[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1349 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1349

To ensure that the Department of Defense and the Department of Veterans 
   Affairs provide to members of the Armed Forces and veterans with 
  traumatic brain injury the services that best meet their individual 
                     needs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 9, 2007

   Mr. Durbin (for himself, Mr. Warner, Mrs. Murray, Mr. Obama, Mr. 
  Graham, Mr. Webb, and Ms. Cantwell) introduced the following bill; 
  which was read twice and referred to the Committee on Armed Services

_______________________________________________________________________

                                 A BILL


 
To ensure that the Department of Defense and the Department of Veterans 
   Affairs provide to members of the Armed Forces and veterans with 
  traumatic brain injury the services that best meet their individual 
                     needs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Military and Veterans Traumatic 
Brain Injury Treatment Act''.

SEC. 2. PROGRAM OF SERVICES FOR TRAUMATIC BRAIN INJURY FOR MEMBERS OF 
              THE ARMED FORCES AND VETERANS.

    (a) Traumatic Brain Injury Program Required.--The Secretary of 
Defense and the Secretary of Veterans Affairs shall jointly establish a 
program meeting the requirements of subsections (c) through (f) under 
which each member of the Armed Forces or veteran who incurs a traumatic 
brain injury during service in the Armed Forces--
            (1) is enrolled in the program; and
            (2) receives, under the program, treatment and 
        rehabilitation meeting the standard of care specified in 
        subsection (b).
    (b) Standard of Care.--The standard of care for treatment and 
rehabilitation specified in this subsection is that each individual who 
is a member of the Armed Forces or veteran who qualifies for care under 
the program established under subsection (a) shall--
            (1) be provided the highest quality of care possible based 
        on the medical judgment of qualified medical professionals in 
        facilities that most appropriately meet the specific needs of 
        the individual; and
            (2) be rehabilitated to the fullest extent possible using 
        the most up-to-date medical technology, medical rehabilitation 
        practices, and medical expertise available.
    (c) Referrals.--
            (1) In general.--If a member of the Armed Forces or a 
        veteran participating in the program established under 
        subsection (a) determines that care provided to such 
        participant by the Department of Defense or the Department of 
        Veterans Affairs, as the case may be, does not meet the 
        standard of care specified in subsection (b), the Secretary of 
        Defense or the Secretary of Veterans Affairs, as the case may 
        be, shall, upon request of the participant, provide to such 
        participant a referral to a public or private provider of 
        medical or rehabilitative care for consultation regarding the 
        care that would meet the standard of care specified in 
        subsection (b).
            (2) Limitation on referrals.--The Department of Defense 
        shall bear the cost of referrals under paragraph (1), except 
        that the Secretary of Defense shall not be required to pay for 
        more than one referral for each participant in any consecutive 
        three month period.
    (d) Screening for Traumatic Brain Injury.--
            (1) Protocols for detection and diagnosis of traumatic 
        brain injury.--
                    (A) In general.--The Secretary of Defense shall, in 
                cooperation with the Secretary of Veterans Affairs, 
                establish protocols for the detection and diagnosis of 
                traumatic brain injury, including the use of various 
                types of screening tools as appropriate.
                    (B) Frequency.--The protocol required by 
                subparagraph (A) shall provide that examinations shall 
                be administered at least once to each member of the 
                Armed Forces--
                            (i) before deployment to a combat theater; 
                        and
                            (ii) during the period beginning on the 
                        30th day after the member returns from such 
                        deployment and ending on the 90th day after the 
                        date on which such member returns to the 
                        member's permanent duty station after such 
                        deployment.
                    (C) Protocol for determination of baseline 
                cognitive functioning.--The protocols required by 
                subparagraph (A) shall include a protocol--
                            (i) for the assessment and documentation of 
                        the cognitive functioning of each member of the 
                        Armed Forces before each such member is 
                        deployed in a combat theater, in order to 
                        facilitate the detection and diagnosis of 
                        traumatic brain injury of such member upon 
                        return from such deployment; and
                            (ii) for the comparison of the cognitive 
                        functioning determined under clause (i) with 
                        the cognitive functioning of the member upon 
                        return from deployment.
                    (D) Administration of computer-based 
                examinations.--The protocol required by subparagraph 
                (C) shall include the administration of computer-based 
                examinations to members of the Armed Forces.
            (2) Incidental detection.--If, while delivering health care 
        services to a member of the Armed Forces or a veteran who is 
        not a participant in the program established under subsection 
        (a), the Secretary of Defense or the Secretary of Veterans 
        Affairs, as the case may be, discovers that such member or 
        veteran may have incurred a service-connected traumatic brain 
        injury, the Secretary concerned shall test such member or 
        veteran for traumatic brain injury.
            (3) Referrals.--If the Secretary of Defense or the 
        Secretary of Veterans Affairs receives a referral for the 
        testing of a member of the Armed Forces or a veteran for 
        traumatic brain injury, the Secretary concerned shall test such 
        member or veteran for traumatic brain injury expeditiously.
            (4) Enrollment.--If a member of the Armed Forces or a 
        veteran is diagnosed under this subsection with a traumatic 
        brain injury that was incurred during service in the Armed 
        Forces, such member or veteran shall be enrolled in the program 
        required by subsection (a).
    (e) Outreach.--
            (1) Outreach to members of the armed forces and veterans.--
        The Secretary of Defense and the Secretary of Veterans Affairs 
        shall conduct a program of outreach to members of the Armed 
        Forces and veterans to inform such members and veterans of--
                    (A) the program required by subsection (a);
                    (B) the availability of screening for the diagnosis 
                of traumatic brain injury under subsection (d);
