An Act to amend title 38, United States Code, to improve the quality of hospital care, medical services, and nursing home care in Veterans' Administration health care facilities; to make certain technical and conforming amendments; and for other purposes.
PL 94-581 (H.R.2735), enacted 10/21/1976

90 STAT. 2842 
PUBLIC LAW 94-581—OCT. 21, 1976 
Public Law 94-581 
94th Congress 
Oct. 21. 1976 
[H.R. 2735] 
Veterans 
Omnibus Health 
Care Act of 1976. 
38 u s e 101 note. 
Investigations. 
Review. 
An Act 
To amend title 38, United States Code, to improve tlie (luality of hospital care, 
medical services, and nursing home care in Veterans' Administration health 
care facilities; to make certain technical and conforming amendments; and 
for other purposes. 
Be it enacted hy the Senate and House of Representatives of the 
United States of America in Congress assembled, That this Act may 
be cited as the "Veterans Omnibus Health Care Act of 1976". 
TITLE I—GENERAL VETERANS HEALTH CARE AND 
DEPARTMENT 
OF 
MEDICINE 
AND 
SURGERY AMEND-
MENTS 
SEC. 101. Section 111 of title 38, United States Code, is amended by— 
(1) inserting in subsection (a) "pursuant to the provisions of 
this section" after "President"; and 
(2) inserting at the end of such section the following new 
subsection: 
"(e) (1) In carrying out the purposes of this section, the Admin-
istrator, in consultation with the Administrator of General Services, 
the Secretary of Transportation, the Comptroller General of the 
United States, and representatives of organizations of veterans, shall 
conduct periodic investigations of the actual cost of travel (including 
lodging and subsistence) to beneficiaries while traveling to or from 
a Veterans' Administration facility or other place pursuant to the 
provisions of this section, and the estimated cost of alternative modes 
of travel, including public transportation and the operation of pri-
vately owned vehicles. The Administrator shall conduct such inves-
tigations immediately following any alteration in the rates described 
in paragraph (3) (C) of this subsection, and, in any event, immediately 
following the enactment of this subsection and not less often than 
annually thereafter, and based thereon, shall determine rates of allow-
ances or reimbursement to be paid under this section. 
"(2) In no event shall payment be provided under this section— 
"(A) unless the person claiming reimbursement has been deter-
mined, based on an annual declaration and certification by such 
person, to be unable to defray the expenses of such travel (except 
with respect to a veteran receiving benefits for or in connection 
with a service-connected disability under this title);; 
"(B) to reimburse for the cost of travel by privately owned 
vehicle in any amount in excess of the cost of such travel by public 
transportation unless (i) public transportation is not reasonably 
accessible or would be medically inadvisable, or (ii) the cost of 
such travel is not greater than the cost of public transportation; 
and 
"(C) in excess of the actual expense incurred by such person 
as certified in writing bj[ such person. 
" (3) In conducting investigations and determining rates under this 
section, the Administrator snail review and analyze, among other 
factors, the following factors: 
PUBLIC LAW 94^581—OCT. 21, 1976 
90 STAT. 2843 
"(A)(i) Depreciation of original vehicle costs; 
"(ii) gasoline and oil costs; 
" (iii) maintenance, accessories, parts, and tire costs; 
"(iv) insurance costs; and 
"(v) State and Federal taxes. 
"(B) 
The availability of and time required for public 
transportation. 
"(C) The per diem rates, mileage allowances, and expenses of 
travel authorized under sections 5702 and 5704 of title 5 for 5 U
S
C 5702, 
employees of the United States. 
^^^*-
"(4) Before determining rates under this section, and not later Report to 
than sixty days after the effective date of this subsection, and there- congressional 
after not later than sixty days after any alteration in the rates committees, 
described in paragraph (3) (C) of this subsection, the Administrator 
shall submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report containing the rates the 
Administrator proposes to establish or continue with a full justifica-
tion therefor in terms of each of the limitations and factors set forth 
in this section.". 
SEC. 102. Section 601 of title 38, United States Code, is amended 
by— 
(1) amending paragraph (5) by striking out in clause (B) 
all after "training" and inserting in lieu thereof "for the members 
of the immediate family or legal guardian of a veteran, or the 
individual in whose household such veteran certifies an intention 
to live, as may be essential to the effective treatment and rehabili-
tation of a veteran or dependent or survivor of a veteran receiving 
care under the last sentence of section 613(b) of this title; and"; 
(2) amending paragraph (6) to read as follows: 
"(6) The term 'medical services' includes, in addition to medical 
examination, treatment, and rehabilitative services— 
"(A)(i) surgical services, dental services and appliances as 
authorized in section 612 (b), (c), (d), and (e) of this title, opto-
metric and podiatric services, and (except under the conditions 
described in section 612(f)(1)(A) of this title), wheelchairs, 
artificial limbs, trusses, and similar appliances, special clothing 
made necessary by the wearing of prosthetic appliances, and such 
other supplies or services as the Administrator determines to be 
reasonable and necessary, and (ii) travel and incidental expenses 
pursuant to the provisions of section 111 of this title; and 
"(B) such consultation, professional counseling, training, and 
mental health services as are necessary in connection with the 
treatment— 
"(i) of the service-connected disability of a veteran pur-
suant to section 612 (a) of this title, and 
"(ii) in the discretion of the Administrator, of the non-
service-connected disability of a veteran eligible for treatment 
under section 612(f) (1) (B) of this title where such services 
were initiated during the veteran's hospitalization and the 
provision of such services on an outpatient basis is essential 
to permit the discharge of the veteran from the hospital, 
for the members of the immediate family or legal guardian of 
a veteran, or the individual in whose household such veteran 
certifies an intention to live, as may be essential to the effective 
treatment and rehabilitation of the veteran (including, under the 
terms and conditions set forth in section 111 of this title, necessary 
'Medical 
90 STAT. 2844 
PUBLIC LAW 94-581—OCT. 21, 1976 
"Domiciliary 
care." 
"Rehabilitative 
Medical 
treatment, 
eligibility. 
expenses of travel and subsistence of such family member or 
individual in the case of a veteran who is receiving care for a 
service-connected disability, or in the case of dependent or sur-
vivor of a veteran receiving care under the last sentence of section 
613(b) of this title). For the purposes of this paragraph, a 
dependent or survivor of a veteran receiving care under the last 
sentence of section 613(b) of this title shall be eligible for the 
same medical services as a veteran."; 
(3) amending paragraph (7) to read as follows: 
" (7) The term 'domiciliary care' includes necessary medical services 
and travel and incidental expenses pursuant to the provisions of 
section 111 of this title."; and 
(4) inserting at the end of such section the following new 
paragraph: 
"(8) The term 'rehabilitative services' means such professional, 
counseling, and guidance services and treatment programs (other than 
those types of vocational rehabilitation services provided under chap-
ter 31 of this title) as are necessary to restore, to the maximum extent 
possible, the physical, mental, and psychological functioning of an ill 
or disabled person.". 
SEC. 103. (a) Section 612 of title 38, United States Code, is amended 
(1) inserting after the first sentence of subsection (a) the 
following new sentence: "The Administrator may also furnish 
to any such veteran such home health services as the Adminis-
trator finds to be necessary or aj>propriate for the effective and 
economical treatment of such disability (including only such 
improvements and structural alterations the cost of which does 
not exceed $2,500 (or reimbursement up to such amount) as are 
necessary to assure the continuation of treatment for such dis-
ability or to provide access to the home or to essential lavatory 
and sanitary facilities."; 
(2) striking out "or" at the end of clause (4) of subsection 
(b); redesignating clause (5) of such subsection as clause (6); 
and inserting after clause (4) of such subsection the following 
new clause (5): 
"(5) which is a non-service-connected condition or disability 
of a veteran for which treatment was begun while such veteran 
was receiving hospital care under this chapter and such services 
and treatment are reasonably necessary to complete such treat-
ment ; or"; 
(3) striking out "may also furnish" in subsection (f) and 
inserting in lieu thereof a comma and "within the limits of Vet-
erans' Administration facilities, may furnish"; 
(4) inserting in clause (1)(A) of subsection (f) "(to the extent 
that facilities are available)" after "or" the first place it appears; 
(5) inserting before the semicolon at the end of clause (1) (B) 
of subsection (f) "(for a period not in excess of twelve months 
after discharge from in-hospital treatment, except where the 
Administrator finds that a longer period is required by virtue of 
the disability being treated)"; 
(6) striking out "80" and inserting in lieu thereof "50" in 
clause (2) of subsection (f); 
(7) inserting at the end of subsection (f) the following ncAv 
sentence: "The Administrator may also furnish to any such vet-
eran such home health services as the Administrator determines to 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2845 
be necessary or appropriate for the effective and economical treat-
ment of a disability of a veteran (including only such improve-
ments and structural alterations the cost of which does not exceed 
$600 (or reimbursement up to such amount) as are necessary to 
assure the continuation of treatment or provide access to the home 
or to essential lavatory and sanitary facilities)."; and 
(8) inserting at the end thereof the following new subsections: 
"(i) Not later than ninety days after the effective date of this sub- Regulations, 
section, the Administrator shall prescribe regulations to ensure that 
special priority in furnishing medical services under this section and 
any other outpatient care with funds appropriated for the medical 
care of veterans shall be accorded in the following order, unless com-
pelling medical reasons require that such care be provided more 
expeditiously: 
"(1) To any veteran for a service-connected disability. 
