,000 17,000 ........................

TOTAL, ARIZONA ................................................................... 40,000 40,000 ........................

ARKANSAS 

DEFENSE-WIDE: 

LITTLE ROCK AFB: 

HYDRANT FUEL SYSTEM ALTERATIONS .................................... 14,000 14,000 ........................

TOTAL, ARKANSAS ................................................................ 14,000 14,000 ........................

CALIFORNIA 

ARMY: 

FORT IRWIN: 

MULTIPURPOSE RANGE COMPLEX ............................................ 29,000 29,000 ........................

NAVY 

CAMP PENDLETON: 

AAV–ACV MAINTENANCE & WAREHOUSE FACILITY .................. 49,410 49,410 ........................

ELECTRICAL UPGRADES ........................................................... 4,020 4,020 ........................

FULL MOTION TRAINER FACILITY .............................................. 10,670 10,670 ........................

POTABLE WATER DISTRIBUTION IMPROVEMENTS ..................... 47,230 47,230 ........................

CORONADO: 

CMV–22B AIRFIELD IMPROVEMENTS ....................................... 77,780 77,780 ........................

LEMOORE: 

F–35 MAINTENANCE HANGAR .................................................. 112,690 112,690 ........................
92 

MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION—Continued 

[In thousands of dollars] 

Installation and project Budget 

estimate 

Committee 

recommendation 

Committee 

recommendation 

compared to 

budget estimate 

MIRAMAR: 

AIRFIELD SECURITY IMPROVEMENTS ....................................... 11,500 11,500 ........................

F–35 VERTICAL LANDING PADS AND TAXIWAY ........................ 20,480 20,480 ........................

POINT MUGU: 

DIRECTED ENERGY SYSTEMS INTERGRATION LAB ................... 22,150 22,150 ........................

SAN DIEGO: 

HARBOR DRIVE SWITCHING STATION ....................................... 48,440 48,440 ........................

PIER 8 REPLACEMENT .............................................................. 108,100 108,100 ........................

SAN NICOLAS ISLAND: 

MISSILE ASSEMBLY BUILD & HIGH EXPLOSIVE MAGAZINE ...... 31,010 31,010 ........................

SEAL BEACH: 

CAUSEWAY, BOAT CHANNEL & TURNING BASIN ...................... 117,830 60,000 ¥57,830 

DEFENSE-WIDE: 

CAMP PENDLETON: 

SOF EOD FACILITY—WEST ....................................................... 3,547 3,547 ........................

SOF HUMAN PERFORMANCE TRAINING CENTER–WEST ............ 9,049 9,049 ........................

CORONADO: 

SOF ATC APPLIED INSTRUCTION FACILITY ............................... 14,819 14,819 ........................

SOF ATC TRAINING FACILITY .................................................... 18,329 18,329 ........................

SOF CLOSE QUARTERS COMBAT FACILITY ............................... 12,768 12,768 ........................

SOF NSWG–1 OPERATIONS SUPPORT FACILITY ........................ 25,172 25,172 ........................

DEFENSE DISTRIBUTION DEPOT-TRACY 

MAIN ACCESS CONTROL POINT UPGRADES ............................. 18,800 18,800 ........................

AIR NATIONAL GUARD: 

CHANNEL ISLANDS ANGS: 

CONSTRUCT C–130J FLIGHT SIMULATOR FACILITY .................. 8,000 8,000 ........................

ARMY RESERVE: 

BARSTOW: 

ECS MODIFIED TEMF / WAREHOUSE ........................................ 34,000 34,000 ........................

NAVY RESERVE: 

SEAL BEACH: 

RESERVE TRAINING CENTER .................................................... 21,740 21,740 ........................

TOTAL, CALIFORNIA .............................................................. 856,534 798,704 ¥57,830 

COLORADO 

ARMY: 

FORT CARSON: 

VEHICLE MAINTENANCE SHOP .................................................. 77,000 77,000 ........................

DEFENSE-WIDE: 

FORT CARSON: 

SOF HUMAN PERFORMANCE TRAINING CENTER ...................... 15,297 15,297 ........................

SOF MOUNTAINEERING FACILITY .............................................. 9,000 9,000 ........................

TOTAL, COLORADO ............................................................... 101,297 101,297 ........................

DISTRICT OF COLUMBIA 

NAVY: 

NAVAL OBSERVATORY: 

MASTER TIME CLOCKS & OPERATIONS FACILITY ..................... 115,600 40,000 ¥75,600 

TOTAL, DISTRICT OF COLUMBIA ........................................... 115,600 40,000 ¥75,600 

FLORIDA 

NAVY: 

MAYPORT: 

LCS OPERATIONAL TRAINING FACILITY ADDITION .................... 29,110 29,110 ........................

LCS SUPPORT FACILITY ............................................................ 82,350 82,350 ........................
93 

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compared to 

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AIR FORCE: 

EGLIN AFB: 

F–35A INTEGRATED TRNG CENTER ACADEMICS BLDG ............ 34,863 34,863 ........................

F–35A STUDENT DORMITORY II ............................................... 28,000 28,000 ........................

MACDILL AFB: 

KC135 BEDDOWN ADD FLIGHT SIMULATOR TRAINING ............. 3,100 3,100 ........................

TOTAL, FLORIDA ................................................. 177,423 177,423 ........................

GEORGIA 

ARMY: 

FORT GORDON: 

CYBER INSTRUCTIONAL FAC AND NETWORK CTR .................... 99,000 99,000 ........................

NAVY RESERVE: 

BENNING: 

RESERVE TRAINING CENTER .................................................... 13,630 13,630 ........................

TOTAL, GEORGIA .................................................................. 112,630 112,630 ........................

HAWAII 

ARMY: 

FORT SHAFTER: 

COMMAND AND CONTROL FACILITY, INCR 4 ........................... 105,000 105,000 ........................

NAVY: 

JOINT BASE PEARL HARBOR-HICKAM: 

DRYDOCK WATERFRONT FACILITY ............................................ 45,000 45,000 ........................

KANEOHE BAY: 

CORROSION CONTROL HANGAR ............................................... 66,100 66,100 ........................

PEARL CITY: 

WATER TRANSMISSION LINE: .................................. 78,320 78,320 ........................

AIR NATIONAL GUARD: 

JOINT BASE PEARL HARBOR-HICKAM: 

CONSTRUCT ADDITION TO F–22 LO/CRF B3408 ...................... 17,000 17,000 ........................

TOTAL, HAWAII ..................................................................... 311,420 311,420 ........................

ILLINOIS 

ARMY NATIONAL GUARD: 

MARSEILLES: 

AUTOMATED RECORD FIRE RANGE .......................................... 5,000 5,000 ........................

AIR NATIONAL GUARD: 

GREATER PEORIA REGIONAL AIRPORT: 

CONSTRUCT NEW FIRE CRASH/RESCUE STATION .................... 9,000 9,000 ........................

TOTAL, ILLINOIS ................................................................... 14,000 14,000 ........................

INDIANA 

ARMY: 

CRANE ARMY AMMUNITION PLANT: 

RAILCAR HOLDING AREA .......................................................... 16,000 16,000 ........................

AIR FORCE RESERVE: 

GRISSOM ARB: 

ADD/ALTER AIRCRAFT MAINTENANCE HANGAR ........................ 12,100 12,100 ........................

TOTAL, INDIANA .................................................................... 28,100 28,100 ........................

KENTUCKY 

ARMY: 

FORT CAMPBELL: 

VEHICLE MAINTENANCE SHOP .................................................. 32,000 32,000 ........................
94 

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FORT KNOX: 

DIGITAL AIR/GROUND INTEGRATION RANGE ............................. 26,000 26,000 ........................

DEFENSE-WIDE: 

FORT CAMPBELL: 

FT CAMPBELL MIDDLE SCHOOL ............................................... 62,634 62,634 ........................

SOF AIR/GROUND INTEG. URBAN LIVE FIRE RANGE ................ 9,091 9,091 ........................

SOF LOGISTICS SUPPORT OPERATIONS FACILITY ..................... 5,435 5,435 ........................

SOF MULTI–USE HELICOPTER TRAINING FACILITY ................... 5,138 5,138 ........................

TOTAL, KENTUCKY ................................................................ 140,298 140,298 ........................

LOUISIANA 

AIR NATIONAL GUARD: 

NEW ORLEANS: 

NORTHCOM—CONSTRUCT ALERT APRON ................................ 15,000 15,000 ........................

TOTAL, LOUISIANA ................................................................ 15,000 15,000 ........................

MAINE 

NAVY: 

KITTERY: 

DRY DOCK #1 SUPERFLOOD BASIN ......................................... 109,960 109,960 ........................

EXTEND PORTAL CRANE RAIL .................................................. 39,725 39,725 ........................

DEFENSE-WIDE: 

KITTERY: 

CONSOLIDATED WAREHOUSE REPLACEMENT ........................... 11,600 11,600 ........................

TOTAL, MAINE ...................................................................... 161,285 161,285 ........................

