Bill summaries are authored by CRS.

Shown Here:
Reported to Senate amended (07/19/1990)

Veterans Benefits and Health Care Amendments of 1990 - Title I: Compensation - Part A: Generally - Directs the Secretary of Veterans Affairs (VA) to increase the rates of, and limitations on, Department of Veterans Affairs disability compensation and dependency and indemnity compensation to coincide with benefit increases under title II (Old Age, Survivors and Disability Insurance) of the Social Security Act. Requires such rate increases to be published in the Federal Register.

Part B: Radiogenic Disabilities - Extends the presumption of service-connection, for purposes of eligibility for veterans' disability compensation, to cover members of the reserves who participated in a radiation-risk activity while serving on active duty for training or inactive duty for training.

Amends Federal provisions relating to the payment of disability compensation due to certain diseases and disabilities presumed to be service-connected to remove the current limitation on the required manifestation period (either 40 or 30 years from the date on which a veteran last participated in a radiation-risk activity). Adds cancer of the salivary gland and cancer of the urinary tract to the list of diseases that will be presumed to be service-connected for purposes of such disability compensation.

Requires the Secretary, within 210 days after enactment of this Act, to identify at least three military activities which likely would have exposed individuals to levels of ionizing radiation above background levels. Requires the Secretary to identify at least three additional activities by October 1 of FY 1991 through 1993. Requires the Secretary, immediately after identifying each additional activity, to direct the Veterans' Advisory Committee on Environmental Hazards to evaluate, make findings, and report on whether participation in such activities resulted in exposure comparable to that resulting from a radiation-risk activity as defined under current law. Requires the Secretary to list each such activity unless the Advisory Committee's report and all other evidence indicate that such activity did not result in comparable exposure to that of veterans participating in radiation-risk activities. Requires the Secretary to make certain reports.

Part C: Agent Orange Exposure and Vietnam Service - Veterans' Agent Orange Exposure and Vietnam Service Benefits Act of 1990 - Establishes a presumption of service connection, for the purposes of eligibility for veterans' disability compensation, for each of the following diseases incurred by individuals who served in Vietnam during the Vietnam era, if such diseases become manifest to a disability degree of ten percent or more: (1) non-Hodgkins lymphoma; (2) each soft-tissue sarcoma; and (3) chloracne.

Provides a presumption of service-connection in the case of a Vietnam veteran suffering from a disease associated with effects of exposure to certain dioxins or other herbicide agents during such service in Vietnam. Directs the Secretary to prescribe regulations listing a positive association between any disease and the biological effects of exposure to an herbicide agent in Vietnam. Requires the Secretary to update such list continually. Requires the Secretary, in prescribing and revising such list, to obtain by contract the determinations and estimates of a contract scientific organization. Requires such organization to: (1) determine which diseases have any degree of association with the biological effects of exposure to a herbicide agent; and (2) estimate the extent of association between each such disease and each such biological effect. Requires the organization to determine such association specifically with respect to lung cancer and each other cancer. Outlines contract provisions required in such agreements between the Secretary and the scientific organization, including surveys, evaluations, and periodic determinations. Requires such scientific organization to provide reports to the Secretary and the Senate and House Veterans' Affairs Committees (veterans' committees) regarding its determinations and evaluations. Requires such organization to determine, in the event of a positive association, whether there is a reasonable basis for concluding that a Vietnam veteran with the highest level of exposure to that herbicide agent in Vietnam was exposed to such agent under the circumstances necessary for such biological effects. Requires a report from the organization to the Secretary and the veterans' committees when no such reasonable basis is found. Requires the Secretary to make certain determinations and follow-up reports after receiving such reports from the contract scientific organization, including the issuance of a report to the veterans' committees and the promulgation of positive association regulations, if necessary. Requires benefits to be continued even though a disease is removed from the list of diseases having positive associations. Terminates such contracting authority ten years after the first day of the fiscal year in which a scientific organization transmits its first report to the Secretary. Provides interim regulations and special effective dates.

Directs the Secretary to compile and analyze all clinical data that: (1) are obtained by the VA in connection with examinations and treatment of veterans for disabilities related to exposure to certain herbicides or to service in Vietnam; and (2) are likely to be scientifically useful in determining the association, if any, between the disabilities of such veterans and their exposure to such herbicides and other toxic substances. Requires the Secretary to submit an annual report to the veterans' committees concerning such analysis and its results. Directs the Secretary to consult with the Director of the Office of Technology Assessment (OTA) before compiling and analyzing such information. Requires the Director of OTA to review each annual report submitted by the Secretary and transmit to the Secretary an evaluation of the contents of each report.

