[Senate Report 106-397]
[From the U.S. Government Publishing Office]
Calendar No. 787
106th Congress Report
SENATE
2d Session 106-397
======================================================================
VETERANS PROGRAMS ENHANCEMENT ACT OF 2000
_______
September 6, 2000.--Ordered to be printed
_______
Mr. Specter, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany S. 1810]
The Committee on Veterans' Affairs, to which was referred a
bill (S. 1810) to clarify and improve veterans' claims and
appellate procedures, having considered the same, reports
favorably thereon and recommends that the bill, as amended, do
pass.
Committee Bill
The amendments are as follows:
Strike out all after the enacting clause and insert in lieu
thereof the following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans Programs
Enhancement Act of 2000''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I--BENEFITS MATTERS
Subtitle A--Compensation and Pension Matters
Sec. 101. Clarification and enhancement of authorities relating to the
processing of claims for veterans benefits.
Sec. 102. Expansion of list of diseases presumed to be service-
connected for radiation-exposed veterans.
Sec. 103. Special monthly compensation for female veterans who lose a
breast as a result of a service-connected disability.
Subtitle B--Education Matters
Sec. 111. Making uniform the requirement for high school diploma or
equivalency before application for Montgomery GI Bill benefits.
Sec. 112. Repeal of requirement for initial obligated period of active
duty as condition of eligibility for Montgomery GI Bill benefits.
Sec. 113. Availability under survivors' and dependents' educational
assistance of preparatory courses for college and graduate school
entrance exams.
Sec. 114. Election of certain recipients of commencement of period of
eligibility for survivors' and dependents' educational assistance.
Sec. 115. Adjusted effective date for award of survivors' and
dependents' educational assistance.
Subtitle C--Housing Matters
Sec. 121. Elimination of reduction in assistance for specially adapted
housing for disabled veterans for veterans having joint ownership of
housing units.
Sec. 122. Increase in maximum amount of housing loan guarantee.
Sec. 123. Termination of collection of loan fees from veterans rated
eligible for compensation at pre-discharge rating examinations.
Subtitle D--Insurance Matters
Sec. 131. Premiums for term service disabled veterans' insurance for
veterans older than age 70.
Sec. 132. Increase in automatic maximum coverage under Servicemembers'
Group Life Insurance and Veterans' Group Life Insurance.
Sec. 133. Family coverage under Servicemembers' Group Life Insurance.
Subtitle E--Burial Matters
Sec. 141. Eligibility for interment in the national cemeteries of
certain Filipino veterans of World War II.
Subtitle F--Employment Matters
Sec. 151. Veterans employment emphasis under Federal contracts for
recently separated veterans.
Sec. 152. Comptroller General audit of veterans employment and training
service of the Department of Labor.
Subtitle G--Benefits for Children of Female Vietnam Veterans
Sec. 161. Short title.
Sec. 162. Benefits for the children of female Vietnam veterans who
suffer from certain birth defects.
Subtitle H--Other Benefits Matters
Sec. 171. Review of dose reconstruction program of the Defense Threat
Reduction Agency.
TITLE II--HEALTH CARE MATTERS
Sec. 201. Veterans not subject to copayments for medications.
Sec. 202. Establishment of position of Advisor on Physician Assistants
within Office of Undersecretary for Health.
Sec. 203. Temporary full-time appointments of certain medical
personnel.
TITLE III--CONSTRUCTION AND FACILITIES MATTERS
Subtitle A--Construction Matters
Sec. 301. Authorization of major medical facility projects for fiscal
year 2001.
Sec. 302. Authorization of additional major medical facility project
for fiscal year 2000.
Sec. 303. Authorization of appropriations.
Subtitle B--Other Matters
Sec. 311. Maximum term of lease of Department of Veterans Affairs
property for homeless purposes.
Sec. 312. Land conveyance, Miles City Veterans Administration Medical
Complex, Miles City, Montana.
Sec. 313. Conveyance of Ft. Lyon Department of Veterans Affairs Medical
Center, Colorado, to the State of Colorado.
Sec. 314. Effect of closure of Ft. Lyon Department of Veterans Affairs
Medical Center on administration of health care for veterans.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this Act an
amendment or repeal is expressed in terms of an amendment to, or repeal
of, a section or other provision, the reference shall be considered to
be made to a section or other provision of title 38, United States
Code.
TITLE I--BENEFITS MATTERS
Subtitle A--Compensation and Pension Matters
SEC. 101. CLARIFICATION AND ENHANCEMENT OF AUTHORITIES RELATING TO THE
PROCESSING OF CLAIMS FOR VETERANS BENEFITS.
(a) Definition of Claimant.--Chapter 51 is amended--
(1) by redesignating section 5101 as section 5101A; and
(2) by inserting before section 5101A, as so redesignated,
the following new section:
``Sec. 5101. Definition of `claimant'
``For purposes of this chapter, the term `claimant' means any
individual who submits a claim for benefits under the laws administered
by the Secretary.''.
(b) Incomplete Applications.--Section 5103(a) is amended by
striking ``evidence'' both places it appears and inserting
``information''.
(c) Reaffirmation and Clarification of Duty to Assist.--Chapter 51
is further amended by inserting after section 5103 the following new
section:
``Sec. 5103A. Assistance to claimants
``(a) Except as provided in subsection (b), the Secretary shall
make reasonable efforts to assist in the development of information and
medical or lay evidence necessary to establish the eligibility of a
claimant for benefits under the laws administered by the Secretary.
``(b) The Secretary is not required to provide assistance to a
claimant under subsection (a) if no reasonable possibility exists, as
determined in accordance with regulations prescribed under subsection
(f), that such assistance would aid in the establishment of the
eligibility of the claimant for benefits under the laws administered by
the Secretary.
``(c) In any claim for benefits under the laws administered by the
Secretary, the assistance provided by the Secretary under subsection
(a) shall include the following:
``(1) Informing the claimant and the claimant's
representative, if any, of the information and medical or lay
evidence needed in order to aid in the establishment of the
eligibility of the claimant for benefits under the laws
administered by the Secretary.
``(2) Informing the claimant and the claimant's
representative, if any, if the Secretary is unable to obtain
any information or medical or lay evidence described in
paragraph (1).
``(d)(1) In any claim for disability compensation under chapter 11
of this title, the assistance provided by the Secretary under
subsection (a) shall include, in addition to the assistance provided
under subsection (c), the following:
``(A) Obtaining the relevant service and medical records
maintained by applicable governmental entities that pertain to
the veteran for the period or periods of the veteran's service
in the active military, naval, or air service.
``(B) Obtaining existing records of relevant medical
treatment or examination provided at Department health-care
facilities or at the expense of the Department, but only if the
claimant has furnished information sufficient to locate such
records.
``(C) Obtaining from governmental entities any other relevant
records the claimant adequately identifies and authorizes the
Secretary to obtain.
``(D) Making reasonable efforts to obtain from private
persons and entities any other relevant records the claimant
adequately identifies and authorizes the Secretary to obtain.
``(E) Providing a medical examination needed for the purpose
of determining the existence of a current disability if the
claimant submits verifiable evidence, as determined in
accordance with the regulations prescribed under subsection
(f), establishing that the claimant is unable to afford medical
treatment.
``(F) Providing such other assistance as the Secretary
considers appropriate.
``(2) The efforts made to obtain records under subparagraphs (A),
(B), and (C) of paragraph (1) shall continue until it is reasonably
certain, as determined in accordance with the regulations prescribed
under subsection (f), that such records do not exist.
``(e) If while obtaining or after obtaining information or lay or
medical evidence under subsection (d) the Secretary determines that a
medical examination or a medical opinion is necessary to substantiate
entitlement to a benefit, the Secretary shall provide such medical
examination or obtain such medical opinion.
``(f) The Secretary shall prescribe regulations for purposes of the
administration of this section.''.
(d) Cost of Other Agencies in Furnishing Information.--Section 5106
is amended by adding at the end the following new sentence: ``The cost
of providing such information shall be borne by the department or
agency providing such information.''.
(e) Repeal of ``Well-Grounded Claim'' Rule.--Section 5107 is
amended to read as follows:
``Sec. 5107. Burden of proof; benefit of the doubt
``(a) Except when otherwise provided by this title or by the
Secretary in accordance with the provisions of this title, a claimant
shall have the burden of proof in establishing entitlement to benefits
under the laws administered by the Secretary.
``(b) The Secretary shall consider all information and lay and
medical evidence of record in a case before the Department with respect
to benefits under laws administered by the Secretary, and shall give
the claimant the benefit of the doubt when there is an approximate
balance of positive and negative evidence regarding an issue material
to the determination of the matter.''.
(f) Applicability of Enhanced Authorities.--(1) Except as
specifically provided otherwise, section 5103A of title 38, United
States Code (as added by subsection (c)), and section 5107 of title 38,
United States Code (as amended by subsection (e)), shall apply to any
claim pending on or filed on or after the date of the enactment of this
Act.
(2)(A) In the case of a claim for benefits described in
subparagraph (B), the Secretary of Veterans Affairs shall, upon the
request of the claimant, or upon the Secretary's motion, order such
claim readjudicated in accordance with section 5103A of title 38,
United States Code (as so added), and section 5107 of title 38, United
States Code (as so amended), as if the denial or dismissal of such
claim as described in that subparagraph had not been made.
(B) A claim for benefits described in this subparagraph is any
claim for benefits--
(i) the denial of which became final during the period
beginning on July 14, 1999, and ending on the date of the
enactment of this Act; and
(ii) which was denied or dismissed because the claim was not
well grounded (as that term was used in section 5107(a) of
title 38, United States Code, during the period referred to in
clause (i)).
(3) No claim shall be readjudicated under paragraph (2) unless the
request for readjudication is filed, or the motion made, not later than
two years after the date of the enactment of this Act.
(4) In the absence of a timely request of a claimant under
paragraph (3), nothing in this subsection shall be construed as
establishing a duty on the part of the Secretary to locate and
readjudicate a claim described in paragraph (2)(B).
(g) Clerical Amendments.--The table of sections at the beginning of
chapter 51 is amended--
(1) by striking the item relating to section 5101 and
inserting the following new items:
``5101. Definition of `claimant'.
``5101A. Claims and forms.''; and
(2) by inserting after the item relating to section 5103 the
following new item:
``5103A. Assistance to claimants.''.
SEC. 102. EXPANSION OF LIST OF DISEASES PRESUMED TO BE SERVICE-
CONNECTED FOR RADIATION-EXPOSED VETERANS.
Section 1112(c)(2) is amended by adding at the end the following:
``(P) Lung cancer.
``(Q) Colon cancer.
``(R) Tumors of the brain and central nervous system.
``(S) Ovarian cancer.''.
SEC. 103. SPECIAL MONTHLY COMPENSATION FOR FEMALE VETERANS WHO LOSE A
BREAST AS A RESULT OF A SERVICE-CONNECTED
DISABILITY.
(a) In General.--Section 1114(k) is amended--
(1) by striking ``or has suffered'' and inserting ``has
suffered''; and
(2) by inserting after ``air and bone conduction,'' the
following: ``or, in the case of a female veteran, has suffered
the anatomical loss of one or both breasts (including loss by
mastectomy),''.
(b) Effective Date.--(1) The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act, and shall
apply with respect to payment of compensation under section 1114(k) of
title 38, United States Code (as so amended), for months beginning on
or after that date.
(2) No compensation may be paid for any period before the date of
the enactment of this Act by reason of the amendments made by
subsection (a).
Subtitle B--Education Matters
SEC. 111. MAKING UNIFORM THE REQUIREMENT FOR HIGH SCHOOL DIPLOMA OR
EQUIVALENCY BEFORE APPLICATION FOR MONTGOMERY GI
BILL BENEFITS.
(a) Active Duty Program.--(1) Section 3011 is amended--
(A) in subsection (a), by striking paragraph (2) and
inserting the following new paragraph (2):
``(2) who completes the requirements of a secondary school
diploma (or equivalency certificate), or successfully completes
(or otherwise receives academic credit for) the equivalent of
12 semester hours in a program of education leading to a
standard college degree, before applying for benefits under
this section; and'';
(B) by striking subsection (e); and
(C) by redesignating subsections (f), (g), (h), and (i) as
subsections (e), (f), (g), and (h), respectively.
(2) Section 3017(a)(1)(A)(ii) is amended by striking ``clause
(2)(A)'' and inserting ``clause (2)''.
(b) Selected Reserve Program.--Section 3012 is amended--
(1) in subsection (a), by striking paragraph (2) and
inserting the following new paragraph (2):
``(2) who completes the requirements of a secondary school
diploma (or equivalency certificate), or successfully completes
(or otherwise receives academic credit for) the equivalent of
12 semester hours in a program of education leading to a
standard college degree, before applying for benefits under
this section; and'';
(2) by striking subsection (f); and
(3) by redesignating subsection (g) as subsection (f).
(c) Withdrawal of Election Not To Enroll.--Section 3018(b)(4) is
amended to read as follows:
``(4) before applying for benefits under this section--
``(A) completes the requirements of a secondary
school diploma (or equivalency certificate); or
``(B) successfully completes (or otherwise receives
academic credit for) the equivalent of 12 semester
hours in a program of education leading to a standard
college degree; and''.
(d) Educational Assistance Program for Members of the Selected
Reserve.--Paragraph (2) of section 16132(a) of title 10, United States
Code, is amended to read as follows:
``(2) before applying for benefits under this section, has
completed the requirements of a secondary school diploma (or an
equivalency certificate);''.
SEC. 112. REPEAL OF REQUIREMENT FOR INITIAL OBLIGATED PERIOD OF ACTIVE
DUTY AS CONDITION OF ELIGIBILITY FOR MONTGOMERY GI
BILL BENEFITS.
(a) Active Duty Program.--Section 3011, as amended by section 111
of this Act, is further amended--
(1) in subsection (a)(1)(A)--
(A) by striking clause (i) and inserting the
following new clause (i):
``(i) who serves an obligated period of
active duty of at least two years of continuous
active duty in the Armed Forces; or''; and
(B) in clause (ii)(II), by striking ``in the case of
an individual who completed not less than 20 months''
and all that follows through ``was at least three
years'' and inserting ``if, in the case of an
individual with an obligated period of service of two
years, the individual completes not less than 20 months
of continuous active duty under that period of
obligated service, or, in the case of an individual
with an obligated period of service of three years, the
individual completes not less than 30 months of
continuous active duty under that period of obligated
service'';
(2) in subsection (d)(1), by striking ``individual's initial
obligated period of active duty'' and inserting ``obligated
period of active duty on which an individual's entitlement to
assistance under this section is based'';
(3) in subsection (g)(2)(A), as redesignated by section
111(a)(1)(C) of this Act, by striking ``during an initial
period of active duty,'' and inserting ``during the obligated
period of active duty on which entitlement to assistance under
this section is based,''; and
(4) in subsection (h), as so redesignated, by striking
``initial''.
(b) Selected Reserve Program.--Section 3012 is amended--
(1) in subsection (a)(1)(A)(i), by striking ``, as the
individual's'' and all that follows through ``Armed Forces''
and inserting ``an obligated period of active duty of at least
two years of continuous active duty in the Armed Forces''; and
(2) in subsection (e)(1), by striking ``initial''.
(c) Duration of Assistance.--Section 3013 is amended--
(1) in subsection (a)(2), by striking ``individual's initial
obligated period of active duty'' and inserting ``obligated
period of active duty on which such entitlement is based''; and
(2) in subsection (b)(1), by striking ``individual's initial
obligated period of active duty'' and inserting ``obligated
period of active duty on which such entitlement is based''.
(d) Amount of Assistance.--Section 3015 is amended--
(1) in the second sentence of subsection (a), by inserting
before ``a basic educational assistance allowance'' the
following: ``in the case of an individual entitled to an
educational assistance allowance under this chapter whose
obligated period of active duty on which such entitlement is
based is three years,'';
(2) in subsection (b), by striking ``and whose initial
obligated period of active duty is two years,'' and inserting
``whose obligated period of active duty on which such
entitlement is based is two years,''; and
(3) in subsection (c)(2), by striking subparagraphs (A) and
(B) and inserting the following new subparagraphs (A) and (B):
``(A) whose obligated period of active duty on which
such entitlement is based is less than three years;
``(B) who, beginning on the date of the commencement
of such obligated period of active duty, serves a
continuous period of active duty of not less than three
years; and''.
SEC. 113. AVAILABILITY UNDER SURVIVORS' AND DEPENDENTS' EDUCATIONAL
ASSISTANCE OF PREPARATORY COURSES FOR COLLEGE AND
GRADUATE SCHOOL ENTRANCE EXAMS.
Paragraph (5) of section 3501(a) is amended by adding at the end
the following new sentence: ``The term also includes any preparatory
course described in section 3002(3)(B) of this title.''.
SEC. 114. ELECTION OF CERTAIN RECIPIENTS OF COMMENCEMENT OF PERIOD OF
ELIGIBILITY FOR SURVIVORS' AND DEPENDENTS'
EDUCATIONAL ASSISTANCE.
Section 3512(a)(3) is amended by striking ``8 years after,'' and
all that follows through the end and inserting ``8 years after the date
elected by the person (if such election is approved as the beginning
date of such period by the Secretary and is made during the period
between such birthdays) which beginning date--
``(A) in the case of a person whose eligibility is based on a
parent who has a service-connected total disability permanent
in nature, shall be between the dates described in subsection
(d) of this section; and
``(B) in the case of a person whose eligibility is based on
the death of a parent, shall be between--
``(i) the date of the parent's death; and
``(ii) the date of the Secretary's decision that the
death was service-connected;''.
SEC. 115. ADJUSTED EFFECTIVE DATE FOR AWARD OF SURVIVORS' AND
DEPENDENTS' EDUCATIONAL ASSISTANCE.
(a) In General.--Section 5113 is amended--
(1) in subsection (a), by striking ``subsection (b) of this
section,'' and inserting ``subsections (b) and (c),'';
(2) by redesignating subsection (b) as subsection (c); and
(3) by inserting after subsection (a) the following new
subsection (b):
``(b)(1) In determining the effective date of an award of
educational assistance under chapter 35 of this title for an individual
described in paragraph (2) based on an original claim, the Secretary
shall consider the individual's application under section 3513 of this
title as having been filed on the effective date from which the
Secretary, by rating decision, determines that the veteran from whom
eligibility for such educational assistance is derived either died of a
service-connected disability or established the existence of a total
service-connected disability evaluated as permanent in nature if that
effective date is more than one year before the date the rating
decision is made.
``(2) An individual referred to in paragraph (1) is a person
eligible for educational assistance under chapter 35 of this title by
reason of subparagraph (A)(i), (A)(ii), (B), or (D) of section
3501(a)(1) of this title who--
``(A) submits to the Secretary an original application under
section 3513 of this title for educational assistance under
that chapter within one year after the date that the Secretary
issues the rating decision on which the individual's
eligibility for such educational assistance is based;
``(B) claims such educational assistance for pursuit of an
approved program of education during a period or periods
preceding the one-year period ending on the date on which the
individual's application under that section is received by the
Secretary; and
``(C) would, without regard to this subsection, have been
entitled to such educational assistance for pursuit of such
approved program of education if the individual had submitted
such application on the effective date from which the Secretary
determined that the individual was eligible for such
educational assistance.''.
(b) Stylistic Amendment.--Subsection (c) of that section, as
redesignated by subsection (a)(2) of this section, is amended by
striking ``of this section''.
(c) Applicability.--The amendments made by this section shall take
effect on the date of the enactment of this Act, and shall apply with
respect to applications first made under section 3513 of title 38,
United States Code, that--
(1) are received by the Secretary of Veterans Affairs on or
after the date of the enactment of this Act; or
(2) as of that date are pending with the Secretary or
exhaustion of available administrative and judicial remedies.
Subtitle C--Housing Matters
SEC. 121. ELIMINATION OF REDUCTION IN ASSISTANCE FOR SPECIALLY ADAPTED
HOUSING FOR DISABLED VETERANS FOR VETERANS HAVING
JOINT OWNERSHIP OF HOUSING UNITS.
Section 2102 is amended by adding at the end the following new
subsection:
``(c) The amount of assistance afforded under subsection (a) for a
veteran authorized assistance by section 2101(a) of this title shall
not be reduced by reason that title to the housing unit, which is
vested in the veteran, is also vested in any other person, if the
veteran resides in the housing unit.''.
SEC. 122. INCREASE IN MAXIMUM AMOUNT OF HOUSING LOAN GUARANTEE.
(a) In General.--Subparagraph (A)(i)(IV) of section 3703(a)(1) is
amended by striking ``$50,750'' and inserting ``$63,175''.
(b) Conforming Amendment.--Subparagraph (B) of that section is
amended by striking ``$50,750'' and inserting ``$63,175''.
SEC. 123. TERMINATION OF COLLECTION OF LOAN FEES FROM VETERANS RATED
ELIGIBLE FOR COMPENSATION AT PRE-DISCHARGE RATING
EXAMINATIONS.
Section 3729(c) is amended--
(1) by inserting ``(1)'' before ``A fee''; and
(2) by adding at the end the following new paragraph:
``(2) A veteran who is rated eligible to receive compensation as a
result of a pre-discharge disability examination and rating shall be
treated as receiving compensation for purposes of this subsection as of
the date on which the veteran is rated eligible to receive compensation
as a result of the pre-discharge disability examination and rating
without regard to whether an effective date of the award of
compensation is established as of that date.''.
Subtitle D--Insurance Matters
SEC. 131. PREMIUMS FOR TERM SERVICE DISABLED VETERANS' INSURANCE FOR
VETERANS OLDER THAN AGE 70.
Section 1922 is amended by adding at the end the following new
subsection:
``(c) The premium rate of any term insurance issued under this
section shall not exceed the renewal age 70 premium rate.''.
SEC. 132. INCREASE IN AUTOMATIC MAXIMUM COVERAGE UNDER SERVICEMEMBERS'
GROUP LIFE INSURANCE AND VETERANS' GROUP LIFE
INSURANCE.
(a) Maximum Under Servicemembers' Group Life Insurance.--Section
1967 is amended in subsections (a), (c), and (d) by striking
``$200,000'' each place it appears and inserting ``$250,000''.
(b) Maximum Under Veterans' Group Life Insurance.--Section 1977(a)
is amended by striking ``$200,000'' each place it appears and inserting
``$250,000''.
(c) Effective Date.--The amendments made by this section shall take
effect on the first day of the first month that begins more than 120
days after the date of the enactment of this Act.
SEC. 133. FAMILY COVERAGE UNDER SERVICEMEMBERS' GROUP LIFE INSURANCE.
(a) Insurable Dependents.--Section 1965 is amended by adding at the
end the following:
``(10) The term `insurable dependent', with respect to a
member, means the following:
``(A) The member's spouse.
``(B) A child of the member for so long as the child
is unmarried and the member is providing over 50
percent of the support of the child.''.
(b) Insurance Coverage.--(1) Subchapter III of chapter 19 is
amended by inserting after section 1967 the following new section:
``Sec. 1967A. Insurance of dependents
``(a) Subject to the provisions of this section, any policy of
insurance purchased by the Secretary under section 1966 of this title
shall also automatically insure against death each insurable dependent
of a member.
``(b)(1) A member insurable under this subchapter may make an
election not to insure a spouse under this subchapter.
``(2) Except as provided in subsection (c)(3), a spouse covered by
an election under paragraph (1) is not insured under this section.
``(3) Except as otherwise provided under this section, no insurable
dependent of a member is insured under this section unless the member
is insured under this subchapter.
``(c)(1) Subject to an election under paragraph (2), the amount for
which a person insured under this section is insured under this
subchapter is as follows:
``(A) In the case of a member's spouse, the lesser of--
``(i) the amount for which the member is insured
under this subchapter; or
``(ii) $50,000.
``(B) In the case of a member's child, $5,000.
``(2) A member may elect in writing to insure the member's spouse
in an amount less than the amount provided for under paragraph (1)(A).
The amount of insurance so elected shall be evenly divisible by
$10,000.
``(3) If a spouse eligible for insurance under this section is not
so insured, or is insured for less than the maximum amount provided for
under subparagraph (A) of paragraph (1) by reason of an election made
by the member concerned under paragraph (2), the spouse may thereafter
be insured under this section in the maximum amount or any lesser
amount elected as provided for in paragraph (2) upon written
application by the member, proof of good health of the spouse, and
compliance with such other terms and conditions as may be prescribed by
the Secretary.
``(d)(1) Insurance coverage under this section with respect to an
insurable dependent of the member shall cease--
``(A) upon election made in writing by the member to
terminate the coverage; or
``(B) the date that is 120 days after the earlier of--
``(i) the date of the member's death;
``(ii) the date of termination of the insurance on
the member under this subchapter; or
``(iii) the date on which the insurable dependent of
the member no longer meets the criteria applicable to
an insurable dependent as specified in section 1965(10)
of this title.
``(2)(A) At the election of an insured spouse whose insurance under
this subchapter is terminated under paragraph (1), the insurance shall
be converted to an individual policy of insurance upon written
application for conversion made to the participating company selected
by the insured spouse and the payment of the required premiums.
``(B) The individual policy of insurance of an insured spouse
making an election under subparagraph (A) shall become effective on the
date of the termination of the spouse's insurance under paragraph (1).
``(C) The second, fourth, and fifth sentences of section 1977(e) of
this title shall apply with respect to the insurance of an insured
spouse under this paragraph.
``(e)(1) During any period in which the spouse of a member is
insured under this section, there shall be deducted each month from the
member's basic or other pay, or otherwise collected from the member,
until the member's separation or release from active duty an amount
determined by the Secretary (which shall be the same for all such
members) as the premium allocable to the pay period for providing that
insurance coverage.