MARYLAND 

AIR FORCE: 

JOINT BASE ANDREWS: 

PAR RELOCATE HAZ CARGO PAD AND EOD RANGE ................. 37,000 37,000 ........................

PRESIDENTIAL AIRCRAFT RECAP COMPLEX, INC. 2 ................. 154,000 129,116 ¥24,884 

DEFENSE-WIDE: 

FORT MEADE: 

MISSION SUPPORT OPERATIONS WAREHOUSE FACILITY .......... 30,000 30,000 ........................

NSAW RECAPITALIZE BUILDING #2 INC 4 ................................ 218,000 218,000 ........................

NSAW RECAPITALIZE BUILDING #3 INC 1 ................................ 99,000 99,000 ........................

TOTAL, MARYLAND ............................................................... 538,000 513,116 ¥24,884 

MASSACHUSETTS 

AIR FORCE: 

HANSCOM AFB: 

MIT–LINCOLN LABORATORY (WEST LAB CSL/MIF) ................... 225,000 90,000 ¥135,000 

TOTAL, MASSACHUSETTS ..................................................... 225,000 90,000 ¥135,000 

MINNESOTA 

AIR FORCE RESERVE: 

MINNEAPOLIS-ST PAUL IAP: 

SMALL ARMS RANGE ................................................................ 9,000 9,000 ........................

TOTAL, MINNESOTA .............................................................. 9,000 9,000 ........................

MISSISSIPPI 

AIR FORCE RESERVE: 

KEESLER AFB: 

AEROMEDICAL STAGING SQUADRON FACILITY ......................... 4,550 4,550 ........................
95 

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TOTAL, MISSISSIPPI .............................................................. 4,550 4,550 ........................

MISSOURI 

DEFENSE-WIDE: 

ST LOUIS: 

NEXT NGA WEST (N2W) COMPLEX PHASE 1 INC. 2 ................. 213,600 181,600 ¥32,000 

NEXT NGA WEST (N2W) COMPLEX PHASE 2 INC. 1 ................. 110,000 110,000 ........................

TOTAL, MISSOURI ................................................................. 323,600 291,600 ¥32,000 

MONTANA 

ARMY NATIONAL GUARD: 

MALTA: 

NATIONAL GUARD READINESS CENTER .................................... 15,000 15,000 ........................

TOTAL, MONTANA ................................................................. 15,000 15,000 ........................

NEBRASKA 

AIR FORCE: 

OFFUTT AFB: 

PARKING LOT, USSTRATCOM .................................................... 9,500 9,500 ........................

TOTAL, NEBRASKA ................................................................ 9,500 9,500 ........................

NEVADA 

AIR FORCE: 

CREECH AFB: 

MQ–9 CPIP GCS OPERATIONS FACILITY ................................... 28,000 28,000 ........................

MQ–9 CPIP OPERATIONS & COMMAND CENTER FAC .............. 31,000 31,000 ........................

NELLIS AFB: 

CRH SIMULATOR ....................................................................... 5,900 5,900 ........................

ARMY NATIONAL GUARD: 

NORTH LAS VEGAS: 

NATIONAL GUARD READINESS CENTER .................................... 32,000 32,000 ........................

TOTAL, NEVADA .................................................................... 96,900 96,900 ........................

NEW HAMPSHIRE 

ARMY NATIONAL GUARD: 

PEMBROKE: 

NATIONAL GUARD READINESS CENTER .................................... 12,000 12,000 ........................

TOTAL, NEW HAMPSHIRE ..................................................... 12,000 12,000 ........................

NEW JERSEY 

ARMY: 

PICATINNY ARSENAL: 

MUNITIONS DISASSEMBLY COMPLEX ....................................... 41,000 41,000 ........................

DEFENSE-WIDE: 

JOINT BASE MCGUIRE-DIX-LAKEHURST: 

HOT CARGO HYDRANT SYSTEM REPLACEMENT ....................... 10,200 10,200 ........................

TOTAL, NEW JERSEY ............................................................ 51,200 51,200 ........................

NEW MEXICO 

ARMY: 

WHITE SANDS: 

INFORMATION SYSTEMS FACILITY ............................................ 40,000 40,000 ........................
96 

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AIR FORCE: 

HOLLOMAN AFB: 

MQ–9 FTU OPS FACILITY .......................................................... 85,000 85,000 ........................

TOTAL, NEW MEXICO ............................................................ 125,000 125,000 ........................

NEW YORK 

ARMY: 

U.S. MILITARY ACADEMY: 

ENGINEERING CENTER ............................................................. 95,000 95,000 ........................

PARKING STRUCTURE ............................................................... 65,000 65,000 ........................

AIR NATIONAL GUARD: 

FRANCIS S. GABRESKI AIRPORT: 

SECURITY FORCES/COMM.TRAINING FACILITY ......................... 20,000 20,000 ........................

AIR FORCE RESERVE: 

NIAGARA FALLS IAP: 

PHYSICAL FITNESS CENTER ..................................................... 14,000 14,000 ........................

TOTAL, NEW YORK ............................................................... 194,000 194,000 ........................

NORTH CAROLINA 

ARMY: 

FORT BRAGG: 

DINING FACILITY ....................................................................... 10,000 10,000 ........................

NAVY: 

CHERRY POINT MARINE CORPS AIR STATION: 

AIRCRAFT MAINTENANCE HANGAR ........................................... 133,970 60,000 ¥73,970 

FLIGHTLINE UTILITY MODERNIZATION ....................................... 106,860 106,860 ........................

DEFENSE-WIDE: 

FORT BRAGG: 

SOF REPLACE TRAINING MAZE AND TOWER ............................ 12,109 12,109 ........................

SOF SERE RESISTANCE TRAINING LAB. COMPLEX ................... 20,257 20,257 ........................

NEW RIVER: 

AMB CARE CENTER/DENTAL CLINIC REPLACEMENT ................ 32,580 32,580 ........................

TOTAL, NORTH CAROLINA .................................................... 315,776 241,806 ¥73,970 

NORTH DAKOTA 

AIR FORCE: 

MINOT AFB: 

CONSOLIDATED HELO/TRF OPS/AMU AND ALERT FACILITY ...... 66,000 66,000 ........................

ARMY NATIONAL GUARD: 

FARGO: 

NATIONAL GUARD READINESS CENTER .................................... 32,000 32,000 ........................

TOTAL, NORTH DAKOTA ........................................................ 98,000 98,000 ........................

OHIO 

AIR FORCE: 

WRIGHT-PATTERSON AFB: 

ADAL INTELLIGENCE PRODUCTION COMPLEX (NASIC) ............. 116,100 116,100 ........................

ARMY NATIONAL GUARD: 

CAMP RAVENNA: 

AUTOMATED MULTIPURPOSE MACHINE GUN RANGE ................ 7,400 7,400 ........................

TOTAL, OHIO ......................................................................... 123,500 123,500 ........................

OKLAHOMA 

AIR FORCE: 

ALTUS AFB: 

KC–46A FTU/FTC SIMULATOR FACILITY PHASE 3 .................... 12,000 12,000 ........................
97 

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TINKER AFB: 

KC–46A DEPOT FUEL MAINTENANCE HANGAR ......................... 85,000 85,000 ........................

KC–46A DEPOT MAINTENANCE HANGAR .................................. 81,000 81,000 ........................

DEFENSE-WIDE: 

MCALESTER: 

BULK DIESEL SYSTEM REPLACEMENT ...................................... 7,000 7,000 ........................

TOTAL, OKLAHOMA ............................................................... 185,000 185,000 ........................

PENNSYLVANIA 

NAVY: 

PHILADELPHIA: 

SUBMARINE PROPULSOR MANUFACTURING SUPPORT FACILITY 71,050 71,050 ........................

AIR NATIONAL GUARD: 

FORT INDIANTOWN GAP: 

REPLACE OPERATIONS TRAINING/DINING HALL ........................ 8,000 8,000 ........................

NAVY RESERVE: 

PITTSBURGH: 

RESERVE TRAINING CENTER—PITTSBURGH, PA ..................... ........................ ........................ ........................

TOTAL, PENNSYLVANIA ......................................................... 79,050 79,050 ........................

SOUTH CAROLINA 

ARMY: 

FORT JACKSON: 

TRAINEE BARRACKS COMPLEX 3, PHASE 2 ............................. 52,000 52,000 ........................

NAVY: 

BEAUFORT: 

RECYCLING/HAZARDOUS WASTE FACILITY ............................... 9,517 9,517 ........................

PARRIS ISLAND: 

RANGE IMPROVEMENTS & MODERNIZATION, PHASE 2 ............ 35,190 35,190 ........................

AIR FORCE: 

SHAW AFB: 

CPIP MQ–9 MCE GROUP .......................................................... 53,000 53,000 ........................

TOTAL, SOUTH CAROLINA ..................................................... 149,707 149,707 ........................

SOUTH DAKOTA 

ARMY NATIONAL GUARD: 

RAPID CITY: 

NATIONAL GUARD READINESS CENTER .................................... 15,000 15,000 ........................

