Department of Veterans Affairs Health-Care Personnel Act of 1991
PL 102-40 (H.R.598), enacted 05/07/1991

PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 187 
Public Law 102-40 
102d Congress 
An Act 
To amend title 38, United States Code, to improve the capability of the Department of 
Veterans Affairs to recruit and retain physicians and dentists through incresises in 
special pay authorities, to authorize collective bargaining over conditions of em-
plo5mient for health-care employees of 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; REFERENCES TO TITLE 38, UNITED STATES 
CODE. 
(a) SHORT TITLE.—This Act may be cited as the "Department of 
Veterans Affairs Health-Care Personnel Act of 1991". 
(b) REFERENCES TO TITLE 38.—Except as otherwise expressly pro-
vided, whenever in this Act an amendment or repeal is expressed in 
terms of an Eimendment 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. 
SEC. 
2
. 
RENAMING OF 
VETERANS HEALTH SERVICES 
AND 
RESEARCH 
ADMINISTRATION. 
(a) RENAMING.—The establishment in the Department of Veterans 
Affairs known as the Veterans Health Services and Research 
Administration is hereby redesignated as the Veterans Health 
Administration. 
(b) REFERENCES.—Any reference to the Veterans Health Services 
and Research Administration (or to the Department of Medicine and 
Surgery of the Veterans' Administration) in any Federal law, Execu-
tive order, regulation, delegation of authority, or document of or 
pertaining to the Department of Veterans Affairs shall be deemed to 
refer to the Veterans Health Administration. 
May 7, 1991 
[H.R. 598] 
Department of 
Veterans Affairs 
Health-Care 
Personnel Act of 
1991. 
Government 
employees. 
38 u s e 101 note. 
38 u s e 201 note. 
TITLE I—SPECIAL PAY FOR PHYSICIANS AND DENTISTS 
SEC. 101. SHORT TITLE. 
This title may be cited as the "Department of Veterans Affairs 
Physician and Dentist Recruitment and Retention Act of 1991". 
SEC. 102. REVISION AND REORGANIZATION OF SPECIAL PAY STATUTE. 
Part V is amended by inserting after chapter 73 the following new 
chapter: 
"CHAPTER 
74—VETERANS 
HEALTH 
ADMINISTRATION-
PERSONNEL 
"SUBCHAPTER in—SPECIAL PAY POR PHYSICIANS AND DENTISTS 
"7431. Special pay: authority. 
"7432. Special pay: written agreements. 
"7433. Special pay: full-time physicians. 
"7434. Speci£d pay: part-time phjrsicians. 
Department of 
Veterans Affairs 
Phjrsician and 
Dentist 
Recruitment and 
Retention Act of 
1991. 
38 u s e 101 note. 
105 STAT. 188 
PUBLIC LAW 102-40—MAY 7, 1991 
"7435. Special pay: full-time dentists. 
"7436. Special pay: part-time dentists. 
"7437. Special pay: general provisions. 
"7438. Special pay: coordination with other benefits laws. 
"7439. Periodic review of pay of physicians eind dentists; quadrennial report. 
"7440. Annual report. 
"SUBCHAPTER III—SPECIAL PAY FOR PHYSICIANS AND 
DENTISTS 
"§ 7431. Special pay: authority 
"(a) In order to recruit and retain highly qualified physicians and 
dentists in the Veterans Health Administration, the Secretary shall 
Regulations. 
provide special pay under this subchapter. Such special pay shall be 
provided under regulations that the Secretary shall prescribe to 
carry out this subchapter. Before prescribing regulations under this 
subchapter, the Secretary shall receive the recommendations of the 
Chief Medical Director with respect to those regulations. 
"(b) Special pay may be paid to a physician or dentist under this 
subchapter only upon the execution of, and for the duration of, a 
written agreement entered into by the physician or dentist in 
accordance with section 7432 of this title. 
"(c) A physician or dentist serving a period of obligated service 
pursuant to chapter 76 of this title is not eligible for special pay 
under this subchapter during the first three years of such obligated 
service, except that, at the discretion of the Secretary and upon the 
recommendation of the Chief Medical Director, such a physician or 
dentist may be paid special pay for full-time status during those 
three years. 
"(d)(1) The Secretary may determine categories of positions ap-
plicable to either physicians or dentists, or both, in the Veterans 
Health Administration as to which there is no significant recruit-
ment and retention problem. While any such determination is in 
effect, the Secretary may not enter into an agreement under this 
subchapter with a physician or dentist serving in a position covered 
by the determination. Before making a determination under this 
paragraph, the Secretary shall receive the recommendations of the 
Chief Medical Director with respect to the determination. 
"(2) Not later than one year after making any such determination 
with respect to a category of positions, and each year thereafter that 
such determination remains in effect, the Secretary shall make a 
redetermination. 
"(3) Any determination under this subsection shall be in accord-
ance with regulations prescribed to carry out this subchapter, 
"(e) If the Chief Medical Director determines that payment of 
special pay to a physician or dentist who is employed on a less than 
half-time basis is the most cost-effective way available for providing 
needed medical or dental specialist services at a Department facil-
ity, the Chief Medical Director may authorize the payment of special 
pay for factors other than for full-time status to that physician or 
dentist at a rate computed on the basis of the proportion that the 
part-time employment of the physician or dentist bears to full-time 
employment. 
"(f) Special pay may not be paid under this section to a physician 
or dentist who— 
"(1) is employed on less than a quarter-time basis or on an 
intermittent basis; 
"(2) occupies an internship or residency training position; or 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 189 
"(3) is a reemployed annuitant. 
"(g)(1) In the case of a physician or dentist who is employed in a 
position that is covered by a determination by the Secretary under 
subsection (dXl) that the Administration does not have a significant 
recruitment or retention problem with respect to a particular cat-
egory of positions and who on the day before the effective date of 
this subchapter was receiving special pay under an agreement 
entered into under section 4118 of this title (as in effect before such 
date), the Secretary may pay to that physician or dentist, in addition 
to basic pay, retention pay under this subsection. 
"(2) The annual rate of such retention pay for any individual may 
not exceed the rate which, when added to the rate of basic pay 
payable to that individual, is equal to the sum of the Euinual rate of 
basic pay and the annual rate of special pay paid to that physician 
or dentist pursuant to the final agreement with that individual 
under such section 4118. 
"(3) Such retention pay shall be treated for all purposes as special 
pay paid under subchapter III of chapter 74 of this title. 
"(4) Retention pay under this subsection shall be paid under such 
regulations as the Secretary may prescribe. 
"§ 7432. Special pay: written agreements 
"(a) An agreement entered into by a physician or dentist under 
this subchapter shall cover a period of one year of service in the 
Vetersins Health Administration unless the physician or dentist 
agrees to an agreement for a longer period of service, not to exceed 
four years, as specified in the agreement. A physician or dentist who 
has previously entered into such an agreement is eligible to enter 
into a subsequent agreement unless the physician or dentist has 
fgiiled to refund to the United States any amount which the physi-
cian or dentist is obligated to refund under any such previous 
agreement. 
"(b)(1) An agreement under this subchapter shall provide that, if 
the physician or dentist entering into the agreement voluntarily, or 
because of misconduct, fails to complete any of the years of service 
covered by the agreement (measured from the anniversary date of 
the agreement), the physician or dentist shall refund an amount of 
special pay received under the agreement for that year equal to— 
"(A) in the case of a failure during the first year of service 
under the Eigreement, 100 percent of the amount received for 
that year; 
"(B) in the case of a failure during the second year of service 
under the agreement, 75 percent of the amount received for 
that year; 
"(C) in the case of a failure during the third year of service 
under the agreement, 50 percent of the amount received for 
that year; and 
"(D) in the case of a failure during the fourth year of service 
under the agreement, 25 percent of the amount received for 
that year. 
"(2) The Secretary may waive (in whole or in part) the require-
ment for a refund under paragraph (1) in any case if the Secretary 
determines (in accordance with regulations prescribed under section 
7431(a) of this title) that the failure to complete such period of 
service is the result of circumstances beyond the control of the 
physician or dentist. 
105 STAT. 190 
PUBLIC LAW 102-40—MAY 7, 1991 
"(3) Any such agreement shall specify the terms under which the 
Department and the physician or dentist may elect to terminate the 
agreement. 
"(c)(1) If a proposed agreement under this subchapter will provide 
a total annual amount of special pay to be provided to a physician or 
dentist who has previously entered into an agreement under this 
subchapter (or under section 4118 of this title as in effect before the 
effective date of the Department of Veterans Affairs Physician and 
Dentist Recruitment and Retention Act of 1991) that will exceed the 
previous annual amount of special pay provided for the physician or 
dentist by more than 50 percent (other than in the case of a 
physician or dentist employed in an executive position in the 
Central Office of the Department), or that will be less than the 
previous annual amount of special pay provided for the physician or 
dentist by more than 25 percent, the proposed agreement shall be 
promptly submitted to the Secretary. The proposed agreement shall 
not take effect if it is disapproved by the Secretary within 60 days 
after the date on which the physician or dentist entered into the 
proposed agreement. 
"(2) For purposes of paragraph (1), the previous annual amount of 
special pay provided for a physician or dentist is the total annual 
amount of special pay provided, or to be provided, to the physician 
or dentist for the most recent year covered by an agreement entered 
into by the physician or dentist under this subchapter or under 
section 4118 of this title. In the case of an agreement entered into 
under section 4118 of this title, incentive pay shall be treated as 
special pay for purposes of this paragraph. 
"(3) The Secretary shall adjust special pay as necessary for pur-
poses of this subsection to reflect appropriately any change in the 
status of a physician or dentist (A) from full-time status to part-time 
status, (B) from part-time status to full-time status, or (C) from one 
proportion of time spent as a Department employee under part-time 
status employment to a different proportion. 
"(d)(1) If a proposed agreement under this subchapter (other than 
an agreement in the case of the Chief Medical Director) will provide 
a total annual amount of special pay to be provided to a physician or 
dentist which, when added to the amount of basic pay of the 
physician or dentist, will be in excess of the amount payable for 
positions specified in section 5312 of title 5, the proposed agreement 
shall be promptly submitted for approval to the Secretary through 
Effective date. 
the Chief Medical Director. The agreement shall take effect at the 
end of the 60-day period beginning on the date on which the 
physician or dentist entered into the proposed agreement if it is 
neither approved nor disapproved within that 60-day period. If the 
agreement is approved within that period, the agreement shall take 
effect as of the date of the approval. A proposed agreement may be 
disapproved under this paragraph only if it is determined that the 
amounts of special pay proposed to be paid are not necessary to 
recruit or retain the physician or dentist. 
"(2) A proposed agreement under this subchapter with the Chief 
Medical Director may provide for payment of special pay for which 
the Chief Medical Director is eligible under this subchapter (other 
than that specified in section 7433(bX4)(B) of this title) only to the 
extent specifically approved by the Secretary. 
"(3) The Secretary shall include in the annual report required by 
section 7440 of this title— 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 191 
"(A) a statement of the number of agreements entered into 
during the period covered by the report under which the total 
amount of special pay to be provided, when added to the amount 
of basic pay of the physician or dentist, will be in excess of the 
amount payable for positions specified in section 5312 of title 5; 
"(B) a statement of the number of proposed agreements which 
during the period covered by the report were disapproved under 
this subsection; and 
"(C) a detailed explanation of the basis for disapproval of each 
such proposed agreement which was disapproved under this 
subsection. 
"(4) This subsection does not apply to any proposed agreement 
entered into after September 30,1994. 
"§ 7433. Special pay: full-time physicians 
"(a) The Secretary shall provide special pay under this subchapter 
to eligible physicians employed on a full-time basis based upon the 
factors, and at the annual rates, specified in subsection (b). 
"(b) The special pay factors, and the annual rates, applicable to 
full-time physicians are as follows: 
"(1) For full-time status, $9,000. 
"(2XA) For length of service as a physician within the Veter-
ans Health Administration— 
Rate 
"Length of Service 
^^._ 
Maxi-
mum 
mum 
2 years but less than 4 years 
$4,000 
$ 6,000 
4 years but less than 8 years 
6,000 
12,000 
8 years but less than 12 years 
12,000 
18,000 
12 years or more 
12,000 
25,000 
"(B) The Chief Medical Director shall specify a uniform na-
tional rate for each range of years of service established by or 
under this paragraph. The Chief Medical Director may, as to 
length of service in excess of 12 years, establish uniform na-
tional rates for such ranges of years of service as the Chief 
Medical Director considers appropriate. 
"(3)(A) For service in a medical specialty with respect to 
which there are extraordinary difficulties (on a nation-wide 
basis or on the bsisis of the needs of a specific medical facility) in 
the recruitment or retention of quEilified physicians, an annual 
rate of not more than $40,000. 
"(B) For service by a physician who serves only a portion of a 
year in a medical specialty for which special pay is paid under 
subparagraph (A), the annual rate shall be calculated on the 
basis of the proportion of time served in the specialty for which 
the special pay is paid. 
"(4)(A) For service in any of the following executive positions, 
an annual rate not to exceed the rate applicable to that position 
as follows: 
105 STAT. 192 
PUBLIC LAW 102-40—MAY 7, 1991 
Rate 
"Position 
Mini- 
Maxi-
mum 
mum 
Service Chief (or in a comparable position as deter- 
$4,500 
$15,000 
mined by the Secretary). 
Chief of Staff or in an Executive Grade 
14,500 
25,000 
Director Grade 
0 
25,000 
"(B) For service in any of the following executive positions, 
the annual rate applicable to that position as follows: 
"Position 
Rate 
"Deputy Service Director 
$20,000 
"Service Director 
25,000 
"Deputy Assistant Chief Medical Director 
27,500 
"Assistant Chief Medical Director 
30,000 
"Associate Deputy Chief Medical Director 
35,000 
"Deputy Chief Medical Director 
40,000 
"Chief Medical Director 
45,000 
"(C) For service by a physician who serves only a portion of a 
year in an executive position listed in subparagraph (A) or (B) or 
who serves a portion of a year in such a position and also serves 
a portion of that year in another position or grade for which 
special pay is provided under this section, the annual rate shall 
be calculated on the basis of the proportion of time served in the 
position or positions for which special pay is provided. 
"(5) For specialty certification or first board certification, 
$2,000, and for subspecialty certification or secondary board 
certification, an additional $500. 
"(6) For service in a specific geographic location with respect 
to which there are extraordinary difficulties in the recruitment 
or retention of qualified physicians in a specific category of 
physicians, an annual rate of not more than $17,000. 
"(7XA) For service by a physician with exceptional qualifica-
tions within a specialty, an annual rate of not more than 
$15,000. 
"(B) Special pay under this paragraph may be paid to a 
physician only if the payment of such pay to that physician is 
approved by the Chief Medical Director personally and on a 
case-by-case basis and only to the extent that the rate paid 
under this paragraph, when added to the total of the rates paid 
to that physician under paragraphs (1) through (6), does not 
exceed the total rate that may be paid under those paragraphs 
to a physician with the same length of service, specialty, and 
position as the physician concerned. 
"§ 7434. Special pay: part-time physicians 
"(a) Subject to section 7431(e) of this title and subsection (b) of this 
section, special pay under this subchapter for physicians employed 
on a part-time basis shall be based on the special-pay factors and 
annual rates specified in section 7433 of this title. 
"(b) The annual rate of special pay paid to a physician employed 
on a part-time basis shall bear the same ratio to the annual rate 
that the physician would be paid under section 7433 (other than for 
full-time status) if the physician were employed on a full-time basis 
as the amount of part-time emplo3mient by the physician bears to 
full-time employment, except that such ratio may not exceed 3/4. 
P U B U C LAW 102-40—MAY 7, 1991 
105 STAT. 193 
"§ 7435. Special pay: full-time dentists 
"(a) The Secretary shall provide special pay under this subchapter 
to eligible dentists employed on a full-time basis based upon the 
factors, and at the anniial rates, specified in subsection G>). 
"G)) The specisd pay factors, £Uid the annual rates, applicable to 
full-time dentists are as follows: 
"(1) For full-time status, $3,500. 
"(2XA) For length of service as a dentist within the Veterans 
Health Administration— 
Rate 
"Length of Service 
j^jj^. 
j^j^^. 
mum 
mum 
2 years but less than 4 years 
$1,000 
$2,000 
4 years but less than 8 years 
2,000 
3,000 
8 years but less than 12 years 
3,000 
3,500 
12 years or more 
3,000 
4,000 
"(B) The Chief Medical Director shall specify a uniform na-
tional rate for each range of years of service established by or 
under this paragraph. TTie Chief Medical Director may, as to 
length of service in excess of 12 years, establish uniform na-
tional rates for such ranges of years of service as the Chief 
Medical Director considers appropriate. 
"(3XA) For service in a dental specialty with respect to which 
there are extraordinary difficulties (on a nation-wide basis or on 
the basis of the need^ of a specific medical facility) in the 
recruitment or retention of qualified dentists, an annual rate of 
not more than $20,000. 
"(B) For service by a dentist who serves only a portion of a 
year in a dental specialty for which special pay is paid under 
subparagraph (A), the £mnual rate shall be calculated on the 
basis of the proportion of time served in the specialty for which 
the special pay is paid. 
"(4XA) For service in any of the following executive positions, 
an annual rate not to exceed the rate applicable to that position 
as follows: 
Rate 
"Position 
Mini- 
Maxi-
mum 
mum 
Service Director 
$1,000 
$9,000 
Deputy Service Director 
1,000 
8,000 
Chief of Staff or in an Executive Grade 
1,000 
8,000 
Director Grade 
0 
8,000 
Service Chief (or in a comparable position as deter- 
1,000 
5,000 
mined by the Secretary). 
"(B) For service in any of the following executive positions, 
the annusd rate applicable to that position as follows: 
"Position 
Rate 
Assistant Chief Medical Director (or in a comparable position as de- 
$10,000 
termined by the Secretary). 
Deputy Assistant Chief Medical Director 
10,000 
105 STAT. 194 
PUBLIC LAW 102-40—MAY 7, 1991 
"(C) For service by a dentist who serves only a portion of a 
year in an executive position listed in subparagraph (A) or (B) or 
who serves a portion of a year in such a position and also serves 
a portion of that year in another position or grade for which 
special pay is provided under this section, the annual rate shall 
be calculated on the basis of the proportion of time served in the 
position or positions for which special pay is provided. 
