I 118th CONGRESS 1st Session H. R. 2441 IN THE HOUSE OF REPRESENTATIVES March 30, 2023 Ms. Pingree introduced the following bill; which was referred to the Committee on Veterans' Affairs , and in addition to the Committee on Armed Services , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title 38, United States Code, to expand health care and benefits from the Department of Veterans Affairs for military sexual trauma, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Servicemembers and Veterans Empowerment and Support Act of 2023 . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—Defining military sexual trauma Sec. 101. Report on military sexual trauma in the digital age. TITLE II—Disability compensation and claims processing Sec. 201. Definition of military sexual trauma. Sec. 202. Conforming changes relating to specialized teams to evaluate claims involving military sexual trauma. Sec. 203. Evaluation of claims involving military sexual trauma. Sec. 204. Choice of location of Department of Veterans Affairs medical examination for assessment of claims for compensation relating to disability resulting from military sexual trauma. Sec. 205. Communications from the Department of Veterans Affairs to individuals who have experienced military sexual trauma. Sec. 206. Study on training and processing relating to claims for disability compensation relating to military sexual trauma. Sec. 207. Annual special focus review of claims for disability compensation for disabilities relating to military sexual trauma. TITLE III—Access to Health Care Sec. 301. Expansion of eligibility for counseling and treatment for military sexual trauma to include all former members of the reserve components of the Armed Forces. Sec. 302. Connection to Veterans Health Administration when a disability claim related to military sexual trauma is submitted to Veterans Benefits Administration. Sec. 303. Pilot program for interim access to mental health care for individuals who have experienced military sexual trauma. Sec. 304. Comptroller General study on access to care from Department of Veterans Affairs for individuals who have experienced military sexual trauma. I Defining military sexual trauma 101. Report on military sexual trauma in the digital age (a) Report required Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on military sexual trauma in the digital age. (b) Requirements The report required under subsection (a) shall include the following: (1) A comprehensive evaluation and assessment of current Department of Veterans Affairs statutes, regulations, and agency guidance relating to military sexual trauma for the purposes of access to health care under chapter 17 of title 38, United States Code, and compensation under chapter 11 of such title to identify— (A) gaps in coverage for health care and compensation eligibility relating to military sexual trauma involving online or other technological communications; and (B) the feasibility and advisability of expanding health care and compensation for trauma that is nonsexual in nature involving online or other technological communications. (2) Recommendations for revising statutes, regulations, and agency guidance in response to the evaluation and assessment under paragraph (1). (c) Consultation In carrying out subsection (a), the Secretary of Veterans Affairs shall consult veterans service organizations and such other stakeholders as the Secretary considers relevant and appropriate. (d) Military sexual trauma defined In this section, the term military sexual trauma — (1) with respect to eligibility for health care, has the meaning given such term in section 1720D(f) of title 38, United States Code, as added by section 301; and (2) with respect to eligibility for compensation, has the meaning given such term in section 1169(i) of title 38, United States Code, as added by section 203(a). II Disability compensation and claims processing 201. Definition of military sexual trauma In this title, the term military sexual trauma has the meaning given such term in section 1169(i) of title 38, United States Code, as added by section 203(a). 202. Conforming changes relating to specialized teams to evaluate claims involving military sexual trauma Subsection (d) of section 1166 of title 38, United States Code, is amended to read as follows: (a) Definitions In this section, the terms covered mental health condition and military sexual trauma have the meanings given those terms in section 1169(i) of this title. . 203. Evaluation of claims involving military sexual trauma (a) In general Subchapter VI of chapter 11 of such title is amended by inserting after section 1166 the following new section: 1166A. Evaluation of claims involving military sexual trauma (a) In general (1) In the case of any veteran who claims that a covered mental health condition based on military sexual trauma was incurred in or aggravated by active military, naval, air, or space service, the Secretary shall consider the following: (A) A diagnosis of such mental health condition by a mental health professional. (B) A link, established by medical evidence, between current symptoms and a military sexual trauma. (C) Credible supporting evidence, in accordance with subsections (b) and (c) that the claimed military sexual trauma occurred. (2) The reasons for granting or denying service-connection in each case described in paragraph (1) shall be recorded in full. (b) Nonmilitary sources of evidence (1) For purposes of subsection (a), evidence from sources other than official records of the Department of Defense regarding the veteran's active military, naval, air, or space