TOTAL, SOUTH DAKOTA ........................................................ 15,000 15,000 ........................

TEXAS 

ARMY: 

FORT BLISS: 

SUPPLY SUPPORT ACTIVITY ...................................................... 24,000 24,000 ........................

AIR FORCE: 

JOINT BASE SAN ANTONIO: 

BMT RECRUIT DORMITORY 6 ................................................... 25,000 25,000 ........................

DEFENSE-WIDE: 

JOINT BASE SAN ANTONIO: 

ENERGY AEROSPACE OPERATIONS FACILITY ............................ 10,200 10,200 ........................

RED RIVER ARMY DEPOT: 

GENERAL PURPOSE WAREHOUSE ............................................. 71,500 71,500 ........................

AIR FORCE RESERVE: 

FORT WORTH: 

MUNITIONS TRAINING/ADMIN FACILITY ..................................... 3,100 3,100 ........................

TOTAL, TEXAS ....................................................................... 133,800 133,800 ........................
98 

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UTAH 

NAVY: 

HILL AFB: 

D5 MISSILE MOTOR RECEIPT/STORAGE FACILITY .................... 105,520 105,520 ........................

TOTAL, UTAH ........................................................................ 105,520 105,520 ........................

VIRGINIA 

NAVY: 

PORTSMOUTH: 

SHIPS MAINTENANCE FACILITY ................................................. 26,120 26,120 ........................

QUANTICO: 

TBS FIRE STATION .................................................................... 21,980 ........................ ¥21,980 

DEFENSE-WIDE: 

DAM NECK: 

SOF MAGAZINES ....................................................................... 8,959 8,959 ........................

FORT A.P. HILL: 

TRAINING CAMPUS ................................................................... 11,734 11,734 ........................

FORT BELVOIR: 

HUMAN PERFORMANCE TRAINING CENTER .............................. 6,127 6,127 ........................

HUMPHREYS ENGINEER CENTER: 

MAINTENANCE AND SUPPLY FACILITY ...................................... 20,257 20,257 ........................

JOINT BASE LANGLEY-EUSTIS: 

FUEL FACILITIES REPLACEMENT ............................................... 6,900 6,900 ........................

GROUND VEHICLE FUELING FACILITY REPLACEMENT .............. 5,800 5,800 ........................

PENTAGON: 

EXTERIOR INFRASTRUC. & SECURITY IMPROVEMENTS ............ 23,650 23,650 ........................

NORTH VILLAGE VACP & FENCING ........................................... 12,200 12,200 ........................

AIR NATIONAL GUARD: 

JOINT BASE LANGLEY-EUSTIS: 

CONSTRUCT CYBER OPS FACILITY ........................................... 10,000 10,000 ........................

TOTAL, VIRGINIA ................................................................... 153,727 131,747 ¥21,980 

WASHINGTON 

NAVY: 

BANGOR: 

PIER AND MAINTENANCE FACILITY ........................................... 88,960 88,960 ........................

WHIDBEY ISLAND: 

FLEET SUPPORT FACILITY ......................................................... 19,450 19,450 ........................

NEXT GENERATION JAMMER FACILITY ...................................... 7,930 7,930 ........................

DEFENSE-WIDE: 

JOINT BASE LEWIS-MCCHORD: 

REFUELING FACILITY ................................................................ 26,200 26,200 ........................

TOTAL, WASHINGTON ............................................................ 142,540 142,540 ........................

WISCONSIN 

ARMY RESERVE: 

FORT MCCOY: 

TRANSIENT TRAINING BARRACKS ............................................. 23,000 23,000 ........................

TOTAL, WISCONSIN ............................................................... 23,000 23,000 ........................

BAHAMAS 

NAVY: 

ANDROS ISLAND: 

AUTEC AUSTERE QUARTERS ..................................................... 31,050 31,050 ........................

TOTAL, BAHAMAS ................................................................. 31,050 31,050 ........................
99 

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BAHRAIN ISLAND 

NAVY: 

SW ASIA: 

FLEET MAINTENANCE FACILITY & TOC ..................................... 26,340 26,340 ........................

TOTAL, BAHRAIN ISLAND ...................................................... 26,340 26,340 ........................

BELGIUM 

DEFENSE-WIDE: 

CHIEVRES AB: 

EUROPE WEST DISTRICT SUPERINTENDENT’S OFFICE ............. 14,305 14,305 ........................

TOTAL, BELGIUM .................................................................. 14,305 14,305 ........................

CONUS CLASSIFIED 

DEFENSE-WIDE: 

CLASSIFIED LOCATION: 

BATTALION COMPLEX, PHASE 2 ............................................... 49,222 49,222 ........................

TOTAL, CONUS CLASSIFIED .................................................. 49,222 49,222 ........................

GERMANY 

ARMY: 

EAST CAMP GRAFENWOEHR: 

MISSION TRAINING COMPLEX ................................................... 31,000 31,000 ........................

NAVY: 

PANZER KASERNE: 

MARFOREUR HQ MODERNIZATION AND EXPANSION ................ 43,950 43,950 ........................

DEFENSE-WIDE: 

BAUMHOLDER: 

SOF JOINT PARACHUTE RIGGING FACILITY ............................... 11,504 11,504 ........................

KAISERLAUTERN AB: 

KAISERSLAUTERN MIDDLE SCHOOL .......................................... 99,955 99,955 ........................

RHINE ORDNANCE BARRACKS: 

MEDICAL CENTER REPLACEMENT INC. 8 ................................. 319,589 319,589 ........................

WIESBADEN: 

CLAY KASERNE ELEMENTARY SCHOOL .................................... 56,048 56,048 ........................

TOTAL, GERMANY ............................................... 562,046 562,046 ........................

GUAM 

NAVY: 

JOINT REGION MARIANAS: 

ACE GYM & DINING .................................................................. 27,910 27,910 ........................

EARTH COVERED MAGAZINES .................................................. 52,270 52,270 ........................

MACHINE GUN RANGE .............................................................. 141,287 50,000 ¥91,287 

ORDNANCE OPS ........................................................................ 22,020 22,020 ........................

UNACCOMPANIED ENLISTED HOUSING ..................................... 36,170 36,170 ........................

AIR FORCE: 

JOINT REGION MARIANAS: 

HAYMAN MUNITIONS STORAGE IGLOOS MSA 2 ........................ 9,800 9,800 ........................

TOTAL, GUAM ....................................................................... 289,457 198,170 ¥91,287 

GUANTANAMO BAY, CUBA 

NAVY: 

GUANTANAMO BAY: 

SOLID WASTE MANAGEMENT FACILITY ..................................... 85,000 85,000 ........................
100 

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DEFENSE-WIDE: 

GUANTANAMO BAY: 

WORKING DOG TREATMENT FACILITY REPLACEMENT .............. 9,080 9,080 ........................

TOTAL, GUANTANAMO BAY, CUBA ........................................ 94,080 94,080 ........................

HONDURAS 

ARMY: 

SOTO CANO AB: 

BARRACKS ................................................................................ 21,000 21,000 ........................

TOTAL, HONDURAS ............................................................... 21,000 21,000 ........................

JAPAN 

NAVY: 

KADENA AB: 

TACTICAL OPERATIONS CENTER ............................................... 9,049 9,049 ........................

DEFENSE-WIDE: 

CAMP MCTUREOUS: 

BECHTEL ELEMENTARY SCHOOL .............................................. 94,851 94,851 ........................

IWAKUNI: 

FUEL PIER ................................................................................ 33,200 33,200 ........................

KADENA AB: 

TRUCK UNLOAD FACILITIES ...................................................... 21,400 21,400 ........................

YOKOSUKA: 

KINNICK HIGH SCHOOL ............................................................. 170,386 60,000 ¥110,386 

TOTAL, JAPAN ..................................................... 328,886 218,500 ¥110,386 

KOREA 

ARMY: 

CAMP TANGO: 

COMMAND AND CONTROL FACILITY ......................................... 17,500 17,500 ........................

TOTAL, KOREA ...................................................................... 17,500 17,500 ........................

KUWAIT 

ARMY: 

CAMP ARIFJAN: 

VEHICLE MAINTENANCE SHOP .................................................. 44,000 44,000 ........................

TOTAL, KUWAIT ..................................................................... 44,000 44,000 ........................

MARIANA ISLANDS 

AIR FORCE: 

TINIAN: 

APR—CARGO PAD WITH TAXIWAY EXTENSION ........................ 46,000 46,000 ........................

APR—MAINTENANCE SUPPORT FACILITY ................................. 4,700 4,700 ........................

TOTAL, MARIANA ISLANDS ................................................... 50,700 50,700 ........................

QATAR 

AIR FORCE: 

AL UDEID: 

FLIGHTLINE SUPPORT FACILITIES ............................................. 30,400 ........................ ¥30,400 

PERSONNEL DEPLOYMENT PROCESSING FACILITY ................... 40,000 ........................ ¥40,000 

TOTAL, QATAR ...................................................................... 70,400 ........................ ¥70,400 
101 

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UNITED KINGDOM 

AIR FORCE: 

ROYAL AIR FORCE LAKENHEATH: 

F–35A 6 BAY HANGAR ............................................................. 39,036 39,036 ........................

