Department of Veterans Affairs FY2023 Appropriations

February 14, 2023 R47423

Department of Veterans Affairs
February 14, 2023
FY2023 Appropriations
Sidath Viranga Panangala
The Department of Veterans Affairs (VA) administers numerous programs that provide benefits
Specialist in Veterans
and services to eligible veterans and their families. These benefits include medical care; disability
Policy
compensation and pensions; education; vocational rehabilitation and employment services;

assistance to homeless veterans; home loan guarantees; administration of life insurance, as well
Jared S. Sussman
as traumatic injury protection insurance for servicemembers; and death benefits that cover burial
Analyst in Health Policy
expenses.

President Biden submitted his VA budget proposal for FY2023 on March 28, 2022. The

Administration requested $298.61 billion, which was $29.35 billion more than the FY2022-
enacted amount. The request included $135.05 billion in discretionary appropriations and $163.58 billion in mandatory
appropriations.
On July 20, 2022, the House passed a six-bill appropriations package (H.R. 8294; House Committee Print 117-55). Division
F of H.R. 8294 included the Military Construction, Veterans Affairs, and Related Agencies (MILCON-VA) appropriations
bill for FY2023. 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 August 3, 2022, a version of the FY2023 MILCON-
VA appropriations bill, identical to an earlier Senate majority appropriations committee draft, was introduced in the Senate as
S. 4759. The S. 4759 version of the FY2023 MILCON-VA appropriations bill, as introduced, recommended $299.91 billion
for VA, which included $164.96 billion in mandatory appropriations and $134.95 billion in discretionary appropriations. On
December 20, 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 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 MICON-VA Act of 2023 provides $303.28 billion for VA, including $168.56 billion in
mandatory appropriations and $134.73 billion in discretionary appropriations.
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. The Honoring our PACT Act of
2022 appropriates $500 million for the Cost of War Toxic Exposures Fund (TEF) for FY2022 to remain available until
September 30, 2024, and further authorizes appropriations (such sums as are necessary) to this fund for FY2023 and each
subsequent fiscal year. The Consolidated Appropriations Act, 2023 (P.L. 117-328), provides $5.0 billion for the TEF to
remain available until September 30, 2027.
Comparative funding levels for FY2022 and FY2023 are as follows (component amounts may not sum to totals due to
rounding and adjustments due to rescissions):
% Change
FY2023 House-
FY2023 Senate
FY2023
FY2022
Passed
Majority
FY2023
Enacted vs.
Enacted
FY2023
(Division F of
Committee
Enacted
FY2022

(P.L. 117-103)
Request
H.R. 8294)
(S. 4759)
(P.L. 117-328)
Enacted
Veterans Benefits
$160.73 bil ion
$167.70 bil ion
$167.70 bil ion
$167.70 bil ion
$167.70 bil ion
4.34%
Administration (VBA,
including General
Operating Expenses)
Veterans Health
$97.93 bil ion
$119.66 bil ion
$119.75 bil ion
$119.66 bil ion
$119.66 bil ion
22.19%
Administration
(VHA)
National Cemetery
$394.0 mil ion
$430.0 mil ion
$430.0 mil ion
$430.0 mil ion
$430.0 mil ion
9.14%
Administration
(NCA)
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Department of Veterans Affairs FY2023 Appropriations

% Change
FY2023 House-
FY2023 Senate
FY2023
FY2022
Passed
Majority
FY2023
Enacted vs.
Enacted
FY2023
(Division F of
Committee
Enacted
FY2022

(P.L. 117-103)
Request
H.R. 8294)
(S. 4759)
(P.L. 117-328)
Enacted
Departmental
$10.28 bil ion
$10.81bil ion
$10.73 bil ion
$10.71 bil ion
$10.58 bil ion
2.88%
Administration
Cost of War Toxic
—
—
—
$1.40 bil ion
$5.0 bil ion
N/A
Exposure Fund
Total VA
$269.26 billion $298.61 billion
$298.56 billion $299.91 billion $303.28 billion
12.63%

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Introduction
The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans
who meet certain eligibility criteria. These benefits and services include, among other things,
hospital and medical care;1 disability compensation and pensions;2 education;3 vocational
rehabilitation and employment services;4 assistance to homeless veterans;5 home loan
guarantees;6 administration of life insurance, as well as traumatic injury protection insurance for
servicemembers; and death benefits that cover burial expenses.7
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)8 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 FY2023 President’s request for VA and subsequent
congressional action. It begins with a discussion of various appropriations and funds that
constitute VA’s budget, followed by a brief overview of the FY2022 congressional appropriations
process and enacted amounts for FY2022. It then discusses the President’s request for FY2023
for care, benefits, and services for veterans and administration of the department, followed by
congressional action on the FY2023 request. The report provides funding levels for the accounts
as presented in the Military Construction, Veterans Affairs, and Related Agencies (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 1 lists FY2022-FY2023 VA

1 For more information on health care programs, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions.
2 For more information on disability benefit programs, see CRS Report R44837, Benefits for Service-Disabled
Veterans; and. CRS Report R46511, Veterans Benefits Administration (VBA): Pension Programs.
3 For a discussion of education benefits, see CRS Report R42785, Veterans’ Educational Assistance Programs and
Benefits: A Primer
4 For details on VA’s vocational rehabilitation and employment, see CRS Report RL34627, Veterans’ Benefits: The
Veteran Readiness and Employment Program.
5 For detailed information on homeless veterans programs, see CRS In Focus IF10167, Veterans and Homelessness.
6 For details on the home loan guarantee program, see CRS Report R42504, VA Housing: Guaranteed Loans, Direct
Loans, and Specially Adapted Housing Grants.
7 For more information on burial benefits, see CRS Report R41386, Veterans’ Benefits: Burial Benefits and National
Cemeteries.
8 Established by the National Cemeteries Act of 1973 (P.L. 93-43).
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appropriations and FY2024 advance appropriations from the MILCON-VA appropriations act,
accompanying committee reports, and the Joint Explanatory Statement released by the House and
Senate Appropriations Committees regarding the Consolidated Appropriations Act, 2023.
Appendix B lists appropriations to VA from FY1995 to FY2022. Funding amounts shown in the
appendices may include transfers in and out of accounts and exclusions of loan guarantees as
calculated by VA; therefore, those amounts may be different from those shown in Table 1.
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 Fund9 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 through authorizing legislation in which the budget authority is not provided for in
advance by appropriations acts.10 “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.”11 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 of
governments who meet specific 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
being enacted. Therefore, if insufficient appropriations are available, the government may
presumably be sued for payment of the benefits.12
Although some entitlement programs such as Medicare and Social Security are permanently
appropriated, some programs (e.g., veterans disability compensation, veteran survivor’s
Dependency and Indemnity Compensation (DIC) program, and pensions) are annually
appropriated entitlements and are known as appropriated entitlements.

9 38 U.S.C. §324.
10 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. 132.
11 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.
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, 103rd
Cong., 2nd sess., May 1994, S.Prt.103-80 (Washington: GPO, 1994), p. 133.
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Appropriated Entitlements13
Generally, appropriated entitlements go 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.”14
“Even though this funding is included in an appropriations bill, it is still considered mandatory
spending rather than discretionary spending.”15 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.16 The appropriations act appropriates the sums necessary to cover the cost
of disability compensation payments. Congress, during the appropriations process, does not have
the discretion to change the amount spent on the disability compensation program.
Discretionary Spending17
Funding for discretionary programs is provided and controlled through the annual enactment of
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.”18
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
survivor’s Dependency and Indemnity Compensation (DIC) program, pensions, vocational
rehabilitation and employment, education, life insurance, housing, clothing allowances, 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, Electronic Health Care Record Modernization (EHRM), the Office of Inspector
General, BVA, NCA, and general operating expenses, among other accounts. These accounts are

13 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: In Brief.
14 CRS Report 98-720 GOV. Manual on the Federal Budget Process (archived/nondistributable but available from the
author to congressional clients), p. 26.
15 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.
16 See 38 U.S.C. §1110; §1121; §1131; §1141. Basic entitlement.
17 For more information, see CRS Report R41726, Discretionary Budget Authority by Subfunction: An Overview.
18 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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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.19
Advance Appropriations20
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.21 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 advance appropriations list of
accounts. 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 (MILCON-VA; P.L. 114-113), those
accounts received advance appropriations for the first time in 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
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 is typically three to four years old.22 For example, the advance
appropriations estimates for FY2023 included in the FY2022 annual budget request to Congress
were developed by VA from about May through July 2020, using data from FY2019. 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

19 For more details about these funds, see Department of Veterans Affairs, 2023 Congressional Submission, Burial and
Benefits Programs and Departmental Administration, vol. 3 of 4, March 2022. 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.
20 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.
21 Codified at 38 U.S.C. §117.
22 Department of Veterans Affairs, FY2023 Congressional Budget Submission, Medical and Information Technology
Programs vol. 2 of 4, March 2022, pp. VHA-438.
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estimate is prepared in the context of uncertainties about the future—including changes in
veterans’ needs, future economic conditions, and shifting leadership priorities.”23 Therefore, each
year the department updates its annual budget request to reflect the most recent data, actual
program experience, and other factors, such as economic trends in unemployment and inflation.24
This “revised request” for the upcoming fiscal year is displayed as additional funding over the
2023 advance appropriations amount.
Under present budget scoring guidelines, advance appropriations are scored as new budget
authority in the fiscal year in which they become available for obligation, not in the fiscal year the
appropriations are enacted, and required to be accommodated within the annual statutory
spending caps.25 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.26 The Honoring our PACT Act of 2022
appropriates $500 million for the Cost of War Toxic Exposures Fund for FY2022, to remain
available until September 30, 2024, and further authorizes appropriations (such sums as are
necessary) to this fund for FY2023 and each subsequent fiscal year for costs associated with the
delivery of health care associated with environmental hazards during active military service.
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.27 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 “Consolidated Appropriations Act, 2023
[H.R. 2617; P.L. 117-328]”).

23 U.S. Government Accountability Office, VA Health Care: Additional Steps Could Help Improve Community Care
Budget Estimates, GAO-20-669, September 2020, p. 3.
24 Office of Management and Budget, Budget of the United States Government, Fiscal Year 2023, Budget Appendix,
March 2022, p. 1038.
25 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/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.
26 38 U.S.C. §324.
27 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.”
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TEF and Future Authorizing Legislation
During a House Veterans’ Affairs Committee mark-up of several measures on September 21,
2022, the then-Ranking Member Mike Bost raised the issue regarding how the Congressional
Budget Office (CBO) plans to score certain authorizing legislation pertaining to VA health care in
the future because of the new TEF. The then-Chairman Mark Takano acknowledged that the TEF
has created some issues for the committee in terms of how future authorizing legislation would be
scored. 28 On December 7, 2022, CBO issued a statement on how the agency plans to score future
veterans benefits and programs authorizing legislation because of the TEF:
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.29

28 During a House Veterans’ Affairs Committee mark-up of several measures on September 21, 2022, the then-Ranking
Member Mike Bost raised the issue regarding how the Congressional Budget Offices (CBO) plans to score certain
legislation pertaining to VA health care in the future because of the new Cost of War Toxic Exposure Fund. In his
statement, Rep. Bost stated: “We have some serious problems and it is going to paralyze this Committee and make it
tougher to serve veterans, if we don't solve it and well that’s because the changes that the Senate made to the Toxic
Exposure Fund in the PACT Act, it is making new legislation much more expensive for taxpayers. Because of the
Fund, what used to be discretionary costs are now mandatory and CBO must add millions or even billions of dollars to
their bill estimates. We just saw this with the extenders bill. Congress passed it every few years to continue a wide
range of important VA programs that would otherwise expire. Now we have never had any problem doing so, however,
this year CBO initially scored the extenders at over $1.1 billion in mandatory costs. That said, after some intervention
by the Budget Committee and CBO reconsidered and concluded it is too early to score the extenders bills this way, but
the CBO warned us that every future extenders bill will be much more expensive. The budget gimmicks in the Toxic
Exposure Fund are already creating a serious obstacle to advancing many of the bills this committee is responsible for
including some of those we will consider today.” The then-Chairman Mark Takano responded by stating: “it raises an
important issue which is the long-term implications of the Cost of War Toxic Exposure Fund or TEF as it has become
known, as created by the Honoring our PACT Act. Now this Fund is absolutely crucial to ensuring VA has the
resources necessary to fully support our veterans and to deliver the new benefits available to them without having to
sacrifice existing programs, and so any potential change to this Fund and how it operates must be considered very
carefully and requires the input of other committees that have a stake in this issue to include Appropriations Committee
and the Budget Committee.... The Toxic Exposure Fund has created some complications for the committee in terms of
how legislation is being scored. Historically certain benefits programs have always been considered mandatory
spending and we address that as it comes up such as in Representative Fletcher’s bill. However much of our legislation
especially related to health care issues has not been subject to mandatory spending. At present CBO has taken a very
rigid and nuanced approach to scoring legislation in the wake of the PACT Act passage and estimating that many bills
will have 30 percent mandatory spending costs whether or not the subject of the legislation is toxic exposure. However,
I believe that as implementation begins and more cost estimates and data are available, CBO will be able to adjust its
assumptions and more finely tune its methodology.... Now I remind you that the intent of the PACT Act, the intent of
Congress in the PACT Act, was to stop pitting veterans against seniors, children, and other Americans. It means not
pitting toxic exposed veterans against other veterans.” See “Full Committee Business Meeting and Markup.”
September 21, 2022, https://veterans.house.gov/events/hearings/full-committee-business-meeting-and-markup (not an
official transcription, but based on the transcript generated by YouTube). On December 7, 2022, CBO issued a
“Statement for the Record Regarding How CBO Would Estimate the Effects of Future Authorizing Legislation on
Spending From the Toxic Exposures Fund.”
29 Congressional Budget Office, Statement for the Record Regarding How CBO Would Estimate the Effects of Future
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Historical Perspective
Figure 1 illustrates funding trends for mandatory, discretionary, and total VA-enacted
appropriations from FY1995 through FY2022 in nominal dollars. Between FY1995 and FY2022,
total mandatory appropriations grew from $19.45 billion to $154.27 billion, a compound annual
growth rate (CAGR) of 7.97%. During this same period, discretionary appropriations grew from
$18.02 billion to $112.22 billion, a CAGR of 7.01%. The total VA appropriations from FY1995
through FY2022 grew from $37.47 billion to $266.48 billion, a CAGR of 7.53%.
Figure 1. VA Appropriations, FY1995-FY2022