"(2) To any veteran described in subsection (f)(2) of this 
section. 
"(3) To any veteran with a disability rated as service-
connected. 
"(4) To any veteran being furnished medical services under 
subsection (g) of this section, 
"(j) In order to assist the Secretary of Health, Education, and 
Welfare in carrying out national immunization programs pursuant to 
other provisions of law^ the Administrator may authorize the admin-
istration of immunizations to eligible veterans (voluntarily request-
ing such immunizations) in connection with the provision of care for 
a disability under this chapter in any Veterans' Administration health 
care facility, utilizing vaccine furnished by the Secretary at no cost 
to the Veterans' Administration, and for such purpose, notwithstand-
ing any other provision of law, the Secretary is authorized to provide 
such vaccine to the Veterans' Administration at no cost and the provi-
sions of section 4116 of this title shall apply to claims alleging negli-
gence or malpractice on the part of Veterans' Administration 
personnel granted immunity under such section.". 
(b) Not later than one year after the effective date of this section. Report to 
and annually thereafter, the Administrator shall report to the Con- Congress, 
gress on the results of the regulations prescribed to carry out the 38 U
S
C 612 note, 
amendment (adding section 612 (i) of title 38, United States Code) 
made by subsection (a) (8) of this section. 
SEO. 104. Subsection (a) of section 613 of title 38, United States 
Code, is amended by amending clause (2) to read as follows: 
"(2) the widow or child of a veteran who (A) died as a result 
of a service-connected disability, or (B) at the time of death had 
a total disability permanent in nature, resulting from a service-
connected disability,". 
SEC. 105. (a) Section 618 of title 38, United States Code, is amended Therapeutic and 
b y — 
rehabilitative 
(1) striking out "The" in the first sentence and inserting in lieu services, 
thereof "(a) In providing rehabilitative services under this 
chapter, the"; 
(2) striking out "hospitals and domiciliaries" and inserting in 
lieu thereof "health care facilities"; and 
(3) inserting below subsection (a) (as redesignated by clause 
(1) of this subsection) the following new subsections: 
89-194 O—78—pt. 2 
87 
90 STAT. 2846 
PUBLIC LAW 94-581—OCT. 21, 1976 
Recordkeeping. 
Veterans' 
Administration 
Special 
Therapeutic and 
Rehabilitation 
Activities Fund. 
Establishment. 
38 
use 
1501, 
1651, 
1700. 
Regulations. 
Qaims, 
settlement. 
38 u s e 618 note. 
"(b) (1) In furnishing rehabilitative services under this chapter, the 
Administrator, upon the recommendation of the Chief Medical 
Director, may enter into contractual arrangements with private indus-
try or other sources outside the Veterans' Administration to provide 
for therapeutic work for remuneration for patients and members in 
Veterans' Administration health care facilities. 
" (2) Notwithstanding any other provision of law, the Administrator 
may also furnish rehabilitative services under this subsection through 
contractual arangements with nonprofit entities to provide for such 
therapeutic work for such patients. The Administrator shall establish 
appropriate fiscal, accounting, management, recordkeeping, and report-
ing requirements with respect to the activities of any such nonprofit 
entity in connection with such contractual arrangements. 
"(c) (1) There is hereby established in the Treasury of the United 
States a revolving fund known as the Veterans' Administration Special 
Therapeutic and Rehabilitation Activities Fund (hereinafter in this 
section referred to as the 'fund') for the purpose of carrying out the 
provisions of subsection (b) of this section. Such amounts of the 
fund as the Administrator may determine to be necessary to estab-
lish and maintain operating accounts for the various rehabilitative 
services activities may be deposited in checking accounts in other 
depositaries selected or established by the Administrator. 
(2) All funds received by the Veterans' Administration under con-
tractual arrangements made under subsection (b) of this section, or 
by nonprofit entities described in paragraph (2) of such subsection, 
shall be deposited in or credited to the fund, and the Administrator 
shall pay out of the fund moneys to participants at rates not less than 
the wage rates specified in the Fair Labor Standards Act (29 U.S.C. 
201 et seq.) and regulations prescribed thereunder for work of similar 
character. 
"(3) The Chief Medical Director shall prepare, for inclusion in the 
annual report submitted to Congress under section 214 of this title, a 
description of the scope and achievements of activities carried out 
under this section (including pertinent data regarding productivity 
and wage rates) during the prior twelve months and an estimate of 
the needs of the program of therapeutic and rehabilitation activities 
to be carried out under this section for the ensuing fiscal year. 
"(d) In providing rehabilitative services under this chapter, the 
Administrator shall take appropriate action to make it possible for the 
patient to take maximum advantage of any benefits to which such 
patient is entitled under chapter 31, 34, or 35 of this title, and, if the 
patient is still receiving treatment of a prolonged nature under this 
chapter, the provision of rehabilitative services under this chapter 
shall be continued during, and coordinated with, the pursuit of edu-
cation and training under such chapter 31,34, or 35. 
"(e) The Administrator shall prescribe regulations to ensure that 
the priorities set forth in section 612(i) of this title shall be applied, 
insofar as practicable, to participation in therapeutic and rehabilita-
tion activities carried out under this section.". 
(b) (1) The Administrator is authorized to settle claims made by the 
Veterans' Administration against any private nonprofit corporation 
organized under the laws of any State, for the use of Veterans' 
Administration facilities and personnel in work projects as a part of a 
therapeutic or rehabilitation program for patients and members in 
Veterans' Administration health care facilities, and to execute a bind-
ing release of all claims by the United States against any such corpora-
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2847 
tion, in such amounts, and upon such terms and conditions as the 
Administrator deems appropriate. 
(2) For the purposes of this subsection, notwithstanding section 
484 of title 31, or any other provision of law, the Administrator may 
utilize any funds received under any settlement made pursuant to 
paragraph (1) of this subsection for any purpose agreed upon by the 
Administrator and such corporation. 
SEC. 106. Section 620 of title 38, United States Code, is amended 
b y - 
. 
. 
. 
(1) inserting in subsection (a) "and except as provided in 
subsection (e)" after "subsection (b)"; 
(2) striking out "40 per centum" and inserting in lieu thereof 
"45 per centum" in clause (ii) of subsection (a); 
(3) inserting before the period at the end of clause (ii) of sub-
section (a) a comma and "or not to exceed 60 per centum of such 
cost where determined necessary by the Administrator, upon 
recommendation of the Chief Medical Director, to provide ade-
quate care"; and 
(4) inserting at the end thereof the following new subsection: 
"(e) For the purposes of this section, the term 'nursing home care' "Nursing home 
includes intermediate care, as determined by the Administrator in care." 
accordance with regulations which the Administrator shall prescribe. 
The cost of intermediate care for purposes of payment by the United 
States pursuant to subsection (a) (ii) of this section shall be determined 
by the Administrator except that the rate of reimbursement shall be 
commensurately less than that provided for nursing home care (as 
defined in section 101 (28) of this title).", 
SEC. 107. (a) Subsection (a) of section 642 of title 38, United States 
Code, is amended by inserting at the end thereof the following new 
sentence: "No payment or grant may be made to any home under this 
subchapter unless such home is determined by the Administrator to 
meet such standards as the Administrator shall prescribe, which stand-
ards with respect to nursing home care shall be no less stringent than 
those prescribed pursuant to section 620(b) of this title.". 
(b) Section 5034 of title 38, United States Code, is amended by— 
(1) striking out "subchapter" the first place it appears and 
inserting in lieu thereof "section or any amendment to it with 
respect to such amendment"; and 
(2) inserting at the end thereof the following new clause: 
" (^3) General standards for the furnishing of nursing home care 
in facilities which are constructed with assistance received under 
this subchapter, which standards shall be no less stringent than 
those standards prescribed by the Administrator j)ursuant to 
section 620(b) of this title. The Administrator may inspect any 
State facility constructed with assistance received under this 
subchapter at such times as the Administrator deems necessary 
to insure that such facility meets such standards.". 
SEC. 108. Subsection (e) of section 1903 of title 38, United States 
Code, is amended by— 
(1) striking out "or member of the Armed Forces" and insert-
ing such language after "title" in paragraph (1); and 
(2) inserting at the end thereof the following new paragraph: 
"(3) Notwithstanding any other provision of law, the Administra-
tor may obtain, by purchase, lease, gift, or otherwise, any automobile, 
motor vehicle, or other conveyance deemed necessary to carry out the 
purposes of this subsection, and may sell, assign, transfer, or convey 
90 STAT. 2848 
PUBLIC LAW 94-581—OCT. 21, 1976 
any such automobile, vehicle, or conveyance to which the Veterans' 
Administration obtains title for such price and upon such terms as the 
Administrator deems appropriate; and any proceeds received from 
any such disposition shall be credited to the applicable Veterans' 
Administration appropriation.". 