F–35A ADAL CONVENTIONAL MUNITIONS MX ........................... 9,204 9,204 ........................

F–35A ADAL PARTS STORE ...................................................... 13,926 13,926 ........................

F–35A AGE FACILITY ................................................................ 12,449 12,449 ........................

F–35A DORM ............................................................................ 29,541 29,541 ........................

F–35A FUEL SYSTEM MAINTENANCE DOCK 2 BAY .................. 16,880 16,880 ........................

F–35A PARKING APRON ........................................................... 27,431 27,431 ........................

DEFENSE-WIDE: 

CROUGHTON RAF: 

AMBULATORY CARE CENTER ADDITION/ALTERATION ............... 10,000 ........................ ¥10,000 

TOTAL, UNITED KINGDOM ..................................................... 158,467 148,467 ¥10,000 

WORLDWIDE CLASSIFIED 

AIR FORCE: 

CLASSIFIED LOCATION: 

TACMOR—UTILITIES AND INFRASTRUCTURE SUPPORT ........... 18,000 18,000 ........................

TOTAL, WORLDWIDE CLASSIFIED .......................................... 18,000 18,000 ........................

NATO SECURITY INVESTMENT PROGRAM ................................. 171,064 171,064 ........................

WORLDWIDE UNSPECIFIED 

ARMY: 

HOST NATION SUPPORT ..................................................................... 34,000 34,000 ........................

MINOR CONSTRUCTION ..................................................................... 72,000 82,000 ∂10,000 

PLANNING AND DESIGN ..................................................................... 71,068 71,068 ........................

PLANNING AND DESIGN ..................................................................... 5,000 5,000 ........................

NAVY: 

PLANNING AND DESIGN ..................................................................... 185,542 185,542 ........................

MINOR CONSTRUCTION ..................................................................... 28,579 28,579 ........................

AIR FORCE: 

PLANNING AND DESIGN ..................................................................... 206,577 206,577 ........................

MINOR CONSTRUCTION ..................................................................... 38,500 38,500 ........................

DEFENSE-WIDE: 

CONTINGENCY CONSTRUCTION ......................................................... 10,000 ........................ ¥10,000 

ENERGY CONSERVATION INVESTMENT PROGRAM ............................. 150,000 195,000 ∂45,000 

PLANNING AND DESIGN: 

DEFENSE WIDE ......................................................................... 24,300 24,300 ........................

DEFENSE HEALTH AGENCY ....................................................... 55,699 55,699 ........................

DEFENSE INFORMATION SYSTEMS AGENCY ............................. 496 496 ........................

DEFENSE LOGISTICS AGENCY ................................................... 42,705 42,705 ........................

MISSILE DEFENSE AGENCY ...................................................... 14,184 14,184 ........................

SPECIAL OPERATIONS COMMAND ............................................. 55,925 55,925 ........................

WASHINGTON HEADQUARTERS SERVICE .................................. 2,036 2,036 ........................

SUBTOTAL, PLANNING AND DESIGN ..................................... 195,345 195,345 ........................

UNSPECIFIED MINOR CONSTRUCTION: 

DEFENSE WIDE ......................................................................... 3,000 3,000 ........................

DEFENSE HEALTH AGENCY ....................................................... 5,000 5,000 ........................

DEFENSE LOGISTICS AGENCY ................................................... 17,366 17,366 ........................

MISSILE DEFENSE AGENCY ...................................................... 10,000 10,000 ........................

SPECIAL OPERATIONS COMMAND ............................................. 13,642 13,642 ........................

THE JOINT STAFF ...................................................................... 12,479 12,479 ........................

SUBTOTAL, UNSPECIFIED MINOR CONSTRUCTION ........................ 61,487 61,487 ........................

ARMY NATIONAL GUARD: 

PLANNING AND DESIGN ..................................................................... 16,622 16,622 ........................
102 

MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION—Continued 

[In thousands of dollars] 

Installation and project Budget 

estimate 

Committee recommendation 

Committee recommendation 

compared to 

budget estimate 

MINOR CONSTRUCTION ..................................................................... 18,100 28,100 ∂10,000 

AIR NATIONAL GUARD: 

PLANNING AND DESIGN ..................................................................... 18,500 18,500 ........................

MINOR CONSTRUCTION ..................................................................... 23,626 33,626 ∂10,000 

ARMY RESERVE: 

PLANNING AND DESIGN ..................................................................... 5,855 5,855 ........................

MINOR CONSTRUCTION ..................................................................... 2,064 2,064 ........................

NAVY RESERVE: 

PLANNING AND DESIGN ..................................................................... 4,695 4,695 ........................

MINOR CONSTRUCTION ..................................................................... 3,000 3,000 ........................

AIR FORCE RESERVE: 

PLANNING AND DESIGN ..................................................................... 4,055 4,055 ........................

MINOR CONSTRUCTION ..................................................................... 3,358 3,358 ........................

FAMILY HOUSING, ARMY 

WISCONSIN: 

FORT MCCOY: 

FAMILY HOUSING NEW CONSTRUCTION (7 units) .................... 6,200 6,200 ........................

PUERTO RICO: 

FORT BUCHANAN: 

FAMILY HOUSING NEW CONSTRUCITON (26 UNITS) ................. 26,000 26,000 ........................

KOREA: 

CAMP WALKER—DAEGU: 

FAMILY HOUSING REPLACEMENT CONSTRUCTION (90 UNITS) 68,000 68,000 ........................

CAMP HUMPHRIES: 

FAMILY HOUSING NEW CONSTRUCTION ................................... 85,000 85,000 ........................

ITALY: 

VICENZA: 

FAMILY HOUSING NEW CONSTRUCTION (111 UNITS) ............... 95,134 95,134 ........................

GERMANY: 

BAUMHOLDER: 

CONSTRUCTION IMPROVEMENTS (72 UNITS) ........................... 32,000 32,000 ........................

PLANNING AND DESIGN ............................................................ 18,326 18,326 ........................

SUBTOTAL, CONSTRUCTION .......................................................... 330,660 330,660 ........................

OPERATION AND MAINTENANCE: 

UTILITIES ACCOUNT .................................................................. 57,872 57,872 ........................

SERVICES ACCOUNT ................................................................. 10,502 10,502 ........................

MANAGEMENT ACCOUNT .......................................................... 36,302 36,302 ........................

MISCELLANEOUS ACCOUNT ...................................................... 408 408 ........................

FURNISHINGS ACCOUNT ........................................................... 15,842 15,842 ........................

LEASING .................................................................................... 161,252 161,252 ........................

MAINTENANCE OF REAL PROPERTY ......................................... 75,530 75,530 ........................

PRIVATIZATION SUPPORT COSTS ..................................... 18,801 18,801 ........................

SUBTOTAL, OPERATION AND MAINTENANCE ................................. 376,509 376,509 ........................

FAMILY HOUSING, NAVY AND MARINE CORPS 

GUAM: 

NSA ANDERSON: 

REPLACEMENT HOUSING PHASE III .......................................... 83,441 83,441 ........................

JAPAN: 

IWAKUNI: 

CONSTRUCTION IMPROVEMENTS (44 UNITS) ........................... 16,638 16,638 ........................

PLANNING AND DESIGN ............................................................ 4,502 4,502 ........................

SUBTOTAL, CONSTRUCTION .......................................................... 104,581 104,581 ........................

OPERATION AND MAINTENANCE: 

UTILITIES ACCOUNT ........................................................................... 60,252 60,252 ........................

SERVICES ACCOUNT .......................................................................... 16,261 16,261 ........................

MANAGEMENT ACCOUNT ................................................................... 50,870 50,870 ........................
103 

MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION—Continued 

[In thousands of dollars] 

Installation and project Budget 

estimate 

Committee recommendation 

Committee recommendation 

compared to 

budget estimate 

MISCELLANEOUS ACCOUNT ............................................................... 148 148 ........................

FURNISHINGS ACCOUNT .................................................................... 16,395 16,395 ........................

LEASING ............................................................................................. 62,515 62,515 ........................

MAINTENANCE OF REAL PROPERTY .................................................. 86,328 86,328 ........................

PRIVATIZATION SUPPORT COSTS ....................................................... 21,767 21,767 ........................

SUBTOTAL, OPERATION AND MAINTENANCE ................................. 314,536 314,536 ........................

FAMILY HOUSING, AIR FORCE 

JAPAN: 

KADENA: 

CONSTRUCTION IMPROVEMENTS (130 UNITS) ......................... 72,129 72,129 ........................

UNITED KINGDOM: 

RAF LAKENHEATH: 

CONSTRUCTION IMPROVEMENTS .............................................. 3,118 3,118 ........................

LANNING AND DESIGN ................................................................................ 3,199 3,199 ........................

SUBTOTAL, CONSTRUCTION .......................................................... 78,446 78,446 ........................

OPERATION AND MAINTENANCE: 

UTILITIES ACCOUNT ........................................................................... 48,566 48,566 ........................