                    (C) the consequences, with regard to the treatment 
                and care of traumatic brain injury, of separation, 
                discharge, and retirement from the Armed Forces; and
                    (D) the rights of such members or veterans 
                described in subsection (f).
            (2) Joint manual of benefits.--As part of the program of 
        outreach under paragraph (1), the Secretary of Defense and the 
        Secretary of Veterans Affairs shall annually and jointly 
        publish and distribute a manual explaining the benefits 
        available to participants in the program required by subsection 
        (a) and their families.
    (f) Rights of Members of the Armed Forces and Veterans With 
Traumatic Brain Injury.--The Secretary of Defense and the Secretary of 
Veterans Affairs shall inform members of the Armed Forces and veterans 
with traumatic brain injury and their families of their rights with 
respect to the following:
            (1) The receipt of medical care from the Department of 
        Defense and the Department of Veterans Affairs.
            (2) The options available to such members and veterans for 
        treatment of traumatic brain injury.
            (3) The options available to such members and veterans for 
        rehabilitation.
            (4) Referrals under subsection (c)(1).
            (5) The right to any administrative or judicial appeal of 
        any agency decision with respect to the program established 
        under subsection (a).
            (6) Reviews of decisions under section 4.
    (g) Coordination of Case Management and Health Care Services for 
Program Participants.--
            (1) Lead case managers.--The Secretary of Defense and the 
        Secretary of Veterans Affairs shall assign a qualified lead 
        case manager to each member of the Armed Forces or veteran, as 
        the case may be, that participates in the program required by 
        subsection (a). Each lead case manager shall, with respect to a 
        participant in the program under subsection (a) to whom the 
        lead case manager has been assigned--
                    (A) coordinate the work of any other case managers 
                associated with such participant;
                    (B) help the participant and the family of such 
                participant manage the stress associated with receiving 
                treatment and rehabilitative services for traumatic 
                brain injury;
                    (C) present the participant with options for the 
                receipt of medical and rehabilitative care, including 
                options for such care outside the Department of Defense 
                and the Department of Veterans Affairs, that meet the 
                standard of care specified in subsection (b);
                    (D) help the participant find and receive the care, 
                including care from outside the Department of Defense 
                and the Department of Veterans Affairs, to which the 
                participant is entitled under subsection (a); and
                    (E) ensure that providers of care to participants 
                in the program required by subsection (a) provide 
                consistent guidance to such participants.
            (2) Primary care physicians.--The Secretary of Defense and 
        the Secretary of Veterans Affairs shall assign a lead primary 
        care physician to each member of the Armed Forces or veteran, 
        as the case may be, who participates in the program required by 
        subsection (a). Such lead primary care physician shall 
        coordinate and oversee the care provided to the participant, 
        including all treatment, rehabilitation, and medications.
            (3) Report.--Not later than 6 months after the date of the 
        enactment of this Act, the Secretary of Defense and the 
        Secretary of Veterans Affairs shall report to Congress on the 
        steps taken to coordinate care, as required by this subsection, 
        along with recommendations, if any, for legislation to improve 
        such coordination.
    (h) Resources.--
            (1) Facilities.--The Secretary of Defense and the Secretary 
        of Veterans Affairs may provide treatment and rehabilitation in 
        accordance with subsection (a) in any of the facilities as 
        follows:
                    (A) Facilities of the Department of Defense.
                    (B) Facilities of the Department of Veterans 
                Affairs.
                    (C) Public or private medical facilities accredited 
                or otherwise qualified to provide treatment and 
                rehabilitation.
            (2) Access to equipment.--The Secretary of Defense and the 
        Secretary of Veterans Affairs shall ensure, by procurement, 
        contract, or agreement, that the program established under 
        subsection (a) has access to all specialized programs, 
        services, equipment, and medical expertise required to ensure 
        that each participant receives the standard of care specified 
        in subsection (b).
            (3) Cooperative agreements, contracts, or partnerships with 
        private and public medical centers.--The Secretary of Defense 
        and the Secretary of Veterans Affairs shall, separately or 
        jointly, enter into cooperative agreements, contracts, or 
        partnerships with private or public medical centers with 
        expertise in the treatment or rehabilitation of individuals 
        with traumatic brain injury to provide consultation, treatment, 
        or rehabilitation to members of the Armed Forces or veterans as 
        required by subsection (a).
            (4) Training program.--The Secretary of Defense and the 
        Secretary of Veterans Affairs shall, separately or jointly, 
        provide grants to, or enter into contracts or agreements with, 
        private or public medical centers with expertise in the 
        treatment or rehabilitation of individuals with traumatic brain 
        injury to provide training, education, or other assistance to 
        personnel of the Department of Defense and the Department of 
        Veterans Affairs to ensure that such personnel are consistently 
        using the most up-to-date and best practices and procedures for 
        the screening, treatment, and rehabilitation of members of the 
        Armed Forces and veterans with traumatic brain injury.
            (5) Overlap of benefits.--
                    (A) In general.--During the 24-month period 
                beginning on the date that a member of the Armed Forces 
                or a veteran is enrolled in the program required by 
                subsection (a), the member or veteran shall be entitled 
                to all of the benefits otherwise available to a veteran 
                (in the case of a member) or member (in the case of a 
                veteran), including participation in the TRICARE 
                program under chapter 55 of title 10, United States 
                Code, and care provided in a facility of the Department 
                of Defense, the Department of Veterans Affairs, or 
                other public or private facility, regardless of the 
                active duty status of such member or veteran.
                    (B) Allocation of costs.--Costs associated with the 
                provision of care under subparagraph (A) shall be borne 
                by the Department of Defense.