``(2)(A) The Secretary shall determine the premium amounts to be
charged for insurance coverage for spouses of members under this
section.
``(B) The premium amounts shall be determined on the basis of sound
actuarial principles and shall include an amount necessary to cover the
administrative costs to the insurer or insurers providing such
insurance.
``(C) Each premium rate for the first policy year shall be
continued for subsequent policy years, except that the rate may be
adjusted for any such subsequent policy year on the basis of the
experience under the policy, as determined by the Secretary in advance
of that policy year.
``(3) Any amounts deducted or collected under paragraph (1),
together with the income derived from any dividends or premium rate
adjustments received from insurers with respect to insurance under this
section, shall be deposited to the credit of the revolving fund
established by section 1969(d) of this title, and shall be available
for payment and use in accordance with the provisions of that section.
``(f) Any amount of insurance in force on an insurable dependent of
a member under this section on the date of the dependent's death shall
be paid, upon the establishment of a valid claim therefor, to the
member or, in the event of the member's death before payment to the
member can be made, then to the person or persons entitled to receive
payment of the proceeds of insurance on the member' life under section
1970 of this title.''.
(2) The table of sections at the beginning of such chapter is
amended by inserting after the item relating to section 1967 the
following new item:
``1967A. Insurance of dependents.''.
(c) Effective Date and Initial Implementation.--(1) This section
and the amendments made by this section shall take effect on the first
day of the first month that begins more than 120 days after the date of
the enactment of this Act, except that paragraph (2) shall take effect
on the date of the enactment of this Act.
(2) The Secretary of Veterans Affairs, in consultation with the
Secretaries of the military departments, the Secretary of
Transportation, the Secretary of Commerce, and the Secretary of Health
and Human Services, shall take such action as is necessary to ensure
that each member of the uniformed services on active duty (other than
active duty for training) during the period between the date of the
enactment of this Act and the effective date under paragraph (1) is
furnished an explanation of the insurance benefits available for
dependents under the amendments made by this section and is afforded an
opportunity before such effective date to make elections that are
authorized under those amendments to be made with respect to
dependents.
Subtitle E--Burial Matters
SEC. 141. ELIGIBILITY FOR INTERMENT IN THE NATIONAL CEMETERIES OF
CERTAIN FILIPINO VETERANS OF WORLD WAR II.
(a) Eligibility of Certain Commonwealth Army Veterans.--Section
2402 is amended by adding at the end the following new paragraph:
``(8) Any individual whose service is described in section
107(a) of this title if such individual at the time of death--
``(A) was a naturalized citizen of the United States;
and
``(B) resided in the United States.''.
(b) Conforming Amendment.--Section 107(a)(3) is amended by striking
the period at the end and inserting the following: ``, and chapter 24
of this title to the extent provided for in section 2402(8) of this
title.''.
(c) Applicability.--The amendments made by this section shall take
effect on the date of the enactment of this Act, and shall apply with
respect to deaths occurring on or after that date.
Subtitle F--Employment Matters
SEC. 151. VETERANS EMPLOYMENT EMPHASIS UNDER FEDERAL CONTRACTS FOR
RECENTLY SEPARATED VETERANS.
(a) Employment Emphasis.--Subsection (a) of section 4212 is amended
in the first sentence by inserting ``recently separated veterans,''
after ``veterans of the Vietnam era,''.
(b) Conforming Amendments.--Subsection (d)(1) of that section is
amended by inserting ``recently separated veterans,'' after ``veterans
of the Vietnam era,'' each place it appears in subparagraphs (A) and
(B).
(c) Recently Separated Veteran Defined.--Section 4211 is amended by
adding at the end the following new paragraph:
``(6) The term `recently separated veteran' means any veteran
during the one-year period beginning on the date of such veteran's
discharge or release from active duty.''.
SEC. 152. COMPTROLLER GENERAL AUDIT OF VETERANS EMPLOYMENT AND TRAINING
SERVICE OF THE DEPARTMENT OF LABOR.
(a) Requirement.--The Comptroller General of the United States
shall carry out a comprehensive audit of the Veterans Employment and
Training Service of the Department of Labor. The purpose of the audit
is to provide a basis for future evaluations of the effectiveness of
the Service is meeting its mission.
(b) Commencement Date.--The audit required by subsection (a) shall
commence not earlier than January 1, 2001.
(c) Elements.--In carrying out the audit of the Veterans Employment
and Training Service required by subsection (a), the Comptroller
General shall--
(1) review the requirements applicable to the Service under
law, including requirements under title 38, United States Code,
and the regulations thereunder;
(2) evaluate the organizational structure of the Service; and
(3) evaluate or assess any other matter relating to the
Service that the Comptroller General considers appropriate for
the purpose specified in subsection (a).
(d) Report.--Not later than one year after the date of the
enactment of this Act, the Comptroller General shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the audit carried out under subsection (a).
The report shall include--
(1) the results of the audit; and
(2) any recommendations that the Comptroller General
considers appropriate regarding the organization or functions
of the Veterans Employment and Training Service of the
Department of Labor.
Subtitle G--Benefits for Children of Female Vietnam Veterans
SEC. 161. SHORT TITLE.
This subtitle may be cited as the ``Children of Women Vietnam
Veterans' Benefits Act of 2000''.
SEC. 162. BENEFITS FOR THE CHILDREN OF FEMALE VIETNAM VETERANS WHO
SUFFER FROM CERTAIN BIRTH DEFECTS.
(a) In General.--Chapter 18 is amended by adding at the end the
following new subchapter:
``SUBCHAPTER II--CHILDREN OF FEMALE VIETNAM VETERANS BORN WITH CERTAIN
BIRTH DEFECTS
``Sec. 1811. Definitions
``In this subchapter:
``(1) The term `child', with respect to a female Vietnam
veteran, means a natural child of the female Vietnam veteran,
regardless of age or marital status, who was conceived after
the date on which the female Vietnam veteran first entered the
Republic of Vietnam during the Vietnam era (as specified in
section 101(29)(A) of this title).
``(2) The term `covered birth defect' means each birth defect
identified by the Secretary under section 1812 of this title.
``(3) The term `female Vietnam veteran' means any female
individual who performed active military, naval, or air service
in the Republic of Vietnam during the Vietnam era (as so
specified), without regard to the characterization of the
individual's service.
``Sec. 1812. Birth defects covered
``(a) Identification.--Subject to subsection (b), the Secretary
shall identify the birth defects of children of female Vietnam veterans
that--
``(1) are associated with the service of female Vietnam
veterans in the Republic of Vietnam during the Vietnam era (as
specified in section 101(29)(A) of this title); and
``(2) result in the permanent physical or mental disability
of such children.
``(b) Limitations.--(1) The birth defects identified under
subsection (a) may not include birth defects resulting from the
following:
``(A) A familial disorder.
``(B) A birth-related injury.
``(C) A fetal or neonatal infirmity with well-established
causes.
``(2) The birth defects identified under subsection (a) may not
include spina bifida.
``(c) List.--The Secretary shall prescribe in regulations a list of
the birth defects identified under subsection (a).
``Sec. 1813. Benefits and assistance
``(a) Health Care.--(1) The Secretary shall provide a child of a
female Vietnam veteran who was born with a covered birth defect such
health care as the Secretary determines is needed by the child for such
birth defect or any disability that is associated with such birth
defect.
``(2) The Secretary may provide health care under this subsection
directly or by contract or other arrangement with a health care
provider.
``(3) For purposes of this subsection, the definitions in section
1803(c) of this title shall apply with respect to the provision of
health care under this subsection, except that for such purposes--
``(A) the reference to `specialized spina bifida clinic' in
paragraph (2) of such section 1803(c) shall be treated as a
reference to a specialized clinic treating the birth defect
concerned under this subsection; and
``(B) the reference to `vocational training under section
1804 of this title' in paragraph (8) of such section 1803(c)
shall be treated as a reference to vocational training under
subsection (b).
``(b) Vocational Training.--(1) The Secretary may provide a program
of vocational training to a child of a female Vietnam veteran who was
born with a covered birth defect if the Secretary determines that the
achievement of a vocational goal by the child is reasonably feasible.
``(2) Subsections (b) through (e) of section 1804 of this title
shall apply with respect to any program of vocational training provided
under paragraph (1).
``(c) Monetary Allowance.--(1) The Secretary shall pay a monthly
allowance to any child of a female Vietnam veteran who was born with a
covered birth defect for any disability resulting from such birth
defect.
``(2) The amount of the monthly allowance paid under this
subsection shall be based on the degree of disability suffered by the
child concerned, as determined in accordance with a schedule for rating
disabilities resulting from covered birth defects that is prescribed by
the Secretary.
``(3) In prescribing a schedule for rating disabilities under
paragraph (2), the Secretary shall establish four levels of disability
upon which the amount of the monthly allowance under this subsection
shall be based.
``(4) The amount of the monthly allowance paid under this
subsection shall be as follows:
``(A) In the case of a child suffering from the lowest level
of disability prescribed in the schedule for rating
disabilities under this subsection, $100.
``(B) In the case of a child suffering from the lower
intermediate level of disability prescribed in the schedule for
rating disabilities under this subsection, the greater of--
``(i) $214; or
``(ii) the monthly amount payable under section
1805(b)(3) of this title for the lowest level of
disability prescribed for purposes of that section.
``(C) In the case of a child suffering from the higher
intermediate level of disability prescribed in the schedule for
rating disabilities under this subsection, the greater of--
``(i) $743; or
``(ii) the monthly amount payable under section
1805(b)(3) of this title for the intermediate level of
disability prescribed for purposes of that section.
``(D) In the case of a child suffering from the highest level
of disability prescribed in the schedule for rating
disabilities under this subsection, the greater of--
``(i) $1,272; or
``(ii) the monthly amount payable under section
1805(b)(3) of this title for the highest level of
disability prescribed for purposes of that section.
``(5) Amounts under subparagraphs (A), (B)(i), (C)(i), and (D)(i)
of paragraph (4) shall be subject to adjustment from time to time under
section 5312 of this title.
``(6) Subsections (c) and (d) of section 1805 of this title shall
apply with respect to any monthly allowance paid under this subsection.
``(d) General Limitations on Availability of Benefits and
Assistance.--(1) No individual receiving benefits or assistance under
this section may receive any benefits or assistance under subchapter I
of this chapter.
``(2) In any case where affirmative evidence establishes that the
covered birth defect of a child results from a cause other than the
active military, naval, or air service in the Republic of Vietnam of
the female Vietnam veteran who is the mother of the child, no benefits
or assistance may be provided the child under this section.
``(e) Regulations.--The Secretary shall prescribe regulations for
purposes of the administration of the provisions of this section.''.
(b) Administrative Provisions.--Chapter 18 is further amended by
inserting after subchapter II, as added by subsection (a) of this
section, the following new subchapter:
``SUBCHAPTER III--ADMINISTRATIVE MATTERS
``Sec. 1821. Applicability of certain administrative provisions
``The provisions of sections 5101(c), 5110(a), (b)(2), (g), and
(i), 5111, and 5112(a), (b)(1), (b)(6), (b)(9), and (b)(10) of this
title shall apply with respect to benefits and assistance under this
chapter in the same manner as such provisions apply to veterans'
disability compensation.
``Sec. 1822. Treatment of receipt of monetary allowance on other
benefits
``(a) Notwithstanding any other provision of law, receipt by an
individual of a monetary allowance under this chapter shall not impair,
infringe, or otherwise affect the right of the individual to receive
any other benefit to which the individual is otherwise entitled under
any law administered by the Secretary.
``(b) Notwithstanding any other provision of law, receipt by an
individual of a monetary allowance under this chapter shall not impair,
infringe, or otherwise affect the right of any other individual to
receive any benefit to which such other individual is entitled under
any law administered by the Secretary based on the relationship of such
other individual to the individual who receives such monetary
allowance.
``(c) Notwithstanding any other provision of law, a monetary
allowance paid an individual under this chapter shall not be considered
as income or resources in determining eligibility for or the amount of
benefits under any Federal or Federally-assisted program.''.
(c) Repeal of Superseded Matter.--(1) Subsections (c) and (d) of
section 1805 are repealed.
(2) Section 1806 is repealed.
(d) Redesignation of Existing Matter.--Chapter 18 is further
amended by inserting before section 1801 the following:
``SUBCHAPTER I--CHILDREN OF VIETNAM VETERANS BORN WITH SPINA BIFIDA''.
(e) Conforming Amendments.--(1) Sections 1801 and 1802 are each
amended by striking ``this chapter'' and inserting ``this subchapter''.
(2) Section 1805(a) is amended by striking ``this chapter'' and
inserting ``this section''.
(f) Clerical Amendments.--(1)(A) The chapter heading of chapter 18
is amended to read as follows:
``CHAPTER 18--BENEFITS FOR CHILDREN OF VIETNAM VETERANS''.
(1) The tables of chapters at beginning, and at the beginning of
part II, are each amended by striking the item relating to chapter 18
and inserting the following new item:
``18. Benefits for Children of Vietnam Veterans........... 1801''.
(2) The table of sections at the beginning of chapter 18 is
amended--
(A) by inserting after the chapter heading the following:
``SUBCHAPTER I--CHILDREN OF VIETNAM VETERANS BORN WITH SPINA BIFIDA'';
(B) by striking the item relating to section 1806; and
(C) by adding at the end the following:
``SUBCHAPTER II--CHILDREN OF FEMALE VIETNAM VETERANS BORN WITH CERTAIN
BIRTH DEFECTS
``1811. Definitions.
``1812. Birth defects covered.
``1813. Benefits and assistance.
``SUBCHAPTER III--ADMINISTRATIVE MATTERS
``1821. Applicability of certain administrative provisions.
``1822. Treatment of receipt of monetary allowance on other
benefits.''.
(g) Applicability.--(1) Except as provided in paragraph (2), the
amendments made by this section shall take effect on the first day of
the first month beginning more than one year after the date of the
enactment of this Act.
(2) The Secretary of Veterans Affairs shall identify birth defects
under section 1822 of title 38, United States Code (as added by
subsection (a) of this section), and shall prescribe the regulations
required by subchapter II of that title (as so added), not later than
the effective date specified in paragraph (1).
(3) No benefit or assistance may be provided under subchapter II of
chapter 18 of title 38, United States Code (as so added), for any
period before the effective date specified in paragraph (1) by reason
of the amendments made by this section.
Subtitle H--Other Benefits Matters
SEC. 171. REVIEW OF DOSE RECONSTRUCTION PROGRAM OF THE DEFENSE THREAT
REDUCTION AGENCY.
(a) Review by National Academy of Sciences.--Not later than 30 days
after the date of the enactment of this Act, the Secretary of Defense
shall enter into a contract with the National Academy of Sciences to
carry out periodic reviews of the dose reconstruction program of the
Defense Threat Reduction Agency.
(b) Review Activities.--The periodic reviews of the dose
reconstruction program under the contract under subsection (a) shall
consist of the periodic selection of random samples of doses
reconstructed by the Defense Threat Reduction Agency in order to
determine--
(1) whether or not the reconstruction of the sampled doses is
accurate;
(2) whether or not the reconstructed dosage number is
accurately reported;
(3) whether or not the assumptions made regarding radiation
exposure based upon the sampled doses are credible; and
(4) whether or not the data from nuclear tests used by the
Defense Threat Reduction Agency as part of the reconstruction
of the sampled doses is accurate.
(c) Duration of Review.--The periodic reviews under the contract
under subsection (a) shall occur over a period of 24 months.
(d) Report.--(1) Not later than 60 days after the conclusion of the
period referred to in subsection (c) the National Academy of Sciences
shall submit to Congress a report on its activities under the contract
under this section.
(2) The report shall include the following:
(A) A detailed description of the activities of the National
Academy of Sciences under the contract.
(B) Any recommendations that the National Academy of Sciences
considers appropriate regarding a permanent system of review of
the dose reconstruction program of the Defense Threat Reduction
Agency.
TITLE II--HEALTH CARE MATTERS
SEC. 201. VETERANS NOT SUBJECT TO COPAYMENTS FOR MEDICATIONS.
Subparagraph (B) of section 1722A(a)(3) is amended to read as
follows:
``(B) to a veteran who is considered by the Secretary to be
unable to defray the expenses of necessary care under section
1722 of this title.''.
SEC. 202. ESTABLISHMENT OF POSITION OF ADVISOR ON PHYSICIAN ASSISTANTS
WITHIN OFFICE OF UNDERSECRETARY FOR HEALTH.
(a) Establishment.--Subsection (a) of section 7306 is amended--
(1) by redesignating paragraph (9) as paragraph (10); and
(2) by inserting after paragraph (8) the following new
paragraph (9):
``(9) The Advisor on Physician Assistants, who shall carry
out the responsibilities set forth in subsection (f).''.
(b) Responsibilities.--That section is further amended--
(1) by redesignating subsection (f) as subsection (g); and
(2) by inserting after subsection (e) the following new
subsection (f):
``(f) The Advisor on Physician Assistants under subsection (a)(9)
shall--
``(1) advise the Under Secretary for Health on matters
regarding the optimal utilization of physician assistants by
the Veterans Health Administration;
``(2) advise the Under Secretary for Health on the
feasibility and desirability of establishing clinical
privileges and practice areas for physician assistants in the
Administration;
``(3) develop initiatives to facilitate the utilization of
the full range of clinical capabilities of the physician
assistants employed by the Administration;
``(4) provide advice on policies affecting the employment of
physician assistants by the Administration, including policies
on educational requirements, national certification,
recruitment and retention, staff development, and the
availability of educational assistance (including scholarship,
tuition reimbursement, and loan repayment assistance); and
``(5) carry out such other responsibilities as the Under
Secretary for Health shall specify.''.
SEC. 203. TEMPORARY FULL-TIME APPOINTMENTS OF CERTAIN MEDICAL
PERSONNEL.
(a) Physician Assistants Awaiting Certification or Licensure.--
Paragraph (2) of section 7405(c) is amended--
(1) by striking ``nursing,'' and inserting ``nursing''; and
(2) by inserting ``who have successfully completed a full
course of training as a physician assistant in a recognized
school approved by the Secretary,'' before ``or who''.
(b) Medical Support Personnel.--That section is further amended--
(1) by redesignating paragraph (3) as paragraph (4); and
(2) by inserting after paragraph (2) the following new
paragraph (3):
``(3)(A) Temporary full-time appointments of persons in positions
referred to in subsection (a)(1)(D) shall not exceed three years.
``(B) Temporary full-time appointments under this paragraph may be
renewed for one or more additional periods not in excess of three years
each.''.
TITLE III--CONSTRUCTION AND FACILITIES MATTERS
Subtitle A--Construction Matters
SEC. 301. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS FOR FISCAL
YEAR 2001.
The Secretary of Veterans Affairs may carry out the following major
medical projects, with each project to be carried out in the amount
specified for that project:
(1) Construction of a 120-bed gero-psychiatric facility at
the Department of Veterans Affairs Palo Alto Health Care
System, Menlo Park Division, California, $26,600,000.
(2) Construction of a nursing home at the Department of
Veterans Affairs Medical Center, Beckley, West Virginia,
$9,500,000.
SEC. 302. AUTHORIZATION OF ADDITIONAL MAJOR MEDICAL FACILITY PROJECT
FOR FISCAL YEAR 2000.
Section 401 of the Veterans Millennium Health Care and Benefits Act
(Public Law 106-117; 113 Stat. 1572) is amended by adding at the end
the following:
``(7) Renovation of psychiatric nursing units at the
Department of Veterans Affairs Medical Center, Murfreesboro,
Tennessee, in an amount not to exceed $14,000,000.''.
SEC. 303. AUTHORIZATION OF APPROPRIATIONS.
(a) Authorization of Appropriations for Fiscal Year 2001
Projects.--There are authorized to be appropriated to the Secretary of
Veterans Affairs for fiscal year 2001 and for fiscal year 2002,
$36,100,000 for the Construction, Major Projects, account for the
projects authorized in section 301.
(b) Authorization of Appropriations for Additional Fiscal Year 2000
Project.--Section 403 of the Veterans Millennium Health Care and
Benefits Act (Public Law 106-117; 113 Stat. 1573) is amended--
(1) in subsection (a)(1), by striking ``$57,500,000 for the
projects authorized in paragraphs (1) through (5)'' and
inserting ``$71,500,000 for the projects authorized in
paragraphs (1) through (5) and (7)''; and
(2) in subsection (b), by inserting ``and (7)'' after
``through (5)'' in the matter preceding paragraph (1).
(c) Limitation.--The projects authorized in section 301 may only be
carried out using--
(1) funds appropriated for fiscal year 2001 or fiscal year
2002 pursuant to the authorization of appropriations in
subsection (a);
(2) funds appropriated for Construction, Major Projects for a
fiscal year before fiscal year 2001 that remain available for
obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 2001 for a category of activity not specific to a
project.
Subtitle B--Other Matters
SEC. 311. MAXIMUM TERM OF LEASE OF DEPARTMENT OF VETERANS AFFAIRS
PROPERTY FOR HOMELESS PURPOSES.
Section 3735(a)(4) is amended by striking ``three years'' and
inserting ``20 years''.
SEC. 312. LAND CONVEYANCE, MILES CITY VETERANS ADMINISTRATION MEDICAL
COMPLEX, MILES CITY, MONTANA.
(a) Conveyance Required.--The Secretary of Veterans Affairs shall
convey, without consideration, to Custer County, Montana (in this
section referred to as the ``County''), all right, title, and interest
of the United States in and to the parcels of real property consisting
of the Miles City Veterans Administration Medical Center complex, which
has served as a medical and support complex for the Department of
Veterans Affairs in Miles City, Montana.
(b) Timing of Conveyance.--The conveyance required by subsection
(a) shall be made as soon as practicable after the date of the
enactment of this Act.
(c) Conditions of Conveyance.--The conveyance required by
subsection (a) shall be subject to the condition that the County--
(1) use the parcels conveyed, whether directly or through an
agreement with a public or private entity, for veterans
activities, community and economic development, or such other
public purposes as the County considers appropriate; or
(2) convey the parcels to an appropriate public or private
entity for use for the purposes specified in paragraph (1).
(d) Conveyance of Improvements.--(1) As part of the conveyance
required by subsection (a), the Secretary may also convey to the County
any improvements, equipment, fixtures, and other personal property
located on the parcels conveyed under that subsection that are not
required by the Secretary.
(2) Any conveyance under this subsection shall be without
consideration.
(e) Use Pending Conveyance.--Until such time as the real property
to be conveyed under subsection (a) is conveyed by deed under this
section, the Secretary may continue to lease the real property,
together with any improvements thereon, under the terms and conditions
of the current lease of the real property.
(f) Maintenance Pending Conveyance.--The Secretary shall be
responsible for maintaining the real property to be conveyed under
subsection (a), and any improvements, equipment, fixtures, and other
personal property to be conveyed under subsection (d), in its condition
as of the date of the enactment of this Act until such time as the real
property, and such improvements, equipment, fixtures, and other
personal property are conveyed by deed under this section.
(g) Legal Description.--The exact acreage and legal description of
the real property to be conveyed under subsection (a) shall be
determined by a survey satisfactory to the Secretary.
(h) Additional Terms and Conditions.--The Secretary may require
such additional terms and conditions in connection with the conveyance
under this section as the Secretary determines appropriate to protect
the interests of the United States.
SEC. 313. CONVEYANCE OF FT. LYON DEPARTMENT OF VETERANS AFFAIRS MEDICAL
CENTER, COLORADO, TO THE STATE OF COLORADO.
(a) Conveyance Authorized.--Notwithstanding any other provision of
law and subject to the provisions of this section, the Secretary of
Veterans Affairs may convey, without consideration, to the State of
Colorado all right, title, and interest of the United States in and to
a parcel of real property, including improvements thereon, consisting
of approximately 512 acres and comprising the location of the Ft. Lyon
Department of Veterans Affairs Medical Center. The purpose of the
conveyance is to permit the State of Colorado to utilize the property
for purposes of a correctional facility.
(b) Public Access.--(1) The Secretary may not make the conveyance
of real property authorized by subsection (a) unless the State of
Colorado agrees to provide appropriate public access to Kit Carson
Chapel, which is located on the real property, and the cemetery located
adjacent to the real property.
(2) The State of Colorado may satisfy the condition specified in
paragraph (1) with respect to Kit Carson Chapel by relocating the
chapel to Fort Lyon National Cemetery, Colorado, or another appropriate
location approved by the Secretary.
(c) Plan Regarding Conveyance.--(1) The Secretary may not make the
conveyance authorized by subsection (a) before the date on which the
Secretary implements a plan providing the following:
(A) Notwithstanding sections 1720(a)(3) and 1741 of title 38,
United States Code, that veterans who are receiving inpatient
or institutional long-term care at Ft. Lyon Department of
Veterans Affairs Medical Center as of the date of the enactment
of this Act are provided appropriate inpatient or institutional
long-term care under the same terms and conditions as such
veterans are receiving inpatient or institutional long-term
care as of that date.
(B) That the conveyance of the Ft. Lyon Department of
Veterans Affairs Medical Center does not result in a reduction
of health care services available to veterans in the catchment
area of the Medical Center.
(C) Improvements in veterans' overall access to health care
in the catchment area through, for example, the opening of
additional outpatient clinics.
(2) The Secretary shall prepare the plan referred to in paragraph
(1) in consultation with appropriate representatives of veterans
service organizations and other appropriate organizations.
(3) The Secretary shall publish a copy of the plan referred to in
paragraph (1) before implementation of the plan.
