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[Senate Report 114-153]
[From the U.S. Government Publishing Office]

                                                      Calendar No. 267
114th Congress     }                                    {       Report
                                 SENATE
 1st Session       }                                    {      114-153

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

 
              21ST CENTURY VETERANS BENEFITS DELIVERY ACT

                                _______
                                

                October 19, 2015.--Ordered to be printed

                                _______
                                

         Mr. Isakson, from the Committee on Veterans' Affairs,
                        submitted the following

                              R E P O R T

                         [To accompany S. 1203]

    The Committee on Veterans' Affairs (hereinafter, 
``Committee''), to which was referred the bill (S. 1203) to 
amend title 38, United States Code (hereinafter, ``U.S.C.''), 
to improve the processing by the Department of Veterans Affairs 
(hereinafter, ``VA'' or ``Department'') of claims for benefits 
under laws administered by the Secretary of Veterans Affairs, 
and for other purposes, having considered the same, reports 
favorably thereon with an amendment in the nature of a 
substitute and an amendment to the title and recommends that 
the bill, as amended, do pass.

                              Introduction

    On May 6, 2015, Senator Heller introduced S. 1203, the 
proposed 21st Century Veterans Benefits Delivery Act. S. 1203 
would improve the processing by VA of claims for benefits. 
Senators Casey, Collins, Heinrich, Manchin, Moran, Tester, 
Toomey, and Vitter are original cosponsors. Senators Cochran 
and Coons were later added as cosponsors of the bill. The bill 
was referred to the Committee.
    On January 7, 2015, Senator Heller introduced S. 114, the 
proposed Veterans Affairs Research Transparency Act of 2015. 
S. 114 would require VA to allow public access to research of 
the Department. The bill was referred to the Committee.
    On January 13, 2015, Senator Heller introduced S. 151, the 
proposed Filipino Veterans Promise Act. S. 151 would require 
the Department of Defense (hereinafter, ``DOD'') to establish a 
process for determining whether individuals who served in the 
organized military forces of the government of the Commonwealth 
of the Philippines or in the Philippine Scouts while in the 
service of the United States Armed Forces during World War II 
and who are not included in the Missouri List are eligible for 
certain benefits relating to their service. Senator Hirono is 
an original cosponsor of the bill. The bill was referred to the 
Committee.
    On January 13, 2015, Senator Tester introduced S. 172, the 
proposed Access to Appropriate Immunizations for Veterans Act 
of 2015. S. 172 would include within authorized preventive 
health services available to veterans through VA immunizations 
against infectious diseases, including each immunization on the 
recommended adult immunization schedule established by the 
Advisory Committee on Immunization Practices. The bill was 
referred to the Committee.
    On January 28, 2015, Senator Heller introduced S. 296, the 
proposed Veterans Small Business Opportunity and Protection Act 
of 2015. S. 296 would enhance treatment of certain small 
business concerns for purposes of VA contracting goals and 
preferences. Senator Manchin is an original cosponsor. The bill 
was referred to the Committee.
    On January 28, 2015, Senator Kirk introduced S. 297, the 
proposed Frontlines to Lifelines Act of 2015. S. 297 would 
direct VA to expand and revive, for a 3-year period, VA's 
Intermediate Care Technician (hereinafter, ``ICT'') Pilot 
Program that was carried out between January 2013 and February 
2014. Senators Manchin and Udall are original cosponsors. 
Senators Blunt and Scott were later added as cosponsors of the 
bill. The bill was referred to the Committee.
    On February 5, 2015, Senator Moran introduced S. 398, the 
proposed Chiropractic Care Available to All Veterans Act of 
2015. S. 398 would require the availability of chiropractic 
care and services at all VA medical centers by the end of 2018. 
Senators Blumenthal, Brown, Grassley, King, Tester, and 
Whitehouse are original cosponsors. Senators Baldwin, Collins, 
Durbin, Sanders, Schumer, and Vitter were later added as 
cosponsors of the bill. The bill was referred to the Committee.
    On March 4, 2015, Senator Franken introduced S. 666, the 
proposed Quicker Veterans Benefits Delivery Act of 2015. S. 666 
would prohibit VA from requesting additional medical 
examinations of veterans who have submitted sufficient medical 
evidence provided by non-VA medical professionals. The bill was 
referred to the Committee.
    On March 10, 2015, Senator Toomey introduced S. 695, the 
proposed Dignified Interment of Our Veterans Act of 2015. 
S. 695 would require VA to study and report to Congress on 
matters relating to the interring of veterans' unclaimed 
remains in national cemeteries under the control of VA's 
National Cemetery Administration. The bill was referred to the 
Committee.
    On March 16, 2015, Senator Boozman introduced S. 743, the 
proposed Honor America's Guard-Reserve Retirees Act of 2015. 
S. 743 would honor as a veteran any person entitled to retired 
pay for nonregular (Reserve) service or who, but for age, would 
be so entitled. Senator Donnelly is an original cosponsor of 
the bill. Senators Capito, Cochran, Coons, Franken, Gillibrand, 
Grassley, Heller, Klobuchar, Menendez, Mikulski, Murkowski, 
Peters, Roberts, Rounds, Schatz, Schumer, Stabenow, Tester, 
Toomey, and Wyden were later added as cosponsors of the bill. 
The bill was referred to the Committee.
    On March 25, 2015, Senator Tester introduced S. 865, the 
proposed Ruth Moore Act of 2015. S. 865 would modify VA's 
disability compensation evaluation procedures for veterans with 
mental health conditions related to military sexual trauma. 
Senators Baldwin, Bennet, Collins, Durbin, Gillibrand, King, 
Klobuchar, and McCaskill are original cosponsors. Senators 
Boxer and Shaheen were later added as cosponsors of the bill. 
The bill was referred to the Committee.
    On April 21, 2015, Senator Durbin introduced S. 1021, the 
proposed Wounded Warrior Workforce Enhancement Act. S. 1021 
would direct VA to award grants to eligible institutions to 
establish a master's degree program in orthotics and 
prosthetics or expand upon an existing master's degree program 
in such area. Senator Murphy is an original cosponsor. Senator 
Coons was later added as a cosponsor of the bill. The bill was 
referred to the Committee.
    On May 14, 2015, Senator Murkowski introduced S. 1358, the 
proposed Hmong Veterans' Service Recognition Act. S. 1358 would 
authorize the interment in national cemeteries under the 
control of the National Cemetery Administration of individuals 
who served in combat support of the Armed Forces in the Kingdom 
of Laos between February 28, 1961, and May 15, 1975. Senators 
Franken, Klobuchar, Sullivan, and Whitehouse are original 
cosponsors of the bill. Senators Baldwin, Boxer, and Feinstein 
were later added as cosponsors of the bill. The bill was 
referred to the Committee.

                           Committee Hearings

    On May 13, 2015, the Committee held a hearing on 
legislation pending before the Committee. Testimony was 
received from David R. McLenachen, Acting Deputy Under 
Secretary for Disability Assistance, Department of Veterans 
Affairs; Anthony Kurta, Deputy Assistant Secretary of Defense, 
Military Personnel Policy, Department of Defense; Teresa W. 
Gerton, Deputy Assistant Secretary for Policy, Veterans' 
Employment and Training Service, Department of Labor; Alphonso 
Maldon, Jr., Chairman, Military Compensation and Retirement 
Modernization Commission; Jeffrey E. Phillips, Executive 
Director, Reserve Officers Association; and Aleks Morosky, 
Deputy Legislative Director, National Legislative Service, 
Veterans of Foreign Wars.
    On June 3, 2015, the Committee held a hearing on 
legislation pending before the Committee. Testimony was 
received from Thomas Lynch, Assistant Deputy Under Secretary 
for Health Clinical Operations, Veterans Health Administration, 
Department of Veterans Affairs; Adrian Atizado, Assistant 
National Legislative Director, Disabled American Veterans; Fred 
Benjamin, Vice President and Chief Operating Officer, 
Medicalodges, Inc.; Thomas J. Snee, National Executive 
Director, Fleet Reserve Association; and Sergeant First Class 
Victor Medina, U.S. Army, Retired.
    On June 24, 2015, the Committee held a hearing on 
legislation pending before the Committee. Testimony was 
received from Dr. Rajiv Jain, Assistant Deputy Under Secretary 
for Health for Patient Care Services, Veterans Health 
Administration, Department of Veterans Affairs; Ian de Planque, 
Legislative Director, The American Legion; Pete Hegseth, CEO, 
Concerned Veterans of America; Adrian Atizado, Assistant 
National Legislative Director, Disabled American Veterans; Carl 
Blake, Associate Executive Director, Paralyzed Veterans of 
America; Max Stier, President and CEO, Partnership for Public 
Service; and John Rowan, National President, Vietnam Veterans 
of America.

                           Committee Meeting

    After reviewing the testimony from the foregoing hearings, 
the Committee met in open session on July 22, 2015, to 
consider, among other legislation, an amended version of 
S. 1203, including provisions derived from S. 1203 as 
introduced and provisions derived from the other legislation 
noted above. The Committee voted by voice vote, without 
objection, to report favorably to the Senate S. 1203 as amended 
and as subsequently amended at the Committee meeting.

               Summary of the Committee Bill as Reported

    S. 1203, as reported (hereinafter, ``the Committee bill''), 
consists of 40 sections, summarized below.
    Section 1 provides a short title and a table of contents.

                      TITLE I--HEALTH CARE MATTERS

     SUBTITLE A--EXPANSION AND IMPROVEMENT OF HEALTH CARE BENEFITS

    Section 101 would specify that VA's preventive health 
services include providing each immunization on the recommended 
adult immunization schedule; would require VA to include 
information on those immunizations in VA's annual report to 
Congress; and would require VA to report to Congress on VA's 
quality measures and metrics to ensure that veterans receiving 
medical services from VA receive each immunization.
    Section 102 would require the increased provision of 
chiropractic care services to veterans at VA medical 
facilities.

                 SUBTITLE B--HEALTH CARE ADMINISTRATION

    Section 111 would authorize $5 million for the purpose of 
VA developing a partnership with institutions of higher 
education to expand programs of advanced degrees in prosthetics 
and orthotics.
    Section 112 would require VA to establish a free, publicly-
available Web site that aggregates information on Department 
research data files; would direct VA to require that any final, 
peer-reviewed manuscript using VA-funded research data be 
submitted to a free, publicly-available Web site; and would 
require the VA-DOD Joint Executive Committee to prepare 
recommendations for establishing a program for long-term 
cooperation and data sharing to facilitate research.
    Section 113 would require VA to revive the Intermediate 
Care Technician Pilot Program.
    Section 114 would require that, in a case in which VA hires 
a health care provider who is or was employed by the Secretary 
of Defense, provided health care services, and was credentialed 
by DOD, the Secretary of Defense must transfer its 
credentialing data regarding that provider to VA upon VA's 
request.
    Section 115 would, in certain circumstances, require VA 
emergency rooms to provide medical screenings and treatment to 
individuals requesting examination or treatment.

              SUBTITLE C--IMPROVEMENT OF MEDICAL WORKFORCE

    Section 121 would require VA to include in its training 
program for health professionals education and training of 
marriage and family therapists and licensed professional mental 
health counselors.
    Section 122 would expand the qualifications for an 
individual to be appointed as a VA licensed professional mental 
health counselor to include individuals with a doctoral degree 
in mental health counseling.
    Section 123 would include physician assistants in the list 
of VA health care personnel who receive pay that is competitive 
with non-VA health care facilities.
    Section 124 would require VA to submit to Congress a report 
on VA's medical workforce.

           TITLE II--COMPENSATION AND OTHER BENEFITS MATTERS

                 SUBTITLE A--BENEFITS CLAIMS SUBMISSION

    Section 201 would express the sense of Congress that DOD 
should establish a process to allow veterans service 
organizations to be present for Transition Assistance Program 
(hereinafter, ``TAP'') seminars related to filing a VA 
disability claim and require DOD to submit to Congress a report 
on participation of veterans service organizations in TAP.
    Section 202 would require VA to make available to the 
public information on the average length of time it takes VA to 
adjudicate an appeal filed within 180 days after VA's initial 
decision and the average length of time it takes VA to 
adjudicate an appeal not filed within 180 days after VA's 
initial decision and require VA to submit a report reflecting 
the number of appeals filed within 180 days and not filed 
within 180 days before and after VA begins publishing those 
statistics.
    Section 203 would provide that a hearing before the Board 
of Veterans' Appeals (hereinafter, ``Board'' or ``BVA'') will 
be conducted as the Board considers appropriate, either in 
person or through video conferencing. However, upon request 
from an appellant, the hearing will be held as the appellant 
considers appropriate, either in person or through video 
conferencing.

 SUBTITLE B--PRACTICES OF REGIONAL OFFICES RELATING TO BENEFITS CLAIMS

    Section 211 would require the Government Accountability 
Office (hereinafter, ``GAO'') to complete a review of the VA 
regional offices to help the Veterans Benefits Administration 
achieve more consistent performance in the processing of claims 
for disability compensation, including an assessment of the 
effectiveness of communication between the regional offices and 
veterans service organizations and caseworkers of Members of 
Congress.
    Section 212 would require VA to include in its annual 
budget submission information regarding the number of claims a 
full-time employee can process in a year, based on a time and 
motion study and other information VA considers appropriate; a 
description of actions VA will take to improve claims 
processing; and an assessment of the effects of actions to 
improve claims processing identified in the prior budget.
    Section 213 would require VA to submit to Congress a report 
outlining the criteria and procedures VA will use to determine 
the appropriate staffing levels at regional offices once VA 
transitions to the National Work Queue for distribution of 
claims processing workload.
    Section 214 would require VA to submit to Congress annual 
reports on VA's progress in implementing the Veterans Benefits 
Management System. This requirement would sunset 3 years after 
enactment.
    Section 215 would require VA to submit to Congress a report 
that details the plans to reduce the inventory of VA's non-
rating workload.
    Section 216 would express the sense of Congress that VA 
should include in its Monday Morning Workload Report 
information regarding the workload of fully-developed claims at 
each regional office and enhanced information regarding pending 
appeals.

                   SUBTITLE C--OTHER BENEFITS MATTERS

    Section 221 would provide that, notwithstanding any law 
regarding the licensure of physicians, certain physicians may 
conduct an examination pursuant to a contract with VA at any 
location in any state, the District of Columbia, or a 
Commonwealth, territory, or possession of the United States, so 
long as the examination is within the scope of the authorized 
duties under such contract and the physician is licensed in at 
least one state.
    Section 222 would require VA and the Chief of the National 
Guard Bureau to jointly develop and implement procedures to 
improve the timely provision to VA of information in possession 
of the National Guard Bureau that VA requires to process claims 
for VA benefits and then submit a report describing the 
requests for information from the National Guard Bureau and the 
timeliness of responses.
    Section 223 would direct VA, in consultation with DOD, to 
review the process for determining whether certain individuals 
have the requisite service requirements for purposes of 
receiving specific Filipino veterans' benefits.
    Section 224 would require VA to provide a report on the 
furnishing of general and specialty medical examinations for 
purposes of claims for VA benefits.
    Section 225 would express the sense of Congress that VA 
should report to Congress on claims based on post-traumatic 
stress disorder alleged to have been incurred or aggravated by 
military sexual trauma.

                      TITLE III--EDUCATION MATTERS

    Section 301 would add sections 12304a and 12304b of title 
10, U.S.C., to the list of authorities in sections 16131 and 
16133 of title 10, U.S.C., under which a Reservist may regain 
lost payments and lost entitlement for the Montgomery GI Bill-
Selected Reserve education program when that activation 
authority is used to order a Reservist to active duty, 
preventing the Reservist from completing his/her studies.
    Section 302 would require educational institutions to 
report annually to VA on the academic progress of students for 
whom it receives payments under the Post-9/11 GI Bill. The 
Secretary of Veterans Affairs would be required to include this 
information in the annual report to Congress on the Post-9/11 
GI Bill.
    Section 303 would require the Secretary of Defense to 
include in its annual report to Congress on the Post-9/11 GI 
Bill the highest level of education attained by each individual 
who transfers his/her Post-9/11 GI Bill benefits to eligible 
dependents.
    Section 304 would require the Secretary concerned to 
collect upon separation the highest level of education attained 
by each member of the Armed Forces.

              TITLE IV--EMPLOYMENT AND TRANSITION MATTERS

    Section 401 would require the Department of Labor's 
Director of Veterans' Employment and Training for each state to 
coordinate his/her activities with the state agencies for labor 
and veterans affairs.
    Section 402 would require an annual report from states to 
include the number of job fairs attended by One-Stop Career 
Center employees at which they had contact with a veteran and 
the number of veterans at each event so contacted.
    Section 403 would require the Secretary of Labor to review 
the challenges employers face in hiring veterans and the 
information sharing among Federal departments and agencies 
serving veterans and separating servicemembers.
    Section 404 would require the Secretary of Defense, in 
consultation with the Secretaries of Veterans Affairs and 
Labor, to review the Transition GPS Core Curriculum and report 
to Congress recommendations on its effectiveness, allocation of 
the roles and responsibilities of Federal departments in the 
program, optimizing each topic by length of instruction and 
whether or not it is mandatory, and developing metrics for 
assessment of the program.
    Section 405 would clarify that preseparation counseling 
shall not be provided to a servicemember discharged before 
completion of 180 continuous days on active duty.

                TITLE V--VETERAN SMALL BUSINESS MATTERS

    Section 501 would permit the surviving spouse of a veteran 
owner of a small business, who is less than 100 percent 
disabled and whose death is not a result of a service-connected 
disability, to maintain the status of such small business 
concern for up to 3 years following the death of such veteran.
    Section 502 would permit the surviving spouse of a 
servicemember, who owns at least 51 percent of a small business 
concern and dies in the line of duty, to maintain the status of 
such small business concern for up to 10 years following the 
death of such servicemember.

                        TITLE VI--BURIAL MATTERS

    Section 601 would require VA to complete a study on matters 
relating to the interring of unclaimed remains of veterans in 
national cemeteries and submit a report to Congress on the 
findings of the study.

                        TITLE VII--OTHER MATTERS

    Section 701 would honor as veterans certain individuals who 
performed service in the Reserve components of the Armed 
Forces.
    Section 702 would require VA, in consultation with DOD and 
such agencies or individuals VA considers appropriate, to 
submit a report to Congress on the extent to which Laotian 
military forces provided combat support to the Armed Forces of 
the United States between February 28, 1961, and May 15, 1975; 
whether the current classification by the DOD Civilian/Military 
Service Review Board is appropriate; and any recommendations 
for legislative action.
    Section 703 would revert to the 2011 rates the reporting 
fees that are paid to educational institutions.

                       Background and Discussion

                      TITLE I--HEALTH CARE MATTERS

     SUBTITLE A--EXPANSION AND IMPROVEMENT OF HEALTH CARE BENEFITS

Sec. 101. Improved access to appropriate immunizations for veterans.

    Section 101 of the Committee bill, which is derived from 
S. 172, would clarify that the term ``preventive health 
services'' encompasses immunizations against infectious 
diseases, including each immunization on the recommended adult 
immunization schedule at the time such immunization is 
indicated on that schedule; require VA to report on programs 
conducted to ensure that veterans have received recommended 
immunizations at the appropriate time; and direct VA to 
develop, implement, and report on quality measures and metrics 
to ensure that veterans receiving VA medical services receive 
each recommended immunization at the appropriate time.
    Background. To promote health and prevent diseases among 
veterans, VA delivers preventive health services, which 
includes providing immunizations against infectious diseases. 
Recommendations on immunizations for adults are made by the 
Advisory Committee on Immunization Practices, an entity that 
advises the Secretary of the Department of Health and Human 
Services and is supported by the Centers for Disease Control 
and Prevention (hereinafter, ``CDC''). That advisory committee 
publishes an immunization schedule for adults. Veterans, 
particularly those at high-risk for vaccine-preventable 
diseases, may benefit from receiving each immunization on the 
recommended adult immunization schedule, as appropriate.
    Committee Bill. Subsection (a) of section 101 of the 
Committee bill would amend section 1701(9)(F) of title 38, 
U.S.C., to clarify that the term ``preventive health services'' 
encompasses immunizations against infectious diseases, 
including each immunization on the recommended adult 
immunization schedule at the time such immunization is 
indicated on that schedule. It would also clarify that the term 
``recommended adult immunization schedule'' means the schedule 
established (and periodically reviewed and, as appropriate, 
revised) by the Advisory Committee on Immunization Practices 
established by the Secretary of Health and Human Services and 
delegated to the CDC.
    Subsection (b) of section 101 of the Committee bill would 
amend section 1704(1)(A) of title 38, U.S.C., to require VA to 
report to Congress not later than October 31 each year on 
programs conducted during the previous fiscal year to ensure 
that veterans have received each immunization on the 
recommended adult immunization schedule at the time such 
immunization is indicated on that schedule.
    Subsection (c) of section 101 of the Committee bill would 
require VA to submit to Congress, within 2 years of enactment, 
a report on the development and implementation of quality 
measures and metrics to ensure that veterans receiving medical 
services from VA receive each immunization on the recommended 
adult immunization schedule at the time such immunization is 
indicated on that schedule.

Sec. 102. Expansion of provision of chiropractic care and services to 
        veterans.

    Section 102 of the Committee bill, which is derived from 
S. 398, would require VA to expand the provision of 
chiropractic services.
    Background. Pursuant to Public Law 107-135, the Department 
of Veterans Affairs Health Care Programs Enhancement Act of 
2001, VA carries out a program to provide chiropractic services 
to veterans through VA Medical Centers (hereinafter, ``VAMCs'') 
and community-based outpatient clinics (hereinafter, 
``CBOCs''). VA is required to designate at least one site in 
each Veterans Integrated Service Network (hereinafter, 
``VISN'') to offer chiropractic services. As of July 1, 2015, 
59 VAMCs and CBOCs provide chiropractic services and VA employs 
73 doctors of chiropractic.
    According to data published by the Department in June 2015, 
more than 61 percent of Operation Enduring Freedom/Operation 
Iraqi Freedom/Operation New Dawn veterans who sought health 
care from the Department over the period of the first quarter 
of fiscal year (hereinafter, ``FY'') 2002 through the first 
quarter of FY 2015 were treated for musculoskeletal ailments. 
Chiropractic therapy can assist with some of these types of 
ailments and injuries.
    Committee Bill. Subsection (a) of section 102 of the 
Committee bill would require that the provision of chiropractic 
care and services be available in at least two VAMCs or clinics 
in each VISN not later than 2 years after enactment of the bill 
and at least 50 percent of VAMCs and clinics in each VISN not 
later than 3 years after enactment.
    Subsection (b) of section 102 of the Committee bill would 
expand the definitions of ``medical services,'' 
``rehabilitative services,'' and ``preventive health services'' 
in section 1701 of title 38, U.S.C., to include chiropractic 
care or services.

                 SUBTITLE B--HEALTH CARE ADMINISTRATION

Sec. 111. Expansion of availability of prosthetic and orthotic care for 
        veterans.

    Section 111 of the Committee bill, which is derived from 
S. 1021, would authorize $5 million to VA for FY 2017 for the 
purpose of developing partnerships with institutions of higher 
education to expand programs of advanced degrees in prosthetics 
and orthotics.
    Background. Currently, veterans can access prosthetic and 
orthotic services through all 150 VAMCs. According to VA, 79 of 
these facilities include accredited VA orthotic and prosthetic 
providers. The remaining locations provide services through 
contracted and fee-based care.
    In 2009, the decision was made by the American Board for 
Certification in Orthotics, Prosthetics and Pedorthics and the 
Board of Certification Accreditation International that a 
master's degree would be the entry level of education required 
for certification in these fields. While certified providers 
were allowed to continue their practice, all new providers were 
required to attain this education level for certification as of 
2012.
    Following over 10 years of war, there is an increased need 
for prosthetics and orthotics services for the management of 
complex injuries. Furthermore, as clinicians in the field 
certified prior to this new degree requirement begin to retire, 
they must be replaced with qualified professionals certified at 
the master's degree level. Therefore, it is important for VA to 
ensure a sufficient number of certified providers will be 
available to provide orthotic and prosthetic care to veterans 
in the years to come.
    While the need for certified prosthetists and orthotists is 
significant, only a small number of schools nationwide offer 
master's and doctoral programs in these fields. Therefore, a 
key component to ensuring an adequate supply of certified 
professionals available to serve veterans lies in VA's 
collaboration with institutions of higher education for the 
expansion and creation of education and training programs.
    Committee Bill. Section 111 of the Committee bill would, in 
a freestanding provision, require VA to take a set of actions 
to expand the number of potential prosthetic and orthotic 
clinicians across the country. Subsection (a) of section 111 of 
the Committee bill would expand the availability of prosthetic 
and orthotic care for veterans by requiring VA to work with 
institutions of higher education for the establishment or 
expansion of advanced degree programs in prosthetics and 
orthotics.
    Subsection (b) of section 111 of the Committee bill would 
require VA to develop and submit a report to the Committee on 
Veterans' Affairs of the Senate and House of Representatives 
setting forth a plan for carrying out subsection (a). VA would 
be required to develop such a plan in consultation with 
veterans service organizations, institutions of higher 
education with accredited degree programs in prosthetics and 
orthotics, and representatives from the prosthetics and 
orthotics field.
    Five million dollars would be authorized in subsection (c) 
of section 111 of the Committee bill to be appropriated to VA 
for FY 2017, which would remain available for expenditure until 
September 30, 2019. Subsection (d) of section 111 of the 
Committee bill requires this section to take effect 1 year 
after the date of enactment of the Committee bill.

Sec. 112. Public access to Department of Veterans Affairs research and 
        data sharing between Departments.

    Section 112 of the Committee bill, which is derived from 
S. 114, would direct VA to enhance public access to information 
on VA's research data files and publications based on research 
funded by VA. This section would also require that VA and DOD 
jointly formulate recommendations for long-term cooperation and 
data-sharing to facilitate research.
    Background. A number of government agencies and departments 
provide funding for research to advance health care, including 
the National Institutes of Health and VA. The focus of this 
research varies across agencies and departments, with VA 
assuming primary responsibility for funding research to improve 
health care for our nation's veterans. VA maintains numerous 
data files that can be used in research to improve veterans' 
health care. For example, VA maintains data files on the cost 
of care veterans receive and researchers may use those files to 
examine the cost effectiveness of various treatments. However, 
many researchers face numerous obstacles in their attempts to 
access those files. These obstacles may result in delays in 
improvements of health care for veterans.
    VA-funded research has not only contributed to numerous 
innovations in veterans' health care, it has made valuable 
contributions to health care overall. Previously, many 
clinicians, veterans, and others lacked access to information 
on these innovations because publications based on this 
research were often only available through subscriptions to 
various scholarly journals, which were cost prohibitive for 
many. VA has made progress in improving public access to peer-
reviewed publications from VA-funded research in compliance 
with the Objectives for Public Access to Scientific 
Publications described in the February 22, 2013, Memorandum to 
the Heads of Executive Departments and Agencies regarding 
increasing access to the results of Federally-funded scientific 
research. However, the Committee notes that the new public 
access requirements apply to VA-funded research and VA 
employees only.
    Like VA, DOD maintains research data files and VA and DOD 
have, in certain instances, shared their data for research on 
topics of importance to both servicemembers and veterans. For 
example, VA has partnered with DOD on two research consortia 
focused on traumatic brain injury and post-traumatic stress 
disorder. The findings from these consortia, particularly in 
the areas of biomarkers and advanced brain imaging, are 
expected to fuel new advances in traumatic brain injury and 
post-traumatic stress disorder care. Additional research is 
needed to inform care and services for servicemembers, 
veterans, and their families. It is important that VA and DOD 
work together to minimize unnecessary barriers researchers 
experience when trying to access data for scholarly purposes.
    Committee Bill. Subsection (a) of section 112 of the 
Committee bill would require VA to make information on VA data 
files, including the contents of such files, and instructions 
for how to access such files for use in research publicly 
available on a VA Web site.
    Subsection (b) of section 112 would require VA to ensure 
that manuscripts based on VA-funded research are available for 
free to the public through a digital archive established by VA 
or another executive agency, consistent with available 
copyright law. This subsection would also require VA, within 1 
year of when VA begins ensuring that publications are submitted 
to a digital archive, to submit an annual report on the 
implementation of this subsection during the most recent 1-year 
period to the Committee on Veterans' Affairs of the Senate and 
House of Representatives.
    Subsection (c) of section 112 of the Committee bill would 
require the VA and DOD Joint Executive Committee to establish a 
program for long-term cooperation and data-sharing to 
facilitate research.
    Subsection (d) of section 112 would define the term 
``executive agency'' with the same meaning in section 133 of 
title 41, U.S.C.
    Subsection (e) establishes the effective date for section 
112 as 1 year after the date of enactment of the Committee 
bill. The Committee intends that VA comply with section 112 by 
continuing ongoing efforts by VA and other departments directed 
at making data from Federally-funded research publicly 
available. The Committee also intends that existing 
requirements, including those that require VA-funded 
investigators place published manuscripts on the National 
Institutes of Health PubMed database and that VA-funded 
clinical trial results be available through the 
ClinicalTrials.gov archive, continue to be utilized as a part 
of fulfilling the requirements of section 112 of the Committee 
bill.

Sec. 113. Revival of Intermediate Care Technician Pilot Program of 
        Department of Veterans Affairs.

