[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2493 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 2493
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
July 29, 2025
Mr. Blumenthal (for himself and Mr. Murphy) 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 Examination
Improvement Act of 2025''.
SEC. 2. PILOT PROGRAM ON CONDUCT OF MEDICAL EXAMINATIONS AT MEDICAL
FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS FOR VETERANS
DISABILITY COMPENSATION CLAIMS UNDER LAWS ADMINISTERED BY
SECRETARY OF VETERANS AFFAIRS.
(a) Pilot Program Authorized.--The Under Secretary of Benefits may
carry out a pilot program to assess the feasibility and advisability of
providing for the conduct of medical examinations, or obtaining medical
opinions, under section 5103A(d) of title 38, United States Code, at
medical facilities of the Department of Veterans Affairs.
(b) Locations.--In carrying out the pilot program under this
section, the Secretary shall carry out the pilot program at medical
facilities of the Department as follows:
(1) In fiscal years before fiscal year 2027, medical
facilities in not more than one Veterans Integrated Service
Network of the Department of Veterans Affairs selected by the
Under Secretary for Benefits, in coordination with the Under
Secretary for Health, for purposes of the pilot program under
this section.
(2) In fiscal year 2029, medical facilities in not more
than three Veterans Integrated Service Networks of the
Department of Veterans Affairs selected by the Under Secretary
for Benefits, in coordination with the Under Secretary for
Health, for purposes of the pilot program under this section.
(3) In fiscal year 2031, medical facilities in not more
than six Veterans Integrated Service Networks of the Department
of Veterans Affairs selected by the Under Secretary for
Benefits, in coordination with the Under Secretary for Health,
for purposes of the pilot program under this section.
(4) In fiscal year 2033, medical facilities in not more
than 10 Veterans Integrated Service Networks of the Department
of Veterans Affairs selected by the Under Secretary for
Benefits, in consultation with the Under Secretary for Health,
for purposes of the pilot program under this section.
(5) In fiscal year 2035 and each fiscal year thereafter,
medical facilities in through such Veterans Integrated Service
Networks of the Department as the Under Secretary for Benefits,
in consultation with the Under Secretary for Health, considers
appropriate for purposes of the pilot program under this
section.
(c) Report to Congress.--
(1) In general.--If the Under Secretary commences
conducting a pilot program pursuant to subsection (a) before
the date that is two years after the date of the enactment of
this Act, the Under Secretary shall, not later than two years
after the date of the enactment of this Act, submit to Congress
a report on the findings of the Under Secretary with respect to
the pilot program.
(2) Contents.--The report submitted pursuant to paragraph
(1) shall include an assessment of the Under Secretary of the
effect of the use of the authority provided by subsection (a)
on the cost, timeliness, quality, and capacity of the
Department to provide medical disability examinations.
(d) Source of Funds.--Amounts expended or obligated by the Under
Secretary to carry out the pilot program under this section, including
for payments for examination travel and incidental expenses under the
terms and conditions set forth by section 111 of title 38, United
States Code, 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
of Veterans Affairs for payment of compensation and pension.
SEC. 3. 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 veterans who reside in rural and highly rural
areas 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,
disaggregated by type of examination, for veterans who
reside in rural and highly rural areas compared to an
average time for veterans who reside in other areas to
complete a covered medical disability examination, 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 housebound veterans or veterans who
live in rural areas to receive examinations without
traveling long distances.
(2) Number of days to complete defined.--For purposes of
paragraph (1)(A), the term ``number of days to complete'' means
the number of days in the period--
(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; 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) Definitions.--In this section:
(1) Covered medical disability examination.--The term
``covered medical disability examination'' means a medical
nexus examination or medical opinion 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.
(2) Rural; highly rural.--The terms ``rural'' and ``highly
rural'' have the meanings given those terms under the rural-
urban commuting areas coding system of the Department of
Agriculture.
SEC. 4. 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 new and probationary 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
a claim for a benefit under laws administered by the Secretary.
