[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2718 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 2718
To amend title 38, United States Code, to improve matters relating to
medical examinations for veterans disability compensation, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 5, 2023
Mr. Tester (for himself and Mr. Tillis) introduced the following bill;
which was read twice and referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to improve matters relating to
medical examinations for veterans disability compensation, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medical Disability Exam Improvement
Act of 2023''.
SEC. 2. MODIFICATION OF ELIGIBILITY REQUIREMENTS FOR MEDICAL NEXUS
EXAMINATIONS FOR TOXIC EXPOSURE RISK ACTIVITIES.
Section 1168(a)(1) of title 38, United States Code, is amended--
(1) by striking ``with evidence of a disability and
evidence of participation in a toxic exposure risk activity''
and inserting ``and expresses that such claim is associated
with a toxic exposure risk activity''; and
(2) by striking ``and such evidence'' and inserting ``and
evidence of record before the Secretary''.
SEC. 3. SPECIFICATION OF ACCOUNTS FOR CERTAIN EXPENSES RELATING TO
MEDICAL EXAMINATIONS FOR VETERANS DISABILITY COMPENSATION
CLAIMS UNDER LAWS ADMINISTERED BY SECRETARY OF VETERANS
AFFAIRS.
Section 5103A(d) of title 38, United States Code, is amended by
adding at the end the following new paragraph:
``(3) Expenses of carrying out a medical examination or obtaining a
medical opinion under paragraph (1), including payment for travel and
incidental expenses under the terms and conditions set forth by section
111 of this title for the examination or medical opinion, shall be
reimbursed to the accounts available for the general operating expenses
of the Veterans Benefits Administration and information technology
systems from amounts available to the Secretary for payment of
compensation and pensions.''.
SEC. 4. STUDY ON IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS COVERED
MEDICAL DISABILITY EXAMINATIONS IN RURAL AREAS.
(a) Study Required.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall complete
a study on access by rural veterans to covered medical disability
examinations.
(b) Elements.--
(1) In general.--The study conducted under subsection (a)
shall include the following:
(A) A comparison of the average number of days to
complete covered medical disability examinations for
rural veterans compared to a national non-rural average
time to complete a covered medical disability
examinations, by either contractors or employees of the
Department.
(B) A root cause analysis of differences identified
pursuant to subparagraph (A).
(C) The plan of the Secretary for the following
year to improve access described in subsection (a),
which shall include a plan for the pursuit of a
commercial or industry-standard solution or technology
that could enable rural or housebound veterans to
receive examinations without traveling long distances.
(2) National non-rural average defined.--For purposes of
paragraph (1)(A), the term ``national non-rural average'' means
the national average of all periods in the previous calendar
year--
(A) beginning on the date on which a contractor or
employee of the Department received a request from the
Secretary to conduct a covered medical disability
examination for a veteran who is not a rural veteran;
and
(B) ending on the date on which the examination was
completed.
(c) Report on Study.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the findings of the
Secretary with respect to the study completed under subsection (a).
(d) Annual Report on Plans.--Not later than two years after the
date of the enactment of this Act and not less frequently than once
each year thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report evaluating the conduct of the
plans of the Secretary to improve access described in subsection (a)
and a new or revised plan for such improvement in the following year.
SEC. 5. IMPROVEMENTS TO TRAINING FOR PROCESSING MEDICAL DISABILITY
EXAMINATIONS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall require
additional training for employees of the Department of Veterans Affairs
who order or review covered medical disability examinations.
(b) Training Requirements.--The training required under subsection
(a) shall include the following:
(1) Instruction on how to assess whether a covered medical
disability examination is adequate for purposes of adjudicating
the particular claim for a benefit under chapter 11 or 15 of
title 38, United States Code, for which the examination was
ordered by the Department.
(2) Instruction on how to assess whether a covered medical
disability examination is necessary for purposes of
adjudicating the particular claim for a benefit under chapter
11 or 15 of title 38, United States Code, for which the
examination was ordered by the Department.
(3) Review of relevant statutes, judicial decisions,
regulations, and policies of the Department regarding covered
medical disability examinations, including, at a minimum--
(A) the duty to assist;
(B) the relevance of causation compared to other
evidentiary standards in covered medical disability
examinations;
(C) the required elements of a covered medical
disability examination, with an emphasis on the
requirement for reasoned analysis to support medical
opinions; and
(D) the relevance of a lack of a statutory or
regulatory presumption of service-connection in covered
medical disability examinations.
