Department of Veterans Affairs FY2024 Appropriations
Congressional research reportMay 1, 2024
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Department of Veterans Affairs
FY2024 Appropriations
May 1, 2024
Congressional Research Service
https://crsreports.congress.gov
R48056
SUMMARY
Department of Veterans Affairs
FY2024 Appropriations
The Department of Veterans Affairs (VA) administers numerous programs that provide benefits
and services to eligible veterans and their families. These benefits include medical care, disability
compensation, Dependency and Indemnity Compensation (DIC), pensions, education, vocational
rehabilitation and employment services, assistance to homeless veterans, home loan guarantees,
and administration of life insurance, as well as traumatic injury protection insurance for
servicemembers and benefits that cover burial expenses.
R48056
May 1, 2024
Sidath Viranga Panangala
Specialist in Veterans
Policy
Jared S. Sussman
Analyst in Health Policy
President Biden submitted his budget proposal for FY2024 on March 9, 2023. The
Administration requested $319.76 billion for VA (+16.48 billion, or + 5.43% over FY2023). The
request included $137.76 billion in discretionary appropriations (+ 3.03 billion, or +2.25% over FY2023) and $182.01 billion
in mandatory appropriations (+13.45 billion, or +7.98%). The President’s budget requested $20.27 billion for the Cost of War
Toxic Exposures Fund (TEF) for FY2024 and $21.46 billion for FY2025. TEF funding is categorized as mandatory funding.
On June 3, 2023, the Fiscal Responsibility Act (FRA) of 2023 (P.L. 118-5) was enacted into law. This law, among other
things, provided funding for TEF. The act provides $20.27 billion, which become available on October 1, 2023, and will
remain available until September 30, 2028, and $24.46 billion, which will become available on October 1, 2024, and will
remain available until September 30, 2029.
On June 13, 2023, the House Appropriations Committee held a full committee markup of its version of the Military
Construction, Veterans Affairs, and Related Agencies (MILCON-VA) appropriations bill for FY2024 (H.R. 4366). The
measure (H.Rept. 118-122) was reported on June 27. The House passed its version of the MILCON-VA appropriations bill
for FY2024 on July 27. The House-passed measure (H.R. 4366) provided $299.49 billion for VA for FY2024. The Housepassed bill provided $137.75 in discretionary appropriations and $161.74 in mandatory appropriations for VA.
On June 22, 2023, the Senate Appropriations Committee held a full committee markup of its version of the
MILCON-VA appropriations bill for FY2024 and reported the bill to the Senate (S. 2127; S.Rept. 118-43). On
November 1, 2023, the Senate passed a consolidated appropriations bill that included three annual appropriations
measures (S.Amdt. 1092 to H.R. 4366). Division A of this bill included the MILCON-VA appropriations bill for
FY2024. The Senate-passed version of the MILCON-VA appropriations bill provided $296.51 billion for FY2024
for VA. This included $134.77 billion in discretionary funds and $161.74 billion in mandatory funds. After a
series of continuing resolutions (P.L. 118-15; P.L. 118-22; P.L. 118-35; P.L. 118-40) that funded some VA accounts
at FY2023 levels, on March 3, 2024, the House and Senate Appropriations Committees released a six-bill
appropriations package. Division A of the consolidated appropriations bill (H.R. 4366, as amended) included the
MILCON-VA appropriations bill for FY2024. Following House and Senate passage on March 6 and 8,
respectively, the President signed the Consolidated Appropriations Act of 2024 (P.L. 118-42) into law on March 9,
2024.
Comparative funding levels for FY2023 (P.L. 117-328) and FY2024 (P.L. 118-42) are listed in the table below
(component amounts may not sum to totals due to rounding and adjustments due to rescissions). TEF funding for
FY2024 funding was provided in P.L. 118-5 and is not reflected in the table totals.
Congressional Research Service
Department of Veterans Affairs FY2024 Appropriations
Veterans Benefits
Administration
(VBA, including
General
Operating
Expenses)
Veterans Health
Administration
(VHA)
National
Cemetery
Administration
(NCA)
Departmental
Administration
Cost of War
Toxic Exposure
Fund (TEF)
% Change
FY2024
Request
House
(H.R. 4366;
H.Rept. 118122)
Senate
(Div. A
H.R. 4366;
S.Rept. 11843)
$167.70 billion
$165.96 billion
$165.96 billion
$165.96 billion
$176.72 billion
5.38%
$119.66 billion
$121.95 billion
$121.95 billion
$119.97 billion
$120.00 billion
0.28%
$430.0 million
$480.0 million
$482.0 million
$480.0 million
$480.0 million
11.63%
$10.58 billion
$11.11 billion
$11.09 billion
$10.09 billion
$10.10 billion
-4.47%
$5.0 billion
$20.27 billion
—
FY2023
Enacted
(P.L. 117-328)
FY2024
Enacted
(P.L. 118-42)
FY2024
Enacted vs.
FY2023
Enacted
—
—
N/A
Total VA
$303.28 billion
$319.76 billion $299.49 billion
$296.51 billion
$307.31billion
1.33%
Total
Mandatory
Total
Discretionary
$168.56 billion
$182.01billion $161.74 billion
$161.74 billion
$172.53 billion
2.36%
$134.73 billion
$137.76 billion $137.75 billion
$134.77 billion
$134.77 billion
0.04%
Congressional Research Service
Department of Veterans Affairs FY2024 Appropriations
Contents
Introduction ..................................................................................................................................... 1
Scope and Limitations of This Report ....................................................................................... 1
The Department of Veterans Affairs Budget ................................................................................... 2
Mandatory (Direct) Spending ................................................................................................... 2
Appropriated Entitlements .................................................................................................. 3
Discretionary Spending ............................................................................................................. 3
VA Funding ............................................................................................................................... 3
Advance Appropriations............................................................................................................ 4
Cost of War Toxic Exposures Fund (TEF) ................................................................................ 5
TEF and Future Authorizing Legislation .................................................................................. 6
Historical Perspective................................................................................................................ 7
FY2023 Budget Summary ............................................................................................................... 8
Budget Request for FY2024 and Congressional Action ................................................................ 11
President’s Request .................................................................................................................. 11
House Action—Subcommittee Markup .................................................................................. 13
The Fiscal Responsibility Act of 2023 (H.R. 3746; P.L. 118-5) ............................................. 14
House Action—Full Committee Markup, Floor Debate and Passage ..................................... 14
Senate Action—Full Committee Markup, Floor Debate and Passage .................................... 15
Continuing Appropriations for FY2024 (P.L. 118-15; P.L. 118-22; P.L. 118-35;
and P.L. 118-40) ............................................................................................................. 15
Consolidated Appropriations Act, 2024 (H.R. 4366; P.L. 118-42) ................................... 16
Mandatory Programs Funding................................................................................................. 17
Compensation and Pensions ............................................................................................. 18
Readjustment Benefits ...................................................................................................... 19
Veterans Insurance and Indemnities.................................................................................. 19
Medical Care and Medical Research Discretionary Programs Funding ................................. 20
Background ....................................................................................................................... 20
The Veteran Patient Population ......................................................................................... 22
President’s Request and Congressional Action ................................................................. 23
Nonmedical Discretionary Programs Funding ........................................................................ 27
National Cemetery Administration (NCA) ....................................................................... 27
VBA, General Operating Expenses .................................................................................. 28
Board of Veterans’ Appeals ............................................................................................... 29
Information Technology Systems (IT Systems) ................................................................ 29
Veterans Electronic Health Record (EHR)........................................................................ 30
Construction, Major Projects ............................................................................................ 33
Construction, Minor Projects ............................................................................................ 34
Grants for Construction of State Extended Care Facilities ............................................... 35
Grants For Construction of Veterans Cemeteries .............................................................. 35
Figures
Figure 1. VA Appropriations, FY1995-FY2023 .............................................................................. 7
Figure 2. VA Appropriations: Nominal and Inflation-Adjusted FY1995-FY2023 .......................... 8
Figure 3. FY2023 VA Budget Request ............................................................................................ 9
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Department of Veterans Affairs FY2024 Appropriations
Figure 4. FY2023 VA Enacted Appropriations (P.L. 117-328) ...................................................... 10
Figure 5. FY2024 VA Budget Request .......................................................................................... 13
Figure 6. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2024 ......................... 22
Tables
Table 1. FY2024 VBA, VHA, NCA and Departmental Administration Appropriations ............... 17
Table 2. First Five EHRM Deployment Sites ................................................................................ 31
Table 3. FY2023-FY2024 Appropriations and FY2025 Advance Appropriations ........................ 37
Table A-1. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2024 ....................... 44
Table B-1. VA Appropriations FY1995-FY1999 ........................................................................... 45
Table B-2. VA Appropriations FY2000-FY2004 ........................................................................... 47
Table B-3. VA Appropriations FY2005-FY2009 ........................................................................... 49
Table B-4. VA Appropriations FY2010-FY2014 ........................................................................... 51
Table B-5. VA Appropriations FY2015-FY2019 ........................................................................... 53
Table B-6. VA Appropriations FY2020-FY2024 ........................................................................... 56
Appendixes
Appendix A. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2024 ................... 44
Appendix B. VA Appropriations FY1995-FY2023 ....................................................................... 45
Contacts
Author Information........................................................................................................................ 60
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Department of Veterans Affairs FY2024 Appropriations
Introduction
The history of the present-day Department of Veterans Affairs (VA) can be traced back to July 21,
1930, when President Hoover issued Executive Order 5398, creating an independent federal
agency known as the Veterans Administration by consolidating many separate veterans’
programs.1 On October 25, 1988, President Reagan signed legislation (P.L. 100-527) creating a
new federal cabinet-level Department of Veterans Affairs to replace the Veterans Administration,
effective March 15, 1989. The department provides a range of benefits and services to veterans
who meet certain eligibility criteria.2 These benefits and services include, among other things,
hospital and medical care;3 disability compensation4 and pensions;5 education;6 vocational
rehabilitation and employment services;7 assistance to homeless veterans;8 home loan guarantees;
administration of life insurance, as well as traumatic injury protection insurance for
servicemembers; and death benefits that cover burial expenses.9
The department carries out its programs nationwide through three administrations and the Board
of Veterans Appeals (BVA). The Veterans Health Administration (VHA) is responsible for health
care services and medical and prosthetic research programs. The Veterans Benefits
Administration (VBA) is responsible for, among other things, providing compensation, pensions,
and education assistance. The National Cemetery Administration (NCA)10 is responsible for
maintaining national veterans cemeteries; providing grants to states for establishing, expanding,
and improving state veterans cemeteries; and providing headstones and markers for the graves of
eligible persons, among other things. The BVA reviews all appeals made by veterans or their
representatives for entitlement to veterans’ benefits, including claims for service connection,
increased disability ratings, pensions, insurance benefits, and educational benefits, among other
things.
Scope and Limitations of This Report
This report provides an overview of the FY2024 President’s budget request for VA (Title II of the
Military Construction, Veterans Affairs, and Related Agencies [MILCON-VA] appropriations bill)
and subsequent congressional action. It begins with a discussion of various appropriations and
1 In the 1920s, three federal agencies, the Veterans Bureau, the Bureau of Pensions in the Department of the Interior,
and the National Home for Disabled Volunteer Soldiers, administered various benefits for the nation’s veterans.
2 For details on basic criteria, including the statutory definition of “veteran,” see CRS Report R47299, U.S. Department
of Veterans Affairs: Who Is a Veteran?
3 For more information on health care programs, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions.
4 For more information on disability benefit programs, see CRS Report R44837, Benefits for Service-Disabled
Veterans, and CRS Report R47163, Department of Veterans Affairs: Claims Process and Compensation and Pension
Exams by Contracted Physicians.
5 For information on pension programs, see CRS Report R46511, Veterans Benefits Administration (VBA): Pension
Programs.
6 For a discussion of education benefits, see CRS Report R42785, Veterans’ Educational Assistance Programs and
Benefits: A Primer.
7 For details on VA’s vocational rehabilitation and employment, see CRS Report RL34627, Veterans’ Benefits: The
Veteran Readiness and Employment Program.
8 For detailed information on homeless veterans programs, see CRS Report RL34024, Veterans and Homelessness.
9 For more information on burial benefits, see CRS Report R41386, Veterans’ Benefits: Burial Benefits and National
Cemeteries.
10 Established by the National Cemeteries Act of 1973 (P.L. 93-43).
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funds that constitute VA’s budget, followed by a brief overview of the FY2023 congressional
appropriations process and enacted amounts for FY2023. It then discusses the President’s request
for FY2024 for care, benefits, and services for veterans and administration of the department,
followed by congressional action on the FY2024 request. The report provides funding levels for
the accounts as presented in the MILCON-VA appropriations bill; it does not provide funding
levels at the subaccount, program, or activity levels. Generally, VA accounts are purpose specific
rather than program specific. For example, VHA’s supply chain modernization program could
include funding from the medical support and compliance account and the information
technology account. Table 3 provides account level details of FY2023-FY2024 VA appropriations
and FY2025 advance appropriations from the MILCON-VA appropriations bill. Appendix B lists
appropriations to VA from FY1995 to FY2023. Funding amounts shown in the appendices may
include transfers in and out of accounts, administrative recissions, and exclusion of the Housing
Benefit Program Fund Credit Subsidy. Therefore, those amounts may be different from those in
Table 3.
The Department of Veterans Affairs Budget
Certain budgetary concepts related to mandatory spending (direct spending), appropriated
entitlements, and discretionary spending are useful in understanding the various accounts that
fund VA’s benefits and services, as well as recent funding provided in the Cost of War Toxic
Exposures Fund (TEF)11 established by the Honoring our PACT Act of 2022 (P.L. 117-168).
Mandatory (Direct) Spending
Mandatory spending, also known as direct spending, is generally characterized as spending that is
provided or effectively controlled through authorizing legislation.12 “The fundamental
characteristic of mandatory spending is the lack of annual discretion to establish spending levels.
Instead, mandatory spending usually involves a binding legal obligation by the [federal
government] to provide funding for an individual, program, or activity.”13 There are several types
of mandatory (direct) spending, and one such category is entitlement authority. Entitlement
authority generally meets a three-part test:
1. Specified benefits: The program’s authorizing legislation specifies particular sums of
money to be paid;
2. Specified beneficiaries: The payments are to be made to a class of persons or
governments who meet specified eligibility requirements; and
3. Federal government has a legal obligation to pay which is not subject to
appropriations: The payment is not discretionary, i.e., the legislation obligates the United
States to make the specified payments to the eligible class and the legal obligation to make
the specified payments to the eligible class of recipients is not contingent on appropriations
11 38 U.S.C. §324.
12 U.S. Congress, Senate Committee on Finance, Program Descriptions and General Budget Information for Fiscal
Year 1995, committee print, prepared by the Staff for the Use of the Committee on Finance, United States Senate, 103 rd
Cong., 2nd sess., May 1994, S.Prt.103-80 (Washington: GPO, 1994), p. 132.
13 U.S. Congress, Senate Committee on the Budget, The Congressional Budget Process: An Explanation, committee
print, 105th Cong., 2nd sess., December 1998, S.Prt.105-67 (Washington: GPO, 1998), p. 5.
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being enacted. Therefore, if insufficient appropriations are available, the government may
presumably be sued for payment of the benefits.14
Although the appropriations for some entitlement programs–such as Medicare and Social
Security–are provided on a permanent basis in the authorizing laws establishing such programs,
some entitlement programs (e.g., veterans disability compensation, veteran survivor’s
Dependency and Indemnity Compensation [DIC] program, and pensions) require funding
provided in annual appropriations legislation. These types of entitlement programs are known as
appropriated entitlements and, although provided in appropriations legislation, the budget
authority provided to fund them is considered mandatory (or direct) spending.
Appropriated Entitlements15
Generally, appropriated entitlements receive funding through the annual appropriations process,
but they are not subject to annual appropriations decisions of the congressional appropriations
committees. “The Appropriations Committees have little or no discretion as to the amounts they
provide.”16 “Even though this funding is included in an appropriations bill, it is still considered
mandatory spending rather than discretionary spending.”17 For example, through the annual
Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, Congress
provides monthly, tax-free disability compensation payments to eligible veterans with disabilities
due to disease or injury incurred or aggravated during military service. However, the actual
funding level for disability compensation is determined by the “entitlement” criteria in Chapter
11, Title 38, of the U.S. Code.18 The appropriations act appropriates the sums necessary to cover
the cost of disability compensation payments.
Discretionary Spending19
Funding for discretionary accounts is provided and controlled through appropriations legislation.
“If the Appropriations Committees decide to lower funding for a [discretionary program] they can
simply reduce the annual appropriation, notwithstanding the authorized funding level sought by
the authorizing committee. Unlike entitlement programs, no formulas need to be changed to alter
funding levels for discretionary spending.”20
VA Funding
VA’s budget includes both mandatory and discretionary accounts. The accounts for VA’s
mandatory programs (appropriated entitlements) fund disability compensation for veterans, the
14 U.S. Congress, Senate Committee on Finance, Program Descriptions and General Budget Information for Fiscal
Year 1995, committee print, prepared by the Staff for the Use of the Committee on Finance, United States Senate, 103 rd
Cong., 2nd sess., May 1994, S.Prt.103-80 (Washington: GPO, 1994), p. 133.
15 For more details, see CRS Report RS20129, Entitlements and Appropriated Entitlements in the Federal Budget
Process. For an overview of mandatory spending, see CRS Report R44641, Trends in Mandatory Spending.
