[Congressional Record Volume 153, Number 55 (Thursday, March 29, 2007)]
[Senate]
[Pages S4203-S4207]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. CLINTON (for herself and Ms. Collins):
  S. 1065. A bill to improve the diagnosis and treatment of traumatic 
brain injury in members and former members of the Armed Forces, to 
review and expand telehealth and telemental health programs of the 
Department of Defense and the Department of Veterans Affairs, and for 
other purposes; to the Committee on Armed Services.
  Mrs. CLINTON. Mr. President, today, I am introducing the Heroes at 
Home Act of 2007, the Restoring Disability Benefits for Injured and 
Wounded Warriors Act of 2007, and the Protecting Military Family 
Financial Benefits Act of 2007 to serve our servicemembers and send a 
message: you will be treated as heroes before deployment, during 
deployment, and upon returning home. You didn't offer excuses and do 
not deserve to be offered excuses by your country.
  I want to thank Senator Collins for co-sponsoring the Heroes at Home 
Act of 2007 and for partnering with me on numerous pieces of 
legislation and initiatives related to these and other important health 
issues.
  This is a moment of profound challenge for our country, for our 
military, and for our men and women in uniform. And while there are 
often strong disagreements here in Washington, I hope we can unite 
around our common values and patriotism when it comes to how we treat 
our servicemembers and veterans.
  If you serve your country your country should serve you. That is the 
promise our country must keep to the men and women who enlist, who 
fight, and who return home often bearing the visible and invisible 
scars of sacrifice. Sadly, too often in the past several years, that 
promise has been broken: whether it's a lack of up-armored vehicles on 
the ground in Iraq or a lack of appropriate care in outpatient 
facilities at Walter Reed.
  Last year, I authored and passed into law the Heroes at Home 
initiative to assist returning servicemembers experiencing the complex, 
diffuse, and life-altering symptoms of traumatic brain injury and other 
mental health difficulties.
  One out of every 10 returning servicemembers are affected by 
traumatic brain injury (TBI), which has been widely identified as the 
``signature wound'' of the Global War on Terror. This includes severe 
injuries as well as invisible wounds that result in trouble remembering 
appointments, holding down a job, and returning to civilian life. 
Unfortunately, troops have an increased risk of sustaining more than 
one mild or moderate TBI because of multiple deployments and the 
prevalent use of Improved Explosive Devices by enemy combatants in 
Operation Iraqi Freedom and Operation Enduring Freedom. However, mild 
and moderate TBI may go undetected, especially if the servicemember has 
sustained more obvious injuries. Further, it can be difficult to 
distinguish mild TBI from Post Traumatic Stress Disorder since both 
conditions have common symptoms, such as irritability, anxiety and 
depression. Although many wounded

[[Page S4205]]

