[Senate Report 114-153]
[From the U.S. Government Publishing Office]
Calendar No. 267
114th Congress } { Report
SENATE
1st Session } { 114-153
======================================================================
21ST CENTURY VETERANS BENEFITS DELIVERY ACT
_______
October 19, 2015.--Ordered to be printed
_______
Mr. Isakson, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany S. 1203]
The Committee on Veterans' Affairs (hereinafter,
``Committee''), to which was referred the bill (S. 1203) to
amend title 38, United States Code (hereinafter, ``U.S.C.''),
to improve the processing by the Department of Veterans Affairs
(hereinafter, ``VA'' or ``Department'') of claims for benefits
under laws administered by the Secretary of Veterans Affairs,
and for other purposes, having considered the same, reports
favorably thereon with an amendment in the nature of a
substitute and an amendment to the title and recommends that
the bill, as amended, do pass.
Introduction
On May 6, 2015, Senator Heller introduced S. 1203, the
proposed 21st Century Veterans Benefits Delivery Act. S. 1203
would improve the processing by VA of claims for benefits.
Senators Casey, Collins, Heinrich, Manchin, Moran, Tester,
Toomey, and Vitter are original cosponsors. Senators Cochran
and Coons were later added as cosponsors of the bill. The bill
was referred to the Committee.
On January 7, 2015, Senator Heller introduced S. 114, the
proposed Veterans Affairs Research Transparency Act of 2015.
S. 114 would require VA to allow public access to research of
the Department. The bill was referred to the Committee.
On January 13, 2015, Senator Heller introduced S. 151, the
proposed Filipino Veterans Promise Act. S. 151 would require
the Department of Defense (hereinafter, ``DOD'') to establish a
process for determining whether individuals who served in the
organized military forces of the government of the Commonwealth
of the Philippines or in the Philippine Scouts while in the
service of the United States Armed Forces during World War II
and who are not included in the Missouri List are eligible for
certain benefits relating to their service. Senator Hirono is
an original cosponsor of the bill. The bill was referred to the
Committee.
On January 13, 2015, Senator Tester introduced S. 172, the
proposed Access to Appropriate Immunizations for Veterans Act
of 2015. S. 172 would include within authorized preventive
health services available to veterans through VA immunizations
against infectious diseases, including each immunization on the
recommended adult immunization schedule established by the
Advisory Committee on Immunization Practices. The bill was
referred to the Committee.
On January 28, 2015, Senator Heller introduced S. 296, the
proposed Veterans Small Business Opportunity and Protection Act
of 2015. S. 296 would enhance treatment of certain small
business concerns for purposes of VA contracting goals and
preferences. Senator Manchin is an original cosponsor. The bill
was referred to the Committee.
On January 28, 2015, Senator Kirk introduced S. 297, the
proposed Frontlines to Lifelines Act of 2015. S. 297 would
direct VA to expand and revive, for a 3-year period, VA's
Intermediate Care Technician (hereinafter, ``ICT'') Pilot
Program that was carried out between January 2013 and February
2014. Senators Manchin and Udall are original cosponsors.
Senators Blunt and Scott were later added as cosponsors of the
bill. The bill was referred to the Committee.
On February 5, 2015, Senator Moran introduced S. 398, the
proposed Chiropractic Care Available to All Veterans Act of
2015. S. 398 would require the availability of chiropractic
care and services at all VA medical centers by the end of 2018.
Senators Blumenthal, Brown, Grassley, King, Tester, and
Whitehouse are original cosponsors. Senators Baldwin, Collins,
Durbin, Sanders, Schumer, and Vitter were later added as
cosponsors of the bill. The bill was referred to the Committee.
On March 4, 2015, Senator Franken introduced S. 666, the
proposed Quicker Veterans Benefits Delivery Act of 2015. S. 666
would prohibit VA from requesting additional medical
examinations of veterans who have submitted sufficient medical
evidence provided by non-VA medical professionals. The bill was
referred to the Committee.
On March 10, 2015, Senator Toomey introduced S. 695, the
proposed Dignified Interment of Our Veterans Act of 2015.
S. 695 would require VA to study and report to Congress on
matters relating to the interring of veterans' unclaimed
remains in national cemeteries under the control of VA's
National Cemetery Administration. The bill was referred to the
Committee.
On March 16, 2015, Senator Boozman introduced S. 743, the
proposed Honor America's Guard-Reserve Retirees Act of 2015.
S. 743 would honor as a veteran any person entitled to retired
pay for nonregular (Reserve) service or who, but for age, would
be so entitled. Senator Donnelly is an original cosponsor of
the bill. Senators Capito, Cochran, Coons, Franken, Gillibrand,
Grassley, Heller, Klobuchar, Menendez, Mikulski, Murkowski,
Peters, Roberts, Rounds, Schatz, Schumer, Stabenow, Tester,
Toomey, and Wyden were later added as cosponsors of the bill.
The bill was referred to the Committee.
On March 25, 2015, Senator Tester introduced S. 865, the
proposed Ruth Moore Act of 2015. S. 865 would modify VA's
disability compensation evaluation procedures for veterans with
mental health conditions related to military sexual trauma.
Senators Baldwin, Bennet, Collins, Durbin, Gillibrand, King,
Klobuchar, and McCaskill are original cosponsors. Senators
Boxer and Shaheen were later added as cosponsors of the bill.
The bill was referred to the Committee.
On April 21, 2015, Senator Durbin introduced S. 1021, the
proposed Wounded Warrior Workforce Enhancement Act. S. 1021
would direct VA to award grants to eligible institutions to
establish a master's degree program in orthotics and
prosthetics or expand upon an existing master's degree program
in such area. Senator Murphy is an original cosponsor. Senator
Coons was later added as a cosponsor of the bill. The bill was
referred to the Committee.
On May 14, 2015, Senator Murkowski introduced S. 1358, the
proposed Hmong Veterans' Service Recognition Act. S. 1358 would
authorize the interment in national cemeteries under the
control of the National Cemetery Administration of individuals
who served in combat support of the Armed Forces in the Kingdom
of Laos between February 28, 1961, and May 15, 1975. Senators
Franken, Klobuchar, Sullivan, and Whitehouse are original
cosponsors of the bill. Senators Baldwin, Boxer, and Feinstein
were later added as cosponsors of the bill. The bill was
referred to the Committee.
Committee Hearings
On May 13, 2015, the Committee held a hearing on
legislation pending before the Committee. Testimony was
received from David R. McLenachen, Acting Deputy Under
Secretary for Disability Assistance, Department of Veterans
Affairs; Anthony Kurta, Deputy Assistant Secretary of Defense,
Military Personnel Policy, Department of Defense; Teresa W.
Gerton, Deputy Assistant Secretary for Policy, Veterans'
Employment and Training Service, Department of Labor; Alphonso
Maldon, Jr., Chairman, Military Compensation and Retirement
Modernization Commission; Jeffrey E. Phillips, Executive
Director, Reserve Officers Association; and Aleks Morosky,
Deputy Legislative Director, National Legislative Service,
Veterans of Foreign Wars.
On June 3, 2015, the Committee held a hearing on
legislation pending before the Committee. Testimony was
received from Thomas Lynch, Assistant Deputy Under Secretary
for Health Clinical Operations, Veterans Health Administration,
Department of Veterans Affairs; Adrian Atizado, Assistant
National Legislative Director, Disabled American Veterans; Fred
Benjamin, Vice President and Chief Operating Officer,
Medicalodges, Inc.; Thomas J. Snee, National Executive
Director, Fleet Reserve Association; and Sergeant First Class
Victor Medina, U.S. Army, Retired.
On June 24, 2015, the Committee held a hearing on
legislation pending before the Committee. Testimony was
received from Dr. Rajiv Jain, Assistant Deputy Under Secretary
for Health for Patient Care Services, Veterans Health
Administration, Department of Veterans Affairs; Ian de Planque,
Legislative Director, The American Legion; Pete Hegseth, CEO,
Concerned Veterans of America; Adrian Atizado, Assistant
National Legislative Director, Disabled American Veterans; Carl
Blake, Associate Executive Director, Paralyzed Veterans of
America; Max Stier, President and CEO, Partnership for Public
Service; and John Rowan, National President, Vietnam Veterans
of America.
Committee Meeting
After reviewing the testimony from the foregoing hearings,
the Committee met in open session on July 22, 2015, to
consider, among other legislation, an amended version of
S. 1203, including provisions derived from S. 1203 as
introduced and provisions derived from the other legislation
noted above. The Committee voted by voice vote, without
objection, to report favorably to the Senate S. 1203 as amended
and as subsequently amended at the Committee meeting.
Summary of the Committee Bill as Reported
S. 1203, as reported (hereinafter, ``the Committee bill''),
consists of 40 sections, summarized below.
Section 1 provides a short title and a table of contents.
TITLE I--HEALTH CARE MATTERS
SUBTITLE A--EXPANSION AND IMPROVEMENT OF HEALTH CARE BENEFITS
Section 101 would specify that VA's preventive health
services include providing each immunization on the recommended
adult immunization schedule; would require VA to include
information on those immunizations in VA's annual report to
Congress; and would require VA to report to Congress on VA's
quality measures and metrics to ensure that veterans receiving
medical services from VA receive each immunization.
Section 102 would require the increased provision of
chiropractic care services to veterans at VA medical
facilities.
SUBTITLE B--HEALTH CARE ADMINISTRATION
Section 111 would authorize $5 million for the purpose of
VA developing a partnership with institutions of higher
education to expand programs of advanced degrees in prosthetics
and orthotics.
Section 112 would require VA to establish a free, publicly-
available Web site that aggregates information on Department
research data files; would direct VA to require that any final,
peer-reviewed manuscript using VA-funded research data be
submitted to a free, publicly-available Web site; and would
require the VA-DOD Joint Executive Committee to prepare
recommendations for establishing a program for long-term
cooperation and data sharing to facilitate research.
Section 113 would require VA to revive the Intermediate
Care Technician Pilot Program.
Section 114 would require that, in a case in which VA hires
a health care provider who is or was employed by the Secretary
of Defense, provided health care services, and was credentialed
by DOD, the Secretary of Defense must transfer its
credentialing data regarding that provider to VA upon VA's
request.
Section 115 would, in certain circumstances, require VA
emergency rooms to provide medical screenings and treatment to
individuals requesting examination or treatment.
SUBTITLE C--IMPROVEMENT OF MEDICAL WORKFORCE
Section 121 would require VA to include in its training
program for health professionals education and training of
marriage and family therapists and licensed professional mental
health counselors.
Section 122 would expand the qualifications for an
individual to be appointed as a VA licensed professional mental
health counselor to include individuals with a doctoral degree
in mental health counseling.
Section 123 would include physician assistants in the list
of VA health care personnel who receive pay that is competitive
with non-VA health care facilities.
Section 124 would require VA to submit to Congress a report
on VA's medical workforce.
TITLE II--COMPENSATION AND OTHER BENEFITS MATTERS
SUBTITLE A--BENEFITS CLAIMS SUBMISSION
Section 201 would express the sense of Congress that DOD
should establish a process to allow veterans service
organizations to be present for Transition Assistance Program
(hereinafter, ``TAP'') seminars related to filing a VA
disability claim and require DOD to submit to Congress a report
on participation of veterans service organizations in TAP.
Section 202 would require VA to make available to the
public information on the average length of time it takes VA to
adjudicate an appeal filed within 180 days after VA's initial
decision and the average length of time it takes VA to
adjudicate an appeal not filed within 180 days after VA's
initial decision and require VA to submit a report reflecting
the number of appeals filed within 180 days and not filed
within 180 days before and after VA begins publishing those
statistics.
Section 203 would provide that a hearing before the Board
of Veterans' Appeals (hereinafter, ``Board'' or ``BVA'') will
be conducted as the Board considers appropriate, either in
person or through video conferencing. However, upon request
from an appellant, the hearing will be held as the appellant
considers appropriate, either in person or through video
conferencing.
SUBTITLE B--PRACTICES OF REGIONAL OFFICES RELATING TO BENEFITS CLAIMS
Section 211 would require the Government Accountability
Office (hereinafter, ``GAO'') to complete a review of the VA
regional offices to help the Veterans Benefits Administration
achieve more consistent performance in the processing of claims
for disability compensation, including an assessment of the
effectiveness of communication between the regional offices and
veterans service organizations and caseworkers of Members of
Congress.
Section 212 would require VA to include in its annual
budget submission information regarding the number of claims a
full-time employee can process in a year, based on a time and
motion study and other information VA considers appropriate; a
description of actions VA will take to improve claims
processing; and an assessment of the effects of actions to
improve claims processing identified in the prior budget.
Section 213 would require VA to submit to Congress a report
outlining the criteria and procedures VA will use to determine
the appropriate staffing levels at regional offices once VA
transitions to the National Work Queue for distribution of
claims processing workload.
Section 214 would require VA to submit to Congress annual
reports on VA's progress in implementing the Veterans Benefits
Management System. This requirement would sunset 3 years after
enactment.
Section 215 would require VA to submit to Congress a report
that details the plans to reduce the inventory of VA's non-
rating workload.
Section 216 would express the sense of Congress that VA
should include in its Monday Morning Workload Report
information regarding the workload of fully-developed claims at
each regional office and enhanced information regarding pending
appeals.
SUBTITLE C--OTHER BENEFITS MATTERS
Section 221 would provide that, notwithstanding any law
regarding the licensure of physicians, certain physicians may
conduct an examination pursuant to a contract with VA at any
location in any state, the District of Columbia, or a
Commonwealth, territory, or possession of the United States, so
long as the examination is within the scope of the authorized
duties under such contract and the physician is licensed in at
least one state.
Section 222 would require VA and the Chief of the National
Guard Bureau to jointly develop and implement procedures to
improve the timely provision to VA of information in possession
of the National Guard Bureau that VA requires to process claims
for VA benefits and then submit a report describing the
requests for information from the National Guard Bureau and the
timeliness of responses.
Section 223 would direct VA, in consultation with DOD, to
review the process for determining whether certain individuals
have the requisite service requirements for purposes of
receiving specific Filipino veterans' benefits.
Section 224 would require VA to provide a report on the
furnishing of general and specialty medical examinations for
purposes of claims for VA benefits.
Section 225 would express the sense of Congress that VA
should report to Congress on claims based on post-traumatic
stress disorder alleged to have been incurred or aggravated by
military sexual trauma.
TITLE III--EDUCATION MATTERS
Section 301 would add sections 12304a and 12304b of title
10, U.S.C., to the list of authorities in sections 16131 and
16133 of title 10, U.S.C., under which a Reservist may regain
lost payments and lost entitlement for the Montgomery GI Bill-
Selected Reserve education program when that activation
authority is used to order a Reservist to active duty,
preventing the Reservist from completing his/her studies.
Section 302 would require educational institutions to
report annually to VA on the academic progress of students for
whom it receives payments under the Post-9/11 GI Bill. The
Secretary of Veterans Affairs would be required to include this
information in the annual report to Congress on the Post-9/11
GI Bill.
Section 303 would require the Secretary of Defense to
include in its annual report to Congress on the Post-9/11 GI
Bill the highest level of education attained by each individual
who transfers his/her Post-9/11 GI Bill benefits to eligible
dependents.
Section 304 would require the Secretary concerned to
collect upon separation the highest level of education attained
by each member of the Armed Forces.
TITLE IV--EMPLOYMENT AND TRANSITION MATTERS
Section 401 would require the Department of Labor's
Director of Veterans' Employment and Training for each state to
coordinate his/her activities with the state agencies for labor
and veterans affairs.
Section 402 would require an annual report from states to
include the number of job fairs attended by One-Stop Career
Center employees at which they had contact with a veteran and
the number of veterans at each event so contacted.
Section 403 would require the Secretary of Labor to review
the challenges employers face in hiring veterans and the
information sharing among Federal departments and agencies
serving veterans and separating servicemembers.
Section 404 would require the Secretary of Defense, in
consultation with the Secretaries of Veterans Affairs and
Labor, to review the Transition GPS Core Curriculum and report
to Congress recommendations on its effectiveness, allocation of
the roles and responsibilities of Federal departments in the
program, optimizing each topic by length of instruction and
whether or not it is mandatory, and developing metrics for
assessment of the program.
Section 405 would clarify that preseparation counseling
shall not be provided to a servicemember discharged before
completion of 180 continuous days on active duty.
TITLE V--VETERAN SMALL BUSINESS MATTERS
Section 501 would permit the surviving spouse of a veteran
owner of a small business, who is less than 100 percent
disabled and whose death is not a result of a service-connected
disability, to maintain the status of such small business
concern for up to 3 years following the death of such veteran.
Section 502 would permit the surviving spouse of a
servicemember, who owns at least 51 percent of a small business
concern and dies in the line of duty, to maintain the status of
such small business concern for up to 10 years following the
death of such servicemember.
TITLE VI--BURIAL MATTERS
Section 601 would require VA to complete a study on matters
relating to the interring of unclaimed remains of veterans in
national cemeteries and submit a report to Congress on the
findings of the study.
TITLE VII--OTHER MATTERS
Section 701 would honor as veterans certain individuals who
performed service in the Reserve components of the Armed
Forces.
Section 702 would require VA, in consultation with DOD and
such agencies or individuals VA considers appropriate, to
submit a report to Congress on the extent to which Laotian
military forces provided combat support to the Armed Forces of
the United States between February 28, 1961, and May 15, 1975;
whether the current classification by the DOD Civilian/Military
Service Review Board is appropriate; and any recommendations
for legislative action.
Section 703 would revert to the 2011 rates the reporting
fees that are paid to educational institutions.
Background and Discussion
TITLE I--HEALTH CARE MATTERS
SUBTITLE A--EXPANSION AND IMPROVEMENT OF HEALTH CARE BENEFITS
Sec. 101. Improved access to appropriate immunizations for veterans.
Section 101 of the Committee bill, which is derived from
S. 172, would clarify that the term ``preventive health
services'' encompasses immunizations against infectious
diseases, including each immunization on the recommended adult
immunization schedule at the time such immunization is
indicated on that schedule; require VA to report on programs
conducted to ensure that veterans have received recommended
immunizations at the appropriate time; and direct VA to
develop, implement, and report on quality measures and metrics
to ensure that veterans receiving VA medical services receive
each recommended immunization at the appropriate time.
Background. To promote health and prevent diseases among
veterans, VA delivers preventive health services, which
includes providing immunizations against infectious diseases.
Recommendations on immunizations for adults are made by the
Advisory Committee on Immunization Practices, an entity that
advises the Secretary of the Department of Health and Human
Services and is supported by the Centers for Disease Control
and Prevention (hereinafter, ``CDC''). That advisory committee
publishes an immunization schedule for adults. Veterans,
particularly those at high-risk for vaccine-preventable
diseases, may benefit from receiving each immunization on the
recommended adult immunization schedule, as appropriate.
Committee Bill. Subsection (a) of section 101 of the
Committee bill would amend section 1701(9)(F) of title 38,
U.S.C., to clarify that the term ``preventive health services''
encompasses immunizations against infectious diseases,
including each immunization on the recommended adult
immunization schedule at the time such immunization is
indicated on that schedule. It would also clarify that the term
``recommended adult immunization schedule'' means the schedule
established (and periodically reviewed and, as appropriate,
revised) by the Advisory Committee on Immunization Practices
established by the Secretary of Health and Human Services and
delegated to the CDC.
Subsection (b) of section 101 of the Committee bill would
amend section 1704(1)(A) of title 38, U.S.C., to require VA to
report to Congress not later than October 31 each year on
programs conducted during the previous fiscal year to ensure
that veterans have received each immunization on the
recommended adult immunization schedule at the time such
immunization is indicated on that schedule.
Subsection (c) of section 101 of the Committee bill would
require VA to submit to Congress, within 2 years of enactment,
a report on the development and implementation of quality
measures and metrics to ensure that veterans receiving medical
services from VA receive each immunization on the recommended
adult immunization schedule at the time such immunization is
indicated on that schedule.
Sec. 102. Expansion of provision of chiropractic care and services to
veterans.
Section 102 of the Committee bill, which is derived from
S. 398, would require VA to expand the provision of
chiropractic services.
Background. Pursuant to Public Law 107-135, the Department
of Veterans Affairs Health Care Programs Enhancement Act of
2001, VA carries out a program to provide chiropractic services
to veterans through VA Medical Centers (hereinafter, ``VAMCs'')
and community-based outpatient clinics (hereinafter,
``CBOCs''). VA is required to designate at least one site in
each Veterans Integrated Service Network (hereinafter,
``VISN'') to offer chiropractic services. As of July 1, 2015,
59 VAMCs and CBOCs provide chiropractic services and VA employs
73 doctors of chiropractic.
According to data published by the Department in June 2015,
more than 61 percent of Operation Enduring Freedom/Operation
Iraqi Freedom/Operation New Dawn veterans who sought health
care from the Department over the period of the first quarter
of fiscal year (hereinafter, ``FY'') 2002 through the first
quarter of FY 2015 were treated for musculoskeletal ailments.
Chiropractic therapy can assist with some of these types of
ailments and injuries.
Committee Bill. Subsection (a) of section 102 of the
Committee bill would require that the provision of chiropractic
care and services be available in at least two VAMCs or clinics
in each VISN not later than 2 years after enactment of the bill
and at least 50 percent of VAMCs and clinics in each VISN not
later than 3 years after enactment.
Subsection (b) of section 102 of the Committee bill would
expand the definitions of ``medical services,''
``rehabilitative services,'' and ``preventive health services''
in section 1701 of title 38, U.S.C., to include chiropractic
care or services.
SUBTITLE B--HEALTH CARE ADMINISTRATION
Sec. 111. Expansion of availability of prosthetic and orthotic care for
veterans.
Section 111 of the Committee bill, which is derived from
S. 1021, would authorize $5 million to VA for FY 2017 for the
purpose of developing partnerships with institutions of higher
education to expand programs of advanced degrees in prosthetics
and orthotics.
Background. Currently, veterans can access prosthetic and
orthotic services through all 150 VAMCs. According to VA, 79 of
these facilities include accredited VA orthotic and prosthetic
providers. The remaining locations provide services through
contracted and fee-based care.
In 2009, the decision was made by the American Board for
Certification in Orthotics, Prosthetics and Pedorthics and the
Board of Certification Accreditation International that a
master's degree would be the entry level of education required
for certification in these fields. While certified providers
were allowed to continue their practice, all new providers were
required to attain this education level for certification as of
2012.
Following over 10 years of war, there is an increased need
for prosthetics and orthotics services for the management of
complex injuries. Furthermore, as clinicians in the field
certified prior to this new degree requirement begin to retire,
they must be replaced with qualified professionals certified at
the master's degree level. Therefore, it is important for VA to
ensure a sufficient number of certified providers will be
available to provide orthotic and prosthetic care to veterans
in the years to come.
While the need for certified prosthetists and orthotists is
significant, only a small number of schools nationwide offer
master's and doctoral programs in these fields. Therefore, a
key component to ensuring an adequate supply of certified
professionals available to serve veterans lies in VA's
collaboration with institutions of higher education for the
expansion and creation of education and training programs.
Committee Bill. Section 111 of the Committee bill would, in
a freestanding provision, require VA to take a set of actions
to expand the number of potential prosthetic and orthotic
clinicians across the country. Subsection (a) of section 111 of
the Committee bill would expand the availability of prosthetic
and orthotic care for veterans by requiring VA to work with
institutions of higher education for the establishment or
expansion of advanced degree programs in prosthetics and
orthotics.
Subsection (b) of section 111 of the Committee bill would
require VA to develop and submit a report to the Committee on
Veterans' Affairs of the Senate and House of Representatives
setting forth a plan for carrying out subsection (a). VA would
be required to develop such a plan in consultation with
veterans service organizations, institutions of higher
education with accredited degree programs in prosthetics and
orthotics, and representatives from the prosthetics and
orthotics field.
Five million dollars would be authorized in subsection (c)
of section 111 of the Committee bill to be appropriated to VA
for FY 2017, which would remain available for expenditure until
September 30, 2019. Subsection (d) of section 111 of the
Committee bill requires this section to take effect 1 year
after the date of enactment of the Committee bill.
Sec. 112. Public access to Department of Veterans Affairs research and
data sharing between Departments.
Section 112 of the Committee bill, which is derived from
S. 114, would direct VA to enhance public access to information
on VA's research data files and publications based on research
funded by VA. This section would also require that VA and DOD
jointly formulate recommendations for long-term cooperation and
data-sharing to facilitate research.
Background. A number of government agencies and departments
provide funding for research to advance health care, including
the National Institutes of Health and VA. The focus of this
research varies across agencies and departments, with VA
assuming primary responsibility for funding research to improve
health care for our nation's veterans. VA maintains numerous
data files that can be used in research to improve veterans'
health care. For example, VA maintains data files on the cost
of care veterans receive and researchers may use those files to
examine the cost effectiveness of various treatments. However,
many researchers face numerous obstacles in their attempts to
access those files. These obstacles may result in delays in
improvements of health care for veterans.
VA-funded research has not only contributed to numerous
innovations in veterans' health care, it has made valuable
contributions to health care overall. Previously, many
clinicians, veterans, and others lacked access to information
on these innovations because publications based on this
research were often only available through subscriptions to
various scholarly journals, which were cost prohibitive for
many. VA has made progress in improving public access to peer-
reviewed publications from VA-funded research in compliance
with the Objectives for Public Access to Scientific
Publications described in the February 22, 2013, Memorandum to
the Heads of Executive Departments and Agencies regarding
increasing access to the results of Federally-funded scientific
research. However, the Committee notes that the new public
access requirements apply to VA-funded research and VA
employees only.
Like VA, DOD maintains research data files and VA and DOD
have, in certain instances, shared their data for research on
topics of importance to both servicemembers and veterans. For
example, VA has partnered with DOD on two research consortia
focused on traumatic brain injury and post-traumatic stress
disorder. The findings from these consortia, particularly in
the areas of biomarkers and advanced brain imaging, are
expected to fuel new advances in traumatic brain injury and
post-traumatic stress disorder care. Additional research is
needed to inform care and services for servicemembers,
veterans, and their families. It is important that VA and DOD
work together to minimize unnecessary barriers researchers
experience when trying to access data for scholarly purposes.
