II 

118TH CONGRESS 

1ST SESSION S. 2718 

To amend title 38, United States Code, to improve matters relating to 

medical examinations for veterans disability compensation, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 5, 2023 

Mr. TESTER (for himself and Mr. TILLIS) introduced the following bill; which 

was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to improve matters 

relating to medical examinations for veterans disability 

compensation, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medical Disability 

5 Exam Improvement Act of 2023’’. 


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1 SEC. 2. MODIFICATION OF ELIGIBILITY REQUIREMENTS 

2 FOR MEDICAL NEXUS EXAMINATIONS FOR 

3 TOXIC EXPOSURE RISK ACTIVITIES. 

4 Section 1168(a)(1) of title 38, United States Code, 

5 is amended— 

6 (1) by striking ‘‘with evidence of a disability 

7 and evidence of participation in a toxic exposure risk 

8 activity’’ and inserting ‘‘and expresses that such 

9 claim is associated with a toxic exposure risk activ10 ity’’; and 

11 (2) by striking ‘‘and such evidence’’ and insert12 ing ‘‘and evidence of record before the Secretary’’. 

13 SEC. 3. SPECIFICATION OF ACCOUNTS FOR CERTAIN EX14 PENSES RELATING TO MEDICAL EXAMINA15 TIONS FOR VETERANS DISABILITY COM16 PENSATION CLAIMS UNDER LAWS ADMINIS17 TERED BY SECRETARY OF VETERANS AF18 FAIRS. 

19 Section 5103A(d) of title 38, United States Code, is 

20 amended by adding at the end the following new para21 graph: 

22 ‘‘(3) Expenses of carrying out a medical examination 

23 or obtaining a medical opinion under paragraph (1), in24 cluding payment for travel and incidental expenses under 

25 the terms and conditions set forth by section 111 of this 

26 title for the examination or medical opinion, shall be reimVerDate Sep 11 2014 20:19 Sep 06, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2718.IS S2718

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1 bursed to the accounts available for the general operating 

2 expenses of the Veterans Benefits Administration and in3 formation technology systems from amounts available to 

4 the Secretary for payment of compensation and pen5 sions.’’. 

6 SEC. 4. STUDY ON IMPROVEMENTS TO DEPARTMENT OF 

7 VETERANS AFFAIRS COVERED MEDICAL DIS8 ABILITY EXAMINATIONS IN RURAL AREAS. 

9 (a) STUDY REQUIRED.—Not later than one year 

10 after the date of the enactment of this Act, the Secretary 

11 of Veterans Affairs shall complete a study on access by 

12 rural veterans to covered medical disability examinations. 

13 (b) ELEMENTS.— 

14 (1) IN GENERAL.—The study conducted under 

15 subsection (a) shall include the following: 

16 (A) A comparison of the average number 

17 of days to complete covered medical disability 

18 examinations for rural veterans compared to a 

19 national non-rural average time to complete a 

20 covered medical disability examinations, by ei21 ther contractors or employees of the Depart22 ment. 

23 (B) A root cause analysis of differences 

24 identified pursuant to subparagraph (A). 


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1 (C) The plan of the Secretary for the fol2 lowing year to improve access described in sub3 section (a), which shall include a plan for the 

4 pursuit of a commercial or industry-standard 

5 solution or technology that could enable rural 

6 or housebound veterans to receive examinations 

7 without traveling long distances. 

8 (2) NATIONAL NON-RURAL AVERAGE DE9 FINED.—For purposes of paragraph (1)(A), the 

10 term ‘‘national non-rural average’’ means the na11 tional average of all periods in the previous calendar 

12 year— 

13 (A) beginning on the date on which a con14 tractor or employee of the Department received 

15 a request from the Secretary to conduct a cov16 ered medical disability examination for a vet17 eran who is not a rural veteran; and 

18 (B) ending on the date on which the exam19 ination was completed. 