(d) Environmental Restoration.--The Secretary may not make the
conveyance authorized by subsection (a) until the Secretary completes
the evaluation and performance of any environmental restoration
activities required by the Comprehensive Environmental Response,
Compensation, and Liability Act of 1980 (42 U.S.C. 9601 et seq.), and
by any other provision of law.
(e) Personal Property.--As part of the conveyance authorized by
subsection (a), the Secretary may convey, without consideration, to the
State of Colorado any furniture, fixtures, equipment, and other
personal property associated with the property conveyed under that
subsection that the Secretary determines is not required for purposes
of the Department of Veterans Affairs health care facilities to be
established by the Secretary in southern Colorado or for purposes of
Fort Lyon National Cemetery.
(f) Legal Description.--The exact acreage and legal description of
the real property to be conveyed under subsection (a) shall be
determined by a survey satisfactory to the Secretary. Any costs
associated with the survey shall be borne by the State of Colorado.
(g) Additional Terms and Conditions.--The Secretary may require
such other terms and conditions in connection with the conveyances
authorized by subsections (a) and (e) as the Secretary considers
appropriate to protect the interests of the United States.
SEC. 314. EFFECT OF CLOSURE OF FT. LYON DEPARTMENT OF VETERANS AFFAIRS
MEDICAL CENTER ON ADMINISTRATION OF HEALTH CARE FOR
VETERANS.
(a) Payment for Nursing Home Care.--Notwithstanding any limitation
under section 1720 or 1741 of title 38, United States Code, the
Secretary of Veterans Affairs may pay the State of Colorado, or any
private nursing home care facility, for costs incurred in providing
nursing home care to any veteran who is relocated from the Ft. Lyon
Department of Veterans Affairs Medical Center, Colorado, to the State
of Colorado or such private facility, as the case may be, as a result
of the closure of the Ft. Lyon Department of Veterans Affairs Medical
Center.
(b) Obligation to Provide Extended Care Services.--Nothing in
section 313 of this Act or this section may be construed to alter or
otherwise effect the obligation of the Secretary to meet the
requirements of section 1710B(b) of title 38, United States Code,
relating to staffing and levels of extended care services in fiscal
years after fiscal year 1998.
(c) Extension of Voluntary Early Retirement Authority.--
Notwithstanding section 1109(a) of the Department of Veterans Affairs
Employment Reduction Assistance Act of 1999 (title XI of Public Law
106-117; 113 Stat. 1599; 5 U.S.C. 5597 note), the authority to pay
voluntary separation incentive payments under that Act to employees of
the Ft. Lyon Department of Veterans Affairs Medical Center shall apply
to eligible employees (as defined by section 1110 of that Act) at the
Ft. Lyon Department of Veterans Affairs Medical Center whose separation
occurs before June 30, 2001.
(d) Report on Veterans Health Care in Southern Colorado.--Not later
than one year after the conveyance, if any, authorized by section 313,
the Under Secretary for Health of the Department of Veterans Affairs,
acting through the Director of Veterans Integrated Service Network
(VISN) 19, shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report on the status of the
health care system for veterans under the Network in the Southern
Colorado. The report shall describe any improvements to the system in
Southern Colorado that have been put into effect in the period
beginning on the date of the conveyance and ending on the date of the
report.
Amend the title to read as follows: ``A Bill to amend title 38,
United States Code, to expand and improve compensation and pension,
education, housing loan, insurance, and other benefits for veterans,
and for other purposes.''.
Introduction
On October 27, 1999, Committee member Senator Patty Murray
introduced S. 1810, the proposed ``Veterans Claims and Appeals
Procedures Clarification and Improvement Act of 2000.'' S.
1810, as introduced, would have clarified the role of the
Department of Veterans Affairs (hereinafter, ``VA'') in
assisting veterans and other claimants in developing the
factual record pertinent to VA's adjudication of the claim. In
addition, S. 1810, as introduced, would have specified that
procedures for hearings, investigations and other proceedings
in connection with the consideration of claims for VA benefits
shall be exclusive; would have precluded the U.S. Court of
Appeals for Veterans Claims (hereinafter, ``CAVC''), in the
exercise of its exclusive jurisdiction to review decisions of
the VA's Board of Veterans' Appeals (hereinafter, ``BVA''),
from considering allegations of error raised by VA that were
not raised by the appellant or the CAVC; and would have amended
the standard under which CAVC might set aside BVA findings of
fact, modifying it from a ``clearly erroneous'' standard to a
``not reasonably supported by a preponderance of the evidence''
standard.
On March 21, 2000, the Committee's ranking minority member,
Senator John D. Rockefeller IV, introduced S. 2264, the
proposed ``Recognition of Physician Assistants in the
Department of Veterans Affairs Act of 2000.'' S. 2264 would
have established within the VA's Veterans Health Administration
(hereinafter, ``VHA'') the position of Advisor on Physician
Assistants.
On May 11, 2000, Ranking Minority Member Rockefeller
introduced S. 2544, the proposed ``Children of Women Vietnam
Veterans' Benefits Act of 2000.'' S. 2544 would have provided
health care, vocational training, and monetary allowance
benefits to children with covered birth defects born to women
Vietnam veterans.
On May 25, 2000, Senator Max Baucus introduced S. 2637, a
bill to require VA to convey land in Miles City, MT, to Custer
County, MT. On June 29, 2000, Senator Wayne Allard introduced
S. 2827, a bill to authorize VA to convey land in Ft. Lyon, CO,
to the State of Colorado, subject to, among other things,
conditions relating to the continued provision of long-term and
extended care medical services provided by VA at that site, and
subject to requirements relating to the retirement rights of VA
personnel employed at that site.
Committee Hearing
On July 20, 2000, the Committee held a hearing on
legislation pending before the Committee. Among the measures on
which the Committee received testimony was S. 1810 and
alternative language, as set forth in a draft bill proposed by
Committee Chairman Arlen Specter, to clarify VA's duty to
assist claimants; S. 2264; S. 2544, and alternative language,
as set forth in a draft bill proposed by Committee Chairman
Specter, which would have provided health care, vocational
training, and monetary allowance benefits to children with
covered birth defects born to women Vietnam veterans; S. 2637;
S. 2827; modifications to VA education, home loan, life
insurance, burial benefit, and employment assistance programs,
as specified in a draft bill proposed by Committee Chairman
Specter; provisions relating to veteran-patients' copayments
for prescription medications and the appointment of physician
assistants as specified in a draft bill proposed by Committee
Chairman Specter; a proposed modification in the maximum term
for which VA might lease acquired real property to providers of
housing assistance services to homeless veterans, and
authorizations for major medical construction projects at
Murfreesboro, TN, and Menlo Park, CA, as specified in a draft
bill proposed by Committee Chairman Specter; provisions
relating to compensation to women veterans who have suffered
the anatomical loss of a breast as a result of a service-
connected disability, as specified in a draft bill proposed by
Committee Chairman Specter; and provisions modifying section
106 of Public Law 102-585 relating to limitations on medical
care services which may be provided to women veterans, as
specified in a draft bill proposed by Committee Chairman
Specter.
The Committee received testimony from, among others,
representatives of VA and representatives of The American
Legion, the Veterans of Foreign Wars, the Disabled American
Veterans, AMVETS, and the Paralyzed Veterans of America. The
Committee also received written statements for the record from
the Vietnam Veterans of America; the Veterans Affairs Physician
Assistants Association; and the American Academy of Physician
Assistants.
Committee Meeting
On July 27, 2000, the Committee met in open session to
consider legislation pending before the Committee. Among the
measures so considered was S. 1810, as amended to incorporate a
substitute which set forth language relating to VA's duty to
assist claimants which was drawn from draft bill language which
had been proposed by Committee Chairman Specter and which had
been on the agenda of the Committee's July 20, 2000, hearing.
Also incorporated into the substitute were other items that had
been on the Committee's July 20, 2000, hearing agenda,
including: S. 2264 (relating to the establishment of the
position of Advisor on Physician Assistants); S. 2544 (relating
to benefits to children with covered birth defects born to
women Vietnam veterans); provisions drawn from S. 2637
(relating to the conveyance of land in Miles City, MT, to
Custer County, MT); provisions drawn from S. 2827 (relating to
the conveyance of land in Ft. Lyon, CO, to the State of
Colorado); and provisions drawn from draft bills proposed by
Committee Chairman Specter relating to modifications to VA
education, home loan, life insurance, burial benefit, and
employment assistance programs; provisions relating to
prescription medication copayments, physician assistant
appointments, VA leases of acquired real property to providers
of services to homeless veterans, and construction
authorizations; and provisions relating to compensation for
women veterans for the service-connected loss of a breast. The
Committee voted by unanimous voice vote to report S. 1810
favorably to the Senate, as so amended and as further amended
to incorporate an amendment offered by Committee member Senator
Paul Wellstone at the Committee meeting relating to diseases
deemed to be presumptively service-connected when contracted by
radiation-exposed veterans.
Summary of the Committee Bill as Reported
S. 1810, as reported (hereinafter, the ``Committee bill'')
contains three titles that would modify current benefits and
health care programs administered by VA, and which relate to VA
construction and facilities management issues, as summarized
below.
title i--benefits matters
Title I contains freestanding provisions and amendments to
title 38, United States Code, that would:
1. Codify VA's duty to assist veterans and other claimants
in developing the factual record pertinent to VA's adjudication
of the veteran's or other claimant's claim (section 101).
2. Add lung cancer, colon cancer, tumors of the brain and
central nervous system, and ovarian cancer to the statutory
listing of diseases that are presumptively service-connected if
they are contracted by a veteran exposed to radiation in
service (section 102).
3. Provide special monthly compensation to women veterans
who have sustained the service-connected loss of a breast
(section 103).
4. Establish uniform eligibility requirements relating to
the receipt of a high school diploma or equivalency certificate
by participants in VA educational assistance programs (section
111).
5. Repeal a limitation on eligibility for educational
assistance which permits participation only after the
completion of an ``initial'' obligated term of service (section
112).
6. Allow survivors and dependents to use eligibility for
educational assistance benefits to pursue test preparation
courses (section 113).
7. Expand the time within which survivors and dependents
may claim educational benefits (section 114).
8. Modify the effective date for survivors' and dependents'
eligibility for educational benefits (section 115).
9. Specify that specially adapted housing grants will not
be reduced merely because the home to be adapted is co-owned by
a person other than the veteran who is entitled to the grant
(section 121).
10. Increase the maximum VA home loan guaranty (from
$50,750 to $63,175) (section 115).
11. Eliminate home loan fees to veterans rated eligible for
compensation at pre-discharge medical examinations (section
122).
12. Cap term Service-Disabled Veterans Insurance premiums
at the age 70 renewable level (section 131).
13. Increase maximum Servicemembers Group Life Insurance
coverage (from $200,000 to $250,000)(section 132).
14. Authorize participation of the dependants of
servicemembers in the Servicemembers Group Life Insurance
program (section 133).
15. Make certain Filipino veterans of World War II eligible
for burial benefits (section 141).
16. Require that the veterans employment emphasis programs
of Federal contractors be extended to recently separated
veterans (section 151).
17. Require the Comptroller General of the United States to
conduct an audit of the Veterans' Employment and Training
Service, U.S. Department of Labor (section 152).
18. Provide health care benefits, vocational training
services, and monetary allowances to children with birth
defects born to women Vietnam veterans (section 162).
19. Require the National Academy of Sciences to conduct a
review of the Department of Defense's methodology for
estimating the doses of radiation to which certain veterans had
been exposed (section 171).
title ii--health care matters
Title II contains amendments to title 38, United States
Code, that would:
1. Waive the requirement that certain veterans who qualify
for priority access to VA health care services on the basis of
income make copayments for prescription medications (section
201).
2. Establish the position of Advisor on Physician
Assistants in VHA (section 202).
3. Authorize temporary appointments of physician assistants
(section 203).
title iii--construction and facilities matters
Title III contains freestanding provisions and amendments
to title 38, United States Code, that would:
1. Authorize major medical construction projects (sections
301-303).
2. Extend the maximum term of leases (from 3 to 20 years)
for which VA may lease acquired property to providers of
services to homeless veterans (section 311).
3. Convey land in Miles City, MT, to Custer County, MT
(section 312).
4. Convey land in Ft. Lyons, CO, to the State of Colorado
(section 313-314).
Discussion
title i--benefits matters
Subtitle A--Compensation and Pension Matters
Duty to assist
Background
Chapter 51, Subchapter I, of title 38, United States Code,
sets out the administrative procedures which must be followed
by claimants applying for benefits under title 38. Claimants
are expected to fill out appropriate claim forms and supply
necessary information to expedite the processing of claims by
VA. Subchapter I also lists the responsibilities of VA to
provide certain types of assistance to claimants. VA must
provide appropriate application forms, notify claimants when
they have submitted incomplete applications, provide timely
decisions to claimants, and provide assistance to claimants in
gathering evidence to substantiate their eligibility for
benefits. With respect to this latter requirement that VA
provide assistance to claimants, section 5107(a) of title 38,
United States Code, states as follows:
[A] person who submits a claim for benefits under a law
administered by the Secretary shall have the burden of
submitting evidence sufficient to justify a belief by a fair
and impartial individual that the claim is well grounded. The
Secretary shall assist such a claimant in developing the facts
pertinent to the claim.
This provision--the principles of which had been specified
by VA regulation prior to codification in the Veterans'
Judicial Review Act of 1988, Public Law 100-687--was enacted to
reflect the longstanding VA policy of assisting veterans and
other claimants in gathering evidence in support of their
claims.
The ``well groundedness'' and ``duty to assist'' concepts,
when they were codified, had meaning in prior VA regulations
and practice. As a consequence of that fact, they were applied
by VA, after codification, in a manner that was consistent with
past practice, rather than in a manner which might have better
conformed to CAVC's later interpretation of the strict terms of
the statute. As in the past, VA continued to assist veterans
and claimants by gathering military service records, VA and
private medical records, other relevant private and
governmental evidence, and, when appropriate, by providing
medical examinations. But VA did not, as a threshold matter,
require that claimants submit evidence necessary to establish
``well groundedness'' before it would render such assistance.
A series of CAVC rulings during the 1990's construed the
``well groundedness'' and ``duty to assist'' concepts, and
explored two major issues: what evidence would be required for
a claimant to satisfy the requirement that he or she submit a
``well-grounded'' claim; and in what sequence would the
claimant's obligation to submit a well-grounded claim and VA's
``duty to assist'' the claimant in developing the facts
pertinent to the claim be discharged. The evolution of CAVC
case law on both issues is summarized below seriatim:
In Gilbert v. Derwinski, 1 Vet.App. 49 (1990), the
Court held that the provisions of section 5107(a) established
``chronological obligations'' in the VA claims process and
that, accordingly, the obligation rests with the claimant to
submit a well-grounded or ``facially valid'' claim before VA
becomes obligated to assist the claimant.
In Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990),
the Court noted that ``[b]ecause a well grounded claim is
neither defined by the statute nor the legislative history, it
must be given a common sense construction. A well grounded
claim is a plausible claim, one which is meritorious on its own
or capable of substantiation. Such a claim need not be
conclusive but only possible . . . . '' See also White v.
Derwinski, 1 Vet.App. 519, 521 (1991) (the well-grounded
threshold is ``rather low,'' and is ``the only requirement
needed to obtain the Secretary's assistance''); Tirpak v.
Derwinski, 2 Vet.App. 609, 610 (1992) (the evidence required to
make a claim well grounded need not be conclusive; however, the
law ``requires more than just an allegation; a claimant must
submit supporting evidence'' that a claim is plausible); King
v. Brown, 5 Vet.App. 19 (1993) (a well-grounded claim is one
that would meet the ``well-pleaded'' requirement applicable to
civil actions under Rule 8(a)(2) of the Federal Rules of Civil
Procedure); and Grottveit v. Brown, 5 Vet.App. 91, 93 (1993)
(in cases where a claimant seeks benefits rooted in a medical
condition claimed to be service related, a well- grounded claim
is one that is supported by medical evidence submitted by the
claimant).
In Grivois v. Brown, 6 Vet.App. 136 (1994), the
Court admonished VA for developing claims that had not
initially met a ``well groundedness'' threshold. The Court
stated that, under Gilbert, supra, it is VA's ``duty to avoid
adjudicating implausible claims at the expense of delaying
well-grounded ones.'' (Despite Grivois, VA issued policy
directives ordering VA regional offices to develop all evidence
pertinent to a claim before making a determination of ``well
groundedness.'')
In Caluza v. Brown, 7 Vet.App. 498, 506 (1995),
the Court identified the following requirements which would, in
the Court's view, be necessary to establish a well-grounded
claim: (1) a medical diagnosis of a current disability; (2)
medical or lay evidence of the inservice occurrence or
aggravation of a disease or injury; and (3) medical evidence of
a nexus or link between an inservice injury or disease and the
current disability. The U.S. Court of Appeals for the Federal
Circuit affirmed Caluza in Epps v. Gober, 126 F.3d 1464 (Fed.
Cir. 1997).
Finally, in Morton v. West, 12 Vet.App. 477
(1999), CAVC held that VA does not have discretion to adopt
policies to assist claimants prior to the submission of a well-
grounded claim under the test set forth in Caluza, and
invalidated the policies adopted by VA after Grivois.
As a consequence of Morton, VA now has directed regional
offices to subject all claims to an initial review to determine
whether they are well grounded before proceeding (if the claim
is well grounded) to assist the claimant in fully developing
the claim. If the claim is not ``well grounded'' and the
claimant fails to make it ``well grounded'' after notice to
that effect, VA will deny the claim.
Committee Bill
Morton and its predecessors have significantly altered the
type--and the timing--of assistance which VA had traditionally
provided to veterans and other claimants seeking VA benefits.
Irrespective of--and prior to--the Court's interpretation of
the language of section 5107, VA had traditionally assisted
claimants ``up front.'' In Morton, the Court ruled that VA is
not free to do so--although the Court did note in Morton that
Congress could specify a different rule by statute. The
Committee here chooses to do so. The Committee bill, in
summary, modifies the pertinent statutes to reinstate VA's
traditional practice of assisting veterans at the beginning of
the claims process. In doing so, the Committee concludes that
the concept of ``well groundedness'' has no further practical
utility, and so it has eliminated the term from pertinent
statutes. The Committee also takes this opportunity to clarify
other legal issues related to the concept of VA's ``duty to
assist'' claimants.
Section 101(a) of the Committee bill would add a new
section 5101 to title 38, United States Code, to define the
term ``claimant.'' The purpose of this provision is to ensure
that VA assists all persons--including nonveterans, e.g.,
survivors, who might be eligible for VA benefits, and persons
claiming to be veterans but who may have not yet proven that
they are, in fact, veterans--at the beginning of the claims
process.
Section 101(b) of the Committee bill would substitute the
term ``information'' in place of the term ``evidence'' in
section 5103(a) of title 38. The purpose of this provision is
to clarify that claimants will not be obligated to present any
evidence per se upon initial application for benefits. What
will be required is for them to completely and accurately
provide the data requested in VA's application for benefits,
omitting none of the pertinent ``information'' requested in
that form. It is the Committee's understanding that such
``information'' consists of items readily in the possession of
most claimants, e.g., residence address, income information,
marital status, etc. Claimants would be under no obligation to
submit medical or lay evidence upon initial application for
benefits, although it would always be to a claimant's advantage
to do so if such information is in his or her possession.
Section 101(c) of the Committee bill would create a new
section 5103A of title 38 to clarify (1) the assistance and
notifications that VA must provide to claimants who apply for
all VA benefits; and (2) the assistance and notifications that
VA will provide, more specifically, to claimants who apply for
disability compensation.
Subsection (a) of the proposed section 5103A would require
VA to make reasonable efforts to assist a claimant in the
development of information and medical or lay evidence
necessary to establish eligibility for benefits sought by the
claimant. The purpose of this subsection is to reaffirm VA's
``duty to assist'' claimants in the development of evidence;
claimants would be entitled to such assistance as a matter of
right. And such assistance would no longer be contingent upon
the claimant first submitting a ``well-grounded'' claim.
The Committee recognizes that VA administers a wide variety
of benefits and that, in many cases, there may be no need for
VA to gather ``medical or lay evidence.'' The Committee
believes that its use of the term ``necessary'' in subsection
(a) gives to VA the necessary latitude to determine the
appropriate evidence to develop. On the other hand, VA
discretion is not unlimited; the Committee expects that
``reasonable efforts'' will be made by VA to assist claimants
and that those efforts will not be perfunctory. At the same
time, the Committee understands that a point may be reached
where the search for evidence becomes futile. In such cases, VA
assistance in the further pursuit of information or evidence
would no longer be ``reasonable.''
Subsection (b) of the proposed 5103A would permit VA to
withhold assistance to claimants if VA determines that no
reasonable possibility exists that such assistance would aid in
the establishing eligibility for the benefit sought. The
Committee understands that there will be some claims that
clearly lack merit due to statutory bars precluding entitlement
or other reasons, e.g., in a case where a veteran served in
peacetime, he or she would lack statutory eligibility for
pension benefits.
Subsection (c) of the proposed 5103A would require the VA
to notify claimants and their representatives, if any, of the
information and medical or lay evidence needed to aid in
establishing eligibility for benefits. It would also require VA
to notify claimants when it is unable to obtain any such
information or medical or lay evidence. While it is the VA's
duty to obtain information and evidence, the Committee expects
that claimants who are made aware of what is needed--or what
cannot be found--will cooperate with VA to locate and obtain
the required evidence if they are able to do so.
Subsection (d) of the proposed 5103A would specify the
assistance that VA will render when a claimant seeks disability
compensation. Paragraph (A) of subsection (d)(1) would direct
VA to obtain relevant service and medical records from
applicable governmental entities, e.g., the Department of the
Army. Paragraph (B) would direct VA to obtain records of
relevant medical treatment provided by VA (or at VA's expense)
if the claimant has submitted to VA sufficient information to
assist VA in locating such records. Paragraph (C) would direct
VA to obtain all other relevant records from other governmental
entities, provided that the claimant adequately identifies such
records. Paragraph (D) would direct VA to obtain private
records that the claimant has adequately identified. Paragraph
(E) would direct VA to provide a medical examination for the
purposes of determining the existence of a current disability
if the claimant submits evidence that he or she is unable to
afford medical treatment. Finally, paragraph (F) would permit
the VA to provide such other assistance as it deems
appropriate. Subsection (d)(2) would require VA to continue its
efforts to obtain records, as required under this subsection,
until it is reasonably certain that such records do not exist.
The above delineation of VA--and claimant--obligations
captures the Committee's understanding of the assistance VA
had, prior to Morton, historically provided to claimants
seeking disability compensation. On the subject of record
retrieval, the Committee notes that a different level of effort
will be expected when VA is obtaining records in the
government's, as opposed to a private entity's, possession.
While efforts to obtain evidence may never be minimal or
perfunctory, a special obligation is imposed on VA when a
governmental entity is the possessor of evidence.
Subsection (e) of the proposed 5103A would require VA to
provide a medical examination when VA determines that a medical
examination is necessary to substantiate entitlement to a
benefit. A determination as to the necessity of an examination
would be made by VA after review of all or, if sufficient, some
of the evidence obtained as a consequence of VA's execution of
subsection (d). It is the Committee's intention that if VA were
about to deny a claim because of the lack of evidence that
would be generated by a medical examination, VA would in such
circumstances provide the veteran with such an examination.
Subsection (f) of the proposed 5103A would authorize the
Secretary to prescribe regulations to administer the provisions
of proposed 5103A.
Section 101(d) of the Committee bill would amend section
5106 of title 38, United States Code, by specifying that costs
associated with providing VA-requested information from other
governmental entities will be borne by the governmental entity
providing such information.
Section 101(e) of the Committee bill would amend section
5107 of title 38, United States Code, to eliminate the
requirement that claimants submit evidence sufficient to
justify the belief that his or her claim is ``well grounded''
before VA will execute its duty to assist. Since the assistance
to be provided by VA would be delineated in the proposed
section 5103A, reference to VA's ``duty to assist'' claimants
would also be eliminated from section 5107. Section 5107(a), as
amended, would specify that the burden of proof to establish
entitlement to VA benefits remains with the claimant; the
Committee notes that while VA will be obligated to provide
assistance to claimants, the responsibility for proving a claim
ultimately will rest with the claimant. That said, the amended
section 5107(b) retains the language in current section 5107(b)
requiring that claimants be given the ``benefit of the doubt''
when there exists an ``approximate balance of positive and
negative evidence regarding an issue material to the
determination of the matter.''
Section 101(f) of the Committee bill would specify that the
assistance required by proposed section 5103A would apply to
any claim filed or pending before VA or the applicable
appellate court on or after the date of enactment. In addition,
section 101(f) would require that claims denied or dismissed by
VA for failure to meet the ``well groundedness'' test since
July 14, 1999--the date of the Morton decision--be
readjudicated at the request of the claimant or upon motion of
the Secretary.
Section 101(g) of the Committee bill would make clerical
amendments to chapter 51 in light of changes contained in
Section 101.
Diseases presumed to be service-connected for radiation-exposed
veterans
Background
As a general rule, diseases which are incurred or
aggravated during active military, naval, or air service are
``service connected'' and, thus, give rise to eligibility for
VA compensation and other benefits. Diseases which become
manifest only after service may give rise to such eligibility
under rules which specify legal presumptions with respect to
such diseases. With respect to veterans who were exposed to
radiation in service, such rules are set forth in section 1112
of title 38, United States Code.
Section 1112(c)(2) of title 38 lists 16 diseases which, if
they become manifest in a radiation-exposed veteran at any time
in his or her lifetime, will be considered to have been
incurred in or aggravated during active service. Thus, veterans
who contract such diseases will generally be eligible for
benefits as ``service-connected'' veterans even though there is
no direct evidence that they contracted such diseases during
service.
