[Congressional Record Volume 153, Number 55 (Thursday, March 29, 2007)]
[Senate]
[Pages S4177-S4179]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BIDEN:
  S. 1044. A bill to improve the medical care of members of the Armed 
Forces and veterans, and for other purposes; to the Committee on Armed 
Services.
  Mr. BIDEN. Mr. President, I would like to take the opportunity today 
to introduce an important piece of legislation to improve the ability 
of the Department of Defense and the Department of Veterans Affairs to 
provide medical care for our Nation's Armed Forces and veterans. We are 
currently finishing up a debate in the Senate on additional war time 
funding for Iraq. As in past years, we are trying to mitigate the 
damage caused by the failure to properly plan for and manage the 
aftermath of Saddam Hussein's fall. I have spoken many times about how 
damaging this lack of planning has been to our efforts in Iraq and to 
our standing in the world.
  For the past two months, the spotlight has shone on another 
administration failure in this war: the shameful conditions our wounded 
soldiers face as outpatients navigating the military health system when 
they return from Iraq or Afghanistan. This is another example of gross 
mismanagement and a strained system. To alleviate the strain on this 
system, I am offering legislation today--the Effective Care for the 
Armed Forces and Veterans Act--to improve the care that members of the 
Armed Forces and veterans receive at Walter Reed and other military 
medical facilities.
  The purpose of this legislation is to ensure that some of the reasons 
for concern at Walter Reed do not occur in the future. As the living 
conditions for outpatients at Walter Reed Army Medical Center indicate, 
moving to private contracts for maintenance at military medical 
facilities can cause problems. After a private contract was awarded for 
maintenance and upkeep of buildings on the campus of Walter Reed Army 
Medical Center, a maintenance crew of approximately 300 was whittled 
down to 50 by the time the contract went in to effect. Many of the 
terrible living conditions in Building 18 that we read about in the 
Washington Post were a direct result of delays in building repair and 
maintenance because of a shortage in manpower. To prevent this 
situation from occurring again, this legislation calls for public-
private competitions of maintenance services at military medical 
complexes to stop while our country is engaged in military conflicts. 
It also calls for a General Accountability Office review of 
contracting-out decisions for basic maintenance work at military 
facilities.
  Other problems discovered at Walter Reed are directly attributable to 
shortages resulting from pressures to cut budgets for military medical 
services. These cuts cannot be tolerated at a time when military 
medical services are needed to treat servicemembers who have been 
wounded in Iraq and Afghanistan. As such, this legislation would 
require medical command budgets to be equal to or exceed the prior year 
amount while the nation is involved in a major military conflict or 
war.
  Another issue that the conditions at Walter Reed brought up is 
whether or not the facility should be closed as the Base Realignment 
and Closure Commission recommended. The Commission recommended building 
new, modern facilities at the National Naval Medical Center at Bethesda 
and at Fort Belvoir to improve the overall quality of care and access 
to care in this region. Military leaders have indicated that the 
planned closure has limited their ability to attract needed 
professionals to jobs at Walter Reed and there have been concerns 
raised whether adequate housing for the families of the wounded has 
been properly planned. To deal with that, this legislation requires the 
Department of Defense to submit to Congress within one year a detailed 
plan that includes an evaluation of the following: the desirability of 
being able to guarantee professional jobs in the D.C. area for two 
years or more following the closure in order to foster a stable 
workforce; detailed construction plans for the new facilities and for 
new family housing; and the costs and benefits of building all of the 
needed medical treatment, rehabilitation, and housing before a single 
unit is moved.
  Another major problem and source of frustration for injured soldiers 
is the length of time it takes to receive a disability determination. 
In order to hasten the disability determination process, we need to 
ensure that the Department of Defense has information systems capable 
of communicating with those in the Department of Veterans Affairs. The 
VA has been a leader in implementing electronic medical record keeping, 
but we have to improve the capability of the Department of Defense to 
send electronic medical records to the VA to speed up the disability 
determination process. Making the disability determination system more 
efficient can reduce the stress on the soldiers and their families 
going through the determination process.
  Caseworkers are also critical. They schedule appointments and make 
sure wounded servicemembers get the rehabilitative and follow-up care 
they need. As more and more soldiers and marines come home wounded, 
many military caseworkers are overwhelmed. To improve the care given to 
servicemembers, this legislation requires a minimum ratio of case 
managers to patients of 1 to 20, that case managers have contact with 
recovering servicemembers at least once a week, and that case managers 
be properly trained on the military's disability and discharge systems 
so they can better assist patients with their paperwork.
  Currently, many combat veterans returning from Iraq and Afghanistan 
have service-related mental health issues like post-traumatic stress 
disorder (PTSD) and traumatic brain injury (TBI). Many have labeled TBI 
the ``signature injury'' of the Iraq and Afghanistan conflicts. It is 
estimated that as many as 10 percent of those serving or who have 
served in Iraq and Afghanistan have brain injuries. That