MANAGEMENT ACCOUNT ................................................................... 54,423 54,423 ........................

SERVICES ACCOUNT .......................................................................... 13,669 13,669 ........................

FURNISHINGS ACCOUNT .................................................................... 30,645 30,645 ........................

MISCELLANEOUS ACCOUNT ............................................................... 2,171 2,171 ........................

LEASING ............................................................................................. 15,832 15,832 ........................

MAINTENANCE ................................................................................... 129,763 129,763 ........................

PRIVATIZATION SUPPORT COSTS ....................................................... 22,205 22,205 ........................

SUBTOTAL, OPERATION AND MAINTENANCE ................................. 317,274 317,274 ........................

FAMILY HOUSING, DEFENSE-WIDE 

OPERATION AND MAINTENANCE: 

NATIONAL SECURITY AGENCY: 

UTILITIES .................................................................................. 106 106 ........................

FURNISHING .............................................................................. 416 416 ........................

LEASING .................................................................................... 13,046 13,046 ........................

MAINTENANCE OF REAL PROPERTY ......................................... 121 121 ........................

DEFENSE INTELLIGENCE AGENCY: 

UTILITIES ........................................................................................... 4,100 4,100 ........................

FURNISHINGS ............................................................................ 643 643 ........................

LEASING .................................................................................... 38,232 38,232 ........................

DEFENSE LOGISTICS AGENCY: 

UTILITIES .................................................................................. 9 9 ........................

FURNISHINGS ............................................................................ 1 1 ........................

SERVICES ................................................................................. 2 2 ........................

MANAGEMENT ........................................................................... 155 155 ........................

MAINTENANCE OF REAL PROPERTY ......................................... 1,542 1,542 ........................

SUBTOTAL, OPERATION AND MAINTENANCE ........................ 58,373 58,373 ........................

DOD MILITARY UNACCOMPANIED HOUSING IMPROVEMENT FUND ............. 600 600 ........................

DOD FAMILY HOUSING IMPROVEMENT FUND ............................................. 1,653 1,653 ........................

BASE REALIGNMENT AND CLOSURE: 

BASE REALIGNMENT AND CLOSURE ACCOUNT ................................. 267,538 277,538 ∂10,000 

ADMINISTRATIVE PROVISIONS 

MILITARY CONSTRUCTION, ARMY ............................................................... ........................ 77,600 ∂77,600 

MILITARY CONSTRUCTION, NAVY AND MARINE CORPS .............................. ........................ 244,400 ∂244,400 

MILITARY CONSTRUCTION, AIR FORCE ....................................................... ........................ 118,516 ∂118,516 

MILITARY CONSTRUCTION, ARMY NATIONAL GUARD .................................. ........................ 22,000 ∂22,000 

MILITARY CONSTRUCTION, AIR NATIONAL GUARD ..................................... ........................ 11,100 ∂11,100 
104 

MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION—Continued 

[In thousands of dollars] 

Installation and project Budget 

estimate 

Committee recommendation 

Committee recommendation 

compared to 

budget estimate 

MILITARY CONSTRUCTION, ARMY RESERVE ............................................... ........................ 10,000 ∂10,000 

MILITARY CONSTRUCTION, AIR FORCE RESERVE ....................................... ........................ 14,400 ∂14,400 

MILITARY CONSTRUCTION—ENHANCING FORCE PROTECTION AND SAFETY ON MILITARY INSTALLATIONS (SEC. 131) ......................................... ........................ ........................ ........................

DEFENSE ACCESS ROADS PROGRAM (SEC. 129) ...................................... ........................ 30,000 ∂30,000 

RESCISSIONS FROM PRIOR YEAR UNOBLIGATED BALANCES 

AIR FORCE (RESCISSION) ........................................................................... ........................ ¥31,158 ¥31,158 

ARMY NATIONAL GUARD (RESCISSION) ...................................................... ........................ ¥10,000 ¥10,000 

42 USC 3374 (SEC. 135) (RESCISSION) .................................................... ........................ ........................ ........................

NATO SECURITY INVESTMENT PROGRAM (RESCISSION) ............................ ........................ ........................ ........................

FAMILY HOUSING, NAVY AND MARINE CORPS (RESCISSION) .................... ........................ ¥2,138 ¥2,138 

RECAP 

ARMY .......................................................................................................... 1,011,768 1,021,768 ∂10,000 

RESCISSION ....................................................................................... ........................ ........................ ........................

NAVY AND MARINE CORPS ......................................................................... 2,543,189 2,222,522 ¥320,667 

RESCISSION ....................................................................................... ........................ ........................ ........................

AIR FORCE .................................................................................................. 1,725,707 1,495,423 ¥230,284 

RESCISSION ....................................................................................... ........................ ¥31,158 ¥31,158 

DEFENSE–WIDE .......................................................................................... 2,693,324 2,575,938 ¥117,386 

RESCISSION ....................................................................................... ........................ ........................ ........................

ARMY NATIONAL GUARD ............................................................................. 180,122 190,122 ∂10,000 

RESCISSION ....................................................................................... ........................ ¥10,000 ¥10,000 

AIR NATIONAL GUARD ................................................................................ 129,126 139,126 ∂10,000 

RESCISSION ....................................................................................... ........................ ........................ ........................

ARMY RESERVE .......................................................................................... 64,919 64,919 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

NAVY RESERVE ........................................................................................... 43,065 43,065 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

AIR FORCE RESERVE .................................................................................. 50,163 50,163 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

NATO ........................................................................................................... 171,064 171,064 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

CHEMICAL DEMILITARIZATION CONSTRUCTION, DEFENSE–WIDE ............... ........................ ........................ ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

DOD UNACCOMPANIED HOUSING IMPROVEMENT FUND ............................. 600 600 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

DOD FAMILY HOUSING IMPROVEMENT FUND ............................................. 1,653 1,653 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

HOMEOWNERS ASSISTANCE PROGRAM ...................................................... ........................ ........................ ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

FAMILY HOUSING, ARMY ............................................................................ 707,169 707,169 ........................

CONSTRUCTION ................................................................................. (330,660) (330,660) ........................

OPERATION AND MAINTENANCE ........................................................ (376,509) (376,509) ........................

RESCISSION .............................................................................. ........................ ........................ ........................

FAMILY HOUSING, NAVY AND MARINE CORP ............................................. 419,117 419,117 ........................

CONSTRUCTION ................................................................................. (104,581) (104,581) ........................

OPERATION AND MAINTENANCE ........................................................ (314,536) (314,536) ........................

RESCISSION .............................................................................. ........................ ¥2,138 ¥2,138 

FAMILY HOUSING, AIR FORCE .................................................................... 395,720 395,720 ........................

CONSTRUCTION ................................................................................. (78,446) (78,446) ........................

OPERATION AND MAINTENANCE ........................................................ (317,274) (317,274) ........................

RESCISSION .............................................................................. ........................ ........................ ........................

FAMILY HOUSING, DEFENSE–WIDE ............................................................. 58,373 58,373 ........................

CONSTRUCTION ................................................................................. ........................ ........................ ........................

OPERATION AND MAINTENANCE ........................................................ (58,373) (58,373) ........................

RESCISSION .............................................................................. ........................ ........................ ........................

BRAC .......................................................................................................... 267,538 277,538 ∂10,000 

RESCISSION .............................................................................. ........................ ........................ ........................

42 USC 3374 (SEC. 135) ........................................................................... ........................ ........................ ........................
105 

MILITARY CONSTRUCTION PROJECT LISTING BY LOCATION—Continued 

[In thousands of dollars] 

Installation and project Budget 

estimate 

Committee 

recommendation 

Committee 

recommendation 

compared to 

budget estimate 

RESCISSION .............................................................................. ........................ ........................ ........................

ADMINISTRATIVE PROVISIONS ......................................... ........................ 528,016 ∂528,016 

RESCISSION .............................................................................. ........................ ........................ ........................

GRAND TOTAL ............................................................................... 10,462,617 10,319,000 ¥143,617 
106 

OVERSEAS CONTINGENCY OPERATIONS 

[In thousands of dollars] 

Budget 

estimate 

Committee 

recommendation 

Committee 

recommendation 

compared to 

budget estimate 

BULGARIA 

ARMY: 

NEVO SELO FOS: 

EDI: AMMUNITION HOLDING AREA ............................................ 5,200 5,200 ........................

GERMANY 

AIR FORCE: 

RAMSTEIN AB: 

EDI: KMC DABS–FEV/RH STORAGE WAREHOUSES ................... 119,000 119,000 ........................

GREECE 

NAVY: 

SOUDA BAY: 

EDI: JOINT MOBILITY PROCESSING CENTER ............................. 41,650 41,650 ........................

EDI: MARATHI LOGISTICS SUPPORT CENTER ........................... 6,200 6,200 ........................

GUANTANAMO BAY, CUBA 

ARMY: 

GUANTANAMO BAY: 

OCO: HIGH VALUE DETENTION FACILITY .................................. 69,000 ........................ ¥69,000 

ITALY 

NAVY: 

SIGONELLA: 

EDI: P–8A TAXIWAY .................................................................. 66,050 66,050 ........................