service may corroborate the veteran's account of the trauma. (2) Examples of evidence described in paragraph (1) include the following: (A) Records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, and physicians. (B) Pregnancy tests and tests for sexually transmitted diseases. (C) Statements from family members, roommates, other members of the Armed Forces or veterans, and clergy. (c) Evidence of behavior changes (1) For purposes of subsection (a), evidence of a behavior change following military sexual trauma is one type of relevant evidence that may be found in sources described in such subsection. (2) Examples of behavior changes that may be relevant evidence of military sexual trauma include the following: (A) A request for a transfer to another military duty assignment. (B) Deterioration in work performance. (C) Substance abuse or substance use disorder. (D) Episodes of depression, panic attacks, or anxiety without an identifiable cause. (E) Unexplained economic or social behavior changes. (d) Notice and opportunity To supply evidence The Secretary may not deny a claim of a veteran for compensation under this chapter for a covered mental health condition that is based on military sexual trauma without first— (1) advising the veteran that evidence described in subsections (b) and (c) may constitute credible corroborating evidence of the military sexual trauma; and (2) allowing the veteran an opportunity to furnish such corroborating evidence or advise the Secretary of potential sources of such evidence. (e) Review of evidence In reviewing a claim for compensation described in subsection (a)(1), for any evidence identified as part of such claim that is described in subsection (b) or (c), the Secretary shall submit such evidence to such medical or mental health professional as the Secretary considers appropriate, including clinical and counseling experts employed by the Department, to obtain an opinion as to whether the evidence indicates that a military sexual trauma occurred. (f) Point of contact The Secretary shall ensure that each document provided to a veteran relating to a claim for compensation described in subsection (a)(1) includes contact information for an appropriate point of contact with the Department. (g) Specialized teams The Secretary shall ensure that all claims for compensation described in subsection (a)(1) are reviewed and processed by a specialized team established under section 1166 of this title. (h) Rule of construction regarding application to nonsexual personal assault The Secretary shall not construe this section as supplanting the standard of proof or evidence required for claims for posttraumatic stress disorder based on nonsexual personal assault, which the Secretary shall continue to define in regulation. (i) Definitions In this section: (1) The term covered mental health condition means post-traumatic stress disorder, anxiety, depression, or other mental health diagnosis that the Secretary determines to be related to military sexual trauma and which may be service-connected under section 1110 of this title. (2) The term mental health professional means a provider in the field of mental health who meets the credential, licensure, education, and training requirements established by the Secretary. (3) The term military sexual trauma means, with respect to a veteran, a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment that occurred while the veteran was serving in the active military, naval, air, or space service. . (b) Outreach Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall implement, with input from the veteran community, an informative outreach program for veterans regarding the standard of proof for evaluation of claims relating to military sexual trauma, including requirements for a medical examination and opinion. (c) Clerical amendment The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1166 the following new item: 1166A. Evaluation of claims involving military sexual trauma. . 204. Choice of location of Department of Veterans Affairs medical examination for assessment of claims for compensation relating to disability resulting from military sexual trauma (a) In general Section 1165 of title 38, United States Code, is amended— (1) in the section heading, by inserting and location of medical examination after examiner ; (2) in subsection (a), by striking a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment and inserting military sexual trauma (as defined in section 1166A(i) of this title) ; (3) by redesignating subsection (c) as subsection (d); and (4) by inserting after subsection (b) the following new subsection (c): (c) Choice of examination location (1) The Secretary shall ensure that a veteran who requires a medical examination in support of a claim described in subsection (a) may request that the medical examination take place at a medical facility of the Department by a qualified employee of the Department rather than at a location designated by a Department contractor that performs such examinations on behalf of the Department. (2) The Secretary— (A) shall grant any request under paragraph (1) if a medical facility of the Department is available not further than 100 miles from the veteran’s home; and (B) may not issue a decision on a claim described in such paragraph before the requested examination is completed, or notice is provided per paragraph (c)(3). (3) If a medical facility of the Department is not available within 100 miles of the veteran’s home, the Secretary shall notify the veteran and provide the veteran the opportunity— (A) to have the examination completed by a contractor of the Department; or (B) to complete the examination at a medical facility further than 100 miles from the veteran’s home. . (b) Clerical amendment The table of sections at the beginning of chapter 11 of such title is amended by striking the item relating to section 1165 and inserting the following new item: 1165. Choice of sex of medical examiner and location of medical examination for certain disabilities. . 