servicemembers receive cognitive evaluations upon returning from 
deployment, the lack of a baseline test conducted prior to the injury 
leads these servicemembers to question the validity of their post-
deployment assessments.
  When I visited Walter Reed a few weeks ago, I met a young Army 
soldier who had lost one arm and lost his ring finger because his 
wedding band had melted onto it. I asked him how he was doing, and he 
said, ``You know, I'm working hard at my rehabilitation and they're 
taking great care of me with my prosthetics.''
  He said, ``but what really bothers me is my memory. I don't have the 
focus that I used to have. I can't really set out tasks and know that I 
can accomplish them.'' And he said, ``That's the thing that really 
bothers me I've got to have my brain back.''
  His story, and the stories of hundreds of other servicemembers like 
him, demonstrates that we need to do more to help rapid identification 
of traumatic brain injury in order to facilitate the best care once the 
servicemembers return home, and expand support systems for members and 
former members of the Armed Services with traumatic brain injury and 
their families.
  That's why I, along with Senator Collins, am introducing the Heroes 
at Home Act of 2007 today, to build on last year's Heroes at Home 
initiative. I am grateful to have developed this proposal with the 
Wounded Warrior Project, the National Military Family Association, the 
Military Officers Association of America, and the American Academy of 
Neurology.
  We should provide pre-deployment cognitive screening to better 
diagnose and treat traumatic brain injury when these men and women 
return home. This legislation will improve detection of mild and 
moderate TBI by implementing an objective, computer-based assessment 
protocol to measure cognitive functioning both prior to and after 
deployment. This baseline test will help detect mild and moderate cases 
of TBI and distinguish them from PTSD. My legislation will also require 
that the same assessment tool be used across all branches of the 
6yArmed Services and for every member of the Armed Forces who will be 
deployed to Iraq and Afghanistan.
  We should also help families take care of a loved one by providing 
them with training to become certified caregivers, so that they can 
receive compensation for care giving they already provide. Family 
members of returning soldiers with TBI are often ill-equipped to handle 
the demands of caring for their loved one, which in some bases can 
become a full-time responsibility. My legislation will establish a 
Traumatic Brain Injury Family Caregiver Personal Care Attendant 
Training and Certification Program, which would train and certify 
family caregivers of TBI patients as personal care attendants, enabling 
them to provide quality care at home and at the same time qualify for 
compensation from the VA.
  Finally, we should explore new ways to treat TBI in rural settings 
and outpatient clinics through telemedicine. Servicemembers and 
veterans continue to face problems in accessing needed medical and 
mental health care, especially veterans or Guard and Reserve members 
who live in rural areas. The Heroes at Home Act of 2007 will help 
increase the reach of needed care for TBI by creating a demonstration 
project, administered jointly by the Departments of Defense and 
Veterans Affairs that would use telehealth technology to assess TBI and 
related mental health conditions and facilitate rehabilitation and 
dissemination of educational material on techniques, strategies and 
skills for servicemembers with TBI.
  On March 6, 2007 Chief of Staff of the Army General Peter Schoomaker 
and the then Army Surgeon General Lieutenant General Kevin C. Kiley, 
testified before the Senate Armed Services Committee that soldiers 
appearing before the Physical Evaluation Board were ``short-changed'' 
and had not received appropriate disability benefits. According to the 
Congressional Research Service, since the enactment of the Traumatic 
Servicemembers Group Life Insurance program at least 45 percent of 
claims have been denied. In March 2006 the Comptroller General issued 
GAO Report 06-362: Military Disability System: Improved Oversight 
Needed to Ensure Consistent and Timely Outcomes for Reserve and Active 
Duty Service Members--the Department of Defense did not heed the 
recommendations provided in this report and as a result injured and 
wounded warriors continue to languish in an inefficient and adversarial 
disability system.
  I am also introducing legislation to fix the disability benefits 
system for our wounded warriors. When I've visited Walter Reed, one 
common thread uniting the problems is the disjointed and unfair process 
for evaluating disabilities. There were only three lawyers and one 
paralegal assigned to Walter Reed's entire evaluation process. Compare 
that to 4,000 Army JAG lawyers assigned to active duty, the National 
Guard, and the Reserves.
  The ``Restoring Disability Benefits for Injured and Wounded Warriors 
Act of 2007'' will restore disability benefits for wounded and injured 
members of the Armed Forces. The act will direct reviews of disability 
claims, traumatic injury claims, and the Physical Evaluation Board 
process. Additionally, the ``Restoring Disability Benefits for Injured 
and Wounded Warriors Act of 2007'' will increase the availability of 
legal counsel for members appealing their disability cases, and direct 
the Comptroller General to provide a follow up report on the efforts 
currently being made by the Department of Defense to address certain 
deficiencies in the Disability Evaluation Systems; the adequacy of the 
Department of Veterans Affairs Disability Schedule for Ratings as it 
relates to the nature of wounds our warriors suffer in combat today; 
and to report on the standards and procedures of Physical Evaluation 
Boards.
  So I am proposing an up-and-down review of previously-denied cases 
and failed appeals, an independent review of traumatic injury claims 
under the Traumatic Servicemembers Group Life Insurance program where 
up to 45 percent of claims have been denied, and a fix to ensure 
members have the proper liaison and legal assistance when appearing 
before the Physical Evaluation Board. We must stop short-changing our 
wounded warriors.
  Finally, I am introducing the Protecting Military Family Financial 
Benefits Act of 2007 to close gaps in coverage for the Death Gratuity 
and Survivor Benefits beneficiaries and improve pre-deployment 
counseling and services for all members of the Armed Forces.
  Every day single-parents deploy to distant battlefields and leave 
their minor children in the care of a financially ill-prepared guardian 
or caretaker. Unfortunately, when tragedy strikes and a military 
servicemember makes the ultimate sacrifice, minor dependent children 
and families are excluded from benefits and entitlements. In too many 
cases pre-deployment counseling and help are under-funded or 
unavailable.
  These provisions will add an option for members of the Armed Forces 
to designate guardians or caretakers as a beneficiary for Death 
Gratuity benefits for care of dependent children and to receive 
annuities under the Survivor Benefit Plan for care of dependent 
children. These options do not exist under current law.
  The Department of Defense will be required to commission an 
independent panel to review and assess military pre-deployment 
counseling and services, and implement recommended changes and best 
practices within 120 days of receiving the report. This review will 
include pre-deployment counseling and services available for unmarried 
members of the Armed Forces with dependent children, unmarried single 
members without dependent children, and married members with or without 
dependent children.
  Specifically, what level of counseling or services are available for 
these members to maximize financial protections for the proper care of 
their surviving dependents under the Servicemembers' Group Life 
Insurance, Traumatic Servicemembers' Group Life Insurance, Death 
Gratuity, Dependency and Indemnity Compensation, Survivor Benefits 
Plan, and benefits payable under the Social Security Act.
  The review will include the preparation and maintenance of Family 
Care Plans for single-parents including elements for such plans 
relating to death