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, dol ars. Discretionary funding excludes offsetting
col ections deposited in the Medical Care Col ections Fund (MCCF).
FY2009: American Recovery and Reinvestment Act (P.L. 111-5) provided supplemental funding. VHA received
$1.0 bil ion for the medical facilities account, and the $700 mil ion was for the economic recovery payments. The
supplemental $700 mil ion is not included in the discretionary subtotal but included in overall VA total.
FY2014: Amounts include $15 bil ion 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: 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 FY2021 in both nominal and inflation-adjusted dollars.
When adjusted for inflation, between FY1995 and FY2021 total mandatory appropriations grew
from $32.08 billion to $154.15 billion, a compound annual growth rate (CAGR) of 6.22%.
During this same period, discretionary appropriations grew from $29.73 billion to $104.43
billion, a CAGR of 4.95%. The total VA appropriations from FY1995 through FY2021 grew from
$61.81 billion to $260.71 billion, a CAGR of 5.69%.

Authorizing Legislation on Spending From the Toxic Exposures Fund, December 7, 2022, pp. 1-2,
https://www.cbo.gov/publication/58843.
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Figure 2. Nominal and Inflation-Adjusted VA Appropriations, FY1995-FY2021

Source: Prepared by CRS based on figures from the Department of Veterans Affairs, Office of Management,
Office of Budget.
Notes: Nominal (or current) dol ar values are adjusted to real (constant) dol ars using the Gross Domestic
Product (GDP) Price Index Series deflator where 2021 = 100; https://www.meps.ahrq.gov/about_meps/
Price_Index.shtml.
FY2022 Budget Summary30
President Biden submitted his formal budget request for FY2022 on May 28, 2021. The
President’s budget requested $268.41 billion for VA. This amount included $155.44 billion in
mandatory funding and $112.97 billion in discretionary appropriations (see Figure 3). The
President’s budget also requested $156.59 billion in advance appropriations for FY2023 for VBA
mandatory accounts and $111.29 billion in advance appropriations for FY2023 for VHA
discretionary accounts.
On July 29, 2021, the House passed H.R. 4502, consisting of seven appropriations bills. Division
F of H.R. 4502 (H.Rept. 117-81) included the Military Construction, Veterans Affairs, and
Related Agencies (MILCON-VA) appropriations bill for FY2022. The House-passed bill provided
$268.59 billion for VA, including $155.44 billion in mandatory spending and $113.15 billion in
discretionary spending. On August 4, 2021, the Senate Appropriations Committee reported its
version of the MILCON-VA bill for FY2022 (S. 2604; S.Rept. 117-35). The Senate
Appropriations Committee-reported bill recommended $268.37 billion for VA for FY2022,
including $155.44 billion in mandatory spending and $112.93 billion in discretionary spending.
Both the House-passed and Senate-reported versions of the MILCON-VA bill for FY2022 include
$267.87 billion in advance appropriations for FY2023. On March 15, 2022, the Consolidated
Appropriations Act, 2022 (P.L. 117-103), was signed into law. The act provides $269.26 billion
for VA for FY2022, including $157.05 in mandatory spending and $112.22 billion in
discretionary spending. About 51.69% of VA’s $269.26 billion total budget authority for FY2022
is for compensation and pensions, while around 36.37% of VA’s total budget is for medical care

30 For a detailed discussion of the FY2022 President’s request and congressional action, see CRS Report R46964,
Department of Veterans Affairs FY2022 Appropriations.
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and research (see Figure 4). The act also includes $272.32 billion in advance appropriations for
FY2023.
Figure 3. FY2022 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, 2022, report to accompany H.R. 4355, 117th Cong., 1st
sess., July 2, 2021, H.Rept. 117-81.
Notes: Total budget authority excludes offsetting col ections deposited in the Medical Care Col ections Fund
(MCCF). Totals may not add up due to rounding.
Figure 4. FY2022 VA-Enacted Appropriations (P.L. 117-103)

Source: Prepared by CRS based on U.S. Congress, committee print, prepared by House Committee on
Appropriations Consolidated Appropriations Act, 2022 (H.R. 2471; P.L. 117-103) [Legislative Text and Explanatory
Statement Book 2 of 2 Divisions G–L,],117th Cong., 2nd sess., April 2022 (Washington: GPO, 2022), pp. 2209-
2221.
Notes: Total budget authority excludes offsetting col ections deposited in the Medical Care Col ections Fund
(MCCF). Totals may not add up due to rounding.
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Budget Request for FY2023 and
Congressional Action
President’s Request
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. As it did with the FY2022
budget request, the Administration proposed to use $968 million from the Recurring Expenses
Transformational Fund to supplement the discretionary budget request. This request anticipated
the transfer of $968 million in unobligated balances into the Recurring Expenses
Transformational Fund at the end of 2022. Of this amount, $805 million was to be obligated in
2023 for major construction projects, and $163.49 million was to be obligated for minor
construction projects, along with installation of zero-emission vehicle charging infrastructure on
VA facility grounds.31 Additionally, the President’s FY2024 advance appropriations request
included $155.35 billion for VBA mandatory accounts and $128.10 billion for VHA discretionary
accounts. Figure 5 provides a breakdown of the FY2023 request. The $10.81 billion for
departmental administration includes the following accounts: general administration, BVA, and
information technology systems (IT systems); veterans electronic health record modernization
(EHRM), Office of Inspector General, construction major and minor accounts, and grants for
construction of state-extended care facilities; grants for the construction of veterans cemeteries,
and administrative expenses related to the Asset and Infrastructure Review (AIR) Commission’s
work.
In its FY2023 budget proposal, the Administration proposed a third new 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.32 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).33 The statutory limits on discretionary spending were in effect through
FY2021.34 According to the President’s budget proposal, “[t]he Budget separates VA medical care
as a third category within the discretionary budget based on a recognition that VA medical care
has grown much more rapidly than other discretionary spending over time, largely due to system
wide growth in health care costs. Setting a separate budget allocation for VA medical care could

31 38 U.S.C. §313 note. The Recurring Expenses Transformational Fund 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.
32 CRS Report R44874, The Budget Control Act: Frequently Asked Questions.
33 CRS Report R44874, The Budget Control Act: Frequently Asked Questions.
34 CRS Report R46752, Expiration of the Discretionary Spending Limits: Frequently Asked Questions.
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help ensure adequate funding for veterans’ health care without shortchanging other critical
programs.” 35
Figure 5. 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.
Note: Total budget authority excludes offsetting col ections deposited in the Medical Care Col ections Fund
(MCCF).
House Action
On June 15, 2022, the House Committee on Appropriations, Subcommittee on Military
Construction, Veterans Affairs, and Related Agencies, held a markup of the FY2023 Military
Construction, Veterans Affairs, and Related Agencies (MILCON-VA) appropriations bill, and
approved the draft bill by voice vote. On June 23, the House Appropriations Committee held a
markup of the FY2023 MILCON-VA appropriations bill, and the bill was reported to the full
House on June 27 (H.R. 8238; H.Rept. 117-391). Subsequently, the text of H.R. 8283 was
included in 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).
The measure passed the House on July 20. 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.
The House committee report (H.Rept. 117-391) supported the Administration’s proposal to use
the Recurring Expenses Transformational Fund to supplement VA’s discretionary budget amount.
During House floor debate, amendments were passed to not provide any funding for the Asset and
Infrastructure Review Commission’s work (see discussion below). Table 1 provides a
comparative breakdown, by account, of House-passed amounts for FY2023.

35 Office of Management and Budget, Budget of the United States Government, Fiscal Year 2023, Analytical
Perspectives , March 28, 2022, p. 121, https://whitehouse.gov/omb/budget/.
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Senate Committee
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.36
On August 3, a 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. The FY2023 MILCON-VA appropriations bill (S. 4759)
recommended $1.40 billion to remain available until September 30, 2027, for the Cost Of War
Toxic Exposures Fund established by the Honoring our PACT Act of 2022 (P.L. 117-168).37 Table
1 provides a comparative breakdown, by account, of recommended amounts in S. 4759.
Continuing Appropriations (Continuing Appropriations and
Ukraine Supplemental Appropriations Act, 2023, H.R. 6833; P.L.
117-180)
Because none of the regular appropriations bills were enacted by the beginning of the fiscal year
on October 1, Congress passed a continuing resolution (CR), the Continuing Appropriations and
Ukraine Supplemental Appropriations Act, 2023, (H.R. 6833; P.L. 117-180), which the President
signed into law on September 30, 2022. The act provided continuing appropriations for VA
through December 16, 2022, at FY2022 funding levels.38 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 budget authority for FY2023 in the Military Construction, Veterans Affairs, and
Related Agencies Appropriations Act, 2022 (Division J of P.L. 117-103), these accounts are not
affected by the CR.
Division E of P.L. 117-180 also included provisions related VA expiring authorities that were set
to expire by the end of the FY2022 or calendar year 2022. The following authorities were
extended to the dates shown below.
 38 U.S.C. §111A(a)(2). Transportation of individuals to and from department
facilities, until September 30, 2024.
 38 U.S.C. §315(b). Maintain a regional office in the Republic of the Philippines,
until September 30, 2024.
 38 U.S.C. §322(d)(4). Office of National Veterans Sports Programs and Special
Events, monthly assistance allowance for disabled veteran athletes, until
September 30, 2026.

36 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-fiscal-
year-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-appropriations-
process.
37 38 U.S.C. §324.
38 For more details, see CRS Report R47283, Overview of Continuing Appropriations for FY2023 (Division A of P.L.
117-180).
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 38 U.S.C. §503(c). Administrative error; equitable relief reporting, until
December 31, 2024.
 38 U.S.C. §521A(g) and (l). Adaptive sports programs for disabled veterans and
members of the Armed Forces, until September 30, 2026.
 38 U.S.C. §544(e). Advisory Committee on Minority Veterans, until September
30, 2026.
 38 U.S.C. §1710 (f)(2)(B). Copayments for hospital and nursing home care, until
September 30, 2024.
 38 U.S.C. §1710A(d). Nursing home care for certain service-connected veterans,
until September 30, 2024.
 38 U.S.C. §2021(e). Homeless veterans reintegration programs, until September
30, 2024.
 38 U.S.C. §2021A. Homeless women veterans and homeless veterans with
children reintegration grant program, until September 30, 2024.
 38 U.S.C. §2031(b). Treatment and rehabilitation for seriously mentally ill and
homeless veterans, general treatment, until September 30, 2024.
 38 U.S.C. §2033(d). Additional services at certain locations for seriously
mentally ill and homeless veterans, until September 30, 2024.
 38 U.S.C. §2044(e)(1)(H). Financial assistance for supportive services for very
low-income veteran families in permanent housing, until September 30, 2024.
 38 U.S.C. §2061(d). Grant program for homeless veterans with special needs,
until September 30, 2024.
 38 U.S.C. §2066(d). Advisory Committee on Homeless Veterans, until September
30, 2026.
 38 U.S.C. §2102A(e). Temporary grant assistance program for individuals
residing temporarily in housing owned by a family member, until December 31,
2024.
 38 U.S.C. §2108(g). Specially adapted housing assistive technology grant
program, until September 30, 2024.
 38 U.S.C. §3692(c).Veterans’ Advisory Committee on Education, until December
31, 2026.
 38 U.S.C. §8111(d)(3). Authority to Continue DOD-VA Health Care Sharing
Incentive Fund, until September 30, 2026.
 38 U.S.C. §8118(a)(5). Authority for the transfer of real property, until September
30, 2024.
 Payments and allowances for beneficiary travel to Vet Centers initiative (Section
104(a) of the Honoring America’s Veterans and Caring for Camp Lejeune
Families Act of 2012 [P.L. 112-154]), until September 30, 2023.
 Authority for joint Department of Defense-Department of Veterans Affairs
medical facility demonstration fund (Section 1704(e) of the National Defense
Authorization Act for Fiscal Year 2010 [P.L. 111-84]), until September 30, 2024.
 Two short term CRs (P.L. 117-229, P.L. 117-264) were enacted until Congress
passed and the President signed into law the consolidated appropriations bill
(H.R. 2617).
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Consolidated Appropriations Act, 2023 (H.R. 2617;
P.L. 117-328)
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
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 (see Table 1).
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.39
Additionally, the FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides
$283.46 billion in advance appropriations for FY2024 that would become available on October 1,
2023. The FY2023 MILCON-VA Appropriations Act includes Section 252 in support of the
Administration’s proposal to use the Recurring Expenses Transformational Fund to supplement
VA’s discretionary budget amount. This includes, $804.51 million for constructing, altering,
extending, and improving VHA medical facilities; $88.49 million for VHA facility improvements,
and $75.0 million for infrastructure or equipment upgrades to support Executive Order on
“Catalyzing Clean Energy Industries and Jobs Through Federal Sustainability” (Executive Order
14057). Table 1 provides a comparative breakdown by account of FY2023 enacted
appropriations.
The following sections discuss account-level details of the President’s FY2023 request and
congressional action on regular VA appropriations.
Mandatory Programs Funding
Major mandatory program funding includes (1) Compensation and Pensions (VA’s disability
compensation program; pensions to low-income veterans, their surviving spouses, and dependent
children), (2) Readjustment Benefits (education and vocational rehabilitation assistance), and (3)
Veterans Insurance and Indemnities (the provision of life insurance).
Compensation and Pensions
The Compensation and Pensions category includes payments for benefits such as disability
compensation, dependency and indemnity 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 FY2023, VA requested $152.02 billion for the Compensation and Pensions account, an
increase of $12.83 billion over the FY2022-enacted funding level. The largest portion of the

