H. Rept. 115-133 - TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE TREATMENT OF MEDICAL EVIDENCE PROVIDED BY NON-DEPARTMENT OF VETERANS AFFAIRS MEDICAL PROFESSIONALS IN SUPPORT OF CLAIMS FOR DISABILITY COMPENSATION UNDER THE LAWS ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS, AND FOR OTHER PURPOSES115th Congress (2017-2018)
Committee Report
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115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-133
======================================================================
TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE TREATMENT OF
MEDICAL EVIDENCE PROVIDED BY NON-DEPARTMENT OF VETERANS AFFAIRS MEDICAL
PROFESSIONALS IN SUPPORT OF CLAIMS FOR DISABILITY COMPENSATION UNDER
THE LAWS ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS, AND FOR
OTHER PURPOSES
_______
May 19, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1725]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1725) to amend title 38, United States Code, to
improve the treatment of medical evidence provided by non-
Department of Veterans Affairs medical professionals in support
of claims for disability compensation under the laws
administered by the Secretary of Veterans Affairs, and for
other purposes, having considered the same, report favorably
thereon with amendments and recommend that the bill as amended
do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 6
Federal Mandates Statement....................................... 7
Advisory Committee Statement..................................... 7
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Statement on Duplication of Federal Programs..................... 7
Disclosure of Directed Rulemaking................................ 7
Section-by-Section Analysis of the Legislation................... 8
Changes in Existing Law Made by the Bill as Reported............. 8
AMENDMENT
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. REPORT ON PROGRESS OF DEPARTMENT OF VETERANS AFFAIRS
ACCEPTABLE CLINICAL EVIDENCE INITIATIVE.
(a) In General.--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 on the progress of the
Acceptable Clinical Evidence initiative of the Department of Veterans
Affairs in reducing the necessity for in-person disability examinations
and other efforts to comply with the provisions of section 5125 of
title 38, United States Code.
(b) Contents of Report.--The report required by subsection (a) shall
include the following:
(1) The number of claims eligible for the Acceptable Clinical
Evidence initiative during the period beginning on the date of
the commencement of the initiative and ending on the date of
the submittal of the report, disaggregated by fiscal year.
(2) The total number of claims eligible for the Acceptable
Clinical Evidence initiative that required a medical examiner
of the Department to supplement the evidence with information
obtained during a telephone interview with a claimant.
(3) Information on any other initiatives or efforts of the
Department to further encourage the use of private medical
evidence and reliance upon reports of a medical examination
administered by a private physician if the report is
sufficiently complete to be adequate for the purposes of
adjudicating a claim.
(4) The anticipated impact on the timeline and accuracy of a
decision on a claim for benefits under chapter 11 or 15 of
title 38, United States Code, if the Secretary were prohibited
from requesting a medical examination in the case of a claim in
support of which a claimant submits medical evidence and a
medical opinion provided by a private physician that is
competent, credible, probative, and otherwise adequate for the
purpose of making a decision on that claim.
(5) Recommendations on how the Department can measure, track,
and prevent the ordering of unnecessary medical examinations
when the provision by a claimant of a medical examination
administered by a private physician in support of a claim for
benefits under chapter 11 or 15 of title 38, United States
Code, is adequate for the purpose of making a decision on that
claim.
SEC. 2. ANNUAL REPORT ON SUBMITTAL OF PRIVATE MEDICAL EVIDENCE IN
SUPPORT OF CLAIMS FOR DEPARTMENT OF VETERANS
AFFAIRS BENEFITS.
Not later than March 1 of fiscal years 2018 through 2024, the
Secretary of Veterans Affairs shall submit to Congress a report that
includes, for the calendar year preceding the year in which the report
is submitted, the following for each regional office of the Department
of Veterans Affairs:
(1) The number of times a veteran who submitted private
medical evidence in support of a claim for compensation or
pension under the laws administered by the Secretary was
scheduled for an examination performed by Department personnel
because the private medical evidence submitted was determined
to be unacceptable.
(2) The most common reasons why private medical evidence
submitted in support of claims for benefits under the laws
administered by the Secretary was determined to be
unacceptable.
(3) The types of disabilities for which claims for benefits
under the laws administered by the Secretary were mostly
commonly denied when private medical evidence was submitted.
Amend the title so as to read:
A bill to direct the Secretary of Veterans Affairs to
submit certain reports relating to medical evidence submitted
in support of claims for benefits under the laws administered
by the Secretary.
PURPOSE AND SUMMARY
H.R. 1725, as amended, the ``Quicker Veterans Benefits
Delivery Act of 2017,'' was introduced by Representative
Timothy J. Walz, Ranking Member of Committee on Veterans'
Affairs, on March 24, 2017. The purpose of H.R. 1725, as
amended, is to help VA reduce the number of unnecessary and
duplicative disability examinations. H.R. 1725, as amended,
would require VA to submit to submit: (1) a report to Congress
on the progress of the VA's Acceptable Clinical Evidence
initiative in reducing the necessity for in-person disability
examinations within 180 days of enactment; and, (2) an annual
report to Congress regarding claims for which VA determined the
private medical evidence was unacceptable, with such
information containing in the report to be disaggregated by
regional office.