16 CRS Report 98-720 GOV. Manual on the Federal Budget Process (archived/nondistributable but available from the
author to congressional clients), p. 26.
17 U.S. Congress, Senate Committee on the Budget, The Congressional Budget Process: An Explanation, committee
print, 105th Cong., 2nd sess., December 1998, S.Prt.105-67 (Washington: GPO, 1998), p. 6.
18 See 38 U.S.C. §1110; §1121; §1131; §1141. Basic entitlement.
19 For more information, see CRS Report R41726, Discretionary Budget Authority by Subfunction: An Overview.
20 U.S. Congress, Senate Committee on Finance, Program Descriptions and General Budget Information for Fiscal
Year 1995, committee print, prepared by the Staff for the Use of the Committee on Finance, United States Senate, 103rd
Cong., 2nd sess., May 1994, S.Prt.103-80 (Washington: GPO, 1994), p. 131.
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survivor’s Dependency and Indemnity Compensation (DIC) program, pensions, Veteran
Readiness and Employment (VR&E), education programs (such as the Post 9-11 GI Bill), life
insurance, housing (guarantee of VA acquired direct home loans), clothing allowances,
automobile grants, adaptive equipment, and burial benefits (such as burial allowances, grave
liners, outer burial receptacles, and headstones and markers), among other benefits and services.
Discretionary accounts fund medical care (which comprises medical services, medical
community care, medical support and compliance, and medical facilities accounts), medical
research, construction programs (which comprises major construction, minor construction, grants
for state-extended care facilities, and grants for state cemeteries accounts), information
technology, Veterans Electronic Health Record (EHR), the Office of Inspector General, BVA,
NCA, and general operating expenses, among other accounts. These accounts are further
supplemented by revolving funds, such as the Canteen Service Revolving Fund; the Pershing Hall
Revolving Fund and Franchise Fund; trust funds, such as the Department of Veterans Affairs
Cemetery Gift Fund and the General Post Fund; and special funds, such as the Medical Care
Collections Fund, Capital Asset Fund, and Recurring Expense Transformational Fund.21
Advance Appropriations22
VA has advance appropriation authority for specified medical care and benefits accounts. In 2009,
Congress enacted the Veterans Health Care Budget Reform and Transparency Act of 2009 (P.L.
111-81), authorizing advance appropriations for three of the four VHA accounts: medical
services, medical support and compliance, and medical facilities.23 In 2014, Congress passed the
Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83; P.L. 113-235), which
amended 38 U.S.C. §117 and included three more accounts to the list of accounts identified for
advance appropriations. This act authorized advance appropriations for three mandatory VA
benefits programs within the Veterans Benefits Administration: compensation and pensions,
readjustment benefits, and veterans insurance and indemnities. Beginning with the FY2016
Military Construction and Veterans Affairs, and Related Agencies Appropriations Act (P.L. 114113), those accounts received advance appropriations for the first time for FY2017, in addition to
the three VHA accounts already authorized to receive advance appropriations.
Section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of
2015 (P.L. 114-41) required the establishment of a separate account for medical community care
beginning with the FY2017 appropriations cycle. The Jeff Miller and Richard Blumenthal
Veterans Health Care and Benefits Improvement Act of 2016 (P.L. 114-315) authorized advance
appropriations for the medical community care account.
Congress had authorized (through P.L. 111-81, P.L. 113-235, and P.L. 114-315) advance
appropriations of new budget authority for the aforementioned VBA and VHA accounts to
21 For more details about these funds, see Department of Veterans Affairs, FY2024 Congressional Budget Submission,
Burial and Benefits Programs and Departmental Administration, vol. 3 of 5, March 2023. For definitions about
“revolving funds,” “trust funds,” and “special funds,” see Executive Office of the President, Office of Management and
Budget (OMB), OMB Circular No. A–11, Section 20- Terms and Concepts, available at https://www.whitehouse.gov/
wp-content/uploads/2018/06/a11.pdf.
22 In general, advance appropriations refer to budget authority provided in an appropriations act that becomes available
for obligation one or more fiscal years after the year covered by the act. For a detailed discussion of advance
appropriations, see CRS Report R43482, Advance Appropriations, Forward Funding, and Advance Funding: Concepts,
Practice, and Budget Process Considerations.
23 Codified at 38 U.S.C. §117.
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prevent potential delays in the delivery of care and benefits to veterans that may have arisen in
the event of a funding lapse.
Generally, VA’s budget estimates for advance appropriations included in its annual budget request
are developed using data that are typically three to four years old.24 For example, the advance
appropriations estimates for FY2025 included in the FY2024 annual budget request to Congress
were developed by VA from about May through July 2022, using data through 2019 due to the
impact of the COVID-19 pandemic.25 The Government Accountability Office (GAO) has stated
that the
process to develop these estimates is inherently complex, as it requires making assumptions
based on imperfect information to predict obligations for VA health care 3 and 4 years into
the future. For this reason, VA’s budget estimate is prepared in the context of uncertainties
about the future—including changes in veterans’ needs, future economic conditions, and
shifting leadership priorities.26
Therefore, the department updates its annual budget request each year to reflect the most recent
data, actual program experience, and other factors, such as economic trends in unemployment and
inflation.27 This “revised request” for the upcoming fiscal year is displayed as additional funding
over the 2024 advance appropriations amount.
Under present budget scoring guidelines, advance appropriations are scored as new budget
authority in the fiscal year in which they first become available for obligation, not in the fiscal
year the appropriations are enacted, and are required to be counted for the purpose of enforcing
any statutory discretionary spending limits in effect for the fiscal year they first become
available.28 Therefore, the advance appropriations numbers noted in the tables of this report are
labeled “memorandum” and appear in the corresponding fiscal year column.
Cost of War Toxic Exposures Fund (TEF)
On August 10, 2022, President Biden signed the Sergeant First Class Heath Robinson Honoring
our Promise to Address Comprehensive Toxics Act of 2022, or “Honoring our PACT Act of
2022” (P.L. 117-168). Section 805(a) of this act established the Cost of War Toxic Exposure
Fund, to be administered by the VA Secretary.29 The Honoring our PACT Act of 2022
appropriated $500 million for the Cost of War Toxic Exposures Fund for FY2022, to remain
available until September 30, 2024, and further authorized appropriations (such sums as are
necessary) to this fund for FY2023 and each subsequent fiscal year for expenses associated with
the delivery of health care associated with exposure to environmental hazards during active
24 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Medical Programs, vol. 2 of 5, March
2023, p. VHA-434.
25 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Medical Programs vol. 2 of 5, March
2023, p. VHA-434.
26 U.S. Government Accountability Office, VA Health Care: Additional Steps Could Help Improve Community Care
Budget Estimates, GAO-20-669, September 2020, p. 3.
27 Office of Management and Budget, Budget of the United States Government, Fiscal Year 2024, Budget Appendix,
March 9, 2023, p. 1016.
28 Executive Office of the President, Office of Management and Budget (OMB), OMB Circular No. A–11, Section 20Terms and Concepts, available at https://www.whitehouse.gov/wp-content/uploads/2018/06/s20.pdf; also see OMB
Circular No. A–11, Appendix A -Scorekeeping Guidelines, available at https://www.whitehouse.gov/wp-content/
uploads/2018/06/a11.pdf.
29 38 U.S.C. §324.
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military service.30 Additionally, funds from the Cost of War Toxic Exposure Fund may be used for
costs associated with medical and other research related to environmental hazards, administrative
expenses related to benefits (including information technology), benefit claims processing, and
adjudicating appeals from veterans.31 The act states that appropriations provided for the Cost of
War Toxic Exposure Fund will be considered “direct spending” and will be treated as an
“appropriated entitlement.” Furthermore, the law states that the fund is exempt from mandatory
sequestration provisions in Section 256(h) of the Balanced Budget and Emergency Deficit
Control Act of 1985 (BBEDCA), as amended (also see discussion under the “Budget Request for
FY2024 and Congressional Action” and the “The Fiscal Responsibility Act of 2023” sections of
this report).
TEF and Future Authorizing Legislation
On December 7, 2022, the Congressional Budget Office (CBO) issued a statement on how certain
provisions of the TEF impact how the agency plans to score future veterans benefits and
programs authorizing legislation:
The TEF will provide support for five kinds of activities: health care, processing disability
claims, medical research, modernizing information technology (IT) programs, and other
services. Some future authorizing bills may affect the costs of those types of activities, both
for veterans generally and for veterans with toxic exposures. As a result, some of those
costs could now be paid in part from the TEF (thereby increasing mandatory spending) and
some could be paid, as they have been previously, from discretionary appropriations
(thereby increasing discretionary authorization levels). CBO would therefore include the
effects of both types of payments in its cost estimates for such legislation.... CBO would
allocate 21 percent of the added costs of subsequent legislation to the TEF in 2023; that
amount would grow to 42 percent by 2032. Those amounts would be shown as mandatory
spending in CBO’s cost estimates.32
In the 118th Congress, CBO has scored some measures using the scoring methodologies described
above. Examples include the Reinforcing Enhanced Support through Promoting Equity for
Caregivers Act of 2023 (S. 216), as ordered reported by the Senate Veterans’ Affairs Committee
on February 16, 2023, and the H.R. 542, Elizabeth Dole Home Care Act, as ordered reported by
the House Committee on Veterans’ Affairs on July 26, 2023. In scoring these bills, CBO has
stated that some of the costs of implementing these measures would be paid from the TEF and
therefore would be scored as mandatory or direct spending.33
30 For details on the allocation of initial appropriation of $500 million of TEF funds, see Department of Veterans
Affairs, Office of the Inspector General, Office of Audits and Evaluations, VA’s Allocation of Initial PACT Act
Funding for the Toxic Exposures Fund, Report #23-02377-35, Washington, DC, January 11, 2024.
31 38 U.S.C §324 note: “The Secretary of Veterans Affairs may use, from amounts appropriated to the Cost of War
Toxic Exposures Fund ... such amounts as may be necessary to continue the modernization, development, and
expansion of capabilities and capacity of information technology systems and infrastructure of the Veterans Benefits
Administration, including for claims automation, to support expected increased claims processing for newly eligible
veterans pursuant to this Act.”
32 Congressional Budget Office, Statement for the Record Regarding How CBO Would Estimate the Effects of Future
Authorizing Legislation on Spending From the Toxic Exposures Fund, December 7, 2022, pp. 1-2,
https://www.cbo.gov/publication/58843.
33 Congressional Budget Office, S. 216, Reinforcing Enhanced Support through Promoting Equity for Caregivers Act
of 2023, March 22, 2023, https://www.cbo.gov/publication/58972, and Congressional Budget Office, H.R. 542,
Elizabeth Dole Home Care Act, September 29, 2023, https://www.cbo.gov/publication/59573.
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Historical Perspective
Figure 1 illustrates funding trends, in nominal dollars, for mandatory, discretionary, and total VAenacted appropriations from FY1995 (a year before significant VA health care eligibility reform
with the enactment of the Veterans’ Health Care Eligibility Reform Act of 1996; P.L. 104-262)
through FY2023.34 Between FY1995 and FY2023, total mandatory appropriations grew from
$19.45 billion to $167.91 billion, a compound annual growth rate (CAGR) of 8.00%. During this
same period, discretionary appropriations grew from $18.02 billion to $129.82 billion, a CAGR
of 7.31%. The total VA appropriations from FY1995 through FY2023 grew from $37.47 billion to
$297.73 billion, a CAGR of 7.68%.
Figure 1.VA Appropriations, FY1995-FY2023
Source: Prepared by CRS based on figures from the Department of Veterans Affairs, Office of Management,
Office of Budget (see Appendix B).
Notes: Amounts in nominal, or noninflation-adjusted, dollars. Discretionary funding excludes offsetting
collections deposited in the Medical Care Collections Fund (MCCF). Mandatory funding excludes Housing
Benefit Program Fund Credit Subsidy Reestimates and includes Cost of War Toxic Exposure Fund (TEF)
amounts.
FY2009: American Recovery and Reinvestment Act (P.L. 111-5) provided supplemental funding. VHA received
$1.0 billion for the medical facilities account, and the $700 million was for the economic recovery payments. The
supplemental $700 million is not included in the discretionary subtotal but is included in overall VA total.
FY2014: Amounts include $15 billion in mandatory funding provided in the Veterans Choice Act (P.L. 113-146).
FY2021: Amounts include American Rescue Plan (ARP) Act (P.L. 117-2) funding.
FY2022 and FY2023: Amounts include unobligated balances of expired discretionary funds transferred to the
Recurring Expenses Transformational Fund.
Figure 2 illustrates funding trends for mandatory, discretionary, and total VA-enacted
appropriations from FY1995 through FY2022, in both nominal and inflation-adjusted dollars.
Between FY1995 and FY2023, total mandatory appropriations, when adjusted for inflation, grew
from $35.42 billion to $167.91 billion in 2023 dollars, a CAGR of 5.71%. During this same
period, discretionary appropriations grew from $32.83 billion to $129.82 billion, a CAGR of
34 As highlighted by the Congressional Budget Office (CBO), after a period of slow growth from 1980 to 1999, “VA’s
budget has roughly tripled in real (inflation-adjusted) terms” since 2000. According to CBO, the growth in disability
compensation and medical care account for most of VA’s budget increases. For additional details, see Congressional
Budget Office, Atlas of Military Compensation, December 5, 2023, https://www.cbo.gov/publication/59475.
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Department of Veterans Affairs FY2024 Appropriations
5.03%. The total VA appropriations from FY1995 through FY2023 grew from $68.25 billion to
$297.73 billion in 2023 dollars, a CAGR of 5.40%.
Figure 2. VA Appropriations: Nominal and Inflation-Adjusted FY1995-FY2023
Source: Prepared by CRS based on figures from the Department of Veterans Affairs, Office of Management,
Office of Budget (see Appendix B).
Notes: Nominal (or current) dollar values are adjusted to real (constant) dollars using the Gross Domestic
Product (GDP) Price Index Series deflator, where 2023 = 100. U.S. Bureau of Economic Analysis, “Table 1.1.4.
Price Indexes for Gross Domestic Product.” Discretionary funding excludes offsetting collections deposited in
the Medical Care Collections Fund (MCCF). Mandatory funding excludes Housing Benefit Program Fund Credit
Subsidy Reestimates and includes Cost of War Toxic Exposure Fund (TEF) amounts.
FY2023 Budget Summary
On March 28, 2022, President Biden submitted his budget request for FY2023. The President’s
request for VA was $298.61 billion. The request included $135.05 billion in discretionary
appropriations and $163.58 billion in mandatory appropriations. Figure 3 provides a breakdown
of the FY2023 request. Additionally, the President’s FY2024 advance appropriations request
included $155.35 billion for VBA mandatory accounts and $128.10 billion for VHA discretionary
accounts.
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Figure 3. FY2023 VA Budget Request
Source: Prepared by CRS based on U.S. Congress, House Committee on Appropriations, Military Construction,
Veterans Affairs, And Related Agencies Appropriations Bill, 2023, report to accompany H.R. 8238, 117th Cong., 2nd
sess., June 27, 2022, H.Rept. 117-391.
Notes: Total budget authority excludes offsetting collections deposited in the Medical Care Collections Fund
(MCCF).
On July 20, 2022, the House passed a six-bill appropriations package (H.R. 8294) consisting of
the FY2023 Transportation/Housing and Urban Development, Agriculture/Rural Development,
Energy and Water Development, Financial Services and General Government,
Interior/Environment, and Military Construction, and Veterans Affairs appropriations bills (House
Committee Print 117-55). Division F of H.R. 8294 contained the FY2023 MILCON-VA
appropriations bill. The House-passed bill (H.R. 8294) provided $298.56 billion for VA, including
$163.56 billion in mandatory appropriations and $135.01 billion in discretionary appropriations.
On July 28, 2022, Senate Appropriations Committee Chairman Senator Patrick Leahy released
drafts of 12 appropriations bills and explanatory statements to accompany the draft measures.35
On August 3, the Senate version of the FY2023 MILCON-VA appropriations bill, identical to the
majority committee draft, was introduced in the Senate as S. 4759. As introduced, S. 4759
recommended $299.91 billion for VA for FY2023, including $164.96 billion in mandatory
appropriations and $134.95 billion in discretionary funding.
On December 20, 2022, the House and Senate Appropriations Committees released the text of the
Consolidated Appropriations Act, 2023 (as an amendment to H.R. 2617). After Senate passage on
35 Senate Appropriations Committee, “Chairman Leahy Releases Fiscal Year 2023 Senate Appropriations Bills,” press
release, July 28, 2022, https://www.appropriations.senate.gov/news/majority/breaking-chairman-leahy-releases-fiscalyear-2023-senate-appropriations-bills. Also see Senate Appropriations Committee, “Shelby: Democrats’ Partisan Bills
Threaten FY23 Appropriations Process, Vice Chairman Warns: FY23 Appropriations Process Imperiled by Democrats’
Failure to Adhere to Bipartisan Framework and Seriously Invest in Defense,” press release, July 28, 2022,
https://www.appropriations.senate.gov/news/minority/shelby-democrats-partisan-bills-threaten-fy23-appropriationsprocess.
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December 22 and House passage on December 23, the bill was signed into law on December 29,
2022 (P.L. 117-328). Division J of P.L. 117-328 contained the MILCON-VA Appropriations Act
of 2023. The FY2023 MILCON-VA Appropriations Act provides $303.28 billion for VA for
FY2023 (without collections). This includes $168.56 billion in mandatory funding and $134.73
billion in discretionary funding. The act also provides $5.0 billion in mandatory (direct) funding
for the Cost of War Toxic Exposures Fund (TEF), to remain available until September 30, 2027.
