103D CONGRESS
1ST SESSION
H. R. 3313
AN ACT
To amend title 38, United States Code, to improve health
care services of the Department of Veterans Affairs relat-
ing to women veterans, to extend and expand authority
for the Secretary of Veterans Affairs to provide priority
health care to veterans who were exposed to ionizing
radiation or to Agent Orange, to expand the scope of
services that may be provided to veterans through Vet
Centers, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Veterans Health Im-
provements Act of 1993’’.
TITLE I—WOMEN VETERANS
HEALTH IMPROVEMENTS
SEC. 101. SHORT TITLE.
This title may be cited as the ‘‘Women Veterans
Health Improvements Act of 1993’’.
SEC. 102. HEALTH CARE SERVICES FOR WOMEN.
(a) ENSURED PROVISION OF SERVICES.—The Sec-
retary of Veterans Affairs shall ensure that each health-
care facility under the direct jurisdiction of the Secretary
is able, through services made available either by individ-
uals appointed to positions in the Veterans Health Admin-
istration or under contracts or other agreements made
under section 7409, 8111, or 8153 of title 38, United
States Code, or title II of Public Law 102–585, to provide
in a timely and appropriate manner women’s health serv-
ices (as defined in section 1701(10) of title 38, United
States Code (as added by section 3)) to any veteran de-
scribed in section 1710(a)(1) of title 38, United States
Code, who is eligible for such services.
(b) ROUTINE HEALTH CARE SERVICES.—The Sec-
retary shall ensure that each health-care facility under the
direct jurisdiction of the Secretary that serves a catchment
area in which the number of women veterans described
in section 1710(a)(1) of title 38, United States Code,
makes it cost effective to do so shall provide routine wom-
en’s health services directly (rather than by contract or
other agreement). The Secretary shall ensure that each
such facility is provided appropriate equipment, facilities,
and staff to carry out the preceding sentence and to en-
sure that the quality of care provided under the preceding
sentence is in accordance with professional standards.
(c) CONFORMING REPEAL.—Section 302 of the Vet-
erans’ Health Care Amendments of 1983 (Public Law 98–
160; 97 Stat. 1004; 38 U.S.C. 1701 note) is repealed.
SEC. 103. WOMEN’S HEALTH SERVICES.
(a) WOMEN’S HEALTH SERVICES.—Section 1701 of
title 38, United States Code, is amended—
(1) in paragraph (6)(A)(i), by inserting ‘‘wom-
en’s health services,’’ after ‘‘preventive health serv-
ices,’’; and
(2) by adding at the end the following:
‘‘(10) The term ‘women’s health services’ means the
following health care services provided to women:
‘‘(A) Papanicolaou tests (pap smear).
‘‘(B) Breast examinations and mammography.
‘‘(C) General reproductive health care (includ-
ing the management of menopause), but not includ-
ing infertility services (other than infertility counsel-
ing), abortions, or pregnancy care (including
prenatal and delivery care), except for such care re-
lating to a pregnancy that is complicated or in which
the risks of complication are increased by a service-
connected condition.
‘‘(D) The management and prevention of sexu-
ally-transmitted diseases.
‘‘(E) The management and treatment of
osteoporosis.
‘‘(F) Counseling and treatment for physical or
psychological conditions arising out of acts of sexual
violence.
‘‘(G) Early detection, management, and treat-
ment for cardiac disease, in the case of women who
are determined to be at risk of cardiac disease.’’.
(b) REPEAL OF SUPERSEDED AUTHORITY.—Section
106 of the Veterans Health Care Act of 1992 (Public Law
102–585; 38 U.S.C. 1710 note) is amended—
(1) by striking out subsection (a); and
(2) by striking out ‘‘(b) RESPONSIBILITIES OF
DIRECTORS
OF FACILITIES.—’’ before ‘‘The Sec-
retary’’.
(c) EXTENSION
OF ANNUAL REPORT REQUIRE-
MENT.—Section 107(a) of such Act is amended by strik-
ing out ‘‘Not later than January 1, 1993, January 1,
1994, and January 1, 1995’’ and inserting in lieu thereof
‘‘Not later than January 1 of 1993 and each year there-
after through 1998’’.
