,,ii  #aah? ,,congress  #a/ ,session    
,s4 #bgah  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #e1 #bjbc,mr4
 ,te/] 7= himself & ,mr4 ,tillis7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,vet]ans' ,affairs  ,a ,,bill  ,to am5d 
title #ch1 ,unit$ ,/ates ,code1 to      
improve matt]s relat+ to m$ical         
exam9ations = vet]ans disability        
comp5sation1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,m$ical ,disability ,exam ,improvem5t   
,act ( #bjbc4  #b4 ,modification (      
eligibility requirem5ts = m$ical nexus  
exam9ations = toxic exposure risk       
activities ,section #aafh7;a77#a7 (     
title #ch1 ,unit$ ,/ates ,code1 is      
am5d$-- 7#a7 by /rik+ ) evid5ce ( a     
disability & evid5ce ( p>ticipation 9 a 
toxic exposure risk activity & ins]t+ & 
expresses t su* claim is associat$ ) a  
toxic exposure risk activity2 &  7#b7 by
 /rik+ & su* evid5ce & ins]t+ & evid5ce 
( record be=e ! ,secret>y4  #c4         

,specification ( acc\nts = c]ta9 exp5ses
 relat+ to m$ical exam9ations = vet]ans 
disability comp5sation claims "u laws   
adm9i/]$ by ,secret>y ( ,vet]ans        
,affairs ,section #eajc;,a7d7 ( title   
#ch1 ,unit$ ,/ates ,code1 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#c7 ,exp5ses ( c>ry+ out a m$ical      
exam9ation or obta9+ a m$ical op9ion "u 
p>agraph 7#a71 includ+ paym5t = travel &
 incid5tal exp5ses "u ! t]ms &          
conditions set =? by section #aaa ( ?is 
title = ! exam9ation or m$ical op9ion1  
%all be reimburs$ to ! acc\nts available
 = ! g5]al op]at+ exp5ses ( ! ,vet]ans  
,b5efits ,adm9i/ration & in=mation      
te*nology sy/ems f am\nts available to !
 ,secret>y = paym5t ( comp5sation &     
p5sions4  4  #d4 ,/udy on improvem5ts to
 ,dep>tm5t ( ,vet]ans ,affairs cov]$    
m$ical disability exam9ations 9 rural   
areas  7a7 ,/udy requir$ ,n lat] ?an "o 
ye> aft] ! date ( ! enactm5t ( ?is ,act1
 ! ,secret>y ( ,vet]ans ,affairs %all   
complete a /udy on access by rural      

vet]ans to cov]$ m$ical disability      
exam9ations4  7b7 ,elem5ts  7#a7 ,9     
g5]al ,! /udy conduct$ "u subsection 7a7
 %all include ! foll[+3 7,a7 ,a         
comp>ison ( ! av]age numb] ( days to    
complete cov]$ m$ical disability        
exam9ations = rural vet]ans comp>$ to a 
national non-rural av]age "t to complete
 a cov]$ m$ical disability exam9ations1 
by ei!r contractors or employees ( !    
,dep>tm5t4  7,b7 ,a root cause analysis 
( diff]5ces id5tifi$ pursuant to        
subp>agraph 7,a74  7,c7 ,! plan ( !     
,secret>y = ! foll[+ ye> to improve     
access describ$ 9 subsection 7a71 :i*   
%all include a plan = ! pursuit ( a     
comm]cial or indu/ry-/&>d solution or   
te*nology t c\ld enable rural or        
h\seb\nd vet]ans to receive exam9ations 
)\t travel+ long di/ances4  7#b7        
,national non-rural av]age def9$ ,=     
purposes ( p>agraph 7#a77;,a71 ! t]m    
national non-rural av]age means !       
national av]age ( all p]iods 9 ! previ\s
 cal5d> ye>-- 7,a7 beg9n+ on ! date on  

:i* a contractor or employee ( !        
,dep>tm5t receiv$ a reque/ f ! ,secret>y
 to conduct a cov]$ m$ical disability   
exam9ation = a vet]an :o is n a rural   
vet]an2 &  7,b7 end+ on ! date on :i* ! 
exam9ation 0 complet$4  7c7 ,report on  
/udy ,n lat] ?an "o ye> aft] ! date ( ! 
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! f9d+s ( ! 
,secret>y ) respect to ! /udy complet$  
"u subsection 7a74  7d7 ,annual report  
on plans ,n lat] ?an two ye>s aft] !    
date ( ! enactm5t ( ?is ,act & n less   
frequ5tly ?an once ea* ye> !reaft]1 !   
,secret>y %all submit to ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives a report        
evaluat+ ! conduct ( ! plans ( !        
,secret>y to improve access describ$ 9  
subsection 7a7 & a new or revis$ plan = 
su* improvem5t 9 ! foll[+ ye>4  #e4     