"(5) For specialty or first board certification, $2,000 and for 
subspecialty or secondary board certification, an additional 
$500. 
"(6) For service in a specific geographic location with respect 
to which there are extraordinary difficulties in the recruitment 
or retention of qualified dentists in a specific category of den-
' 
tists, an annual rate not more than $5,000. 
"(7)(A) For service by a dentist with exceptional qualifications 
within a specialty, an annual rate of not more than $5,000. 
"(B) Special pay under this paragraph may be paid to a 
dentist only if the pajnnent of such pay to that dentist is 
approved by the Chief Medical Director personally and on a 
• ' case-by-case basis and only to the extent that the rate paid 
under this paragraph, when added to the total of the rates paid 
to that dentist under paragraphs (1) through (6), does not exceed 
the total rate that may be paid under those paragraphs to a 
dentist with the same length of service, specialty, and position 
as the dentist concerned. 
"§ 7436. Special pay: part-time dentists 
"(a) Subject to section 7431(e) of this title and subsection (b) of this 
section, special pay under this subchapter for dentists employed on a 
part-time basis shall be based on the special-pay factors and annual 
rates specified in section 7435 of this title. 
"(b) The annual rate of special pay paid to a dentist employed on a 
part-time basis shall bear the same ratio to the annual rate that the 
dentist would be paid under section 7435 of this title (other than for 
full-time status) if the dentist were employed on a full-time basis as 
the amount of part-time emplojrment by the dentist bears to full-
time emplojnnent, except that such ratio may not exceed 3/4. 
'*§ 7437. Special pay: general provisions 
"(a) A physician who is provided special pay for service in an 
executive position under paragraph (4XB) of section 7433(b) of this 
title may not also be provided scarce specialty special pay under 
paragraph (3) of that section. A dentist who is provided special pay 
for service in an executive position under paragraph (4) of section 
7435(b) of this title for service as a Service Director, Deputy Service 
Director, Deputy Assistant Chief Medical Director, or Assistant 
Chief Medical Director may not also be provided scarce specialty 
special pay under paragraph (3) of that section. 
R^ruiations. 
"(b) The following determinations under this subchapter shall be 
made under regulations prescribed under section 7431 of this title: 
"(1) A determination that there are extraordinary difficulties 
(on a nation-wide basis or on the basis of the needs of a specific 
medical facility) in the recruitment or retention of qualified 
physicians in a medical specialty or in the recruitment or 
retention of qualified dentists in a dental specialty. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 195 
"(2) A determination of the rate of special pay to be paid to a 
physician or dentist for a factor of special pay for which the 
applicable rate is specified as a range of rates. 
"(3) A determination of whether there are extraordinary 
difficulties in a specific geographic location in the recruitment 
or retention of qualified physicians in a specific category of 
physicians or in the recruitment or retention of qualified den-
tists in a specific category of dentists. 
"(c) A determination for the purposes of this subchapter that 
there are extraordinary difficulties in the recruitment or retention 
of qualified physicians in a medical specialty, or in the recruitment 
or retention of qualified dentists in a dental specialty, on the basis of 
the needs of a specific medical facility may only be made upon the 
request of the director of that facility. 
"(d) A physician or dentist may not be provided scarce specialty 
pay under section 7433(b), 7434(b), 7435(b), or 7436(b) of this title 
(whichever is applicable) on the basis of the needs of a specific 
medical facility unless the Secretary also determines that geo-
graphic location pay under that section is insufficient to meet the 
needs of that facility for qualified physicians or dentists, as the case 
may be. 
"(eXD A physician or dentist shall be paid special pay under this 
; 
subchapter at a rate not less than the rate of special pay the 
physician or dentist was paid under section 4118 of this title as of 
the day before the effective date of this subchapter if the physician 
or dentist— 
"(A) is employed on a full-time basis in the Veterans Health 
Administration; 
"(B) was employed as a physician or dentist on a full-time 
basis in the Administration on the day before such effective 
date; and 
"(C) on such effective date was being paid only for the special-
pay factors of primary, full-time, and length of service. 
"(2) A physician or dentist shall be paid special pay under this 
subchapter at a rate not less than the rate of special pay the 
physician or dentist was paid under section 4118 of this title as of 
the day before the effective date of this subchapter if the physician 
or dentist— 
"(A) is employed on a part-time basis in the Veterans Health 
Administration; 
"(B) was employed as a physician or dentist on a part-time 
basis in the Administration on the day before such effective 
date; and 
"(C) on such effective date was being paid only for the special-
pay factors of primary and length of service. 
"(f) Any amount of special pay payable under this subchapter 
shall be psdd in equal installments in accordance with regularly 
established pay periods. 
"(g) Except as otherwise expressly provided by law, special pay 
may not be provided to a physician or dentist in the Veterans 
Health Administration for any factor not specified in section 7433, 
7434, 7435, or 7436, as applicable, of this title. 
"(h) In no case may the total amount of compensation paid to a 
physician or dentist under this title in any year exceed the amount 
of annual compensation (excluding expenses) specified in section 102 
of title 3. 
105 STAT. 196 
PUBLIC LAW 102-40—MAY 7, 1991 
"§ 7438. Special pay: coordination with other benefits laws 
"(a) Special pay paid under this subchapter shall be in addition to 
any other pay and allowances to which a physician or dentist is 
entitled. 
"(bXl) A physician or dentist who has no section 4118 service and 
has completed not less than 15 years of service as a physician or 
dentist in the Veterans Health Administration shall be entitled to 
have special pay paid to the physician or dentist under this sub-
chapter considered basic pay for the purposes of chapter 83 or 84 of 
title 5, as appropriate. 
"(2) A physician or dentist who has section 4118 service and has 
completed a total of not less than 15 years of service as a physician 
or dentist in the Veterans Health Administration shall be entitled 
to have special pay paid to the physician or dentist under this 
subchapter considered basic pay for the purposes of chapter 83 or 84, 
as appropriate, of title 5 as follows: 
"(A) In an amount equal to the amount that would have been 
so considered under section 4118 of this title on the day before 
the effective date of this section based on the rates of special 
pay the physician or dentist was entitled to receive under that 
section on the day before such effective date. 
"(B) With respect to any amount of special pay received under 
this subchapter in excess of the amount such physician or 
dentist was entitled to receive under section 4118 of this title on 
the day before the effective date of this section, in an amount 
equal to 25 percent of such excess amount for each two years 
that the physician or dentist has completed as a physician or 
dentist in the Veterans Health Administration after the effec-
tive date of this section. 
"(3) All special pay paid under this subchapter shall be included in 
average pay (as defined in sections 8331(4) or 8401(3) of title 5, as 
appropriate) for purposes of computing benefits paid under section 
8337, 8341 (d) or (e), 8442(b), 8443, or 8451 of such title. 
"(4) Special pay paid under section 4118 of this title, as in effect 
before the effective date of this section, to a physician or dentist who 
has section 4118 service shall be credited to the physician or dentist 
for the same purposes and in the same manner and to the same 
extent that such special pay was credited to the physician or dentist 
before such effective date. 
"(5) For purposes of this subsection: 
"(A) The term 'physician or dentist who has no section 4118 
service' means a physician or dentist employed as a physician or 
dentist in the Veterans Health Administration who has no 
i 
previous service as a physician or dentist in the Administration 
(or its predecessor) before the effective date of this section. 
"(B) The term 'physician or dentist who has section 4118 
service' means a physician or dentist employed as a physician or 
dentist in the Veterans Health Administration who has pre-
vious service as a physician or dentist in the Administration (or 
its predecessor) before the effective date of this section. 
"(C) Service in any predecessor entity of the Veterans Health 
Administration shall be considered to be service in the Veterans 
Health Administration. 
"(c) Compensation paid as special pay under this subchapter or 
under an agreement entered into under section 4118 of this title (as 
in effect on the day before the effective date of the Department of 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 197 
Veterans Affairs Physician and Dentist Recruitment and Retention 
Act of 1991) shall be considered as annual pay for the purposes of 
chapter 87 of title 5, relating to life insurance for Federal employees. 
"§7439. Periodic review of pay of physicians and dentists; 
quadrennial report 
"(a) In order to make possible the recruitment and retention of a 
well-qualified work force of physicians and dentists capable of 
providing quality care for eligible veterans, it is the policy of 
Congress to ensure that the levels of total pay for physicians and 
dentists of the Veterans Health Administration are fixed at levels 
reEisonably comparable— 
"(1) with the levels of total pay of physicians and dentists 
employed by or serving in other departments and agencies of 
the Federal Government; and 
"(2) with the income of non-Federal physicians and dentists 
for the performance of services as physicians and dentists. 
"(bXD To assist the Congress and the President in carrjdng out the 
policy stated in subsection (a), the Secretary shall— 
"(A) define the bases for pay distinctions, if any, among 
various categories of physicians and dentists, 
including 
distinctions between physicians and dentists employed by the 
Veterans Health Administration and physicians and dentists 
employed by other departments and agencies of the Federal 
Government and between all Federal sector and non-Federal 
sector physicians and dentists; and 
"(B) obtain measures of income from the employment or 
practice of physicians and dentists outside the Administration, 
including both the Federal and non-Federal sectors, for use as 
guidelines for setting and periodically adjusting the amounts of 
special pay for physicians and dentists of the Administration, 
"(2) The Secretary shall submit to the President a report, on such 
date as the President may designate but not later than December 31, 
1994, and once every four years thereafter, recommending appro-
priate rates of special pay to carry out the policy set forth in 
subsection (a) with respect to the pay of physicians and dentists in 
the Veterans Health Administration. The Secretary shall include in 
such report, when considered appropriate and necessary by the 
Secretary, recommendations for modifications of the special pay 
levels set forth in this subchapter whenever— 
"(A) the Department is unable to recruit or retain a sufficient 
work force of well-qualified physicians and dentists in the 
Administration because the incomes and other employee bene-
fits, to the extent that those benefits are reasonably quantifi-
able, of physicians and dentists outside the Administration who 
perform comparable types of duties are significantly in excess of 
the levels of total pay (including basic pay and special pay) and 
other employee benefits, to the extent that those benefits are 
reasonably quantifiable, available to those physicians and den-
tists employed by the Administration; or 
"(B) other extraordinary circumstances are such that special 
pay levels are needed to recruit or retain a sufficient number of 
well-qualified physicians and dentists. 
"(c) The President shall include in the budget transmitted to the President. 
Congress under section 1105 of title 31 after the submission of each 
report of the Secretary under subsection (bX2) recommendations 
with respect to the exact rates of special pay for physicians and 
49-194 O - 92 - 8 : QL. 3 Part 1 
105 STAT. 198 
PUBLIC LAW 102-40—MAY 7, 1991 
dentists under this subchapter and the cost of those rates compared 
with the cost of the special pay rates in effect under this subchapter 
at the time the budget is transmitted. 
"§ 7440. Annual report 
"The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives an annu£il report 
on the use of the authorities provided in this subchapter. The report 
shall be submitted each year as part of the budget justification 
documents submitted by the Secretary in support of the budget of 
the President submitted pursuant to section 1105 of title 31 that 
year. Each such report shall include the following: 
"(1) A review of the use of the authorities provided in this 
subchapter (including the Secretary's and Chief Medical Direc-
tor's actions, findings, recommendations, and other activities 
under this subchapter) during the preceding fiscal year and the 
fiscal year during which th^ report is submitted. 
"(2) The plans for the use of the authorities provided in this 
subchapter for the next fiscal year. 
"(3) A description of the amounts of special pay paid during 
the preceding fiscal year, shown by category of pay. 
"(4) A list of those geographic areas, and those scarce special-
ties, for which special pay was paid during the preceding fiscal 
year, those for which special pay is being paid during the 
current fiscal year, and those for which special pay is expected 
to be paid during the next fiscal year, together with a summary 
of any differences among those three lists. 
"(5) The number of physicians and dentists (A) who left 
emplo3mient with the Veterans Health Administration during 
the preceding year, (B) who cheinged from full-time status to 
part-time status, (C) who changed from part-time status to full-
time status, as well as (D) a summary of the reasons therefor. 
"(6) By specialty, the number of positions created and the 
number of positions abolished during the preceding fiscal year 
and a summary of the reasons for such actions. 
"(7) The number of unfilled physician and dentist positions in 
each specialty in the Veterans Health Administration, the aver-
age and maximum lengths of time that such positions have been 
unfilled, and a summary of the reasons that such positions 
remain unfilled and, in the case of any specialty not designated 
as a scarce specialty for purposes of special pay under this 
subchapter, an explanation (including comparisons with other 
specialties that have been so designated) of why the specialty 
has not been so designated.". 
SEC. 103. OTHER COMPENSATION BENEFITS. 
(a) IN GENERAL.—Subchapter I of chapter 74 (as added by section 
401(bX2)) is amended by adding at the end the following sections: 
"§ 7410. Additional pay authorities 
"The Secretary may authorize the Chief Medical Director to pay 
advance payments, recruitment or relocation bonuses, and retention 
allowances to the personnel described in paragraph (1) of section 
7401 of this title, or interview expenses to candidates for appoint-
ment as such personnel, in the same manner, and subject to the 
same limitations, as in the case of the authority provided under 
sections 5524a, 5706b, 5753, and 5754 of title 5. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 199 
"§7411. Full-time board-certified physicians and dentists: re-
imbursement of continuing professional education ex-
penses 
"The Secretary shall reimburse any full-time board-certified 
physician or dentist appointed under section 7401(1) of this title for 
expenses incurred, up to $1,000 per year, for continuing professional 
education.". 
(2) The table of sections at the beginning of chapter 74 (as 
amended by section 401(b)(1)(A)) is amended by inserting after the 
item relating to section 7409 the following: 
"7410. Additional pay authorities. 
"7411. Full-time board-certified physicians and dentists: reimbursement of continu-
ing professional education expenses.". 
(b) EFFECTIVE DATE,—Section 7411 of title 38, United States Code, 38 USC 7411 
as added by subsection (a), shall apply with respect to expenses ^°^-
incurred for continuing professional education that is pursued after 
September 30,1991. 
SEC. 104. EFFECTIVE DATE AND TRANSITION. 
38 USC 7431 
(a) EFFECTIVE DATE.—Subchapter III of chapter 74 of title 38, 
United States Code, as added by section 102, shall take effect on the 
first day of the first pay period beginning after the earlier o
f
— 
(1) July 1,1991; or 
(2) the end of the 90-day period beginning on the date of the 
enactment of this Act. 
(b) TRANSITIONS PROVISIONS.—(1) In the case of an agreement 
entered into under section 4118 of title 38, United States Code, 
before the date of the enactment of this Act that expires after the 
effective date specified in subsection (a), the Secretary of Veterans 
Affairs and the physician or dentist concerned may agree to termi-
nate that agreement as of that effective date in order to permit a 
new agreement under subchapter III of chapter 74 of title 38, United 
States Code, as added by section 102, to take effect as of that 
effective date. 
(2) In the case of an Eigreement entered into under section 4118 of 
title 38, United States Code, before the date of the enactment of this 
Act that expires during the period beginning on the date of the 
enactment of this Act and ending on the effective date specified in 
subsection (a), an extension or renewal of that agreement may not 
extend beyond that effective date. 
(3) In the case of a physician or dentist who begins employment 
with the Department of Veterans Affairs during the period begin-
ning on the date of the enactment of this Act and ending on the 
effective date specified in subsection (a) who is eligible for an 
agreement under section 4118 of title 38, United States Code, any 
such agreement may not extend beyond that effective date. 
(c) SAVINGS PROVISION.—Except as provided in subsection (b)(1), 
any agreement entered into under section 4118 of title 38, United 
States Code, before the effective date specified in subsection (a) shall 
remain in effect in accordance with its terms and shall be treated 
for all purposes in accordance with such section as in effect on the 
day before such effective date. 
(d) PROHIBITION OF RETROACTIVE AGREEMENTS.—An agreement 
entered into under subchapter III of chapter 74 of title 38, United 
States Code, as added by section 102, may not provide special pay 
105 STAT. 200 
PUBLIC LAW 102-40—MAY 7, 1991 
Department of 
Veterans Affairs 
Labor Relations 
Improvement 
Act of 1991. 
38 u s e 101 note. 
Regulations. 
with respect to a period before the effective date specified in subsec-
tion (a). 
TITLE II—LABOR-MANAGEMENT RELATIONS 
SEC. 201. SHORT TITLE. 
This title may be cited £is the "Department of Veterans Affairs 
Labor Relations Improvement Act of 1991". 
SEC. 202. COLLECTIVE BARGAINING FOR TITLE 38 EMPLOYEES. 
Chapter 74, as added by section 102, is amended by inserting 
before subchapter III the following: 
''SUBCHAPTER II—COLLECTIVE BARGAINING AND 
PERSONNEL ADMINISTRATION 
"§ 7421. Personnel administration: in general 
>; « 
"(a) Notwithstanding any law, Executive order, or regulation, the 
Secretary shall prescribe by regulation the hours and conditions of 
employment and leaves of absence of employees appointed under 
any provision of this chapter in positions in the Veterans Health 
Administration listed in subsection (b). 
"(b) Subsection (a) refers to the following positions: 
"(1) Physicians. 
"(2) Dentists. 
"(3) Podiatrists. 
"(4) Optometrists. 
"(5) Registered nurses. 
"(6) Physician assistants. 
"(7) Expanded-duty dental auxiliaries. 
"§ 7422. Collective bargaining 
"(a) Except as otherwise specifically provided in this title, the 
authority of the Secretary to prescribe regulations under section 
7421 of this title is subject to the right of Federal employees to 
engage in collective barggiining with respect to conditions of employ-
ment through representatives chosen by them in accordance with 
chapter 71 of title 5 (relating to labor-management relations). 
"(b) Such collective bargaining (and any grievance procedures 
provided under a collective bargsiining agreement) in the case of 
employees described in section 7421(b) of this title may not cover, or 
have any applicability to, any matter or question concerning or 
arising out of (1) professional conduct or competence, (2) peer review, 
or (3) the establishment, determination, or adjustment of employee 
compensation under this title. 
"(c) For purposes of this section, the term 'professional conduct or 
competence' means any of the following: 
"(1) Direct patient care. 
