Veterans' Medical Programs Amendments of 1992
PL 102-405 (S.2344), enacted 10/09/1992

106 STAT. 1972 
PUBLIC LAW 102-405—OCT. 9, 1992 
Public Law 102-
102d Congress 
•405 
An Act 
Oct. 9, 1992 
[S. 2344] 
Veterans' 
Medical 
Programs 
Amendments of 
1992 
38 u s e 101 note. 
To improve the provision of health care and other services to veterans by the 
Department of Veterans Affairs, and for other purposes. 
Be it enacted by the Senate and House of Representatives 
of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—^This Act may be cited as the "Veterans' 
Medical Programs Amendments of 1992". 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. References to title 38, United States Code, and to Secretary of Veterans Af-
fairs. 
TITLE I—HEALTH CARE 
PART A—GENERAL HEALTH CARE 
Sec. 101. Increase in limit on certain grants for home structviral alterations for dis-
abled veterans. 
Sec. 102. Submission of reports of Geriatrics and Gerontology Advisory Committee. 
Sec. 103. Authority to hold joint title to medical equipment. 
Sec. 104. Quality assurance activities. 
Sec. 105. Advisory Committee on Prosthetics and Special-Disabilities Programs. 
Sec. 106. Prosthetic services report. 
Sec. 107. Services for homeless veterans. 
PART B—MENTAL HEALTH PROVISIONS 
Sec. 121. Marriage and family counseling for Persian Gulf War veterans. 
Sec. 122. Post-traumatic stress disorder research and reports. 
Sec. 123. Post-traumatic stress disorder program planning. 
TITLE II—HEALTH-CARE PERSONNEL 
Sec. 201 
Sec. 202 
Sec. 203 
Sec. 204 
Cap on certain rates of pay. 
Minimum period of service for scholarship recipients. 
Authority to purchase items of nominal value for recruitment purposes. 
Special pay for certain physicians and dentists based on board cer-
tification. 
Sec. 205. Authority to appoint non-physician directors to the Oflice of the Under 
Secretary for Health. 
Sec. 206. Expansion of director grade of the physician and dentist pay schedule. 
TITLE III—MISCELLANEOUS PROVISIONS 
Sec. 301. Authorization requirement for construction of new medical facilities. 
Sec. 302. Redesignation of certain positions within the Department of Veterans Af-
fairs. 
Sec. 303. Attorney fees in connection with certain Department of Veterans Affairs 
proceedings. 
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE, AND TO 
SECRETARY OF VETERANS AFFAIRS. 
(a) REFERENCES TO TiTLE 38.—Except as otherwise expressly 
provided, whenever in this Act an amendment or repeal is expressed 
in terms of an amendment to, or repeal of, a section or other 
provision, the reference shall be considered to be made to a section 
or other provision of title 38, United States Code. 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1973 
(b) REFERENCES TO SECRETARY.—Except as otherwise expressly 
provided, any reference in this Act to "the Secretary" is a reference 
to the Secretary of Veterans Affairs. 
TITLE I—HEALTH CARE 
PART 
A—GENERAL 
HEALTH 
CARE 
SEC. 101. INCREASE IN LIMIT ON CERTAIN GRANTS FOR HOME STRUC-
TURAL ALTERATIONS FOR DISABLED VETERANS. 
(a) INCREASE.—Section 1717(a)(2) is amended by striking out 
"$2,500" and "$600" and inserting in Ueu thereof "$4,100" and 
"$1,200", respectively. 
(b) EFFECTIVE DATE.—The amendments made by subsection 
38 use 1717 
(a) shall apply with respect to a veteran who first applies for ^°^-
benefits under section 1717(a)(2) of title 38, United States Code, 
after December 31, 1989. 
(c) APPLICABILITY,—^A veteran who exhausts such veteran's eli- 38 use 1717 
f
lbility for benefits under section 1717(a)(2) of title 38, United "°*®-
tates Code, before January 1, 1990, is not entitled to additional 
benefits under such section by reason of the amendments made 
by subsection (a). 
SEC. 102. SUBMISSION OF REPORTS OF GERIATRICS AND GERON-
TOLOGY ADVISORY COMMITTEE. 
Paragraph (2) of section 7315(c) is amended to read as follows: 
"(2) Whenever the Committee submits a report to the Secretary 
under paragraph (1), the Committee shall at the same time transmit 
a copy of the report in the same form to the appropriate committees 
of Congress. Not later than 90 days after receipt of a report under 
that paragraph, the Secretary shall submit to the appropriate com-
mittees of Congress a report containing any comments and rec-
ommendations of the Secretary with respect to the report of the 
Committee.". 
SEC. 103. AUTHORITY TO HOLD JOINT TITLE TO MEDICAL EQUIPMENT. 
(a) IN GENERAL.—(1) Chapter 81 is amended by adding at 
the end of subchapter IV the following new sections: 
*
*
§ 8157. Joint title to medical equipment 
"(a) Subject to subsection (b), the Secretary may enter into 
agreements with institutions described in section 8153(a) of this 
title for the joint acquisition of medical equipment. 
