119-s2493

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2493 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2493

 To amend title 38, United States Code, to improve matters relating to 
 medical examinations for veterans disability compensation, and for 
 other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 July 29, 2025

 Mr. Blumenthal (for himself and Mr. Murphy) introduced the following 
 bill; which was read twice and referred to the Committee on Veterans' 
 Affairs

_______________________________________________________________________

 A BILL

 To amend title 38, United States Code, to improve matters relating to 
 medical examinations for veterans disability compensation, and for 
 other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Medical Disability Examination 
Improvement Act of 2025''.

SEC. 2. PILOT PROGRAM ON CONDUCT OF MEDICAL EXAMINATIONS AT MEDICAL 
 FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS FOR VETERANS 
 DISABILITY COMPENSATION CLAIMS UNDER LAWS ADMINISTERED BY 
 SECRETARY OF VETERANS AFFAIRS.

    (a) Pilot Program Authorized.--The Under Secretary of Benefits may 
carry out a pilot program to assess the feasibility and advisability of 
providing for the conduct of medical examinations, or obtaining medical 
opinions, under 

section 5103A
            (d) of title 38, United States Code, at 
medical facilities of the Department of Veterans Affairs.

    (b) Locations.--In carrying out the pilot program under this 
section, the Secretary shall carry out the pilot program at medical 
facilities of the Department as follows:

    (1) In fiscal years before fiscal year 2027, medical 
 facilities in not more than one Veterans Integrated Service 
 Network of the Department of Veterans Affairs selected by the 
 Under Secretary for Benefits, in coordination with the Under 
 Secretary for Health, for purposes of the pilot program under 
 this section.

    (2) In fiscal year 2029, medical facilities in not more 
 than three Veterans Integrated Service Networks of the 
 Department of Veterans Affairs selected by the Under Secretary 
 for Benefits, in coordination with the Under Secretary for 
 Health, for purposes of the pilot program under this section.

    (3) In fiscal year 2031, medical facilities in not more 
 than six Veterans Integrated Service Networks of the Department 
 of Veterans Affairs selected by the Under Secretary for 
 Benefits, in coordination with the Under Secretary for Health, 
 for purposes of the pilot program under this section.

    (4) In fiscal year 2033, medical facilities in not more 
 than 10 Veterans Integrated Service Networks of the Department 
 of Veterans Affairs selected by the Under Secretary for 
 Benefits, in consultation with the Under Secretary for Health, 
 for purposes of the pilot program under this section.

    (5) In fiscal year 2035 and each fiscal year thereafter, 
 medical facilities in through such Veterans Integrated Service 
 Networks of the Department as the Under Secretary for Benefits, 
 in consultation with the Under Secretary for Health, considers 
 appropriate for purposes of the pilot program under this 
 section.
            (c) Report to Congress.--

    (1) In general.--If the Under Secretary commences 
 conducting a pilot program pursuant to subsection

    (a) before 
 the date that is two years after the date of the enactment of 
 this Act, the Under Secretary shall, not later than two years 
 after the date of the enactment of this Act, submit to Congress 
 a report on the findings of the Under Secretary with respect to 
 the pilot program.

    (2) Contents.--The report submitted pursuant to paragraph

    (1) shall include an assessment of the Under Secretary of the 
 effect of the use of the authority provided by subsection

    (a) on the cost, timeliness, quality, and capacity of the 
 Department to provide medical disability examinations.
            (d) Source of Funds.--Amounts expended or obligated by the Under 
Secretary to carry out the pilot program under this section, including 
for payments for examination travel and incidental expenses under the 
terms and conditions set forth by 

section 111 of title 38, United 
States Code, shall be reimbursed to the accounts available for the 
general operating expenses of the Veterans Benefits Administration and 
information technology systems from amounts available to the Secretary 
of Veterans Affairs for payment of compensation and pension.

SEC. 3. STUDY ON IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS COVERED 
 MEDICAL DISABILITY EXAMINATIONS IN RURAL AREAS.

    (a) Study Required.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
a study on access by veterans who reside in rural and highly rural 
areas to covered medical disability examinations.

    (b) Elements.--

    (1) In general.--The study conducted under subsection

    (a) shall include the following:
        (A) A comparison of the average number of days to 
 complete covered medical disability examinations, 
 disaggregated by type of examination, for veterans who 
 reside in rural and highly rural areas compared to an 
 average time for veterans who reside in other areas to 
 complete a covered medical disability examination, by 
 either contractors or employees of the Department.
        (B) A root cause analysis of differences identified 
 pursuant to subparagraph
        (A) .
            (C) The plan of the Secretary for the following 
 year to improve access described in subsection

    (a) , 
 which shall include a plan for the pursuit of a 
 commercial or industry-standard solution or technology 
 that could enable housebound veterans or veterans who 
 live in rural areas to receive examinations without 
 traveling long distances.