Directs the Secretary to establish and maintain a system for the collection and storage of voluntarily contributed samples of blood and tissue of veterans who performed active service in Vietnam during the Vietnam era. Outlines provisions concerning the security and authorized uses of such specimens, as well as limitations on the acceptance of such samples. Requires the Secretary to consult with the National Academy of Sciences (NAS) to the extent that an agreement has been reached with NAS serving as the contract scientific organization for the Secretary. Requires the Secretary to consult with the Director of OTA if no agreement is made with NAS.

Directs the Secretary to establish a program to provide for studies of the feasibility of conducting additional scientific research on health hazards resulting from: (1) exposure to dioxin; (2) exposure to other toxic agents in herbicides used in support of U.S. and allied military operations in Vietnam during the Vietnam era; and (3) active military, naval, or air service there. Requires the Secretary to report to the veterans' committees on the results of such studies. Requires the Secretary to consult with NAS before undertaking such studies and requires NAS to review such studies and report recommendations to the Secretary and the veterans' committees to the extent provided under any agreement between the Secretary and NAS.

Amends the Veterans' Benefits Improvement Act of 1988 to require the Secretary to annually furnish updated information to individuals listed in the Department of Veterans Affairs Agent Orange Registry on health risks resulting from exposure to dioxin or other toxic agents in herbicides as a result of service in Vietnam during the Vietnam era.

Directs the Secretary of Health and Human Services to report to the veterans' committees on the research being conducted to develop treatments for psychological absorption of dioxin and other toxic agents used in herbicides by the United States in Vietnam, including research relating to exposure to dioxin and other toxic agents outside Vietnam.

Extends through December 31, 1993, the eligibility for hospital and nursing home care for veterans exposed to toxic substances in Vietnam.

Amends the Veterans' Benefits Improvement Act of 1988 to authorize direct consultation between the Ranch Hand Advisory Committee and Department of the Air Force scientists conducting the Ranch Hand Study (a study of the long-term health effects of exposure to phenoxy herbicides and contaminants). Requires the preparation and submission of annual reports and a final report in connection with such study.

Title II: Health Care - Part A: Mental Health - Authorizes the provision of health care and services for veterans of World War I or II, the Korean Conflict, the Vietnam Era, or any other area during a period in which hostilities occurred who have been diagnosed to be suffering from post-traumatic stress disorder related to such services even though such disorder has not been determined to be service-connected. Requires the VA to accomplish an evaluation of a veteran within seven days after referral of such veteran to a Department health-care facility from a Vet Center (a center for treatment of veterans with mental illness disabilities).

Expands eligibility for readjustment counseling at Vet Centers to include veterans of wars prior to Vietnam and veterans of service in any areas in which U.S. personnel were subjected to danger from armed conflict comparable to that occurring in battle with an enemy during a period of war.

Directs the Secretary to establish and operate up to five VA health-care facilities as centers of mental illness research, education, and clinical activities, taking into account appropriate geographic distribution of such facilities.

Precludes the Secretary from designating any health-care facility as a center unless the facility has (or may reasonably be anticipated to develop): (1) an arrangement with an accredited medical school or graduate school of psychology which provides education and training in psychiatry and psychology through regular rotation through such center so as to provide training in the diagnosis and treatment of mental illness; (2) an arrangement under which nurses, social workers, or other allied health personnel receive education and training in mental health care through regular rotation through such facility; (3) the ability to attract the participation of scientists who are capable of ingenuity and creativity in research into the causes, treatment, and prevention of mental illness and into models for furnishing care and treatment to veterans suffering from mental illness; (4) a policymaking advisory committee to advise the directors of such facility and center on policy matters pertaining to the activities of such center; and (5) the capability to conduct effectively evaluations of the activities of such center.

Authorizes appropriations.

Declares that activities of clinical and scientific investigation at each center shall be eligible to compete for the award of funding from funds appropriated for the Department's medical and prosthetics research account and shall receive priority insofar as funds are awarded to projects for mental illness.

Requires the Chief Medical Director (CMD) to ensure that: (1) research activities carried out through such centers include an appropriate emphasis on the psychosocial dimension of mental illness and on models for furnishing care and treatment to veterans suffering from mental illness; and (2) useful information produced by the centers is disseminated throughout the Veterans Health Services and Research Administration.

Requires the Secretary to submit to the veterans' committees an annual report on activities and effectiveness of the centers.

Directs the Special Committee on Post-Traumatic Stress Disorder to submit to the Secretary and veterans' committees Committees no later than February 15 of each of the years 1991 through 1993 a report on the Committee's evaluation of the results of a study required under the Veteran's Health Care Amendments of 1983 relating to the diagnosis and treatment of veterans suffering from post-traumatic stress disorder. Directs the Secretary to comment to the veterans' committees concerning such report. Requires the Committee to update certain reports required of the Committee under the Veterans' Health Care Act of 1984 and requires the Secretary to comment to the veterans' committees concerning such updates.