    Section 113 of the Committee bill, which is derived from 
S. 297, would require VA to revive the Intermediate Care 
Technician Pilot Program.
    Background. Starting in January 2013 through February 2014, 
the Veterans Health Administration created a pilot program to 
increase veterans hiring and serve as a conduit for future 
medical professionals. The original Intermediate Care 
Technician Pilot Program hired veteran medics and corpsmen to 
function as skilled nursing assistants in VA Emergency 
Departments (hereinafter, ``ED''). Because of their past role 
in the military, veteran medics and corpsmen often have more 
experience than VA's traditional ED technician. VA selected 45 
veterans to serve as ICTs at 15 VA EDs for 13 months. According 
to the ``ICT After Action Report'' dated August 2014, ``ICT's 
made a positive impact on patient care in the Emergency 
Departments'' and after the pilot's conclusion ``the 15 
facilities overwhelming[ly] supported the expansion of the ICT 
role.''
    Committee Bill. Section 113 of the Committee bill would, in 
a freestanding provision, require the revival of the 
Intermediate Care Technician Pilot Program.
    Specifically, subsection (a) of section 113 of the 
Committee bill would require the revival of the ICT Pilot 
Program.
    Subsection (b) of section 113 of the Committee bill would 
direct the Secretary of Veterans Affairs to select at least 45 
ICTs to participate in the ICT Pilot Program. Subsection (b) 
directs VA, in determining the facilities to participate in the 
pilot program, to give priority to facilities with the longest 
wait times for appointments.
    Subsection (c) of section 113 of the Committee bill would 
designate that the duration of the pilot program would be 3 
years.
    Subsection (d) of section 113 of the Committee bill would 
define the terms ``hospital care'' and ``medical services'' 
with the same meaning in section 1701 of title 38, U.S.C.
    Subsection (e) of section 113 of the Committee bill 
specifies that this section will become effective 1 year after 
enactment.

Sec. 114. Transfer of health care provider credentialing data from 
        Secretary of Defense to Secretary of Veterans Affairs.

    Section 114 of the Committee bill, which is derived from 
S. 297, would require, in the instance a health care provider 
is or was employed by DOD, the Secretary of Defense to transfer 
the credentials of that provider to VA upon VA's request.
    Background. According to a March 9, 2015, report from VA 
entitled ``A Report Assessing the Staffing Needs of Each 
Medical Facility within the Department of Veterans Affairs,'' 
VA will need to hire an additional 10,682 full-time staff to 
provide direct care to veterans. The hiring process at VA can 
be lengthy, particularly for hiring medical professionals whose 
credentials and licenses must be verified prior to starting 
employment with the agency. Requiring DOD to transfer a 
provider's credentials upon his/her hiring at a VA facility 
could shorten and improve VA's hiring process.
    Committee Bill. In a freestanding provision, section 114 of 
the Committee bill would address the transfer of credentialing 
data from DOD to VA. Subsection (a) of section 114 of the 
Committee bill would direct the Secretary of Defense to 
transfer to the Secretary of Veterans Affairs the credentialing 
data of a covered health care provider upon the request of the 
Secretary of Veterans Affairs.
    Subsection (b) of section 114 of the Committee bill defines 
a covered health care provider as an individual who is or was 
employed by the Secretary of Defense, provides or provided 
health care related services, and was credentialed by the 
Secretary of Defense.
    Subsection (c) of section 114 of the Committee bill would 
direct the Secretaries of Defense and Veterans Affairs to 
establish policies through regulations to carry out this 
section.
    Subsection (d) of section 114 of the Committee bill defines 
credentialing as the process of screening and evaluating a 
health care provider's qualifications and credentials, 
including licensure, education, training and experience, and 
current competence and health status.
    Subsection (e) of section 114 of the Committee bill 
specifies that this section will become effective 1 year after 
enactment.

Sec. 115. Examination and treatment by Department of Veterans Affairs 
        for emergency medical conditions and women in labor.

    Section 115 of the Committee bill, which is derived from an 
amendment offered by Senator Murray at the Committee meeting on 
July 22, 2015, would require VA to ensure all of its hospitals 
with emergency departments are providing appropriate 
stabilizing treatment for emergency medical conditions and 
labor.
    Background. The Emergency Medical Treatment and Active 
Labor Act (hereinafter, ``EMTALA''), originally enacted as a 
part of Public Law 99-272, the Consolidated Omnibus Budget 
Reconciliation Act of 1985, requires all hospitals that accept 
payment from the Department of Health and Human Services, 
Centers for Medicare and Medicaid Services, Medicare program to 
either provide treatment to any individual at or within 250 
yards of such a hospital who is seeking emergency treatment or 
stabilize that individual prior to transfer to another 
facility. Although VA hospitals are not subject to EMTALA by 
law, the Veterans Health Administration Handbook 1101.05 states 
VA practice is to provide evaluations and emergency care that 
is compliant with EMTALA. Because inpatient VA facilities 
currently do not always offer the same care as other hospitals 
that would provide emergency care, particularly as relates to 
labor and delivery care, the exact requirements of how EMTALA 
applies to VA facilities is not always clear.
    Committee Bill. Section 115 of the Committee bill would add 
a new section, 1784A, to title 38, U.S.C., to require any VA 
facility with an emergency department to provide stabilizing 
care in the form of an examination or treatment for an 
emergency medical condition for any individual who is on the 
campus of the hospital and requests treatment or has a request 
for treatment made on his/her behalf.
    In this section, an emergency medical condition means a 
medical condition with acute symptoms of sufficient severity, 
including severe pain, such that the lack of immediate medical 
attention could reasonably be expected to result in putting the 
individual's health in serious jeopardy, serious impairment to 
bodily functions, or serious dysfunction of any bodily organ or 
part. With respect to a pregnant woman who is having 
contractions, an emergency medical condition includes a 
situation in which there is inadequate time to safely transfer 
her to another hospital before delivery or one in which a 
transfer would pose a threat to the health or safety of the 
woman or unborn child. The treatment provided would be that 
within the existing capability of the emergency department 
including services routinely provided by an emergency 
department to determine whether an emergency medical condition 
exists. Under this section, the campus of a hospital includes 
the physical area immediately adjacent to the main buildings of 
the hospital, other areas or structures within 250 yards from 
the main building and any other areas the Secretary of Veterans 
Affairs determines are part of the hospital.
    It is the intent of the Committee that VA facilities take 
reasonable efforts to ensure that individuals with an emergency 
medical condition are stabilized, that no material 
deterioration of the condition is likely, with reasonable 
medical probability, to occur during transfer of the individual 
from a medical facility. In the case of a pregnant woman, that 
includes delivery during transfer. Under this section, 
transferring means a person employed by, or person affiliated 
or associated with, the hospital directing the movement of an 
individual from the hospital unless the individual has been 
declared dead or leaves the facility without permission of any 
such person.
    A hospital is deemed to meet the requirements of this 
section if it offers information about a medical examination 
and treatment, including the risks and benefits of that 
examination and treatment to the individual or person acting on 
the individual's behalf and that individual or person acting on 
the individual's behalf refuses treatment. The hospital is also 
considered to have met the requirements of this section if it 
offers to transfer the individual and that individual or person 
acting on behalf of the individual refuses treatment. In cases 
in which an examination, treatment, or transfer is not done 
because an individual does not consent, the hospital shall take 
all reasonable steps to obtain the written informed consent of 
the individual refusing the examination, treatment, or 
transfer.
    The section requires that a hospital first stabilize a 
patient before any transfer occurs. That requirement does not 
apply to an appropriate transfer to another facility if the 
individual or a person legally acting on behalf of the 
individual has been informed of the risks of transfer and 
requests a transfer to another medical facility in writing or a 
physician of the Department has signed a certification that the 
medical benefits reasonably expected from providing appropriate 
medical treatment at another medical facility outweigh the 
increased risks. If a physician of the Department is not 
physically present in the emergency department at the time, a 
qualified medical person as defined by the Secretary of 
Veterans Affairs for the purposes of this section may sign a 
certification after the physician of the Department has made 
the required determination. The certification must include a 
summary of the risks and benefits upon which the certification 
was based.
    An appropriate transfer under this section is one in which 
the transferring hospital provides the available medical 
treatment within its capacity to minimize the risks of health 
to the individuals involved, the receiving facility has the 
space and personnel available to treat the individual and 
agrees to provide the treatment, the transferring hospital 
sends the receiving facility all medical records or copies of 
medical records that are available and relate to the 
individual's emergency medical condition, and the transfer is 
done using all necessary and medically appropriate life support 
measures through qualified personnel and transportation 
equipment. The Secretary of Veterans Affairs may also include 
other requirements related to the health and safety of 
individuals transferred in order for a transfer to be 
considered appropriate. The information in the record should 
include observations of signs or symptoms, any preliminary 
diagnosis, any treatment provided, the results of any tests, 
and the informed written consent (or copy of) requesting the 
transfer.

              SUBTITLE C--IMPROVEMENT OF MEDICAL WORKFORCE

Sec. 121. Inclusion of mental health professionals in education and 
        training program for health personnel of the Department of 
        Veterans Affairs.

    Section 121 of the Committee bill, which is derived from an 
amendment offered by Senator Tester at the Committee meeting on 
July 22, 2015, would require the Secretary of Veterans Affairs 
to include education and training of marriage and family 
therapists and licensed professional mental health counselors 
in required education and training programs.
    Background. Pursuant to Public Law 109-461, the Veterans 
Benefits, Health Care, and Information Technology Act of 2006, 
VA is authorized to hire licensed professional mental health 
counselors and marriage and family therapists to provide 
veterans with appropriate behavioral health services. However, 
those professionals make up less than 1 percent of VA's 
behavioral health workforce, a significantly lower percentage 
than in other parts of the health care delivery system. In the 
overall behavioral health care workforce, mental health 
counselors and marriage and family therapists represent forty 
percent of the workforce.
    Behavioral health care is a specialty that is very much in 
demand both at VA and in the overall health care delivery 
system. In 2014, VA data showed that it provided specialized 
mental health treatment to more than 1.4 million veterans and 
the Department expects to complete 12.7 million outpatient 
visits for recipients of VA mental health care in FY 2016. 
Appropriate and accessible training for a variety of behavioral 
health care providers is important to ensure access to timely, 
quality care.
    Section 7302(a)(1) of title 38, U.S.C., requires VA to 
conduct education and training programs to better serve 
veterans within VA's health care system and also to play a 
leadership role in educating future health care professionals 
for the entire health care delivery system.
    Committee Bill. Section 121 of the Committee bill would 
require VA to include the education and training of marriage 
and family therapists and licensed professional mental health 
counselors in the education and training programs that are 
authorized under section 7302(a)(1) of title 38, U.S.C.

Sec. 122. Expansion of qualifications for licensed mental health 
        counselors of the Department of Veterans Affairs to include 
        doctoral degrees.

    Section 122 of the Committee bill, which is derived from an 
amendment offered by Senator Tester at the Committee meeting on 
July 22, 2015, would require VA to include doctoral degrees in 
VA's qualifications for licensed mental health counselors.
    Background. Section 7402(b)(11)(A) of title 38, U.S.C., 
specifies the levels of training that are necessary to be 
eligible to hold specific positions within VA. This section 
restricts the criteria for mental health counselors to master's 
degrees. Many training programs for mental health counselors 
are at the master's level, which typically take about 2 or 3 
years to complete and include direct clinical experience as a 
requirement for graduation. Doctoral degrees also include 
clinical experience requirements along with a research 
component and typically take 5 years to complete. Under current 
law, mental health counselors working in VA must have master's 
degrees, but candidates with doctoral degrees are not eligible 
for positions within VA despite having additional years of 
training.
    Committee Bill. Section 122 of the Committee bill would 
amend section 7402(b)(11)(A) of title 38, U.S.C., to expand the 
qualifications of licensed mental health counselors to include 
those with a doctoral degree.

Sec. 123. Requirement that physician assistants employed by the 
        Department of Veterans Affairs receive competitive pay.

    Section 123 of the Committee bill, which is derived from an 
amendment offered by Senator Tester at the Committee meeting on 
July 22, 2015, would include physician assistants in the types 
of providers who are eligible for locality pay.
    Background. Section 7451(a)(2) of title 38, U.S.C., allows 
VA to ensure that rates of pay for health care personnel 
positions within VA facilities are competitive with the rates 
of pay in non-VA facilities in the same labor market area. This 
allows VA to operate on fair footing with other potential 
health care employers that would be competing to hire for the 
same or similar positions. VA is explicitly authorized to use 
locality pay for registered nurses and the positions listed in 
section 7401(1) and (3) of title 38, U.S.C. Although the 
Secretary of Veterans Affairs is able to appoint other 
specialties to the list, this authority has yet to be utilized.
    VA is affiliated with more than 30 accredited physician 
assistant education programs and offers continuing medical 
education programs, tuition support programs, education debt 
reduction programs, and employee incentive scholarship programs 
as incentives to help grow the number of physician assistants 
within VA. However, physician assistant positions can still be 
difficult for facilities to fill. According to a September 2015 
VA Inspector General review entitled, Office of Inspector 
General Determination of Veterans Health Administration's 
Occupational Staffing Shortages, physician assistants were the 
occupation with the fourth largest staffing shortages for 2014.
    Committee Bill. Section 123 of the Committee bill modifies 
section 7451(a)(2) of title 38, U.S.C., to allow VA to offer 
rates of pay that are competitive with non-VA facilities within 
the same labor market areas when hiring for physician assistant 
positions.

Sec. 124. Report on medical workforce of the Department of Veterans 
        Affairs.

    Section 124 of the Committee bill, which is derived from an 
amendment offered by Senator Tester at the Committee meeting on 
July 22, 2015, would require the Secretary of Veterans Affairs 
to submit a report on the medical workforce of VA.
    Background. VA operates the largest integrated health care 
system in the nation, comprised of 150 VA medical centers, 830 
community-based outpatient clinics, 136 community-living 
centers, 300 Vet Centers, and 80 mobile Vet Centers. These 
sites of care employ nearly 300,000 employees and serve nearly 
7 million unique patients. In the past year, VA's patient 
workload has increased by 10.5 percent.
    For a number of years, GAO and the VA Inspector General 
have reported that inadequate staffing and gaps in hiring 
health care professionals at VA medical facilities across the 
country have adversely impacted patient care. Issues related to 
recruiting and retaining a capable workforce also became a 
focus last summer following the VA Inspector General's report 
about Phoenix.
    In comparison to other segments of health care services at 
VA, demand for behavioral health services is one of the fastest 
growing. Between FY 2013 and FY 2014, VA witnessed a 4.4 
percent increase in the number of veterans receiving mental 
health care. To help meet the behavioral health needs of 
veterans, VA can hire a variety of mental health professionals, 
including psychiatrists, psychologists, and social workers, as 
well as licensed professional mental health counselors and 
marriage and family therapists.
    Section 7601, et seq. of title 38, U.S.C., provides VA with 
authority to carry out VA's Health Professionals Education 
Assistance Program to provide scholarships, tuition assistance, 
debt reduction assistance, and other educational programs to VA 
health care professionals. The Health Professionals Education 
Assistance Program serves as a recruitment and retention tool 
for the Department. The Veterans Access, Choice, and 
Accountability Act of 2014, Public Law 113-146, increased from 
$60,000 to $120,000 the cap on debt reduction payments to an 
individual participant in the Education Debt Reduction Program. 
Additionally, Public Law 113-175, the Department of Veterans 
Affairs Expiring Authorities Act of 2014, allows VA to pay 
student loan expenses directly, rather than require the 
participant to pay upfront.
    Committee Bill. Subsection (a) of section 124 of the 
Committee bill would, in a freestanding provision, require VA 
not later than 120 days after enactment to submit to the 
Committee on Veterans' Affairs of the Senate and House of 
Representatives a report regarding the medical workforce at VA.
    Subsection (b) of section 124 of the Committee bill 
specifies that the report shall include details related to the 
number of licensed professional mental health counselors and 
marriage and family therapists at VA and a description of the 
actions taken by VA in consultation with the Director of the 
Office of Personnel Management to create an occupational series 
for such counselors and therapists, including a timeline among 
other things. This subsection also indicates the report should 
include a breakdown of spending by VA in connection with its 
Education Debt Reduction Program during the 3 years prior to 
release of the report; an update on the efforts of the 
Secretary of Veterans Affairs to offer training opportunities 
in telemedicine to medical residents in VA medical facilities 
that use telemedicine, consistent with medical residency 
program requirements established by the Accreditation Council 
for Graduate Medical Education, as required in section 108(b) 
of Public Law 112-154, the Honoring America's Veterans and 
Caring for Camp Lejeune Families Act of 2012; and an assessment 
of the development and implementation by the Secretary of 
Veterans Affairs of succession planning policies to address the 
prevalence of vacancies in positions in the Veterans Health 
Administration of more than 180 days.

           TITLE II--COMPENSATION AND OTHER BENEFITS MATTERS

                 SUBTITLE A--BENEFITS CLAIMS SUBMISSION

Sec. 201. Participation of veterans service organizations in Transition 
        Assistance Program.

    Section 201 of the Committee bill, which is derived from 
S. 1203 as introduced, would express the sense of Congress that 
DOD should establish a process to allow veterans service 
organizations to be present for TAP seminars related to filing 
a VA disability claim and would require DOD to submit to 
Congress a report on participation of veterans service 
organizations in TAP.
    Background. Under section 1144 of title 10, U.S.C., the 
Departments of Defense, Homeland Security, Veterans Affairs, 
and Labor are required to carry out TAP, which provides 
multiple days of seminars to servicemembers who are separating 
from the military. Although those seminars outline benefits 
that separating servicemembers may be eligible to receive from 
VA, representatives from veterans service organizations who are 
authorized to represent veterans applying for VA benefits are 
generally not present. A memorandum from the Secretary of 
Defense, dated in December 2014, entitled ``Installation Access 
and Support Services for Nonprofit Non-Federal Entities'' 
encourages installation commanders to permit non-profit 
entities to provide services to servicemembers and their 
families on military installations.
    Committee Bill. Section 201(a) of the Committee bill would 
express the sense of Congress that the Secretary of Defense, in 
collaboration with the Secretary of Labor, the Secretary of 
Homeland Security, and the Secretary of Veterans Affairs, 
should establish a process by which a representative of a 
veterans service organization may be present at any portion of 
TAP relating to the submittal of claims to VA for disability 
compensation or dependency and indemnity compensation.
    Section 201(b) of the Committee bill would require DOD, not 
later than 18 months after enactment, to submit to Congress a 
report on participation of veterans service organizations in 
TAP. The report must include an assessment of the compliance of 
DOD facilities with the directives included in the Secretary of 
Defense memorandum entitled ``Installation Access and Support 
Services for Nonprofit Non-Federal Entities''; the number of 
military bases that have complied with those directives; and 
how many veterans service organizations have been present at a 
portion of TAP.
    Section 201(c) of the Committee bill would define veterans 
service organization as any organization recognized by VA for 
representation of veterans under section 5902 of title 38, 
U.S.C.

Sec. 202. Requirement that Secretary of Veterans Affairs publish the 
        average time required to adjudicate timely and untimely 
        appeals.

    Section 202 of the Committee bill, which is derived from 
S. 1203 as introduced, would require VA to make publicly 
available information on the time it takes VA to adjudicate 
timely appeals and untimely appeals and would require VA to 
submit a report reflecting the number of timely appeals and 
untimely appeals filed before and after VA begins publishing 
those statistics.
    Background. Under current law, section 7105(b) of title 38, 
U.S.C., a claimant has 1 year to file a Notice of Disagreement 
(hereinafter, ``NOD'') after the date on which VA mails notice 
of an initial decision on a claim for benefits. If a claimant 
waits until the end of the 1-year period to file an NOD, VA may 
be required to re-develop the record to ensure that the 
evidence is current. Data from VA suggests that VA is able to 
process appeals with less delay if the NOD is filed during the 
first 180 days of the appeal period. In FY 2011, 2012, and 
through August 31, 2013, where the agency of original 
jurisdiction received an NOD more than 180 days after the date 
the decision was mailed, it took, on average, 46.5 additional 
days to decide the appeal. In FY 2014, the Veterans Benefits 
Administration resolved appeals in an average of 561 days if 
the appeal was filed within the first 180 days, compared to an 
average of 595 days for NODs filed more than 180 days after 
notice of the decision.
    In its FY 2016 budget submission, VA included a legislative 
proposal to reduce from 1 year to 60 days the time period 
within which an NOD must be filed after the initial decision. 
Before determining whether the appeal period should be 
shortened, it is the view of the Committee that it would be 
useful to ascertain whether it would encourage more claimants 
to file their appeals within the first 180 days of the appeal 
period if they are made aware that appeals are resolved more 
quickly when they do so.
    Committee Bill. In a freestanding provision, section 202 of 
the Committee bill would address information on processing 
appeals. Section 202(a) of the Committee bill would require VA, 
on an on-going basis, to make available to the public the 
average length of time it takes for VA to adjudicate a timely 
appeal and the average length of time it takes VA to adjudicate 
an untimely appeal. This requirement would take effect 1 year 
after enactment and would apply until 3 years after enactment.
    Section 202(b) would require VA to submit to the Committee 
on Veterans' Affairs of the Senate and House of Representatives 
a report on whether publication of that data has had an effect 
on the number of timely appeals that are filed. Specifically, 
the report would include the number of appeals and timely 
appeals filed during the 1-year period before the requirement 
to publish the data takes effect and the number of appeals and 
timely appeals filed during the 1-year period beginning 1 year 
after the requirement to publish the data takes effect.
    Section 202(c) would define a ``timely'' appeal for these 
purposes as meaning an appeal filed not more than 180 days 
after the date VA mails notice of the initial decision and an 
``untimely'' appeal as meaning an appeal filed more than 180 
days after VA mails notice of the initial decision.

Sec. 203. Determination of manner of appearance for hearings before 
        Board of Veterans' Appeals.

    Section 203 of the Committee bill, which is derived from 
S. 1203 as introduced, would allow the Board of Veterans' 
Appeals to determine whether a hearing will be held through 
video conference rather than in-person, unless the appellant 
requests a specific type of hearing.
    Background. Under current law, section 7107(d) of title 38, 
U.S.C., an individual who appeals to the Board of Veterans' 
Appeals may request a hearing at the Board's location in 
Washington, DC, or at a VA facility outside of Washington, DC 
(a field hearing). Further, under section 7107(e) of title 38, 
U.S.C., VA may provide equipment so that hearings outside of 
the Washington, DC, area can be conducted through video 
teleconference technology with Board members located in DC. If 
VA has made that technology available, the Chairman of the 
Board may allow appellants the opportunity to participate in a 
hearing using video teleconference technology, rather than 
having an in-person hearing with a Board member.
    According to the Fiscal Year 2013 Annual Report of the 
Board of Veterans' Appeals, in FY 2013, the Board conducted 
11,431 hearings, 51 percent of which were via video 
teleconferencing. In that report, the Board noted that, by 
increasing the percent of hearings conducted by video 
teleconference, ``the Board reduced its travel costs by 26 
percent and reduced down time faced by [Veterans Law Judges] 
when traveling to in-person hearing sites.'' In FY 2014, the 
Board then conducted 10,879 hearings and 54 percent were video 
teleconference hearings. More recently, VA provided this 
testimony before the Senate Veterans' Affairs Committee in May 
2015 regarding the content of section 203:

          The Board has historically been able to schedule 
        video conference hearings more quickly than in-person 
        hearings, saving valuable time in the appeals process 
        for Veterans who elect this type of hearing. In FY 
        2014, on average, video conference hearings were held 
        124 days sooner than in-person hearings before a 
        Veterans Law Judge * * * at a Regional Office Travel 
        Board hearing * * *.

           *       *       *       *       *       *       *

        * * * Enactment of [this provision] could also lead to 
        an increase in the number of final decisions for 
        Veterans as a result of increased productivity at the 
        Board. Time lost due to travel and time lost in the 
        field due to appellants failing to show up for their 
        hearing would be greatly reduced, allowing [Veterans 
        Law Judges] to better focus their time and resources on 
        issuing final Board decisions for Veterans.

    Committee Bill. Section 203 of the Committee bill would 
amend section 7107 of title 38, U.S.C., to provide that a 
hearing before the Board will be conducted, as the Board 
considers appropriate, either in person or through picture and 
voice transmission. It would further provide that, upon request 
by an appellant, a hearing before the Board will be conducted 
as the appellant considers appropriate, either in person or 
through picture and voice transmission.
    Amended section 7107 would also provide that, in a case in 
which a hearing before the Board is to be conducted through 
picture and voice transmission, VA must provide suitable 
facilities and equipment to the Board or other components of VA 
to enable an appellant located at an appropriate facility 
within the area served by a regional office to participate in 
the hearing. Amended section 7107 would further provide that 
any hearing conducted through picture and voice transmission 
must be conducted in the same manner as, and must be considered 
the equivalent of, a personal hearing. Finally, it would 
provide that, in a case in which a hearing before the Board is 
to be conducted in person, the hearing must be held at the 
principal location of the Board or at a VA facility located 
within the area served by a VA regional office.
    The amendments made by section 203 of the Committee bill 
would apply to cases received by the BVA pursuant to NODs 
submitted on or after the date of enactment.
    The Committee is of the view that allowing the Board the 
flexibility to conduct a greater percentage of hearings through 
video conferencing could reduce delays and increase 
productivity. However, the Committee also intends to ensure 
that an appellant will retain the option to appear in person 
for a Board hearing, if the appellant so desires.

 SUBTITLE B--PRACTICES OF REGIONAL OFFICES RELATING TO BENEFITS CLAIMS

Sec. 211. Comptroller General review of claims processing performance 
        of regional offices of Veterans Benefits Administration.

    Section 211 of the Committee bill, which is derived from 
S. 1203 as introduced, would require a GAO review of VA 
regional offices.
    Background. VA processes claims for disability benefits at 
56 regional offices around the country. In its Monday Morning 
Workload Report, VA publicly reports a number of performance 
outcomes with regard to each regional office, including the 
average number of days it takes to complete a claim, the 
quality of decisions, and the percentage of claims considered 
backlogged. Those performance outcomes reflect that there are 
significant differences in how quickly and how accurately the 
various regional offices process disability claims. For 
example, VA's Monday Morning Workload Report reflects that, as 
of July 25, 2015, the percentage of claims backlogged at the 
regional offices ranged from less than 20 percent to nearly 50 
percent and the claim-level accuracy ranged from less than 85 
percent to more than 97 percent.
    Committee Bill. Section 211(a) and (b) of the Committee 
bill would require GAO to complete a review of VA's regional 
offices in order to help the Veterans Benefits Administration 
achieve more consistent performance in the processing of claims 
for disability compensation. The review would include an 
identification of the factors that distinguish higher 
performing regional offices from other regional offices, 
including management practices; the best practices employed by 
higher performing regional offices that distinguish the 
performance of those offices from other regional offices; and 
other management practices or tools that could be used to 
improve the performance of regional offices.
    The review would also include an assessment of the 
effectiveness of communication with respect to the processing 
of claims between the regional offices and veterans service 
organizations and caseworkers employed by Members of Congress.
    The review must be completed by not later than 15 months 
after the date that is 270 days after the date of enactment. 
GAO would be required to submit to the Committee on Veterans' 
Affairs of the Senate and House of Representatives a report on 
the results of that review.

Sec. 212. Inclusion in annual budget submission of information on 
        capacity of Veterans Benefits Administration to process 
        benefits claims.

    Section 212 of the Committee bill, which is derived from 
S. 1203 as introduced, would require VA to include in its 
annual budget submissions additional information regarding the 
capacity of the Veterans Benefits Administration to process 
claims for VA benefits.
    Background. In its annual budget submission, VA typically 
includes information regarding the total number of claims for 
VA benefits that it expects to process in the year covered by 
the budget and the total number of staff VA is requesting to 
process those claims. However, the budget submission generally 
does not reflect a breakdown of the number of claims each 
employee should be able to process in a single year (without 
relying on mandatory overtime) or the information VA would use 
to determine how many claims each employee should be able to 
process, such as a time and motion study. The budget submission 
also does not generally include an assessment of the claims 
processing initiatives that were funded by Congress in the 
prior budget year and what impact each initiative had on VA's 
ability to process claims. All of that information would allow 
Congress to better assess the efficacy of VA's staffing 
requests for claims processing employees and overall request 
for claims processing activities.
    Committee Bill. In a freestanding provision, section 212(a) 
and (b) of the Committee bill would require VA to include in 
its annual budget submission information on the capacity of the 
Veterans Benefits Administration to process claims for VA 
benefits, including an estimate of the average number of claims 
for benefits that a single full-time equivalent employee can 
process in a year (excluding claims completed during mandatory 
overtime), based on a time and motion study and such other 
information as the Secretary considers appropriate; a 
description of the actions VA will take to improve the 
processing of claims; and an assessment of the actions VA 
identified in the previous year that would be taken to improve 
claims processing and the effects of those actions. This 
requirement would apply with respect to the budget submitted 
for FY 2017 and any fiscal year thereafter.

Sec. 213. Report on staffing levels at regional offices of Department 
        of Veterans Affairs after transition to National Work Queue.

    Section 213 of the Committee bill, which is derived from 
S. 1203 as introduced, would require VA to submit to Congress a 
report on the criteria and procedures that will be used to 
determine the appropriate staffing levels at regional offices 
once VA transitions to the National Work Queue.
    Background. In general, each VA regional office has 
traditionally received claims from veterans and their families 
in the surrounding geographic area. The Veterans Benefits 
Administration would then use a tool--called the Resource 
Allocation Model--in order to determine how many claims 
processing employees to assign to each VA regional office based 
on the workload at that office. According to VA, the Resource 
Allocation Model ``uses a weighted model to assign compensation 
and pension [full-time equivalent] resources based on regional 
office * * * workload in rating receipts, rating inventory, 
non-rating receipts, and appeals receipts.'' In FY 2016, the 
Veterans Benefits Administration plans to transition to a 
workload management system--called the National Work Queue--
that will allow the VA Central Office to distribute claims-
related workload among regional offices based on available 
capacity to handle that workload. Once VA transitions to that 
workload management system, it is unclear what factors will be 
considered in determining how to allocate employees among the 
regional offices.
    Committee Bill. In a freestanding provision, section 213 of 
the Committee bill would require VA, not later than 15 months 
after enactment, to submit to the Committee on Veterans' 
Affairs of the Senate and House of Representatives a report on 
the criteria and procedures that VA will use to determine 
appropriate staffing levels at the regional offices once VA has 
transitioned to using the National Work Queue for the 
distribution of claims processing work.