"(2) Clinical competence. 
"(d) An issue of whether a matter or question concerns or arises 
out of (1) professional conduct or competence, (2) peer review, or (3) 
the estaljlishment, determination, or adjustment of employee com-
pensation under this title shall be decided by the Secretary and is 
not itself subject to collective bargaining and may not be reviewed 
by any other agency. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 201 
"(e) A petition for judicial review or petition for enforcement 
under section 7123 of title 5 in any case involving employees de-
scribed in section 7421(b) of this title or arising out of the applicabil-
ity of chapter 71 of title 5 to employees in those positions, shall be 
taken only in the United States Court of Appeals for the District of 
Columbia Circuit. 
"§ 7423. Personnel administration: full-time employees 
"(a) The hours of employment in carrying out responsibilities 
under this title of any employee who is appointed in the Administra-
tion under any provision of this chapter on a full-time basis in a 
position listed in section 7421(b) of this title (other than an intern or 
resident appointed pursuant to section 7406 of this title) and who 
accepts responsibilities for carrying out professional services for 
remuneration other than those assigned under this title shall con-
sist of not less than 80 hours in a biweekly pay period (as that term 
is used in section 5504 of title 5). 
"(b) A person covered by subsection (a) may not do any of the 
following: 
"(1) Assume responsibility for the medical care of any patient 
other than a patient admitted for treatment at a Department 
facility, except in those cases where the person, upon request 
and with the approval of the Chief Medical Director, assumes 
such responsibilities to assist communities or medical practice 
groups to meet medical needs which would not otherwise be 
available for a period not to exceed 180 calendar days, which 
may be extended by the Chief Medical Director for additional 
periods not to exceed 180 calendar days each. 
"(2) Teach or provide consultative services at any affiliated 
institution if such teaching or consultation will, because of its 
nature or duration, conflict with such person's responsibilities 
under this title. 
"(3) Accept payment under any insurance or assistance pro-
gram established under title XVIII or XIX of the Social Security 
Act or under chapter 55 of title 10 for professional services 
rendered by such person while carrying out such person's 
responsibilities under this title. 
"(4) Accept from any source, with respect to any travel per-
formed by such person in the course of carrying out such 
person's responsibilities under this title, any pajonent or per 
diem for such travel, other than as provided for in section 4111 
of title 5. 
"(5) Request or permit any individual or organization to pay, 
on such person's behalf for insurance insuring such person 
against malpractice claims arising in the course of carrying out 
such person's responsibilities under this title or for such per-
son's dues or similar fees for membership in medical or dental 
societies or related professional associations, except where such 
payments constitute a part of such person's remuneration for 
the performance of professional responsibilities permitted 
under this section, other than those carried out under this title. 
"(6) Perform, in the course of carrying out such person's 
responsibilities under this title, professional services for the 
purpose of generating money for any fund or account which is 
maintained by an affiliated institution for the benefit of such 
institution, or for such person's personal benefit, or both. 
105 STAT. 202 
PUBLIC LAW 102-40—MAY 7, 1991 
"(c) In the case of any fund or account described in subsection 
Ot)X6) that was established before September 1,1973— 
Colleges and 
"(1) the affiliated institution shall submit semiannually an 
univeraities. 
accounting to the Secretary and to the Comptroller General of 
° 
the United States with respect to such fund or account and shall 
maintain such fund or account subject to full public disclosure 
and audit by the Secretary and the Comptroller General for a 
period of three years or for such longer period as the Secretary 
shall prescribe, and 
"(2) no person in a position specified in paragraph (IXB) may 
receive £iny cash from amounts deposited in such fund or ac-
count derived from services performed before that date. 
"(d) As used in this section: 
"(1) The term 'affiliated institution' means a medical school 
or other institution of higher learning with which the Secretary 
has a contract or agreement as referred to in section 7313 of this 
title for the training or education of health personnel. 
"(2) The term 
remuneration' mesuis the receipt of any 
amount of monetary benefit from any non-Department source 
in pa3mient for carrjdng out any professional responsibilities.". 
SEC. 203. ADVERSE PERSONNEL ACTIONS. 
(a) REFORM OF DISCIPUNARY PROCEDURES FOR SECTION 7401(1) 
EMPLOYEES.—Chapter 74, as added by section 102 and amended by 
section 202, is further amended by adding at the end the following: 
"SUBCHAPTER V—DISCIPLINARY AND GRIEVANCE 
PROCEDURES 
"§ 7461. Adverse actions: section 7401(1) employees 
"(a) Whenever the Chief Medical Director (or an official des-
ignated by the Chief Medical Director) brings charges based on 
conduct or performance against a section 7401(1) employee and as a 
result of those charges an adverse personnel action is taken against 
the employee, the employee shall have the r i ^ t to appeal the 
action. 
"(b)(1) If the case involves or includes a question of professional 
conduct or competence in which a major adverse action w£is taken, 
such an appeal shall be made to a Disciplinary Appeals Board under 
section 7462 of this title. 
"(2) In any other case, such an appeal shall be made— 
"(A) through Department grievance procedures under section 
7463 of this title, in any case that involves or includes a question 
of professional conduct or competence in which a major adverse 
action was not taken or in any case of an employee who is not 
covered by a collective bargaining agreement under chapter 71 
of title 5; or 
"(B) through grievance procedures provided through collec-
tive bargaining under chapter 71 of title 5 or through Depart-
ment grievance procedures under section 7463 of this title, as 
the employee elects, in the case of an employee covered by a 
collective bargaining agreement under chapter 71 of title 5 that 
does not involve or include a question of professional conduct or 
competence. 
"(c) For purposes of this subchapter— 
"(1) Section 7401(1) employees are employees of the Depart-
ment employed on a full-time basis under a permanent appoint-
publication. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 203 
merit in a position listed in section 7401(1) of this title (other 
than interns and residents appointed pursuant to section 7406 
of this title). 
^ 
i
< 
"(2) A major adverse action is an adverse action which in- 
" 
eludes any of the following: 
"(A) Suspension. 
"(B) Transfer. 
"(C) Reduction in grade. 
"(D) Reduction in basic pay. 
"(E) Discharge. 
"(3) A question of professional conduct or competence is a 
question involving any of the following: 
"(A) Direct patient care. 
"(B) Clinical competence. 
"(d) An issue of whether a matter or question concerns, or arises 
out of, professional conduct or competence is not itself subject to any 
grievance procedure provided by law, regulation, or collective 
bargaining and may not be reviewed by any other agency. 
"(e) Whenever the Secretary proposes to prescribe regulations Federal 
under this subchapter, the Secretary shall publish the proposed ^^^J^„ 
regulations in the Federal Register for notice-and-comment not less 
than 30 days before the day on which they take effect. 
"§ 7462. Mtgor adverse actions involving professional conduct or 
competence 
"(aXD Disciplinary Appeals Boards appointed under section 7464 
of this title shall have exclusive jurisdiction to review any case— 
"(A) which arises out of (or which includes) a question of 
professional conduct or competence of a section 7401(1) 
employee; and 
"(B) in which a major adverse action was taken. 
"(2) The board shall include in its record of decision in any mixed 
CEise a statement of the board's exclusive jurisdiction under this 
subsection and the basis for such exclusive jurisdiction. 
"(3) For purposes of paragraph (2), a mixed case is a case that 
includes both a major adverse action arising out of a question of 
professional conduct or competence and an adverse action which is 
not a major adverse action or which does not arise out of a question 
of professional conduct or competence. 
"(b)(1) In any case in which charges are brought against a section 
7401(1) employee which arises out of, or includes, a question of 
professional conduct or competence which could result in a major 
adverse action, the employee is entitled to the following: 
"(A) At least 30 days advance written notice from the Chief 
Medical Director or other charging official specifically stating 
the basis for each charge, the adverse actions that could be 
taken if the charges are sustained, and a statement of any 
specific law, regulation, policy, procedure, practice, or other 
specific instruction that has been violated with respect to each 
charge, except that the requirement for notification in advance 
may be waived if there is reasonable cause to believe that the 
employee has committed a crime for which the employee may 
be imprisoned. 
"(B) A reasonable time, but not less than seven days, to 
present an answer orally and in writing to the Chief Medical 
Director or other deciding official, who shall be an official 
105 STAT. 204 
PUBLIC LAW 102-40—MAY 7, 1991 
higher in rank than the charging official, and to submit affida-
vits and other documentary evidence in support of the answer. 
"(2) In any case described in paragraph (1), the employee is 
entitled to be represented by an attorney or other representative of 
the employee's choice at all stages of the case. 
"(3)(A) If a proposed adverse action covered by this section is not 
withdrawn, the deciding official shall render a decision in writing 
within 21 days of receipt by the deciding official of the employee's 
answer. The decision shall include a statement of the specific rea-
sons for the decision with respect to each charge. If a major adverse 
action is imposed, the decision shall state whether any of the 
charges sustained arose out of a question of professional conduct or 
competence. If any of the charges are sustained, the notice of the 
decision to the employee shall include notice of the employee's 
rights of appeal. 
"(B) Notwithstanding the 21-day period specified in subparagraph 
(A), a proposed adverse action may be held in abeyance if the 
employee requests, and the deciding official agrees, that the em-
ployee shall seek counseling or treatment for a condition covered 
under the Rehabilitation Act of 1973. Any such abeyance of a 
proposed action may not extend for more than one year. 
"(4)(A) The Secretary may require that any answer and submis-
sion under paragraph (1)(B) be submitted so as to be received within 
30 days of the date of the written notice of the charges, except that 
the Secretary shall allow the granting of extensions for good cause 
shown. 
"(B) The Secretary shall require that any appeal to a Disciplinary 
Appeals Board from a decision to impose a major adverse action 
shall be received within 30 days after the date of service of the 
written decision on the employee. 
"(c)(1) When a Disciplinary Appeals Board convenes to consider an 
appeal in a case under this section, the board, before proceeding to 
consider the merits of the appeal, shall determine whether the case 
is properly before it. 
"(2) Upon hearing such an appeal, the board shall, with respect to 
each charge appealed to the board, sustain the charge, dismiss the 
charge, or sustain the charge in part and dismiss the charge in part. 
If the deciding official is sustained (in whole or in part) with respect 
to any such charge, the board shall— 
"(A) approve the action as imposed; 
"(B) approve the action with modification, reduction, or excep-
tion; or 
"(C) reverse the action. 
"(3) A board shall afford an employee appealing an adverse action 
under this section an opportunity for an oral hearing. If such a 
hearing is held, the board shall provide the employee with a tran-
script of the hearing. 
"(4) The board shall render a decision in any case within 45 days 
of completion of the hearing, if there is a hearing, and in any event 
no later than 120 days after the appeal commenced. 
"(d)(1) After resolving any question gis to whether a matter in-
volves professional conduct or competence, the Secretary shall cause 
to be executed the decision of the Disciplinary Appeals Board in a 
timely manner and in any event in not more than 90 days after the 
decision of the Board is received by the Secretary. Pursuant to the 
board's decision, the Secretary may order reinstatement, award 
back pay, and provide such other remedies as the board found 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 205 
appropriate relating directly to the proposed action, including 
expungement of records relating to the action. 
"(2) If the Secretary finds a decision of the board to be clearly 
contrary to the evidence or unlawful, the Secretary may— 
"(A) reverse the decision of the board, or 
"(B) vacate the decision of the board and remand the matter 
to the Board for further consideration. 
"(3) If the Secretary finds the decision of the board (while not 
clearly contrary to the evidence or unlawful) to be not justified by 
the nature of the charges, the Secretary may mitigate the adverse 
action imposed. 
"(4) The Secretary's execution of a board's decision shall be the 
final administrative action in the case. 
"(e) The Secretary may designate an employee of the Department 
to represent management in any case before a Disciplinary Appeals 
Board. 
"(fKD A section 7401(1) employee adversely affected by a final 
order or decision of a Disciplinary Appeals Board (as reviewed by 
the Secretary) may obtain judicial review of the order or decision. 
"(2) In any case in which judicial review is sought under this 
subsection, the court shall review the record £ind hold unlawful and 
set aside any agency action, finding, or conclusion found to be— 
"(A) arbitrary, capricious, an abuse of discretion, or otherwise 
not in accordance with law; 
"(B) obtained without procedures required by law, rule, or 
regulation having been followed; or 
"(C) unsupported by substantial evidence. 
"§ 7463. Other adverse actions 
"(a) The Secretary shall prescribe by regulation procedures for the Regulations, 
consideration of grievances of section 7401(1) employees arising from 
adverse personnel actions in which each action taken either— 
"(1) is not a major adverse action; or 
"(2) does not arise out of a question of professional conduct or 
competence. 
Disciplinary Appeals Boards shall not have jurisdiction to review 
such matters, other than as part of a mixed case (as defined in 
section 7462(aX3) of this title). 
"(b) In the case of an employee who is a member of a collective 
bargaining unit under chapter 71 of title 5, the employee may seek 
review of an adverse action described in subsection (a) either under 
the grievance procedures provided through regulations prescribed 
under subsection (a) or through grievance procedures determined 
through collective bargaining, but not under both. The employee 
shall elect which grievance procedure to follow. Any such election 
may not be revoked. 
"(cXD In any case in which charges are brought against a section 
7401(1) employee which could result in a major adverse action and 
which do not involve professional conduct or competence, the em-
ployee is entitled to the same notice and opportunity to answer with 
respect to those charges as provided in subparagraphs (A) and (B) of 
section 7462(bXl) of this title. 
"(2) In any other case in which charges are brought against a 
section 7401(1) employee, the employee is entitled to— 
"(A) an advance written notice stating the specific reason for 
the proposed action, and 
105 STAT. 206 
PUBLIC LAW 102-40—MAY 7, 1991 
Regulations. 
Records. 
Penalties. 
"(B) a reasonable time to answer orally and in writing and to 
furnish affidavits and other documentary evidence in support of 
the answer. 
"(d) Grievance procedures prescribed under subsection (a) shall 
include the following: 
"(1) A right to formal review by an impartial examiner within 
the Department of Veterans Affairs, who, in the case of an 
adverse action arising from a question of professional conduct or 
competence, shall be selected from the panel designated under 
section 7464 of this title. 
"(2) A right to a prompt report of the findings and rec-
ommendations by the impartial examiner. 
"(3) A right to a prompt review of the examiner's findings and 
recommendations by an official of a higher level than the 
official who decided upon the action. That official may accept, 
modify, or reject the examiner's recommendations. 
"(e) In any review of an adverse action under the grievance 
procedures prescribed under subsection (a), the employee is entitled 
to be represented by an attorney or other representative of the 
employee's choice at all stages of the case. 
"§ 7464. Disciplinary Appeals Boards 
"(a) The Secretary shall from time to time appoint boards to hear 
appeals of major adverse actions described in section 7462 of this 
title. Such boards shall be known as Disciplinary Appeals Boards. 
Each board shall consist of three employees of the Department, each 
of whom shall be of the same grade as, or be senior in grade to, the 
employee who is appealing an adverse action. At least two of the 
members of each board shall be employed in the same category of 
position as the employee who is appealing the adverse action. 
Members of a board shall be appointed from individuals on the 
panel established under subsection (d). 
"(bXD In appointing a board for any case, the Secretary shall 
designate one of the members to be chairman and one of the 
members to be secretary of the board, each of whom shall have 
authority to administer oaths. 
"(2) Appointment of boards, and the proceedings of such boards, 
shall be carried out under regulations prescribed by the Secretary. A 
verbatim record shall be maintained of board hearings. 
"(cXD Notwithstandmg sections 5701 and 7332 of this title, the 
chairman of a board, upon request of an employee whose case is 
under consideration by the board (or a representative of that em-
ployee) may, in connection with the considerations of the board, 
review records or information covered by those sections and may 
authorize the disclosure of such records or information to that 
employee (or representative) to the extent the board considers 
appropriate for purposes of the proceedings of the board in that case. 
(2) In any such case the board chairman may direct that meas-
ures be taken to protect the personal privacy of individuals whose 
records are involved. Any person who uses or discloses a record or 
information covered by this subsection for any purpose other than in 
connection with the proceedings of the board shall be fined not more 
than $5,000 in the case of a first offense and not more than $20,000 
in the case of a subsequent offense. 
"(d)(1) The Secretary shall provide for the periodic designation of 
employees of the Department who are qualified to serve on Discipli-
nary Appeals Boards. Those employees shall constitute the panel 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 207 
from which board members in a case are appointed. The Secretary 
shall provide (without charge) a list of the names of employees on 
the panel to any person requesting such list. 
"(2) The Secretary shall announce periodically, and not less often 
than annually, that the roster of employees on the panel is available 
as described in paragraph (1). Such announcement shall be made at 
Department medical facilities and through publication in the Fed-
eral Register. Notice of a name being on the list must be provided at 
least 30 days before the individual selected may serve on a Board or 
as a grievance examiner. Employees, employee organizations, and 
other interested parties may submit comments to the Secretary 
concerning the suitability for service on the panel of any employee 
whose name is on the list. 
"(3) The Secretary shall provide training in the functions and 
duties of Disciplinary Appeals Boards and grievance procedures 
under section 7463 of this title for employees selected to be on the 
panel.". 
(b) CLERICAL AMENDMENTS.—The table of sections at the beginning 
of chapter 74, as added by section 102, is amended— 
(1) by inserting before the item relating to subchapter III the 
following: 
" S U B C H A P T E R II—COLLECTIVE BARGAINING AND PERSONNEL ADMINISTRATION 
"7421. Personnel administration: in general. 
"7422. Collective bargaining. 
"7423. Personnel administration: full-time employees."; and 
(2) by adding at the end the following: 
" S U B C H A P T E R V—DISCIPUNARY AND GRIEVANCE PROCEDURES 
"7461. Adverse actions: section 7401(1) employees. 
"7462. M^or adverse actions involving professional conduct or competence. 
"7463. Other adverse actions. 
"7464. Disciplinary Appeals Boards.". 
SEC. 204. DEADLINE FOR REGULATIONS. 
The Secretary of Veterans Affairs shall prescribe regulations 
under subchapter V of chapter 74 of title 38, United States Code (as 
added by section 203), not later than 180 days after the date of the 
enactment of this Act. Such regulations shall be published in the 
Federal Register for notice-and-comment not less than 30 days 
before the day on which they take effect. 