These funds would be used for new costs associated with eligibility expansions authorized in the
Honoring our PACT Act of 2022 (P.L. 117-168). According to explanatory statement
accompanying the Consolidated Appropriations Act, 2023, there is no shift in discretionary
appropriations to the TEF.36 Figure 4 provides a breakdown of the enacted amounts for VA for
FY2023.
Figure 4. FY2023 VA Enacted Appropriations (P.L. 117-328)
Source: Figure prepared by CRS based on U.S. Congress, committee print, prepared by House Committee on
Appropriations Consolidated Appropriations Act, 2023 (H.R. 2617, P.L. 117-328) [Legislative Text and
Explanatory Statement] Book 2 of 2 Divisions G–N],117th Cong., 2nd sess. (Washington: GPO, 2023), pp. 24792493.
Notes: Total budget authority excludes offsetting collections deposited in the Medical Care Collections Fund
(MCCF). Totals may not add up due to rounding.
36 Explanatory Statement Submitted by Mr. Leahy, Chair Of The Senate Committee on Appropriations, Regarding H.R.
2617, Consolidated Appropriations Act, 2023 Congressional Record, vol. 168, Book II (December 20, 2022), p. S9235.
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Budget Request for FY2024 and
Congressional Action
President’s Request
On March 9, 2023, President Biden submitted his budget request for FY2024. The President’s
request for VA was $319.76 billion. The request included $137.76 billion in discretionary
appropriations and $182.01 billion in mandatory appropriations (see Figure 5). The mandatory
appropriations included $20.27 billion for the Cost of War Toxic Exposures Fund (TEF) (also see
text box). Similar to its previous budget proposals in FY2022 and FY2023, the President’s budget
proposed to use the Recurring Expenses Transformational Fund (RETF) to supplement its
discretionary appropriations.37 For FY2024, the Administration proposed transferring $600
million in unobligated balances into the RETF for eight major construction projects.
Similar to FY2023, the President’s FY2024 budget proposed a new third budget category within
the overall federal discretionary budget. The Budget Control Act of 2011 (BCA; P.L. 112-25), as
amended, imposed annual statutory discretionary spending limits by categorizing spending by
defense and nondefense spending.38 The defense category consists of discretionary spending in
budget function 050 (national defense) only. The nondefense category includes discretionary
spending in all other budget functions, including a majority of budget function 700 (veterans’
benefits and services).39 The statutory limits on discretionary spending were in effect through
FY2021.40 The Fiscal Responsibility Act of 2023 (P.L. 118-5) “includes provisions that would
establish enforceable discretionary spending limits (caps) for FY2024 and FY2025.”41 According
to the FY2024 President’s budget proposal,
a third category of discretionary spending will allow the Congress to consider the funding
needs for VA medical care holistically, taking into account both discretionary and
mandatory funding streams together. Setting a separate budget allocation for VA medical
care accomplishes three important goals. First, it helps ensure adequate funding for
veterans’ healthcare without adversely impacting other critical programs, whether inside
or outside of VA. Second, it also ensures that other critical priorities—both defense and
non-defense—won’t adversely impact veterans medical care. And third, it prevents the use
of the mandatory TEF funding as a mechanism to shift discretionary resources into the nonVA medical care categories.42
Cost of War Toxic Exposure Fund (TEF) Budget Request
37 38 U.S.C. §313 note. The Recurring Expenses Transformational Fund (RETF) was established by the Consolidated
Appropriations Act, 2016 (P.L. 114-113, Division J, Title II, Section 243). The law allows unobligated balances of
expired discretionary appropriations, in FY2016 or any succeeding fiscal year, to be transferred from the General Fund
of the Treasury to VA and deposited in the Recurring Expenses Transformational Fund at the end of the fifth fiscal year
after the last fiscal year for which such funds were available. The law stipulates that amounts deposited in the fund may
be available for facility infrastructure improvements, including nonrecurring maintenance, at existing VA hospitals and
clinics, and information technology systems improvements and sustainment, subject to approval by the Office of
Management and Budget (OMB) and House and Senate Appropriations Committees.
38 CRS Report R44874, The Budget Control Act: Frequently Asked Questions.
39 CRS Report R44874, The Budget Control Act: Frequently Asked Questions.
40 CRS Report R46752, Expiration of the Discretionary Spending Limits: Frequently Asked Questions.
41 CRS Insight IN12168, Discretionary Spending Caps in the Fiscal Responsibility Act of 2023.
42 Office of Management and Budget, Budget of the United States Government, Fiscal Year 2024, Analytical
Perspectives, March 9, 2023, p. 36.
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Department of Veterans Affairs FY2024 Appropriations
As required by the Honoring our PACT Act of 2022 (P.L. 117-168; 38 U.S.C. §324), the President’s Budget
request for FY2024 included the funding request for TEF for FY2024 and advance appropriations for FY2025. For
FY2024, the budget requested $20.27 billion in mandatory funding. This included $17.12 billion for medical care
and $3.15 billion in nonmedical mandatory funding. The nonmedical request comprises $46 million for medical and
prosthetic research account, $1.24 billion for the information technology account, $4 million for the Board of
Veterans’ Appeals, $1.77 billion for VBA general operating expenses account, and $90 million for the general
administration account. The discretionary appropriations request for FY2024 was adjusted to account for
expenses requested in the TEF. Additionally, for FY2025, the President’s budget request for TEF is $21.46 billion
in mandatory funding.
Medical Care Methodology43
In developing estimates for the medical care portion of TEF, VA decided that Priority Group 6 veterans
represented the best cohort to draw a sample for modeling the TEF costs for medical care. Even prior to the
enactment of Honoring our PACT Act of 2022, veterans who did not meet any other eligibility criteria and who
were seeking care for various environmental exposures (e.g., Agent Orange herbicide exposure or radiationexposure, among others) were enrolled in Priority Group 6. Of this population, VA estimated that 84% do not pay
any copayments or were not billed for care. In other words, a majority of this cohort is treated for diseases
potentially associated with military environmental exposures and therefore are not required to pay copayments
(veterans do not require an adjudication of service-connection to establish eligibility for care). These veterans are
eligible for treatment of specific conditions despite insufficient medical evidence to conclude that such conditions
are attributable to such service. Then VA used projected health care costs for veterans who were deployed during
the post-9/11 Gulf War and Vietnam eras from the Enrollee Health Care Projection Model (EHCPM), and applied
those costs to a proxy sample of 211 that did not pay any copayments or were not billed for care, applied the
discount for medical facility leases (since the EHCPM already includes lease costs, 1.1% was reduced from the TEF
calculations), and then subtracted out the FY2021 baseline amount to determine the estimated amount for
medical care in TEF.
Nonmedical Care Methodology
In developing nonmedical estimates related to the delivery of health care and disability benefits associated with
toxic exposures, VA estimated the following amounts for five accounts:44
Medical Prosthetic Research: $46 million for research relating to exposure to environmental hazards, such as
supporting the Interagency working group on toxic exposure research and the Military Exposure Research
Program (MERP). 45
Information Technology Systems: $1.24 billion to support PACT-related information technology (IT) efforts.
In developing the methodology, the VA Office of Information Technology (OIT) looked at what portion of pay and
staffing would be involved in PACT Act related work and what percentage of an IT platform or application would
be focused on activities related to the PACT Act.46
Board of Veterans Appeals: $4 million for the PACT Act, based on a historic number of veterans filing notice
of disagreement and appealing their claims. Uses historical data and applies it to veterans who will potentially file
43 Based on Office of Management and Budget, Budget of the United States Government, Fiscal Year 2024, Analytical
Perspectives, March 9, 2023, p. 36.; Department of Veterans Affairs, FY2024 Congressional Budget Submission,
Medical Programs, vol. 2 of 5, March 2023, pp. VHA-17, VHA-18; and Department of Veterans Affairs, TEF Request
Methodology Briefing to Congressional Staff, April 12, 2023.
44 A Management Advisory Memorandum issued by VA’s Office of the Inspector General stated, “As of September
2023, the estimation methodologies had not been completed for every VA administration and office. While VHA
finalized its estimation methodology to support expenses that are allowable under the TEF, both VBA and OIT were
still in the process of preparing estimation methodologies to explain their TEF spend plans.” Source: Department of
Veterans Affairs, Office of the Inspector General, Office of Audits and Evaluations, VA’s Allocation of Initial PACT
Act Funding for the Toxic Exposures Fund, Report #23-02377-35, Washington, DC, January 11, 2024, p. 4.
Subsequently, on February 13, 2024, VA finalized and approved financial policies for TEF; see Volume II Appropriations Funds and Related Information, Chapter 12–Toxic Exposures Fund, dated February 13, 2024, available
at https://department.va.gov/financial-policy-documents/ (accessed March 18, 2024).
45Department of Veterans Affairs, FY2024 Congressional Budget Submission, Medical Programs, vol. 2 of 5, March
2023, p. VHA-568.
46 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Information Technology Programs and
Electronic Health Record Modernization, Volume 5 of 5, March 2023, p. EHRM-165.
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appeals, including those under the Appeals Modernization Act (AMA). Following passage of the PACT Act, BVA
estimates that it could receive as many as 29,000 PACT Act appeals in 2024. 47
VBA General Operating Expenses: $1.77 billion for estimated TEF costs, for an increase of over 8,000 fulltime equivalent (FTE) staff to support the implementation PACT Act. Costs would include more than $1.2 billion
in payroll and $533 million in non-pay costs to include training, equipment, travel, contractual costs, and
reimbursement to the Veterans Experience Office (VEO) for Contact Center operations.48
General Administration: $90 million for staffing VA Office of General Counsel (OGC), as well as for veterans
outreach efforts, such as PACT Act town halls, and an increased workload for MyVA411(VA’s customer service
number).
Figure 5. FY2024 VA Budget Request
Source: Prepared by CRS based on U.S. Congress, House Committee on Appropriations, Military Construction,
Veterans Affairs, and Related Agencies Appropriations Bill, 2024, report to accompany H.R. 4366, 118th Cong., 1st
sess., June 27, 2023, H.Rept. 118-122; and U.S. Congress, Senate Committee on Appropriations, Military
Construction, Veterans Affairs, And Related Agencies Appropriation Bill, 2024, report to accompany S. 2127, 118th
Cong., 1st sess., June 22, 2023, S.Rept. 118-43.
Note: Total budget authority excludes offsetting collections deposited in the Medical Care Collections Fund
(MCCF).
House Action—Subcommittee Markup
On May 17, 2023, the House Committee on Appropriations, Subcommittee on Military
Construction, Veterans Affairs, and Related Agencies, held a markup of the Military Construction,
Veterans Affairs, and Related Agencies (MILCON-VA) appropriations bill and approved the draft
bill by voice vote. The draft bill did not recommend the President’s requested amount for the Cost
47 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Benefits and Burial Programs and
Departmental Administration, vol. 3 of 5, March 2023, p. VBA-57.
48 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Benefits and Burial Programs and
Departmental Administration, vol. 3 of 5, March 2023,
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of War Toxic Exposure Fund (TEF) of $20.27 billion to be fully funded as a mandatory
appropriation. According to the draft bill, $5.54 billion was recommended for TEF, and of this
amount, $2.39 billion was for veterans’ medical care, $1.77 billion was for VBA general
operating expenses, $1.24 billion was for information technology, $90 million was for general
administration, $46 million was for medical and prosthetic research, and $4 million was for the
Board of Veterans Appeals.49 The subcommittee draft bill did not recommend TEF funding for
FY2025.
Due to the debt ceiling negotiations during the latter part of May 2023, the full committee markup
of the MILCON-VA appropriations bill that was scheduled during the week of May 22 was
postponed.50
The Fiscal Responsibility Act of 2023 (H.R. 3746; P.L. 118-5)
As part of the deal between President Biden and former Speaker Kevin McCarthy to suspend the
debt limit, on June 3, 2023, President Biden signed into law the Fiscal Responsibility Act of 2023
(P.L. 118-5). The act, among other things, established statutory discretionary spending limits
(caps) for FY2024 and FY2025.51 The act also provided funding for the Cost of War Toxic
Exposure Fund (TEF). For FY2024, the act provided $20.27 billion, which became available on
October 1, 2023, and will remain available until September 30, 2028; for FY2025, it provided
$24.46 billion, which will become available on October 1, 2024, and remain available until
September 30, 2029, and would be fully funded as a mandatory appropriation.
Furthermore, the Fiscal Responsibility Act of 2023, under the provision “Rescission of
Unobligated Funds,” did not have any specific references to titles or sections pertaining to VA
COVID-19 funds provided in the Families First Coronavirus Response Act (P.L. 116-127); the
Coronavirus Aid, Relief, and Economic Security Act, “CARES Act” (P.L. 116-136); or the
American Rescue Plan Act of 2021 (P.L. 117-2).
House Action—Full Committee Markup, Floor Debate and Passage
Following the enactment of the Fiscal Responsibility Act of 2023, the House Appropriations
Committee resumed markup activities, and on June 13, 2023, the full committee marked up the
FY2024 MILCON-VA appropriations bill and the measure was approved by a vote of 34 to 27.
The bill was reported to the full House on June 27 (H.R. 4366; H.Rept. 118-122). The committee
49 U.S. Congress, House Committee on Appropriations, FY24 Military Construction, Veterans Affairs, and Related
Agencies - Subcommittee Mark, Subcommittee Print, 118th Cong., 2nd sess., May 16, 2023, http://docs.house.gov/
meetings/AP/AP18/20230517/115985/BILLS-118—AP—MilCon-FY24MilconAppropriation.pdf; also see House
Committee on Appropriations (Republicans), “Committee Releases FY24 Military Construction, Veterans Affairs, and
Related Agencies and FY24 Legislative Branch Appropriations Bills,” press release, May 16, 2023,
https://appropriations.house.gov/news/press-releases/committee-releases-fy24-military-construction-veterans-affairsand-related, and see bill summary at https://appropriations.house.gov/sites/republicans.appropriations.house.gov/files/
documents/
FY24%20Military%20Construction%2C%20Veterans%20Affairs%2C%20and%20Related%20Agencies%20%20Bill%20Summary.pdf. Also see House Committee on Appropriations (Democrats), “Military Construction,
Veterans Affairs, and Related Agencies Funding Bill Fails to Honor Our Commitment to Veterans,” press release, May
16, 2023, https://democrats-appropriations.house.gov/news/press-releases/military-construction-veterans-affairs-andrelated-agencies-funding-bill-fails.
50 House Committee on Appropriations, “Appropriations Markups Postponed,” press release, May 22, 2023,
https://appropriations.house.gov/news/press-releases/appropriations-markups-postponed.
51 For more details, see CRS Insight IN12168, Discretionary Spending Caps in the Fiscal Responsibility Act of 2023;
CRS Insight IN12183, The FRA’s Discretionary Spending Caps Under a CR: FAQs; and CRS Insight IN12296, The
Fiscal Responsibility Act (FRA) in FY2024: Current Status.
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also directed VA to provide detailed estimates of “incremental costs for implementation of the
PACT Act,” beginning with the FY2025 congressional budget submissions.52
On July, 27 2023, the House passed its version of the FY2024 MILCON-VA appropriations bill
(H.R. 4366). The House-passed bill provided $299.49 billion for VA for FY2024, an amount that
included $161.74 billion in mandatory funding and $137.75 billion in discretionary
appropriations. During floor debate, several amendments were adopted, including increased
funding for the medical and prosthetic research account, Board of Veterans’ Appeals account,
grants for construction of veterans cemeteries account, and grants for construction of state
extended care facilities account, by redirecting funds from the general administration and
information technology systems accounts. Table 1 provides a comparative breakdown, by
account, of the House-passed amounts for FY2024 and advance appropriations amounts for
FY2025.
Senate Action—Full Committee Markup, Floor Debate and Passage
On June 22, 2023, the Senate Committee on Appropriations held a markup of its version of the
FY2024 MILCON-VA appropriations bill and reported it out of committee (S. 2127; S.Rept. 11843). On September 6, 2023, Senator Patty Murray and Senator Susan Collins announced the
Senate Appropriations Committee’s plans for full Senate consideration of the first package of
appropriations bills.53 Among the appropriations bills included in the three-bill package was the
FY2024 MILCON-VA bill (S. 2127; S.Rept. 118-43).54 On September 7, S.Amdt. 1092 was
introduced by Senator Patty Murray and Senator Susan Collins as an amendment in the nature of
a substitute to the House-passed H.R. 4366. S.Amdt. 1092 included the text of the Senate
Appropriations Committee-reported MILCON-VA bill (S. 2127), among other appropriations
bills (S. 2131 and S. 2437). On November 1, 2023, having agreed to S.Amdt. 1092, as amended,
the Senate passed its version of the MILCON-VA appropriations bill (Division A of the
Consolidated Appropriations bill, 2024; H.R. 4366; S.Rept. 118-43). The Senate-passed version
of the MILCON-VA appropriations bill (Division A of H.R. 4366, as amended; S.Rept. 118-43)
provided $296.51 billion for VA for FY2024. This amount includes $134.77 billion in
discretionary funding, as well as $161.74 billion in mandatory appropriations. Table 1 provides a
comparative breakdown, by account, of the Senate-passed amounts (Division A of H.R. 4366 as
amended) for FY2024 and advance appropriations amounts for FY2025.