39 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 is disability compensation, and VA estimates that $141.42 billion in compensation
payments would go to an estimated 5.5 million veterans, 482,949 survivors, and 1,098 children in
FY2023. Pension payments are estimated to be $3.5 billion to approximately 162,377 veterans
and 114,250 survivors. Finally, an estimated $411.78 million would be allocated for burial
benefits.40
The increase in requested funding reflected several policy changes that occurred in 2021 and
2022. In August 2021, VA established presumption of service connection for three respiratory
health conditions associated with exposure to particulate matter: asthma, sinusitis, and rhinitis.
These presumptions apply to Persian Gulf War and Post-9/11 veterans, and VA estimates it will
increase compensation and pension obligations by $1.1 billion in 2022. In September 2021, VA
amended its adjudication regulations for chronic multisymptom illness suffered by Persian Gulf
War veterans and extended the presumptive period for qualifying disabilities to December 31,
2026. VA estimates that doing so will increase compensation and pension obligations by $14
million in 2022. In November 2021, changes and updates to the VA Schedule for Rating
Disabilities (VASRD) went into effect for the cardiovascular and genitourinary systems. VA
estimates these changes will increase compensation and pension obligations by $45.8 million in
2022. Finally, the average payments for benefits, including disability compensation, pension, and
survivor benefits, were expected to increase due to the annual cost-of-living adjustment
(COLA).41
The House-passed measure (Division F, Title II, of H.R. 8294), and the Senate Appropriations
Committee (S. 4759) bill would have provided $152.02 billion for the compensation and pensions
account. The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328)
provides $152.02 billion, which is equal to VA’s FY2023 request (see Table 1). The act also
provides $146.78 billion in advance appropriations for FY2024 for this account.
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;
vocational rehabilitation and employment training for service-connected disabled veterans; and
assistance to help veterans purchase and/or rehabilitate homes.
For FY2023, VA requested appropriations of $8.91 billion to provide funding for Readjustment
Benefits. In addition to the appropriated funds, VA is to combine $154.2 million in offsetting
collections from the Department of Defense (DOD) and an estimated unobligated balance of $8.3
billion from FY2022 to sufficiently provide the required benefits.42
The requested appropriations include changes to education and Vocational Rehabilitation and
Employment (VR&E) benefits that were authorized in response to the COVID-19 pandemic in
the Responsible Education Migrating Options and Technical Extensions Act of 2021 (P.L. 117-
76). This law extended multiple expiring provisions, including authorizing VA to continue to pay

40 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, p. VBA-169.
41 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, p. VBA-171.
42 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, p. VBA-193.
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housing and subsistence allowances, and to extend the usage periods, and prohibiting VA from
changing entitlement if beneficiaries are adversely affected by the pandemic.
The House Appropriations Committee, in its report, encouraged VA to increase coordination with
Departments of Labor and Defense to help veterans transition from service to civilian life. The
committee also stressed the importance of technology in modernizing tools such as the GI Bill
Comparison tool, which could be updated to provide greater assistance to veterans seeking higher
education programs.43
The House-passed measure (Division F, Title II, of H.R. 8294), and the Senate Appropriations
Committee (S. 4759) bill would have provided $8.91 billion for the readjustment benefits
account. The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328)
provides $8.91 billion, which is equal to VA’s FY2023 request (see Table 1). The act also
provides $8.45 billion in advance appropriations for FY2024 for this account.
Veterans Insurance and Indemnities
The Veterans Insurance and Indemnities account is the mandatory funding mechanism 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),44 Service-Disabled Veterans Insurance (S-DVI),45 and Veterans Mortgage
Life Insurance (VMLI).46
For FY2023, VA estimates that this account will require a combined appropriation of $109.86
million and collections of $6.5 million to fund a total obligation of $116.4 million. Provided
appropriations would enable VA to transfer $10,000 to the NSLI program, $31.6 million to the
VMLI program, and $78.3 million to the S-DVI program.47 As of December 31, 2022, VA is to no
longer accept new policyholders for the S-DVI program; appropriations and payouts are to
remain for those policyholders already in the program who do not choose to switch to the new
insurance program.
The Veterans Affairs Life Insurance (VALI) program created under the Johnny Isakson and David
P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (P.L. 116-315) began
on January 1, 2023. This program is designed to be self-supporting.

43 U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, and Related Agencies
Appropriations Bill, 2023, report to accompany H.R. 8294, 117th Cong., 2st sess., June 27, 2022, H.Rept. 117-391, p.
32.
44 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.
45 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/.
46 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/life-
insurance/options-eligibility/vmli/.
47 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, p. VBA-246.
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The House-passed measure (Division F, Title II, of H.R. 8294), and the Senate Appropriations
Committee (S. 4759) bill would have provided $109.86 million for FY2023 insurance and
indemnities account, the exact amount requested by VA. The final FY2023 MILCON-VA
Appropriations Act (Division J of P.L. 117-328) provides the same amount. Additionally, the act
provides $121.13 million in advance appropriations for FY2024 (see Table 1).
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.48 VHA’s primary mission is to provide health care services to
eligible veterans.49 VHA generally provides care directly through over 1,700 sites of care,
including hospitals, clinics, and health care facilities.50
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.51 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
policies and guidelines to be applied throughout the VA health care system, management
authority for basic decisionmaking and budgetary responsibilities is delegated to the VISNs.52 As
of September 30, 2021, VHA operated 145 hospitals, 134 nursing homes, 727 community-based
outpatient clinics (CBOCs),53 and 300 Readjustment Counseling Centers (Vet Centers).54 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.55

48 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-21.
49 38 U.S.C. §7301.
50 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-21.
51 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.
52 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.
53 For more information on CBOCs, see CRS Report R41044, Veterans Health Administration: Community-Based
Outpatient Clinics (archived).
54 Department of Veterans Affairs, FY2023 Budget Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-483. 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.
55 Ibid., p. VHA-484.
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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.56 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.57 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).58 In addition, VHA provides grants for construction of state-owned nursing homes
and domiciliary facilities59 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.60 It is
required to conduct medical research,61 serve as a contingency backup to the DOD medical
system during a national security emergency,62 provide support to the National Disaster Medical
System and the Department of Health and Human Services as necessary,63 and train health care
professionals to provide an adequate supply of health personnel for VA and the nation.64
The Veteran Patient Population
VA projects that in FY2023, the overall population of veterans nationwide will decrease but
enrollment in the VA health care system and utilization of the system will increase.65 In FY2022,
approximately 9.2 million of the 18.8 million total veterans were enrolled in VA’s health care
system.66 VA estimates that in FY2023, enrollment will grow by approximately 29,000. In
FY2022, VA anticipated treating approximately 6.48 million unique veteran patients and 827,000
nonveteran patients.67 VHA estimates that in FY2023, it will treat about 6.49 million unique
veteran patients and 856,000 nonveterans.

56 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).
57 For more information, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions.
58 For details on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of Veterans.
59 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.
60 38 U.S.C. §7301(b).
61 38 U.S.C. §7303.
62 38 U.S.C. §8111A.
63 38 U.S.C. §8117(e).
64 38 U.S.C. §7302.
65 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, pp. VHA-417 to VHA-421.
66 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.
67 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,
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VHA estimates that outpatient visits will increase from 137.42 million visits in FY2022 to 148.38
million visits in FY2023, an increase of 10.97 million, or 8.0%. VHA anticipates an increase in
the total number of inpatients treated in all inpatient facilities from 1.28 million patients in
FY2022 to 1.30 million patients in FY2022, an increase of 1.54%.68
The FY2023 increase 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 growing (see Figure 6 and
Table A-1). In FY2000, 18.4% of the veteran population enrolled in the health care system. In
FY2023, 50% of the veteran population will have enrolled in the health care system.
Figure 6. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2023

Sources: Total “Veteran Population” numbers are from VetPop2018 (FY2018-FY2023), available at
https://www.va.gov/vetdata/docs/Demographics/New_Vetpop_Model/1L_VetPop2018_National.xlsx., and an
archived copy of an earlier version no longer available on the website (FY2000-FY2017). “Enrol ed-VA Veterans”
numbers and “Veteran Patients” numbers were obtained from the VA and/or the VA budget 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).
Notes: FY2023 total veteran population projected as of September 30, 2021. FY2022 and FY2023 veteran
enrol ee and patient data are estimates.
Some portion of the increase in enrollment among living veterans is likely due to maturity of the
modern enrollment system.69 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.70 The services provided

FY2023 Budget Submission, Medical Programs and Information Technology Programs, vol. 2 of 4, March 2022, p.
VHA-39.
68 Department of Veterans Affairs, FY2023 Budget Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-41.
69 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/FR-
1999-10-06/pdf/99-25871.pdf.
70 For information on qualifying for enrollment, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions.
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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 FY2050.71 In addition, VA projects that enrollment will remain relatively constant
through 2030 while the veteran population declines overall.72
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, 2022 (Division J; P.L. 117-103),
provided FY2023 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 $7.46 billion over the advance appropriations amount in
FY2023.73 Most of this increase is due to an adjustment to the projected cost of claims for
community care.74 The FY2023 budget request for VHA totaled $123.57 billion, including
medical care collections.75
As required by the Veterans Health Care Budget Reform and Transparency Act of 2009 (P.L. 111-
81), the President’s FY2023 budget requests $128.1 billion in advance appropriations for the four
medical care appropriations (medical services, medical community care, medical support and
compliance, and medical facilities) for FY2024, an increase of approximately 7.9% over the
FY2023-requested amount of $118.75 billion. In FY2024, the Administration’s budget request
would provide $74.0 billion for the medical services account, $33.0 billion for medical

71 Veteran population numbers are from VetPop2020, available at https://www.va.gov/vetdata/docs/Demographics/
New_Vetpop_Model/1L_VetPop2020_National_NCVAS.xlsx.
72 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, FY2023 Congressional Submission, Medical Programs and Information Technology Programs, vol. 2
of 4, March 2022, pp. VHA-417 to VHA-421.
73 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-13.
74 Ibid., p. VHA-361.
75 The committees on appropriations include medical care cost recovery collections when considering funding for the
VHA. Congress has provided VHA the authority to bill some veterans and most health care insurers for nonservice-
connected 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-
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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community care, $12.3 billion for the medical support and compliance account, and $8.8 billion
for the medical facilities account.
The House-passed version of the MILCON-VA appropriations bill (Division F of H.R. 8294;
H.Rept. 117-391) would have provided a larger VHA appropriation than the President’s request
for FY2023 ($83 million more), while the Senate Appropriations Committee MILCON-VA bill
for FY2023 (S. 4759) recommended the same amount as the President’s request. The House-
passed bill would have included additional funding for existing medical care initiatives, such as
gender-specific care for women and the substance use disorder program.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides a total
VHA appropriation of $123.57 billion including collections; equal to both the President’s
requested amount and the Senate Appropriations Committee (S. 4759) recommended amount (see
Table 1).
The sections below detail the amounts requested for each VHA account for FY2023, including
the funds provided in the House-passed bill, recommended in the Senate Appropriations
Committee bill (S. 4759) for each account, and ultimately included in the enacted FY2023
MILCON-VA Appropriations Act (Division J of P.L. 117-328).
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 FY2023, the President’s budget requested $70.58 billion for the medical services account, a
$261 million increase from the FY2023 advance appropriated amount. The House-passed version
of the MILCON-VA appropriations bill (Division F, Title II, of H.R. 8294), provided $78 million
over the FY2023 President’s request. The Senate Appropriations Committee MILCON-VA bill
recommendation for FY2023 was the same as the President’s request. Both the House-passed bill
and the Senate Appropriations Committee bill provided FY2024 advance appropriations equal to
the President’s request of $74.0 billion.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $70.58
billion for the medical services account, equal to both the President’s requested amount and the
Senate Appropriations Committee amount. It also provides FY2024 advance appropriations equal
to the President’s request of $74.0 billion.
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 that eligible veterans
receive through community health care providers. These programs include the Veterans
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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.76
The President’s budget requested $28.46 billion for the medical community care account, a $4.3
billion increase over the FY2023 advance appropriated amount. The revised request amount is
due to an adjustment to the projected cost of different types of community care claims (e.g.,
ambulatory care).77
The House-passed version of the MILCON-VA appropriations bill (Division F, Title II, of H.R.
8294), provided $5 million less than the President’s request. The Senate Appropriations
Committee MILCON-VA bill for FY2023 (S. 4759) recommended the same amount as the
FY2023 request. Both bills would have provided FY2024 advance appropriation amounts
equivalent to the President’s request.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $28.46
billion for the medical community care account, equal to both the President’s requested amount
and the Senate Appropriations Committee amount. It also provides FY2024 advance
appropriations equal to the President’s request of $33.0 billion.
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, VMAC 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
supply chain management, and financial management.”78 This account also funds 18 Veterans
Integrated Service Network (VISN)79 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.80 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