SEC. 205. PRESERVATION 
OF 
EXISTING 
COLLECTIVE-BARGAINING 
ARRANGEMENTS AND PENDING ACTIONS. 
(a) 
EXISTING 
COLLECTIVE-BARGAINING 
ARRANGEMENTS.—Any 
determination under chapter 71 of title 5, United States Code, of a 
collective bargaining unit within the Veterans Health Administra-
tion of the Department of Veterans Affairs, and any recognition 
under that chapter of an employee labor organization as the exclu-
sive bargaining representative for employees in a collective bargain-
ing unit of the Department of Veterans Affairs, that is in effect on 
the date of the enactment of this Act shall not be affected by the 
amendments made by this Act and shall continue in effect in 
accordance with the terms of such determination or regulation. 
(b) PENDING CASES.—With respect to cases pending on the date of 
the enactment of this Act, or those cases which are brought before 
the establishment of either an administrative grievance procedure 
Federal 
Register, 
publication. 
Training 
programs. 
38 u s e 7461 
note. 
Federal 
Register, 
publication. 
38 u s e 7421 
note. 
105 STAT. 208 
PUBLIC LAW 102-40—MAY 7, 1991 
pursuant to section 7463 of title 38, United States Code (as added by 
the amendments made by this title), or a negotiated grievance 
procedure established under a collective bargaining agreement, such 
cases shall proceed in the same manner as they would have if this 
Act had not been enacted. 
TITLE III—MISCELLANEOUS 
SEC. 301. AMENDMENTS TO PROVISIONS ENACTED BY THE DEPARTMENT 
OF VETERANS AFFAIRS NURSE PAY ACT OF 1990. 
38 use 7451 
(a) SAVINGS PROVISION.—Physician assistants and expanded-func-
"°*®- 
tion dental auxiliaries shall continue to be paid after August 14, 
1990, according to the Nurse Schedule in section 4107(b) of title 38, 
United States Code, as in effect on August 14, 1990, until the 
effective date of a determination by the Secretary to convert those 
occupations to "covered positions" and pay them pursuant to section 
7451 of such title, as redesignated by section 401(c). 
(b) CHIEF MEDICAL DIRECTOR AUTHORITY.—Section 4141(d) is 
amended— 
(1) in paragraph (1)(B), by inserting "or the Chief Medical 
Director, with respect to covered Regional and Central Office 
employees in that grade," before "determines"; 
(2) in paragraph (3)— 
(A) by redesignating subparagraph (C) as subparagraph 
(D) and by inserting "or Chief Medical Director" in that 
subparagraph after facility"; and 
(B) by inserting after subparagraph (B) the following: 
Regulations. 
"(C) The Chief Medical Director shall prescribe regulations provid-
ing for the adjustment of the rates of basic pay for Regional and 
Central Office employees in covered positions in order to assure that 
those rates are sufficient and competitive."; and 
(3) in paragraph (4), by inserting ", or the Chief Medical 
Director with respect to Regional and Central Office employ-
ees," in the first sentence after "facility" the first place it 
appears. 
(c) INCLUSION OF CERTAIN TITLE 5 EMPLOYEES.—Section 4141(aX3) 
is amended by inserting "or chapter 53 of title 5" before the period 
at the end. 
(d) TECHNICAL AMENDMENT.—Section 4142(aX3) is amended by 
striking out "appointed" and inserting in lieu thereof "paid". 
38 use 4141 
(e) EFFECTIVE DATE.—Section 104(aX2) of Public Law 101-366 is 
"°*®' 
amended by inserting "the first day of the first pay period beginning 
after" before "April 1,1991". 
SEC. 
3
0
2
. 
EXTENSION 
OF 
ANNUAL 
REPORT 
ON 
FURNISHING 
NONSERVICE-
CONNECTED 
HEALTH 
CARE. 
Section 19011(eXl) of the Veterans' Health Care Amendments of 
1986 (38 U.S.C. 610 note) is amended by striking out "each o f and 
all that follows through "1989" and inserting in lieu thereof "each 
fiscal year through fiscal year 1991". 
SEC. 303. ADMINISTRATIVE REORGANIZATION AUTHORITY. 
Section 210(bX2) is amended— 
(1) in subparagraph (A), by striking out the second and third 
sentences and inserting in lieu thereof the following: "No action 
to carry out such reorganization may be taken after the submis-
sion of such report until the end of a 90-day period of continuous 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 209 
session of Congress following the date of the submission of the 
report. For purposes of the preceding sentence, continuity of a 
session of Congress is broken only by an adjournment sine die, 
and there shall be excluded from the computation of such 90-
day period any day during which either House of Congress is 
not in session during an adjournment of more than three days 
to a day certain."; 
(2) by striking out subparagraph (B) and inserting in lieu 
thereof the following: 
"(B) An administrative reorganization described in this subpara-
graph is an administrative reorganization of a covered field office or 
facility that involves a reduction during any fiscal year in the 
number of full-time equivalent employees with permanent duty 
stations at such office or facility— 
"(i) by 15 percent or more; or 
"(ii) by a percent which, when added to the percent reduction 
made in the number of such employees with permanent duty 
stations at such office or facility during the preceding fiscal 
year, is 25 percent or more."; 
(3) in subparagraph (C)— 
(A) by inserting "administrative" before "reorganization" 
the first place it appears; 
' . , > 
(B) by striking out "the reorganization" after "applies to" 
and inserting in lieu thereof "an administrative reorganiza-
tion"; 
(C) by striking out "more than 25 but less than 100 
employees" and inserting in lieu thereof "30 or more 
employees"; and 
(D) by striking out "in such unit—" and all that follows 
and inserting in lieu thereof "in such unit by 50 percent or 
more."; and 
(4) in subparagraph (D)— 
(A) by adding at the end of clause (i) the following new 
sentence: "Such term does not include a consolidation or 
redistribution of functions at a covered field office or facil-
ity, or between components of the Veterans Benefits 
Administration and the Veterans Health Administration at 
a Department medical and regional office center, if after 
the consolidation or redistribution the same number of full-
time equivalent employees continues to perform the af-
fected functions at that field office, facility, or center."; 
(B) by striking out clause (ii); and 
(C) by redesignating clauses (iii) and (iv) as clauses (ii) and 
(iii), respectively. 
SEC. 304. TECHNICAL CORRECTION TO LIMITATION ON PAYMENT OF PEN-
SION TO VETERANS IN NURSING HOMES. 
(a) EXCLUSION OF STATE HOMES.—Section 3203(f)(lXB) is amended 
by inserting before the period at the end the following: ", other than 
a facility that is a State home with respect to which the Secretary 
makes per diem pajnnents for nursing home care pursuant to sec-
tion 641(a) of this title". 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 38USC5503 
shall apply as if included in the amendment made by section 8003(a) ^°^-
of the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-
508; 104 Stat. 1388-874). 
105 STAT. 210 
PUBLIC LAW 102-40—MAY 7, 1991 
SEC. 305. TECHNICAL AMENDMENTS. 
(a) SECTION 3202.—Section 3202(d) is amended by striking out "an 
inmate" and inserting in lieu thereof "a patient". 
(b) SuBCHAPTEK HEADING.—(1) The heading of subchapter II of 
chapter 85 is amended by striking out "INMATE" and inserting in 
lieu thereof "PATIENT". 
(2) The item relating to such subchapter heading in the table of 
sections at the beginning of such chapter is amended by striking out 
"INMATE" and inserting in lieu thereof "PATIENT". 
TITLE IV—REORGANIZATION AND REDESIGNATION OF 
PARTS IV, V, AND VI OF TITLE 38 
SEC. 401. FURTHER REVISION AND REORGANIZATION OF CHAPTER 73. 
(a) IN GENERAL.—Chapter 73 is amended as follows: 
(1) The heading of such chapter is amended to read as follows: 
"CHAPTER 73~VETERANS HEALTH ADMINISTRATION-
ORGANIZATION AND FUNCTIONS". 
(2) Such chapter is amended— 
38 use 4151, 
(A) by striking out subchapter V; and 
Qfl TTQT' 
^^^ ^y redesignating subchapter VI as subchapter IV. 
4161 
^^^' 
^^^ ^^^^ chapter is further amended by striking out the table 
3g ugc 
of sections and subchapters I and II and inserting in lieu thereof 
4101-4124. 
the following: 
"SUBCHAPTER I—ORGANIZATION 
"Sec. 
"7301. Functions of Veterans Hefdth Administration: in general. 
"7302. Functions of Veterans Health Administration: health-care personnel educa-
tion and training programs. 
"7303. Functions of Veterans Health Administration: research programs. 
"7304. Regulations. 
"7305. Divisions of Veterans Health Administration. 
"7306. Office of the Chief Medical Director. 
"SUBCHAPTER II—GENERAL AUTHORITY AND ADMINISTRATION 
"7311. Quality assurance. 
"7312. Special medical advisory group. 
"7313. Advisory committees: affiliated institutions. 
"7314. Geriatric research, education, and clinical centers. 
"7315. Geriatrics and (Jerontology Advisory Committee. 
"7316. Mfilpractice and negligence suits: defense by United States. 
"7317. Hazardous research projects: indemnification of contractors. 
"SUBCHAPTER III—PATIENT RIGHTS 
"7331. Informed consent. 
"7332. Confidentiality of certain medical records. 
"7333. Nondiscrimination against alcohol and drug abusers and persons infected 
with human immunodeficiency virus. 
"7334. Regulations. 
"SUBCHAPTER 
IV—RESEARCH 
CORPORATIONS 
"7361. Authority to establish; status. 
"7362. Purpose of corporations. 
"7363. Board of directors; executive director. 
"7364. General powers. 
"7365. Applicable State law. 
"7366. Accountability and oversight. 
"7367. Report to Congress. 
"7368. Expiration of authority. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 211 
"SUBCHAPTER I—ORGANIZATION 
i 
"§ 7301. Functions of Veterans Health Administration: in general 
"(a) There is in the Department of Veterans Affairs a Veterans 
Health Administration. The Chief Medical Director is the head of 
the Administration. 
"(b) The primary function of the Administration is to provide a 
complete medical and hospital service for the medical care and 
treatment of veterans, as provided in this title and in regulations 
prescribed by the Secretary pursuant to this title. 
"§ 7302. Functions of Veterans Health Administration: health-care 
personnel education and training programs 
"(a) In order to carry out more effectively the primary function of 
the Veterans Health Administration and in order to assist in provid-
ing an adequate supply of health personnel to the Nation, the 
Secretary— 
"(1) to the extent feasible without interfering with the medi-
cal care and treatment of veterans, shall develop and carry out 
a program of education and training of health personnel; and 
"(2) shall carry out a major program for the recruitment, 
training, and employment of veterans with medical military 
occupation specialties as— 
"(A) physician assistants; 
"(B) expanded-function dental auxiliaries; and 
"(C) other medical technicians, 
"(b) In carrying out subsection (a)(1), the Secretary shall include in 
the program of education and training under that subsection the 
developing and evaluating of new health careers, interdisciplinary 
approaches, and career advancement opportunities. 
"(c) In carrying out subsection (a)(2), the Secretary shall include in 
the program of recruitment, training, and employment under that 
subsection measures to advise all qualified veterans with military 
occupation specialties referred to in that subsection, and all mem-
bers of the armed forces about to be discharged or released from 
active duty who have such military occupation specialties, of 
emplojonent opportunities with the Administration. 
"(d) The Secretary shall carry out subsection (a) in cooperation 
with the following institutions and organizations: 
"(1) Schools of medicine, osteopathy, dentistry, nursing, phar-
macy, optometry, podiatry, public health, or allied health 
professions. 
"(2) Other institutions of higher learning. 
"(3) Medical centers. 
"(4) Academic health centers. 
"(5) Hospitals. 
"(6) Such other public or nonprofit agencies, institutions, or 
organizations as the Secretary considers appropriate. 
"§ 7303. Functions of Veterans Health Administration: research Diseases. 
programs 
Handicapped. 
"(a)(1) In order to carry out more effectively the primary function 
of the Administration and in order to contribute to the Nation's 
knowledge about disease and disability, the Secretary shall carry 
105 STAT. 212 
PUBLIC LAW 102-40—MAY 7, 1991 
out a program of medical research in connection with the provision 
of medical care and treatment to veterans. 
"(2) Such program of medical research shall include biomedical 
research, mental illness research, prosthetic and other rehabilita-
tive research, and health-care-services research. 
"(3) Such program shall stress— 
"(A) research into spinal-cord injuries and other diseases that 
lead to paralysis of the lower extremities; and 
"(B) research into injuries and illnesses particularly related to 
service. 
"(4) In carrying out such research program, the Secretary shall 
act in cooperation with the entities described in section 7302(d) of 
this title. 
"(b) Prosthetic research shall include research and testing in the 
field of prosthetic, orthotic, and orthopedic appliances and sensory 
Public 
devices. In order that the unique investigative material and re-
information, 
search data in the possession of the Government may result in the 
improvement of such appliances and devices for all disabled persons, 
the Secretary (through the Chief Medical Director) shall make the 
results of such research available to any person, and shall consult 
and cooperate with the Secretary of Health and Human Services 
and the Secretary of Education, in connection with programs carried 
out under section 204(b)(2) of the Rehabilitation Act of 1973 (29 
U.S.C. 762(b)(2)) (relating to the establishment and support of Re-
habilitation Engineering Research Centers). 
"(c) Funds appropriated to carry out this section shall remain 
available until expended. 
"§ 7304. Regulations 
"(a) Unless specifically otherwise provided, the Chief Medical 
Director shall prescribe all regulations necessary to the administra-
tion of the Veterans Health Administration, including regulations 
relating to— 
"(1) travel, transportation of household goods and effects, and 
deductions from pay for quarters and subsistence; and 
"(2) the custody, use, and preservation of the records, papers, 
and property of the Administration. 
"(b) Regulations prescribed by the Chief Medical Director are 
subject to the approval of the Secretary. 
"§ 7305. Divisions of Veterans Health Administration 
"The Veterans Health Administration shall include the following: 
"(1) The Office of the Chief Medical Director. 
"(2) A Medical Service. 
"(3) A Dental Service. 
"(4) A Podiatric Service. 
"(5) An Optometric Service. 
"(6) A Nursing Service. 
"(7) Such other professional and auxiliary services as the 
Secretary may find to be necessary to carry out the functions of 
the Administration. 
"§ 7306. Office of the Chief Medical Director 
"(a) The Office of the Chief Medical Director shall consist of the 
following: 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 213 
"(1) The Deputy Chief Medical Director, who shall be the 
principal assistant of the Chief Medical Director and who shall 
be a qualified doctor of medicine. 
"(2) The Associate Deputy Chief Medical Director, who shall 
be an assistant to the Chief Medical Director and the Deputy 
Chief Medical Director and who shall be a qualified doctor of 
medicine. 
"(3) Not to exceed eight Assistant Chief Medical Directors. 
"(4) Such Medical Directors as may be appointed to suit the 
needs of the Department, who shall be either a qualified doctor 
of medicine or a qualified doctor of dental surgery or dental 
medicine. 
"(5) A Director of Nursing Service, who shall be a qualified 
registered nurse and who shall be responsible to the Chief 
Medical Director for the operation of the Nursing Service. 
"(6) A Director of Pharmacy Service, a Director of Dietetic 
Service, a Director of Pediatric Service, and a Director of 
Optometric Service, who shall be responsible to the Chief Medi-
cal Director for the operation of their respective Services. 
"(7) Such other personnel as may be authorized by this chap-
ter. 
"(b) Of the Assistant Chief Medical Directors appointed under 
subsection (a)(3)— 
"(1) not more than two may be persons qualified in the 
administration of health services who are not doctors of medi-
cine, dental surgery, or dental medicines; 
"(2) one shall be a qualified doctor of dental surgery or dental 
medicine who shall be directly responsible to the Chief Medical 
Director for the operation of the Dental Service; and 
"(3) one shall be a qualified physician trained in, or having 
suitable extensive experience in, geriatrics who shall be respon-
sible to the Chief Medical Director for evaluating all research, 
educational, and clinical health-care programs carried out in 
the Administration in the field of geriatrics and who shall serve 
as the principal advisor to the Chief Medical Director with 
respect to such programs. 
"(c) Appointments under subsection (a) shall be made by the 
Secretary. In the case of appointments under paragraphs (1), (2), (3), 
and (4) of that subsection, such appointments shall be made upon 
the recommendation of the Chief Medical Director. 
"(d) Except as provided in subsection (e)— 
"(1) any appointment under this section shall be for a period 
of four years, with reappointment permissible for successive like 
periods, 
"(2) any such appointment or reappointment may be extended 
by the Secretary for a period not in excess of three years, and 
"(3) any person so appointed or reappointed or whose appoint-
ment or reappointment is extended shall be subject to removal 
by the Secretary for cause. 
"(e)(1) The Secretary may designate a member of the Chaplain 
Service of the Department as Director, Chaplain Service, for a 
period of two years, subject to removal by the Secretary for cause. 
Redesignation under this subsection may be made for successive like 
periods or for any period not exceeding two years. 
"(2) A person designated £is Director, Chaplain Service, shall at 
the end of such person's period of service as Director revert to the 
position, grade, and status which such person held immediately 
105 STAT. 214 
PUBLIC LAW 102-40—MAY 7, 1991 
before being designated Director, Chaplain Service, and all service 
as Director, Chaplain Service, shall be creditable as service in the 
former position. 
"SUBCHAPTER II—GENERAL AUTHORITY AND 
ADMINISTRATION 
"§ 7311. Quality assurance 
"(a) The Secretary shall— 
"(1) establish and conduct a comprehensive program to mon-
itor and evaluate the quality of health care furnished by the 
Veterans Health Administration (hereinafter in this section 
referred to as the 'quality-assurance program'); and 
"(2) delineate the responsibilities of the Chief Medical Direc-
tor with respect to the quality-assurance program, including the 
duties prescribed in this section. 
"(bXD As part of the quality-assurance program, the Chief Medi-
cal Director shall periodically evaluate— 
"(A) whether there are significant deviations in mortality and 
morbidity rates for surgical procedures performed by the 
Administration from prevailing national mortality and morbid-
ity standards for similar procedures; and 
"(B) if there are such deviations, whether they indicate defi-
ciencies in the quality of health care provided by the Adminis-
tration. 