[[Page S4206]]

benefits, wills, powers of attorney, trusts, safeguarding of the plan 
during deployment, and the acknowledgement of specific guardian and 
caretaker duties relating to use of financial benefits for the care of 
minor dependent children.
  Finally, this review will determine the adequate level of resources 
available at military pre-deployment centers including: the 
availability of legal and financial counseling, training level of pre-
deployment counselors, Family Support Group involvement, availability 
of PTSD screening, and availability of suicide prevention counseling.
  Let us all join together in accepting our responsibility as a nation 
to those who serve and resolve to improve their care for traumatic 
brain injuries, reform their disability benefits, and fix their 
survivor benefits.
  I ask unanimous consent letters of support for this legislation be 
printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the record, as follows:

                                                 Military Officers


                                       Association of America,

                                   Alexandria, VA, March 28, 2007.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: On behalf of the 362,000 members of 
     the Military Officers Association of America (MOAA), I am 
     writing to express our support for your leadership in 
     sponsoring the ``Heroes at Home Act of 2007'' that will 
     improve the diagnosis and treatment of traumatic brain injury 
     (TBI) in current and former military members. This is a key 
     step in closing the gap and providing for a more seamless 
     transition between DoD and the VA.
       We are proud of the sacrifice our military members and 
     their families are willing to make for our country. For those 
     wounded servicemembers, their sacrifices represent an 
     especially unique population that deserves special attention. 
     Like you, we are particularly concerned about those who bear 
     the burden of what has been diagnosed as TBI, the ``signature 
     wound'' for this War on Terrorism.
       MOAA appreciates your dedication to our military community 
     and for taking the lead in sponsoring this very important 
     measure to help improve the quality of life of our wounded 
     troops and family members. Your legislation will facilitate 
     diagnosing servicemembers with TBI early in the health care 
     and rehabilitation process, it will provide a program that 
     will ensure family caregivers have the resources and training 
     they need to care for their loved ones, and allows for a 
     demonstration project to evaluate existing technology and 
     identify effective telehealth or telemental health resources 
     within the DoD and VA systems.
       MOAA thanks you for introducing this legislation. We look 
     forward to working closely with you in seeking timely 
     enactment of this legislation in the 110th Congress.
           Sincerely and Thank You,
                                                  Norbert R. Ryan,
     President and CEO.
                                  ____