76 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-366.
77 Ibid., p. VHA-361.
78 Ibid., p. VHA-379.
79 Ibid., p. VHA-380. 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.
80 Ibid., p. VHA-381.
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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 $11.07 billion for the medical support and compliance account,
a $1.4 billion increase over the FY2023 advance appropriated amount.
Both the House-passed version of the MILCON-VA appropriations bill and the Senate
Appropriations Committee bill would have provided the same amount as the President’s request,
and would have provided FY2024 advance appropriation amounts equivalent to the President’s
request.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $11.07
billion for the medical support and compliance account, equal to both the President’s requested
amount, the House-passed MILCON-VA bill and Senate Appropriations Committee
recommended amount. It also provides FY2024 advance appropriations equal to the President’s
request of $12.3 billion.
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 $8.63 billion for the medical facilities account, a $1.5 billion
increase over the FY2023 advance appropriated amount.
Both the House-passed version of the MILCON-VA appropriations bill and the Senate
Appropriations Committee bill would have provided the same amount as the President’s request.
Both bills would have also provided FY2024 advance appropriation amounts equivalent to the
President’s request.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $8.63
billion for the medical facilities account, equal to both the President’s requested amount, the
House-passed MILCON-VA bill and Senate Appropriations Committee amount. It also provides
FY2024 advance appropriations equal to the President’s request of $8.8 billion.
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.
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The President’s budget requested $916 million for the medical and prosthetic research account, an
increase of $34 million, or 3.9%, above the FY2022-enacted amount of $882 million. The VHA’s
major research priorities in FY2022 include, among others, traumatic brain injury (TBI), military
exposures, precision oncology, and implementation of the Commander John Scott Hannon
Veterans Mental Health Care Improvement Act of 2019 (P.L. 116-171).81
The House-passed version of the MILCON-VA appropriations bill would have provided $10
million more than the FY2023 request. The amount recommended by the Senate Appropriations
Committee bill for FY2022 was the same as the request.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $916
million for the medical and prosthetic research account, equal to both the President’s requested
amount and the Senate Appropriations Committee recommended amount.
Nonmedical Discretionary Programs Funding
National Cemetery Administration (NCA)
The majority of NCA’s discretionary funding falls into the Operations and Maintenance category.
VA requested a total of $430 million in FY2023 for this account—a $36 million increase for
NCA’s operations and maintenance expenses over the FY2022-enacted amount. The requested
funding will provide for an estimated 135,079 interments, continued perpetual care of 4.2 million
gravesites, and the operations and maintenance of 158 national cemeteries and 34 additional
sites.82 The request also includes funding to support hiring an additional 64 full-time equivalent
(FTE) employees, bringing the total number of FTEs from 2,217 in FY2022 to 2,281 in
FY2023.83
VA continues to work toward its goal of providing 95% of veterans with access to a cemetery
within 75 miles of their homes. The $140 million major construction request would provide
funding for a replacement cemetery in Albuquerque, NM; a gravesite expansion at Jefferson
Barracks, St. Louis, MO; and Phase 1C at Western New York cemetery. VA requests 157.3 million
in minor construction to assist with additional gravesite expansion and columbaria projects to
continue providing burial space at the national cemeteries.84
Division F of H.R. 8924 would have provided $430 million for NCA expenses in FY2023, the
exact amount that VA requested in its budget submission. The House Appropriations Committee,
in its report, expressed concern that VA is not adequately serving veterans in rural and
geographically isolated areas. The committee also asserted that the criteria for creating a new
national cemetery may not be adequate for certain areas and states where the state cemeteries do
not meet the “national shrine standards.”85 The Senate Appropriations Committee also

81 Ibid., pp. VHA-570 to VHA-571.
82 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, pp. NCA-7, 12.
83 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Budget in Brief, March 2022, p. BiB-40.
84 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, pp. NCA-8.
85 U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, and Related Agencies
Appropriations Bill, 2023, report to accompany H.R. 8294, 117th Cong., 2st sess., June 27, 2022, H.Rept. 117-391, p.
76.
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recommended $430 million for NCA in FY2023. The final FY2023 MILCON-VA Appropriations
Act (Division J of P.L. 117-328) provides $430 million for NCA expenses in FY2023.
VBA, General Operating Expenses
VA requested $3.86 billion in funding for VBA General Operating Expenses for FY2023. This
amount was an estimated $409 million, or 11.8% increase, over the enacted FY2022 budget and
was to support the hiring of 1,189 more FTEs than in 2022. The majority of the new hires were to
be designated to address claims associated with environmental exposures.86 In addition, VA’s two
“strategic and overarching themes” driving the increased budget request are benefits delivery and
service connection for environmental exposure.87
To address these priorities, VA requested $120.5 million to update, automate, and modernize the
compensation and pension claims process to allow employees to focus on decisionmaking
processes such as the adjudication and authorization of benefits. In addition, VA requested $34.7
million to continue expanding the pension automation efforts, which it estimated would decrease
processing times from months to weeks or days.
Division F of H.R. 8294 would have provided $3.86 billion for VBA General Operating Expenses
in FY2023, the exact amount VA requested. The committee asserted that this request will improve
VBA’s ability to address and process benefit claims, hire new claims processors, and continue the
modernization and automation of the claims process. The main concerns expressed by the
committee were toxic exposures, disability claims, data tracking and reporting related to burn
pits, compensation and pension exams, and military sexual assault claims. The committee
directed VA to continue reporting to Congress on its progress in these areas, along with its work
to train, educate, and inform staff processing these claims.88
The Senate Appropriations Committee, in S. 4759, recommended $3.86 billion for VBA general
operating expenses in FY2023, the exact amount VA requested. The final FY2023 MILCON-VA
Appropriations Act (Division J of P.L. 117-328) provides $3.86 billion for necessary VBA
operating expenses in FY2023.
Board of Veterans’ Appeals
The Board of Veterans’ Appeals (BVA) is an agency within VA established in 1933.89 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 FY2023 request for BVA was $285 million, a $57 million increase over the FY2022-enacted
amount. The increased funding takes into consideration overtime payments to address the
projected workload increase resulting from expanding the decisions that are now appealable,

86 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, pp. VBA-51.
87 U.S. Department of Veterans Affairs, FY2022 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, pp. VBA-54.
88 U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, and Related Agencies
Appropriations Bill, 2023, report to accompany H.R. 8294, 117th Cong., 2st sess., June 27, 2022, H.Rept. 117-391, p.
36.
89 38 U.S.C. §§7101-7113.
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including new presumptive service conditions and VHA caregivers ability to appeal.90 The
requested budget would support 250 new full-time equivalent (FTE) staff and an additional 12
Veteran Law Judges.
Division F of H.R. 8294, would have provided $285 million for BVA in FY2023, the same
amount VA requested. In its report, the committee acknowledged the work and number of
hearings (mostly virtual) that BVA held during the COVID-19 pandemic and said that the
recommended funding would allow BVA to increase the number of hearings it can hold.91 The
Senate Appropriations Committee, in S. 4759, also recommended $285 million for BVA FY2023,
and the final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides
$285 million for necessary BVA operating expenses in FY2023.
Information Technology
The information technology (IT) 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 FY2023 request for IT was $5.78 billion, an increase of 939.2 million above the
FY2022-enacted level. The requested amount included $142.1 million for IT development, such
as building new software applications; $4.15 billion for operations and maintenance (O&M); and
$1.49 billion for staffing and administrative support services.92
The House-passed measure, Division F of H.R. 8294, would have provided approximately $5.78
billion. During floor debate, amendments were adopted that would have transferred $1 million
from this account to the medical services account to support VA Suicide Prevention Coordinators,
and transferred another $1 million to the grants for construction of state veterans cemeteries
account to help states and tribal organizations establish, expand, and improve veterans
cemeteries.93 The Senate majority committee FY2023 MILCON-VA appropriations bill (S. 4759
as introduced) recommended $5.78 billion for this account, which was same as the
Administration’s request.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $5.78
billion for the IT systems account (see Table 1). This amount includes $1.49 billion for salaries
and expenses, $4.15 billion for operation and maintenance of existing IT programs, and $142.1
million for IT development.

90 U.S. Department of Veterans Affairs, FY2023 Budget Submission, Benefits and Burial Programs and Departmental
Administration, vol. 3 of 4, March 2022, pp. BVA-262, 264.
91 U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, and Related Agencies
Appropriations Bill, 2023, report to accompany H.R. 8294, 117th Cong., 2st sess., June 27, 2022, H.Rept. 117-391, p.
79.
92 Department of Veterans Affairs, FY2023 Congressional Budget Submission, Medical and Information Technology
Programs, vol. 2 of 4, March 2022, p. IT- 681.
93 See amendments to H.R. 8294 (Transportation, Housing and Urban Development, Agriculture, Rural Development,
Energy and Water Development, Financial Services and General Government, Interior, Environment, Military
Construction, and Veterans Affairs Appropriations Act, 2023), at https://appropriations.house.gov/hr-8294-amendment-
tracker.
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Electronic Health Record Modernization (EHRM)94
On May 17, 2018, VA signed a contract with Cerner Corporation (now Oracle Cerner, after
Oracle Corporation completed the acquisition of Cerner on June 8, 2022) to modernize its
electronic health care record system. This 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. 115-
141), 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). 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 Mann-
Grandstaff VAMC in Spokane, WA, and the West Consolidated Patient Account Center. 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.95 The results of this review were released in
July 2021, and a final update was released in November 2021.96 On December 1, 2021, VA
announced an updated plan to move forward with the EHRM Program, mitigating challenges
documented during the strategic review and implementing lessons learned and feedback from VA
medical providers at initial deployment sites.97 Under the new plan, VA has revised its EHRM
deployment schedule for FY2022, FY2023, and the start of FY2024, and is working to finalize
the remainder of the 10-year deployment timeline. The new plan also includes revised EHRM
governance and management structures.98 Thus far, VA has deployed the new EHR to VA medical
facilities in Spokane, WA; Columbus, OH; Walla Walla, WA; Roseburg, OR; and White City,
OR.99 Several recent congressional hearings have highlighted the ongoing challenges of the new
EHR rollout.100 Generally, these issues can be categorized as (1) patient safety, (2) system

94 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].”
95 Department of Veterans Affairs, “VA announces strategic review of Electronic Health Record Modernization
program,” press release, March 19, 2021, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5647.
96 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.
97 Department of Veterans Affairs, “VA advances Electronic Health Record Modernization program,” press release,
December 1, 2021, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5745.
98 See VA’s Electronic Health Record Comprehensive Lessons Learned update, November 2021, http://www.va.gov/
opa/docs/EHRM-Comprehensive-Lessons-Learned-Progress-Update-FINAL-11-29-21.pdf.
99 EHR Deployment Schedule, at https://www.ehrm.va.gov/deployment-schedule#FY22.
100 U.S. Congress, Senate Committee on Appropriations, Subcommittee on Military Construction and Veterans Affairs,
and Related Agencies, VA’s Electronic Health Record Modernization: An Update on Rollout, Cost, and Schedule, 117th
Cong., 2nd sess., September 21, 2022; U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on
Technology Modernization, Protecting our Veterans: Patient Safety and Electronic Health Record Modernization
Program Subcommittee on Technology Modernization, 117th Cong., 2nd sess., July 27, 2022; U.S. Congress, Senate
Committee on Veterans’ Affairs, Examining the Status of VA’s Electronic Health Record Modernization Program,
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reliability (i.e., system outages and degradations of the of the Oracle Cerner Millennium EHR
platform), (3) adequate training of clinicians and staff, (4) information technology (IT) and other
physical infrastructure readiness, and (5) program governance. On October 13, 2022, VA
announced that it has paused further EHR deployment at all sites until June 2023.101
The Further Consolidated Appropriations Act, 2020 (P.L. 116-94); the Consolidated
Appropriation Act, 2021 (P.L. 116-260); the Consolidated Appropriations Act, 2022 (P.L. 117-
103), and the Consolidated Appropriations Act, 2023 (P.L. 117-328) requires VA to submit
quarterly reports to Senate and House Committees on Appropriations detailing obligations,
expenditures, and EHR deployment strategy by VA medical facility. Additionally, GAO is
required to perform quarterly reviews of the EHR deployment.
The President’s FY2023 appropriation request for the EHRM effort was $1.76 billion, about $541
million less than the FY2022-enacted level. Of this amount $1.12 billion was for EHR
deployment at VAMC and its associated clinics and other ancillary facilities, $441 million was for
infrastructure readiness to cover IT infrastructure costs prior EHR deployment, and $199 million
was for program management for costs associated with staff, contractor support, leases, and
employee training.
The House-passed measure, Division F of H.R. 8294, would have provided $1.76 billion for the
EHRM effort, the same amount as the President’s request. The Senate majority committee
FY2023 MILCON-VA appropriations bill (S. 4759 as introduced) recommended $1.68 billion,
including the administrative rescission.
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $1.61
billion for the EHRM initiative. In the explanatory statement to accompany the act, the
committees stated:
While the Committees remain supportive of the need to modernize VA’s electronic health
record system, there continue to be wide-ranging and alarming implementation issues with
the new system, including serious usability problems that have led to or contributed to
instances of patient harm and reduced employee productivity. The Committees support the
Department’s decision to pause further deployments to address problems with the new
system and improve the operation at existing sites. The Committees are hopeful that the
Department will resolve outstanding issues expeditiously and in a manner that will allow
the Department to resume rollout of the new system safely and efficiently in Summer 2023,
as planned.102
Furthermore, the committees are requiring the VA to submit reports to the Committees on
Appropriations on action taken to:
(1) revise and enhance the EHR training program; (2) independently validate the efficacy
of the super user program and the training for such program; (3) ensure proper medication
management and accurate patient data through such record; (4) demonstrate that patient
record flags that identify veterans who are at high risk for suicide are properly displayed in