(d) REPORT ON HEALTH CARE AND RESEARCH.—
Section 107(b) of such Act is amended—
(1) in paragraph (1), by striking out ‘‘services
described in section 106 of this Act’’ and inserting
in lieu thereof ‘‘women’s health services (as such
term is defined in section 1701(10) of title 38,
United States Code)’’;
(2) in paragraph (2)(A), by inserting ‘‘(includ-
ing information on the number of inpatient stays
and the number of outpatient visits through which
such services were provided)’’ after ‘‘facility’’; and
(3) by adding at the end the following new
paragraph:
‘‘(5) A description of the actions taken by the
Secretary to foster and encourage the expansion of
such research.’’.
SEC. 104. MAMMOGRAPHY QUALITY STANDARDS.
(a) IN GENERAL.—(1) Subchapter II of chapter 73
of title 38, United States Code, is amended by adding at
the end the following new section:
‘‘§ 7319. Mammography quality standards
‘‘(a) A mammogram may not be performed at a De-
partment facility unless that facility is accredited for that
purpose by a private nonprofit organization designated by
the Secretary. An organization designated by the Sec-
retary under this subsection shall meet the standards for
accrediting bodies established under section 354(e) of the
Public Health Service Act (42 U.S.C. 263b(e)).
‘‘(b) The Secretary, in consultation with the Sec-
retary of Health and Human Services, shall prescribe
quality assurance and quality control standards relating
to the performance and interpretation of mammograms
and use of mammogram equipment and facilities of the
Department of Veterans Affairs consistent with the re-
quirements of section 354(f)(1) of the Public Health Serv-
ice Act. Such standards shall be no less stringent than
the standards prescribed by the Secretary of Health and
Human Services under section 354(f) of the Public Health
Service Act and shall be prescribed during the 120-day
period beginning on the date on which the Secretary of
Health and Human Services prescribes quality standards
under section 354(f) of the Public Health Service Act (42
U.S.C. 263b(f)).
‘‘(c)(1) The Secretary, to ensure compliance with the
standards prescribed under subsection (b), shall provide
for an annual inspection of the equipment and facilities
used by and in Department health care facilities for the
performance of mammograms. Such inspections shall be
carried out in a manner consistent with the inspection of
certified facilities by the Secretary of Health and Human
Services under section 354(g) of the Public Health Service
Act.
‘‘(2) The Secretary may not provide for an inspection
under paragraph (1) to be performed by a State agency.
‘‘(d) The Secretary shall ensure that mammograms
performed for the Department under contract with any
non-Department facility or provider conform to the quality
standards prescribed by the Secretary of Health and
Human Services under section 354 of the Public Health
Service Act.
‘‘(e) For the purposes of this section, the term ‘mam-
mogram’ has the meaning given such term in section
354(a)(5) of the Public Health Service Act (42 U.S.C.
263b(a)).’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 7318 the following new item:
‘‘7319. Mammography quality standards.’’.
(b) TRANSITION.—(1) Subsection (a) of section 7319
of title 38, United States Code, as added by subsection
(a), shall take effect on the date on which standards are
prescribed by the Secretary of Veterans Affairs under sub-
section (b) of such section.
(2) During the transition period, the Secretary may
waive the requirement of subsection (a) of section 7319
of title 38, United States Code, as added by subsection
(a), to any facility of the Department. The Secretary may
provide such a waiver in the case of any facility only if
the Secretary determines, based upon the recommendation
of the Under Secretary for Health, that during the period
such a waiver is in effect for such facility (including any
extension of the waiver under paragraph (3)) the facility
will be operated in accordance with standards prescribed
by the Secretary under subsection (b) of such section to
assure the safety and accuracy of mammography services
provided.
(3) The transition period for purposes of this section
is the six-month period beginning on the date specified in
paragraph (1). The Secretary may extend such period for
a period not to exceed 90 days in the case of any Depart-
ment facility. Any such extension may be made only if the
Under Secretary for Health determines that—
(A) without the extension access of veterans to
mammography services in the geographic area
served by the facility would be significantly reduced;
and
(B) appropriate steps will be taken before the
end of the transition period (as extended) to obtain
accreditation of the facility as required by subsection
(a) of section 7319 of title 38, United States Code,
as added by subsection (a).
