House Report 110-166 - TRAUMATIC BRAIN INJURY HEALTH ENHANCEMENT AND LONG-TERM SUPPORT ACT OF 2007

[House Report 110-166]
[From the U.S. Government Publishing Office]

110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-166

======================================================================

TRAUMATIC BRAIN INJURY HEALTH ENHANCEMENT AND LONG-TERM SUPPORT ACT OF
2007

_______

May 23, 2007.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following

R E P O R T

[To accompany H.R. 2199]

[Including cost estimate of the Congressional Budget Office]

The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2199) to amend title 38, United States Code, to
direct the Secretary of Veterans Affairs to provide certain
improvements in the treatment of individuals with traumatic
brain injuries, and for other purposes, having considered the
same, report favorably thereon with amendments and recommend
that the bill as amended do pass.

CONTENTS

Page
Purpose and Summary.............................................. 2
Background and Discussion........................................ 3
Legislative History.............................................. 7
Section-by-Section............................................... 7
Explanation of Amendments........................................ 9
Committee Consideration.......................................... 9
Rollcall Votes................................................... 9
Application of Law to the Legislative Branch..................... 9
Statement of Oversight Findings and Recommendations of the
Committee...................................................... 9
Statement of General Performance Goals and Objectives............ 10
Constitutional Authority Statement............................... 10
Federal Advisory Committee Act................................... 10
Unfunded Mandate Statement....................................... 10
Earmark Identification........................................... 10
Committee Estimate............................................... 10
Budget Authority and Congressional Budget Office Cost Estimate... 10
Changes in Existing Law Made by the Bill as Reported............. 13

The amendments (stated in terms of the page and line numbers
of the introduced bill) are as follows:
Page 19, lines 3-5, strike ``READJUSTMENT COUNSELING AND
MENTAL HEALTH SERVICES'' and insert ``CERTAIN SERVICES''.
Page 19, line 10, amend the heading to read as follows:
``Pilot program for delivery of certain services through mobile
Vet Centers''.
Page 19, lines 16-17, strike ``readjustment counseling and
related mental health services'' and insert ``readjustment
counseling, related mental health services, benefits outreach,
and, to the extent practicable, assistance with claims for
benefits under this title''.
Page 20, line 15, after ``mental health'' insert ``and
outreach''.
Page 21, lines 14-15, strike ``readjustment counseling and
related mental health services'' and insert ``readjustment
counseling, related mental health services, benefits outreach,
and claims assistance''.
Page 21, after line 24, amend the item proposed to be
inserted to read as follows:

``1712C. Pilot program for delivery of certain services through mobile
Vet Centers.''.

Purpose and Summary

H.R. 2199, the ``Traumatic Brain Injury Health Enhancement
and Long-Term Care Support Act of 2007,'' was introduced on May
8, 2007, by Representative Michael H. Michaud, the Chairman of
the Subcommittee on Health. The legislation would improve the
ability of the Department of Veterans Affairs (VA) to provide
treatment and rehabilitative care to veterans suffering from
traumatic brain injuries (TBI), as well as improve the VA's
research and educational efforts into TBI. The legislation also
improves the Department's ability to provide mental health
services to rural veterans and establishes an Advisory
Committee on Rural Veterans to assist the Secretary in
providing health care and benefits to rural veterans.
H.R. 2199 would:
1. Require the VA to establish a program to screen veterans
for TBI, and to report to Congress not later than one year
after enactment, and annually thereafter, data on the screening
program.
2. Require the VA to develop and carry out a comprehensive
program of long-term care for post-acute TBI rehabilitation for
OEF/OIF veterans diagnosed with moderate-to-severe TBI who are
unable to manage routine activities of daily living without
supervision or assistance that includes residential, community,
and home-based components utilizing interdisciplinary treatment
teams at four geographically dispersed polytrauma network
sites.
3. Require the establishment of TBI transition offices at
each VA polytrauma network site to coordinate the provision of
health care and services to veterans suffering from moderate to
severe TBI who are in need of health care and services not
immediately offered by the VA. Provide explicit authority for
the VA to arrange for the provision of health care and services
through cooperative agreements with appropriate public or
private entities that have established long-term
neurobehavioral rehabilitation and recovery services.
4. Require the establishment of a TBI Veterans' Health
Registry.
5. Require the establishment of Centers for TBI Research,
Education, and Clinical Activities.
6. Require the VA to establish a Committee on Care of
Veterans with TBI and to report to Congress annually on the
recommendations and assessments of the Committee.
7. Establish a pilot program consisting of two mobile Vet
Centers in each of five designated Veterans Integrated Service
Networks (VISNs) for delivery of readjustment counseling,
mental health services, benefits outreach, and claims
assistance through mobile Vet Centers.
8. Require the VA to establish an Advisory Committee on
Rural Veterans and to report to Congress on the activities of
the VA that pertain to rural veterans.