"(2) The evaluation under paragraph (IXA) shall be made using 
the information compiled under subsection (c)(1). The evaluation 
under paragraph (1)(B) shall be made taking into account the factors 
described in subsection (c)(2)(B). 
"(3) If, based upon an evaluation under paragraph (1)(A), the Chief 
Medical Director determines that there is a deviation referred to in 
that paragraph, the Chief Medical Director shall explain the devi-
ation in the report submitted under subsection (f). 
"(cXD The Chief Medical Director shall— 
"(A) determine the prevailing national mortality and morbid-
ity standards for each type of surgical procedure performed by 
the Administration; and 
Records. 
"(B) collect data and other information on mortality and 
morbidity rates in the Administration for each type of surgical 
procedure performed by the Administration and (with respect to 
each such procedure) compile the data and other information so 
collected— 
"(i) for each medical facility of the Department, in the 
case of cardiac surgery, heart transplant, and renal trans-
plant programs; and 
"(ii) in the aggregate, for each other type of surgical 
procedure. 
"(2) The Chief Medical Director shall— 
"(A) compare the mortality and morbidity rates compiled 
under paragraph (IXB) with the national mortality and morbid-
ity standards determined under paragraph (IXA); and 
"(B) analyze any deviation between such rates and such 
standards in terms of the following: 
"(i) The characteristics of the respective patient popu-
lations. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 215 
"(ii) The level of risk for the procedure involved, based 
on— 
"(I) patient age; 
"(II) the tjrpe and severity of the disease; 
"(III) the effect of any complicating diseases; and 
"(IV) the degree of difficulty of the procedure, 
"(iii) Any other factor that the Chief Medical Director 
considers appropriate. 
"(d) Based on the information compiled and the comparisons, 
analyses, evaluations, and explanations made under subsections (b) 
and (c), the Chief Medical Director, in the report under subsection 
(f), shall make such recommendations with respect to quality assur-
ance as the Chief Medical Director considers appropriate. 
"(eXD The Secretary shall allocate sufficient resources (including 
sufficient personnel with the necessary skills and qualifications) to 
enable the Administration to carry out its responsibilities under this 
section. 
"(2) The Inspector General of the Department shall allocate suffi-
cient resources (including sufficient personnel with the necessary 
skills and qualifications) to enable the Inspector General to monitor 
the quality-assurance program. 
"(fKD Not later than February 1, 1991, the Chief Medical Director Reports, 
shall submit to the Secretary a report on the experience through the 
end of the preceding fiscal year under the quality-assurance pro-
gram carried out under this section. 
"(2) Such report shall include— 
"(A) the data and other information compiled and the 
comparisons, analyses, and evaluations made under subsections 
(b) and (c) with respect to the period covered by the report; and 
"(B) recommendations under subsection (d). 
"(g)(1) Not later than 60 days after receiving such report, the 
Secretary shall submit to the Committees on Veterans' Affairs of 
the Senate and House of Representatives a copy of the report, 
together with any comment concerning the report that the Sec-
retary considers appropriate. 
"(2) A report submitted under paragraph (1) shall not be consid-
ered to be a record or document as described in section 5705(a) of 
this title. 
"§ 7312. Special medical advisory group 
"(a) The Secretary shall establish an advisory committee to be 
known £is the special medical advisory group. TTie advisory group 
shall advise the Secretary, through the Chief Medical Director, and 
the Chief Medical Director directly, relative to the care and treat-
ment of disabled veterans and other matters pertinent to the 
Administration. 
"(b) Members of the special medical advisory group shall be 
appointed by the Secretary upon the recommendation of the Chief 
Medical Director. The special medical advisory group shall be com-
posed of— 
"(1) members of the medical, dental, podiatric, optometric, 
and allied scientific professions; 
"(2) other individuals considered by the Chief Medical Direc-
tor to have experience pertinent to the mission of the Adminis-
tration; and 
"(3) a disabled veteran. 
I 
105 STAT. 216 
PUBLIC LAW 102-40—MAY 7, 1991 
Reports. 
(Colleges and 
universities. 
Health facilities. 
Nonprofit 
organizations. 
"(c) The special medical advisory group shall meet on a regular 
basis as prescribed by the Secretary. The number, terms of service, 
pay, and allowances of members of the advisory group shall be 
prescribed in accordance with existing law and regulations. 
"(d) Not later than February 1 of each year, the special medical 
advisory group shall submit to the Secretary and the Congress a 
report on the advisory groups activities during the preceding fiscal 
year. 
"§ 7313. Advisory committees: afHliated institutions 
"(a) In each case where the Secretary has a contract or agreement 
with any school, institution of higher learning, medical center, 
hospital, or other public or nonprofit agency, institution, or 
organization for the training or education of health personnel, the 
Secretary shall establish an advisory committee to advise the Sec-
retary and the Chief Medical Director with respect to policy matters 
arising in connection with, and the operation of, the program with 
respect to which it was appointed. Such a committee may be a 
dean's committee, a medical advisory committee, or the like. 
"(b) Any such advisory committee may be established on an 
institution-wide, multi-disciplinary beisis or on a regional basis 
whenever establishment on such a basis is found to be feasible. 
"(c) Members of each such advisory committee shall be appointed 
by the Secretary and shall include personnel of the Department 
(including appropriate representation from the full-time staff) and 
of the entity with which the Secretary has entered into the contract 
or agreement. The number of members, and terms of members, of 
each advisory committee shall be prescribed by the Secretary. 
"(d) The Secretary shall require that the Chief of the Nursing 
Service (or the designee of the Chief) at each Department health-
care facility be included in the membership of each policymaking 
committee at that facility. Such committees include: (1) committees 
relating to matters such as budget, education, position management, 
clinical executive issues, planning, and resource allocation, and (2) 
the dean's committee or other advisory committee established under 
subsection (a). 
"§ 7314. Geriatric research, education, and clinical centers 
"(a) The Secretary, upon the recommendation of the Chief Medical 
Director and pursuant to the provisions of this section, shall des-
ignate not more than 25 Department health-care facilities as the 
locations for centers of geriatric research, education, and clinical 
activities and (subject to the appropriation of sufficient funds for 
such purpose) shall establish and operate such centers at such 
locations in accordance with this section. 
"(b) In designating locations for centers under subsection (a), the 
Secretary, upon the recommendation of the Chief Medical Director, 
shall— 
"(1) designate each Department health-care facility that as of 
August 26, 1980, was operating a geriatric research, education, 
and clinical center unless (on the recommendation of the Chief 
Medical Director) the Secretary determines that such facility 
does not meet the requirements of subsection (c) or has not 
demonstrated effectiveness in carrying out the established pur-
poses of such center or the purposes of title III of the Vetergms' 
Administration Health-Care Amendments of 1980 (Public Law 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 217 
96-330; 94 Stat. 1048) or the potential to carry out such purposes 
effectively in the reasonably foreseeable future; and 
"(2) assure appropriate geographic distribution of such facili-
ties. 
"(c) The Secretary may not designate a health-care facility as a 
location for a center under subsection (a) unless the Secretary (upon 
the recommendation of the Chief Medical Director) determines that 
the facility has (or may reasonably be anticipated to develop) each of 
the following: 
"(1) An arrangement with an accredited medical school which 
provides education and training in geriatrics and with which 
such facility is affiliated under which residents receive edu-
cation and training in geriatrics through regular rotation 
through such center and through nursing home, extended care, 
or domiciliary units of such facility so as to provide such 
residents with training in the diagnosis and treatment of 
chronic diseases of older individuals, including cardiopulmonary 
conditions, senile dementia, and neurological disorders. 
"(2) An arrangement under which nursing or allied health 
personnel receive training and education in geriatrics through 
regular rotation through nursing home, extended care, or domi-
ciliary units of such facility. 
"(3) The ability to attract the participation of scientists who 
are capable of ingenuity and creativity in health-care research 
efforts. 
"(4) A policjnnaking advisory committee composed of appro-
priate health-care and research representatives of the facility 
and of the affiliated school or schools to advise the directors of 
such facility and such center on policy matters pertaining to the 
activities of such center during the period of the operation of 
such center. 
"(5) The capability to conduct effectively evaluations of the 
activities of such center. 
"(d) Before providing funds for the operation of any such center at 
a health-care facility other than a health-care facility designated 
under subsection (b)(1), the Secretary shall assure that the center at 
each facility designated under such subsection is receiving adequate 
funding to enable such center to function effectively in the areas of 
geriatric research, education, and clinical activities. 
"(e) There are authorized to be appropriated such sums as may be Appropriation 
necessary for the support of the research and education activities of authorization, 
the centers established pursuant to subsection (a). The Chief Medical 
Director shall allocate to such centers from other funds appro-
priated generally for the Department medical care account and 
medical and prosthetics research account, as appropriate, such 
amounts as the Chief Medicsd Director determines appropriate. 
"(f) Activities of clinical and scientific investigation at each center 
established under subsection (a) shall be eligible to compete for the 
award of funding from funds appropriated for the Department 
medical and prosthetics research account and shall receive priority 
in the award of funding from such account insofar as funds are 
awarded to projects for research in geriatrics and gerontology. 
"§ 7315. Geriatrics and Gerontology Advisory Committee 
"(a) The Secretary shall establish in the Administration a Geri-
atrics and Gerontology Advisory Committee (hereinafter in this 
section referred to as the 'Committee'). The membership of the 
105 STAT. 218 
PUBLIC LAW 102-40—MAY 7, 1991 
Committee shall be appointed by the Secretary, upon the rec-
ommendation of the Chief Medical Director, and shall include 
individuals who are not employees of the Federal Government and 
who have demonstrated interest and expertise in research, edu-
cation, and clinical activities related to aging and at least one 
representative of a national veterans service organization. The Sec-
retary, upon the recommendation of the Chief Medical Director, 
shall invite representatives of other appropriate departments and 
agencies of the United States to participate in the activities of the 
Committee and shall provide the Committee with such staff and 
other support as may be necessary for the Committee to carry out 
effectively its functions under this section. 
"(b) The Committee shall— 
"(1) advise the Chief Mediceil Director on all matters pertain-
ing to geriatrics and gerontology; 
(2) assess, through an evaluation process (including a site 
visit conducted not later than three years after the date of the 
establishment of each new center and not later than two years 
after the date of the last evaluation of those centers in oper-
, ation on August 26, 1980), the ability of each center established 
under section 7314 of this title to achieve its established pur-
poses and the purposes of title III of the Veterans' Administra-
tion Health-Care Amendments of 1980 (Public Law 96-330; 94 
Stat. 1048); 
"(3) £issess the capability of the Department to provide high 
quality geriatric services, extended services, and other health-
care services to eligible older veterans, taking into consideration 
the likely demand for such services from such veterans; 
"(4) assess the current and projected needs of eligible older 
veterans for geriatric services, extended-care services, and other 
health-care services from the Department and its activities and 
plans designed to meet such needs; and 
"(5) perform such additional functions as the Secretary or 
Chief Medical Director may direct. 
Sports. 
"(c)(1) The Committee shall submit to the Secretary, through the 
Chief Medical Director, such reports as the Committee considers 
appropriate with respect to its findings and conclusions under 
subsection Ot)). Such reports shall include the following: 
"(A) Descriptions of the operations of the centers of geriatric 
research, education, and clinical activities established pursuant 
to section 7314 of this title. 
"(B) Assessments of the quality of the operations of such 
centers. 
"(C) An assessment of the extent to which the Department, 
through the operation of such centers and other health-care 
facilities and programs, is meeting the needs of eligible older 
veterans for geriatric services, extended-care services, and other 
health-care services. 
"(D) Assessments of and recommendations for correcting any 
, deficiencies in the operations of such centers. 
"(E) Recommendations for such other geriatric services, ex-
tended-care services, and other health-care services as may be 
needed to meet the needs of older veterans. 
"(2) Not later than 90 days after receipt of a report submitted 
under paragraph (1), the Secretary shall transmit the report, to-
gether with the Secretary's comments and 
recommendations 
thereon, to the appropriate committees of the Congress. 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 219 
'*§ 7316. Malpractice and negligence suits: defense by United States 
"(aXD The remedy— 
"(A) against the United States provided by sections 1346(b) 
and2672oftitle28,or 
"(B) through proceedings for compensation or other benefits 
from the United States as provided by any other law, where the 
availability of such benefits precludes a remedy under section 
1346(b) or 2672 of title 28, 
for damages for personal injury, including death, allegedly arising 
from malpractice or negligence of a medical care employee of the 
Administration in furnishing medical care or treatment while in the 
exercise of that employee's duties in or for the Administration shall 
be exclusive of any other civil action or proceeding by reason of the 
same subject matter against the medical care employee (or employ-
ee's estate) whose act or omission gave rise to such claim. 
"(2) For purposes of paragraph (1), the term 'medical care em-
ployee of the Administration means a physician, dentist, podiatrist, 
optometrist, nurse, physician assistant, expanded-function dental 
auxiliary, pharmacist, or paramedical (such as medical and dental 
technicians, nursing assistants, and therapists), or other supporting 
personnel. 
"(b) The Attorney Greneral shall defend any civil action or 
proceeding brought in any court stgainst any person referred to in 
subsection (a) (or such person's estate) for any such damage or 
injury. Any such person against whom such civil action or proceed-
ing is brought shall deliver within such time after date of service or 
knowledge of service as determined by the Attorney General, all 
process served upon such person or an attested true copy thereof to 
such person's immediate superior or to whomever w£is designated by 
the Secretary to receive such papers and such person shall promptly 
furnish copies of the pleading and process therein to the United 
States attorney for the district embracing the place wherein the 
proceeding is brought, to the Attorney General, and to the Sec-
retary. 
"(c) Upon a certification by the Attorney General that the defend-
ant was acting in the scope of such person's emplojmient in or for 
the Administration at the time of the incident out of which the suit 
arose, any such civil action or proceeding commenced in a State 
court shall be removed without bond at any time before trial by the 
Attorney General to the district court of the United States of the 
district and division embracing the place wherein it is pending and 
the proceeding deemed a tort action brought against the United 
States under the provisions of title 28 and all references thereto. 
After removal the United States shall have available all defenses to 
which it would have been entitled if the action had originally been 
commenced against the United States. Should a United States 
district court determine on a hearing on a motion to remand held 
before a trial on the merits that the employee whose act or omission 
gave rise to the suit was not acting within the scope of such person's 
office or employment, the csise shall be remanded to the State court. 
"(d) The Attorney General may compromise or settle any claim 
asserted in such civil action or proceeding in the manner provided in 
section 2677 of title 28, and with the same effect. 
"(e) The Secretary may, to the extent the Secretary considers 
appropriate, hold harmless or provide liability insurance for any 
person to whom the immunity provisions of this section apply (as 
105 STAT. 220 
PUBLIC LAW 102-40—MAY 7, 1991 
described in subsection (a)), for damage for personal injury or death, 
or for property damage, negligently caused by such person while 
furnishing medical care or treatment (including the conduct of 
clinical studies or investigations) in the exercise of such person's 
duties in or for the Administration, if such person is assigned to a 
foreign country, detailed to State or political division thereof, or is 
acting under any other circumstances which would preclude the 
remedies of an injured third person against the United States, 
provided by sections 1346G3) and 2672 of title 28, for such damage or 
injury. 
"(f) The exception provided in section 2680(h) of title 28 shall not 
apply to any claim arising out of a negligent or wrongful act or 
omission of any person described in subsection (a) in furnishing 
medical care or treatment (including medical care or treatment 
furnished in the course of a clinical study or investigation) while in 
the exercise of such person's duties in or for the Administration. 
"§ 7317. Hazardous research projects: indemnification of contrac-
tors 
"(aXl) With the approval of the Secretary, any contract or re-
search authorized by section 7303 of this title, the performance of 
which involves a risk of an unusually hazardous nature, may pro-
vide that the United States will indemnify the contractor as pro-
vided in paragraph (2), but only to the extent that the liability, loss, 
or damage concerned arises out of the direct performance of the 
contract and to the extent not covered by the financial protection 
required under subsection (e). 
* (2) Indemnity under paragraph (1) is indemnity against either 
or both of the following: 
"(A) Liability (including reasonable expenses of litigation or 
settlement) to third persons, except liability under State or 
Federal workers' injury compensation laws to employees of the 
contractor employed at the site of and in connection with the 
contract for which indemnification is granted, for death, bodily 
injury, or loss of or damage to property, from a risk that the 
contract defines as unusually hazardous. 
"(B) Loss of or damage to property of the contractor from a 
risk that the contract defines as unusually hazardous. 
"(b) A contract that provides for indemnification in accordance 
with subsection (a) must also provide for— 
"(1) notice to the United States of any claim or suit against 
the contractor for death, bodily injury, or loss of or damage to 
property; and 
"(2) control of or assistance in the defense by the United 
States, at its election, of any such suit or claim for which 
indemnification is provided hereunder. 
"(c) A payment may not be made under subsection (a) unless the 
Secretary certifies that the amount is just and reasonable. 
"(d) Upon approval by the Secretary, pajmients under subsection 
(a) may be made from— 
"(1) funds obligated for the performance of the contract con-
cerned; 
"(2) funds available for research or development or both, and 
not otherwise obligated; or 
"(3) funds appropriated for those pa3mients. 
"(e) Each contractor which is a party to an indemnification agree-
ment under subsection (a) shall have and maintain financial protec-
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 221 
tion of such type and in such amounts as the Secretary shall require 
to cover liability to third persons and loss of or damage to the 
contractor's property. The amount of financial protection required 
shall be the maximum amount of insurance available from private 
sources, except that the Secretary may establish a lesser amount, 
taking into consideration the cost and terms of private insurance. 
Such financial protection may include private insurance, private 
contractual indemnities, self-insurance, other proof of financial 
responsibility, or a combination of such measures. 
"(f) In administering the provisions of this section, the Secretary 
may use the facilities and services of private insurance organiza-
tions and may contract to pay a reasonable compensation therefor. 
Any contract made under the provisions of this section may be made 
without regard to the provisions of section 3709 of the Revised 
Statutes (41 U.S.C. 5), upon a showing by the Secretary that 
advertising is not resisonably practicable, and advance pa5nnents 
may be made under any such contract. 