"(b)(1) The Secretary may not pay more than one-half of the 
purchase price of equipment acquired through an agreement imder 
subsection (a). 
"(2) Any equipment to be procured under such an agreement 
shall be procured by the Secretary. Title to such equipment shall 
be held jointly by the United States and the institution. 
"(3) Before equipment acquired under such an agreement may Contracts, 
be used, the parties to the agreement shall arrange by contract 
under section 8153 of this title for the exchange or use of the 
equipment. 
"(4) The Secretary may not contract for the acquisition of medi-
cal equipment to be purchased jointly under an agreement under 
subsection (a) until the institution which enters into the agreement 
106 STAT. 1974 
PUBLIC LAW 102-405—OCT. 9, 1992 
provides to the Secretary its share of the purchase price of the 
medical equipment. 
"(c)(1) Notwithstanding any other provision of law, the Sec-
retary may transfer the interest of the Department in equipment 
acquired through an agreement under subsection (a) to the institu-
tion which holds joint title to the equipment if the Secretary deter-
mines that the transfer would be justified by compelling clinical 
considerations or the economic interest of the Department. Any 
such transfer may only be made upon agreement by the institution 
to pay to the Department the amount equal to one-half of the 
depreciated purchase price of the equipment. Any such payment 
when received shall be credited to the applicable Department medi-
cal appropriation. 
"(2) Notwithstanding any other provision of law, the Secretary 
may acquire the interest of an institution in equipment acquired 
under subsection (a) if the Secretary determines that the acquisition 
would be justified by compelling clinical considerations or the eco-
nomic interests of the Department. The Secretary may not pay 
more than one-half the depreciated purchase price of that equip-
ment. 
'*§ 8158. Deposit in escrow 
"(a) To facilitate the procurement of medical equipment pursu-
ant to section 8157 of this title, the Secretary may enter into 
escrow agreements with institutions described in section 8153(a) 
of this title. Any such agreement shall provide that— 
"(1) the institutions shall pay to the Secretary the funds 
necessary to make a payment under section 8157(b)(4) of this 
title; 
"(2) the Secretary, as escrow agent, shall administer those 
funds in an escrow account; and 
"(3) the Secretary shall disburse the escrowed funds to 
pay for such equipment upon its delivery or in accordance 
with the contract to procure the equipment and shall disburse 
all accrued interest or other earnings on the escrowed funds 
to the institution. 
"(b) As escrow agent for funds placed in escrow pursuant to 
an agreement under subsection (a), the Secretary may— 
"(1) invest the escrowed funds in obligations of the Federal 
Government or obligations which are insured or guaranteed 
by the Federal Government; 
"(2) retain in the escrow account interest or other earnings 
on such investments; 
"(3) disburse the funds pursuant to the escrow agreement; 
and 
"(4) return undisbursed funds to the institution. 
"(c)(1) If the Secretary enters into an escrow agreement under 
this section, the Secretary may enter into an agreement to procure 
medical equipment if one-half the purchase price of the equipment 
is available in an appropriation or fund for the expenditure or 
obligation. 
"(2) Funds held in an escrow account under this section shall 
not be considered to be public funds.". 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1975 
(2) The table of sections at the beginning of chapter 81 is 
amended by inserting after the item relating to section 8156 the 
following new items: 
"8157. Joint title to medical equipment. 
"8158. Deposit in escrow.". 
(b) REPORT.—^Not later than 45 days 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 on the Secretarj^s plans for implementation of this section. 
The report shall include an identification and discussion of— 
(1) the instructions the Secretary proposes to issue to medi-
cal facilities to guide the development of proposals for procure-
ment of medical equipment under this section, including 
instructions for ensuring equitable arrangements for use of 
the equipment by the Department and the co-purchasers of 
the equipment; 
(2) the criteria by which the Secretary plans to evaluate 
proposals to procure medical equipment under this section; 
(3) the means by which the Secretary will integrate the 
process of procuring equipment under this section with the 
policies and procedures governing health care planning by the 
Veterans Health Administration; and 
(4) the criteria by which determinations to transfer title 
to equipment under section 8157(c) of title 38, United States 
Code, as added by subsection (a), would be made. 
SEC. 104. QUALITY ASSURANCE ACTIYITIES. 
38 USC 7311 
Effective on October 1, 1992, programs and activities which Effective date. 
(1) the Secretary carries out pursuant to section 7311(a) of title 
38, United States Code, or (2) are described in sections 201(a)(1) 
and 201(a)(3) of Public Law 100-322 (102 Stat. 508) shall be deemed 
to be part of the operation of hospitals, nursing homes, and domi-
ciliary facilities of the Department of Veterans Affairs, without 
regard to the location of the duty stations of employees carrying 
out those programs and activities. 
SEC. 105. ADVISORY COMMITTEE ON PROSTHETICS AND SPECIAL-DIS-
ABILTTIES PROGRAMS. 