(c) IMPLEMENTATION REPORT.—The Secretary of
Veterans Affairs shall submit to the Committees on Veter-
ans’ Affairs of the Senate and House of Representatives
a report on the Secretary’s implementation of section
7319 of title 38, United States Code, as added by sub-
section (a). The report shall be submitted not later than
120 days after the date on which the Secretary prescribes
the quality standards required under subsection (b) of that
section.
SEC. 105. RESEARCH RELATING TO WOMEN VETERANS.
(a) INCLUSION
OF WOMEN
AND MINORITIES
IN
CLINICAL RESEARCH PROJECTS.—(1) In conducting or
supporting clinical research, the Secretary of Veterans Af-
fairs shall ensure that, whenever possible and appro-
priate—
(A) women who are veterans are included as
subjects in each project of such research; and
(B) members of minority groups who are veter-
ans are included as subjects of such research.
(2) In the case of a project of clinical research in
which women or members of minority groups will under
paragraph (1) be included as subjects of the research, the
Secretary of Veterans Affairs shall ensure that the project
is designed and carried out so as to provide for a valid
analysis of whether the variables being tested in the re-
search affect women or members of minority groups, as
the case may be, differently than other persons who are
subjects of the research.
(b) POPULATION STUDY.—Section 110(a) of the Vet-
erans Health Care Act of 1992 (Public Law 102–585; 106
Stat. 4948) is amended by adding at the end of paragraph
(3) the following: ‘‘If it is feasible to do so within the
amounts available for the conduct of the study, the Sec-
retary shall ensure that the sample referred to in sub-
section (a) constitutes a representative sampling (as deter-
mined by the Secretary) of the ages, the ethnic, social and
economic backgrounds, the enlisted and officer grades,
and the branches of service of all veterans who are
women.’’.
SEC. 106. SEXUAL TRAUMA COUNSELING.
(a) EXTENSION OF PERIOD OF AUTHORITY TO PRO-
VIDE SEXUAL TRAUMA COUNSELING.—Subsection (a) of
section 1720D of title 38, United States Code, is amend-
ed—
(1) by striking out ‘‘December 31, 1995,’’ in
paragraph (1) and inserting in lieu thereof ‘‘Decem-
ber 31, 1998,’’; and
(2) by striking out ‘‘December 31, 1994,’’ in
paragraph (3) and inserting in lieu thereof ‘‘Decem-
ber 31, 1998,’’.
(b) PERIOD OF ELIGIBILITY TO SEEK COUNSEL-
ING.—(1) Such subsection is further amended—
(A) by striking out paragraph (2); and
(B) by redesignating paragraph (3) (as amend-
ed by subsection (a)(2)) as paragraph (2).
(2) Section 102(b) of the Veterans Health Care Act
of 1992 (Public Law 102–585; 106 Stat. 4946; 38 U.S.C.
1720D note) is repealed.
(c) REPEAL OF LIMITATION ON PERIOD OF RECEIPT
OF COUNSELING.—Section 1720D of title 38, United
States Code, is further amended—
(1) by striking out subsection (b); and
(2) by redesignating subsections (c), (d), and
(e) as subsections (b), (c), and (d), respectively.
(d) INCREASED PRIORITY OF CARE.—Section 1712(i)
of title 38, United States Code, is amended—
(1) in paragraph (1)—
(A) by inserting ‘‘(A)’’ after ‘‘To a vet-
eran’’; and
(B) by inserting ‘‘, or (B) who is eligible
for counseling under section 1720D of this title,
for the purposes of such counseling’’ before the
period at the end; and
(2) in paragraph (2)—
(A) by striking out ‘‘, (B)’’ and inserting
in lieu thereof ‘‘or (B)’’; and
(B) by striking out ‘‘, or (C)’’ and all that
follows through ‘‘such counseling’’.