Committee Bill
Section 102 of the Committee bill would amend section
1112(c)(2) of title 38 by adding four additional diseases-lung
cancer, colon cancer, tumors of the brain and central nervous
system, and ovarian cancer--to the statutory listing of
diseases which will be presumed to be ``service-connected'' if
they are contracted by radiation-exposed veterans.
Special monthly compensation for breast loss
Background
Addition to ``ordinary'' disability compensation, VA pays
additional compensation to veterans who, as a result of a
service-connected disability, have suffered the anatomical
loss, or the loss of use of, organs specified by statute.
Currently, additional compensation of $76 per month per loss is
paid to veterans who have suffered the loss of a foot, a hand,
a creative organ, or both buttocks. Additional compensation is
also paid to veterans who have lost vision, speech or hearing
capabilities. See 38 U.S.C. Sec. 1114(k). More serious
anatomical losses, e.g., the loss of both feet, both legs, or
total blindness, give rise to additional compensation at
different, and higher, rates.
Committee Bill
The Committee bill would add the following additional
anatomical loss to the ``special monthly compensation''
statutory listing in cases where such loss is sustained by a
woman veteran due to service-connected disability: ``one or
both breasts (including loss by mastectomy)''. In the
Committee's view, the loss of a breast by a woman is consistent
with the types of anatomical losses now listed in subsection
(k).
Subtitle B--Education Matters
Background
Under chapter 30 of title 38, United States Code,
educational assistance benefits (commonly referred to as the
Montgomery GI Bill or ``MGIB'' benefits) are provided to
otherwise eligible members of the armed services who first
entered active duty after June 30, 1985, and who did not
decline to participate in the program. The rate of basic pay of
servicemembers who are MGIB participants is reduced by $100 for
each of the first 12 months of active duty service. Those who
serve at least 3 years in active service, or who serve at least
2 years in active service and, thereafter, serve 4 years of
continuous duty in the Selected Reserve, and who participate in
full-time study after service, receive $536 per month; for
full-time-study, veteran students/trainees whose enlistment
terms were 2 years receive a monthly benefit $436.
The spouses and children of servicemembers who died in
service, or were permanently and totally disabled in service,
are eligible for Dependents Educational Assistance benefits,
under Chapter 35 of title 38, so long as they meet eligibility
criteria set forth in chapter 35. Surviving spouses, for
example, remain eligible so long as they are not remarried.
Surviving children generally remain eligible for such benefits
until they reach the age of 26, although extensions may be
granted. Full-time students participating in the Dependents
Educational Assistance program receive $485 per month.
Committee Bill
In order to be eligible for MGIB participation, veterans
and members of the Selected Reserves must have secured a high
school diploma or a diploma equivalency certificate, or must
have completed the equivalent of 12 semester hours in a program
of education leading to a standard college degree. Generally,
this prerequisite must be satisfied before completion of an
initial period of obligated service or, in the case of the
Selected Reserve benefit, before completion of initial active
duty for training. Exceptions to this general rule have been
enacted to allow, in certain cases, larger timeframes to
satisfy its terms; such exceptions, however, have led to
confusion and, perhaps, inequity. More fundamentally, such
timeframes, tied as they are to the applicant's time in
service, have led to the denial of benefits to individuals who
served their country honorably but have only later--after such
statutory deadlines have passed--earned a high school diploma
or equivalency certificate or completed 12 semester hours of
college. Section 111 of the Committee bill would simplify this
situation by creating a single, uniform secondary school
diploma requirement as a prerequisite for eligibility for
education benefits--a requirement that, prior to applying for
benefits, the applicant will have received a high school
diploma or equivalency certificate, or will have completed the
equivalent of 12 semester hours in a program of education
leading to a standard college degree.
Another prerequisite to MGIB eligibility is completion of
an ``initial obligated period of active duty.'' See 38 U.S.C.
Sec. Sec. 3011(a)(1)(A)(i), 3012(a)(1)(A)(i)(emphasis added).
The Committee has learned of cases involving individuals who
failed to complete an initial period of service and who later
enlisted again and then served honorably for an entire
obligated period of service. Such individuals are not now
eligible for MGIB participation even though they completed an
entire enlistment because the enlistment they did complete was
not their initial enlistment. Section 112 of the Committee bill
would strike the requirement that MGIB benefit entitlement be
predicated on serving an ``initial'' period of obligated
service and substitute in its place a requirement that an
obligated period of active duty be served.
Sections 3002(3) and 3501(a)(5) of title 38 define the
``programs of education'' for which veterans, and surviving
spouses and children, will receive education assistance
benefits. Section 701 of Public Law 106-118 modified section
3002(3) to permit such assistance while a veteran--but not a
surviving spouse or child--takes preparatory courses for
standardized tests used for admission to college or graduate
school. Section 113 of the Committee bill rectifies that
oversight by allowing survivors' and dependents' educational
assistance benefits to be provided to this group while such
preparatory courses are being taken.
As noted above, children who are eligible for Dependents
Educational Assistance benefits generally remain eligible until
they reach the age of 26. In cases, however, where a child only
becomes eligible for those benefits after he or she has reached
18 years of age (due, e.g., to the death or service-connected
permanent and total disability of a servicemember-parent when
the child is 20), such benefits remain available to the child
for a period of 8 years after the service-connected death or
disability. As these rules are now drafted, they can operate,
in practice, to shorten the timeframe of eligibility in cases
where, for example, the child only becomes aware of his or her
eligibility when it is later determined that the death or
disability was, in fact, service connected. Section 114 of the
Committee bill would rectify the loss of benefits otherwise
permitted in such situations by allowing the Dependents
Educational Assistance-eligible child to choose the starting
date of his or her eligibility. Such children could choose any
date as a starting date between the time when they first become
eligible for benefits (the date of the parent's actual death or
disability) and the date on which VA has made a determination
that the death or disability in question was, in fact, service
connected. A similar rule now applies to Dependents Educational
Assistance-eligible spouses. See 38 U.S.C. Sec. 3512(b)(3).
As noted in the preceding paragraph, cases arise where
eligibility for Dependents Educational Assistance is not
determined until VA adjudicates a claim. Cases can arise where
a particular death or disability is not determined to be
service connected until a considerable period of time--even
years--after death or the onset of disability. In many such
cases, the spouse or child might have already started (or even
completed) his or her higher education prior to the
adjudication of the underlying claim, but had not requested
that his or her eligibility for Chapter 35 Dependents
Educational Assistance benefits be adjudicated in advance of a
decision on the underlying claim. Under current law, such
persons may be deemed eligible for Chapter 35 benefits
retroactively, but only for a 1-year period. Section 114 of the
Committee bill would rectify this situation by allowing VA to
retroactively award Chapter 35 benefits for a period exceeding
1 year to a spouse or child who would otherwise be eligible for
Chapter 35 benefits so long as the claiming person files an
application for such benefits within 1 year after VA makes a
determination on the death or disability claim from which
eligibility for the requested benefits arises.
Subtitle C--Housing Matters
Specially adapted housing grants
Background
Veterans with severe disabilities that limit ambulatory
powers, e.g., the loss of use of both legs, are eligible under
chapter 21 of title 38 for specially adapted housing grants of
up to $43,000 to finance the purchase or remodeling of housing
units with special adaptions necessary to accommodate their
disabilities. Co-ownership of the property by the veteran and
another person is not relevant to the amount of the grant if
the co-owner is the veteran's spouse. If, however, the co-owner
is person other than the veteran's spouse, the maximum grant
amount is reduced by regulation to reflect the veteran's
partial ownership of the property interest, e.g., if the
veteran jointly owns the property with one other person, the
maximum grant is $21,500. 38 C.F.R. Sec. 36.4403. In 1999, VA
made 770 specially adapted housing grants; VA estimates that it
makes 5-10 grants per year to persons who owned a home with a
person other than a spouse.
Committee Bill
Section 121 of the Committee Bill would amend section 2102
of chapter 21 to allow VA to make non-reduced grants for
specially adapted housing in cases where title to the housing
unit is not vested solely in the veteran, if the veteran
resides in the housing unit.
Home loan guaranty ceiling and fees
Background
The VA Home Loan Guaranty Program facilitates the extension
of favorable credit terms by private lenders to veterans, to
active duty servicemembers, to certain members of the Selected
Reserves, and to certain surviving spouses, see 38 U.S.C.
Sec. 3701, for the purchase, construction, or improvement of
homes. The program operates by substituting the Federal
Government's guaranty of a portion of the loan amount, thereby
enabling creditworthy borrowers to secure favorable credit
terms even if they lack funds for a significant downpayment.
For loans of up to $45,000, VA guarantees up to 50 percent of
the loan amount; for loans between $45,000 and $144,000, VA
guarantees up to 40 percent, with a maximum guaranty of
$36,000; and for loans of more than $144,000, VA guarantees 25
percent of the loan amount, with a maximum guaranty of $50,750.
Under current mortgage loan industry practices, a loan guaranty
of $50,750 is sufficient to allow a veteran home purchaser to
borrow up to $203,000 toward the purchase of a home with no
downpayment.
Home purchasers participating in the VA home loan guaranty
program generally must pay a fee for participation. The amount
of the fee depends upon the percentage of downpayment made by
the veteran. Veterans who make a downpayment of less than 5%
pay a fee of 3% of the loan amount. Those who make a
downpayment of between 5% and 10% pay a 1.5% fee. Veterans who
make a downpayment of 10% or more pay a fee of 1.25% of the
loan amount. Fees are waived with respect to veterans receiving
compensation for a service-connected disability. See 38 U.S.C.
Sec. 3729(c).
Committee Bill
Section 122 of the Committee Bill would amend section 3703
(a)(1) of title 38 to increase the maximum amount of the VA
guaranty from $50,750 to $63,175. In many markets, housing
prices have risen to the point that a guaranty of $50,750 is
not sufficient to allow a veteran-purchaser who would otherwise
qualify to finance the purchase of a significant segment of the
housing stock in his or her home area. An increase of the
guaranty amount to $63,175 would make no downpayment financing
of up to $252,700 available to qualified home loan guaranty
program participants.
As noted above, fees are waived with respect to veterans
receiving compensation for a service-connected disability.
Section 123 of the Committee Bill would amend section 3729 of
title 38 to add an additional category of fee-exempt borrower:
persons who have been evaluated by VA as having compensable
service-connected disabilities but who are not yet receiving
disability compensation because they are still on active duty.
In order to streamline its processes for adjudicating
eligibility for compensation, VA increasingly offers medical
examinations to, and rates the disabilities of, active duty
servicemembers as part of the separation or retirement process.
Under current law, VA cannot now waive collection of loan fees
from such persons because they are not actually receiving--and
they cannot actually receive--compensation while they remain on
active duty. Active duty servicemembers can, however,
participate in the VA home loan guaranty program. The Committee
Bill would allow VA to waive fees for such persons even though
they are not receiving VA compensation at the time they seek
home loan financing.
Subtitle D--Insurance Matters
Background
Under Chapter 19 of title 38, VA administers programs
providing life insurance coverage for certain veterans. These
programs include the Service-Disabled Veterans Insurance (SDVI)
program, which was created in 1951. This program provides up to
$10,000 in life insurance coverage to veterans with service-
connected disabilities, and up to $30,000 for veterans who are
totally disabled. (Premiums are waived with respect to this
latter group.) There are currently 147,870 SDVI policies in
force.
Disabled veterans insured through the SDVI program pay
premiums at the same rate as comparable non-disabled
individuals. Veterans may elect coverage under either term or
``permanent'' policies. Premiums for ``permanent'' plans are
substantially higher initially, but they do not increase as the
insured ages. Term insurance premiums are substantially lower
than ``permanent'' plan premiums when the insured is relatively
young but, as is the case with all term life insurance
policies, these premiums increase over time. In the case of
SDVI term policies, premiums increase every 5 years to reflect
the increased risk of death as individuals age.
The Servicemembers Group Life Insurance Program (SGLI)
provides up to $200,000 in coverage to individuals on active
duty in the Armed Forces; to members of the Ready Reserves, the
Commissioned Corps of the National Oceanic and Atmospheric
Administration, and the Public Health Service; to cadets and
midshipmen of the four service academies; and to members of the
Reserve Officer Training Corps. The SGLI program is entirely
self supporting except for costs attributable to excess
mortality resulting from military hazards; those ``excess''
costs, if any, are borne by the uniformed services, a
contingency last experienced during the Vietnam War. Coverage
is available in $10,000 increments up to a maximum of $200,000
unless the servicemember declines coverage or elects coverage
at a reduced amount. The current SGLI premium is $.08 per month
per $1,000 of coverage. There are 2,307,000 SGLI policies in
force.
Committee Bill
Section 131 of the Committee bill would cap premiums for
SDVI term policies at the age 70 renewal rate, currently, $5.87
per month per thousand dollars coverage. Term insurance
policies become almost unaffordable for veterans over the age
of 70. In recognition of that fact, premiums for other VA life
insurance programs, e.g., the National Service Life Insurance
program available to World War II veterans, have been capped at
the rate established for renewal at age 70. The Committee Bill
would provide the same benefit to the service-connected
veterans insured through the SDVI program.
Section 132 of the Committee bill would increase the
maximum amount of coverage available through the SGLI program
from $200,000 to $250,000. The maximum amount of SGLI coverage
has not been increased since 1992; the Consumer Price Index has
increased 18% since that time.
Section 133 of the Committee bill would create a new
section 1967A within chapter 19 of title 38. This new section
would provide to SGLI-insured servicemembers an opportunity to
provide for coverage of their spouses and children. Just as is
the case for coverage of servicemembers, dependents' coverage
would be ``automatic'' unless it is declined. The amount of
coverage for a spouse would be equal to the coverage of the
insured servicemember, up to a maximum of $50,000. The lives of
an insured servicemembers' dependent children would be insured
for $5,000.
Subtitle E--Burial Matters
Background
The Philippine Islands became a U.S. possession at the
conclusion of the Spanish-American War in 1898, and remained a
U.S. possession until 1946. Public Law 73-127, enacted in 1934,
established the Philippine Islands as a Commonwealth which had
certain powers relating to its internal affairs and the power
to organize and maintain a Commonwealth Army. The United States
reserved the right to place all Commonwealth forces under U.S.
command between 1934 and the date of Philippine independence
(July 4, 1946); President Franklin D. Roosevelt exercised this
authority on July 26, 1941, and brought the Philippine
Commonwealth Army under the command of the U.S. Army Forces of
the Far East (USAFFE). During World War II, certain organized
guerrilla resistance units were recognized by the U.S. Army as
having fought under U.S. command; these units are now
recognized to have been part of the Philippine Commonwealth
Army. Members of the Philippine Commonwealth Army remained
under command of the USAFFE until June 29, 1946.
After World War II, Congress limited the size and scope of
U.S. veterans' benefits available to Commonwealth Army
veterans, taking into consideration differences in the costs-
of-living in the United States and the Philippines, and also
taking into account the newly independent Nation's
responsibility to care for its own veterans. Congress did not,
however, make Commonwealth Army veterans ineligible for U.S.
benefits. Then-and now-former members of the Commonwealth Army
may qualify for disability compensation, burial benefits, and
National Service Life Insurance benefits, and their survivors
may qualify for Dependency and Indemnity Compensation. Such
benefits, however, are provided at half the rate they are
provided to U.S. veterans due to the difference in the cost of
living in the Phillippines relative to the United States.
Commonwealth Army veterans are not eligible for other VA
benefits, including pension payments, health care benefits
(except on a space-available basis, in the United States, for
service-connected disabilities), burial in the national
cemeteries, or readjustment benefits.
Committee Bill
Section 141 of the Committee bill would amend 38 U.S.C.
Sec. 2402(4) to provide, in cases where a Commonwealth Army
veteran dies after enactment of section 141, for the
eligibility of a Commonwealth Army veteran for burial in a
national cemetery if, at the time of death, he is a naturalized
citizen of the United States, and he is resident in the United
States.
Subtitle F--Employment Matters
Background
The Department of Labor, Veterans' Employment and Training
Service (VETS), has primary responsibility for the
implementation of laws relating to veterans' employment.
Section 4102 of title 38 states Congressional intent with
respect to veterans' employment programs as follows: ``The
Congress declares as its intent that there shall be an
effective (1) job and job training counseling program, (2)
employment placement service program, and (3) job training
placement service program for eligible veterans and eligible
persons. . . .''
Chapter 42 of title 38 specifies employment and training
programs for certain veterans. Among these programs is one, set
forth in section 4212, which requires that certain Federal
contractors and subcontractors take affirmative action to
employ and advance ``special disabled veterans'' (generally,
veterans with serious employment handicaps or disability
ratings of 30% or higher), Vietnam-era veterans, and other
veterans who are ``preference eligible'' (generally, veterans
who have served during wartime or in a campaign or expedition
for which a campaign badge has been authorized).
Public Law 104-275, the ``Veterans' Benefits Improvements
Act of 1996,'' established the Commission on Servicemembers and
Veterans Transition Assistance, a bipartisan commission which
was charged with reviewing all programs designed to assist
servicemembers and veterans in making the transition from
service to civilian life, and with recommending improvements in
those programs. In its report to the Congress, the Commission
concluded, among other things, that the employment service
priorities of VETS do not focus on the veterans most in need of
assistance; that VETS is not sufficiently accountable for
results; and that services that are provided would be improved
if they were privatized or transferred from the Department of
Labor to VA.
Committee Bill
Section 151 of the Committee bill would add ``recently
separated veterans'' (veterans who have been discharged or
released from active duty within a 1-year period) to the
universe of veterans to whom Federal contractors and
subcontractors must extend affirmative action to employ and
advance. It is the Committee's finding that such veterans are
among those who most urgently need to be reintegrated into the
civilian economy.
The Committee is concerned that programs administered by
VETS are not as effective as they might be. Particularly
troublesome to the Committee is the fact that, according to
VETS data, only 26% of veterans who sought assistance from
State employment offices secured jobs in a recent program year
as a result of that assistance, and only 12% of veterans
secured permanent employment. In addition, the Committee
remains mindful of the findings of the Commission on
Servicemembers and Veterans Transition Assistance summarized
above. Thus, Section 152 of the Committee bill directs that the
General Accounting Office conduct a comprehensive audit of VETS
to evaluate the organizational structure of VETS and applicable
legislation and regulations governing it.
Subtitle G--Benefits for Children of Female Vietnam Veterans
Background
In October 1998, the VA's Environmental Epidemiology
Service released a study titled ``Women Vietnam Veterans
Reproductive Outcomes Health Study.'' This study, which was
based on a review of the actual health histories of over 80% of
the 4,140 women Vietnam veterans known to be alive as of
January 1, 1992, found that the offspring of these women have
suffered a statistically significant increase in the prevalence
of birth defects (10.5% vs. 7.0%), and severe birth defects
(7.7% vs. 5.8%) in comparison to the children of other women
Vietnam-era veterans. The study came to these conclusions after
having accounted for variations in age, race and other
demographic factors, rank and characteristics of service
variables, and variations in smoking, alcohol and drug use, and
other potentially confounding factors, of cohort and control
group members. This VA analysis has been subjected to peer
review for verification, which review has resulted in,
according to VA, acceptance for publication of the VA study in
September 2000.
VA currently has authority to compensate veterans (and
dependents) for a veteran's service-connected diseases or
injuries. In addition, VA may, pursuant to Public Law 104-204,
provide benefits to children of Vietnam veterans--but only to
those children who were born with spina bifida.
Committee Bill
Subtitle G of Title I of the Committee bill would, in
summary, extend (with a single variation) to the children born
with birth defects to women Vietnam veterans the same benefits
as those now afforded to Vietnam veterans' children with spina
bifida under chapter 18 of title 38, United States Code. Under
chapter 18 of title 38, children with spina bifida of Vietnam
veterans currently receive:
1. A monthly monetary allowance, varying by degree of
disability of the person with spina bifida;
2. Health care for any disability associated with that
person's spina bifida; and
3. Vocational training, job placement, and post-job-
placement services.
The Committee concludes that the ``Women Vietnam Veterans
Reproductive Outcomes Health Study'' sufficiently makes the
case that women Vietnam veterans have sustained a
disproportionate risk of bearing children with birth defects
and that, accordingly, benefits like those extended to the
spina bifida children of Vietnam veterans should be afforded to
all children with birth defects who were born to Vietnam
veteran women.
Section 162 of the Committee bill puts into place the basic
entitlement to benefits and creates a new subchapter to chapter
18 of title 38. Section 1811 of that new subchapter would
define key terms, and section 1812 would specify the health
care, vocational training, and monetary allowance benefits to
which covered persons would be entitled. Benefits would be
provided to women Vietnam veterans' children born with birth
defects which have resulted in permanent physical or mental
disability, except for birth defects which VA may determine
were caused by familial disorders, birth-related injuries, or
fetal or neonatal infirmities. As noted above, the benefits
provided would be, with one exception, the same as those
provided to spina bifida children of Vietnam veterans. The
variation is this: Public Law 104-204 provides for a three-
tiered monetary allowance scheme under which the spina bifida
children of Vietnam veterans with varying degrees of disability
receive compensation. The Committee bill adds a fourth, and
lower, tier benefit for persons covered by the Committee bill
in recognition of the fact that the Committee bill covers a
broad spectrum of birth defects and some of those birth defects
are less disabling than spina bifida is.
Subtitle H--Other Benefits Matters
Background
Pursuant to Public Law 100-321, VA provides compensation to
veterans who were exposed to ionizing radiation in service (due
to participation in the occupation forces of Hiroshima or
Nagasaki immediately after WWII, or in nuclear testing
activities during the Cold War era) and who, subsequently, are
diagnosed with the ``presumptive diseases'' listed in 38 U.S.C.
Sec. 1112(c)(2). VA may also compensate radiation-exposed
veterans with diseases not presumed to be service connected if
it determines that it is at least as likely as not that the
disease is the result of exposure taking into account the
amount of exposure and the radiogenic properties of the
disease, but VA requires that such exposures be verified
through dose reconstruction analysis provided by the Department
of Defense (hereinafter, ``DOD''). See 38 C.F.R. Sec. 3.311.
On April 21, 1998, the Committee held a hearing regarding
compensation for illnesses associated with exposure to ionizing
radiation while in service. At that hearing, the Committee
learned that very few veterans have been granted service
connection for diseases potentially resulting from radiation
exposures in cases where the veterans have had to rely on DOD
dose reconstruction. In most cases, DOD dose reconstructions
have led VA to conclude that if the veteran was exposed to
radiation, the exposure was not at a sufficient level of
radiation to cause illness. Some members of a panel of
scientists at that hearing, however, were skeptical of DOD's
dose reconstruction methodology.
In light of the absence of consensus on the validity of
DOD's dose reconstruction methodology, Chairman Specter and
Ranking Minority Member Rockefeller requested that GAO review
DOD's dose reconstruction process. The results of that inquiry
are set forth in GAO's report, ``Independent Review Could
Improve Credibility of Radiation Exposure Estimates'' (GAO/
HEHS-00-32), January 28, 2000. While GAO found that dose
reconstruction tends to overstate rather than understate actual
exposure, GAO also found that, among other things, the National
Academy of Sciences' Institute of Medicine, and the National
Research Council, are critical of DOD's quality controls and
its lack of a peer review process. GAO recommended that DOD
establish a process for independent review of its dose
reconstruction process.
Committee Bill
Section 171 of the Committee bill specifies that,
consistent with GAO's recommendation, DOD shall contract with
the National Academy of Sciences (hereinafter, ``NAS'') to
carry out periodic reviews of the dose reconstruction program.
NAS would review whether DOD's reconstruction of sampled doses
is accurate; whether DOD assumptions regarding exposure based
upon sampled doses are credible; and whether data from nuclear
testing used by DOD in its reconstructions are accurate. The
review would last 24 months and culminate in a report detailing
NAS' findings and recommendations, if any, for a permanent
review program.
title ii--health care matters
Medication copayments
Background
Under current law, VA provides medical care, without
imposing an obligation to make copayments for such care, to
veterans who are ``unable to defray the expenses of necessary
care . . . .'' 38 U.S.C. Sec. 1710(a)(2)(G). Whether a given
veteran is, or is not, ``unable to defray'' is determined by
comparing his or her annual income against a sliding scale of
income thresholds (currently calculated at $22,888 for veterans
with no dependents, $27,469 for veterans with one dependent,
plus additional allowances for additional dependents).
A separate provision of law, 38 U.S.C. Sec. 1722A, mandates
that VA charge a copayment for each 30-day supply of
prescription medications provided to a veteran on an outpatient
basis if that medication is for the treatment of a non-service-
connected condition. Two categories of veterans are exempted
from the copayment obligation: veterans who have service-
connected disability ratings of 50% or higher; and veterans
whose annual income does not exceed the maximum amount of
``means-tested'' VA pension that would be payable if such
veteran were to qualify for pension. Eligibility for pension--
like priority eligibility for health care on the basis of one's
means--is determined by measuring the veteran's annual income
and comparing it to a sliding scale of income thresholds. The
eligibility thresholds, however, differ from one another; the
pension threshold is $8,989 for a veteran with no dependents
and $11,773 for a veteran with one dependent, and, as noted
above, the ``unable to defray'' thresholds are higher. As a
consequence, veterans who are given priority access to VA
health care and are exempted from making copayments for that
health care under one measurement of their means, are required
to make copayments for medications under a different
measurement of their means.
Committee Bill
Section 201 of the Committee bill would unify the copayment
exemption thresholds at the pension rate. It is the Committee's
view that if a veteran is deemed to be eligible for priority
access to health care without copayments because he or she
meets an ``unable to defray'' test, the veteran similarly lacks
the means to defray a medication copayment obligation.