SEC. 109. Subsection (b)(1) of section 4114 of title 38, United 
States Code, is amended by inserting "(which may be established 
retroactively based on changes in such customary amount and terms)" 
after "pay". 
SEC. 110. Subchapter I of chapter 73 of title 38, United States Code, 
is further amended by— 
(1) inserting in section 4102 "a Pediatric Service, an Opto-
metric Service," after "Dental Service,"; 
(2) striking out "and a Director of Optometry, appointed by 
the Administrator." and inserting in lieu thereof "a Director 
of Podiatric Service, and a Director of Optometric Service, 
appointed by the Administrator, and who shall be responsible to 
the Chief Medical Director for the operation of their respective 
Services." in clause (7) of subsection (a) of section 4103; 
-•'' 
' 
(3) amending section 4104 by— 
(A) inserting "podiatrists, optometrists," after "dentists," 
in clause (1); and 
(B) striking out "optometrists," in clause (2); 
(4) redesignating clauses (5), (6), (7), and (8) in subsection 
(a) of section 4105 as clauses (6), (7), (8), and (9), respectively, 
and inserting after clause (4) the following new clause: 
"(5) Podiatrist— 
"hold the degree of doctor of podiatric medicine, or its 
equivalent, from a school of podiatric medicine approved 
by the Administrator, and be licensed to practice 
podiatry in a State;"; 
(5) inserting "podiatrists, optometrists," after "dentists," in 
subsections (a) and (c) and inserting "podiatrist, optometrist," 
after "dentist," in subsection (e) of section 4106; 
(6) amending section 4107 by— 
(A) (i) inserting in the SECTION 4IO3 SCHEDULE in subsec-
tion (a) 
"Director of Podiatric Service, $36,338 minimum to $46,026 
maximum." 
immediately below 
"Director of Nursing Service, $42,066 minimum to $47,674 
maximum."; and 
(ii) striking out "Director of Optometry" and inserting 
in lieu thereof "Director of Optometric Service" in such 
schedule in such subsection; and 
(B) inserting immediately below the NURSE SCHEDULE in 
paragraph (1) of subsection (b) the following new schedule: 
u 
CLINICAL PODIATRIST AND OPTOMETRIST SCHEDULE 
"Chief grade, $31,309 minimum to $40,705 maximum. 
"Senior grade, $26,861 minimum to $34,916 maximum. 
"Intermediate grade, $22,906 minimum to $29,782 maximum. 
"Full grade, $19,386 minimum to $25,200 maximum. 
"Associate grade, $16,255 minimum to $21,133 maximum."; 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2849 
(7) inserting "podiatrists, optometrists," after "dentists," and 
"podiatrist, optometrist," after "dentist," each place those words 
appear in the language preceding clause (1) and in subclause (B) 
of clause (6) of subsection (a) of section 4108; 
38 USC 4108. 
(8) inserting "podiatric, optometric," after "dental," in subsec-
tion (a) of section 4112; 
(9) mserting "podiatrists, optometrists," after "dentists," in 
section 4113; 
(10) amending section 4114 by— 
(A) inserting "podiatrists, optometrists," after "dentists," 
each place such term appears in paragraphs (1) (A) and 
(B) and (3) (A) and (B) of subsection (a); and 
(B) striking out "or dentist" and inserting in lieu thereof 
a comma and "dentist, podiatrist, or optometrist" in the 
language preceding clause (1) of subsection (d) and in clause 
(1) of such subsection j 
(11) inserting "podiatrist, optometrist," after "dentist," each 
place such word appears in subsection (a) of section 4116; and 
(12) amending section 4117 by— 
(A) striking out "medical schools," and inserting in lieu 
thereof "schools and colleges of medicine, osteopathy, den-
tistry, podiatry, optometry, and nursing,"; and 
(B) inserting "podiatrists, optometrists," after "dentists,". 
SEC. 111. (a)(1) Chapter 73 of title 38, United States Code is 
amended by inserting at the end thereof the following new subchapter: 
"Subchapter III—Protection of Patient Rights 
"§ 4131. Informed consent 
38 USC 4131. 
"The Administrator, upon the recommendation of the Chief Medi- Regulations. 
cal Director and pursuant to the provisions of section 4134 of this 
title, shall prescribe regulations establishing procedures to ensure that 
all medical and prosthetic research carried out and, to the maximum 
extent practicable, all patient care furnished under this title shall be 
carried out only with the full and informed consent of the patient or 
subject or, in appropriate cases, a representative thereof. 
*
*
§ 4132. Confidentiality of certain medical records 
38 USC 4132. 
"(a) Records of the identity, diagnosis, prognosis, or treatment of 
any patient or subject which are maintained in connection with the 
performance of any program or activity (including education, train-
ing, treatment, rehabilitation, or research) relating to drug abuse, alco-
holism or alcohol abuse, or sickle cell anemia which is carried out by or 
for the Veterans' Administration under this title shall, except as pro-
vided in subsection (e) of this section, be confidential, and (section 
3301 of this title to the contrary notwithstanding) such records may be 
disclosed only for the purposes and under the circumstances expressly 
authorized under subsection (b) of this section. 
"(b) (1) The content of any record referred to in subsection (a) of 
this section may be disclosed by the Administrator in accordance with 
the prior written consent of the patient or subject with respect to 
whom such record is maintained, but only to such extent, under such 
circumstances, and for such purposes as may be allowed in regulations 
prescribed by the Administrator pursuant to section 41.34 of this title. 
"(2) Whether or not any patient or subject, with respect to whom 
any given record referred to in subsection (a) of this section is main-
90 STAT. 2850 
PUBLIC LAW 94-581—OCT. 21, 1976 
tained, gives written consent, the content of such record may be dis-
closed by the Administrator as follows: 
"(A) To medical personnel to the extent necessary to meet a 
bona fide medical emergency. 
"(B) To qualified personnel for the purpose of conducting 
scientific research, management audits, financial audits, or pro-
gram evaluation, but such personnel may not identify, directly 
or indirectly, any individual patient or subject in any report of 
such research, audit, or evaluation, or otherwise disclose patient 
or subject identities in any manner. 
"(C) If authorized by an appropriate order of a court of com-
petent jurisdiction granted after application showing good cause 
therefor. In assessing good cause the court shall weigh the public 
interest and the need for disclosure against the injury to the 
patient or subject, to the physician-patient relationsnip, and to 
the treatment services. Upon the granting of such order, the court, 
in determining the extent to which any disclosure of all or any 
part of any record is necessary, shall impose appropriate safe-
guards against unauthorized disclosure. 
"(3) In the event that the patient or subject who is the subject of 
any record referi-ed to in subsection (a) of this section is deceased, the 
content of any such record may be disclosed by the Administrator only 
upon the prior written request of the next of kin, executor, adminis-
trator, or other personal representative of such patient or subject and 
only if the Administrator determines that such disclosure is necessary 
for such survivor to obtain benefits to which such survivor may be 
entitled, including the pursuit of legal action, but then only to the 
extent, under such circumstances, and for such purposes as ma^ be 
allowed in regulations prescribed pursuant to section 4131 of this title. 
"(c) Except as authorized by a court order granted under sub-
section (b)(2)(C) of this section, no record referred to in subsection 
(a) of this section may be used to initiate or substantiate any criminal 
charges against, or to conduct any investigation of, a patient or 
subject. 
"(d) The prohibitions of this section shall continue to appl^ to 
records concerning any person who has been a patient or subject, irre-
. 
spective of whether or when such person ceases to be a patient. 
"(e) The prohibitions of this section shall not prevent any inter-
change of records— 
" (1) within and among those components of the Veterans' 
Administration furnishing health care to veterans, or determin-
ing eligibility for benefits under this title; or 
"(2) between such components furnishing health care to vet-
erans and the Armed Forces. 
"(f) Any person who violates any provision of this section or any 
regulation issued pursuant to this section shall be fined not more than 
$500 in the case of a fii-st offense, and not more than $.5,000 in the case 
of each subsequent offense. 
38 use 4133. 
'^§4133. Nondiscrimination in the admission of alcohol and 
drug abusers to Veterans' Administration liealth care 
facilities 
38 use 601 et 
"Veterans eligible for treatment under chapter 17 of this title who 
**?• 
are alcohol or drug abusers and who are suffering from medical dis-
abilities shall not be discriminated against in admission or treatment, 
solely because of their alcohol or drug abuse or dependence, by any 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2851 
Veterans' Administration health care facility. The Administrator, 
pursuant to the provisions of section 4134 of this title, shall prescribe 
regulations for the enforcement of this nondiscrimination policy with 
respect to the admission and treatment of such eligible veterans who 
are alcohol or drug abusers. 