(a) STATUS AND NAME OF COMMITTEE.—The Federal advisory 
38 use 543 note. 
committee established by the Secretary and known as the Prosthet-
ics Service Advisory Committee shall after the date of the enactment 
of this Act be known as the Advisory Committee on Prosthetics 
and Special-Disabilities Programs and shall operate as though such 
committee had been established by law. Notwithstanding any other 
provision of law, the Committee may, upon the enactment of this 
Act, meet and act on any matter covered by subsection (b) of 
section 543 of title 38, United States Code, as added by subsection 
(b) of this section. 
(b) STATUTORY ESTABLISHMENT.—(1) Chapter 5 is amended by 
adding at the end of subchapter III the following new section: 
**§543. Advisory Committee on Prosthetics and Special-Dis-
abilities Programs 
"(a) There is in the Department an advisory committee known 
as the Advisory Committee on Prosthetics and Special-Disabilities 
Programs (hereinafter in this section referred to as the 'Committee'). 
106 STAT. 1976 
PUBLIC LAW 102-405—OCT. 9, 1992 
"(b) The objectives and scope of activities of the Committee 
shall relate to— 
"(1) prosthetics and special-disabilities programs adminis-
tered by the Secretary; 
"(2) the coordination of programs of the Department for 
the development and testing of, and for information exchange 
regarding, prosthetic devices; 
"(3) the coordination of Department and non-Department 
programs that involve the development and testing of prosthetic 
devices; and 
"(4) the adequacy of funding for the prosthetics and special-
disabilities programs of the Department. 
"(c) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee on the matters described in 
subsection (b). 
Reports. 
«(d) Not later than January 15 of 1993, 1994, and 1995, the 
Committee shall submit to the Secretary and the Committees on 
Veterans' Affairs of the Senate and House of Representatives a 
report on the effectiveness of the prosthetics and special-disabilities 
programs administered by the Secretary during the preceding fiscal 
year. Not more than 60 days after the date on which any such 
report is received by the Secretary, the Secretary shall submit 
a report to such committees commenting on the report of the Com-
mittee. 
"(e) As used in this section, the term 'special-disabilities pro-
grams' includes all programs administered by the Secretary for— 
"(1) spinal-cord-injured veterans; 
"(2) blind veterans; 
"(3) veterans who have lost or lost the use of extremities; 
"(4) hearing-impaired veterans; and 
"(5) other veterans with serious incapacities in terms of 
daily life functions.". 
(2) The table of sections at the beginning of chapter 5 is 
amended by adding at the end the following new item: 
"543. Advisory Committee on Prosthetics and Special-Disabilities Programs.". 
SEC. 106. PROSTHETIC SERVICES REPORT. 
Not later than six months after the date of the enactment 
of this Act, the Secretary shall submit to the Committees on Vet-
erans' Affairs of the Senate and House of Representatives a report 
containing— 
(1) the Secretary's evaluation of the reasons for the backlog 
that occurred in the procurement of prosthetic appliances in 
fiscal year 1989, and for the failure to furnish prosthetic appli-
ances in accordance with the priority established in section 
1712(i) of title 38, United States Code; and 
(2) a description of the actions that the Secretary has 
taken and plans to take to prevent a recurrence of— 
(A) the accumulation of a significant backlog in the 
procurement of prosthetic appliances; and 
(B) the failure to furnish prosthetic appliances in 
accordance with such priority, including a schedule for 
any such planned actions. 
SEC. 107. SERVICES FOR HOMELESS VETERANS. 
38 use 527 note. 
(a) PROGRAM DEVELOPMENT.—The Secretary shall assess all 
programs developed by facilities of the Department of Veterans 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1977 
Affairs which have been designed to assist homeless veterans. To 
the maximum extent practicable, the Secretary shall seek to rep-
licate at other facilities of the Department those programs that 
have as a goal the rehabilitation of homeless veterans and which 
the Secretary has determined to be successful in achieving that 
goal by fostering reintegration of homeless veterans into the commu-
nity and employment of such veterans. 
(b) ASSESSMENT AND COORDINATION.—(1) In carrying out sub- 38 use 527 note, 
section (a), the Secretary shall require the director of each medical 
center or the director of each regional benefits office to make an 
assessment of the needs of homeless veterans living within the 
area served by the medical center or regional office, as the case 
may be. 
(2) Each such assessment shall be made in coordination with 
representatives of State and local governments, other appropriate 
departments and agencies of the Federal Government, and non-
governmental organizations that have experience working with 
homeless persons in that area. 
(3) Each such assessment shall identify the needs of homeless 
veterans with respect to the following: 
(A) Health care. 
(B) Education and training. 
(C) Employment. 
(D) Shelter. 
(E) Counseling. 
(F) Outreach services. 
(4) Each assessment shall also indicate the extent to which 
the needs referred to in paragraph (3) are being met adequately 
by the programs of the Department, of other departments and 
agencies of the Federal Government, of State and local governments, 
and of nongovernmental organizations. 
