II 119th CONGRESS 1st Session S. 2493 IN THE SENATE OF THE UNITED STATES July 29, 2025 Mr. Blumenthal (for himself and Mr. Murphy ) 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. Short title This Act may be cited as the Medical Disability Examination Improvement Act of 2025 . 2. Pilot program on conduct of medical examinations at medical facilities of Department of Veterans Affairs for veterans disability compensation claims under laws administered by Secretary of Veterans Affairs (a) Pilot program authorized The Under Secretary of Benefits may carry out a pilot program to assess the feasibility and advisability of providing for the conduct of medical examinations, or obtaining medical opinions, under section 5103A(d) of title 38, United States Code, at medical facilities of the Department of Veterans Affairs. (b) Locations In carrying out the pilot program under this section, the Secretary shall carry out the pilot program at medical facilities of the Department as follows: (1) In fiscal years before fiscal year 2027, medical facilities in not more than one Veterans Integrated Service Network of the Department of Veterans Affairs selected by the Under Secretary for Benefits, in coordination with the Under Secretary for Health, for purposes of the pilot program under this section. (2) In fiscal year 2029, medical facilities in not more than three Veterans Integrated Service Networks of the Department of Veterans Affairs selected by the Under Secretary for Benefits, in coordination with the Under Secretary for Health, for purposes of the pilot program under this section. (3) In fiscal year 2031, medical facilities in not more than six Veterans Integrated Service Networks of the Department of Veterans Affairs selected by the Under Secretary for Benefits, in coordination with the Under Secretary for Health, for purposes of the pilot program under this section. (4) In fiscal year 2033, medical facilities in not more than 10 Veterans Integrated Service Networks of the Department of Veterans Affairs selected by the Under Secretary for Benefits, in consultation with the Under Secretary for Health, for purposes of the pilot program under this section. (5) In fiscal year 2035 and each fiscal year thereafter, medical facilities in through such Veterans Integrated Service Networks of the Department as the Under Secretary for Benefits, in consultation with the Under Secretary for Health, considers appropriate for purposes of the pilot program under this section. (c) Report to Congress (1) In general If the Under Secretary commences conducting a pilot program pursuant to subsection (a) before the date that is two years after the date of the enactment of this Act, the Under Secretary shall, not later than two years after the date of the enactment of this Act, submit to Congress a report on the findings of the Under Secretary with respect to the pilot program. (2) Contents The report submitted pursuant to paragraph (1) shall include an assessment of the Under Secretary of the effect of the use of the authority provided by subsection (a) on the cost, timeliness, quality, and capacity of the Department to provide medical disability examinations. (d) Source of funds Amounts expended or obligated by the Under Secretary to carry out the pilot program under this section, including for payments for examination travel and incidental expenses under the terms and conditions set forth by section 111 of title 38, United States Code, shall be reimbursed to the accounts available for the general operating expenses of the Veterans Benefits Administration and information technology systems from amounts available to the Secretary of Veterans Affairs for payment of compensation and pension. 3. Study on improvements to Department of Veterans Affairs covered medical disability examinations in rural areas (a) Study required Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a study on access by veterans who reside in rural and highly rural areas to covered medical disability examinations. (b) Elements (1) In general The study conducted under subsection (a) shall include the following: (A) A comparison of the average number of days to complete covered medical disability examinations, disaggregated by type of examination, for veterans who reside in rural and highly rural areas compared to an average time for veterans who reside in other areas to complete a covered medical disability examination, by either contractors or employees of the Department. (B) A root cause analysis of differences identified pursuant to subparagraph (A). (C) The plan of the Secretary for the following year to improve access described in subsection (a), which shall include a plan for the pursuit of a commercial or industry-standard solution or technology that could enable housebound veterans or veterans who live in rural areas to receive examinations without traveling long distances. (2) Number of days to complete defined For purposes of paragraph (1)(A), the term number of days to complete means the number of days in the period— (A) beginning on the date on which a contractor or employee of the Department received a request from the Secretary to conduct a covered medical disability examination; and (B) ending on the date on which the examination was completed. (c) Report on study 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 on the findings of the Secretary with respect to the study completed under subsection (a). (d) Definitions In this section: (1) Covered medical disability examination The term covered medical disability examination means a medical nexus examination or medical opinion for the purposes of adjudicating a benefit under chapter 11 or 15 of title 38, United States Code, regardless of whether conducted by an employee or a contractor of the Department. (2) Rural; highly rural The terms rural and highly rural have the meanings given those terms under the rural-urban commuting areas coding system of the Department of Agriculture. 4. Improvements to training for processing medical disability examinations (a) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall require additional training for new and probationary employees of the Department of Veterans Affairs who order or review covered medical disability examinations. (b) Training requirements The training required under subsection (a) shall include the following: (1) Instruction on how to assess whether a covered medical disability examination is adequate for purposes of adjudicating a claim for a benefit under laws administered by the Secretary. (2) Instruction on how to assess whether a medical disability examination is necessary for purposes of adjudicating a particular claim for a benefit. (3) Review of relevant statutes, judicial decisions, regulations, and policies of the Department regarding covered medical disability examinations, including, at a minimum— (A) the duty to assist; (B) the relevance of causation compared to other evidentiary standards in covered medical disability examinations; (C) the required elements of a covered