Physician assistants
Background
Physician assistants have become an increasingly important
component of VA treatment teams, particularly as VA, like the
Nation's health care system generally, makes a transition to
primary-based care. VA's current medical management structure
does not fully reflect this reality; it remains, in part, as it
was when VA was a hospital-based provider of care. For example,
the Office of the Under Secretary for Health is staffed by
various officials, drawn from the professions of medicine,
nursing, pharmacy, dietetics, podiatry, and optometry. See 38
U.S.C. Sec. 7306. That office, however, is not staffed by a
service director or other official trained as a physician
assistant.
Similarly, VA has statutory authority to employ, on a
temporary full-time basis, yet-to-be licensed professionals who
have successfully completed a full course of training in
nursing, or in other statutorily recognized disciplines, but
not physician assistants. See 38 U.S.C. Sec. 7405(c)(2). This
statute was enacted to facilitate VA hiring of such
professionals, on a temporary basis, after they have completed
training but not to exceed 2 years, while they await the
receipt of licenses, registrations, or certifications which are
prerequisites to meeting professional quality standards and to
securing non-temporary employment at VA.
At the time section 7405 was enacted, physician assistants
were not required by the Commission on Accreditation of Allied
Health Education Programs to obtain licenses or other
certifications before meeting professional quality standards--
but now they are. VA, however, only offers them 1-year, non-
renewable appointments rather than 2-year appointments while
they await licensing. See 38 U.S.C. Sec. 7405(3). This
limitation has harmed VA physician assistant recruiting efforts
since it can take more than 1 year for these professionals to
complete their licensing requirements, a situation that causes
recently trained physician assistants to decline VA
appointments which must be terminated if licensing is not
completed within 1 year.
Committee Bill
Section 202 of the Committee bill adds to the list of
professions which, by statute, form the Office of the Under
Secretary for Health. It would direct that that office employ
an Advisor to the Under Secretary on Physician Assistants. This
person would be responsible for advising the Under Secretary on
matters relating to the optimal utilization of physician
assistants, the appropriate clinical privileges and practice
areas for physician assistants, initiatives to utilize
physician assistants more optimally, and policies affecting the
employment of physician assistants.
Section 203 of the Committee bill would authorize VA to
appoint persons who have completed a full course of physician
assistant training to temporary full-time positions on the same
2-year basis under which nurses, and other professionals, are
now hired.
title iii--construction and facilities matters
Subtitle A--Construction Matters
Background
VA may not obligate or expend funds on any ``major medical
facility project'' unless that project has been specifically
authorized by law. See 38 U.S.C. Sec. 8104. A ``major medical
facility project'' is one that will involve the construction,
alteration, or acquisition of a medical facility involving the
total expenditure of more than $4 million.
In 1999, funds were appropriated for VA to proceed on a
major construction project in Murfreesboro, TN, which has not
been authorized. VA, therefore, has been precluded from
expending funds on that project. VA has requested authorization
to proceed on that project and on a second project in Menlo
Park, CA. The Committee's staff has considered both proposals
and has visited the sites of both proposed projects.
Committee Bill
Subtitle A of title III of the Committee bill would
authorize the two major medical facility projects requested by
VA: a renovation of a psychiatric nursing care unit at
Murfreesboro, TN ($14 million); and the construction of a gero-
psychiatric facility at Palo Alto/Menlo Park, CA ($26.6
million). In addition, the Committee bill would authorize the
construction of a nursing home at Beckley, WV, at a cost of
$9.5 million.
The Murfreesboro, TN, project would provide renovations to
the medical center's long-term psychiatric care unit by
rebuilding four units of 30 beds each. The current facility,
constructed in the 1940's, lacks proper privacy facilities in
sleeping and shower areas, and is equipped to treat only two
female patients at a given time. In addition, the long-term
psychiatric care unit's nursing station is ill-equipped to
monitor and care for severely mentally ill patients. As a
consequence, the Joint Commission on Accreditation of
Healthcare Organizations has been critical of the facility.
The Menlo Park, CA, project would replace the current 109-
bed gero-psychiatric care nursing home on the grounds of the
Palo Alto Health Care System's Menlo Park Division. In addition
to replacing existing beds, the project would add an additional
11 beds, for a total of 120 gero-psychiatric beds, that are
needed to meet increasing demand for nursing home care in
northern California. The current facility, built in 1967, meets
neither VA nor State of California earthquake safety standards,
and this project is necessary to ensure structural integrity
and, thus, the safety of the elder veterans this facility
treats.
The West Virginia project would provide for a new 120-bed
nursing home care unit on the grounds of the Beckley VA Medical
Center to replace the medical center's current 50-bed unit,
which is fully occupied 95% of the time. The demand for skilled
and palliative care in the medical center's catchment area far
exceeds VA's current capacity, and with only two community
facilities offering even limited access to veterans for
Alzheimer's/dementia care, the community is unable to meet the
needs of local veterans. Of the 120 beds in the new facility,
20 would be devoted to skilled nursing care, 20 to a dementia
special care unit, and 80 for long-term nursing beds, with 10
of those specifically designated for palliative care use.
Subtitle B--Other Matters
Leases to providers of services to homeless veterans
Background
As noted above, VA's Home Loan Guaranty Program assists
veterans in readjusting to civilian life by facilitating their
purchase, construction, or improvement of homes. VA does so by
encouraging private lenders to extend favorable credit terms to
veterans by guaranteeing repayment of a portion of the lender-
provided home loan.
Unfortunately, it is the case that, in unusual
circumstances, veterans default on mortgage loans guaranteed by
VA. In such cases, the lender will foreclose and VA, as
guarantor, may come into possession of the property. Such
properties, typically, are sold to the public by VA. VA,
however, has the option of leasing such properties to public
and nonprofit private providers of services to homeless
veterans so that such service-providers may offer shelter and
other services to homeless veterans and their families. See 38
U.S.C. Sec. 3735. Such leases to the providers of services to
homeless veterans, however, may not exceed 3 years in term.
Committee Bill
Providers of services to homeless veterans have shown a
willingness to invest funds in the renovation of VA-leased
properties to make them more suitable for providing services to
homeless veterans and their families. VA encourages such
investments by service-providers by offering grants and per
diem subsidies to assist them in establishing assistance
programs. Even so, providers typically require financing to
cover their share of costs, but lenders often require assurance
that the borrower's program will operate for a period exceeding
3 years before they will provide renovation financing. Section
311 of the Committee bill would extend the maximum term of VA
leases to providers of services to homeless veterans from 3 to
20 years.
Property transfers
Background
Generally, when a Federal agency such as VA finds that it
no longer needs real property that it occupies, it reports the
``excess'' to the General Services Administration (hereinafter,
``GSA''). GSA then ``shops'' the property to other Federal
entities and, simultaneously, requests that the Department of
Housing and Urban Development (hereinafter, ``HUD'') determine
whether the property is suitable for use in providing services
to homeless persons. See 42 U.S.C. Sec. 11411. In cases where
another Federal agency can use the property, it is transferred
to that agency. If there is no such Federal need, it is made
available to HUD for use for providing shelter or other
services to homeless persons--if it is suitable for that
purpose. If it is not suitable for that purpose, it is declared
``surplus'' and then may be transferred to State or local
government entities, but only for specific statutory purposes,
see 40 U.S.C. Sec. 484(j). Otherwise, it can only be sold for
other governmental use for a fair market value price, or it can
be sold to the public by sealed bid or auction.
Committee Bill
Sections 312-314 would, for these two cases, streamline the
above-outlined property disposal procedures by authorizing VA
to convey two properties to other governmental users (in one
case, a county government and in the other case, a State
government). In one case, VA would transfer medical center
facilities in Miles City, MT, to Custer County, MT, while
leasing back space in which it would operate an outpatient
clinic. Custer County would devote the transferred land to
assisted living apartments for the elderly and to a number of
other economic enhancement and community activity uses,
including education and training courses at Miles Community
College, a Technology Center, local fire department training,
and use by the Montana Area Food Bank. VA, in turn, would be
relieved of the requirement to spend over $500,000 per year
maintaining a facility that is poorly suited to provide health
care to the veterans of eastern Montana. VA could devote the
funds so saved to opening and operating outpatient clinics
throughout rural Montana.
The other property conveyance would take place at Ft. Lyon,
CO. In this case, excess VA property used as medical center and
nursing home care facilities would be conveyed to the State of
Colorado for use by the State as a corrections facility. Under
the terms of the Committee bill, the conveyance would not take
place unless and until arrangements had been made to protect
the interests of affected patients and employees of the Ft.
Lyon VA Medical Center (VAMC). With respect to patients, VA
would be directed to make alternate arrangements to ensure that
appropriate medical care and nursing home care services would
continue to be provided, on the same basis that care had been
provided at the Ft. Lyon VAMC, to all veterans who had been
receiving such services at the medical center. Such services
would be provided, if necessary, by community facilities at VA
expense notwithstanding any legal limitations--e.g., those set
forth in 38 U.S.C. Sec. 1720 limiting the time for which such
care might be provided to veterans for non-service-connected
disabilities--that might otherwise apply. Further, VA would be
authorized to offer voluntary separation incentive payments to
eligible employees of the Ft. Lyon VAMC. In addition, the State
would be required to allow public access to the Kit Carson
Chapel located on the grounds of the VAMC. And, finally, the
Committee bill would require that VA file a report, not later
than 1 year after the conveyance, concerning the status of the
VA health care system in Southern Colorado.
Cost Estimate
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the Congressional Budget Office
(hereinafter, ``CBO''), estimates that enactment of the
Committee bill would result in an increase in direct spending,
as compared to costs under current law and as scored against
the current CBO baseline, of $44 million in fiscal year 2001,
$651 million in fiscal years 2001 through 2005, and $1.7
billion in fiscal years 2001 through 2010. In addition,
enactment of the Committee bill would, according to CBO, result
in additional outlays of $64 million in fiscal year 2001, and
$369 million in fiscal years 2001 through 2005, assuming
appropriations of the necessary amounts. The Committee bill
would not affect the budgets of State, local, or tribal
governments, and would impose no intergovernmental or private
sector mandates as defined in the Unfunded Mandates Reform Act.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:
U.S. Congress,
Congressional Budget Office,
Washington, DC, August 22, 2000.
Hon. Arlen Specter,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 1810, the Veterans
Programs Enhancement Act of 2000.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Dan L. Crippen, Director.
Enclosure.
congressional budget office cost estimate
S. 1810--Veterans Programs Enhancement Act of 2000
Summary: S. 1810 contains provisions that would affect a
wide range of veterans' programs, including readjustment
benefits, disability compensation, dependency and indemnity
compensation (DIC), and veterans' medical care. CBO estimates
that enacting the bill would increase direct spending by $44
million in 2001, $651 million over the 2001-2005 period, and
$1.7 billion over the 2001-2010 period. Because the bill would
affect direct spending, pay-as-you-go procedures would apply.
In addition, the bill would authorize funding or modify
provisions governing a number of discretionary veterans'
programs, which would result in additional outlays of $64
million in 2001 and $369 million over the 2001-2005 period,
assuming appropriation of the necessary amounts.
S. 1810 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments. Any costs to state, local, or tribal governments
as a result of enactment of this bill would be incurred
voluntarily.
Estimated cost to the Federal Government: The estimated
budgetary impact of the bill is shown in Table 1. The costs of
this legislation fall within budget function 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED BUDGETARY IMPACT OF S. 1810, AS ORDERED REPORTED BY THE SENATE COMMITTEE ON VETERANS'
AFFAIRS
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars
-------------------------------------------------
2001 2002 2003 2004 2005
----------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Estimated budget authority.................................... 32 76 154 177 197
Estimated outlays............................................. 44 81 152 176 198
CHANGES IN SPENDING SUBJECT TO APPROIPRIATION
Estimated authorization level................................. 126 93 61 61 61
Estimated outlays............................................. 64 98 72 71 64
----------------------------------------------------------------------------------------------------------------
basis of estimate
Direct spending
The bill would affect direct spending in several programs,
including disability compensation, veterans' home loans, and
readjustment benefits (see Table 2).
Disability Compensation.--Enacting the bill would increase
direct spending for compensation for veterans exposed to
radiation, veterans who suffer a service-connected loss of one
or both breasts, and certain veterans' children with birth
defects.
Veterans exposed to radiation.--Section 102 would add four
conditions to the list of diseases presumed to be connected to
participation in atmospheric testing or occupation of Hiroshima
and Nagasaki. By requiring a presumption that, for certain
veterans, these illnesses are service-connected, the bill would
increase the number of radiation-exposed veterans who are
eligible for disability compensation or whose spouses are
eligible for dependency and indemnity compensation. CBO
estimates that enacting section 102 would increase direct
spending by $19 million in 2001 and by about $513 million over
the 2001-2005 period.
Data from the Defense Special Weapons Agency (formerly the
Defense Nuclear Agency) indicate that approximately 210,000
military personnel participated in atmospheric nuclear tests.
In addition, approximately 200,000 military personnel
participated in the post-war occupation of Hiroshima and
Nagasaki, Japan. Assuming that the average age of participants
was 24 years at the time for participation, CBO estimates that
about 200,000 of those veterans are alive today.
TABLE 2.--ESTIMATED CHANGES IN DIRECT SPENDING UNDER S. 1810
----------------------------------------------------------------------------------------------------------------
By fiscal year, outlays in millions of dollars
-----------------------------------------------------------
2000 2001 2002 2003 2004 2005
----------------------------------------------------------------------------------------------------------------
DISABILITY COMPENSATION
Spending under current law.......................... 18,816 19,719 20,505 21,215 21,898 24,377
Proposed changes.................................... 0 20 63 121 146 169
-----------------------------------------------------------
Spending under S. 1810........................ 18,816 19,739 20,568 21,336 22,044 24,546
===========================================================
VETERANS' HOME LOANS
Spending under current law.......................... 506 187 154 395 393 390
Proposed changes.................................... 0 9 8 25 25 24
-----------------------------------------------------------
Spending under S. 1810........................ 506 196 162 420 418 414
===========================================================
READJUSTMENT BENEFITS
Spending under current law.......................... 1,459 1,473 1,489 1,512 1,545 1,587
Proposed changes.................................... 0 1 2 2 2 2
-----------------------------------------------------------
Spending under S. 1810........................ 1,459 1,474 1,491 1,514 1,547 1,589
===========================================================
SERVICE-DISABLED VETERANS' INSURANCE
Spending under current law.......................... 13 18 5 5 5 5
Proposed changes.................................... 0 (\1\) (\1\) 1 1 1
-----------------------------------------------------------
Spending Under S. 1810........................ 13 18 5 6 6 6
===========================================================
PRESCRIPTION COPAYMENTS
Spending under current law.......................... 0 -68 -41 -41 -39 -36
Proposed changes.................................... 0 14 8 3 2 2
-----------------------------------------------------------
Spending under S. 1810........................ 0 -54 -33 -38 -37 -34
----------------------------------------------------------------------------------------------------------------
\1\ Less than $500,000.
To estimate the caseload of veterans having each disease,
CBO used disease and age-specific incidence and mortality rates
from the National Cancer Institute. (CBO has no basis for
estimating different incidence and mortality rates for this
particular population.) Based on this analysis, CBO estimates
that about 8,000 of these veterans and nearly 11,000 spouses of
deceased veterans would be eligible for benefits in 2001. The
estimate assumes that roughly 25,000 veterans died from these
diseases during the 1945-2000 period, that two-thirds of the
deceased veterans had spouses, that 20 percent of those spouses
remarried, making them ineligible for DIC, and that some
spouses died during the same period.
For the 2001-2005 period, CBO estimates benefit payments
based on the incidence of the qualifying diseases, expected
mortality rates among veterans and survivors, the number of
potential beneficiaries at the start of 2001, and assumptions
about annual participation. CBO projects that of the 19,000
veterans and survivors who would be eligible for benefits in
2001 about 2,000 would receive benefits in that year.
Recognizing that a small number of affected veterans and
survivors may draw benefits under current law and that not all
potential new beneficiaries would participate, CBO assumes that
50 percent of all eligible survivors at the end of 2000 would
apply for benefits and 75 percent of all veterans and post-1998
survivors would participate in the program. We also assume that
it would take about three years to reach the full estimated
participation rate. CBO anticipates that by 2005 approximately
13,000 veterans and survivors would receive benefits as a
result of enacting this section.
CBO used data from the Department of Veterans Affairs (VA)
that was specific to the four diseases to calculate the average
compensation payments to veterans. Average annual benefits for
veterans with the diseases vary from about $16,000 for brain
cancer to about $5,000 for ovarian cancer, reflecting the
differing disability ratings of veterans currently receiving
benefits for these illnesses. However, those benefit levels
also include payments to veterans for additional disabilities,
and thus incremental benefits under section 102 would be less
than those averages. CBO has no information as to what portions
of those averages stem from disabilities other than those
covered by the bill. We assume that incremental compensation
benefits would fall below those averages by $2,000. For DIC
recipients, the estimated benefit is approximately $11,000
annually for all survivors. This estimate also assumes that
beneficiaries would receive annual cost-of-living adjustments.
Section 102 also would lead VA to provide additional
medical care services, assuming appropriation of necessary
amounts. Information about those estimated costs are provided
below with other spending subject to appropriation.
Compensation for mastectomies.--Section 103 would provide
additional disability compensation to veterans who suffer a
service-connected loss of one or both breasts by mastectomy.
Under current law, veterans who lose certain body parts or
sensory or vocal capabilities because of a service-connected
condition are entitled to special monthly compensation of $76 a
month in 2000 for each eligible impairment. Section 103 would
authorize these special payments for veterans who have lost one
or both breasts from a radical or modified mastectomy that is
related to a service-connected condition.
CBO estimates that about 350 veterans are currently
receiving disability payments for these type of mastectomies,
and based on data from VA, about 35 new beneficiaries are added
every year. Over the 2001-2004 period, the new payments would
cost less than $500,000 annually. From 2005 through 2010,
annual spending would be over $500,000 but less than $1
million.
Children with birth defects.--Under current law, certain
children with spina bifida are eligible for benefits from VA.
Section 162 would extend those benefits to certain children
with other birth defects. Children with birth defects that are
genetic in nature and that arise from well-known and recognized
causes would not be eligible.
This section provides for a monthly allowance to be paid to
each individual based on the severity of the disability. The
bill would establish four levels of disability and associated
payments that would range from $100 a month to $1,272 a month.
For this estimate, CBO assumes that potential beneficiaries
would be distributed uniformly across the four categories and
that 75 percent of them would apply for and receive payments.
CBO estimates that the allowance would cost about $1 million a
year.
Section 162 also would extend health care benefits to these
children, assuming appropriation of the necessary amounts.
Information about the estimated costs are provided below with
other spending subject to appropriation.
Veterans' Home Loans.--The bill also would increase direct
spending for certain veterans' housing benefits.
Increase in loan guaranty.--Section 122 would increase the
maximum loan guaranty amount from $50,750 to $63,175, thereby
raising the maximum loan amount from $203,000 to $252,700 (for
large loan amounts, VA can only guaranty 25 percent of the loan
amount). CBO estimates that enacting this section would
increase direct spending by $9 million in 2001 and by $90
million over the 2001-2005 period. The cost over 10 years would
be approximately $220 million. Based on information from VA,
CBO estimates that the provision would result in 8,000 new
loans a year over the 2001-2010 period. In addition, roughly
3,000 loans each year would now be made with higher loan
amounts--these would not be new borrowers, but veterans who
would no longer need a downpayment to qualify for the VA loan
guaranty benefit.
Other housing provisions.--Section 121 would prohibit VA
from reducing a grant for specially adapted housing if the
title to the property is held jointly by the veteran and
another person. Section 123 would waive the loan fee for any
veteran who has been rated eligible for compensation benefits
even if an effective date for receiving compensation has not
yet been established; under current law, a veteran must be
receiving compensation payments before the loan fee is waived.
Both sections would affect few borrowers and would have
insignificant effects on direct spending.
Readjustment Benefits.--Subtitle B contains several
provisions that would affect veterans readjustment benefits.
Diploma requirement.--To be eligible for the Montgomery GI
Bill (MGIB) under current law, an individual must meet certain
educational prerequisites before the end of his or her initial
period of obligated service. Section 111 would remove the time
constraint by allowing a secondary school diploma or its
equivalent to be obtained at any time before applying for MGIB
benefits. Based on information from the Department of Defense
(DoD), CBO estimates that this section would make an additional
300 individuals eligible for the program each year. Based on
current usage rates for MGIB benefits, CBO estimates an
additional 20 trainees would use MGIB benefits in 2001,
increasing to almost 300 additional trainees in 2010. CBO
estimates that the provision would cost $100,000 in 2001, $2
million over the 2001-2005 period, and $7 million over the
2001-2010 period.
Obligation for duty.--MGIB eligibility also requires an
individual to complete his initial service obligation. Section
112 would relax that requirement, allowing eligibility to be
based on any completed period of obligated service. This would
allow an individual who separated from the service during one
period of duty to qualify for MGIB benefits by completing a
subsequent obligated period of service. Based on information
from DoD, CBO estimates that, of those individuals separating
from the service each year, an additional 65 would be eligible
for MGIB benefits. Assuming that about half of these
individuals use their benefits and that they train according to
current usage rates, the cost would be about $60,000 in 2001,
about $1 million over the 2001-2005 period, and about $3
million over the 2001-2010 period.
Preparatory courses.--Section 113 would extend MGIB
benefits to cover preparatory courses for college or graduate
school entrance exams. Veterans who would otherwise consume
their entire entitlement would forgo a payment at the end of
their training if they use the benefit under this section, but
for all other veterans, this section would add to spending. CBO
estimates that this provision would increase direct spending by
about $3 million over the 2001-2005 period. The estimate
assumes that each year about 1,700 participants would receive
an average benefit of about $365 for preparatory courses.
Period of eligibility.--Section 114 would offer certain
children, who are eligible for education benefits because of
the service-connected death or total disability of a parent, a
greater choice as to the beginning date of their eligibility
period. Current law allows a child who becomes eligible for
such benefits between the ages of 18 and 26 to choose a
starting date that is either the date of the parent's death or
the date the Secretary of Veterans Affairs finds the death to
be service-connected. Section 114 would allow those adult
children to begin the period of eligibility at any time between
those two dates. Similarly, adult children whose eligibility is
based on a parent's disability could choose to begin their
eligibility periods at any time between the effective date of
the parent's disability and the date the Secretary first finds
the disability to be permanent, total, and service-connected.
The bill would extend the eligibility period for about
1,700 adult children whose benefits expire each year according
to data from VA. About 7 percent of them are training when they
reach the end of the eligibility period. CBO assumes that half
of those adult children whose eligibility period expires could
gain extra time by changing their start dates as the bill would
allow. CBO estimates this provision would result in an
additional 60 trainees a year at a total annual cost of about
$200,000.
Effective date of entitlement.--Section 115 would allow
retroactive payments to otherwise eligible dependents of
veterans for education undertaken during the period after the
veteran died or became totally disabled but before the
disability was found to be total or the death or disability was
found to be service-connected. Currently, most dependents file
an application for benefits after the Secretary's finding of
service-connected death or disability. While this finding may
be made several years after the date of death or what is found
to be the effective date of the disability, benefits may not be
granted for more than one year before the date of receipt of
the dependent's application. This section would direct the
Secretary to consider any application received within a year of
the finding to have been filed on the effective date of death
or disability.
Based on information from the VA, CBO estimates section 115
would initially result in about 125 additional requests for
retroactive benefits in 2001 and 2002, and about 50 additional
requests in succeeding years. Thus, the cost would be higher in
the first few years because of a backlog of newly qualified
applicants. The estimated cost over the 2001-2005 period would
be about $2.5 million.
Service-Disabled Veterans' Insurance.--The Service-Disabled
Veterans' Insurance (SDVI) program insures veterans with
service-connected disabilities. Participants receive a subsidy
equal to the difference between the premiums they pay, which
account for age but not disabilities, and the actual cost of
the program. The term policies are renewable for life, but the
premiums at the older ages can be costly. Section 131 would
eliminate increases in premiums when beneficiaries over age 70
renew their policies; that is, premiums on renewals would be
capped at the rate for 70-year-olds.
For this estimate, CBO used data from VA on premiums for
policyholders 70 or more years of age and the premiums under
the proposed cap. The difference represents an additional
subsidy that VA would provide. For 2001 and 2002, the cost
would be less than $500,000 annually. From 2003 through 2005,
the annual cost would be more than $500,000 but less than $1
million.
Prescription Copayments.--The bill contains a provision
that would lower the amounts that VA receives from copayments
for medical care. Under current law, VA may spend some of those
receipts; thus, the impact on direct spending is limited to the
effects of timing and the likelihood that VA does not spend as
much as it collects. Because receipts would be forgone before
spending would be lowered, the effect of timing is to raise
costs in the near term. Eventually, the lowered spending would
offset the loss of receipts except, however, to the extent that
VA does not spend all that it could from those collections. CBO
estimates that this provision would cost $14 million in 2001,
but the annual cost would decline to about $2 million a year by
2004. At some point after then reduced spending might offset
the forgone receipts. Other assumptions and impacts of this
provision are discussed below with other parts of the bill that
would affect spending subject to appropriation.
Burial Benefits for Certain Filipino Veterans.--Section 141
would expand the eligibility for interment in national
cemeteries to certain Filipino veterans of World War II (WWII).
Current law allows for certain members of Philippine military
forces that were in service to the Armed Forces of the United
States during World War II to receive some veterans' benefits.