(5) Each assessment shall be carried out in accordance with 
uniform procedures and guidelines prescribed by the Secretary. 
(c) PLANNING.—In furtherance of subsection (a), the Secretary 
38 use 527 note, 
shall require the director of each medical center and the director 
of each regional benefits office, in coordination with representatives 
of State and local governments, other Feder£d officials, and non-
governmental organizations that have experience working with 
homeless persons in the areas served by such facility, to— 
(1) develop a list of all public and private programs that 
provide assistance to homeless persons or homeless veterans 
in the area concerned, together with a description of the services 
offered by those programs; and 
(2) seek to encourage the development by the rep-
resentatives of such entities, in coordination with the director, 
of a plan to coordinate among such public and private programs 
the provision of services to homeless veterans. 
(d) SERVICES.—In furtherance of subsection (a), the Secretary 
38 use 527 note, 
shall require the director of each medical center or regional benefits 
office, in carrying out such director's responsibilities luider title 
38, United States Code, to take appropriate action to— 
(1) meet, to the maximum extent practicable through exist-
ing programs and available resources, the needs of homeless 
veterans that are identified in the assessment conducted under 
subsection (b); and 
(2) attempt to inform homeless veterans whose needs the 
director cannot meet under paragraph (1) of the services avail-
106 STAT. 1978 
PUBLIC LAW 102-405—OCT. 9, 1992 
able to such veterans within the area served by such center 
or office. 
38 use 527 note. 
(e) AUTHORITY TO ACCEPT DONATIONS FOR CERTAIN PRO-
GRAMS.—The Secretary may accept donations of funds and services 
for the purposes of providing one-stop, non-residential services and 
mobile support teams and for expanding the medical services to 
homeless veterans eligible for such services from the Department 
of Veterans Affairs. 
38 use 527 note. 
(f) DEFINITIONS.—As used in subsections (a) through (e): 
(1) The term "medical center" means a medical center 
of the Department of Veterans Affairs. 
(2) The term "regional benefits office" means a regional 
benefits office of the Department of Veterans Affairs. 
(3) The term "veteran" has the meaning given such term 
in section 101(2) of title 38, United States Code. 
(4) The term "homeless" has the meaning given such term 
in section 103(a), as limited by section 103(c), of the Stewart 
B. McKinney Homeless Assistance Act (42 U.S.C. 11302(a)). 
(g) EXTENSION OF CERTAIN PROGRAMS FOR HOMELESS VET-
ERANS.—Section 801 of the Stewart B. McKinney Homeless Assist-
ance Amendments Act of 1988 (Public Law 100-628; 102 Stat. 
3257) is amended— 
(1) in subsection (a), by striking out "to the Veterans' 
Administration" and all that follows through the period and 
inserting in lieu thereof the following: "to the Department 
of Veterans Affairs $50,000,000 for fiscal year 1993 for medical 
care of veterans. Funds appropriated pursuant to this section 
shall be in addition to any funds appropriated pursuant to 
any other authorizations (whether definite or indefinite) for 
medical care of veterans."; and 
(2) in subsections (b) and (c), by striking out "Of the amoimt 
appropriated pursuant to subsection (a), 50 percent" and insert-
ing in lieu thereof "The amounts appropriated pursuant to 
subsection (a)". 
(h) EXTENSION OF PROGRAM FOR MENTALLY I I I HOMELESS VET-
ERANS.—Section 115(d) of the Veterans' Benefits and Services Act 
of 1988 (38 U.S.C. 1712 note) is amended by striking out "1992" 
and inserting in lieu thereof "1994". 
(i) REPORT.—Not later than February 1, 1993, the Secretary 
shall submit to the Committees on Veterans' Affairs of the Senate 
and House of Representatives a report containing an evaluation 
of the programs referred to in subsections (a) and (e). 
PART B—^MENTAL HEALTH PROVISIONS 
38 use 1712A 
note. 
Termination 
date. 
SEC. 121. MARRIAGE AND FAMILY COUNSELING FOR PERSIAN GULF 
WAR VETERANS. 
(a) REQUIREMENT.—Subject to the availability of funds appro-
priated pursuant to the authorization in subsection (g), the Sec-
retary snail conduct a program to furnish to the persons referred 
to in subsection (b) the marriage and family counseling services 
referred to in subsection (c). The authority to conduct the program 
shall expire on September 30, 1994. 
(b) PERSONS ELIGIBLE FOR COUNSELING.—The persons eligible 
to receive marriage £uid family counseling services under the pro-
gram are— 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1979 
(1) veterans who were awarded a campaign medal for 
active-duty service during the Persian Gulf War and the 
spouses and children of such veterans; and 
(2) veterans who are or were members of the reserve compo-
nents who were called or ordered to active duty during the 
Persian Gulf War and the spouses and children of such mem-
bers. 