Directs the Secretary, in certain papers required to be submitted to the President annually, to identify the amounts in the appropriations requests for the VA that are estimated to be obligated for payments and treatments for veterans suffering from post-traumatic stress disorder, and for education, training, research, and the operation of the National Center on Post-Traumatic Stress Disorder.

Part B: General Health - Authorizes the VA to furnish wheelchairs, prosthetic devices, and other medically necessary supplies and services as part of veterans' outpatient care when necessary either to obviate the need for hospital admission or in preparation for hospital admission.

Provides outpatient dental care when medically necessary in preparation for hospital admission or for a veteran otherwise receiving other outpatient care or services.

Increases the maximum cost limitation for the provision of certain home health care services to disabled veterans.

Makes permanent the program of community-based contract veterans' alcohol and drug treatment program (currently expires September 30, 1991).

Extends through FY 1995 the authority to provide contract care to U.S. veterans in the Veterans Memorial Medical Center in the Philippines. Extends the authorization of appropriations for the upgrading and replacement of equipment and facilities for such Center through FY 1995. Decreases such annual authorization amount from $1,000,000 to $500,000. Earmarks the first $50,000 of grants appropriated to the Center for educating and training hospital personnel.

Authorizes VA medical centers to convert space at their facility for child care purposes, without reimbursement to the Veterans Canteen Service for the cost of such conversion.

Expands the current authority of the Secretary to acquire and provide housing for homeless veterans in order to allow entities to provide transitional housing for veterans recovering from substance abuse or mental illness disabilities. Extends such program through 1993.

Establishes in the Treasury the Transitional Housing Fund for the provision of housing and loans to assist veterans in recovering from alcohol or drug dependence or abuse disabilities. Outlines loan conditions and conditions for veterans residing in housing provided. Requires the Secretary to issue guidelines for the operation of such residences.

Requires the director of either each medical center or each regional office of the VA to make an assessment of the needs of homeless veterans living within the area served, including needs for health care, education and training, employment, shelter, counseling, and outreach services. Requires the director of each medical center to develop a plan for each of FY 1991 through 1993 for the provision of outreach and other services to meet the needs identified. Requires actions taken under such plans to be coordinated with other programs of the VA and Federal, State, or local governments. Requires the director to disseminate information regarding services provided to homeless veterans by the medical center or other facilities of the VA.

Directs the Secretary to conduct a pilot program to determine the effectiveness of providing, through community-based organizations, domiciliary care (including medical services) to homeless veterans. Authorizes the Secretary to enter into contracts with community-based organizations for the provision of such care. Authorizes appropriations for FY 1991 through 1993. Authorizes the Secretary to reprogram certain previously-appropriated funds to such program if it is found to be effective. Authorizes the Secretary to accept donations of funds or services in order to expand the medical services provided to homeless veterans through the VA.

Amends the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 to extend through FY 1993: (1) the authorization of appropriations for medical programs of the VA; (2) earmarked amounts for the conversion of unused space in urban VA facilities into domiciliary care beds for homeless veterans; and (3) earmarked amounts for the furnishing of care and services to homeless veterans who have chronic mental illness disabilities. Amends the Veterans' Benefits and Services Act of 1988 to extend its program for mentally ill homeless veterans.

Extends through FY 1991 a pilot program under the Veterans' Benefits and Services Act of 1988 for the provision of mobile health-care clinics for the treatment of veterans residing at least 100 miles from a VA treatment facility.

Requires the Secretary to establish the Advisory Committee on Prosthetics and Special-Disabilities Programs to advise the Secretary and the CMD on the coordination of VA and non-VA programs, and the adequacy of funding, for prosthetics and special disabilities programs administered by the Secretary. Requires a report.

Includes within the definition of "medical services" for coverage under Federal veterans' benefits provisions services to achieve pregnancy in a veteran or a veteran's spouse when such services are necessary to overcome a service-connected disability impairing the veteran's procreative ability. Directs the CMD to appoint an advisory committee to advise the CMD on the exercise of authority to furnish such services.

Authorizes use of the Special Therapeutic and Rehabilitation Activities Fund of the VA for the payment of travel and related expenses necessary for the training of employees in the administration of therapeutic and rehabilitative services.

Directs the Secretary, during FY 1991-1995, to conduct a compensated work therapy and therapeutic residence pilot program (CWTTR). Directs the Secretary to establish nonprofit corporations for the making of contracts for conducting work therapy programs under the CWTTR program at no less than ten or more than 15 VA medical centers operating such programs. Requires the Secretary to be assured from a nonprofit corporation that it will operate a therapeutic residence for eligible veterans in conjunction with an existing compensated work therapy program at a medical center. Allows for the provision of in-kind services from the Secretary to the corporation, including technical and clinical advice, supervision of activities, and minor maintenance and repairs to a therapeutic residence. Authorizes the Secretary to lend amounts to a corporation in order to assist such corporations to lease or purchase property for use as therapeutic residential treatment centers. Provides loan limits and other administrative provisions concerning such loans. Directs the Secretary to transfer to the Veterans Health Services and Research Administration no less than ten residences acquired by the VA for use for such centers. Requires each such property to be leased to a nonprofit corporation for operation as a therapeutic residence under the pilot program. Outlines lease conditions and other administrative provisions concerning the establishment of nonprofit corporations for therapeutic residences. Requires each such corporation to submit to the Secretary annual reports providing a detailed statement of its operations, activities, and accomplishments during the preceding year. Requires the Secretary to report to the veterans' committees concerning each such corporation and its participation under the pilot program.