This provision would allow for the burial of these veterans in
national cemeteries. Using the number of living WWII Filipino
veterans, expected mortality rates, assumptions about veterans'
burial rates in national cemeteries, and the costs for such
interment, CBO estimates that it would cost less than $500,000
annually to provide this benefit.
Spending subject to appropriation
Table 3 shows the estimated effects of S. 1810 on
discretionary programs, assuming that appropriations are
provided in the amount of the estimated authorizations.
Medical Care.--Implementing the bill would increase
discretionary spending for veterans' medical care by $58
million in 2001 and $287 million over the 2001-2005 period.
TABLE 3. ESTIMATED CHANGES IN SPENDING SUBJECT TO APPROPRIATION FOR S. 1810
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars
-----------------------------------------------------------
2000 2001 2002 2003 2004 2005
----------------------------------------------------------------------------------------------------------------
VETERANS' MEDICAL CARE
Spending under current law:
Estimated authorization level 1,2............... 19,493 19,493 19,493 19,493 19,493 19,493
Estimated outlays:.............................. 18,791 19,312 19,441 19,415 19,396 19,377
Proposed changes:
Estimated authorization level................... 0 72 86 53 53 53
Estimated outlays............................... 0 58 78 49 51 51
Spending under S. 1810:
Estimated authorization level................... 19,493 19,565 19,579 19,546 19,546 19,546
Estimated outlays............................... 18,791 19,370 19,518 19,464 19,447 19,428
GENERAL OPERATING EXPENSES
Spending under current law:
Estimated authorization Level 1,2............... 941 941 941 941 941 941
Estimated outlays............................... 925 941 941 941 941 941
Proposed changes:
Estimated authorization level................... 0 4 7 8 8 8
Estimated outlays............................... 0 4 7 7 8 8
Spending under S. 1810:
Estimated authorization level................... 941 945 948 949 949 949
Estimated outlays............................... 925 945 948 948 949 949
CONSTRUCTION OF MEDICAL FACILITIES
Spending under current law:
Budget authority 1.............................. 65 0 0 0 0 0
Estimated outlays............................... 253 217 171 116 56 27
Proposed changes:
Estimated authorization level................... 0 50 0 0 0 0
Estimated outlays............................... 0 2 13 16 12 5
Spending under S. 1810:
Estimated authorization level................... 65 50 0 0 0 0
Estimated outlays............................... 253 219 184 132 68 32
SUMMARY OF CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated authorization level................... 0 126 93 61 61 61
Estimated outlays............................... 0 64 98 72 71 64
----------------------------------------------------------------------------------------------------------------
\1\ The figure shown for 2000 is the amount appropriated for that year.
\2\ The estimate assumes that funding under current law will remain at the level appropriated for 2000 without
adjustment for inflation. If funding over the 2001-2005 period is adjusted for inflation, the base amounts for
medical care and general operating expenses would increase by about $600 million a year and $30 million a
year, respectively. In both cases the estimated changes would remain as shown under ``Proposed Changes.''
Prescription copayments. Under current law, VA provides
prescription drugs to beneficiaries when VA both writes and
fills a prescription. The current copayment for these
prescriptions is $2, although VA may increase the copayment to
$5 in early 2001. Many veterans are exempted from the copayment
because they have service-connected disabilities or a low
enough income. Section 201 would raise the income threshold
thereby increasing the number of veterans who would not pay for
prescriptions.
For income-based exemptions the current threshold is about
$9,000 for a single individual, although the amount varies
based on the number of dependents. The new threshold would be
roughly $22,000 for a single individual. According to VA, the
individuals in the affected category purchase about 40 percent
of the prescriptions for which VA charges a copayment. In 2001,
CBO expects pharmaceutical copayments to reach about $80
million from the $2 copayment amount and an additional $120
million from the increase in pharmaceutical copayments from $2
to $5. Thus, the cost of the proposal would be 40 percent of
those amounts.
Differentiating the copayment into two streams is important
because the relevant amounts are treated differently in federal
budgeting. Money from the first $2 in copayments can be spent
by VA only if it receives a subsequent appropriation. (The
authority to collect the first $2 of the copayment expires at
the end of fiscal year 2002.) Additional copayment receipts
over $2 can be spent automatically, that is, without further
appropriation. Although the forgone receipts are nearly offset
by a reduction in spending, the provision would result in a
greater demand for appropriations to offset the reduced
spending. CBO estimates that VA's need for discretionary
funding would increase by $297 million over the 2001-2005
period.
Veterans exposed to radiation.--VA provides medical care to
veterans based on priorities established in law. The highest
priorities are given to veterans with service-connected
disabilities, but VA also has a program to provide health care
to veterans with potentially radiogenic diseases, but only for
treatment of those diseases. Under section 102, certain
veterans with lung, ovarian, colon, and tumors of the brain and
central nervous system would receive the highest priorities
because their diseases would be presumed to be service-
connected. By requiring this presumption of service connection,
the bill would probably draw a greater number of veterans to VA
for care. It might also lead some veterans who currently
receive care from VA to have a greater share of their needs
taken care of by VA.
CBO estimates that implementing the bill would raise
spending on veterans' medical care for radiation-related
treatment by $1 million in 2001 and by $14 million over the
2001-2005 period, assuming appropriation of the necessary
amounts. This estimate depends primarily on assumptions about
how many of the affected veterans already receive the highest
priorities, how many veterans the bill would attract to the VA
health system, and how many current patients would receive a
greater range of care. The key assumptions are as follows:
Roughly one-third of these veterans would already
have high-priority access based on other compensable service-
connected disabilities or income, as allowed under current law.
(This figure is based on CBO's estimate of the proportion of
WWII veterans with such status in 1996.)
About one-tenth of the veterans who gain a higher
priority would use VA medical services. CBO estimates that VA's
per capita spending would be about $13,000 annually for most
new cancer patients. This cost factor, which is roughly three
times VA's average annual cost per user, is based on a recent
study showing a comparable difference between Medicare's
average annual cost per beneficiary with certain types of
cancer, including lung cancer, and all beneficiaries who
receive medical care. CBO estimates that care for the remaining
new patients would cost VA the same per capita amount that it
spends for current patients.
About one-fourth of the veterans who would use
priority care under this bill would already be receiving cancer
treatment from VA, based on data from the 1992 Survey of
Veterans. CBO estimates that VA would spend an additional
$1,300 annually for these veterans.
Section 102 also would provide for additional payments of
disability compensation and DIC that would constitute direct
spending. The estimates of those costs are discussed above
under the heading ``Direct Spending.''
Children with birth defects.--Under current law, certain
children with spina bifida are eligible for benefits from VA.
Section 162 would extend those benefits to certain children
with other birth defects. CBO estimates that fewer than 200
people would be eligible for benefits under the bill, based on
information from VA and adjustments for mortality and the
severity of the birth defect. Given the potential for severe
birth defects, we estimate that the cost of providing health
care to those individuals could total up to $12,000 per person.
As with spina bifida patients, new beneficiaries would not need
to receive their health care at VA facilities, but could
instead be reimbursed by VA for care received outside of the VA
system. Because the health care need not be received at VA
facilities, CBO expects that roughly 50 percent of those
eligible would use this benefit. (If the care had to be
received at VA facilities, we expect that this percentage would
be significantly lower.) CBO estimates that providing health
care to these people would cost $1 million a year, assuming
appropriation of the necessary amounts.
This section also provides for a monthly allowance that
would constitute direct spending. The estimates of those costs
are discussed above under the heading ``Direct Spending.''
General Operating Expenses.--CBO estimates that
implementing S. 1810 would increase VA operating expenses by $4
million in 2001 and $34 million over the 2001-2005 period.
Section 101 would require VA to provide more assistance than it
does under current law to veterans who file claims for
benefits. The bill would require VA to pursue certain records
that are necessary to establish a claim, to inform veterans of
any information the VA needs to adjudicate an incomplete claim,
pursue information the veteran authorizes or requests the VA to
obtain, and inform the veteran when the department cannot
locate information pertinent to a claim.
If relevant for claims to disability compensation, VA would
be required to obtain pertinent records, including a veterans'
medical record from military service, his or her service
record, any records of treatment provided by the VA, and any
other relevant materials available from other federal agencies.
The bill would also require VA to provide medical exams to
veterans who need them to substantiate their claims. Also, the
bill would allow any claimant who had a claim denied since July
14, 1999, to resubmit it if the claim was denied because of
insufficient evidence.
CBO expects that, in order to carry out its
responsibilities under section 101, VA would have to hire
additional claims adjudicators. Based on information from the
VA, CBO assumes that 110 additional claims adjudicators would
be hired at an estimated cost of $3 million in salary and
benefits in 2001 and about $7 million annually thereafter. CBO
estimates that training would cost about $1 million a year and
that one-time costs associated with expanding the claims
processing staff would be about $700,000 in 2001. The cost of
providing medical exams is covered under current law. CBO does
not expect a significant increase in benefit payments as a
result of this bill.
Construction of Medical Facilities.--Section 303 would
authorize appropriations of $50.1 million to complete three
projects that are specified in the bill and to continue certain
projects authorized under current law. CBO estimates that those
funds would be spent over the next five years, with most of the
outlays occurring from 2002 through 2004.
Dose Reconstruction Review.--Section 171 would require DoD
to enter into a contract with the National Academy of Sciences
(NAS) to carry out periodic reviews of the dose reconstruction
program, which is used to estimate the amount of radiation to
which certain veterans may have been exposed. Between 1945 and
1962 about 200,000 active military personnel participated in
atmospheric nuclear tests, and some were exposed to potentially
harmful doses of radiation. For certain types of cancers not
automatically presumed linked to radiation exposure, dose
reconstruction is used to adjudicate compensation benefits.
This section would require NAS to review the current dose
reconstruction program, over a period of not more than 24
months, to determine its accuracy. Based on information
provided by NAS, CBO estimates that the two-year study would
cost less than $1 million.
Pay-as-you-go Considerations: The Balanced Budget and
Emergency Deficit Control Act sets up pay-as-you-go procedures
for legislation affecting direct spending or receipts. The net
changes in direct spending are shown in the following table.
For the purposes of enforcing pay-as-you-go procedures, only
the effects in the current year, the budget year, and the
succeeding four years are counted.
TABLE 4. ESTIMATED IMPACT OF S. 1810 ON DIRECT SPENDING AND RECEIPTS
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars
---------------------------------------------------------------------------------------
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
--------------------------------------------------------------------------------------------------------------------------------------------------------
Changes in outlays.............................................. 0 44 81 152 176 198 193 186 208 214 217
Changes in receipts............................................. Not applicable
--------------------------------------------------------------------------------------------------------------------------------------------------------
Intergovernmental and private-sector impact: S. 1810
contains no intergovernmental or private-sector mandates as
defined in UMRA. A provision of the bill that would authorize
the conveyance of the Fort Lyon medical facility would place
certain conditions on the state of Colorado. Any costs to the
state as a result of those conditions would be incurred
voluntarily. The remaining provisions of the bill would impose
no costs on state, local, or tribal governments.
Estimate prepared by: Federal Costs: Veterans Home Loans:
Sunita D'Monte; Readjustment Benefits: Sarah T. Jennings;
Disability Compensation: Michelle Patterson; and Veterans
Medical Programs: Sam Papenfuss.
Impact on State, Local, and Tribal Governments: Susan Sieg
Tompkins.
Impact on the Private Sector: Rachel Schmidt.
Estimate approved by: Peter H. Fontaine, 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 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 27, 2000, meeting. On that date,
the Committee, by unanimous voice vote, ordered S. 1810, as
amended, reported favorably to the Senate.
Agency Report
On July 20, 2000, the Honorable Joseph Thompson, Under
Secretary for Benefits, Department of Veterans Affairs,
appeared before the Committee and submitted testimony on, among
other things, a draft bill to increase, effective as of
December 1, 2000, the rates of compensation for veterans with
service-connected disabilities and the rates of dependency and
indemnity compensation for the survivors of certain disabled
veterans. Excerpts from this statement are reprinted below:
Statement of Joseph Thompson, Under Secretary for Benefits, Department
of Veterans Affairs, before the Committee on Veterans' Affairs, United
States Senate, July 20, 2000
introduction
Mr. Chairman and Members of the Committee, thank you for
the opportunity to testify today on the Department of Veterans
Affairs (sic) disability claims processing. I am pleased to be
here with you to provide a status report on the adjudication of
these claims and to discuss the efforts the Department has made
to improve claims processing.
* * * * * * *
legislation
Mr. Chairman, you have also asked that we comment on
several bills, including S. 1810, S. 2264, S. 2544, S. 2637, S.
2827, and 3 draft bills which your staff provided late last
week. In view of the short amount of time available for the
formulation of this testimony, we are unable to present the
Department's views with respect to certain provisions of the
bills and draft proposals. However, we will be pleased to
provide our formal written views concerning them at a later
date once the necessary executive branch coordination is
completed.
* * * * * * *
S. 1810 and Section 101 of Draft Bill [O:/ARM/ARM00.997--July 13,
2000]--Duty to Assist
S. 1810 would amend 38 U.S.C. Sec. 5107(a) to clarify that
VA has a duty to assist all claimants in developing the facts
pertinent to their claims. This would countermand precedent
decisions of the United States Court of Appeals for Veterans
Claims and the United States Court of Appeals for the Federal
Circuit which have held that VA is required to assist only
those claimants who have shown that their claims are ``well
grounded,'' as that term has been defined by the courts.
Section 101 of the draft bill would, similarly, eliminate
the well-grounded claim threshold for VA's duty to assist. That
section would also specify a number of actions VA would be
required to take to carry out its duty to assist, including
special requirements in claims for service-connected disability
compensation, the most frequently claimed VA benefit. The
required actions would include informing claimants of the type
of evidence that would be helpful to their claims, obtaining
service medical records, VA treatment records, and other
records which claimants have adequately identified and
authorized VA to obtain, and providing medical examinations or
medical opinions when necessary.
Section 101 also contains a provision which would permit
readjudication of any claim that was denied as being not well
grounded on or after July 14, 1999, the date of the CAVC's
decision in Morton v. West, 12 Vet. App. 477 (1999). In Morton,
the CAVC held that VA cannot assist a claimant whose claim is
not well grounded. As a result of that decision, VA has had to
greatly restrict assistance to claimants whose claims are not
well grounded.
VA supports the purpose of both proposals which is to
clarify VA's duty to assist claimants in processing claims.
However, we believe that a more detailed approach, such as that
reflected in section 101 of the draft bill, is preferable
because it would establish greater certainty concerning the
requirements of VA's duty and would limit the need for judicial
interpretation of these important provisions. Additionally,
because this approach would provide a clear statutory framework
for the claim-development process, VA would be able to
implement those provisions more quickly and efficiently,
without the need to rely extensively upon future rule making to
establish uniform procedures for assisting claimants.
However, the details in the language used in the draft bill
could have an enormous impact on the resources of the
Department. Once we have had more time to consider the language
of the draft bill, we will be pleased to provide our formal
views regarding the duty to assist provisions contained in it,
as well as an estimate of the effect of this language on VBA's
administrative expenses in the General Operating Expenses
appropriation.
S. 2544 and Draft Bill [O:/ARM/ARM00.881--June 16, 2000]--Women's
Health Issues
S. 2544--Benefits for Children of Women Vietnam Veterans Who Were Born
With Certain Birth Defects and Section 2 of Draft Bill
Mr. Chairman, you also asked that we provide comment
regarding S. 2544, 106th Congress, the ``Children of Women
Vietnam Veterans' Benefits Act of 2000,'' a bill to provide
compensation and benefits to children of women Vietnam veterans
who were born with certain birth defects. VA strongly supports
the enactment of this bill.
Background
In March 1999, the Secretary of Veterans Affairs appointed
a task force, headed by the Under Secretary for Health, to
review a report issued by the National Academy of Sciences'
(NAS) Institute of Medicine (IOM) in February entitled
``Veterans and Agent Orange: Update 1998'' and to make
appropriate recommendations to the Secretary regarding matters
addressed in the report. The task force established a working
group of knowledgeable individuals from within VA and from
other Federal organizations who reviewed and analyzed the
report and solicited input from veterans service organizations
and other interested groups.
The working group also reviewed a report, issued in October
1998, of a study conducted by VA's Environmental Epidemiology
Service entitled the ``Women Vietnam Veterans Reproductive
Outcomes Health Study.'' This study was not addressed in the
NAS report. This study represented the last of three
epidemiologic studies of women Vietnam veterans conducted in
response to a congressional mandate for a comprehensive study
of any long-term adverse health effects they may have suffered.
In the VA study, a total of 4,140 women Vietnam veterans
surviving as of January 1, 1992, and an equal number of women
who served during the Vietnam-era but not in Vietnam, were
identified for a structured telephone health interview.
Overall, almost 92 percent of these women were located and 90
percent of those contacted participated in the study, resulting
in a response rate of 82 percent.
A multivariate analysis of survey results found no
appreciable difference in reported rates of miscarriage,
stillbirth, low birth weight, pre-term births, or infant deaths
between the Vietnam veterans and the Vietnam-era veterans who
did not serve in Vietnam. However, the study identified a
statistically significant increase in birth defects (10.5
percent vs. 7.0 percent) and severe birth defects (7.7 percent
vs. 5.8 percent) in the offspring of women Vietnam veterans in
comparison to the offspring of other women Vietnam-era
veterans. The study found that the risk of a woman Vietnam
veteran having a child with birth defects was significantly
elevated even after adjustment for age, demographic variables,
military characteristics, and smoking and alcohol consumption
of the mothers.
Following its review, the task force recommended that the
VA study be subjected to additional peer review and submitted
to a scientific journal for publication. This study has been
accepted for publication; its expected release date is
September 2000. In addition, the task force recommended that
the Secretary seek statutory authority to provide health care
and other benefits to women Vietnam veterans' offspring with
birth defects. The Secretary approved both recommendations,
and, on July 23, 1999, advised you that VA was in the process
of developing legislation to benefit these individuals. On
March 7, 2000, as a technical service, VA's General Counsel
provided Senator John D. Rockefeller IV with draft bill
language upon which S. 2544 is based.
Provisions of S. 2544
S. 2544 would restructure existing provisions in chapter 18
of title 38, United States Code, and add a new subchapter
authorizing benefits for women Vietnam veterans' children who
were born with certain birth defects. This subchapter would
apply with respect to birth defects, other than spina bifida,
which result in permanent physical or mental disability, except
for birth defects determined by the Secretary to result from
familial disorders, birth-related injuries, or fetal or
neonatal infirmities with well-established causes. In addition,
the provision of health care or other benefits under this
subchapter would not be authorized if evidence establishes that
a particular birth defect suffered by an individual resulted
from a cause other than the mother's service in Vietnam.
The Secretary would be required to identify, within one
year after the date of enactment of the Act, the birth defects
associated with service of women Vietnam veterans in the
Republic of Vietnam during the Vietnam era and to promulgate
regulations delineating the birth defects identified. Certain
categories of birth defects would be excluded because of a
likelihood that they result from inherited disorders rather
than as the result of the mothers' service in Vietnam.
Similarly, defects which result from causes such as birth-
related conditions, or fetal or neonatal infirmities, would
also be excluded.
A key element of S. 2544 is authorization for the provision
of comprehensive medical care, which could be provided directly
by VA or by contract with non-VA providers. Second, because of
the likelihood that individuals who suffer from certain
severely disabling birth defects will encounter difficulties in
pursuing vocational goals, the bill authorizes the Secretary to
assist these individuals through the provision of vocational
training benefits. Finally, in recognition of the additional
financial needs likely to face persons suffering from disabling
birth defects, the bill authorizes the Secretary to provide
these individuals with a monetary allowance to help defray
additional expenses associated with these disabilities. The
Secretary would be required to base the amount of the allowance
on each child's level of disability, in accordance with a
schedule to be established for this purpose. VA would pay the
allowance based upon four levels of disability, resulting in
monthly payments of $100 for the lowest level of disability,
$214 for the lower intermediate level of disability, $743 for
the next higher intermediate level of disability, and $1,272
for the highest level of disability. The dollar amounts for the
upper three levels of disability would be equivalent to the
three levels of allowance currently payable under section 1805
of title 38, United States Code, to children of Vietnam
veterans who suffer from spina bifida. The lower dollar amount
of $100 would provide a limited benefit consistent with a level
of disability that does not result in a significant economic
burden. The legislation would be effective one year after the
date of its enactment, in order to allow time for establishment
of implementing regulations.
VA's Position
VA does not have authority to provide health care or other
benefits to the women Vietnam veterans' children who suffer
from birth defects other than spina bifida. Thus, enabling
legislation is necessary to address the needs of these
children. We believe the legislative model adopted by Congress
in Pub. L. No. 104-204 for the benefit of Vietnam veterans'
children born with spina bifida, which is reflected in the
provisions of S. 2544, is an appropriate one to follow in this
instance. As was the case with Vietnam veterans' children who
suffer from spina bifida, the provision of assistance to women
Vietnam veterans' children who suffer other birth defects would
be an appropriate extension of the principle of providing
benefits for disabilities that are incurred or aggravated as a
result of service on active duty in the Armed Forces of the
United States. Accordingly, we strongly support enactment of
this legislation.
S. 2544 is subject to the PAYGO requirements of the OBRA
and, if enacted, would result in benefit costs of $1.7 million
in Fiscal Year (FY) 2001 and $17 million during FYs 2001-2005.
Section 2 of the draft bill contains provisions similar to
S. 2544.
Special monthly compensation for service-connected loss of one or both
breasts due to mastectomy
Section 3 of the draft bill would authorize special monthly
compensation under 38 U.S.C. Sec. 1114(k) for female veterans
who have suffered the service-connected loss of one or both
breasts (including loss by mastectomy). VA supports this
provision in principle, but would prefer that no distinction be
made between male and female veterans.
Section 1114(k) of title 38, United States Code, authorizes
a special rate of compensation (the ``k'' rate) if a veteran,
as the result of service-connected disability, has suffered the
anatomical loss or loss of use of one or more creative organs,
or one foot, or one hand, or both buttocks, or blindness of one
eye, having only light perception, or has suffered complete
organic aphonia with constant inability to communicate by
speech, or deafness of both ears, having absence of air and
bone conduction. Under current section 1114(k), a monthly award
of $76 is payable, generally, for each such loss or loss of
use. This special monthly compensation is payable in addition
to the compensation payable by reason of percentage disability
ratings assigned under the rating schedule.
Under the current schedule for rating disabilities, the
disability suffered following surgical removal of one breast by
radical mastectomy is assigned a 50% disability rating. (38
C.F.R. Sec. 4.116). The resulting disability following removal
of both breasts by radical mastectomy is currently assigned an
80% disability rating. The loss of one breast by modified
radical mastectomy is rated 40% disabling, and the removal of
both breasts by modified radical mastectomy is rated 60%
disabling. A veteran is also compensated for at least six
months at the total-disability level following the cessation of
any surgical procedure to treat breast cancer.
Special monthly compensation is currently authorized for
certain anatomical losses or losses of use for which the rating
schedule, which is based solely on impairment of earning
capacity, is considered inadequate for compensation purposes.
The statute recognizes that the loss of a hand or foot, for
example, or loss of a creative organ, involves loss of bodily
integrity which may negatively affect self-image and
precipitate considerable emotional distress.
The service-connected radical or modified-radical
mastectomies covered by section 3 involve loss of bodily
integrity and associated emotional trauma to a degree that is
at least comparable to the removal of a single testicle, for
example, for which special monthly compensation is currently
payable regardless of its effect on a veteran's procreative
ability and regardless of whether the veteran is still of
procreative age. As a matter of simple equity, these
mastectomies warrant equal compensation for the veterans who
undergo them.
Section 3 of the draft bill would be subject to the PAYGO
requirement of the Omnibus Budget Reconciliation Act of 1990
(OBRA) and, if enacted, would increase direct spending.
According to our preliminary estimates, enactment of section 3
(with the inclusion of male veterans) would increase benefits
cost by less than $500,000 in FY 2001 and $2.5 million over the
2001-2005 period.
Omnibus Draft Bill [O:/ARM/ARM00.997--July 13, 2000]
VA does not have positions regarding several provisions of
the draft bill. However, we will be pleased to provide our
formal written views concerning them at a later date once the
necessary executive branch coordination is completed. Those
provisions for which we have developed positions follow:
Title I--Compensation and Pension Matters
Our comments on section 101 of the draft bill, regarding
VA's duty to assist veterans in the development of their
claims, are noted above.
Title VII--Construction and Facilities Matters
Sections 701 and 702 of the draft bill would authorize the
Secretary of Veterans Affairs to carry out two major medical
facility projects for fiscal year 2001 using $40,600,000 for
the Construction, Major Projects account.
VA is not opposed to these provisions because they would
authorize funding for the two major medical facility
construction projects located in Palo Alto, California and in
Murfreesboro, Tennessee as reflected in the President's budget.
Last year, Congress appropriated, but did not authorize
$14,000,000 in fiscal year 2000 funding for the Murfreesboro,
Tennessee project. Accordingly, Section 702(a), which
authorizes the appropriations, needs to be changed to
specifically authorize $26,600,000 for fiscal year 2001 for the
Palo Alto California project and $14,000,000 for fiscal year
2000 for the Murfreesboro Tennessee project. Sections 702(a)
and (b) refer to the authorization of funds for fiscal year
2001. This language needs to be extended an additional year for
fiscal year 2002. With this additional language, major
construction projects authorized in fiscal year 2001 but not
carried out until fiscal year 2002 would not have to be
authorized again.