Continuing Appropriations for FY2024 (P.L. 118-15; P.L. 118-22; P.L. 118-35; and
P.L. 118-40)
Because none of the regular appropriations bills for FY2024 were enacted by the beginning of the
fiscal year on October 1, 2023, Congress passed the Continuing Appropriations Act, 2024 and
52 U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, and Related Agencies
Appropriations Bill, 2024, report to accompany H.R. 4366, 118th Cong., 1st sess., June 27, 2023, H.Rept. 118-122, p.
57.
53 Senate Committee on Appropriations, “Senators Murray and Collins Issue Statement on Plans to Proceed with First
Package of Appropriations Bills on Senate Floor,” press release, September 6, 2023,
https://www.appropriations.senate.gov/news/majority/senators-murray-and-collins-issue-statement-on-plans-toproceed-with-first-package-of-appropriations-bills-on-senate-floor.
54 The other bills in the package were the FY2024 Agriculture, Rural Development, Food and Drug Administration, and
Related Agencies appropriations bill (S. 2131; S.Rept. 118-44), and the FY2024 Transportation, Housing and Urban
Development, and Related Agencies appropriations bill (S. 2437; S.Rept. 118-70).
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Other Extensions Act (H.R. 5860; P.L. 118-15) on September 30, 2023.55 The act provided
continuing appropriations for some VA accounts through November 17, 2023, generally at the
same funding levels and under the same terms and conditions as was enacted for FY2023
(Division J of P.L. 117-328). A second continuing resolution (CR), the Further Continuing
Appropriations and Other Extensions Act, 2024 (H.R. 6363; P.L. 118-22), was enacted on
November 16, 2023, which in part extended the continuing appropriations under P.L. 118-15
through January 19, 2024. A third CR, the Further Additional Continuing Appropriations and
Other Extensions Act, 2024 (H.R. 2872; P.L. 118-35), was enacted on January 19, 2024, which in
part further extended the continuing appropriations under P.L. 118-15 through March 1, 2024.
Lastly, a fourth CR, the Extension of Continuing Appropriations and Other Matters Act, 2024
(H.R. 7463; P.L. 118-40), was enacted on March 1, 2024, which further extended continuing
appropriations for some VA accounts through March 8, 2024.
Since seven accounts (compensation and pensions, readjustment benefits, insurance and
indemnities, medical services, medical community care, medical support and compliance, and
medical facilities) received advance appropriations for FY2024 in the Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act, 2023 (Division J of P.L. 117-328),
these accounts were not affected by these four CRs.
Consolidated Appropriations Act, 2024 (H.R. 4366; P.L. 118-42)
On Sunday March 3, 2024, the House and Senate Appropriations Committees released the text of
the Consolidated Appropriations Act, 2024 (agreed to as a House amendment to a Senate
amendment to H.R. 4366 on March 6, 2024 through the adoption of H.Res. 1061). The six-bill
appropriations package included regular appropriations for FY2024 as follows:
•
•
•
•
•
•
Division A—Military Construction, Veterans Affairs, and Related Agencies
Appropriations Act, 2024.
Division B—Agriculture, Rural Development, Food and Drug Administration,
and Related Agencies Appropriations Act, 2024.
Division C—Commerce, Justice, Science, and Related Agencies Appropriations
Act, 2024.
Division D—Energy and Water Development and Related Agencies
Appropriations Act, 2024.
Division E—Department of the Interior, Environment, and Related Agencies
Appropriations Act, 2024.
Division F—Transportation, Housing and Urban Development, and Related
Agencies Appropriations Act, 2024.
On March 6 and March 8, the House and Senate passed H.R. 4366, as amended, respectively, and
President Biden signed the Consolidated Appropriations Act, 2024 (P.L. 118-42), into law on
March 9. The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides
$307.31 billion for VA, including $172.53 billion in mandatory funding and $134.77 billion in
discretionary funding. Additionally, the FY2024 MILCON-VA Appropriations Act provides
$308.43 billion in advance appropriations for FY2025, which would become available on October
1, 2024. This amount includes $195.85 billion for the Compensation and Pensions, Readjustment
Benefits, and Veterans Insurance and Indemnities accounts, and $112.58 billion for Medical
55 For more details see, CRS Report R47749, Overview of Continuing Appropriations for FY2024 (Division A of P.L.
118-15).
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Services, Medical Community Care, Medical Support and Compliance, Medical Facilities
accounts. Table 1 provides comparative FY2024 funding levels for VBA, VHA, NCA, and
Departmental Administration. Table 3 provides account-level details.
Table 1. FY2024 VBA, VHA, NCA and Departmental Administration Appropriations
Veterans Benefits
Administration
(VBA, including
General
Operating
Expenses)
Veterans Health
Administration
(VHA)
National
Cemetery
Administration
(NCA)
Departmental
Administration
Cost of War
Toxic Exposure
Fund (TEF)a
Total VA
Total
Mandatory
Total
Discretionary
% Change
FY2024
Request
House
(H.R. 4366;
H.Rept. 118122)
Senate
(Div. A
H.R. 4366;
S.Rept. 11843)
$165.96 billion
$165.96 billion
$165.96 billion
$176.72 billion
6.48%
$121.95 billion
$121.95 billion
$119.97 billion
$120.00 billion
-1.59%
$480.0 million
$482.0 million
$480.0 million
$480.0 million
0%
$11.11 billion
$11.09 billion
$10.09 billion
$10.10 billion
-9.05%
$20.27 billion
—
—
—a
N/A
$319.76 billion $299.49 billion
$296.51 billion
$307.31 billion
-3.89%
$182.01billion $161.74 billion
$161.74 billion
$172.53 billion
-5.21%
$137.76 billion $137.75 billion
$134.77 billion
$134.77 billion
-2.16%
FY2024
Enacted
(P.L. 118-42)
FY2024
Enacted vs.
FY2024
Request
Sources: H.Rept. 118-122, S.Rept. 118-43, and “Explanatory Statement Submitted by Mrs. Murray, Chair of The
Senate Committee on Appropriations, Regarding H.R. 4366, Consolidated Appropriations Act, 2024,”
Congressional Record, vol. 170, part 39 (March 5, 2024), pp. S1273-S1285.
a. Fiscal Responsibility Act of 2023 (P.L. 118-5) provided $20.27 billion, which become available on October 1,
2023, and will remain available until September 30, 2028, and $24.46 billion, which will become available on
October 1, 2024, and will remain available until September 30, 2029.
The following sections discuss account-level details of the President’s budget request for FY2024
and subsequent House and Senate action on regular VA appropriations.
Mandatory Programs Funding
Major mandatory program funding includes (1) Compensation and Pensions (VA’s disability
compensation program, Dependency and Indemnity Compensation (DIC) for service-connected
deaths for surviving spouses, and dependent children pensions to low-income veterans,), (2)
Readjustment Benefits (education and vocational rehabilitation assistance), and (3) Veterans
Insurance and Indemnities (the provision of life insurance).
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Compensation and Pensions
The compensation and pensions account provides payments for benefits such as disability
compensation, DIC, pension benefits for low-income disabled or elderly wartime veterans and
their survivors, burial benefits (allowances, flags, headstones, etc.), and a clothing allowance for
certain disabled veterans.
For FY2024, the President’s budget request for the compensation and pension account was
$151.43 billion. This included $4.65 billion in additional funding over the FY2024 advance
appropriation amount of $146.79 billion. In FY2024, VA estimates that approximately $147.6
billion in compensation payments would go to about 6.1 million veterans, approximately 563,000
survivors, and 1,049 children.56
The increase in funding reflects changes made by the Sergeant First Class Heath Robinson
Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 (P.L. 117-168),
which significantly expands benefits and services for veterans exposed to toxic substances. The
PACT Act directly affects the C&P account due to the addition of 24 categories of presumptive
conditions, including 300 diseases and medical conditions related to burn pits and other toxic
exposures, and the addition of more presumptive-exposure locations for Agent Orange and
radiation.57
The PACT Act established certain effective dates, or phased-in applicability dates, for the
presumptive service-connected conditions established by the act. Effective dates begin on August
10, 2022, and end on October 1, 2025. The Secretary determined that all presumptions in the
PACT Act will be applicable on the date the bill was signed into law. This means that August 10,
2022, is the earliest effective date for establishing entitlement to presumptive service-connected
compensation benefits. The VBA began processing PACT Act claims on January 1, 2023. The
department estimated compensation and pension costs associated with the PACT Act to be $5.7
billion in 2023 and $9.8 billion in 2024.58
Additionally, Section 204 of the PACT Act requires VA to reevaluate previously denied
Dependency and Indemnity Compensation (DIC) benefits claims and the award of effective dates
“as if the establishment or modification of the presumption of service connection had been in
effect on the date of the submission of the original claim” As a result, VA estimated $1.8 billion in
DIC retroactive payments to nearly 15,000 survivors in 2023.59
The House- and Senate-passed versions of the MILCON-VA bill (H.R. 4366) provided $151.43
billion for the compensation and pension account for FY2024, the same as the President’s request.
Additionally, the bill provided advance appropriations budget authority of $181.39 billion for
FY2025, which would become available on October 1, 2024.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $161.85
billion for the compensation and pension account for FY2024, a 6.47% increase over the
FY2023-enacted amount and a 6.88% increase over the FY2024 request (see Table 3). Moreover,
56 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Benefits and Burial Programs and
Departmental Administration, vol. 3 of 5, March 2023, p. VBA–177.
57 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Benefits and Burial Programs and
Departmental Administration, vol. 3 of 5, March 2023, pp. VBA–178-179.
58 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Benefits and Burial Programs and
Departmental Administration, vol. 3 of 5, March 2023, p. VBA–179.
59 Department of Veterans Affairs, FY2024 Congressional Budget Submission, Benefits and Burial Programs and
Departmental Administration, vol. 3 of 5, March 2023, p. VBA–179.
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the act provides advance appropriations budget authority of $182.31 billion for FY2025, which
would become available on October 1, 2024.
Readjustment Benefits
The Readjustment Benefits category reflects several benefits related to the transition of
servicemembers from active-duty status to veteran status, as well as benefits for disabled
veterans. Some of these programs include education benefits for veterans, survivors, and
dependents, such as the Post 9-11 GI Bill;60 the survivors’ and dependents’ educational assistance
program; the Veteran Readiness and Employment (VR&E) program;61 and programs to provide
housing, automotive, and adaptive equipment grants for disabled veterans.62
For FY2024, the President’s budget request for the readjustment benefits account is $8.45 billion,
the same amount provided as advance appropriation budget authority for FY2024 and included in
the Consolidated Appropriations Act, 2023 (H.R. 2617; Division J of P.L. 117-328). Additionally,
it is estimated that in FY2024, $169.3 million in offsetting collections from the Department of
Defense (DOD), and an estimated $6.0 billion in unobligated balances from 2023, would be
available for obligation for readjustment benefits.
The House-passed and Senate-passed versions of the MILCON-VA bill (H.R. 4366) provided
$8.45 billion for FY2024 for the readjustment benefits account, the same as the President’s
request, and both versions of the MILCON-VA bill provided $11.52 billion in advance
appropriations budget authority for FY2025, which would become available on October 1, 2024.
The FY2024 MILCON-VA Appropriations Act provides $8.45 billion for the readjustment
benefits account for FY2024, a 4.44% increase over the FY2024 request. Additionally, the act
provides $13.39 billion in advance appropriations budget authority for FY2025, which would
become available on October 1, 2024, a 16.29% increase over the $11.52 billion in advance
appropriations requested for this account (see Table 3).
Veterans Insurance and Indemnities
The Veterans Insurance and Indemnities account is the mandatory funding stream for several
government life insurance programs for veterans. In addition to direct payments made to insured
veterans and their beneficiaries, this category includes supplemental funding for National Service
Life Insurance (NSLI),63 Service-Disabled Veterans Insurance (S-DVI),64 and Veterans Mortgage
Life Insurance (VMLI).65 The Veterans Affairs Life Insurance (VA Life) program established
60 For more information, see CRS Report R42755, The Post-9/11 GI Bill: A Primer.
61 For more information, see CRS Report RL34627, Veterans’ Benefits: The Veteran Readiness and Employment
Program.
62 For more information, see CRS Report R44837, Benefits for Service-Disabled Veterans.
63 The National Service Life Insurance (NSLI) program was created on October 8, 1940, to handle insurance needs of
World War II veterans. These policies were issued until April 24, 1951, and provided a maximum of $10,000 in
coverage. See https://www.benefits.va.gov/insurance/nsli.asp.
64 The Service-Disabled Veterans Insurance (S-DVI) program was established on April 25, 1951, and remains open for
new policies to service-connected disabled veterans who separated under other than dishonorable conditions. S-DVI
provides up to $10,000 in coverage, for which premium relief is available to certain insured veterans. Up to an
additional $30,000 in supplemental coverage may be granted without a waiver of premiums. See https://www.va.gov/
life-insurance/options-eligibility/s-dvi/.
65 The Veterans Mortgage Life Insurance (VMLI) program provides veterans who meet certain requirements, including
having received a grant for specially adapted housing, with up to $200,000 of mortgage protection life insurance. This
program pays the benefit directly to the bank or lender of the veteran’s mortgage. See https://www.va.gov/lifeinsurance/options-eligibility/vmli/.
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under the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (P.L. 116-315) opened for enrollment on January 1, 2023. This program
is funded by the Public Enterprise Revolving Fund and is designed as a self-supporting
program.66
For FY2024, the President’s budget requested $133.83 million for the veterans insurance and
indemnities account, which includes $121.13 million in advance appropriation budget authority
for FY2024 and included in the Consolidated Appropriations Act, 2023 (H.R. 2617; Division J of
P.L. 117-328), and $12.70 million in additional funding for FY2024.
The House- and Senate-passed versions of the MILCON-VA bill (H.R. 4366) provided $133.83
million for FY2024 for the veterans insurance and indemnities account, the same as the
President’s request, and both versions of the MILCON-VA bill provided $135.12 million in
advance appropriations budget authority for FY2025, which would become available on October
1, 2024.
The FY2024 MILCON-VA Appropriations Act provides $133.83 million for FY2024 and $135.12
million in advance appropriations budget authority for FY2025, which would become available
on October 1, 2024 (see Table 3).
Medical Care and Medical Research Discretionary
Programs Funding
Background
The VA’s Veterans Health Administration (VHA) operates the nation’s largest public integrated
direct health care delivery system.67 VHA’s primary mission is to provide health care services to
eligible veterans.68 VHA generally provides care directly through over 1,700 sites of care,
including hospitals, clinics, and health care facilities.69
VHA is not a health insurance financing program that provides reimbursement to providers for all
or a portion of a patient’s health care costs. It operates associated facilities and employs
clinicians.70 This model differs from the predominant health care financing and delivery model in
the United States, in which there is a payer for health care services (e.g., Medicare, private health
insurance plan), a provider (e.g., hospital, physician), and a recipient of care (the patient).
The VA’s health care system is organized into 18 geographically defined administrative regions
known as Veterans Integrated Service Networks (VISNs). Although VA headquarters develops
66 Public Enterprise Revolving Funds “are expenditure accounts authorized by law to be credited with offsetting
collections, primarily from the public, that are generated by and earmarked to finance a continuing cycle of businesstype operations” (Source: Financial Policy Documents, Chapter 02–VA’s Budget Cycle and Fund Symbols, available at
https://department.va.gov/financial-policy-documents/financial-document/chapter-02-vas-budget-cycle-and-fundsymbols/, accessed February 7, 2024.
67 Department of Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, p.
VHA-26.
68 38 U.S.C. §7301.
69 Department of Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, p.
VHA-26.
70 VHA does pay for care in the community (i.e., non-VA providers) under certain circumstances. The VA Maintaining
Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L. 115-182)
established the Veterans Community Care Program (VCCP), which requires VHA to provide for care in the community
to all enrolled veterans who meet specified criteria.
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policies and guidelines to be applied throughout the VA health care system, management
authority for basic decision making and budgetary responsibilities is delegated to the VISNs.71 As
of September 30, 2021, VHA operated 145 hospitals, 135 nursing homes, 702 community-based
outpatient clinics (CBOCs),72 and 300 Readjustment Counseling Centers (Vet Centers).73 In 2009,
VA began a pilot Mobile Vet Center (MVC) program to improve access to services for veterans in
rural areas, and the department has deployed 83 MVCs to date.74
Although VHA provides most health care services to eligible veterans through its integrated
network of facilities, it does pay for care in the community under certain circumstances. The
Veterans Community Care Program (VCCP) applies eligibility for care in the community broadly
to all enrolled veterans based on specific criteria.75 VA is authorized to provide care in the
community through individual agreements with community providers, called veterans care
agreements. VA is also authorized to reimburse for emergency care visits if specific criteria are
met.76 Inpatient and outpatient care is provided in the private sector to eligible dependents of
veterans under the Civilian Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA).77 In addition, VHA provides grants for construction of state-owned nursing homes
and domiciliary facilities78 and collaborates with the Department of Defense in sharing health
care resources and services.
VHA has additional statutory missions besides providing direct patient care to veterans.79 It is
required to conduct medical research,80 serve as a contingency backup to the DOD medical
system during a national security emergency,81 provide support to the National Disaster Medical
System and the Department of Health and Human Services as necessary,82 and train health care
professionals to provide an adequate supply of health personnel for VA and the nation.83
71 Kenneth Kizer, John Demakis, and John Feussner, “Reinventing VA health care: Systematizing Quality
Improvement and Quality Innovation,” Medical Care, vol. 38, no. 6 (June 2000), Suppl. 1:17-116.
72 For more information on CBOCs, see CRS Report R41044, Veterans Health Administration: Community-Based
Outpatient Clinics (archived).