[[Page S4178]]

would mean about 150,000 of the 1.5 million soldiers and marines who 
have served in Operation Enduring Freedom or Operation Iraqi Freedom 
have suffered a brain injury. In many cases, these injuries are not 
diagnosed because there is not an external wound. Depending on the 
severity of these injuries, returning soldiers can require immediate 
treatment or not have symptoms show up until several years later. This 
legislation calls for every returning soldier to be screened for TBI. 
While the VA has announced plans to do this, it needs to happen in 
active-duty military medical facilities too. In addition, the 
legislation calls for a study on the advisability of treating TBI as a 
presumptive condition in every service's disability evaluation system, 
as well as the VA disability evaluation system.
  We often hear about the 25,000 soldiers and marines who have been 
wounded in these wars--but that figure grossly underestimates the 
demand that the VA health care system faces. Since our country was 
attacked on September 11, 2001, more than 1.5 million soldiers have 
been deployed to Afghanistan, Iraq, and other locations. Of these, 
630,000 are now veterans and, according to the Department of Defense, 
more than 205,000 have already received medical treatment through the 
Department of Veterans Affairs. A recent Harvard study on the long-term 
costs of treating these new veterans estimates that by 2012 more than 
643,000 veterans from Iraq and Afghanistan will be using the VA system, 
an almost three-fold increase of what the system faces now. With a 
significant backlog of claims currently existing, the system is in 
desperate need of an upgrade. To address this concern, my legislation 
directs the Secretary of Veterans Affairs to submit to Congress a plan 
for the long-term care needs for veterans for the next 50 years.
  It is our highest obligation to heal the hundreds of thousands of 
brave men and women who will bear the physical and emotional scars of 
these wars for the rest of their lives. Those of us who have the 
privilege of serving in Congress must act now to improve the medical 
care we provide to our Armed Forces and veterans.
  I ask unanimous consent that the text of the legislation be printed 
in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1044

       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 ``Effective Care for the Armed 
     Forces and Veterans Act of 2007''.

     SEC. 2. PROHIBITION ON COMPETITIVE SOURCING OF CERTAIN 
                   ACTIVITIES AT MEDICAL FACILITIES OF THE 
                   DEPARTMENT OF DEFENSE.

