[Congressional Record Volume 153, Number 76 (Wednesday, May 9, 2007)]
[Senate]
[Pages S5874-S5877]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Warner, Mrs. Murray, Mr. Obama, 
        Mr. Graham, Mr. Webb, and Ms. Cantwell):
  S. 1349. 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; to the Committee on 
Armed Services.
  Mr. DURBIN. Mr. President, traumatic brain injury is the signature 
injury of the Iraq war. The widespread use of Improvised Explosive 
Devices, IEDs, has taken a terrible toll. Even those who have walked 
off the battlefield without visible scars often find they have suffered 
the internal trauma of a traumatic brain injury.
  Today, I am introducing legislation, along with Senators Warner, 
Murray, Graham, Obama, Webb, and Cantwell, to create a Traumatic Brain 
Injury Program, operated jointly by the Department of Defense and the 
Department of Veterans Affairs, to ensure that those servicemembers who 
suffer a brain injury receive all the services they need. The 
legislation establishes a standard of care for each individual found to 
have suffered a brain injury, improves the coordination of care, 
strengthen the rights of brain injury patients, and expands brain 
injury research in the Departments of Defense and Veterans Affairs.
  This legislation will reduce the number of our wounded soldiers who 
fall through the cracks and are left to fend for themselves as they 
struggle to recover from a traumatic brain injury. I am pleased to have 
the support of Veterans for America for this legislative effort.
  We have made tremendous progress in battlefield medical care. During 
Vietnam, one in three servicemembers who were injured died. In Iraq and 
Afghanistan, 1 in 16 who are injured die. But with the changes in 
warfare and in medical technology, more of our servicemembers are 
coming home with serious brain injuries from Iraq and Afghanistan than 
from any other recent conflicts we've known.
  For some of these wounded warriors, the greatest battle comes at home 
when they seek care. Many of these returning troops need long-term 
treatment and rehabilitation long after their discharge from active 
duty, as they fight to overcome the severe disabilities that a 
traumatic brain injury can cause.
  For others, there is a different story. Some servicemembers don't 
even realize they suffered a traumatic brain injury until long after 
their discharge, because we don't do a very good job of identifying and 
treating those who may have suffered a brain injury.
  Fortunately, many of those who suffer a brain injury are able to 
recover fairly quickly. But for some, the experience is life-altering, 
even life-shattering. We must not fail them in their time of need.
  Consider the case of Sgt. Eric Edmundson. Eric left my home state of 
Illinois to serve in Iraq. In October 2005, he suffered a severe head 
concussion when a roadside bomb exploded near him. He was cared for at 
Walter Reed Hospital, then was transferred to a VA facility where he 
and his family felt he was not receiving the kind of treatment that 
would allow him to continue to make progress in rehabilitation.
  He would have been stuck there if the family had not found a creative 
way to obtain the care he needed. The family found a way to ensure that 
Eric could receive treatment and rehabilitation at one of the premiere 
rehabilitation hospitals in the nation: the Rehabilitation Institute of 
Chicago. He is making great progress there and hopes to walk out of the 
hospital some day soon.
  We need to use private hospitals more. In fact, we should use them 
whenever they are the best option for our returning soldiers who are 
wounded. In the case of traumatic brain injury, they often have the 
special expertise needed, because the leading facilities in this field 
deal with brain injuries day in and day out as a result of construction 
accidents and car crashes.
  Now consider the case of Sgt. Garrett Anderson of Champaign, 
Illinois. Garrett went to Iraq with the Illinois National Guard. After 
4 months there, an IED exploded next to his armored Humvee in Baghdad. 
The blast tore off his right arm below the elbow, shattered his jaw, 
severed part of his tongue, damaged his hearing, and punctured his body 
with shrapnel.
  He spent 7 months at Walter Reed, where he received excellent care in 
Ward 57, the famous amputee ward. However, the outpatient care that 
followed has been filled with paperwork and red tape. It was months 
before the VA recognized that Garrett had suffered a traumatic brain 
injury. He has not received the kind of treatment for brain injury that 
could make a significant difference in the trajectory of his 
rehabilitation.
  We need to change the way we handle patients with traumatic brain 
injury, so that they receive the care they need at the time they need 
it.
  The legislation I am introducing takes a comprehensive approach to 
dealing with the traumatic brain injuries that plague our troops and 
veterans.
  First, this legislation would establish a Traumatic Brain Injury 
Program, run by DOD and the VA, to provide treatment and rehabilitation 
to servicemembers and veterans who have suffered a service-connected 
traumatic brain injury.
  Second, this bill would establish a standard of care for the 
participants in the TBI Program. Specifically, each individual in the 
program shall 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 they shall be rehabilitated to the fullest extent 
possible using the most up-to-date medical technology, medical 
rehabilitation practices, and medical expertise available.''