Committee Bill. Subsection (a) of section 112 of the
Committee bill would require VA to make information on VA data
files, including the contents of such files, and instructions
for how to access such files for use in research publicly
available on a VA Web site.
Subsection (b) of section 112 would require VA to ensure
that manuscripts based on VA-funded research are available for
free to the public through a digital archive established by VA
or another executive agency, consistent with available
copyright law. This subsection would also require VA, within 1
year of when VA begins ensuring that publications are submitted
to a digital archive, to submit an annual report on the
implementation of this subsection during the most recent 1-year
period to the Committee on Veterans' Affairs of the Senate and
House of Representatives.
Subsection (c) of section 112 of the Committee bill would
require the VA and DOD Joint Executive Committee to establish a
program for long-term cooperation and data-sharing to
facilitate research.
Subsection (d) of section 112 would define the term
``executive agency'' with the same meaning in section 133 of
title 41, U.S.C.
Subsection (e) establishes the effective date for section
112 as 1 year after the date of enactment of the Committee
bill. The Committee intends that VA comply with section 112 by
continuing ongoing efforts by VA and other departments directed
at making data from Federally-funded research publicly
available. The Committee also intends that existing
requirements, including those that require VA-funded
investigators place published manuscripts on the National
Institutes of Health PubMed database and that VA-funded
clinical trial results be available through the
ClinicalTrials.gov archive, continue to be utilized as a part
of fulfilling the requirements of section 112 of the Committee
bill.
Sec. 113. Revival of Intermediate Care Technician Pilot Program of
Department of Veterans Affairs.
Section 113 of the Committee bill, which is derived from
S. 297, would require VA to revive the Intermediate Care
Technician Pilot Program.
Background. Starting in January 2013 through February 2014,
the Veterans Health Administration created a pilot program to
increase veterans hiring and serve as a conduit for future
medical professionals. The original Intermediate Care
Technician Pilot Program hired veteran medics and corpsmen to
function as skilled nursing assistants in VA Emergency
Departments (hereinafter, ``ED''). Because of their past role
in the military, veteran medics and corpsmen often have more
experience than VA's traditional ED technician. VA selected 45
veterans to serve as ICTs at 15 VA EDs for 13 months. According
to the ``ICT After Action Report'' dated August 2014, ``ICT's
made a positive impact on patient care in the Emergency
Departments'' and after the pilot's conclusion ``the 15
facilities overwhelming[ly] supported the expansion of the ICT
role.''
Committee Bill. Section 113 of the Committee bill would, in
a freestanding provision, require the revival of the
Intermediate Care Technician Pilot Program.
Specifically, subsection (a) of section 113 of the
Committee bill would require the revival of the ICT Pilot
Program.
Subsection (b) of section 113 of the Committee bill would
direct the Secretary of Veterans Affairs to select at least 45
ICTs to participate in the ICT Pilot Program. Subsection (b)
directs VA, in determining the facilities to participate in the
pilot program, to give priority to facilities with the longest
wait times for appointments.
Subsection (c) of section 113 of the Committee bill would
designate that the duration of the pilot program would be 3
years.
Subsection (d) of section 113 of the Committee bill would
define the terms ``hospital care'' and ``medical services''
with the same meaning in section 1701 of title 38, U.S.C.
Subsection (e) of section 113 of the Committee bill
specifies that this section will become effective 1 year after
enactment.
Sec. 114. Transfer of health care provider credentialing data from
Secretary of Defense to Secretary of Veterans Affairs.
Section 114 of the Committee bill, which is derived from
S. 297, would require, in the instance a health care provider
is or was employed by DOD, the Secretary of Defense to transfer
the credentials of that provider to VA upon VA's request.
Background. According to a March 9, 2015, report from VA
entitled ``A Report Assessing the Staffing Needs of Each
Medical Facility within the Department of Veterans Affairs,''
VA will need to hire an additional 10,682 full-time staff to
provide direct care to veterans. The hiring process at VA can
be lengthy, particularly for hiring medical professionals whose
credentials and licenses must be verified prior to starting
employment with the agency. Requiring DOD to transfer a
provider's credentials upon his/her hiring at a VA facility
could shorten and improve VA's hiring process.
Committee Bill. In a freestanding provision, section 114 of
the Committee bill would address the transfer of credentialing
data from DOD to VA. Subsection (a) of section 114 of the
Committee bill would direct the Secretary of Defense to
transfer to the Secretary of Veterans Affairs the credentialing
data of a covered health care provider upon the request of the
Secretary of Veterans Affairs.
Subsection (b) of section 114 of the Committee bill defines
a covered health care provider as an individual who is or was
employed by the Secretary of Defense, provides or provided
health care related services, and was credentialed by the
Secretary of Defense.
Subsection (c) of section 114 of the Committee bill would
direct the Secretaries of Defense and Veterans Affairs to
establish policies through regulations to carry out this
section.
Subsection (d) of section 114 of the Committee bill defines
credentialing as the process of screening and evaluating a
health care provider's qualifications and credentials,
including licensure, education, training and experience, and
current competence and health status.
Subsection (e) of section 114 of the Committee bill
specifies that this section will become effective 1 year after
enactment.
Sec. 115. Examination and treatment by Department of Veterans Affairs
for emergency medical conditions and women in labor.
Section 115 of the Committee bill, which is derived from an
amendment offered by Senator Murray at the Committee meeting on
July 22, 2015, would require VA to ensure all of its hospitals
with emergency departments are providing appropriate
stabilizing treatment for emergency medical conditions and
labor.
Background. The Emergency Medical Treatment and Active
Labor Act (hereinafter, ``EMTALA''), originally enacted as a
part of Public Law 99-272, the Consolidated Omnibus Budget
Reconciliation Act of 1985, requires all hospitals that accept
payment from the Department of Health and Human Services,
Centers for Medicare and Medicaid Services, Medicare program to
either provide treatment to any individual at or within 250
yards of such a hospital who is seeking emergency treatment or
stabilize that individual prior to transfer to another
facility. Although VA hospitals are not subject to EMTALA by
law, the Veterans Health Administration Handbook 1101.05 states
VA practice is to provide evaluations and emergency care that
is compliant with EMTALA. Because inpatient VA facilities
currently do not always offer the same care as other hospitals
that would provide emergency care, particularly as relates to
labor and delivery care, the exact requirements of how EMTALA
applies to VA facilities is not always clear.
Committee Bill. Section 115 of the Committee bill would add
a new section, 1784A, to title 38, U.S.C., to require any VA
facility with an emergency department to provide stabilizing
care in the form of an examination or treatment for an
emergency medical condition for any individual who is on the
campus of the hospital and requests treatment or has a request
for treatment made on his/her behalf.
In this section, an emergency medical condition means a
medical condition with acute symptoms of sufficient severity,
including severe pain, such that the lack of immediate medical
attention could reasonably be expected to result in putting the
individual's health in serious jeopardy, serious impairment to
bodily functions, or serious dysfunction of any bodily organ or
part. With respect to a pregnant woman who is having
contractions, an emergency medical condition includes a
situation in which there is inadequate time to safely transfer
her to another hospital before delivery or one in which a
transfer would pose a threat to the health or safety of the
woman or unborn child. The treatment provided would be that
within the existing capability of the emergency department
including services routinely provided by an emergency
department to determine whether an emergency medical condition
exists. Under this section, the campus of a hospital includes
the physical area immediately adjacent to the main buildings of
the hospital, other areas or structures within 250 yards from
the main building and any other areas the Secretary of Veterans
Affairs determines are part of the hospital.
It is the intent of the Committee that VA facilities take
reasonable efforts to ensure that individuals with an emergency
medical condition are stabilized, that no material
deterioration of the condition is likely, with reasonable
medical probability, to occur during transfer of the individual
from a medical facility. In the case of a pregnant woman, that
includes delivery during transfer. Under this section,
transferring means a person employed by, or person affiliated
or associated with, the hospital directing the movement of an
individual from the hospital unless the individual has been
declared dead or leaves the facility without permission of any
such person.
A hospital is deemed to meet the requirements of this
section if it offers information about a medical examination
and treatment, including the risks and benefits of that
examination and treatment to the individual or person acting on
the individual's behalf and that individual or person acting on
the individual's behalf refuses treatment. The hospital is also
considered to have met the requirements of this section if it
offers to transfer the individual and that individual or person
acting on behalf of the individual refuses treatment. In cases
in which an examination, treatment, or transfer is not done
because an individual does not consent, the hospital shall take
all reasonable steps to obtain the written informed consent of
the individual refusing the examination, treatment, or
transfer.
The section requires that a hospital first stabilize a
patient before any transfer occurs. That requirement does not
apply to an appropriate transfer to another facility if the
individual or a person legally acting on behalf of the
individual has been informed of the risks of transfer and
requests a transfer to another medical facility in writing or a
physician of the Department has signed a certification that the
medical benefits reasonably expected from providing appropriate
medical treatment at another medical facility outweigh the
increased risks. If a physician of the Department is not
physically present in the emergency department at the time, a
qualified medical person as defined by the Secretary of
Veterans Affairs for the purposes of this section may sign a
certification after the physician of the Department has made
the required determination. The certification must include a
summary of the risks and benefits upon which the certification
was based.
An appropriate transfer under this section is one in which
the transferring hospital provides the available medical
treatment within its capacity to minimize the risks of health
to the individuals involved, the receiving facility has the
space and personnel available to treat the individual and
agrees to provide the treatment, the transferring hospital
sends the receiving facility all medical records or copies of
medical records that are available and relate to the
individual's emergency medical condition, and the transfer is
done using all necessary and medically appropriate life support
measures through qualified personnel and transportation
equipment. The Secretary of Veterans Affairs may also include
other requirements related to the health and safety of
individuals transferred in order for a transfer to be
considered appropriate. The information in the record should
include observations of signs or symptoms, any preliminary
diagnosis, any treatment provided, the results of any tests,
and the informed written consent (or copy of) requesting the
transfer.
SUBTITLE C--IMPROVEMENT OF MEDICAL WORKFORCE
Sec. 121. Inclusion of mental health professionals in education and
training program for health personnel of the Department of
Veterans Affairs.
Section 121 of the Committee bill, which is derived from an
amendment offered by Senator Tester at the Committee meeting on
July 22, 2015, would require the Secretary of Veterans Affairs
to include education and training of marriage and family
therapists and licensed professional mental health counselors
in required education and training programs.
Background. Pursuant to Public Law 109-461, the Veterans
Benefits, Health Care, and Information Technology Act of 2006,
VA is authorized to hire licensed professional mental health
counselors and marriage and family therapists to provide
veterans with appropriate behavioral health services. However,
those professionals make up less than 1 percent of VA's
behavioral health workforce, a significantly lower percentage
than in other parts of the health care delivery system. In the
overall behavioral health care workforce, mental health
counselors and marriage and family therapists represent forty
percent of the workforce.
Behavioral health care is a specialty that is very much in
demand both at VA and in the overall health care delivery
system. In 2014, VA data showed that it provided specialized
mental health treatment to more than 1.4 million veterans and
the Department expects to complete 12.7 million outpatient
visits for recipients of VA mental health care in FY 2016.
Appropriate and accessible training for a variety of behavioral
health care providers is important to ensure access to timely,
quality care.
Section 7302(a)(1) of title 38, U.S.C., requires VA to
conduct education and training programs to better serve
veterans within VA's health care system and also to play a
leadership role in educating future health care professionals
for the entire health care delivery system.
Committee Bill. Section 121 of the Committee bill would
require VA to include the education and training of marriage
and family therapists and licensed professional mental health
counselors in the education and training programs that are
authorized under section 7302(a)(1) of title 38, U.S.C.
Sec. 122. Expansion of qualifications for licensed mental health
counselors of the Department of Veterans Affairs to include
doctoral degrees.
Section 122 of the Committee bill, which is derived from an
amendment offered by Senator Tester at the Committee meeting on
July 22, 2015, would require VA to include doctoral degrees in
VA's qualifications for licensed mental health counselors.
Background. Section 7402(b)(11)(A) of title 38, U.S.C.,
specifies the levels of training that are necessary to be
eligible to hold specific positions within VA. This section
restricts the criteria for mental health counselors to master's
degrees. Many training programs for mental health counselors
are at the master's level, which typically take about 2 or 3
years to complete and include direct clinical experience as a
requirement for graduation. Doctoral degrees also include
clinical experience requirements along with a research
component and typically take 5 years to complete. Under current
law, mental health counselors working in VA must have master's
degrees, but candidates with doctoral degrees are not eligible
for positions within VA despite having additional years of
training.
Committee Bill. Section 122 of the Committee bill would
amend section 7402(b)(11)(A) of title 38, U.S.C., to expand the
qualifications of licensed mental health counselors to include
those with a doctoral degree.
Sec. 123. Requirement that physician assistants employed by the
Department of Veterans Affairs receive competitive pay.
Section 123 of the Committee bill, which is derived from an
amendment offered by Senator Tester at the Committee meeting on
July 22, 2015, would include physician assistants in the types
of providers who are eligible for locality pay.
Background. Section 7451(a)(2) of title 38, U.S.C., allows
VA to ensure that rates of pay for health care personnel
positions within VA facilities are competitive with the rates
of pay in non-VA facilities in the same labor market area. This
allows VA to operate on fair footing with other potential
health care employers that would be competing to hire for the
same or similar positions. VA is explicitly authorized to use
locality pay for registered nurses and the positions listed in
section 7401(1) and (3) of title 38, U.S.C. Although the
Secretary of Veterans Affairs is able to appoint other
specialties to the list, this authority has yet to be utilized.
VA is affiliated with more than 30 accredited physician
assistant education programs and offers continuing medical
education programs, tuition support programs, education debt
reduction programs, and employee incentive scholarship programs
as incentives to help grow the number of physician assistants
within VA. However, physician assistant positions can still be
difficult for facilities to fill. According to a September 2015
VA Inspector General review entitled, Office of Inspector
General Determination of Veterans Health Administration's
Occupational Staffing Shortages, physician assistants were the
occupation with the fourth largest staffing shortages for 2014.
Committee Bill. Section 123 of the Committee bill modifies
section 7451(a)(2) of title 38, U.S.C., to allow VA to offer
rates of pay that are competitive with non-VA facilities within
the same labor market areas when hiring for physician assistant
positions.
Sec. 124. Report on medical workforce of the Department of Veterans
Affairs.
Section 124 of the Committee bill, which is derived from an
amendment offered by Senator Tester at the Committee meeting on
July 22, 2015, would require the Secretary of Veterans Affairs
to submit a report on the medical workforce of VA.
Background. VA operates the largest integrated health care
system in the nation, comprised of 150 VA medical centers, 830
community-based outpatient clinics, 136 community-living
centers, 300 Vet Centers, and 80 mobile Vet Centers. These
sites of care employ nearly 300,000 employees and serve nearly
7 million unique patients. In the past year, VA's patient
workload has increased by 10.5 percent.
For a number of years, GAO and the VA Inspector General
have reported that inadequate staffing and gaps in hiring
health care professionals at VA medical facilities across the
country have adversely impacted patient care. Issues related to
recruiting and retaining a capable workforce also became a
focus last summer following the VA Inspector General's report
about Phoenix.
In comparison to other segments of health care services at
VA, demand for behavioral health services is one of the fastest
growing. Between FY 2013 and FY 2014, VA witnessed a 4.4
percent increase in the number of veterans receiving mental
health care. To help meet the behavioral health needs of
veterans, VA can hire a variety of mental health professionals,
including psychiatrists, psychologists, and social workers, as
well as licensed professional mental health counselors and
marriage and family therapists.
Section 7601, et seq. of title 38, U.S.C., provides VA with
authority to carry out VA's Health Professionals Education
Assistance Program to provide scholarships, tuition assistance,
debt reduction assistance, and other educational programs to VA
health care professionals. The Health Professionals Education
Assistance Program serves as a recruitment and retention tool
for the Department. The Veterans Access, Choice, and
Accountability Act of 2014, Public Law 113-146, increased from
$60,000 to $120,000 the cap on debt reduction payments to an
individual participant in the Education Debt Reduction Program.
Additionally, Public Law 113-175, the Department of Veterans
Affairs Expiring Authorities Act of 2014, allows VA to pay
student loan expenses directly, rather than require the
participant to pay upfront.
Committee Bill. Subsection (a) of section 124 of the
Committee bill would, in a freestanding provision, require VA
not later than 120 days after enactment to submit to the
Committee on Veterans' Affairs of the Senate and House of
Representatives a report regarding the medical workforce at VA.
Subsection (b) of section 124 of the Committee bill
specifies that the report shall include details related to the
number of licensed professional mental health counselors and
marriage and family therapists at VA and a description of the
actions taken by VA in consultation with the Director of the
Office of Personnel Management to create an occupational series
for such counselors and therapists, including a timeline among
other things. This subsection also indicates the report should
include a breakdown of spending by VA in connection with its
Education Debt Reduction Program during the 3 years prior to
release of the report; an update on the efforts of the
Secretary of Veterans Affairs to offer training opportunities
in telemedicine to medical residents in VA medical facilities
that use telemedicine, consistent with medical residency
program requirements established by the Accreditation Council
for Graduate Medical Education, as required in section 108(b)
of Public Law 112-154, the Honoring America's Veterans and
Caring for Camp Lejeune Families Act of 2012; and an assessment
of the development and implementation by the Secretary of
Veterans Affairs of succession planning policies to address the
prevalence of vacancies in positions in the Veterans Health
Administration of more than 180 days.
TITLE II--COMPENSATION AND OTHER BENEFITS MATTERS
SUBTITLE A--BENEFITS CLAIMS SUBMISSION
Sec. 201. Participation of veterans service organizations in Transition
Assistance Program.
Section 201 of the Committee bill, which is derived from
S. 1203 as introduced, would express the sense of Congress that
DOD should establish a process to allow veterans service
organizations to be present for TAP seminars related to filing
a VA disability claim and would require DOD to submit to
Congress a report on participation of veterans service
organizations in TAP.
Background. Under section 1144 of title 10, U.S.C., the
Departments of Defense, Homeland Security, Veterans Affairs,
and Labor are required to carry out TAP, which provides
multiple days of seminars to servicemembers who are separating
from the military. Although those seminars outline benefits
that separating servicemembers may be eligible to receive from
VA, representatives from veterans service organizations who are
authorized to represent veterans applying for VA benefits are
generally not present. A memorandum from the Secretary of
Defense, dated in December 2014, entitled ``Installation Access
and Support Services for Nonprofit Non-Federal Entities''
encourages installation commanders to permit non-profit
entities to provide services to servicemembers and their
families on military installations.
Committee Bill. Section 201(a) of the Committee bill would
express the sense of Congress that the Secretary of Defense, in
collaboration with the Secretary of Labor, the Secretary of
Homeland Security, and the Secretary of Veterans Affairs,
should establish a process by which a representative of a
veterans service organization may be present at any portion of
TAP relating to the submittal of claims to VA for disability
compensation or dependency and indemnity compensation.
Section 201(b) of the Committee bill would require DOD, not
later than 18 months after enactment, to submit to Congress a
report on participation of veterans service organizations in
TAP. The report must include an assessment of the compliance of
DOD facilities with the directives included in the Secretary of
Defense memorandum entitled ``Installation Access and Support
Services for Nonprofit Non-Federal Entities''; the number of
military bases that have complied with those directives; and
how many veterans service organizations have been present at a
portion of TAP.
Section 201(c) of the Committee bill would define veterans
service organization as any organization recognized by VA for
representation of veterans under section 5902 of title 38,
U.S.C.
Sec. 202. Requirement that Secretary of Veterans Affairs publish the
average time required to adjudicate timely and untimely
appeals.
Section 202 of the Committee bill, which is derived from
S. 1203 as introduced, would require VA to make publicly
available information on the time it takes VA to adjudicate
timely appeals and untimely appeals and would require VA to
submit a report reflecting the number of timely appeals and
untimely appeals filed before and after VA begins publishing
those statistics.
Background. Under current law, section 7105(b) of title 38,
U.S.C., a claimant has 1 year to file a Notice of Disagreement
(hereinafter, ``NOD'') after the date on which VA mails notice
of an initial decision on a claim for benefits. If a claimant
waits until the end of the 1-year period to file an NOD, VA may
be required to re-develop the record to ensure that the
evidence is current. Data from VA suggests that VA is able to
process appeals with less delay if the NOD is filed during the
first 180 days of the appeal period. In FY 2011, 2012, and
through August 31, 2013, where the agency of original
jurisdiction received an NOD more than 180 days after the date
the decision was mailed, it took, on average, 46.5 additional
days to decide the appeal. In FY 2014, the Veterans Benefits
Administration resolved appeals in an average of 561 days if
the appeal was filed within the first 180 days, compared to an
average of 595 days for NODs filed more than 180 days after
notice of the decision.
In its FY 2016 budget submission, VA included a legislative
proposal to reduce from 1 year to 60 days the time period
within which an NOD must be filed after the initial decision.
Before determining whether the appeal period should be
shortened, it is the view of the Committee that it would be
useful to ascertain whether it would encourage more claimants
to file their appeals within the first 180 days of the appeal
period if they are made aware that appeals are resolved more
quickly when they do so.
Committee Bill. In a freestanding provision, section 202 of
the Committee bill would address information on processing
appeals. Section 202(a) of the Committee bill would require VA,
on an on-going basis, to make available to the public the
average length of time it takes for VA to adjudicate a timely
appeal and the average length of time it takes VA to adjudicate
an untimely appeal. This requirement would take effect 1 year
after enactment and would apply until 3 years after enactment.
Section 202(b) would require VA to submit to the Committee
on Veterans' Affairs of the Senate and House of Representatives
a report on whether publication of that data has had an effect
on the number of timely appeals that are filed. Specifically,
the report would include the number of appeals and timely
appeals filed during the 1-year period before the requirement
to publish the data takes effect and the number of appeals and
timely appeals filed during the 1-year period beginning 1 year
after the requirement to publish the data takes effect.
Section 202(c) would define a ``timely'' appeal for these
purposes as meaning an appeal filed not more than 180 days
after the date VA mails notice of the initial decision and an
``untimely'' appeal as meaning an appeal filed more than 180
days after VA mails notice of the initial decision.
Sec. 203. Determination of manner of appearance for hearings before
Board of Veterans' Appeals.
Section 203 of the Committee bill, which is derived from
S. 1203 as introduced, would allow the Board of Veterans'
Appeals to determine whether a hearing will be held through
video conference rather than in-person, unless the appellant
requests a specific type of hearing.
Background. Under current law, section 7107(d) of title 38,
U.S.C., an individual who appeals to the Board of Veterans'
Appeals may request a hearing at the Board's location in
Washington, DC, or at a VA facility outside of Washington, DC
(a field hearing). Further, under section 7107(e) of title 38,
U.S.C., VA may provide equipment so that hearings outside of
the Washington, DC, area can be conducted through video
teleconference technology with Board members located in DC. If
VA has made that technology available, the Chairman of the
Board may allow appellants the opportunity to participate in a
hearing using video teleconference technology, rather than
having an in-person hearing with a Board member.
According to the Fiscal Year 2013 Annual Report of the
Board of Veterans' Appeals, in FY 2013, the Board conducted
11,431 hearings, 51 percent of which were via video
teleconferencing. In that report, the Board noted that, by
increasing the percent of hearings conducted by video
teleconference, ``the Board reduced its travel costs by 26
percent and reduced down time faced by [Veterans Law Judges]
when traveling to in-person hearing sites.'' In FY 2014, the
Board then conducted 10,879 hearings and 54 percent were video
teleconference hearings. More recently, VA provided this
testimony before the Senate Veterans' Affairs Committee in May
2015 regarding the content of section 203:
The Board has historically been able to schedule
video conference hearings more quickly than in-person
hearings, saving valuable time in the appeals process
for Veterans who elect this type of hearing. In FY
2014, on average, video conference hearings were held
124 days sooner than in-person hearings before a
Veterans Law Judge * * * at a Regional Office Travel
Board hearing * * *.
* * * * * * *
* * * Enactment of [this provision] could also lead to
an increase in the number of final decisions for
Veterans as a result of increased productivity at the
Board. Time lost due to travel and time lost in the
field due to appellants failing to show up for their
hearing would be greatly reduced, allowing [Veterans
Law Judges] to better focus their time and resources on
issuing final Board decisions for Veterans.
Committee Bill. Section 203 of the Committee bill would
amend section 7107 of title 38, U.S.C., to provide that a
hearing before the Board will be conducted, as the Board
considers appropriate, either in person or through picture and
voice transmission. It would further provide that, upon request
by an appellant, a hearing before the Board will be conducted
as the appellant considers appropriate, either in person or
through picture and voice transmission.
Amended section 7107 would also provide that, in a case in
which a hearing before the Board is to be conducted through
picture and voice transmission, VA must provide suitable
facilities and equipment to the Board or other components of VA
to enable an appellant located at an appropriate facility
within the area served by a regional office to participate in
the hearing. Amended section 7107 would further provide that
any hearing conducted through picture and voice transmission
must be conducted in the same manner as, and must be considered
the equivalent of, a personal hearing. Finally, it would
provide that, in a case in which a hearing before the Board is
to be conducted in person, the hearing must be held at the
principal location of the Board or at a VA facility located
within the area served by a VA regional office.
The amendments made by section 203 of the Committee bill
would apply to cases received by the BVA pursuant to NODs
submitted on or after the date of enactment.
The Committee is of the view that allowing the Board the
flexibility to conduct a greater percentage of hearings through
video conferencing could reduce delays and increase
productivity. However, the Committee also intends to ensure
that an appellant will retain the option to appear in person
for a Board hearing, if the appellant so desires.
SUBTITLE B--PRACTICES OF REGIONAL OFFICES RELATING TO BENEFITS CLAIMS
Sec. 211. Comptroller General review of claims processing performance
of regional offices of Veterans Benefits Administration.
Section 211 of the Committee bill, which is derived from
S. 1203 as introduced, would require a GAO review of VA
regional offices.
Background. VA processes claims for disability benefits at
56 regional offices around the country. In its Monday Morning
Workload Report, VA publicly reports a number of performance
outcomes with regard to each regional office, including the
average number of days it takes to complete a claim, the
quality of decisions, and the percentage of claims considered
backlogged. Those performance outcomes reflect that there are
significant differences in how quickly and how accurately the
various regional offices process disability claims. For
example, VA's Monday Morning Workload Report reflects that, as
of July 25, 2015, the percentage of claims backlogged at the
regional offices ranged from less than 20 percent to nearly 50
percent and the claim-level accuracy ranged from less than 85
percent to more than 97 percent.