205. Communications from the Department of Veterans Affairs to individuals who have experienced military sexual trauma (a) Review board (1) In general The Secretary of Veterans Affairs shall establish a board to review correspondence relating to military sexual trauma. (2) Membership The board established under paragraph (1) shall be composed of members who shall be appointed by the Secretary from among employees of the Department of Veterans Affairs who are experts in military sexual trauma and mental health, of whom— (A) one or more shall be appointed from among mental health providers of the Veterans Health Administration; (B) one or more shall be appointed from among experts on sexual assault and sexual harassment of the Veterans Benefits Administration; and (C) one or more shall be appointed from among experts on sexual assault and sexual harassment of the Board of Veterans’ Appeals. (3) Duties The board established under paragraph (1) shall— (A) review standard correspondence, which may include templates for notices under sections 5103, 5104, 5104B, and 7104 of title 38, United States Code, from the Department to individuals who have experienced military sexual trauma for sensitivity; and (B) ensure that the correspondence— (i) treats such individuals with dignity and respect; and (ii) does not re-traumatize such individuals. (4) Individual who has experienced military sexual trauma defined In this subsection, the term individual who has experienced military sexual trauma means— (A) a veteran who has filed a claim for compensation under chapter 11 of title 38, United States Code, relating to military sexual trauma; (B) a veteran who has been awarded compensation under such chapter relating to military sexual trauma; or (C) a former member of the Armed Forces or a veteran who is receiving care from the Department relating to military sexual trauma. (b) Contents of certain written communications to individuals who have experienced military sexual trauma (1) Notice to claimants of required information and evidence Section 5103 of title 38, United States Code, is amended by adding at the end the following new subsection: (c) Written communications to individuals who have experienced military sexual trauma (1) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma includes contact information for each of the following: (A) The military sexual trauma coordinator of the Veterans Benefits Administration. (B) The military sexual trauma coordinator of the Veterans Health Administration. (C) The Veterans Crisis Line. (D) The facility of the Veterans Health Administration closest to where the individual resides. (2) In this subsection: (A) The term individual who has experienced military sexual trauma means— (i) a veteran who has filed a claim for compensation under chapter 11 of this title relating to military sexual trauma; (ii) a veteran who has been awarded compensation under such chapter relating to military sexual trauma; or (iii) a former member of the Armed Forces or a veteran who is receiving care from the Department relating to military sexual trauma. (B) The term military sexual trauma has the meaning given that term in section 1166A(i) of this title. (C) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . (2) Decisions and notices of decisions Section 5104 of title 38, United States Code, is amended by adding at the end the following new subsection: (e) (1) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma includes contact information for each of the following: (A) The military sexual trauma coordinator of the Veterans Health Administration. (B) The Veterans Crisis Line. (C) The facility of the Veterans Health Administration closest to where the individual resides. (2) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma that includes notification of an award of compensation under chapter 11 of this title relating to military sexual trauma includes— (A) the contact information described in paragraph (1); and (B) the contact information for the military sexual trauma coordinator of the Veterans Benefits Administration. (3) In this subsection: (A) The term individual who has experienced military sexual trauma means— (i) a veteran who has filed a claim for compensation under chapter 11 of this title relating to military sexual trauma; (ii) a veteran who has been awarded compensation under such chapter relating to military sexual trauma; or (iii) a former member of the Armed Forces or a veteran who is receiving care from the Department relating to military sexual trauma. (B) The term military sexual trauma has the meaning given that term in section 1166A(i) of this title. (C) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . (3) Higher-level review by the agency of original jurisdiction Section 5104B of title 38, United States Code, is amended by adding at the end the following new subsection: (f) Written communications to individuals who have experienced military sexual trauma (1) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma includes contact information for each of the following: (A) The military sexual trauma coordinator of the Veterans Health Administration. (B) The Veterans Crisis Line. (C) The facility of the Veterans Health