       (a) Findings.--Congress finds the following:
       (1) The health and recovery of wounded members of the Armed 
     Forces may be risked by competitive sourcing of services at 
     military medical facilities.
       (2) The provision of medical services to members and former 
     members of the Armed Forces who were injured while serving in 
     Operation Iraqi Freedom or Operation Enduring Freedom is a 
     basic service that is the responsibility of the Government 
     and any disruption is unacceptable when it risks the health 
     of veterans and members of the Armed Forces.
       (3) The Department of Defense has attempted to implement 
     competitive sourcing of services at military medical 
     facilities despite the fact that doing so provides no 
     improvement in the efficiency or effectiveness of such 
     services.
       (b) Prohibition on Initiation of Competitive Sourcing 
     Activities at Medical Facilities of Department of Defense 
     During Period of Major Military Conflict.--
       (1) In general.--Except as provided in paragraph (2), 
     during a period in which the Armed Forces are involved in a 
     major military conflict, the Secretary of Defense shall not 
     take any action under the Office of Management and Budget 
     Circular A-76 or any other similar administrative regulation, 
     directive, or policy--
       (A) to subject work performed by an employee of a medical 
     facility of the Department of Defense or employee of a 
     private contractor of such a medical facility to public-
     private competition; or
       (B) to convert such employee or the work performed by such 
     employee to private contractor performance.
       (2) Exception to prevent negative impact on provision of 
     services.--Paragraph (1) shall not apply to any action at a 
     medical facility of the Department of Defense if the 
     Secretary of Defense certifies to Congress that not 
     initiating such action during such period would have a 
     negative impact on the provision of services at such military 
     medical facility.
       (c) Study on Competitive Sourcing Activities at Medical 
     Facilities of Department of Defense.--The Comptroller General 
     of the United States shall assess the efficiency and 
     advisability of subjecting work performed by an employee of a 
     medical facility of the Department of Defense or a private 
     contractor of such a medical facility to public-private 
     competition, or converting such employee or the work 
     performed by such employee to private contractor performance, 
     under the Office of Management and Budget Circular A-76 or 
     any other similar administrative regulation, directive, or 
     policy.

     SEC. 3. MINIMUM BUDGET FOR MEDICAL SERVICES OF THE ARMED 
                   FORCES DURING PERIOD OF MAJOR MILITARY 
                   CONFLICT.

       (a) Findings.--Congress finds the following:
       (1) Pressure to reduce the budget for the medical services 
     of the Department of Defense has contributed to many of the 
     current problems at Walter Reed Army Medical Center.
       (2) It is inappropriate to reduce the budget for medical 
     services of the Department of Defense or the Department of 
     Veterans Affairs while such services are needed to treat 
     members of the Armed Forces or veterans who were wounded in 
     Iraq and Afghanistan.
       (b) Minimum Budget for Medical Services.--
       (1) In general.--Except as provided in paragraph (2), if 
     the Armed Forces are involved in a major military conflict at 
     the time the President submits the budget for a fiscal year 
     to Congress, the President shall not include in that budget a 
     total aggregate amount allocated for medical services for the 
     Department of Defense and the Department of Veterans Affairs 
     that is less than the total aggregate amount allocated for 
     such purposes in the budget submitted by the President to 
     Congress for the previous fiscal year.
       (2) Exception.--Paragraph (1) shall not apply if the 
     President--
       (A) certifies to Congress that submitting a total aggregate 
     amount allocated for medical services for the Department of 
     Defense and the Department of Veterans Affairs that is less 
     than that required under paragraph (1) is in the national 
     interest; and
       (B) submits to Congress a report on the reasons for the 
     reduction described by subparagraph (A).

     SEC. 4. LIMITATION ON IMPLEMENTATION OF RECOMMENDATION TO 
                   CLOSE WALTER REED ARMY MEDICAL CENTER.

       (a) Findings.--Congress finds the following:
       (1) The final recommendations of the Defense Base Closure 
     and Realignment Commission under the 2005 round of defense 
     base closure and realignment include recommendations to close 
     Walter Reed Army Medical Center and to build new, modern 
     facilities at the National Naval Medical Center at Bethesda 
     and at Fort Belvoir to improve the overall quality of and 
     access to health care for members of the Armed Forces.
       (2) These recommendations include the transfer of medical 
     services from the Walter Reed Army Medical Center to the 
     National Naval Medical Center at Bethesda and at Fort 
     Belvoir, but they do not adequately provide for housing for 
     the families of wounded members of the Armed Forces who will 
     receive treatment at such new facilities.
       (3) The recommended closure of the Walter Reed Army Medical 
     Center has impaired the ability of the Secretary of Defense 
     to attract the personnel required to provide proper medical 
     services at such medical center.
       (b) Limitation on Implementation of Recommendations.--The 
     Secretary of Defense shall not take any action to implement 
     the recommendations of the Defense Base Closure and 
     Realignment Commission under the 2005 round of defense base 
     closure and realignment relating to the transfer of medical 
     services from Walter Reed Army Medical Center to the National 
     Naval Medical Center at Bethesda and at Fort Belvoir during 
     the period beginning on the date of the enactment of this Act 
     and ending on the date that is 60 days after the date on 
     which Congress receives the plan required under subsection 
     (c).
       (c) Plan Required.--Not later than one year after the date 
     of the enactment of this Act, the Secretary of Defense shall 
     submit to Congress a plan that includes an assessment of the 
     following:
       (1) The feasibility and advisability of providing current 
     or prospective employees at Walter Reed Army Medical Center a 
     guarantee that their employment will continue in the 
     Washington, DC, metropolitan area for more than two years 
     after the date on which Walter Reed Army Medical Center is 
     closed.
       (2) Detailed construction plans for new medical facilities 
     and family housing at the National Naval Medical Center at 
     Bethesda and at Fort Belvoir to accommodate the transfer of 
     medical services from Walter Reed Army Medical Center to the 
     National Naval Medical Center at Bethesda and at Fort 
     Belvoir.
       (3) The costs, feasibility, and advisability of completing 
     all of the construction planned for the transfer of medical 
     services from Walter Reed Army Medical Center to the National 
     Naval Medical Center at Bethesda and at Fort Belvoir before 
     any patients are transferred to such new facilities from 
     Walter Reed Army Medical Center as a result of the 
     recommendations of the Defense Base