(c) COUNSELING SERVICES.—Under the program, the Secretary 
may provide marriage and family counseling that the Secretary 
determines, based on an assessment by a mental-health professional 
employed by the Department and designated by the Secretary (or, 
in an area where no such professional is available, a mental-
health professional designated by the Secretary and performing 
services under a contract or fee arreuigement with the Secretary), 
is necessary for the amelioration of psychological, marital, or famil-
ial difficulties that result from the active duty service referred 
to in subsection (b) (1) or (2). 
(d) MANNER OF FURNISHING SERVICES.—(1) Marriage and family 
counseling services shall be furnished under the program— 
(A) by personnel of the Department of Veterans Affairs 
who are qualified to provide such counseling services; 
(B) by appropriately certified marriage and family coun-
selors employed by the Department; and 
(C) by qualified mental health professionals pursuant to 
contracts with the Department, when Department facilities are 
not capable of furnishing economical medical services because 
of geographical inaccessibility or are not capable of furnishing 
the services required. 
(2) The Secretary shall establish the qualifications required 
of personnel under subparagraphs (A) and (C) of paragraph (1) 
and shall prescribe the training, experience, and certification 
required of appropriately certified marriage and family counselors 
under subparagraph (B) of such paragraph. 
(3) The Secretary may employ licensed or certified marriage 
and family counselors to provide counseling under paragraph (1)(B) 
and may classify the positions in which they are employed at 
levels determined appropriate by the Secretary, taking into consid-
eration the training, experience, and licensure or certification 
required of such counselors. 
(e) CONTRACT COUNSELING SERVICES.—(1) Subject to para-
graphs (2) and (4), a mental health professional referred to in 
subsection (d)(1)(C) may furnish marriage and family counseling 
services to a person under the program as follows: 
(A) For a period of not more than 15 days beginning on 
the date of the commencement of the furnishing of such services 
to the person. 
(B) For a 90-day period beginning on such date if— 
(i) the mental health professional submits to the Sec-
retary a treatment plan with respect to the person not 
later than 15 days after such date; and 
(ii) the treatment plan and the assessment made under 
subsection (c) are approved by an appropriate mental 
health professional of^the Department designated for that 
purpose by the Under Secretary for Health. 
(C) For an additional 90-day period beginning on the date 
of the expiration of the 90-day period referred to in subpara-
graph (B) (or any subsequent 90-aay period) if— 
106 STAT. 1980 
PUBLIC LAW 102-405—OCT. 9, 1992 
(i) not more than 30 days before the expiration of 
the 90-day period referred to in subparagraph (B) (or any 
subsequent 90-day period), the mental health professional 
submits to the Secretary a revised treatment plan contain-
ing a justification of the need of the person for additional 
counseling services; and 
(ii) the plan is approved in accordance with the provi-
sions of subparagraph (B)(ii). 
(2)(A) A mental health professional referred to in paragraph 
(1) who assesses the need of any person for services for the purposes 
of subsection (c) may not furnish counseling services to that person. 
(B) The Secretary may waive the prohibition referred to in 
subparagraph (A) for locations (as determined by the Secretary) 
in which the Secretary is unable to obtain the assessment referred 
to in that subparagraph from a mental health professional other 
than the mental health professional with whom the Secretary enters 
into contracts under subsection (d)(1)(C) for the furnishing of coun-
seling services. 
(3) The Secretary shall reimburse mental health professionals 
for the reasonable cost (as determined by the Secretary) of fur-
nishing counseling services under paragraph (1). In the event of 
the disapproval of a treatment plan of a person submitted by 
a mental health professional under paragraph (l)(B)(i), the Sec-
retary shall reimburse the mental health professional for the rea-
sonable cost (as so determined) of furnishing counseling services 
to the person for the period beginning on the date of the commence-
ment of such services and ending on the date of the disapproval. 
(4) The Secretary may authorize the furnishing of counseling 
in an individual case for a period shorter than the 90-day period 
specified in subparagraph (B) or (C) of paragraph (1) and, upon 
further consideration, extend the shorter period to the full 90 days. 
(5)(A) For the purposes of this subsection, the term "treatment 
plan", with respect to a person entitled to counseling services under 
the program, must include— 
(i) an assessment by the mental health professional submit-
ting the plan of the counseling needs of the person described 
in the plan on the date of the submittal of the plan; and 
(ii) a description of the counseling services to be furnished 
to the person by the mental health professional during the 
90-day period covered by the plan, including the number of 
counseling sessions proposed as part of such services. 
(B) The Secretary shall prescrioe an appropriate form for the 
treatment plan. 
(f) COST RECOVERY.—For the purposes of section 1729 of title 
38, United States Code, marriage and family counseling services 
furnished under the program shall be deemed to be care and serv-
ices furnished by the Department under chapter 17 of such title, 
and the United States shall be entitled to recover or collect the 
reasonable cost of such services in accordance with that section. 
(g) AUTHORIZATION OF APPROPRIATIONS.—^There is authorized 
to be appropriated $10,000,000 for each of fiscal years 1993 and 
1994 to carry out this section. 