20 (c) REPORT ON STUDY.—Not later than one year 

21 after the date of the enactment of this Act, the Secretary 

22 shall submit to the Committee on Veterans’ Affairs of the 

23 Senate and the Committee on Veterans’ Affairs of the 

24 House of Representatives a report on the findings of the 


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1 Secretary with respect to the study completed under sub2 section (a). 

3 (d) ANNUAL REPORT ON PLANS.—Not later than two 

4 years after the date of the enactment of this Act and not 

5 less frequently than once each year thereafter, the Sec6 retary shall submit to the Committee on Veterans’ Affairs 

7 of the Senate and the Committee on Veterans’ Affairs of 

8 the House of Representatives a report evaluating the con9 duct of the plans of the Secretary to improve access de10 scribed in subsection (a) and a new or revised plan for 

11 such improvement in the following year. 

12 SEC. 5. IMPROVEMENTS TO TRAINING FOR PROCESSING 

13 MEDICAL DISABILITY EXAMINATIONS. 

14 (a) IN GENERAL.—Not later than 180 days after the 

15 date of the enactment of this Act, the Secretary of Vet16 erans Affairs shall require additional training for employ17 ees of the Department of Veterans Affairs who order or 

18 review covered medical disability examinations. 

19 (b) TRAINING REQUIREMENTS.—The training re20 quired under subsection (a) shall include the following: 

21 (1) Instruction on how to assess whether a cov22 ered medical disability examination is adequate for 

23 purposes of adjudicating the particular claim for a 

24 benefit under chapter 11 or 15 of title 38, United 


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1 States Code, for which the examination was ordered 

2 by the Department. 

3 (2) Instruction on how to assess whether a cov4 ered medical disability examination is necessary for 

5 purposes of adjudicating the particular claim for a 

6 benefit under chapter 11 or 15 of title 38, United 

7 States Code, for which the examination was ordered 

8 by the Department. 

9 (3) Review of relevant statutes, judicial deci10 sions, regulations, and policies of the Department 

11 regarding covered medical disability examinations, 

12 including, at a minimum— 

13 (A) the duty to assist; 

14 (B) the relevance of causation compared to 

15 other evidentiary standards in covered medical 

16 disability examinations; 

17 (C) the required elements of a covered 

18 medical disability examination, with an empha19 sis on the requirement for reasoned analysis to 

20 support medical opinions; and 

21 (D) the relevance of a lack of a statutory 

22 or regulatory presumption of service-connection 

23 in covered medical disability examinations. 

24 (c) FREQUENCY.—The Secretary shall ensure that 

25 each employee of the Department who orders or uses a 


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1 covered medical disability examination to evaluate a claim 

2 for a benefit under chapter 11 or 15 of title 38, United 

3 States Code, completes training that incorporates the re4 quirements of subsection (b) not less frequently than once 

5 each year. 

6 (d) MODIFICATION OF REPORTS.— 

7 (1) BOARD OF VETERANS’ APPEALS.—Section 

8 7101(d)(2) of title 38, United States Code, is 

9 amended— 

10 (A) in subparagraph (F), by striking ‘‘; 

11 and’’ and inserting a semicolon; 

12 (B) in subparagraph (G), by striking the 

13 period at the end and inserting ‘‘; and’’; and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(H) a summary of recurring issues that the 

17 Chairman believes could be resolved by better train18 ing for employees of the Department, increased over19 sight, or clarification from either the Department or 

20 Congress.’’. 

21 (2) UNITED STATES COURT OF APPEALS FOR

22 VETERANS CLAIMS.—Section 7288(b) of title 38, 

23 United States Code, is amended by adding at the 

24 end the following new paragraph: 


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1 ‘‘(16) A summary of recurring issues that the 

2 chief judge of the Court believes could be resolved by 

3 better training for employees of the Department, in4 creased oversight, or clarification from either the 

5 Department or Congress.’’. 

6 (e) DEFINITION OF COVERED MEDICAL DISABILITY

7 EXAMINATION.—In this section, the term ‘‘covered med8 ical disability examination’’ means a medical examination 

9 or medical opinion that the Secretary determines nec10 essary for the purposes of adjudicating a benefit under 

11 chapter 11 or 15 of title 38, United States Code, regard12 less of whether conducted by an employee or a contractor 

13 of the Department. 