Requires the Secretary, under the pilot program, to operate residences as therapeutic residences for the furnishing of transitional housing solely for veterans who are furnished compensated work therapy under applicable Federal law. Authorizes the Secretary to purchase, lease, or otherwise acquire residential housing for the purpose of furnishing such transitional housing for veterans being furnished compensated work therapy. Outlines the following conditions for the operation of such transitional housing: (1) that only qualified veterans and a house manager live in such residence; (2) that each resident (other than the house manager) pay the VA rent for the period of residence in such housing; (3) that, in the establishment and operation of such housing, the Secretary must comply with all local zoning, building, and other similar requirements; and (4) that the residence meet the State and community fire and safety requirements applicable to property used for similar purposes. Authorizes the Secretary to provide for free room and subsistence for a house manager. Requires the CMD to be responsible for the management, maintenance, and disposition of property acquired for such transitional housing. Authorizes the Secretary to dispose of such property when no longer used for such purpose. Authorizes appropriations. Requires the Secretary to report to the veterans' committees on the experience under the pilot program.

Allows the Secretary to authorize the establishment of one or more nonprofit corporations to provide a flexible funding mechanism for the conduct of VA compensated work therapy programs for veterans (including homeless veterans) in such community or communities as the Secretary may designate. Requires such corporations to be established solely for such programs. Requires funds received by such a corporation for the conduct of such programs to be transferred to the Special Therapeutic and Rehabilitation Activities Fund. Outlines administrative provisions concerning the establishment and operation of each such nonprofit corporation, including provisions concerning: (1) the board of directors and executive officers; (2) general powers; (3) applicable State law; and (4) accountability and oversight. Requires the Secretary to report to the Congress no later than February 1, 1993, on the experience under the program. Prohibits the establishment of any nonprofit corporation for such purposes after September 30, 1993.

Authorizes the use of the Special Therapeutic and Rehabilitation Activities Fund for the purchase of property to be used for transitional housing under this Act.

Directs the Secretary, during the four-year period beginning on October 1, 1990, to conduct a pilot program for the furnishing of medical, rehabilitative, and health-related services in noninstitutional settings for veterans who: (1) are eligible for nursing home care; (2) are in receipt of or in need of nursing home care primarily for the treatment of a service-connected disability; and (3) have a service-connected disability rated at 50 percent or more. Directs the Secretary, under such program, to: (1) furnish appropriate health-related services solely through contracts with appropriate public and private agencies that provide such services; and (2) in the case of each veteran provided services under the program, appoint a VA health-care employee to furnish case management services. Authorizes the Secretary to provide in-kind assistance (through the services of VA employees and the sharing of other VA resources) to a facility furnishing such noninstitutional services to veterans. Outlines administrative provisions concerning the provision of such in-kind assistance. Limits the total cost of the provision of such alternative services to eligible veterans to 65 percent of the cost that would have been incurred by the VA if the VA had furnished such nursing home care to such veteran. Directs the Secretary to report to the veterans' committees the Secretary's evaluation, findings, and conclusions regarding the provision of such alternative noninstitutional care.

Extends through FY 1995 the pilot program for the furnishing of preventive health-care services for veterans by the Secretary. Directs the Secretary to implement annually at each VA facility a major preventive health-care and health-promotion initiative for any veteran receiving other care and services administered through the Secretary. Limits expenditures for such programs and initiatives through FY 1995.

Directs the CMD to designate an official in such Administration as the Director of Preventive Health-Care and Health-Promotion Programs. Requires such Director to prepare guidance regarding, to be responsible for coordinating and evaluating, and to advise the CMD on, all activities carried out under such programs and initiatives.

Requires the Secretary to submit to the veterans' committees an interim and final report on experiences under the pilot program.

Directs the Secretary, during FY 1991 through 1994, to conduct a pilot program for providing assistive animals to aid veterans in the performance of daily living tasks which they are unable to perform due to certain disabilities or handicaps. Outlines administrative provisions and requires reports from the Secretary to the veterans' committees concerning such program. Directs the CMD, before furnishing assistive monkeys to veterans under such program, to conduct an independent evaluation of the way such monkeys would be treated during training and placement under the pilot program. Requires the CMD to consult with representatives of animal welfare organizations prior to conducting such evaluation.