SEC. 3. FACILITATION OF CONTINUITY OF CARE FROM DEPARTMENT OF DEFENSE 
              TO DEPARTMENT OF VETERANS AFFAIRS.

    The Secretary of Defense and the Secretary of Veterans Affairs 
shall establish protocols to ensure that members of the Armed Forces 
receive, with regard to health care benefits and services from the 
Department of Veterans Affairs and otherwise, a continuity of care and 
assistance during and after the transition from military service to 
civilian life, including protocols for the following:
            (1) The expeditious transfer of medical records from the 
        Department of Defense to the Department of Veterans Affairs.
            (2) Continuity of health care services, treatment, and 
        coverage for members of the Armed Forces who are transitioning 
        to civilian life, with particular emphasis on providing 
        continued health care to participants in the program required 
        by section 2.
            (3) The development of a specific, individualized 
        transition plan for each member, prior to discharge or release 
        from the Armed Forces, outlining the member's seamless 
        continuity of care.

SEC. 4. REVIEW OF CERTAIN DECISIONS OF THE DEPARTMENT OF DEFENSE AND 
              THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Review of Other Than Honorable Discharge Status for Former 
Members of the Armed Forces With Traumatic Brain Injury.--
            (1) Review required.--The Secretary of Defense shall, upon 
        the request of any former member of the Armed Forces who served 
        in the Armed Forces after October 6, 2001, and has been 
        discharged from the Armed Forces under other than honorable 
        conditions, conduct a review (including a medical evaluation) 
        to determine whether a traumatic brain injury was a cause of 
        the actions of the member that precipitated the discharge under 
        other than honorable conditions. Such request may also be made 
        by an authorized representative of the member.
            (2) Reconsideration.--If the Secretary of Defense 
        determines under this subsection that the traumatic brain 
        injury of a member was a cause of the actions of the member 
        that precipitated the discharge under other than honorable 
        conditions, the Secretary shall reconsider the discharge and 
        redesignate the status of such discharge if such action is 
        warranted.
    (b) Review of Decisions of Secretary of Veterans Affairs Affecting 
Veterans With Traumatic Brain Injury.--Upon the request of any veteran 
diagnosed with a traumatic brain injury, the Secretary of Veterans 
Affairs shall review and adjust as the Secretary considers appropriate, 
the disability rating of such veteran.

SEC. 5. TRAUMATIC BRAIN INJURY RESEARCH.