Background and Discussion

Brain injury has become a leading health issue for
civilians and the military. According to the Centers for
Disease Control and Prevention (CDC), in the United States
civilian population 1.4 million individuals sustain TBI
annually, resulting in 235,000 hospital admissions and 50,000
deaths. Additionally, 80,000 survive with residual long-term
impairments. CDC estimates that long-term disability as a
result of brain injuries affects 5.3 million Americans.
According to the Defense and Veterans Brain Injury Center,
in prior military conflicts TBI was present in fourteen to
twenty percent of surviving casualties. For Operations Enduring
Freedom and Iraqi Freedom servicemembers (OEF/OIF) the numbers
are predicted to go much higher. The wounded from the wars in
Afghanistan and Iraq are returning with multiple injuries, due
in large part to the use of Improvised Explosive Devices, or
IEDs. The use of Kevlar helmets and body armor has
significantly reduced the frequency of penetrating injuries to
the head and to vital organs. However, body armor offers
limited protection against non-penetrating injuries from blasts
and high-impact falls. The brain, eyes, ears, facial
structures, and limbs still remain exposed and subject to
violent injuries.
The Veterans Health Administration Directive 2005-024,
Polytrauma Rehabilitation Centers, issued on June 8, 2005,
defines polytrauma as ``injury to the brain in addition to
other body parts or systems resulting in physical, cognitive,
psychological, or psychosocial impairments and functional
disability.'' The Directive also defines brain injury as an
``impairment, which guides the course of the rehabilitation.''
Many polytrauma patients have a combination of multiple
disabling conditions, including TBI.
TBI is considered by many to be the signature injury of the
war. Among veterans and servicemembers from OEF/OIF treated at
Walter Reed for injuries of any type, approximately 65 percent
have TBI as a primary or comorbid diagnosis. It is estimated
that thousands more veterans are returning with mild TBI.
Severe TBI is often easily recognizable. Moderate TBI is
less easily recognizable. Mild TBI is very difficult to detect
and is often missed. Because of this, veterans may not even
know they are suffering from mild TBI and may go untreated.
More research needs to be conducted to evaluate the
symptoms of, and treatment methods for, veterans who have
experienced TBI. VA needs to be able to address and treat both
the medical and mental health aspects of TBI, including
research into the long-term consequences of mild TBI in OEF/OIF
veterans. The Committee believes that H.R. 2199 is an important
step in addressing the issue of TBI among veterans.
This legislation also addresses issues of accessibility of
mental health care services and outreach in the rural
communities. The National Guard and Reserve components have
been deployed in record numbers to help fight the wars in
Afghanistan and Iraq. Many of these units come from rural parts
of the country. Currently, over 40 percent of the returning
OEF/OIF veterans are from rural areas. Oftentimes, it is
difficult for these veterans to access quality health care and
mental health services in a timely manner. H.R. 2199 begins to
address the needs of rural veterans by providing the VA with
the authority to establish a pilot program of mobile Vet
Centers to bring mental health services, benefits outreach, and
assistance with claims for benefits, to veterans in their
communities. Additionally, to advise the Secretary on how best
to serve veterans in the rural community, this legislation
establishes an Advisory Committee on Rural Veterans

SCREENING FOR TRAUMATIC BRAIN INJURIES

Mandatory screening of all returning veterans from OEF/OIF
for signs and symptoms of TBI will help to better diagnose
veterans with mild TBI, and assist in identifying and referring
veterans who need treatment. Veterans are often unaware that
they have a mild TBI because the symptoms are common ones and
do not readily point to a diagnosis of TBI. Veterans may
experience headaches, decreased memory, slow mental processing
speed, poor attention, sleep disturbance and irritability. The
less time that passes between the injury and the detection of
TBI, the greater the chance for a normal or near-normal life
for the veteran.

COMPREHENSIVE PROGRAM FOR LONG-TERM TRAUMATIC BRAIN INJURY
REHABILITATION

Establishment of a long-term rehabilitation program for TBI
patients that includes residential, community and home-based
components utilizing interdisciplinary treatment teams will
provide the VA with an important and essential component of its
overall effort to provide health care treatment and
rehabilitation to veterans suffering from moderate to severe
TBI, and enable the VA to serve as a model to other health care
providers. It will take the VA several years to build the
expertise, and develop an effective program, to meet the
complex needs of veterans with more severe TBI and
neurobehavioral impairments. For veterans who suffer from
moderate to severe TBI and are unable to manage routine
activities of daily living without supervision or assistance,
VA care should be an option for them. The establishment of this
program will ensure that.