Authorizes the Secretary to provide signal dogs specially trained to provide hearing assistance to veterans who have service-connected hearing impairments and are in need of such dogs. Provides for the payment of travel and other expenses incurred in becoming adjusted to the signal dogs.

Directs the Secretary to report to the veterans' committees concerning a backlog that has occurred in the procurement of prosthetic appliances in FY 1989, for the failure to furnish certain other prosthetic appliances, and the actions planned by the Secretary to prevent a recurrence of such problem. Increases from $500 to $1,000 the total amount that may be expended on any veteran in a 12-month period for such services and treatment.

Repeals the authority of the Secretary to furnish tobacco to veterans receiving hospital or domiciliary care.

Includes health-care facilities in a provision authorizing the sharing of specialized medical resources with medical schools, hospitals, and medical research centers. Revises the authority to share specialized medical resources.

Directs the Secretary to establish a task force to recommend policies and legislation for the elimination of inconsistencies among provisions of law relating to veterans' eligibility for certain health-care benefits. Directs the Secretary to review the report submitted by the task force and either approve the recommendations for legislation contained therein or prepare alternative legislative proposals appropriate for the elimination of the inconsistencies identified by the task force. Requires a report to the veterans' committees concerning the recommendation of such legislative proposals.

Part C: Health-Care Personnel - Veterans Health-Care Personnel Act of 1990 - Authorizes the Secretary to provide assistance in the form of a Reserve member stipend program under the Armed Forces Educational Assistance Program. Requires an individual, in order to be eligible for such assistance, to be: (1) accepted or enrolled as a full-time student at a qualifying educational institution in a course of education or training approved by the Secretary that leads toward completion of a degree in a health profession involving direct patient care or care incident to such direct patient care; (2) receiving benefits under the Reserve GI Bill Program; and (3) achieving a certain qualifying score on the Armed Forces Qualification Test.

Directs the Secretary to pay a qualifying individual $400 monthly under such program in exchange for a period of obligated service as a full-time VA employee. Makes such individual liable to the United States for failure to serve in the VA in such capacity for the agreed upon period. Increases the Reserve member stipend amount whenever there is a general Federal pay increase.

Directs the Secretary, for the pay period beginning on or after July 1, 1991, to establish the rates of basic pay for the following health-care personnel employed within the Veterans Health Services and Research Administration (HSRA) of the VA: registered nurses and registered nurse anesthetists, physicians, dentists, podiatrists, optometrists, nurses, physician assistants, dental assistants, certain clinical or counseling psychologists, certain therapists, practical or vocational nurses, pharmacists, and occupational therapists. Requires the director of each VA health-care facility to conduct a survey which will establish the rate of basic pay in each appropriate pay grade by a specified date. Requires the director to conduct an annual review to determine if such basic pay rates need to be adjusted, and to adjust them, if necessary. Requires the director, as part of such survey, to survey the equivalent entry-level positions for such work performed in non-VA health-care facilities in order to determine the amount of basic pay for similar work. Outlines further administrative provisions relating to the determination of a similar labor market area for purposes of making such pay-rate determinations, requiring the director of a VA facility to notify the CMD of the labor market area identified and of his or her selection of a labor market area, and requiring the CMD to approve or disapprove of such a labor market area selection within a specified time. Provides maximum amounts for such minimum rates of basic pay as established under this Act. Outlines employee exceptions to such basic pay rates. Requires the Secretary to submit an annual report to the veterans' committees regarding the exercise of authority under this Act for the preceding fiscal year and to prescribe final regulations setting forth criteria and procedures to carry out this Act. Requires the director of each VA facility to establish and adjust such basic pay rates by a specified date even if such final regulations have not been implemented. Requires each director, within a specified period, to conduct a survey and establish an interim competitive pay rate to be followed until such final regulations and pay rates are determined.

Authorizes overtime pay for nurses who perform in excess of 40 hours in an administrative workweek. (Currently, overtime is authorized only for work performed in excess of eight hours a day.) Authorizes the payment of six percent additional pay per hour for nurses performing work as a head nurse.

Authorizes the payment of special pay on the same basis as that given to registered nurses to those health-care professionals who are furnishing direct care to patients or services incident to direct patient care.

Increases the limitation on the amount authorized to be paid as special pay to certain individuals in the HSRA of the VA. Requires increases in such pay of a specified amount or more to be reported by the Secretary to the veterans' committees.

Authorizes a one-time lump-sum payment of special pay to each nurse who is recertified in the specialty in which the nurse is employed.

Includes coverage of HSRA personnel under Federal employees' collective bargaining rights and procedures.

Revises provisions concerning disciplinary actions and grievances within the HSRA.

Includes physical therapists, occupational therapists, and pharmacists among positions to which temporary full-time appointments shall not exceed two years. Provides that students who have a temporary appointment and are pursuing a degree in such field may be reappointed for a period not to exceed the duration of the student's academic program.