73 Department of Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, p.
VHA-457. Vet Centers are a nationwide system of community-based programs separate from VA medical centers
(VAMCs). Client services provided by Vet Centers include psychological counseling and psychotherapy (individual
and group), screening for and treatment of mental health issues, substance abuse screening and counseling,
employment/educational counseling, and bereavement counseling, among other services.
74 Ibid.
75 For more information on the VCCP and the eligibility criteria, see CRS Report R45390, VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L.115-182).
76 For more information, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions.
77 For details on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of Veterans.
78 Under the grant program, VA may fund up to 65% of the cost of these state-owned facilities. States must fund the
remaining 35%. The law requires that 75% of the residents in a state-extended care facility must be veterans (38 U.S.C.
§§8131-8138.) All nonveteran residents must be spouses of veterans or parents of children who died while serving in
the U.S. Armed Forces. VA is prohibited by law from exercising any supervision or control over the operation of a
state veterans nursing home, including setting admission criteria. States exclusively determine admission requirements.
See CRS In Focus IF11656, State Veterans Homes.
79 38 U.S.C. §7301(b).
80 38 U.S.C. §7303.
81 38 U.S.C. §8111A.
82 38 U.S.C. §8117(e).
83 38 U.S.C. §7302.
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The Veteran Patient Population
VA projects that in FY2024, the overall population of veterans nationwide will decrease, but
utilization of the system will remain relatively constant.84 In FY2024, approximately 9.0 million
of the 17.9 million total veterans were enrolled in VA’s health care system.85 VA estimates that in
FY2024, enrollment will shrink by 79,407 to 9.0 million veterans. In FY2024, VA anticipates
treating approximately 6.4 million unique veteran patients and 1.0 million nonveteran patients
(see Table A-1).86
VHA estimates that outpatient visits will increase from 137.9 million visits in FY2023 to 139.7
million visits in FY2024, an increase of 1.8 million, or 1.3%. VHA anticipates an increase in the
total number of inpatients treated in all inpatient facilities from 1.07 million patients in FY2023 to
1.08 million patients in FY2024, an increase of 1.2%.87
The change in enrollment and utilization is indicative of a long-term trend. The veteran
population is declining—due to the death of World War II and Vietnam-era veterans—while
enrollment in the VA health care system and health care utilization is staying relatively constant
(see Figure 6). In FY2000, 18.4% of the veteran population was enrolled in the health care
system. In FY2024, over 50% of the veteran population will have enrolled in the health care
system.
Figure 6.Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2024
Sources: Total “Veteran Population” numbers are from VetPop2020, available at https://www.va.gov/vetdata/
Veteran_Population.asp, and archived copies of earlier version no longer available on the website. “Enrolled-VA
Veterans” numbers and “Veteran Patients” numbers were obtained from the VA and/or the VA budget
84
Department of Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, pp.
VHA-413–VHA-415.
85 In general, a veteran is required to be enrolled in the VA health care system to receive health care services, and once
a veteran is enrolled, that veteran remains enrolled in the VA health care system and maintains access to VA health
care services. For more information on enrollment, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions.
86 A unique veteran patient means each patient is counted only once in each fiscal year. However, there could be
multiple visits (clinical encounters) per unique veteran patient in a given fiscal year. Department of Veterans Affairs,
FY2024 Budget Submission, Medical Programs, vol. 2 of 4, March 2023, p. VHA-42.
87 Department of Veterans Affairs, FY2043 Budget Submission, Medical Programs, vol. 2 of 5, March 2023, p. VHA43.
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submissions to Congress for FY2002-FY2023; the number for each fiscal year is taken from the budget
submission two years later (e.g., the FY2021 number is from the FY2023 budget submission).
Note: FY2023 and FY2024 veteran enrollee and patient data are estimates.
Some portion of the increase in proportional enrollment among living veterans is likely due to
maturity of the modern enrollment system.88 However, multiple other factors may be contributing
to increased enrollment and utilization of the health care system. For instance, Congress on
multiple occasions has expanded qualifying criteria for enrollment in VA health care.89 The
services provided through VHA have also expanded over time, such as the addition of benefits for
family caregivers, expansion of gender-specific care, and expansion of long-term care benefits,
thereby increasing the appeal of the VA health care system.
VA anticipates that the veteran population will continue to decline—projecting 11.9 million
veterans in FY2050.90 In addition, VA projects that enrollment will remain relatively constant
through 2031 while the veteran population declines overall.91
President’s Request and Congressional Action
The VA’s annual appropriations for the medical services, medical community care, medical
support and compliance, and medical facilities accounts include advance appropriations that
become available one fiscal year after the fiscal year for which the appropriations act was
enacted. Therefore, the Consolidated Appropriations Act, 2023 (Division J; P.L. 117-328),
provided FY2024 funding for these four accounts. However, in any given year, the
Administration could request additional funding for the upcoming fiscal year and Congress could
revise these amounts through the annual appropriations process. Across all four accounts, the
President’s budget increased by $10.0 billion over the advance appropriations amount in
FY2024.92 The request reflects implementation of the PACT Act, with $17.1 billion in new
mandatory appropriations in the TEF, which is offset by cancellation of $7.1 billion in
unobligated discretionary balances.93 The FY2024 budget request for VHA totals $142.5 billion,
including medical care collections.94
88 Veterans have generally been required to enroll in the VA health care system since FY1999. Therefore, the data
presented in Figure 6 represents the inaugural years of the enrollment system. It is likely that this is at least partially
the reason for enrollment growth in earlier years. Department of Veterans Affairs, “Enrollment—Provision of Hospital
and Outpatient Care to Veterans,” 64 Federal Register 54207, October 1999, https://www.govinfo.gov/content/pkg/FR1999-10-06/pdf/99-25871.pdf.
89 For information on qualifying for enrollment, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions.
90 Veteran population numbers are from VetPop2020, available at “https://www.va.gov/vetdata/docs/Demographics/
New_Vetpop_Model/1L_VetPop2020_National_NCVAS.xlsx.
91 VA uses actuarial models to support formulation of the VA health care budget. The primary model, the Enrollee
Health Care Projection Model (EHCPM), supports approximately 90% of the medical care budget. Department of
Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, pp. VHA-417 to
VHA-421.
92 Department of Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, p.
VHA-14.
93 Ibid., p. VHA-13.
94 The appropriations committees include medical care cost recovery collections when considering funding for VHA.
Congress has provided VHA with the authority to bill some veterans and most health care insurers for nonserviceconnected care provided to veterans enrolled in the VA health care system, to help defray the cost of delivering medical
services to veterans. Funds collected from first- and third-party (copayments and insurance) bills are retained by the
VA health care facility that provided the care for the veteran. The Consolidated Omnibus Budget Reconciliation Act of
1985 (P.L. 99-272), enacted into law in 1986, established means testing for veterans seeking care for nonservice(continued...)
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Department of Veterans Affairs FY2024 Appropriations
As required by the Veterans Health Care Budget Reform and Transparency Act of 2009 (P.L. 11181), the President’s FY2024 budget requests $112.6 billion in advance appropriations for the four
medical care appropriations (medical services, medical community care, medical support and
compliance, and medical facilities) for FY2025, a decrease of approximately 12.1% from the
FY2024 advance appropriation of $128.1 billion. In FY2025, the Administration’s budget request
would provide $71.0 billion for the medical services account, $20.4 billion for medical
community care, $11.8 billion for the medical support and compliance account, and $9.4 billion
for the medical facilities account.
The House-passed version of the MILCON-VA appropriations bill provided a larger VHA
appropriation than the President’s request. The Senate-passed version of the bill provided a
smaller VHA appropriation than the President’s request. The House-passed version of the
MILCON-VA appropriations bill (H.R. 4366) provided $3 million more, while the Senate-passed
version of the bill provided approximately $2.0 billion less.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $120 billion
for VHA for FY2024. This is nearly $2 billion less than the President’s request. The act provides
$112.6 billion in advance appropriations budget authority for FY2025, in line with the President’s
request and both the House- and Senate-passed bills.
The sections below detail the amounts requested for each VHA account for FY2024, including
the funds provided in the House-passed bill and Senate-passed bills for each account. The
sections also detail the amounts provided in the FY2024 MILCON-VA Appropriations Act
(Division A of P.L. 118-42).
Medical Services
The medical services account covers expenses for furnishing inpatient and outpatient care and
treatment of veterans and certain dependents. It also includes care and treatment in non-VA
facilities; outpatient care on a fee basis; medical supplies and equipment; salaries and expenses of
employees hired under Title 38 of the U.S. Code; cost of hospital food service operations; grants
for adaptive sports programs for disabled veterans and members of the Armed Forces; beneficiary
travel; prosthetics; Long-Term Services and Supports (LTSS); aid to state veterans’ homes;
assistance and support services for family caregivers; and costs associated with activation of
newly constructed or leased VA medical care facilities, among other distinct activities.
For FY2024, the President’s budget requested $69.1 billion for the medical services account. This
amount includes an administrative recission that decreases the FY2024 advance-appropriated
amount by $4.9 billion. The House-passed version of the MILCON-VA appropriations bill (H.R.
4366) provided the same amount to the Medical Services account as the President’s request. The
Senate- passed version of the Consolidated Appropriations Act, 2024, further decreased the
FY2024 appropriation to $68.1 billion. VA estimates $9.5 billion in expenditures from TEF to
connected conditions. The Balanced Budget Act of 1997 (P.L. 105-33) established the Department of Veterans Affairs
Medical Care Collections Fund (MCCF) and gave VHA the authority to retain these funds in the MCCF. Instead of
returning the funds to the Treasury, VA can use them, without fiscal year limitations, for medical services for veterans.
In FY2004, the Administration’s budget requested consolidating several existing medical collections accounts into one
MCCF. The conferees of the Consolidated Appropriations Act, 2004 (H.Rept. 108-401), recommended that collections
that would otherwise be deposited in the Health Services Improvement Fund (former name), Veterans Extended Care
Revolving Fund (former name), Special Therapeutic and Rehabilitation Activities Fund (former name), Medical
Facilities Revolving Fund (former name), and the Parking Revolving Fund (former name) should be deposited in
MCCF. The Consolidated Appropriations Act of 2005 (P.L. 108-447, H.Rept. 108-792) provided VA with permanent
authority to deposit funds from these five accounts into the MCCF.
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support medical services in FY2024. Both the House-passed bill and the Senate-passed bill
provide FY2025 advance appropriations equal to the President’s request of $71.0 billion.
The FY2024 MILCON-VA Appropriations Act provides $70.97 billion for FY2024 and $71.0
billion in advance appropriations budget authority for FY2025, which would become available on
October 1, 2024 (see Table 3).
Medical Community Care
Section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of
2015 (P.L. 114-41) required the establishment of a separate new account for medical community
care, beginning with the FY2017 appropriations cycle. The Jeff Miller and Richard Blumenthal
Veterans Health Care and Benefits Improvement Act of 2016 (P.L. 114-315) authorized advance
appropriations for the medical community care account. The account consolidates all community
care programs in a single appropriation. It is the funding source for care that eligible veterans
receive through community health care providers. These programs include the Veterans
Community Care Program (VCCP), the Camp Lejeune Family Member Program (CLFMP),
CHAMPVA, the Foreign Medical Program (FMP), the Spina Bifida Health Care Program, the
Children of Women Vietnam Veterans Health Care Benefits Program (CWVV), and the Indian
Health Service (IHS)/Tribal Health Programs (THP) Reimbursement Agreements Program.
The medical support and compliance and the Information Technology accounts fund some
expenses related to the community care program. These expenses include administrative expenses
related to claims processing performed by the Third-Party Administrators (TPAs) and VHA, and
software required for information technology (IT) systems related to the community care
program.95
The President’s budget requested $31.1 billion for the medical community care account. This
includes an administrative recission that decreases the FY2024 advance-appropriated amount by
$1.9 billion. The House-passed version of the MILCON-VA appropriations bill (H.R. 4366)
provided the same amount to the Medical Community Care account as the President’s request.
The Senate-passed version of the Consolidated Appropriations Act, 2024, further decreased the
FY2024 appropriation to $28.9 billion. VA estimates $6.7 billion in expenditures from TEF to
support medical community care in FY2024. Both the House-passed bill and the Senate-passed
bill provided FY2025 advance appropriations equal to the President’s request of $20.4 billion.
The FY2024 MILCON-VA Appropriations Act provides $30.34 billion for FY2024 and $20.4
billion in advance appropriations budget authority for FY20205, which would become available
on October 1, 2024 (see Table 3).
Medical Support and Compliance
The medical support and compliance account provides for expenses related to the management,
security, and administration of VA’s health care system through the operation of VA medical
centers (VAMCs) and other medical facilities, such as community-based outpatient clinics
(CBOCs) and Vet Centers. This includes, among other things, VAMC leadership teams (Director,
Chief of Staff, Chief Medical Officer, and Chief Nurse) and VAMC support functions, such as
“quality of care oversight, security services, legal services, billing and coding activities,
acquisition, procurement, and logistics activities, human resource management, logistics and
95 Department of Veterans Affairs, FY2024 Congressional Submission, Medical Programs, vol. 2 of 5, March 2023, p.
VHA-366.
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supply chain management, and financial management.”96 This account also funds 18 Veterans
Integrated Service Network (VISN)97 offices, which include network management activities such
as the following network leadership teams within each VISN: Network Director, Deputy Network
Director, Chief Financial Officer, Chief Medical Officer, and Chief Information Officer.98 This
account also provides for expenses related to VHA Central Office (VHACO) operating units,
such as offices of the Assistant Under Secretary for Community Care and Deputy Assistant Under
Secretary for Community Care, the Office of the Assistant Under Secretary for Health for Clinical
Services and the Chief Medical Officer (AUSH/CS), and the Office of Discovery, Education, and
Affiliate Networks (DEAN), among other offices and suboffices.
The President’s budget requested $12.3 billion for the medical support and compliance account,
the same amount as the FY2024 advance-appropriated amount. Both the House-passed and the
Senate-passed bills provided the same amount as the President’s request and would provide
FY2025 advance appropriation amounts equivalent to the President’s request of $11.8 billion.
The FY2024 MILCON-VA Appropriations Act provides $10.75 billion for FY2024 and $11.8
billion in advance appropriations budget authority for FY2025, which would become available on
October 1, 2024.
Medical Facilities
The medical facilities account funds expenses pertaining to the operations and maintenance of
VHA’s capital infrastructure. These expenses include utilities and administrative expenses related
to planning, designing, and executing construction or renovation projects at VHA facilities. It also
funds medical facility leases, including clinical space in CBOCs, engineering and environmental
management, grounds maintenance, fire protection, nonrecurring maintenance, recurring
maintenance and repairs, textile care processing and maintenance, and operating equipment
maintenance and repairs, among others.
The President’s budget requested $8.5 billion for the medical facilities account. This amount
includes an administrative recission that decreases the FY2024 advance-appropriated amount by
$250.5 million. The House-passed version of the MILCON-VA appropriations bill (H.R. 4366)
provided the same amount to the Medical Facilities account as the President’s request. The
Senate-passed version of the bill provided $9.8 billion, which is $1.0 billion over the advanceappropriated amount and $1.251 billion over the President’s request.
Both the House-passed version of the MILCON-VA appropriations bill and the Senate
Appropriations Committee bill provided the same FY2025 advance appropriation as the
President’s request of $9.4 billion.
The FY2024 MILCON-VA Appropriations Act provides $8.95 billion for FY2024 and $9.4
billion in advance appropriations budget authority for FY2025, which would become available on
October 1, 2024 (see Table 3).
96 Ibid., p. VHA-378.
97 Ibid., p. VHA-378. VISN offices provide management and oversight to the medical centers and clinics within their
assigned geographic areas. Each VISN office is responsible for allocating funds to facilities, clinics, and programs
within its region and coordinating the delivery of health care to veterans.
98 Ibid., p. VHA-379.
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Medical and Prosthetic Research
As required by law, the medical and prosthetic research program (medical research) focuses on
research into the special health care needs of veterans. This account provides funding for many
types of research, such as investigator-initiated research; mentored research; large-scale, multisite
clinical trials; and centers of excellence. VA researchers receive funding not only through this
account but also from DOD, the National Institutes of Health (NIH), and private sources. The
medical services, medical support and compliance, and medical facilities accounts also provide
funds for additional expenses required for VAMCs supporting research activities.
In general, VA’s research program is intramural; VA investigators conduct research at VA facilities
and in approved off-site space occupied by VA under a legal agreement. Unlike other federal
agencies, such as NIH and DOD, VA does not have the statutory authority to make research
grants to colleges and universities, cities and states, or any other non-VA entities.
The President’s budget requested $938 million for the medical and prosthetic research account, an
increase of $22 million, or 2.4%, above the FY2023-enacted amount of $916 million. The VHA’s
major research priorities in FY2024 include, among others, traumatic brain injury (TBI), military
exposures, precision oncology, and mental health.99
The House-passed version of the bill provided $3.0 million more than the FY2024 request. The
Senate-passed version of the bill provided the same level as the request.
The FY2024 MILCON-VA Appropriations Act provides $943 million for FY2024, which is $5
million more than the President’s request (see Table 3).
Nonmedical Discretionary Programs Funding
National Cemetery Administration (NCA)
The majority of NCA’s discretionary funding falls into the Operations and Maintenance category.