TRAUMATIC BRAIN INJURY TRANSITION OFFICE

The Committee intends for these TBI Transition Offices to
assist in coordinating needed care for veterans who suffer from
moderate-to-severe TBI when that care is not immediately
available within the VA health care system. These Transition
Offices will be located at each polytrauma network site, which
currently number 21. These offices will expedite the provision
of care with appropriate public or private entities that have
established long-term neurobehavioral rehabilitation and
recovery programs. Veterans should not have to wait an unduly
long time to receive such care. H.R. 2199 provides explicit
authority to the VA to arrange for the provision of this care.
The Transition Offices will help alleviate the anxiety veterans
and their families feel as they go through the process of
finding the best care for the veteran.

TRAUMATIC BRAIN INJURY REGISTRY

The TBI Registry will provide the VA with a database to
assist in future research endeavors involving TBI, as the VA
looks to the future of providing care and treatment to these
veterans. In addition, the Committee envisions the Registry as
being an invaluable resource for disseminating information
concerning significant developments in research on the health
consequences of military service in OEF/OIF theaters of
operations.

CENTERS FOR TRAUMATIC BRAIN INJURY RESEARCH, EDUCATION, AND CLINICAL
ACTIVITIES

The Committee believes that an effort similar to the
successful Mental Illness Research, Education and Clinical
Centers (MIRECCs) is necessary to begin to address TBI in the
VA health care system.
MIRECCs were created by Public Law 104-262, the ``Veterans
Health Care Eligibility Reform Act of 1996.'' There are
currently ten MIRECCs throughout the VA health care system.
Each focuses on different mental illnesses and co-occurring
illnesses. The MIRECCs are involved in discovering the causes
of major mental illnesses and investigating innovative
treatment strategies. The mission of the MIRECCs is to take
treatments that work in research settings and bring those
treatments to the clinical settings for veterans. The MIRECCs
have been a success story in VA and have contributed
significantly in moving forward the research and treatment of
mental illnesses.
Section 302 of Public Law 108-422, the ``Veterans' Health
Programs Improvement Act of 2004,'' required VA to establish
Centers for Research, Education, and Clinical Activities on
Complex Multi-Trauma Associated with Combat Injuries. These
Centers were intended to consolidate a number of VA clinical,
research, and other practices for TBI, blind rehabilitation,
and combat-injury rehabilitation. These Centers became VA's
Polytrauma System of Care.
The Committee strongly recommends that the new TBI
Research, Education and Clinical Activities Centers established
in H.R. 2199 be co-located with VA's Polytrauma Rehabilitation
Centers. This will enable VA to capitalize on the experience
and expertise available at the Polytrauma Centers and enhance
the ability to understand and treat the entire spectrum of TBI
from mild to most severe. Such co-location would further the
Centers' mission to improve research, education, and clinical
activities relating to TBI.
Additionally, the Committee is concerned over the
prevalence of epilepsy among veterans suffering from TBI.
Research conducted by the VA and the Department of Defense
found that slightly more than half of the Vietnam veterans who
suffered penetrating head injuries developed epilepsy. Early
treatment is essential: Although a 1986 study found that the
relative risk of developing epilepsy ten to fifteen years after
injury was still 25 times higher than the normal age-matched
population, 95 percent of patients with a penetrating brain
injury remained seizure-free if they had no seizure during the
first three years after injury. The Committee urges the
Secretary to encourage research into epilepsy and other common
effects of TBI at one or more of these Centers.

COMMITTEE ON CARE OF VETERANS WITH TRAUMATIC BRAIN INJURY

The VA is facing thousands of veterans returning home from
service with mild, moderate and severe TBI. The VA does not
currently have adequate programs and procedures in place to
care for these veterans. The VA is the acknowledged leader in
mental health treatment; the Committee wishes to see the VA
take a leadership role in the care, treatment, and
rehabilitation of veterans with TBI, and to be recognized as a
leader and model in this field.
This Committee on Care of Veterans with TBI, comprised of
VA employees with expertise in TBI, will evaluate the care
veterans receive and identify any systemic problems encountered
in VA facilities regarding TBI care. Additionally, the
Committee on Care of Veterans with TBI would identify
facilities that are exhibiting best practices and share and
disseminate these practices throughout the VA health care
system. The Committee believes that the establishment of a
Committee on Care of Veterans with TBI within the VA system
would play a major role in advancing VA's TBI treatment, care
and research endeavors.