Committee Bill. Section 211(a) and (b) of the Committee
bill would require GAO to complete a review of VA's regional
offices in order to help the Veterans Benefits Administration
achieve more consistent performance in the processing of claims
for disability compensation. The review would include an
identification of the factors that distinguish higher
performing regional offices from other regional offices,
including management practices; the best practices employed by
higher performing regional offices that distinguish the
performance of those offices from other regional offices; and
other management practices or tools that could be used to
improve the performance of regional offices.
The review would also include an assessment of the
effectiveness of communication with respect to the processing
of claims between the regional offices and veterans service
organizations and caseworkers employed by Members of Congress.
The review must be completed by not later than 15 months
after the date that is 270 days after the date of enactment.
GAO would be required to submit to the Committee on Veterans'
Affairs of the Senate and House of Representatives a report on
the results of that review.
Sec. 212. Inclusion in annual budget submission of information on
capacity of Veterans Benefits Administration to process
benefits claims.
Section 212 of the Committee bill, which is derived from
S. 1203 as introduced, would require VA to include in its
annual budget submissions additional information regarding the
capacity of the Veterans Benefits Administration to process
claims for VA benefits.
Background. In its annual budget submission, VA typically
includes information regarding the total number of claims for
VA benefits that it expects to process in the year covered by
the budget and the total number of staff VA is requesting to
process those claims. However, the budget submission generally
does not reflect a breakdown of the number of claims each
employee should be able to process in a single year (without
relying on mandatory overtime) or the information VA would use
to determine how many claims each employee should be able to
process, such as a time and motion study. The budget submission
also does not generally include an assessment of the claims
processing initiatives that were funded by Congress in the
prior budget year and what impact each initiative had on VA's
ability to process claims. All of that information would allow
Congress to better assess the efficacy of VA's staffing
requests for claims processing employees and overall request
for claims processing activities.
Committee Bill. In a freestanding provision, section 212(a)
and (b) of the Committee bill would require VA to include in
its annual budget submission information on the capacity of the
Veterans Benefits Administration to process claims for VA
benefits, including an estimate of the average number of claims
for benefits that a single full-time equivalent employee can
process in a year (excluding claims completed during mandatory
overtime), based on a time and motion study and such other
information as the Secretary considers appropriate; a
description of the actions VA will take to improve the
processing of claims; and an assessment of the actions VA
identified in the previous year that would be taken to improve
claims processing and the effects of those actions. This
requirement would apply with respect to the budget submitted
for FY 2017 and any fiscal year thereafter.
Sec. 213. Report on staffing levels at regional offices of Department
of Veterans Affairs after transition to National Work Queue.
Section 213 of the Committee bill, which is derived from
S. 1203 as introduced, would require VA to submit to Congress a
report on the criteria and procedures that will be used to
determine the appropriate staffing levels at regional offices
once VA transitions to the National Work Queue.
Background. In general, each VA regional office has
traditionally received claims from veterans and their families
in the surrounding geographic area. The Veterans Benefits
Administration would then use a tool--called the Resource
Allocation Model--in order to determine how many claims
processing employees to assign to each VA regional office based
on the workload at that office. According to VA, the Resource
Allocation Model ``uses a weighted model to assign compensation
and pension [full-time equivalent] resources based on regional
office * * * workload in rating receipts, rating inventory,
non-rating receipts, and appeals receipts.'' In FY 2016, the
Veterans Benefits Administration plans to transition to a
workload management system--called the National Work Queue--
that will allow the VA Central Office to distribute claims-
related workload among regional offices based on available
capacity to handle that workload. Once VA transitions to that
workload management system, it is unclear what factors will be
considered in determining how to allocate employees among the
regional offices.
Committee Bill. In a freestanding provision, section 213 of
the Committee bill would require VA, not later than 15 months
after enactment, to submit to the Committee on Veterans'
Affairs of the Senate and House of Representatives a report on
the criteria and procedures that VA will use to determine
appropriate staffing levels at the regional offices once VA has
transitioned to using the National Work Queue for the
distribution of claims processing work.
Sec. 214. Annual report on progress in implementing Veterans Benefits
Management System.
Section 214 of the Committee bill, which is derived from
S. 1203 as introduced, would require VA to submit to Congress a
report, not later than each of 1 year, 2 years, and 3 years
after enactment, on the progress in implementing the Veterans
Benefits Management System (hereinafter, ``VBMS'').
Background. In response to the tremendous claims backlog,
VA set out to transform the way it administers claims for
benefits. In 2012, VBMS, a web-based electronic claims
processing solution, was launched under a pilot program at five
VA regional offices. As of today, VBMS is used at 148 VA
facilities. According to VA, it moved from a points-based work
credit system dependent on employee-user input to a system that
can automatically capture employees' transactions, activities,
claims completions, and timeliness. VA has set a goal of
eliminating the claims backlog in 2015 and processing all
claims within 125 days with 98 percent accuracy.
The Committee has heard concerns about the ability of VBMS
to process claims that are complicated or have a significant
number of issues, as well as concerns over the interoperability
of certain functions within VA with VBMS.
Committee Bill. In a freestanding provision, section 214 of
the Committee bill would require VA to submit reports to
Congress annually on the progress in implementing VBMS. The
report is required to include an assessment of the current
functionality of VBMS, recommendations submitted to VA by
employees involved in claims processing for legislative or
administrative action considered appropriate to improve the
processing of claims, and recommendations submitted to VA by
veterans service organizations who use VBMS for legislative or
administrative action considered appropriate to improve the
system.
The reporting requirement would sunset 3 years after
enactment.
Given the importance of delivering benefits to our nation's
veterans in an accurate and timely manner, it is essential for
VA to assess VBMS and solicit valuable recommendations from
employees and veterans service organizations that use the
system, while providing that information to Congress for
oversight.
Sec. 215. Report on plans of Secretary of Veterans Affairs to reduce
inventory of non-rating workload.
Section 215 of the Committee bill, which is derived from
S. 1203 as introduced, would require VA to submit to Congress a
report on VA's plans to reduce the inventory of non-rating work
pending at the Veterans Benefits Administration.
Background. In its Monday Morning Workload Report, the
Veterans Benefits Administration reports its claims-related
workload in a number of different categories, including rating-
related work (such as initial claims for disability
compensation) and non-rating work (such as requests for
increased compensation based on addition of a dependent). Each
category of work is given a specific label--called an End
Product. In reporting its statistics on the ``backlog'' of
disability claims, VA includes work items from only certain
rating-related End Products.
In recent years, there has been a large increase in the
number of pending non-rating work items that do not fall under
VA's definition of the backlog. In July 2014, the VA Inspector
General's office testified before the House Committee on
Veterans' Affairs that, ``[a]lthough [the Veterans Benefits
Administration's] reported backlog has decreased by over 50
percent since March 2013, other workloads such as appeals
management and benefit reductions have had significant
corresponding increases.'' In fact, between October 2010 and
July 2015, the number of pending dependency adjustments for
compensation recipients grew from less than 50,000 to more than
220,000. Over that period, similar increases have been seen in
non-rating categories of work that VA labels as Correspondence
(increased from 7,963 to 104,601), Miscellaneous determinations
(increased from 26,700 to 142,058), Due process (increased from
19,540 to 125,707), and many others.
Committee Bill. In a freestanding provision, section 215 of
the Committee bill would require VA, not later than 120 days
after enactment, to submit to the Committee on Veterans'
Affairs of the Senate and House of Representatives a report
that details VA's plans to reduce the inventory of work items
listed in the Monday Morning Workload Report under End Products
130 (Dependency--compensation), 137 (Dependency--pension), 173
(Pre-decisional hearings), 290 (Misc. determinations), 400
(Correspondence), 600 (Due process--compensation), 607 (Due
process--pension), 690 (Cost of Living Adjustments and Social
Security number verification), 930 (Review, including quality
assurance), and 960 (Correction of errors).
Sec. 216. Sense of Congress on increased transparency relating to
claims for benefits and appeals of decisions relating to
benefits in Monday Morning Workload Report.
Section 216 of the Committee bill, which is derived from
S. 1203 as introduced, would express the sense of Congress that
VA should include in the Monday Morning Workload Report
additional information regarding fully-developed claims and
appeals.
Background. In July 2014, the VA Inspector General's office
testified before the House Committee on Veterans' Affairs that
``[a] key concern is the increased appeals inventory at [VA
regional offices'' and that ``[t]his workload has continued to
grow at an alarming rate.'' Although VA's Monday Morning
Workload Report includes some information about the number of
pending appeals at the regional offices, it does not provide
sufficient information to ascertain how well each regional
office is performing with respect to its appeals inventory.
Similarly, VA's Web site includes information about the
time it takes the Veterans Benefits Administration as a whole
to complete disability claims that are fully-developed when
submitted to VA but does not contain sufficient information to
ascertain how well each regional office is performing with
respect to those types of claims.
Committee Bill. Section 216 of the Committee bill would
express the sense of Congress that VA should include in the
Monday Morning Workload Report the number of fully-developed
claims received by each regional office; the number of those
claims that are pending at each office; and the number of those
claims that have been pending a decision for more than 125
days. In addition, it would express the sense of Congress that
VA should include in the Monday Morning Workload Report
enhanced information about pending appeals, including the
information currently contained in VA reports entitled
``Appeals Pending'' and ``Appeals Workload by Station.''
SUBTITLE C--OTHER BENEFITS MATTERS
Sec. 221. Modification of pilot program for use of contract physicians
for disability examinations.
Section 221 of the Committee bill, which is derived from
S. 1203 as introduced, would allow certain licensed physicians
performing compensation and pension examinations pursuant to a
contract with VA to perform the examinations in any state,
territory, possession, Commonwealth, or the District of
Columbia, without the need to obtain another license.
Background. Under section 504 of Public Law 104-275, VA was
authorized to conduct a pilot program to use mandatory funding
to provide compensation and pension examinations through the
use of contractors. Currently, a physician providing an
evaluation under this authority must be licensed in the state
or territory in which the examination takes place. That means,
if the contractor wishes to send its physicians to another
state to help alleviate a backlog of examination requests,
those physicians would first need to apply for a license in
that other state. On the other hand, medical professionals who
work directly for the Veterans Health Administration are
authorized to work at VA facilities in any state or territory,
as long as they are licensed in at least one state. In May
2015, VA testified before the Senate Committee on Veterans'
Affairs that granting a similar authority to these contract
examiners ``would help provide flexibility in examinations
through non-VA medical providers while maintaining licensure
standards and accelerating benefits delivery.''
Committee Bill. Section 221 of the Committee bill would
modify the authority for the pilot program to provide that,
notwithstanding any law regarding the licensure of physicians,
a physician described below may conduct an examination pursuant
to a contract entered into under the authority granted in
Public Law 104-275 at any location in any state, the District
of Columbia, or a Commonwealth, territory, or possession of the
United States, so long as the examination is within the scope
of the authorized duties under such contract. This new
authority would apply to a physician who has a current license
to practice the health care profession of the physician and is
performing authorized duties for VA pursuant to a contract for
compensation and pension examinations.
Sec. 222. Development of procedures to increase cooperation with
National Guard Bureau.
Section 222 of the Committee bill, which is derived from
S. 1203 as introduced, would require VA and the Chief of the
National Guard Bureau to jointly develop and implement
procedures to improve the timely provision to VA of records
required to process claims for VA benefits.
Background. Under current law, section 5103A of title 38,
U.S.C., VA has a duty to assist claimants in obtaining evidence
necessary to substantiate a claim for benefits. This duty to
assist requires VA to obtain certain Federal records, including
service treatment records. The Veterans Benefits Administration
has often cited delays in obtaining service records as one
reason for delays in processing disability claims, particularly
for claims involving the Guard and Reserves.
Committee Bill. In a freestanding provision, section 222 of
the Committee bill would require the Secretary of Veterans
Affairs and the Chief of the National Guard Bureau to jointly
develop and implement procedures, including requirements
relating to timeliness, to improve the timely provision to VA
of such information in the possession of the Chief as VA
requires to process claims submitted to VA for benefits. Not
later than 1 year after implementation of those procedures, VA
and the Chief would be required to jointly submit to Congress a
report describing the requests for information relating to
records of members of the National Guard made by VA to the
Chief pursuant to those procedures and the timeliness of the
responses of the Chief to those requests.
Sec. 223. Review of determination of certain service in Philippines
during World War II.
Section 223 of the Committee bill, which is derived from
S. 151, would require VA to review the process used to
determine whether certain individuals served in support of the
Armed Forces of the United States during World War II.
Background. Public Law 111-5, the American Recovery and
Reinvestment Act of 2009 (hereinafter, ``ARRA'') authorized the
payment of a one-time, lump-sum benefit to eligible World War
II Philippine veterans. The deadline to apply for this benefit
was February 16, 2010.
Under the ARRA, veterans who served before July 1, 1946, in
the organized military forces of the government of the
Commonwealth of the Philippines, while such forces were in the
service of the Armed Forces of the United States, members of
the organized guerrilla forces under commanders appointed,
designated, or subsequently recognized by the Commander-in-
Chief, Southwest Pacific Area, or other competent authority in
the Army of the United States, and individuals who served in
the Philippine Scouts under section 14 of the Armed Forces
Voluntary Recruitment Act of 1945 were all eligible to apply
for the benefit.
During the 1-year filing period, the Veterans Benefits
Administration received 42,755 claims. As of August 1, 2015,
18,951 claims for benefits were granted; 23,804 claims were
denied; and 9 reopened claims were pending. 4,561 appeals of
denied claims were received; 63 appeals were still pending; and
3 appeals were overturned by the Board of Veterans' Appeals.
Due to the difficulty in verifying eligible service,
Filipino veteran advocates have expressed concern that the
process for determining eligibility is flawed. Recognizing
these concerns, in October 2012, the White House Initiative on
Asian Americans and Pacific Islanders created the Filipino
Veterans Equity Compensation Fund Interagency Working Group to
analyze the process faced by Filipino veterans in demonstrating
eligibility for the lump-sum benefit. The Interagency Working
Group found the United States Army's process to determine
service is appropriate.
Committee Bill. In a freestanding provision, section 223 of
the Committee bill would require VA to review the process used
to determine whether Filipino veterans served in support of the
Armed Forces during World War II. VA would be required to
consult DOD and military historians recommended by DOD during
this review and submit a report to the Committee on Veterans'
Affairs of the Senate and House of Representatives detailing
findings, actions taken, or recommendations for legislative
action.
The Committee recognizes the actions already undertaken in
this area. However, given the advanced age of veterans who
might be eligible for the benefit, it is appropriate to make
certain that all avenues for reviewing the process by which
eligibility is determined have been exhausted.
Sec. 224. Reports on Department disability medical examinations and
prevention of unnecessary medical examinations.
Section 224 of the Committee bill, which is derived from
S. 666, would require VA to submit a report on the provision of
medical examinations for purposes of adjudicating claims and a
plan to prevent the ordering of unnecessary medical
examinations.
Background. Under section 5125 of title 38, U.S.C., to
establish eligibility for benefits VA may accept a report of a
medical examination conducted by a private physician if the
report is sufficiently complete to be adequate for purposes of
adjudicating a claim.
Despite this authority, the Committee frequently hears
concerns that VA dismisses private medical evidence and orders
VA medical examinations despite sufficient private medical
evidence, which could be used to make a decision on a claim.
For example on March 13, 2013, Joseph Violante, Legislative
Director of Disabled American Veterans at the time of the
hearing, stated:
We hear from the field, from our people, that in some
cases where the medical evidence is sufficient to be
rated, the fact that it comes in from a private
physician triggers an unnecessary examination.
VA has also acknowledged efficiencies may be achieved by
reducing unnecessary medical examinations provided by VA. For
example, in 2013, VA launched the Acceptable Clinical Evidence
initiative to help alleviate the need for medical examinations
provided by VA. This initiative allows VA medical providers to
perform assessments without an in-person examination when
sufficient information already exists. The Acceptable Clinical
Evidence initiative enables a VA medical provider to complete a
Disability Benefits Questionnaire by reviewing existing medical
evidence and supplementing such evidence with information
obtained during a telephone interview with the veteran. VA
reports that this initiative has reduced the average time is
takes to complete a Disability Benefits Questionnaire from 25
days to 8 days.
In evaluating claims for disabilities involving the
musculoskeletal system, section 4.40 of title 38, Code of
Federal Regulations (hereinafter, ``C.F.R.''), (Functional
loss) requires an assessment of the impact of the disability on
the performance of ``the normal working movements of the body
with normal excursion, strength, speed, coordination and
endurance.'' Following the court's decision in DeLuca v. Brown,
8 Vet. App. 202 (1995), VA developed a medical examination
which evaluates the effect of repetitive motion on normal
working movements, by having the claimant perform an activity
three times in the examining physician's office.
During oversight visits, VA physicians have indicated to
staff that the ``three repetition requirement'' does not
provide a scientifically sound basis for evaluating the effect
of repetitive motion on ``normal working movements,'' such as
those performed during a normal 8-hour work day. Physicians
have expressed concern about the time it takes to perform
repetitive motion actions on joints for which no disability is
alleged.
Committee Bill. Section 224 of the Committee bill would, in
a freestanding provision, require VA to submit, within 18
months of enactment, a report on the provision of medical
examinations for purposes of adjudicating claims and a plan to
prevent the ordering of unnecessary medical examinations. There
are two distinct reporting requirements contained in section
224 of the Committee bill.
The first reporting requirement requires VA to submit a
report on the furnishing of general medical and specialty
medical examinations. The report must include the number of
general medical examinations furnished by VA during FY 2011
through FY 2014. The report must also include the number of
specialty medical examinations furnished by VA during the same
time period. Additionally, the report must include a summary of
medical and scientific studies that provide a basis for
determining that three repetitions of a joint movement is
adequate to assess the effect of repetitive motion on
functional loss when assessing range of motion during joint
examinations. The report must identify all examination reports
used for evaluation of compensation and pension disability
claims which require measurements of repeated ranges of motion
testing. Finally, the report would include the number of
examinations for FY 2014 that required such measurements, the
average amount of time taken to perform the three repetitions
of movement method for each joint, a discussion of whether
there are more efficient and effective methods of testing range
of motion, and recommendations on whether to continue the
practice of measuring functional impairment by using the three
repetitions of movement method.
The second reporting requirement requires VA to submit a
report on VA efforts to reduce the need for in-person
disability examinations and use of the authority provided by
section 5125 of title 38, U.S.C. This report would contain
information on the Acceptable Clinical Evidence initiative. It
would also contain information on any other efforts to further
encourage the use of medical evidence provided by a private
health care provider and the reliance upon reports of a medical
examination or a medical opinion administered by a private
physician if such report is sufficiently complete to be
adequate for the purposes of adjudicating a claim for service-
connection. Under this second requirement, VA would also have
to submit a plan to measure, track, and prevent the ordering of
unnecessary medical examinations and actions to eliminate
requests for medical examinations when the record contains
medical evidence and/or opinions provided by a private health
care provider that is adequate for purposes of making a
decision on a claim.
Further, Congress has provided authority to allow VA to
accept private medical evidence and take actions consistent
with this authority to improve the timeliness and accuracy of
claims decisions. It is the Committee's intent that VA continue
to ensure medical examinations are appropriate and used
efficiently.
Sec. 225. Sense of Congress on submittal of information relating to
claims for disabilities incurred or aggravated by military
sexual trauma.
Section 225 of the Committee bill, which is derived from
S. 865, would express the sense of Congress that VA should
submit an annual report to Congress on claims for disabilities
alleged to have been incurred or aggravated by military sexual
trauma.
Background. VA's efforts to improve the adjudication of
disability claims based on military sexual trauma remains an
issue of concern to the Committee. In the ``Department of
Defense Fiscal Year 2014 Annual Report on Sexual Assault in the
Military,'' DOD estimates that 18,900 servicemembers
experienced unwanted sexual contact in 2014, which is a
decrease from the 26,000 servicemembers estimated in 2012.
Other data, derived from VA's national screening program,
reveal that about 1 in 4 women and 1 in 100 men receiving
health care at VA report experiencing military sexual trauma.
The Committee has received testimony from advocacy groups
stressing the need for continued oversight of VA's efforts to
improve the adjudication of disability claims related to
military sexual trauma.
Committee Bill. Section 225 of the Committee bill, in a
freestanding provision, would express the sense of Congress
that VA should submit an annual report to Congress on claims
for disabilities alleged to have been incurred or aggravated by
military sexual trauma.
Section 225 of the Committee bill specifies that the
contents of each such report should include specific
information on the adjudication of disability claims related to
military sexual trauma. Specifically, the report would include
(1) the number and percentage of claims submitted by each
gender that were approved and denied; (2) the rating percentage
assigned for claims that were approved disaggregated by gender;
(3) the three most common reasons for denials; and (4) the
number of denials based on the failure of a veteran to report
for a medical examination. The report should include this same
information for claims that were resubmitted after a denial in
a previous adjudication. Finally, the annual report should also
include the number of claims pending and on appeal and the
average number of days from submission to completion of a claim
during the past fiscal year.
The Committee recognizes VA's ongoing efforts to improve
the adjudication of claims based on military sexual trauma.
However, continued oversight, such as the reporting
requirements of this section, would allow the Committee to make
more informed decisions about what future action, if any, may
be necessary to ensure survivors of military sexual trauma
receive the benefits to which they are entitled.
TITLE III--EDUCATION MATTERS
Sec. 301. Retention of entitlement to educational assistance during
certain additional periods of active duty.
Section 301 of the Committee bill, which is an original
provision, would add two active duty authorities to the
existing authorities under which a Reservist may regain lost
payments or lost entitlement for the Montgomery GI Bill-
Selected Reserve program if activation under such authority
prevented the completion of his/her studies.
Background. Section 12304a of title 10, U.S.C., allows the
Secretary of Defense to order any Reserve unit, or member not
assigned to a unit, to active duty for up to 120 days in order
to respond to a Governor's request for Federal assistance in a
major disaster or emergency. Section 12304b of title 10,
U.S.C., authorizes military Secretaries to order up to 60,000
members of the Selected Reserve to active duty for a period up
to 365 days in order to augment active forces for preplanned
missions. Under both of these authorities, a servicemember may
be ordered to active duty without his/her consent and the
notification requirements and length of typical mobilizations
make it unlikely such service would require a Reserve member to
not complete a course in which he/she is enrolled, but it
remains a possibility.
Sections 16131 and 16133 of title 10, U.S.C., list five
authorities for mobilizing the Reserves under which a Reservist
receiving educational assistance under the Montgomery GI Bill-
Selected Reserve program would not have such assistance charged
against his/her entitlement to benefits. This prevents
Reservists from losing benefits when service under these
authorities interrupts their studies and prevents them from
earning credit for a certain term.
Section 522 of the DOD legislative proposals sent to
Congress for inclusion in the FY 2016 National Defense
Authorization Act contained the provisions now included in
section 301 of the Committee bill.
Committee Bill. Section 301 of the Committee bill would add
sections 12304a and 12304b of title 10, U.S.C., to the list of
authorities in sections 16131 and 16133 of title 10, U.S.C.,
under which a Reservist may regain lost payments and lost
entitlement for Montgomery GI Bill-Selected Reserve education
benefits when that activation authority prevented the Reservist
from completing his/her studies.
Sec. 302. Reports on progress of students receiving Post-9/11
Educational Assistance.
Section 302 of the Committee bill, which is an original
provision, would require educational institutions to report
annually to VA on the academic progress of students for whom it
receives payments under the Post-9/11 GI Bill. The Secretary of
Veterans Affairs would be required to include this information
in the annual report to Congress on the Post-9/11 GI Bill.
Background. The National Defense Authorization Act of FY
2013 (Public Law 112-239) established the Military Compensation
and Retirement Modernization Commission (hereinafter,
``MCRMC'') to conduct a review of the military compensation and
retirement systems and to make recommendations to modernize
such systems. The MCRMC issued its final report in January 2015
that included 15 recommendations around Pay and Benefits,
Health Benefits, and Quality of Life for Servicemembers and
Retirees. Recommendations 11 and 12 focused largely on
education benefits and transition programs. In May 2015, the
MCRMC issued an addendum to its report.
Since its inception in 2009, the Post-9/11 GI Bill has paid
$53 billion on behalf of more than 1.4 million beneficiaries.
The MCRMC Addendum suggested that gaining a better
understanding of the benefit, how it is used, and its impact on
beneficiaries will help inform any potential future changes to
the benefit. VA is currently required to submit to Congress an
annual report on the completion of credit hours and educational
objectives by beneficiaries using the Post-9/11 GI Bill. In its
February 2014 report to Congress, VA recommended requiring
educational institutions to provide additional information on
the progress of students using Post-9/11 GI Bill benefits.
Section 1109 of the legislative proposals in the report of
the MCRMC Addendum included the material that is now contained
in section 302 of the Committee bill.
Committee Bill. Section 302 of the Committee bill would add
a new section 3326 to chapter 33 of title 38, U.S.C. The new
section would require that any educational institution
receiving payments for beneficiaries using the Post-9/11 GI
Bill report annually to the Secretary of Veterans Affairs on
each beneficiary's academic progress towards his/her
educational objective. Section 302 of the Committee bill would
also amend section 3325(c) of title 38, U.S.C., to require the
Secretary of Veterans Affairs to include in the report to
Congress required by that section the information reported by
educational institutions under new section 3326 of title 38,
U.S.C.
Sec. 303. Secretary of Defense report on level of education attained by
those who transfer entitlement to Post-9/11 educational
assistance.
Section 303 of the Committee bill, which is an original
provision, would require the Secretary of Defense to include in
its annual report to Congress on the Post-9/11 GI Bill the
highest level of education attained by each individual who
transfers his/her Post-9/11 GI Bill benefits to eligible
dependents.