(e) PROGRAM REVISION.—(1) Section 1720D of title
38, United States Code, is further amended—
(A) by striking out ‘‘woman’’ in subsection
(a)(1);
(B) by striking out ‘‘women’’ in subsection
(b)(2)(C) and in the first sentence of subsection (c),
as redesignated by subsection (c); and
(C) by striking out ‘‘women’’ in subsection
(c)(2), as so redesignated, and inserting in lieu
thereof ‘‘individuals’’.
(2)(A) The heading of such section is amended to
read as follows:
‘‘§ 1720D. Counseling for sexual trauma’’.
(B) The item relating to such section in the table of
sections at the beginning of chapter 17 of such title is
amended to read as follows:
‘‘1720D. Counseling for sexual trauma.’’.
(f) INFORMATION BY TELEPHONE.—(1) Paragraph
(1) of section 1720D(c) of title 38, United States Code,
as redesignated by subsection (c) of this section, is amend-
ed to read as follows:
‘‘(1) shall include availability of a toll-free tele-
phone number (commonly referred to as an 800
number), and’’.
(2) In providing information on counseling available
to veterans as required under section 1720D(c)(1) of title
38, United States Code (as amended by this section), the
Secretary of Veterans Affairs shall ensure that the De-
partment of Veterans Affairs personnel who provide as-
sistance under such section are trained in the provision
to persons who have experienced sexual trauma of infor-
mation about the care and services relating to sexual trau-
ma that are available to veterans in the communities in
which such veterans reside, including care and services
available under programs of the Department (including
the care and services available under section 1720D of
such title) and from non-Department agencies or organi-
zations.
(3) Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to Con-
gress a report on the operation of the telephone assistance
service required under section 1720D(c)(1) of title 38,
United States Code (as so amended). The report shall set
forth the following:
(A) The number of persons who sought infor-
mation during the period covered by the report
through a toll free telephone number regarding serv-
ices available to veterans relating to sexual trauma,
with a separate display of the number of such per-
sons arrayed by State (as such term is defined in
section 101(20) of title 38, United States Code).
(B) A description of the training provided to
the personnel who provide such assistance.
(C) The recommendations and plans of the Sec-
retary for the improvement of the service.
SEC. 107. COORDINATORS OF WOMEN’S SERVICES.
(a) FULL-TIME STATUS.—Section 108 of the Veter-
ans Health Care Act of 1992 (Public Law 102–585; 106
Stat. 4948; 38 U.S.C. 1710 note) is amended—
(1) by inserting ‘‘(a)’’ before ‘‘The Secretary’’;
and
(2) by adding at the end the following:
‘‘(b) Each official who serves in the position of coordi-
nator of women’s services under subsection (a) shall serve
in such position on a full-time basis.’’.
(b) EMPOWERMENT.—The Secretary of Veterans Af-
fairs shall take appropriate actions to ensure that the co-
ordinator of women’s services at each facility of the Veter-
ans Health Administration—
(1) is able to carry out the responsibilities of a
coordinator in ensuring that women veterans receive
quality medical care and, to the extent practicable,
have equal access to Veterans Administration facili-
ties; and
(2) has direct access to the Director or Chief of
Staff of the facility to which the coordinator is as-
signed.
SEC. 108. PATIENT PRIVACY.
(a) IDENTIFICATION OF DEFICIENCIES.—The Sec-
retary of Veterans Affairs shall conduct a survey of each
medical center under the jurisdiction of the Secretary to
identify deficiencies relating to patient privacy afforded to
women patients in the clinical areas at each such center
which may interfere with appropriate treatment of such
patients.
(b) CORRECTION OF DEFICIENCIES.—The Secretary
shall ensure that plans and, where appropriate, interim
steps, to correct the deficiencies identified in the survey
conducted under subsection (a) are developed and are in-
corporated into the Department’s construction planning
processes and given a high priority.