"§4134. Coordination; reports 
"(a) Regulations prescribed pursuant to section 4131 of this title, 
section 4132 of this title with respect to the confidentiality of alcohol 
and drug abuse medical records, and section 4133 of this title, shall, 
to the maximum extent feasible consistent with other provisions of 
this title, make applicable the regulations governing— 
"(1) human experimentation and informed consent prescribed 
by the Secretary of Health, Education, and Welfare, based on 
the recommendations of the National Commission for the Pro-
tection of Human Subjects of Biomedical and Behavioral 
Research, established by section 201 of the National Research 
Act, as amended (Public Law 93-348; 88 Stat. 348), and 
"(2) (A) the confidentiality of drug and alcohol abuse medical 
records, and (B) the admission of drug and alcohol abusers to 
private and public hospitals, prescribed pursuant to the Compre-
hensive Alcohol Abuse and Alcoholism Prevention, Treatment, 
and Rehabilitation Act of 1970, as amended (42 U.S.C. 4551 et 
seq.), and the Drug Abuse Office and Treatment Act of 1972, as 
amended (21 U.S.C. 1101 et seq.), 
to the conduct of research and to the provision of hospital care, nurs-
ing home care, domiciliary care, and medical services under this title. 
Such regulations may contain such definitions, and may provide for 
such safeguards and procedures (including procedures and criteria for 
the issuance and scope of court orders under section 4132(b) (2) (C) 
of this title) as are necessary to prevent circumvention or evasion 
thereof, or to facilitate compliance therewith. In prescribing and 
implementing regulations pursuant to this subsection, the Adminis-
trator shall, from time to time, consult with the Secretary of Health, 
Education, and Welfare, and, as appropriate, the Director of the 
Office of Drug Abuse Policy (or any successor authority), in order to 
achieve the maximum possible coordination of the regulations, and the 
implementation thereof, which they and the Administrator prescribe. 
" (b) Not later than sixty days after the effective date of this sub-
section, the Administrator shall submit to the appropriate committees 
of the House of Representatives and the Senate a full report with 
respect to the regulations (including guidelines, policies, and pro-
cedures thereunder) prescribed pursuant to subsection (a) of this 
section. Such report shall include (1) an explanation of any inconsist-
ency between such regulations and the regulations of the Secretary 
referred to in such subsection (a); (2) an account of the extent, sub-
stance, and results of consultations with the Secretary (or Director, 
as appropriate) respecting the prescribing and implementation of 
the Administrator's regulations; and (3) such recommendations for 
legislation and administrative actions as the Administrator deter-
mines are necessary and desirable. The Administrator shall timely 
publish such report in the Federal Register.". 
(2) The table of sections at the beginning of such chapter is amended 
by adding at the end thereof: 
Regulations. 
38 u s e 4134. 
42 u s e 289/-1 
note. 
Consultation. 
Report to 
congressional 
committees. 
Contents. 
Legislative 
recommenda-
tions. 
Publication in 
Federal Register. 
90 STAT. 2852 
PUBLIC LAW 94-581—OCT. 21, 1976 
"" 
"SUBCHAPTER III 
PROTECTION OF PATIENT RIGHTS 
"4131. Informed consent. 
"4132. Confidentiality of certain medical records. 
"4133. Nondiscrimination in the admission of alcohol and drug abusers to Vet-
erans' Administration health care facilities. 
"4134. Coordination; reports.". 
(b) Subsection (b) of section 653 of title 38, United States Code, 
is amended to read as follows: 
"(b) Patient records prepared or obtained under this subchapter 
shall be held confidential in the same manner and under the same con-
ditions prescribed in section 4132 of this title.". 
(c) The following provisions of law are superseded by the provi-
sions of the amendments to chapter 73 of title 38, United States Code, 
made by subsection (a) of this section: 
(1) Paragraph (2) of subsection (b) of section 321 of the Compre-
hensive Alcohol Abuse and Alcoholism Prevention, Treatment, and 
Kehabilitation Act of 1970 (42 U.S.C. 4581(b)(2)), as added by 
section 121(a) of the Comprehensive Alcohol Abuse and Alcoholism 
Prevention, Treatment, and Rehabilitation Act Amendments of 1974 
(Public Law 93-282; 88 Stat. 130). 
(2) Paragraph (2) of subsection (b) of section 407 of the Drug 
Abuse Office and Treatment Act of 1972 (21 U.S.C. 1174(b) (2)), as 
amended by section 6(a) of the Act entitled "An Act to amend the 
Drug Abuse Office and Treatment Act of 1972, and for other purposes", 
approved March 19,1976 (Public Law 94-237; 90 Stat. 244-5). 
(3) Subsection (h) of section 408 of such 1972 Act (21 U.S.C. 
1175(h)), as amended by section 303(b)(2)(B) of such 1974 Act 
(88 Stat. 137). 
(4) Subsection (h) of section 333 of such 1970 Act (42 U.S.C. 
4582(h)), as amended by section 122(a) of such 1974 Act (88 Stat. 
131). 
42 use 4581 
(5) Subsection (b) of section 121 of such 1970 Act (88 Stat. 131). 
(6) Subsection (b) of section 6 of the Act entitled "An Act to 
amend the Drug Abuse Office and Treatment Act of 1972, and for other 
purposes", approved March 19, 1976 (90 Stat. 245). 
owkr 117^ 
C^) Subsection (c) of section 303 of such 1974 Act (88 Stat. 139). 
note 
(8) Subsection (c) of section 122 of such 1974 Act (88 Stat. 133). 
42 use 4582 
SEC. 112. Section 6(a) (2) of the Veterans' Administration Physi-
note, 
cian and Dentist Pay Comparability Act of 1975 (Public Law 94-123; 
38 use 4118 
89 Stat. 669) is amended by striking out "October 11,1976" and insert-
note, 
ing in lieu thereof "September 30,1977". 
SEC. 113. Section 4123 is amended by adding at the end thereof the 
following new sentence: "Any proceeds to the Government received 
therefrom shall be credited to the applicable Veterans' Administration 
medical appropriation.". 
SEC. 114. Subsection (a)(3) of section 5001 of title 38, United States 
Code, is amended by striking out "eight thousand beds in the fiscal 
year ending June 30,1974," and inserting in lieu thereof "ten thousand 
beds in fiscal year 1980". 
SEC. 115. (a) Subchapter IV of chapter 81 of title 38, United States 
Code, is amended by— 
(1) inserting at the end of section 5053 the following new 
subsection: 
"(d) When a Veterans' Administration health care facility provides 
hospital care or medical services, pursuant to a contract or agreement 
authorized by this section, to an individual who is not eligible for such 
note. 
21 use 1174 
note. 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2853 
care or services under chapter 17 of this title and who is entitled to 
hospital or medical insurance benefits under subchapter XVIII of 
chapter 7 of title 42, such benefits shall be paid, notwithstanding any 
condition, limitation, or other provision in that title which would 
otherwise preclude such payment, in accordance with— 
"(1) rates prescribed by the Secretary of Health, Education, 
and Welfare, after consultation with the Administrator, and 
"(2) procedures jointly prescribed by the Secretary and the 
Administrator to assure reasonable quality of care and services 
and efficient and economical utilization of resources, 
to such facility therefor or, if the contract or agreement so provides, 
to the community health care facility which is a party to the contract 
or agreement."; and 
(2) amending section 5056 by— 
(A) amending the catchline to read as follows: 
"§ 5056. Coordination with health services development activities 
carried out under the National Health Planning and 
Resources Development Act of 1974**; and 
(B) striking out "title IX" and inserting in lieu thereof 
"part F of title XVI". 
(b) The table of sections at the beginning of such chapter is amended 
by striking out 
"5056. Coordination witli programs carried out under the Heart Disease, Cancer, 
and Stroke Amendments of 1965." 
and inserting in lieu thereof 
"5056. Coordination witli liealtli services development activities carried out 
under the National Health Planning and Resources Development Act 
of 1974.". 
(c) At such time as the rates and procedures described in section 
5053(d) of title 38, United States Code, are prescribed, the Secre-
tary of Health, Education, and Welfare; in consultation with the 
Administrator of Veterans' Aflfairs, shall submit to the Committee on 
Ways and Means and the Committee on Veterans' Affairs of the 
House of Representatives and to the Committee on Finance and the 
Committee on Veterans' Affairs of the Senate a full report describing 
such rates and procedures (and any such additional matters relating 
to the formulation of such rates and procedures as the Secretary 
may consider pertinent). 
SEC. 116. Chapter 82 of title 38, United States Code, is amended 
by— 
. 
. 
. 
(1) redesignating subsections (e) and (f) of section 5070 as 
subsections (f) and (g), respectively, and inserting the following 
new subsection (e): 
"(e) In carrying out the purposes of this chapter, the Adminis-
trator may lease to any eligible institution for such consideration and 
under such terms and conditions as the Administrator deems appro-
priate, such land, buildings, and structures including equipment 
therein) under the control and jurisdiction of the Veterans' Admin-
istration as may be necessary. The three-year limitation on the term 
of a lease prescribed in section 5012(a) of this title shall not apply 
with respect to any lease entered into pursuant to this chapter. Any 
lease entered into pursuant to this chapter may be entered into with-
out regard to the provisions of section 3709 of the Revised Statutes 
(41 U.S.C. 5). Notwithstanding section 321 of the Act entitled 'An 
Act making appropriations for the Legislative Branch of the Gov-
38 u s e 601 et 
seq. 