NORWAY 

AIR FORCE: 

RYGGE: 

EDI: CONSTRUCT TAXIWAY ....................................................... 13,800 13,800 ........................

POLAND 

ARMY: 

POWIDZ AB: 

EDI: AMMUNITION STORAGE FACILITY ...................................... 52,000 52,000 ........................

EDI: BULK FUEL STORAGE ........................................................ 21,000 21,000 ........................

EDI: RAIL EXTENSION & RAILHEAD .......................................... 14,000 14,000 ........................

ZAGAN 

EDI: RAIL EXTENSION AND RAILHEAD ...................................... 6,400 6,400 ........................

EDI: STAGING AREA .................................................................. 51,000 ........................ ¥51,000 

EDI: STAGING AREA .................................................................. ........................ 34,000 ∂34,000 

DRAWSKO POMORSKI: 

EDI: STAGING AREA .................................................................. ........................ 17,000 ∂17,000 

QATAR 

AIR FORCE: 

AL UDEID 

OCO: FLIGHTLINE SUPPORT FACILITIES .................................... ........................ 29,000 ∂29,000 

OCO: PERSONNEL DEPLOYMENT PROCESSING FCILITY ............ ........................ 40,000 ∂40,000 

DEFENSE-WIDE: 

AL UDEID 

OCO: TRANS–REGIONAL LOGISTICS COMPLEX ......................... 60,000 60,000 ........................

ROMANIA 

ARMY: 

MIHAIL KOGALNICEANU 

EDI: EXPLOSIVES & AMMO LOAD/UNLOAD APRON ................... 21,651 21,651 ........................
107 

OVERSEAS CONTINGENCY OPERATIONS—Continued 

[In thousands of dollars] 

Budget 

estimate 

Committee 

recommendation 

Committee 

recommendation 

compared to 

budget estimate 

SLOVAKIA 

AIR FORCE: 

MALACKY: 

EDI: REGIONAL MUNITIONS STORAGE AREA ............................. 59,000 59,000 ........................

SPAIN 

NAVY: 

ROTA: 

EDI: PORT OPERATIONS FACILITIES .......................................... 21,590 21,590 ........................

UNITED KINGDOM 

NAVY: 

LOSSIEMOUTH: 

EDI: P–8 BASE IMPROVEMENTS ............................................... 79,130 79,130 ........................

AIR FORCE: 

RAF FAIRFORD: 

EDI: CONSTRUCT DABS–FEV STORAGE .................................... 87,000 87,000 ........................

EDI: MUNITIONS HOLDING AREA .............................................. 19,000 19,000 ........................

ESTONIA 

DEFENSE-WIDE: 

UNSPECIFIED LOCATIONS: 

EDI: SOF OPERATIONS FACILITY ............................................... 6,100 6,100 ........................

EDI: SOF TRAINING FACILITY .................................................... 9,600 9,600 ........................

WORLDWIDE UNSPECIFIED 

ARMY: 

EDI: PLANNING AND DESIGN .................................................... 20,999 20,999 ........................

NAVY: 

EDI: PLANNING AND DESIGN .................................................... 12,700 12,700 ........................

AIR FORCE: 

EDI: PLANNING & DESIGN FUNDS ............................................ 48,000 48,000 ........................

DEFENSE-WIDE 

EDI: PLANNING AND DESIGN .................................................... 7,100 7,100 ........................

EDI: PLANNING AND DESIGN .................................................... 4,250 4,250 ........................

RECAP 

ARMY .......................................................................................................... 261,250 192,250 ¥69,000 

RESCISSION ....................................................................................... ........................ ........................ ........................

NAVY AND MARINE CORPS ......................................................................... 227,320 227,320 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

AIR FORCE .................................................................................................. 345,800 414,800 ∂69,000 

RESCISSION ....................................................................................... ........................ ........................ ........................

DEFENSE-WIDE ........................................................................................... 87,050 87,050 ........................

RESCISSION ....................................................................................... ........................ ........................ ........................

GRAND TOTAL ............................................................................... 921,420 921,420 ........................
108 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 

appropriation Budget estimate 

TITLE I—DEPARTMENT OF DEFENSE 

Military Construction, Army .................................................................................................................................................. 923,994 1,011,768 1,021,768 ∂97,774 ∂10,000 Military Construction, Navy and Marine Corps .................................................................................................................... 1,553,275 2,543,189 2,222,522 ∂669,247 ¥320,667 Military Construction, Air Force ............................................................................................................................................ 1,543,558 1,725,707 1,495,423 ¥48,135 ¥230,284 Military Construction, Defense–Wide ................................................................................................................................... 2,811,513 2,693,324 2,575,938 ¥235,575 ¥117,386 

Total, Active components ........................................................................................................................................ 6,832,340 7,973,988 7,315,651 ∂483,311 ¥658,337 

Military Construction, Army National Guard ........................................................................................................................ 220,652 180,122 190,122 ¥30,530 ∂10,000 Military Construction, Air National Guard ............................................................................................................................ 171,491 129,126 139,126 ¥32,365 ∂10,000 Military Construction, Army Reserve .................................................................................................................................... 83,712 64,919 64,919 ¥18,793 ..........................Military Construction, Navy Reserve .................................................................................................................................... 95,271 43,065 43,065 ¥52,206 ..........................Military Construction, Air Force Reserve .............................................................................................................................. 73,535 50,163 50,163 ¥23,372 ..........................

Total, Reserve components ..................................................................................................................................... 644,661 467,395 487,395 ¥157,266 ∂20,000 

North Atlantic Treaty Organization Security Investment Program 177,932 171,064 171,064 ¥6,868 ..........................

Chemical demilitarization construction, Defense–Wide .............................................................................................. .......................... .......................... .......................... .......................... ..........................Department of Defense Base Closure Account ........................................................................................................... 310,000 267,538 277,538 ¥32,462 ∂10,000 

Total, Military Construction .................................................................................................................................... 7,964,933 8,879,985 8,251,648 ∂286,715 ¥628,337 

Family Housing Construction, Army ..................................................................................................................................... 182,662 330,660 330,660 ∂147,998 ..........................Family Housing Operation and Maintenance, Army ............................................................................................................. 348,907 376,509 376,509 ∂27,602 ..........................Family Housing Construction, Navy and Marine Corps ....................................................................................................... 83,682 104,581 104,581 ∂20,899 ..........................Family Housing Operation and Maintenance, Navy and Marine Corps ............................................................................... 328,282 314,536 314,536 ¥13,746 ..........................Family Housing Construction, Air Force ............................................................................................................................... 85,062 78,446 78,446 ¥6,616 ..........................Family Housing Operation and Maintenance, Air Force ...................................................................................................... 318,324 317,274 317,274 ¥1,050 ..........................Family Housing Operation and Maintenance, Defense–Wide .............................................................................................. 59,169 58,373 58,373 ¥796 ..........................Department of Defense Family Housing Improvement Fund ............................................................................................... 2,726 1,653 1,653 ¥1,073 ..........................
109 

DoD Military Unaccompanied Housing Improvement Fund .................................................................................................. 623 600 600 ¥23 ..........................

Total, Family Housing ............................................................................................................................................. 1,409,437 1,582,632 1,582,632 ∂173,195 ..........................

ADMINISTRATIVE PROVISIONS 

Defense Access Roads (Sec. 132) ....................................................................................................................................... .......................... .......................... .......................... .......................... ..........................Military Construction, Air Force (Sec. 125) (rescission) ...................................................................................................... .......................... .......................... ¥31,158 ¥31,158 ¥31,158 Military Construction, Army (Sec. 124) ................................................................................................................................ 93,800 .......................... 77,600 ¥16,200 ∂77,600 Military Construction, Navy and Marine Corps (Sec. 124) .................................................................................................. 202,130 .......................... 244,400 ∂42,270 ∂244,400 Military Construction, Air National Guard (Sec. 124) .......................................................................................................... 52,000 .......................... 11,100 ¥40,900 ∂11,100 Military Construction, Army National Guard (Sec. 124) ...................................................................................................... 113,500 .......................... 22,000 ¥91,500 ∂22,000 Military Construction, Army National Guard (Sec. 125) (rescission) .................................................................................. .......................... .......................... ¥10,000 ¥10,000 ¥10,000 Military Construction, Army Reserve (Sec. 124) .................................................................................................................. 76,000 .......................... 10,000 ¥66,000 ∂10,000 NATO Security Investment Program (Sec. 125) (rescission) ................................................................................................ ¥25,000 .......................... .......................... ∂25,000 ..........................42 USC 3374 (Sec. 125) ...................................................................................................................................................... .......................... .......................... .......................... .......................... ..........................Military Construction, Air Force (Sec. 124) .......................................................................................................................... 138,100 .......................... 118,516 ¥19,584 ∂118,516 Military Construction, Air Force Reserve (Sec. 124) ............................................................................................................ 64,100 .......................... 14,400 ¥49,700 ∂14,400 Family Housing Construction, Army (Sec. 126) ................................................................................................................... ¥18,000 .......................... .......................... ∂18,000 ..........................Family Housing Construction, Navy and Marine Corps (Sec. 125) ..................................................................................... .......................... .......................... ¥2,138 ¥2,138 ¥2,138 Family Housing Construction, Air Force (Sec. 126) ............................................................................................................. .......................... .......................... .......................... .......................... ..........................Defense Access Roads Program (Sec. 129) ......................................................................................................................... 20,000 .......................... 30,000 ∂10,000 ∂30,000 