medical disability examination, with an emphasis on the requirement for reasoned analysis to support medical opinions; and (D) the relevance of a lack of a statutory or regulatory presumption of service-connection in covered medical disability examinations. (4) Input from impacted employees of the Department, including duly appointed labor representatives of Department employees. (c) Second level of review for new employees The Secretary shall ensure that a new employee described in subsection (a) is subject to a second level of review before the employee can order a covered medical disability examination until the employee achieves an accuracy rate of 90 percent on decisions of claims. (d) Modification of reports (1) Board of Veterans’ Appeals Section 7101(d)(2) of title 38, United States Code, is amended— (A) in subparagraph (F), by striking ; and and inserting a semicolon; (B) in subparagraph (G), by striking the period at the end and inserting ; and ; and (C) by adding at the end the following new subparagraph: (H) a summary of recurring issues that result in the Board remanding appeals back to the agency of original jurisdiction. . (2) United States Court of Appeals for Veterans Claims Section 7288(b) of title 38, United States Code, is amended by adding at the end the following new paragraph: (16) A summary of recurring issues that result in remands. . (e) Definition of covered medical disability examination In this section, the term covered medical disability examination means a medical examination or medical opinion that the Secretary determines necessary for the purposes of adjudicating a benefit under chapter 11 or 15 of title 38, United States Code, regardless of whether conducted by an employee or a contractor of the Department. 5. Review and priority processing of claims with inadequate or unnecessary examinations (a) Review Not later than one year after the date of the enactment of this Act and not less frequently than once every three months thereafter until the date that is three years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall review a statistically significant sample of all covered medical disability examinations completed during the previous three-month period. (b) Further sample requirements Under each review required by subsection (a), the Secretary shall ensure the review includes— (1) a statistically significant sample of covered medical disability examinations completed by employees of the Department of Veterans Affairs; and (2) a statistically significant sample of covered medical disability examinations completed by each contractor that provides such examinations for the Department. (c) Analysis Under each review required by subsection (a), the Secretary shall— (1) analyze the samples specified in subsection (b); and (2) pursuant to such analysis, identify— (A) the percentage of examinations that were adequate for purposes of adjudicating the particular claim for a benefit under chapter 11 or 15 of title 38, United States Code, for which the examination was ordered by the Department; and (B) the percentage of examinations considered overdeveloped for purposes of adjudicating claims for a benefit under chapter 11 or 15 of title 38, United States Code, for which the examination was ordered by the Department. (d) Priority processing (1) In general Except as provided for in paragraph (2), if during a review under subsection (a) the Secretary finds any covered medical disability examination to be not adequate for adjudicating a claim, the Secretary shall ensure the claimant examined by that examination— (A) receives another examination, if necessary, on a priority basis; and (B) receives priority processing for the entirety of impacted claim. (2) Exception The Secretary is not required to furnish an additional examination under paragraph (1) if the Secretary determines such an examination to be unnecessary for purposes of adjudicating the claim. (e) Comptroller General of the United States study The Comptroller General of the United States shall conduct a review of the methodology and effectiveness of the reviews conducted under subsection (a). (f) Covered medical disability examination defined In this section, the term covered medical disability examination means a medical examination or opinion for the purposes of adjudicating a claim for a benefit under chapter 11 or 15 of title 38, United States Code, regardless of whether conducted by an employee or a contractor of the Department. 6. Mechanism for contractors conducting disability examinations under certain Department of Veterans Affairs pilot program to transmit medical evidence introduced by claimants during examinations (a) In general Section 504 of the Veterans’ Benefits Improvements Act of 1996 ( Public Law 104–275 ; 38 U.S.C. 5101 note) is amended— (1) by redesignating subsections (d) and (e) as subsections (e) and (f), respectively; and (2) by inserting after subsection (c) the following new subsection (d): (d) Mechanism for transmittal of evidence introduced by applicants during examinations The Secretary shall establish a mechanism whereby a health care professional who conducts medical examinations or opinions under section 5103A(d) of title 38, United States Code, may transmit to a veteran’s claims file, evidence introduced by the applicant during a medical examination or in conjunction with a medical opinion that examiner used to inform such medical examination or opinion. . 7. Review and plan regarding Department of Veterans Affairs scheduling of medical examinations (a) Review required Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a review of scheduling request tools, contracts, and systems used by employees and contractors of the Department of Veterans Affairs to order and conduct medical disability examinations. (b) Plan 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 plan to ensure the following: (1) Systems and processes used by the Department enable seamless and clear communication of requirements between the claims processors who request medical disability examinations and medical disability examination vendors, including through a contract. (2) Medical disability examiners, including through a contract, review the medical records and claims information necessary to conduct exams that are adequate for purposes of rating claims for benefits under laws administered by the Secretary. (3) Claimants or appellants for whom a medical disability examination is requested of the Department have agency in determining when and where the examination is conducted within a reasonable timeframe, as determined by the Secretary. (4) Claimants or appellants for whom a medical disability examination is requested of the Department have a seamless experience when scheduling their examinations without regard to which medical disability vendor conducts the examinations. (5) The Department conducts customer satisfaction and experience surveys of claimants or appellants who attend medical disability examinations provided under laws administered by the Secretary.