    (2) Number of days to complete defined.--For purposes of 
 paragraph

    (1)
        (A) , the term ``number of days to complete'' means 
 the number of days in the period--
        (A) beginning on the date on which a contractor or 
 employee of the Department received a request from the 
 Secretary to conduct a covered medical disability 
 examination; and
        (B) ending on the date on which the examination was 
 completed.
            (c) Report on Study.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a report on the findings of the 
Secretary with respect to the study completed under subsection

    (a) .
            (d) === Definitions. ===
-In this section:

    (1) Covered medical disability examination.--The term 
 ``covered medical disability examination'' means a medical 
 nexus examination or medical opinion for the purposes of 
 adjudicating a benefit under chapter 11 or 15 of title 38, 
 United States Code, regardless of whether conducted by an 
 employee or a contractor of the Department.

    (2) Rural; highly rural.--The terms ``rural'' and ``highly 
 rural'' have the meanings given those terms under the rural-
 urban commuting areas coding system of the Department of 
 Agriculture.

SEC. 4. IMPROVEMENTS TO TRAINING FOR PROCESSING MEDICAL DISABILITY 
 EXAMINATIONS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall require 
additional training for new and probationary employees of the 
Department of Veterans Affairs who order or review covered medical 
disability examinations.

    (b) Training Requirements.--The training required under subsection

    (a) shall include the following:

    (1) Instruction on how to assess whether a covered medical 
 disability examination is adequate for purposes of adjudicating 
 a claim for a benefit under laws administered by the Secretary.

    (2) Instruction on how to assess whether a medical 
 disability examination is necessary for purposes of 
 adjudicating a particular claim for a benefit.

    (3) Review of relevant statutes, judicial decisions, 
 regulations, and policies of the Department regarding covered 
 medical disability examinations, including, at a minimum--
        (A) the duty to assist;
        (B) the relevance of causation compared to other 
 evidentiary standards in covered medical disability 
 examinations;
            (C) the required elements of a covered medical 
 disability examination, with an emphasis on the 
 requirement for reasoned analysis to support medical 
 opinions; and
            (D) the relevance of a lack of a statutory or 
 regulatory presumption of service-connection in covered 
 medical disability examinations.

    (4) Input from impacted employees of the Department, 
 including duly appointed labor representatives of Department 
 employees.
            (c) Second Level of Review for New Employees.--The Secretary shall 
ensure that a new employee described in subsection

    (a) is subject to a 
second level of review before the employee can order a covered medical 
disability examination until the employee achieves an accuracy rate of 
90 percent on decisions of claims.
            (d) Modification of Reports.--

    (1) Board of veterans' appeals.--

Section 7101
            (d) (2) of 
 title 38, United States Code, is amended--
        (A) in subparagraph
        (F) , by striking ``; and'' and 
 inserting a semicolon;
        (B) in subparagraph
        (G) , by striking the period at 
 the end and inserting ``; and''; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
        (H) a summary of recurring issues that result in the 
 Board remanding appeals back to the agency of original 
 jurisdiction.''.

    (2) United states court of appeals for veterans claims.--
 

Section 7288

    (b) of title 38, United States Code, is amended by 
 adding at the end the following new paragraph:
 ``

    (16) A summary of recurring issues that result in 
 remands.''.

    (e) Definition of Covered Medical Disability Examination.--In this 
section, the term ``covered medical disability examination'' means a 
medical examination or medical opinion that the Secretary determines 
necessary for the purposes of adjudicating a benefit under chapter 11 
or 15 of title 38, United States Code, regardless of whether conducted 
by an employee or a contractor of the Department.

SEC. 5. REVIEW AND PRIORITY PROCESSING OF CLAIMS WITH INADEQUATE OR 
 UNNECESSARY EXAMINATIONS.

    (a) Review.--Not later than one year after the date of the 
enactment of this Act and not less frequently than once every three 
months thereafter until the date that is three years after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
review a statistically significant sample of all covered medical 
disability examinations completed during the previous three-month 
period.