S. 2264--Establishment of Position of Advisor on PAs
Section 2 of S. 2264 would establish a position of Advisor
on Physician Assistants (PAs) within the Office of the Under
Secretary for Health. Section 2 would also require such Advisor
to advise the Under Secretary for Health on matters concerning
the optimal use of physician assistants by the Veterans Health
Administration (VHA) and the feasibility of establishing
clinical privileges and practice areas for this specialty. In
addition, this section would require the Advisor to (1) develop
initiatives to assist the Under Secretary for Health in using
the full range of clinical capabilities of physician assistants
and (2) advise the Under Secretary for Health on policies
affecting the employment of such personnel by VHA.
VHA does not consider it necessary to enact legislation to
require a PA advisor in Headquarters. The Chief Consultant,
Primary and Ambulatory Care who is in direct contact with the
Physician Assistant Field Advisory Group (PAFAG) currently
represents PAs in VHA. The composition of the PAFAG consists of
four PAs and two physicians. Its chairperson serves as program
advisor to the Chief Consultant for Primary and Ambulatory
Care. Further, one PA from that advisory group participates in
Primary and Ambulatory Care office conferences and is routinely
included in office communications and decisions. The current
chairperson of the advisory group, Rebecca Goldsmith, PA-C, has
served on the Under Secretary for Health's Work Group tasked
with Exploring Internal Practice Barriers for Advanced Practice
Nurses, Clinical Pharmacy Specialists and Physician Assistants.
The work group identified barriers to hiring non-physician
health care providers in VHA. Ms. Goldsmith also serves as the
Co-Chair of the Multidisciplinary Practice Advisory Council.
This group is charged with implementing changes to overcome the
barriers to hiring non-physician health providers. VHA has
promulgated the ``PA Employment Handbook'' which has provided
guidance to VHA health care facilities when hiring PAs and the
``PA Practice Issues Handbook,'' which is an educational tool
that assists health care managers to understand the role of PAs
in VHA. The work of Ms. Goldsmith and others on the PAFAG has
helped VHA health facilities to recruit and retain PAs. The
relationship between the Chief Consultant, Primary and
Ambulatory Care and the PAFAG has worked well in supporting the
PA Program.
S. 2637--Miles City, MT Land Transfer and S. 2827--Ft. Lyon, CO Land
Transfer
S. 2637 would require VA, as soon as practicable, to
transfer ownership of the Miles City VA Medical Center complex
to Custer County, Montana. VA has not developed a position with
respect to the transfer of this facility, but we will be
pleased to provide our formal written views at a later date.
Section 1 of S. 2827 would authorize VA to transfer the Ft.
Lyon VA Medical Center to the State of Colorado for the purpose
of establishing a correctional facility. VA has not developed a
position with respect to this bill; however, we will be pleased
to provide our formal written views at a later date.
This concludes my formal testimony.
Changes in Existing Law Made by the Committee Bill, as Reported
In compliance with paragraph 12 of rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
the Committee 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 E--Reserve Components
* * * * * * *
PART IV--TRAINING FOR RESERVE COMPONENTS AND EDUCATIONAL ASSISTANCE
PROGRAMS
* * * * * * *
CHAPTER 1606--EDUCATIONAL ASSISTANCE FOR MEMBERS OF THE SELECTED
RESERVE
* * * * * * *
Sec. 16132. Eligibility for educational assistance
(a) A person who--
(1) * * *
[(2) before completing initial active duty for
training has completed the requirements of a secondary
school diploma (or an equivalency certificate), or in
the case of an individual who reenlists or extends an
enlistment as described in paragraph (1)(A) of this
subsection, has completed such requirements at any time
before such reenlistment or extension;] (2) before
applying for benefits under this section, has completed
the requirements of a secondary school diploma (or an
equivalency certificate);
* * * * * * *
TITLE 38, UNITED STATES CODE
* * * * * * *
CHAPTERS OF TITLE 38
* * * * * * *
PART II--GENERAL BENEFITS
Chap.
11. * * *
* * * * * * *
[18. Benefits for Children of Vietnam Veterans Who Are Born With
Spina Bifida........................................ 1801]
18. Benefits for Children of Vietnam Veterans..................... 1801
* * * * * * *
PART I--GENERAL PROVISIONS
CHAPTER 1--GENERAL
* * * * * * *
Sec. 107. Certain service deemed not to be active service
(a) Service 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 pursuant to the military order of
the President dated July 26, 1941, including among such
military forces 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, shall not be deemed
to have been active military, naval, or air service for the
purposes of any law of the United States conferring rights,
privileges, or benefits upon any person by reason of the
service of such person or the service of any other person in
the Armed Forces, except benefits under--
(1) * * *
* * * * * * *
(3) chapters 11, 13 (except section 1312(a)), and 23
of this title[.], and chapter 24 of this title to the
extent provided for in section 2402(8) of this title.
* * * * * * *
PART II--GENERAL BENEFITS
Chap.
11. * * *
* * * * * * *
[18. Benefits for Children of Vietnam Veterans Who Are Born With
Spina Bifida........................................ 1801]
1801nefits for Children of Vietnam Veterans.....................
* * * * * * *
CHAPTER 11--COMPENSATION FOR SERVICE-CONNECTED DISABILITY OR DEATH
* * * * * * *
Subchapter II--Wartime Disability Compensation
* * * * * * *
Sec. 1112. Presumptions relating to certain diseases and disabilities
(a) * * *
* * * * * * *
(c)(1) * * *
(2) The diseases referred to in paragraph (1) of this
subsection are the following:
(A) * * *
* * * * * * *
(P) Lung cancer.
(Q) Colon cancer.
(R) Tumors of the brain and central nervous system.
(S) Ovarian cancer.
* * * * * * *
Sec. 1114. Rates of wartime disability compensation
For the purposes of section 1110 of this title--
(a) * * *
* * * * * * *
(k) if the veteran, as the result of service-
connected disability, has suffered the anatomical loss
or loss of use of one or more creative organs, or one
foot, or one hand, or both buttocks, or blindness of
one eye, having only light perception, [or has
suffered] has suffered complete organic aphonia with
constant inability to communicate by speech, or
deafness of both ears, having absence of air and bone
conduction, or, in the case of a female veteran, has
suffered the anatomical loss of one or both breasts
(including loss by mastectomy), the rate of
compensation therefor shall be $76 per month for each
such loss or loss of use independent of any other
compensation provided in subsections (a) through (j) or
subsection (s) of this section but in no event to
exceed $2,533 per month; and in the event the veteran
has suffered one or more of the disabilities heretofore
specified in this subsection, in addition to the
requirement for any of the rates specified in
subsections (l) through (n) of this section, the rate
of compensation shall be increased by $76 per month for
each such loss or loss of use, but in no event to
exceed $3,553 per month;
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
Subchapter III--Miscellaneous Provisions Relating to Hospital and
Nursing Home Care and Medical Treatment of Veterans
* * * * * * *
Sec. 1722A. Copayment for medications
(a)(1) * * *
* * * * * * *
(3) Paragraph (1) does not apply--
(A) * * *
[(B) to a veteran whose annual income (as determined
under section 1503 of this title) does not exceed the
maximum annual rate of pension which would be payable
to such veteran if such veteran were eligible for
pension under section 1521 of this title.] (B) to a
veteran who is considered by the Secretary to be unable
to defray the expenses of necessary care under section
1722 of this title.
* * * * * * *
[CHAPTER 18--BENEFITS FOR CHILDREN OF VIETNAM VETERANS WHO ARE BORN
WITH SPINA BIFIDA]
CHAPTER 18_BENEFITS FOR CHILDREN OF VIETNAM VETERANS
Subchapter I_Children of Vietnam Veterans Born With Spina Bifida
Sec.
1801. * * *
* * * * * * *
[1806. Applicability of certain administrative provisions]
Subchapter II_Children of Female Vietnam Veterans Born With Certain
Birth Defects
1811. Definitions.
1812. Birth defects covered.
1813. Benefits and assistance.
``Subchapter III_Administrative Matters
1821. Applicability of certain administrative provisions.
1822. Treatment of receipt of monetary allowance on other benefits.
Subchapter I_Children of Vietnam Veterans Born With Spina Bifida
Sec. 1801. Definitions
For the purposes of [this chapter] this subchapter--
(1) * * *
* * * * * * *
Sec. 1802. Spina bifida conditions covered
[This chapter] This subchapter applies with respect to all
forms and manifestations of spina bifida except spina bifida
occulta.
* * * * * * *
Sec. 1805. Monetary allowance
(a) The Secretary shall pay a monthly allowance under [this
chapter] this section to any child of a Vietnam veteran for any
disability resulting from spina bifida suffered by such child.
* * * * * * *
[(c) Notwithstanding any other provision of law, receipt by
a child of an allowance under this section shall not impair,
infringe, or otherwise affect the right of the child to receive
any other benefit to which the child may otherwise be entitled
under any law administered by the Secretary, nor shall receipt
of such an allowance impair, infringe, or otherwise affect the
right of any individual to receive any benefit to which the
individual is entitled under any law administered by the
Secretary that is based on the child's relationship to the
individual.
[(d) Notwithstanding any other provision of law, the
allowance paid to a child under this section shall not be
considered income or resources in determining eligibility for
or the amount of benefits under any Federal or federally
assisted program.]
[Sec. 1806. Repealed]
Subchapter II--Children of Female Vietnam Veterans Born With Certain
Birth Defects
Sec. 1811. Definitions
In this subchapter:
(1) The term ``child'', with respect to a female
Vietnam veteran, means a natural child of the female
Vietnam veteran, regardless of age or marital status,
who was conceived after the date on which the female
Vietnam veteran first entered the Republic of Vietnam
during the Vietnam era (as specified in section
101(29)(A) of this title).
(2) The term ``covered birth defect'' means each
birth defect identified by the Secretary under section
1812 of this title.
(3) The term ``female Vietnam veteran'' means any
female individual who performed active military, naval,
or air service in the Republic of Vietnam during the
Vietnam era (as so specified), without regard to the
characterization of the individual's service.
Sec. 1812. Birth defects covered
(a) Identification.--Subject to subsection (b), the
Secretary shall identify the birth defects of children of
female Vietnam veterans that--
(1) are associated with the service of female Vietnam
veterans in the Republic of Vietnam during the Vietnam
era (as specified in section 101(29)(A) of this title);
and
(2) result in the permanent physical or mental
disability of such children.
(b) Limitations.--(1) The birth defects identified under
subsection (a) may not include birth defects resulting from the
following:
(A) A familial disorder.
(B) A birth-related injury.
(C) A fetal or neonatal infirmity with well-
established causes.
(2) The birth defects identified under subsection (a) may
not include spina bifida.
(c) List.--The Secretary shall prescribe in regulations a
list of the birth defects identified under subsection (a).
Sec. 1813. Benefits and assistance
(a) Health Care.--(1) The Secretary shall provide a child
of a female Vietnam veteran who was born with a covered birth
defect such health care as the Secretary determines is needed
by the child for such birth defect or any disability that is
associated with such birth defect.
(2) The Secretary may provide health care under this
subsection directly or by contract or other arrangement with a
health care provider.
(3) For purposes of this subsection, the definitions in
section 1803(c) of this title shall apply with respect to the
provision of health care under this subsection, except that for
such purposes--
(A) the reference to `specialized spina bifida
clinic' in paragraph (2) of such section 1803(c) shall
be treated as a reference to a specialized clinic
treating the birth defect concerned under this
subsection; and
(B) the reference to ``vocational training under
section 1804 of this title'' in paragraph (8) of such
section 1803(c) shall be treated as a reference to
vocational training under subsection (b).
(b) Vocational Training.--(1) The Secretary may provide a
program of vocational training to a child of a female Vietnam
veteran who was born with a covered birth defect if the
Secretary determines that the achievement of a vocational goal
by the child is reasonably feasible.
(2) Subsections (b) through (e) of section 1804 of this
title shall apply with respect to any program of vocational
training provided under paragraph (1).
(c) Monetary Allowance.--(1) The Secretary shall pay a
monthly allowance to any child of a female Vietnam veteran who
was born with a covered birth defect for any disability
resulting from such birth defect.
(2) The amount of the monthly allowance paid under this
subsection shall be based on the degree of disability suffered
by the child concerned, as determined in accordance with a
schedule for rating disabilities resulting from covered birth
defects that is prescribed by the Secretary.
(3) In prescribing a schedule for rating disabilities under
paragraph (2), the Secretary shall establish four levels of
disability upon which the amount of the monthly allowance under
this subsection shall be based.
(4) The amount of the monthly allowance paid under this
subsection shall be as follows:
(A) In the case of a child suffering from the lowest
level of disability prescribed in the schedule for
rating disabilities under this subsection, $100.
(B) In the case of a child suffering from the lower
intermediate level of disability prescribed in the
schedule for rating disabilities under this subsection,
the greater of--
(i) $214; or
(ii) the monthly amount payable under section
1805(b)(3) of this title for the lowest level
of disability prescribed for purposes of that
section.
(C) In the case of a child suffering from the higher
intermediate level of disability prescribed in the
schedule for rating disabilities under this subsection,
the greater of--
(i) $743; or
(ii) the monthly amount payable under section
1805(b)(3) of this title for the intermediate
level of disability prescribed for purposes of
that section.
(D) In the case of a child suffering from the highest
level of disability prescribed in the schedule for
rating disabilities under this subsection, the greater
of--
(i) $1,272; or
(ii) the monthly amount payable under section
1805(b)(3) of this title for the highest level
of disability prescribed for purposes of that
section.
(5) Amounts under subparagraphs (A), (B)(i), (C)(i), and
(D)(i) of paragraph (4) shall be subject to adjustment from
time to time under section 5312 of this title.
(6) Subsections (c) and (d) of section 1805 of this title
shall apply with respect to any monthly allowance paid under
this subsection.
(d) General Limitations on Availability of Benefits and
Assistance.--(1) No individual receiving benefits or assistance
under this section may receive any benefits or assistance under
subchapter I of this chapter.
(2) In any case where affirmative evidence establishes that
the covered birth defect of a child results from a cause other
than the active military, naval, or air service in the Republic
of Vietnam of the female Vietnam veteran who is the mother of
the child, no benefits or assistance may be provided the child
under this section.
(e) Regulations.--The Secretary shall prescribe regulations
for purposes of the administration of the provisions of this
section.
Subchapter III--Administrative Matters
Sec. 1821. Applicability of certain administrative provisions
The provisions of sections 5101(c), 5110(a), (b)(2), (g),
and (i), 5111, and 5112(a), (b)(1), (b)(6), (b)(9), and (b)(10)
of this title shall apply with respect to benefits and
assistance under this chapter in the same manner as such
provisions apply to veterans' disability compensation.
Sec. 1822. Treatment of receipt of monetary allowance on other benefits
(a) Notwithstanding any other provision of law, receipt by
an individual of a monetary allowance under this chapter shall
not impair, infringe, or otherwise affect the right of the
individual to receive any other benefit to which the individual
is otherwise entitled under any law administered by the
Secretary.
(b) Notwithstanding any other provision of law, receipt by
an individual of a monetary allowance under this chapter shall
not impair, infringe, or otherwise affect the right of any
other individual to receive any benefit to which such other
individual is entitled under any law administered by the
Secretary based on the relationship of such other individual to
the individual who receives such monetary allowance.
(c) Notwithstanding any other provision of law, a monetary
allowance paid an individual under this chapter shall not be
considered as income or resources in determining eligibility
for or the amount of benefits under any Federal or Federally-
assisted program.
* * * * * * *
CHAPTER 19--INSURANCE
Subchapter I--National Service Life Insurance
Sec.
1901. * * *
* * * * * * *
1967. * * *
1967A. Insurance of dependents.
* * * * * * *
Subchapter I--National Service Life Insurance
* * * * * * *
Sec. 1922. Service disabled veterans' insurance
(a) * * *
* * * * * * *
(c) The premium rate of any term insurance issued under
this section shall not exceed the renewal age 70 premium rate.
* * * * * * *
Subchapter III--Servicemembers' Group Life Insurance
Sec. 1965. Definitions
For the purpose of this subchapter--
(1) * * *
* * * * * * *
(10) The term `insurable dependent', with respect to
a member, means the following:
(A) The member's spouse.
(B) A child of the member for so long as the
child is unmarried and the member is providing
over 50 percent of the support of the child.
* * * * * * *
Sec. 1967. Persons insured; amount
(a) Any policy of insurance purchased by the Secretary
under section 1966 of this title shall automatically insure
against death--
(1) * * *
(2) any member of the Ready Reserve of a uniformed
service who meets the qualifications set forth in
section 1965(5)(B) of this title; in the amount of
[$200,000] $250,000, unless such member elects in
writing (A) not to be insured under this subchapter, or
(B) to be insured in an amount less than [$200,000]
$250,000 that is evenly divisible by $10,000. The
insurance shall be effective the first day of active
duty or active duty for training, or the beginning of a
period of inactive duty training scheduled in advance
by competent authority, or the first day a member of
the Ready Reserve meets the qualifications set forth in
section 1965(5)(B) of this title, or the date certified
by the Secretary to the Secretary concerned as the date
Servicemembers' Group Life Insurance under this
subchapter for the class or group concerned takes
effect, whichever is the later date.
* * * * * * *
(c) If any member elects not to be insured under this
subchapter or to be insured in any amount less than [$200,000]
$250,000, such member may thereafter be insured under this
subchapter in the amount of [$200,000] $250,000 or any lesser
amount evenly divisible by $10,000 upon written application,
proof of good health, and compliance with such other terms and
conditions as may be prescribed by the Secretary. Any former
member insured under Veterans' Group Life Insurance who again
becomes eligible for Servicemembers' Group Life Insurance and
declines such coverage solely for the purpose of maintaining
such member's Veterans' Group Life Insurance in effect shall
upon termination of coverage under Veterans' Group Life
Insurance be automatically insured under Servicemembers' Group
Life Insurance, if otherwise eligible therefor.
(d) Whenever a member has the opportunity to make an
election under subsection (a) not to be insured under this
subchapter, or to be insured under this subchapter in an amount
less than the maximum amount of [$200,000] $250,000, and at
such other times periodically thereafter as the Secretary
concerned considers appropriate, the Secretary concerned shall
furnish to the member general information concerning life
insurance. Such information shall include--
(1) * * *
* * * * * * *
Sec. 1967A. Insurance of dependents
(a) Subject to the provisions of this section, any policy
of insurance purchased by the Secretary under section 1966 of
this title shall also automatically insure against death each
insurable dependent of a member.
(b)(1) A member insurable under this subchapter may make an
election not to insure a spouse under this subchapter.
(2) Except as provided in subsection (c)(3), a spouse
covered by an election under paragraph (1) is not insured under
this section.
(3) Except as otherwise provided under this section, no
insurable dependent of a member is insured under this section
unless the member is insured under this subchapter.
(c)(1) Subject to an election under paragraph (2), the
amount for which a person insured under this section is insured
under this subchapter is as follows:
(A) In the case of a member's spouse, the lesser of--
(i) the amount for which the member is
insured under this subchapter; or
(ii) $50,000.
(B) In the case of a member's child, $5,000.
(2) A member may elect in writing to insure the member's
spouse in an amount less than the amount provided for under
paragraph (1)(A). The amount of insurance so elected shall be
evenly divisible by $10,000.
(3) If a dependent spouse eligible for insurance under this
section is not so insured, or is insured for less than the
maximum amount provided for under subparagraph (A) of paragraph
(1) by reason of an election made by the member concerned under
paragraph (2), the spouse may thereafter be insured under this
section in the maximum amount or any lesser amount elected as
provided for in paragraph (2) upon written application by the
member, proof of good health of the spouse, and compliance with
such other terms and conditions as may be prescribed by the
Secretary.
(d)(1) Insurance coverage under this section with respect
to an insurable dependent of the member shall cease--
(A) upon election made in writing by the member to
terminate the coverage; or
(B) the date that is 120 days after the earlier of--
(i) the date of the member's death;
(ii) the date of termination of the insurance
on the member under this subchapter; or
(iii) the date on which the insurable
dependent of the member no longer meets the
criteria applicable to an insurable dependent
as specified in section 1965(10) of this title.
(2)(A) At the election of an insured spouse whose insurance
under this subchapter is terminated under paragraph (1), the
insurance shall be converted to an individual policy of
insurance upon written application for conversion made to the
participating company selected by the insured spouse and the
payment of the required premiums.
(B) The individual policy of insurance of an insured spouse
making an election under subparagraph (A) shall become
effective on the date of the termination of the spouse's
insurance under paragraph (1).
(C) The second, fourth, and fifth sentences of section
1977(e) of this title shall apply with respect to the insurance
of an insured spouse under this paragraph.
(e)(1) During any period in which the spouse of a member is
insured under this section, there shall be deducted each month
from the member's basic or other pay, or otherwise collected
from the member, until the member's separation or release from
active duty an amount determined by the Secretary (which shall
be the same for all such members) as the premium allocable to
the pay period for providing that insurance coverage.
(2)(A) The Secretary shall determine the premium amounts to
be charged for insurance coverage for spouses of members under
this section.
(B) The premium amounts shall be determined on the basis of
sound actuarial principles and shall include an amount
necessary to cover the administrative costs to the insurer or
insurers providing such insurance.
(C) Each premium rate for the first policy year shall be
continued for subsequent policy years, except that the rate may
be adjusted for any such subsequent policy year on the basis of
the experience under the policy, as determined by the Secretary
in advance of that policy year.
(3) Any amounts deducted or collected under paragraph (1),
together with the income derived from any dividends or premium
rate adjustments received from insurers with respect to
insurance under this section, shall be deposited to the credit
of the revolving fund established by section 1969(d) of this
title, and shall be available for payment and use in accordance
with the provisions of that section.
(f) Any amount of insurance in force on an insurable
dependent of a member under this section on the date of the
dependent's death shall be paid, upon the establishment of a
valid claim therefor, to the member or, in the event of the
member's death before payment to the member can be made, then
to the person or persons entitled to receive payment of the
proceeds of insurance on the member' life under section 1970 of
this title.
* * * * * * *
Subchapter III--Servicemembers' Group Life Insurance
* * * * * * *
Sec. 1977. Veterans' Group Life Insurance
(a)(1) Veterans' Group Life Insurance shall be issued in
the amounts specified in section 1967(a) of this title. In the
case of any individual, the amount of Veterans' Group Life
Insurance may not exceed the amount of Servicemembers' Group
Life Insurance coverage continued in force after the expiration
of the period of duty or travel under section 1967(b) or
1968(a) of this title. No person may carry a combined amount of
Servicemembers' Group Life Insurance and Veterans' Group Life
Insurance in excess of [$200,000] $250,000 at any one time.
(2) If any person insured under Veterans' Group Life
Insurance again becomes insured under Servicemembers' Group
Life Insurance but dies before terminating or converting such
person's Veterans' Group Insurance, Veterans' Group Life
Insurance shall be payable only if such person is insured for
less than [$200,000] $250,000 under Servicemembers' Group Life
Insurance, and then only in an amount which, when added to the
amount of Servicemembers' Group Life Insurance payable, does
not exceed [$200,000] $250,000.
* * * * * * *
CHAPTER 21--SPECIALLY ADAPTED HOUSING FOR DISABLED VETERANS
* * * * * * *
Sec. 2102. Limitations on assistance furnished
(a) * * *
* * * * * * *
(c) The amount of assistance afforded under subsection (a)
for a veteran authorized assistance by section 2101(a) of this
title shall not be reduced by reason that title to the housing
unit, which is vested in the veteran, is also vested in any
other person, if the veteran resides in the housing unit.
* * * * * * *
CHAPTER 24--NATIONAL CEMETERIES AND MEMORIALS
* * * * * * *
Sec. 2402. Persons eligible for interment in national cemeteries
Under such regulations as the Secretary may prescribe and
subject to the provisions of section 6105 of this title, the
remains of the following persons may be buried in any open
national cemetery under the control of the National Cemetery
Administration:
(1) * * *
* * * * * * *
(8) Any individual whose service is described in
section 107(a) of this title if such individual at the
time of death--
(A) was a naturalized citizen of the United
States; and
(B) resided in the United States.