                                                 National Military


                                     Family Association, Inc.,

                                   Alexandria, VA, March 29, 2007.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: The National Military Family 
     Association (NMFA) is the only national organization whose 
     sole focus is the military family and whose goal is to 
     influence the development and implementation of policies that 
     will improve the lives of the families of the Army, Navy, Air 
     Force, Marine Corps, Coast Guard, and the Commissioned Corps 
     of the Public Health Service and the National Oceanic and 
     Atmospheric Administration. For more than 35 years, its staff 
     and volunteers, comprised mostly of military members, have 
     built a reputation for being the leading experts on military 
     family issues. On behalf of NMFA and the families it serves, 
     we commend your proposal of the Heroes at Home Act of 2007 
     that builds on previous legislation.
       The National Military Family Association supports this 
     legislation addressing several issues affecting military 
     service members, veterans and their families. Traumatic Brain 
     Injury (TBI) has been found to be the signature wound of 
     service members serving in Operation Enduring Freedom and 
     Operation Iraqi Freedom. Establishing a protocol for 
     obtaining a baseline measurement for cognitive functioning of 
     service members would provide a better understanding of TBI. 
     NMFA is concerned with the lack of knowledge regarding mild 
     and moderate TBI incidents, its long term effects on service 
     members and potential long-term impact on the resources 
     required by the DoD and VA health care systems. Also, 
     research on TBI will help to identify better methods for 
     diagnosis and treatment of this condition. Establishing a 
     training and certification program for family caregivers 
     recognizes the important commitment family members make in 
     caring for their loved ones diagnosed with TBI.
       Access to health care and counseling is a major challenge 
     facing returning service members and veterans living in rural 
     areas. Telehealth and telemental health services would offer 
     an alternative to long travel time and encourage service 
     members and veterans to make greater use of these needed 
     services. Additionally, partnering with existing resources 
     offers an efficient way to deliver these services.
       Thank you for your support of military service members and 
     veterans diagnosed with TBI, and the families who care for 
     them. If you have any questions you may contact Barbara 
     Cohoon in our Government Relations department.
           Sincerely,
                                                Tanna K. Schmidli,
     Chairman, Board of Governors.
                                  ____



                                American Academy of Neurology,

                                     St. Paul, MN, March 28, 2007.
     Hon. Hillary Clinton,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Clinton: The American Academy of Neurology 
     (AAN), representing over 20,000 neurologists and neuroscience 
     professionals, believes that our veterans deserve the best 
     possible care and treatment for neurological injuries 
     sustained in their service to our country. The conflicts in 
     Iraq and Afghanistan have created an emerging epidemic of 
     traumatic brain injury (TBI) among combat veterans.
       For that reason, we are proud to support your Heroes at 
     Home Act of 2007. TBI is associated with cognitive 
     dysfunction, post-traumatic epilepsy, headaches and other 
     motor and sensory neurological complications. It is essential 
     that the federal government provide all veterans with access 
     to the necessary neurological interventions and long-term 
     treatments that their injuries require. The Heroes at Home 
     Act of 2007 makes great steps towards providing that care.
       Specifically, the AAN strongly supports the Act's 
     provisions to implement fully pre- and post-deployment 
     cognitive and memory screening of all active duty and reserve 
     personnel.
       The AAN also supports the bill's provision to expand 
     telehealth and telemental health services offered by the VA 
     to improve the surveillance and treatment of veterans with 
     TBI and related seizure disorders. Ongoing outreach to 
     veterans suffering TBI is essential, especially those who are 
     discharged and return to rural communities.
       Lastly, the AAN supports the Heroes at Home Act's 
     implementation of a national program to train veterans who 
     have experienced a TBI, their family caregivers and personal 
     care attendants in the skills necessary to manage the long-
     term consequences of TBI.
           Sincerely,
                                                  Thomas R. Swift,
     President.
                                  ____