Sec. 214. Annual report on progress in implementing Veterans Benefits 
        Management System.

    Section 214 of the Committee bill, which is derived from 
S. 1203 as introduced, would require VA to submit to Congress a 
report, not later than each of 1 year, 2 years, and 3 years 
after enactment, on the progress in implementing the Veterans 
Benefits Management System (hereinafter, ``VBMS'').
    Background. In response to the tremendous claims backlog, 
VA set out to transform the way it administers claims for 
benefits. In 2012, VBMS, a web-based electronic claims 
processing solution, was launched under a pilot program at five 
VA regional offices. As of today, VBMS is used at 148 VA 
facilities. According to VA, it moved from a points-based work 
credit system dependent on employee-user input to a system that 
can automatically capture employees' transactions, activities, 
claims completions, and timeliness. VA has set a goal of 
eliminating the claims backlog in 2015 and processing all 
claims within 125 days with 98 percent accuracy.
    The Committee has heard concerns about the ability of VBMS 
to process claims that are complicated or have a significant 
number of issues, as well as concerns over the interoperability 
of certain functions within VA with VBMS.
    Committee Bill. In a freestanding provision, section 214 of 
the Committee bill would require VA to submit reports to 
Congress annually on the progress in implementing VBMS. The 
report is required to include an assessment of the current 
functionality of VBMS, recommendations submitted to VA by 
employees involved in claims processing for legislative or 
administrative action considered appropriate to improve the 
processing of claims, and recommendations submitted to VA by 
veterans service organizations who use VBMS for legislative or 
administrative action considered appropriate to improve the 
system.
    The reporting requirement would sunset 3 years after 
enactment.
    Given the importance of delivering benefits to our nation's 
veterans in an accurate and timely manner, it is essential for 
VA to assess VBMS and solicit valuable recommendations from 
employees and veterans service organizations that use the 
system, while providing that information to Congress for 
oversight.

Sec. 215. Report on plans of Secretary of Veterans Affairs to reduce 
        inventory of non-rating workload.

    Section 215 of the Committee bill, which is derived from 
S. 1203 as introduced, would require VA to submit to Congress a 
report on VA's plans to reduce the inventory of non-rating work 
pending at the Veterans Benefits Administration.
    Background. In its Monday Morning Workload Report, the 
Veterans Benefits Administration reports its claims-related 
workload in a number of different categories, including rating-
related work (such as initial claims for disability 
compensation) and non-rating work (such as requests for 
increased compensation based on addition of a dependent). Each 
category of work is given a specific label--called an End 
Product. In reporting its statistics on the ``backlog'' of 
disability claims, VA includes work items from only certain 
rating-related End Products.
    In recent years, there has been a large increase in the 
number of pending non-rating work items that do not fall under 
VA's definition of the backlog. In July 2014, the VA Inspector 
General's office testified before the House Committee on 
Veterans' Affairs that, ``[a]lthough [the Veterans Benefits 
Administration's] reported backlog has decreased by over 50 
percent since March 2013, other workloads such as appeals 
management and benefit reductions have had significant 
corresponding increases.'' In fact, between October 2010 and 
July 2015, the number of pending dependency adjustments for 
compensation recipients grew from less than 50,000 to more than 
220,000. Over that period, similar increases have been seen in 
non-rating categories of work that VA labels as Correspondence 
(increased from 7,963 to 104,601), Miscellaneous determinations 
(increased from 26,700 to 142,058), Due process (increased from 
19,540 to 125,707), and many others.
    Committee Bill. In a freestanding provision, section 215 of 
the Committee bill would require VA, not later than 120 days 
after enactment, to submit to the Committee on Veterans' 
Affairs of the Senate and House of Representatives a report 
that details VA's plans to reduce the inventory of work items 
listed in the Monday Morning Workload Report under End Products 
130 (Dependency--compensation), 137 (Dependency--pension), 173 
(Pre-decisional hearings), 290 (Misc. determinations), 400 
(Correspondence), 600 (Due process--compensation), 607 (Due 
process--pension), 690 (Cost of Living Adjustments and Social 
Security number verification), 930 (Review, including quality 
assurance), and 960 (Correction of errors).

Sec. 216. Sense of Congress on increased transparency relating to 
        claims for benefits and appeals of decisions relating to 
        benefits in Monday Morning Workload Report.

    Section 216 of the Committee bill, which is derived from 
S. 1203 as introduced, would express the sense of Congress that 
VA should include in the Monday Morning Workload Report 
additional information regarding fully-developed claims and 
appeals.
    Background. In July 2014, the VA Inspector General's office 
testified before the House Committee on Veterans' Affairs that 
``[a] key concern is the increased appeals inventory at [VA 
regional offices'' and that ``[t]his workload has continued to 
grow at an alarming rate.'' Although VA's Monday Morning 
Workload Report includes some information about the number of 
pending appeals at the regional offices, it does not provide 
sufficient information to ascertain how well each regional 
office is performing with respect to its appeals inventory.
    Similarly, VA's Web site includes information about the 
time it takes the Veterans Benefits Administration as a whole 
to complete disability claims that are fully-developed when 
submitted to VA but does not contain sufficient information to 
ascertain how well each regional office is performing with 
respect to those types of claims.
    Committee Bill. Section 216 of the Committee bill would 
express the sense of Congress that VA should include in the 
Monday Morning Workload Report the number of fully-developed 
claims received by each regional office; the number of those 
claims that are pending at each office; and the number of those 
claims that have been pending a decision for more than 125 
days. In addition, it would express the sense of Congress that 
VA should include in the Monday Morning Workload Report 
enhanced information about pending appeals, including the 
information currently contained in VA reports entitled 
``Appeals Pending'' and ``Appeals Workload by Station.''

                   SUBTITLE C--OTHER BENEFITS MATTERS

Sec. 221. Modification of pilot program for use of contract physicians 
        for disability examinations.

    Section 221 of the Committee bill, which is derived from 
S. 1203 as introduced, would allow certain licensed physicians 
performing compensation and pension examinations pursuant to a 
contract with VA to perform the examinations in any state, 
territory, possession, Commonwealth, or the District of 
Columbia, without the need to obtain another license.
    Background. Under section 504 of Public Law 104-275, VA was 
authorized to conduct a pilot program to use mandatory funding 
to provide compensation and pension examinations through the 
use of contractors. Currently, a physician providing an 
evaluation under this authority must be licensed in the state 
or territory in which the examination takes place. That means, 
if the contractor wishes to send its physicians to another 
state to help alleviate a backlog of examination requests, 
those physicians would first need to apply for a license in 
that other state. On the other hand, medical professionals who 
work directly for the Veterans Health Administration are 
authorized to work at VA facilities in any state or territory, 
as long as they are licensed in at least one state. In May 
2015, VA testified before the Senate Committee on Veterans' 
Affairs that granting a similar authority to these contract 
examiners ``would help provide flexibility in examinations 
through non-VA medical providers while maintaining licensure 
standards and accelerating benefits delivery.''
    Committee Bill. Section 221 of the Committee bill would 
modify the authority for the pilot program to provide that, 
notwithstanding any law regarding the licensure of physicians, 
a physician described below may conduct an examination pursuant 
to a contract entered into under the authority granted in 
Public Law 104-275 at any location in any state, the District 
of Columbia, or a Commonwealth, territory, or possession of the 
United States, so long as the examination is within the scope 
of the authorized duties under such contract. This new 
authority would apply to a physician who has a current license 
to practice the health care profession of the physician and is 
performing authorized duties for VA pursuant to a contract for 
compensation and pension examinations.

Sec. 222. Development of procedures to increase cooperation with 
        National Guard Bureau.

    Section 222 of the Committee bill, which is derived from 
S. 1203 as introduced, would require VA and the Chief of the 
National Guard Bureau to jointly develop and implement 
procedures to improve the timely provision to VA of records 
required to process claims for VA benefits.
    Background. Under current law, section 5103A of title 38, 
U.S.C., VA has a duty to assist claimants in obtaining evidence 
necessary to substantiate a claim for benefits. This duty to 
assist requires VA to obtain certain Federal records, including 
service treatment records. The Veterans Benefits Administration 
has often cited delays in obtaining service records as one 
reason for delays in processing disability claims, particularly 
for claims involving the Guard and Reserves.
    Committee Bill. In a freestanding provision, section 222 of 
the Committee bill would require the Secretary of Veterans 
Affairs and the Chief of the National Guard Bureau to jointly 
develop and implement procedures, including requirements 
relating to timeliness, to improve the timely provision to VA 
of such information in the possession of the Chief as VA 
requires to process claims submitted to VA for benefits. Not 
later than 1 year after implementation of those procedures, VA 
and the Chief would be required to jointly submit to Congress a 
report describing the requests for information relating to 
records of members of the National Guard made by VA to the 
Chief pursuant to those procedures and the timeliness of the 
responses of the Chief to those requests.

Sec. 223. Review of determination of certain service in Philippines 
        during World War II.

    Section 223 of the Committee bill, which is derived from 
S. 151, would require VA to review the process used to 
determine whether certain individuals served in support of the 
Armed Forces of the United States during World War II.
    Background. Public Law 111-5, the American Recovery and 
Reinvestment Act of 2009 (hereinafter, ``ARRA'') authorized the 
payment of a one-time, lump-sum benefit to eligible World War 
II Philippine veterans. The deadline to apply for this benefit 
was February 16, 2010.
    Under the ARRA, veterans who served before July 1, 1946, in 
the organized military forces of the government of the 
Commonwealth of the Philippines, while such forces were in the 
service of the Armed Forces of the United States, members of 
the organized guerrilla forces under commanders appointed, 
designated, or subsequently recognized by the Commander-in-
Chief, Southwest Pacific Area, or other competent authority in 
the Army of the United States, and individuals who served in 
the Philippine Scouts under section 14 of the Armed Forces 
Voluntary Recruitment Act of 1945 were all eligible to apply 
for the benefit.
    During the 1-year filing period, the Veterans Benefits 
Administration received 42,755 claims. As of August 1, 2015, 
18,951 claims for benefits were granted; 23,804 claims were 
denied; and 9 reopened claims were pending. 4,561 appeals of 
denied claims were received; 63 appeals were still pending; and 
3 appeals were overturned by the Board of Veterans' Appeals.
    Due to the difficulty in verifying eligible service, 
Filipino veteran advocates have expressed concern that the 
process for determining eligibility is flawed. Recognizing 
these concerns, in October 2012, the White House Initiative on 
Asian Americans and Pacific Islanders created the Filipino 
Veterans Equity Compensation Fund Interagency Working Group to 
analyze the process faced by Filipino veterans in demonstrating 
eligibility for the lump-sum benefit. The Interagency Working 
Group found the United States Army's process to determine 
service is appropriate.
    Committee Bill. In a freestanding provision, section 223 of 
the Committee bill would require VA to review the process used 
to determine whether Filipino veterans served in support of the 
Armed Forces during World War II. VA would be required to 
consult DOD and military historians recommended by DOD during 
this review and submit a report to the Committee on Veterans' 
Affairs of the Senate and House of Representatives detailing 
findings, actions taken, or recommendations for legislative 
action.
    The Committee recognizes the actions already undertaken in 
this area. However, given the advanced age of veterans who 
might be eligible for the benefit, it is appropriate to make 
certain that all avenues for reviewing the process by which 
eligibility is determined have been exhausted.

Sec. 224. Reports on Department disability medical examinations and 
        prevention of unnecessary medical examinations.

    Section 224 of the Committee bill, which is derived from 
S. 666, would require VA to submit a report on the provision of 
medical examinations for purposes of adjudicating claims and a 
plan to prevent the ordering of unnecessary medical 
examinations.
    Background. Under section 5125 of title 38, U.S.C., to 
establish eligibility for benefits VA may accept a report of a 
medical examination conducted by a private physician if the 
report is sufficiently complete to be adequate for purposes of 
adjudicating a claim.
    Despite this authority, the Committee frequently hears 
concerns that VA dismisses private medical evidence and orders 
VA medical examinations despite sufficient private medical 
evidence, which could be used to make a decision on a claim. 
For example on March 13, 2013, Joseph Violante, Legislative 
Director of Disabled American Veterans at the time of the 
hearing, stated:

        We hear from the field, from our people, that in some 
        cases where the medical evidence is sufficient to be 
        rated, the fact that it comes in from a private 
        physician triggers an unnecessary examination.

    VA has also acknowledged efficiencies may be achieved by 
reducing unnecessary medical examinations provided by VA. For 
example, in 2013, VA launched the Acceptable Clinical Evidence 
initiative to help alleviate the need for medical examinations 
provided by VA. This initiative allows VA medical providers to 
perform assessments without an in-person examination when 
sufficient information already exists. The Acceptable Clinical 
Evidence initiative enables a VA medical provider to complete a 
Disability Benefits Questionnaire by reviewing existing medical 
evidence and supplementing such evidence with information 
obtained during a telephone interview with the veteran. VA 
reports that this initiative has reduced the average time is 
takes to complete a Disability Benefits Questionnaire from 25 
days to 8 days.
    In evaluating claims for disabilities involving the 
musculoskeletal system, section 4.40 of title 38, Code of 
Federal Regulations (hereinafter, ``C.F.R.''), (Functional 
loss) requires an assessment of the impact of the disability on 
the performance of ``the normal working movements of the body 
with normal excursion, strength, speed, coordination and 
endurance.'' Following the court's decision in DeLuca v. Brown, 
8 Vet. App. 202 (1995), VA developed a medical examination 
which evaluates the effect of repetitive motion on normal 
working movements, by having the claimant perform an activity 
three times in the examining physician's office.
    During oversight visits, VA physicians have indicated to 
staff that the ``three repetition requirement'' does not 
provide a scientifically sound basis for evaluating the effect 
of repetitive motion on ``normal working movements,'' such as 
those performed during a normal 8-hour work day. Physicians 
have expressed concern about the time it takes to perform 
repetitive motion actions on joints for which no disability is 
alleged.
    Committee Bill. Section 224 of the Committee bill would, in 
a freestanding provision, require VA to submit, within 18 
months of enactment, a report on the provision of medical 
examinations for purposes of adjudicating claims and a plan to 
prevent the ordering of unnecessary medical examinations. There 
are two distinct reporting requirements contained in section 
224 of the Committee bill.
    The first reporting requirement requires VA to submit a 
report on the furnishing of general medical and specialty 
medical examinations. The report must include the number of 
general medical examinations furnished by VA during FY 2011 
through FY 2014. The report must also include the number of 
specialty medical examinations furnished by VA during the same 
time period. Additionally, the report must include a summary of 
medical and scientific studies that provide a basis for 
determining that three repetitions of a joint movement is 
adequate to assess the effect of repetitive motion on 
functional loss when assessing range of motion during joint 
examinations. The report must identify all examination reports 
used for evaluation of compensation and pension disability 
claims which require measurements of repeated ranges of motion 
testing. Finally, the report would include the number of 
examinations for FY 2014 that required such measurements, the 
average amount of time taken to perform the three repetitions 
of movement method for each joint, a discussion of whether 
there are more efficient and effective methods of testing range 
of motion, and recommendations on whether to continue the 
practice of measuring functional impairment by using the three 
repetitions of movement method.
    The second reporting requirement requires VA to submit a 
report on VA efforts to reduce the need for in-person 
disability examinations and use of the authority provided by 
section 5125 of title 38, U.S.C. This report would contain 
information on the Acceptable Clinical Evidence initiative. It 
would also contain information on any other efforts to further 
encourage the use of medical evidence provided by a private 
health care provider and the reliance upon reports of a medical 
examination or a medical opinion administered by a private 
physician if such report is sufficiently complete to be 
adequate for the purposes of adjudicating a claim for service-
connection. Under this second requirement, VA would also have 
to submit a plan to measure, track, and prevent the ordering of 
unnecessary medical examinations and actions to eliminate 
requests for medical examinations when the record contains 
medical evidence and/or opinions provided by a private health 
care provider that is adequate for purposes of making a 
decision on a claim.
    Further, Congress has provided authority to allow VA to 
accept private medical evidence and take actions consistent 
with this authority to improve the timeliness and accuracy of 
claims decisions. It is the Committee's intent that VA continue 
to ensure medical examinations are appropriate and used 
efficiently.

Sec. 225. Sense of Congress on submittal of information relating to 
        claims for disabilities incurred or aggravated by military 
        sexual trauma.

    Section 225 of the Committee bill, which is derived from 
S. 865, would express the sense of Congress that VA should 
submit an annual report to Congress on claims for disabilities 
alleged to have been incurred or aggravated by military sexual 
trauma.
    Background. VA's efforts to improve the adjudication of 
disability claims based on military sexual trauma remains an 
issue of concern to the Committee. In the ``Department of 
Defense Fiscal Year 2014 Annual Report on Sexual Assault in the 
Military,'' DOD estimates that 18,900 servicemembers 
experienced unwanted sexual contact in 2014, which is a 
decrease from the 26,000 servicemembers estimated in 2012. 
Other data, derived from VA's national screening program, 
reveal that about 1 in 4 women and 1 in 100 men receiving 
health care at VA report experiencing military sexual trauma.
    The Committee has received testimony from advocacy groups 
stressing the need for continued oversight of VA's efforts to 
improve the adjudication of disability claims related to 
military sexual trauma.
    Committee Bill. Section 225 of the Committee bill, in a 
freestanding provision, would express the sense of Congress 
that VA should submit an annual report to Congress on claims 
for disabilities alleged to have been incurred or aggravated by 
military sexual trauma.
    Section 225 of the Committee bill specifies that the 
contents of each such report should include specific 
information on the adjudication of disability claims related to 
military sexual trauma. Specifically, the report would include 
(1) the number and percentage of claims submitted by each 
gender that were approved and denied; (2) the rating percentage 
assigned for claims that were approved disaggregated by gender; 
(3) the three most common reasons for denials; and (4) the 
number of denials based on the failure of a veteran to report 
for a medical examination. The report should include this same 
information for claims that were resubmitted after a denial in 
a previous adjudication. Finally, the annual report should also 
include the number of claims pending and on appeal and the 
average number of days from submission to completion of a claim 
during the past fiscal year.
    The Committee recognizes VA's ongoing efforts to improve 
the adjudication of claims based on military sexual trauma. 
However, continued oversight, such as the reporting 
requirements of this section, would allow the Committee to make 
more informed decisions about what future action, if any, may 
be necessary to ensure survivors of military sexual trauma 
receive the benefits to which they are entitled.

                      TITLE III--EDUCATION MATTERS

Sec. 301. Retention of entitlement to educational assistance during 
        certain additional periods of active duty.

    Section 301 of the Committee bill, which is an original 
provision, would add two active duty authorities to the 
existing authorities under which a Reservist may regain lost 
payments or lost entitlement for the Montgomery GI Bill-
Selected Reserve program if activation under such authority 
prevented the completion of his/her studies.
    Background. Section 12304a of title 10, U.S.C., allows the 
Secretary of Defense to order any Reserve unit, or member not 
assigned to a unit, to active duty for up to 120 days in order 
to respond to a Governor's request for Federal assistance in a 
major disaster or emergency. Section 12304b of title 10, 
U.S.C., authorizes military Secretaries to order up to 60,000 
members of the Selected Reserve to active duty for a period up 
to 365 days in order to augment active forces for preplanned 
missions. Under both of these authorities, a servicemember may 
be ordered to active duty without his/her consent and the 
notification requirements and length of typical mobilizations 
make it unlikely such service would require a Reserve member to 
not complete a course in which he/she is enrolled, but it 
remains a possibility.
    Sections 16131 and 16133 of title 10, U.S.C., list five 
authorities for mobilizing the Reserves under which a Reservist 
receiving educational assistance under the Montgomery GI Bill-
Selected Reserve program would not have such assistance charged 
against his/her entitlement to benefits. This prevents 
Reservists from losing benefits when service under these 
authorities interrupts their studies and prevents them from 
earning credit for a certain term.
    Section 522 of the DOD legislative proposals sent to 
Congress for inclusion in the FY 2016 National Defense 
Authorization Act contained the provisions now included in 
section 301 of the Committee bill.
    Committee Bill. Section 301 of the Committee bill would add 
sections 12304a and 12304b of title 10, U.S.C., to the list of 
authorities in sections 16131 and 16133 of title 10, U.S.C., 
under which a Reservist may regain lost payments and lost 
entitlement for Montgomery GI Bill-Selected Reserve education 
benefits when that activation authority prevented the Reservist 
from completing his/her studies.

Sec. 302. Reports on progress of students receiving Post-9/11 
        Educational Assistance.

    Section 302 of the Committee bill, which is an original 
provision, would require educational institutions to report 
annually to VA on the academic progress of students for whom it 
receives payments under the Post-9/11 GI Bill. The Secretary of 
Veterans Affairs would be required to include this information 
in the annual report to Congress on the Post-9/11 GI Bill.
    Background. The National Defense Authorization Act of FY 
2013 (Public Law 112-239) established the Military Compensation 
and Retirement Modernization Commission (hereinafter, 
``MCRMC'') to conduct a review of the military compensation and 
retirement systems and to make recommendations to modernize 
such systems. The MCRMC issued its final report in January 2015 
that included 15 recommendations around Pay and Benefits, 
Health Benefits, and Quality of Life for Servicemembers and 
Retirees. Recommendations 11 and 12 focused largely on 
education benefits and transition programs. In May 2015, the 
MCRMC issued an addendum to its report.
    Since its inception in 2009, the Post-9/11 GI Bill has paid 
$53 billion on behalf of more than 1.4 million beneficiaries. 
The MCRMC Addendum suggested that gaining a better 
understanding of the benefit, how it is used, and its impact on 
beneficiaries will help inform any potential future changes to 
the benefit. VA is currently required to submit to Congress an 
annual report on the completion of credit hours and educational 
objectives by beneficiaries using the Post-9/11 GI Bill. In its 
February 2014 report to Congress, VA recommended requiring 
educational institutions to provide additional information on 
the progress of students using Post-9/11 GI Bill benefits.
    Section 1109 of the legislative proposals in the report of 
the MCRMC Addendum included the material that is now contained 
in section 302 of the Committee bill.
    Committee Bill. Section 302 of the Committee bill would add 
a new section 3326 to chapter 33 of title 38, U.S.C. The new 
section would require that any educational institution 
receiving payments for beneficiaries using the Post-9/11 GI 
Bill report annually to the Secretary of Veterans Affairs on 
each beneficiary's academic progress towards his/her 
educational objective. Section 302 of the Committee bill would 
also amend section 3325(c) of title 38, U.S.C., to require the 
Secretary of Veterans Affairs to include in the report to 
Congress required by that section the information reported by 
educational institutions under new section 3326 of title 38, 
U.S.C.

Sec. 303. Secretary of Defense report on level of education attained by 
        those who transfer entitlement to Post-9/11 educational 
        assistance.

    Section 303 of the Committee bill, which is an original 
provision, would require the Secretary of Defense to include in 
its annual report to Congress on the Post-9/11 GI Bill the 
highest level of education attained by each individual who 
transfers his/her Post-9/11 GI Bill benefits to eligible 
dependents.
    Background. Under section 3319 of title 38, U.S.C., certain 
servicemembers who are eligible for the Post-9/11 GI Bill and 
meet other eligibility criteria may be permitted to transfer 
the unused portion of their Post-9/11 GI Bill benefits to one 
or more dependent. The MCRMC's final report noted that the 
impact of making changes to these criteria for transferring 
benefits is not well understood. The MCRMC recommendation to 
collect more information on who is transferring their unused 
Post-9/11 GI Bill benefits supports the idea that a better 
understanding of the people who transfer benefits and their 
motivations for doing so will allow the Department of Defense 
to improve the use of transferability as a retention tool.
    Section 1105 of the legislative proposals in the report of 
the MCRMC included the material now contained in section 303 of 
the Committee bill.
    Committee Bill. Section 303 of the Committee bill amends 
section 3325(b) of title 38, U.S.C., to add to it a requirement 
that the Secretary of Defense include in the annual report to 
Congress the highest level of education attained by each 
individual who transfers a portion of his/her entitlement to 
educational assistance under section 3319 of title 38, U.S.C. 
This new requirement would take effect 1 year after enactment 
of this bill.

Sec. 304. Reports on educational levels attained by certain members of 
        the Armed Forces at time of separation from the Armed Forces.

    Section 304 of the Committee bill, which is an original 
provision, would require the Secretary concerned to collect 
upon separation the highest level of education attained by each 
member of the Armed Forces. The Secretary concerned would be 
required to submit that information to Congress annually 
beginning 1 year after enactment of this bill.
    Background. In its final report, the MCRMC noted that DOD 
is not collecting data on the educational levels of those who 
transfer their Post-9/11 GI Bill benefits and DOD has only 
limited data on those servicemembers who use the Post-9/11 GI 
Bill or Tuition Assistance. The MCRMC's recommendation to 
collect information at the point of separation from service 
regarding the education level attained by those transferring 
their unused Post-9/11 GI Bill benefits is intended to improve 
the understanding of how use or transfer of the benefits 
impacts the educational levels of servicemembers.
    Section 1106 of the legislative proposals in the report of 
the MCRMC included the material now contained in section 304 of 
the Committee bill.
    Committee Bill. In a freestanding provision, section 304 of 
the Committee bill requires each military service Secretary to 
report annually to Congress on the educational levels attained 
by certain members of the Armed Forces at the time they 
separated from the Armed Forces during the preceding year. This 
report is only applicable to members of the Armed Forces who 
transferred unused education benefits to family members 
pursuant to section 3319 of title 38, U.S.C., while serving as 
members of the Armed Forces.

              TITLE IV--EMPLOYMENT AND TRANSITION MATTERS

Sec. 401. Required coordination between Directors for Veterans' 
        Employment and Training with State departments of labor and 
        veterans affairs.

    Section 401 of the Committee bill, which is an original 
provision, would require the Department of Labor's Director of 
Veterans' Employment and Training for each state to coordinate 
his/her activities with the state agencies for labor and 
veterans affairs.
    Background. Pursuant to section 4103 of title 38, U.S.C., 
the Department of Labor is required to assign to each state a 
Director for Veterans' Employment and Training to serve as a 
representative of the Department of Labor's Veterans' 
Employment and Training Service.
    In its final report from January 2015, the MCRMC noted that 
unemployment remains a challenge for many transitioning 
veterans. The report cited feedback from veterans who shared 
experiences where employers' lack of understanding about 
military service prevented them from being hired. The report 
also noted that most employment services for veterans are 
administered by labor departments at the state level and not by 
each state's veterans agency. Any deficiency in that state 
labor department's understanding of veterans' unique employment 
challenges poses additional barriers to the success of its Jobs 
for Veterans State Grant (hereinafter, ``JVSG'') program. The 
report did note, however, that Texas administered its veterans 
employment services as part of the JVSG program via its Texas 
Veterans Commission. The report cited the testimony of Rear 
Admiral W. Clyde Marsh, USN (Ret.), President of the National 
Association of State Directors of Veterans Affairs, where he 
suggested the JVSG program would benefit from increased 
coordination with the state veterans affairs directors.
    Section 1202 of the legislative proposals in the report of 
the MCRMC Addendum included the material that is now contained 
in section 401 of the Committee bill.
    Committee Bill. Section 401 of the Committee bill adds a 
requirement to section 4103 of title 38, U.S.C., requiring each 
Director for Veterans' Employment and Training in a state to 
coordinate his/her activities with the state's departments of 
labor and veterans affairs. This new requirement would take 
effect 1 year after the enactment of the Committee bill.

Sec. 402. Report on job fairs attended by One-Stop Career Center 
        employees at which such employees encounter veterans.

    Section 402 of the Committee bill, which is an original 
provision, would require an annual report from states to 
include the number of job fairs attended by One-Stop Career 
Center employees at which they had contact with a veteran and 
the number of veterans at each event so contacted.
    Background. The MCRMC noted in its final report from 
January 2015 that One-Stop Career Centers, which are part of 
state workforce agencies or employment commissions, are 
significant providers of employment services for veterans after 
they leave military service. The staff at these centers 
includes those focused solely on serving veterans with 
significant barriers to employment as well as staff who serve 
both veterans and non-veterans. The services that may be 
provided to veterans may vary depending on their employment 
needs and specific situations. One way for the One-Stop Career 
Center staff to connect with veterans in need of services is to 
attend job fairs and conduct outreach. Because these outreach 
connections are not tracked, it is difficult to evaluate 
whether or not attending these job fairs increases successful 
outcomes.
    Section 1201 of the legislative proposals in the report of 
the MCRMC Addendum included the material that is now contained 
in section 402 of the Committee bill.
    Committee Bill. Section 402 of the Committee bill adds a 
requirement to section 136(d)(1) of Public Law 105-220, the 
Workforce Investment Act of 1998, that the number of job fairs 
attended by One-Stop Career Center employees where veterans 
were contacted, along with the number of veterans contacted, be 
included in the annual reports submitted to Congress. This 
requirement would take effect 1 year after enactment of the 
bill.

Sec. 403. Review of challenges faced by employers seeking to hire 
        veterans and sharing of information among Federal agencies that 
        serve veterans.

