The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans and eligible dependents who meet certain criteria as authorized by law. These benefits include medical care, disability compensation and pensions, education, vocational rehabilitation and employment services, assistance to homeless veterans, home loan guarantees, administration of life insurance and traumatic injury protection insurance for service members, and death benefits that cover burial expenses. Chapter 1 focuses on FY2018 appropriations and FY2019 advance appropriations for the Department of Veterans Affairs (VA). VA is one of the Federal government’s largest property holding entities with a capital asset portfolio that includes thousands of medical facilities spanning hundreds of millions of square feet in both owned and leased space across the country. The average VA medical facility building is five times older than the average building in a not for profit hospital system. All too often current facilities, including those that have been well maintained, are not equipped to support the provisions of modern high quality care and are not well suited to providing care in the current VA healthcare system. As reported in chapter 2, there is a wide and growing gap between VA’s capital need and the antiquated and anticipated resources. Following the brief legislative history of VA provided community care, chapter 3 describes the background and legislative history leading up to the enactment of the VA MISSION Act. This is followed by summaries of the major provisions in the VA MISSION Act by title. The chapter concludes with an appendix providing implementation and reporting deadlines contained in the VA MISSION Act. VHA anticipates that it will provide care to more than 7 million veterans in fiscal year 2019. The majority of veterans using VHA health care services receive care in one or more of the 172 medical centers or at associated outpatient facilities. Chapter 4 assesses VHA’s management of medical center performance. Chapter 5 reviews the new rule entitled "VA Claims and Appeals Modernization" (RIN: 2900-AQ26), which amends the regulations governing claims adjudication and appeals. VBA employees have authority to request reexaminations for veterans "whenever VA determines there is a need to verify either the continued existence or the current severity of a disability," and when there is no exclusion from reexamination. Chapter 6 determines whether Veterans Benefits Administration (VBA) employees required disabled veterans to submit to unwarranted medical reexaminations. Training health care professionals is part of the VA’s statutory mission. The VA is the largest provider of medical training in the United States and is involved in training at all levels: medical students, medical residents, and medical fellows Chapter 7 focuses on physician training.