MOBILE VET CENTERS

With the large number of veterans returning from OEF/OIF
residing in rural communities, the Committee believes that the
VA must develop innovative solutions to address the need for
mental health services in areas of the country that the VA may
lack an established infrastructure within which to provide
these services. H.R. 2199 would provide the VA with the
authority to establish a pilot program of mobile Vet Centers in
an effort to provide these services in remote areas. In
addition to providing readjustment counseling and mental health
services, these mobile Vet Centers would also provide veterans
with assistance with claims for benefits and provide
information and outreach concerning veterans' benefits. The
Committee believes that these mobile Vet Centers would provide
a VA presence in our rural communities.

ADVISORY COMMITTEE ON RURAL VETERANS

Of the veterans returning from OEF/OIF, over 40 percent are
from rural communities. These veterans will expect to have the
same quality and access to services that their urban
counterparts enjoy. The prevalence of rural veterans poses
significant problems that the VA must address to meet the
health care needs of these veterans. The Advisory Committee on
Rural Veterans would advise the Secretary on all facets of the
delivery of rural health care. The Advisory Committee
membership would be representative of rural veterans, disabled
rural veterans and experts in the delivery of rural health
care. The Secretary can rely on the Advisory Committee to
provide much-needed guidance and recommendations to the
Secretary on how to best to deliver health services to rural
veterans.

Legislative History

On March 15, 2007, the Subcommittee on Health held a
hearing on TBI and the VA's polytrauma centers. On April 18,
2007, the Subcommittee on Health held a hearing on rural
veterans and access to VA health care and services. On April
26, 2007, the Subcommittee on Health held a hearing on a number
of bills introduced in the 110th Congress, including H.R. 1944
and a Discussion Draft of legislation concerning rural
veterans.
H.R. 2199 contains provisions from H.R. 1944, introduced by
Representative Jason Altmire of Pennsylvania; H.R. 2226,
introduced by Representative Peter Welch of Vermont; H.R. 2201,
introduced by Representative Jerry McNerney of California; H.R.
2179, introduced by Representative Timothy J. Walz of
Minnesota; and H.R. 2190, introduced by Representative Joe
Donnelly of Indiana.
On May 10, 2007, the Subcommittee on Health marked up H.R.
2199, and ordered it reported favorably to the Committee. On
May 15, 2007, the Committee held a markup on a number of bills,
including H.R. 2199. Representative Doug Lamborn of Colorado
offered an amendment to H.R. 2199 that was agreed to by voice
vote. The Committee, by voice vote, ordered H.R. 2199, as
amended, reported favorably to the House of Representatives.

Section-by-Section

Section 1. Short title

This section would provide the short title of H.R. 2199 as
the ``Traumatic Brain Injury Health Enhancement and Long-Term
Support Act of 2007.''

Section 2. Screening, rehabilitation, and treatment for traumatic brain
injury

This section would create a new subchapter IX--Traumatic
Brain Injury in chapter 17 of title 38, United States Code.
The following new sections would be added by subsection (a)
to chapter 17 of title 38, United States Code:
New section 1791 would require the VA to establish a
program to screen veterans for symptoms of TBI. The VA would be
required to submit a report to the Committees on Veterans'
Affairs of the Senate and House of Representatives not later
than one year after enactment, and annually thereafter,
containing the number of veterans screened during the preceding
year; the prevalence of TBI symptoms among veterans screened
under the program; and recommendations for improving care and
services to veterans exhibiting symptoms of TBI.
New section 1792 would require the VA to develop and carry
out a comprehensive program of long-term care for post-acute
TBI rehabilitation that includes residential, community, and
home-based components utilizing interdisciplinary treatment
teams in four geographically dispersed polytrauma network
sites. To be eligible for care under this program, a veteran
would have to be otherwise eligible for VA care; have served on
active duty in a theater of combat operations during a period
of war after the Persian Gulf War, or in combat against a
hostile force during a period of hostilities after November 11,
1998; be diagnosed as suffering from moderate to severe TBI;
and be unable to manage routine activities of daily living
without supervision or assistance. The VA would be required to
submit a report to the Committees on Veterans' Affairs of the
Senate and House of Representatives not later than one year
after enactment, and annually thereafter, containing a
description of the operation of the program; the number of
veterans provided care under this program; and the annual cost
of operating the program.
New section 1793 would require the VA to establish a TBI
transition office at each Department polytrauma network site
for the purposes of coordinating the provision of health care
services to veterans who suffer from moderate to severe TBI and
are in need of health care services not immediately offered by
the VA. These transition offices would be expressly authorized
to arrange for the provision of care and services through
cooperative agreements with public or private entities that
have established long-term neurobehavioral rehabilitation and
recovery programs.
New section 1794 would require the VA to maintain a
registry of individuals who have served in the Armed Forces in
OEF or OIF who have exhibited symptoms associated with TBI, and
to notify individuals on the registry of significant
developments in research on the health consequences of military
service in the OEF and OIF theaters of operations.
New section 1795 would require the VA to establish and
operate not more than five centers for TBI research, education,
and clinical activities to conduct research into TBI; the use
by the VA of specific models for furnishing such care;
education and training of health care professionals of the
Department; and the development and implementation of
innovative clinical activities and systems of care with respect
to the delivery of such care. The Secretary would be required,
upon the recommendation of the Under Secretary for Health, to
designate the centers and to ensure that the centers are
located in various geographic regions. $10,000,000 would be
authorized to be appropriated for fiscal year 2008, and
$20,000,000 for each of fiscal years 2009 through 2011.
New section 1796 would require the VA to establish in the
Veterans Health Administration a Committee on Care of Veterans
with Traumatic Brain Injury. This section would require the
Under Secretary for Health to appoint VA employees with
expertise in the care of veterans with TBI to serve on the
committee. The committee would assess, and carry out a
continuing assessment, of the capability of the Veterans Health
Administration to effectively meet the treatment and
rehabilitation needs of veterans with TBI. The Secretary would
be required to report annually, beginning on June 1, 2008, to
the Committees on Veterans' Affairs of the Senate and House of
Representatives on the committee's membership, assessments, and
recommendations.
Subsection (b) would require the Secretary to implement the
requirements of Subchapter IX of title 38, United States Code,
not later than 180 days after enactment of the Act.