    Section 403 of the Committee bill, which is an original 
provision, would require the Secretary of Labor to review the 
challenges employers face in hiring veterans and the 
information sharing among Federal departments and agencies 
serving veterans and separating servicemembers.
    Background. In its final report from January 2015, the 
MCRMC noted reports both from employers and from veterans that 
it remained difficult for employers to find veterans with the 
right skills to fill open positions. The MCRMC also shared 
feedback from employers that veterans seemed to lack the 
employment skills necessary to network and find jobs for which 
they could apply. Although transition classes, employment 
services, and other benefits are provided to veterans, the 
employers who hire veterans are the ultimate audience for the 
skills and practices these services provide to the veterans. A 
thorough understanding of where employers face difficulties 
connecting with veteran job seekers and where there are gaps in 
bridging military and civilian skills could improve the 
substance and delivery of employment training provided to 
transitioning servicemembers and veterans.
    Section 1203 of the legislative proposals in the report of 
the MCRMC Addendum included the material now contained in 
section 403 of the Committee bill.
    Committee Bill. In a freestanding provision, section 403 of 
the Committee bill directs the Secretary of Labor, in 
consultation with the Secretaries of Defense and Veterans 
Affairs, to review the challenges employers face in hiring 
veterans and information sharing among Federal agencies that 
serve separating members of the Armed Forces and veterans. The 
review specifically includes barriers employers face 
identifying job-seeking veterans and the ways in which Federal 
departments and agencies that serve veterans and separating 
servicemembers may more easily connect them with employers. The 
Secretary of Labor would be required to submit to Congress 
recommendations on addressing the barriers employers face as 
described in the review along with recommendations on improving 
information sharing by the Federal departments and agencies 
serving veterans and servicemembers. These recommendations 
would be due 120 days after the effective date of the Committee 
bill, which would be 1 year after its passage.

Sec. 404. Review of Transition GPS Program Core Curriculum.

    Section 404 of the Committee bill, which is an original 
provision, would require the Secretary of Defense, in 
consultation with the Secretaries of Veterans Affairs and 
Labor, to review the Transition GPS Core Curriculum and report 
to Congress recommendations on its effectiveness, allocation of 
the roles and responsibilities of Federal departments in the 
program, optimizing each topic by length of instruction and 
whether or not it is mandatory, and developing metrics for 
assessment of the program.
    Background. Transition GPS is the curriculum delivered to 
transitioning servicemembers prior to their separation from the 
Armed Forces. It includes mandatory subjects on transition, 
resiliency, translating military skills, financial planning, 
and VA benefits. There are also optional class tracks on 
accessing higher education, pursuing technical careers, and 
entrepreneurship. The MCRMC's final report notes that the 
Departments of Labor and Defense are of the view that 
Transition GPS has areas that can be improved. One possible 
change is making the optional tracks mandatory based on the 
individual servicemember's transition plan. Another area of 
potential improvement mentioned is measuring outcomes from the 
curriculum. The report cites a GAO study that concluded current 
metrics for evaluating outcomes were ``incomplete.''
    The Transition GPS curriculum is the foundation for 
servicemembers' transition experience when they leave the Armed 
Forces. It sets up expectations for what they will encounter 
after separation and provides skills and tools with which to 
navigate life as a civilian. Continued evaluation and 
refinement of the curriculum is important to achieving the 
highest standard of quality in subject matter and to ensure 
that subject matter is current with the evolving standards of 
career skills, educational practices, and business processes.
    Section 1204 of the legislative proposals in the report of 
the MCRMC Addendum included the material that is now contained 
in section 404 of the Committee bill.
    Committee Bill. In a freestanding provision, section 404 of 
the Committee bill would require the Secretary of Defense, in 
consultation with the Secretaries of Veterans Affairs and 
Labor, to conduct a review of the Transition GPS Core 
Curriculum. The review would include the roles and 
responsibilities of the various Federal departments and 
agencies involved in the program, the distribution of time 
spent on the various topics covered by the curriculum, whether 
any of the optional tracks should be mandatory, and the 
feasibility of standard outcome measures and metrics for 
evaluating the program. The Secretary of Defense would be 
required to report to Congress within 120 days of the effective 
date of this section of the Committee bill the results of this 
curriculum review and any recommendations for improving the 
curriculum, the delivery of the curriculum, and the measurement 
of its outcomes.

Sec. 405. Modification of requirement for provision of preseparation 
        counseling.

    Section 405 of the Committee bill, which is an original 
provision, would clarify that preseparation counseling shall 
not be provided to a servicemember discharged before completion 
of 180 continuous days on active duty.
    Background. Section 1142 of title 10, U.S.C., currently 
prohibits the provision of preseparation counseling to 
servicemembers being discharged from service before they 
complete their first 180 days of active duty. The current 
language could be interpreted to mean any combination of 180 
days of active service, even if they were not consecutive days 
of service. Such a scenario could apply to Reservists or 
members of the National Guard ordered to active duty for 
multiple periods of less than 180 days.
    Section 545 of the DOD legislative proposals sent to 
Congress for inclusion in the FY 2016 National Defense 
Authorization Act included the material now contained in 
section 405 of the Committee bill.
    Committee Bill. Section 405 of the Committee bill would 
amend section 1142 of title 10, U.S.C., to insert 
``continuous'' before ``180 days.'' It would also clarify the 
meaning of ``active duty'' in section 1142 of title 10, U.S.C., 
to exclude full-time training duty, annual training duty, or 
attendance at a service school while on active duty.

                TITLE V--VETERAN SMALL BUSINESS MATTERS

Sec. 501. Modification of treatment under contracting goals and 
        preferences of Department of Veterans Affairs for small 
        businesses owned by veterans of small businesses after death of 
        disabled veteran owners.

    Section 501 of the Committee bill, which is derived from 
S. 296, would permit the surviving spouse of a veteran owner of 
a small business, who is less than 100 percent disabled and 
whose death is not a result of a service-connected disability, 
to maintain the status of such small business concern for up to 
3 years following the death of such veteran.
    Background. Under current law, section 8127(h) of title 38, 
U.S.C., if the death of a veteran causes a small business to be 
less than 51 percent owned by one or more veterans, the 
surviving spouse may be treated as if the surviving spouse is 
the veteran under limited circumstances for up to 10 years for 
the purpose of receiving contracting preferences from VA. 
Specifically, the spouse can only retain the status as a 
service-disabled veteran-owned small business (hereinafter, 
``SDVOSB'') if, following the death of the veteran owner, the 
spouse acquires ownership rights of at least 51 percent and the 
veteran had a service-connected disability rated as 100 percent 
disabling or if the veteran died as a result of a service-
connected condition.
    For spouses not covered by section 8127(h), the small 
business concern immediately loses the SDVOSB designation, thus 
precluding them from benefiting from future VA procurement 
preferences.
    Committee Bill. Section 501 of the Committee bill would 
amend section 8127(h) of title 38, U.S.C., by providing that 
the surviving spouse may retain the SDVOSB designation for a 
period of up to 3 years in cases where the veteran had a 
service-connected disability rated at less than 100 percent or 
who did not die as a result of a service-connected condition.
    The Committee is concerned that surviving spouses may be 
forced to quickly sell the company or go out of business 
following the death of a disabled veteran if the small business 
loses the SDVOSB designation immediately upon death of the 
veteran. The 3-year period will provide adequate time for the 
surviving spouse to evaluate what course of action is 
appropriate for the small business following the death of the 
veteran.

Sec. 502. Treatment of businesses after deaths of servicemember-owners 
        for purposes of Department of Veterans Affairs contracting 
        goals and preferences.

    Section 502 of the Committee bill, which is derived from 
S. 296, would permit the surviving spouse of a servicemember 
who owns at least 51 percent of a small business concern and 
dies in the line of duty to maintain the status of such small 
business concern for up to 10 years following the death of such 
servicemember.
    Background. Current law, section 8127 of title 38, U.S.C., 
requires VA to establish contracting goals for veteran-owned 
small businesses (hereinafter, ``VOSBs'') and SDVOSBs. Further, 
the section grants VA authority to use certain contracting 
preferences to meet established goals and requires a VOSB or 
SDVOSB to be certified as eligible by VA prior to being awarded 
a contract under this section. To be eligible, a former 
servicemember must be a veteran as defined by section 101(2) of 
title 38, U.S.C. A servicemember who is wounded in action, upon 
discharge, will meet the statutory definition of a veteran and 
become eligible for certain VA contracting preferences. Current 
law provides, under section 8127(h) of title 38, U.S.C., that 
if a wounded veteran establishes eligibility and is certified 
as an SDVOSB, the surviving spouse can retain the designation 
for VA contracting preferences if the veteran dies and is rated 
as 100 percent disabled or dies as a result of a service-
connected disability. However, if a servicemember dies on 
active duty in the line of duty, he/she will never have the 
ability to apply for the SDVOSB designation, and any surviving 
spouse or dependent would not be viewed as an SDVOSB for the 
purposes of VA contracting following the servicemember's death.
    Committee Bill. Section 502 of the Committee bill would 
amend section 8127 of title 38, U.S.C., by inserting a new 
subsection (i). The new subsection would provide that, if a 
member of the Armed Forces dies in the line of duty while on 
active duty and owned at least 51 percent of a small business 
prior to his or her death, the surviving spouse or dependent, 
who acquired the ownership rights of the small business, will 
be treated as a service-disabled veteran for the purposes of 
SDVOSB certification and VA contracting preferences.
    Surviving spouses may retain the SDVOSB designation until 
the date they remarry, the date they no longer own and control 
51 percent of the small business, or the date that is 10 years 
after the death of the servicemember. Dependents may retain the 
designation until they no longer own and control 51 percent of 
the small business or the date which is 10 years after the 
death of the servicemember.
    SDVOSB contracting goals and preferences are designed to 
help service-disabled veterans lead productive and fulfilling 
lives after their military service by recognizing the sacrifice 
of those who were wounded in service to their country. The 
Committee believes extending the SDVOSB designation to 
surviving spouses and dependents, who have lost family members 
in the line of duty, is a small recognition of their sacrifice 
and may assist them in successfully operating their businesses.

                        TITLE VI--BURIAL MATTERS

Sec. 601. Department of Veterans Affairs study on matters relating to 
        burial of unclaimed remains of veterans in national cemeteries.

    Section 601 of the Committee bill, which is derived from 
S. 695, would require VA to complete a study on matters 
relating to the interring of unclaimed remains of veterans in 
national cemeteries and submit a report to Congress on the 
findings of the study.
    Background. The Dignified Burial and Other Veterans' 
Benefits Improvements Act of 2012, Public Law 112-260, 
authorized burial of the unclaimed remains of a veteran in a 
national cemetery when no known next-of-kin was able to make 
the request for the burial benefit. The Missing in America 
Project has worked to identify unclaimed remains and assist in 
the interment of unclaimed remains identified as those of a 
veteran. They have identified and helped inter over two 
thousand unclaimed remains of veterans. Identifying and then 
interring the unclaimed remains of veterans requires 
coordination and cooperation between government and 
nongovernment entities, as well as coordination between local, 
state, and Federal entities. There are also various local and 
state laws that apply to the interring of unclaimed remains. 
Additionally, there is a need to make all the appropriate 
entities aware that the unclaimed remains of veterans may 
qualify for this benefit.
    Committee Bill. In a freestanding provision, section 601 of 
the Committee bill directs the Secretary of Veterans Affairs to 
conduct a study and report to Congress on various matters 
relating to the interment of unclaimed remains of veterans in 
national cemeteries. The study would include an estimate of the 
number of unclaimed remains, an assessment of state and local 
laws impacting the interment of unclaimed remains, and an 
assessment of VA procedures for working with other entities in 
custody of the unclaimed remains of veterans. Section 601 of 
the Committee bill also provides for a methodology for the 
study to look at a subset of those entities having custody of 
the unclaimed remains and a subset of applicable state and 
local laws that impact the interment of unclaimed remains. This 
section would take effect 1 year after enactment of the 
Committee bill and the report to Congress would be required 1 
year after the effective date.

                        TITLE VII--OTHER MATTERS

Sec. 701. Honoring as veterans certain persons who performed service in 
        the Reserve components of the Armed Forces.

    Section 701 of the Committee bill, which is derived from 
S. 743, would recognize the service of certain individuals in 
the Reserve components of the Armed Forces by honoring them as 
veterans.
    Background. Under current law, section 101(2) of title 38, 
U.S.C., for purposes of determining eligibility for benefits 
administered by VA, a veteran is defined as ``a person who 
served in the active military, naval, or air service, and who 
was discharged or released therefrom under conditions other 
than dishonorable.'' As such, a member of the Reserve 
components who is eligible for retirement pay, or in receipt of 
retired pay, who did not have qualifying active duty service, 
is not recognized as a veteran for purposes of eligibility for 
certain VA benefits. This has led to some confusion as to 
whether an individual who served in the Reserves, but did not 
have qualifying active duty service, should be referred to as a 
``veteran'' for purposes other than determining eligibility for 
VA benefits.
    Committee Bill. Section 701 of the Committee bill would, in 
a non-codified provision, honor as a veteran those individuals 
who are entitled under chapter 1223 of title 10, U.S.C., to 
retired pay for irregular service or who would be entitled to 
retired pay, but for age. Section 701 would ensure those who 
are honored as ``veterans'' under this section would not be 
entitled to any VA benefit by reason of such recognition.

Sec. 702. Report on Laotian military support of Armed Forces of the 
        United States during Vietnam War.

    Section 702 of the Committee bill, which is derived from 
S. 1358, would require VA, in consultation with DOD and such 
agencies or individuals VA considers appropriate, to submit a 
report to Congress on the extent to which Laotian military 
forces provided combat support to the Armed Forces of the 
United States between February 28, 1961, and May 15, 1975; 
whether the current classification by the DOD Civilian/Military 
Service Review Board is appropriate; and any recommendations 
for legislative action.
    Background. Due to American involvement in South-East Asia 
in the 1960s, Laos became a focal point for both American and 
North Vietnamese operations. Due to the limited ability of 
formal Laotian forces to stop cross border threats and stymie 
North Vietnamese supply lines, the United States. began to 
train and supply Hmong guerillas in Laos.\1\ The Hmong 
``Special Guerrilla Units'' were trained by members of the 
Central Intelligence Agency (hereinafter, ``CIA''). This effort 
by the CIA became known as the CIA's ``Secret War.''\2\ The 
Hmong were primarily responsible for interrupting communist 
supply lines and rescuing downed pilots.\3\ Given the secrecy 
that surrounded the program, establishing concrete figures for 
the number of Hmong guerillas who fought along-side American 
forces during this period is challenging. One estimate claims 
it was in the tens of thousands.\4\ Casualties amongst this 
cohort mounted rapidly. A source indicates that by 1975, 
100,000 Hmong had been killed.\5\ After the fall of Saigon and 
the takeover of Laos by communist forces, the CIA stopped all 
further assistance to the Hmong. This discontinuation of 
support by the CIA effectively left the Hmong to fend for 
themselves.\6\ Those who remained sought refuge in neighboring 
Thailand, while others fled to the United States.
---------------------------------------------------------------------------
    \1\Tim Weiner, Gen. Vang Pao's Last War, New York Times Magazine, 
May 11, 2008. http://www.nytimes.com/2008/05/11/magazine/11pao-
t.html?pagewanted=all&/www.vva.org/veteran/0207/
laos.html
    \3\William Lloyd-George, The CIA's ``Secret War,'' The Diplomat, 
February 25, 2011. http://thediplomat.com/2011/02/25/the-cia%E2 
percent80 percent99s-secret-war/?all=true
    \4\Weiner
    \5\Lloyd-George
    \6\Weiner
---------------------------------------------------------------------------
    Consequently, over the years, concern over the treatment of 
the Hmong has been expressed. In recent years, members of 
Congress have argued for interment rights at national 
cemeteries for these individuals. During the 114th Congress, 
Senator Murkowski introduced S. 1358, which would grant certain 
burial benefits to former Hmong guerillas who qualify. Although 
rare, the United States has granted certain benefits to other 
groups who have assisted American war efforts including certain 
Filipino veterans who served under American command during 
World War II.
    However, given the protracted covert nature of events in 
South-East Asia during the Cold War, questions have been raised 
about the ability to verify and document individuals' claims 
about participation as well as whether or not these individuals 
acted in accordance with norms associated with the law of armed 
conflict. Recognizing the difficulty of answering these 
questions, the Committee developed a compromise proposal to get 
a better understanding of the Hmong involvement in American 
operations during the Vietnam War.
    Committee Bill. In a freestanding provision, section 702 of 
the Committee bill would require VA to submit to Congress a 
report documenting the extent to which Laotian military forces 
provided combat support to the Armed Forces of the United 
States between February 28, 1961, and May 15, 1975. This report 
requires consultation with DOD and any other agencies or 
individuals VA considers appropriate in order to determine 
whether the current classification by the DOD Civilian/Military 
Service Review Board is fitting and if further legislative 
action is necessary.

Sec. 703. Restoration of prior reporting fee multipliers.

    Section 703 of the Committee bill, which is an original 
provision, would revert to the 2011 rates the reporting fees 
that are paid to educational institutions.
    Background. Section 3684(c) of title 38, U.S.C., provides 
for the payment of reporting fees to educational and training 
institutions based on the number of veterans or other eligible 
students enrolled. The amount paid per eligible student is 
currently $9 or, in the case of an institution that accepts 
advance payments from VA, $13 per student. On September 26, 
2016, those rates are scheduled to increase to $12 and $15, 
respectively.
    Previously, the reporting fees paid to educational and 
training institutions by VA was increased from $5 and $6 to $7 
and $11, respectively, in 1977 by section 304 of Public Law 95-
202, the GI Bill Improvements Act. The $12 and $15 fee payment 
structure was later established in 2011 by section 204 of 
Public Law 111-377, the Post-9/11 Veterans Educational 
Assistance Improvements Act of 2010. Then, section 406 of 
Public Law 113-175 shifted the fees from $12 and $15 to $9 and 
$13 for a 1-year period following enactment of that law, and 
section 410 of Public Law 114-58 lengthened it to a 2-year 
period. Upon expiration of that 2-year period, the fees are 
scheduled to increase to $12 and $15. In contrast, under the 
Federal Pell Grant Program, institutions of higher learning 
receive $5 per grant to administer and distribute Federal Pell 
awards.
    Committee Bill. Section 204 of the Committee bill would 
amend section 3684(c) of title 38, U.S.C., to decrease for a 
10-year period the reporting fees paid by VA to educational and 
training institutions to $7 and $11, respectively. This change 
would take effect on enactment of the Committee bill.
    The Committee is of the opinion that the tuition dollars 
paid, and a lower reporting fee provided, to education and 
training institutions is adequate in offsetting any overhead 
created on the school's part in administering the benefit.

                      Committee Bill Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the Congressional Budget Office 
(hereinafter, ``CBO''), estimates that enactment of the 
Committee bill would, relative to current law, increase 
discretionary spending by $124 million over the 2016-2020 
period and would reduce direct spending by $60 million over the 
2016-2025 period. Enactment of the Committee bill would not 
affect the budget of state, local, or tribal governments.
    The cost estimate provided by CBO, setting forth a detailed 
breakdown of costs, follows:

                               Congressional Budget Office,
                                   Washington, DC, October 1, 2015.
Hon. Johnny Isakson,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.

    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1203, the 21st 
Century Veterans Benefits Delivery and Other Improvements Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is David Newman.
            Sincerely,
                                                Keith Hall,
                                                          Director.

  Enclosure.

S. 1203--21st Century Veterans Benefits Delivery and Other Improvements 
        Act

    Summary: S. 1203 contains provisions that would modify 
employment and compensation levels at the Department of 
Veterans Affairs (VA), expand training for medical staff, and 
require the agency to post additional material on its website. 
In total, CBO estimates that implementing the bill would cost 
$124 million over the 2016-2020 period, subject to 
appropriation of the necessary amounts.
    In addition, enacting S. 1203 would reduce administrative 
costs for veterans' education benefits and restore such 
benefits to a small number of military personnel who were 
unable to complete a term of instruction because of certain 
types of deployments. In total, those changes would decrease 
direct spending by $60 million over the 2016-2025 period.
    Pay-as-you-go procedures apply because enacting the 
legislation would affect direct spending. Enacting the bill 
would not affect revenues.
    S. 1203 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would benefit public institutions of higher education that 
participate in educational programs under the GI Bill. Any 
costs those entities might incur, including reductions in fee 
payments from VA, would be incurred as conditions of 
participating in a voluntary federal program.
    Estimated cost to the Federal Government: The estimated 
budgetary effect of S. 1203 is shown in Table 1. The costs of 
this legislation fall within budget function 700 (veterans 
benefits and services).

 Table 1.--Budgetary Effects of S.1203, The 21st Century Veterans Benefits Delivery Pand Other Improvements Act
----------------------------------------------------------------------------------------------------------------
                                                                 By fiscal year, in millions of dollars--
                                                         -------------------------------------------------------
                                                            2016     2017     2018     2019     2020   2016-2020
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION
 
Competitive Pay for Physician Assistants
    Estimated Authorization Level.......................     12       16       17       19       21        85
    Estimated Outlays...................................     11       15       17       19       21        83
Pilot Program for Intermediate Care Technicians
    Estimated Authorization Level.......................      0        3        3        3        3        12
    Estimated Outlays...................................      0        3        3        3        3        12
Chiropractic Care
    Estimated Authorization Level.......................      0        0        3        3        3         9
    Estimated Outlays...................................      0        0        3        3        3         9
Training for Mental Health Professionals
    Estimated Authorization Level.......................      1        1        2        2        2         8
    Estimated Outlays...................................      1        1        2        2        2         8
Prosthetic and Orthotic Care
    Authorization Level.................................      0        5        0        0        0         5
    Estimated Outlays...................................      0        3        1        1        0         5
Data Sharing
    Estimated Authorization Level.......................      0        1        1        1        1         4
    Estimated Outlays...................................      0        1        1        1        1         4
Reports
    Estimated Authorization Level.......................      *        1        1        1        *         3
    Estimated Outlays...................................      *        1        1        1        *         3
                                                         -------------------------------------------------------
    Total Changes in Spending Subject to Appropriation
        Estimated Authorization Level...................     13       27       27       29       30       126
        Estimated Outlays...............................     12       24       28       30       30       124
 
                                           CHANGES IN DIRECT SPENDING
Payments for Reportsa
    Estimated Budget Authority..........................     -6       -6       -6       -6       -6       -30
    Estimated Outlays...................................     -6       -6       -6       -6       -6       -30
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.
aIn addition to the changes in direct spending shown above, S.1203 would have effects beyond 2020. CBO estimates
  that enacting S.1203 would decrease direct spending by $60 million over the 2016-2025 period.

    Basis of estimate: For this estimate, CBO assumes that 
S. 1203 will be enacted near the beginning of fiscal year 2016, 
that the estimated amounts will be appropriated each year, and 
that outlays will follow historical spending patterns for 
affected programs.

Spending subject to appropriation

    CBO estimates that implementing S. 1203 would increase 
personnel and administrative costs at VA by a total of $124 
million over the 2016-2020 period, subject to appropriation of 
the necessary amounts.
    Competitive Pay for Physician Assistants (PAs). Section 123 
would require VA to compensate PAs at rates that are 
competitive with those paid by other health care providers. 
Currently, VA employs about 1,850 physician assistants. Based 
on wages paid by private-sector providers, we estimate that the 
pay rate for those employees would increase by 6 percent in 
2016 (from $104,000 to $110,000) if VA paid competitive rates.
    In addition, we expect that the higher pay level would help 
ameliorate VA's current difficulties in recruiting and 
retaining physicians assistants, and would thus increase the 
total number of PAs employed by VA. Based on data from VA on 
hiring and retaining nurses, who are paid at competitive rates, 
CBO estimates that under section 123 VA would employ roughly 
2,000 physicians assistants by 2020 (or an 8 percent increase 
above the current staffing level). On that basis, CBO estimates 
that implementing this section would cost $83 million over the 
2016-2020 period.
    Pilot Program for Intermediate Care Technicians. Effective 
1 year after the date of enactment, section 113 would revive 
for 3 years an expired pilot program to hire 45 veterans who 
recently separated from medical positions in the military. 
Those personnel would serve as intermediate-care technicians 
and would supplement other technicians at VA facilities by 
performing duties such as removing sutures, taking vital signs, 
and administering medications under the supervision of a 
physician or nurse.
    VA ran a similar program from January 2013 to February 
2014. Based on information about that program, we estimate it 
would cost about $60,000 annually for each veteran hired under 
the program authorized by this section. In addition, we expect 
that technicians hired under the pilot program would continue 
to be employed by VA after the program expired. Thus, 
implementing section 113 would cost of $12 million over the 
2017-2020 period, CBO estimates.
    Chiropractic Care. Section 102 would require VA to provide 
chiropractic care at 42 VA Medical Centers (VAMCs) by 2017 and 
at 76 VAMCs by 2018. VA currently has about 60 full-time 
chiropractors practicing at 59 VAMCs. Based on that level of 
service CBO estimates that VA would require 17 additional 
chiropractors beginning in 2018.
    Based on the average cost of employing chiropractors at VA 
(about $145,000 in 2015) and adjusting for inflation, CBO 
estimates that implementing section 102 would increase costs by 
$9 million over the 2018-2020 period.
    Training for Mental Health Professionals. Section 121 would 
require VA to provide education and training to licensed mental 
health professionals and marriage counselors employed by the 
agency. VA regularly provides training and education to health 
care personnel (primarily physicians, dentists, and nurse 
practitioners).
    VA currently employs about 300 licensed mental health 
professionals and marriage counselors. Some VA medical 
facilities currently offer, or plan to offer, annual training 
opportunities to those employees. Based on information from VA, 
we estimate that under this provision about 70 percent of its 
licensed mental health professionals and marriage counselors--
about 200 employees in 2016--would need to be trained at an 
annual cost of $7,500 per person. On that basis, and adjusting 
for inflation and gradual implementation, CBO estimates 
implementing this section would cost $8 million over the 2016-
2020 period.
    Prosthetic and Orthotic Care. Section 111 would authorize 
the appropriation of $5 million in 2017 to establish programs 
of education leading to advanced degrees in prosthetics and 
orthotics. Under this section, CBO expects that VA would work 
with medical schools to help expand higher education programs 
in those areas. CBO estimates that implementing section 111 
would cost $5 million over the 2017-2020 period.
    Data Sharing. Section 112 would require VA to post on its 
website information and data about research being conducted by 
the department, as well as final, peer-reviewed manuscripts 
using such data. Section 112 would further require both VA and 
the Department of Defense (DOD) to share data between the two 
departments to facilitate research on various topics relating 
to veterans, members of the Armed Forces, and their families. 
Those requirements would take effect 1 year after the date of 
enactment of S. 1203. Based on information from VA about the 
cost of creating and managing content on its website, CBO 
estimates that implementing section 112 would cost about $4 
million over the 2017-2020 period.
    Reports. The bill would require VA, DOD, and the Department 
of Labor to produce a total of 21 reports on matters such as 
medical care, educational levels, benefit claims, and job 
training. CBO estimates that preparing those reports would cost 
a total of $3 million over the 2016-2020 period.

Direct spending

    S. 1203 contains provisions that would modify education 
benefits for veterans. CBO estimates that those provisions 
would decrease net direct spending by $60 million over the 
2016-2025 period (see Table 2).

                            Table 2.--Estimated Effects of S.1203 on Direct Spending
----------------------------------------------------------------------------------------------------------------
                                                    By fiscal year, in millions of dollars--
                               ---------------------------------------------------------------------------------
                                2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2016-2020  2016-2025
----------------------------------------------------------------------------------------------------------------
                                           CHANGES IN DIRECT SPENDING
Payments for Reports
  Estimated Budget Authority..    -6    -6    -6    -6    -6    -6    -6    -6    -6    -6       -30        -60
  Estimated Outlays...........    -6    -6    -6    -6    -6    -6    -6    -6    -6    -6       -30        -60
Restoration of Benefits
  Estimated Budget Authority..     *     *     *     *     *     *     *     *     *     *         *          *
  Estimated Outlays...........     *     *     *     *     *     *     *     *     *     *         *          *
                               ---------------------------------------------------------------------------------
  Total Changes in Direct
   Spending
    Estimated Budget Authority    -6    -6    -6    -6    -6    -6    -6    -6    -6    -6       -30        -60
    Estimated Outlays.........    -6    -6    -6    -6    -6    -6    -6    -6    -6    -6       -30        -60
----------------------------------------------------------------------------------------------------------------
Note: * = between $0 and $500,000.

    Payments for Reports. Section 703 would temporarily reduce 
the fee that VA pays educational institutions to report certain 
information on enrollees who are using VA education benefits at 
those institutions. The annual amount VA pays per enrollee 
would decline by $5 (from $12 to $7) for 10 years beginning on 
September 26, 2015. (In a small number of cases, VA pays a $15 
fee, which would be reduced to $11.) About 1.2 million people 
use veterans' education benefits each year and the costs of 
those benefits--including the reporting fees--are paid from 
mandatory appropriations. Thus, cutting the fee would reduce 
direct spending by about $6 million annually and $60 million 
over the 2016-2025 period, CBO estimates.
    Restoration of Benefits. Section 301 would expand VA's 
authority to restore educational benefits for servicemembers in 
the Reserve component who are called to active duty. Reservists 
would be eligible for this adjustment if they had to 
discontinue a course of education upon being ordered to active 
duty under the following circumstances:

     To assist a state in response to a major disaster 
or emergency; or
     To augment the active component in support of a 
preplanned mission for the combatant commands.

    Under current law, VA can restore education benefits for 
military personnel deployed for several other reasons. Further, 
most servicemembers are notified more than 180 days in advance 
of a deployment, giving them sufficient time to complete a 
course or make other arrangements with the education 
institution. Based on information from DOD, CBO estimates that 
about 200 reservists would be unable to complete coursework in 
any year for the reasons listed above. However, most of those 
personnel would not exhaust all of their education benefits, so 
restoring lost benefits would not result in additional spending 
on their behalf. Approximately 50 reservists who would use all 
of their benefits would have about $600 each in lost benefits 
restored under section 301. Thus, the additional costs for 
those whose benefits would increase direct spending by less 
than $500,000 over the 2016-2025 period, CBO estimates.
    Pay-As-You-Go Considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The net changes in outlays that are subject to those 
pay-as-you-go procedures are shown in the following table.