[[Page S4179]]

     Closure and Realignment Commission under the 2005 round of 
     defense base closure and realignment.

     SEC. 5. IMPROVING CASE MANAGEMENT SERVICES FOR MEMBERS OF THE 
                   ARMED FORCES.

       (a) Findings.--Congress makes the following findings:
       (1) Case managers are important for scheduling appointments 
     and making sure recovering servicemembers get the care they 
     need.
       (2) Many case managers are overwhelmed by the large number 
     of wounded members of the Armed Forces returning from 
     deployment in Iraq and Afghanistan.
       (3) Regular contact between health care providers and 
     members of the Armed Forces returning from deployment is 
     important for the diagnosis of post traumatic stress disorder 
     in such members.
       (4) It is inappropriate to require a wounded member of the 
     Armed Forces or a family member of such member to provide a 
     photo or a medal from deployment in Iraq or Afghanistan to 
     prove that such member served in and was injured from such 
     deployment.
       (5) Case managers are well qualified to assist recovering 
     servicemembers and their families with the disability 
     evaluation system and discharge procedures of the Department 
     of Defense.
       (b) Case Managers.--
       (1) In general.--The Secretary of Defense shall assign at 
     least one case manager for every 20 recovering servicemembers 
     to assist in the recovery of such recovering servicemember.
       (2) Minimum contact.--The Secretary of Defense shall ensure 
     that case managers contact each of their assigned recovering 
     servicemembers not less than once per week.
       (3) Training.--The Secretary of Defense shall ensure that 
     case managers of the Department of Defense are familiar with 
     the disability and discharge system of the Department of 
     Defense and that such case managers are able to assist 
     recovering servicemembers complete necessary and related 
     forms.
       (c) Recovering Servicemember.--In this section, the term 
     ``recovering servicemember'' means a member of the Armed 
     Forces, including a member of the National Guard or a 
     Reserve, who is undergoing medical treatment, recuperation, 
     or therapy, or is otherwise in medical hold or holdover 
     status, for an injury, illness, or disease incurred or 
     aggravated while on active duty in the Armed Forces.

     SEC. 6. SCREENING FOR TRAUMATIC BRAIN INJURY.