Background. Under section 3319 of title 38, U.S.C., certain
servicemembers who are eligible for the Post-9/11 GI Bill and
meet other eligibility criteria may be permitted to transfer
the unused portion of their Post-9/11 GI Bill benefits to one
or more dependent. The MCRMC's final report noted that the
impact of making changes to these criteria for transferring
benefits is not well understood. The MCRMC recommendation to
collect more information on who is transferring their unused
Post-9/11 GI Bill benefits supports the idea that a better
understanding of the people who transfer benefits and their
motivations for doing so will allow the Department of Defense
to improve the use of transferability as a retention tool.
Section 1105 of the legislative proposals in the report of
the MCRMC included the material now contained in section 303 of
the Committee bill.
Committee Bill. Section 303 of the Committee bill amends
section 3325(b) of title 38, U.S.C., to add to it a requirement
that the Secretary of Defense include in the annual report to
Congress the highest level of education attained by each
individual who transfers a portion of his/her entitlement to
educational assistance under section 3319 of title 38, U.S.C.
This new requirement would take effect 1 year after enactment
of this bill.
Sec. 304. Reports on educational levels attained by certain members of
the Armed Forces at time of separation from the Armed Forces.
Section 304 of the Committee bill, which is an original
provision, would require the Secretary concerned to collect
upon separation the highest level of education attained by each
member of the Armed Forces. The Secretary concerned would be
required to submit that information to Congress annually
beginning 1 year after enactment of this bill.
Background. In its final report, the MCRMC noted that DOD
is not collecting data on the educational levels of those who
transfer their Post-9/11 GI Bill benefits and DOD has only
limited data on those servicemembers who use the Post-9/11 GI
Bill or Tuition Assistance. The MCRMC's recommendation to
collect information at the point of separation from service
regarding the education level attained by those transferring
their unused Post-9/11 GI Bill benefits is intended to improve
the understanding of how use or transfer of the benefits
impacts the educational levels of servicemembers.
Section 1106 of the legislative proposals in the report of
the MCRMC included the material now contained in section 304 of
the Committee bill.
Committee Bill. In a freestanding provision, section 304 of
the Committee bill requires each military service Secretary to
report annually to Congress on the educational levels attained
by certain members of the Armed Forces at the time they
separated from the Armed Forces during the preceding year. This
report is only applicable to members of the Armed Forces who
transferred unused education benefits to family members
pursuant to section 3319 of title 38, U.S.C., while serving as
members of the Armed Forces.
TITLE IV--EMPLOYMENT AND TRANSITION MATTERS
Sec. 401. Required coordination between Directors for Veterans'
Employment and Training with State departments of labor and
veterans affairs.
Section 401 of the Committee bill, which is an original
provision, would require the Department of Labor's Director of
Veterans' Employment and Training for each state to coordinate
his/her activities with the state agencies for labor and
veterans affairs.
Background. Pursuant to section 4103 of title 38, U.S.C.,
the Department of Labor is required to assign to each state a
Director for Veterans' Employment and Training to serve as a
representative of the Department of Labor's Veterans'
Employment and Training Service.
In its final report from January 2015, the MCRMC noted that
unemployment remains a challenge for many transitioning
veterans. The report cited feedback from veterans who shared
experiences where employers' lack of understanding about
military service prevented them from being hired. The report
also noted that most employment services for veterans are
administered by labor departments at the state level and not by
each state's veterans agency. Any deficiency in that state
labor department's understanding of veterans' unique employment
challenges poses additional barriers to the success of its Jobs
for Veterans State Grant (hereinafter, ``JVSG'') program. The
report did note, however, that Texas administered its veterans
employment services as part of the JVSG program via its Texas
Veterans Commission. The report cited the testimony of Rear
Admiral W. Clyde Marsh, USN (Ret.), President of the National
Association of State Directors of Veterans Affairs, where he
suggested the JVSG program would benefit from increased
coordination with the state veterans affairs directors.
Section 1202 of the legislative proposals in the report of
the MCRMC Addendum included the material that is now contained
in section 401 of the Committee bill.
Committee Bill. Section 401 of the Committee bill adds a
requirement to section 4103 of title 38, U.S.C., requiring each
Director for Veterans' Employment and Training in a state to
coordinate his/her activities with the state's departments of
labor and veterans affairs. This new requirement would take
effect 1 year after the enactment of the Committee bill.
Sec. 402. Report on job fairs attended by One-Stop Career Center
employees at which such employees encounter veterans.
Section 402 of the Committee bill, which is an original
provision, would require an annual report from states to
include the number of job fairs attended by One-Stop Career
Center employees at which they had contact with a veteran and
the number of veterans at each event so contacted.
Background. The MCRMC noted in its final report from
January 2015 that One-Stop Career Centers, which are part of
state workforce agencies or employment commissions, are
significant providers of employment services for veterans after
they leave military service. The staff at these centers
includes those focused solely on serving veterans with
significant barriers to employment as well as staff who serve
both veterans and non-veterans. The services that may be
provided to veterans may vary depending on their employment
needs and specific situations. One way for the One-Stop Career
Center staff to connect with veterans in need of services is to
attend job fairs and conduct outreach. Because these outreach
connections are not tracked, it is difficult to evaluate
whether or not attending these job fairs increases successful
outcomes.
Section 1201 of the legislative proposals in the report of
the MCRMC Addendum included the material that is now contained
in section 402 of the Committee bill.
Committee Bill. Section 402 of the Committee bill adds a
requirement to section 136(d)(1) of Public Law 105-220, the
Workforce Investment Act of 1998, that the number of job fairs
attended by One-Stop Career Center employees where veterans
were contacted, along with the number of veterans contacted, be
included in the annual reports submitted to Congress. This
requirement would take effect 1 year after enactment of the
bill.
Sec. 403. Review of challenges faced by employers seeking to hire
veterans and sharing of information among Federal agencies that
serve veterans.
Section 403 of the Committee bill, which is an original
provision, would require the Secretary of Labor to review the
challenges employers face in hiring veterans and the
information sharing among Federal departments and agencies
serving veterans and separating servicemembers.
Background. In its final report from January 2015, the
MCRMC noted reports both from employers and from veterans that
it remained difficult for employers to find veterans with the
right skills to fill open positions. The MCRMC also shared
feedback from employers that veterans seemed to lack the
employment skills necessary to network and find jobs for which
they could apply. Although transition classes, employment
services, and other benefits are provided to veterans, the
employers who hire veterans are the ultimate audience for the
skills and practices these services provide to the veterans. A
thorough understanding of where employers face difficulties
connecting with veteran job seekers and where there are gaps in
bridging military and civilian skills could improve the
substance and delivery of employment training provided to
transitioning servicemembers and veterans.
Section 1203 of the legislative proposals in the report of
the MCRMC Addendum included the material now contained in
section 403 of the Committee bill.
Committee Bill. In a freestanding provision, section 403 of
the Committee bill directs the Secretary of Labor, in
consultation with the Secretaries of Defense and Veterans
Affairs, to review the challenges employers face in hiring
veterans and information sharing among Federal agencies that
serve separating members of the Armed Forces and veterans. The
review specifically includes barriers employers face
identifying job-seeking veterans and the ways in which Federal
departments and agencies that serve veterans and separating
servicemembers may more easily connect them with employers. The
Secretary of Labor would be required to submit to Congress
recommendations on addressing the barriers employers face as
described in the review along with recommendations on improving
information sharing by the Federal departments and agencies
serving veterans and servicemembers. These recommendations
would be due 120 days after the effective date of the Committee
bill, which would be 1 year after its passage.
Sec. 404. Review of Transition GPS Program Core Curriculum.
Section 404 of the Committee bill, which is an original
provision, would require the Secretary of Defense, in
consultation with the Secretaries of Veterans Affairs and
Labor, to review the Transition GPS Core Curriculum and report
to Congress recommendations on its effectiveness, allocation of
the roles and responsibilities of Federal departments in the
program, optimizing each topic by length of instruction and
whether or not it is mandatory, and developing metrics for
assessment of the program.
Background. Transition GPS is the curriculum delivered to
transitioning servicemembers prior to their separation from the
Armed Forces. It includes mandatory subjects on transition,
resiliency, translating military skills, financial planning,
and VA benefits. There are also optional class tracks on
accessing higher education, pursuing technical careers, and
entrepreneurship. The MCRMC's final report notes that the
Departments of Labor and Defense are of the view that
Transition GPS has areas that can be improved. One possible
change is making the optional tracks mandatory based on the
individual servicemember's transition plan. Another area of
potential improvement mentioned is measuring outcomes from the
curriculum. The report cites a GAO study that concluded current
metrics for evaluating outcomes were ``incomplete.''
The Transition GPS curriculum is the foundation for
servicemembers' transition experience when they leave the Armed
Forces. It sets up expectations for what they will encounter
after separation and provides skills and tools with which to
navigate life as a civilian. Continued evaluation and
refinement of the curriculum is important to achieving the
highest standard of quality in subject matter and to ensure
that subject matter is current with the evolving standards of
career skills, educational practices, and business processes.
Section 1204 of the legislative proposals in the report of
the MCRMC Addendum included the material that is now contained
in section 404 of the Committee bill.
Committee Bill. In a freestanding provision, section 404 of
the Committee bill would require the Secretary of Defense, in
consultation with the Secretaries of Veterans Affairs and
Labor, to conduct a review of the Transition GPS Core
Curriculum. The review would include the roles and
responsibilities of the various Federal departments and
agencies involved in the program, the distribution of time
spent on the various topics covered by the curriculum, whether
any of the optional tracks should be mandatory, and the
feasibility of standard outcome measures and metrics for
evaluating the program. The Secretary of Defense would be
required to report to Congress within 120 days of the effective
date of this section of the Committee bill the results of this
curriculum review and any recommendations for improving the
curriculum, the delivery of the curriculum, and the measurement
of its outcomes.
Sec. 405. Modification of requirement for provision of preseparation
counseling.
Section 405 of the Committee bill, which is an original
provision, would clarify that preseparation counseling shall
not be provided to a servicemember discharged before completion
of 180 continuous days on active duty.
Background. Section 1142 of title 10, U.S.C., currently
prohibits the provision of preseparation counseling to
servicemembers being discharged from service before they
complete their first 180 days of active duty. The current
language could be interpreted to mean any combination of 180
days of active service, even if they were not consecutive days
of service. Such a scenario could apply to Reservists or
members of the National Guard ordered to active duty for
multiple periods of less than 180 days.
Section 545 of the DOD legislative proposals sent to
Congress for inclusion in the FY 2016 National Defense
Authorization Act included the material now contained in
section 405 of the Committee bill.
Committee Bill. Section 405 of the Committee bill would
amend section 1142 of title 10, U.S.C., to insert
``continuous'' before ``180 days.'' It would also clarify the
meaning of ``active duty'' in section 1142 of title 10, U.S.C.,
to exclude full-time training duty, annual training duty, or
attendance at a service school while on active duty.
TITLE V--VETERAN SMALL BUSINESS MATTERS
Sec. 501. Modification of treatment under contracting goals and
preferences of Department of Veterans Affairs for small
businesses owned by veterans of small businesses after death of
disabled veteran owners.
Section 501 of the Committee bill, which is derived from
S. 296, would permit the surviving spouse of a veteran owner of
a small business, who is less than 100 percent disabled and
whose death is not a result of a service-connected disability,
to maintain the status of such small business concern for up to
3 years following the death of such veteran.
Background. Under current law, section 8127(h) of title 38,
U.S.C., if the death of a veteran causes a small business to be
less than 51 percent owned by one or more veterans, the
surviving spouse may be treated as if the surviving spouse is
the veteran under limited circumstances for up to 10 years for
the purpose of receiving contracting preferences from VA.
Specifically, the spouse can only retain the status as a
service-disabled veteran-owned small business (hereinafter,
``SDVOSB'') if, following the death of the veteran owner, the
spouse acquires ownership rights of at least 51 percent and the
veteran had a service-connected disability rated as 100 percent
disabling or if the veteran died as a result of a service-
connected condition.
For spouses not covered by section 8127(h), the small
business concern immediately loses the SDVOSB designation, thus
precluding them from benefiting from future VA procurement
preferences.
Committee Bill. Section 501 of the Committee bill would
amend section 8127(h) of title 38, U.S.C., by providing that
the surviving spouse may retain the SDVOSB designation for a
period of up to 3 years in cases where the veteran had a
service-connected disability rated at less than 100 percent or
who did not die as a result of a service-connected condition.
The Committee is concerned that surviving spouses may be
forced to quickly sell the company or go out of business
following the death of a disabled veteran if the small business
loses the SDVOSB designation immediately upon death of the
veteran. The 3-year period will provide adequate time for the
surviving spouse to evaluate what course of action is
appropriate for the small business following the death of the
veteran.
Sec. 502. Treatment of businesses after deaths of servicemember-owners
for purposes of Department of Veterans Affairs contracting
goals and preferences.
Section 502 of the Committee bill, which is derived from
S. 296, would permit the surviving spouse of a servicemember
who owns at least 51 percent of a small business concern and
dies in the line of duty to maintain the status of such small
business concern for up to 10 years following the death of such
servicemember.
Background. Current law, section 8127 of title 38, U.S.C.,
requires VA to establish contracting goals for veteran-owned
small businesses (hereinafter, ``VOSBs'') and SDVOSBs. Further,
the section grants VA authority to use certain contracting
preferences to meet established goals and requires a VOSB or
SDVOSB to be certified as eligible by VA prior to being awarded
a contract under this section. To be eligible, a former
servicemember must be a veteran as defined by section 101(2) of
title 38, U.S.C. A servicemember who is wounded in action, upon
discharge, will meet the statutory definition of a veteran and
become eligible for certain VA contracting preferences. Current
law provides, under section 8127(h) of title 38, U.S.C., that
if a wounded veteran establishes eligibility and is certified
as an SDVOSB, the surviving spouse can retain the designation
for VA contracting preferences if the veteran dies and is rated
as 100 percent disabled or dies as a result of a service-
connected disability. However, if a servicemember dies on
active duty in the line of duty, he/she will never have the
ability to apply for the SDVOSB designation, and any surviving
spouse or dependent would not be viewed as an SDVOSB for the
purposes of VA contracting following the servicemember's death.
Committee Bill. Section 502 of the Committee bill would
amend section 8127 of title 38, U.S.C., by inserting a new
subsection (i). The new subsection would provide that, if a
member of the Armed Forces dies in the line of duty while on
active duty and owned at least 51 percent of a small business
prior to his or her death, the surviving spouse or dependent,
who acquired the ownership rights of the small business, will
be treated as a service-disabled veteran for the purposes of
SDVOSB certification and VA contracting preferences.
Surviving spouses may retain the SDVOSB designation until
the date they remarry, the date they no longer own and control
51 percent of the small business, or the date that is 10 years
after the death of the servicemember. Dependents may retain the
designation until they no longer own and control 51 percent of
the small business or the date which is 10 years after the
death of the servicemember.
SDVOSB contracting goals and preferences are designed to
help service-disabled veterans lead productive and fulfilling
lives after their military service by recognizing the sacrifice
of those who were wounded in service to their country. The
Committee believes extending the SDVOSB designation to
surviving spouses and dependents, who have lost family members
in the line of duty, is a small recognition of their sacrifice
and may assist them in successfully operating their businesses.
TITLE VI--BURIAL MATTERS
Sec. 601. Department of Veterans Affairs study on matters relating to
burial of unclaimed remains of veterans in national cemeteries.
Section 601 of the Committee bill, which is derived from
S. 695, would require VA to complete a study on matters
relating to the interring of unclaimed remains of veterans in
national cemeteries and submit a report to Congress on the
findings of the study.
Background. The Dignified Burial and Other Veterans'
Benefits Improvements Act of 2012, Public Law 112-260,
authorized burial of the unclaimed remains of a veteran in a
national cemetery when no known next-of-kin was able to make
the request for the burial benefit. The Missing in America
Project has worked to identify unclaimed remains and assist in
the interment of unclaimed remains identified as those of a
veteran. They have identified and helped inter over two
thousand unclaimed remains of veterans. Identifying and then
interring the unclaimed remains of veterans requires
coordination and cooperation between government and
nongovernment entities, as well as coordination between local,
state, and Federal entities. There are also various local and
state laws that apply to the interring of unclaimed remains.
Additionally, there is a need to make all the appropriate
entities aware that the unclaimed remains of veterans may
qualify for this benefit.
Committee Bill. In a freestanding provision, section 601 of
the Committee bill directs the Secretary of Veterans Affairs to
conduct a study and report to Congress on various matters
relating to the interment of unclaimed remains of veterans in
national cemeteries. The study would include an estimate of the
number of unclaimed remains, an assessment of state and local
laws impacting the interment of unclaimed remains, and an
assessment of VA procedures for working with other entities in
custody of the unclaimed remains of veterans. Section 601 of
the Committee bill also provides for a methodology for the
study to look at a subset of those entities having custody of
the unclaimed remains and a subset of applicable state and
local laws that impact the interment of unclaimed remains. This
section would take effect 1 year after enactment of the
Committee bill and the report to Congress would be required 1
year after the effective date.
TITLE VII--OTHER MATTERS
Sec. 701. Honoring as veterans certain persons who performed service in
the Reserve components of the Armed Forces.
Section 701 of the Committee bill, which is derived from
S. 743, would recognize the service of certain individuals in
the Reserve components of the Armed Forces by honoring them as
veterans.
Background. Under current law, section 101(2) of title 38,
U.S.C., for purposes of determining eligibility for benefits
administered by VA, a veteran is defined as ``a person who
served in the active military, naval, or air service, and who
was discharged or released therefrom under conditions other
than dishonorable.'' As such, a member of the Reserve
components who is eligible for retirement pay, or in receipt of
retired pay, who did not have qualifying active duty service,
is not recognized as a veteran for purposes of eligibility for
certain VA benefits. This has led to some confusion as to
whether an individual who served in the Reserves, but did not
have qualifying active duty service, should be referred to as a
``veteran'' for purposes other than determining eligibility for
VA benefits.
Committee Bill. Section 701 of the Committee bill would, in
a non-codified provision, honor as a veteran those individuals
who are entitled under chapter 1223 of title 10, U.S.C., to
retired pay for irregular service or who would be entitled to
retired pay, but for age. Section 701 would ensure those who
are honored as ``veterans'' under this section would not be
entitled to any VA benefit by reason of such recognition.
Sec. 702. Report on Laotian military support of Armed Forces of the
United States during Vietnam War.
Section 702 of the Committee bill, which is derived from
S. 1358, would require VA, in consultation with DOD and such
agencies or individuals VA considers appropriate, to submit a
report to Congress on the extent to which Laotian military
forces provided combat support to the Armed Forces of the
United States between February 28, 1961, and May 15, 1975;
whether the current classification by the DOD Civilian/Military
Service Review Board is appropriate; and any recommendations
for legislative action.
Background. Due to American involvement in South-East Asia
in the 1960s, Laos became a focal point for both American and
North Vietnamese operations. Due to the limited ability of
formal Laotian forces to stop cross border threats and stymie
North Vietnamese supply lines, the United States. began to
train and supply Hmong guerillas in Laos.\1\ The Hmong
``Special Guerrilla Units'' were trained by members of the
Central Intelligence Agency (hereinafter, ``CIA''). This effort
by the CIA became known as the CIA's ``Secret War.''\2\ The
Hmong were primarily responsible for interrupting communist
supply lines and rescuing downed pilots.\3\ Given the secrecy
that surrounded the program, establishing concrete figures for
the number of Hmong guerillas who fought along-side American
forces during this period is challenging. One estimate claims
it was in the tens of thousands.\4\ Casualties amongst this
cohort mounted rapidly. A source indicates that by 1975,
100,000 Hmong had been killed.\5\ After the fall of Saigon and
the takeover of Laos by communist forces, the CIA stopped all
further assistance to the Hmong. This discontinuation of
support by the CIA effectively left the Hmong to fend for
themselves.\6\ Those who remained sought refuge in neighboring
Thailand, while others fled to the United States.
---------------------------------------------------------------------------
\1\Tim Weiner, Gen. Vang Pao's Last War, New York Times Magazine,
May 11, 2008. http://www.nytimes.com/2008/05/11/magazine/11pao-
t.html?pagewanted=all& To assist a state in response to a major disaster
or emergency; or
To augment the active component in support of a
preplanned mission for the combatant commands.
Under current law, VA can restore education benefits for
military personnel deployed for several other reasons. Further,
most servicemembers are notified more than 180 days in advance
of a deployment, giving them sufficient time to complete a
course or make other arrangements with the education
institution. Based on information from DOD, CBO estimates that
about 200 reservists would be unable to complete coursework in
any year for the reasons listed above. However, most of those
personnel would not exhaust all of their education benefits, so
restoring lost benefits would not result in additional spending
on their behalf. Approximately 50 reservists who would use all
of their benefits would have about $600 each in lost benefits
restored under section 301. Thus, the additional costs for
those whose benefits would increase direct spending by less
than $500,000 over the 2016-2025 period, CBO estimates.
Pay-As-You-Go Considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO Estimate of Pay-As-You-Go Effects for S.1203 as ordered reported by the PSenate Committee on Veterans'
Affairs on July 22, 2015
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
---------------------------------------------------------------------------------
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2016-2020 2016-2025
----------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact -6 -6 -6 -6 -6 -6 -6 -6 -6 -6 -30 -60
----------------------------------------------------------------------------------------------------------------
Intergovernmental and private-sector impact: S. 1203
contains no intergovernmental or private-sector mandates as
defined in UMRA and would benefit public institutions of higher
education that participate in educational programs under the GI
Bill. Any costs those entities might incur, including
reductions in fee payments from the VA, would be incurred as
conditions of participating in a voluntary federal program.
Estimate prepared by: Federal Costs: Ann E. Futrell, David
Newman, and Dwayne M. Wright; Impact on State, Local, and
Tribal Governments: Jon Sperl; Impact on the Private Sector:
Paige Piper/Bach.
Estimate approved by: H. Samuel Papenfuss, Deputy Assistant
Director for Budget Analysis.
Regulatory Impact Statement
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans'
Affairs has made an evaluation of the regulatory impact that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses or result in any impact
on the personal privacy of any individuals and that the
paperwork resulting from enactment would be minimal.
Tabulation of Votes Cast in Committee
In compliance with paragraph 7(b) of rule XXVI of the
Standing Rules of the Senate, the following is a tabulation of
votes cast in person or by proxy by members of the Committee on
Veterans' Affairs at its July 22, 2015, meeting. Five
amendments to S. 1203 were voted on by Members of the
Committee.
An amendment by Senator Murray would have required VA to
provide child care assistance to certain veterans receiving
health care from VA. This amendment was not agreed to by a roll
call vote.
----------------------------------------------------------------------------------------------------------------
Yeas Senator Nays
----------------------------------------------------------------------------------------------------------------
Mr. Moran X
Mr. Boozman X
Mr. Heller X
Mr. Cassidy X
Mr. Rounds X
Mr. Tillis X
Mr. Sullivan X
X Mr. Blumenthal
X Mrs. Murray
X Mr. Sanders
X (by proxy) Mr. Brown
X Mr. Tester
X Ms. Hirono
X Mr. Manchin
Mr. Isakson, Chairman X
----------------------------------------------------------------------------------------------------------------
7 TALLY 8
----------------------------------------------------------------------------------------------------------------
An amendment by Senator Murray would have required VA to
improve the women veterans contact center. This amendment was
not agreed to by a roll call vote.
----------------------------------------------------------------------------------------------------------------
Yeas Senator Nays
----------------------------------------------------------------------------------------------------------------
Mr. Moran X
Mr. Boozman X
Mr. Heller X
Mr. Cassidy X
Mr. Rounds X
Mr. Tillis X
Mr. Sullivan X
X Mr. Blumenthal
X Mrs. Murray
X Mr. Sanders
X (by proxy) Mr. Brown
X Mr. Tester
X Ms. Hirono
X Mr. Manchin
Mr. Isakson, Chairman X
----------------------------------------------------------------------------------------------------------------
7 TALLY 8
----------------------------------------------------------------------------------------------------------------
An amendment by Senator Murray would require VA to provide
treatment for certain emergency medical conditions and women in
labor. This amendment was agreed to by voice vote.
An amendment by Senator Tester would require VA to submit
to Congress a report on VA's medical workforce. This amendment
was agreed to by voice vote.
An amendment by Senator Tester would address the training,
compensation, and qualifications for certain health care
providers at VA. This amendment was agreed to by voice vote.
The Committee also discussed amendments sponsored by
Senators Blumenthal, Murray, Sanders, Tester, and Hirono but
did not vote on those amendments because they were withdrawn.
S. 1203 as amended, and as subsequently amended during the
Committee meeting, was agreed to by voice vote and ordered
favorably reported to the Senate.
Agency Report
On May 13, 2015, David R. McLenachen, Acting Deputy Under
Secretary for Disability Assistance; on June 3, 2015, Thomas
Lynch, Assistant Deputy Under Secretary for Health Clinical
Operations, Veterans Health Administration; and on June 24,
2015, Dr. Rajiv Jain, Assistant Deputy Under Secretary for
Health for Patient Care Services, Veterans Health
Administration from the Department of Veterans Affairs appeared
before the Committee on Veterans' Affairs and submitted
testimony on various bills incorporated into the Committee
bill. In addition, on July 15, 2015, and September 4, 2015, VA
provided views on various bills incorporated into the Committee
bill. Excerpts from these statements are reprinted below:
STATEMENT OF DAVID R. McLENACHEN, ACTING DEPUTY UNDER SECRETARY FOR
DISABILITY ASSISTANCE, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Good afternoon, Mr. Chairman and Members of the Committee.
I am pleased to be here today to provide the views of the
Department of Veterans Affairs (VA) on pending legislation
affecting VA's programs, including the following: S. 270,
S. 602, S. 627, the ``21st Century Veterans Benefits Delivery
Act,'' the ``Veterans' Compensation Cost-of-Living Adjustment
Act of 2015,'' and a draft bill concerning VA small business
contracting, Veterans benefits, and burial matters. We will
separately provide views on the following bills: S. 681;
sections 202, 203 and 206 of the ``21st Century Veterans
Benefits Delivery Act;'' the bill associated with legislative
proposals from the Report of the Military Compensation and
Retirement Modernization Commission; the bill associated with
legislative proposals from the Department of Defense (DOD); and
sections 201 and 206 of the consolidated bill related to bills
from the 113th Congress. Accompanying me this afternoon is
Renee Szybala, Assistant General Counsel.