[[Page S5875]]

  That's the standard of care we should provide to these injured troops 
who gave so much of themselves for us. They should receive the best we 
have to give.
  Third, the measure would direct the Defense Department to develop and 
administer a standardized cognitive pre-test, which would be 
administered to all military personnel prior to deployment and again 
upon return from deployment to determine if they have suffered a brain 
injury.
  It also would require DOD and the VA to refer any servicemember or 
veteran for TBI screening if it is found, in the course of later 
treatment or contacts, that the servicemember or veteran may have 
suffered a service-connected brain injury.
  Anyone found to have suffered a traumatic brain injury would be 
enrolled in the TBI program and receive the care they need.
  One of the things the families of TBI patients complain most about is 
the confusion that surrounds their efforts to ensure that their loved 
one received all needed care. The fourth thing this measure would do is 
to direct DOD and the VA to assign each patient a lead case manager to 
ease the stress on the patient and family, facilitate navigation 
through the DOD and VA systems, ensure proper care, present options for 
care outside of DOD and the VA, and ensure consistent guidance. 
Additionally, DOD and the VA would assign to each patient a lead 
primary care physician to coordinate and oversee the care provided to 
the patient, including all treatment, rehabilitation, and medications.
  Another complaint of families and TBI patients is that they are 
sometimes blocked from receiving the care they need due to their status 
as either a veteran or an active duty member. DOD and the VA have 
different health benefit options. In some cases, servicemembers have 
found that, because they accepted a discharge, they lost access to 
benefits that would help them.
  Our bill addresses this problem by establishing, for these TBI 
patients, a temporary overlap of benefits. The participants in the TBI 
Program will be allowed, for 2 years, to receive any of the benefits 
available to veterans and to active duty members, regardless of their 
active duty status. This will help ensure they receive the best care 
and rehabilitation available, wherever it may be.
  Our bill would spell out some other rights that are important for the 
rehabilitation of TBI patients. First, DOD and the VA would be required 
to provide a referral to a medical professional outside of DOD and the 
VA when requested by a TBI patient. This will allow patients to 
determine whether there is better care in the private sector that is 
not being provided to that patient. They would also have a right to an 
appeals process to challenge any failure to provide the standard of 
care required in the TBI Program.
  In some cases, undiagnosed traumatic brain injuries may contribute to 
behavior resulting in other than honorable discharges. Upon the request 
of a servicemember who served since 2001 and was discharged under other 
than honorable conditions, the DOD would be directed to review the 
discharge to determine whether a brain injury might be the root cause 
of the actions that precipitated the adverse discharge, with fair 
reconsideration of the discharge if such evidence is found.
  Similarly, the VA would be required to make available, upon request, 
an appeals process to update the disability rating of a veteran who is 
found to have suffered a traumatic brain injury.
  Finally, this measure authorizes additional funding for research 
related to traumatic brain injury both in DOD and in the VA, to improve 
screening, diagnosis, treatment, and rehabilitation for traumatic brain 
injury.
  This is a comprehensive effort to improve the treatment of our 
Nation's wounded servicemembers who have suffered a traumatic brain 
injury. I can't imagine the anguish that must be associated with such 
an injury, but I can imagine the kind of medical system I would like to 
have in place if it were my son or daughter struggling to recover from 
such an injury. This legislation reflects that vision.
  I thank my cosponsors, Senators Warner, Murray, Graham, Obama, Webb, 
and Cantwell, and I urge all of my colleagues to support this measure.
  Mr. President, I ask unanimous consent that the text of the bill 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. 1349

       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

[[Page S5876]]

     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:

[[Page S5877]]

       ``(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.

                          ____________________