S. 2493 — Medical Disability Examination Improvement Act of 2025

This section establishes a pilot program, to be carried out by the Under Secretary for Benefits, to assess the feasibility and advisability of conducting medical examinations or obtaining medical opinions for veterans disability compensation claims under 38 U.S.C. §5103A(d) at Department of Veterans Affairs (VA) medical facilities. The pilot program phases in participation as follows: (1) before FY2027, at medical facilities in up to one Veterans Integrated Service Network (VISN); (2) in FY2029, up to three VISNs; (3) in FY2031, up to six VISNs; (4) in FY2033, up to 10 VISNs; and (5) in FY2035 and thereafter, through such VISNs as appropriate, with VISN selections made by the Under Secretary for Benefits in coordination or consultation with the Under Secretary for Health. If commenced within two years of enactment, the Under Secretary must submit to Congress, not later than two years after enactment, a report assessing the pilot program's effects on the cost, timeliness, quality, and capacity of VA medical disability examinations. Costs of the pilot program, including travel and incidental expenses under 38 U.S.C. §111 (i.e., beneficiary travel payments), are to be reimbursed from compensation and pension funds to accounts for Veterans Benefits Administration operating expenses and information technology systems.

This section directs the Secretary of Veterans Affairs to complete a study, not later than one year after the date of enactment, on access by veterans residing in rural and highly rural areas (as defined by the Department of Agriculture's rural-urban commuting areas coding system) to covered medical disability examinations (i.e., medical nexus examinations or medical opinions for adjudicating benefits under 38 U.S.C. chapters 11 or 15, conducted by VA employees or contractors). The study must include (1) a comparison of average days to complete such examinations—measured from the date of the VA's request to the contractor or employee to the completion date—disaggregated by examination type, for rural and highly rural veterans versus those in other areas; (2) a root cause analysis of any identified differences; and (3) a plan for the following year to improve access, including pursuit of commercial or industry-standard technology to enable housebound or rural veterans to receive examinations without long-distance travel. The Secretary must submit a report on the study's findings to the Senate and House Committees on Veterans’ Affairs by the same deadline.

This section directs the Secretary of Veterans Affairs, not later than 180 days after enactment, to require additional training for new and probationary Department employees who order or review covered medical disability examinations (i.e., medical exams or opinions necessary to adjudicate veterans' disability compensation or pension claims under 38 U.S.C. chapters 11 or 15). The training must include (1) assessing exam adequacy and necessity for claims adjudication; (2) relevant statutes, judicial decisions, regulations, and policies, including the duty to assist, causation versus other evidentiary standards, required elements with reasoned analysis, and lack of service-connection presumption; and (3) input from affected employees, including labor representatives. This section further requires second-level review of such new employees' claims decisions until they achieve 90% accuracy and amends annual reports of (1) the Board of Veterans’ Appeals to summarize recurring issues causing remands to the agency of original jurisdiction and (2) the U.S. Court of Appeals for Veterans Claims to summarize recurring issues causing remands.

This section requires the Secretary of Veterans Affairs, not later than one year after enactment and not less frequently than quarterly thereafter through three years after enactment, to review statistically significant samples of covered medical disability examinations (i.e., medical exams or opinions for adjudicating veterans' disability compensation claims under 38 U.S.C. ch. 11 or survivors' dependency and indemnity compensation claims under ch. 15), including samples from VA employees and each contractor. Under each review, the Secretary must analyze the samples to determine the percentage of exams that are adequate or overdeveloped for claim adjudication. If an exam is inadequate, the section requires priority processing of the entire claim and a new exam on a priority basis (unless deemed unnecessary by the Secretary). (Thus, inadequate exams trigger faster claim resolution.) It also requires the Comptroller General of the United States to review the methodology and effectiveness of the VA's reviews.

This section directs the Secretary of Veterans Affairs to establish a mechanism allowing health care professionals conducting medical examinations under the pilot program for contractor-provided disability examinations (Sec. 504, Veterans’ Benefits Improvements Act of 1996; 38 U.S.C. 5101 note)—i.e., examinations contracted out under 38 U.S.C. 5103A(d)—to transmit evidence introduced by the applicant during such an examination, or used by the examiner to inform it, directly to the veteran’s claims file.

This section directs the Secretary of Veterans Affairs, not later than one year after the date of enactment of this Act, to complete a review of scheduling request tools, contracts, and systems used by department employees and contractors to order and conduct medical disability examinations. The section further requires the Secretary to submit to the Senate and House Committees on Veterans’ Affairs a plan to ensure (1) seamless communication of requirements between claims processors and medical disability examination vendors; (2) examiners’ review of necessary medical records and claims information for adequate exams used in rating veterans’ benefits claims; (3) claimants’ choice in the timing and location of examinations within a reasonable timeframe; (4) a seamless scheduling experience regardless of vendor; and (5) customer satisfaction surveys of claimants attending such examinations.