Total, Administrative Provisions ............................................................................................................................. 716,630 .......................... 484,720 ¥231,910 ∂484,720 

Appropriations ................................................................................................................................................ (759,630 ) .......................... (528,016 ) (¥231,614 ) (∂528,016 ) Rescissions .................................................................................................................................................... (¥43,000 ) .......................... (¥43,296 ) (¥296 ) (¥43,296 ) 

Total, title I, Department of Defense ..................................................................................................................... 10,091,000 10,462,617 10,319,000 ∂228,000 ¥143,617 

Appropriations ................................................................................................................................................ (10,134,000 ) (10,462,617 ) (10,362,296 ) (∂228,296 ) (¥100,321 ) Rescissions .................................................................................................................................................... (¥43,000 ) .......................... (¥43,296 ) (¥296 ) (¥43,296 ) 

TITLE II—DEPARTMENT OF VETERANS AFFAIRS 

Veterans Benefits Administration 

Compensation and pensions: 

Advance from prior year .............................................................................................................................................. (90,119,449 ) (95,768,462 ) (95,768,462 ) (∂5,649,013 ) ..........................Current year request ................................................................................................................................................... .......................... 1,410,332 1,410,332 ∂1,410,332 ..........................

Subtotal, current year .................................................................................................................................... 90,119,449 97,178,794 97,178,794 ∂7,059,345 ..........................

Advance appropriation, fiscal year 2020 .................................................................................................................... 95,768,462 107,119,807 107,119,807 ∂11,351,345 ..........................
110 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 

appropriation Budget estimate 

Readjustment benefits: 

Advance from prior year .............................................................................................................................................. (13,708,648 ) (11,832,175 ) (11,832,175 ) (¥1,876,473 ) ..........................

Subtotal .......................................................................................................................................................... 13,708,648 11,832,175 11,832,175 ¥1,876,473 ..........................

Advance appropriation, fiscal year 2020 .................................................................................................................... 11,832,175 14,065,282 14,065,282 ∂2,233,107 ..........................

Veterans insurance and indemnities: 

Advance from prior year .............................................................................................................................................. (107,899 ) (109,090 ) (109,090 ) (∂1,191 ) ..........................Current year request ................................................................................................................................................... 12,439 .......................... .......................... ¥12,439 ..........................

Subtotal .......................................................................................................................................................... 120,338 109,090 109,090 ¥11,248 ..........................

Advance appropriation, fiscal year 2020 .................................................................................................................... 109,090 111,340 111,340 ∂2,250 ..........................

Veterans housing benefit program fund: 

(Limitation on direct loans) ........................................................................................................................................ (500 ) (500 ) (500 ) .......................... ..........................Administrative expenses .............................................................................................................................................. 178,626 200,612 200,612 ∂21,986 ..........................

Vocational rehabilitation loans program account ............................................................................................................... 30 39 39 ∂9 ..........................

(Limitation on direct loans) ........................................................................................................................................ (2,356 ) (2,037 ) (2,037 ) (¥319 ) ..........................Administrative expenses .............................................................................................................................................. 395 396 396 ∂1 ..........................

Native American veteran housing loan program account ................................................................................................... 1,163 1,149 1,163 .......................... ∂14 General operating expenses, VBA ........................................................................................................................................ 2,910,000 2,868,909 2,956,316 ∂46,316 ∂87,407 

Total, Veterans Benefits Administration ................................................................................................................. 110,812,380 125,777,866 125,865,287 ∂15,052,907 ∂87,421 

Appropriations .................................................................................................................................................... (3,102,653 ) (4,481,437 ) (4,568,858 ) (∂1,466,205 ) (∂87,421 ) Advance appropriations, fiscal year 2020 ......................................................................................................... (107,709,727 ) (121,296,429 ) (121,296,429 ) (∂13,586,702 ) ..........................Advances from prior year appropriations .......................................................................................................... (103,935,996 ) (107,709,727 ) (107,709,727 ) (∂3,773,731 ) ..........................

Veterans Health Administration: 

Medical services: 

Advance from prior year .............................................................................................................................................. (44,886,554 ) (49,161,165 ) (49,161,165 ) (∂4,274,611 ) ..........................
111 

Current year request 1 ................................................................................................................................................. 1,962,984 .......................... 750,000 ¥1,212,984 ∂750,000 

Subtotal .......................................................................................................................................................... 46,849,538 49,161,165 49,911,165 ∂3,061,627 ∂750,000 

Advance appropriation, fiscal year 2020 .................................................................................................................... 49,161,165 48,747,988 51,411,165 ∂2,250,000 ∂2,663,177 

Medical community care: 

Advance from prior year .............................................................................................................................................. (9,409,118 ) (8,384,704 ) (8,384,704 ) (¥1,024,414 ) ..........................Current year request ................................................................................................................................................... 419,176 .......................... .......................... ¥419,176 ..........................4/13/2018 Budget Amendment ................................................................................................................................... .......................... 500,000 1,000,000 ∂1,000,000 ∂500,000 

Subtotal .......................................................................................................................................................... 9,828,294 8,884,704 9,384,704 ¥443,590 ∂500,000 

Advance appropriation, fiscal year 2020 .................................................................................................................... 8,384,704 14,419,786 10,758,399 ∂2,373,695 ¥3,661,387 Choice Fund ................................................................................................................................................................. .......................... 1,900,000 .......................... .......................... ¥1,900,000 

Medical support and compliance: 

Advance from prior year .............................................................................................................................................. (6,654,480 ) (7,239,156 ) (7,239,156 ) (∂584,676 ) ..........................Current year request ................................................................................................................................................... 100,000 .......................... .......................... ¥100,000 ..........................

Subtotal .......................................................................................................................................................... 6,754,480 7,239,156 7,239,156 ∂484,676 ..........................

Advance appropriation, fiscal year 2020 .................................................................................................................... 7,239,156 7,106,150 7,239,156 .......................... ∂133,006 

Medical facilities: 

Advance from prior year .............................................................................................................................................. (5,434,880 ) (5,914,288 ) (5,914,288 ) (∂479,408 ) ..........................Current year request ................................................................................................................................................... 707,000 .......................... 211,000 ¥496,000 ∂211,000 

Subtotal .......................................................................................................................................................... 6,141,880 5,914,288 6,125,288 ¥16,592 ∂211,000 

Advance appropriation, fiscal year 2020 .................................................................................................................... 5,914,288 5,276,676 6,141,880 ∂227,592 ∂865,204 Medical and prosthetic research ................................................................................................................................ 722,262 727,369 779,000 ∂56,738 ∂51,631 

Medical care cost recovery collections: 

Offsetting collections .................................................................................................................................................. ¥2,507,000 ¥3,590,000 ¥3,590,000 ¥1,083,000 ..........................Appropriations (indefinite) .......................................................................................................................................... 2,507,000 3,590,000 3,590,000 ∂1,083,000 ..........................

Subtotal .......................................................................................................................................................... .......................... .......................... .......................... .......................... ..........................

DoD–VA Joint Medical Funds (by transfer) .......................................................................................................................... (297,137 ) (301,578 ) (301,578 ) (∂4,441 ) ..........................DoD-VA Health Care Sharing Incentive Fund (by transfer) (15,000 ) (15,000 ) (15,000 ) .......................... ..........................

Total, Veterans Health Administration ................................................................................................................... 74,610,735 78,677,969 78,290,600 ∂3,679,865 ¥387,369 

Appropriations ................................................................................................................................................ (3,911,422 ) (3,127,369 ) (2,740,000 ) (¥1,171,422 ) (¥387,369 ) (By transfer) ................................................................................................................................................... (312,137 ) (316,578 ) (316,578 ) (∂4,441 ) ..........................

Advance appropriations, fiscal year 2020 .................................................................................................................. (70,699,313 ) (75,550,600 ) (75,550,600 ) (∂4,851,287 ) ..........................
112 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 

appropriation Budget estimate 

Advances from prior year appropriations ................................................................................................................... (66,385,032 ) (70,699,313 ) (70,699,313 ) (∂4,314,281 ) ..........................

National Cemetery Administration 

National Cemetery Administration ....................................................................................................................................... 306,193 315,836 315,836 ∂9,643 ..........................