Directs the Secretary to pay a cash award to any VA employee who is a supervisor or manager employed in any of the following positions: physician, dentist, podiatrist, optometrist, nurse, physicians' assistant, or expanded-function dental auxiliary.

Directs the Secretary to establish and conduct a dependent care assistance program, which meets certain requirements of the Internal Revenue Code of 1986, for the care of dependents of employees of the HSRA. Requires such program to be implemented no later than June 1, 1991.

Requires current representatives of the field of paramedics to assist in the establishment of cooperative arrangements to provide for the training of health and paramedical personnel in order to improve the manpower utilization of such personnel. Requires such arrangements to be implemented no later than February 1, 1991. Authorizes appropriations for FY 1991 through 1994 for making grants for such cooperative programs.

Directs the CMD of the VA to conduct a pilot program at no less than five VA medical facilities during FY 1991 through 1993 in order to determine the effect on employees of VA pay and personnel management practices. Requires the CMD to establish certain alternative pay and personnel management practices, such as increasing certain pay differentials for day versus evening duty, utilizing registered nurses in new ways for the furnishing of direct patient care, and establishing a collaborative practice committee involving physicians, nurses, and other direct health-care personnel. Requires various reports between the CMD, the Secretary, and the veterans' committees relating to the results of such pilot program.

Directs the Secretary to pay special incentive pay to psychologists employed within the HSRA. Requires psychologists receiving such special pay to hold diplomas in psychology from a recognized institution unless the Secretary determines that such psychologists are not needed to furnish appropriate psychological services for veterans.

Part D: Special Pay for Physicians and Dentists - Department of Veterans Affairs Physicians' and Dentists' Corporation Act of 1990 - Revises provisions of Federal law relating to special pay for VA physicians and dentists. Authorizes the Secretary, in order to recruit and retain highly qualified physicians and dentists, to provide special pay to such individuals under regulations prescribed by the Secretary after the Secretary has received the recommendations of the CMD. Conditions such special pay on the execution of a written agreement by the physician or dentist to perform a period of obligated service within the HSRA. Provides that such individual is not entitled to such special pay during the first three years of such service, except at the discretion of the CMD for full-time services. Prohibits special pay for those physician and dentist positions for which there is no significant recruitment and retention problem.

Sets forth requirements of a written agreement, including provisions providing for: (1) a covered period of one to four years; (2) refunding of special pay for unfulfilled services; (3) the waiver of such refund requirement due to circumstances beyond the control of the physician or dentist; and (4) terms under which the Secretary and the physician or dentist may terminate the agreement.

Directs the Secretary to provide special pay to eligible full-time physicians based upon specified factors, including: (1) tenure within the HSRA; (2) service in a medical specialty for which it is extremely difficult to recruit and retain qualified professionals; (3) service in certain executive positions; (4) specialty or board certifications; (5) service in a geographic location for which there are extraordinary difficulties in the recruitment or retention of qualified personnel; and (6) service by a physician with exceptional qualifications within a specialty. Requires all special pay for such full-time physicians to be personally approved by the CMD on a case-by-case basis. Sets forth conditions and limitations to the payment of such special pay.

Directs the Secretary to provide special pay to part-time eligible physicians based upon similar factors. Requires the Secretary to pay each such physician an amount of special pay equal to the proportion of full-time service that physician performs.

Directs the Secretary to provide special pay to eligible full-time and part-time dentists based upon similar factors.

Prohibits a physician from receiving such special pay while also receiving special pay for serving in certain executive positions. Allows scarce specialty pay (another form of special pay that rewards scarce specialty areas of practice) for a physician or dentist serving as a chief of staff only if it is necessary to recruit or retain qualified physicians or dentists for such position and only if the CMD personally approves such specialty pay.

Requires, with regard to the payment of special pay, determinations: (1) that there are extraordinary difficulties in recruitment or retention; and (2) of whether there are extraordinary difficulties in a specific geographic location in the recruitment or retention of qualified physicians or dentists. Sets forth considerations for determinations with respect to extraordinary recruitment and retention difficulties and the payment of special pay for individual medical facilities of the VA. Requires the director of an individual facility, in such a case, to recommend the payment of such special pay to the CMD and wait 45 days after which such pay would become effective unless disapproved by the CMD. Provides for delegation of the approval power of the CMD.

Prohibits special pay from being paid to a physician or dentist who: (1) is employed on a less than half-time basis or on an intermittent basis unless the CMD determines it is the most cost-effective way of providing needed medical or dental services at a VA facility; (2) occupies an internship or residency training position; or (3) is a reemployed annuitant. Reinstates the payment of special pay under this Act for full-time physicians or dentists of the HSRA who had been receiving special pay under primary, full-time, and tenure categories before the authority for the payment of that special pay was repealed. Reinstates similarly the payment of special pay under the primary and tenure categories for part-time physicians and dentists of the HSRA.