"(g) The authority to indemnify contractors under this section 
does not create any rights in third persons which would not other-
wise exist by law. 
"(h) Funds appropriated to carry out this section shall remain 
available until expended. 
"(i) In this section, the term 'contractor' includes subcontractors of 
any tier under a contract containing an indemnification provision 
pursuant to subsection (a).". 
(4) Such chapter is further amended— 
(A) by redesignating sections 4131, 4132, 4133, and 4134 as 
sections 7331, 7332, 7333, and 7334, respectively; and 
(B) by redesignating sections 4161, 4162, 4163, 4164, 4165, 
4166, 4167, and 4168 as sections 7361, 7362, 7363, 7364, 7365, 
7366, 7367, and 7368, respectively. 
(b) ENACTMENT OF OTHER PROVISIONS OF OLD CHAPTER 73 IN NEW 
CHAPTER 74.—Chapter 74, as added by section 102 and amended by 
section 202, is amended as follows: 
(1) The table of sections (as added by section 102 and amended 
by section 203(b)) is amended— 
(A) by inserting at the beginning the following: 
"SUBCHAPTER I—APPOINTMENTS 
"Sec. 
"7401. Appointments in Veterans Health Administration. 
"7402. Qualifications of appointees. 
"7403. Period of appointments; promotions. 
"7404. Grades and pay scales. 
"7405. Temporary full-time appointments, part-time appointments, and without-
compensation appointments. 
"7406. Residencies and internships. 
"7407. Administrative provisions for section 7405 and 7406 appointments. 
"7408. Appointment of additional employees. 
"7409. Contracts for scarce medical specialist services."; 
(B) by inserting after the item relating to section 7423 (as 
added by section 203(b)(1)) the following: 
"7424. Travel expenses of certain employees. 
"7425. Employees: laws not applicable. 
"7426. Retirement rights."; 
(C) by inserting after the item relating to section 7440 (as 
added by section 102) the following: 
105 STAT. 222 
PUBLIC LAW 102-40—MAY 7, 1991 
" S U B C H A P T E R IV—PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL 
"7451. Nurses and other health-care personnel: competitive pay. 
"7452. Nurses smd other health-care personnel: administration of pay. 
"7453. Nurses: additional pay. 
"7454. Physician assistants and other health care professionals: additional pay. 
"7455. Increases in rates of basic pay. 
"7456. Nurses: special rules for weekend duty. 
"7457. On-call pay. 
"7458. Recruitment and retention bonus pay."; and 
(D) by adding at the end the following: 
SUBCHAPTER VI—REGIONAL MEDICAL EDUCATION CENTERS 
"7471. Designation of Regional Medical E^ducation Centers. 
"7472. Supervision and staffing of Centers. 
"7473. Personnel eligible for training. 
"7474. Consultation.". 
(2) Such chapter is further amended by inserting before sub-
chapter II (as added by section 202) the foUow^ing: 
"SUBCHAPTER I—APPOINTMENTS 
"§ 7401. Appointments in Veterans Health Administration 
"There may be appointed by the Secretary such personnel as the 
Secretary may find necessary for the medical care of veterans (in 
addition to those in the Office of the Chief Medical Director ap-
pointed under section 7306 of this title), as follows: 
"(1) Physicians, dentists, podiatrists, optometrists, registered 
nurses, physician assistants, and expanded-function 
dental 
auxiliaries. 
"(2) Psychologists (other than those described in paragraph 
(3)), dietitians, and other scientific and professional personnel, 
such as microbiologists, chemists, biostatisticians, and medical 
and dental technologists. 
"(3) Clinical or counseling psychologists who hold diplomas as 
diplomates in psychology from an accrediting authority ap-
proved by the Secretary, certified or registered respiratory 
therapists, licensed physical therapists, licensed practical or 
vocational nurses, pharmacists, and occupational therapists. 
"§ 7402. Qualincations of appointees 
"(a) To be eligible for appointment to the positions in the Adminis-
tration covered by subsection (b), a person must have the applicable 
qualifications set forth in that subsection. 
"(b)(1) PHYSICIAN.—To be eligible to be appointed to a physician 
position, a person must— 
"(A) hold the degree of doctor of medicine or of doctor of 
osteopathy from a college or university approved by the Sec-
retary, 
"(B) have completed an internship satisfactory to the Sec-
retary, and 
"(C) be licensed to practice medicine, surgery, or osteopathy 
in a State. 
"(2) DENTIST.—To be eligible to be appointed to a dentist position, 
a person must— 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 223 
"(A) hold the degree of doctor of dental surgery or dental 
medicine from a college or university approved by the Sec-
retary, and 
"(B) be licensed to practice dentistry in a State. 
"(3) NURSE.—To be eligible to be appointed to a nurse position, a 
person must— 
"(A) have successfully completed a full course of nursing in a 
recognized school of nursing, approved by the Secretary, and 
"(B) be registered as a graduate nurse in a State. 
"(4) DIRECTOR OF A HOSPITAL, DOMICIUARY, CENTER, OR OUT-
PATIENT CuNic.—To be eligible to be appointed to a director 
position, a person must have such business and administrative 
experience and qualifications as the Secretary shall prescribe. 
"(5) PODIATRIST.—To be eligible to be appointed to a podiatrist 
position, a person must— 
"(A) hold the degree of doctor of podiatric medicine, or its 
equivalent, from a school of podiatric medicine approved by the 
Secretary, and 
"(B) be licensed to practice podiatry in a State. 
"(6) OPTOMETRIST.—To be eligible to be appointed to an optom-
etrist position, a person must— 
"(A) hold the degree of doctor of optometry, or its equivalent, 
from a school of optometry approved by the Secretary, and 
"(B) be licensed to practice optometry in a State. 
"(7) PHARMACIST.—To be eligible to be appointed to a pharmacist 
position, a person must— 
"(A) hold the degree of bachelor of science in pharmacy, or its 
equivalent, from a school of pharmacy, approved by the Sec-
retary, and 
"(B) be registered as a pharmacist in a State. 
"(8) PSYCHOLOGIST.—To be eligible to be appointed to a psycholo-
gist position, a person must— 
"(A) hold a doctoral degree in psychology from a college or 
university approved by the Secretary, 
"(B) have completed study for such degree in a specialty area 
of psychology and an internship which are satisfactory to the 
Secretary, and 
"(C) be licensed or certified as a psychologist in a State, except 
that the Secretary may waive the requirement of licensure or 
certification for an individual psychologist for a period not to 
exceed two years on the condition that that psychologist provide 
patient care only under the direct supervision of a psychologist 
who is so licensed or certified. 
"(9) OTHER HEALTH-CARE POSITIONS.—To be appointed as a physi-
cian assistant, expanded-function dental auxiliary, certified or reg-
istered respiratory therapist, licensed physical therapist, licensed 
practical or vocational nurse, occupational therapist, dietitian, 
microbiologist, chemist, biostatistician, medical technologist, dental 
technologist, or other position, a person must have such medical, 
dental, scientific, or technical qualifications as the Secretary shall 
prescribe. 
"(c) Except £is provided in section 7407(a) of this title, a person 
may not be appointed in the Administration to a position listed in 
section 7401(1) of this title unless the person is a citizen of the 
United States. 
"(d) A person may not be appointed under section 7401(1) of this 
title to serve in the Administration in any direct patient-care capac-
105 STAT. 224 
PUBLIC LAW 102-40—MAY 7, 1991 
Regulations. 
Regulations. 
Records. 
ity unless the Chief Medical Director determines that the person 
possesses such basic proficiency in spoken and written English as 
will permit such degree of communication with patients and other 
health-care personnel as will enable the person to carry out the 
person's headth-care responsibilities satisfactorily. Any determina-
tion by the Chief Medical Director under this subsection shall be in 
accordance with regulations which the Secretary shall prescribe. 
"(e) A person may not serve as Chief of Staff of a Department 
health-care facility if the person is not serving on a full-time basis. 
"§ 7403. Period of appointments; promotions 
"(a)(1) Appointments under this chapter of health-care profes-
sionals to whom this section applies may be made only after quali-
fications have been satisfactorily established in accordance with 
regulations prescribed by the Secretary, without regard to civil-
service requirements. 
"(2) This section applies to the following persons appointed under 
this chapter: 
"(A) Physicians. 
. ' > • ' • 
"(B) Dentists. 
"(C) Podiatrists. 
"(D) Optometrists. 
"(E) Nurses. 
"(F) Physician assistants. 
"(G) Expanded-function dental auxiliaries. 
"(b)(1) Appointments described in subsection (a) shall be for a 
probationary period of two years. 
"(2) The record of each person serving under such an appointment 
in the Medical, Dental, and Nursing Services shall be reviewed from 
time to time by a board, appointed in accordance with regulations of 
the Secretary. If such a board finds that such person is not fully 
qualified and satisfactory, such person shall be separated from the 
service. 
"(c) Promotions of persons to whom this section applies shall be 
made only after examination given in accordance with regulations 
prescribed by the Secretary. Advancement within grade may be 
made in increments of the minimum rate of basic pay of the grade 
in accordance with regulations prescribed by the Secretary. 
"(d) In determining eligibility for reinstatement in the Federal 
civil service of persons appointed to positions in the Administration 
under this chapter who at the time of appointment have a civil-
service status, and whose employment in the Administration is 
terminated, the period of service performed in the Administration 
shall be included in computing the period of service under 
applicable civil-service rules and regulations. 
"(e) In accordance with regulations prescribed by the Secretary, 
the grade and annual rate of basic pay of a person to whom this 
section applies whose level of assignment is changed from a level of 
assignment in which the grade level is based on both the nature of 
the assignment and personal qualifications may be adjusted to the 
grade and annual rate of basic pay otherwise appropriate. 
"(f)(1) Upon the recommendation of the Chief Medical Director, 
the Secretary may— 
"(A) use the authority in subsection (a) to establish the quali-
fications for and (subject to paragraph (2)) to appoint individuals 
to positions listed in section 7401(3) of this title; and 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 225 
"(B) use the authority provided in subsection (c) for the 
promotion and advancement of Department employees serving 
in such positions. 
"(2) In using such authority to appoint individuals to such posi-
tions, the Secretary shall apply the principles of preference for the 
hiring of veterans and other persons established in subchapter I of 
chapter 33 of title 5. 
"(3) Notwithstanding any other provision of this title or other law, 
all matters relating to adverse actions, disciplinary actions, and 
grievance procedures involving individuals appointed to such 
positions (including similar actions and procedures involving an 
employee in a probationary status) shall be resolved under the 
provisions of title 5 as though such individuals had been appointed 
under that title. 
"(g)(1) The Secretary may appoint in the competitive civil service 
without regard to the provisions of subchapter I of chapter 33 of title 
5 (other than sections 3303 and 3328 of such title) an individual 
who— 
"(A) has a recognized degree or certificate from an accredited 
institution in a health-care profession or occupation; and 
"(B) has successfully completed a clinical education program 
affiliated with the Department. 
"(2) In using the authority provided by this subsection, the Sec-
retary shall apply the principles of preference for the hiring of 
veterans and other persons established in subchapter I of chapter 33 
of title 5. 
"§ 7404. Grades and pay scales 
"(a) The annual rates or ranges of rates of basic pay for positions 
provided in section 7306 of this title shall be prescribed from time to 
time by Executive order as authorized by chapter 53 of title 5 or as 
otherwise authorized by law. 
"(bXD The grades for positions provided for in paragraph (1) of 
section 7401 of this title shall be as follows. The annual ranges of 
rates of basic pay for those grades shall be prescribed from time to 
time by Executive order as authorized by chapter 53 of title 5 or as 
otherwise authorized by law: 
"PHYSICIAN AND DENTIST SCHEDULE 
"Director grade. 
"Executive grade. 
"Chief grade. 
"Senior grade. 
"Intermediate grade. 
"Full grade. 
"Associate grade. 
"NURSE SCHEDULE 
"Director grade. 
"Senior grade. 
"Intermediate grade. 
| 
"Entry grade. 
I 
"CLINICAL PODIATRIST AND OPTOMETRIST SCHEDULE 
"Chief grade. 
105 STAT. 226 
PUBLIC LAW 102-40—MAY 7, 1991 
"Senior grade. 
"Intermediate grade. 
"Full grade. 
"Associate grade. 
"(2) A person may not hold the director grade in the Physician 
and Dentist Schedule unless the person is serving as a director of a 
hospital, domiciliary, center, or outpatient clinic (independent). A 
person may not hold the executive grade in that Schedule unless the 
person holds the position of chief of staff at a hospital, center, or 
outpatient clinic (independent), or comparable position. 
"(c) Notwithstanding the provisions of section 7425(a) of this title, 
a person appointed under section 7306 of this title who is not eligible 
for special pay under subchapter III shall be deemed to be a career 
appointee for the purposes of sections 4507 and 5384 of title 5. 
"(d) Except as provided under subchapter III and in section 7457 of 
this title, pay may not be paid at a rate in excess of the rate of basic 
pay for an appropriate level authorized by section 5315 or 5316 of 
title 5 for positions in the Executive Schedule, as follows: 
"(1) Level IV for the Deputy Chief Medical Director. 
"(2) Level V for all other positions for which such basic pay is 
paid under this section. 
"§7405. Temporary full-time appointments, part-time appoint-
ments, and without-compensation appointments 
"(a) The Secretary, upon the recommendation of the Chief Medical 
Director, may employ, without regard to civil service or classifica-
tion laws, rules, or regulations, personnel as follows: 
"(1) On a temporary full-time basis, part-time basis, or with-
out compensation basis, persons in the following positions: 
"(A) Positions listed in section 7401(1) of this title. 
"(B) Certified 
or 
registered 
respiratory 
therapists, 
licensed physical therapists, licensed practical or vocational 
nurses, pharmacists, and occupational therapists. 
"(C) Dietitians, social workers, and librarians. 
"(D) Other professional, clerical, technical, and unskilled 
personnel (including interns, residents, trainees, and stu-
dents in medical support programs). 
"(2) On a fee basis, persons in the following positions: 
"(A) Positions listed in section 7401(1) of this title. 
"(B) Certified 
or 
registered 
respiratory 
therapists, 
licensed physical therapists, licensed practical or vocational 
nurses, pharmacists, and occupational therapists. 
"(C) Other professional and technical personnel. 
"(b) Personnel employed under subsection (a)— 
"(1) shall be in addition to personnel described in section 7306, 
pargigraphs (1) and (3) of section 7401, and section 7408 of this 
title; and 
"(2) shall be paid such rates of pay as the Secretary may 
prescribe. 
"(c)(1) Temporary full-time appointments under this section of 
persons in positions listed in section 7401(1) of this title may be for a 
period in excess of 90 days only if the Chief Medical Director finds 
that circumstances render it impracticable to obtain the necessary 
services through appointments under that section. 
"(2) Temporary full-time appointments of persons who have 
successfully completed a full course of nursing in a recognized school 
of nursing, approved by the Secretary, or who have successfully 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 227 
completed a full course of training for any category of personnel 
described in paragraph (3) of section 7401 of this title in a recognized 
education or training institution approved by the Secretary, and 
who are pending registration or licensure in a State, or certification 
by a national board recognized by the Secretary, shall not exceed 
two years. 
"(3) Temporary full-time appointments of other personnel may not 
be for a period in excess of one year except as authorized in 
subsection (f). 
"(d) A part-time appointment may not be for a period of more 
than one year, except for appointments of persons specified in 
subsection (aXlXA) and interns, residents, and other trainees in 
medical support programs and except as authorized in subsection (f). 
"(e) A student who has a temporary appointment under this 
section and who is pursuing a full course of nursing in a recognized 
school of nursing approved by the Secretary, or who is pursuing a 
full course of training for any category of personnel described in 
paragraph (3) of section 7401 of this title in a recognized education 
or training institution approved by the Secretary, may be 
reappointed for a period not to exceed the duration of the student's 
academic program. 
"(f) During any period during which the Secretary is exercising 
the authority provided in subsections (a) and (fXl) of section 7403 of 
this title in connection with the appointment, under paragraph (3) of 
section 7401 of this title, of personnel in a category of personnel 
described in such paragraph— 
"(1) the Secretary may make temporary full-time appoint-
ments of personnel in such category for periods exceeding 90 
days if the Chief Medical Director finds that circumstances 
render it impractical to obtain the necessary services through 
appointments under paragraph (3) of section 7401 of this title; 
and 
"(2) part-time appointments of personnel in such category 
may be for periods of more than one year. 
"§ 7406. Residencies and internships 
"(aXl) The Secretary may establish residencies and internships. 
The Secretary may appoint qualified persons to such positions with-
out regard to civil service or classification laws, rules, or regula-
tions. 
"(2) For the purposes of this section: 
"(A) The term 'internship' includes the equivalency of an Regulations, 
internship £is determined in accordance with regulations which 
the Secretary shall prescribe. 
"(B) The term 'intern' means a person serving an internship. 
"(b) The Secretary may prescribe the conditions of emplo5rment of 
persons appointed under this section, including necessary training, 
and the customary amount and terms of pay for such positions 
during the period of such emplojnnent and training. The amount 
and terms of such pay may be established retroactively based on 
changes in such customary amount and terms. 
"(cXD In order to carry out more efficiently the provisions of 
subsection (aXD, the Secretary may contract with one or more 
hospitals, medical schools, or medical installations having hospital 
facilities and participating with the Department in the training of 
interns or residents to provide, by the designation of one such 
105 STAT. 228 
PUBLIC LAW 102-40—MAY 7, 1991 
institution to serve as a central administrative agency, for the 
central administration— 
"(A) of stipend pajnnents; 
"(B) provision of fringe benefits; and 
"(C) maintenance of records for such interns and residents. 
"(2) The Secretary may pay to such designated agency, without 
regard to any other law or regulation governing the expenditure of 
Government moneys either in advance or in arrears, an amount to 
cover the cost for the period such intern or resident serves in a 
Department hospital of— 
"(A) stipends fixed by the Secretary pursuant to paragraph 
(1); 
"(B) hospitalization, medical care, and life insurance and any 
other employee benefits as are agreed upon by the participating 
institutions for the period that such intern or resident serves in 
a Department hospital; 
"(C) tax on employers pursuant to chapter 21 of the Internal 
Revenue Code of 1986, where applicable; and 
"(D) an amount to cover a pro rata share of the cost of 
expense of such central administrative agency. 