VA requests a total of $480 million in FY2024 for this account, an increase of $50 million over
FY2023. In FY2024, NCA would provide 140,472 interments and the perpetual care of 4.3
million gravesites at 158 national cemeteries and 34 other cemetery installations and support
2,331 fulltime equivalent (FTE) employees.100
NCA continues to pursue its long-range goal of providing 95% of veterans with “access to first
interment burial options (for casketed or cremated remains, either in-ground or in columbaria) in
a national or state [v]eteran’s cemetery within 75 miles of the [v]eteran’s place of residence.”101
The House version of the MILCON-VA bill (H.R. 4366) provided $482 million for FY2024 for
NCA, whereas the Senate version of the MILCON-VA bill (H.R. 4366) provided $480 million,
the same as the President’s request.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $480 million,
the same as the President’s request (see Table 3).
99 Ibid., pp. VHA-572.
100 Department of Veterans Affairs FY2024 President’s Budget Request, Budget Rollout Presentation March 9, 2023, p.
15, http://www.va.gov/budget/docs/summary/fy2024-va-budget-rollout-briefing.pdf (last accessed February 7, 2024)
101 U.S. Department of Veterans Affairs, FY2024 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 5, March 2023, p. NCA-12.
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In the explanatory statement to accompany P.L. 118-42, the committee states that it supports the
“Administration’s efforts to construct additional infrastructure at its Rural Initiative national
cemeteries”102 and urges VA to “conduct an assessment at each Rural Initiative National Cemetery
site, with feedback from community stakeholders—to include veterans, veterans service
organizations, volunteers, local leadership, adjacent landowners, and visitors, to determine if it is
advisable to construct permanent support infrastructure.”103 Furthermore, it encourages VA “to
work with State and local entities, and non-profit organizations interested in constructing and
donating facilities or donating funding for VA-built facilities, to include funds for construction
and future operations and maintenance costs, to help meet location-specific needs, as
appropriate.”104
VBA, General Operating Expenses
VBA’s General Operating Expenses (GOE) accounts provide for the expenses pertaining to the
administration of disability compensation, Dependency and Indemnity Compensation (DIC),
pension benefits, fiduciary programs, education benefits, the provision of Veteran Readiness &
Employment (VR&E) services, administration of the loan guaranty program, Veteran Transitional
Assistance Grant Program, and outreach programs, among others.
For FY2024, the Administration’s budget requests $3.90 billion for this account. This funding
would be for 25,762 fulltime equivalent (FTE) employees, and would provide for overtime pay to
process claims and to implement the Veteran Transitional Assistance Grant Program (VTAGP).105
The President’s request for FY2024 includes an additional $5.0 million for VTAGP over FY2023
to support an increase of three FTEs and approximately $4.5 million in grants awards.106
The House- and Senate-passed versions of the MILCON-VA bill (H.R. 4366) provided $3.90
billion for FY2024 for VBA’s GOE account, the same as the President’s request.
Division A of P.L. 118-42 provides $3.87 billion for the VBA General Operating Expenses
account. This includes the Section 260 provision in the FY2024 MILCON-VA Appropriations Act
rescinding $30 million from unobligated balances in the VBA General Operating Expenses
account (see Table 3).
The explanatory statement to accompany P.L. 118-42 states that the appropriations committees
“are concerned about a growing disability claims backlog and limited oversight of contracted
providers for medical exams…” and “strongly encourages the implementation of special training
protocols and oversight of C&P [Compensation and Pension] medical exams, especially for
claims related to military sexual trauma.”107 Furthermore, the explanatory statement directs VA to
102 “Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on Appropriations, Regarding
H.R. 4366, Consolidated Appropriations Act, 2024,” Congressional Record, vol. 170, part 39 (March 5, 2024), p.
S1230.
103 “Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on Appropriations, Regarding
H.R. 4366, Consolidated Appropriations Act, 2024,” Congressional Record, vol. 170, part 39 (March 5, 2024), p.
S1230.
104 “Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on Appropriations, Regarding
H.R. 4366, Consolidated Appropriations Act, 2024,” Congressional Record, vol. 170, part 39 (March 5, 2024), p.
S1230.
105 U.S. Department of Veterans Affairs, FY2024 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 5, March 2023, p. VBA–54.
106 U.S. Department of Veterans Affairs, FY2024 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 5, March 2023, p. VBA–55.
107 Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on Appropriations, Regarding
(continued...)
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provide a report to the appropriations committees on the use of third-party contractors conducting
C&P examinations.108
Board of Veterans’ Appeals
The Board of Veterans’ Appeals (BVA) is an agency within VA established in 1933.109 The BVA’s
role is to conduct hearings and make final decisions on behalf of the VA Secretary regarding
appeals for veterans’ benefits and services from VBA, VHA, and NCA, as well as the Office of
General Counsel (OGC), that are presented to BVA for appellate review.
The President’s FY2024 request for BVA is $287 million, a $2 million increase over the FY2023
enacted amount. The additional funding for FY2024 would be for 124 additional FTEs, including
seven Veterans Law Judges (VLJs), 82 decision-writing attorneys, and 35 operational and support
staff.110 Additional staff would be for adjudication of the Veterans Appeals Improvement and
Modernization Act of 2017 (P.L. 115-55), appeals, and appeals pertaining to the Program of
Comprehensive Assistance for Family Caregivers (PCAFC).111
The House version of the MILCON-VA bill (H.R. 4366) provided $289 million for FY2024 for
BVA, whereas the Senate version of the bill (H.R. 4366) provides $287 million, the same as the
President’s request.
Division A of P.L. 118-42 provides $272 million for BVA for FY2024. This amount includes a
rescission of $15 million from unobligated balances as required by Section 260 of Division A of
P.L. 118-42 (see Table 3).
Information Technology Systems (IT Systems)
The IT Systems account provides funding for department-wide IT activities such as IT and
telecommunications support, management of data systems, and acquisition of IT systems and
department-wide cybersecurity efforts, among other things.
The President’s request for IT Systems was $6.40 billion, an increase of $619 million, above the
FY2023-enacted amount. The requested amount included $125.7 million for IT development,
such as building new software applications; $4.67 billion for operations and maintenance (O&M);
and $1.61 billion for staffing and administrative support services.112
The House version of the MILCON-VA bill (H.R. 4366) provided $6.396 billion for FY2024 for
IT Systems, whereas the Senate version of the MILCON-VA bill (H.R. 4366) provided $6.401
billion, same as the President’s request.
H.R. 4366, Consolidated Appropriations Act, 2024,” Congressional Record, vol. 170, part 39 (March 5, 2024), p.
S1228.
108 Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on Appropriations, Regarding
H.R. 4366, Consolidated Appropriations Act, 2024,” Congressional Record, vol. 170, part 39 (March 5, 2024), p.
S1228.
109 38 U.S.C. §§7101-7113.
110 U.S. Department of Veterans Affairs, FY2024 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 5, March 2023, p. BVA–272.
111 U.S. Department of Veterans Affairs, FY2024 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 5, March 2023, p. BVA–272.
112 U.S. Department of Veterans Affairs, FY2024 Budget Submission, Information Technology Programs and
Electronic Health Record Modernization, vol. 5 of 5, March 2023, p. IT & EHRM–11.
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The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $6.39 billion
for IT Systems. Of this amount, $1.61 billion is for salaries and expenses, $4.67 billion is for
operation and maintenance (O&M) of existing IT programs, and $125.65 million is for IT
development. The total IT systems amount of $6.39 billion includes a rescission of $15 million
from unobligated balances as required by Section 260 of Division A of P.L. 118-42 (see Table 3).
Veterans Electronic Health Record (EHR)113
On May 17, 2018, VA entered into an indefinite-delivery, indefinite-quantity (IDIQ) contract114
with Cerner Government Services Inc. (Oracle Cerner, after Oracle Corporation completed the
acquisition of Cerner on June 8, 2022) for the procurement of an Electronic Health Record (EHR)
solution (Cerner Millennium Solution), with the goal of providing seamless care to veterans as
they transition from the Department of Defense (DOD) health care system, including the
Department of Homeland Security’s U.S. Coast Guard, and to replace the legacy EHR system.115
The Veterans Electronic Health Record account provides funding for activities required to plan
and deploy the Cerner Millennium electronic health care record system at VA medical facilities.
This includes funding for the Electronic Health Record (EHR) contract, infrastructure readiness,
and expenses related to the Project Management Office (PMO). Beginning with the Military
Construction, Veterans Affairs, and Related Agencies Appropriations Act for FY2018 (P.L. 115141), Congress established this account, which is “intended to be the single source of funding
within VA for the electronic health record effort” (H.Rept. 115-673), and for which “[n]o
authority is provided for funds from other VA accounts to be transferred into this account nor for
funds from this account to be transferred out to other accounts” (H.Rept. 118-122). The Office of
the Deputy Secretary is the only office responsible for administering the funds in this account.
On October 24, 2020, VA began initial deployment of the Cerner Millennium EHR at the MannGrandstaff VAMC in Spokane, WA. Due to various implementation challenges, and potential
patient safety issues encountered during transition to the new EHR system, as highlighted by the
Government Accountability Office (GAO), VA OIG, and medical center staff, on March 19, 2021,
Secretary Denis McDonough announced a strategic review of the EHRM program.116 The results
of this review were released in July 2021, and a final update was released in November 2021.117
On December 1, 2021, VA announced an updated plan to move forward with the EHRM Program,
113 P.L. 115-407, Title V, §503, 132 Stat. 5376 as amended by P.L. 117-154. §2(a) 136 Stat. 1303 defines “Electronic
Health Record Modernization Program” as “any activities by the Department of Veterans Affairs to procure or
implement an electronic health or medical record system to replace any or all of the Veterans Information Systems and
Technology Architecture, the Computerized Patient Record System, the Joint Legacy Viewer, or the Enterprise Health
Management Platform; and any contracts or agreements entered into by the Secretary of Veterans Affairs to carry out,
support, or analyze the activities under the [Electronic Health Record Modernization Program].”
114 Department of Veterans Affairs, “Statement by Acting Secretary Robert Wilkie – VA signs contract with Cerner for
an electronic health record system” press release, May 17, 2018, https://news.va.gov/press-room/statement-by-actingsecretary-robert-wilkie-va-signs-contract-with-cerner-for-an-electronic-health-record-system/ (accessed January 24,
2024). For more information about IDIQ contracts, see CRS In Focus IF12558, Indefinite Delivery, Indefinite Quantity
Contracts, by Dominick A. Fiorentino and Alexandra G. Neenan.
115 The legacy EHR system is the Veterans Health Information Systems and Technology Architecture (VistA)/
Computerized Patient Record System (CPRS) system.
116 Department of Veterans Affairs, “VA announces strategic review of Electronic Health Record Modernization
program,” press release, March 19, 2021, https://news.va.gov/press-room/va-announces-strategic-review-of-electronichealth-record-modernization-program/ (accessed January 24, 2024).
117 Department of Veterans Affairs, Electronic Health Record Modernization: Comprehensive Lessons Learned Report,
July 2021, and VA’s Electronic Health Record Comprehensive Lessons Learned update, November 2021, available at
http://www.va.gov/opa/docs/EHRM-Comprehensive-Lessons-Learned-Progress-Update-FINAL-11-29-21.pdf
(accessed January 24, 2024).
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mitigating challenges documented during the strategic review and implementing lessons learned
and feedback from VA medical providers at initial deployment sites.118 It also instituted new
management and governance structures to oversee the deployments. After the initial deployment
on October 24, 2020, VA deployed the Cerner Millennium EHR at four other medical centers
throughout early 2022. In total, the new EHR was deployed at five VAMCs (see Table 2), 22
Community based Outpatient Clinics (CBOCs) affiliated with the VAMCs, the West Consolidated
Patient Accounts Center (WCPAC), the North Central Consolidated Patient Accounts Center
(NCCPAC),119 and 52 remote sites.120
Table 2. First Five EHRM Deployment Sites
Name of Facility
Location
Veterans Integrated
Service Network
(VISN)
Date of Deployment
Mann-Grandstaff VAMC
Spokane, WA
20
October 24, 2020
Jonathan M. Wainwright
Memorial VAMC
Walla Walla, WA
20
March 26, 2022
Chalmers P. Wylie
Veterans Outpatient
Clinic
Columbus, OH
10
April 30, 2022a
Roseburg VAMC
Roseburg, OR
20
June 11, 2022
VA Southern Oregon
Rehabilitation Center and
Clinics
White City, OR
20
June 11, 2022
Sources: EHR Deployment Schedule, https://digital.va.gov/ehr-modernization/resources/ehr-deploymentschedule/ (accessed January 24, 2024) and U.S. Congress, Senate Committee on Veterans’ Affairs, Examining the
Status of VA’s Electronic Health Record Modernization Program, 117th Cong., 2nd sess., July 20, 2022, S. HRG. 117-636
(Washington: GPO, 2023), p. 43; and Department of Veterans Affairs, Office of Inspector General (OIG),
Scheduling Challenges Within the New Electronic Health Record May Affect Future Sites, 23-03295-80, March 21, 2024,
p. 3.
a. The EHR scheduling system was implemented at the Chalmers P. Wylie Veterans Outpatient Clinic in
August 2020, but the full implementation happened on April 30, 2022.
The next deployment site was the Boise VAMC, which was scheduled to go live on July 23, 2022.
Due to site deployment readiness issues, deployment was further postponed,121 and on October
13, 2022, VA announced that it had paused further EHR deployment at all sites until June 2023.122
118 Department of Veterans Affairs, “VA advances Electronic Health Record Modernization program,” press release,
December 1, 2021, https://news.va.gov/press-room/va-advances-electronic-health-record-modernization-program/
(accessed January 24, 2024).
119 Consolidated Patient Account Centers (CPAC) provide health care billing and collections functions through seven
regional centers. The new Cerner Millennium EHR system’s financial processes and workflows are required to be
aligned to the existing CPAC and financial management system; therefore, these two sits have been included in the
initial deployments. (Sources: Department of Veterans Affairs, OEHRM Site Infrastructure and End User Device
(EUD) Requirements, April 15, 2021, p. 30; and Department of Veterans Affairs, Congressionally Mandated Report on
the Oversight of the Electronic Health Record Modernization Program, Quarter 2, Fiscal Year 2023, June 2023, p. 33.)
120 U.S. Congress, Senate Committee on Veterans’ Affairs, Examining the Status of VA’s Electronic Health Record
Modernization Program, 117th Cong., 2nd sess., July 20, 2022, S. HRG. 117-636 (Washington: GPO, 2023), p. 43.
121 Department of Veterans Affairs, “VA adjusts electronic health record rollout schedule to assure continued success,”
press release, August 10, 2022, https://digital.va.gov/ehr-modernization/news-stories/va-adjusts-electronic-healthrecord-rollout-schedule-to-assure-continued-success/ (accessed January 24, 2024).
122 Department of Veterans Affairs, “VA extends delay of upcoming electronic health record deployments to June 2023
(continued...)
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With all further deployments postponed, VA established an EHRM Sprint Project Team to
evaluate and recommend solutions to “critical patient safety issues as identified by the National
Center for Patient Safety (NCPS) led Patient Safety Team (PST).”123 Then on April 21, 2023, VA
once again announced that all future deployments of the new Cerner EHR would be stopped “as
part of a larger program reset.”124 During the reset, VA plans to prioritize improvements at the
five sites that currently use the new EHR and fix the issues with the EHR that were identified by
health care providers. According to VA,
additional deployments will not be scheduled until VA is confident that the new EHR is
highly functioning at current sites and ready to deliver to Veterans and VA clinician at
future sites. This readiness will be demonstrated by clear improvements in the clinician
and Veteran experience; sustained high performance and high reliability of the system
itself; improved levels of productivity at the sites where the EHR is in use … when these
criteria have been met and the reset period concludes, VA will release a new deployment
schedule and re-start deployment activities.125
Meanwhile, on May, 16, 2023, VA finalized renegotiations on a modified contract with Oracle
Cerner (Cerner Government Services Inc.) for the next option period of the contract. The contract
was renegotiated from a five-year term to five one-year terms, so VA would be able to review
Cerner’s performance and renegotiate again in one year if needed. The renegotiated contract
includes the following key components:
Reliability: Minimizing outages (time when the system crashes completely), incidents
(time when one component of the system isn’t working), and interruptions (time when the
system is operating slowly) of the system.
Responsiveness: Quickly and reliably resolving help tickets and clinician requests.
Interoperability with other health care systems: Ensuring that VA can quickly and
reliably access patient health records from private sector hospitals when necessary.
Interoperability with other applications: Ensuring that the EHR system interfaces with
VA’s website, mobile app, and other critical applications, so Veterans have a seamless and
integrated health care experience.126
While deployment of the EHR to future sites was paused, on March 9, 2024, VA and DOD
launched the new EHR at the Captain James A. Lovell Federal Health Care Center (Lovell
to address technical and other system performance issues,” press release, October 23, 2022, https://news.va.gov/pressroom/va-extends-delay-of-upcoming-electronic-health-record-deployments-to-june-2023-to-address-technical-andother-system-performance-issues/ (accessed January 24, 2024).
123 Department of Veterans Affairs, Veterans Health Administration, EHRM Sprint Report, March 2023, p. 4. The
major patient safety issues that were identified and needed fixes were “1) Unknown queue and related issues (including
medications); 2) No show and cancelled appointment orders failed to route to scheduling queues; 3) Add Referral
button not creating visible external site referral for worklist action; 4) Usability issues with the EHR application,
allowing providers to order procedure charge codes for imaging without ordering the actual clinical imaging.”
124 Department of Veterans Affairs, “VA announces reset of Electronic Health Record project” press release, April 21,
2023, https://news.va.gov/press-room/va-announces-reset-of-electronic-health-record-project/ (accessed January 24,
2024).