(c) Frequency.--The Secretary shall ensure that each employee of
the Department who orders or uses a covered medical disability
examination to evaluate a claim for a benefit under chapter 11 or 15 of
title 38, United States Code, completes training that incorporates the
requirements of subsection (b) not less frequently than once each year.
(d) Modification of Reports.--
(1) Board of veterans' appeals.--Section 7101(d)(2) of
title 38, United States Code, is amended--
(A) in subparagraph (F), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (G), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(H) a summary of recurring issues that the Chairman
believes could be resolved by better training for employees of
the Department, increased oversight, or clarification from
either the Department or Congress.''.
(2) United states court of appeals for veterans claims.--
Section 7288(b) of title 38, United States Code, is amended by
adding at the end the following new paragraph:
``(16) A summary of recurring issues that the chief judge
of the Court believes could be resolved by better training for
employees of the Department, increased oversight, or
clarification from either the Department or Congress.''.
(e) Definition of Covered Medical Disability Examination.--In this
section, the term ``covered medical disability examination'' means a
medical examination or medical opinion that the Secretary determines
necessary for the purposes of adjudicating a benefit under chapter 11
or 15 of title 38, United States Code, regardless of whether conducted
by an employee or a contractor of the Department.
SEC. 6. REVIEW AND PRIORITY PROCESSING OF CLAIMS WITH INADEQUATE OR
UNNECESSARY EXAMINATIONS.
(a) Review.--Not later than 1 year after the date of the enactment
of this Act and not less frequently than once every calendar month
thereafter, the Secretary of Veterans Affairs shall review a
statistically significant sample of all covered medical disability
examinations completed during the previous calendar month.
(b) Further Sample Requirements.--Under each review required by
subsection (a), the Secretary shall ensure the review includes--
(1) a statistically significant sample of covered medical
disability examinations completed by employees of the
Department of Veterans Affairs; and
(2) a statistically significant sample of covered medical
disability examinations completed by each contractor that
provides such examinations for the Department.
(c) Analysis.--Under each review required by subsection (a), the
Secretary shall analyze--
(1) the sample specified in subsection (b)(1) and identify
the percentage of examinations that were adequate for purposes
of adjudicating the particular claim for a benefit under
chapter 11 or 15 of title 38, United States Code, for which the
examination was ordered by the Department;
(2) the sample specified in subsection (b)(2) and identify
the percentage of examinations that were adequate for purposes
of adjudicating the particular claim for a benefit under
chapter 11 or 15 of title 38, United States Code, for which the
examination was ordered by the Department; and
(3) the overall sample specified in subsection (a) and
identify the percentage of examinations that were necessary for
purposes of adjudicating the particular claim for a benefit
under chapter 11 or 15 of title 38, United States Code, for
which the examination was ordered by the Department.
(d) Priority Processing.--If during a review under subsection (a)
the Secretary finds any covered medical disability examination to be
not adequate or not necessary for adjudicating a claim of a claimant,
the Secretary may provide such claimant--
(1) another examination on a priority basis; and
(2) priority processing for the entirety of impacted claim.
(e) Covered Medical Disability Examination Defined.--In this
section, the term ``covered medical disability examination'' means a
medical examination or medical opinion that the Secretary determines
necessary for the purposes of adjudicating a benefit under chapter 11
or 15 of title 38, United States Code, regardless of whether conducted
by an employee or a contractor of the Department.
SEC. 7. MECHANISM FOR CONTRACTORS CONDUCTING DISABILITY EXAMINATIONS
UNDER CERTAIN DEPARTMENT OF VETERANS AFFAIRS PILOT
PROGRAM TO TRANSMIT MEDICAL EVIDENCE INTRODUCED BY
CLAIMANTS DURING EXAMINATIONS.
Section 504 of the Veterans' Benefits Improvements Act of 1996
(Public Law 104-275; 38 U.S.C. 5101 note) is amended--
(1) by redesignating subsections (d) and (e) as subsection
(e) and (f), respectively; and
(2) by inserting after subsection (c) the following new
subsection (d):
``(d) Mechanism for Transmittal of Evidence Introduced by
Applicants During Examinations.--The Secretary shall establish a
mechanism whereby a health care professional can transmit to the
Secretary, evidence introduced by the applicant during a medical
examination or in conjunction with such examination.''.
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