* * * * * * *
S. 1203
Section 101
Section 101 would amend section 1144 of title 10, United
States Code, by adding a subsection (f) to require
modifications to the eBenefits Internet Web site to ensure that
members of the Armed Forces and spouses have access to the
online curriculum for the Transition Assistance Program (TAP),
as administered by the Secretary of Labor, the Secretary of
Defense, the Secretary of Homeland Security, and the Secretary
of Veterans Affairs. This would require modifications to the
eBenefits Web site to host the online version of the TAP
curriculum.
Section 101 would also note Congress' intent that the
Secretary of Labor, the Secretary of Defense, the Secretary of
Homeland Security, and the Secretary of Veterans Affairs
collaborate to establish a process by which Veterans service
organizations may be present for TAP to provide assistance
relating to submitting claims for VA compensation and pension
benefits. The Secretary of Defense would be required to submit
a report to Congress, no later than 1 year after enactment, on
Veterans service organizations' participation.
VA does not support the provision to make TAP curriculum
available through eBenefits because it is unnecessary. This
provision would be duplicative as all TAP curriculums are
already available through the Joint Knowledge Online (JKO)
system, which is linked to eBenefits. VA modified the eBenefits
portal in fiscal year 2014 to provide an online version of VA's
section of the TAP curriculum through the JKO link and
facilitate online participation for transitioning
Servicemembers and their families. This functionality lends
support to geographically dispersed Servicemembers as well as
members of the National Guard and Reserve components who are
required to participate in VA's section of TAP. Additionally,
the online version is beneficial to Veterans and their families
if they would like to access the curriculum after separation.
VA defers to DOD and the Department of Homeland Security
for comment on proposed new 10 U.S.C. Sec. 1144(f)(2) regarding
the feasibility of ensuring that Servicemembers who are
mandated to fulfill the TAP requirement can satisfy the
requirement through means other than solely through an Internet
Web site.
VA does not oppose having a process for Veterans service
organizations (VSOs) to provide assistance relating to
submittal of claims for VA compensation and pension benefits.
VA currently provides an overview of the services offered by
VSOs and introduces VSOs to Servicemembers during our benefits
briefings. VA also partners with VSOs at military installations
where they are co-located or available to offer claims support.
VA defers to DOD on subsection (b)(2) of section 101 of the
bill regarding the requirement to provide a report on
participation of VSOs in TAP.
VA estimates that no administrative or benefit costs to VA
would be associated with enactment of this section.
Section 102
Section 102 would amend 38 U.S.C. Sec. 5104, which provides
requirements for VA's decisions and notices of decision. It
would require VA, upon issuing a decision for a claimed
benefit, to also explain the procedure for obtaining review of
the decision and explain the benefits of filing a Notice of
Disagreement (NOD) within 180 days.
VA does not support this section. While VA appreciates the
effort to encourage individuals to file their NOD in a timelier
manner, VA would prefer a more definitive legislative solution.
As noted in VA's Strategic Plan to Transform the Appeal
Process, which was provided to the Senate Committee on
Veterans' Affairs on February 26, 2014, the current process
provides appellants with multiple reviews in the Veterans
Benefits Administration (VBA) and one or more reviews at the
Board of Veterans' Appeals (Board), depending upon the
submission of new evidence or whether the Board determines that
it is necessary to remand the matter to VBA. The multi-step,
open-record appeal process set out in current law precludes the
efficient delivery of benefits to all Veterans. The longer an
appeal takes, the more likely it is that a claimed disability
will change, resulting in the need for additional medical and
other evidence and further processing delays. As a result, the
length of the process is driven by how many cycles and
readjudications are triggered. VA's FY 2016 budget request
includes legislative proposals to improve the appeal process,
and VA has collaborated with Veterans service organizations to
develop an optional fully developed appeals pilot program. VA
continues to work with Congress and other stakeholders to
explore long-term solutions that would provide Veterans the
timely appeals process they deserve.
VA estimates that GOE costs associated with this section
would be insignificant.
Section 103
Section 103 would allow for greater use of video conference
hearings by the Board, while still providing Veterans with the
opportunity to request an in-person hearing if they so elect.
This provision would apply to cases received by the Board
pursuant to Notices of Disagreement submitted on or after the
date of the enactment of the Act. VA fully supports section 103
as drafted, as this provision would potentially decrease
hearing wait times for Veterans, enhance efficiency within VA,
and better focus Board resources toward issuing more final
decisions.
The Board has historically been able to schedule video
conference hearings more quickly than in-person hearings,
saving valuable time in the appeals process for Veterans who
elect this type of hearing. In FY 2014, on average, video
conference hearings were held 124 days sooner than in-person
hearings before a Veterans Law Judge (VLJ) at a Regional Office
Travel Board hearing. Section 103 would allow both the Board
and Veterans to capitalize on these time savings by giving the
Board greater flexibility to schedule video conference hearings
than is possible under the current statutory scheme.
Historical data also shows that there is no statistical
difference in the ultimate disposition of appeals based on the
type of hearing selected. Veterans who had video conference
hearings had an allowance rate for their appeals that was
virtually the same as Veterans who had in-person hearings;
however, Veterans who had video conference hearings were able
to have their hearings scheduled much more quickly. Section 103
would continue to allow Veterans who want an in-person hearing
the opportunity to specifically request and receive one.
Enactment of section 103 could also lead to an increase in
the number of final decisions for Veterans as a result of
increased productivity at the Board. Time lost due to travel
and time lost in the field due to appellants failing to show up
for their hearing would be greatly reduced, allowing VLJs to
better focus their time and resources on issuing final Board
decisions for Veterans.
Major technological upgrades to the Board's video
conference hearing equipment over the past several years leave
the Board well-positioned for the enactment of section 103.
This includes the purchase of high-definition video equipment,
a state-of-the art digital audio recording system,
implementation of a virtual hearing docket, and significantly
increased video conference hearing capacity. Section 103 would
allow the Board to better leverage these important
technological enhancements.
We observe that section 103 would redesignate current
subsection (f) of section 7107 of title 38, United States Code,
as subsection (g); however, the draft legislation does not
revise the reference to current subsection (f) in subsection
(a) of section 7107 of title 38, United States Code. We suggest
revising subsection (a)(1) to state: ``Except as provided in
paragraphs (2) and (3) and in subsection (g), each case
received pursuant to application for review on appeal shall be
considered and decided in regular order according to its place
upon the docket.''
In short, section 103 would result in shorter hearing wait
times, focusing Board resources on issuing more decisions, and
providing maximum flexibility for both Veterans and VA, while
fully utilizing recent technological improvements. VA therefore
strongly endorses this proposal.
Section 201
We defer to the U.S. Government Accountability Office.
Section 204
We defer to the VA Office of the Inspector General.
Section 205
Section 205 would require VA to submit an annual report to
Congress on the capacity of VBA to process claims during the
next 1-year period. The reports would include the number of
claims VBA expects to process; number of full-time equivalent
(FTE) employees who are dedicated to processing such claims; an
estimate of the number of claims a single FTE can process in a
year; an assessment of whether VA requires additional or fewer
FTE to process such claims during the next 1-year, 5-year, and
10-year periods; a description of actions VA will take to
improve claims processing; and an assessment of actions
identified in previous reports required by this section. VA
would be required to make the report publicly available on the
Internet.
VA believes this legislation is unnecessary as VA's current
budget reports address these issues adequately, and such budget
reports are available publicly.
No administrative costs would be associated with enactment
of this section.
Section 207
Section 207 would require VA to submit to Congress a report
on the Department's progress in implementing the Veterans
Benefits Management System (VBMS). The report would include (1)
an assessment of current VBMS functionality; (2)
recommendations from VA's claims processors, including Veterans
Service Representatives, Rating Veterans Service
Representatives, and Decision Review Officers, on legislative
or administrative actions to improve the claims process; and
(3) recommendations from VSOs that use VBMS on legislative or
administrative actions to improve VBMS. VA would be required to
submit a report within 180 days after enactment of the bill and
no less frequently than once every 180 days thereafter until 3
years after enactment.
VA believes this legislation unnecessary as VA currently
provides regular updates to Congress regarding implementation
and functionality of VBMS; quarterly briefings to the House and
Senate Committees on Veterans' Affairs, advising them of the
status of VBA operations and updates to VBMS; and a quarterly
report to the House and Senate Appropriations Committees
summarizing recent and upcoming changes to VBMS. Additional
reporting requirements are not needed at this time.
VA estimates GOE costs associated with this section would
be insignificant.
Section 208
Section 208 would require VA to submit, within 90 days of
enactment of this Act, a report to Congress detailing plans to
reduce the inventory of claims for dependency and indemnity
compensation (DIC) and pension benefits.
VA does not support section 208. It is unnecessary as VBA
continues to make significant improvements in processing DIC
and pension claims.
VA's Pension and Fiduciary (P&F) Service, which oversees
administration of the DIC and pension programs, reviewed the
policies and procedures applicable to the adjudication of these
claims to identify obstacles to timely processing. P&F Service
determined that certain claim processing steps are redundant
and appropriate for elimination. On March 22, 2013, P&F Service
issued Fast Letter 13-04 (FL 13-04), Simplified Processing of
Dependency and Indemnity Compensation (DIC) Claims, which
instructs VBA field staff on the procedures to follow when
processing DIC claims. P&F Service is working on similar
guidance for pension claims.
On July 7, 2014, VA began automating payment of DIC to
certain surviving spouses of Veterans rated totally disabled at
death. As part of VA's notice of death process, VA systems
determine if the deceased Veteran met the requirements of
section 1318 and if the surviving spouse met the relationship
requirements. If the system determines that both requirements
are met it will automatically process and award DIC under
section 1318 within 6 days of notification of the Veteran's
death.
Based on these changes and an aggressive workload
management plan in VA's Pension Management Centers, VA has
reduced its pending DIC claim inventory by 55 percent from its
peak of 19,100 claims to 8,600 claims, and backlog by 87
percent from its peak of 8,800 to 1,000. Veterans pension
inventory was reduced by 68 percent from its peak of 36,100 to
11,400, and backlog by 96 percent from its peak of 14,500 to
600. Average processing time for DIC has improved by 100 days
from its peak of 168 days to 68 days, while maintaining 99
percent accuracy.
No benefits or GOE costs would be associated with enactment
of this section.
Section 209
This section would require VA to include in its Monday
Morning Workload Report (MMWR) the number of claims received by
regional offices and pending decisions, disaggregated by the
number of claims that have been pending for more than 125 days;
the number of claims that have been pending for 125 days or
less; and the number of claims that do not require a decision
concerning a disability rating. This section would also require
VA to include in the MMWR, the sections entitled
``Transformation'' and ``Aggregate,'' the number of partial
ratings assigned. Additionally, this section would require VA
to include in the MMWR a report on the total number of fully
developed claims (FDC) received by regional offices that are
pending a decision and the subset of those claims that have
been pending for more than 125 days, disaggregated by station.
VA does not support this section. The information required
by section 209(a) is already published in the MMWR for rating-
related disability compensation and pension claims. The section
appears to propose requiring all other non-rating pending
compensation and pension workload be added to the MMWR; however
information about these pending claims is also already
published in the MMWR. The single distinguishing new feature
would be the application of the backlog metric of 125 days to
all non-rating-related claims by regional office. However, 125
days is not a useful metric for the majority of non-rating-
related claims. The significant differences in the work effort
required for various types of non-rating-related claims and the
fact that much of this work is consolidated to the Pension
Management Centers make comparison at the aggregate level
across all regional offices a comparison without context or any
real capability to inform how one regional office compares to
another.
Section 209(b) would elevate tallies of partial ratings of
various claim types into a tool of comparison between regional
offices. Data on partial ratings that award benefits for some,
but not all, claimed conditions are not informative in this way
as they reflect the unique circumstances of each claim.
Additionally, irrespective of partial rating decisions, over
half of the Veterans with pending claims are already receiving
compensation as a result of a previously filed claim. Adding
this partial-rating metric would not provide meaningful
comparisons at the regional office level.
Section 209(c) would require pending FDC claims, one VBA
high-priority claims category, to be added to the MMWR. To the
degree making comparisons between regional offices is desired,
the existing reporting in the MMWR on claims older than 125
days, VA's largest pending group of high priority claims,
provides a better metric for such comparisons than FDC claims.
However, should it be determined that a pending FDC metric
would be useful, legislation is not required to add this metric
to the MMWR.
VA estimates GOE costs associated with this section would
be insignificant.
Section 210
This section would require VA to make available to the
public on the Internet the ``Appeals Pending'' and ``Appeals
Workload by Station'' reports. VA would be required to include
in one of these reports the percentage of appeals granted by
station and the percentage of claims previously adjudicated by
VBA's Appeals Management Center that were subsequently granted
or remanded by the Board.
VA does not support this section. VBA's MMWR currently
includes the total number of appeals pending and other metrics
related to appeals. Before adding data elements to reports, VBA
needs to ensure that the information is provided in a useful
way that can be easily understood by the public.
For example, VBA is changing its workload management
strategy by developing the National Work Queue (NWQ), a
paperless workload management initiative designed to improve
VBA's overall production capacity. In the initial phase of NWQ,
VBA is matching its inventory with claims processing capacity
at the regional office-level, moving claims electronically from
a centralized queue to an office identified as having capacity
to complete the work. With this national workload approach, VA
will continue to focus on the improvement of its traditional
performance metrics, with an emphasis on improving quality and
consistency of claims and appeals processing nationwide to
ensure Veterans and their families receive timely benefits,
regardless of where they reside. Appeals data by station will
be less useful to the public as NWQ is implemented.
Additionally, it is unclear how the bill would define
``appeals granted by station.'' Multiple decisions may be
appealed in each claim, and it is unclear if VA would be
required to report percentages associated with each decision or
each appeal. Similarly, it is unclear at what point in the
appeal process this metric would be reported. The current
process provides appellants with multiple reviews in VBA and
one or more reviews at the Board, depending upon the submission
of new evidence or whether the Board determines that it is
necessary to remand the matter to VBA. The longer an appeal
takes, the more likely it is that a claimed disability will
change, resulting in the need for additional evidence, further
processing delays, and less clarity in whether an initial
decision was correctly made.
VA estimates GOE costs associated with this section would
be insignificant.
Section 211
Section 211 would revise provisions of the Veterans'
Benefits Improvement Act of 1996 relating to contract
examinations to clarify that, notwithstanding any law regarding
the licensure of physicians, a licensed physician may conduct
disability examinations for VA in any state, the District of
Columbia, or a commonwealth, territory, or possession of the
United States, provided the examination is within the scope of
the physician's authorized duties under a contract with VA.
VA supports the provision regarding licensure requirements
as a means to ensure the quality of contract examinations. The
demand for medical disability examinations has increased,
largely due to an increase in the complexity of disability
claims, an increase in the number of disabilities that Veterans
claim, and changes in eligibility requirements for disability
benefits. This authority would help provide flexibility in
examinations through non-VA medical providers while maintaining
licensure standards and accelerating benefits delivery.
No benefit or discretionary costs would be associated with
enactment of this section.
Section 301
Section 301 would require the appointment of at least one
liaison between VA and DOD, and between VA and each of the
Reserve components. It would also require the National Archives
and Records Administration (NARA) to appoint a liaison to VA.
The intent of these appointments is to expedite the provision
of information needed to process claims by VA, to ensure that
such information would be provided within 30 days of the
request. VA would be required to submit a report to Congress
annually regarding the timeliness of responses from DOD and
NARA.
While VA appreciates the intent to facilitate records
retrieval, VA believes that this section of the bill is
unnecessary because of the extensive ongoing efforts between VA
and other Federal agencies to improve response times to VA
requests for records that are required to adjudicate disability
claims. For example, a memorandum of understanding (MOU)
between VA and DOD provides VA, at time of discharge, certified
and complete service treatment records in an electronic,
searchable format. As this MOU applies to the 300,000 annually
separated Active Duty, National Guard, and Reserve Component
members, it will significantly contribute to VA's efforts to
achieve its 125-day goal for completion of disability
compensation claims.
Costs associated with enactment of this section would be
insignificant. DOD and NARA would be required to appoint
liaisons; VBA would not hire additional employees. Costs
associated with the report required by section 301(d) would be
insignificant.
Section 302
Section 302 would require DOD and VA to jointly submit to
Congress a report that sets forth a timeline with milestones
for achieving interoperability between the electronic health
records systems of both Departments.
The Veterans Health Administration (VHA) runs the largest
integrated health care system in the country; delivering the
quality care Veterans deserve is not possible without
innovative information technology and data sharing. VA's
Electronic Health Record (EHR)--Veterans Health Information
Systems and Technology Architecture (VistA)--is the most widely
used EHR in the United States, and VA is working rapidly to
modernize it. VA is developing a new web application and
services platform called the Enterprise Health Management
Platform (eHMP). eHMP is the VistA application clinicians will
use during their clinical interactions with Veterans. eHMP
brings exciting new features to the clinician, including
Google-like search capabilities and information buttons that
help clinicians find needed information much faster than
current systems. VA is already piloting eHMP, and expects to
deploy it to 30 sites by the end of the calendar year, with
full rollout--including regular updates--over the next 3 years.
VA continues to work with DOD on health data
interoperability, but it is important to note that the two
Departments already share health care data on millions of
Servicemembers and Veterans. In fact, the two Departments share
more health data than any other health care entities in the
nation. In addition to sharing health care data, VA and DOD
have also paved the way for standardizing health care data, so
that regardless of what system a clinician uses, the data is
available in the right place and in the right way; for example,
Tylenol and acetaminophen appear in the same place in the
record because the system understands, through our data
standardization, that they are the same medication. Today, VA
and DOD clinicians can use the Joint Legacy Viewer (JLV) to see
VA and DOD data on a single screen in a Servicemember or
Veteran's record. Eventually, eHMP will replace JLV and will
allow clinicians to see VA, DOD, and third-party provider data
in their regular clinical care tool.
The Department does not object to providing a report. Costs
of this report would be insignificant as the Department
currently provides a similar report to Congress.
* * * * * * *
DRAFT TO AMEND TITLE 38, UNITED STATES CODE, TO MODIFY THE TREATMENT
UNDER CONTRACTING GOALS AND PREFERENCES OF THE DEPARTMENT OF VETERANS
AFFAIRS FOR SMALL BUSINESSES OWNED BY VETERANS, TO CARRY OUT A PILOT
PROGRAM ON THE TREATMENT OF CERTAIN APPLICATIONS FOR DEPENDENCY AND
INDEMNITY COMPENSATION AS FULLY DEVELOPED CLAIMS, AND FOR OTHER
PURPOSES
Section 101
Section 101 would expand the flexibility provided to a
service-disabled Veteran-owned small business (SDVOSB) to
continue to hold that socioeconomic status upon the death of
the service-disabled Veteran owner. Current law provides a
transition period for SDVOSBs for up to 10 years after the
Veteran's death, if the Veteran had a service-connected
disability with a 100-percent rating or died as a result of a
service-connected disability. This bill would create a similar
transition period for 3 years, if the Veteran had a service-
connected disability with a rating of less than 100 percent and
did not die as a result of a service-connected disability.
VA supports this provision because, without the proposed
transition period, the death of the Veteran owner could put at
risk the jobs and livelihoods of the firm's employees, as well
as the surviving spouse. The transition period provides the
spouse a reasonable period of time to determine what should be
done with the business after the Veteran's death.
VA anticipates enactment of this provision would entail
minor administrative costs. VA would incorporate this change
into its existing application processes with no material
addition to costs.
Section 102
Section 102 would amend 38 U.S.C. Sec. 8127 by providing a
transition rule for a member of the Armed Forces who owns at
least 51 percent of a small business and is killed in the line
of duty. Such a Veteran's surviving spouse who acquires
ownership interest in the small business would be treated as a
service disabled Veteran owner until the earliest of the
following: 10 years after the Servicemember's death; the date
on which the surviving spouse remarries; or the date on which
the spouse no longer owns at least 51 percent of the small
business. Such a Veteran's dependent child that acquires
ownership interest in the small business would be treated as a
Veteran owner for 10 years after the Servicemember's death or
the date on which the child no longer owns at least 51 percent
of the small business, whichever occurs first.
VA supports the spirit behind this provision but notes two
substantive concerns with the draft language. First, Congress
sought to ensure that Veteran small business owners genuinely
own and control the small business receiving benefits under the
Veterans First Contracting Program. This would be a challenge
for members of the regular Armed Forces, especially those
serving in active duty abroad. Moreover, members of the Armed
Forces are also Federal employees, which places limits on their
ability to receive Federal contracts under conflict of interest
rules. In practice, this rule would mainly apply to members of
the National Guard and Army Reserve who own small businesses in
their civilian lives, become activated, and are killed in the
line of duty, leaving survivors to assume operational control
of the firm as a service disabled Veteran-owned small business.
Second, if a dependent child owner is still a minor, this may
complicate the actual operation of this rule because of
limitations on a minor's capacity to enter into binding
contracts or engage in commercial transactions as an owner. The
firm may need to reside in a trust for the benefit of the
dependent minor child with an adult trustee controlling the
firm until the dependent reaches adulthood. VA would be pleased
to provide technical assistance to seek resolution of these
issues.
VA anticipates enactment of this provision would entail
minor administrative costs. VA would incorporate this change
into its existing application processes with no material
addition to costs.
Section 202
Section 202 would require VA to submit a report on the
standard of proof for service-connected disability compensation
for military sexual trauma (MST)-based mental health conditions
to the House and Senate Committees on Veterans' Affairs no
later than 90 days after enactment. The report would include
recommendations for an appropriate standard of proof and
legislative actions, if necessary.
VA believes this legislation is unnecessary as VA provided
a report with this information to the House and Senate
Appropriations Committees in March 2015 and can share it with
other interested Congressional offices.
No benefit or GOE costs would be associated with enactment
of this section.
Section 203
Section 203 would require VA to submit a report with data
on compensation claims for MST-based PTSD to Congress no later
than December 1, 2016 and each year thereafter through 2020.
The report would include the following information from the
preceding fiscal year:
1. The number of MST-related PTSD claims submitted;
2. The number and percentage of claims submitted by gender;
3. The number of approved claims, including number and
percentage by gender;
4. The number of denied claims, including number and
percentage by gender;
5. The number of claims assigned to each rating percentage,
including number and percentage by gender;
6. The three most common reasons given for denial of such
claims under 38 U.S.C. Sec. 5104(b)(1);
7. The number of denials that were based on the failure of
the Veteran to report for a medical examination;
8. The number of MST-based PTSD claims resubmitted after
denial in a previous adjudication and items 2-7 from this list
for this subset of claims;
9. The number of claims that were pending at the end of the
fiscal year and separately the number of such claims on appeal;
and
10. The average number of days to complete MST-based PTSD
claims.
VA believes this legislation is unnecessary as VA provided
a report with most of this information to the House and Senate
Appropriations Committees in March 2015 and can share it with
other interested Congressional offices. If additional
information or data for subsequent years are needed, VA can
provide this to interested Congressional offices without
legislation.
No benefit or GOE costs would be associated with enactment
of this section.
Section 204
Section 204 would direct VA to establish a 1-year pilot
program within 90 days of enactment to assess the feasibility
and advisability of expediting the treatment of certain DIC
claims, to include claims submitted:
1. Within 1 year of the death of the Veteran upon whose
service the claim is based;
2. By dependents of Veterans who received benefits for one
or more service-connected conditions as of the date of death;
3. With evidence indicating the Veteran's death was due to
a service-connected or compensable disability; and
4. By a spouse of a deceased Veteran who certifies that he
or she has not remarried since the Veteran's death.
Section 204 would also require VA to submit a report to the
House and Senate Committees on Veterans' Affairs within 270
days of completing the pilot program. The report would include:
1. The number of DIC claims adjudicated under the pilot
disaggregated by claims received by a spouse, child, or parent
of a deceased Veteran;
2. The number of DIC claims adjudicated but for which
benefits were not awarded under the pilot disaggregated by
claims received by a spouse, child, or parent of a deceased
Veteran;
3. A comparison of accuracy and timeliness of claims
adjudicated under the pilot and DIC claims not adjudicated
under the pilot;
4. VA's finding with respect to the pilot; and
5. Recommendations the VA may have for legislative or
administrative action to improve processing of DIC claims.
VA supports the intent of this legislation, but believes it
is unnecessary. As discussed above, in fiscal year 2013, VBA's
P&F Service reviewed the policies and procedures applicable to
the adjudication of DIC claims to identify obstacles to timely
processing. P&F Service determined that VA could quickly grant
many DIC claims with little or no additional development, and
that certain claim processing steps are redundant and
appropriate for elimination. On March 22, 2013, P&F Service
issued Fast Letter 13-04 (FL 13-04), Simplified Processing of
Dependency and Indemnity Compensation (DIC) Claims, which
instructs VBA field staff on the procedures to follow when
processing claims.
The new procedures require screening of claims at the
intake point and limited or no development of additional
evidence when information in VBA systems supports granting
benefits. It also clarifies that VA grants DIC under 38 U.S.C.
Sec. 1318 based upon total service-connected disability for a
prescribed period before death in the same manner as if the
death were service connected. Accordingly, in these cases, our
field staff will grant service-connected burial benefits and
presume the permanence of total disability for purposes of
establishing the survivor's entitlement to VA education and
health care benefits. These new procedures allowed us to grant
DIC benefits faster and without unnecessary development.
Also, as discussed above, on July 7, 2014, VA automated
some benefits to surviving spouses. VA can now automatically
pay certain surviving spouses under section 1318. As part of
VA's notice of death process, VA systems determine if the
deceased Veteran met the requirements of section 1318 and if
the surviving spouse met the relationship requirements. If the
system determines that both requirements are met, it will
automatically process and award DIC under section 1318 within 6
days of notification of the Veteran's death.
Based on these changes and aggressive workload management
plan in VA's Pension Management Centers, VA has reduced its
pending DIC claim inventory by 55 percent from its peak of
19,100 claims to 8,600 claims. Average processing time for
these claims has improved by 100 days from its peak of 168 days
to 68 days while maintaining 99 percent accuracy.
VA estimates no benefit or GOE costs would be associated
with enactment of this section.