(h) REPORT.—^Not later than July 1, 1994, the Secretary shall 
submit to Congress a report on the program conducted pursuant 
to this section. The report shall contedn information regarding the 
persons 
furnished 
counseling 
services 
under 
the program, 
including— 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1981 
(1) the number of such persons, stated as a total number 
and separately for each eligibiUty status referred to in sub-
section (b); 
(2) the age and gender of such persons; 
(3) the manner in which such persons were furnished such 
services under the program; and 
(4) the number of counseling sessions furnished to such 
persons. 
(i) DEFINITIONS.—^For the purposes of this section, the terms 
"veteran", "child", "active duty", "reserve component", "spouse", and 
"Persian Gulf War" have the meanings given such terms in para-
graphs 101 (2), (4), (21), (27), (31), and (33) of section 101 of 
title 38, United States Code, respectively. 
SEC. 122. POST-TRAUMATIC STRESS 
DISORDER 
RESEARCH 
AND 
REPORTS. 
(a) RESEARCH PRIORITY.—In carrying out research and award-
ing grants under chapter 73 of title 38, United States Code, the 
Secretary shall assign a high priority to the conduct of research 
on mental illness, including research regarding (1) post-traumatic 
stress disorder, (2) post-traumatic stress disorder in association 
with substance abuse, and (3) the treatment of those disorders. 
(b) UPDATES OF REPORTS UNDER SECTION 110(C) OF PUBLIC 
LAW 98-528.—(1) Not later than October 1, 1992, and October 
1, 1993, the Special Committee on Post-Traumatic-Stress Disorder 
established pursuant to section 110(b)(1) of the Veterans' Health 
Care Act of 1984 (38 U.S.C. 1712A note) shall concurrently submit 
to the Secretary and the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report containing informa-
tion updating the reports submitted to the Secretary under section 
110(e) of the Veterans' Health Care Act of 1984, together with 
any additional information the Special Committee considers appro-
priate regarding the overall efforts of the Department of Veterans 
Affairs to meet the needs of veterans with post-traumatic stress 
disorder and other psychological problems in readjusting to civilian 
life. 
(2) Not later than 90 days after receiving each of the reports 
under paragraph (1), the Secretary shall submit to the committees 
any comments concerning the report that the Secretary considers 
appropriate. 
SEC. 123. POST-TRAUMATIC STRESS DISORDER PROGRAM PLANNING. 
(a) PLAN.—^The Secretary shall develop a plan— 
(1) to ensure, to the maximum extent practicable, that 
veterans suffering from post-traumatic stress disorder related 
to active duty are provided appropriate treatment and rehabili-
tative services for that condition in a timely manner; 
(2) to expand and improve the services available for vet-
erans suffering from post-traumatic stress disorder related to 
active duty; 
(3) to eliminate waiting lists for inpatient treatment and 
other modes of treatment for post-traumatic stress disorder; 
(4) to enhance outreach activities carried out to inform 
combat-area veterans of the availability of treatment for post-
traumatic stress disorder; and 
(5) to ensure, to the extent practicable, that there are 
Department post-traumatic stress disorder treatment units in 
38 use 7303 
note. 
38 use 1712A 
note. 
38 use 1712A 
note. 
106 STAT. 1982 
PUBLIC LAW 102-405—OCT. 9, 1992 
locations that are readily accessible to veterans residing in 
rural areas of the United States. 
(b) CONSIDERATIONS.—In developing the plan referred to in 
subsection (a), the Secretary shall consider— 
(1) the numbers of veterans suffering from post-traumatic 
stress disorder related to active duty, as indicated by relevant 
studies, scientific and clinical reports, and other pertinent 
information; 
(2) the numbers of veterans who would likely seek post-
traumatic stress disorder treatment from the Department if 
waiting times for treatment were eliminated and outreach 
activities to combat-area veterans with post-traumatic stress 
disorder were enhanced; 
(3) the current and projected capacity of the Department 
to provide appropriate treatment and rehabilitative services 
for post-traumatic stress disorder; 
(4) the level and geographic accessibility of inpatient and 
outpatient care available through the Department for veterans 
suffering from post-traumatic stress disorder across the United 
States; 
(5) the desirability of providing that inpatient and out-
patient post-traumatic stress disorder care be furnished in 
facilities of the Department that are physically independent 
of general psychiatric wards of the medical facilities of the 
Department; 
(6) the treatment needs of veterans suffering from post-
traumatic stress disorder who are women, of such veterans 
who are ethnic minorities (including Native Americans, Native 
Hawaiians, Asian-Pacific Islanders, and Native Alaskans), and 
of such veterans who suffer from substance abuse problems 
in addition to post-traumatic stress disorder; and 
(7) the recommendations of the Special Committee on Post-
Traumatic-Stress Disorder with respect to (A) specialized 
inpatient and outpatient programs of the Department for the 
treatment of post-traumatic stress disorder, and (B) with 
respect to the establishment of educational programs that are 
designed for each of the various levels of education, training, 
and experience of the various mental health professionals 
involved in the treatment of veterans suffering from post-trau-
matic stress disorder. 