"(3XA) Any amounts paid by the Secretary to such central 
administrative agency to cover the cost of hospitalization, medical 
care, or life insurance or other employee benefits shall be in lieu of 
any benefits of like nature to which such intern or resident may be 
entitled under the provisions of title 5, and the acceptance of 
stipends and employee benefits from the designated central adminis-
trative agency shall constitute a waiver by the recipient of any 
claim such recipient might have to any payment of stipends or 
employee benefits to which such recipient may be entitled under 
this title or title 5. 
"(B) Notwithstanding subparagraph (A), any period of service of 
any such intern or resident in a Department hospital shall be 
deemed creditable service for the purposes of section 8332 of title 5. 
"(4) The agreement with such central administrative agency may 
further provide that the designated central administrative agency 
shall— 
"(A) make all appropriate deductions from the stipend of each 
intern and resident for local, State, and Federal taxes; 
"(B) maintain all records pertinent to such deductions and 
make proper deposits of such deductions; and 
"(C) maintain all records pertinent to the leave accrued by 
such intern and resident for the period during which such 
recipient serves in a participating hospital, including a Depart-
ment hospital. 
"(5) Leave described in paragraph (4XC) may be pooled, and the 
intern or resident may be afforded leave by the hospital in which 
such person is serving at the time the leave is to be used to the 
extent of such person's total accumulated leave, whether or not 
earned at the hospital in which such person is serving at the time 
the leave is to be afforded. 
"§7407. Administrative provisions for section 7405 and 7406 
appointments 
"(a) When the Chief Medical Director determines that it is not 
possible to recruit qualified citizens for the necessary services, 
appointments under sections 7405 and 7406 of this title may be made 
without regard to the citizenship requirements of section 7402(c) of 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 229 
this title or of any other law prohibiting the emplojnnent of, or 
payment of compensation to, a person who is not a citizen of the 
United States. 
"Ot)Xl) Subject to paragraph (2), the Chief Medical Director may 
waive for the purpose of the appointment of an individual under 
section 7405 or 7406 of this title the requirements set forth in section 
7402(b) of this title— 
"(A) that a physician, dentist, psychologist, optometrist, reg-
istered nurse, practical or vocational nurse, or physical thera-
pist be licensed or certified, as appropriate; 
"(B) that the licensure or certification of such an individual be 
in a State; and 
"(C) that a psychologist have completed an internship. 
"(2) The waivers authorized in paragraph (1) may be granted— 
"(A) in the case of clauses (A) and (C) of such paragraph, if the 
individual (i) will be employed to conduct research or serve in 
an academic position, and (ii) will have no responsibility for 
furnishing direct patient care services; and 
"(B) in the case of clause (B) of such paragraph, if the individ-
ual will be employed to serve in a country other than the 
United States and the individual's licensure or registration is in 
the country in which the individual is to serve. 
"(c) The program of training prescribed by the Secretary in order 
to qualify a person for the position of full-time physician assistant or 
expanded-function dental auxiliary shall be considered a full-time 
institutional program for purposes of chapter 34 of this title. The 
Secretary may consider training for such a position to be on a less 
than full-time basis for purposes of such chapter when the combined 
classroom (and other formal instruction) portion of the program and 
the on-the-job training portion of the program total less than 30 
hours per week. 
"(d) A person may not be appointed under section 7405 or 7406 of 
this title to an occupational category described in section 7401(1) of 
this title or in section 7406 of this title unless the person meets the 
requirements established in section 7402(d) of this title and regula-
tions prescribed under that section. 
"(e) In accordance with the provisions of section 7425(b) of this 
title, the provisions of chapter 34 of title 5 pertaining to part-time 
career employment shall not apply to part-time appointments under 
sections 7405 and 7406 of this title. 
"§ 7408. Appointment of additional employees 
* 
"(a) There shall be appointed by the Secretary under civil-service 
laws, rules, and regulations, such additional employees, other than 
those provided in section 7306 and paragraphs (1) and (3) of section 
7401 of this title and those specified in sections 7405 and 7406 of this 
title, as may be necessary to carry out the provisions of this chapter. 
"(b) The Secretary, after considering an individual's existing pay, 
higher or unique qualifications, or the special needs of the Depart-
ment, may appoint the individual to a position in the Administra-
tion providing direct patient-care services or services incident to 
direct patient-services at a rate of pay above the minimum rate of 
the appropriate grade. 
"§ 7409. Contracts for scarce medical specialist services 
"(a) The Secretary may enter into contracts with institutions and 
persons described in subsection (b) to provide scarce medical special-
105 STAT. 230 
PUBLIC LAW 102-40—MAY 7, 1991 
ist services at Department facilities. Such services may include the 
services of physicians, dentists, podiatrists, optometrists, nurses, 
physicism assistants, expanded-function dental auxiliaries, techni-
cians, and other medical support personnel. 
"0)) Institutions and persons with whom the Secretary may enter 
into contracts under subsection (a) are the following: 
"(1) Schools and colleges of medicine, osteopathy, dentistry, 
podiatry, optometry, and nursing. 
"(2) Clinics. 
"(3) Any other group or individual capable of furnishing such 
scarce medical specialist services.". 
(3) Subchapter II of such chapter (as added by section 202) is 
amended— 
(A) by adding at the end of section 7423 the following new 
subsection: 
"(eXl) The Secretary shall establish a leave transfer program for 
the benefit of health-care professionals in positions listed in section 
7401(1) of this title. The Secretary may also establish a leave bank 
program for the benefit of such health-care professionals. 
"(2) To the maximum extent feasible— 
"(A) the leave transfer program shall provide the same or 
similar requirements and conditions as are provided for the 
progreim established by the Director of the Office of Personnel 
Management under subchapter III of chapter 63 of title 5; and 
"(B) any leave bank program established pursuant to para-
graph (1) shall be consistent with the requirements and condi-
tions provided for agency leave bank programs in subchapter IV 
of such chapter. 
"(3) Participation by a health-care professional in the leave trans-
fer program established pursuant to paragraph (1), and in any leave 
bank program established pursuant to such paragraph, shall be 
voluntary. The Secretary may not require any health-care profes-
sional to participate in such a program. 
"(4)(A) The Secretary and the Director of the Office of Personnel 
Management may enter into an agreement that permits health-care 
professionals referred to in paragraph (1) to participate in the leave 
transfer program established by the Director of the Office of Person-
nel Management under subchapter III of chapter 63 of title 5 or in 
any leave bank program established for other employees of the 
Department pursuant to subchapter IV of chapter 63 of title 5, or 
both. 
"(B) Participation of such health-care professionals in a leave 
transfer program or a leave bank program pursuant to an agree-
ment entered into under subparagraph (A) shall be subject to such 
requirements and conditions as may be prescribed in such agree-
ment. 
"(5) The Secretary is not required to establish a leave transfer 
program for any personnel permitted to participate in a leave 
transfer program pursuant to an agreement referred to in para-
graph (4). ; and 
(B) by adding at the end the following new sections: 
"§ 7424. Travel expenses of certain employees 
"(a) The Secretary may pay the expenses (other than membership 
fees) of persons described in sections 7306 and 7401(1) of this title 
(including persons in positions described in section 7401(1) of this 
title who are appointed on a temporary full-time basis or a part-time 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 231 
basis under section 7405 of this title) who are detailed by the Chief 
Medical Director to attend meetings of associations for the pro-
motion of medical and related science. 
"0)X1) The Secretary may prescribe regulations establishing condi-
tions under which officers and employees of the Administration who 
are nationally recognized principal investigators in medical re-
search may be permitted to accept payment, in cash or in kind, from 
non-Federal agencies, organizations, and individuals for travel and 
such reasonable subsistence expenses as are approved by the Sec-
retary pursuant to such regulations— 
"(A) in connection with their attendance at meetings or in 
performing advisory services concerned with the functions or 
' 
activities of the Department; or 
"(B) in connection with acceptance of significant awards or 
with activity related thereto concerned with functions or activi-
ties of the Department. 
"(2) Any such payment may be retained by such officers and 
employees to cover the cost of such expenses or shall be deposited to 
the credit of the appropriation from which the cost of such expenses 
is paid, as may be provided in such regulations. 
"§ 7425. Employees: laws not applicable 
"(a) Physicians, dentists, nurses, and other health-care profes-
sionals employed by the Administration and appointed under sec-
tion 7306, 7401(1), 7405, or 7406 of this chapter are not subject to the 
following provisions of law: 
"(1) Section 413 of the Civil Service Reform Act of 1978. 
"(2) Subchapter II of chapter 31 of title 5. 
"(3) Subchapter VIII of chapter 33 of title 5. 
"(4) Subchapter V of chapter 35 of title 5. 
"(5) Subchapter II of chapter 43 of title 5. 
"(6) Section 4507 of title 5. 
"(7) Subchapter VIII of chapter 53 of title 5. 
"(8) Subchapter V of chapter 75 of title 5. 
"(b) Notwithstanding any other provision of law, no provision of 
title 5 or any other law pertaining to the civil service system which 
is inconsistent with any provision of section 7306 of this title or this 
chapter shall be considered to supersede, override, or otherwise 
modify such provision of that section or this chapter except to the 
extent that such provision of title 5 or of such other law specifically 
provides, by specific reference to a provision of this chapter, or such 
provision to be superseded, overridden, or otherwise modified. 
"§ 7426. Retirement rights 
"(a) Except as provided in subsection (b), persons appointed to the 
Administration shall be subject to the provisions of and entitled to 
benefits under subchapter III of chapter 83 of title 5 or subchapter II 
of chapter 84 of title 5, whichever is applicable. 
"(bXD In computing the annuity under subchapter III of chapter 
83, or subchapter II of chapter 84, of title 5 of an individual who 
retires under such subchapter (other than under section 8337 or 
8451 of such title) after December 31, 1981, and who served at any 
time on a less-than-fuU-time basis in a position in the Administra-
tion to which such individual was appointed under subchapter I— 
"(A) for the purpose of determining such individual's average 
pay, as defined by section 8331(4) or 8401(3) of title 5, whichever 
105 STAT. 232 
PUBLIC LAW 102-40—MAY 7, 1991 
is applicable, the annual rate of basic pay for full-time service 
shall be deemed to be such individual's rate of basic pay; and 
"(B) the amount of such individual's annuity as computed 
under section 8339 or 8415 of title 5 (before application of any 
reduction required by subsection (i) of section 8339) shall be 
multiplied by the fraction equal to the ratio that that individ-
, 
ual's total full-time equivalent service bears to that individual's 
creditable service as determined under section 8332 or 8411 of 
title 5, whichever is applicable. 
"(2) For the purposes of paragraph (IXB), an individual's full-time 
equivalent service is the individual's creditable service as deter-
mined under section 8332 or 8411 of title 5, whichever is applicable, 
except that any period of service of such individual served on a less-
than-fuU-time basis shall be prorated based on the fraction such 
service bears to full-time service. For the purposes of the preceding 
sentence, full-time service shall be considered to be 80 hours of 
service per biweekly pay period. 
"(3) A survivor annuity computed under section 8341, or sub-
chapter IV of chapter 84, of title 5 based on the service of an 
individual described in paragraph (1) shall be computed based upon 
such individual's annuity as determined in accordance with such 
paragraph. 
"(c) The Secretary may authorize an exception to the restrictions 
in subsections (a), (b), and (c) of section 5532 of title 5 if necessary to 
meet special or emergency employment needs which result from a 
severe shortage of well-qualified candidates in physician positions, 
and registered nurse positions, which otherwise cannot be readily 
Termination 
met. Tlie authority of the Secretary under the preceding sentence 
*
*
*
*
*
* 
with respect to registered-nurse positions expires on September 30, 
1992.". 
(4) Chapter 74 is further amended by inserting after subchapter 
in (as added by section 102) the following: 
"SUBCHAPTER IV—PAY FOR NURSES AND OTHER HEALTH-
CARE PERSONNEL 
"§ 7453. Nurses: additional pay 
"(a) In addition to the rate of basic pay provided for nurses, a 
nurse shall receive additional pay as provided by this section. 
"(b) A nurse performing service on a tour of duty, any part of 
which is within the period commencing at 6 postmeridian and 
ending at 6 antemeridian, shall receive additional pay for each hour 
of service on such tour at a rate equal to 10 percent of the nurse's 
hourly rate of basic pay if at least four hours of such tour fall 
between 6 postmeridian and 6 antemeridian. When less than four 
hours of such tour fall between 6 postmeridian and 6 antemeridian, 
the nurse shall be paid the differential for each hour of service 
performed between those hours. 
"(c) A nurse performing service on a tour of duty, any part of 
which is within the period commencing at midnight Friday and 
ending at midnight Sunday, shall receive additional pay for each 
hour of service on such tour at a rate equal to 25 percent of such 
nurse's hourly rate of basic pay. 
"(d) A nurse performing service on a holiday designated by Fed-
eral statute or Executive order shall receive for each hour of such 
service the nurse's hourly rate of basic pay, plus additional pay at a 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 233 
rate equal to such hourly rate of basic pay, for that holiday service, 
including overtime service. Any service required to be performed by 
a nurse on such a designated holiday shall be deemed to be a 
minimum of two hours in duration. 
"(eXl) A nurse performing officially ordered or approved hours of 
service in excess of 40 hours in an administrative workweek, or in 
excess of eight hours in a day, shall receive overtime pay for each 
hour of such additional service. The overtime rates shall be one and 
one-half times such nurse's hourly rate of basic pay. 
"(2) For the purposes of this subsection, overtime must be of at 
least 15 minutes duration in a day to be creditable for overtime pay. 
"(3) Compensatory time off in lieu of pay for service performed 
under the provisions of this subsection shall not be permitted, 
except as voluntarily requested in writing by the nurse in question. 
"(4) Any excess service performed under this subsection on a day 
when service was not scheduled for such nurse, or for which such 
nurse is required to return to the nurse's place of emplojmient, shall 
be deemed to be a minimum of two hours in duration. 
"(5) For the purposes of this subsection, the period of a nurse's 
officially ordered or approved travel away from such nurse's duty 
station may not be considered to be hours of service unless— 
"(A) such travel occurs during such nurse's tour of duty; or 
"(B) such travel— 
"(i) involves the performance of services while traveling, 
"(ii) is incident to travel that involves the performance of 
services while traveling, 
"(iii) is carried out under arduous conditions as deter-
mined by the Secretary, or 
"(iv) results from an event which could not be scheduled 
or controlled administratively. 
"(f) For the purpose of computing the additional pay provided by 
subsections (b), (c), (d), or (e), a nurse's hourly rate of basic pay shall 
be derived by dividing such nurse's annual rate of basic pay by 
2,080. 
"(g) When a nurse is entitled to two or more forms of additional 
pay under subsections (b), (c), (d), or (e) for the same period of 
service, the amounts of such additional pay shall be computed 
separately on the basis of such nurse's hourly rate of basic pay, 
except that no overtime pay as provided in subsection (e) shall be 
payable for overtime service performed on a holiday designated by 
Federal statute or Executive order in addition to pay received under 
subsection (d) for such service. 
"(h) A nurse who is officially scheduled to be on call outside such 
nurse's regular hours or on a holiday designated by Federal statute 
or Executive order shall be paid for each hour of such on-call duty, 
except for such time as such nurse may be called back to work, at a 
rate equal to 10 percent of the hourly rate for excess service as 
provided in subsection (e). 
"(i) Any additional pay paid pursuant to this section shall not be 
considered as basic pay for the purposes of the following provisions 
of title 5 (and any other provision of law relating to benefits based 
on basic pay): 
"(1) Subchapter VI of chapter 55. 
"(2) Section 5595. 
"(3) Chapters 81, 83, 84, and 87 of title 5. 
"(jXD Notwithstanding any other provision of law and subject to 
paragraph (2), the Secretary may increase the rates of additional 
105 STAT. 234 
PUBLIC LAW 102-40—MAY 7, 1991 
pay authorized under subsections Qj) through (h) if the Secretary 
determines that it is necessary to do so in order to obtain or retain 
the services of nurses. 
"(2) An increase under paragraph (1) in rates of additionsd pay— 
"(A) may be made at any specific Department health-care 
facility in order to provide nurses, or any category of nurses, at 
such facility additional pay in an amount competitive with, but 
not exceeding, the amount of the same type of pay that is paid 
to the same category of nurses at non-Federal health-care facili-
ties in the same geographic area as such Department health-
care facility (based upon a reasonably representative sampling 
of such non-Federal facilities); and 
"(B) may be made on a nationwide, local, or other geographic 
basis if the Secretary finds that such an increase is justified on 
the basis of a review of the need for such increase (based upon a 
reasonably representative sampling of non-Federal health-care 
facilities in the geographic area involved). 
"§ 7454. Physician assistants and other health care professionals: 
additional pay 
"(a) Physician assistants and expanded-function dental auxiliaries 
shall be entitled to additional pay on the same basis as provided for 
nurses in section 7453 of this title. 
"(b) When the Secretary determines it to be necessary in order to 
obtain or retain the services of certified or registered respiratory 
therapists, licensed physical therapists, licensed practical or voca-
tional nurses, pharmacists, or occupational therapists, the Secretary 
may, on a nationwide, local, or other geographic basis, pay persons 
employed in such positions additional pay on the same basis as 
provided for nurses in section 7453 of this title. 
Regulations. 
"(c) The Secretary shall prescribe by regulation standards for 
compensation and payment under this section. 
"§ 7455. Increases in rates of basic pay 
"(a)(1) Subject to subsections (b), (c), and (d), when the Secretary 
determines it to be necessary in order to obtain or retain the 
services of persons described in paragraph (2), the Secretary may 
increase the minimum, intermediate, or maximum rates of basic pay 
authorized under applicable statutes and regulations. Any increase 
in such rates of basic pay— 
"(A) may be made on a nationwide basis, local basis, or other 
geographic basis; and 
"(B) may be made— 
"(i) for one or more of the grades listed in the schedules in 
subsection (b)(1) of section 7404 of this title; 
"(ii) for one or more of the health personnel fields within 
such grades; or 
"(iii) for one or more of the grades of the General Sched-
ule under section 5332 of title 5. 
"(2) Paragraph (1) applies to the following: 
"(A) Individuals employed in positions listed in paragraphs (1) 
and (3) of section 7401 of this title. 