(c) REPORTS TO CONGRESS.—The Secretary shall
compile an annual inventory, by medical center, of defi-
ciencies identified under subsection (a) and of plans and,
where appropriate, interim steps, to correct such defi-
ciencies. The Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and the House of Rep-
resentatives, not later than October 1, 1994, and not later
than October 1 each year thereafter through 1996 a report
on such deficiencies. The Secretary shall include in such
report the inventory compiled by the Secretary, the pro-
posed corrective plans, and the status of such plans.
TITLE II—CARE FOR VETERANS
EXPOSED 
TO 
TOXIC 
SUB-
STANCES
SEC. 201. AUTHORITY TO PROVIDE HEALTH CARE.
(a) 
AUTHORIZED
INPATIENT
CARE.—Section
1710(e) of title 38, United States Code, is amended to
read as follows:
‘‘(e)(1)(A) Subject to paragraph (2), a herbicide-ex-
posed veteran is eligible for hospital care and nursing
home care under subsection (a)(1)(G) for any disease
specified in subparagraph (B).
‘‘(B) The diseases referred to in subparagraph (A)
are those for which the National Academy of Sciences, in
a report issued in accordance with section 2 of the Agent
Orange Act of 1991, has determined—
‘‘(i) that there is sufficient evidence to conclude
that there is a positive association between occur-
rence of the disease in humans and exposure to a
herbicide agent;
‘‘(ii) that there is evidence which is suggestive
of an association between occurrence of the disease
in humans and exposure to a herbicide agent, but
such evidence is limited in nature; or
‘‘(iii) that available studies are insufficient to
permit a conclusion about the presence or absence of
an association between occurrence of the disease in
humans and exposure to a herbicide agent.
‘‘(C) A radiation-exposed veteran is eligible for hos-
pital care and nursing home care under subsection
(a)(1)(G) for—
‘‘(i) any disease listed in section 1112(c)(2) of
this title; and
‘‘(ii) any other disease for which the Secretary,
based on the advice of the Advisory Committee on
Environmental Hazards, determines that there is
credible evidence of a positive association between
occurrence of the disease in humans and exposure to
ionizing radiation.
‘‘(2) Hospital and nursing home care may not be pro-
vided under or by virtue of paragraph (1)(A) after Sep-
tember 30, 1996.
‘‘(3) For purposes of this subsection and section
1712 of this title—
‘‘(A) the term ‘herbicide-exposed veteran’
means a veteran (i) who served on active duty in the
Republic of Vietnam during the Vietnam era, and
(ii) who the Secretary finds may have been exposed
during such service to a herbicide agent;
‘‘(B) the term ‘herbicide agent’ has the mean-
ing given that term in section 1116(a)(4) of this
title; and
‘‘(C) the term ‘radiation-exposed veteran’ has
the meaning given that term in section 1112(c)(4) of
this title.’’.
(b) AUTHORIZED OUTPATIENT CARE.—Section 1712
of such title is amended—
(1) in subsection (a)(1)—
(A) by striking out ‘‘and’’ at the end of
subparagraph (B);
(B) by striking out the period at the end
of subparagraph (C) and inserting in lieu there-
of a semicolon; and
(C) by adding at the end the following:
‘‘(D) during the period before October 1,
1996, to any herbicide-exposed veteran for any
disease listed in section 1710(e)(1)(B) of this
title; and
‘‘(E) to any radiation-exposed veteran for
any 
disease 
covered 
under 
section
1710(e)(1)(C) of this title.’’; and
(2) in subsection (i)(3)—
(A) by striking out ‘‘(A)’’; and
(B) by striking out ‘‘, or (B)’’ and all that
follows through ‘‘title’’.
SEC. 202. SAVINGS PROVISION.
The provisions of sections 1710(e) and 1712(a) of
title 38, United States Code, as in effect on the day before
the date of the enactment of this Act, shall apply with
respect to hospital care, nursing home care, and medical
services in the case of any veteran furnished care or serv-
ices before such date of enactment on the basis of pre-
sumed exposure to a substance or radiation under the au-
thority of those provisions.
TITLE III—READJUSTMENT
SERVICES
SEC. 301. SCOPE OF SERVICES PROVIDED IN VET CENTERS.