,improvem5ts to tra9+ = process+ m$ical 
disability exam9ations  7a7 ,9 g5]al ,n 
lat] ?an #ahj days aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y (      
,vet]ans ,affairs %all require          
additional tra9+ = employees ( !        
,dep>tm5t ( ,vet]ans ,affairs :o ord] or
 review cov]$ m$ical disability         
exam9ations4  7b7 ,tra9+ requirem5ts ,! 
tra9+ requir$ "u subsection 7a7 %all    
include ! foll[+3 7#a7 ,in/ruction on h[
 to assess :e!r a cov]$ m$ical          
disability exam9ation is adequate =     
purposes ( adjudicat+ ! p>ticul> claim =
 a b5efit "u *apt] #aa or #ae ( title   
#ch1 ,unit$ ,/ates ,code1 = :i* !       
exam9ation 0 ord]$ by ! ,dep>tm5t4  7#b7
 ,in/ruction on h[ to assess :e!r a     
cov]$ m$ical disability exam9ation is   
necess>y = purposes ( adjudicat+ !      
p>ticul> claim = a b5efit "u *apt] #aa  
or #ae ( title #ch1 ,unit$ ,/ates ,code1
 = :i* ! exam9ation 0 ord]$ by !        
,dep>tm5t4  7#c7 ,review ( relevant     
/atutes1 judicial decisions1            

regulations1 & policies ( ! ,dep>tm5t   
reg>d+ cov]$ m$ical disability          
exam9ations1 includ+1 at a m9imum-- 7,a7
 ! duty to assi/2  7,b7 ! relevance (   
causation comp>$ to o!r evid5ti>y /&>ds 
9 cov]$ m$ical disability exam9ations2  
7,c7 ! requir$ elem5ts ( a cov]$ m$ical 
disability exam9ation1 ) an emphasis on 
! requirem5t = reason$ analysis to      
support m$ical op9ions2 &  7,d7 !       
relevance ( a lack ( a /atutory or      
regulatory presumption (                
s]vice-connection 9 cov]$ m$ical        
disability exam9ations4  7c7 ,frequ5cy  
,! ,secret>y %all ensure t ea* employee 
( ! ,dep>tm5t :o ord]s or uses a cov]$  
m$ical disability exam9ation to evaluate
 a claim = a b5efit "u *apt] #aa or #ae 
( title #ch1 ,unit$ ,/ates ,code1       
completes tra9+ t incorporates !        
requirem5ts ( subsection 7b7 n less     
frequ5tly ?an once ea* ye>4  7d7        
,modification ( reports  7#a7 ,bo>d (   
,vet]ans' ,appeals ,section             
#gaja7;d77#b7 ( title #ch1 ,unit$ ,/ates

 ,code1 is am5d$-- 7,a7 9 subp>agraph   
7,f71 by /rik+ 2 & & ins]t+ a semicolon2
  7,b7 9 subp>agraph 7,g71 by /rik+ !   
p]iod at ! end & ins]t+ 2 &2 &  7,c7 by 
add+ at ! end ! foll[+ new subp>agraph3 
7,h7 a summ>y ( recurr+ issues t !      
,*airman believes c\ld be resolv$ by    
bett] tra9+ = employees ( ! ,dep>tm5t1  
increas$ ov]sight1 or cl>ification f    
ei!r ! ,dep>tm5t or ,congress4  4  7#b7 
,unit$ ,/ates ,c\rt ( ,appeals =        
,vet]ans ,claims ,section #gbhh7;b7 (   
title #ch1 ,unit$ ,/ates ,code1 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#af7 ,a summ>y ( recurr+ issues t !  
*ief judge ( ! ,c\rt believes c\ld be   
resolv$ by bett] tra9+ = employees ( !  
,dep>tm5t1 increas$ ov]sight1 or        
cl>ification f ei!r ! ,dep>tm5t or      
,congress4  4  7e7 ,def9ition ( cov]$   
m$ical disability exam9ation ,9 ?is     
section1 ! t]m cov]$ m$ical disability  
exam9ation means a m$ical exam9ation or 
m$ical op9ion t ! ,secret>y det]m9es    
necess>y = ! purposes ( adjudicat+ a    