42 use 
1395b-l. 
38 u s e 5056. 
Report to 
congressional 
committees. 
38 use 5053 
note. 
Limitation, 
exception. 
90 STAT. 2854 
PUBLIC LAW 94-581—OCT. 21, 1976 
!; ; 
ernment for the fiscal year ending June 30, 1933, and for other pur-
poses', approved June 30, 1932 (40 U.S.C. 303b), or any other 
provision of law, a lease entered into pursuant to this chapter may 
provide for the maintenance, protection, or restoration, by the lessee, 
of the property leased, as a part or all of the consideration of the 
lease."; 
38 use 5070. 
(2) inserting at the end of section 5070 the following new 
subsection: 
Report to 
"(h) Not later than ninety days after the end of each fiscal year, 
Congress. 
IJ^Q Administrator shall submit to the Congress a report on activities 
carried out under this chapter, including (1) an appraisal of the 
effectiveness of the programs authorized herein in carrying out their 
statutory purposes and the degree of cooperation from other sources, 
financial and otherwise, (2) an appraisal of the contributions of such 
programs in improving the quantity and quality of physicians and 
other health care personnel furnishing hospital care and medical serv-
ices to veterans under this title, (3) a list of the approved but 
unfunded projects under this chapter and the funds needed for each 
such project, and (4) recommendations for the improvement or more 
effective administration of such programs, including any necessary 
legislation."; 
(3) striking out paragraph (1) of subsection (a) of section 
5073 and redesignating paragraphs (2) and (3) as paragraphs 
(1) and (2), respectively; and 
(4) striking out "subsections (a) (1) and" and inserting in lieu 
thereof "section 5070(e) of this title and subsection" in section 
5073(b)(2). 
Study. 
SEC. 117. (a) The Chief Medical Director of the Department of 
38 use 4103 
Medicine and Surgery of the Veterans' Administration shall carry out 
^°^- 
or provide for a studj^ to determine the short-range and long-range 
direction of the hospital and medical program carried out under 
38 use 101 et 
title 38, United States Code, for eligible veterans and persons with 
**?• 
reference to the increasing average age of the eligible veteran popu-
Report to 
lation. Not later than twelve months after the date of enactment of 
congressional 
this Act, the Chief Medical Director, through the Administrator of 
"""" 
Veterans' Affairs, shall submit to the appropriate Committees on Vet-
erans' Affairs of the Senate and the House of Representatives a report 
on the results of such study, including, but not limited to, specific 
plans for— 
(1) adjusting the number of Veterans' Administration hospi-
tal, nursing home, intermediate care, and domiciliary beds; 
(2) adjusting the program for contracting for such nursing 
home care (including intermediate and personal care) in commu-
nity facilities; 
(3) expanding alternatives to institutional care, including pro-
vision of home health (including homemaker and special nutri-
tion) services; 
(4) emphasizing treatment programs particularly suited to 
meeting the health care needs of an aging population; 
(5) emphasizing education and training of health care person-
nel specializing in the treatment of elderly persons and diseases 
and infirmities characteristic of an aging population; 
(6) emphasizing biomedical and health services research 
designed to ameliorate geriatric care problems; and 
(7) meeting the special architectural, transportation, and 
environmental needs of an aging population. 
committees. 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2855 
(b) Not later than ninety days after the eflfective date of this Act, 
the Administrator shall take all appropriate steps to ensure that, to 
the maximum extent feasible, each individual eligible for new or 
expanded care and services as a result of the amendments made by 
this Act is personally notified, in a clear and simple manner, about 
such new or expanded eligibility and the way to secure such care and 
services, and shall send copies of all such notification forms to the 
appropriate committees of the House of Representatives and the Sen-
ate, along with a description of how such forms were distributed. 
TITLE II—MEDICAL TECHNICAL AND CONFORMING 
AMENDMENTS 
SEC. 201. This title may be cited as the "Veterans Medical Technical 
and Conforming Amendments of 1976". 
SEC. 202. Chapter 17 of title 38, United States Code, is amended as 
follows: 
(a) The title of such chapter is amended by inserting "NURSING 
HOME," before "DOMICILIARY**. 
(b) Section 601 is amended by— 
(1) striking out "and exclusive" in clause (A) of paragraph 
(2) (A) msertmg after "contracts" in clause (C) of para-
graph (4) "when facilities described in clause (A) or (B) of this 
paragraph are not capable of furnishing economical care because 
of geographical inaccessibility or of furnishing the care or serv-
ices required"; 
(B) redesignating subclauses (ii) and (iii) of such clause (C) 
as subclauses (iv) and (v), respectively; 
(C) striking out subclause (i) of such clause (C) and inserting 
in lieu thereof the following subclauses: "(i) hospital care or 
medical services to a veteran for the treatment of a service-con-
nected disability or a disability for which a veteran was discharged 
or released from the active military, naval, or air service; (ii) 
medical services for the treatment of any disability of a veteran 
described in clause (1) (B) or (2) of section 612(f) of this title, 
(iii) hospital care or medical services for the treatment of medi-
cal emergencies which pose a serious threat to the life or health 
of a veteran receiving hospital care in a facility described in clause 
(A) or (B) of this paragraph;"; and 
(D) striking out "clause (iii)" where the term appears in sub-
clause (v) (as so redesignated) of such clause (C) and inserting 
in lieu thereof "subclause (v)"; and 
(S) striking out in subclause (ii) of clause (A) of paragraph 
(5) "for any veteran who is in need of treatment for a service-
connected disability or is unable to defray the expense of trans-
portation" and inserting in lieu thereof "pursuant to the 
provisions of section 111 of this title". 
(c) The subchapter heading at the beginning of subchapter II of 
such chapter is amended by inserting a comma and "Nursing Home,** 
after "Hospitar. 
(d) Section 610 is amended by— 
(1) inserting a comma and "nursing home,** after "hospital" 
in the catchline of such section; 
(2) inserting "or nursing home" after "hospital" in subsection 
(a)(1)(B); 
Individual 
notification for 
new services, 
copies to 
congressional 
committees. 
38 u s e 612 note. 
Veterans Medical 
Technical and 
Conforming 
Amendments of 
1976. 
38 u s e 101 note. 
90 STAT. 2856 
PUBLIC LAW 94-581—OCT. 21, 1976 
(3) striking out "of any war or of service after January 31, 
1955," and the comma after "domiciliary care" in subsection 
(b)(2); and 
(4) striking out "and exclusive" in subsection (d). 
38iISC611. 
(e)(1) The catchline of section 611 is amended by striking out 
"Hospitalization" and inserting in lieu thereof "Care". 
(2) Subsection (b) of section 611 is amended by inserting "or 
medical services" after "hospital care". 
(f) Section 612 is amended by— 
(1) striking out "Indian wars" and inserting in lieu thereof 
"Indian Wars" in subsection (e); 
(2) striking out "granted" and inserting in lieu thereof "fur-
nished" in subsection (f) (1) (B); and 
(3) inserting after "Administrator" in subsection (g) a comma 
and "within the limits of Veterans' Administration facilities,". 
(g) Section 616 is amended by striking out "Bureau of the Budget" 
and inserting in lieu thereof "Ofl&ce of Management and Budget". 
(h) Subsection (a) of section 620 is amended by— 
(1) striking out "and exclusive" in clause (1) and in the last 
sentence of such subsection; and 
(2) striking out "from time to time" and inserting in lieu 
thereof "annually" in clause (ii). 
(i) The subchapter heading at the beginning of subchapter III of 
such chapter is amended by inserting "and Nursing Home" after 
"Hospital". 
(j) Clauses (1) through (3) of section 621 are amended by insert-
ing a comma and "nursing home," after "hospital" each time it 
appears. 
(k) Subsection (a) of section 622 is amended by striking out "610 
(a)(1)" and inserting in lieu thereof "610(a) (1) (B)", and by striking 
out "632(b)" and inserting in lieu thereof "632(a) (2)". 
(1) Subsection (c) of section 624 is amended by striking out "of 
any war" after "veteran". 
(m) Section 627 is amended by striking out "1958" and inserting in 
lieu thereof "1957". 
(n) Subsection (a) (1) of section 628 is amended by striking out 
"they" and inserting in lieu thereof "delay". 
(o) Section 641 is amended by striking out "of any war or of service 
after January 31,1955". 
SEC. 203. (a) The table of chapters and parts at the beginning of 
title 38, United States Code, and the table of chapters at the beginning 
of part II of such title are each amended by inserting in the title of 
chapter 17 "NURSING HOME," after "HbSPITAL". 
(b) The table of sections at the beginning of chapter 17 of such 
title is amended by— 
(1) inserting in the heading of subchapter II a comma and 
"NUESING HOME" after "HOSPITAL" ; 
(2) inserting in the item relating to section 610 a comma and 
"nursing home" after "hospital"; 
(3) inserting in the heading of subchapter III "AND NUKSING 
HOME" after "HOSPITAL" ; and 
(4) striking out "Hospitalization" and inserting in lieu thereof 
"Care" in the item relating to section 611. 