117th Cong., 2nd sess., July 20, 2022; U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on
Technology Modernization, Next Steps: Examining Plans for the Continuation of the Department of Veterans Affairs
Electronic Health Record Modernization Program, 117th Cong., 2nd sess., April 26, 2022.
101 Department of Veterans Affairs, “VA extends delay of upcoming electronic health record deployments to June 2023
to address technical and other system performance issues,” press release, October 23, 2022, https://www.va.gov/opa/
pressrel/pressrelease.cfm?id=5833.
102 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.
S9234.
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such record; and (5) implement a policy for regular updates to affected employees about
progress on and estimated completion dates for issues arising from trouble tickets.103
Construction
Construction accounts include major construction, minor construction, and construction and
renovation grants for state-extended care facilities, as well as grants for state veterans cemeteries.
The major construction account provides funds for capital projects costing $20 million or more
that are intended to design, build, alter, extend, or improve a VHA facility. Projects identified
through the Strategic Capital Investment Planning (SCIP) process are submitted for congressional
authorization. Congress reviews, approves, and funds major construction on a project-by-project
basis. Typical major VA construction projects are replacements of hospital buildings, the addition
of large ambulatory care centers, and new hospitals or nursing homes.
The minor construction account provides funds for capital projects costing less than $20 million
that are intended to design, build, alter, extend, or improve a VHA facility. The total cost of a
minor construction project cannot be greater than this statutory threshold. Minor construction
projects are approved by the Office of Capital Asset Management and Support at the VA Central
Office through the SCIP process. The grants to the state-extended care facilities account provides
participating states funding to construct or acquire of state home facilities, including funds to
remodel, modify, or alter existing buildings used for furnishing domiciliary, nursing home, or
hospital care to veterans.104 A grant may not exceed 65% of the total cost of the project. Lastly,
the grants for the construction of veterans cemeteries account provides funding to states,
territories, and federally recognized tribal governments for the establishment, expansion, or
improvement of state and tribal veterans cemeteries.
The President’s FY2023 budget request for construction and construction grants was
approximately $2.27 billion. This amount included $1.45 billion for the major construction
account, $626.1 million for the minor construction account, $150 million for grants for
construction of state-extended care facilities, and $50 million for grants for construction of
veterans cemeteries. In addition, the budget request proposed $804.5 million from the Recurring
Expenses Transformational Fund to supplement the major construction account and $163.5
million from this fund for minor construction projects in FY2023.105
The House-passed measure, Division F of H.R. 8294, provided $2.2 billion for construction and
construction grants. This amount included $1.37 billion for the major construction account,

103 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.
S9234. These issues were discussed at various House and Senate VA Committee hearings and also in VA Office of the
Inspector General (VAOIG) reports. See for example, U.S. Congress, House Committee on Veterans’ Affairs,
Subcommittee on Technology Modernization, Protecting our Veterans: Patient Safety and Electronic Health Record
Modernization Program, 117th Cong., 2nd sess., July 27, 2022.
104 For more details on state veterans homes, see CRS In Focus IF11656, State Veterans Homes.
105 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.
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$626.11 million for the minor construction account, $150 million for grants for construction of
state-extended care facilities, and $51 million for grants for construction of veterans cemeteries.
According to the House Committee report (H.Rept. 117-391), “the Committee supports the
Department’s plan to allocate [$804.5 million] from the Recurring Expenses Transformational
Fund to support Major Construction projects in Portland, OR, Canandaigua, NY, Fort Harrison,
MT, and for other purposes within the account”; furthermore, “[the] Committee supports the
Department’s plan to allocate [$163.5 million] from the Recurring Expenses Transformational
Fund to support Minor Construction projects, which would support the completion of
construction projects at VA facilities nationwide as well as installation of zero-emission vehicle
charging infrastructure on VA campuses.”106
The final FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) provides $2.2
billion for construction and construction grants. This includes $1.45 billion for major construction
account, $626.11 million for the minor construction account, $150 million for grants for
construction of state-extended care facilities, and $50 million for grants for construction of
veterans cemeteries. The final enacted MILCON-VA Appropriations Act does not provide the
requested new authority for VHA to use funds from the major construction account for land
acquisition (see Table 1).
The explanatory statement to accompany the act, supports VA’s plan to allocate $804.5 million of
the Recurring Expenses Transformational Fund balances to fund construction projects in Portland,
OR; Canandaigua, NY; Fort Harrison, MT. Additionally, the agreement supports VA’s plan to
allocate $88.49 million of the Recurring Expenses Transformational Fund balances to fund
facility improvements at existing VA medical facilities.107
Asset and Infrastructure Review
Title II of the VA MISSION Act (P.L. 115-182) included the VA Asset and Infrastructure Review
(AIR) Act of 2018. The AIR Act establishes a process for realigning and modernizing VHA
facilities. Under this process, VA is to develop criteria for selecting VHA facilities to dispose of,
modernize, or acquire, so as to better meet the health care needs of veterans.108 VA must then
create a list of recommendations based on those criteria and submit it to a newly created Asset
and Infrastructure Review Commission (the Commission). This nine-member commission
reviews and evaluates VA’s recommendations but may not alter them, unless it determines that
one or more recommendations are inconsistent with the criteria. The Commission submits the list
of recommendations to the President, who either approves the list in its entirety or sends it back to
the Commission with the reasons for disapproval. The Commission shall take into account the
reasons for disapproval and submit a second report to the President with recommendations for
realignment and modernization of VHA facilities. The President may approve or disapprove the
revised list. If the President approves the original or revised list, then VA must begin

106 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, pp,
84 and 86.
107 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.
S9234-S9235.
108 Department of Veterans Affairs, “Draft Criteria for Section 203 of the MISSION Act,” 86 Federal Register 7921,
February 2, 2021; and final selection criteria published in Department of Veterans Affairs, “Asset and Infrastructure
Review Commission Foreword and Criteria,” 86 Federal Register 28932-28935, May 28, 2021.
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implementation of the recommendations within three years, unless Congress passes a joint
resolution of disapproval, in which case the process terminates.109
As required by the AIR Act, VA conducted its market assessments, which are health care service
delivery plans for 96 Veterans Integrated Services Networks (VISNs) markets, known as the
Market Area Health Systems Optimization (MAHSO) analysis, and publicly released the
department’s recommendations on March 14, 2022.110 Furthermore, as required by the AIR Act,
President Biden submitted nominees to the AIR Commission to the Senate. On June 27, 2022,
Senate Veterans’ Affairs Committee Chairman Jon Tester and several other Senators issued a
statement stating that the AIR Commission process would not move forward. According to the
press release, “Without the Senate’s approval of the nominees, no Commission will be established
and the process as outlined by the VA MISSION Act will not move forward.”111
The Administration’s budget request for FY2023 included a request of $5 million to support the
work of the Commission, including staff, contractual services, and travel costs. During floor
debate of Division F of H.R. 8294, an amendment offered by Representative Jim McGovern was
adopted that eliminated funding for the AIR Commission and transferred the $5 million to the
medical services account to support health care for homeless veterans.112
The Senate majority committee FY2023 MILCON-VA appropriations bill (S. 4759 as introduced)
provided no funding for the AIR Commission. According to the majority explanatory statement:
The Committee provides no funding for the AIR account. While VA providing
recommendations to the AIR Commission was required by statute, bipartisan concerns
were raised related to the inaccuracy, completeness, and poor quality of the data used for
the market analysis, much of which was done prior to shifts in healthcare resulting from
the COVID-19 pandemic. Additional concerns were raised related to the potential
consequences of specific recommendations, such as the creation of additional barriers to
care (e.g., increased travel time), and at this time, the nominated Commissioners are not
expected to be approved by the Senate or seated as part of the Commission. Without
Commissioners to review and act upon recommendations, the AIR account requires no
funding.113
Section 208 of the AIR Act provides the Secretary authority to continue certain activities. This
includes recommendations for future asset reviews, where the Secretary may, after consulting

109 For a section-by-section summary of AIR Act provisions, see CRS Report R45390, VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L.115-182).
110 Department of Veterans Affairs, “Recommendations for Modernization or Realignment of Veterans Health
Administration (VHA) Facilities,” 87 Federal Register 14328-14329, March 14, 2022. The full recommendations are
available at https://www.va.gov/aircommissionreport/. Department of Veterans Affairs, “VA releases Asset and
Infrastructure Review report,” press release, March 14, 2022, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=
5774.
111 Senator Jon Tester, “Tester, Manchin, Rounds, Colleagues Statement on Bipartisan Opposition to the Asset and
Infrastructure Review Commission Process,” press release, June 27, 2022, https://www.tester.senate.gov/?p=
press_release&id=9185 and https://www.veterans.senate.gov/2022/6/tester-manchin-rounds-colleagues-statement-on-
bipartisan-opposition-to-the-asset-and-infrastructure-review-commission-process. Also see House Committee on
Veterans Affairs, “Ranking Members Bost, Moran Statement on Senators’ Refusal to Move Forward with VA Asset
and Infrastructure Review,” press release, June 27, 2022, https://republicans-veterans.house.gov/news/
documentsingle.aspx?DocumentID=6026.
112 See “Transportation, Housing and Urban Development, And Related Agencies Appropriations Act, 2023,”
Congressional Record, daily edition, vol. 168, no. 120 (July 20, 2022), pp. H6895-H6897.
113 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-fiscal-
year-2023-senate-appropriations-bills and https://www.appropriations.senate.gov/download/mcvafy23rpt.
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with veterans service organizations (VSO), include in congressional budget submissions
recommendations for future commissions or other capital asset realignment and management
processes. Similarly, the VA MISSION Act (P.L. 115-182) included a requirement for a
Quadrennial VHA review, which requires VHA to perform a market area assessments regarding
the health care services furnished under the laws administered by the Secretary.114 During a
monthly press conference held on July 20, 2022, Secretary Denis McDonough stated:
The Mission ACT does require us to update the market assessments on which the
recommendations from March were based. So, they require us to do that. That statute
requires us to do that every four years. I don't see any of the provisions in the House or
Senate right now stopping us from doing that and doing that, updating those assessments
is really important. I think one thing everybody agrees on is the assessments that were made
initially are now dated in as much as they're based on a pre-pandemic view of healthcare.
So, we will continue to update those market assessments. We will then use those market
assessments to collaborate with our stakeholders across the board. That includes Congress,
of course, but it also includes Veterans, VSOs, local providers who are in our network for
example, our academic affiliates that Dr. Ramoni talked about. And that will then inform
our internal infrastructure modernization planning, the so-called [Strategic Capital
Investment Planning] SCIP process, the strategic capitalization investment program. So we
will continue that of our own accord, using this requirement to do the quadrennial reviews.
Lastly, I anticipate, given the steps the President has taken to date and his focus on the fact
that our facilities are relatively older by an order of magnitude than the average facility in
the private sector, that the President will continue to ask for the kind- the levels of funding
necessary for us to modernize the system.115
The FY2023 MILCON-VA Appropriations Act (Division J of P.L. 117-328) does not provide any
funding for this account. In the explanatory statement to accompany the act, the committees’
state:
The agreement provides no funding for the Asset and Infrastructure Review account given
the Asset and Infrastructure Review Commission was not seated. As the Department moves
forward with the quadrennial market assessments and Strategic Capital Investment
Planning Process, when recommending future infrastructure changes the Department is
urged to focus on maintaining or improving veterans’ access to medical care nationwide,
including in dense urban or rural areas. In addition, the Department should consider how
any changes could create additional barriers to care (e.g., increased travel time).116

114 38 U.S.C. §7330C.
115 Based on transcript provided to CRS by the Department of Veterans Affairs, July 22, 2022.
116 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.
S9228.