Section 205
Section 205 would require VA, DOD, and military historians
recommended by DOD to review the process used to determine if
individuals who applied for Filipino Veterans Equity
Compensation (FVEC) benefits served during World War II in
accordance with the requirements to receive this benefit
payment. Section 205 would also require VA to submit a report
to the House and Senate Committees on Veterans' Affairs no
later than 90 days after enactment. The report would detail any
findings, actions taken, or recommendations for legislative
action with respect to the review. If a new process is
established as a result of this review, the process shall
include mechanisms to ensure individuals who receive payments
did not engage in any disqualifying conduct during their
service, including collaboration with the enemy or criminal
conduct.
VA does not support this section. In determining whether a
claimant is eligible for a VA benefit, including FVEC, VA is
legally bound by service department determinations as to what
service a claimant performed. VA regulations provide two
methods for establishing service. Under 38 C.F.R.
Sec. 3.203(a), VA may accept evidence submitted by a claimant
if the evidence is a document issued by a U.S. service
department; contains the needed information as to length, time,
and character of service; and, in VA's opinion, is genuine and
accurate. Otherwise, under 38 C.F.R. Sec. 3.203(c), VA must
seek verification of service from the appropriate service
department. These regulations are applicable to all claimants.
For claims based on Philippine Service in World War II, the
U.S. Army is the relevant service department, but VA requests
verification from the National Personnel Records Center which,
since 1998, has acted as the custodian of the U.S. Army's
collection of Philippine Army and Guerrilla records.
No benefit or GOE costs would be associated with enactment
of this section.
Section 301
Section 301 would require VA to conduct a study and report
to Congress on matters relating to the interment of unclaimed
remains of Veterans in national cemeteries under the control of
the National Cemetery Administration (NCA), including: (1)
determining the scope of issues relating to unclaimed remains
of Veterans, to include an estimate of the number of unclaimed
remains; (2) assessing the effectiveness of VA's procedures for
working with persons or entities having custody of unclaimed
remains to facilitate interment in national cemeteries; (3)
assessing State and local laws that affect the Secretary's
ability to inter such remains; and (4) recommending legislative
or administrative action the VA considers appropriate.
Section 301 would provide flexibility for VA to review a
subset of applicable entities in the estimating of the number
of unclaimed remains of Veterans as well as assess a sampling
of applicable State and local laws.
In December 2014, NCA published a Fact Sheet to provide the
public with information on VA burial benefits for unclaimed
remains of Veterans. NCA prepared the Fact Sheet in
collaboration with representatives from NCA, VBA, and VHA. As
well as being posted on VA's Web site, the Fact Sheet was
widely distributed to targeted employees in VA, including
Homeless Veteran Coordinators, Decedent Affairs personnel, VBA
Regional Compensation Representatives, and NCA Cemetery
Directors as well as shared in a GovDelivery message sent to
over 28,000 funeral director and coroner's office recipients
who are entities that may come to NCA seeking assistance to
ensure burial of a Veteran whose remains are unclaimed.
NCA strongly supports the goal of ensuring all Veterans,
including those whose remains are unclaimed and do not have
sufficient resources, who earned the right to burial and
memorialization in a national, State, or tribal Veterans
cemetery are accorded that honor. NCA appreciates the continued
Congressional support to meet the needs of Veterans whose
remains are unclaimed. While NCA is remains concerned that the
study may be unnecessary or premature at this time, we would
appreciate working with the Committee to make sure any study
that the Department is mandated to produce is targeting data
that can be used to better serve these Veterans.
Over the past several years, Congressional and Departmental
actions have increased the Department's ability to ensure
dignified burials for the unclaimed remains of eligible
Veterans. The Dignified Burial and Other Veterans' Benefits
Improvement Act of 2012 (Public Law 112-260) authorizes VA to
furnish benefits for the burial in a national cemetery for the
unclaimed remains of a Veteran with no known next-of-kin and
where sufficient financial resources are not available for this
purpose. Those benefits include reimbursements for the cost of
a casket or urn, for costs of transportation to the nearest
national cemetery, and for certain funeral expenses.
NCA is pleased to report that our final rule was published
on April 13, 2015, beginning today, we are able to accept
requests for reimbursement for caskets or urns purchased for
the interment of deceased Veterans who died on or after January
10, 2014, without next of kin, and where sufficient resources
for burial are not available. As this new benefit is
administered, NCA will have a new source for collecting data on
the number of Veterans whose unclaimed remains are brought to
NCA for interment. The data can be used to assist in targeting
outreach efforts to partners and getting a fuller understanding
of the issue.
The Department continues to identify areas to recommend
legislative or administrative action that would support
dignified burial of unclaimed remains of Veterans. Two
legislative proposals are included in VA's FY 2016 Budget
Submission. Currently, VA may furnish a reimbursement for the
cost of a casket or urn and for the cost of transportation to
the nearest national cemetery. These benefits are based on the
Veteran being interred in a VA national cemetery. The
legislative proposals are to expand these two benefits to
include those Veterans who are interred in a state or tribal
organization Veteran cemetery.
In conjunction with discussions we had last year with
congressional staff, NCA reviewed its internal procedures and
began to follow-up every thirty days with the public officials
on any unclaimed remain cases shown as pending until the cases
are scheduled for burial and the Veterans' remains are
interred. While state and local laws designate who may act as
an authorized representative to claim remains, NCA can work
with any individual or entity that contacts us to determine a
Veteran's eligibility for burial and scheduling the burial in a
VA national cemetery.
The great work of the Missing in America Project (MIAP) and
individual funeral directors is invaluable in complementing
VA's role of ensuring that all Veterans, including those whose
unclaimed remains are brought to us, receive the proper
resources to ensure receipt of a dignified burial. Over the
past several years, NCA has developed a strong working
relationship with funeral homes, coroner offices, and medical
examiners, to actively provide responses to requests for
eligibility reviews. In FY 2014, NCA processed 2,805 MIAP
requests to determine eligibility for burial in a VA national
cemetery, of which 1,642 were verified as eligible.
In light of VA's recent activities, detailed above, to
implement legislation targeted at ensuring appropriate burial
of the unclaimed remains of Veterans, NCA feels it is premature
to undertake the proposed study. Furthermore, if legislation is
passed requiring the study, we do not object to the proposed
scope and content, we are concerned that the timeframe for
reporting in the bill is unrealistic.
To implement the mandatory requirements outlined in the
bill, even with the flexibilities included in the bill
language, the Department would be required to contract with one
or more private entities to perform such a study. Survey
instruments would need to be developed to assess the number of
remains in the possession of funeral directors and other
entities for individuals with no known next of kin, and an
appropriate sample would have to be identified and a legal
review of state and local laws conducted regarding unclaimed
remains of Veterans.
The bill provides a reporting timeframe of 1 year. The need
to get formal clearances on survey instruments takes several
months; therefore, a more realistic timeframe is 2 years.
The bill does not identify a funding source for this
mandate. NCA is still evaluating the cost associated with this
legislation.
Section 401
Section 401 would honor any person entitled under chapter
1223 of title 10, United States Code, to retired pay for
nonregular service or who, but for age, would be entitled under
this chapter to retired pay for nonregular service, as a
Veteran. However, these individuals would not be entitled to
any benefit by reason of this honor.
VA does not support this section. It would conflict with
the definition of ``Veteran'' in 38 U.S.C. Sec. 101(2) and
would cause confusion about the definition of a Veteran and
associated benefits. In title 38, United States Code, Veteran
status is conditioned on the performance of ``active military,
naval, or air service.'' Under current law, a National Guard or
Reserve member is considered to have had such service only if
he or she served on active duty, was disabled or died during
active duty for training from a disease or injury incurred or
aggravated in line of duty, or was disabled or died during
inactive duty training from an injury incurred or aggravated in
line of duty or from an acute myocardial infarction, a cardiac
arrest, or a cerebrovascular accident. Section 401 would
eliminate these service requirements for National Guard or
Reserve members who served in such a capacity for at least 20
years. Retirement status alone would make them eligible for
Veteran status.
VA recognizes that the National Guard and Reserves have
admirably served this country and in recent years have played
an important role in our Nation's overseas conflicts.
Nevertheless, VA does not support this bill because it
represents a departure from active service as the foundation
for Veteran status. This section would extend Veteran status to
those who never performed active military, naval, or air
service, the very circumstance which qualifies an individual as
a Veteran. Thus, this section would equate longevity of reserve
service with the active service long ago established as the
hallmark for Veteran status.
VA estimates that there would be no additional benefit or
administrative costs associated with this section of the bill
if enacted.
This concludes my testimony. We appreciate the opportunity
to present our views on these bills and look forward to working
with the Committee.
------
STATEMENT OF THOMAS LYNCH, M.D., ASSISTANT DEPUTY UNDER SECRETARY FOR
HEALTH CLINICAL OPERATIONS, VETERANS HEALTH ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Good morning Chairman Isakson, Ranking Member Blumenthal,
and Members of the Committee. Thank you for inviting us here
today to present our views on several bills that would affect
VA benefits programs and services. Joining us today is Maureen
McCarthy, M.D., VHA's Deputy Chief Patient Care Services
Officer and Susan Blauert, Deputy Assistant General Counsel in
VA's Office of General Counsel.
We do not yet have cleared views on sections 2 and 4 of
S. 297, S. 471, the draft bill on Joint VA-DOD formulary for
pain and psychiatric medications, and the draft bill Veterans
Health Act of 2015. We will forward the views to the Committee
as soon as they are available.
* * * * * * *
S. 297, FRONTLINES TO LIFELINES ACT OF 2015
Section 3(a) of the Frontlines to Lifelines Act of 2015
would direct the Secretary of Defense to transfer to the
Secretary of Veterans Affairs the credentialing data of a
covered health care provider who has been hired by VA, upon
receiving a request from VA for the Department of Defense's
(DOD) credentialing data related to such health care provider.
Section 3(b) would define a ``covered health care
provider'' as a health care provider who is or was employed by
the Secretary of Defense, provides or provided health care
related services as part of such employment, and was
credentialed by the Secretary of Defense.
Section 3(c) would require the Secretaries of Veterans
Affairs and Defense to establish policies and promulgate
regulations as may be necessary to carry out this section.
Section 3(d) would define the term ``credentialing'' to
mean the systematic process of screening and evaluating
qualifications and other credentials, including licensure,
required education, relevant training and experience, and
current competence and health status.
Credentialing is required to ensure a health care provider
has the necessary clinical competence, professional experience,
health status, education, training and licensure to provide
specified medical or other patient care services. VA
understands the goals of section 3, and the sharing of
credentialing data between departments would facilitate VA's
credentialing process and the appointment of only qualified,
covered health care providers to the VA facility's medical
staff. However, as this provision places requirements upon DOD,
consultation with DOD is necessary before VA can present a
position on this provision.
* * * * * * *
STATEMENT OF DR. RAJIV JAIN, ASSISTANT DEPUTY UNDER SECRETARY FOR
HEALTH FOR PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Good morning Chairman Isakson, Ranking Member Blumenthal,
and Members of the Committee. Thank you for inviting us here
today to present our views on several bills that would affect
VA benefits programs and services. Joining us today is
Catherine Mitrano, Deputy Assistant Secretary for Resolution
Management, and Jennifer Gray, Staff Attorney in VA's Office of
General Counsel.
We do not yet have cleared views on the Draft Biological
Implant Tracking and Veteran Safety Act of 2015 or on S. 1117,
the Ensuring Veteran Safety Through Accountability Act of 2015.
Additionally, we do not have cleared views on sections 203,
205, 208, and 209(b) of S. 469, sections 3 through 8 of
S. 1085, section 2 of the draft bill referred to on the agenda
as ``Discussion Draft'' or sections 101-106, 204, 205, 403 and
501 of The Jason Simcakoski Memorial Opioid Safety Act. We will
be glad to work with the Committee on prioritization of those
views and cost estimates not included in our statement.
* * * * * * *
DISCUSSION DRAFT
Section 1 of the Discussion Draft would require the
Secretary of Veterans Affairs to work with institutions of
higher learning to develop partnerships for the establishment
or expansion of programs of advanced degrees in prosthetics and
orthotics with a goal of improving and enhancing the
availability of prosthetic and orthotic care for Veterans.
VA provides rehabilitation services to Veterans with a mix
of providers, including physical medicine and rehabilitation
physicians, physical therapists, occupational therapists,
prosthetists and orthotists all of whom work with the Veteran
to enable the best possible rehabilitation given the
individual's needs. VA offers in-house orthotic and prosthetic
services at 79 locations across VA. In addition, VA contracts
with more than 600 vendors for specialized orthotic and
prosthetic services. Through both in-house staffing and
contractual arrangements, VA is able to provide state-of the
art commercially available items ranging from advanced
myoelectric prosthetic arms to specific custom fitted orthoses.
Nationally, VA has approximately 312 orthotic and prosthetic
staff.
With regard to training and development, VA offers one of
the largest orthotic and prosthetic residency programs in the
nation. In fiscal year 2015, VA's Office of Academic
Affiliations allocated $877,621 to support 20 orthotics and
prosthetics residents at 10 Veterans Affairs Medical Centers.
The training consists of a yearlong post-masters residency,
with an average salary of $44,000 per trainee. In recent years,
VA has expanded the number of training sites and the number of
trainees, but expansion has been limited due to a lack of
certified supervisors for the training programs.
While VA supports means to improve and enhance the ability
to hire and retain prosthetists and orthotists, it cannot
support the proposed bill. Under the proposed bill, VA would be
required to partner with colleges and universities for the
establishment or expansion of programs of advanced degrees in
prosthetics and orthotics. These programs, however, would not
directly benefit VA or Veterans as the legislation does not
require that the programs affiliate with VA or send their
trainees to VA as part of a service obligation.
Tying the granting of funds to the establishment or
expansion of programs of advanced degrees that would directly
benefit VA and Veterans is one of the changes that VA
recommends for this legislation. VA looks forward to working
with the Committee to craft a bill that more directly enhances
advanced degrees in prosthetics and orthotics while benefiting
VA and Veterans.
* * * * * * *
* * * * * * *
* * * * * * *
* * * * * * *
* * * * * * *
U.S. Department of Veterans Affairs,
Washington, September 4, 2015.
Hon. Johnny Isakson,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The agenda for the Senate Committee on
Veterans' Affairs' June 3, 2015, and June 24, 2015, legislative
hearings included a number of bills that the Department of
Veterans Affairs (VA) was unable to address in our testimony or
in our prior correspondence with you on July 15, 2015. By this
letter, we are providing the final remaining views and cost
estimates on the following bills from the June 3, 2015,
legislative hearing: sections 2 and 4 of S. 297, the Frontlines
to Lifelines Act of 2015; the draft bill on establishing a
joint VA-Department of Defense (DOD) formulary for systemic
pain and psychiatric medications; and sections 2, 3, and 5 of
the draft bill, Veterans Health Act of 2015.
We are also providing the final remaining views and cost
estimates on the following bills from the June 24, 2015,
legislative hearing: sections 203, 208, and 209(b) of S. 469,
Women Veterans and Families Health Services Act of 2015;
sections 4(b) and 8 of S. 1085, Military and Veteran Caregiver
Services Improvement Act of 2015; and sections 105, 205, 403,
and 501 of the Jason Simcakoski Memorial Opioid Safety Act.
We appreciate this opportunity to comment on this
legislation and look forward to working with you and the other
Committee Members on these important legislative issues.
Sincerely,
Robert A. McDonald,
Secretary.
Enclosure.
JUNE 3, 2015
S. 297, Frontlines to Lifelines Act of 2015
Section 2 of S. 297 would require VA to revive the
Intermediate Care Technician Pilot Program of the Department of
Veterans Affairs (VA) that was carried out between January 2013
and February 2014. VA would be required to expand the pilot
program to include not less than 250 intermediate care
technicians in the pilot program. It would also permit VA to
assign any intermediate care technician hired under this
program to a VA medical facility, with the Secretary giving
priority to facilities at which Veterans have the longest wait
times for appointments for the receipt of hospital care or
medical services. The pilot would be authorized during the 3-
year period beginning on the date of the enactment of this Act.
As we explained in a response to a question from Senator
Rounds at the hearing, we are currently working to expand the
program beyond emergency services, most notably to increase
support in podiatry and surgical clinics given the
qualifications of those participating in the earlier pilot
program. We do not require additional legislation for this
expansion of the program, and consequently, VA does not support
section 2 of this bill because we are already moving ahead with
a permanent program, rather than a pilot program.
Section 4(a) of S. 297 would give discretion to the
Secretary to authorize ``covered nurses'' to practice
independently, without supervision or direction of others,
under a set of privileges approved by the Secretary. Such
authority would be notwithstanding any provision of state law
and regardless of the state in which the covered nurse would be
employed by VA. Section 4(b) would define a ``covered nurse''
as an advanced practice registered nurse (APRN) who is employed
by VA in any of the following specializations: Nurse Midwife,
Clinical Nurse Specialist (with respect to the provision of
mental health care), and Nurse Practitioner.
VA supports the intent of section 4, but we offer four
recommendations for technical revisions to the legislation.
First, we recommend adding a reference to state of licensure in
section 4(a). This would enable the Secretary to standardize
the practice of APRNs throughout VA's health care system,
regardless of the state(s) in which they are licensed and/or
employed by VA. This technical revision would facilitate the
provision of additional health care services in medically-
underserved areas, thereby increasing access to high quality
health care for all Veterans.
Second, we recommend that the phrase ``under a set of
privileges approved by the Secretary'' be deleted from section
4(a), as unnecessary. To practice professionally, all health
care providers must be granted a scope of practice or clinical
privileges by the medical facility where they work.
Third, we recommend that the word ``Licensed Certified'' be
added to the titles of Nurse Midwife, Clinical Nurse
Specialist, and Nurse Practitioner.
Fourth, we recommend that Section 4 contain a new
subsection (c) to clarify that covered nurses may prescribe
controlled substances provided they are authorized by their
state licensure to do so and comply with the limitations and
restrictions on that prescribing authority.
* * * * * * *
Draft Bill, Veterans Health Act of 2015
Section 2 of the draft bill, ``Veterans Health Act of
2015,`` would amend the definition of ``preventive health
services'' in 38 United States Code (U.S.C.) 1701(9) to include
immunizations against infectious diseases, including each
immunization on the recommended adult immunization schedule at
the time such immunization is indicated by the Advisory
Committee on Immunization Practices established by the
Secretary of Health and Human Services and delegated to the
Centers for Disease Control and Prevention. It would also
modify the requirements of the annual report to Congress on
preventive health services by including a requirement to report
on VA's programs to provide Veterans each immunization on the
recommended adult immunization schedule at the time such
immunization is indicated. Finally, section 2 would require VA,
within 2 years of enactment of the Act, to submit to Congress a
report on the development and implementation of quality
measures and metrics, including targets for compliance, to
ensure Veterans receiving medical services receive each
immunization on the recommended adult immunization schedule at
the time such immunization is indicated.
VA strongly supports preventive care measures, including
making a wide range of immunizations available at VA medical
facilities. However, because we believe VA is already
satisfying the purpose of this bill, we do not support this
legislation. Under current policy, VA already provides
preventive immunizations at no cost to the Veteran. In
addition, VHA is represented as an ex-officio member of the
Advisory Committee on Immunization Practices (ACIP), and VA
develops clinical preventive services guidance statements on
immunizations in accordance with ACIP recommendations. All
ACIP-recommended vaccines are available to Veterans at VA
medical facilities. These vaccines currently include: hepatitis
A, hepatitis B, human papillomavirus, influenza, measles/mumps/
rubella, meningococcal, pneumococcal, tetanus/diphtheria/
pertussis, tetanus/diphtheria, varicella, and zoster. As the
ACIP recommendations change, VHA policy reflects those changes.
The delivery of preventive care, including vaccinations,
has been well established in the VHA Performance Measurement
system for more than 10 years with targets that are appropriate
for the type of preventive service or vaccine. VA updates the
performance measures to reflect changes in medical practice
over time.
Section 3 would require VA to carry out a program to
provide chiropractic care and services to Veterans through VA
medical facilities at not fewer than two VA medical centers in
each VISN by not later than 2 years after the date of the
enactment of this Act, and at not fewer than 50 percent of all
VA medical centers in each VISN by not later than 3 years after
the date of the enactment of this Act. It would also modify 38
U.S.C. 1701 to amend the definition of ``medical services'' to
include chiropractic care and would amend the definition of
``preventive health services'' to include periodic and
preventive chiropractic examinations and services.
VA supports the intent of section 3 of this bill,
conditioned on the availability of additional resources to
implement this provision. Expanding the number of VA medical
facilities providing on-station chiropractic care would serve
the needs of Veterans in expanding the availability of
evidence-based treatment for musculoskeletal pain conditions
that are highly prevalent in Veterans. Chiropractic treatment
has been shown to be clinically effective, cost effective, and
in high demand by Veterans. Patients who have access to
chiropractic care are less likely to receive opiate medications
and spinal surgeries. Just this year, The Joint Commission
added chiropractic care to its pain management standards.
Additionally, VA has already been expanding access to
chiropractic services for Veterans. In fiscal year (FY) 2014,
VA provided on-station chiropractic care to 26,395 Veterans, an
increase of 14 percent from FY 2013. As of May 2015, 52 VA
medical centers have chiropractic clinics, up from 47 in FY
2014. Nevertheless, VA continues to face significant variation
in access to chiropractic care across the country. Therefore,
expanding the minimum number of chiropractic clinics per VISN
will facilitate providing these services to Veterans in a more
equitable manner.
We offer two recommendations for technical revisions to the
legislation. First, we recommend removing the reference to
clinics in the proposed amendment to section 204(c) of Public
Law 107-135. This change would focus the language on VA medical
centers and would not result in confusion over whether clinic
referred to a service at a medical center or an independent
clinic at another location. Second, we recommend the
legislation not amend the definition of preventive health
services in section 1701(9). Chiropractic services are provided
as part of the medical benefits package and are administered
based on clinical need, similar to all other medical care. It
would be inconsistent with the professional standards for other
medical disciplines and inappropriate to provide ``periodic and
preventative chiropractic examination and services'' when there
are no clinical indications that such care is needed.
We estimate that VA would need to add chiropractic services
at five facilities to meet the requirement to operate the
program at not fewer than two VA medical centers in each VISN
within 2 years of the date of the enactment of this Act, and at
another 23 facilities to meet the requirement that these
services be available at not fewer than 50 percent of all VA
medical centers in each VISN within 3 years of the date of the
enactment of this Act. We estimate that the cost to hire these
additional staff would be $3.67 million per year after the
requirements of section 3 are fully phased in.
Section 5 would require VA to make available on an Internet
website data files that contain information on research of the
Department, a data dictionary on each data file, and
instructions for how to obtain access to each data file for use
in research. It would also require, within 18 months of the
date of the enactment of this Act, that any final, peer-
reviewed manuscript prepared for publication that uses data
gathered or formulated from research funded by the Department
be submitted to the Secretary for deposit in a digital archive.
VA would be required to establish this archive within 18 months
of the date of the enactment of the Act or to partner with
another executive agency to compile such manuscripts in a
digital archive. The digital archive would have to be publicly
available on an Internet website, and each manuscript would
have to be available through the archive within 1 year of the
official date on which the manuscript is published. VA would
also be required, within 1 year of making manuscripts available
and annually thereafter, to report to Congress on the
implementation of this section. Finally, within 1 year of the
date of the enactment of this Act, the VA-DOD Joint Executive
Committee would be required to submit to the VA and DOD
Secretaries options and recommendations for the establishment
of a program for long-term cooperation and data sharing between
the two Departments.
VA supports the goal of this bill and is already taking
action to achieve its objectives. Public access to research has
been an increasingly important topic among Federal research
agencies over the past several years. As a result, most of what
is required in this bill has already been accomplished or is in
process. On February 22, 2013, the White House Office of
Science and Technology Policy (OSTP) directed each Federal
agency with over $100 million in annual expenditures for the
conduct of research and development to develop a plan to
support increased public access to the results of research
funded by the Federal Government, including any results
published in peer-reviewed scholarly publications that are
based on research that directly arises from Federal funds. The
bill's requirement to make information on VA research publicly
available on an Internet website is nearly identical to
requirements established by OSTP. Similarly, VA has already
taken steps to satisfy the bill's requirement that VA ensure
public access to manuscripts on VA-funded research. All VA-
funded investigators are required to place their published
manuscripts on the National Institutes of Health (NIH) PubMed,
which provides manuscripts free to the public. Use of PubMed
ensures that texts and their associated content will be stored
in non-proprietary and/or widely-distributed archival, machine
readable formats; provide access to persons with disabilities
in accordance with Section 508 of the Rehabilitation Act of
1973; enable interoperability with other Federal public access
archival solutions and other appropriate archives; and ensure
that attribution to authors, journals, and original publishers
will be maintained. VA also currently requires, and will
continue to require, that the results of applicable VA-funded
clinical trials must be provided to the public through the
ClinicalTrials.gov archive, which provides access to the
results of clinical trials involving products regulated by the
Food and Drug Administration. Additionally, VA is working with
DOD to develop data sharing agreements, and several such
agreements are already in place.
We are concerned that the bill, as written, would greatly
increase costs to the Department and may inadvertently limit
the public availability of manuscripts. As stated, VA is
currently making much of this information public, but through
other mechanisms, such as PubMed or ClinicalTrials.gov.
Requiring VA to develop its own website would require
additional expenses with no net benefit in terms of the
availability of information. Additionally, creating a separate
repository for this information from PubMed or
ClinicalTrials.gov would spread information among several
Federal websites, making it more difficult for users to find
information. VA is unable to offer a cost estimate at this time
because we cannot determine the information technology (IT)
costs associated with these requirements.
* * * * * * *
------
On May 13, 2015, Anthony Kurta, Deputy Assistant Secretary
of Defense, Military Personnel Policy, Department of Defense,
appeared before the Committee on Veterans' Affairs and
submitted testimony on various bills incorporated into the
Committee bill. An excerpt from that testimony is reprinted
below:
STATEMENT OF ANTHONY KURTA, DEPUTY ASSISTANT SECRETARY OF DEFENSE,
MILITARY PERSONNEL POLICY, U.S. DEPARTMENT OF DEFENSE
Good afternoon, Chairman Isakson, Ranking Member
Blumenthal, and esteemed Members of the Committee. I am pleased
to appear before you today to discuss pending benefits
legislation.