       (a) Findings.--Congress finds the following:
       (1) Many of the members of the Armed Forces deployed in 
     Iraq and Afghanistan have brain injuries.
       (2) In many cases, such injuries are not diagnosed because 
     there is no external indication of such injury.
       (3) The Secretary of Veterans Affairs carries out programs 
     to screen all recent combat veterans for traumatic brain 
     injury; the Secretary of Defense does not do so.
       (b) Screening Required.--The Secretary of Defense shall 
     screen every member of the Armed Forces returning from 
     deployment in Operation Iraqi Freedom or Operation Enduring 
     Freedom for traumatic brain injury upon the return of each 
     such member.
       (c) Studies on Treating Traumatic Brain Injury as 
     Presumptive Condition for Disability Compensation.--
       (1) Study by secretary of defense.--
       (A) In general.--The Secretary of Defense shall conduct a 
     study on the feasability and advisability of treating 
     traumatic brain injury as a presumptive condition for members 
     of the Armed Forces who served in Operation Iraqi Freedom or 
     Operation Enduring Freedom for the qualification for 
     disability compensation under laws administered by the 
     Secretary of Defense.
       (B) Report.--Not later than 180 days after the date of the 
     enactment of this Act, the Secretary of Defense shall submit 
     to Congress a report on the results of the study required by 
     subparagraph (A).
       (2) Study by secretary of veterans affairs.--
       (A) In general.--The Secretary of Veterans Affairs shall 
     conduct a study on the feasability and advisability of 
     treating traumatic brain injury as a presumptive condition 
     for veterans who served as members of the Armed Forces in 
     Operation Iraqi Freedom or Operation Enduring Freedom for the 
     qualification for disability compensation under laws 
     administered by the Secretary of Veterans Affairs.
       (B) Report.--Not later than 180 days after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs 
     shall submit to Congress a report on the results of the study 
     required by subparagraph (A).
       (3) Study by director of national institutes of health.--
       (A) In general.--The Director of the National Institutes of 
     Health shall conduct a study on traumatic brain injury, 
     including the detection of traumatic brain injury and the 
     measurement and classification of the severity of traumatic 
     brain injury.
       (B) Report.--Not later than 180 days after the date of the 
     enactment of this Act, the Director of the National 
     Institutes of Health shall submit to Congress a report on the 
     results of the study required by subparagraph (A).

     SEC. 7. REQUIRING MEDICAL RECORDS MANAGEMENT SYSTEMS OF 
                   DEPARTMENT OF DEFENSE TO COMMUNICATE WITH 
                   MEDICAL RECORDS MANAGEMENT SYSTEMS OF 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Findings.--Congress makes the following findings:
       (1) The electronic transfer of medical records of members 
     of the Armed Forces from the medical records management 
     systems of the Department of Defense to the medical records 
     management systems of the Department of Veterans Affairs 
     would be prudent.
       (2) The Department of Veterans Affairs has been a leader in 
     the implementation of electronic medical records management 
     systems.
       (b) Electronic Communication Between Medical Records 
     Management Systems Required.--
       (1) In general.--Not later than two years after the date of 
     the enactment of this Act, the Secretary of Defense shall 
     ensure that the medical records management systems of the 
     Department of Defense are capable of transmitting medical 
     records to and receiving medical records from the medical 
     records management systems of the Department of Veterans 
     Affairs electronically.
       (2) Initiation of activities.--Not later than one year 
     after the date of the enactment of this Act, the Secretary of 
     Defense shall begin any activities required to meet the 
     requirements of paragraph (1).

     SEC. 8. DEPARTMENT OF VETERANS AFFAIRS ASSESSMENT OF LONG-
                   TERM CARE NEEDS OF VETERANS.

       (a) Findings.--Congress makes the following findings:
       (1) Multiple studies show that, in the next five years, the 
     Department of Veterans Affairs will add hundreds of thousands 
     of new veterans to the medical records management systems of 
     the Department of Veterans Affairs.
       (2) During such period, many veterans will have multiple 
     medical care needs caused by complex medical conditions.
       (b) Assessment of Long-Term Care Needs.--The Secretary of 
     Veterans Affairs shall assess the current ability of the 
     Department of Veterans Affairs to meet long-term care needs 
     of veterans during the 50-year period that begins on the date 
     of the enactment of this Act.
       (c) Determination of Actions Required to Meet Long-Term 
     Care Needs.--The Secretary of Veterans Affairs shall 
     determine what actions are required to ensure that the needs 
     described in subsection (b) are satisfied.
       (d) Report Required.--Not later than one year after the 
     date of the enactment of this Act, the Secretary of Veterans 
     Affairs shall submit to Congress a report on the assessment 
     required in subsection (b) and the determination required in 
     subsection (c).
                                 ______