SEC. 204. Chapter 23 of title 38, United States Code, is amended by 
inserting in subsection (a) of section 903 a comma and "nursing 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2857 
home," after "hospital", and by striking out "611" and inserting in 
lieu thereof "611 (a)" in such subsection. 
SEC. 205. Subchapter I of chapter 73 of title 38, United States Code, 
is amended as follows: 
(a) (1) The second sentence of subsection (a) of section 4101 is 
amended to read as follows: "The primary function of the Department 
of Medicine and Surgery shall be to provide a complete medical and 
hospital service, as provided in this title and in regulations prescribed 
by the Administrator pursuant thereto, for the medical care and 
treatment of veterans.". 
(2) Subsection (b) of section 4101 is amended by striking out "to 
provide a complete medical and hosiptal service for the medical care 
and treatment of veterans". 
(3) Section 4101 is further amended by redesignating subsection 
(c) as subsection (d) and inserting the following new subsection (c): 
" (c) (1) In order to carry out more effectively the primary function 
of the Department of Medicine and Surgery and in order to contribute 
to the Nation's knowledge about disease and disability, the Adminis-
trator shall, in connection with the provision of medical care and 
treatment to veterans, carry out a program of medical research (includ-
ing biomedical, prosthetic, and health care services research, and 
stressing research into spinal cord injuries and diseases and other 
disabilities that lead to paralysis of the lower extremities). In carrying 
out such research program, the Administrator shall act in cooperation 
with the entities described in subsection (b) of this section. 
"(2) Prosthetic research shall include research and testing in the 
field of prosthetic, orthotic, and orthopedic appliances and sensory 
devices. In order that the unique investigative material and research 
data in the possession of the Government may result in the improve-
ment of such appliances and devices for all disabled persons, the 
Administrator, 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, Education, and Welfare and 
the Commissioner of the Rehabilitation Services Administration, 
Department of Health, Education, and Welfare, in connection with 
programs carried out under section 3(b) of the Rehabilitation Act of 
1973 (Public Law 93-112; 87 Stat. 357) (relating to the development 
and support, and the stimulation of the development and utilization, 
including production and distribution of new and existing devices, 
of innovative methods of applying advanced medical technology, 
scientific achievement, and psychological and social knowledge to solve 
rehabilitation problems), section 202(b) (2) of such Act (relating to 
the establishment and support of Rehabilitation Engineering Research 
Centers), and section 405 of such Act (relating to the secretarial 
responsibilities for planning, analysis, promoting utilization of 
scientific advances, and information clearinghouse activities), 
"(3) (A) With the approval of the Administrator, any contract or 
research authorized by this section, the performance of which involves 
a risk of an unusually hazardous nature, may provide that the United 
States will indemnify the contractor against either or both of the 
following, but only to the extent that they arise out of the direct per-
formance of the contract and to the extent not covered by the financial 
protection required under subparagraph (E) of this paragraph. 
"(i) 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 
38 use 4101. 
29 use 702. 
29 use 762. 
29 use 785. 
Hazardous 
research, 
indemnification 
of contractor. 
90 STAT. 2858 
PUBLIC LAW 94-581—OCT. 21, 1976 
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. 
"(ii) 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 subparagraph (A) of this paragraph must also provide for— 
" (i) 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 
"(ii) control of or assistance in the defense by the United 
States, at its election, of any such suit or claim for which indemni-
fication is provided hereunder. 
"(C) No payment may be made under subparagraph (A) of this 
paragraph unless the Administrator, or the Administrator's designee, 
certifies that the amount is just and reasonable. 
"(D) Upon approval by the Administrator, payments under sub-
paragraph (A) of this paragraph may be made from— 
"(i) funds obligated for the performance of the contract 
concerned; 
"(ii) funds available for research or development or both, and 
not otherwise obligated; or 
" (iii) funds appropriated for those payments. 
"(E) Each contractor which is a party to an indemnification agree-
ment under subparagraph (A) of this paragraph shall have and main-
tain financial protection of such type and in such amounts as the 
Administrator 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 avail-
able from private sources, except that the Administrator may estab-
lish 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 paragraph, the 
Administrator may use the facilities and services of private insura nee 
organizations, and may contract to pay a reasonable compensation 
therefor. Any contract made under the provisions of this paragraph 
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 Administrator 
that advertising is not reasonably practicable, and advance payments 
may be made under any such contract. 
"(G) The authority to indemnify contractors under this paragraph 
does not create any rights in third persons which would not otherwise 
exist by law. 
"Contractor." 
"(H) As used in this section, the term 'contractor' includes sub-
contractors of any tier under a contract containing an idemnification 
provision pursuant to subparagraph (A) of this paragraph. 
"(4) Funds appropriated to carry out this subsection shall remain 
available until expended.". 
(b) Chapter 39 of title 38, United States Code, is amended by— 
(1) striking out in the table of sections 
"1904. Research and development; coordination with other Federal programs." 
and inserting in lieu thereof 
"19()4. Research and development,"; 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2859 
(2) amending the catchline of section 1904 to read as follows: 38 USC 1904. 
"§1904. Research and development"; 
and 
(3) amending subsection (a) of section 1904 by striking out 
"prosthetic and orthopedic appliance research under section 216 
and medical research" and inserting in lieu thereof "medical and 
prosthetic research". 
(c) Chapter 3 of title 38, United States Code, is amended by— 
(1) striking out section 216 in its entirety; and 
(2) amending the table of sections at the beginning thereof 
by striking out 
"216. Research by the Administrator; indemnification of contractors.". 
(d) Section 4103 of such title is amended by— 
(1) inserting "upon the recommendation of the Chief Medical 
Director" after "Administrator" in paragraphs (2) and (3) of 
subsection (a); 
(2) striking out "recommendations" and inserting in lieu 
thereof "recommendation" in subsection (a) (4); 
(3) inserting "or whose appointment or reappointment, is 
extended" after "reappointed" in subsection (b) (3); and 
(4) inserting "or for any period not exceeding two years" in 
subsection (c) before the period at the end of the second sentence. 
(e) Subsection (a)(6) (as redesignated by section 110(4) of this 
Act) of section 4105 of title 38, United States Code, is amended by 
inserting "hold the degree of doctor of optometry, or its equivalent, 
from a school of optometry approved by the Administrator and" 
before "be". 
(f) Siibsection (b) of section 4108 is amended by striking out "pur-
suant to" after "agreement" and inserting in lieu thereof "as referred 
to in". 
(g) Subsection (b) (2) of section 4114 is amended to read as 
follows: 
"(2) For the purposes of this title, the term 'internship' shall in- "Internship." 
elude the equivalency of an internship as determined in accordance 
with regulations which the Administrator shall prescribe, and the 
term 'intern' shall mean a person serving an internship.". 
"Intern." 
SEC. 206. Chapter 81 of title 38, United States Code, is amended as 
follows: 
(a) Section 5001 is amended by— 
(1) striking out "and exclusive" in the first sentence of sub-
section (a) (2), and striking out "tuberculosis" and inserting in 
lieu thereof "tuberculous" in such sentence; and 
(2) striking out "and exclusive" in the first sentence of sub-
section (a) (3). 
(b) Subchapter III of such chapter is amended by striking out 
"war" each time it appears in paragraph (a) of section 5031, section 
5032, paragraph (1) of section 5034, paragraphs (4) of subsections 
(a) and (b) of section 5035, and section 5036. 
(c) Section 5053 is amended by— 
(1) striking out "paragraphs" and inserting in lieu thereof 
"clauses" in the first sentence of subsection (a) ; and 
(2) inserting "health care" after "Veterans' Administration" 
each place it appears in clauses (1) and (2) of subsection (a) 
and in subsection (c). 
(d) Subsection (b) of section 5054 is amended by inserting "the" 
before "surrounding medical community" the second place it appears. 
(e) The second sentence of subsection (a) of section 5055 is amended 
90 STAT. 2860 
PUBLIC LAW 94-581—OCT. 21, 1976 
by striking out "for Research and PMucation in Medicine" and 
inserting in lieu thereof "charged with administration of tlie Depart-
ment of Medicine and Surgery medical research program". 
SEC. 207. Subchapter II of" chapter 82 of title 38, United States 
Code, is amended by striking out "subchapter IV of chapter 81 of" in 
38 use 5083. 
subsection (a) of section 5083. 
SEC. 208. Chapter 85 of title 38, United States Code, is amended 
as follows: 
(a) The first sentence of subsection (b) of section 5202 is amended 
by inserting "or a dependent or survivor of a veteran receiving care 
under the last sentence of section 613 (b) of this title," after " (admitted 
as a veteran)," in the first sentence. 
(b) Subsection (a) of section 5220 is amended by inserting a comma 
and "or a dependent or survivor of a veteran receiving care under 
the last sentence of section 613(b) of this title," after "(admitted 
as a veteran)". 