14 SEC. 6. REVIEW AND PRIORITY PROCESSING OF CLAIMS 

15 WITH INADEQUATE OR UNNECESSARY EXAMI16 NATIONS. 

17 (a) REVIEW.—Not later than 1 year after the date 

18 of the enactment of this Act and not less frequently than 

19 once every calendar month thereafter, the Secretary of 

20 Veterans Affairs shall review a statistically significant 

21 sample of all covered medical disability examinations com22 pleted during the previous calendar month. 

23 (b) FURTHER SAMPLE REQUIREMENTS.—Under 

24 each review required by subsection (a), the Secretary shall 

25 ensure the review includes— 


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1 (1) a statistically significant sample of covered 

2 medical disability examinations completed by em3 ployees of the Department of Veterans Affairs; and 

4 (2) a statistically significant sample of covered 

5 medical disability examinations completed by each 

6 contractor that provides such examinations for the 

7 Department. 

8 (c) ANALYSIS.—Under each review required by sub9 section (a), the Secretary shall analyze— 

10 (1) the sample specified in subsection (b)(1) 

11 and identify the percentage of examinations that 

12 were adequate for purposes of adjudicating the par13 ticular claim for a benefit under chapter 11 or 15 

14 of title 38, United States Code, for which the exam15 ination was ordered by the Department; 

16 (2) the sample specified in subsection (b)(2) 

17 and identify the percentage of examinations that 

18 were adequate for purposes of adjudicating the par19 ticular claim for a benefit under chapter 11 or 15 

20 of title 38, United States Code, for which the exam21 ination was ordered by the Department; and 

22 (3) the overall sample specified in subsection 

23 (a) and identify the percentage of examinations that 

24 were necessary for purposes of adjudicating the par25 ticular claim for a benefit under chapter 11 or 15 


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1 of title 38, United States Code, for which the exam2 ination was ordered by the Department. 

3 (d) PRIORITY PROCESSING.—If during a review 

4 under subsection (a) the Secretary finds any covered med5 ical disability examination to be not adequate or not nec6 essary for adjudicating a claim of a claimant, the Sec7 retary may provide such claimant— 

8 (1) another examination on a priority basis; and 

9 (2) priority processing for the entirety of im10 pacted claim. 

11 (e) COVERED MEDICAL DISABILITY EXAMINATION

12 DEFINED.—In this section, the term ‘‘covered medical dis13 ability examination’’ means a medical examination or med14 ical opinion that the Secretary determines necessary for 

15 the purposes of adjudicating a benefit under chapter 11 

16 or 15 of title 38, United States Code, regardless of wheth17 er conducted by an employee or a contractor of the De18 partment. 


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1 SEC. 7. MECHANISM FOR CONTRACTORS CONDUCTING DIS2 ABILITY EXAMINATIONS UNDER CERTAIN DE3 PARTMENT OF VETERANS AFFAIRS PILOT 

4 PROGRAM TO TRANSMIT MEDICAL EVIDENCE 

5 INTRODUCED BY CLAIMANTS DURING EXAMI6 NATIONS. 

7 Section 504 of the Veterans’ Benefits Improvements 

8 Act of 1996 (Public Law 104–275; 38 U.S.C. 5101 note) 

9 is amended— 

10 (1) by redesignating subsections (d) and (e) as 

11 subsection (e) and (f), respectively; and 

12 (2) by inserting after subsection (c) the fol13 lowing new subsection (d): 

14 ‘‘(d) MECHANISM FOR TRANSMITTAL OF EVIDENCE

15 INTRODUCED BY APPLICANTS DURING EXAMINATIONS.— 

16 The Secretary shall establish a mechanism whereby a 

17 health care professional can transmit to the Secretary, evi18 dence introduced by the applicant during a medical exam19 ination or in conjunction with such examination.’’. 

Æ 


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