"(B) Health-care personnel who— 
"(i) are employed in the Administration (other than 
administrative, clerical, and physical plant maintenance 
and protective services employees); 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 235 
"(ii) are paid under the General Schedule pursuant to 
section 5332 of title 5; 
"(iii) are determined by the Secretary to be providing 
either direct patient-care services or services incident to 
direct patient-care services; and 
"(iv) would not otherwise be available to provide medical 
care and treatment for veterans. 
"(C) Employees who are Department police officers providing 
services under section 218 of this title. 
"(b) Increases in rates of basic pay may be made under subsection 
(a) only in order— 
"(1) to provide pay in an amount competitive with, but not 
exceeding, the amount of the same type of pay paid to the same 
category of personnel at non-Federal facilities in the same labor 
market; 
"(2) to achieve adequate staffing at particular facilities; or 
"(3) to recruit personnel with specialized skills, especially 
those with skills which are especially difficult or demanding. 
"(c) The amount of any increase under subsection (a) in the 
maximum rate for any grade may not (except in the case of nurse 
anesthetists and licensed physical therapists) exceed the amount by 
which the maximum for such grade (under applicable provisions of 
law other than this subsection) exceeds the minimum for such grade 
(under applicable provisions of law other than this subsection), and 
the maximum rate as so increased may not exceed the rate paid for 
individuals serving as Assistant Chief Medical Director. 
"(d)(1) In the exercise of the authority provided in subsection (a) President, 
with respect to personnel described in subparagraph (B) or (C) of 
paragraph (2) of that subsection to increase the rates of basic pay for 
any category of personnel not appointed under subchapter I, the 
Secretary shall, not less than 45 days before the effective date of a 
proposed increase, notify the President of the Secretary's intention 
to provide such an increase. 
"(2) Such a proposed increase shall not take effect if, before the 
effective date of the proposed increase, the President disapproves 
such increase and provides the appropriate committees of the Con-
gress with a written statement of the President's reasons for such 
disapproval. 
"(3) If, before that effective date, the President approves such 
increase, the Secretary may advance the effective date to any date 
not earlier than the date of the President's approval. 
"§ 7456. Nurses: special rules for weekend duty 
"(a) Subject to subsection (b), if the Secretary determines it to be 
necessary in order to obtain or retain the services of nurses at any 
Department health-care facility, the Secretary may provide, in the 
case of nurses appointed under this chapter and employed at such 
facility, that such nurses who work two regularly scheduled 12-hour 
tours of duty within the period commencing at midnight Friday and 
ending at midnight the following Sunday shall be considered for all 
purposes (except computation of full-time equivalent employees for 
the purposes of determining compliance with personnel ceilings) to 
have worked a full 40-hour basic workweek. 
"(b)(1) Basic and additional pay for a nurse who is considered 
under subsection (a) to have worked a full 40-hour basic workweek 
shall be subject to paragraphs (2) and (3). 
105 STAT. 236 
PUBLIC LAW 102-40—MAY 7, 1991 
"(2) The hourly rate of basic pay for such a nurse for service 
performed as part of a regularly scheduled 12-hour tour of duty 
within the period commencing at midnight Friday and ending at 
midnight the following Sunday shall be derived by dividing the 
nurse's annual rate of basic pay by 1,248. 
"(3XA) Such a nurse who performs a period of service in excess of 
such nurse's regularly scheduled two 12-hour tours of duty is enti-
tled to overtime pay under section 7453(e) of this title, or other 
applicable law, for officially ordered or approved service performed 
in excess of eight hours on a day other than a Saturday or Sunday or 
in excess of 24 hours within the period commencing at midnight 
Friday and ending at midnight the following Sunday. 
"(B) Except as provided in subparagraph (C), a nurse to whom this 
subsection is applicable is not entitled to additional pay under 
section 7453 of this title, or other applicable law, for any period 
included in a regularly scheduled 12-hour tour of duty. 
"(C) If the Secretary determines it to be further necessary in order 
to obtain or retain the services of nurses at a particular facility, a 
nurse to whom this paragraph is applicable who performs service in 
excess of such nurse's regularly scheduled two 12-hour tours of duty 
may be paid overtime pay under section 7453(e) of this title, or other 
applicable law, for all or part of the hours of officially ordered or 
approved service performed by such nurse in excess of 40 hours 
during an administrative workweek. 
"(c) A nurse described in subsection (b)(1) who is absent on ap-
proved sick leave or annual leave during a regularly scheduled 12-
hour tour of duty shsill be charged for such leave at a rate of five 
hours of leave for three hours of absence. 
Regulations. 
"(d) The Secretary shall prescribe regulations for the implementa-
tion of this section. 
"§ 7457. On-call pay 
"(a) The Secretary may pay an employee to whom this section 
applies pay at the rate provided in section 7453(h) of this title except 
for such time as the employee may be called back to work. 
"(b) This section applies to an employee who meets each of the 
following criteria: 
"(1) The employee is employed in a position listed in para-
graph (3) of section 7401 of this title or meets the criteria 
specified in clauses (i), (ii), and (iii) of section 7455(a)(2)(B) of this 
title. 
"(2) The employee is employed in a work unit for which on-
call premium pay is authorized. 
"(3) The employee is officially scheduled to be on call outside 
such employee's regular hours or on a holiday designated by 
Federal statute or Executive order. 
"(c) An employee who is eligible for on-call pay under subsection 
(a) and who was receiving standby premium pay pursuant to section 
5545 of title 5 on May 20, 1988, shall, as long £is such employee is 
employed in the same position and work unit £ind remains eligible 
for such standby pay, receive pay for any period of on-call duty at 
the rate equal to the greater of— 
"(1) the rate of pay which such employee would receive if 
being paid the rate of standby pay pursuant to such section that 
such individual would be entitled to receive if such individual 
were not scheduled to be on call instead, or 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 237 
"(2) the rate of pay which such employee is entitled to receive 
including on-call premium pay described in subsection (a).". 
(5) Such chapter is further amended by adding after sub-
chapter V (as added by section 203(a)) the following: 
"SUBCHAPTER VI—REGIONAL MEDICAL EDUCATION 
CENTERS 
"§ 7471. Designation of Regional Medical Education Centers 
"(a) In carrying out the Secretary's functions under section 7302 of 
this title with regard to the training of health personnel, the 
Secretary shall implement a program under which the Secretary 
shall designate as Regional Medical Education Centers such Depart-
ment hospitals as the Secretary determines appropriate to carry out 
the provisions of this subchapter, 
"(b) Each Regional Medical Education Center (hereinafter in this 
subchapter referred to as 'Center') designated under subsection (a) 
shall provide continuing medical and related education programs 
for personnel eligible for training under this subchapter. Such 
programs shall include the following: 
"(1) The teaching of newly developed medical skills and the 
use of newly developed medical technologies and equipment. 
"(2) Advanced clinical instruction. 
"(3) The opportunity for conducting clinical investigations. 
"(4) Clinics! demonstrations in the use of new types of health 
personnel and in the better use of the skills of existing health 
personnel. 
"(5) Routine verification of basic medical skills and, where 
determined necessary, remediation of any deficiency in such 
skills. 
"§ 7472. Supervision and stafHng of Centers 
"(a) Centers shall be operated under the supervision of the Chief 
Medical Director and shall be staffed with personnel qualified to 
provide the highest quality instruction and training in various 
medical and health care disciplines. 
"(b) As a means of providing appropriate recognition to persons in 
the career service of the Administration who possess outstanding 
qualifications in a particular medical or health care discipline, the 
Chief Medical Director shall from time to time and for such period 
as the Chief Medical Director considers appropriate assign such 
persons to serve as visiting instructors at Centers. 
"(c) Whenever the Chief Medical Director considers it necessary 
for the effective conduct of the program provided for under this 
subchapter, the Chief Medical Director may contract for the services 
of highly qualified medical and health personnel from outside the 
Department to serve as instructors at such Centers. 
"§ 7473. Personnel eligible for training 
"(a) The Chief Medical Director shall determine the manner in 
which personnel are to be selected for training in the Centers. 
Preference shall be given to career personnel of the Administration. 
"(b) To the extent that facilities are available medical and health 
personnel from outside the Administration may, on a reimbursable 
basis, be provided training in the Centers. Such reimbursement may 
include reciprocal training of personnel of the Administration pro-
105 STAT. 238 
PUBLIC LAW 102-40—MAY 7, 1991 
vided under sharing arrangements entered into by the Chief Medi-
cal Director and the heads of the entities providing such reciprocal 
training. Any amounts received by the United States as reimburse-
ment under this subsection shall be credited to the applicable 
Department medical appropriation account. 
"§ 7474. Consultation 
"The Chief Medical Director shall carry out this subchapter after 
consultation with the special medical advisory group established 
pursuant to section 7312(a) of this title.". 
(c) TRANSFERS OF CHAPTER 73 SECTIONS TO NEW CHAPTER 
74.— 
(IXA) Sections 4141 and 4142, as amended by section 301, are 
redesignated as sections 7451 and 7452, respectively, and are trans-
ferred to subchapter IV of chapter 74, as added by subsection 0)), 
and inserted before section 7453. 
(B) The heading for subchapter IV of chapter 73, as added by 
section 102(b) of Public Law 101-366, is repealed. 
(2) Section 7451, as so redesignated and transferred, is amended— 
(A) in subsection (a)— 
(i) by striking out "clauses (1) and (3) of section 4104" in 
paragraph (2)(B) and inserting in lieu thereof "paragraphs 
(1) and (3) of section 7401"; 
(ii) by striking out "section 4107" in paragraph (3) and 
inserting in lieu thereof "section 7404"; 
(iii) by striking out "section 4142" in paragraph (4) and 
inserting in lieu thereof "section 7452"; 
(B) by striking out "section 4104(1)" and "section "41070))" in 
subsection (b) and inserting in lieu thereof "section 7401(1)" and 
"section 7404(b)", respectively; and 
(C) by striking out "section 4142(b)(2)" in subsection (g)(8) and 
inserting in lieu thereof "section 7452(b)(2)". 
(3) Section 7452, as so redesignated and transferred, is amended— 
(A) in subsection (a)— 
(i) by striking out "section 4141(a)" in paragraph (1) and 
inserting in lieu thereof "section 7451(a)"; and 
(ii) by striking out "section 4141(c)(1)" in paragraph (2) 
and inserting in lieu thereof "section 7451(c)(1)"; 
(B) by striking out "section 4141(g)" in subsection (b)(2) and 
inserting in lieu thereof "section 7451(g)"; 
(C) by striking out "section 4104(1) in subsections (cXD and 
(e) and inserting in lieu thereof "section 7401(1)"; and 
(D) by striking out "section 4141" in subsection (f) and insert-
ing in lieu thereof "section 7451". 
(4) Section 4120 of such title, as in effect on the day before the date 
of the enactment of this Act, is redesignated as section 7458, trans-
ferred to the end of subchapter IV of chapter 74 of that title, as 
added by subsection (b), and amended by striking out "section 4118 
of this title" in subsection (f) and inserting in lieu thereof "sub-
chapter III". 
SEC. 402. REDESIGNATION OF SECTIONS OF CHAPTERS 51 THROUGH 85. 
(a) TRANSFER OF CHAPTER 75.—Chapter 75 is transferred to the 
end of part V and is redesignated as chapter 78. 
(b) REDESIGNATION OF SECTIONS TO CONFORM TO CHAPTER NUM-
BERS.—(1) Each section contained in any of chapters 51, 53, 55, 57, 
59, 61, 71, 72, 76, 78 (as redesignated by subsection (a)), 81, 83, and 85 
is redesignated so that the first two digits of the section number of 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 239 
that section are the same as the chapter number of the chapter 
containing that section. 
(2) Chapter 82 is amended— 
(A) by redesignating section 5070 as section 8201; 
(B) by redesignating sections 5071, 5072, 5073, and 5074 as 
sections 8211, 8212, 8213, and 8214, respectively; 
(C) by redesignating sections 5081, 5082, and 5083 as sections 
8221, 8222, and 8223, respectively; 
(D) by redesignating sections 5091, 5092, and 5093 as sections 
8231, 8232, and 8233, respectively; and 
(E) by redesignating section 5096 as section 8241. 
(c) TABLES OF SECTIONS AND CHAPTERS.—(1) The tables of sections 
at the beginning of the chapters referred to in subsection 0)) are 
revised so as to conform the section references in those tables to the 
redesignations made by that subsection. 
(2) The table of chapters before part I and the tables of chapters at 
the beginning of parts IV, V, and VI are revised so as to conform the 
section references in those tables to the redesignations made by 
subsection (b). 
(d) CROSS-REFERENCES.—(1) Each provision of title 38, United 
States Code, that contains a reference to a section redesignated by 
section 401(aX4) or by subsection (b) is amended so that the reference 
refers to the section as redesignated. 
(2) Any reference in a provision of law other than title 38, United 
States Code, to a section redesignated by subsection (b) shall be 
deemed to refer to the section as so redesignated. 
SEC. 403. CONFORMING AMENDMENTS. 
(a) SUBCHAPTERS OF CHAPTER 73.—Subchapter III and subchapter 
IV (as redesignated by section 401(aX2)) of chapter 73 are amended— 
(1) by striking out "Administrator" and "Administrator's" 
each place they appear and inserting in lieu thereof "Secretary" 
and "Secretary's", respectively; and 
(2) by striking out "Veterans' Administration" each place it 
appears and inserting in lieu thereof "Department"; 
(3) by striking out "section 4101(cXl)" in section 7362 and 
inserting in lieu thereof "section 7303(a)"; 
(4) by striking out "of this section" and "of this subsection" 
each place they appear (other than in subsections (d), (e), and (g) 
of section 7332 and in section 7333(b)); and 
(5) by striking out "of this paragraph" in section 7332(fK2XB). 
(b) REFERENCES TO CHAPTER 73 PROVISIONS.— 
(1) Section 1904(a) is amended by striking out "section 4101" 
and inserting in lieu thereof "section 7303". 
(2) Section 5705(a) (as redesignated by section 402(b)) is 
amended by striking out "section 4152(b)" and inserting in lieu 
thereof "section 7311(g)". 
(3) Section 7604(1XB) (as redesignated by section 402(b)) is 
amended by striking out "section 4105" and inserting in lieu 
thereof "section 7402". 
(4) Section 7612(b) (as redesignated by section 402(b)) is 
amended— 
(A) in parsigraph (2)— 
(i) by striking out "section 4104" in the matter 
preceding subparagraph (A) and inserting in lieu 
thereof "section 7401"; and 
105 STAT. 240 
PUBLIC LAW 102-40—MAY 7, 1991 
(ii) by striking out "section 4104(3)" in subparagraph 
(B) and inserting in lieu thereof "section 7401(3) ; and 
(B) in paragraph (3), by striking out "section 4107(g)(lXB) 
of this title" and inserting in lieu thereof "subsection (a)(1) 
of section 7455 of this title for personnel described in 
subsection (aX2)(B) of such section". 
(5) Section 7616(bX4) (as redesignated by section 402(b)) is 
amended by striking out "section 4108(cXl)" and inserting in 
lieu thereof "section 7423(dXl)". 
(6) Section 8201(f) (as redesignated by section 402(b)) is 
amended by striking out "section 4101(b)" and inserting in lieu 
thereof "section 7302". 
(7) Section 8241 (as redesignated by section 402(b)) is amended 
by striking out "section 4101(b)" and inserting in lieu thereof 
"section 7302". 
(c) REFERENCES IN TITLE 5, UNITED STATES CODE.—Title 5, United 
States Code, is amended as follows: 
(1) Section 5102(c) is amended— 
(A) in paragraph (14), by striking out "section 4202 of title 
38" and inserting in lieu thereof ^'section 7802 of title 38"; 
and 
(B) in paragraph (16), by striking out "section 4114" and 
inserting in lieu thereof "sections 7405 and 7406". 
(2) Section 6123 is amended— 
(A) in subsection (aXD, by striking out "section 4107(eX5)" 
and inserting in lieu thereof "section 7453(e)"; and 
(B) in subsection (cX2)— 
(i) by striking out "section 4107(eX2)" in the matter 
.ij< 
preceding subparagraph (A) and inserting in lieu 
- •...• 
thereof "section 7453(b)"; and 
(ii) by striking out "subsection (eX2) of such section 
4107" in subparagraph (B) and inserting in lieu thereof 
"subsection (b) of such section 7453". 
(3) Section 6128(a) is amended by striking out "section 
4107(eX5)" and inserting in lieu thereof "section 7453(e)". 
(e) PART V HEADING.— 
(1) The heading of part V is amended to read as follows: 
"PART V—BOARDS, ADMINISTRATIONS, AND SERVICES". 
(2) The item relating to part V in the table of parts before 
part I is amended to read as follows: 
"V. Boards, Administrations, and Services 
7101". 
(f) TABLES OF CHAPTERS.— 
(1) The table of chapters before part I is amended— 
(A) by striking out the heading for part V and inserting 
in lieu thereof the following: 
"PART V—BOARDS, ADMINISTRATIONS, AND 
SERVICES"; 
(B) by striking out the items relating to chapters 73 and 
75 and inserting in lieu thereof the following: 
PUBLIC LAW 102-40—MAY 7, 1991 
105 STAT. 241 
"73. Veterans Health Administration—Organization and Functions 
^^^^„ 
"74. Veterans Health Administration—Personnel 
7401"; 
and 
(C) by inserting after the item relating to chapter 76 the 
following new item: 
"78. Veterans' Canteen Service 
7801". 
(2) The table of chapters at the beginning of part V is 
amended— 
(A) by striking out the items relating to chapters 73 and 
75 and inserting in lieu thereof the following: 
"73. Veterans Health Administration—Organization and Functions 
7301 
"74. Veterans Health Administration—Personnel 
7401"; 
and 
(B) by adding at the end the following new item: 
"78. Veterans' Canteen Service 
7801". 
Approved May 7, 1991. 
LEGISLATIVE HISTORY—H.R. 598 (S. 675): I 
CONGRESSIONAL RECORD, Vol. 137 (1991): 
Jan. 30, considered and passed House. 
Apr. 17, considered and passed Senate, amended, in lieu of S. 675. 
Apr. 23, House concurred in Senate amendment.