    (b) Further Sample Requirements.--Under each review required by 
subsection

    (a) , the Secretary shall ensure the review includes--

    (1) a statistically significant sample of covered medical 
 disability examinations completed by employees of the 
 Department of Veterans Affairs; and

    (2) a statistically significant sample of covered medical 
 disability examinations completed by each contractor that 
 provides such examinations for the Department.
            (c) Analysis.--Under each review required by subsection

    (a) , the 
Secretary shall--

    (1) analyze the samples specified in subsection

    (b) ; and

    (2) pursuant to such analysis, identify--
        (A) the percentage of examinations that were 
 adequate for purposes of adjudicating the particular 
 claim for a benefit under chapter 11 or 15 of title 38, 
 United States Code, for which the examination was 
 ordered by the Department; and
        (B) the percentage of examinations considered 
 overdeveloped for purposes of adjudicating claims for a 
 benefit under chapter 11 or 15 of title 38, United 
 States Code, for which the examination was ordered by 
 the Department.
            (d) Priority Processing.--

    (1) In general.--Except as provided for in paragraph

    (2) , 
 if during a review under subsection

    (a) the Secretary finds any 
 covered medical disability examination to be not adequate for 
 adjudicating a claim, the Secretary shall ensure the claimant 
 examined by that examination--
        (A) receives another examination, if necessary, on 
 a priority basis; and
        (B) receives priority processing for the entirety 
 of impacted claim.

    (2) Exception.--The Secretary is not required to furnish an 
 additional examination under paragraph

    (1) if the Secretary 
 determines such an examination to be unnecessary for purposes 
 of adjudicating the claim.

    (e) Comptroller General of the United States Study.--The 
Comptroller General of the United States shall conduct a review of the 
methodology and effectiveness of the reviews conducted under subsection

    (a) .

    (f) Covered Medical Disability Examination Defined.--In this 
section, the term ``covered medical disability examination'' means a 
medical examination or opinion for the purposes of adjudicating a claim 
for a benefit under chapter 11 or 15 of title 38, United States Code, 
regardless of whether conducted by an employee or a contractor of the 
Department.

SEC. 6. MECHANISM FOR CONTRACTORS CONDUCTING DISABILITY EXAMINATIONS 
 UNDER CERTAIN DEPARTMENT OF VETERANS AFFAIRS PILOT 
 PROGRAM TO TRANSMIT MEDICAL EVIDENCE INTRODUCED BY 
 CLAIMANTS DURING EXAMINATIONS.

    (a) In General.--

Section 504 of the Veterans' Benefits Improvements 
Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note) is amended--

    (1) by redesignating subsections
            (d) and

    (e) as subsections

    (e) and

    (f) , respectively; and

    (2) by inserting after subsection
            (c) the following new 
 subsection
            (d) :
 ``
            (d) Mechanism for Transmittal of Evidence Introduced by 
Applicants During Examinations.--The Secretary shall establish a 
mechanism whereby a health care professional who conducts medical 
examinations or opinions under 

section 5103A
            (d) of title 38, United 
States Code, may transmit to a veteran's claims file, evidence 
introduced by the applicant during a medical examination or in 
conjunction with a medical opinion that examiner used to inform such 
medical examination or opinion.''.

SEC. 7. REVIEW AND PLAN REGARDING DEPARTMENT OF VETERANS AFFAIRS 
 SCHEDULING OF MEDICAL EXAMINATIONS.

    (a) Review Required.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall complete 
a review of scheduling request tools, contracts, and systems used by 
employees and contractors of the Department of Veterans Affairs to 
order and conduct medical disability examinations.

    (b) Plan Required.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives a plan to ensure the following:

    (1) Systems and processes used by the Department enable 
 seamless and clear communication of requirements between the 
 claims processors who request medical disability examinations 
 and medical disability examination vendors, including through a 
 contract.

    (2) Medical disability examiners, including through a 
 contract, review the medical records and claims information 
 necessary to conduct exams that are adequate for purposes of 
 rating claims for benefits under laws administered by the 
 Secretary.

    (3) Claimants or appellants for whom a medical disability 
 examination is requested of the Department have agency in 
 determining when and where the examination is conducted within 
 a reasonable timeframe, as determined by the Secretary.

    (4) Claimants or appellants for whom a medical disability 
 examination is requested of the Department have a seamless 
 experience when scheduling their examinations without regard to 
 which medical disability vendor conducts the examinations.

    (5) The Department conducts customer satisfaction and 
 experience surveys of claimants or appellants who attend 
 medical disability examinations provided under laws 
 administered by the Secretary.
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