Per the agenda for today's hearing, the Committee requested
the Department of Defense's view on a series of bills and
proposals. Since both funding and administration of the Post-9/
11 GI Bill fall under the purview of the Department of Veterans
Affairs, I will focus my comments only on those proposals that
will affect the Department of Defense and generally defer to
the Departments of Labor and Veterans Affairs to provide
responses on those with no significant DOD impacts. This
statement will follow the order on the printed agenda.
* * * * * * *
DRAFT BILL, 21ST CENTURY VETERANS BENEFITS DELIVERY ACT
Section 101, ``Improvements To Transition Assistance
Program,'' of this bill states that an individual subject to
the requirement under subsection (c), which requires
participation in the program (defined as employment assistance,
job training assistance and other transitional services), may
not satisfy such requirement by participating in the program
carried out under this section solely through an Internet Web
site. The Department of Defense does not support that portion
of the language. The Administration should have flexibility in
determining what methods and tools, to include Internet Web
sites, should be used to deliver transition services to
eligible transitioning Servicemembers and their spouses. This
language would take away the flexibility to make such
decisions. The Department of Defense and our interagency
partners have agreed to allow Servicemembers who are subject to
a short-notice separation or are geographically remote and
isolated, to use the Department of Veterans Affairs Benefits
module (part of full Transition Assistance Program (TAP)
virtual curriculum) and the Department of Labor Employment
Workshop through Joint Knowledge Online, which connects to
other Department of Defense systems for mandatory attendance
tracking. Implementation of this restrictive language would end
that initiative and the millions of dollars invested in our on-
line curriculum would be lost. The Department of Defense must
have the flexibility to meet the needs of our Servicemembers;
we strongly advocate that the Congress not deprive the
Secretary of Defense of this flexibility.
Section 101 also requires the Secretary of Defense, in
collaboration with the Secretaries of Labor, Homeland Security,
and Veterans Affairs to establish a process to allow a
representative of a Veteran Service Organization (VSO) to be
present at the benefits portion of the program under Section
1144, title 10, United States Code (the program under Section
1144 pertains to employment assistance, job training assistance
and other transitional services) relating to the submission of
claims to the Secretary of Veteran Affairs. The Department of
Defense does not support this provision. The Department of
Defense recognizes and appreciates the tremendous support VSOs
provide to Servicemembers who file claims with the VA. However,
we believe that process best occurs outside the standard TAP
classroom in a one-on-one private conversation between the
Servicemember and the VSO representative. The redesigned TAP
focus is to make Servicemembers career ready by meeting Career
Readiness Standards. The preparation occurs in the classroom
with the delivery of Transition GPS (Goals, Plans, Success)
curriculum. The Department of Veterans Affairs provides two
robust classes: VA Benefits I, which focus on VA Benefits, and
VA Benefits II, which introduces Servicemembers to, and walks
them through, the process of filing a claim for Department of
Veterans Affairs benefits. It would be more appropriate at the
conclusion of VA Benefits II briefing for the Department of
Veterans Affairs instructor delivering the briefing to
introduce the VSO representative who can assist Servicemembers
with their claims. The VSO representative can connect with
Servicemembers at the end of the class. At that time the VSO
representative can set up one-on-one appointments to assist
those Servicemembers planning to file a claim.
Finally, the Department of Defense opposes that provision
in section 101 that requires the Secretary of Defense to
provide a report to Congress that assesses the compliance of
facilities of the Department of Defense per the Secretary's
Memorandum title ``Installation Access and Support Services for
Nonprofit Non-Federal Entities'' dated December 23, 2014. This
would require a tracking and reporting system to capture how
many Veterans and Military Service organizations and other
Nonprofit Non-Federal Entities are on each installation and the
number of installations in compliance with the Secretary's
Memorandums. This will pose a significant burden/hardship upon
the installation staff and cause a diversion of already limited
and stretched transition resources from the primary mission of
the redesigned TAP.
MILITARY COMPENSATION AND RETIREMENT MODERNIZATION COMMISSION REPORT
The committee requested input from the Department of
Defense on the legislative proposals in two of the
recommendations in the recently released Military Compensation
and Retirement Modernization Commission Report: Recommendation
11: Safeguard education benefits for Servicemembers by reducing
redundancy and ensuring the fiscal sustainability of education
programs, and Recommendation 12: Better prepare Servicemembers
for transition to civilian life by expanding education and
granting states more flexibility to administer the Jobs for
Veterans State Grants Program. I would like to state up front
that the Department of Defense worked closely with the
Commission in evaluating its recommendations, and included
experts from the Departments of Labor and Veterans Affairs, as
well as the Office of Management and Budget, in our working
groups designed to formulate DOD's response to the President.
RECOMMENDATION 11: SAFEGUARD EDUCATION BENEFITS FOR SERVICEMEMBERS BY
REDUCING REDUNDANCY AND ENSURING THE FISCAL SUSTAINABILITY OF EDUCATION
PROGRAMS
The Department agrees with the Commission's objectives of
safeguarding education benefits for Servicemembers by reducing
redundancy and ensuring the fiscal sustainability of education
programs. We support sun-setting both the Montgomery GI Bill
(chapter 30 of title 38, United States Code, also known as
MGIB-AD) and the Reserve Education Assistance Program (REAP),
with a view to maintaining the Post-9/11 GI Bill as the primary
education benefit. The Commission and the Department also agree
that in order to keep faith with our Servicemembers, we must
grandfather those who already have the benefits that will be
phased out. Further, the Department and the Commission agree on
how best to achieve the objective of collecting, tracking, and
reporting on Servicemember, Veteran, or dependent education
related data. The Commission recommends requiring that Tuition
Assistance be used for ``professional development'' courses
only. DOD has already issued policy guidance to the Services to
this effect where all signatories of the Department of Defense
Education Partnership Memorandum of Understanding must provide
an approved education plan for each Tuition Assistance
recipient. This plan provides the roadmap for their educational
goal development to include supporting courses.
The Department would like to ensure that once the MGIB-AD
sunsets, Servicemembers will be able to combine Post-9/11 GI
Bill benefits with Tuition Assistance (commonly referred to as
``top up'') using the same ``top up'' usage method as currently
available under the MGIB-AD.
The Department submitted a legislative proposal to Congress
on May 1 that would sunset the MGIB-AD and REAP, grandfather
Servicemembers currently receiving those benefits, and provide
a ``top up'' benefit.
Without data enabling the Department of Defense to
understand the potential effects on retention, the Department
of Defense--and the Joint Chiefs are particularly concerned on
this point--cannot support the recommendation to sunset the
Post-9/11 GI Bill housing stipend for dependents, or the
recommendation to increase the eligibility requirements for
transferring Post-9/11 GI Bill benefits. To this end, the
Department of Defense has sponsored a study with RAND National
Defense Research Institute to review education benefits for
Servicemembers, including the benefits of the Post-9/11 GI Bill
and their impacts on retention (with a focus on impacts of
transferability). We anticipate the study to be completed in
the summer of 2016, allowing the Department of Defense to
evaluate the potential effects of altering the features of the
benefit on retention.
Lastly, the Department of Defense does not support the
recommendation that would prohibit ex-Servicemembers from
receiving unemployment compensation (as authorized under
chapter 85, subchapter II, of title 5, United States Code)
while simultaneously receiving the living stipend as part of
Post-9/11 GI Bill benefits. State-level unemployment
compensation programs already provide guidance regarding
students' status within the workforce and eligibility to
receive benefits (as detailed in Congressional Research Service
Report, (Unemployment Compensation (UC): Eligibility for
Students Under State and Federal Laws, dated September 7,
2012). Eliminating concurrent receipt of educational benefits
and Unemployment Compensation for Ex-Service Members (UCX) may
be viewed as penalizing Servicemembers who are pursuing courses
at trade/vocational schools to acquire skills/certifications
that would make them more employable. This Commission
recommendation could also have a disproportionate impact on
Reserve Component Servicemembers because both separated and
currently serving Reserve Component members may be affected.
RECOMMENDATION 12: BETTER PREPARE SERVICEMEMBERS FOR TRANSITION TO
CIVILIAN LIFE BY EXPANDING EDUCATION AND GRANTING STATES MORE
FLEXIBILITY TO ADMINISTER THE JOBS FOR VETERANS STATE GRANTS PROGRAM
The Department of Defense supports the Commission's
objective of better preparing Servicemembers for transition to
civilian life, but does not believe additional legislation is
required. The Department of Defense has significantly re-
designed the Transition Assistance Program over the last 2
years and implemented the VOW to Hire Heroes Act legislation
enacted in 2011; these modifications significantly address the
Commission's objectives.
The Department of Defense, together with the Departments of
Labor and Veterans Affairs, has developed Transition Assistance
Program curriculum to support Servicemembers' educational
goals. The Accessing Higher Education (AHE) track focuses
transitioning Servicemembers on selecting an institution of
higher education and achieving academic success. The Career
Technical Training (CTT) track focuses on credentials earned
during military service and higher education in select
technical training schools and fields. The Department of
Defense concurs with mandatory participation in the AHE or CTT
track, for Servicemembers who identify an interest in attending
college or a career technical school after separation, with
authorized exemptions. Contrary to the re-designed Transition
Assistance Program, the Commission proposal does not enable
transition planning according to the individual goals and needs
of each transitioning Servicemember. The proposed legislation
is a ``one size fits all'' approach and does not take into
consideration the numerous other education benefits active duty
Servicemembers have, or are eligible for, prior to separating,
such as tuition assistance and the GI Bills. These other
benefits require an education plan and individual counseling
with an education professional. Furthermore, the proposed
legislation does not appear to consider how it might affect
those Servicemembers who enter on active duty with a college
diploma, credential and/or license.
The Department of Veterans Affairs is developing a module
specifically focused on the benefits, eligibility, and
transferability of the Post-9/11 GI Bill as part of military
career deliberations. The goals of the Commission's
recommendation will be met as a result of Servicemembers
attending the new Department of Veterans Affairs training for
Post-9/11 GI Bill benefits prior to developing an education
program plan or using their Post-9/11 GI Bill benefits.
Expected implementation date for the new Post-9/11 GI Bill
training is October 1, 2015.
The Commission's legislative proposal to review and
evaluate the core Transition Goals, Plans, Success (GPS)
curriculum is aligned with the current Department of Defense
and TAP Inter-agency Evaluation Strategy. New legislation is
not required because an interagency annual review is a pillar
of the Office of Management and Budget approved TAP Evaluation
Strategy. This strategy requires analysis of metrics and
benchmark performance criteria to enable the Department of
Defense to provide programs and support to meet the needs of
transitioning Servicemembers. It necessitates an annual review
of all curriculum components in concert with participant
feedback to ensure curriculum and training resources support
the achievement of career readiness standards and career
success post military service.
The Transition Assistance Program Inter-agency Curriculum
Working Group, comprised of members from each of the TAP Inter-
agency partners, the Military Services, and relevant subject
matter experts, conducts an annual review of the Transition GPS
curriculum. The Working Group develops changes based on content
relevancy, participant assessments, Servicemember feedback,
roles and responsibilities of partners, facilitator
recommendations, and best practices and lessons learned as a
result of staff assistance visits to installations. Proposed
curriculum revisions are vetted and approved by the TAP Inter-
agency Executive Council.
DEPARTMENT OF DEFENSE LEGISLATIVE PROPOSALS
The committee requested input on several of the Legislative
Proposals included in the Department of Defense National
Defense Authorization Act for Fiscal Year 2016 submission.
Sec. 514. Inclusion of duty performed by a reserve component member
under a call or order to active duty for medical purposes as
qualifying active duty time for purposes of Post-9/11 GI Bill
education benefits
Similar to S. 602, ``GI Bill Fairness Act of 2015,'' this
section includes active duty performed under the authority of
title10, United States Code, section 12301(h), as qualifying
active duty for the purposes of Post-9/11 GI Bill Education
Benefits. As pointed out in my discussion of that bill, the
Department's proposal differs in that it is not retroactive to
September 11, 2001. The Department of Defense urges adoption of
this proposal.
Sec. 522. Retention of entitlement to educational assistance during
certain additional periods of active duty
This section would amend chapter 1606, (Montgomery GI Bill-
Selected Reserve (MGIB-SR) of title 10, United States Code.
Specifically this proposal would add 10 United States Code
12304a and 12304b to the existing list of authorities in 10
United States Code16131 under which a servicemember may regain
lost payments. Further, both 10 United States Code 12304a and
12304b would be added to 10 United States Code 16133 under
which a Servicemember may regain lost entitlement time for
MGIB-SR benefits. The Department of Defense urges adoption of
this proposal.
Sec. 542. Update to involuntary mobilization duty authorities exempt
from 5-year limit under the Uniformed Services Employment and
Reemployment Rights Act
This section would amend section 4312 of title 38, United
States Code, to update the involuntary mobilization authorities
exempted from the Uniformed Services Employment and
Reemployment Rights Act (USERRA) 5-year limit. Adding
references to sections 12304a and 12304b of title 10 will
complete the list of current involuntary mobilization
authorities exempted from that limit in section 4312 of title
38.
USERRA, codified in 38 U.S.C. 4301-4335, protects
individuals performing, or who have performed or will perform,
uniformed service from employment discrimination on the basis
of their uniformed service. It provides for prompt reemployment
when they return to civilian life. The Department of Defense
urges adoption of this proposal.
Sec. 545. Required provision of pre-separation counseling
This section would amend section 1142 and 1144 of Title 10,
United States Code, to authorize Pre-separation, Employment
Assistance and all other transition services prescribed in
Department of Defense policy by the Secretary of Defense for
ALL Active Component Servicemembers of the Armed Forces and for
ALL National Guard and Reserve Servicemembers called or ordered
to active duty or full-time operational support after
completion of their first 180 continuous days or more under
Title 10, United States Code, (other than for full-time
training duty, annual training duty, and attendance, while in
the active military service, at a school designated as service
school by law or by the Secretary of the military department
concerned), whose discharge or release from active duty is
anticipated as of a specific date. The Department of Defense
urges adoption of this proposal.
Sec. 1041. Transfer of functions of the Veterans' Advisory Board on
Dose Reconstruction to the Secretaries of Veterans Affairs and
Defense
This section would repeal the statutory requirement for a
Federal Advisory Committee Act (FACA) advisory board for the
Radiation Dose Reconstruction Program. The Department of
Defense believes that this advisory board has achieved its
objectives, and that its functions can now be more effectively
conducted through an interagency effort rather than through a
FACA advisory board. The Department of Defense urges adoption
of this proposal.
The final item on the agenda is a discussion of provisions
derived from a series of pending bills. I will comment only on
those that affect the Department of Defense.
S. 151. Filipino Veterans Promise Act
This bill would require the Secretary of Defense to
establish a process to determine whether individuals claiming
certain service in the Philippines during World War II are
eligible for certain benefits despite not being on the so-
called ``Missouri List.'' The Department does not support any
further legislation concerning determining service eligibility
for the WWII Filipino Guerilla Veterans. The Army has a program
in place that is verifiable. This program, due to its thorough
processes, is the foundation for the Army's position, past and
current, for making final service determinations for
eligibility. The Army maintains complete confidence that the
records and files completed in 1948 provide the best and most
accurate determinations that could have been made from that
time until today.
S. 743. Honor America's Guard-Reserve Retirees Act of 2015
This bill amends title 38, United States Code, to recognize
the service in the reserve components of the Armed Forces of
certain persons by honoring them with status as Veterans under
law, and for other purposes. The Department recognizes and
values the service of these Servicemembers who qualify for a
Reserve retirement, but may not be Veterans, but opposes
identifying these Servicemembers with any type of honorary
Veteran status. Although S. 743 defines this honorary status to
be without eligibility for Veteran's benefits from the
Department of Veterans Affairs, the Department of Defense
believes this honorary status would create confusion about
eligibility for the Department of Veterans Affairs benefits
among the current and former Servicemembers and could increase
the potential for error in determining benefits entitlements.
Mr. Chairman this concludes my statement. As has been
stated numerous times in hearings before this committee, post
service education benefits have been a cornerstone of our
military recruiting and retention efforts since 1985, and a
major contributor to the continued success of the All-Volunteer
Force. Money for education has been and remains at the
forefront of reasons cited by young Americans for joining the
military. From its inception we fully expected the Post-9/11 GI
Bill to continue to have this impact and we are seeing that
happen in the form of sustained recruiting success. I thank you
and the members of this Committee for your outstanding and
continuing support of the men and women of the Department of
Defense. We look forward to working closely with you to
strengthen the All-Volunteer force through a balanced program
of recruiting, retention, and vital education benefits, and to
recognize the service of our Veterans.
------
On May 13, 2015, Teresa W. Gerton, Deputy Assistant
Secretary for Policy, Veterans' Employment and Training
Service, Department of Labor, appeared before the Committee and
submitted testimony on various bills incorporated into the
Committee bill. An excerpt from that testimony is reprinted
below:
STATEMENT OF TERESA W. GERTON, DEPUTY ASSISTANT SECRETARY FOR POLICY,
VETERANS' EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR
INTRODUCTION
Good afternoon, Chairman Isakson, Ranking Member
Blumenthal, and distinguished Members of the Committee. Thank
you for the opportunity to participate in today's hearing. I
would like to thank the Commission, which was assigned to
develop the Military Compensation and Retirement Modernization
(MCRMC) Report, for all its hard work. As President Obama
indicated, the report's recommendations ``represent an
important step forward in protecting the long-term viability of
the All-Volunteer Force,'' and ``improving quality-of-life for
servicemembers and their families.'' As Deputy Assistant
Secretary for Policy at the Veterans' Employment and Training
Service (VETS) at the Department of Labor (DOL or Department),
I appreciate the opportunity to discuss the Department's views
on pending legislation and proposals impacting veterans.
The Department's charter, for over 100 years, has been to
``foster, promote and develop the welfare of working people, to
improve their working conditions, and to enhance their
opportunities for profitable employment.'' The Department's
collective resources and expertise are integrated with state
workforce agencies and local communities to meet the employment
and training needs of all Americans, including veterans,
transitioning servicemembers, members of the National Guard and
Reserve, their families, and survivors.
As the Federal Government's leader on veterans' employment,
VETS ensures that the full resources of the Department are
readily available for veterans and servicemembers seeking to
transition into the civilian labor force. VETS' mission is
focused on four key areas: (1) preparing veterans for
meaningful careers; (2) providing them with employment
resources and expertise; (3) protecting their employment
rights; and, (4) promoting the employment of veterans and
related training opportunities to employers across the country.
While this hearing addresses several legislative proposals,
the Department limits its remarks to those legislative
proposals that have a direct impact on the programs
administered by the Department, specifically, the ``21st
Century Veterans' Benefits Delivery Act,'' and the legislative
proposals based on MCRMC Recommendations 11 and 12.
S. 1203, ``21ST CENTURY VETERANS BENEFITS DELIVERY ACT''
The draft Senate bill, ``21st Century Veterans Benefits
Delivery Act,'' seeks to amend title 38 of the U.S. Code, to
improve the processing by the Department of Veterans Affairs
(VA) of claims for benefits under laws administered by the
Secretary of Veterans Affairs, and for other purposes.
Section 101
Section 101 would amend section 1144 of title 10 of the U.S
Code, adding subsection (f) to require modifications to the
VA's eBenefits Web site, which would ensure that
servicemembers, veterans, and their spouses have access to the
Transition Assistance Program (TAP) online curriculum, as
administered by the Secretary of Labor, the Secretary of
Defense, the Secretary of Homeland Security, and the Secretary
of Veterans Affairs. The Department believes that it has
already met the intent of this proposal. DOL has worked with
the Department of Defense (DOD) and VA to host the TAP
curriculum online. Currently, servicemembers and their spouses
are able to access the entire Transition GPS curriculum online
via DOD's Joint Knowledge Online, the VA's eBenefits Web site,
or DOL VETS' Web site. Section 101 also states: ``An individual
subject to a requirement under subsection (c) may not satisfy
such requirement by participating in the program carried out
under this section solely through an Internet Web site.'' DOL
appreciates the intent of this statement and notes that the
vast majority of servicemembers who attend our employment
workshop do so in person. We defer to DOD on the impact of this
requirement, and to the VA on the inclusion of our Veterans
Service Organization (VSO) partners.
LEGISLATIVE PROPOSALS FROM THE MCRMC REPORT
The Administration has indicated its general support for
Recommendations 11 and 12, in the Presidential Memorandum
issued on April 30, 2015. As DOL recently shared with the staff
of this Committee, the Department has initiated many of the
Commission's recommendations prior to publication of the
Commission's report. Accordingly, any legislative proposal to
implement these recommendations should be modified to reflect
these recent VETS program improvements, as well as to ensure
continued access to unemployment benefits for servicemembers
who need income support, while availing themselves of
educational and training programs.
Recommendation 11
Recommendation 11, ``Safeguard education benefits for
Servicemembers by reducing redundancy and ensuring the fiscal
sustainability of education programs,'' is primarily directed
toward DOD and VA, who administer a myriad of benefit programs
for servicemembers. The Department generally supports
Recommendation 11. The sub-recommendation of interest to DOL
would prevent individuals receiving housing stipend benefits
under the Post-9/11 GI Bill from simultaneously receiving
unemployment insurance (UI). This sub-recommendation would
amend title 5 of the U.S. Code, at section 8525, on
Unemployment Compensation for Ex-Servicemembers (UCX), as well
as any other regulation and policy pertaining to section 8525.
The MCRMC's companion legislative proposal to implement this
sub-recommendation is contained in Section 1109, Unemployment
Insurance.
To achieve the goal of safeguarding education benefits of
servicemembers, it is necessary that servicemembers have
adequate income support to take advantage of these programs.
The Department would like to ensure equitable treatment for
servicemembers compared to their civilian counterparts, who
also are seeking UI benefits for approved training. The receipt
of other benefits, such as the Post-9/11 GI Bill retraining
incentives or housing benefits, currently do not prevent
veterans from taking advantage of the same provision given to
regular (civilian) unemployment insurance (UI) recipients when
training is approvable/approved under state law.
Providing income support for servicemembers eligible for
UCX helps to ensure that their retraining leads to employment
in a more sustainable labor market after specialized military
service. Unemployment insurance is designed to provide benefits
for workers to enable their successful transition to new
employment; it is affirmatively intended to provide for costs
of living beyond housing. Additionally, State UI laws contain
requirements regarding an individual's availability for work,
which entails being ready, willing, and able to work. This
includes the requirement that a claimant receiving UCX register
with the public employment service. Thus, receipt of UCX
benefits connects veterans to reemployment services through the
public workforce system, which in conjunction with receiving GI
Bill benefits, helps to more effectively support the
individual's successful reentry to civilian employment.
Therefore, preventing GI Bill beneficiaries from receiving
unemployment compensation may be a detriment to their
successful reemployment. While the Department does not favor
Section 1109 as currently drafted, we would be willing to
continue discussions with Congress and the Department of
Veterans Affairs on this issue.
Recommendation 12
Recommendation 12, ``Better prepare Servicemembers for
transition to civilian life by expanding and granting states
more flexibility to administer the Jobs for Veterans State
Grants Program,'' seeks to expand servicemembers' knowledge of
educational benefits, improve Transition GPS, and improve the
Jobs for Veterans State Grant (JVSG) program. The Department
generally supports Recommendation 12; for purposes of this
hearing, the Department will focus specifically on the
following sub-recommendations:
(1) The Congress should require DOD, VA, and DOL to review
and report on the core curriculum for Transition GPS to
reevaluate if the current curriculum most accurately addresses
the needs of transitioning Servicemembers. This report should
include review of the current curriculum; the roles and
responsibilities of each Department and whether they are
adequately aligned; and the distribution of time between the
three departments in the core curriculum and whether it is
adequate to provide all information regarding important
benefits that can assist transitioning Servicemembers. This
review should indicate whether any of the information in the
three optional tracks should be addressed instead in mandatory
tracks. It should also include a standard implementation plan
of long-term outcome measures for a comprehensive system of
metrics. This review should identify any areas of concern
regarding the program and recommendations for addressing those
concerns.
DOL notes that processes already in place address the
intent of this proposal, and would be pleased to share our
curriculum review results with this Committee. The MCRMC's
companion legislative proposal to implement this sub-
recommendation is contained in Section 1204, Transition GPS
Program Core Curriculum Review and Report.
In Fiscal Year (FY) 2014, as a member of the TAP Senior
Steering Curriculum Working Group with DOD and VA, the
Department began an annual curriculum evaluation. This
evaluation included analysis of results from the web-based
Transition GPS participant survey instrument developed by DOD,
and input from various stakeholders. Based on this evaluation,
the Department revised the TAP Employment Workshop curriculum
to include Equal Employment Opportunity and Americans with
Disability Act content, the Veterans Employment Center content,
and enhanced information on Workforce Investment Act training,
dislocated worker training, and Registered Apprenticeship
programs.
The FY 2015 curriculum review began in April 2015, in
conjunction with the TAP Senior Steering Curriculum Working
Group's planned review of the entire Transition GPS curriculum.
Any changes that may result from this review should be
available to transitioning servicemembers in November 2015.
Additionally, the Department will address this sub-
recommendation before the TAP Senior Steering Group for
consideration in the FY 2015 curriculum review.
(2) The Congress should amend the relevant statutes to
permit state departments of labor or their equivalent agencies
to work directly with state Veterans Affairs directors or
offices to coordinate implementation of the JVSG program.
DOL believes that it has already met the intent of this
proposal, which is contained in Section 1202, Coordination with
State Departments of Labor and VA. The process this proposal
seeks to implement is already in place; the Department's
standards of performance for each of the Directors for
Veterans' Employment and Training (DVET) specifies in the
``duties and responsibilities'' section that each DVET must
coordinate with state Departments of Labor and Veterans
Affairs. Moreover, current law does not prohibit inter-agency
coordination with respect to JVSG, including coordination with
the VA (title 38, U.S. Code 4102A(b)(3)). In fact, the
Workforce Innovation and Opportunity Act, passed in 2014,
supports greater inter-agency cooperation. The public workforce
system is designed to be a decentralized network of strong
partnerships at the Federal, state, local, and regional levels.
(3) DOL should require One-Stop Career Centers to track the
number of job fairs their employees participate in and the
number of veterans they connect with at each job fair. This
information should be included in each state's annual report to
the DOL, and provided to the Congress.