b5efit "u *apt] #aa or #ae ( title #ch1 
,unit$ ,/ates ,code1 reg>dless ( :e!r   
conduct$ by an employee or a contractor 
( ! ,dep>tm5t4  #f4 ,review & priority  
process+ ( claims ) inadequate or       
unnecess>y exam9ations  7a7 ,review ,n  
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is ,act & n less frequ5tly ?an once 
e cal5d> mon? !reaft]1 ! ,secret>y (    
,vet]ans ,affairs %all review a         
/ati/ically significant sample ( all    
cov]$ m$ical disability exam9ations     
complet$ dur+ ! previ\s cal5d> mon?4    
7b7 ,fur!r sample requirem5ts ,"u ea*   
review requir$ by subsection 7a71 !     
,secret>y %all ensure ! review          
includes-- 7#a7 a /ati/ically           
significant sample ( cov]$ m$ical       
disability exam9ations complet$ by      
employees ( ! ,dep>tm5t ( ,vet]ans      
,affairs2 &  7#b7 a /ati/ically         
significant sample ( cov]$ m$ical       
disability exam9ations complet$ by ea*  
contractor t provides su* exam9ations = 
! ,dep>tm5t4  7c7 ,analysis ,"u ea*     

review requir$ by subsection 7a71 !     
,secret>y %all analyze-- 7#a7 ! sample  
specifi$ 9 subsection 7b77#a7 & id5tify 
! p]c5tage ( exam9ations t 7 adequate = 
purposes ( adjudicat+ ! p>ticul> claim =
 a b5efit "u *apt] #aa or #ae ( title   
#ch1 ,unit$ ,/ates ,code1 = :i* !       
exam9ation 0 ord]$ by ! ,dep>tm5t2  7#b7
 ! sample specifi$ 9 subsection 7b77#b7 
& id5tify ! p]c5tage ( exam9ations t 7  
adequate = purposes ( adjudicat+ !      
p>ticul> claim = a b5efit "u *apt] #aa  
or #ae ( title #ch1 ,unit$ ,/ates ,code1
 = :i* ! exam9ation 0 ord]$ by !        
,dep>tm5t2 &  7#c7 ! ov]all sample      
specifi$ 9 subsection 7a7 & id5tify !   
p]c5tage ( exam9ations t 7 necess>y =   
purposes ( adjudicat+ ! p>ticul> claim =
 a b5efit "u *apt] #aa or #ae ( title   
#ch1 ,unit$ ,/ates ,code1 = :i* !       
exam9ation 0 ord]$ by ! ,dep>tm5t4  7d7 
,priority process+ ,if dur+ a review "u 
subsection 7a7 ! ,secret>y f9ds any     
cov]$ m$ical disability exam9ation to be
 n adequate or n necess>y = adjudicat+ a

 claim ( a claimant1 ! ,secret>y may    
provide su* claimant-- 7#a7 ano!r       
exam9ation on a priority basis2 &  7#b7 
priority process+ = ! entirety ( impact$
 claim4  7e7 ,cov]$ m$ical disability   
exam9ation def9$ ,9 ?is section1 ! t]m  
cov]$ m$ical disability exam9ation means
 a m$ical exam9ation or m$ical op9ion t 
! ,secret>y det]m9es necess>y = !       
purposes ( adjudicat+ a b5efit "u *apt] 
#aa or #ae ( title #ch1 ,unit$ ,/ates   
,code1 reg>dless ( :e!r conduct$ by an  
employee or a contractor ( ! ,dep>tm5t4 
#g4 ,me*anism = contractors conduct+    
disability exam9ations "u c]ta9         
,dep>tm5t ( ,vet]ans ,affairs pilot     
program to transmit m$ical evid5ce      
introduc$ by claimants dur+ exam9ations 
,section #ejd ( ! ,vet]ans' ,b5efits    
,improvem5ts ,act ( #aiif 7,public ,law 
#ajd-bge2 #ch ,u4,s4,c4 #eaja note7 is  
am5d$-- 7#a7 by r$esignat+ subsections  
7d7 & 7e7 z subsection 7e7 & 7f71       
respectively2 &  7#b7 by ins]t+ aft]    
subsection 7c7 ! foll[+ new subsection  

7d73  7d7 ,me*anism = transmittal (     
evid5ce introduc$ by applicants dur+    
exam9ations ,! ,secret>y %all e/abli% a 
me*anism :]eby a heal? c>e pr(essional c
 transmit to ! ,secret>y1 evid5ce       
introduc$ by ! applicant dur+ a m$ical  
exam9ation or 9 conjunction ) su*       
exam9ation4  4