(2) Instruction on how to assess whether a medical
disability examination is necessary for purposes of
adjudicating a particular claim for a benefit.
(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.
(4) Input from impacted employees of the Department,
including duly appointed labor representatives of Department
employees.
(c) Second Level of Review for New Employees.--The Secretary shall
ensure that a new employee described in subsection (a) is subject to a
second level of review before the employee can order a covered medical
disability examination until the employee achieves an accuracy rate of
90 percent on decisions of claims.
(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 result in the
Board remanding appeals back to the agency of original
jurisdiction.''.
(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 result in
remands.''.
(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. 5. REVIEW AND PRIORITY PROCESSING OF CLAIMS WITH INADEQUATE OR
UNNECESSARY EXAMINATIONS.
(a) Review.--Not later than one year after the date of the
enactment of this Act and not less frequently than once every three
months thereafter until the date that is three years after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
review a statistically significant sample of all covered medical
disability examinations completed during the previous three-month
period.
(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--
(1) analyze the samples specified in subsection (b); and
(2) pursuant to such analysis, identify--
(A) 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
(B) the percentage of examinations considered
overdeveloped for purposes of adjudicating claims 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.--
(1) In general.--Except as provided for in paragraph (2),
if during a review under subsection (a) the Secretary finds any
covered medical disability examination to be not adequate for
adjudicating a claim, the Secretary shall ensure the claimant
examined by that examination--
(A) receives another examination, if necessary, on
a priority basis; and
(B) receives priority processing for the entirety
of impacted claim.
(2) Exception.--The Secretary is not required to furnish an
additional examination under paragraph (1) if the Secretary
determines such an examination to be unnecessary for purposes
of adjudicating the claim.
(e) Comptroller General of the United States Study.--The
Comptroller General of the United States shall conduct a review of the
methodology and effectiveness of the reviews conducted under subsection
(a).
(f) Covered Medical Disability Examination Defined.--In this
section, the term ``covered medical disability examination'' means a
medical examination or opinion for the purposes of adjudicating a claim
for 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. MECHANISM FOR CONTRACTORS CONDUCTING DISABILITY EXAMINATIONS
UNDER CERTAIN DEPARTMENT OF VETERANS AFFAIRS PILOT
PROGRAM TO TRANSMIT MEDICAL EVIDENCE INTRODUCED BY
CLAIMANTS DURING EXAMINATIONS.
(a) In General.--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 subsections
(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 who conducts medical
examinations or opinions under section 5103A(d) of title 38, United
States Code, may transmit to a veteran's claims file, evidence
introduced by the applicant during a medical examination or in
conjunction with a medical opinion that examiner used to inform such
medical examination or opinion.''.
SEC. 7. REVIEW AND PLAN REGARDING DEPARTMENT OF VETERANS AFFAIRS
SCHEDULING OF MEDICAL EXAMINATIONS.
(a) Review Required.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall complete
a review of scheduling request tools, contracts, and systems used by
employees and contractors of the Department of Veterans Affairs to
order and conduct medical disability examinations.
(b) Plan Required.--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 plan to ensure the following:
(1) Systems and processes used by the Department enable
seamless and clear communication of requirements between the
claims processors who request medical disability examinations
and medical disability examination vendors, including through a
contract.
(2) Medical disability examiners, including through a
contract, review the medical records and claims information
necessary to conduct exams that are adequate for purposes of
rating claims for benefits under laws administered by the
Secretary.
(3) Claimants or appellants for whom a medical disability
examination is requested of the Department have agency in
determining when and where the examination is conducted within
a reasonable timeframe, as determined by the Secretary.
(4) Claimants or appellants for whom a medical disability
examination is requested of the Department have a seamless
experience when scheduling their examinations without regard to
which medical disability vendor conducts the examinations.
(5) The Department conducts customer satisfaction and
experience surveys of claimants or appellants who attend
medical disability examinations provided under laws
administered by the Secretary.
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