BACKGROUND AND NEED FOR LEGISLATION
VA may afford medical examinations to veterans seeking
disability benefits, but there may be a long wait time before
VA can schedule such examinations. In such cases, the veteran
may wish to submit private medical evidence in support of their
claim for disability benefits. There may also be cases in which
the veteran simply prefers to submit private medical evidence
in support of his or her claim, regardless of the timeliness of
scheduling an examination with a VA medical professional.
Section 1525 of title 38, U.S.C., currently authorizes VA
to accept a report of medical examination administered by a
private physician, if such report is sufficiently complete and
is adequate for the purpose of adjudicating the veteran's claim
for disability benefits. However, the law does not require VA
to accept such a report.
In 2013, VA developed the Acceptable Clinical Evidence
Initiative (ACE), which gives VA the option to review a
veteran's existing medical records and determine if additional
medical information is necessary to adjudicate a disability
claim. The purpose of ACE is to expedite the disability ratings
process by eliminating the wait time to schedule and conduct an
in-person examination. If the Department determines that the
veteran's existing medical records contain sufficient evidence
to decide the claim, VA may decide such claim without ordering
a new disability examination.
During the April 5, 2017, Subcommittee on Disability
Assistance and Memorial Affairs hearing, The American Legion
testified that it had documented many instances of VA
scheduling unnecessary and duplicative examinations with a VA
physician, even though the veteran had already submitted
sufficient medical evidence from a private physician to decide
the claim. These duplicative examinations add unnecessary
delays to the disability claims process. Moreover, reducing the
number of disability examinations conducted by VA physicians
would allow such medical professionals to devote more resources
to providing care for our nation's veterans and improve the
timeliness for those VA compensation examinations conducted by
VA physicians.
H.R. 1725, as amended, seeks to reduce the number of
unnecessary disability examinations by requiring additional
information be provided to Congress regarding VA's use of
private medical evidence in support of claims for disability
compensation.
HEARINGS
On April 5, 2017, the Subcommittee on Disability Assistance
and Memorial Affairs conducted a legislative hearing on various
bills introduced during the 115th Congress, including H.R.
1725.
The following witnesses testified:
The Honorable Mike Bost, U.S. House of
Representatives; The Honorable Julia Brownley, U.S.
House of Representatives; The Honorable Jim Banks, U.S.
House of Representatives; The Honorable Jack Bergman,
U.S. House of Representatives; The Honorable David G.
Valadao, U.S. House of Representatives; Ms. Beth
Murphy, Director, Compensation Service, Veterans
Benefits Administration, U. S. Department of Veterans
Affairs, accompanied by Dr. Ralph L. Erickson, Chief
Consultant for Post Deployment Health Service, Veterans
Health Administration, U. S. Department of Veterans
Affairs; Ms. Patricia Watts, Director, Legislative and
Regulatory Service, National Cemetery Administration,
U. S. Department of Veterans Affairs; Mr. Zachary
Hearn, Deputy Director, Veterans Affairs and
Rehabilitation Division, The American Legion; Mr. Rick
Weidman, Executive Director, Policy and Government
Affairs, Vietnam Veterans of America; Mr. Patrick
Murray, Associate Director, National Legislative
Service, Veterans of Foreign Wars; Mr. LeRoy Acosta,
Assistant National Legislative Director, Disabled
American Veterans; and, Mr. John B. Wells, Executive
Director, Military-Veterans Advocacy, Inc.
Statements for the record were submitted by:
The Honorable Timothy J. Walz, U.S. House of
Representatives and the Paralyzed Veterans of America
SUBCOMMITTEE CONSIDERATION
On April 27, 2017, the Subcommittee on Disability
Assistance and Memorial Affairs met in open markup session, a
quorum being present, and favorably forwarded to the full
Committee H.R. 1725, as amended. During consideration of H.R.
1725, the following amendment in the nature of a substitute was
considered and adopted by voice vote:
An amendment in the nature of a substitute offered by Ms.
Esty of Connecticut that retained provisions that would require
VA submit: (1) a report to Committees on Veterans' Affairs of
the House of Representatives and the Senate on the progress on
the Acceptable Clinic Evidence Initiative; and, (2) annual
reports to Congress on the treatment of private medical
evidence provided by non-VA medical professionals in support of
claims for disability compensation. The amendment in the nature
of a substitute removed the provisions that would have mandated
VA accept reports of private physician examinations, if such
reports were sufficiently complete for the purpose of
adjudicating a claim for veterans benefits.