   CBO Estimate of Pay-As-You-Go Effects for S.1203 as ordered reported by the PSenate Committee on Veterans'
                                            Affairs on July 22, 2015
----------------------------------------------------------------------------------------------------------------
                                                    By fiscal year, in millions of dollars--
                               ---------------------------------------------------------------------------------
                                2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2016-2020  2016-2025
----------------------------------------------------------------------------------------------------------------
                                   NET INCREASE OR DECREASE (-) IN THE DEFICIT
 
Statutory Pay-As-You-Go Impact    -6    -6    -6    -6    -6    -6    -6    -6    -6    -6       -30        -60
----------------------------------------------------------------------------------------------------------------

    Intergovernmental and private-sector impact: S. 1203 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would benefit public institutions of higher 
education that participate in educational programs under the GI 
Bill. Any costs those entities might incur, including 
reductions in fee payments from the VA, would be incurred as 
conditions of participating in a voluntary federal program.
    Estimate prepared by: Federal Costs: Ann E. Futrell, David 
Newman, and Dwayne M. Wright; Impact on State, Local, and 
Tribal Governments: Jon Sperl; Impact on the Private Sector: 
Paige Piper/Bach.
    Estimate approved by: H. Samuel Papenfuss, Deputy Assistant 
Director for Budget Analysis.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee on Veterans' 
Affairs has made an evaluation of the regulatory impact that 
would be incurred in carrying out the Committee bill. The 
Committee finds that the Committee bill would not entail any 
regulation of individuals or businesses or result in any impact 
on the personal privacy of any individuals and that the 
paperwork resulting from enactment would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7(b) of rule XXVI of the 
Standing Rules of the Senate, the following is a tabulation of 
votes cast in person or by proxy by members of the Committee on 
Veterans' Affairs at its July 22, 2015, meeting. Five 
amendments to S. 1203 were voted on by Members of the 
Committee.
    An amendment by Senator Murray would have required VA to 
provide child care assistance to certain veterans receiving 
health care from VA. This amendment was not agreed to by a roll 
call vote.

 
----------------------------------------------------------------------------------------------------------------
                Yeas                                 Senator                                 Nays
----------------------------------------------------------------------------------------------------------------
                                     Mr. Moran                                                                X
                                     Mr. Boozman                                                              X
                                     Mr. Heller                                                               X
                                     Mr. Cassidy                                                              X
                                     Mr. Rounds                                                               X
                                     Mr. Tillis                                                               X
                                     Mr. Sullivan                                                             X
                                 X   Mr. Blumenthal
                                 X   Mrs. Murray
                                 X   Mr. Sanders
                      X (by proxy)   Mr. Brown
                                 X   Mr. Tester
                                 X   Ms. Hirono
                                 X   Mr. Manchin
                                     Mr. Isakson, Chairman                                                    X
----------------------------------------------------------------------------------------------------------------
                                 7   TALLY                                                                    8
----------------------------------------------------------------------------------------------------------------

    An amendment by Senator Murray would have required VA to 
improve the women veterans contact center. This amendment was 
not agreed to by a roll call vote.

 
----------------------------------------------------------------------------------------------------------------
                Yeas                                 Senator                                 Nays
----------------------------------------------------------------------------------------------------------------
                                     Mr. Moran                                                                X
                                     Mr. Boozman                                                              X
                                     Mr. Heller                                                               X
                                     Mr. Cassidy                                                              X
                                     Mr. Rounds                                                               X
                                     Mr. Tillis                                                               X
                                     Mr. Sullivan                                                             X
                                 X   Mr. Blumenthal
                                 X   Mrs. Murray
                                 X   Mr. Sanders
                      X (by proxy)   Mr. Brown
                                 X   Mr. Tester
                                 X   Ms. Hirono
                                 X   Mr. Manchin
                                     Mr. Isakson, Chairman                                                    X
----------------------------------------------------------------------------------------------------------------
                                 7   TALLY                                                                    8
----------------------------------------------------------------------------------------------------------------

    An amendment by Senator Murray would require VA to provide 
treatment for certain emergency medical conditions and women in 
labor. This amendment was agreed to by voice vote.
    An amendment by Senator Tester would require VA to submit 
to Congress a report on VA's medical workforce. This amendment 
was agreed to by voice vote.
    An amendment by Senator Tester would address the training, 
compensation, and qualifications for certain health care 
providers at VA. This amendment was agreed to by voice vote.
    The Committee also discussed amendments sponsored by 
Senators Blumenthal, Murray, Sanders, Tester, and Hirono but 
did not vote on those amendments because they were withdrawn.
    S. 1203 as amended, and as subsequently amended during the 
Committee meeting, was agreed to by voice vote and ordered 
favorably reported to the Senate.

                             Agency Report

    On May 13, 2015, David R. McLenachen, Acting Deputy Under 
Secretary for Disability Assistance; on June 3, 2015, Thomas 
Lynch, Assistant Deputy Under Secretary for Health Clinical 
Operations, Veterans Health Administration; and on June 24, 
2015, Dr. Rajiv Jain, Assistant Deputy Under Secretary for 
Health for Patient Care Services, Veterans Health 
Administration from the Department of Veterans Affairs appeared 
before the Committee on Veterans' Affairs and submitted 
testimony on various bills incorporated into the Committee 
bill. In addition, on July 15, 2015, and September 4, 2015, VA 
provided views on various bills incorporated into the Committee 
bill. Excerpts from these statements are reprinted below:

  STATEMENT OF DAVID R. McLENACHEN, ACTING DEPUTY UNDER SECRETARY FOR 
     DISABILITY ASSISTANCE, VETERANS BENEFITS ADMINISTRATION, U.S. 
                     DEPARTMENT OF VETERANS AFFAIRS

    Good afternoon, Mr. Chairman and Members of the Committee. 
I am pleased to be here today to provide the views of the 
Department of Veterans Affairs (VA) on pending legislation 
affecting VA's programs, including the following: S. 270, 
S. 602, S. 627, the ``21st Century Veterans Benefits Delivery 
Act,'' the ``Veterans' Compensation Cost-of-Living Adjustment 
Act of 2015,'' and a draft bill concerning VA small business 
contracting, Veterans benefits, and burial matters. We will 
separately provide views on the following bills: S. 681; 
sections 202, 203 and 206 of the ``21st Century Veterans 
Benefits Delivery Act;'' the bill associated with legislative 
proposals from the Report of the Military Compensation and 
Retirement Modernization Commission; the bill associated with 
legislative proposals from the Department of Defense (DOD); and 
sections 201 and 206 of the consolidated bill related to bills 
from the 113th Congress. Accompanying me this afternoon is 
Renee Szybala, Assistant General Counsel.

           *       *       *       *       *       *       *

                                S. 1203

Section 101
    Section 101 would amend section 1144 of title 10, United 
States Code, by adding a subsection (f) to require 
modifications to the eBenefits Internet Web site to ensure that 
members of the Armed Forces and spouses have access to the 
online curriculum for the Transition Assistance Program (TAP), 
as administered by the Secretary of Labor, the Secretary of 
Defense, the Secretary of Homeland Security, and the Secretary 
of Veterans Affairs. This would require modifications to the 
eBenefits Web site to host the online version of the TAP 
curriculum.
    Section 101 would also note Congress' intent that the 
Secretary of Labor, the Secretary of Defense, the Secretary of 
Homeland Security, and the Secretary of Veterans Affairs 
collaborate to establish a process by which Veterans service 
organizations may be present for TAP to provide assistance 
relating to submitting claims for VA compensation and pension 
benefits. The Secretary of Defense would be required to submit 
a report to Congress, no later than 1 year after enactment, on 
Veterans service organizations' participation.
    VA does not support the provision to make TAP curriculum 
available through eBenefits because it is unnecessary. This 
provision would be duplicative as all TAP curriculums are 
already available through the Joint Knowledge Online (JKO) 
system, which is linked to eBenefits. VA modified the eBenefits 
portal in fiscal year 2014 to provide an online version of VA's 
section of the TAP curriculum through the JKO link and 
facilitate online participation for transitioning 
Servicemembers and their families. This functionality lends 
support to geographically dispersed Servicemembers as well as 
members of the National Guard and Reserve components who are 
required to participate in VA's section of TAP. Additionally, 
the online version is beneficial to Veterans and their families 
if they would like to access the curriculum after separation.
    VA defers to DOD and the Department of Homeland Security 
for comment on proposed new 10 U.S.C. Sec. 1144(f)(2) regarding 
the feasibility of ensuring that Servicemembers who are 
mandated to fulfill the TAP requirement can satisfy the 
requirement through means other than solely through an Internet 
Web site.
    VA does not oppose having a process for Veterans service 
organizations (VSOs) to provide assistance relating to 
submittal of claims for VA compensation and pension benefits. 
VA currently provides an overview of the services offered by 
VSOs and introduces VSOs to Servicemembers during our benefits 
briefings. VA also partners with VSOs at military installations 
where they are co-located or available to offer claims support.
    VA defers to DOD on subsection (b)(2) of section 101 of the 
bill regarding the requirement to provide a report on 
participation of VSOs in TAP.
    VA estimates that no administrative or benefit costs to VA 
would be associated with enactment of this section.
Section 102
    Section 102 would amend 38 U.S.C. Sec. 5104, which provides 
requirements for VA's decisions and notices of decision. It 
would require VA, upon issuing a decision for a claimed 
benefit, to also explain the procedure for obtaining review of 
the decision and explain the benefits of filing a Notice of 
Disagreement (NOD) within 180 days.
    VA does not support this section. While VA appreciates the 
effort to encourage individuals to file their NOD in a timelier 
manner, VA would prefer a more definitive legislative solution.
    As noted in VA's Strategic Plan to Transform the Appeal 
Process, which was provided to the Senate Committee on 
Veterans' Affairs on February 26, 2014, the current process 
provides appellants with multiple reviews in the Veterans 
Benefits Administration (VBA) and one or more reviews at the 
Board of Veterans' Appeals (Board), depending upon the 
submission of new evidence or whether the Board determines that 
it is necessary to remand the matter to VBA. The multi-step, 
open-record appeal process set out in current law precludes the 
efficient delivery of benefits to all Veterans. The longer an 
appeal takes, the more likely it is that a claimed disability 
will change, resulting in the need for additional medical and 
other evidence and further processing delays. As a result, the 
length of the process is driven by how many cycles and 
readjudications are triggered. VA's FY 2016 budget request 
includes legislative proposals to improve the appeal process, 
and VA has collaborated with Veterans service organizations to 
develop an optional fully developed appeals pilot program. VA 
continues to work with Congress and other stakeholders to 
explore long-term solutions that would provide Veterans the 
timely appeals process they deserve.
    VA estimates that GOE costs associated with this section 
would be insignificant.
Section 103
    Section 103 would allow for greater use of video conference 
hearings by the Board, while still providing Veterans with the 
opportunity to request an in-person hearing if they so elect. 
This provision would apply to cases received by the Board 
pursuant to Notices of Disagreement submitted on or after the 
date of the enactment of the Act. VA fully supports section 103 
as drafted, as this provision would potentially decrease 
hearing wait times for Veterans, enhance efficiency within VA, 
and better focus Board resources toward issuing more final 
decisions.
    The Board has historically been able to schedule video 
conference hearings more quickly than in-person hearings, 
saving valuable time in the appeals process for Veterans who 
elect this type of hearing. In FY 2014, on average, video 
conference hearings were held 124 days sooner than in-person 
hearings before a Veterans Law Judge (VLJ) at a Regional Office 
Travel Board hearing. Section 103 would allow both the Board 
and Veterans to capitalize on these time savings by giving the 
Board greater flexibility to schedule video conference hearings 
than is possible under the current statutory scheme.
    Historical data also shows that there is no statistical 
difference in the ultimate disposition of appeals based on the 
type of hearing selected. Veterans who had video conference 
hearings had an allowance rate for their appeals that was 
virtually the same as Veterans who had in-person hearings; 
however, Veterans who had video conference hearings were able 
to have their hearings scheduled much more quickly. Section 103 
would continue to allow Veterans who want an in-person hearing 
the opportunity to specifically request and receive one.
    Enactment of section 103 could also lead to an increase in 
the number of final decisions for Veterans as a result of 
increased productivity at the Board. Time lost due to travel 
and time lost in the field due to appellants failing to show up 
for their hearing would be greatly reduced, allowing VLJs to 
better focus their time and resources on issuing final Board 
decisions for Veterans.
    Major technological upgrades to the Board's video 
conference hearing equipment over the past several years leave 
the Board well-positioned for the enactment of section 103. 
This includes the purchase of high-definition video equipment, 
a state-of-the art digital audio recording system, 
implementation of a virtual hearing docket, and significantly 
increased video conference hearing capacity. Section 103 would 
allow the Board to better leverage these important 
technological enhancements.
    We observe that section 103 would redesignate current 
subsection (f) of section 7107 of title 38, United States Code, 
as subsection (g); however, the draft legislation does not 
revise the reference to current subsection (f) in subsection 
(a) of section 7107 of title 38, United States Code. We suggest 
revising subsection (a)(1) to state: ``Except as provided in 
paragraphs (2) and (3) and in subsection (g), each case 
received pursuant to application for review on appeal shall be 
considered and decided in regular order according to its place 
upon the docket.''
    In short, section 103 would result in shorter hearing wait 
times, focusing Board resources on issuing more decisions, and 
providing maximum flexibility for both Veterans and VA, while 
fully utilizing recent technological improvements. VA therefore 
strongly endorses this proposal.
Section 201
    We defer to the U.S. Government Accountability Office.
Section 204
    We defer to the VA Office of the Inspector General.
Section 205
    Section 205 would require VA to submit an annual report to 
Congress on the capacity of VBA to process claims during the 
next 1-year period. The reports would include the number of 
claims VBA expects to process; number of full-time equivalent 
(FTE) employees who are dedicated to processing such claims; an 
estimate of the number of claims a single FTE can process in a 
year; an assessment of whether VA requires additional or fewer 
FTE to process such claims during the next 1-year, 5-year, and 
10-year periods; a description of actions VA will take to 
improve claims processing; and an assessment of actions 
identified in previous reports required by this section. VA 
would be required to make the report publicly available on the 
Internet.
    VA believes this legislation is unnecessary as VA's current 
budget reports address these issues adequately, and such budget 
reports are available publicly.
    No administrative costs would be associated with enactment 
of this section.
Section 207
    Section 207 would require VA to submit to Congress a report 
on the Department's progress in implementing the Veterans 
Benefits Management System (VBMS). The report would include (1) 
an assessment of current VBMS functionality; (2) 
recommendations from VA's claims processors, including Veterans 
Service Representatives, Rating Veterans Service 
Representatives, and Decision Review Officers, on legislative 
or administrative actions to improve the claims process; and 
(3) recommendations from VSOs that use VBMS on legislative or 
administrative actions to improve VBMS. VA would be required to 
submit a report within 180 days after enactment of the bill and 
no less frequently than once every 180 days thereafter until 3 
years after enactment.
    VA believes this legislation unnecessary as VA currently 
provides regular updates to Congress regarding implementation 
and functionality of VBMS; quarterly briefings to the House and 
Senate Committees on Veterans' Affairs, advising them of the 
status of VBA operations and updates to VBMS; and a quarterly 
report to the House and Senate Appropriations Committees 
summarizing recent and upcoming changes to VBMS. Additional 
reporting requirements are not needed at this time.
    VA estimates GOE costs associated with this section would 
be insignificant.
Section 208
    Section 208 would require VA to submit, within 90 days of 
enactment of this Act, a report to Congress detailing plans to 
reduce the inventory of claims for dependency and indemnity 
compensation (DIC) and pension benefits.
    VA does not support section 208. It is unnecessary as VBA 
continues to make significant improvements in processing DIC 
and pension claims.
    VA's Pension and Fiduciary (P&F) Service, which oversees 
administration of the DIC and pension programs, reviewed the 
policies and procedures applicable to the adjudication of these 
claims to identify obstacles to timely processing. P&F Service 
determined that certain claim processing steps are redundant 
and appropriate for elimination. On March 22, 2013, P&F Service 
issued Fast Letter 13-04 (FL 13-04), Simplified Processing of 
Dependency and Indemnity Compensation (DIC) Claims, which 
instructs VBA field staff on the procedures to follow when 
processing DIC claims. P&F Service is working on similar 
guidance for pension claims.
    On July 7, 2014, VA began automating payment of DIC to 
certain surviving spouses of Veterans rated totally disabled at 
death. As part of VA's notice of death process, VA systems 
determine if the deceased Veteran met the requirements of 
section 1318 and if the surviving spouse met the relationship 
requirements. If the system determines that both requirements 
are met it will automatically process and award DIC under 
section 1318 within 6 days of notification of the Veteran's 
death.
    Based on these changes and an aggressive workload 
management plan in VA's Pension Management Centers, VA has 
reduced its pending DIC claim inventory by 55 percent from its 
peak of 19,100 claims to 8,600 claims, and backlog by 87 
percent from its peak of 8,800 to 1,000. Veterans pension 
inventory was reduced by 68 percent from its peak of 36,100 to 
11,400, and backlog by 96 percent from its peak of 14,500 to 
600. Average processing time for DIC has improved by 100 days 
from its peak of 168 days to 68 days, while maintaining 99 
percent accuracy.
    No benefits or GOE costs would be associated with enactment 
of this section.
Section 209
    This section would require VA to include in its Monday 
Morning Workload Report (MMWR) the number of claims received by 
regional offices and pending decisions, disaggregated by the 
number of claims that have been pending for more than 125 days; 
the number of claims that have been pending for 125 days or 
less; and the number of claims that do not require a decision 
concerning a disability rating. This section would also require 
VA to include in the MMWR, the sections entitled 
``Transformation'' and ``Aggregate,'' the number of partial 
ratings assigned. Additionally, this section would require VA 
to include in the MMWR a report on the total number of fully 
developed claims (FDC) received by regional offices that are 
pending a decision and the subset of those claims that have 
been pending for more than 125 days, disaggregated by station.
    VA does not support this section. The information required 
by section 209(a) is already published in the MMWR for rating-
related disability compensation and pension claims. The section 
appears to propose requiring all other non-rating pending 
compensation and pension workload be added to the MMWR; however 
information about these pending claims is also already 
published in the MMWR. The single distinguishing new feature 
would be the application of the backlog metric of 125 days to 
all non-rating-related claims by regional office. However, 125 
days is not a useful metric for the majority of non-rating-
related claims. The significant differences in the work effort 
required for various types of non-rating-related claims and the 
fact that much of this work is consolidated to the Pension 
Management Centers make comparison at the aggregate level 
across all regional offices a comparison without context or any 
real capability to inform how one regional office compares to 
another.
    Section 209(b) would elevate tallies of partial ratings of 
various claim types into a tool of comparison between regional 
offices. Data on partial ratings that award benefits for some, 
but not all, claimed conditions are not informative in this way 
as they reflect the unique circumstances of each claim. 
Additionally, irrespective of partial rating decisions, over 
half of the Veterans with pending claims are already receiving 
compensation as a result of a previously filed claim. Adding 
this partial-rating metric would not provide meaningful 
comparisons at the regional office level.
    Section 209(c) would require pending FDC claims, one VBA 
high-priority claims category, to be added to the MMWR. To the 
degree making comparisons between regional offices is desired, 
the existing reporting in the MMWR on claims older than 125 
days, VA's largest pending group of high priority claims, 
provides a better metric for such comparisons than FDC claims. 
However, should it be determined that a pending FDC metric 
would be useful, legislation is not required to add this metric 
to the MMWR.
    VA estimates GOE costs associated with this section would 
be insignificant.
Section 210
    This section would require VA to make available to the 
public on the Internet the ``Appeals Pending'' and ``Appeals 
Workload by Station'' reports. VA would be required to include 
in one of these reports the percentage of appeals granted by 
station and the percentage of claims previously adjudicated by 
VBA's Appeals Management Center that were subsequently granted 
or remanded by the Board.
    VA does not support this section. VBA's MMWR currently 
includes the total number of appeals pending and other metrics 
related to appeals. Before adding data elements to reports, VBA 
needs to ensure that the information is provided in a useful 
way that can be easily understood by the public.
    For example, VBA is changing its workload management 
strategy by developing the National Work Queue (NWQ), a 
paperless workload management initiative designed to improve 
VBA's overall production capacity. In the initial phase of NWQ, 
VBA is matching its inventory with claims processing capacity 
at the regional office-level, moving claims electronically from 
a centralized queue to an office identified as having capacity 
to complete the work. With this national workload approach, VA 
will continue to focus on the improvement of its traditional 
performance metrics, with an emphasis on improving quality and 
consistency of claims and appeals processing nationwide to 
ensure Veterans and their families receive timely benefits, 
regardless of where they reside. Appeals data by station will 
be less useful to the public as NWQ is implemented.
    Additionally, it is unclear how the bill would define 
``appeals granted by station.'' Multiple decisions may be 
appealed in each claim, and it is unclear if VA would be 
required to report percentages associated with each decision or 
each appeal. Similarly, it is unclear at what point in the 
appeal process this metric would be reported. The current 
process provides appellants with multiple reviews in VBA and 
one or more reviews at the Board, depending upon the submission 
of new evidence or whether the Board determines that it is 
necessary to remand the matter to VBA. The longer an appeal 
takes, the more likely it is that a claimed disability will 
change, resulting in the need for additional evidence, further 
processing delays, and less clarity in whether an initial 
decision was correctly made.
    VA estimates GOE costs associated with this section would 
be insignificant.
Section 211
    Section 211 would revise provisions of the Veterans' 
Benefits Improvement Act of 1996 relating to contract 
examinations to clarify that, notwithstanding any law regarding 
the licensure of physicians, a licensed physician may conduct 
disability examinations for VA in any state, the District of 
Columbia, or a commonwealth, territory, or possession of the 
United States, provided the examination is within the scope of 
the physician's authorized duties under a contract with VA.
    VA supports the provision regarding licensure requirements 
as a means to ensure the quality of contract examinations. The 
demand for medical disability examinations has increased, 
largely due to an increase in the complexity of disability 
claims, an increase in the number of disabilities that Veterans 
claim, and changes in eligibility requirements for disability 
benefits. This authority would help provide flexibility in 
examinations through non-VA medical providers while maintaining 
licensure standards and accelerating benefits delivery.
    No benefit or discretionary costs would be associated with 
enactment of this section.
Section 301
    Section 301 would require the appointment of at least one 
liaison between VA and DOD, and between VA and each of the 
Reserve components. It would also require the National Archives 
and Records Administration (NARA) to appoint a liaison to VA. 
The intent of these appointments is to expedite the provision 
of information needed to process claims by VA, to ensure that 
such information would be provided within 30 days of the 
request. VA would be required to submit a report to Congress 
annually regarding the timeliness of responses from DOD and 
NARA.
    While VA appreciates the intent to facilitate records 
retrieval, VA believes that this section of the bill is 
unnecessary because of the extensive ongoing efforts between VA 
and other Federal agencies to improve response times to VA 
requests for records that are required to adjudicate disability 
claims. For example, a memorandum of understanding (MOU) 
between VA and DOD provides VA, at time of discharge, certified 
and complete service treatment records in an electronic, 
searchable format. As this MOU applies to the 300,000 annually 
separated Active Duty, National Guard, and Reserve Component 
members, it will significantly contribute to VA's efforts to 
achieve its 125-day goal for completion of disability 
compensation claims.
    Costs associated with enactment of this section would be 
insignificant. DOD and NARA would be required to appoint 
liaisons; VBA would not hire additional employees. Costs 
associated with the report required by section 301(d) would be 
insignificant.
Section 302
    Section 302 would require DOD and VA to jointly submit to 
Congress a report that sets forth a timeline with milestones 
for achieving interoperability between the electronic health 
records systems of both Departments.
    The Veterans Health Administration (VHA) runs the largest 
integrated health care system in the country; delivering the 
quality care Veterans deserve is not possible without 
innovative information technology and data sharing. VA's 
Electronic Health Record (EHR)--Veterans Health Information 
Systems and Technology Architecture (VistA)--is the most widely 
used EHR in the United States, and VA is working rapidly to 
modernize it. VA is developing a new web application and 
services platform called the Enterprise Health Management 
Platform (eHMP). eHMP is the VistA application clinicians will 
use during their clinical interactions with Veterans. eHMP 
brings exciting new features to the clinician, including 
Google-like search capabilities and information buttons that 
help clinicians find needed information much faster than 
current systems. VA is already piloting eHMP, and expects to 
deploy it to 30 sites by the end of the calendar year, with 
full rollout--including regular updates--over the next 3 years.
    VA continues to work with DOD on health data 
interoperability, but it is important to note that the two 
Departments already share health care data on millions of 
Servicemembers and Veterans. In fact, the two Departments share 
more health data than any other health care entities in the 
nation. In addition to sharing health care data, VA and DOD 
have also paved the way for standardizing health care data, so 
that regardless of what system a clinician uses, the data is 
available in the right place and in the right way; for example, 
Tylenol and acetaminophen appear in the same place in the 
record because the system understands, through our data 
standardization, that they are the same medication. Today, VA 
and DOD clinicians can use the Joint Legacy Viewer (JLV) to see 
VA and DOD data on a single screen in a Servicemember or 
Veteran's record. Eventually, eHMP will replace JLV and will 
allow clinicians to see VA, DOD, and third-party provider data 
in their regular clinical care tool.
    The Department does not object to providing a report. Costs 
of this report would be insignificant as the Department 
currently provides a similar report to Congress.

           *       *       *       *       *       *       *

 DRAFT TO AMEND TITLE 38, UNITED STATES CODE, TO MODIFY THE TREATMENT 
 UNDER CONTRACTING GOALS AND PREFERENCES OF THE DEPARTMENT OF VETERANS 
 AFFAIRS FOR SMALL BUSINESSES OWNED BY VETERANS, TO CARRY OUT A PILOT 
  PROGRAM ON THE TREATMENT OF CERTAIN APPLICATIONS FOR DEPENDENCY AND 
    INDEMNITY COMPENSATION AS FULLY DEVELOPED CLAIMS, AND FOR OTHER 
                                PURPOSES

Section 101
    Section 101 would expand the flexibility provided to a 
service-disabled Veteran-owned small business (SDVOSB) to 
continue to hold that socioeconomic status upon the death of 
the service-disabled Veteran owner. Current law provides a 
transition period for SDVOSBs for up to 10 years after the 
Veteran's death, if the Veteran had a service-connected 
disability with a 100-percent rating or died as a result of a 
service-connected disability. This bill would create a similar 
transition period for 3 years, if the Veteran had a service-
connected disability with a rating of less than 100 percent and 
did not die as a result of a service-connected disability.
    VA supports this provision because, without the proposed 
transition period, the death of the Veteran owner could put at 
risk the jobs and livelihoods of the firm's employees, as well 
as the surviving spouse. The transition period provides the 
spouse a reasonable period of time to determine what should be 
done with the business after the Veteran's death.
    VA anticipates enactment of this provision would entail 
minor administrative costs. VA would incorporate this change 
into its existing application processes with no material 
addition to costs.
Section 102
    Section 102 would amend 38 U.S.C. Sec. 8127 by providing a 
transition rule for a member of the Armed Forces who owns at 
least 51 percent of a small business and is killed in the line 
of duty. Such a Veteran's surviving spouse who acquires 
ownership interest in the small business would be treated as a 
service disabled Veteran owner until the earliest of the 
following: 10 years after the Servicemember's death; the date 
on which the surviving spouse remarries; or the date on which 
the spouse no longer owns at least 51 percent of the small 
business. Such a Veteran's dependent child that acquires 
ownership interest in the small business would be treated as a 
Veteran owner for 10 years after the Servicemember's death or 
the date on which the child no longer owns at least 51 percent 
of the small business, whichever occurs first.
    VA supports the spirit behind this provision but notes two 
substantive concerns with the draft language. First, Congress 
sought to ensure that Veteran small business owners genuinely 
own and control the small business receiving benefits under the 
Veterans First Contracting Program. This would be a challenge 
for members of the regular Armed Forces, especially those 
serving in active duty abroad. Moreover, members of the Armed 
Forces are also Federal employees, which places limits on their 
ability to receive Federal contracts under conflict of interest 
rules. In practice, this rule would mainly apply to members of 
the National Guard and Army Reserve who own small businesses in 
their civilian lives, become activated, and are killed in the 
line of duty, leaving survivors to assume operational control 
of the firm as a service disabled Veteran-owned small business. 
Second, if a dependent child owner is still a minor, this may 
complicate the actual operation of this rule because of 
limitations on a minor's capacity to enter into binding 
contracts or engage in commercial transactions as an owner. The 
firm may need to reside in a trust for the benefit of the 
dependent minor child with an adult trustee controlling the 
firm until the dependent reaches adulthood. VA would be pleased 
to provide technical assistance to seek resolution of these 
issues.
    VA anticipates enactment of this provision would entail 
minor administrative costs. VA would incorporate this change 
into its existing application processes with no material 
addition to costs.
Section 202
    Section 202 would require VA to submit a report on the 
standard of proof for service-connected disability compensation 
for military sexual trauma (MST)-based mental health conditions 
to the House and Senate Committees on Veterans' Affairs no 
later than 90 days after enactment. The report would include 
recommendations for an appropriate standard of proof and 
legislative actions, if necessary.
    VA believes this legislation is unnecessary as VA provided 
a report with this information to the House and Senate 
Appropriations Committees in March 2015 and can share it with 
other interested Congressional offices.
    No benefit or GOE costs would be associated with enactment 
of this section.
Section 203
    Section 203 would require VA to submit a report with data 
on compensation claims for MST-based PTSD to Congress no later 
than December 1, 2016 and each year thereafter through 2020. 
The report would include the following information from the 
preceding fiscal year:

    1. The number of MST-related PTSD claims submitted;
    2. The number and percentage of claims submitted by gender;
    3. The number of approved claims, including number and 
percentage by gender;
    4. The number of denied claims, including number and 
percentage by gender;
    5. The number of claims assigned to each rating percentage, 
including number and percentage by gender;
    6. The three most common reasons given for denial of such 
claims under 38 U.S.C. Sec. 5104(b)(1);
    7. The number of denials that were based on the failure of 
the Veteran to report for a medical examination;
    8. The number of MST-based PTSD claims resubmitted after 
denial in a previous adjudication and items 2-7 from this list 
for this subset of claims;
    9. The number of claims that were pending at the end of the 
fiscal year and separately the number of such claims on appeal; 
and
    10. The average number of days to complete MST-based PTSD 
claims.