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Table 1. FY2022-FY2023 Appropriations and FY2024 Advance Appropriations
($ in Thousands)
Consolidated
House
Consolidated
Appropriations Act, 2022
(Division F of H.R. 8294;
Senate Majority
Appropriations Act, 2023

(H.R. 2471 / P.L. 117-103)
President’s Request
H.Rept. 117-391)
Committee (S. 4759)
(H.R. 2617/P.L. 117-328)
Program
FY2022
FY2023
FY2023
FY2024
FY2023
FY2024
FY2023
FY2024
FY2023
FY2024
Compensation and
$130,227,650
—
$152,016,542
—
$152,016,542
—
$152,016,542
—
$152,016,542
—
Pensions
Over FY2022-
8,955,364
—
—
—
—
—
—
—
—
—
Enacted Advance
Appropriations
Subtotal
139,183,014
—
152,016,542
—
152,016,542
—
152,016,542
—
152,016,542
—
Compensation and
Pensions
Readjustment
14,946,618
—
8,906,851
—
8,906,851
—
8,906,851
—
8.906,851
—
Benefits
Insurance and
136,950
—
109,865
—
109,865
—
109,865
—
109,865
—
Indemnities
Housing Benefit
2,781,000
—
2,524,000
—
2,524,000
—
2,524,000
—
2,524,000
—
Program Fund Credit
Subsidy
Housing Benefit
229,500
—
282,361
—
282,361
—
282,361
—
282,361
—
Program Fund
Administrative
Expenses
Vocational
3
—
7
—
7
—
7
—
7
—
Rehabilitation Loan
Program
Vocational
429
—
446
—
446
—
446
—
446
—
Rehabilitation Loan
Program
CRS-33

Consolidated
House
Consolidated
Appropriations Act, 2022
(Division F of H.R. 8294;
Senate Majority
Appropriations Act, 2023

(H.R. 2471 / P.L. 117-103)
President’s Request
H.Rept. 117-391)
Committee (S. 4759)
(H.R. 2617/P.L. 117-328)
Program
FY2022
FY2023
FY2023
FY2024
FY2023
FY2024
FY2023
FY2024
FY2023
FY2024
Readjustment
—
8,906,851
—
8,452,500
—
8,452,500
—
8,452,500
—
8,452,500
Benefits
Veterans Insurance
—
109,865
—
121,126
—
121,126
—
121,126
—
121,126
and Indemnities
Subtotal
—
161,033,258
—
155,351,762
—
155,351,762
—
155,351,762
—
155,351,762
Medical Services
—
70,323,116
—
74,004,000
—
74,004,000
—
74,004,000
—
74,004,000
Medical Community
—
24,156,659
—
33,000,000
—
33,000,000
—
33,000,000
—
33,000,000
Care
Medical Support and
—
9,673,409
—
12,300,000
—
12,300,000
—
12,300,000
—
12,300,000
Compliance
Medical facilities
—
7,133,816
—
8,800,000
—
8,800,000
—
8,800,000
—
8,800,000
Subtotal
—
111,287,000
—
128,104,000
—
128,104,000
—
128,104,000
—
128,104,000
Total Advance
—
$272,320,258
—
283,455,762
—
283,455,762
—
283,455,762
—
283,455,762
Appropriations
Source: U.S. Congress, committee print, prepared by House Committee on Appropriations Consolidated Appropriations Act, 2022 (H.R. 2471; P.L. 117-103)
[Legislative Text and Explanatory Statement Book 2 of 2 Divisions G–L,], 117th Cong., 2nd sess., April 2022 (Washington: GPO, 2022), pp. 2209-2221. 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; legislative text of Division F of H.R. 8294; Majority Explanatory Statement, Military Construction, Veterans Affairs, And Related Agencies
Appropriations Bill, 2023 (S. 4759) posted at https://www.appropriations.senate.gov/download/mcvafy23rpt; and 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), pp.
S9275- S9282.

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Department of Veterans Affairs FY2023 Appropriations

Appendix A. Veteran Population, VA Enrollees, and
VA Patients, FY2000-FY2023
Table A-1. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2023

Patients Using VA Health Care During the Year
Total Veteran
VA-Enrolled
Year
Population
Veterans
Veterans
Nonveterans
Total Patients
FY2000
26,745,368
4,936,259
3,462,082
355,191
3,817,273
FY2001
26,092,046
6,073,264
3,890,871
356,333
4,247,204
FY2002
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
19,162,515
9,134,760
6,407,529
990,602
7,398,131
FY2022
18,792,191
9,185,019
6,475,035
827,169
7,308,204
FY2023
18,433,480
9,214,315
6,491,535
855,860
7,347,395
Source: “Total Veteran Population” numbers are from VetPop2018 (FY2018-FY2023), available at
https://www.va.gov/vetdata/docs/Demographics/New_Vetpop_Model/1L_VetPop2018_National.xlsx., and an
archived copy of an earlier version no longer available on the website (FY2000-FY2017). “VA-Enrol ed 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-FY2023; other than the last two fiscal years, 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).
Notes: FY2023 total veteran population projected as of September 30, 2021. FY2022 and FY2023 veteran
enrol ee and patient data are estimates.
Congressional Research Service

39

Department of Veterans Affairs FY2023 Appropriations

Appendix B. VA Appropriations FY1995-FY2022
Table B-1. VA Appropriations FY1995-FY1999
($ in Thousands)
FY1995
FY1996
FY1997
FY1998
FY1999

Enacted
Enacted
Enacted
Enacted
Enacted
Veterans Benefits Administration (VBA)
Compensation and Pensions
$17,626,892
$18,331,561
$18,671,259
$19,932,997
$21,857,058
Supplemental
—
$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
$24,760
$24,890
$38,970
$51,360
$46,450
Indemnities
Education Loan Program
$196
$196
$196
$201
$207
Account
Loan Guaranty Program
$78,035
$75,088
$47,901
—
—
Account
Guaranty & Indemnity
$428,120
$569,348
$263,869
—
—
Program Account
Direct Loan Program
$1,042
$487
$110
—
—
Veterans Housing Benefit
—
—
—
$192,447
$263,587
Program Fund
Veterans Housing Benefit
—
—
—
$160,437
$159,121
Program Fund Administrative
Expenses
Vocational Rehabilitation Loan
$54
$54
$49
$44
$55
Program
Vocational Rehabilitation Loan
$767
$377
$377
$388
$400
Program Administrative
Expenses
Native American Veterans
$218
$205
$205
$515
$515
Housing Loan Program
Administrative Expenses
Subtotal VBA
$19,446,684
$20,447,506
$21,327,936
$22,254,389 $23,502,393
Veterans Health Administration (VHA)
Medical Care
$16,232,756
$16,564,000
$17,013,447
$17,057,396
$17,306,000
Rescission
-$84,762
-$21,250
—
—
-$35,373
Medical Administration and
$69,808
$63,602
$61,207
$59,860
$63,000
Miscellaneous Operating
Expenses (MAMOE)
Rescission
-$44
-$86
—
—
-$67
Health Professional
$10,386
—
—
—
—
Scholarships
Medical and Prosthetic
$252,000
$257,000
$262,000
$272,000
$316,000
Research
Congressional Research Service

40

Department of Veterans Affairs FY2023 Appropriations

FY1995
FY1996
FY1997
FY1998
FY1999

Enacted
Enacted
Enacted
Enacted
Enacted
Rescission
-$574
-$322
—
—
-$348
Medical Care Col ections Fund
—
—
—
$666,579
$587,000
(MCCF)
Subtotal VHA
$16,479,570
$16,862,944
$17,336,654
$18,055,835 $18,236,212
National Cemetery
$72,663
$72,604
$76,864
$84,183
$92,006
Administration (NCA)
Rescission
-$128
-$97
—
—
-$122
Subtotal NCA
$72,535
$72,507
$76,864
$84,183
$91,884
Departmental Administration
General Operating Expenses
$890,600
$848,143
$827,584
$786,135
$855,661
Rescission
-$879
-$1,127
—
—
-$1,558
Office of Inspector General
$31,819
$30,900
$30,900
$31,013
$36,000
Rescission
-$32
-$42
—
—
-$43
Construction, Major Projects
$355,612
$136,155
$250,858
$175,000
$142,300
Rescission
-$32,337
-$186
-$32,100
—
-$13
Construction, Minor Projects
$153,540
$190,000
$175,000
$177,900
$175,000
Rescission
-$634
-$260
—
—
-$16
Supplemental
—
—
—
$32,100
—
Parking Fund
$16,300
—
$12,300
—
—
Rescission
—
—
—
—
-$23
Grants to Republic of the
$500
—
—
—
—
Philippines
Grants for State Extended
$47,397
$47,397
$47,397
$80,000
$90,000
Care Facilities
Grants for State Veterans
$5,378
$1,000
$1,000
$10,000
$10,000
Cemeteries
Subtotal Departmental
$1,467,264
$1,251,980
$1,312,939
$1,292,148
$1,307,308
Administration
Total Department of
$37,466,053
$38,634,937
$40,054,393
$41,686,555 $43,137,797
Veterans Affairs with
MCCF
Total Department of
$37,466,053
$38,634,937
$40,054,393
$41,019,976 $42,550,797
Veterans Affairs without
MCCF
Total Mandatory
$19,445,449
$20,446,674
$21,327,109
$22,092,804 $23,342,095
Total Discretionary with
$18,020,604
$18,188,263
$18,727,284
$19,593,751 $19,795,702
MCCF
Total Discretionary
$18,020,604
$18,188,263
$18,727,284
$18,927,172 $19,208,702
without MCCF
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Affairs, Office of Management, Office of Budget.
Congressional Research Service

41

Department of Veterans Affairs FY2023 Appropriations

Table B-2. VA Appropriations FY2000-FY2004
($ in Thousands)
FY2000
FY2001
FY2002
FY2003
FY2004

Enacted
Enacted
Enacted
Enacted
Enacted
Veterans Benefits Administration (VBA)
Compensation and Pensions
$21,568,364
$22,766,276
$24,944,288
$28,949,000
$29,845,127
Supplemental
—
$589,413
$1,100,000
—
—
Readjustment Benefits
$1,469,000
$1,634,000
$2,135,000
$2,264,808
$2,529,734
Supplemental
—
$347,000
—
—
—
Veterans Insurance and
$28,670
$19,850
$26,200
$27,530
$29,017
Indemnities
Education Loan Program
$215
$221
$65
$71
$71
Account
Guaranteed Transitional
$48,250
—
—
—
—
Housing for Homeless
Veterans
Veterans Housing Benefit
$282,342
$165,740
$203,278
$437,522
$305,834
Program Fund
Veterans Housing Benefit
$156,958
$162,000
$164,497
$168,207
$154,850
Program Fund Administrative
Expenses
Rescission
—
-$356
-$123
-$1,093
-$914
Vocational Rehabilitation
$57
$52
$72
$54
$52
Loan Program
Vocational Rehabilitation
$415
$432
$274
$289
$300
Loan Program Administrative
Expenses
Rescission
—
-$1
—
-$2
-$2
Native American Veterans
$520
$532
$544
$558
$571
Housing Loan Program
Administrative Expenses
Rescission
—
-$1
—
-$4
-$3
Subtotal VBA
$23,554,791
$25,685,156
$28,574,095
$31,846,939
$32,864,636
Veterans Health Administration (VHA)
Medical Care
$19,006,000
$20,281,587
$21,331,164
$23,889,304
—
Supplemental
—
—
$142,000
—
—
Rescission
-$79,519
-$46,234
-$16,084
—
—
Medical Administration and
$59,703
$62,000
$66,731
$74,716
—
Miscellaneous Operating
Expenses (MAMOE)
Rescission
—
-$136
-$50
-$486
—
Medical Services
—
—
—
—
$17,867,220
Rescission
—
—
—
—
-$103,823
Congressional Research Service

42

Department of Veterans Affairs FY2023 Appropriations

FY2000
FY2001
FY2002
FY2003
FY2004

Enacted
Enacted
Enacted
Enacted
Enacted
Medical Administration
—
—
—
—
$5,000,000
Rescission
—
—
—
—
-$29,500
Medical Facilities
—
—
—
—
$4,000,000
Rescission
—
—
—
—
-$23,600
Medical and Prosthetic
$321,000
$351,000
$371,000
$400,000
$408,000
Research
Rescission
—
-$772
-$278
-$2,600
-$2,407
Medical Care Col ections
$563,755
$767,687
$1,133,214
$1,474,716
$1,708,026
Fund (MCCF)
Subtotal VHA
$19,870,939
$21,415,132
$23,027,697
$25,835,650
$28,823,916
National Cemetery
$97,256
$109,889
$121,169
$133,149
$144,203
Administration (NCA)
Rescission
—
-$241
-$91
-$865
—
Supplemental
—
$217
—
—
-$851
Subtotal NCA
$97,256
$109,865
$121,078
$132,284
$143,352
Departmental Administration
General Operating Expenses
$912,594
$1,050,000
$1,195,728
$1,254,000
$1,283,272
Rescission
—
-$2,382
-$900
-$8,151
-$7,571
Supplemental
—
—
$2,000
$100,000
—
Office of Inspector General
$43,200
$46,464
$52,308
$58,000
$62,000
Rescission
—
-$102
-$39
-$377
-$366
Construction, Major Projects
$65,140
$66,040
$183,180
$99,777
$273,190
Rescission
—
-$145
—
-$649
-$1,612
Construction, Minor Projects
$160,000
$162,000
$210,900
$226,000
$252,144
Rescission
—
-$366
—
-$1,469
-$1,488
Supplemental
—
$8,840
—
—
—
Parking Fund
—
—
$4,000
—
—
Rescission
—
-$14
—
—
—
Grants for State Extended
$90,000
$100,000
$100,000
$100,000
$102,100
Care Facilities
Rescission
—
-$220
$25,000
-$650
-$602
Grants for State Veterans
$25,000
$25,000
—
$32,000
$32,000
Cemeteries
Rescission
—
-$55
—
-$208
-$189
Subtotal Departmental
$1,295,934
$1,455,060
$1,772,177
$1,858,273
$1,992,878
Administration
Total Department of
$44,818,920
$48,665,214
$53,495,047
$59,673,147
$63,824,783
Veterans Affairs with
MCCF
Congressional Research Service