COMMITTEE CONSIDERATION
On May 17, 2017, the Full Committee met in an open markup
session, a quorum being present, and ordered H.R. 1725, as
amended, reported favorably to the House of Representatives by
voice vote. During consideration of the bill, the following
amendment to the Subcommittee Print of H.R. 1725, was
considered and agreed to by voice vote:
An amendment offered by Mr. Walz of Minnesota that
specified that the requirement that VA issue annual reports to
Congress on the treatment of private medical evidence provided
by non-VA medical professions in support of claims for
disability compensation be submitted for fiscal years 2018
through 2024.
COMMITTEE VOTES
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the recorded
votes on the motion to report the legislation and amendments
thereto. There were no recorded votes taken on amendments or in
connection with ordering H.R. 1725, as amended, reported to the
House. A motion by Ranking Member Timothy Walz of Minnesota to
report H.R. 1725, as amended, favorably to the House of
Representatives was agreed to by voice vote.
COMMITTEE OVERSIGHT FINDINGS
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the objectives for this
legislation are to provide Congress informationon the use of
private medical evidence in support of claims for veterans
disability benefits.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
EARMARKS AND TAX AND TARIFF BENEFITS
H.R. 1725, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate on H.R.
1725, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 1725, as amended, provided by the Director of the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 17, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1725, a bill to
direct the Secretary of Veterans Affairs to submit certain
reports relating to medical evidence submitted in support of
claims for benefits under the laws administered by the
Secretary.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Dwayne M.
Wright.
Sincerely,
Keith Hall.
Enclosure.
H.R. 1725--A bill to direct the Secretary of Veterans Affairs to submit
certain reports relating to medical evidence submitted in
support of claims for benefits under the laws administered by
the Secretary
H.R. 1725 would require the Department of Veterans Affairs
(VA) to submit several reports to the Congress regarding the
use of private medical evidence in lieu of a VA-provided
examination for purposes of establishing eligibility for
disability compensation or pension. CBO estimates that
implementing H.R. 1725 would cost less than $500,000 to prepare
those reports over the 2018-2022 period; such spending would be
subject to the availability of appropriated funds.
Section 1 would require VA to submit a report detailing the
progress of the Acceptable Clinical Evidence initiative--a VA
initiative created to allow the department to accept private
medical evidence to support an eligible individual's claim for
disability compensation or pension--and recommendations on how
VA can best use private medical evidence in its claims process.
That report would be due within 180 days of enactment of the
bill.
Section 2 would require annual reports on disability
examinations requested each year by VA because the private
medical evidence submitted was deemed unacceptable by the
department. Those reports would document the number of cases
where private evidence was found to be unacceptable, the most
common reasons why such evidence was unacceptable, and the most
common disabilities for which private medical evidence was
deemed unacceptable.
Enacting H.R. 1725 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 1725 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 1725 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Dwayne M.
Wright. The estimate was approved by Theresa Gullo, Assistant
Director for Budget Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1725, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1725, as amended.
CONSTITUTIONAL AUTHORITY STATEMENT
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1725, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that H.R. 1725, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 1725, as amended, establishes or reauthorizes a program
of the Federal Government known to be duplicative of another
Federal program, a program that was included in any report from
the Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
DISCLOSURE OF DIRECTED RULEMAKING
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 1725, as amended, contains no
directed rule making that would require the Secretary to
prescribe regulations.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1--Report on progress of Department of Veterans Affairs
Acceptable Clinical Evidence initiative
Section 1 would require VA to, not later than 180 days
after the date of enactment: submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a report on the progress of VA's Acceptable Clinical
Evidence initiative in reducing the necessity for in-person
disability examinations. Such report must include: (1) the
number of claims eligible for the Acceptable Clinical Evidence
initiative; (2) the number of claims eligible for the
Acceptable Clinical Evidence initiative that required a VA
medical examiner to supplement the evidence with information
obtained during a telephone interview with the claimant; (3)
information on VA's other efforts to encourage the use of
private medical evidence; (4) the anticipated impact on
processing claims for veterans benefits if VA were prohibited
from requesting a medical examination when a claimant submits
medical evidence and a medical opinion provided by a private
physician that is adequate for the purpose of making a decision
on the claim; and, (5) recommendations on how VA can measure,
track, and prevent the ordering of unnecessary medical
examinations.
Section 2--Annual report on submittal of private medical evidence in
support of claims for Department of Veterans Affairs benefits
Section 2 would require VA to, not later than March 1 of
each year for seven years after the date of enactment, submit
to Congress a report that includes for the preceding calendar
year, the following information disaggregated by each regional
office: (1) the number of times a veteran who submitted private
medical evidence in support of a claim for compensation or
pension was scheduled for an examination conducted by a VA
medical provider because the private medical evidence submitted
was determined to be unacceptable, (2) the most common reasons
why private medical evidence submitted in support of claims for
veterans benefits was determined to be unacceptable, and (3)
the types of disabilities for which claims for veterans
benefits were most commonly denied when private medical
evidence was submitted.
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
If enacted, this bill would make no changes in existing
law.
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