* * * * * * *
PART III--READJUSTMENT AND RELATED BENEFITS
CHAPTER 30--ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM
* * * * * * *
Subchapter II--Basic Educational Assistance
Sec. 3011. Basic educational assistance entitlement for service on
active duty
(a) Except as provided in subsection (c) of this section,
each individual--
(1) who--
(A) after June 30, 1985, first becomes a
member of the Armed Forces or first enters on
active duty as a member of the Armed Forces
and--
[(i) who (I) serves, as the
individual's initial obligated period
of active duty, at least three years of
continuous active duty in the Armed
Forces, or (II) in the case of an
individual whose initial period of
active duty is less than three years,
serves at least two years of continuous
active duty in the Armed Forces; or]
(i) who serves an obligated period of
active duty of at least two years of
continuous active duty in the Armed
Forces; or
(ii) who serves in the Armed Forces
and is discharged or released from
active duty (I) for a service-connected
disability, for a medical condition
which preexisted such service on active
duty and which the Secretary determines
is not service connected, for hardship,
or for a physical or mental condition
that was not characterized as a
disability and did not result from the
individual's own willful misconduct but
did interfere with the individual's
performance of duty, as determined by
the Secretary of each military
department in accordance with
regulations prescribed by the Secretary
of Defense or by the Secretary of
Transportation with respect to the
Coast Guard when it is not operating as
a service in the Navy; (II) for the
convenience of the Government, [in the
case of an individual who completed not
less than 20 months of continuous
active duty, if the initial obligated
period of active duty of the individual
was less than three years, or in the
case of an individual who completed not
less than 30 months of continuous
active duty if the initial obligated
period of active duty of the individual
was at least three years] if, in the
case of an individual with an obligated
period of service of two years, the
individual completes not less than 20
months of continuous active duty under
that period of obligated service, or,
in the case of an individual with an
obligated period of service of three
years, the individual completes not
less than 30 months of continuous
active duty under that period of
obligated service; or (III)
involuntarily for the convenience of
the Government as a result of a
reduction in force, as determined by
the Secretary of the military
department concerned in accordance with
regulations prescribed by the Secretary
of Defense or by the Secretary of
Transportation with respect to the
Coast Guard when it is not operating as
a service in the Navy; or
* * * * * * *
[(2) who, except as provided in subsection (e) of
this section, completed the requirements of a secondary
school diploma (or equivalency certificate) not later
than--
[(A) the original ending date of the
individual's initial obligated period of active
duty in the case of an individual described in
clause (1)(A) of this subsection, regardless of
whether the individual is discharged or
released from active duty on such date;
[(B) December 31, 1989, in the case of an
individual described in clause (1)(B) of this
subsection; except that (i) an individual
described in clause (1)(B) of this subsection
may meet the requirement of this clause by
having successfully completed (or otherwise
received academic credit for) the equivalent of
12 semester hours in a program of education
leading to a standard college degree, and (ii)
an individual described in clause (1)(A) of
this subsection may meet such requirement by
having successfully completed (or otherwise
received academic credit for) the equivalent of
such 12 semester hours before the end of the
individual's initial obligated period of active
duty; and]
(2) who completes the requirements of a secondary
school diploma (or equivalency certificate), or
successfully completes (or otherwise receives academic
credit for) the equivalent of 12 semester hours in a
program of education leading to a standard college
degree, before applying for benefits under this
section; and
* * * * * * *
(d)(1) For purposes of this chapter, any period of service
described in paragraphs (2) and (3) of this subsection shall
not be considered a part of an [individual's initial obligated
period of active duty] obligated period of active duty on which
an individual's entitlement to assistance under this section is
based.
* * * * * * *
[(e) For the purposes of subsection (a)(2) of this section,
an individual who was on active duty on August 2, 1990, and who
completes the requirements of a secondary school diploma (or
equivalency certificate) before October 28, 1994, shall be
considered to have completed such requirements within the
individual's initial obligated period of active duty.]
[(f)] (e)(1) * * *
* * * * * * *
[(g)] (f) * * *
[(h)] (g)(1) * * *
(2) This subsection applies to a member who--
(A) [during an initial period of active duty,] during
the obligated period of active duty on which
entitlement to assistance under this section is based,
commences pursuit of a course of education--
(i) * * *
* * * * * * *
[(i)] (h) The Secretary concerned shall inform any member
of the Armed Forces who has not completed that member's
[initial] obligated period of active duty (as described in
subsection (a)(1)(A)) and who indicates the intent to be
discharged or released from such duty for the convenience of
the Government of the minimum active duty requirements for
entitlement to educational assistance benefits under this
chapter. Such information shall be provided to the member in a
timely manner.
Sec. 3012. Basic educational assistance entitlement for service in the
Selected Reserve
(a) Except as provided in subsection (d) of this section,
each individual--
(1) who--
(A) after June 30, 1985, first becomes a
member of the Armed Forces or first enters on
active duty as a member of the Armed Forces
and--
(i) serves[, as the individual's
initial obligated period of active
duty, at least two years of continuous
active duty in the Armed Forces] an
obligated period of active duty of at
least two years of continuous active
duty in the Armed Forces, subject to
subsection (b) of this section,
characterized by the Secretary
concerned as honorable service; and
(ii) * * *
* * * * * * *
[(2) who, except as provided in subsection (f) of
this section, before completion of the service
described in clause (1) of this subsection, has
completed the requirements of a secondary school
diploma (or an equivalency certificate), except that
(i) an individual described in clause (1)(B) of this
subsection may meet the requirement of this clause by
having successfully completed (or otherwise received
academic credit for) the equivalent of 12 semester
hours in a program of education leading to a standard
college degree, and (ii) an individual described in
clause (1)(A) of this subsection may meet such
requirement by having successfully completed (or
otherwise received academic credit for) the equivalent
of such 12 semester hours before the end of the
individual's initial obligated period of active duty;
and]
(2) who completes the requirements of a secondary
school diploma (or equivalency certificate), or
successfully completes (or otherwise receives academic
credit for) the equivalent of 12 semester hours in a
program of education leading to a standard college
degree, before applying for benefits under this
section; and
(3) * * *
* * * * * * *
(e)(1) An individual described in subclause (I) or (III) of
subsection (b)(1)(B)(ii) of this section may elect entitlement
to basic educational assistance under section 3011 of this
title, based on an [initial] obligated period of active duty of
two years, in lieu of entitlement to assistance under this
section.
(2) * * *
* * * * * * *
[(f) For the purposes of subsection (a)(2) of this section,
an individual who was on active duty on August 2, 1990, and who
completes the requirements of a secondary school diploma (or
equivalency certificate) before October 28, 1994, shall be
considered to have completed such requirements within the
individual's initial obligated period of active duty.]
[(g)] (f)(1) * * *
* * * * * * *
Sec. 3013. Duration of basic educational assistance
(a)(1) * * *
(2) Subject to section 3695 of this title and subsection
(d) of this section, in the case of an individual described in
section 3011(a)(1)(A)(ii)(I) or (III) of this title who is not
also described in section 3011(a)(1)(A)(i) of this title or an
individual described in section 3011(a)(1)(B)(ii)(I) or (III)
of this title who is not also described in section
3011(a)(1)(B)(i) of this title, the individual is entitled to
one month of educational assistance benefits under this chapter
for eachmonth of continuous active duty served by such
individual after June 30, 1985, as part of the [individual's initial
obligated period of active duty] obligated period of active duty on
which such entitlement is based in the case of an individual described
in section 3011(a)(1)(A)(ii)(I) or (III) of this title, or in the case
of an individual described in section 3011(a)(1)(B)(ii)(I) or (III) of
this title, after June 30, 1985.
(b) Subject to section 3695 of this title and subsection
(d) of this section, each individual entitled to basic
educational assistance under section 3012 of this title is
entitled to (1) one month of educational assistance benefits
under this chapter for each month of continuous active duty
served by such individual after June 30, 1985, as part of the
[individual's initial obligated period of active duty]
obligated period of active duty on which such entitlement is
based, or in the case of an individual described in section
3012(a)(1)(B) of this title, after June 30, 1985, and (2) one
month of educational assistance benefits under this chapter for
each four months served by such individual in the Selected
Reserve after the applicable date specified in clause (1) of
this subsection (other than any month in which the individual
served on active duty).
* * * * * * *
Sec. 3015. Amount of basic educational assistance
(a) The amount of payment of educational assistance under
this chapter is subject to section 3032 of this title. Except
as otherwise provided in this section, in the case of an
individual entitled to an educational assistance allowance
under this chapter whose obligated period of active duty on
which such entitlement is based is three years, a basic
educational assistance allowance under this subchapter shall be
paid--
(1) * * *
* * * * * * *
(b) In the case of an individual entitled to an educational
assistance allowance under section 3011 or 3018 of this title
[and whose initial obligated period of active duty is two
years,] whose obligated period of active duty on which such
entitlement is based is two years, a basic educational
assistance allowance under this chapter shall (except as
provided in the succeeding subsections of this section) be
paid--
(1) * * *
* * * * * * *
(c)(1) * * *
(2) Paragraph (1) of this subsection applies to an
individual entitled to an educational assistance allowance
under section 3011 of this title--
[(A) whose initial obligated period of active duty is
less than three years;
[(B) who, beginning on the date of the commencement
of the person's initial obligated period of such duty,
serves a continuous period of active duty of not less
than three years; and]
(A) whose obligated period of active duty on which
such entitlement is based is less than three years;
(B) who, beginning on the date of the commencement of
such obligated period of active duty, serves a
continuous period of active duty of not less than three
years; and
(C) * * *
* * * * * * *
Sec. 3017. Death benefit
(a)(1) In the event of the service-connected death of any
individual--
(A) who--
(i) * * *
(ii) is on active duty in the Armed Forces
and but for clause (1)(A)(i) or [clause (2)(A)]
clause (2) of section 3011(a) or clause
(1)(A)(i) or (ii) or clause (2) of section
3012(a) of this title would be eligible for
such basic educational assistance; and
(B) * * *
* * * * * * *
Sec. 3018. Opportunity for certain active-duty personnel to withdraw
election not to enroll
(a) * * *
(b) An individual described in clauses (1) through (3) of
subsection (a) of this section who made an election under
section 3011(c)(1) or 3012(d)(1) of this title and who--
(1) * * *
* * * * * * *
[(4) before completing such obligated period of
service (i) has completed the requirements of a
secondary school diploma (or an equivalency
certificate), or (ii) has successfully completed (or
otherwise received academic credit for) the equivalent
of 12 semester hours in a program of education leading
to a standard college degree; and] (4) before applying
for benefits under this section--
(A) completes the requirements of a secondary
school diploma (or equivalency certificate); or
(B) successfully completes (or otherwise
receives academic credit for) the equivalent of
12 semester hours in a program of education
leading to a standard college degree; and
(5) * * *
* * * * * * *
CHAPTER 35--SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE
* * * * * * *
Subchapter I--Definitions
* * * * * * *
Sec. 3501. Definitions
(a) For the purposes of this chapter and chapter 36 of this
title--
(1) * * *
* * * * * * *
(5) The term ``program of education'' means any
curriculum or any combination of unit courses or
subjects pursued at an educational institution which is
generally accepted as necessary to fulfill the
requirements for the attainment of a predetermined and
identified educational, professional, or vocational
objective. The term also includes any preparatory
course described in section 3002(3)(B) of this title.
Subchapter II--Eligibility and Entitlement
* * * * * * *
Sec. 3512. Periods of eligibility
(a) The educational assistance to which an eligible person
(within the meaning of section 3501(a)(1)(A) of this title) is
entitled under section 3511 of this title or subchapter V of
this chapter may be afforded the person during the period
beginning on the person's eighteenth birthday, or on the
successful completion of the person's secondary schooling,
whichever first occurs, and ending on the person's twenty-sixth
birthday, except that--
(1) * * *
* * * * * * *
(3) if the Secretary first finds that the parent from
whom eligibility is derived has a service-connected
total disability permanent in nature, or if the death
of the parent from whom eligibility is derived occurs,
after the eligible person's eighteenth birthday but
before the person's twenty-sixth birthday, then (unless
paragraph (4) applies) such period shall end [8 years
after, whichever date last occurs: (A) the date on
which the Secretary first finds that the parent from
whom eligibility is derived has a service-connected
total disability permanent in nature, or (B) the date
of death of the parent from whom eligibility is
derived;] 8 years after the date elected by the person
(if such election is approved as the beginning date of
such period by the Secretary and made during the period
between such birthdays) which beginning date--
(A) in the case of a person whose eligibility
is based on a parent who has a service-
connected total disability permanent in nature
shall be between the dates described in
subsection (d) of this section; and
(B) in the case of a person whose eligibility
is based on the death of a parent shall be
between--
(i) the date of the parent's death;
and
(ii) the date of the Secretary's
decision that the death was service-
connected;
* * * * * * *
CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS
Subchapter I--General
* * * * * * *
Sec. 3703. Basic provisions relating to loan guaranty and insurance
(a)(1)(A) Any loan to a veteran eligible for benefits under
this chapter, if made for any of the purposes specified in
section 3710 of this title and in compliance with the
provisions of this chapter, is automatically guaranteed by the
United States in an amount not to exceed the lesser of--
(i)(I) * * *
* * * * * * *
(IV) in the case of any loan of more than $144,000
for a purpose specified in clause (1), (2), (3), (6),
or (8) of section 3710(a) of this title, the lesser of
[$50,750] $63,175 or 25 percent of the loan; or
(ii) * * *
(B) The maximum amount of guaranty entitlement available to
a veteran for purposes specified in section 3710 of this title
shall be $36,000, or in the case of a loan described in
subparagraph (A)(i)(IV) of this paragraph, [$50,750] $63,175,
reduced by the amount of entitlement previously used by the
veteran under this chapter and not restored as a result of the
exclusion in section 3702(b) of this title.
* * * * * * *
Subchapter III--Administrative Provisions
* * * * * * *
Sec. 3729. Loan fee
(a)(1) * * *
* * * * * * *
(c)(1) * * *
(2) A veteran who is rated eligible to receive compensation
as a result of a pre-discharge disability examination and
rating shall be treated as receiving compensation for purposes
of this subsection as of the date on which the veteran is rated
eligible to receive compensation as a result of the pre-
discharge disability examination and rating without regard to
whether an effective date of the award of compensation is
established as of that date.
* * * * * * *
Sec. 3735. Housing assistance for homeless veterans
(a)(1) * * *
* * * * * * *
(4) The term of any lease under this subsection may not
exceed [three years] 20 years.
* * * * * * *
CHAPTER 42--EMPLOYMENT AND TRAINING OF VETERANS
* * * * * * *
Sec. 4211. Definitions
As used in this chapter--
(1) * * *
* * * * * * *
(6) The term ``recently separated veteran'' means any
veteran during the one-year period beginning on the
date of such veteran's discharge or release from active
duty.
* * * * * * *
Sec. 4212. Veterans' employment emphasis under Federal contracts
(a) Any contract in the amount of $25,000 or more entered
into by any department or agency for the procurement of
personal property and non-personal services (including
construction) for the United States, shall contain a provision
requiring that the party contracting with the United States
shall take affirmative action to employ and advance in
employment qualified special disabled veterans, veterans of the
Vietnam era, recently separated veterans, and any other
veterans who served on active duty during a war or in a
campaign or expedition for which a campaign badge has been
authorized. The provisions ofthis section shall apply to any
subcontract entered into by a prime contractor in carrying out any
contract for the procurement of personal property and non-personal
services (including construction) for the United States. In addition to
requiring affirmative action to employ such veterans under such
contracts and subcontracts and in order to promote the implementation
of such requirement, the President shall implement the provisions of
this section by promulgating regulations which shall require that (1)
each such contractor undertake in such contract to list immediately
with the appropriate local employment service office all of its
employment openings except that the contractor may exclude openings for
executive and top management positions, positions which are to be
filled from within the contractor's organization, and positions lasting
three days or less, and (2) each such local office shall give such
veterans priority in referral to such employment openings.
* * * * * * *
(d)(1) Each contractor to whom subsection (a) of this
section applies shall, in accordance with regulations which the
Secretary of Labor shall prescribe, report at least annually to
the Secretary of Labor on--
(A) the number of employees in the work force of such
contractor, by job category and hiring location, who
are special disabled veterans, veterans of the Vietnam
era, recently separated veterans, or other veterans who
served on active duty during a war or in a campaign or
expedition for which a campaign badge has been
authorized;
(B) the total number of new employees hired by the
contractor during the period covered by the report and
the number of such employees who are special disabled
veterans, veterans of the Vietnam era, recently
separated veterans, or other veterans who served on
active duty during a war or in a campaign or expedition
for which a campaign badge has been authorized; and
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 51--CLAIMS, EFFECTIVE DATES, AND PAYMENTS
Subchapter I--Claims
Sec.
[5101. Claims and forms.]
5101. Definition of ``claimant.''
5101A. Claims and forms.
* * * * * * *
5103. * * *
5103A. Assistance to claimants.
* * * * * * *
Sec. 5101. Definition of ``claimant''
For purposes of this chapter, the term ``claimant'' means
any individual who submits a claim for benefits under the laws
administered by the Secretary.
[Sec. 5101.] Sec. 5101A. Claims and forms
(a) * * *
* * * * * * *
Sec. 5103. Incomplete applications
(a) If a claimant's application for benefits under the laws
administered by the Secretary is incomplete, the Secretary
shall notify the claimant of the [evidence] information
necessary to complete the application. If such [evidence]
information is not received within one year from the date of
such notification, no benefits may be paid or furnished by
reason of such application.
(b) * * *
* * * * * * *
Sec. 5103A. Assistance to claimants
(a) Except as provided in subsection (b), the Secretary
shall make reasonable efforts to assist in the development of
information and medical or lay evidence necessary to establish
the eligibility of a claimant for benefits under the laws
administered by the Secretary.
(b) The Secretary is not required to provide assistance to
a claimant under subsection (a) if no reasonable possibility
exists, as determined in accordance with regulations prescribed
under subsection (f), that such assistance would aid in the
establishment of the eligibility of the claimant for benefits
under the laws administered by the Secretary.
(c) In any claim for benefits under the laws administered
by the Secretary, the assistance provided by the Secretary
under subsection (a) shall include the following:
(1) Informing the claimant and the claimant's
representative, if any, of the information and medical
or lay evidence needed in order to aid in the
establishment of the eligibility of the claimant for
benefits under the laws administered by the Secretary.
(2) Informing the claimant and the claimant's
representative, if any, if the Secretary is unable to
obtain any information or medical or lay evidence
described in paragraph (1).
(d)(1) In any claim for disability compensation under
chapter 11 of this title, the assistance provided by the
Secretary under subsection (a) shall include, in addition to
the assistance provided under subsection (c), the following:
(A) Obtaining the relevant service and medical
records maintained by applicable governmental entities
that pertain to the veteran for the period or periods
of the veteran's service in the active military, naval,
or air service.
(B) Obtaining existing records of relevant medical
treatment or examination provided at Department health-
care facilities or at the expense of the Department,
but only if the claimant has furnished information
sufficient to locate such records.
(C) Obtaining from governmental entities any other
relevant records the claimant adequately identifies and
authorizes the Secretary to obtain.
(D) Making reasonable efforts to obtain from private
persons and entities any other relevant records the
claimant adequately identifies and authorizes the
Secretary to obtain.
(E) Providing a medical examination needed for the
purpose of determining the existence of a current
disability if the claimant submits verifiable evidence,
as determined in accordance with the regulations
prescribed under subsection (f), establishing that the
claimant is unable to afford medical treatment.
(F) Providing such other assistance as the Secretary
considers appropriate.
(2) The efforts made to obtain records under subparagraphs
(A), (B), and (C) of paragraph (1) shall continue until it is
reasonably certain, as determined in accordance with the
regulations prescribed under subsection (f), that such records
do not exist.
(e) If while obtaining or after obtaining information or
lay or medical evidence under subsection (d) the Secretary
determines that a medical examination or a medical opinion is
necessary to substantiate entitlement to a benefit, the
Secretary shall provide such medical examination or obtain such
medical opinion.
(f) The Secretary shall prescribe regulations for purposes
of the administration of this section.
* * * * * * *
Sec. 5106. Furnishing of information by other agencies
The head of any Federal department or agency shall provide
such information to the Secretary as the Secretary may request
for purposes of determining eligibility for or amount of
benefits, or verifying other information with respect thereto.
The cost of providing such information shall be borne by the
department or agency providing such information.
[Sec. 5107. Burden of proof; benefit of the doubt
[(a) Except when otherwise provided by the Secretary in
accordance with the provisions of this title, a person who
submits a claim for benefits under a law administered by the
Secretary shall have the burden of submitting evidence
sufficient to justify a belief by a fair and impartial
individual that the claim is well grounded. The Secretary shall
assist such a claimant in developing the facts pertinent to the
claim. Such assistance shall include requesting information as
described in section 5106 of this title.
[(b) When, after consideration of all evidence and material
of record in a case before the Department with respect to
benefits under laws administered by the Secretary, there is an
approximate balance of positive and negative evidence regarding
the merits of an issue material to the determination of the
matter, the benefit of the doubt in resolving each such issue
shall be given to the claimant. Nothing in this subsection
shall be construed as shifting from the claimant to the
Secretary the burden specified in subsection (a) of this
section.]
Sec. 5107. Burden of proof; benefit of the doubt
(a) Except when otherwise provided by this title or by the
Secretary in accordance with the provisions of this title, a
claimant shall have the burden of proof in establishing
entitlement to benefits under the laws administered by the
Secretary.
(b) The Secretary shall consider all information and lay
and medical evidence of record in a case before the Department
with respect to benefits under laws administered by the
Secretary, and shall give the claimant the benefit of the doubt
when there is an approximate balance of positive and negative
evidence regarding an issue material to the determination of
the matter.
* * * * * * *
Subchapter II--Effective Dates
Sec. 5113. Effective dates of educational benefits
(a) Except as provided in [subsection (b) of this section,]
subsections (b) and (c), effective dates relating to awards
under chapters 30, 31, 32, 34, and 35 of this title or chapter
106 of title 10 shall, to the extent feasible, correspond to
effective dates relating to awards of disability compensation.
(b)(1) In determining the effective date of an award of
educational assistance under chapter 35 of this title for an
individual described in paragraph (2) based on an original
claim, the Secretary shall consider the individual's
application under section 3513 of this title as having been
filed on the effective date from which the Secretary, by rating
decision, determines that the veteran from whom eligibility for
such educational assistance is derived either died of a
service-connected disability or established the existence of a
total service-connected disability evaluated as permanent in
nature if that effective date is more than one year before the
date the rating decision is made.
(2) An individual referred to in paragraph (1) is a person
eligible for educational assistance under chapter 35 of this
title by reason of subparagraph (A)(i), (A)(ii), (B), or (D) of
section 3501(a)(1) of this title who--
(A) submits to the Secretary an original application
under section 3513 of this title for educational
assistance under that chapter within one year after the
date that the Secretary issues the rating decision on
which the individual's eligibility for such educational
assistance is based;
(B) claims such educational assistance for pursuit of an
approved program of education during a period or periods
preceding the one-year period ending on the date on which the
individual's application under that section is received by the
Secretary; and
(C) would, without regard to this subsection, have been
entitled to such educational assistance for pursuit of such
approved program of education if the individual had submitted
such application on the effective date from which the Secretary
determined that the individual was eligible for such
educational assistance.
[(b)] (c) The effective date of an adjustment of benefits
under any chapter referred to in subsection (a) [of this
section], if made on the basis of a certification made by the
veteran or person and accepted by the Secretary under section
3680(g) of this title, shall be the date of the change.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION-ORGANIZATION AND FUNCTIONS
* * * * * * *
Subchapter I--Organization
* * * * * * *
Sec. 7306. Office of the Under Secretary for Health
(a) The Office of the Under Secretary for Health shall
consist of the following:
(1) * * *
* * * * * * *
(9) The Advisor on Physician Assistants, who shall
carry out the responsibilities set forth in subsection
(f).
[(9)] (10) * * *
* * * * * * *
(e)(1) * * *
(f) The Advisor on Physician Assistants under subsection
(a)(9) shall--
(1) advise the Under Secretary for Health on matters
regarding the optimal utilization of physician
assistants by the Veterans Health Administration;
(2) advise the Under Secretary for Health on the
feasibility and desirability of establishing clinical
privileges and practice areas for physician assistants
in the Administration;
(3) develop initiatives to facilitate the utilization
of the full range of clinical capabilities of the
physician assistants employed by the Administration;
(4) provide advice on policies affecting the
employment of physician assistants by the
Administration, including policies on educational
requirements, national certification, recruitment and
retention, staff development, and the availability of
educational assistance (including scholarship, tuition
reimbursement, and loan repayment assistance); and
(5) carry out such other responsibilities as the
Under Secretary for Health shall specify.
[(f)] (g) * * *
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION-PERSONNEL
* * * * * * *
Subchapter I--Appointments
* * * * * * *
Sec. 7405. Temporary full-time appointments, part-time appointments,
and without-compensation appointments
(a) * * *
* * * * * * *
(c)(1) Temporary full-time appointments under this section
of persons in positions listed in section 7401(1) of this title
may be for a period in excess of 90 days only if the Under
Secretary for Health finds that circumstances render it
impracticable to obtain the necessary services through
appointments under that section.
(2) Temporary full-time appointments of persons who have
successfully completed a full course of nursing in a recognized
school of [nursing,] nursing approved by the Secretary, who
have successfully completed a full course of training as a
physician assistant in a recognized school approved by the
Secretary, or who have successfully completed a full course of
training for any category of personnel described in paragraph
(3) of section 7401 of this title in a recognized education or
training institution approved by the Secretary, and who are
pending registration or licensure in a State, or certification
by a national board recognized by the Secretary, shall not
exceed two years.
(3)(A) Temporary full-time appointments of persons in
positions referred to in subsection (a)(1)(D) shall not exceed
three years.
(B) Temporary full-time appointments under this paragraph
may be renewed for one or more additional periods not in excess
of three years each.
[(3)] (4) * * *
* * * * * * *
----------
VETERANS MILLENNIUM HEALTH CARE AND BENEFITS ACT
* * * * * * *
TITLE IV--CONSTRUCTION AND FACILITIES MATTERS
* * * * * * *
SEC. 401. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.
The Secretary of Veterans Affairs may carry out the
following major medical facility projects, with each project to
be carried out in the amount specified for that project:
(1) * * *
* * * * * * *
(7) Renovation of psychiatric nursing units at the
Department of Veterans Affairs Medical Center,
Murfreesboro, Tennessee, in an amount not to exceed
$14,000,000.
* * * * * * *
SEC. 403. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to
the Secretary of Veterans Affairs for fiscal year 2000 and for
fiscal year 2001--
(1) for the Construction, Major Projects, account
[$57,500,000 for the projects authorized in paragraphs
(1) through (5)] $71,500,000 for the projects
authorized in paragraphs (1) through (5) and (7) of
section 401; and
(2) for the Medical Care account, $2,178,500 for the
leases authorized in section 402.
(b) Limitation.--The projects authorized in paragraphs (1)
through (5) and (7) of section 401 may only be carried out
using--
(1) * * *
* * * * * * *