43

Department of Veterans Affairs FY2023 Appropriations

FY2000
FY2001
FY2002
FY2003
FY2004

Enacted
Enacted
Enacted
Enacted
Enacted
Total Department of
$44,255,165
$47,897,527
52,361,833
$58,198,431
$62,116,757
Veterans Affairs without
MCCF
Total Mandatory
$23,348,376
$25,522,279
$28,408,766
$31,678,860
$32,709,712
Total Discretionary with
$21,470,544
$23,142,935
$25,086,281
$27,994,287
$31,115,071
MCCF
Total Discretionary
$20,906,789
$22,375,248
$23,953,067
$26,519,571
$29,407,045
without MCCF
Source: Source: Table prepared by the Congressional Research Service based on data from the Department of
Veterans Affairs, Office of Management, Office of Budget.
Table B-3. VA Appropriations FY2005-FY2009
($ in Thousands)
FY2005
FY2006
FY2007
FY2008
FY2009

Enacted
Enacted
Enacted
Enacted
Enacted
Veterans Benefits Administration (VBA)
Compensation and Pensions
$32,607,688
$33,897,787
$38,172,360
$41,236,322
$43,111,681
Supplemental
—
—
—
—
$700,000
Readjustment Benefits
$2,556,232
$3,309,234
$3,262,006
$3,300,289
$3,832,944
Veterans Insurance and
$44,380
$45,907
$49,850
$41,250
$42,300
Indemnities
Veterans Housing Benefit
$43,784
$64,586
$66,234
$17,389
$2,000
Program Fund
Credit Subsidy
—
—
—
-$108,000
—
Veterans Housing Benefit
$154,075
$153,575
$154,284
$154,562
$157,210
Program Fund Administrative
Expenses
Rescission
-$1,233
—
—
—
—
Vocational Rehabilitation
$47
$53
$53
$71
$61
Loan Program
Vocational Rehabilitation
$311
$305
$306
$311
$320
Loan Program Administrative
Expenses
Rescission
-$2.865
—
—
—
—
Native American Veterans
$571
$580
$584
$628
$646
Housing Loan Program
Administrative Expenses
Rescission
-$4.569
—
—
—
—
Subtotal VBA
$35,405,848
$37,472,027
$41,705,677
$44,642,822
$47,847,162
Medical Services
$19,472,777
$21,322,141
$25,518,254
$29,104,220
$30,969,903
Budget Supplemental
$1,500,000
$1,225,000
$466,800
—
—
Hurricane Supplemental
$38,783
$198,265
—
—
—
Congressional Research Service

44

Department of Veterans Affairs FY2023 Appropriations

FY2005
FY2006
FY2007
FY2008
FY2009

Enacted
Enacted
Enacted
Enacted
Enacted
Pandemic Influenza
—
$27,000
—
—
—
Supplemental
Rescission
-$155,782
—
—
—
—
Total Medical Services
$20,855,778
$22,772,406
$25,985,054
$29,104,220
$30,969,903
Medical Administration
$4,705,000
$2,858,442
$3,177,968
$3,517,000
$4,450,000
Supplemental
$1,940
—
$250,000
—
—
Rescission
-$37,640
—
—
—
—
Medical Facilities
$3,745,000
$3,297,669
$3,569,533
$4,100,000
$5,029,000
Supplemental
$46,909
—-
$595,000
—
$1,000,000
Rescission
-$29,960
—
—
—
—
Medical and Prosthetic
$405,593
$412,000
$413,980
$480,000
$510,000
Research
Supplemental
—
—
$32,500
—
—
Rescission
-$3,245
—
—
—
—
Medical Care Col ections
$1,953,020
$2,170,000
$2,198,154
$2,414,000
$2,544,000
Fund (MCCF)
Subtotal VHA
$31,642,395
$31,510,517
$36,222,190
$39,615,220
$44,502,903
National Cemetery
$148,925
$156,447
$160,747
$195,000
$230,000
Administration (NCA)
Rescission
-$1,191
—
—
—
$50,000
Supplemental
$50
$200
—
—

Subtotal NCA
$147,784
$156,647
$160,747
$195,000
$280,000
General Operating Expenses
$1,324,753
$1,410,520
$1,481,472
$1,605,000
$1,801,867
Rescission
-$10,598
—
—
—
—
Supplemental
$545
$24,871
$83,200
$100,000
$157,100
Filipino Veterans Equity
—
—
—
—
$198,000
Compensation Fund
Office of Inspector General
$69,711
$70,174
$70,641
$80,500
$87,818
Rescission
-$558
—
—
—
$1,000
Information Technology
—
$1,213,820
$1,213,820
$1,966,465
$2,489,391
Supplemental
—
—
$35,100
$20,000
$50,100
Construction, Major Projects
$458,800
$607,100
$399,000
$1,069,100
$923,382
Rescission
-$3,670
—
—
—
—
Supplemental
—
$953,419
—
$396,377
—
Construction, Minor Projects
$230,779
$198,937
$198,937
$630,535
$741,534
Rescission
-$1,846
—
—
—
—
Supplemental
$36,343
$1,800
$326,000
—
—
Grants for State Extended
$105,163
$85,000
$85,000
$165,000
$175,000
Care Facilities
Rescission
-$841
—
—
—
$150,000
Congressional Research Service

45

Department of Veterans Affairs FY2023 Appropriations

FY2005
FY2006
FY2007
FY2008
FY2009

Enacted
Enacted
Enacted
Enacted
Enacted
Grants for State Veterans
$32,000
$32,000
$32,000
$39,500
$42,000
Cemeteries
Rescission
-$256
—
—
—
—
Subtotal Departmental
$2,240,324
$4,597,641
$3,925,171
$6,072,477
$6,817,192
Administration
Total Department of
$69,436,351
$73,736,832
$82,013,784
$90,525,519
$99,670,165
Veterans Affairs with
MCCF
Total Department of
$67,483,331
$71,566,832
$79,815,630
$88,111,519
$96,903,257
Veterans Affairs without
MCCF
Total Mandatory
$35,252,084
$37,317,514
$41,550,450
$44,487,250
$46,988,925
Total Discretionary with
$34,184,267
$36,419,318
$40,463,334
$46,038,269
$51,981,240
MCCF
Total Discretionary
$32,231,247
$34,249,318
$38,265,180
$43,624,269
$49,214,332
without MCCF
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Affairs, Office of Management, Office of Budget.
Table B-4. VA Appropriations FY2010-FY2014
($ in Thousands)
FY2010
FY2011
FY2012
FY2013
FY2014
Enacted
Enacted
Enacted
Enacted
Enacted

Veterans Benefits Administration (VBA)
Compensation and Pensions
$47,396,106
$53,978,000
$51,237,567
$60,599,855
$71,476,104
Readjustment Benefits
$9,232,369
$10,396,245
$12,108,488
$12,023,458
$13,135,898
Veterans Insurance and
$49,288
$77,589
$100,252
$104,600
$77,567
Indemnities
Veterans Housing Benefit
$23,553
$19,078
$318,612
$184,859
—
Program Fund
Veterans Housing Benefit
—
$165,082
$154,698
$157,605
$158,430
Program Fund Administrative
Expenses
Rescission
$165,082
-$330
—
—
—
Vocational Rehabilitation Loan
—
$29
$19
$19
$5
Program
Rescission
$29
-$1
—
—
—
Vocational Rehabilitation Loan
$328
$337
$343
$346
$354
Program Administrative
Expenses
Rescission
—
-$10
—
—
—
Native American Veterans
$664
$707
$1,116
$1,087
$1,109
Housing Program
Administrative Expenses
Congressional Research Service

46

Department of Veterans Affairs FY2023 Appropriations

FY2010
FY2011
FY2012
FY2013
FY2014
Enacted
Enacted
Enacted
Enacted
Enacted

Rescission
—
-$44
—
—
—
Subtotal VBA
$56,867,419
$64,636,683
$63,921,095
$73,071,830
$86,886,074
Veterans Health Administration (VHA)
Medical Services
$34,707,500
$37,136,000
$39,649,985
$41,509,000
$43,557,000
Budget Supplemental
—
—
—
— $40,000
Hurricane Supplemental
—
—
—
$21,000
—
Rescission
—
-$74,272
—
-$14,937
-$179,000
Total Medical Services
$34,707,500
$37,061,728
$39,649,985
$41,515,063
$43,418,000
Medical Administration
$4,930,000
$5,307,000
$5,535,000
$5,746,000
$6,033,000
Rescission
—
-$44,546
—
-$2,039
-$50,000
Medical Facilities
$4,859,000
$5,740,000
$5,426,000
$5,441,000
$4,872,000
Supplemental
—
—
—
$6,000
$85,000
Rescission
—
-$26,450
—
-$1,991
—
Medical and Prosthetic
$581,000
$590,000
$581,000
$581,905
$585,664
Research
Rescission
—
-$10,162
—
—
—
Medical Care Col ections Fund
$2,847,565
$2,775,214
$2,830,302
$2,903,092
—
(MCCF)
Subtotal VHA
$47,925,065
$51,392,784
$54,022,287
$56,189,031
$58,031,656
National Cemetery
$250,000
$250,000
$250,934
$258,284
$250,000
Administration (NCA)
Rescission
—
-$500
—
-$341
-$1,000
Supplemental
—
—
—
$2,100
—
Subtotal NCA
$250,000
$249,500
$250,934
$260,043
$249,000
Departmental Administration
VBA—General Operating
—
$2,622,110
$2,018,764
$2,164,074
$2,465,490
Expenses
Rescission
$250,000
-$87,834
—
-$2,856
—
General Administration
—
—
$416,737
$424,737
$415,885
Rescission
—
—
—
-$561
-$2,000
Office of Inspector General
$109,000
$109,367
$112,391
$114,848
121,411
Rescission
—
-$585
—
—
—
Information Technology
$3,307,000
$3,307,000
$3,111,376
$3,323,053
$3,703,344
Rescission
—

—
Supplemental
$1,194,000
-$166,396
—
—
—
Construction, Major Projects
—
$1,151,036
$589,604
$531,767
$342,130
Rescission
—
-$2,302
—
—
—
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47

Department of Veterans Affairs FY2023 Appropriations

FY2010
FY2011
FY2012
FY2013
FY2014
Enacted
Enacted
Enacted
Enacted
Enacted

Construction, Minor Projects
$703,000
$467,700
$482,386
$606,728
$714,870
Rescission
—
-$935
—
—
—
Supplemental
—

511,200
Grants for State Extended
$100,000
$85,000
$85,000
$84,888
$85,000
Care Facilities
Rescission
—
-$170
—
—
—
Grants for State Veterans
$46,000
$46,000
$46,000
$45,939
$46,000
Cemeteries
Rescission
—
-$92
—
—
—
Subtotal Departmental
$7,539,607
$7,529,899
$6,862,258
$6,871,298
$8,403,330
Administration
Total Department of
$112,582,091 $123,733,866 $125,056,574 $137,020,522 $168,570,058
Veterans Affairs with
MCCF
Total Department of
$109,734,526 $120,958,652 $122,226,272 $134,117,429 $165,482,068
Veterans Affairs without
MCCF
Total Mandatory
$56,701,316
$64,470,912
$63,764,919
$72,912,772 $101,726,176
Total Discretionary with
$55,880,775
$59,262,954
$61,291,655
$64,107,750
$66,843,882
MCCF
Total Discretionary
$53,033,210
$56,487,740
$58,461,353
$61,204,657
$63,755,892
without MCCF
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Affairs, Office of Management, Office of Budget.
Table B-5. VA Appropriations FY2016-FY2020
($ in Thousands)
FY2015
FY2016
FY2017
FY2018
FY2019
Enacted
Enacted
Enacted
Enacted
Enacted

Veterans Benefits Administration (VBA)
Compensation and Pensions
$79,071,000
$76,865,545
$86,083,128
$90,119,449
$95,768,462
Budget Supplemental
—
—
—
—
$2,994,366
Readjustment Benefits
$14,997,136
$14,313,357
$16,340,828
$13,708,648
$11,832,175
Veterans Insurance and
$63,257
$77,160
$108,525
$120,338
$109,090
Indemnities
Budget Supplemental
—
—
—
—
—
Veterans Housing Benefit
—
$509,008
—
—
—
Program Fund
Veterans Housing Benefit
$160,881
$164,558
$198,856
$178,626
$200,612
Program Fund
Administrative Expenses
Rescission
—
—
—
—
—
Congressional Research Service