    VA believes this legislation is unnecessary as VA provided 
a report with most of this information to the House and Senate 
Appropriations Committees in March 2015 and can share it with 
other interested Congressional offices. If additional 
information or data for subsequent years are needed, VA can 
provide this to interested Congressional offices without 
legislation.
    No benefit or GOE costs would be associated with enactment 
of this section.
Section 204
    Section 204 would direct VA to establish a 1-year pilot 
program within 90 days of enactment to assess the feasibility 
and advisability of expediting the treatment of certain DIC 
claims, to include claims submitted:

    1. Within 1 year of the death of the Veteran upon whose 
service the claim is based;
    2. By dependents of Veterans who received benefits for one 
or more service-connected conditions as of the date of death;
    3. With evidence indicating the Veteran's death was due to 
a service-connected or compensable disability; and
    4. By a spouse of a deceased Veteran who certifies that he 
or she has not remarried since the Veteran's death.

    Section 204 would also require VA to submit a report to the 
House and Senate Committees on Veterans' Affairs within 270 
days of completing the pilot program. The report would include:

    1. The number of DIC claims adjudicated under the pilot 
disaggregated by claims received by a spouse, child, or parent 
of a deceased Veteran;
    2. The number of DIC claims adjudicated but for which 
benefits were not awarded under the pilot disaggregated by 
claims received by a spouse, child, or parent of a deceased 
Veteran;
    3. A comparison of accuracy and timeliness of claims 
adjudicated under the pilot and DIC claims not adjudicated 
under the pilot;
    4. VA's finding with respect to the pilot; and
    5. Recommendations the VA may have for legislative or 
administrative action to improve processing of DIC claims.

    VA supports the intent of this legislation, but believes it 
is unnecessary. As discussed above, in fiscal year 2013, VBA's 
P&F Service reviewed the policies and procedures applicable to 
the adjudication of DIC claims to identify obstacles to timely 
processing. P&F Service determined that VA could quickly grant 
many DIC claims with little or no additional development, and 
that certain claim processing steps are redundant and 
appropriate for elimination. On March 22, 2013, P&F Service 
issued Fast Letter 13-04 (FL 13-04), Simplified Processing of 
Dependency and Indemnity Compensation (DIC) Claims, which 
instructs VBA field staff on the procedures to follow when 
processing claims.
    The new procedures require screening of claims at the 
intake point and limited or no development of additional 
evidence when information in VBA systems supports granting 
benefits. It also clarifies that VA grants DIC under 38 U.S.C. 
Sec. 1318 based upon total service-connected disability for a 
prescribed period before death in the same manner as if the 
death were service connected. Accordingly, in these cases, our 
field staff will grant service-connected burial benefits and 
presume the permanence of total disability for purposes of 
establishing the survivor's entitlement to VA education and 
health care benefits. These new procedures allowed us to grant 
DIC benefits faster and without unnecessary development.
    Also, as discussed above, on July 7, 2014, VA automated 
some benefits to surviving spouses. VA can now automatically 
pay certain surviving spouses under section 1318. As part of 
VA's notice of death process, VA systems determine if the 
deceased Veteran met the requirements of section 1318 and if 
the surviving spouse met the relationship requirements. If the 
system determines that both requirements are met, it will 
automatically process and award DIC under section 1318 within 6 
days of notification of the Veteran's death.
    Based on these changes and aggressive workload management 
plan in VA's Pension Management Centers, VA has reduced its 
pending DIC claim inventory by 55 percent from its peak of 
19,100 claims to 8,600 claims. Average processing time for 
these claims has improved by 100 days from its peak of 168 days 
to 68 days while maintaining 99 percent accuracy.
    VA estimates no benefit or GOE costs would be associated 
with enactment of this section.
Section 205
    Section 205 would require VA, DOD, and military historians 
recommended by DOD to review the process used to determine if 
individuals who applied for Filipino Veterans Equity 
Compensation (FVEC) benefits served during World War II in 
accordance with the requirements to receive this benefit 
payment. Section 205 would also require VA to submit a report 
to the House and Senate Committees on Veterans' Affairs no 
later than 90 days after enactment. The report would detail any 
findings, actions taken, or recommendations for legislative 
action with respect to the review. If a new process is 
established as a result of this review, the process shall 
include mechanisms to ensure individuals who receive payments 
did not engage in any disqualifying conduct during their 
service, including collaboration with the enemy or criminal 
conduct.
    VA does not support this section. In determining whether a 
claimant is eligible for a VA benefit, including FVEC, VA is 
legally bound by service department determinations as to what 
service a claimant performed. VA regulations provide two 
methods for establishing service. Under 38 C.F.R. 
Sec. 3.203(a), VA may accept evidence submitted by a claimant 
if the evidence is a document issued by a U.S. service 
department; contains the needed information as to length, time, 
and character of service; and, in VA's opinion, is genuine and 
accurate. Otherwise, under 38 C.F.R. Sec. 3.203(c), VA must 
seek verification of service from the appropriate service 
department. These regulations are applicable to all claimants. 
For claims based on Philippine Service in World War II, the 
U.S. Army is the relevant service department, but VA requests 
verification from the National Personnel Records Center which, 
since 1998, has acted as the custodian of the U.S. Army's 
collection of Philippine Army and Guerrilla records.
    No benefit or GOE costs would be associated with enactment 
of this section.
Section 301
    Section 301 would require VA to conduct a study and report 
to Congress on matters relating to the interment of unclaimed 
remains of Veterans in national cemeteries under the control of 
the National Cemetery Administration (NCA), including: (1) 
determining the scope of issues relating to unclaimed remains 
of Veterans, to include an estimate of the number of unclaimed 
remains; (2) assessing the effectiveness of VA's procedures for 
working with persons or entities having custody of unclaimed 
remains to facilitate interment in national cemeteries; (3) 
assessing State and local laws that affect the Secretary's 
ability to inter such remains; and (4) recommending legislative 
or administrative action the VA considers appropriate.
    Section 301 would provide flexibility for VA to review a 
subset of applicable entities in the estimating of the number 
of unclaimed remains of Veterans as well as assess a sampling 
of applicable State and local laws.
    In December 2014, NCA published a Fact Sheet to provide the 
public with information on VA burial benefits for unclaimed 
remains of Veterans. NCA prepared the Fact Sheet in 
collaboration with representatives from NCA, VBA, and VHA. As 
well as being posted on VA's Web site, the Fact Sheet was 
widely distributed to targeted employees in VA, including 
Homeless Veteran Coordinators, Decedent Affairs personnel, VBA 
Regional Compensation Representatives, and NCA Cemetery 
Directors as well as shared in a GovDelivery message sent to 
over 28,000 funeral director and coroner's office recipients 
who are entities that may come to NCA seeking assistance to 
ensure burial of a Veteran whose remains are unclaimed.
    NCA strongly supports the goal of ensuring all Veterans, 
including those whose remains are unclaimed and do not have 
sufficient resources, who earned the right to burial and 
memorialization in a national, State, or tribal Veterans 
cemetery are accorded that honor. NCA appreciates the continued 
Congressional support to meet the needs of Veterans whose 
remains are unclaimed. While NCA is remains concerned that the 
study may be unnecessary or premature at this time, we would 
appreciate working with the Committee to make sure any study 
that the Department is mandated to produce is targeting data 
that can be used to better serve these Veterans.
    Over the past several years, Congressional and Departmental 
actions have increased the Department's ability to ensure 
dignified burials for the unclaimed remains of eligible 
Veterans. The Dignified Burial and Other Veterans' Benefits 
Improvement Act of 2012 (Public Law 112-260) authorizes VA to 
furnish benefits for the burial in a national cemetery for the 
unclaimed remains of a Veteran with no known next-of-kin and 
where sufficient financial resources are not available for this 
purpose. Those benefits include reimbursements for the cost of 
a casket or urn, for costs of transportation to the nearest 
national cemetery, and for certain funeral expenses.
    NCA is pleased to report that our final rule was published 
on April 13, 2015, beginning today, we are able to accept 
requests for reimbursement for caskets or urns purchased for 
the interment of deceased Veterans who died on or after January 
10, 2014, without next of kin, and where sufficient resources 
for burial are not available. As this new benefit is 
administered, NCA will have a new source for collecting data on 
the number of Veterans whose unclaimed remains are brought to 
NCA for interment. The data can be used to assist in targeting 
outreach efforts to partners and getting a fuller understanding 
of the issue.
    The Department continues to identify areas to recommend 
legislative or administrative action that would support 
dignified burial of unclaimed remains of Veterans. Two 
legislative proposals are included in VA's FY 2016 Budget 
Submission. Currently, VA may furnish a reimbursement for the 
cost of a casket or urn and for the cost of transportation to 
the nearest national cemetery. These benefits are based on the 
Veteran being interred in a VA national cemetery. The 
legislative proposals are to expand these two benefits to 
include those Veterans who are interred in a state or tribal 
organization Veteran cemetery.
    In conjunction with discussions we had last year with 
congressional staff, NCA reviewed its internal procedures and 
began to follow-up every thirty days with the public officials 
on any unclaimed remain cases shown as pending until the cases 
are scheduled for burial and the Veterans' remains are 
interred. While state and local laws designate who may act as 
an authorized representative to claim remains, NCA can work 
with any individual or entity that contacts us to determine a 
Veteran's eligibility for burial and scheduling the burial in a 
VA national cemetery.
    The great work of the Missing in America Project (MIAP) and 
individual funeral directors is invaluable in complementing 
VA's role of ensuring that all Veterans, including those whose 
unclaimed remains are brought to us, receive the proper 
resources to ensure receipt of a dignified burial. Over the 
past several years, NCA has developed a strong working 
relationship with funeral homes, coroner offices, and medical 
examiners, to actively provide responses to requests for 
eligibility reviews. In FY 2014, NCA processed 2,805 MIAP 
requests to determine eligibility for burial in a VA national 
cemetery, of which 1,642 were verified as eligible.
    In light of VA's recent activities, detailed above, to 
implement legislation targeted at ensuring appropriate burial 
of the unclaimed remains of Veterans, NCA feels it is premature 
to undertake the proposed study. Furthermore, if legislation is 
passed requiring the study, we do not object to the proposed 
scope and content, we are concerned that the timeframe for 
reporting in the bill is unrealistic.
    To implement the mandatory requirements outlined in the 
bill, even with the flexibilities included in the bill 
language, the Department would be required to contract with one 
or more private entities to perform such a study. Survey 
instruments would need to be developed to assess the number of 
remains in the possession of funeral directors and other 
entities for individuals with no known next of kin, and an 
appropriate sample would have to be identified and a legal 
review of state and local laws conducted regarding unclaimed 
remains of Veterans.
    The bill provides a reporting timeframe of 1 year. The need 
to get formal clearances on survey instruments takes several 
months; therefore, a more realistic timeframe is 2 years.
    The bill does not identify a funding source for this 
mandate. NCA is still evaluating the cost associated with this 
legislation.
Section 401
    Section 401 would honor any person entitled under chapter 
1223 of title 10, United States Code, to retired pay for 
nonregular service or who, but for age, would be entitled under 
this chapter to retired pay for nonregular service, as a 
Veteran. However, these individuals would not be entitled to 
any benefit by reason of this honor.
    VA does not support this section. It would conflict with 
the definition of ``Veteran'' in 38 U.S.C. Sec. 101(2) and 
would cause confusion about the definition of a Veteran and 
associated benefits. In title 38, United States Code, Veteran 
status is conditioned on the performance of ``active military, 
naval, or air service.'' Under current law, a National Guard or 
Reserve member is considered to have had such service only if 
he or she served on active duty, was disabled or died during 
active duty for training from a disease or injury incurred or 
aggravated in line of duty, or was disabled or died during 
inactive duty training from an injury incurred or aggravated in 
line of duty or from an acute myocardial infarction, a cardiac 
arrest, or a cerebrovascular accident. Section 401 would 
eliminate these service requirements for National Guard or 
Reserve members who served in such a capacity for at least 20 
years. Retirement status alone would make them eligible for 
Veteran status.
    VA recognizes that the National Guard and Reserves have 
admirably served this country and in recent years have played 
an important role in our Nation's overseas conflicts. 
Nevertheless, VA does not support this bill because it 
represents a departure from active service as the foundation 
for Veteran status. This section would extend Veteran status to 
those who never performed active military, naval, or air 
service, the very circumstance which qualifies an individual as 
a Veteran. Thus, this section would equate longevity of reserve 
service with the active service long ago established as the 
hallmark for Veteran status.
    VA estimates that there would be no additional benefit or 
administrative costs associated with this section of the bill 
if enacted.
    This concludes my testimony. We appreciate the opportunity 
to present our views on these bills and look forward to working 
with the Committee.
                                ------                                

 STATEMENT OF THOMAS LYNCH, M.D., ASSISTANT DEPUTY UNDER SECRETARY FOR 
   HEALTH CLINICAL OPERATIONS, VETERANS HEALTH ADMINISTRATION, U.S. 
                     DEPARTMENT OF VETERANS AFFAIRS

    Good morning Chairman Isakson, Ranking Member Blumenthal, 
and Members of the Committee. Thank you for inviting us here 
today to present our views on several bills that would affect 
VA benefits programs and services. Joining us today is Maureen 
McCarthy, M.D., VHA's Deputy Chief Patient Care Services 
Officer and Susan Blauert, Deputy Assistant General Counsel in 
VA's Office of General Counsel.
    We do not yet have cleared views on sections 2 and 4 of 
S. 297, S. 471, the draft bill on Joint VA-DOD formulary for 
pain and psychiatric medications, and the draft bill Veterans 
Health Act of 2015. We will forward the views to the Committee 
as soon as they are available.

           *       *       *       *       *       *       *

              S. 297, FRONTLINES TO LIFELINES ACT OF 2015

    Section 3(a) of the Frontlines to Lifelines Act of 2015 
would direct the Secretary of Defense to transfer to the 
Secretary of Veterans Affairs the credentialing data of a 
covered health care provider who has been hired by VA, upon 
receiving a request from VA for the Department of Defense's 
(DOD) credentialing data related to such health care provider.
    Section 3(b) would define a ``covered health care 
provider'' as a health care provider who is or was employed by 
the Secretary of Defense, provides or provided health care 
related services as part of such employment, and was 
credentialed by the Secretary of Defense.
    Section 3(c) would require the Secretaries of Veterans 
Affairs and Defense to establish policies and promulgate 
regulations as may be necessary to carry out this section.
    Section 3(d) would define the term ``credentialing'' to 
mean the systematic process of screening and evaluating 
qualifications and other credentials, including licensure, 
required education, relevant training and experience, and 
current competence and health status.
    Credentialing is required to ensure a health care provider 
has the necessary clinical competence, professional experience, 
health status, education, training and licensure to provide 
specified medical or other patient care services. VA 
understands the goals of section 3, and the sharing of 
credentialing data between departments would facilitate VA's 
credentialing process and the appointment of only qualified, 
covered health care providers to the VA facility's medical 
staff. However, as this provision places requirements upon DOD, 
consultation with DOD is necessary before VA can present a 
position on this provision.

           *       *       *       *       *       *       *

   STATEMENT OF DR. RAJIV JAIN, ASSISTANT DEPUTY UNDER SECRETARY FOR 
HEALTH FOR PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION, U.S. 
                     DEPARTMENT OF VETERANS AFFAIRS

    Good morning Chairman Isakson, Ranking Member Blumenthal, 
and Members of the Committee. Thank you for inviting us here 
today to present our views on several bills that would affect 
VA benefits programs and services. Joining us today is 
Catherine Mitrano, Deputy Assistant Secretary for Resolution 
Management, and Jennifer Gray, Staff Attorney in VA's Office of 
General Counsel.
    We do not yet have cleared views on the Draft Biological 
Implant Tracking and Veteran Safety Act of 2015 or on S. 1117, 
the Ensuring Veteran Safety Through Accountability Act of 2015. 
Additionally, we do not have cleared views on sections 203, 
205, 208, and 209(b) of S. 469, sections 3 through 8 of 
S. 1085, section 2 of the draft bill referred to on the agenda 
as ``Discussion Draft'' or sections 101-106, 204, 205, 403 and 
501 of The Jason Simcakoski Memorial Opioid Safety Act. We will 
be glad to work with the Committee on prioritization of those 
views and cost estimates not included in our statement.

           *       *       *       *       *       *       *

                            DISCUSSION DRAFT

    Section 1 of the Discussion Draft would require the 
Secretary of Veterans Affairs to work with institutions of 
higher learning to develop partnerships for the establishment 
or expansion of programs of advanced degrees in prosthetics and 
orthotics with a goal of improving and enhancing the 
availability of prosthetic and orthotic care for Veterans.
    VA provides rehabilitation services to Veterans with a mix 
of providers, including physical medicine and rehabilitation 
physicians, physical therapists, occupational therapists, 
prosthetists and orthotists all of whom work with the Veteran 
to enable the best possible rehabilitation given the 
individual's needs. VA offers in-house orthotic and prosthetic 
services at 79 locations across VA. In addition, VA contracts 
with more than 600 vendors for specialized orthotic and 
prosthetic services. Through both in-house staffing and 
contractual arrangements, VA is able to provide state-of the 
art commercially available items ranging from advanced 
myoelectric prosthetic arms to specific custom fitted orthoses. 
Nationally, VA has approximately 312 orthotic and prosthetic 
staff.
    With regard to training and development, VA offers one of 
the largest orthotic and prosthetic residency programs in the 
nation. In fiscal year 2015, VA's Office of Academic 
Affiliations allocated $877,621 to support 20 orthotics and 
prosthetics residents at 10 Veterans Affairs Medical Centers. 
The training consists of a yearlong post-masters residency, 
with an average salary of $44,000 per trainee. In recent years, 
VA has expanded the number of training sites and the number of 
trainees, but expansion has been limited due to a lack of 
certified supervisors for the training programs.
    While VA supports means to improve and enhance the ability 
to hire and retain prosthetists and orthotists, it cannot 
support the proposed bill. Under the proposed bill, VA would be 
required to partner with colleges and universities for the 
establishment or expansion of programs of advanced degrees in 
prosthetics and orthotics. These programs, however, would not 
directly benefit VA or Veterans as the legislation does not 
require that the programs affiliate with VA or send their 
trainees to VA as part of a service obligation.
    Tying the granting of funds to the establishment or 
expansion of programs of advanced degrees that would directly 
benefit VA and Veterans is one of the changes that VA 
recommends for this legislation. VA looks forward to working 
with the Committee to craft a bill that more directly enhances 
advanced degrees in prosthetics and orthotics while benefiting 
VA and Veterans.

           *       *       *       *       *       *       *

           *       *       *       *       *       *       *

           *       *       *       *       *       *       *

           *       *       *       *       *       *       *

           *       *       *       *       *       *       *
                       U.S. Department of Veterans Affairs,
                                     Washington, September 4, 2015.
Hon. Johnny Isakson,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.

    Dear Mr. Chairman: The agenda for the Senate Committee on 
Veterans' Affairs' June 3, 2015, and June 24, 2015, legislative 
hearings included a number of bills that the Department of 
Veterans Affairs (VA) was unable to address in our testimony or 
in our prior correspondence with you on July 15, 2015. By this 
letter, we are providing the final remaining views and cost 
estimates on the following bills from the June 3, 2015, 
legislative hearing: sections 2 and 4 of S. 297, the Frontlines 
to Lifelines Act of 2015; the draft bill on establishing a 
joint VA-Department of Defense (DOD) formulary for systemic 
pain and psychiatric medications; and sections 2, 3, and 5 of 
the draft bill, Veterans Health Act of 2015.
    We are also providing the final remaining views and cost 
estimates on the following bills from the June 24, 2015, 
legislative hearing: sections 203, 208, and 209(b) of S. 469, 
Women Veterans and Families Health Services Act of 2015; 
sections 4(b) and 8 of S. 1085, Military and Veteran Caregiver 
Services Improvement Act of 2015; and sections 105, 205, 403, 
and 501 of the Jason Simcakoski Memorial Opioid Safety Act.
    We appreciate this opportunity to comment on this 
legislation and look forward to working with you and the other 
Committee Members on these important legislative issues.
            Sincerely,
                                        Robert A. McDonald,
                                                         Secretary.

  Enclosure.

                              JUNE 3, 2015

              S. 297, Frontlines to Lifelines Act of 2015

    Section 2 of S. 297 would require VA to revive the 
Intermediate Care Technician Pilot Program of the Department of 
Veterans Affairs (VA) that was carried out between January 2013 
and February 2014. VA would be required to expand the pilot 
program to include not less than 250 intermediate care 
technicians in the pilot program. It would also permit VA to 
assign any intermediate care technician hired under this 
program to a VA medical facility, with the Secretary giving 
priority to facilities at which Veterans have the longest wait 
times for appointments for the receipt of hospital care or 
medical services. The pilot would be authorized during the 3-
year period beginning on the date of the enactment of this Act.
    As we explained in a response to a question from Senator 
Rounds at the hearing, we are currently working to expand the 
program beyond emergency services, most notably to increase 
support in podiatry and surgical clinics given the 
qualifications of those participating in the earlier pilot 
program. We do not require additional legislation for this 
expansion of the program, and consequently, VA does not support 
section 2 of this bill because we are already moving ahead with 
a permanent program, rather than a pilot program.
    Section 4(a) of S. 297 would give discretion to the 
Secretary to authorize ``covered nurses'' to practice 
independently, without supervision or direction of others, 
under a set of privileges approved by the Secretary. Such 
authority would be notwithstanding any provision of state law 
and regardless of the state in which the covered nurse would be 
employed by VA. Section 4(b) would define a ``covered nurse'' 
as an advanced practice registered nurse (APRN) who is employed 
by VA in any of the following specializations: Nurse Midwife, 
Clinical Nurse Specialist (with respect to the provision of 
mental health care), and Nurse Practitioner.
    VA supports the intent of section 4, but we offer four 
recommendations for technical revisions to the legislation. 
First, we recommend adding a reference to state of licensure in 
section 4(a). This would enable the Secretary to standardize 
the practice of APRNs throughout VA's health care system, 
regardless of the state(s) in which they are licensed and/or 
employed by VA. This technical revision would facilitate the 
provision of additional health care services in medically-
underserved areas, thereby increasing access to high quality 
health care for all Veterans.
    Second, we recommend that the phrase ``under a set of 
privileges approved by the Secretary'' be deleted from section 
4(a), as unnecessary. To practice professionally, all health 
care providers must be granted a scope of practice or clinical 
privileges by the medical facility where they work.
    Third, we recommend that the word ``Licensed Certified'' be 
added to the titles of Nurse Midwife, Clinical Nurse 
Specialist, and Nurse Practitioner.
    Fourth, we recommend that Section 4 contain a new 
subsection (c) to clarify that covered nurses may prescribe 
controlled substances provided they are authorized by their 
state licensure to do so and comply with the limitations and 
restrictions on that prescribing authority.

           *       *       *       *       *       *       *

                Draft Bill, Veterans Health Act of 2015

    Section 2 of the draft bill, ``Veterans Health Act of 
2015,`` would amend the definition of ``preventive health 
services'' in 38 United States Code (U.S.C.) 1701(9) to include 
immunizations against infectious diseases, including each 
immunization on the recommended adult immunization schedule at 
the time such immunization is indicated by the Advisory 
Committee on Immunization Practices established by the 
Secretary of Health and Human Services and delegated to the 
Centers for Disease Control and Prevention. It would also 
modify the requirements of the annual report to Congress on 
preventive health services by including a requirement to report 
on VA's programs to provide Veterans each immunization on the 
recommended adult immunization schedule at the time such 
immunization is indicated. Finally, section 2 would require VA, 
within 2 years of enactment of the Act, to submit to Congress a 
report on the development and implementation of quality 
measures and metrics, including targets for compliance, to 
ensure Veterans receiving medical services receive each 
immunization on the recommended adult immunization schedule at 
the time such immunization is indicated.
    VA strongly supports preventive care measures, including 
making a wide range of immunizations available at VA medical 
facilities. However, because we believe VA is already 
satisfying the purpose of this bill, we do not support this 
legislation. Under current policy, VA already provides 
preventive immunizations at no cost to the Veteran. In 
addition, VHA is represented as an ex-officio member of the 
Advisory Committee on Immunization Practices (ACIP), and VA 
develops clinical preventive services guidance statements on 
immunizations in accordance with ACIP recommendations. All 
ACIP-recommended vaccines are available to Veterans at VA 
medical facilities. These vaccines currently include: hepatitis 
A, hepatitis B, human papillomavirus, influenza, measles/mumps/
rubella, meningococcal, pneumococcal, tetanus/diphtheria/
pertussis, tetanus/diphtheria, varicella, and zoster. As the 
ACIP recommendations change, VHA policy reflects those changes.
    The delivery of preventive care, including vaccinations, 
has been well established in the VHA Performance Measurement 
system for more than 10 years with targets that are appropriate 
for the type of preventive service or vaccine. VA updates the 
performance measures to reflect changes in medical practice 
over time.
    Section 3 would require VA to carry out a program to 
provide chiropractic care and services to Veterans through VA 
medical facilities at not fewer than two VA medical centers in 
each VISN by not later than 2 years after the date of the 
enactment of this Act, and at not fewer than 50 percent of all 
VA medical centers in each VISN by not later than 3 years after 
the date of the enactment of this Act. It would also modify 38 
U.S.C. 1701 to amend the definition of ``medical services'' to 
include chiropractic care and would amend the definition of 
``preventive health services'' to include periodic and 
preventive chiropractic examinations and services.
    VA supports the intent of section 3 of this bill, 
conditioned on the availability of additional resources to 
implement this provision. Expanding the number of VA medical 
facilities providing on-station chiropractic care would serve 
the needs of Veterans in expanding the availability of 
evidence-based treatment for musculoskeletal pain conditions 
that are highly prevalent in Veterans. Chiropractic treatment 
has been shown to be clinically effective, cost effective, and 
in high demand by Veterans. Patients who have access to 
chiropractic care are less likely to receive opiate medications 
and spinal surgeries. Just this year, The Joint Commission 
added chiropractic care to its pain management standards.
    Additionally, VA has already been expanding access to 
chiropractic services for Veterans. In fiscal year (FY) 2014, 
VA provided on-station chiropractic care to 26,395 Veterans, an 
increase of 14 percent from FY 2013. As of May 2015, 52 VA 
medical centers have chiropractic clinics, up from 47 in FY 
2014. Nevertheless, VA continues to face significant variation 
in access to chiropractic care across the country. Therefore, 
expanding the minimum number of chiropractic clinics per VISN 
will facilitate providing these services to Veterans in a more 
equitable manner.
    We offer two recommendations for technical revisions to the 
legislation. First, we recommend removing the reference to 
clinics in the proposed amendment to section 204(c) of Public 
Law 107-135. This change would focus the language on VA medical 
centers and would not result in confusion over whether clinic 
referred to a service at a medical center or an independent 
clinic at another location. Second, we recommend the 
legislation not amend the definition of preventive health 
services in section 1701(9). Chiropractic services are provided 
as part of the medical benefits package and are administered 
based on clinical need, similar to all other medical care. It 
would be inconsistent with the professional standards for other 
medical disciplines and inappropriate to provide ``periodic and 
preventative chiropractic examination and services'' when there 
are no clinical indications that such care is needed.
    We estimate that VA would need to add chiropractic services 
at five facilities to meet the requirement to operate the 
program at not fewer than two VA medical centers in each VISN 
within 2 years of the date of the enactment of this Act, and at 
another 23 facilities to meet the requirement that these 
services be available at not fewer than 50 percent of all VA 
medical centers in each VISN within 3 years of the date of the 
enactment of this Act. We estimate that the cost to hire these 
additional staff would be $3.67 million per year after the 
requirements of section 3 are fully phased in.
    Section 5 would require VA to make available on an Internet 
website data files that contain information on research of the 
Department, a data dictionary on each data file, and 
instructions for how to obtain access to each data file for use 
in research. It would also require, within 18 months of the 
date of the enactment of this Act, that any final, peer-
reviewed manuscript prepared for publication that uses data 
gathered or formulated from research funded by the Department 
be submitted to the Secretary for deposit in a digital archive. 
VA would be required to establish this archive within 18 months 
of the date of the enactment of the Act or to partner with 
another executive agency to compile such manuscripts in a 
digital archive. The digital archive would have to be publicly 
available on an Internet website, and each manuscript would 
have to be available through the archive within 1 year of the 
official date on which the manuscript is published. VA would 
also be required, within 1 year of making manuscripts available 
and annually thereafter, to report to Congress on the 
implementation of this section. Finally, within 1 year of the 
date of the enactment of this Act, the VA-DOD Joint Executive 
Committee would be required to submit to the VA and DOD 
Secretaries options and recommendations for the establishment 
of a program for long-term cooperation and data sharing between 
the two Departments.
    VA supports the goal of this bill and is already taking 
action to achieve its objectives. Public access to research has 
been an increasingly important topic among Federal research 
agencies over the past several years. As a result, most of what 
is required in this bill has already been accomplished or is in 
process. On February 22, 2013, the White House Office of 
Science and Technology Policy (OSTP) directed each Federal 
agency with over $100 million in annual expenditures for the 
conduct of research and development to develop a plan to 
support increased public access to the results of research 
funded by the Federal Government, including any results 
published in peer-reviewed scholarly publications that are 
based on research that directly arises from Federal funds. The 
bill's requirement to make information on VA research publicly 
available on an Internet website is nearly identical to 
requirements established by OSTP. Similarly, VA has already 
taken steps to satisfy the bill's requirement that VA ensure 
public access to manuscripts on VA-funded research. All VA-
funded investigators are required to place their published 
manuscripts on the National Institutes of Health (NIH) PubMed, 
which provides manuscripts free to the public. Use of PubMed 
ensures that texts and their associated content will be stored 
in non-proprietary and/or widely-distributed archival, machine 
readable formats; provide access to persons with disabilities 
in accordance with Section 508 of the Rehabilitation Act of 
1973; enable interoperability with other Federal public access 
archival solutions and other appropriate archives; and ensure 
that attribution to authors, journals, and original publishers 
will be maintained. VA also currently requires, and will 
continue to require, that the results of applicable VA-funded 
clinical trials must be provided to the public through the 
ClinicalTrials.gov archive, which provides access to the 
results of clinical trials involving products regulated by the 
Food and Drug Administration. Additionally, VA is working with 
DOD to develop data sharing agreements, and several such 
agreements are already in place.
    We are concerned that the bill, as written, would greatly 
increase costs to the Department and may inadvertently limit 
the public availability of manuscripts. As stated, VA is 
currently making much of this information public, but through 
other mechanisms, such as PubMed or ClinicalTrials.gov. 
Requiring VA to develop its own website would require 
additional expenses with no net benefit in terms of the 
availability of information. Additionally, creating a separate 
repository for this information from PubMed or 
ClinicalTrials.gov would spread information among several 
Federal websites, making it more difficult for users to find 
information. VA is unable to offer a cost estimate at this time 
because we cannot determine the information technology (IT) 
costs associated with these requirements.