125 U.S. Congress, Senate Committee on Veterans’ Affairs, Examining the Future Path of VA’s Electronic Health
Record Modernization Program, 118th Cong., 1st sess., March 15, 2023, S. HRG. 118-150 (Washington: GPO, 2023),
p. 133.
126 EHRM Contract Update handout provided to House and Senate VA Committees and Department of Veterans
Affairs, Oversight of the Electronic Health Record Modernization Program, FY2023, Third Quarter Report to
Congress, August 2023, p. 4.
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FHCC) in North Chicago, IL—the only joint VA and DOD medical facility.127 According to VA,
“deploying concurrently with DOD at this facility is critical to understanding the extent to which
VA has successfully addressed many of the challenges that were identified ... and will also enable
VA to prepare for successful future deployments at more complex sites”128
The President’s request for this account was $1.86 billion, and the House version of the
MILCON-VA bill (H.R. 4366) provided the same amount as requested. The Senate version of the
MILCON-VA bill (H.R. 4366) provided $894.39 million.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $874.14
million for this account, which includes a rescission of $460 million from unobligated balances as
required by Section 256 of Division A of P.L. 118-42 (see Table 3). The explanatory statement to
accompany the act directs VA to submit a report on the “earned value analysis of the Veterans
Electronic Health Record system, including a graphic performance report, a schedule and cost
performance indexes, an estimate of completion and a budget at completion, and a variance
analysis for cost and schedule.”129
Construction, Major Projects
The major construction account provides funding for capital projects where the cost is expected to
exceed more than $30 million or where budget authority was previously provided under the major
construction appropriation account.130 Funding provided in this account could be used for
constructing, altering, extending, and improving any VA facilities, including planning,
architectural and engineering services, construction management services, offsite utility and
storm drainage system construction costs, and site acquisition. Generally, projects are identified
through the Strategic Capital Investment Planning (SCIP) process and submitted for
congressional authorization.131 Congress reviews, approves, and funds major construction
projects on a project-by-project basis. Typical major construction projects are new or
replacements of hospital buildings and new large ambulatory care centers, among others.
For FY2024, the President’s budget requested $881 million for this account. In addition, the
President’s budget included a $1.53 billion mandatory funding proposal for the major
127 Department of Veterans Affairs, “VA, DOD, and FEHRM roll out Federal Electronic Health Record in North
Chicago,” press release, March 9, 2024, https://news.va.gov/press-room/va-dod-fehrm-launch-ehr-lovell-health-care/
(accessed March 27, 2024).
128 Department of Veterans Affairs, Oversight of the Electronic Health Record Modernization Program, FY2023,
Fourth Quarter Report to Congress, December 2023, p. 4.
129 “Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on Appropriations, Regarding
H.R. 4366, Consolidated Appropriations Act, 2024,” Congressional Record, vol. 170, part 39 (March 5, 2024), p.
S1231.
130 38 U.S.C. §8104(a)(3)(A) defines a major medical facility construction as a project for the construction, alteration,
or acquisition of a medical facility involving a total expenditure of more than $30 million. The FY2024 National
Defense Authorization Act (NDAA; H.R. 2670 /P.L. 118-31) Section 5001 increased the threshold amount from $20
million to $30 million and authorized the Secretary to annually adjust the $30 million amount by the “percentage
increase, if any, in construction costs during the prior calendar year, as determined by—(I) the relevant composite
construction and lease cost indices pursuant to section 3307(h) of 11 title 40, or any similar successor index developed
by the Administrator of the General Services Administration; or (II) the Producer Price Index for New Health Care
Building Construction published by the Bureau of Labor Statistics of the Department of Labor, or any similar successor
index developed by the Secretary of Labor.”
131 Beginning with the FY2012 budget cycle, VA began utilizing an integrated, comprehensive, planning process for
capital programs known as SCIP. SCIP is used to identify critical performance gaps in safety, security, utilization,
access, seismic safety, facility condition, space, parking, and energy. The process identifies current deficiencies, as well
as future demand, through the use of long-range workload estimates in each market area.
Congressional Research Service
33
Department of Veterans Affairs FY2024 Appropriations
construction account and $600 million from the Recurring Expenses Transformational Fund
allocated to major construction to supplement the major construction account.132 The budget also
requested authority for the necessary land acquisition for VHA for major medical facility
construction, through the land acquisition line item similar to authority available to NCA to
acquire land for establishing new national cemeteries and to expand existing cemeteries.
According to VA, if VHA has the authority to begin the land acquisition process as soon as a
project was approved, similar to NCA’s authority, VHA could avoid land appreciation costs.133
The House and Senate versions of the MILCON-VA bill (H.R. 4366) both provided $881 million,
the same amount as requested. The House- and Senate-passed versions of the MILCON-VA bill
approved the mandatory construction request of $1.53 billion. H.Rept. 118-122 mentioned that
such mandatory construction budget requests should not be included in future fiscal years.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $881 million
for the major construction account, which includes a rescission of $80.22 million from
unobligated balances as required by Section 260 of Division A of P.L. 118-42 (see Table 3). The
act also provides the requested new authority for the VHA land acquisition line item and limits
this new authority to projects included on the five-year development plan provided to Congress
through the annual budget submission. It also approves VA’s request to allocate $600 million of
the Recurring Expenses Transformational Fund balances to this account and further approves an
additional $46 million for planning and design for a new VA medical facility in St. Louis, MO.
Therefore, the total allocation from the Recurring Expenses Transformational Fund balances to
this account is $646 million.
Construction, Minor Projects
The major construction account provides funding for capital projects where the cost is equal to or
less than $30 million, or where budget authority was previously provided under the minor
construction appropriation account.134 Funding in this account could be used for constructing,
132 The Recurring Expenses Transformational Fund was established by the Consolidated Appropriations Act, 2016
(P.L. 114-113, Division J, Title II, §243). The law allows unobligated balances of expired discretionary appropriations,
in FY2016 or any succeeding fiscal year, to be transferred from the General Fund of the Treasury to VA and deposited
in the Recurring Expenses Transformational Fund at the end of the fifth fiscal year after the last fiscal year for which
such funds were available. The law stipulates that amounts deposited in the fund may be available for facility
infrastructure improvements, including nonrecurring maintenance, at existing VA hospitals and clinics, and information
technology systems improvements and sustainment, subject to approval by the Office of Management and Budget
(OMB) and House and Senate Appropriations Committees.
133 For example, if VA were able to purchase land for the Indianapolis VHA major construction project in FY2025
versus FY2027, it is estimated that the VA would save 5% on the acquisition cost for each year, as per the U.S. Land
Index, according to the National Association of Realtors. Similarly, “in FY2021 VA made the decision to pursue a new
site of care in Reno, NV, rather than mitigate the seismic deficiencies of the existing hospital. Had VA pursued the land
acquisition at that time, it is estimated that the VA could have acquired the land in FY2023 for $40-45 million. The
land acquisition cost is now estimated at over $50 million. This is based on VA’s FY24 revised authorization request
for approval of the new scope for the Reno Medical Center replacement which includes the land acquisition.” (Source:
email correspondence with VA’s Office of Congressional and Legislative Affairs, February 21, 2024).
134 38 U.S.C. §8104(a)(3)(A) defines a major medical facility construction as a project for the construction, alteration,
or acquisition of a medical facility involving a total expenditure of more than $30 million. The FY2024 National
Defense Authorization Act (NDAA; H.R. 2670 /P.L. 118-31) Section 5001 increased the threshold amount from $20
million to $30 million and authorized the Secretary to annually adjust the $30 million amount by the “percentage
increase, if any, in construction costs during the prior calendar year, as determined by—(I) the relevant composite
construction and lease cost indices pursuant to section 3307(h) of 11 title 40, or any similar successor index developed
by the Administrator of the General Services Administration; or (II) the Producer Price Index for New Health Care
Building Construction published by the Bureau of Labor Statistics of the Department of Labor, or any similar successor
index developed by the Secretary of Labor.”
Congressional Research Service
34
Department of Veterans Affairs FY2024 Appropriations
altering, and extending and improving facilities, including planning, architectural and engineering
services, and land acquisition and disposition. Minor construction projects are approved by the
Office of Capital Asset Management through the SCIP process.
The President’s budget requested $680 million for this account and included a $400 million
mandatory funding proposal for this account. The House- and Senate-passed versions of the
MILCON-VA bill (H.R. 4366) both provided $680 million for this account.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $692 million
for the minor construction account (see Table 3). Of this amount, $346.15 million would be for
VHA, $182.56 million would be for NCA, $62.07 million would be for VBA, and $101.22
million would be for staff offices.
Grants for Construction of State Extended Care Facilities
VA is authorized to provide grants to participating states (including state homes on tribal lands) as
a share of the cost of construction. Specifically, VA provides states up to 65% of the cost to
construct, acquire, remodel, or modify state homes.135
The FY2024 budget requested $164 million for this account. The House-passed version of the
MILCON-VA bill (H.R. 4366) provided $176 million for this account, and the Senate-passed
version of the measure (H.R. 4366) provided the same amount as the President’s request. The
Senate Appropriations Committee requested the VA, when awarding grants,136
to consider supplementing established prioritization criteria to take into account: (1)
geographic diversity among grant recipients, including the need for a balance in addressing
the needs of urban and rural areas; (2) age and condition of the facility, to prioritize
facilities over 80 years with an industry standard Facility Condition Index maximum rating
of poor; and (3) access to other providers who can appropriately meet the veterans’
extended care facilities’ needs, to prioritize facilities with limited access to other such
providers … and encouraged [VA] to prioritize funding to facilities that have only one
State Extended Care Facility.137
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $171 million
for this account and would be available until expended (see Table 3).
Grants For Construction of Veterans Cemeteries
VA is authorized to makes grants to state and territorial governments for state and territorial
veterans cemeteries, as well as federally recognized tribal governments, to establish, expand,
improve, operate, and maintain veterans cemeteries. Grant-funded cemeteries (tribal, state, and
territorial) must meet VA design and operation standards and must be reserved solely for the
interment of qualified veterans and their families.138
The President’s budget request for FY2024 requested $60 million for grants for the construction
of veterans cemeteries. The House-passed version of the MILCON-VA bill (H.R. 4366) provided
135 38 U.S.C.§ 8131. Also see CRS In Focus IF11656, State Veterans Homes.
136 VA is required by 38 U.S.C. §8135 to fund projects in the order of their ranking on the VA Priority List.
Applications are categorized into 1 of 8 priority groups. Projects with state matching funds before August 1 of the prior
fiscal year are placed in Priority Group 1. Projects that do not have state matching funds are placed in groups 2-8.
137 U.S. Congress, Senate Committee on Appropriations, Military Construction, Veterans Affairs, And Related Agencies
Appropriations Bill, 2024, report to accompany S. 2127, 118th Cong., 1st sess., June 22, 2023, S.Rept. 118-43, p.66.
138 38 U.S.C. §2408. Also see CRS Report R46813, Department of Veterans Affairs: Burial Benefits and the National
Cemetery Administration.
Congressional Research Service
35
Department of Veterans Affairs FY2024 Appropriations
$62 million for this account, and the Senate-passed version of the measure (H.R. 4366) provided
the same amount as the President’s request.
The FY2024 MILCON-VA Appropriations Act (Division A of P.L. 118-42) provides $60 million
for this account and would be available until expended (see Table 3).
Congressional Research Service
36
Table 3. FY2023-FY2024 Appropriations and FY2025 Advance Appropriations
($ in Thousands)
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
Program
President’s Request
FY2024
FY2024
FY2025
͞
$146,778,136
͞
$146,778,136
͞
͞
4,655,879
͞
4,655,879
152,016,542
͞
151,434,015
͞
Readjustment
Benefits
8,906,851
͞
8,452,500
Over FY2024Enacted Advance
Appropriations
͞
͞
Subtotal Readjustment
Benefits
͞
Compensation and
Pensions
FY2023
House (H.R. 4366;
H.Rept. 118-122).
Over FY2024Enacted Advance
Appropriations
Subtotal
Compensation and
Pensions
Insurance and
Indemnities
Over FY2024Enacted Advance
Appropriations
FY2024
FY2025
$146,778,136
͞
$146,778,136
͞
͞
4,655,879
͞
15,072,388
͞
151,434,015
͞
151,434,015
͞
161,850,524
͞
͞
8,452,500
͞
8,452,500
͞
8,452,500
͞
͞
͞
͞
͞
͞
͞
374,852
͞
͞
͞
͞
͞
͞
͞
͞
8,827,352
͞
͞
121,126
͞
121,126
͞
121,126
͞
121,126
͞
͞
12,701
͞
12,701
͞
12,701
͞
12,701
͞
133,827
͞
1,720,000
͞
͞
109,865
͞
Subtotal Insurance
and Indemnities
109,865
͞
133,827
Housing Benefit
Program Fund
Credit Subsidy
2,524,000
͞
1,720,000
CRS-37
FY2025
͞
133,827
1,720,000
FY2024
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
FY2025
$152,016,542
FY2024
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
͞
133,827
1,720,000
͞
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
Program
FY2023
Housing Benefit
Program Fund
Administrative
Expenses
FY2024
President’s Request
FY2024
FY2025
House (H.R. 4366;
H.Rept. 118-122).
FY2024
FY2025
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
FY2024
FY2025
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
FY2024
FY2025
282,361
͞
316,742
͞
316,742
͞
316,742
͞
316,742
͞
Vocational
Rehabilitation Loan
Program
7
͞
78
͞
78
͞
78
͞
78
͞
Vocational
Rehabilitation Loan
Program
Administrative
Expenses
446
͞
461
͞
461
͞
461
͞
461
͞
Native American
Housing Loan
Program
1,400
͞
2,719
͞
2,719
͞
2,719
͞
2,719
͞
General Operating
Expenses (VBA)
(including P.L. 11842 Section 260
rescission)
3,863,000
͞
3,899,000
͞
3,899,000
͞
3,899,000
͞
3,869,000
͞
Total, Veterans
Benefits
Administration
(VBA)
167,704,472
͞
165,959,342
͞
165,959,342
͞
165,959,342
͞
176,720,703
͞
Medical Services
70,323,116
74,004,000
͞
Over FY2023Enacted Advance
Appropriations
261,000
Administrative
rescission
Subtotal Medical
Services
CRS-38
͞
74,004,000
͞
͞
͞
74,004,000
͞
͞
͞
͞
͞
(4,933,113)
͞
(4,933,113)
͞
(5,933,113)
͞
(3,034,205)
͞
͞
69,070,887
͞
69,070,887
͞
68,070,887
͞
70,969,795
͞
͞
70,584,116
͞
74,004,000
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
Program
FY2023
FY2024
President’s Request
FY2024
FY2025
33,000,000
House (H.R. 4366;
H.Rept. 118-122).
FY2024
FY2025
Medical Community
Care
24,156,659
͞
33,000,000
Over FY2023
Enacted Advance
Appropriations
4,300,000
͞
Administrative
rescission
͞
͞
(1,909,069)
͞
(1,909,069)
͞
͞
͞
͞
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
FY2024
FY2025
33,000,000
͞
͞
͞
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
FY2024
FY2025
33,000,000
͞
͞
͞
͞
͞
(4,135,589)
͞
(2,657,977)
͞
͞
Subtotal Medical
Community Care
28,456,659
͞
31,090,931
͞
31,090,931
͞
28,864,411
͞
30,342,023
͞
Medical Support and
Compliance
9,673,409
͞
12,300,000
͞
12,300,000
͞
12,300,000
͞
12,300,000
͞
Over FY2023
Enacted Advance
Appropriations
1,400,000
͞
͞
͞
͞
͞
͞
͞
͞
͞
Administrative
rescission
͞
͞
͞
͞
͞
͞
͞
͞
(1,550,000)
͞
Subtotal Medical
Support and
Compliance
11,073,409
͞
12,300,000
͞
12,300,000
͞
12,300,000
͞
10,750,000
͞
Medical Facilities
7,133,816
͞
8,800,000
͞
8,800,000
͞
8,800,000
͞
8,800,000
͞
Over FY2023
Enacted Advance
Appropriations
1,500,000
͞
͞
͞
͞
͞
͞
͞
͞
͞
Over FY2024Enacted Advance
Appropriations
͞
͞
͞
͞
͞
͞
1,000,000
͞
149,485
͞
Administrative
rescission
͞
͞
(250,515)
͞
(250,515)
͞
͞
͞
͞
͞
Subtotal Medical
Facilities
8,633,816
͞
8,549,485
͞
8,549,485
͞
9,800,000
͞
CRS-39
8,949,485
͞
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
Program
Medical and
Prosthetic Research
FY2023
FY2024
916,000
President’s Request
FY2024
FY2025
938,000
͞
House (H.R. 4366;
H.Rept. 118-122).
