Take Care of America’s Veterans Act

(a) Study on improvements to Department of Veterans Affairs covered medical disability examinations in rural areas

(1) 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.

(2) Elements

(A) In general. The study conducted under paragraph (1) shall include the following:

(i) 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.

(ii) A root cause analysis of differences identified pursuant to clause (i).

(iii) The plan of the Secretary for the following year to improve access described in paragraph (1), 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.

(B) Number of days to complete defined. For purposes of subparagraph (A)(i), the term number of days to complete means the number of days in the period—

(i) 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

(ii) ending on the date on which the examination was completed.

(3) 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 paragraph (1).

(4) Definitions. In this subsection:

(A) The term covered medical disability examination means a medical nexus examination or medical 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.

(B) 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.

(b) Review of training for veterans service representatives and rating veterans service representatives

(1) Review required. The Secretary of Veterans Affairs shall conduct a comprehensive review of the training provided to Veterans Service Representatives (VSRs) and Rating Veterans Service Representatives (RVSRs) regarding covered medical disability examinations for the purpose of claims adjudication.

(2) Scope of review. The review shall include, at minimum, an evaluation of training and policies relating to—

(A) assessing the adequacy of covered medical disability examinations for claims adjudication;

(B) determining the necessity of medical disability examinations where claims can be adjudicated based on existing evidence without ordering additional examinations;

(C) relevant statutes, judicial decisions, regulations, and Department policies, including—

(i) the duty to assist claimants;

(ii) evidentiary standards regarding causation;

(iii) required elements and standards for covered medical disability examinations, including the need for reasoned medical opinions; and

(iv) the absence of statutory or regulatory presumptions of service connection in covered medical disability examinations; and

(D) input from impacted Department employees, including duly appointed labor representatives.

(3) Second-level review for new employees. The Secretary shall evaluate the effectiveness of current policies requiring a second level of review of claims decisions made by new Veterans Service Representatives and Rating Veterans Service Representatives before such employees are authorized to order covered medical disability examinations, including any applicable accuracy thresholds.

(4) Report to Congress. Not later than 180 days 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 detailing the findings of the Secretary with respect to the review conducted under paragraph (1), the data used by the Secretary to support such findings, and such recommendations as the Secretary may have for improvements to training or policies.

(5) Comptroller General of the United States review of findings. Not later than 180 days after the date on which the Secretary submits the report under paragraph (4), the Comptroller General of the United States shall conduct a review of the findings and recommendations contained in the report.

(6) Modification of reports by the Board of Veterans’ Appeals and United States Court of Appeals for Veterans Claims

(A) Board of Veterans’ Appeals. Section 7101(d)(2) of title 38, United States Code, is amended—

(i) in subparagraph (F), by striking ; and and inserting a semicolon;

(ii) in subparagraph (G), by striking the period at the end and inserting ; and; and

(iii) by adding at the end the following new subparagraph:

(B) 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:

(7) Definition of covered medical disability examination. In this subsection, the term covered medical disability examination means a medical examination or medical opinion that the Secretary determines necessary 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.

(c) Review and priority processing of claims with inadequate or unnecessary examinations

(1) Review. Not later than 1 year after the date of the enactment of this Act and not less frequently than once every three months thereafter, the Secretary of Veterans Affairs shall review a random and representative sample of all covered medical disability examinations completed during the previous three-month period.

(2) Further sample requirements. Under each review required by paragraph (1), the Secretary shall ensure the review includes—

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

(B) a statistically significant sample of covered medical disability examinations completed by each contractor that provides such examinations for the Department.

(3) Analysis. Under each review required by paragraph (1), the Secretary shall—

(A) analyze the samples specified in paragraph (2); and

(B) pursuant to such analysis, identify—

(i) 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

(ii) 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.

(4) Priority processing

(A) In general. Except as provided for in subparagraph (B), if during a review under paragraph (1) 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—

(i) receives another examination, if necessary, on a priority basis; and

(ii) receives priority processing for the entirety of impacted claim.

(B) Exception. The Secretary is not required to furnish an additional examination under subparagraph (A) if the Secretary determines such an examination to be unnecessary for purposes of adjudicating the claim.

(5) 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 Departments review required in paragraph (1).

(6) Covered medical disability examination defined. In this subsection, 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.

(d) Review and plan regarding department of veterans affairs scheduling of medical examinations

(1) 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.

(2) 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:

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

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

(C) 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.

(D) 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 who conducts the examinations.

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