Section 3. Pilot program for delivery of certain services to veterans
through mobile vet centers

This section would add new section 1712C to chapter 17 of
title 38, United States Code, which would require the VA to
establish and carry out a pilot program to provide readjustment
counseling and related mental health services, benefits
outreach, and assistance with claims for benefits through the
use of mobile Vet Centers. The Secretary would be required to
establish two mobile Vet Centers in each of the following
Veterans Integrated Service Networks (VISNs): VISN1; VISN 16;
VISN 19; VISN 20; and VISN 23. The pilot program would operate
for three years, and the Secretary would report to the
Committees on Veterans' Affairs of the Senate and House of
Representatives on the pilot program not later than 90 days
after termination of the pilot program. $7,500,000 would be
authorized to be appropriated for each fiscal year to operate
the pilot program.

Section 4. Advisory committee on rural veterans

This section would add a new section 546 to subchapter III
of chapter 5 of title 38, United States Code, which requires
the Secretary to establish an Advisory Committee on Rural
Veterans to assist the VA in providing benefits and health care
to rural veterans.

Explanation of Amendments

The following amendment was adopted in Committee:
Representative Doug Lamborn of Colorado offered an
amendment to expand the mobile Vet Center pilot program created
in section 3 of H.R. 2199 to include providing benefits
outreach and, as far as practicable, assistance with claims for
benefits.

Committee Consideration

On May 15, 2007, the Committee ordered H.R. 2199, as
amended, reported favorably to the House of Representatives by
voice vote.

Rollcall Votes

The Committee held no rollcall votes on this bill. A motion
to order H.R. 2199, as amended, reported favorably to the House
of Representatives was agreed to by voice vote.

Application of Law to the Legislative Branch

Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch where the bill relates to the terms and conditions of
employment or access to public services and accommodations.
This bill does not relate to employment or access to public
services and accommodations.

Statement of Oversight Findings and Recommendations of the Committee

In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.

Statement of General Performance Goals and Objectives

In accordance with clause (3)(c)(4) of rule XIII of the
Rules of the House of Representatives, the Committee's
performance goals and objectives are reflected in the
descriptive portions of this report.

Constitutional Authority Statement

Under clause 3(d)(1) of rule XIII of the Rules of the House
of Representatives, the Committee must include a statement
citing the specific powers granted to Congress to enact the law
proposed by H.R. 2199. Article 1, Section 8 of the Constitution
of the United States grants Congress the power to enact this
law.

Federal Advisory Committee Act

The Committee finds that the legislation does not establish
or authorize the establishment of an advisory committee within
the definition of 5 U.S.C. App., Section 5(b).

Unfunded Mandate Statement

Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4) requires a statement whether
the provisions of the reported bill include unfunded mandates.
In compliance with this requirement the Committee has received
a letter from the Congressional Budget Office that is included
herein.

Earmark Identification

H.R. 2199, as amended, does not contain any congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9(d), 9(e), or 9(f) of rule XXI of the Rules
of the House of Representatives.