Outlines the manner in which special pay is to be considered for purposes of other benefits laws for Federal employees.

States that it is the policy of the Congress to assure that total pay for HSRA physicians and dentists is comparable to total pay of other Government physicians and dentists and to the income of non-Federal physicians and dentists. Directs the Secretary: (1) in order to assist in implementing such policy, to obtain measures of income of such non-VA physicians and dentists and to define the bases for pay distinctions; (2) to report to the President quadrennially on appropriate amounts of special pay to HSRA physicians and dentists to carry out such policy; and (3) to report to specified congressional committees annually on the use of authorities under this title.

Directs the Secretary to reimburse any full-time board-certified physician or dentist appointed in the HSRA for expenses incurred, up to $1,000 per year, for continuing professional education.

Allows a physician or dentist within the HSRA who had previously received special pay under the full-time, primary, or tenure categories (repealed by this Act) and had elected not to have such pay treated as basic pay for purposes of retirement and annuity amounts to elect to treat the special pay provided under this Act as basic pay for such purposes.

Title III: Education and Employment - Extends through 1993 the period in which a Vietnam era veteran will be considered as such for purposes of eligibility for job training, counseling, and placement services.

Authorizes the Secretary of Labor to expand an employment and training program implemented under the Veterans' Benefits Amendments of 1989 in order to furnish employment and training information and services under such program in more than ten geographically dispersed areas of the United States. Requires the Secretary to make certain determinations with regard to the success of such program before undertaking such expansion. Requires the Secretary to report to the veterans' committees on such expansion. Requires the Secretary to utilize disabled veterans' outreach program specialists or local veterans' employment representatives and other resources in implementing such expansion.

Makes persons receiving outpatient medical care or services pending discharge from active military service eligible for veterans' vocational rehabilitation if such persons are being treated at a hospital under contract or agreement with the Secretary of Defense.

Extends by one year the period of automatic disenrollment for veterans' educational assistance benefits to allow for the filing of a claim for such benefits.

Authorizes the Secretary of Veterans Affairs to enter into an agreement with an individual whereby the individual agrees to perform work-study service and the Secretary deducts the allowance otherwise payable to such individual from indebtedness resulting from any overpayment received by such individual under VA-administered education, rehabilitation, or training benefits. Authorizes the Secretary, in order to reduce or eliminate such individual's indebtedness, to waive certain work-study program eligibility requirements and limitations, as well as certain debt collection requirements. Prohibits such an agreement from continuing in force after the individual's debt has been liquidated. Requires the Secretary to compensate such an individual for work-study services performed after such debt has been liquidated.

Authorizes the Secretary to approve the pursuit of flight training for an individual entitled to post-Vietnam era veterans' educational assistance if: (1) such training is necessary for the attainment of the individual's vocational objective; (2) the individual possesses a valid pilot's license and meets all medical requirements necessary for a commercial pilot's license; and (3) the flight school courses are approved by the Federal Aviation Administration and the State. Sets forth the amount of assistance and other conditions for such flight training, including receipt by the Secretary of a certificate from the individual and institution involved of the flight training completed and the tuition and other fees.

Includes as eligible for veterans' educational assistance under the Montgomery GI Bill those individuals who: (1) commenced their third academic year at one of the service academies or as a member of the Senior Reserve Officer Training Corps in a program of educational assistance before January 1, 1977; (2) served on active duty for a period of more than 180 days as a commissioned officer; (3) were discharged or released from such duty under conditions other than dishonorable; and (4) submit to the Secretary before January 1, 1990, an irrevocable election to be eligible for such assistance. Directs the Secretary to refund to any person fulfilling such requirements his or her unused contributions to the Post-Vietnam Era Veterans Education Account.

Revises provisions concerning the number of changes of programs of education allowed for veterans and other eligible persons, allowing one such change without the approval of the Secretary. Authorizes the Secretary to approve a program change necessitated by circumstances beyond the control of the eligible veteran or other person. Provides conditions under which the Secretary may approve a second or subsequent change of program of education.

Title IV: Housing - Makes permanent (currently ends September 30, 1990) the requirement for the VA to notify and counsel veterans about the impact of, and alternatives to, foreclosure when the veterans default on a VA-guaranteed home loan.

Allows the VA to sell vendee loan assets (collateral) either: (1) with recourse; or (2) without recourse only if the amount received by the VA is at least equal to the unpaid balance of the loan.

Extends through FY 1992 the authority for certain home loan lenders to review appraisals.

Makes permanent certain current Federal provisions concerning default procedures and property management with regard to home loans guaranteed by the VA.

Exempts individuals obtaining VA-guaranteed home loans from the requirement that individuals obtaining federally guaranteed loans of over $150,000 disclose their lobbying activities.

Directs the VA, at the request of the Secretary of Housing and Urban Development, to issue certificates of veteran status to veterans seeking certain benefits under laws administered by HUD. Authorizes the VA to issue such certificates without reimbursement.