48

Department of Veterans Affairs FY2023 Appropriations

FY2015
FY2016
FY2017
FY2018
FY2019
Enacted
Enacted
Enacted
Enacted
Enacted

Vocational Rehabilitation
$10
$31
$36
$30
$39
Loan Program
Rescission
—
—
—
—
—
Vocational Rehabilitation
$361
$367
$389
$395
$396
Loan Program
Administrative Expenses
Rescission
—
—
—
—
—
Native American Veterans
$1,130
$1,114
$1,163
$1,163
$1,163
Housing Program
Administrative Expenses
Rescission
—
—
—
—
—
Subtotal VBA
$94,753,582
$91,931,140
$102,732,905
$104,128,649
$110,906,303
Veterans Health Administration (VHA)
Medical Services
$45,015,527
$47,603,202
$51,673,000
$44,886,554
$49,161,165
Budget Supplemental
209,189
$2,369,158
1,078,993
$1,962,984
$750,000
Hurricane Supplemental
—
—
—
$11,075
—
P.L. 115-31, (Opioid
—
—
$50,000
—
—
Supplemental)
Families First
—
—
—
—
—
Coronavirus Response
Act (P.L. 116-127)
CARES Act (P.L. 116-
—
—
—
—
—
136)
Rescission
-28,829.839
—
-$7,380,181
-$751,000
—
Total Medical Services
$45,195,886.1
$49,972,360
$45,421,812
$46,109,613
$49,911,165
61
Medical Community Care
—
—
—
$9,409,118
$8,384,704
Budget Supplemental
—
—
7,246,181
$419,176
$1,000,000
Families First
—
—
—
—
—
Coronavirus Response
Act (P.L. 116-127)
CARES Act (P.L. 116-
—
—
—
—
—
136)
Total Medical Community
—
—
$7,246,181
$9,828,294
$9,384,704
Care
Medical Administration
$5,879,700
$6,144,000
$6,524,000
$6,654,480
$7,239,156
Budget Supplemental
—
—
—
$100,000
—
Hurricane
—
—
—
$3,209
—
Supplemental
Rescission
-5,609.461
—
-$26,000
—
-$211,000
CARES Act (P.L. 116-
—
—
—
—
—
136)
Congressional Research Service

49

Department of Veterans Affairs FY2023 Appropriations

FY2015
FY2016
FY2017
FY2018
FY2019
Enacted
Enacted
Enacted
Enacted
Enacted

Total Medical
—
$6,144,000
$6,498,000
$6,757,689
$7,028,156
Administration
Medical Facilities
$4,739,000
$4,915,000
$5,074,000
$5,434,880
$5,914,288
Supplemental
—
$105,312
$247,668
$1,707,000
$890,180
Hurricane
—
—
—
$75,108
$3,000
Supplemental
Rescission
-1,999.835
—
-$9,000
—
—
CARES Act (P.L. 116-
—
—
—
—
—
136)
Total Medical Facilities
—
$5,020,312
$5,312,668
$7,216,988
$6,807,468
Medical and Prosthetic
$588,922
$630,735
$675,366
$722,262
$779,000
Research
Rescission
-409.359
—
-$2,000
—
—
Total Medical and
—
$630,735
$673,366
$722,262
$779,000
Prosthetic Research
Medical Care Col ections
—
$3,503,146
$3,561,642
$3,515,635
$3,915,045
Fund (MCCF)
Subtotal VHA
$59,619,422
$62,270,373
$68,713,669
$74,150,481
$77,825,538
Veterans Choice Act
—
—
$2,100,000
$7,300,000
—
Mandatory Funds
National Cemetery
$256,800
$271,220
$286,193
$306,193
$315,836
Administration (NCA)
Rescission
-169.500
—
—
—
—
Supplemental
—
—
—
—
—
Subtotal NCA
$256,631
$271,220
$286,193
$306,193
$315,836
Departmental Administration
VBA—General Operating
$2,534,254
$2,707,734
$2,856,160
$2,910,000
$2,956,316
Expenses
Rescission
-2,355.482
—
-$12,000
—
—
General Administration
$321,591
$336,659
$345,391
$335,891
$355,897
Rescission
-446.436
—
—
—
—
Board of Veterans Appeals
—
$109,884
$156,096
$161,048
$174,748
Rescission
—
—
-$500
—
—
Office of Inspector General
$126,411
$136,766
$160,106
$164,000
$192,000
Rescission
—
—
-$500
—
—
Information Technology
$3,903,344
$4,133,363
$4,278,259
$4,055,500
$4,103,000
Rescission
-1,066
—
-$8,000
—
—
CARES Act (P.L. 116-
—
—
—
—
—
136)
Electronic Health Records
—
—
—
$782,000
$1,107,000
Modernization (EHRM)
Congressional Research Service

50

Department of Veterans Affairs FY2023 Appropriations

FY2015
FY2016
FY2017
FY2018
FY2019
Enacted
Enacted
Enacted
Enacted
Enacted

Construction, Major
$561,800
$1,243,800
$325,812
$1,442,750
$2,503,786
Projects
Rescission

—
-$20,322
-$420,000

Construction, Minor
$495,200
$406,200
$372,069
$767,570
$799,514
Projects
Supplemental

—
—
$4,088
—
Grants for State Extended
$90,000
$120,000
$90,000
$685,000
$150,000
Care Facilities
Grants for State Veterans
$46,000
$46,000
$45,000
$45,000
$45,000
Cemeteries
Subtotal Departmental
$8,173,912
$9,240,406
$8,587,571
$10,932,847
$12,387,261
Administration
Total Department of
$162,803,546
$166,713,139
$182,420,358
$196,818,170
$201,434,938
Veterans Affairs with
MCCF
Total Department of
$159,579,614
$163,209,993
$178,858,716
$193,302,535
$197,519,893
Veterans Affairs without
MCCF
Total Mandatory
$94,591,200
$91,765,070
$104,632,481
$111,248,435
$110,704,093
Total Discretionary with
$68,212,346
$74,948,069
$77,787,876
$85,569,735
$90,730,845
MCCF
Total Discretionary
$64,988,414
$71,444,923
$74,226,235
$82,054,100
$86,815,800
without MCCF
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Affairs, Office of Management, Office of Budget.
Table B-6. VA Appropriations FY2020-FY2024
($ in Thousands)
FY2020
FY2021
FY2022
FY2023
FY2024
Enacted
Enacted
Enacted
Enacted
Enacted

Veterans Benefits

Administration (VBA)
Compensation and Pensions
$109,017,152
$118,246,975
$130,227,650
—
—
Budget Supplemental
$1,439,931
$6,110,252
$8,955,364
—
—
Readjustment Benefits
$14,065,282
$12,578,965
$14,946,618
—
—
ARPA (P.L. 117-2)
—
$386,000
—
—
—
Veterans Insurance and
$111,340
$129,224
$136,950
—
—
Indemnities
Budget Supplemental
$17,620
$2,148
—
—
—
Veterans Housing Benefit
—
—
—
—
—
Program Fund
Veterans Housing Benefit
200,377
$204,400
$229,500
—
—
Program Fund
Administrative Expenses
Congressional Research Service

51

Department of Veterans Affairs FY2023 Appropriations

FY2020
FY2021
FY2022
FY2023
FY2024
Enacted
Enacted
Enacted
Enacted
Enacted

Vocational Rehabilitation
$58
$34
$3
—
—
Loan Program
Vocational Rehabilitation
$402
$424
$429
—
—
Loan Program
Administrative Expenses
Native American Veterans
$1,186
$1,186
$1,400
—
—
Housing Program
Administrative Expenses
Subtotal VBA
$138,918,630
$150,238,573
$154,497,914
—
—
Medical Services
$51,411,165
$56,158,015
$58,897,219
—
—
Budget Supplemental
—
$497,468
—
—
—
Hurricane Supplemental
—
—
—
—
—
P.L. 115-31, (Opioid
—
—
—
—
—
Supplemental)
Families First
$30,000
—
—
—
—
Coronavirus Response
Act (P.L. 116-127)
CARES Act (P.L. 116-
$14,432,000
—
—
—
—
136)
ARPA (P.L. 117-2)
—
$627,900
—
—
—
Rescission
-$350,000
-$100,000
-200,000
—
—
Total Medical Services
$65,523,165
$57,183,383
$58,697,219

Medical Community Care
$10,758,399
$17,131,179
$20,148,244
—
—
Budget Supplemental
$3,906,400
$1,380,800
$3,269,000

Families First
$30,000
—
—
—
—
Coronavirus Response
Act (P.L. 116-127)
CARES Act (P.L. 116-
$2,100,000
—

136)
ARPA (P.L. 117-2)
—
$322,100
—
—
—
Recession

-200,000

Total Medical Community
$16,794,799
$18,834,079
$23,217,244
—
—
Care
Medical Administration
$7,239,156
$7,914,191
$8,403,117
—
—
Budget Supplemental
$98,800
$300,000
—
—
—
CARES Act (P.L. 116-
$100,000
—
—
—
—
136)
Rescission
-$10,000
-$15,000
—
—
—
Total Medical
$7,427,956
$8,199,191
$8,403,117
—
—
Administration
Medical Facilities
$6,141,880
$6,433,265
$6,734,680
—
—
Congressional Research Service

52

Department of Veterans Affairs FY2023 Appropriations

FY2020
FY2021
FY2022
FY2023
FY2024
Enacted
Enacted
Enacted
Enacted
Enacted

Budget Supplemental
—
$150,000
$150,000
—
—
CARES Act (P.L. 116-
$606,000
—
—
—
—
136)
Total Medical Facilities
$6,747,880
$6,583,265
$6,734.680
—
—
Medical and Prosthetic
$3,429,116
$815,000
$882,000
—
—
Research
Rescission
-$50,000
-$20,000
—
—
—
Total Medical and
$750,000
$795,000
$882,000
—
—
Prosthetic Research
Medical Care Col ections
$3,429,116
$2,965,445
$3,920,671
—
—
Fund (MCCF)
ARPA (P.L. 117-2)
—
$300,000
—
—
—
ARPA (P.L. 117-2)
—
$14,482,000
—
—
—
ARPA (P.L. 117-2)
—
$80,000
—
—
—
Subtotal VHA
$100,672,916
$109,422,363
$102,004,931
—
—
National Cemetery
$329,000
$352,000
$394,000
—
—
Administration (NCA)
Rescission
-$1,000
—
—
—
—
Subtotal NCA
$328,000
$352,000
$394,000
—
—
VBA—General Operating
$3,125,000
$3,180,000
$3,453,813
—
—
Expenses
Rescission
-$258
-$16,000
—
—
—
CARES Act (P.L. 116-
13,000
—
—
—
—
136)
ARPA (P.L. 117-2)
—
$262,000
—
—
—
General Administration
$355,911
$365,911
$401,200
—
—
Rescission
$6,000
-$12,000
—
—
—
CARES Act (P.L. 116-
$182,000
—
—
—
—
136)
Board of Veterans Appeals
$182,000
$196,000
$228,000
—
—
Rescission
-$8,000
—
—
—
—
ARPA (P.L. 117-2)
—
$10,000
—
—
—
Office of Inspector General
$210,000
$228,000
$239,000
—
—
CARES Act (P.L. 116-
$12,500
—
—
—
—
136)
ARPA (P.L. 117-2)
—
$10,000
—
—
—
Information Technology
$4,371,615
$4,912,000
$4,842,800
—
—
Transformational Funds

$670,000

Rescission
—
-$37,500
-$76,105
—
—
Congressional Research Service

53

Department of Veterans Affairs FY2023 Appropriations

FY2020
FY2021
FY2022
FY2023
FY2024
Enacted
Enacted
Enacted
Enacted
Enacted

CARES Act (P.L. 116-
$2,150,000
—
—
—
—
136)
ARPA (P.L. 117-2)
—
$100,000
—
—
—
Electronic Health Records
$1,500,000
$2,627,000
$2,500,000
—
—
Modernization (EHRM)
Rescission
-70,000
-$20,000
-200,000
—
—
Construction, Major
$1,270,200
$1,316,000
$1,611,000
—
—
Projects
Construction, Minor
$398,800
$390,000
$553,000
—
—
Projects
Rescission
—
-$35,700
—
—
—
Grants for State Extended
$90,000
$90,000
$50,000
—
—
Care Facilities
CARES Act (P.L. 116-
$150,000
—
—
—
—
136)
ARPA (P.L. 117-2)
—
$500,000
—
—
—
Grants for State Veterans
$45,000
$45,000
$48,500
—
—
Cemeteries
Subtotal Departmental
$13,801,768
$14,110,711
$14,326,208
—
—
Administration
Total Department of
$239,656,032
$261,544,682
$270,403,053
—
—
Veterans Affairs with
MCCF
Total Department of
$236,226,916
$258,579,237
$266,482,382
—
—
Veterans Affairs without
MCCF
Total Mandatory
$124,651,325
$154,147,564
$157,047,582
—
—
Total Discretionary with
$115,004,707
$107,397,118
$116,136,471
—
—
MCCF
Total Discretionary
$111,575,591
$104,431,673
$112,215,800
—
—
without MCCF
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Affairs, Office of Management, Office of Budget.

Congressional Research Service

54

Department of Veterans Affairs FY2023 Appropriations

Author Information

Sidath Viranga Panangala
Jared S. Sussman
Specialist in Veterans Policy
Analyst in Health Policy

Acknowledgments
Heather M. Salazar, a former Analyst in Veterans Policy, contributed to this report, and John H. Gorman,
CRS Research Assistant in the Domestic Social Policy Division, provided invaluable assistance with this
report.

Disclaimer
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