Committee Estimate

Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
H.R. 2199, as amended. However, clause 3(d)(3)(B) of that rule
provides that this requirement does not apply when the
Committee has included in its report a timely submitted cost
estimate of the bill prepared by the Director of the
Congressional Budget Office under Section 402 of the
Congressional Budget Act.

Budget Authority and Congressional Budget Office Cost Estimate

U.S. Congress,
Congressional Budget Office,
Washington, DC, May 22, 2007.
Hon. Bob Filner, Chairman,
Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2199, the
Traumatic Brain Injury Health Enhancement and Long-Term Support
Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Michelle S.
Patterson.
Sincerely,
Peter R. Orszag,
Director.
Enclosure.

H.R. 2199--Traumatic Brain Injury Health Enhancement and Long-Term
Support Act of 2007

Summary: H.R. 2199 would expand the health care available
to veterans with traumatic brain injuries and would create a
pilot program to provide mental health care and services to
veterans in rural areas. CBO estimates that implementing this
bill would cost the Department of Veterans Affairs (VA) $27
million in 2008 and $138 million over the 2008-2012 period,
assuming the appropriation of the necessary amounts. Enacting
the bill would not affect direct spending or revenues.
H.R. 2199 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated Cost to the Federal Government: The estimated
budgetary impact of H.R. 2199 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
Basis of Estimate: For this estimate, CBO assumes the
legislation will be enacted near the end of fiscal year 2007,
that the necessary funds for implementing the bill will be
provided each year, and that the outlays will follow historical
spending patterns for the VA medical services program.
H.R. 2199 would require the Secretary of VA to create
several programs that would enhance the care provided to
veterans with traumatic brain injuries. The bill also would
establish a pilot program that would use mobile centers to
provide counseling and other health services to veterans in
rural areas. CBO estimates that implementing H.R. 2199 would
cost $27 million in 2008 and $138 million over the 2008-2012
period, subject to appropriation of the necessary amounts.

----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------
2007 2008 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level............................. 0 30 36 36 29 9
Estimated Outlays......................................... 0 27 35 36 29 11
----------------------------------------------------------------------------------------------------------------

Traumatic brain injury centers

Section 2 would require VA to establish and operate up to
five centers for research, education, and clinical activities
focused on traumatic brain injury. CBO expects that those
centers would be located within existing VA medical centers and
would be established after a facility submits a proposal to be
designated as a traumatic brain injury center and a peer review
panel determines that the proposal meets certain standards.
H.R. 2199 would authorize the appropriation of $10 million in
2008 and $20 million in each of years 2009 through 2011 to
support those centers. CBO estimates that implementing this
provision would cost $9 million in 2008 and $70 million over
the 2008-2012 period.

Long-term care for traumatic brain injury

Section 2 also would require a program of long-term care,
to include residential facilities, community-based care, and
home-based care for veterans with moderate-to-severe traumatic
brain injuries. The program would be carried out at four VA
medical centers that already specialize in care for
servicemembers with multiple injuries. VA already provides
long-term care for veterans with severe traumatic brain
injuries, either at a VA medical facility, at a state-run
veterans' nursing home, or through contract care provided in
the veteran's community. VA has indicated that it would meet
the requirements of this section by creating four centers that
would specialize in caring for veterans with brain injuries, in
addition to the four centers that already exist. Based on
information from VA regarding the number of employees needed to
staff these centers and the renovation and equipment needed to
establish a center, CBO estimates that implementing this
provision would cost $11 million in 2008 and about $45 million
over the 2008-2012 period, assuming appropriation of the
necessary amounts each year.

Mobile health centers for rural veterans

Section 3 would authorize a three-year pilot program in
which VA would use mobile health centers to provide
readjustment counseling and related health services to veterans
in rural areas. The bill would require the use of two mobile
centers in each of five specific geographic areas. Other mobile
centers could be established if the Secretary determined they
were needed. In addition to counseling and mental health
services, the mobile centers would advise veterans of other
benefits they may be eligible for and, to the extent possible,
would help the veterans to apply for those additional benefits.
H.R. 2199 would authorize the appropriation of $7.5 million
a year for three years to fund the mobile centers. CBO
estimates that implementing this section would cost $7 million
in 2008 and about $22 million over the 2008-2012 period.

Other provisions

Section 2 also would require VA to:
Screen all veterans for signs and symptoms
of traumatic brain injury--which VA has already begun;
Establish a committee to assess VA's
traumatic brain injury programs;
Create a registry of veterans being treated
for traumatic brain injury; and
Establish offices at polytrauma centers to
assist veterans who need care outside of VA.
CBO estimates that implementing those additional provisions
would have an insignificant impact on discretionary spending.
Intergovernmental and private-sector impact: H.R. 2199
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal Costs: Michelle S. Patterson;
Impact on state, local, and tribal governments: Melissa
Merrell; Impact on the private sector: Victoria Liu.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.