Limits the time during which a veteran may apply for waiver of a home-loan debt to the one-year period following the date on which the VA notified the debtor of the indebtedness. Requires that debt notices for home-loan and non-home-loan debts inform the recipient of his or her right to apply for a waiver and the procedures for such application.

Title V: Insurance - Increases from $10,000 to $20,000 the maximum amount of Service Disabled Veterans' Insurance available to those veterans who are eligible for a waiver of premiums due to total and permanent disability.

Increases from $40,000 to $90,000 the maximum amount of Veterans' Mortgage Life Insurance available to veterans who have received a specially-adapted housing grant.

Title VI: Minority Affairs - Amends the Department of Veterans Affairs Act to assign as one of the functions of the Assistant Secretary of Veterans Affairs the review and assessment of the effects of policies, programs and activities of the VA on minority veterans and the monitoring of access of such veterans to services and benefits under laws administered by the VA. Defines "minority veterans" as veterans who are black, Native-American, Hispanic-American, Asian-American, Pacific Islander-Americans, or women.

Reestablishes, as of October 1, 1990, the Advisory Committee on Native Americans. Requires reports from such Committee concerning the plight of Native Americans and their access to services and benefits of the VA. Terminates such Committee 90 days after their second report is transferred to the veterans' committees.

Title VII: Miscellaneous - Defines "minor child" for purposes of eligibility for burial in national cemeteries as a child under 21 years of age or under 23 if the person is pursuing a course of instruction at an educational institution.

Authorizes the Secretary to provide for flat grave markers in a section of the Florida National Cemetery that had installed preplaced grave liners as of a specified date.

States that the prohibition on the payment of attorneys' fees in connection with VA benefits proceedings applies only where the individual is applying for such benefits, and not when the Government is proceeding against a person to collect an indebtedness or in cases in which other attorneys' fees statutes apply.

Modifies certain administrative reorganization requirements within the VA.

Authorizes the Secretary to enter into enhanced use agreements (a written agreement for the use of a VA facility consistent with the Department's mission in return for the payment of consideration to the VA) with respect to designated property and to direct the disposal of such property. Provides lease terms and other conditions with respect to such agreements. Requires the Secretary, before designating a property for an enhanced-use lease, to conduct local hearings to consider the proposed lease and its possible effects on the local community. Requires the veterans' committees to be notified of any such designation. Requires a specified notice to be published in the Federal Register. Allows the Secretary to initiate action for the disposal of leased property no longer needed by the VA to the lessee by requesting the Administrator of General Services to carry out a special disposition of such property. Requires notice of a special disposition to be provided to the veterans' committees and published in the Federal Register. Requires funds received by the VA under an enhanced-use agreement to be deposited into the nursing home revolving fund and administered as part of that fund. Outlines provisions concerning construction standards, exemption from State and local taxes, and limitations on the number of enhanced-use agreements. Terminates the authority to enter into such leases as of September 30, 1994.

Makes standards relating to disqualification of Federal judges applicable to judges serving on the Court of Veterans Appeals.

Makes all funds in the Department's Medical Care account exempt from sequestration under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act).

Extends from three to 12 months the period during which a veteran with no spouse or dependent children may be furnished domiciliary or nursing home care by the VA before such veteran's pension is reduced. Provides that, when a veteran's pension payments are so reduced, up to $10,000 of the benefits withheld shall be repaid to the veteran upon discharge.

Increases from $1,500 to $6,000 the value of the estate allowed a hospitalized incompetent veteran without dependents before the VA suspends the veteran's compensation or benefits. Increases from $500 to $2,000 the amount to which an estate must be reduced before such benefits may be resumed.

Prohibits the Secretary from delegating the functional and technical supervision of the performance of security and law enforcement functions within the VA to any official outside the Office of the Secretary. Requires the Secretary to report to the veterans' committees concerning security and law enforcement matters within the VA.

Amends the Internal Revenue Code to permit disclosure to the VA of income-related tax return information for the purpose of determining eligibility for specified veterans' pension and benefit programs.

Amends Federal law to prohibit the Secretary from using such tax return information to terminate, deny, suspend, or reduce a person's benefits or services without first: (1) taking appropriate steps to verify independently the amount and accessibility of the income in question; and (2) providing the affected individual with notice and an opportunity to respond to the findings. Restricts the Secretary's right to verify or act upon information relating to disability compensation. Requires the Secretary to initially notify and periodically renotify benefit recipients and applicants that income reported to the VA will be subject to verification against such individual's tax return information. Provides for the payment of administrative costs associated with such income verification procedures.

Amends the Department of Veterans Affairs Act to increase the number of people authorized to be appointed by the Secretary to a commission formed for the purpose of selecting individuals for the position of the CMD whenever a vacancy in such position occurs.