(c) REPORT.—Not later than six months 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 on the plan developed pursuant to subsection (a). The 
report shall include specific information relating to the consideration 
given to the matters described in subsection (b). 
(d) DEFINITIONS.—For the purposes of this section: 
(1) The term "active duty" has the meaning given that 
term in section 101(21) of title 38, United States Code. 
(2) The term "veteran" has the meaning given that term 
in section 101(2) of such title. 
(3) The term "combat-area veteran" means a veteran who 
served on active duty in an area at a time during which 
hostilities (as defined in section 1712A(a)(2)(B) of such title) 
occurred in such area. 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1983 
TITLE II—HEALTH-CARE PERSONNEL 
SEC. 201. CAP ON CERTAIN RATES OF PAY. 
Section 7455(c) is amended— 
(1) by inserting "(1)" after "(c)"; 
(2) by inserting **by two times" after "exceed" the first 
place it appears; and 
(3) by adding at the end the following: 
"(2) Whenever the amount of an increase under subsection 
(a) results in a rate of basic pay for a position being equal to 
or greater than the amount that is 94 percent of the maximum 
amount permitted under paragraph (1), the Secretary 
shall 
promptly notify the Committees on Veterans' Affairs of the Senate 
and House of Representatives of the increase and the amount 
thereof.". 
SEC. 202. MINIMUM PERIOD OF SERVICE FOR SCHOLARSHIP RECIPI-
ENTS. 
(a) MINIMUM SERVICE REQUIREMENT.—Section 7612(c)(1) is 
amended by striking out the period at the end of subparagraph 
(B) and inserting in lieu thereof ", but for not less than two years.". 
(b) EFFECTIVE DATE.—^The amendment made by subsection (a) ^^^Y^ '^^^^ 
shall apply to scholarship agreements entered into after the date 
of the enactment of this Act. 
note. 
SEC. 203. AUTHORITY TO PURCHASE ITEMS OF NOMINAL VALUE FOR 
RECRUITMENT PURPOSES. 
Section 7423 is amended by adding at the end the following 
new subsection: 
"(f) The Secretary may purchase promotional items of nominal 
value for use in the recruitment of individuals for emplo)anent 
under this chapter. The Secretary shall prescribe guidelines for 
the administration of the preceding sentence.". 
SEC. 204. SPECIAL PAY FOR CERTAIN PHYSICIANS AND DENTISTS 
BASED ON BOARD CERTIFICATION. 
(a) IN GENERAL.—Section 7437(e) is amended by striking out 
"only for the special-pay" and all that follows through the period 
in paragraphs (1)(C) and (2)(C) and inserting in lieu thereof "for 
no special-pay factors other than primary, full-time, length of serv-
ice, and specialty or board certification.". 
(b) EFFECTIVE DATE.—^The amendments made by subsection 
38 use 7437 
(a) shall apply as if enacted with the amendment made by section "°*®-
102 of the Department of Veterans Affairs Health-Care Personnel 
Act of 1991 (PubHc Law 102-40; 105 Stat. 187). 
(c) AVAILABILITY OF FUNDS.—Expenses incurred for periods 
38 use 7437 
before October 1, 1991, by reason of the amendments made by "°*®" 
subsection (a) may be charged to fiscal year 1992 appropriations 
available for the same purpose. 
SEC. 205. AUTHORITY TO APPOINT NON-PHYSICIAN DIRECTORS TO 
THE OFFICE OF THE UNDER SECRETARY FOR HEALTH. 
Section 7306(a) is amended— 
(1) by redesignating paragraph (7) as paragraph (8); and 
(2) by inserting after paragraph (6) the following new para-
graph (7): 
106 STAT. 1984 
PUBLIC LAW 102-405—OCT. 9, 1992 
"(7) Such directors of such other professional or auxiliary 
services as may be appointed to suit the needs of the Depart-
ment, who shall be responsible to the Under Secretary for 
Health for the operation of their respective services.". 
SEC. 206. EXPANSION OF DIRECTOR GRADE OF THE PHYSICIAN AND 
DENTIST PAY SCHEDULE. 
Section 7404(b)(2) is amended in the first sentence by inserting 
", or comparable position" before the period. 
TITLE III—MISCELLANEOUS 
SEC. 301. AUTHORIZATION REQUIREMENT FOR CONSTRUCTION OF 
NEW MEDICAL FACILITIES. 
(a) AUTHORIZATION REQUIREMENT.—(1) Paragraph (2) of section 
8104(a) is amended to read as follows: 
"(2) No funds may be appropriated for any fiscal year, and 
the Secretary may not obligate or expend funds (other than for 
advance planning and design), for any major medical facility project 
or any major medical facility lease unless funds for that project 
or lease have been specifically authorized by law.". 
(2) Paragraph (3)(B) of that section is amended— 
(A) by inserting "new" before "medical facility" the second 
place it appears; and 
(B) by striking out "$500,000" and inserting in lieu thereof 
"$300,000". 