Administration closest to where the individual resides. (2) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma that includes notification of an award of compensation under chapter 11 of this title relating to military sexual trauma includes— (A) the contact information described in paragraph (1); and (B) the contact information for the military sexual trauma coordinator of the Veterans Benefits Administration. (3) In this subsection: (A) The term individual who has experienced military sexual trauma means— (i) a veteran who has filed a claim for compensation under chapter 11 of this title relating to military sexual trauma; (ii) a veteran who has been awarded compensation under such chapter relating to military sexual trauma; or (iii) a former member of the Armed Forces or a veteran who is receiving care from the Department relating to military sexual trauma. (B) The term military sexual trauma has the meaning given that term in section 1166A(i) of this title. (C) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . (4) Board of Veterans’ Appeals Section 7104 of title 38, United States Code, is amended by adding at the end the following new subsection: (g) (1) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma includes contact information for each of the following: (A) The military sexual trauma coordinator of the Veterans Health Administration. (B) The Veterans Crisis Line. (C) The facility of the Veterans Health Administration closest to where the individual resides. (2) The Secretary shall ensure that any written communication under this section from the Department to an individual who has experienced military sexual trauma that includes notification of an award of compensation under chapter 11 of this title relating to military sexual trauma includes— (A) the contact information described in paragraph (1); and (B) the contact information for the military sexual trauma coordinator of the Veterans Benefits Administration. (3) In this subsection: (A) The term individual who has experienced military sexual trauma means— (i) a veteran who has filed a claim for compensation under chapter 11 of this title relating to military sexual trauma; (ii) a veteran who has been awarded compensation under such chapter relating to military sexual trauma; or (iii) a former member of the Armed Forces or a veteran who is receiving care from the Department relating to military sexual trauma. (B) The term military sexual trauma has the meaning given that term in section 1166A(i) of this title. (C) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . 206. Study on training and processing relating to claims for disability compensation relating to military sexual trauma (a) Study required The Secretary of Veterans Affairs shall conduct a study on— (1) the quality of training provided to personnel of the Department of Veterans Affairs who review claims for disability compensation under chapter 11 of title 38, United States Code, for disabilities relating to military sexual trauma; and (2) the quality of the procedures of the Department for reviewing the accuracy of the processing of such claims. (b) Elements The study required by subsection (a) shall include the following: (1) With respect to the quality of training described in paragraph (1) of such subsection: (A) Whether the Department ensures personnel complete such training on time. (B) Whether the training has resulted in improvements to the processing of claims described in such subsection and issue-based accuracy. (C) Such recommendations as the Secretary of Veterans Affairs may have for improving the training. (2) With respect to the quality of procedures described in paragraph (2) of such subsection: (A) Whether the procedures of the Department for reviewing the accuracy of the processing of claims described in such subsection comport with generally accepted statistical methodologies to ensure reasonable accuracy of such reviews. (B) Whether such procedures adequately include mechanisms to correct errors found in such reviews. (C) Such recommendations as the Secretary may have for improving such procedures. (c) Report required Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report detailing the findings of the Secretary with respect to the study conducted under subsection (a). 207. Annual special focus review of claims for disability compensation for disabilities relating to military sexual trauma (a) Annual special focus review (1) In general Each year, the Under Secretary for Benefits of the Department of Veterans Affairs shall conduct a special focus review on the accuracy of the processing of claims for disability compensation under chapter 11 of title 38, United States Code, for disabilities relating to military sexual trauma. (2) Elements Each review conducted under paragraph (1) shall include a review of the following: (A) A statistically significant, nationally representative sample of all claims for benefits under the laws administered by the Secretary of Veterans Affairs relating to military sexual trauma filed during the fiscal year preceding the fiscal year in which the report is submitted. (B) The accuracy of each decision made with respect to each claim described in subparagraph (A). (C) The types of benefit entitlement errors found, disaggregated by category. (D) Trends from year to year. (E) Training completion rates for personnel of the Department who process claims described in paragraph (1). (b) Reprocessing of claims If the Under Secretary finds, pursuant to a special focus review conducted under subsection (a)(1), that an error was made with respect to the entitlement of a veteran to a