This bill mandates the Secretary of Veterans Affairs to establish a program addressing the bowel and bladder care needs of covered veterans , defined as those enrolled in the VA system with spinal cord injuries or disorders who are dependent on others for this care in non-institutional settings. Congress finds that this care is a necessary medical service, essential for improving quality of life, optimizing health, and preventing severe, potentially life-threatening complications like autonomic dysreflexia. Care under the program will be provided based on clinical need , determined through an individualized assessment of the hours required for each veteran. Services can be delivered by qualified family members, individually employed caregivers, or contracted home health agencies. The bill ensures that family members and individually employed caregivers receive necessary supportive medical training and are paid a monthly stipend, capped at the rate of a nursing assistant at the nearest VA medical facility, while home health agencies receive payments at VA-established rates. Importantly, family and individually employed caregivers are explicitly stated not to be considered vendors or contractors. To safeguard veterans, the bill requires that any denial of care must undergo review and concurrence from a designated VA Spinal Cord Injuries and Disorders Center. Furthermore, if a veteran has been medically determined to require care for a continuous period of three years or more, they are deemed to require such care for life, unless a medical provider determines it is no longer needed. The program also requires coordination with other VA benefits to avoid duplication and ensure comprehensive support.