    (a) Research Required of Department of Defense.--The Secretary of 
Defense shall conduct research--
            (1) to improve the screening, diagnosis, and treatment of 
        traumatic brain injury;
            (2) to improve rehabilitation of members of the Armed 
        Forces with traumatic brain injury;
            (3) to improve best practices for the activities described 
        in paragraphs (1) and (2); and
            (4) to identify the mechanisms of brain injury and ways to 
        prevent or ameliorate secondary effects of brain injuries.
    (b) Research Required of Department of Veterans Affairs.--Section 
7303 of title 38, United States Code, is amended--
            (1) in subsection (a)(2), by inserting ``traumatic brain 
        injury research,'' after ``mental illness research,''; and
            (2) by adding at the end the following new subsection:
    ``(e) Traumatic brain injury research shall include research--
            ``(1) to improve the screening, diagnosis, and treatment of 
        traumatic brain injury;
            ``(2) to improve rehabilitation of veterans with traumatic 
        brain injury;
            ``(3) to improve best practices for the activities 
        described in paragraphs (1) and (2); and
            ``(4) to identify the mechanisms of brain injury and ways 
        to prevent or ameliorate secondary effects of brain 
        injuries.''.
    (c) Grants or Cooperative Agreements.--In conducting the research 
required by subsection (a) or in accordance with section 7303(e) of 
title 38, United States Code, the Secretary of Defense and the 
Secretary of Veterans Affairs may provide grants to, or enter into 
cooperative agreements with, private or public medical centers with 
expertise in research on traumatic brain injury, including the 
treatment or rehabilitation of individuals with traumatic brain injury.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated--
            (1) to the Secretary of Defense, $20,000,000 to carry out 
        the provisions of subsection (a); and
            (2) to the Secretary of Veterans Affairs, $20,000,00 to 
        carry out the amendments made by subsection (b).

SEC. 6. REPORT.

    Not later than December 15 of each year, the Secretary of Defense 
shall, in conjunction with the Secretary of Veterans Affairs, submit to 
Congress a report that contains, with respect to the fiscal year ending 
in the year such report is submitted, the following:
            (1) Descriptions of the activities, accomplishments, and 
        limitations of the program on traumatic brain injury 
        established under section 2.
            (2) Recommendations of the Secretary of Defense and the 
        Secretary of Veterans Affairs, if any, for improving the 
        program established under section 2.
            (3) Information on the following:
                    (A) The number of members of the Armed Forces and 
                veterans tested for traumatic brain injury by the 
                Department of Defense and the Department of Veterans 
                Affairs under section 2(d).
                    (B) The number of members of the Armed Forces and 
                veterans diagnosed with a traumatic brain injury.
                    (C) The number of members of the Armed Forces and 
                veterans enrolled in the program on traumatic brain 
                injury established under section 2.
                    (D) The types of treatment and rehabilitation 
                provided as part of the program established under 
                section 2.
                    (E) The types of facilities in which services were 
                provided under section 2 and how such facilities were 
                chosen to meet the individual needs of individual 
                patients.
                    (F) The mechanisms used by the Department of 
                Defense and the Department of Veterans Affairs to 
                ensure continuity of care for members of the Armed 
                Forces as they transition from receipt of health care 
                services from the Department of Defense to the receipt 
                of such services from the Department of Veterans 
                Affairs.
                    (G) The number and nature of any cooperative 
                agreements engaged in under section 2(h).
                    (H) The outreach activities carried out under 
                subsections (e) and (f) of section 2.
            (4) A description of the expenditures associated with the 
        outreach, screening, diagnosis, treatment, rehabilitation, and 
        other services provided to members of the Armed Forces and 
        veterans under sections 2 and 3.

SEC. 7. DEFINITION OF TRAUMATIC BRAIN INJURY.

    In this Act, the term ``traumatic brain injury'' means an acquired 
injury to the brain. Such term does not include brain dysfunction 
caused by congenital or degenerative disorders, nor birth trauma, but 
may include brain injuries caused by anoxia due to trauma. The 
Secretary of Defense and the Secretary of Veterans Affairs may jointly 
revise the definition of such term as the Secretaries determine 
necessary, after consultation with the following:
            (1) The Secretary of Health and Human Services.
            (2) Representatives of any organization recognized by the 
        Secretary of Veterans Affairs for the representation of 
        veterans under section 5902 of title 38, United States Code.
            (3) Such public or nonprofit private entities that the 
        Secretary of Defense or the Secretary of Veterans Affairs 
        considers appropriate.
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