(c) Section 5221 is amended by inserting a comma and "or a depend-
ent or survivor of a veteran receiving care under the last sentence of 
section 613 (b) of this title," after " (admitted as such)". 
SEC. 209. (a) Subchapter I of chapter 73 of title 38, United States 
Code, is amended as follows: 
(1) Subsection (b) of section 4101, clause (1) of section 4104, sub-
section (b) of section 4105, subsection (f) of section 4106, subsection 
(f) of section 4107, the language preceding clause (1) in subsection 
(a) and clause (6) (B) in subsection (a) of section 4108, and section 
4117, are each amended by striking out "physicians' " and inserting in 
lieu thereof "physician". 
(2) Clause (1) of section 4104, clause (8) of subsection (a) and 
subsection (b) of section 4105, subsection (f) of section 4107, and 
the language preceding clause (1) in subsection (a) and subclause 
(B) of clause (6) of subsection (a) of section 4108 are each amended 
by striking out "expanded-duty" each place it appears and inserting 
in lieu thereof "expanded-function". 
(3) Subsection (b) of section 4101 is further amended by striking 
out "dentists' assistants" and inserting in lieu thereof "expanded-
function dental auxiliaries". 
(4) Clause (8) of subsection (a) of section 4105 is further amended 
by striking out "Physicians'" and inserting in lieu thereof 
"Physician". 
(5) Section 4113 is amended by striking out "and nurses" and 
inserting in lieu thereof "nurses, physician assistants, and expanded-
function dental auxiliaries". 
(6) Section 4114 is amended by— 
(A) inserting "physician assistants, expanded-function dental 
auxiliaries," after "nurses," in clauses (A) and (B) of subsection 
(a)(1); 
(B) striking out "and nurses" and inserting in lieu thereof 
"nurses, physician assistants, and expanded-function dental auxil-
iaries" in the first sentence of subsection (a) (3) (A); 
(C) striking out "nurses and interns, and" and inserting in 
lieu thereof "nurses, physician assistants, expanded-function den-
tal auxiliaries, and interns," in subsection (a)(3)(B); and 
(D) striking out "dentist's assistant" and inserting in lieu 
thereof "expanded-function dental auxiliary" in the first sentence 
of subsection (e). 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2861 
(7) Subsection (a) of section 4116 is amended by striking out 38 U
S
C 4116. 
"physicians' assistant, dentists' assistant" each time those terms appear 
and inserting in lieu thereof "physician assistant, expanded-function 
dental auxiliary". 
(8) Section 4117 is amended by striking out "dentists' assistants" 
and mserting in lieu thereof "expanded-function dental auxiliaries". 
(b) Subchapter I of chapter 73 of title 38, United States Code, is 
further amended as follows: 
(1) Section 4106 is amended by— 
(A) inserting "rate of basic" after "minimum" in the second 
sentence of subsection (c); and 
(B) striking out "level and salary" and "and salary" and 
inserting in lieu thereof "and annual rate of basic pay" each place 
those words appear in subsection (e). 
(2) Section 4107 IS amended by— 
(A) striking out "per annum full-pay scale or ranges" and 
inserting in lieu thereof "annual rates or ranges of rates of basic 
pay" in subsection (a); 
(B) striking out "per annum full-pay ranges" and inserting in 
lieu thereof "annual ranges of rates of basic pay" in the first sen-
tence of subsection (b) (1) ; 
(C) inserting "facility" after "domiciliary" each place it 
appears in subsection (c); and 
(D) amending subsection (e) by— 
(i) striking out "basic compensation" and inserting in lieu 
thereof "rate of basic pay" in paragraph (1); 
(ii) striking out "basic hourly rate" and "basic hourly 
rate of pay" and inserting in lieu thereof "hourly rate of 
basic pay" in paragraphs (2), (3), (5), (6), and (7); 
(iii) striking out "compensation" each time it appears in 
paragraphs (1), (2), (3), (6), and (9) and inserting in lieu 
thereof "pay" j 
(iv) amending the first sentence of paragraph (4) to read 
as follows: "A nurse performing service on a holiday desig-
nated by Federal statute or Executive order shall re(;eive for 
each hour of such service the nurse's hourly rate of basic 
pay, plus additional pay at a rate equal to such hourly rate 
of basic pay, for that holiday service, including overtime 
service."; and 
(v) striking out "compensated" and inserting in lieu thereof 
"paid" in paragraph (8). 
(3) Subsection (a) of section 4112 is amended by striking out "com-
pensation" and inserting in lieu thereof "pay" in the last sentence of 
such subsection. 
(c) Chapter 73 of title 38, United States Code, is further amended 
as follows: 
(1) Section 4103 is amended by— 
(A) striking out "individuals" and inserting in lieu thereof 
"persons" in the second sentence of subsection (a) (4); 
^B) striking out "and emi)Ioyecs" in subsection (a) (8); and 
(C) striking out "An individual" and inserting in lieu thereof 
"A person" in the third sentence of subsection (c). 
(2) Subsection (a) of section 4105 is amended by striking out 
"employees" and inserting in lieu thereof "personnel" in clause (7). 
(3) Section 4107 is amended by— 
89-194 O—78—pt. 2 
88 
90 STAT. 2862 
PUBLIC LAW 94-581—OCT. 21, 1976 
(A) striking out "individual" and inserting in lieu thereof 
"person" in the first sentence of subsection (c); 
(B) striking out "employee's" and inserting in lieu thereof 
"nurse's", and striking out "work" and inserting in lieu thereof 
"service", in paragraph (2) of subsection (e); and 
(C) striking out "duty" and inserting in lieu thereof "service" 
in paragraph (7) of subsection (e). 
38 use 4108. 
(4) Clause (1) of subsection (a) of section 4108 is amended by 
striking out "individual" and inserting in lieu thereof "person". 
(5) Section 4113 is amended by— 
(A) striking out "of employees" and inserting in lieu thereof 
a comma and "of persons"; and 
(B) striking out "paragraph (1) of section 4104" and inserting 
in lieu thereof "section 4104(1),". 
(6) Subsection (d) (2) of section 4114 is amended by striking out 
"individual" and inserting in lieu thereof "person". 
(7) Subsection (b) of section 4122 is amended by striking out 
"individuals" each time it appears and inserting in lieu thereof 
"persons". 
SEC. 210. (a) Chapter 17 of title 38, United States Code, is amended 
as follows: 
(1) Section 610 is amended by— 
(A) striking out "he" and inserting in lieu thereof "the Admin-
istrator" in the first sentence of subsection (a); 
(B) striking out "he" and inserting in lieu thereof "such vet-
eran" in subsections (a) (1) (B), (b) (2), and (c); and 
(C) striking out "he" and inserting in lieu thereof "such per-
son" in subsection (b) (1). 
(2) Section 611 is amended by— 
(A) striking out "him" and inserting in lieu thereof "the 
Administrator" in subsection (a); and 
(B) striking out "he" and "him" each place those words appear 
in 
subsection 
(b) 
and 
inserting 
m 
lieu 
thereof 
"the 
Administrator"; 
(3) Section 612 is amended by— 
(A) striking out "he" and inserting in lieu thereof "the Admin-
istrator" in the first sentence of subsection (a) ; 
(B) striking out "him" and "he" each place those words appear 
in 
subsection 
(d) 
and 
inserting 
in 
lieu 
thereof 
^'the 
Administrator"; 
(C) striking out "he" and inserting in lieu thereof "the Admin-
istrator" in subsection (g) ; and 
(D) striking out "his" each place it appears in the second sen-
tence of subsection (h) and inserting in lieu thereof "such 
veteran's". 
(4) Section 613 is amended by— 
(A) striking out "he" and inserting in lieu thereof "the Secre-
tarv" in subsection (b) (1); and 
(B) striking out "he" each place it appears and inserting in 
lieu thereof "the Administrator" in subsection (b)(2). 
(5) Section 614 is amended by— 
(A) striking out "his" and inserting in lieu thereof "such vet-
eran's" in subsection (a); and 
(B) striking out "he" in subsection (b). 
(6) Section 619 is amended by striking out "him" and inserting in 
lieu thereof "such veteran". 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2863 
(7) The first sentence of subsection (b) of section 620 is amended 38 USC 620. 
by striking out "he" and inserting in lieu thereof "the Administrator". 
(8) Paragraphs (1) and (3) of section 621 are amended by striking 
out "he" each place it appears and inserting in lieu thereof "the 
Administrator". 
(9) Subsection (b) of section 622 is amended by striking out "his" 
and inserting in lieu thereof "such veteran's". 
(10) Section 623 is amended by striking out "he" and inserting in 
^ 
lieu thereof "the Administrator". 
(11) The first sentence of subsection (c) of section 624 is amended 
by striking out "he" and inserting in lieu thereof "the Administrator". 
(12) Section 626 is amended by striking out "he" and inserting in 
lieu thereof "the Administrator". 