           *       *       *       *       *       *       *

                                ------                                

    On May 13, 2015, Anthony Kurta, Deputy Assistant Secretary 
of Defense, Military Personnel Policy, Department of Defense, 
appeared before the Committee on Veterans' Affairs and 
submitted testimony on various bills incorporated into the 
Committee bill. An excerpt from that testimony is reprinted 
below:

  STATEMENT OF ANTHONY KURTA, DEPUTY ASSISTANT SECRETARY OF DEFENSE, 
         MILITARY PERSONNEL POLICY, U.S. DEPARTMENT OF DEFENSE

    Good afternoon, Chairman Isakson, Ranking Member 
Blumenthal, and esteemed Members of the Committee. I am pleased 
to appear before you today to discuss pending benefits 
legislation.
    Per the agenda for today's hearing, the Committee requested 
the Department of Defense's view on a series of bills and 
proposals. Since both funding and administration of the Post-9/
11 GI Bill fall under the purview of the Department of Veterans 
Affairs, I will focus my comments only on those proposals that 
will affect the Department of Defense and generally defer to 
the Departments of Labor and Veterans Affairs to provide 
responses on those with no significant DOD impacts. This 
statement will follow the order on the printed agenda.

           *       *       *       *       *       *       *

        DRAFT BILL, 21ST CENTURY VETERANS BENEFITS DELIVERY ACT

    Section 101, ``Improvements To Transition Assistance 
Program,'' of this bill states that an individual subject to 
the requirement under subsection (c), which requires 
participation in the program (defined as employment assistance, 
job training assistance and other transitional services), may 
not satisfy such requirement by participating in the program 
carried out under this section solely through an Internet Web 
site. The Department of Defense does not support that portion 
of the language. The Administration should have flexibility in 
determining what methods and tools, to include Internet Web 
sites, should be used to deliver transition services to 
eligible transitioning Servicemembers and their spouses. This 
language would take away the flexibility to make such 
decisions. The Department of Defense and our interagency 
partners have agreed to allow Servicemembers who are subject to 
a short-notice separation or are geographically remote and 
isolated, to use the Department of Veterans Affairs Benefits 
module (part of full Transition Assistance Program (TAP) 
virtual curriculum) and the Department of Labor Employment 
Workshop through Joint Knowledge Online, which connects to 
other Department of Defense systems for mandatory attendance 
tracking. Implementation of this restrictive language would end 
that initiative and the millions of dollars invested in our on-
line curriculum would be lost. The Department of Defense must 
have the flexibility to meet the needs of our Servicemembers; 
we strongly advocate that the Congress not deprive the 
Secretary of Defense of this flexibility.
    Section 101 also requires the Secretary of Defense, in 
collaboration with the Secretaries of Labor, Homeland Security, 
and Veterans Affairs to establish a process to allow a 
representative of a Veteran Service Organization (VSO) to be 
present at the benefits portion of the program under Section 
1144, title 10, United States Code (the program under Section 
1144 pertains to employment assistance, job training assistance 
and other transitional services) relating to the submission of 
claims to the Secretary of Veteran Affairs. The Department of 
Defense does not support this provision. The Department of 
Defense recognizes and appreciates the tremendous support VSOs 
provide to Servicemembers who file claims with the VA. However, 
we believe that process best occurs outside the standard TAP 
classroom in a one-on-one private conversation between the 
Servicemember and the VSO representative. The redesigned TAP 
focus is to make Servicemembers career ready by meeting Career 
Readiness Standards. The preparation occurs in the classroom 
with the delivery of Transition GPS (Goals, Plans, Success) 
curriculum. The Department of Veterans Affairs provides two 
robust classes: VA Benefits I, which focus on VA Benefits, and 
VA Benefits II, which introduces Servicemembers to, and walks 
them through, the process of filing a claim for Department of 
Veterans Affairs benefits. It would be more appropriate at the 
conclusion of VA Benefits II briefing for the Department of 
Veterans Affairs instructor delivering the briefing to 
introduce the VSO representative who can assist Servicemembers 
with their claims. The VSO representative can connect with 
Servicemembers at the end of the class. At that time the VSO 
representative can set up one-on-one appointments to assist 
those Servicemembers planning to file a claim.
    Finally, the Department of Defense opposes that provision 
in section 101 that requires the Secretary of Defense to 
provide a report to Congress that assesses the compliance of 
facilities of the Department of Defense per the Secretary's 
Memorandum title ``Installation Access and Support Services for 
Nonprofit Non-Federal Entities'' dated December 23, 2014. This 
would require a tracking and reporting system to capture how 
many Veterans and Military Service organizations and other 
Nonprofit Non-Federal Entities are on each installation and the 
number of installations in compliance with the Secretary's 
Memorandums. This will pose a significant burden/hardship upon 
the installation staff and cause a diversion of already limited 
and stretched transition resources from the primary mission of 
the redesigned TAP.

  MILITARY COMPENSATION AND RETIREMENT MODERNIZATION COMMISSION REPORT

    The committee requested input from the Department of 
Defense on the legislative proposals in two of the 
recommendations in the recently released Military Compensation 
and Retirement Modernization Commission Report: Recommendation 
11: Safeguard education benefits for Servicemembers by reducing 
redundancy and ensuring the fiscal sustainability of education 
programs, and Recommendation 12: Better prepare Servicemembers 
for transition to civilian life by expanding education and 
granting states more flexibility to administer the Jobs for 
Veterans State Grants Program. I would like to state up front 
that the Department of Defense worked closely with the 
Commission in evaluating its recommendations, and included 
experts from the Departments of Labor and Veterans Affairs, as 
well as the Office of Management and Budget, in our working 
groups designed to formulate DOD's response to the President.

 RECOMMENDATION 11: SAFEGUARD EDUCATION BENEFITS FOR SERVICEMEMBERS BY 
REDUCING REDUNDANCY AND ENSURING THE FISCAL SUSTAINABILITY OF EDUCATION 
                                PROGRAMS

    The Department agrees with the Commission's objectives of 
safeguarding education benefits for Servicemembers by reducing 
redundancy and ensuring the fiscal sustainability of education 
programs. We support sun-setting both the Montgomery GI Bill 
(chapter 30 of title 38, United States Code, also known as 
MGIB-AD) and the Reserve Education Assistance Program (REAP), 
with a view to maintaining the Post-9/11 GI Bill as the primary 
education benefit. The Commission and the Department also agree 
that in order to keep faith with our Servicemembers, we must 
grandfather those who already have the benefits that will be 
phased out. Further, the Department and the Commission agree on 
how best to achieve the objective of collecting, tracking, and 
reporting on Servicemember, Veteran, or dependent education 
related data. The Commission recommends requiring that Tuition 
Assistance be used for ``professional development'' courses 
only. DOD has already issued policy guidance to the Services to 
this effect where all signatories of the Department of Defense 
Education Partnership Memorandum of Understanding must provide 
an approved education plan for each Tuition Assistance 
recipient. This plan provides the roadmap for their educational 
goal development to include supporting courses.
    The Department would like to ensure that once the MGIB-AD 
sunsets, Servicemembers will be able to combine Post-9/11 GI 
Bill benefits with Tuition Assistance (commonly referred to as 
``top up'') using the same ``top up'' usage method as currently 
available under the MGIB-AD.
    The Department submitted a legislative proposal to Congress 
on May 1 that would sunset the MGIB-AD and REAP, grandfather 
Servicemembers currently receiving those benefits, and provide 
a ``top up'' benefit.
    Without data enabling the Department of Defense to 
understand the potential effects on retention, the Department 
of Defense--and the Joint Chiefs are particularly concerned on 
this point--cannot support the recommendation to sunset the 
Post-9/11 GI Bill housing stipend for dependents, or the 
recommendation to increase the eligibility requirements for 
transferring Post-9/11 GI Bill benefits. To this end, the 
Department of Defense has sponsored a study with RAND National 
Defense Research Institute to review education benefits for 
Servicemembers, including the benefits of the Post-9/11 GI Bill 
and their impacts on retention (with a focus on impacts of 
transferability). We anticipate the study to be completed in 
the summer of 2016, allowing the Department of Defense to 
evaluate the potential effects of altering the features of the 
benefit on retention.
    Lastly, the Department of Defense does not support the 
recommendation that would prohibit ex-Servicemembers from 
receiving unemployment compensation (as authorized under 
chapter 85, subchapter II, of title 5, United States Code) 
while simultaneously receiving the living stipend as part of 
Post-9/11 GI Bill benefits. State-level unemployment 
compensation programs already provide guidance regarding 
students' status within the workforce and eligibility to 
receive benefits (as detailed in Congressional Research Service 
Report, (Unemployment Compensation (UC): Eligibility for 
Students Under State and Federal Laws, dated September 7, 
2012). Eliminating concurrent receipt of educational benefits 
and Unemployment Compensation for Ex-Service Members (UCX) may 
be viewed as penalizing Servicemembers who are pursuing courses 
at trade/vocational schools to acquire skills/certifications 
that would make them more employable. This Commission 
recommendation could also have a disproportionate impact on 
Reserve Component Servicemembers because both separated and 
currently serving Reserve Component members may be affected.

  RECOMMENDATION 12: BETTER PREPARE SERVICEMEMBERS FOR TRANSITION TO 
     CIVILIAN LIFE BY EXPANDING EDUCATION AND GRANTING STATES MORE 
  FLEXIBILITY TO ADMINISTER THE JOBS FOR VETERANS STATE GRANTS PROGRAM

    The Department of Defense supports the Commission's 
objective of better preparing Servicemembers for transition to 
civilian life, but does not believe additional legislation is 
required. The Department of Defense has significantly re-
designed the Transition Assistance Program over the last 2 
years and implemented the VOW to Hire Heroes Act legislation 
enacted in 2011; these modifications significantly address the 
Commission's objectives.
    The Department of Defense, together with the Departments of 
Labor and Veterans Affairs, has developed Transition Assistance 
Program curriculum to support Servicemembers' educational 
goals. The Accessing Higher Education (AHE) track focuses 
transitioning Servicemembers on selecting an institution of 
higher education and achieving academic success. The Career 
Technical Training (CTT) track focuses on credentials earned 
during military service and higher education in select 
technical training schools and fields. The Department of 
Defense concurs with mandatory participation in the AHE or CTT 
track, for Servicemembers who identify an interest in attending 
college or a career technical school after separation, with 
authorized exemptions. Contrary to the re-designed Transition 
Assistance Program, the Commission proposal does not enable 
transition planning according to the individual goals and needs 
of each transitioning Servicemember. The proposed legislation 
is a ``one size fits all'' approach and does not take into 
consideration the numerous other education benefits active duty 
Servicemembers have, or are eligible for, prior to separating, 
such as tuition assistance and the GI Bills. These other 
benefits require an education plan and individual counseling 
with an education professional. Furthermore, the proposed 
legislation does not appear to consider how it might affect 
those Servicemembers who enter on active duty with a college 
diploma, credential and/or license.
    The Department of Veterans Affairs is developing a module 
specifically focused on the benefits, eligibility, and 
transferability of the Post-9/11 GI Bill as part of military 
career deliberations. The goals of the Commission's 
recommendation will be met as a result of Servicemembers 
attending the new Department of Veterans Affairs training for 
Post-9/11 GI Bill benefits prior to developing an education 
program plan or using their Post-9/11 GI Bill benefits. 
Expected implementation date for the new Post-9/11 GI Bill 
training is October 1, 2015.
    The Commission's legislative proposal to review and 
evaluate the core Transition Goals, Plans, Success (GPS) 
curriculum is aligned with the current Department of Defense 
and TAP Inter-agency Evaluation Strategy. New legislation is 
not required because an interagency annual review is a pillar 
of the Office of Management and Budget approved TAP Evaluation 
Strategy. This strategy requires analysis of metrics and 
benchmark performance criteria to enable the Department of 
Defense to provide programs and support to meet the needs of 
transitioning Servicemembers. It necessitates an annual review 
of all curriculum components in concert with participant 
feedback to ensure curriculum and training resources support 
the achievement of career readiness standards and career 
success post military service.
    The Transition Assistance Program Inter-agency Curriculum 
Working Group, comprised of members from each of the TAP Inter-
agency partners, the Military Services, and relevant subject 
matter experts, conducts an annual review of the Transition GPS 
curriculum. The Working Group develops changes based on content 
relevancy, participant assessments, Servicemember feedback, 
roles and responsibilities of partners, facilitator 
recommendations, and best practices and lessons learned as a 
result of staff assistance visits to installations. Proposed 
curriculum revisions are vetted and approved by the TAP Inter-
agency Executive Council.

              DEPARTMENT OF DEFENSE LEGISLATIVE PROPOSALS

    The committee requested input on several of the Legislative 
Proposals included in the Department of Defense National 
Defense Authorization Act for Fiscal Year 2016 submission.
Sec. 514. Inclusion of duty performed by a reserve component member 
        under a call or order to active duty for medical purposes as 
        qualifying active duty time for purposes of Post-9/11 GI Bill 
        education benefits
    Similar to S. 602, ``GI Bill Fairness Act of 2015,'' this 
section includes active duty performed under the authority of 
title10, United States Code, section 12301(h), as qualifying 
active duty for the purposes of Post-9/11 GI Bill Education 
Benefits. As pointed out in my discussion of that bill, the 
Department's proposal differs in that it is not retroactive to 
September 11, 2001. The Department of Defense urges adoption of 
this proposal.
Sec. 522. Retention of entitlement to educational assistance during 
        certain additional periods of active duty
    This section would amend chapter 1606, (Montgomery GI Bill-
Selected Reserve (MGIB-SR) of title 10, United States Code. 
Specifically this proposal would add 10 United States Code 
12304a and 12304b to the existing list of authorities in 10 
United States Code16131 under which a servicemember may regain 
lost payments. Further, both 10 United States Code 12304a and 
12304b would be added to 10 United States Code 16133 under 
which a Servicemember may regain lost entitlement time for 
MGIB-SR benefits. The Department of Defense urges adoption of 
this proposal.
Sec. 542. Update to involuntary mobilization duty authorities exempt 
        from 5-year limit under the Uniformed Services Employment and 
        Reemployment Rights Act
    This section would amend section 4312 of title 38, United 
States Code, to update the involuntary mobilization authorities 
exempted from the Uniformed Services Employment and 
Reemployment Rights Act (USERRA) 5-year limit. Adding 
references to sections 12304a and 12304b of title 10 will 
complete the list of current involuntary mobilization 
authorities exempted from that limit in section 4312 of title 
38.
    USERRA, codified in 38 U.S.C. 4301-4335, protects 
individuals performing, or who have performed or will perform, 
uniformed service from employment discrimination on the basis 
of their uniformed service. It provides for prompt reemployment 
when they return to civilian life. The Department of Defense 
urges adoption of this proposal.
Sec. 545. Required provision of pre-separation counseling
    This section would amend section 1142 and 1144 of Title 10, 
United States Code, to authorize Pre-separation, Employment 
Assistance and all other transition services prescribed in 
Department of Defense policy by the Secretary of Defense for 
ALL Active Component Servicemembers of the Armed Forces and for 
ALL National Guard and Reserve Servicemembers called or ordered 
to active duty or full-time operational support after 
completion of their first 180 continuous days or more under 
Title 10, United States Code, (other than for full-time 
training duty, annual training duty, and attendance, while in 
the active military service, at a school designated as service 
school by law or by the Secretary of the military department 
concerned), whose discharge or release from active duty is 
anticipated as of a specific date. The Department of Defense 
urges adoption of this proposal.
Sec. 1041. Transfer of functions of the Veterans' Advisory Board on 
        Dose Reconstruction to the Secretaries of Veterans Affairs and 
        Defense
    This section would repeal the statutory requirement for a 
Federal Advisory Committee Act (FACA) advisory board for the 
Radiation Dose Reconstruction Program. The Department of 
Defense believes that this advisory board has achieved its 
objectives, and that its functions can now be more effectively 
conducted through an interagency effort rather than through a 
FACA advisory board. The Department of Defense urges adoption 
of this proposal.
    The final item on the agenda is a discussion of provisions 
derived from a series of pending bills. I will comment only on 
those that affect the Department of Defense.

                 S. 151. Filipino Veterans Promise Act

    This bill would require the Secretary of Defense to 
establish a process to determine whether individuals claiming 
certain service in the Philippines during World War II are 
eligible for certain benefits despite not being on the so-
called ``Missouri List.'' The Department does not support any 
further legislation concerning determining service eligibility 
for the WWII Filipino Guerilla Veterans. The Army has a program 
in place that is verifiable. This program, due to its thorough 
processes, is the foundation for the Army's position, past and 
current, for making final service determinations for 
eligibility. The Army maintains complete confidence that the 
records and files completed in 1948 provide the best and most 
accurate determinations that could have been made from that 
time until today.

       S. 743. Honor America's Guard-Reserve Retirees Act of 2015

    This bill amends title 38, United States Code, to recognize 
the service in the reserve components of the Armed Forces of 
certain persons by honoring them with status as Veterans under 
law, and for other purposes. The Department recognizes and 
values the service of these Servicemembers who qualify for a 
Reserve retirement, but may not be Veterans, but opposes 
identifying these Servicemembers with any type of honorary 
Veteran status. Although S. 743 defines this honorary status to 
be without eligibility for Veteran's benefits from the 
Department of Veterans Affairs, the Department of Defense 
believes this honorary status would create confusion about 
eligibility for the Department of Veterans Affairs benefits 
among the current and former Servicemembers and could increase 
the potential for error in determining benefits entitlements.
    Mr. Chairman this concludes my statement. As has been 
stated numerous times in hearings before this committee, post 
service education benefits have been a cornerstone of our 
military recruiting and retention efforts since 1985, and a 
major contributor to the continued success of the All-Volunteer 
Force. Money for education has been and remains at the 
forefront of reasons cited by young Americans for joining the 
military. From its inception we fully expected the Post-9/11 GI 
Bill to continue to have this impact and we are seeing that 
happen in the form of sustained recruiting success. I thank you 
and the members of this Committee for your outstanding and 
continuing support of the men and women of the Department of 
Defense. We look forward to working closely with you to 
strengthen the All-Volunteer force through a balanced program 
of recruiting, retention, and vital education benefits, and to 
recognize the service of our Veterans.
                                ------                                

    On May 13, 2015, Teresa W. Gerton, Deputy Assistant 
Secretary for Policy, Veterans' Employment and Training 
Service, Department of Labor, appeared before the Committee and 
submitted testimony on various bills incorporated into the 
Committee bill. An excerpt from that testimony is reprinted 
below:

 STATEMENT OF TERESA W. GERTON, DEPUTY ASSISTANT SECRETARY FOR POLICY, 
  VETERANS' EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR

                              INTRODUCTION

    Good afternoon, Chairman Isakson, Ranking Member 
Blumenthal, and distinguished Members of the Committee. Thank 
you for the opportunity to participate in today's hearing. I 
would like to thank the Commission, which was assigned to 
develop the Military Compensation and Retirement Modernization 
(MCRMC) Report, for all its hard work. As President Obama 
indicated, the report's recommendations ``represent an 
important step forward in protecting the long-term viability of 
the All-Volunteer Force,'' and ``improving quality-of-life for 
servicemembers and their families.'' As Deputy Assistant 
Secretary for Policy at the Veterans' Employment and Training 
Service (VETS) at the Department of Labor (DOL or Department), 
I appreciate the opportunity to discuss the Department's views 
on pending legislation and proposals impacting veterans.
    The Department's charter, for over 100 years, has been to 
``foster, promote and develop the welfare of working people, to 
improve their working conditions, and to enhance their 
opportunities for profitable employment.'' The Department's 
collective resources and expertise are integrated with state 
workforce agencies and local communities to meet the employment 
and training needs of all Americans, including veterans, 
transitioning servicemembers, members of the National Guard and 
Reserve, their families, and survivors.
    As the Federal Government's leader on veterans' employment, 
VETS ensures that the full resources of the Department are 
readily available for veterans and servicemembers seeking to 
transition into the civilian labor force. VETS' mission is 
focused on four key areas: (1) preparing veterans for 
meaningful careers; (2) providing them with employment 
resources and expertise; (3) protecting their employment 
rights; and, (4) promoting the employment of veterans and 
related training opportunities to employers across the country.
    While this hearing addresses several legislative proposals, 
the Department limits its remarks to those legislative 
proposals that have a direct impact on the programs 
administered by the Department, specifically, the ``21st 
Century Veterans' Benefits Delivery Act,'' and the legislative 
proposals based on MCRMC Recommendations 11 and 12.

        S. 1203, ``21ST CENTURY VETERANS BENEFITS DELIVERY ACT''

    The draft Senate bill, ``21st Century Veterans Benefits 
Delivery Act,'' seeks to amend title 38 of the U.S. Code, to 
improve the processing by the Department of Veterans Affairs 
(VA) of claims for benefits under laws administered by the 
Secretary of Veterans Affairs, and for other purposes.
Section 101
    Section 101 would amend section 1144 of title 10 of the U.S 
Code, adding subsection (f) to require modifications to the 
VA's eBenefits Web site, which would ensure that 
servicemembers, veterans, and their spouses have access to the 
Transition Assistance Program (TAP) online curriculum, as 
administered by the Secretary of Labor, the Secretary of 
Defense, the Secretary of Homeland Security, and the Secretary 
of Veterans Affairs. The Department believes that it has 
already met the intent of this proposal. DOL has worked with 
the Department of Defense (DOD) and VA to host the TAP 
curriculum online. Currently, servicemembers and their spouses 
are able to access the entire Transition GPS curriculum online 
via DOD's Joint Knowledge Online, the VA's eBenefits Web site, 
or DOL VETS' Web site. Section 101 also states: ``An individual 
subject to a requirement under subsection (c) may not satisfy 
such requirement by participating in the program carried out 
under this section solely through an Internet Web site.'' DOL 
appreciates the intent of this statement and notes that the 
vast majority of servicemembers who attend our employment 
workshop do so in person. We defer to DOD on the impact of this 
requirement, and to the VA on the inclusion of our Veterans 
Service Organization (VSO) partners.

              LEGISLATIVE PROPOSALS FROM THE MCRMC REPORT

    The Administration has indicated its general support for 
Recommendations 11 and 12, in the Presidential Memorandum 
issued on April 30, 2015. As DOL recently shared with the staff 
of this Committee, the Department has initiated many of the 
Commission's recommendations prior to publication of the 
Commission's report. Accordingly, any legislative proposal to 
implement these recommendations should be modified to reflect 
these recent VETS program improvements, as well as to ensure 
continued access to unemployment benefits for servicemembers 
who need income support, while availing themselves of 
educational and training programs.
Recommendation 11
    Recommendation 11, ``Safeguard education benefits for 
Servicemembers by reducing redundancy and ensuring the fiscal 
sustainability of education programs,'' is primarily directed 
toward DOD and VA, who administer a myriad of benefit programs 
for servicemembers. The Department generally supports 
Recommendation 11. The sub-recommendation of interest to DOL 
would prevent individuals receiving housing stipend benefits 
under the Post-9/11 GI Bill from simultaneously receiving 
unemployment insurance (UI). This sub-recommendation would 
amend title 5 of the U.S. Code, at section 8525, on 
Unemployment Compensation for Ex-Servicemembers (UCX), as well 
as any other regulation and policy pertaining to section 8525. 
The MCRMC's companion legislative proposal to implement this 
sub-recommendation is contained in Section 1109, Unemployment 
Insurance.
    To achieve the goal of safeguarding education benefits of 
servicemembers, it is necessary that servicemembers have 
adequate income support to take advantage of these programs. 
The Department would like to ensure equitable treatment for 
servicemembers compared to their civilian counterparts, who 
also are seeking UI benefits for approved training. The receipt 
of other benefits, such as the Post-9/11 GI Bill retraining 
incentives or housing benefits, currently do not prevent 
veterans from taking advantage of the same provision given to 
regular (civilian) unemployment insurance (UI) recipients when 
training is approvable/approved under state law.
    Providing income support for servicemembers eligible for 
UCX helps to ensure that their retraining leads to employment 
in a more sustainable labor market after specialized military 
service. Unemployment insurance is designed to provide benefits 
for workers to enable their successful transition to new 
employment; it is affirmatively intended to provide for costs 
of living beyond housing. Additionally, State UI laws contain 
requirements regarding an individual's availability for work, 
which entails being ready, willing, and able to work. This 
includes the requirement that a claimant receiving UCX register 
with the public employment service. Thus, receipt of UCX 
benefits connects veterans to reemployment services through the 
public workforce system, which in conjunction with receiving GI 
Bill benefits, helps to more effectively support the 
individual's successful reentry to civilian employment. 
Therefore, preventing GI Bill beneficiaries from receiving 
unemployment compensation may be a detriment to their 
successful reemployment. While the Department does not favor 
Section 1109 as currently drafted, we would be willing to 
continue discussions with Congress and the Department of 
Veterans Affairs on this issue.
Recommendation 12
    Recommendation 12, ``Better prepare Servicemembers for 
transition to civilian life by expanding and granting states 
more flexibility to administer the Jobs for Veterans State 
Grants Program,'' seeks to expand servicemembers' knowledge of 
educational benefits, improve Transition GPS, and improve the 
Jobs for Veterans State Grant (JVSG) program. The Department 
generally supports Recommendation 12; for purposes of this 
hearing, the Department will focus specifically on the 
following sub-recommendations:

    (1) The Congress should require DOD, VA, and DOL to review 
and report on the core curriculum for Transition GPS to 
reevaluate if the current curriculum most accurately addresses 
the needs of transitioning Servicemembers. This report should 
include review of the current curriculum; the roles and 
responsibilities of each Department and whether they are 
adequately aligned; and the distribution of time between the 
three departments in the core curriculum and whether it is 
adequate to provide all information regarding important 
benefits that can assist transitioning Servicemembers. This 
review should indicate whether any of the information in the 
three optional tracks should be addressed instead in mandatory 
tracks. It should also include a standard implementation plan 
of long-term outcome measures for a comprehensive system of 
metrics. This review should identify any areas of concern 
regarding the program and recommendations for addressing those 
concerns.
    DOL notes that processes already in place address the 
intent of this proposal, and would be pleased to share our 
curriculum review results with this Committee. The MCRMC's 
companion legislative proposal to implement this sub-
recommendation is contained in Section 1204, Transition GPS 
Program Core Curriculum Review and Report.
    In Fiscal Year (FY) 2014, as a member of the TAP Senior 
Steering Curriculum Working Group with DOD and VA, the 
Department began an annual curriculum evaluation. This 
evaluation included analysis of results from the web-based 
Transition GPS participant survey instrument developed by DOD, 
and input from various stakeholders. Based on this evaluation, 
the Department revised the TAP Employment Workshop curriculum 
to include Equal Employment Opportunity and Americans with 
Disability Act content, the Veterans Employment Center content, 
and enhanced information on Workforce Investment Act training, 
dislocated worker training, and Registered Apprenticeship 
programs.
    The FY 2015 curriculum review began in April 2015, in 
conjunction with the TAP Senior Steering Curriculum Working 
Group's planned review of the entire Transition GPS curriculum. 
Any changes that may result from this review should be 
available to transitioning servicemembers in November 2015. 
Additionally, the Department will address this sub-
recommendation before the TAP Senior Steering Group for 
consideration in the FY 2015 curriculum review.

    (2) The Congress should amend the relevant statutes to 
permit state departments of labor or their equivalent agencies 
to work directly with state Veterans Affairs directors or 
offices to coordinate implementation of the JVSG program.
    DOL believes that it has already met the intent of this 
proposal, which is contained in Section 1202, Coordination with 
State Departments of Labor and VA. The process this proposal 
seeks to implement is already in place; the Department's 
standards of performance for each of the Directors for 
Veterans' Employment and Training (DVET) specifies in the 
``duties and responsibilities'' section that each DVET must 
coordinate with state Departments of Labor and Veterans 
Affairs. Moreover, current law does not prohibit inter-agency 
coordination with respect to JVSG, including coordination with 
the VA (title 38, U.S. Code 4102A(b)(3)). In fact, the 
Workforce Innovation and Opportunity Act, passed in 2014, 
supports greater inter-agency cooperation. The public workforce 
system is designed to be a decentralized network of strong 
partnerships at the Federal, state, local, and regional levels.