benefit under the laws administered by the Secretary, the Secretary shall return the relevant claim of the veteran to the appropriate regional office of the Department for reprocessing to ensure that the veteran receives an accurate decision with respect to the claim. (c) Re-Reviewing of claims If the Under Secretary finds, pursuant to a special focus review conducted under paragraph (1) of subsection (a), that the accuracy rate, under paragraph (2)(B) of such subsection, is less than 90 percent, the Secretary shall conduct a review of each claim for benefits under the laws administered by the Secretary of Veterans Affairs relating to military sexual trauma filed during the fiscal year preceding the fiscal year in which the report is submitted. (d) Report Section 5501(b)(2) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 ( Public Law 116–315 ; 134 Stat. 5048) is amended by adding at the end the following new subparagraph: (I) The findings of the most recent special focus review conducted under subsection (a)(1) of section 207 of the Servicemembers and Veterans Empowerment and Support Act of 2023 , including— (i) the elements under subsection (a)(2) of such section; (ii) the number of claims returned for reprocessing under subsection (b) of such section; and (iii) the number of claims described in clause (ii) for which the decision relating to service-connection or entitlement to compensation changed as a result of reprocessing the claim. . (e) Sunset On the date that the Under Secretary determines, pursuant to special focus reviews conducted under paragraph (1) of subsection (a), that the accuracy rates under paragraph (2)(B) of such subsection have been 95 percent or greater for five consecutive years— (1) subsection (a)(1) shall cease to be in effect; and (2) subparagraph (I) of section 5501(b)(2) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 ( Public Law 116–315 ; 134 Stat. 5048), as added by subsection (d), is repealed. III Access to Health Care 301. Expansion of eligibility for counseling and treatment for military sexual trauma to include all former members of the reserve components of the Armed Forces Section 1720D of title 38, United States Code, is amended— (1) in subsection (a)— (A) in paragraph (1), by striking a physical assault and all that follows through the period at the end and inserting military sexual trauma. ; and (B) in paragraph (2)(A), by striking was suffered and all that follows through the period at the end and inserting resulted from military sexual trauma. ; and (2) by striking subsections (f) and (g) and inserting the following new subsection (f): (f) In this section: (1) The term former member of the Armed Forces means a person who served on active duty, active duty for training, or inactive duty training, and who was discharged or released therefrom under any condition that is not— (A) a discharge by court-martial; or (B) a discharge subject to a bar to benefits under section 5303 of this title. (2) The term military sexual trauma means, with respect to a member of the Armed Forces or former member of the Armed Forces, a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the member or former member was serving on duty, regardless of duty status or line of duty determination (as that term is used in section 12323 of title 10). (3) The term sexual harassment means unsolicited verbal or physical contact of a sexual nature which is threatening in character. . 302. Connection to Veterans Health Administration when a disability claim related to military sexual trauma is submitted to Veterans Benefits Administration (a) In general Not later than 14 days after the date on which a veteran submits a claim for disability compensation to the Veterans Benefits Administration for a disability related to military sexual trauma, the Secretary of Veterans Affairs shall send a communication to the veteran with the following information: (1) The contact information for the nearest military sexual trauma coordinator for the veteran at the Veterans Benefits Administration and a description of the assistance such coordinator can provide. (2) The contact information for the nearest military sexual trauma coordinator for the veteran at the Veterans Health Administration and a description of the assistance such coordinator can provide. (3) The types of services that individuals who have experienced military sexual trauma are eligible to receive from the Department of Veterans Affairs, including the nearest locations and the contact information for such services. (4) The contact information for the Veterans Crisis Line established under section 1720F(h) of title 38, United States Code. (5) Such other information on services, care, or resources for military sexual trauma as the Secretary determines appropriate. (b) Definition of military sexual trauma In this section, the term military sexual trauma has the meaning given that term in section 1166A(i) of title 38, United States Code, as added by section 203(a). 