(13) Subsection (a) of section 628 is amended by— 
(A) striking out "he" and inserting in lieu thereof "the 
Administrator" in the first sentence of such subsection; and 
(B) striking out "his" and inserting in lieu thereof "such vet-
eran's" in paragraph (2) (D) (ii) of such subsection. 
(14) The second sentence of subsection (d) of section 632 is 
amended by striking out "him" and inserting in lieu thereof "the 
Administrator". 
(15) Section 633 is amended by striking out "he" and inserting in 
lieu thereof "the President", and by striking out "his". 
(16) Subsection (a) of section 642 is amended by striking out "he" 
and inserting in lieu thereof "the Administrator". 
(b) Section 3301 of title 38, United States Code^ is amended by— 
(1) striking out "his" and inserting "of a claimant" after "rep-
resentative" in subsection (b) (1), and striking out "himself" and 
inserting in lieu thereof "the claimant" in such subsection; 
(2) striking out "in his" and inserting in lieu thereof "as a 
matter of" in subsection (d); and 
(3) striking out "his" and inserting in lieu thereof "the Admin-
istrator's" in subsection (e). 
(c) Chapter 73 of title 38, United States Code, is amended as 
follows: 
(1) Section 4101 is amended by— 
(A) striking out "servicemen" and inserting in lieu thereof 
"members of the armed forces" in subsection (b); and 
(B) striking out "his" and "he" and inserting in lieu thereof 
"the Administrator's" and "the Administrator", respectively, in 
subsection (d) (2) (as redesignated by section 205(a) (3) of this 
Act). 
(2) Section 4103 is amended by— 
(A) striking out the period at the end of the first sentence and 
inserting in lieu thereof a comma, and striking out "He" in the 
second sentence and inserting in lieu thereof "and who", in para-
graphs (1), (2), and (3) of subsection (a); and 
(B) striking out "his" and "he" and inserting in lieu thereof 
"such person's" and "such person", respectively, in the third 
sentence of subsection (c). 
(3) Section 4104 is amended by striking out "he" and inserting in 
lieu thereof "the Administrator". 
(4) Section 4107 is amended by— 
90 STAT. 2864 
PUBLIC LAW 94-581—OCT. 21, 1976 
(A) striking out "he" each place it appears in subsection 
(b)(2) and inserting in lieu thereof "such person"; and 
(B) striking out "he" and "his" and inserting in lieu thereof 
"such person" and "such person's", respectively, in subsection (c). 
38 use 4108. 
(5) Subsection (a) of section 4108 is amended by— 
(A) striking out "his" and inserting in lieu thereof "such 
person's" in clause (2); 
(B) striking out "him" and "his" and inserting in lieu thereof 
"such person" and "such person's", respectively, in clause (3); 
(C) striking out "him" and "his" and inserting in lieu thereof 
"such person" and "such person's", respectively, in clause (4); 
(D) striking out "his" each place it appears and "him" in 
clause (5) and inserting in lieu thereof "such person's" and "such 
person", respectively; and 
(E) striking out "his" each place it appears and inserting in 
thereof "such person's" in clause (6). 
(6) The first sentence of subsection (b) of section 4112 is amended 
by striking out "he" and inserting in lieu thereof "the Administrator". 
(7) Section 4114 is amended by— 
(A) striking out "he" each place it appears in the third and 
fifth sentences in subsection (b) (3) and inserting in lieu thereof 
"such recipient"; 
(B) striking out "he" and "his" each place those words appear 
in the last sentence of subsection (b) (3) and inserting in lieu 
thereof "such person" and "such person's", respectively; 
(C) striking out "he" and inserting in lieu thereof "the person" 
in subsection (d) (1); and 
(D) striking out "his" and "he" and inserting in lieu thereof 
"such person's" and "the person", respectively, in subsection 
(d)(2), 
(8) Section 4116 is amended by— 
(A) striking out "his" each place it appears in subsection (a) 
and inserting in lieu thereof "such person's"; 
(B) strikmg out "his" and "him" and inserting in lieu thereof 
"such person's" and "such person", respectively, in subsection (b); 
(C) striking out "his" each place it appears in subsection (c) 
and inserting in lieu thereof "such person's"; and 
(D) striking out "he" and "his" each place those words appear 
in subsection (e) and inserting in lieu thereof "the Administrator" 
and "such person's", 
(9) Subsection (a) of section 4121 is amended by striking out "his" 
and "he" each place those words appear and inserting in lieu thereof 
"the Administrator's" and "the Administrator", respectively. 
(10) Section 4122 is amended by striking out "he" and inserting 
in lieu thereof "the Chief Medical Director" in subsections (b) 
and (c). 
(d) Chapter 75 of title 38, United States Code is amended by 
striking out "he" each place it appears in clauses (3), (9)j (10), and 
(11) of section 4202 and inserting in lieu thereof "the Admmistrator", 
(e) Chapter 81 of title 38, United States Code, is amended as 
follows: 
(1) Subsection (b) of section 5001 is amended by striking out "him" 
and "his" and inserting in lieu thereof "the Administrator" and "the 
Chief Medical Director's", respectively. 
PUBLIC LAW 94-581—OCT. 21, 1976 
90 STAT. 2865 
(2) Section 5002 is amended by— 
38 USC 5002. 
(A) striking out "he" each place it appears and inserting in 
lieu thereof "the President"; and 
(B) striking out "his opinion" and inserting in lieu thereof 
"the opinion of the President such is". 
(3) Paragraphs (2) and (3) of subsection (b) of section 5004 are 
amended by striking out "he" and inserting in lieu thereof "the 
Administrator". 
(4) The second sentence of section 5005 is amended by striking out 
"He" and inserting in lieu thereof "The President". 
(5) The first sentence of section 5007 is amended by striking out 
"his" and inserting in lieu thereof "the Administrator's" 
(6) Subsection (c) of section 5011 is amended by striking out "him" 
and inserting in lieu thereof "the Administrator". 
(7) Section 5012 is amended by— 
(A) striking out "his" in the first and fourth sentences of 
subsection (a) and inserting in lieu thereof "the Administrator's"; 
(B) striking out "he" and inserting in lieu thereof "the Admin-
istrator" in subsection (b); and 
(C) striking out "him" and inserting in lieu thereof "the 
Administrator" in subsection (c). 
(8) Section 5013 is amended by striking out "he" and inserting in 
lieu thereof "the Administrator". 
(9) Section 5014 is amended by— 
(A) striking out "he" each place it appears in the first and 
fourth sentences and inserting in lieu thereof "the Administra-
tor" ; and 
(B) striking out "his" in the first sentence and inserting in lieu 
thereof "the Administrator's". 
(10) Subsection (b) of section 5035 is amended by striking out 
"he" and inserting in lieu thereof "the Administrator". 
(11) The first sentence of subsection (a) of section 5053 is amended 
by striking out "he" and inserting in lieu thereof "the Administrator". 
(12) The second sentence of subsection (b) of section 5054 is 
amended by striking out "he" and inserting in lieu thereof "the 
Administrator". 
(13) The first sentence of subsection 
(a) of section 5055 
is amended by striking out "him" and inserting in lieu thereof "the 
Administrator". 
(f) Chapter 82 of title 38, United States Code, is amended as 
follows: 
(1) The second sentence of subsection (f) (as redesignated by 
section 116(1) of this Act) of section 5070 is amended by striking out 
"he" and inserting in lieu thereof "the Administrator". 
(2) Section 5071 is amended by striking out "he" and inserting in 
lieu thereof "the Administrator". 
(3) Section 5073 is amended by— 
(A) striking out "he" each place it appears in subsection (b) 
and inserting in lieu thereof "the Administrator"; and 
(B) striking out "he" each place it appears in subsection (c) 
and inserting in lieu thereof "the Administrator". 
(4) Subsection (b) of section 5083 is amended by striking out "his" 
in the language preceding clause (1) and in clause (4) and inserting 
in lieu thereof "the Administrator's". 
90 STAT. 2866 
PUBLIC LAW 94-581—OCT. 21, 1976 
38 use 5093. 
^ ) Subsection (b) of section 5093 is amended by striking out "his" 
in the language preceding clause (1) and in clause (4) and inserting 
in lieu thereof "the Administrator's". 
(6) Section 5096 is amended by striking out "he" and inserting in 
lieu thereof "the Administrator". 
Effective date. 
SEC. 211. Except as otherwise provided in this Act, the amendments 
38 use 111 note, made by this Act to title 38, United States Code, shall take effect on 
October 1, 1976, or on the date of enactment, whichever is later. 
Approved October 21, 1976. 
LEGISLATIVE HISTORY: 
HOUSE REPORT No. 94-703 (eomm. on Veterans' Affairs). 
eONGRESSIONAL REeORD: 
Vol. 121 (1975): Dec. 15, considered and passed House. 
VoL 122 (1976): Sept. 16, considered and passed Senate, amended. 
Sept. 29, House agreed to Senate amendments with amend-
ments. 
Oct. 1, Senate agreed to House amendments. 
WEEKLY eOMPILATION OF PRESIDENTIAL DOeUMENTS: 
Vol. 12, No. 43: Oct. 22, Presidential statement.