FY2024
FY2025
941,000
͞
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
FY2024
FY2025
938,000
͞
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
FY2024
FY2025
943,000
͞
Medical Care
Collections Fund
(MCCF)
͞
͞
(Offsetting
Receipts)
3,910,000
͞
3,991,000
͞
3,991,000
͞
3,991,000
͞
3,991,000
͞
(Appropriations
—indefinite
(3,910,000)
͞
(3,991,000)
͞
(3,991,000)
͞
(3,991,000)
͞
(3,991,000)
͞
Total, Veterans
Health
Administration
(VHA including
P.L. 118-42
Section 259
rescission)
119,664,000
͞
121,949,303
͞
121,952,303
͞
119,973,298
͞
120,002,553
͞
Total VHA with
MCCF
123,574,000
͞
125,940,303
͞
125,943,303
123,993,553
͞
National Cemetery
Administration
(NCA)
430,000
͞
480,000
͞
482,000
͞
480,000
͞
480,000
͞
Total NCA
430,000
͞
480,000
͞
482,000
͞
480,000
͞
480,000
͞
General
Administration
(including P.L. 11842 Section 260
rescission)
433,000
͞
475,000
͞
450,500
͞
431,500
͞
470,000
͞
Board of Veterans
Appeals (including
P.L. 118-42 Section
260 rescission)
285,000
͞
287,000
͞
289,000
͞
287,000
͞
272,000
͞
CRS-40
123,964,298
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
Program
FY2023
FY2024
President’s Request
FY2024
FY2025
House (H.R. 4366;
H.Rept. 118-122).
FY2024
FY2025
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
FY2024
FY2025
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
FY2024
FY2025
Information
Technology
(including P.L. 11842 Section 260
rescission)
5,782,000
͞
6,401,000
͞
6,396,000
͞
6,401,000
͞
6,386,000
͞
Veterans Electronic
Health Record (EHR
including P.L. 117328 rescission
Section 255)
1,609,000
͞
1,863,000
͞
1,863,000
͞
894,392
͞
874,137
͞
Office of Inspector
General
273,000
͞
296,000
͞
296,000
͞
296,000
͞
296,000
͞
Construction, major
projects (including
P.L. 117-328
rescission Section
255 and P.L. 118-42
Section 260
rescission)
1,371,890
͞
881,000
͞
881,000
͞
881,000
͞
881,000
͞
Construction, minor
projects
626,110
͞
680,000
͞
680,000
͞
680,000
͞
692,000
͞
Grants for StateExtended Care
Facilities
150,000
͞
164,000
͞
176,000
͞
164,000
͞
171,000
͞
Grants for State
Veterans
Cemeteries
50,000
͞
60,000
͞
62,000
͞
60,000
͞
60,000
͞
Asset and
Infrastructure
Review (AIR)
Commission
($5,000)
͞
CRS-41
͞
͞
͞
͞
͞
͞
͞
͞
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
Program
FY2023
FY2024
President’s Request
FY2024
FY2025
House (H.R. 4366;
H.Rept. 118-122).
FY2024
FY2025
11,093,500
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
FY2024
FY2025
FY2024
FY2025
͞
10,102,137
͞
͞
͞
Total,
Departmental
Administration
10,575,000
͞
11,107,000
͞
10,094,892
Cost of War Toxic
Exposures Fund
5,000,000
͞
20,268,000a
͞
͞
͞
͞
͞
Administrative
rescissions
(90,874)
͞
͞
͞
͞
͞
͞
͞
͞
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
͞
Reimbursement for
Special Mode of
Transportation
(Section 261)
͞
͞
͞
͞
͞
͞
6,000
͞
͞
͞
Total,
Department of
Veterans Affairs
(without MCCF)
303,282,598
͞
319,763,645
͞
299,487,145
͞
296,513,532
͞
307,305,393
͞
Total Mandatory
168,557,258
͞
182,008,342
͞
161,740,342
͞
161,740,342
͞
172,531,703
͞
Total Discretionary
134,725,340
͞
137,755,303
͞
137,746,803
͞
134,773,190
͞
134,773,690
͞
Memorandum: Advance Appropriations
Compensation and
Pensions
͞
146,778,136
͞
$181,390,281
͞
$181,390,281
͞
$181,390,281
͞
$182,310,515
Readjustment
Benefits
͞
8,452,500
͞
11,523,134
͞
11,523,134
͞
11,523,134
͞
13,399,805
Veterans Insurance
and Indemnities
͞
121,126
͞
135,119
͞
135,119
͞
135,119
͞
135,119
Cost of War Toxic
Exposures Fund
͞
͞
21,454,542b
͞
Subtotal
͞
155,351,762
͞
214,503,076
͞
193,048,534
͞
193,048,534
͞
195,845,439
Medical Services
͞
74,004,000
͞
71,000,000
͞
71,000,000
͞
71,000,000
͞
71,000,000
CRS-42
͞
͞
͞
͞
͞
Consolidated Appropriations
Act, 2023
(H.R. 2617/P.L. 117-328)
FY2024
President’s Request
FY2024
FY2025
House (H.R. 4366;
H.Rept. 118-122).
FY2024
FY2025
Senate (Div. A of H.R. 4366;
S.Rept. 118-43)
FY2024
FY2025
Consolidated
Appropriations Act, 2024
(H.R. 4366/P.L. 118-42)
Program
FY2023
FY2024
FY2025
Medical Community
Care
͞
33,000,000
͞
20,382,000
͞
20,382,000
͞
20,382,000
͞
20,382,000
Medical Support and
Compliance
͞
12,300,000
͞
11,800,000
͞
11,800,000
͞
11,800,000
͞
11,800,000
Medical facilities
͞
8,800,000
͞
9,400,000
͞
9,400,000
͞
9,400,000
͞
9,400,000
Subtotal
͞
128,104,000
͞
112,582,000
͞
112,582,000
͞
112,582,000
͞
112,582,000
Total Advance
Appropriations
͞
$283,455,762
͞
$327,085,076
͞
$305,630,534
͞
$305,630,534
͞
308,427,439
Sources: “Division J—Military Construction, Veterans Affairs, And Related Agencies Appropriations Act, 2023,” Explanatory Statement Submitted by Mr. Leahy, Chair of The Senate
Committee on Appropriations, Regarding H.R. 2617, Consolidated Appropriations Act, 2023, Congressional Record, vol. 168, No. 198—Book II (December 20, 2022), pp. S9275-S9284;
U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2024, report to accompany H.R.4366, 118th Cong., 1st
sess., June 27, 2023, H.Rept.118-122, pp. 101-111; U.S. Congress, Senate Committee on Appropriations, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2024,
report to accompany S.2127, 118th Cong., 1st sess., June 22, 2023, S.Rept.118-43, pp. 109-115; and Explanatory Statement Submitted by Mrs. Murray, Chair of The Senate Committee on
Appropriations, Regarding H.R. 4366, Consolidated Appropriations Act, 2024, Congressional Record, vol. 170, part 39 (March 5, 2024), pp. S1273-1281.
a. For FY2024, the amount requested by the President for the Cost of War Toxic Exposures Fund (TEF) was $20.268 billion. The Fiscal Responsibility Act of 2023 (P.L. 118-5)
provided this amount, and it became available on October 1, 2023, and will remain available until September 30, 2028.
b. For FY2025, the amount requested by the President (advance appropriations request) for the Cost of War Toxic Exposures Fund (TEF) was $21.455 billion, and the Fiscal
Responsibility Act of 2023 (P.L. 118-5) included $24.455 billion, which will remain available until September 30, 2029.
CRS-43
Department of Veterans Affairs FY2024 Appropriations
Appendix A. Veteran Population, VA Enrollees, and
VA Patients, FY2000-FY2024
Table A-1.Veteran Population,VA Enrollees, and VA Patients, FY2000-FY2024
Patients Using VA Health Care During the Year
Year
Total Veteran
Population
VA-Enrolled
Veterans
FY2000
26,745,368
4,936,259
FY2001
26,092,046
FY2002
Veterans
Nonveterans
Total Patients
3,462,082
355,191
3,817,273
6,073,264
3,890,871
356,333
4,247,204
25,627,596
6,882,488
4,246,084
380,320
4,671,037
FY2003
25,217,342
7,186,643
4,504,508
417,023
4,961,453
FY2004
24,862,857
7,419,851
4,713,583
453,250
5,166,833
FY2005
24,521,247
7,746,201
4,862,992
445,322
5,308,314
FY2006
24,179,183
7,872,438
5,030,582
435,488
5,466,070
FY2007
23,816,018
7,833,445
5,015,689
463,240
5,478,929
FY2008
23,442,489
7,834,763
5,078,269
498,420
5,576,689
FY2009
23,066,965
8,048,560
5,221,583
523,110
5,744,693
FY2010
23,031,892
8,343,117
5,441,059
559,051
6,000,110
FY2011
22,676,149
8,574,198
5,582,171
584,020
6,166,191
FY2012
22,328,279
8,762,548
5,680,374
652,717
6,333,091
FY2013
21,972,964
8,926,546
5,803,890
680,774
6,484,664
FY2014
21,999,108
9,078,615
5,955,725
677,010
6,632,735
FY2015
21,680,534
8,965,923
6,047,750
694,120
6,741,870
FY2016
21,368,156
9,124,712
6,168,606
705,743
6,874,349
FY2017
21,065,561
9,247,803
6,277,360
715,928
6,993,288
FY2018
20,333,894
9,178,149
6,170,756
744,740
6,915,496
FY2019
19,928,795
9,237,638
6,271,019
764,777
7,035,796
FY2020
19,541,961
9,190,143
6,211,825
764,006
6,975,831
FY2021
18,957,110
9,134,760
6,407,529
990,602
7,398,131
FY2022
18,592,457
9,080,134
6,296,830
951,616
7,248,446
FY2023
18,250,044
9,062,488
6,340,582
978,661
7,319,243
FY2024
17,916,954
9,048,043
6,377,593
1,003,158
7,380,751
Source: “Total Veteran Population” numbers are from Veteran Population Projection Model 2020
(VetPop2020) (FY2020-FY2024), available at https://www.va.gov/vetdata/docs/Demographics/
New_Vetpop_Model/1L_VetPop2020_National_NCVAS.xlsx, and an archived copy of an earlier version no
longer available on the website (FY2000-FY2019). “VA-Enrolled Veterans” numbers and “Patients Using VA
Health Care During the Year” numbers were obtained from the VA and/or the VA budget submissions to
Congress for FY2002-FY2024; the number for each fiscal year is taken from the budget submission two years
later (e.g., the FY2022 number is from the FY2024 budget submission).
Notes: FY2024 total veteran population projected as of September 30, 2022. FY2023 and FY2024 veteran
enrollee and patient data are estimates.
Congressional Research Service
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Department of Veterans Affairs FY2024 Appropriations
Appendix B. VA Appropriations FY1995-FY2023
Table B-1.VA Appropriations FY1995-FY1999
($ in Thousands)
FY1995
Enacted
FY1996
Enacted
FY1997
Enacted
FY1998
Enacted
FY1999
Enacted
$17,626,892
$18,331,561
$18,671,259
$19,932,997
$21,857,058
—
$100,000
$928,000
$550,000
—
Readjustment Benefits
$1,286,600
$1,345,300
$1,377,000
$1,366,000
$1,175,000
Veterans Insurance and
Indemnities
$24,760
$24,890
$38,970
$51,360
$46,450
Education Loan Program
Account
$196
$196
$196
$201
$207
Loan Guaranty Program
Account
$78,035
$75,088
$47,901
—
—
Guaranty & Indemnity
Program Account
$428,120
$569,348
$263,869
—
—
Direct Loan Program
$1,042
$487
$110
—
—
Veterans Housing Benefit
Program Fund
—
—
—
$192,447
$263,587
Veterans Housing Benefit
Program Fund Administrative
Expenses
—
—
—
$160,437
$159,121
Vocational Rehabilitation Loan
Program
$54
$54
$49
$44
$55
Vocational Rehabilitation Loan
Program Administrative
Expenses
$767
$377
$377
$388
$400
Native American Veterans
Housing Loan Program
Administrative Expenses
$218
$205
$205
$515
$515
$19,446,684
$20,447,506
$21,327,936
$22,254,389
$23,502,393
$16,232,756
$16,564,000
$17,013,447
$17,057,396
$17,306,000
-$84,762
-$21,250
—
—
-$35,373
$69,808
$63,602
$61,207
$59,860
$63,000
-$44
-$86
—
—
-$67
Health Professional
Scholarships
$10,386
—
—
—
—
Medical and Prosthetic
Research
$252,000
$257,000
$262,000
$272,000
$316,000
Veterans Benefits Administration (VBA)
Compensation and Pensions
Supplemental
Subtotal VBA
Veterans Health Administration (VHA)
Medical Care
Rescission
Medical Administration and
Miscellaneous Operating
Expenses (MAMOE)
Rescission
Congressional Research Service
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Department of Veterans Affairs FY2024 Appropriations
FY1995
Enacted
Rescission
FY1996
Enacted
FY1997
Enacted
FY1998
Enacted
FY1999
Enacted
-$574
-$322
—
—
-$348
—
—
—
$666,579
$587,000
$16,479,570
$16,862,944
$17,336,654
$18,055,835
$18,236,212
$72,663
$72,604
$76,864
$84,183
$92,006
Rescission
-$128
-$97
—
—
-$122
Subtotal NCA
$72,535
$72,507
$76,864
$84,183
$91,884
$890,600
$848,143
$827,584
$786,135
$855,661
-$879
-$1,127
—
—
-$1,558
$31,819
$30,900
$30,900
$31,013
$36,000
-$32
-$42
—
—
-$43
$355,612
$136,155
$250,858
$175,000
$142,300
-$32,337
-$186
-$32,100
—
-$13
$153,540
$190,000
$175,000
$177,900
$175,000
Rescission
-$634
-$260
—
—
-$16
Supplemental
—
—
—
$32,100
—
$16,300
—
$12,300
—
—
—
—
—
—
-$23
Grants to Republic of the
Philippines
$500
—
—
—
—
Grants for State Extended
Care Facilities
$47,397
$47,397
$47,397
$80,000
$90,000
Grants for State Veterans
Cemeteries
$5,378
$1,000
$1,000
$10,000
$10,000
Subtotal Departmental
Administration
$1,467,264
$1,251,980
$1,312,939
$1,292,148
$1,307,308
Total Department of
Veterans Affairs with
MCCF
$37,466,053
$38,634,937
$40,054,393
$41,686,555
$43,137,797
Total Department of
Veterans Affairs without
MCCF
$37,466,053
$38,634,937
$40,054,393
$41,019,976
$42,550,797
Total Mandatory
$19,445,449
$20,446,674
$21,327,109
$22,092,804
$23,342,095
Total Discretionary with
MCCF
$18,020,604
$18,188,263
$18,727,284
$19,593,751
$19,795,702
Total Discretionary
without MCCF
$18,020,604
$18,188,263
$18,727,284
$18,927,172
$19,208,702
Medical Care Collections Fund
(MCCF)
Subtotal VHA
National Cemetery
Administration (NCA)
Departmental Administration
General Operating Expenses
Rescission
Office of Inspector General
Rescission
Construction, Major Projects
Rescission
Construction, Minor Projects
Parking Fund
Rescission
Source: Table prepared by CRS based on data from the Department of Veterans Affairs, Office of Management,
Office of Budget.
Congressional Research Service
46
Department of Veterans Affairs FY2024 Appropriations
Table B-2.VA Appropriations FY2000-FY2004
($ in Thousands)
FY2000
Enacted
FY2001
Enacted
FY2002
Enacted
FY2003
Enacted
FY2004
Enacted
$21,568,364
$22,766,276
$24,944,288
$28,949,000
$29,845,127
—
$589,413
$1,100,000
—
—
$1,469,000
$1,634,000
$2,135,000
$2,264,808
$2,529,734
—
$347,000
—
—
—
Veterans Insurance and
Indemnities
$28,670
$19,850
$26,200
$27,530
$29,017
Education Loan Program
Account
$215
$221
$65
$71
$71
Guaranteed Transitional
Housing for Homeless
Veterans
$48,250
—
—
—
—
Veterans Housing Benefit
Program Fund
$282,342
$165,740
$203,278
$437,522
$305,834
Veterans Housing Benefit
Program Fund Administrative
Expenses
$156,958
$162,000
$164,497
$168,207
$154,850
—
-$356
-$123
-$1,093
-$914
Vocational Rehabilitation
Loan Program
$57
$52
$72
$54
$52
Vocational Rehabilitation
Loan Program Administrative
Expenses
$415
$432
$274
$289
$300
—
-$1
—
-$2
-$2
$520
$532
$544
$558
$571
Rescission
—
-$1
—
-$4
-$3
Subtotal VBA
$23,554,791
$25,685,156
$28,574,095
$31,846,939
$32,864,636
$19,006,000
$20,281,587
$21,331,164
$23,889,304
—
—
—
$142,000
—
—
-$79,519
-$46,234
-$16,084
—
—
$59,703
$62,000
$66,731
$74,716
—
Rescission
—
-$136
-$50
-$486
—
Medical Services
—
—
—
—
$17,867,220
Rescission
—
—
—
—
-$103,823
Veterans Benefits Administration (VBA)
Compensation and Pensions
Supplemental
Readjustment Benefits
Supplemental
Rescission
Rescission
Native American Veterans
Housing Loan Program
Administrative Expenses
Veterans Health Administration (VHA)
Medical Care
Supplemental
Rescission
Medical Administration and
Miscellaneous Operating
Expenses (MAMOE)
Congressional Research Service
47
Department of Veterans Affairs FY2024 Appropriations
FY2000
Enacted
FY2001
Enacted
FY2002
Enacted
FY2003
Enacted
FY2004
Enacted
Medical Administration
—
—
—
—
$5,000,000
Rescission
—
—
—
—
-$29,500
Medical Facilities
—
—
—
—
$4,000,000
Rescission
—
—
—
—
-$23,600
$321,000
$351,000
$371,000
$400,000
$408,000
—
-$772
-$278
-$2,600
-$2,407
$563,755
$767,687
$1,133,214
$1,474,716
$1,708,026
$19,870,939
$21,415,132
$23,027,697
$25,835,650
$28,823,91
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