303. Pilot program for interim access to mental health care for individuals who have experienced military sexual trauma (a) In general Commencing not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to provide intensive outpatient mental health care to current and former members of the Armed Forces who have experienced military sexual trauma when the wait times for residential mental health care from the Department of Veterans Affairs for the individual is more than 14 days. (b) Duration The Secretary shall carry out the pilot program under subsection (a) for a three-year period beginning on the commencement of the pilot program. (c) Locations (1) In general The Secretary shall carry out the pilot program under subsection (a) at not fewer than four Veterans Integrated Service Networks of the Department. (2) Selection of locations In selecting locations for the pilot program under subsection (a), the Secretary shall select locations that have the longest wait times for residential mental health care, particularly for individuals who have experienced military sexual trauma. (3) Notification Before commencing the pilot program under subsection (a), the Secretary shall notify the Committee on Veterans' Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives of the locations selected for the pilot program. (d) Types of services Subject to the preference of the individual participating in the pilot program under subsection (a) and the capacity of facilities of the Department, the Secretary may provide services under the pilot program via telehealth or in person at a facility of the Department. (e) Participation (1) Clarification on participation Participation by an individual in the pilot program under subsection (a) shall be during the period in which the individual is waiting for a residential mental health bed opening and shall not disqualify the individual from receiving residential mental health care following their participation in the pilot program. (2) Decisions on participation Decisions about the participation of an individual in the pilot program and the transition of the individual to residential mental health care shall be made by the individual and their health care provider. (f) Report Not later than 180 days after the conclusion of the pilot program under subsection (a), the Secretary shall submit to Congress a report on— (1) participation in the pilot program; (2) clinical outcomes under the pilot program; and (3) such recommendations for continuation or termination of the program as the Secretary may have, including recommendations for legislative or administrative action. (g) Definition of military sexual trauma In this section, the term military sexual trauma has the meaning given that term in section 1720D(f) of title 38, United States Code, as added by section 301. 304. Comptroller General study on access to care from Department of Veterans Affairs for individuals who have experienced military sexual trauma (a) In general The Comptroller General of the United States shall conduct a study on access to mental health care at facilities of the Department of Veterans Affairs for individuals who have experienced military sexual trauma. (b) Elements The study conducted under subsection (a) shall include an assessment of the following: (1) The availability of residential and outpatient services, including wait times and geographic disparities for such services, to include— (A) an assessment of the availability of bed spaces in the mental health residential rehabilitation treatment programs of the Department of Veterans Affairs for individuals who have experienced military sexual trauma, including an assessment of the suitability of those programs for such individuals and the wait times for services under those programs; (B) an assessment of geographic disparities in access to those programs for individuals who have experienced military sexual trauma, including by region and by rural and urban areas; (C) an assessment of alternative care options provided when an individual who has experienced military sexual trauma is waiting for residential care, the efficacy of those alternatives, and the satisfaction of patients with those alternatives; (D) recommendations for reducing the average wait time for services under those programs to 14 days or less, including by increasing bed space or addressing staffing needs; and (E) an assessment of the satisfaction of patients with the tracks of those programs specific to military sexual trauma, an assessment of the wait times for services under those tracks, and recommendations for increasing or changing the number of locations for services under those tracks to better meet the needs of individuals who have experienced military sexual trauma. (2) The communication and advertisement by the Department of the care, services, and resources available for individuals who have experienced military sexual trauma. (3) The barriers to accessing health care related to military sexual trauma at a facility of the Department for individuals who have experienced military sexual trauma, including transportation, child care, lack of telehealth, gender-specific barriers, and more. (4) The extent to which the Secretary has assessed the quality of the training provided to providers of the Department on military sexual trauma and made any adjustments in response to such assessment. (5) The role of Vet Centers in providing care to individuals who have experienced military sexual trauma, including current and former members of the Armed Forces. (6) Any current actions by the Secretary to strengthen access to high-quality care for individuals who have experienced military sexual trauma and such recommendations for improving access to care for such individuals as the Comptroller General considers appropriate. (c) Report Not later than two years after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the findings of the study conducted under subsection (a). (d) Definitions In this section: (1) Military sexual trauma The term military sexual trauma has the meaning given that term in section 1720D(f) of title 38, United States Code, as added by section 301. (2) Vet Center The term Vet Center has the meaning given that term in section 1712A(h) of title 38, United States Code.