    (3) DOL should require One-Stop Career Centers to track the 
number of job fairs their employees participate in and the 
number of veterans they connect with at each job fair. This 
information should be included in each state's annual report to 
the DOL, and provided to the Congress.
    The Department does not find American Job Center (AJC) 
staff attendance at Transition GPS Employment Workshops, job 
fair participation rates, or the number of transitioning 
servicemembers and veterans with whom JVSG staff interact to be 
measures reflective of meaningful outcomes data. Tracking these 
activities may, in fact, result in the unintended consequence 
of incentivizing the quantity of interactions between AJC staff 
and veterans, rather than the quality and effectiveness of the 
services AJC staff provide to veterans. Also, this proposal, 
contained in Section 1201, Job Fair Participation Rates, seeks 
to amend the Workforce Investment Act of 1998, which has been 
superseded by the Workforce Innovation and Opportunity Act 
(WIOA), making it difficult to interpret how it would be 
executed. Nevertheless, this proposal is not in keeping with 
Section 116 of WIOA (which replaced section 136 of WIA), which 
establishes common performance accountability measures that 
apply across the Department's core employment and training 
programs to assess the effectiveness of States and local areas 
in achieving positive outcomes for individuals served by 
related programs. While JVSG is not a core program under WIOA, 
38 U.S.C. 4102A requires JVSG performance measures to ``be 
consistent with'' those under WIOA. The Departments of Labor 
and Education on April 16 jointly issued a WIOA Notice of 
Proposed Rulemaking seeking public comments on such topics as 
performance accountability to ensure that Federal employment 
and training program investments report on common performance 
indicators such as how many individuals, including veterans, 
entered employment and their median wages. The Departments 
welcome comments from this Committee on our proposal.

    (4) The Congress should require a one-time joint report 
from DOD, VA, and DOL to the Senate and House Committees on 
Armed Services and Veterans' Affairs regarding the challenges 
employers face when seeking to hire veterans. The report should 
identify the barriers employers face gaining information 
identifying veterans seeking jobs. It should also include 
recommendations addressing barriers for employers and improving 
information sharing between Federal agencies that serve 
veterans and separating Servicemembers, so they may more easily 
connect employers and veterans. The report should also review 
the Transition GPS career preparation core curriculum and 
recommend any improvements that can be made to better prepare 
Servicemembers trying to obtain private-sector employment.
    The Department supports the intent of this recommendation 
and looks forward to continuing our work with our Federal 
partners on this important issue. However, we already have 
gathered much information from employers on their challenges in 
hiring veterans. This is provided in recent reports, such as 
the 2014 RAND report titled, ``Lessons from the 100,000 Job 
Mission.'' We already are working with agency partners to 
address many of those challenges. In addition, and given the 
volume of information and the workload required to obtain 
additional data, we recommend that we work with our agency 
partners to develop the information you believe would be 
helpful in assessing issues related to barriers to employers 
hiring veterans. We then can meet with you to share the 
requested material.

           *       *       *       *       *       *       *

                               CONCLUSION

    We at the Department of Labor remain committed to our 
Nation's veterans and we look forward to working with the 
Committee to ensure the continued success of our efforts. The 
Department lauds the hard work the Commission placed into their 
recommendations. It is our hope that the Committee will 
consider the modifications we have provided and is open to 
working with the Committee members to provide technical 
assistance. Mr. Chairman, Ranking Member Blumenthal, and 
Members of the Committee, this concludes my statement. Thank 
you again for the opportunity to testify today. I am happy to 
answer any questions that you may have.

                        Changes in Existing Law

    In compliance with paragraph 12 of Rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman).

Title 10. Armed Forces

           *       *       *       *       *       *       *

Subtitle A. General Military Law

           *       *       *       *       *       *       *

Part II. Personnel

           *       *       *       *       *       *       *

   Chapter 58. Benefits and Services for Members Being Separated or 
Recently Separated

           *       *       *       *       *       *       *

SEC. 1142. PRESEPARATION COUNSELING; TRANSMITTAL OF MEDICAL RECORDS TO 
                    DEPARTMENT OF VETERANS AFFAIRS

    (a) Requirement.--
          (1)  * * *

           *       *       *       *       *       *       *

          (4)(A) Subject to subparagraph (B), the Secretary 
        concerned shall not provide preseparation counseling to 
        a member who is being discharged or released before the 
        completion of that member's first continuous 180 days 
        of active duty.
          (B)  * * *
          (C) For purposes of subparagraph (A), the term 
        ``active duty'' does not include full-time training 
        duty, annual training duty, and attendance, while in 
        the active military service, at a school designated as 
        a service school by law or by the Secretary concerned.

           *       *       *       *       *       *       *

Subtitle E. Reserve Components

           *       *       *       *       *       *       *

  Part IV. Training for Reserve Components and Educational Assistance 
Programs

           *       *       *       *       *       *       *

   Chapter 1606. Educational Assistance for Members of the Selected 
Reserve

           *       *       *       *       *       *       *

SEC. 16131. EDUCATIONAL ASSISTANCE PROGRAM: ESTABLISHMENT; AMOUNT

           *       *       *       *       *       *       *

    (c)(1) * * *

           *       *       *       *       *       *       *

    (3)(A) * * *

           *       *       *       *       *       *       *

    (B) * * *
          (i) had to discontinue such course pursuit as a 
        result of being ordered to serve on active duty under 
        section 12301(a), 12301(d), 12301(g), 12302, [or 12304] 
        12304, 12304a, or 12304b of this title; and
          (ii) * * *

           *       *       *       *       *       *       *

SEC. 16133. TIME LIMITATION FOR USE OF ENTITLEMENT

    (a) * * *
    (b)(1) In the case of a person--

           *       *       *       *       *       *       *

    (4) In the case of a member of the Selected Reserve of the 
Ready Reserve who serves on active duty pursuant to an order to 
active duty issued under section 12301(a), 12301(d), 12301(g), 
12302, [or 12304] 12304, 12304a, or 12304b of this title--

           *       *       *       *       *       *       *

Title 38. Veterans' Benefits

           *       *       *       *       *       *       *

Part II. General Benefits

           *       *       *       *       *       *       *

   Chapter 17. Hospital, Nursing Home, Domiciliary, and Medical Care

                         SUBCHAPTER I. GENERAL

SEC.

           *       *       *       *       *       *       *

SUBCHAPTER VIII. HEALTH CARE OF PERSONS OTHER THAN VETERANS

           *       *       *       *       *       *       *

1784. HUMANITARIAN CARE.

1784A. EXAMINATION AND TREATMENT FOR EMERGENCY MEDICAL CONDITIONS AND 
                    WOMEN IN LABOR.

           *       *       *       *       *       *       *

Subchapter I. General

           *       *       *       *       *       *       *

SEC. 1701. DEFINITIONS

    For the purposes of this chapter--

           *       *       *       *       *       *       *

          (6) * * *

           *       *       *       *       *       *       *

                  (H) Chiropractic services.

           *       *       *       *       *       *       *

          (8) The term ``rehabilitative services'' means such 
        professional, counseling, chiropractic, and guidance 
        services and treatment programs as are necessary to 
        restore, to the maximum extent possible, the physical, 
        mental, and psychological functioning of an ill or 
        disabled person.
          (9) The term ``preventive health services'' means--

           *       *       *       *       *       *       *

                  (F) periodic and preventive chiropractic 
                examinations and services;
                  
                  (G) [(F) immunizations against infectious 
                disease;] immunizations against infectious 
                diseases, including each immunization on the 
                recommended adult immunization schedule at the 
                time such immunization is indicated on that 
                schedule;
                  (H) [(G)] prevention of musculoskeletal 
                deformity or other gradually developing 
                disabilities of a metabolic or degenerative 
                nature;
                  (I) [(H)] genetic counseling concerning 
                inheritance of genetically determined diseases;
                  (J) [(I)] routine vision testing and eye care 
                services;
                  (K) [(J)] periodic reexamination of members 
                of likely target populations (high-risk groups) 
                for selected diseases and for functional 
                decline of sensory organs, together with 
                attendant appropriate remedial intervention; 
                and
                  (L) [(K)] such other health-care services as 
                the Secretary may determine to be necessary to 
                provide effective and economical preventive 
                health care.
          (10) The term ``recommended adult immunization 
        schedule'' means the schedule established (and 
        periodically reviewed and, as appropriate, revised) by 
        the Advisory Committee on Immunization Practices 
        established by the Secretary of Health and Human 
        Services and delegated to the Centers for Disease 
        Control and Prevention.

           *       *       *       *       *       *       *

SEC. 1704. PREVENTIVE HEALTH SERVICES: ANNUAL REPORT

          (1) * * *
                  (A) * * *
                          (i) to educate veterans with respect 
                        to health promotion and disease 
                        prevention; [and]
                          (ii) to provide veterans with 
                        preventive health screenings and other 
                        clinical services, with such 
                        description setting forth the types of 
                        resources used by the Department to 
                        conduct such screenings and services 
                        and the number of veterans reached by 
                        such screenings and services[.] ; and
                          (iii) to provide veterans each 
                        immunization on the recommended adult 
                        immunization schedule at the time such 
                        immunization is indicated on that 
                        schedule.

           *       *       *       *       *       *       *

                Subchapter VIII. Health Care of Persons 
Other Than Veterans

           *       *       *       *       *       *       *

SEC. 1784. HUMANITARIAN CARE

    The Secretary may furnish hospital care or medical services 
as a humanitarian service in emergency cases, but the Secretary 
shall charge for such care and services at rates prescribed by 
the Secretary.

SEC. 1784A. EXAMINATION AND TREATMENT FOR EMERGENCY MEDICAL CONDITIONS 
                    AND WOMEN IN LABOR

    (a) In General.--In the case of a hospital of the 
Department that has an emergency department, if any individual 
comes to the hospital or the campus of the hospital and a 
request is made on behalf of the individual for examination or 
treatment for a medical condition, the hospital must provide 
for an appropriate medical screening examination within the 
capability of the emergency department, including ancillary 
services routinely available to the emergency department, to 
determine whether or not an emergency medical condition exists.
    (b) Necessary Stabilizing Treatment for Emergency Medical 
Conditions and Labor.--(1) If any individual comes to a 
hospital of the Department that has an emergency department or 
the campus of such a hospital and the hospital determines that 
the individual has an emergency medical condition, the hospital 
must provide either--
          (A) within the staff and facilities available at the 
        hospital, for such further medical examination and such 
        treatment as may be required to stabilize the medical 
        condition; or
          (B) for transfer of the individual to another medical 
        facility in accordance with subsection (c).
    (2) A hospital is deemed to meet the requirement of 
paragraph (1)(A) with respect to an individual if the hospital 
offers the individual the further medical examination and 
treatment described in that paragraph and informs the 
individual (or a person acting on behalf of the individual) of 
the risks and benefits to the individual of such examination 
and treatment, but the individual (or a person acting on behalf 
of the individual) refuses to consent to the examination and 
treatment. The hospital shall take all reasonable steps to 
secure the written informed consent of the individual (or 
person) to refuse such examination and treatment.
    (3) A hospital is deemed to meet the requirement of 
paragraph (1) with respect to an individual if the hospital 
offers to transfer the individual to another medical facility 
in accordance with subsection (c) and informs the individual 
(or a person acting on behalf of the individual) of the risks 
and benefits to the individual of such transfer, but the 
individual (or a person acting on behalf of the individual) 
refuses to consent to the transfer. The hospital shall take all 
reasonable steps to secure the written informed consent of the 
individual (or person) to refuse such transfer.
    (c) Restricting Transfers Until Individual Stabilized.--(1) 
If an individual at a hospital of the Department has an 
emergency medical condition that has not been stabilized, the 
hospital may not transfer the individual unless--
          (A)(i) the individual (or a legally responsible 
        person acting on behalf of the individual), after being 
        informed of the obligations of the hospital under this 
        section and of the risk of transfer, requests, in 
        writing, transfer to another medical facility;
          (ii) a physician of the Department has signed a 
        certification that, based upon the information 
        available at the time of transfer, the medical benefits 
        reasonably expected from the provision of appropriate 
        medical treatment at another medical facility outweigh 
        the increased risks to the individual and, in the case 
        of labor, to the unborn child from effecting the 
        transfer; or
          (iii) if a physician of the Department is not 
        physically present in the emergency department at the 
        time an individual is transferred, a qualified medical 
        person (as defined by the Secretary for purposes of 
        this section) has signed a certification described in 
        clause (ii) after a physician of the Department, in 
        consultation with the person, has made the 
        determination described in such clause, and 
        subsequently countersigns the certification; and
          (B) the transfer is an appropriate transfer to that 
        facility.
    (2) A certification described in clause (ii) or (iii) of 
paragraph (1)(A) shall include a summary of the risks and 
benefits upon which the certification is based.
    (3) For purposes of paragraph (1)(B), an appropriate 
transfer to a medical facility is a transfer--
          (A) in which the transferring hospital provides the 
        medical treatment within its capacity that minimizes 
        the risks to the health of the individual and, in the 
        case of a woman in labor, the health of the unborn 
        child;
          (B) in which the receiving facility--
                  (i) has available space and qualified 
                personnel for the treatment of the individual; 
                and
                  (ii) has agreed to accept transfer of the 
                individual and to provide appropriate medical 
                treatment;
          (C) in which the transferring hospital sends to the 
        receiving facility all medical records (or copies 
        thereof) available at the time of the transfer relating 
        to the emergency medical condition for which the 
        individual has presented, including--
                  (i) observations of signs or symptoms;
                  (ii) preliminary diagnosis;
                  (iii) treatment provided;
                  (iv) the results of any tests; and
                  (v) the informed written consent or 
                certification (or copy thereof) provided under 
                paragraph (1)(A);
          (D) in which the transfer is effected through 
        qualified personnel and transportation equipment, 
        including the use of necessary and medically 
        appropriate life support measures during the transfer; 
        and
          (E) that meets such other requirements as the 
        Secretary considers necessary in the interest of the 
        health and safety of individuals transferred.
    (d) Definitions.--In this section:
          (1) The term ``campus'' means, with respect to a 
        hospital of the Department--
                  (A) the physical area immediately adjacent to 
                the main buildings of the hospital;
                  (B) other areas and structures that are not 
                strictly contiguous to the main buildings but 
                are located not less than 250 yards from the 
                main buildings; and
                  (C) any other areas determined by the 
                Secretary to be part of the campus of the 
                hospital.
          (2) The term ``emergency medical condition'' means--
                  (A) a medical condition manifesting itself by 
                acute symptoms of sufficient severity 
                (including severe pain) such that the absence 
                of immediate medical attention could reasonably 
                be expected to result in--
                          (i) placing the health of the 
                        individual (or, with respect to a 
                        pregnant woman, the health of the woman 
                        or her unborn child) in serious 
                        jeopardy;
                          (ii) serious impairment to bodily 
                        functions; or
                          (iii) serious dysfunction of any 
                        bodily organ or part; or
                  (B) with respect to a pregnant woman who is 
                having contractions--
                          (i) that there is inadequate time to 
                        effect a safe transfer to another 
                        hospital before delivery; or
                          (ii) that transfer may pose a threat 
                        to the health or safety of the woman or 
                        the unborn child.
          (3)(A) The term ``to stabilize'' means, with respect 
        to an emergency medical condition described in 
        paragraph (2)(A), to provide such medical treatment of 
        the condition as may be necessary to assure, within 
        reasonable medical probability, that no material 
        deterioration of the condition is likely to result from 
        or occur during the transfer of the individual from a 
        facility, or, with respect to an emergency medical 
        condition described in paragraph (2)(B), to deliver 
        (including the placenta).
          (B) The term ``stabilized'' means, with respect to an 
        emergency medical condition described in paragraph 
        (2)(A), that no material deterioration of the condition 
        is likely, within reasonable medical probability, to 
        result from or occur during the transfer of the 
        individual from a facility, or, with respect to an 
        emergency medical condition described in paragraph 
        (2)(B), that the woman has delivered (including the 
        placenta).
          (4) The term ``transfer'' means the movement 
        (including the discharge) of an individual outside the 
        facilities of a hospital of the Department at the 
        direction of any person employed by (or affiliated or 
        associated, directly or indirectly, with) the hospital, 
        but does not include such a movement of an individual 
        who--
                  (A) has been declared dead; or
                  (B) leaves the facility without the 
                permission of any such person.

           *       *       *       *       *       *       *

Part III. Readjustment and Related Benefits

           *       *       *       *       *       *       *

              Chapter 33. Post-9/11 Educational Assistance

                       SUBCHAPTER I. DEFINITIONS

SEC.

           *       *       *       *       *       *       *

SUBCHAPTER III. ADMINISTRATIVE PROVISIONS

           *       *       *       *       *       *       *

3325. REPORTING REQUIREMENT.

3326. REPORT ON STUDENT PROGRESS.

           *       *       *       *       *       *       *

Subchapter III. Administrative Provisions

           *       *       *       *       *       *       *

SEC. 3325. REPORTING REQUIREMENT

           *       *       *       *       *       *       *

    (b) * * *
          (1) * * *
                  (A) * * *
                  (B) indicating whether it is necessary for 
                the purposes of maintaining adequate levels of 
                well-qualified active-duty personnel in the 
                Armed Forces to continue to offer the 
                opportunity for educational assistance under 
                this chapter to individuals who have not yet 
                entered active-duty service; [and]
                  (C) * * *
                  (D) indicating the highest level of education 
                attained by each individual who transfers a 
                portion of the individual's entitlement to 
                educational assistance under section 3319 of 
                this title; and
          (2) * * *
    (c) * * *
          (1) * * *
          (2) appropriate student outcome measures, such as the 
        number of credit hours, certificates, degrees, and 
        other qualifications earned by beneficiaries under this 
        chapter and chapter 35 of this title during the 
        academic year covered by the report; [and]
          (3) the information received by the Secretary under 
        section 3326 of this title; and
          (4) [(3)] such recommendations for administrative and 
        legislative changes regarding the provision of 
        educational assistance to members of the Armed Forces 
        and veterans, and their dependents, as the Secretary 
        considers appropriate.

SEC. 3326. REPORT ON STUDENT PROGRESS

    As a condition on approval under chapter 36 of this title 
of a course offered by an educational institution (as defined 
in section 3452 of this title), each year, each educational 
institution (as so defined) that received a payment in that 
year on behalf of an individual entitled to educational 
assistance under this chapter shall submit to the Secretary 
such information regarding the academic progress of the 
individual as the Secretary may require.

           *       *       *       *       *       *       *

    Chapter 41. Job Counseling, Training, and Placement Service for 
Veterans

           *       *       *       *       *       *       *

SEC. 4103. DIRECTORS AND ASSISTANT DIRECTORS FOR VETERANS' EMPLOYMENT 
                    AND TRAINING; ADDITIONAL FEDERAL PERSONNEL

           *       *       *       *       *       *       *

    (c) Coordination With State Departments of Labor and 
Veterans Affairs.--Each Director for Veterans' Employment and 
Training for a State shall coordinate the Director's activities 
under this chapter with the State department of labor and the 
State department of veterans affairs.

           *       *       *       *       *       *       *

             Part V. Boards, Administrations, and Services

Chapter 71. Board of Veterans' Appeals

           *       *       *       *       *       *       *

SEC. 7107. APPEALS: DOCKETS; HEARINGS

    (a)(1) Except as provided in paragraphs (2) and (3) and [in 
subsection (f)] in subsection (g), each case received pursuant 
to application for review on appeal shall be considered and 
decided in regular order according to its place upon the 
docket.

           *       *       *       *       *       *       *

    (d)(1) Subject to paragraph (2), a hearing before the Board 
shall be conducted, as the Board considers appropriate--
          (A) in person; or
          (B) through picture and voice transmission, by 
        electronic or other means, in such manner that the 
        appellant is not present in the same location as the 
        member or members of the Board during the hearing.
    (2) Upon request by an appellant, a hearing before the 
Board shall be conducted, as the appellant considers 
appropriate--
          (A) in person; or
          (B) through picture and voice transmission as 
        described in paragraph (1)(B).
    (e)(1) In a case in which a hearing before the Board is to 
be conducted through picture and voice transmission as 
described in subsection (d)(1)(B), the Secretary shall provide 
suitable facilities and equipment to the Board or other 
components of the Department to enable an appellant located at 
an appropriate facility within the area served by a regional 
office to participate as so described.
    (2) Any hearing conducted through picture and voice 
transmission as described in subsection (d)(1)(B) shall be 
conducted in the same manner as, and shall be considered the 
equivalent of, a personal hearing.
    [(e)(1) At the request of the Chairman, the Secretary may 
provide suitable facilities and equipment to the Board or other 
components of the Department to enable an appellant located at 
a facility within the area served by a regional office to 
participate, through voice transmission or through picture and 
voice transmission, by electronic or other means, in a hearing 
with a Board member or members sitting at the Board's principal 
location.
    [(2) When such facilities and equipment are available, the 
Chairman may afford the appellant an opportunity to participate 
in a hearing before the Board through the use of such 
facilities and equipment in lieu of a hearing held by 
personally appearing before a Board member or panel as provided 
in subsection (d). Any such hearing shall be conducted in the 
same manner as, and shall be considered the equivalent of, a 
personal hearing. If the appellant declines to participate in a 
hearing through the use of such facilities and equipment, the 
opportunity of the appellant to a hearing as provided in such 
subsection (d) shall not be affected.]
    (f) [(d)](1) [An appellant may request that a hearing 
before the Board be held at its principal location or at a 
facility of the Department located within the area served by a 
regional office of the Department] In a case in which a hearing 
before the Board is to be conducted in person, the hearing 
shall be held at the principal location of the Board or at a 
facility of the Department located within the area served by a 
regional office of the Department.

           *       *       *       *       *       *       *

    (g) [(f)] * * *

           *       *       *       *       *       *       *

Chapter 74. Veterans Health Administration--Personnel

           *       *       *       *       *       *       *

Subchapter I. Appointments

           *       *       *       *       *       *       *

SEC. 7402. QUALIFICATIONS OF APPOINTEES

           *       *       *       *       *       *       *

    (b)(1) * * *

           *       *       *       *       *       *       *

    (11) * * *
          (A) hold a master's degree or doctoral degree in 
        mental health counseling, or a related field, from a 
        college or university approved by the Secretary; and

           *       *       *       *       *       *       *

     Subchapter IV. Pay for Nurses and Other Health-Care Personnel

SEC. 7451. NURSES AND OTHER HEALTH-CARE PERSONNEL: COMPETITIVE PAY

    (a)(1) * * *
          (2) * * *
                  (A) * * *
          (B) Physician assistant.
          (C) [(B)] Such positions referred to in paragraphs 
        (1) and (3) of section 7401 of this title (other than 
        the positions of physician, dentist, [and registered 
        nurse] registered nurse, and physician assistant) as 
        the Secretary may determine upon the recommendation of 
        the Under Secretary for Health.

           *       *       *       *       *       *       *

Part VI. Acquisition and Disposition of Property

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

Subchapter II. Procurement and Supply

           *       *       *       *       *       *       *

SEC. 8127. SMALL BUSINESS CONCERNS OWNED AND CONTROLLED BY VETERANS: 
                    CONTRACTING GOALS AND PREFERENCES

           *       *       *       *       *       *       *

    (h) * * *
    (2) * * *

           *       *       *       *       *       *       *

          [(C) The date that is ten years after the date of the 
        veteran's death.]
          (C) The date that--
                  (i) in the case of a surviving spouse of a 
                veteran with a service-connected disability 
                rated as 100 percent disabling or who dies as a 
                result of a service-connected disability, is 10 
                years after the date of the veteran's death; or
                  (ii) in the case of a surviving spouse of a 
                veteran with a service-connected disability 
                rated as less than 100 percent disabling who 
                does not die as a result of a service-connected 
                disability, is three years after the date of 
                the veteran's death.
    (3) Paragraph (1) only applies to a surviving spouse of a 
veteran with a service-connected disability [rated as 100 
percent disabling or who dies as a result of a service-
connected disability].
    (i) Treatment of Businesses After Death of Servicemember-
owner.--(1) If a member of the Armed Forces owns at least 51 
percent of a small business concern and such member is killed 
in line of duty in the active military, naval, or air service, 
the surviving spouse or dependent child of such member who 
acquires such ownership rights in such small business concern 
shall, for the period described in paragraph (2), be treated as 
if the surviving spouse or dependent child were a veteran with 
a service-connected disability for purposes of determining the 
status of the small business concern as a small business 
concern owned and controlled by veterans for purposes of 
contracting goals and preferences under this section.
    (2) The period referred to in paragraph (1) is the period 
beginning on the date on which the member of the Armed Forces 
dies and ending on the date as follows:
          (A) In the case of a surviving spouse, the earliest 
        of the following dates:
                  (i) The date on which the surviving spouse 
                remarries.
                  (ii) The date on which the surviving spouse 
                relinquishes an ownership interest in the small 
                business concern and no longer owns at least 51 
                percent of such small business concern.
                  (iii) The date that is ten years after the 
                date of the member's death.
          (B) In the case of a dependent child, the earliest of 
        the following dates:
                  (i) The date on which the surviving dependent 
                child relinquishes an ownership interest in the 
                small business concern and no longer owns at 
                least 51 percent of such small business 
                concern.
                  (ii) The date that is ten years after the 
                date of the member's death.
    (j) [(i)] * * *

           *       *       *       *       *       *       *

    (k) [(j)] * * *

           *       *       *       *       *       *       *

    (l) [(k)] * * *

           *       *       *       *       *       *       *

    (m) [(l)] * * *

           *       *       *       *       *       *       *

                    Workforce Investment Act of 1998

(29 U.S.C. 2871(d)(1))

           *       *       *       *       *       *       *

Title I. Workforce Investment Systems

           *       *       *       *       *       *       *

Subtitle B. Statewide and Local Workforce Investment Systems

           *       *       *       *       *       *       *

                     Chapter 6. General Provisions

SEC. 136. PERFORMANCE ACCOUNTABILITY SYSTEM.

           *       *       *       *       *       *       *

    (d) Report.--
          (1) In general.--Each State that receives an 
        allotment under section 127 or 132 shall annually 
        prepare and submit to the Secretary a report on the 
        progress of the State in achieving State performance 
        measures, including information on the levels of 
        performance achieved by the State with respect to the 
        core indicators of performance and the customer 
        satisfaction indicator. The annual report also shall 
        include information regarding the progress of local 
        areas in the State in achieving local performance 
        measures, including information on the levels of 
        performance achieved by the areas with respect to the 
        core indicators of performance and the customer 
        satisfaction indicator. The report also shall include 
        information on the status of State evaluations of 
        workforce investment activities described in subsection 
        (e). The report also shall include information, for the 
        year preceding the year the report is submitted, on the 
        number of job fairs attended by One-Stop Career Center 
        employees at which the employees had contact with a 
        veteran, and the number of veterans contacted at each 
        such job fair.

           *       *       *       *       *       *       *

                  Veterans' Benefits Improvements Act 
                                of 1996

(Public Law 104-275; 38 U.S.C. 5101 Note)

           *       *       *       *       *       *       *

Title V. Department of Veterans Affairs Administrative Matters

           *       *       *       *       *       *       *

SEC. 504. PILOT PROGRAM FOR USE OF CONTRACT PHYSICIANS FOR DISABILITY 
                    EXAMINATIONS

           *       *       *       *       *       *       *

    (c) Licensure of Contract Physicians.--
          (1) In general.--Notwithstanding any law regarding 
        the licensure of physicians, a physician described in 
        paragraph (2) may conduct an examination pursuant to a 
        contract entered into under subsection (a) at any 
        location in any State, the District of Columbia, or a 
        Commonwealth, territory, or possession of the United 
        States, so long as the examination is within the scope 
        of the authorized duties under such contract.
          (2) Physician described.--A physician described in 
        this paragraph is a physician who--
                  (A) has a current license to practice the 
                health care profession of the physician; and
                  (B) is performing authorized duties for the 
                Department of Veterans Affairs pursuant to a 
                contract entered into under subsection (a).
    (d) [(c)] Source of Funds.--Payments for contracts under 
the pilot program under this section shall be made from amounts 
available to the Secretary of Veterans Affairs for payment of 
compensation and pensions.
    (e) [(d)] Report to Congress.--Not later than three years 
after the date of the enactment of this Act, the Secretary 
shall submit to the Congress a report on the effect of the use 
of the authority provided by subsection (a) on the cost, 
timeliness, and thoroughness of medical disability 
examinations.

           *       *       *       *       *       *       *

Department of Veterans Affairs Health Care Programs Enhancement Act of 
                                  2001

(Public Law 107-135; 115 Stat. 2459; 38 U.S.C. 1710 note)

           *       *       *       *       *       *       *

Title II. Other Matters

           *       *       *       *       *       *       *

SEC. 204. PROGRAM FOR PROVISION OF CHIROPRACTIC CARE AND SERVICES TO 
                    VETERANS.

           *       *       *       *       *       *       *

    (c) Location of Program.--(1) The program shall be carried 
out at sites designated by the Secretary for purposes of the 
program. The Secretary shall designate at least one site for 
such program in each geographic service area of the Veterans 
Health Administration. The sites so designated shall be medical 
centers and clinics located in urban areas and in rural areas.
    (2) The program shall be carried out at not fewer than two 
medical centers or clinics in each Veterans Integrated Service 
Network by not later than two years after the date of the 
enactment of the 21st Century Veterans Benefits Delivery and 
Other Improvements Act, and at not fewer than 50 percent of all 
medical centers in each Veterans Integrated Service Network by 
not later than three years after such date of enactment.

           *       *       *       *       *       *       *

      
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