                                          Brain Injury Association


                                                   of America,

                                       McLean, VA, March 28, 2007.
     Sen. Hillary Rodham Clinton,
     Russell Senate Building,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: The Brain Injury Association of 
     America enthusiastically endorses the ``Heroes at Home Act of 
     2007'' as a critical move forward in meeting the 
     rehabilitation and emotional adjustment needs of traumatic 
     brain injury (TBI) survivors of Operation Iraq Freedom (OIF) 
     and Operation Enduring Freedom (OEF).
       The Brain Injury Association of America and its nationwide 
     network of state affiliates commend you for recognizing the 
     critical role played by family caregivers in facilitating 
     recovery from brain injury and for addressing the pressing 
     need to increase support for these caregivers by providing 
     access to education, training and financial compensation.
       The Brain Injury Association of America also applauds the 
     steps this bill takes to establish a protocol for the 
     assessment and documentation of cognitive functioning of each 
     member of the Armed Forces both before and after deployment, 
     including appropriate mechanisms to permit the differential 
     diagnosis of TBI and post traumatic stress disorder (PTSD) in 
     returning service members. It is time to make use of the 
     increased availability of superior technology in detecting 
     and treating TBI among all Armed Services personnel.
       The Brain Injury Association of America is proud to endorse 
     the ``Heroes at Home Act of 2007,'' and commends your 
     leadership on one of the most important issues related to the 
     War on Terror, the unanticipated high incidence of traumatic 
     brain injuries among America's brave service members.
           Sincerely,
                                                 Susan H. Connors,
     President/CEO.
                                  ____



                                      Wounded Warrior Project,

                                 Jacksonville, FL, March 29, 2007.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: The Wounded Warrior Project (WWP) 
     strongly supports your legislation entitled the ``Heroes At 
     Home

[[Page S4207]]

     Act of 2007'' that you will soon be introducing. We are 
     especially grateful that, included in your legislation are 
     provisions brought to your attention by our organization. 
     These provisions require the Department of Defense to perform 
     a pre-deployment cognitive assessment on all servicemembers 
     and will require the Department of Veterans Affairs to 
     establish a Personal Care Attendant (PCA) Training and 
     Certification program for family caregivers of severely brain 
     injured servicemembers.
       Traumatic Brain Injury (TBI) has been called the 
     ``signature wound'' of the Global War on Terror. Many wounded 
     servicemembers have received cognitive evaluations upon 
     returning from deployment, but question the value of their 
     assessment as no baseline test was conducted prior to the 
     injury. The adoption of a ``Pre-Deployment Cognitive 
     Assessment'' would assist both the Departments of Defense and 
     Veterans Affairs in the diagnosis and treatment of brain 
     injured servicemembers and, in some cases, help enhance the 
     ability to distinguish between Post Traumatic Stress Disorder 
     (PTSD) and TBI.
       The second provision, the ``Traumatic Brain Injury Family 
     Caregiver Personal Care Attendant (PCA) Training and 
     Certification program'' would offer family members serving as 
     the primary caregivers for severely traumatically brain 
     injured servicemembers training and certification from the 
     Department of Veterans Affairs (VA) as a personal care 
     attendant. They would also then qualify for VA payment for 
     services rendered to the TBI veteran in their care. In many 
     circumstances, the family caregiver is forced to leave his/
     her job to provide the necessary care for their loved one, 
     leaving the entire family in an adverse economic situation. 
     In these cases, the family member often develops critical 
     skills to assist in the servicemember's care but have been 
     denied financial compensation for such labor. This program 
     would be offered through the four Tier I VA Polytrauma 
     centers on a rotating and regular basis.
       These provisions, as well as the Telehealth and TeleMental 
     Health study, contained in the ``Heroes At Home Act'' will go 
     far towards insuring the long term health and well-being of 
     service members incurring Traumatic Brain Injury. Again, WWP 
     thanks you for your leadership on these issues and we stand 
     committed to assisting you in seeing this legislation through 
     to passage and enactment.
           Sincerely,
                                                       John Melia,
                                               Executive Director.
                                 ______