Changes in Existing Law Made by the Bill, as Reported

In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italics and existing law in which no change is
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

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PART I--GENERAL PROVISIONS

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CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY

SUBCHAPTER I--GENERAL AUTHORITIES

Sec.
501. Rules and regulations.
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SUBCHAPTER III--ADVISORY COMMITTEES

* * * * * * *
546. Advisory Committee on Rural Veterans.

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SUBCHAPTER III--ADVISORY COMMITTEES

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Sec. 546. Advisory Committee on Rural Veterans

(a) Establishment.--(1) The Secretary shall establish an
advisory committee to be known as the ``Advisory Committee on
Rural Veterans'' (hereinafter in this section referred to as
``the Committee'').
(2)(A) The Committee shall consist of members appointed by
the Secretary from the general public, including--
(i) representatives of rural veterans;
(ii) individuals who are recognized authorities in
fields pertinent to the needs of rural veterans,
including specific or unique health-care needs of rural
veterans and access issues of rural veterans;
(iii) individuals who have expertise in the delivery
of mental health care in rural areas;
(iv) individuals who have expertise in the delivery
of long-term care in rural areas;
(v) at least one veterans service organization
representative from a rural State; and
(vi) representatives of rural veterans with service-
connected disabilities.
(B) The Committee shall include, as ex officio members--
(i) the Secretary of Health and Human Services (or a
representative of the Secretary of Health and Human
Services designated by that Secretary);
(ii) the Director of the Indian Health Service (or a
representative of that Director); and
(iii) the Under Secretary for Health and the Under
Secretary for Benefits, or their designees.
(C) The Secretary may invite representatives of other
departments and agencies of the United States to participate in
the meetings and other activities of the Committee.
(3) The Secretary shall determine the number, terms of
service, and pay and allowances of members of the Committee
appointed by the Secretary, except that a term of service of
any such member may not exceed three years. The Secretary may
reappoint any such member for additional terms of service.
(b) Responsibilities of Committee.--The Secretary shall, on a
regular basis, consult with and seek the advice of the
Committee with respect to the administration of benefits by the
Department for rural veterans, reports and studies pertaining
to rural veterans, and the needs of rural veterans with respect
to primary care, mental health care, and long-term care needs
of rural veterans.
(c) Report.--(1) Not later than September 1 of each odd-
numbered year until 2013, the Committee shall submit to the
Secretary a report on the programs and activities of the
Department that pertain to rural veterans. Each such report
shall include--
(A) an assessment of the needs of rural veterans with
respect to primary care, mental health care, and long-
term care needs of rural veterans and other benefits
and programs administered by the Department;
(B) a review of the programs and activities of the
Department designed to meet such needs; and
(C) such recommendations (including recommendations
for administrative and legislative action) as the
Committee considers appropriate.
(2) The Secretary shall, within 60 days after receiving each
report under paragraph (1), submit to Congress a copy of the
report, together with any comments concerning the report that
the Secretary considers appropriate.
(3) The Committee may also submit to the Secretary such other
reports and recommendations as the Committee considers
appropriate.
(4) The Secretary shall submit with each annual report
submitted to Congress pursuant to section 529 of this title a
summary of all reports and recommendations of the Committee
submitted to the Secretary since the previous annual report of
the Secretary submitted pursuant to that section.

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PART II--GENERAL BENEFITS

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CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
* * * * * * *

SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT

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1712C. Pilot program for delivery of certain services through mobile
Vet Centers.
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SUBCHAPTER IX--TRAUMATIC BRAIN INJURY

1791. Screening for traumatic brain injuries.
1792. Comprehensive program for long-term traumatic brain injury
rehabilitation.
1793. Traumatic brain injury transition offices.
1794. Traumatic brain injury registry.
1795. Centers for traumatic brain injury research, education, and
clinical activities.
1796. Committee on Care of Veterans with Traumatic Brain Injury.
* * * * * * *

* * * * * * *

SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT

* * * * * * *

Sec. 1712C. Pilot program for delivery of certain services through
mobile Vet Centers