(a) EXPANSION OF SERVICES.—Section 1712A of
title 38, United States Code, is amended—
(1) in subsection (a)(1) by inserting ‘‘and, to
the extent otherwise authorized by law, may furnish
such additional needed services as described in sub-
section (i)’’ in the first sentence after ‘‘life’’;
(2) by redesignating subsection (i) as subsection
(j); and
(3) by inserting after subsection (g) the follow-
ing new subsections:
‘‘(h) The Secretary may, to the extent resources and
facilities are available, furnish to any veteran who served
in combat during World War II or the Korean conflict
counseling in a center to assist such veteran in overcoming
the effects of the veteran’s combat experience.
‘‘(i) In operating centers under this section, the Sec-
retary may provide (1) preventive health care services, (2)
medical services reasonably necessary in preparation for
hospital admission, and (3) referral services to assist in
obtaining specialized care. The Secretary shall provide
such services through such health care personnel as the
Secretary determines appropriate.’’.
(b) REPORT.—Not later than one year after the date
of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans’ Affairs of the Senate and
House of Representatives a report relating to the imple-
mentation of the amendments made by subsection (a). The
report shall include the following:
(1) The number of veterans provided services
described in section 1712A(i) of title 38, United
States Code, as added by subsection (a).
(2) The number of centers which provided serv-
ices described in that section.
(3) An assessment of the effect providing such
services has had on access to and timeliness of serv-
ice delivery.
SEC. 302. ADVISORY COMMITTEE ON THE READJUSTMENT
OF VETERANS.
(a) IN GENERAL.—(1) Subchapter II of chapter 17
of title 38, United States Code, is amended by inserting
after section 1712B the following new section:
‘‘§ 1712C. Advisory Committee on Veterans Readjust-
ment Counseling
‘‘(a)(1) There is in the Department the Advisory
Committee on Veterans Readjustment Counseling (herein-
after in this section referred to as the ‘Committee’).
‘‘(2) The Committee shall consist of 18 members.
The members of the Committee shall be appointed by the
Secretary and shall include individuals who are recognized
authorities in fields pertinent to the social, psychological,
economic, or educational readjustment of veterans. An of-
ficer or employee of the United States may not be ap-
pointed as a member of the Committee. At least 12 of
the Committee shall be veterans of the Vietnam era or
other period of war. Appointments of members of the
Committee shall be made from among individuals who
have experience with the provision of veterans benefits and
services by the Department or who are otherwise familiar
with programs of the Department.
‘‘(3) The Secretary shall seek to ensure that members
appointed to the Committee include persons from a wide
variety of geographic areas and ethnic backgrounds, per-
sons from veterans service organizations, minorities, and
women.
‘‘(4) The Secretary shall determine the terms of serv-
ice and pay and allowances of the members of the Commit-
tee, except that a term of service may not exceed two
years. The Secretary may reappoint any member for addi-
tional terms of service.
‘‘(b)(1) The Secretary shall, on a regular basis, con-
sult with and seek the advice of the Committee with re-
spect to the provision by the Department of benefits and
services to veterans in order to assist veterans in the re-
adjustment to civilian life.
‘‘(2) In providing advice to the Secretary under this
subsection, the Committee shall—
to which the Inspector General of the Department has re-
sponsibilities under such Act.
‘‘(2) Such a corporation shall be considered an agen-
cy for the purposes of section 716 of title 31 (relating to
availability of information and inspection of records by the
Comptroller General).
‘‘(3) Each such corporation shall submit to the Sec-
retary an annual report providing a detailed statement of
its operations, activities, and accomplishments during that
year. The corporation shall obtain a report of independent
auditors concerning the receipts and expenditures of funds
by the corporation during that year and shall include that
report in the corporation’s report to the Secretary for that
year.
‘‘(4) Each member of the board of directors of a cor-
poration established under this section, each employee of
such corporation, and each employee of the Department
who is involved in the functions of the corporation during
any year shall—
‘‘(A) be subject to Federal laws and regulations
applicable to Federal employees with respect to con-
flicts of interest in the performance of official func-
tions; and
‘‘(B) submit to the Secretary an annual state-
ment signed by the director or employee certifying