(3) Subsection (c) of section 8104 is amended by striking out 
"resolution" both places it appears and inserting in lieu thereof 
"law". 
38 use 8104 
(b) APPLICABILITY,—^The amendments made by subsection (a) 
^°^- 
shall not apply with respect to any project for which fimds were 
appropriated before the date of the enactment of this Act. 
SEC. 302. REDESIGNATION OF CERTAIN POSITIONS WITHIN THE 
DEPARTMENT OF VETERANS AFFAIRS. 
38 use 305 note. 
(a) REDESIGNATION OF POSITION OF CHIEF MEDICAL DIREC-
TOR.—The position of Chief Medical Director of the Department 
of Veterans Affairs is hereby redesignated as Under Secretary for 
Health of the Department of Veterans Affairs. 
38 use 306 note. 
(b) REDESIGNATION OF POSITION OF CHIEF BENEFITS DIREC-
TOR.—The position of Chief Benefits Director of the Department 
of Veterans Affairs is hereby redesignated as Under Secretary for 
Benefits of the Department of Veterans Affairs. 
(c) TITLE 38 CONFORMING AMENDMENTS.—(1) Title 38, United 
States Code, is amended by striking out "Chief Medical Director" 
and "Chief Benefits Director" each place they appear (including 
in headings and tables but not including the sentences added by 
paragraphs (2) and (3)) and inserting in lieu thereof "Under Sec-
retary for Health" and "Under Secretary for Benefits", respectively. 
(2) Section 7301(a) is amended by adding gifter the last sentence 
the following: "The Under Secretary for Health may be referred 
to as the Chief Medical Director.". 
(3) Section 7701(b) is amended by adding after the last sentence 
the following: "The Under Secretary for Benefits may be referred 
to as the Chief Benefits Director.". 
PUBLIC LAW 102-405—OCT. 9, 1992 
106 STAT. 1985 
(d) EXECUTIVE SCHEDULE CONFORMING AMENDMENT.—Section 
5314 of title 5, United States Code, is amended by striking out 
the following: 
"Chief Medical Director, Department of Veterans Affairs. 
"Chief Benefits Director, Department of Veterans Affairs."; 
and inserting in lieu thereof the following: 
"Under Secretary for Health, Department of Veterans 
Affairs. 
"Under Secretary for Benefits, Department of Veterans 
Affairs.". 
(e) REFERENCES IN OTHER LAWS.—^Any reference in any Federal 38 use 305 note, 
law. Executive order, rule, regulation, or delegation of authority, 
or any document of or pertaining to the Department of Veterans 
Affairs— 
(1) to the Chief Medical Director of the Department of 
Veterans Affairs shall be deemed to refer to the Under Sec-
retary for Health of the Department of Veterans Affairs; and 
(2) to the Chief Benefits Director of the Department of 
Veterans Affairs shall be deemed to refer to the Under Sec-
retary for Benefits of the Department of Veterans Affairs. 
SEC. 303. ATTORNEY FEES IN CONNECTION WITH CERTAIN DEPART-
MENT OF VETERANS AFFAIRS PROCEEDINGS. 
(a) IN GENERAL.—Section 5904(c) is amended— 
(1) By striking out "In" at the beginning of paragraph 
(1) and inserting in lieu thereof "Except as provided in para-
graph (3), in"; and 
(2) Ijy adding at the end the following new paragraph: 
"(3) A reasonable fee may be charged or paid in connection 
with any proceeding before the Department in a case arising out 
of a loan made, guaranteed, or insured under chapter 37 of this 
title. A person who charges a fee under this paragraph shall enter Contracts. 
into a written agreement with the person represented and shall 
file a copy of the fee agreement with the Secretary at such time, 
and in such manner, as may be specified by the Secretary.". 
(b) EFFECTIVE DATE.—Paragraph (3) of section 5904(c) of title 
38 use 5904 
38, United States Code, as added by subsection (a), shall apply "°*®-
with respect to services of agents and attorneys provided after 
the date of the enactment of this Act. 
Approved October 9, 1992. 
L E G I S L A T I V E H I S T O R Y — S . 2344 (H.R. 2280) (S. 869): 
HOUSE REPORTS: Nos. 102-130 accompanying H.R. 2280 (Comm. on Veterans' 
Affairs) and 102-871 (Comm. of Conference). 
SENATE REPORTS: No. 102-118 accompanying S. 869 (Comm. on Veterans' Affairs). 
CONGRESSIONAL RECORD: 
Vol. 137 (1991): June 25, H.R. 2280 considered and passed House. 
Nov. 20, considered and passed Senate, amended, in lieu of 
S. 869. 
Nov. 25, House concurred in Senate amendments with 
amendments. 
Vol. 138 (1992): Mar. 11, S. 2344 considered and passed Senate. 
May 12, considered and passed House, amended. 
Sept. 24, House agreed to conference report. 
Sept. 25, Senate agreed to conference report.