Departmental Administration 

General administration ......................................................................................................................................................... 335,891 367,629 365,976 ∂30,085 ¥1,653 Board of Veterans Appeals .................................................................................................................................................. 161,048 174,748 174,748 ∂13,700 ..........................Information technology systems ........................................................................................................................................... 4,055,500 4,184,571 4,184,571 ∂129,071 ..........................Veterans Electronic Health Record ....................................................................................................................................... 782,000 1,207,000 800,000 ∂18,000 ¥407,000 Office of Inspector General .................................................................................................................................................. 164,000 172,054 192,000 ∂28,000 ∂19,946 Construction, major projects ................................................................................................................................................ 512,430 1,127,486 1,127,486 ∂615,056 ..........................Construction, minor projects ................................................................................................................................................ 342,570 706,889 706,889 ∂364,319 ..........................Grants for construction of State extended care facilities ................................................................................................... 110,000 150,000 150,000 ∂40,000 ..........................Grants for the construction of veterans cemeteries ............................................................................................................ 45,000 45,000 45,000 .......................... ..........................

Total, Departmental Administration ....................................................................................................................... 6,508,439 8,135,377 7,746,670 ∂1,238,231 ¥388,707 

Administrative Provisions 

Mandatory disability exams language (Sec. 256) ............................................................................................................... 25,000 .......................... .......................... ¥25,000 ..........................Medical Support and Compliance (Sec. 236) (rescission) .................................................................................................. .......................... .......................... ¥211,000 ¥211,000 ¥211,000 Medical services (Sec. 237) (rescission) ............................................................................................................................. ¥751,000 .......................... .......................... ∂751,000 ..........................VA deferred maintenance (Sec. 248) ................................................................................................................................... 2,000,000 .......................... 2,000,000 .......................... ∂2,000,000 Construction, major projects: 

Sec. 243(a) rescission ................................................................................................................................................. ¥10,000 .......................... .......................... ∂10,000 ..........................Sec. 243(b) reappropriation ........................................................................................................................................ 10,000 .......................... .......................... ¥10,000 ..........................Sec. 243(c) rescission ................................................................................................................................................. ¥410,000 .......................... .......................... ∂410,000 ..........................Sec. 243(d) reappropriation ........................................................................................................................................ 410,000 .......................... .......................... ¥410,000 ..........................
113 

Total Administrative Provisions .............................................................................................................................. 1,274,000 .......................... 1,789,000 ∂515,000 ∂1,789,000 Total, title II ............................................................................................................................................................ 193,511,747 212,907,048 214,007,393 ∂20,495,646 ∂1,100,345 

Appropriations ................................................................................................................................................ (15,853,707 ) (16,060,019 ) (17,371,364 ) (∂1,517,657 ) (∂1,311,345 ) Reappropriations ............................................................................................................................................ (420,000 ) .......................... .......................... (¥420,000 ) ..........................Emergency appropriations ............................................................................................................................. .......................... .......................... .......................... .......................... ..........................Rescissions .................................................................................................................................................... (¥1,171,000 ) .......................... (¥211,000 ) (∂960,000 ) (¥211,000 ) (By transfer) ................................................................................................................................................... (312,137 ) (316,578 ) (316,578 ) (∂4,441 ) ..........................

TITLE III—RELATED AGENCIES 

American Battle Monuments Commission 

Salaries and expenses ......................................................................................................................................................... 79,000 75,100 81,000 ∂2,000 ∂5,900 Foreign currency fluctuations account ................................................................................................................................. .......................... .......................... .......................... .......................... ..........................

Total, American Battle Monuments Commission ................................................................................................... 79,000 75,100 81,000 ∂2,000 ∂5,900 

U.S. Court of Appeals for Veterans Claims 

Salaries and expenses ......................................................................................................................................................... 33,600 107,455 34,955 ∂1,355 ¥72,500 

(Transfer out) .............................................................................................................................................................. .......................... (¥72,500 ) .......................... .......................... (∂72,500 ) 

Department of Defense—Civil 

Cemeterial Expenses, Army 

Salaries and expenses ......................................................................................................................................................... 80,800 70,800 80,800 .......................... ∂10,000 Construction ......................................................................................................................................................................... 167,000 .......................... 56,600 ¥110,400 ∂56,600 

Total, Cemeterial Expenses, Army .......................................................................................................................... 247,800 70,800 137,400 ¥110,400 ∂66,600 

Armed Forces Retirement Home—Trust Fund 

Operation and maintenance ................................................................................................................................................. 41,300 41,300 41,300 .......................... ..........................Capital program ................................................................................................................................................................... 1,000 1,000 1,000 .......................... ..........................Payment from General Fund ................................................................................................................................................ 22,000 22,000 22,000 .......................... ..........................

Total, Armed Forces Retirement Home ................................................................................................................... 64,300 64,300 64,300 .......................... ..........................Total, title III ........................................................................................................................................................... 424,700 317,655 317,655 ¥107,045 ..........................
114 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 

appropriation Budget estimate 

TITLE IV—OVERSEAS CONTINGENCY OPERATIONS 

Overseas Contingency Operations 

Army ...................................................................................................................................................................................... 130,400 69,000 .......................... ¥130,400 ¥69,000 Navy ...................................................................................................................................................................................... 13,390 .......................... .......................... ¥13,390 ..........................Air Force ............................................................................................................................................................................... 275,522 .......................... 69,000 ¥206,522 ∂69,000 Defense–Wide ....................................................................................................................................................................... 22,400 60,000 60,000 ∂37,600 ..........................

Subtotal ................................................................................................................................................................... 441,712 129,000 129,000 ¥312,712 ..........................

European Deterrence/Reassurance Initiative 

Army ...................................................................................................................................................................................... 15,700 192,250 192,250 ∂176,550 ..........................Navy ...................................................................................................................................................................................... 19,858 227,320 227,320 ∂207,462 ..........................Air Force ............................................................................................................................................................................... 270,830 345,800 345,800 ∂74,970 ..........................Defense–Wide ....................................................................................................................................................................... 1,900 27,050 27,050 ∂25,150 ..........................

Subtotal ................................................................................................................................................................... 308,288 792,420 792,420 ∂484,132 ..........................Total, title IV ........................................................................................................................................................... 750,000 921,420 921,420 ∂171,420 ..........................

OTHER APPROPRIATIONS 

DEPARTMENT OF DEFENSE 

Hurricane Supplemental (Public Law 115–123) (emergency) ............................................................................................. 201,636 .......................... .......................... ¥201,636 ..........................Additional Funds (Public Law 115–96) (emergency) .......................................................................................................... 200,000 .......................... .......................... ¥200,000 ..........................Hurricane Supplemental (Public Law 115–123) (emergency) ............................................................................................. 519,345 .......................... .......................... ¥519,345 ..........................

Total, Military Construction .................................................................................................................................... 920,981 .......................... .......................... ¥920,981 ..........................
115 

DEPARTMENT OF VETERANS AFFAIRS 

Veterans Health Administration 

Hurricane Supplemental (Public Law 115–123) (emergency) ............................................................................................. 11,075 .......................... .......................... ¥11,075 ..........................Hurricane Supplemental (Public Law 115–123) (emergency) ............................................................................................. 4,088 .......................... .......................... ¥4,088 ..........................Hurricane Supplemental (Public Law 115–123) (emergency) ............................................................................................. 3,209 .......................... .......................... ¥3,209 ..........................Hurricane Supplemental (Public Law 115–123) (emergency) ............................................................................................. 75,108 .......................... .......................... ¥75,108 ..........................

Total, Veterans Health Administration ................................................................................................................... 93,480 .......................... .......................... ¥93,480 ..........................Total, Further Additional Supplemental Appropriations for Disaster Relief Requirements Act, 2018 .................. 1,014,461 .......................... .......................... ¥1,014,461 ..........................Grand total .............................................................................................................................................................. 205,791,908 224,608,740 225,565,468 ∂19,773,560 ∂956,728 

Appropriations ................................................................................................................................................ (26,412,407 ) (26,840,291 ) (28,051,315 ) (∂1,638,908 ) (∂1,211,024 ) Reappropriations ............................................................................................................................................ (420,000 ) .......................... .......................... (¥420,000 ) ..........................Rescissions .................................................................................................................................................... (¥1,214,000 ) .......................... (¥254,296 ) (∂959,704 ) (¥254,296 ) Advance appropriations, fiscal year 2020 .................................................................................................... (178,409,040 ) (196,847,029 ) (196,847,029 ) (∂18,437,989 ) ..........................Overseas contingency operations .................................................................................................................. (750,000 ) (921,420 ) (921,420 ) (∂171,420 ) ..........................Emergency appropriations ............................................................................................................................. (1,014,461 ) .......................... .......................... (¥1,014,461 ) ..........................

Advances from prior year appropriations ............................................................................................................... (170,321,028 ) (178,409,040 ) (178,409,040 ) (∂8,088,012 ) ..........................(By transfer) ............................................................................................................................................................ (312,137 ) (316,578 ) (316,578 ) (∂4,441 ) ..........................(Limitation on direct loans) .................................................................................................................................... (2,856 ) (2,537 ) (2,537 ) (¥319 ) ..........................

1 $2.1 billion in emergency funding for Medical: Services purposes was appropriated in H. J. Res. 124 in addition to these funds.

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