The Department does not find American Job Center (AJC)
staff attendance at Transition GPS Employment Workshops, job
fair participation rates, or the number of transitioning
servicemembers and veterans with whom JVSG staff interact to be
measures reflective of meaningful outcomes data. Tracking these
activities may, in fact, result in the unintended consequence
of incentivizing the quantity of interactions between AJC staff
and veterans, rather than the quality and effectiveness of the
services AJC staff provide to veterans. Also, this proposal,
contained in Section 1201, Job Fair Participation Rates, seeks
to amend the Workforce Investment Act of 1998, which has been
superseded by the Workforce Innovation and Opportunity Act
(WIOA), making it difficult to interpret how it would be
executed. Nevertheless, this proposal is not in keeping with
Section 116 of WIOA (which replaced section 136 of WIA), which
establishes common performance accountability measures that
apply across the Department's core employment and training
programs to assess the effectiveness of States and local areas
in achieving positive outcomes for individuals served by
related programs. While JVSG is not a core program under WIOA,
38 U.S.C. 4102A requires JVSG performance measures to ``be
consistent with'' those under WIOA. The Departments of Labor
and Education on April 16 jointly issued a WIOA Notice of
Proposed Rulemaking seeking public comments on such topics as
performance accountability to ensure that Federal employment
and training program investments report on common performance
indicators such as how many individuals, including veterans,
entered employment and their median wages. The Departments
welcome comments from this Committee on our proposal.
(4) The Congress should require a one-time joint report
from DOD, VA, and DOL to the Senate and House Committees on
Armed Services and Veterans' Affairs regarding the challenges
employers face when seeking to hire veterans. The report should
identify the barriers employers face gaining information
identifying veterans seeking jobs. It should also include
recommendations addressing barriers for employers and improving
information sharing between Federal agencies that serve
veterans and separating Servicemembers, so they may more easily
connect employers and veterans. The report should also review
the Transition GPS career preparation core curriculum and
recommend any improvements that can be made to better prepare
Servicemembers trying to obtain private-sector employment.
The Department supports the intent of this recommendation
and looks forward to continuing our work with our Federal
partners on this important issue. However, we already have
gathered much information from employers on their challenges in
hiring veterans. This is provided in recent reports, such as
the 2014 RAND report titled, ``Lessons from the 100,000 Job
Mission.'' We already are working with agency partners to
address many of those challenges. In addition, and given the
volume of information and the workload required to obtain
additional data, we recommend that we work with our agency
partners to develop the information you believe would be
helpful in assessing issues related to barriers to employers
hiring veterans. We then can meet with you to share the
requested material.
* * * * * * *
CONCLUSION
We at the Department of Labor remain committed to our
Nation's veterans and we look forward to working with the
Committee to ensure the continued success of our efforts. The
Department lauds the hard work the Commission placed into their
recommendations. It is our hope that the Committee will
consider the modifications we have provided and is open to
working with the Committee members to provide technical
assistance. Mr. Chairman, Ranking Member Blumenthal, and
Members of the Committee, this concludes my statement. Thank
you again for the opportunity to testify today. I am happy to
answer any questions that you may have.
Changes in Existing Law
In compliance with paragraph 12 of Rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman).
Title 10. Armed Forces
* * * * * * *
Subtitle A. General Military Law
* * * * * * *
Part II. Personnel
* * * * * * *
Chapter 58. Benefits and Services for Members Being Separated or
Recently Separated
* * * * * * *
SEC. 1142. PRESEPARATION COUNSELING; TRANSMITTAL OF MEDICAL RECORDS TO
DEPARTMENT OF VETERANS AFFAIRS
(a) Requirement.--
(1) * * *
* * * * * * *
(4)(A) Subject to subparagraph (B), the Secretary
concerned shall not provide preseparation counseling to
a member who is being discharged or released before the
completion of that member's first continuous 180 days
of active duty.
(B) * * *
(C) For purposes of subparagraph (A), the term
``active duty'' does not include full-time training
duty, annual training duty, and attendance, while in
the active military service, at a school designated as
a service school by law or by the Secretary concerned.
* * * * * * *
Subtitle E. Reserve Components
* * * * * * *
Part IV. Training for Reserve Components and Educational Assistance
Programs
* * * * * * *
Chapter 1606. Educational Assistance for Members of the Selected
Reserve
* * * * * * *
SEC. 16131. EDUCATIONAL ASSISTANCE PROGRAM: ESTABLISHMENT; AMOUNT
* * * * * * *
(c)(1) * * *
* * * * * * *
(3)(A) * * *
* * * * * * *
(B) * * *
(i) had to discontinue such course pursuit as a
result of being ordered to serve on active duty under
section 12301(a), 12301(d), 12301(g), 12302, [or 12304]
12304, 12304a, or 12304b of this title; and
(ii) * * *
* * * * * * *
SEC. 16133. TIME LIMITATION FOR USE OF ENTITLEMENT
(a) * * *
(b)(1) In the case of a person--
* * * * * * *
(4) In the case of a member of the Selected Reserve of the
Ready Reserve who serves on active duty pursuant to an order to
active duty issued under section 12301(a), 12301(d), 12301(g),
12302, [or 12304] 12304, 12304a, or 12304b of this title--
* * * * * * *
Title 38. Veterans' Benefits
* * * * * * *
Part II. General Benefits
* * * * * * *
Chapter 17. Hospital, Nursing Home, Domiciliary, and Medical Care
SUBCHAPTER I. GENERAL
SEC.
* * * * * * *
SUBCHAPTER VIII. HEALTH CARE OF PERSONS OTHER THAN VETERANS
* * * * * * *
1784. HUMANITARIAN CARE.
1784A. EXAMINATION AND TREATMENT FOR EMERGENCY MEDICAL CONDITIONS AND
WOMEN IN LABOR.
* * * * * * *
Subchapter I. General
* * * * * * *
SEC. 1701. DEFINITIONS
For the purposes of this chapter--
* * * * * * *
(6) * * *
* * * * * * *
(H) Chiropractic services.
* * * * * * *
(8) The term ``rehabilitative services'' means such
professional, counseling, chiropractic, and guidance
services and treatment programs as are necessary to
restore, to the maximum extent possible, the physical,
mental, and psychological functioning of an ill or
disabled person.
(9) The term ``preventive health services'' means--
* * * * * * *
(F) periodic and preventive chiropractic
examinations and services;
(G) [(F) immunizations against infectious
disease;] immunizations against infectious
diseases, including each immunization on the
recommended adult immunization schedule at the
time such immunization is indicated on that
schedule;
(H) [(G)] prevention of musculoskeletal
deformity or other gradually developing
disabilities of a metabolic or degenerative
nature;
(I) [(H)] genetic counseling concerning
inheritance of genetically determined diseases;
(J) [(I)] routine vision testing and eye care
services;
(K) [(J)] periodic reexamination of members
of likely target populations (high-risk groups)
for selected diseases and for functional
decline of sensory organs, together with
attendant appropriate remedial intervention;
and
(L) [(K)] such other health-care services as
the Secretary may determine to be necessary to
provide effective and economical preventive
health care.
(10) The term ``recommended adult immunization
schedule'' means the schedule established (and
periodically reviewed and, as appropriate, revised) by
the Advisory Committee on Immunization Practices
established by the Secretary of Health and Human
Services and delegated to the Centers for Disease
Control and Prevention.
* * * * * * *
SEC. 1704. PREVENTIVE HEALTH SERVICES: ANNUAL REPORT
(1) * * *
(A) * * *
(i) to educate veterans with respect
to health promotion and disease
prevention; [and]
(ii) to provide veterans with
preventive health screenings and other
clinical services, with such
description setting forth the types of
resources used by the Department to
conduct such screenings and services
and the number of veterans reached by
such screenings and services[.] ; and
(iii) to provide veterans each
immunization on the recommended adult
immunization schedule at the time such
immunization is indicated on that
schedule.
* * * * * * *
Subchapter VIII. Health Care of Persons
Other Than Veterans
* * * * * * *
SEC. 1784. HUMANITARIAN CARE
The Secretary may furnish hospital care or medical services
as a humanitarian service in emergency cases, but the Secretary
shall charge for such care and services at rates prescribed by
the Secretary.
SEC. 1784A. EXAMINATION AND TREATMENT FOR EMERGENCY MEDICAL CONDITIONS
AND WOMEN IN LABOR
(a) In General.--In the case of a hospital of the
Department that has an emergency department, if any individual
comes to the hospital or the campus of the hospital and a
request is made on behalf of the individual for examination or
treatment for a medical condition, the hospital must provide
for an appropriate medical screening examination within the
capability of the emergency department, including ancillary
services routinely available to the emergency department, to
determine whether or not an emergency medical condition exists.
(b) Necessary Stabilizing Treatment for Emergency Medical
Conditions and Labor.--(1) If any individual comes to a
hospital of the Department that has an emergency department or
the campus of such a hospital and the hospital determines that
the individual has an emergency medical condition, the hospital
must provide either--
(A) within the staff and facilities available at the
hospital, for such further medical examination and such
treatment as may be required to stabilize the medical
condition; or
(B) for transfer of the individual to another medical
facility in accordance with subsection (c).
(2) A hospital is deemed to meet the requirement of
paragraph (1)(A) with respect to an individual if the hospital
offers the individual the further medical examination and
treatment described in that paragraph and informs the
individual (or a person acting on behalf of the individual) of
the risks and benefits to the individual of such examination
and treatment, but the individual (or a person acting on behalf
of the individual) refuses to consent to the examination and
treatment. The hospital shall take all reasonable steps to
secure the written informed consent of the individual (or
person) to refuse such examination and treatment.
(3) A hospital is deemed to meet the requirement of
paragraph (1) with respect to an individual if the hospital
offers to transfer the individual to another medical facility
in accordance with subsection (c) and informs the individual
(or a person acting on behalf of the individual) of the risks
and benefits to the individual of such transfer, but the
individual (or a person acting on behalf of the individual)
refuses to consent to the transfer. The hospital shall take all
reasonable steps to secure the written informed consent of the
individual (or person) to refuse such transfer.
(c) Restricting Transfers Until Individual Stabilized.--(1)
If an individual at a hospital of the Department has an
emergency medical condition that has not been stabilized, the
hospital may not transfer the individual unless--
(A)(i) the individual (or a legally responsible
person acting on behalf of the individual), after being
informed of the obligations of the hospital under this
section and of the risk of transfer, requests, in
writing, transfer to another medical facility;
(ii) a physician of the Department has signed a
certification that, based upon the information
available at the time of transfer, the medical benefits
reasonably expected from the provision of appropriate
medical treatment at another medical facility outweigh
the increased risks to the individual and, in the case
of labor, to the unborn child from effecting the
transfer; or
(iii) if a physician of the Department is not
physically present in the emergency department at the
time an individual is transferred, a qualified medical
person (as defined by the Secretary for purposes of
this section) has signed a certification described in
clause (ii) after a physician of the Department, in
consultation with the person, has made the
determination described in such clause, and
subsequently countersigns the certification; and
(B) the transfer is an appropriate transfer to that
facility.
(2) A certification described in clause (ii) or (iii) of
paragraph (1)(A) shall include a summary of the risks and
benefits upon which the certification is based.
(3) For purposes of paragraph (1)(B), an appropriate
transfer to a medical facility is a transfer--
(A) in which the transferring hospital provides the
medical treatment within its capacity that minimizes
the risks to the health of the individual and, in the
case of a woman in labor, the health of the unborn
child;
(B) in which the receiving facility--
(i) has available space and qualified
personnel for the treatment of the individual;
and
(ii) has agreed to accept transfer of the
individual and to provide appropriate medical
treatment;
(C) in which the transferring hospital sends to the
receiving facility all medical records (or copies
thereof) available at the time of the transfer relating
to the emergency medical condition for which the
individual has presented, including--
(i) observations of signs or symptoms;
(ii) preliminary diagnosis;
(iii) treatment provided;
(iv) the results of any tests; and
(v) the informed written consent or
certification (or copy thereof) provided under
paragraph (1)(A);
(D) in which the transfer is effected through
qualified personnel and transportation equipment,
including the use of necessary and medically
appropriate life support measures during the transfer;
and
(E) that meets such other requirements as the
Secretary considers necessary in the interest of the
health and safety of individuals transferred.
(d) Definitions.--In this section:
(1) The term ``campus'' means, with respect to a
hospital of the Department--
(A) the physical area immediately adjacent to
the main buildings of the hospital;
(B) other areas and structures that are not
strictly contiguous to the main buildings but
are located not less than 250 yards from the
main buildings; and
(C) any other areas determined by the
Secretary to be part of the campus of the
hospital.
(2) The term ``emergency medical condition'' means--
(A) a medical condition manifesting itself by
acute symptoms of sufficient severity
(including severe pain) such that the absence
of immediate medical attention could reasonably
be expected to result in--
(i) placing the health of the
individual (or, with respect to a
pregnant woman, the health of the woman
or her unborn child) in serious
jeopardy;
(ii) serious impairment to bodily
functions; or
(iii) serious dysfunction of any
bodily organ or part; or
(B) with respect to a pregnant woman who is
having contractions--
(i) that there is inadequate time to
effect a safe transfer to another
hospital before delivery; or
(ii) that transfer may pose a threat
to the health or safety of the woman or
the unborn child.
(3)(A) The term ``to stabilize'' means, with respect
to an emergency medical condition described in
paragraph (2)(A), to provide such medical treatment of
the condition as may be necessary to assure, within
reasonable medical probability, that no material
deterioration of the condition is likely to result from
or occur during the transfer of the individual from a
facility, or, with respect to an emergency medical
condition described in paragraph (2)(B), to deliver
(including the placenta).
(B) The term ``stabilized'' means, with respect to an
emergency medical condition described in paragraph
(2)(A), that no material deterioration of the condition
is likely, within reasonable medical probability, to
result from or occur during the transfer of the
individual from a facility, or, with respect to an
emergency medical condition described in paragraph
(2)(B), that the woman has delivered (including the
placenta).
(4) The term ``transfer'' means the movement
(including the discharge) of an individual outside the
facilities of a hospital of the Department at the
direction of any person employed by (or affiliated or
associated, directly or indirectly, with) the hospital,
but does not include such a movement of an individual
who--
(A) has been declared dead; or
(B) leaves the facility without the
permission of any such person.
* * * * * * *
Part III. Readjustment and Related Benefits
* * * * * * *
Chapter 33. Post-9/11 Educational Assistance
SUBCHAPTER I. DEFINITIONS
SEC.
* * * * * * *
SUBCHAPTER III. ADMINISTRATIVE PROVISIONS
* * * * * * *
3325. REPORTING REQUIREMENT.
3326. REPORT ON STUDENT PROGRESS.
* * * * * * *
Subchapter III. Administrative Provisions
* * * * * * *
SEC. 3325. REPORTING REQUIREMENT
* * * * * * *
(b) * * *
(1) * * *
(A) * * *
(B) indicating whether it is necessary for
the purposes of maintaining adequate levels of
well-qualified active-duty personnel in the
Armed Forces to continue to offer the
opportunity for educational assistance under
this chapter to individuals who have not yet
entered active-duty service; [and]
(C) * * *
(D) indicating the highest level of education
attained by each individual who transfers a
portion of the individual's entitlement to
educational assistance under section 3319 of
this title; and
(2) * * *
(c) * * *
(1) * * *
(2) appropriate student outcome measures, such as the
number of credit hours, certificates, degrees, and
other qualifications earned by beneficiaries under this
chapter and chapter 35 of this title during the
academic year covered by the report; [and]
(3) the information received by the Secretary under
section 3326 of this title; and
(4) [(3)] such recommendations for administrative and
legislative changes regarding the provision of
educational assistance to members of the Armed Forces
and veterans, and their dependents, as the Secretary
considers appropriate.
SEC. 3326. REPORT ON STUDENT PROGRESS
As a condition on approval under chapter 36 of this title
of a course offered by an educational institution (as defined
in section 3452 of this title), each year, each educational
institution (as so defined) that received a payment in that
year on behalf of an individual entitled to educational
assistance under this chapter shall submit to the Secretary
such information regarding the academic progress of the
individual as the Secretary may require.
* * * * * * *
Chapter 41. Job Counseling, Training, and Placement Service for
Veterans
* * * * * * *
SEC. 4103. DIRECTORS AND ASSISTANT DIRECTORS FOR VETERANS' EMPLOYMENT
AND TRAINING; ADDITIONAL FEDERAL PERSONNEL
* * * * * * *
(c) Coordination With State Departments of Labor and
Veterans Affairs.--Each Director for Veterans' Employment and
Training for a State shall coordinate the Director's activities
under this chapter with the State department of labor and the
State department of veterans affairs.
* * * * * * *
Part V. Boards, Administrations, and Services
Chapter 71. Board of Veterans' Appeals
* * * * * * *
SEC. 7107. APPEALS: DOCKETS; HEARINGS
(a)(1) Except as provided in paragraphs (2) and (3) and [in
subsection (f)] in subsection (g), each case received pursuant
to application for review on appeal shall be considered and
decided in regular order according to its place upon the
docket.
* * * * * * *
(d)(1) Subject to paragraph (2), a hearing before the Board
shall be conducted, as the Board considers appropriate--
(A) in person; or
(B) through picture and voice transmission, by
electronic or other means, in such manner that the
appellant is not present in the same location as the
member or members of the Board during the hearing.
(2) Upon request by an appellant, a hearing before the
Board shall be conducted, as the appellant considers
appropriate--
(A) in person; or
(B) through picture and voice transmission as
described in paragraph (1)(B).
(e)(1) In a case in which a hearing before the Board is to
be conducted through picture and voice transmission as
described in subsection (d)(1)(B), the Secretary shall provide
suitable facilities and equipment to the Board or other
components of the Department to enable an appellant located at
an appropriate facility within the area served by a regional
office to participate as so described.
(2) Any hearing conducted through picture and voice
transmission as described in subsection (d)(1)(B) shall be
conducted in the same manner as, and shall be considered the
equivalent of, a personal hearing.
[(e)(1) At the request of the Chairman, the Secretary may
provide suitable facilities and equipment to the Board or other
components of the Department to enable an appellant located at
a facility within the area served by a regional office to
participate, through voice transmission or through picture and
voice transmission, by electronic or other means, in a hearing
with a Board member or members sitting at the Board's principal
location.
[(2) When such facilities and equipment are available, the
Chairman may afford the appellant an opportunity to participate
in a hearing before the Board through the use of such
facilities and equipment in lieu of a hearing held by
personally appearing before a Board member or panel as provided
in subsection (d). Any such hearing shall be conducted in the
same manner as, and shall be considered the equivalent of, a
personal hearing. If the appellant declines to participate in a
hearing through the use of such facilities and equipment, the
opportunity of the appellant to a hearing as provided in such
subsection (d) shall not be affected.]
(f) [(d)](1) [An appellant may request that a hearing
before the Board be held at its principal location or at a
facility of the Department located within the area served by a
regional office of the Department] In a case in which a hearing
before the Board is to be conducted in person, the hearing
shall be held at the principal location of the Board or at a
facility of the Department located within the area served by a
regional office of the Department.
* * * * * * *
(g) [(f)] * * *
* * * * * * *
Chapter 74. Veterans Health Administration--Personnel
* * * * * * *
Subchapter I. Appointments
* * * * * * *
SEC. 7402. QUALIFICATIONS OF APPOINTEES
* * * * * * *
(b)(1) * * *
* * * * * * *
(11) * * *
(A) hold a master's degree or doctoral degree in
mental health counseling, or a related field, from a
college or university approved by the Secretary; and
* * * * * * *
Subchapter IV. Pay for Nurses and Other Health-Care Personnel
SEC. 7451. NURSES AND OTHER HEALTH-CARE PERSONNEL: COMPETITIVE PAY
(a)(1) * * *
(2) * * *
(A) * * *
(B) Physician assistant.
(C) [(B)] Such positions referred to in paragraphs
(1) and (3) of section 7401 of this title (other than
the positions of physician, dentist, [and registered
nurse] registered nurse, and physician assistant) as
the Secretary may determine upon the recommendation of
the Under Secretary for Health.
* * * * * * *
Part VI. Acquisition and Disposition of Property
* * * * * * *
Chapter 81. Acquisition and Operation of Hospital and Domiciliary
Facilities; Procurement and Supply; Enhanced-Use Leases of Real
Property
* * * * * * *
Subchapter II. Procurement and Supply
* * * * * * *
SEC. 8127. SMALL BUSINESS CONCERNS OWNED AND CONTROLLED BY VETERANS:
CONTRACTING GOALS AND PREFERENCES
* * * * * * *
(h) * * *
(2) * * *
* * * * * * *
[(C) The date that is ten years after the date of the
veteran's death.]
(C) The date that--
(i) in the case of a surviving spouse of a
veteran with a service-connected disability
rated as 100 percent disabling or who dies as a
result of a service-connected disability, is 10
years after the date of the veteran's death; or
(ii) in the case of a surviving spouse of a
veteran with a service-connected disability
rated as less than 100 percent disabling who
does not die as a result of a service-connected
disability, is three years after the date of
the veteran's death.
(3) Paragraph (1) only applies to a surviving spouse of a
veteran with a service-connected disability [rated as 100
percent disabling or who dies as a result of a service-
connected disability].
(i) Treatment of Businesses After Death of Servicemember-
owner.--(1) If a member of the Armed Forces owns at least 51
percent of a small business concern and such member is killed
in line of duty in the active military, naval, or air service,
the surviving spouse or dependent child of such member who
acquires such ownership rights in such small business concern
shall, for the period described in paragraph (2), be treated as
if the surviving spouse or dependent child were a veteran with
a service-connected disability for purposes of determining the
status of the small business concern as a small business
concern owned and controlled by veterans for purposes of
contracting goals and preferences under this section.
(2) The period referred to in paragraph (1) is the period
beginning on the date on which the member of the Armed Forces
dies and ending on the date as follows:
(A) In the case of a surviving spouse, the earliest
of the following dates:
(i) The date on which the surviving spouse
remarries.
(ii) The date on which the surviving spouse
relinquishes an ownership interest in the small
business concern and no longer owns at least 51
percent of such small business concern.
(iii) The date that is ten years after the
date of the member's death.
(B) In the case of a dependent child, the earliest of
the following dates:
(i) The date on which the surviving dependent
child relinquishes an ownership interest in the
small business concern and no longer owns at
least 51 percent of such small business
concern.
(ii) The date that is ten years after the
date of the member's death.
(j) [(i)] * * *
* * * * * * *
(k) [(j)] * * *
* * * * * * *
(l) [(k)] * * *
* * * * * * *
(m) [(l)] * * *
* * * * * * *
Workforce Investment Act of 1998
(29 U.S.C. 2871(d)(1))
* * * * * * *
Title I. Workforce Investment Systems
* * * * * * *
Subtitle B. Statewide and Local Workforce Investment Systems
* * * * * * *
Chapter 6. General Provisions
SEC. 136. PERFORMANCE ACCOUNTABILITY SYSTEM.
* * * * * * *
(d) Report.--
(1) In general.--Each State that receives an
allotment under section 127 or 132 shall annually
prepare and submit to the Secretary a report on the
progress of the State in achieving State performance
measures, including information on the levels of
performance achieved by the State with respect to the
core indicators of performance and the customer
satisfaction indicator. The annual report also shall
include information regarding the progress of local
areas in the State in achieving local performance
measures, including information on the levels of
performance achieved by the areas with respect to the
core indicators of performance and the customer
satisfaction indicator. The report also shall include
information on the status of State evaluations of
workforce investment activities described in subsection
(e). The report also shall include information, for the
year preceding the year the report is submitted, on the
number of job fairs attended by One-Stop Career Center
employees at which the employees had contact with a
veteran, and the number of veterans contacted at each
such job fair.
* * * * * * *
Veterans' Benefits Improvements Act
of 1996
(Public Law 104-275; 38 U.S.C. 5101 Note)
* * * * * * *
Title V. Department of Veterans Affairs Administrative Matters
* * * * * * *
SEC. 504. PILOT PROGRAM FOR USE OF CONTRACT PHYSICIANS FOR DISABILITY
EXAMINATIONS
* * * * * * *
(c) Licensure of Contract Physicians.--
(1) In general.--Notwithstanding any law regarding
the licensure of physicians, a physician described in
paragraph (2) may conduct an examination pursuant to a
contract entered into under subsection (a) at any
location in any State, the District of Columbia, or a
Commonwealth, territory, or possession of the United
States, so long as the examination is within the scope
of the authorized duties under such contract.
(2) Physician described.--A physician described in
this paragraph is a physician who--
(A) has a current license to practice the
health care profession of the physician; and
(B) is performing authorized duties for the
Department of Veterans Affairs pursuant to a
contract entered into under subsection (a).
(d) [(c)] Source of Funds.--Payments for contracts under
the pilot program under this section shall be made from amounts
available to the Secretary of Veterans Affairs for payment of
compensation and pensions.
(e) [(d)] Report to Congress.--Not later than three years
after the date of the enactment of this Act, the Secretary
shall submit to the Congress a report on the effect of the use
of the authority provided by subsection (a) on the cost,
timeliness, and thoroughness of medical disability
examinations.
* * * * * * *
Department of Veterans Affairs Health Care Programs Enhancement Act of
2001
(Public Law 107-135; 115 Stat. 2459; 38 U.S.C. 1710 note)
* * * * * * *
Title II. Other Matters
* * * * * * *
SEC. 204. PROGRAM FOR PROVISION OF CHIROPRACTIC CARE AND SERVICES TO
VETERANS.
* * * * * * *
(c) Location of Program.--(1) The program shall be carried
out at sites designated by the Secretary for purposes of the
program. The Secretary shall designate at least one site for
such program in each geographic service area of the Veterans
Health Administration. The sites so designated shall be medical
centers and clinics located in urban areas and in rural areas.
(2) The program shall be carried out at not fewer than two
medical centers or clinics in each Veterans Integrated Service
Network by not later than two years after the date of the
enactment of the 21st Century Veterans Benefits Delivery and
Other Improvements Act, and at not fewer than 50 percent of all
medical centers in each Veterans Integrated Service Network by
not later than three years after such date of enactment.
* * * * * * *
[all]