(a) Pilot Program.--To improve access to mental health
services in rural areas, the Secretary shall carry out a pilot
program under which the Secretary shall provide readjustment
counseling, related mental health services, benefits outreach,
and, to the extent practicable, assistance with claims for
benefits under this title through the use of mobile centers (as
that term is defined in section 1712A(i)(1)), to be known as
``mobile Vet Centers''. In carrying out the pilot program, the
Secretary shall determine the most effective manner in which to
operate the mobile Vet Centers.
(b) Scope and Location.--(1) The Secretary shall establish
two mobile Vet Centers in each of the following five Veterans
Integrated Service Networks:
(A) Veterans Integrated Service Network 1.
(B) Veterans Integrated Service Network 16.
(C) Veterans Integrated Service Network 19.
(D) Veterans Integrated Service Network 20.
(E) Veterans Integrated Service Network 23.
(2) Within each Veterans Integrated Service Network under
paragraph (1), the Secretary shall determine the area to be
serviced by each mobile Vet Center. In making that
determination, the Secretary shall give priority to areas in
which limited mental health and outreach services are
available.
(3) If the Secretary determines that mobile Vet Centers in
addition to such centers required under paragraph (1) are
warranted, the Secretary may establish additional mobile Vet
Centers and may establish such centers in Veterans Integrated
Service Networks other than the Veterans Integrated Service
Networks referred to in that paragraph. Upon such a
determination by the Secretary, the Secretary shall notify the
Committees on Veterans' Affairs of the Senate and House of
Representatives of such determination.
(c) Termination.--The authority to carry out a pilot program
under this section shall terminate on the date that is three
years after the date of the enactment of this section.
(d) Report.--Not later than 90 days after the date on which
the pilot program terminates under subsection (a), the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on the
pilot program. Such report shall describe how the Secretary
established and carried out the pilot program and include an
evaluation of the Secretary of the benefits and disadvantages
of providing readjustment counseling, related mental health
services, benefits outreach, and claims assistance through the
use of mobile Vets Centers.
(e) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section $7,500,000 for fiscal
year 2008 and each subsequent fiscal year.

* * * * * * *

SUBCHAPTER IX--TRAUMATIC BRAIN INJURY

Sec. 1791. Screening for traumatic brain injuries

(a) Screening Program.--The Secretary shall establish a
program to screen veterans who are eligible for hospital care,
medical services, and nursing home care under section
1710(e)(1)(D) of this title for symptoms of traumatic brain
injury.
(b) Report.--Not later than one year after the date of the
enactment of this section, and annually thereafter, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and the House of Representatives a report
containing the following information:
(1) The number of veterans screened under the program
during the year preceding such report.
(2) The prevalence of traumatic brain injury symptoms
among the veterans screened under the program.
(3) Recommendations for improving care and services
to veterans exhibiting symptoms of traumatic brain
injury.

Sec. 1792. Comprehensive program for long-term traumatic brain injury
rehabilitation

(a) Comprehensive Program.--The Secretary shall develop and
carry out a comprehensive program of long-term care for post-
acute traumatic brain injury rehabilitation that includes
residential, community, and home-based components utilizing
interdisciplinary treatment teams.
(b) Location of Program.--The Secretary shall carry out the
program developed under subsection (a) in four geographically
dispersed polytrauma network sites designated by the Secretary.
(c) Eligibility.--A veteran is eligible for care under the
program developed under subsection (a) if the veteran is
otherwise eligible for care under this chapter and--
(1) served on active duty in a theater of combat
operations (as determined by the Secretary in
consultation with the Secretary of Defense) during a
period of war after the Persian Gulf War, or in combat
against a hostile force during a period of hostilities
(as defined in section 1712A(a)(2)(B) of this title)
after November 11, 1998;
(2) is diagnosed as suffering from moderate to severe
traumatic brain injury; and
(3) is unable to manage routine activities of daily
living without supervision or assistance.
(d) Report.--Not later than one year after the date of the
enactment of this section, and annually thereafter, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and the House of Representatives a report
containing the following information:
(1) A description of the operation of the program.
(2) The number of veterans provided care under the
program during the year preceding such report.
(3) The annual cost of operating the program.

Sec. 1793. Traumatic brain injury transition offices

(a) Establishment.--The Secretary shall establish a traumatic
brain injury transition office at each Department polytrauma
network site for the purposes of coordinating the provision of
health-care and services to veterans who suffer from moderate
to severe traumatic brain injuries and are in need of health-
care and services not immediately offered by the Department.
(b) Cooperative Agreements.--The Secretary, through each such
office established under subsection (a), shall have the
authority to arrange for the provision of health-care and
services through cooperative agreements with appropriate public
or private entities that have established long-term
neurobehavioral rehabilitation and recovery programs.

Sec. 1794. Traumatic brain injury registry

(a) In General.--The Secretary shall establish and maintain a
registry to be known as the ``Traumatic Brain Injury Veterans'
Health Registry'' (in this section referred to as the
``Registry'').
(b) Description.--The Registry shall include the following
information:
(1) A list containing the name of each individual who
served as a member of the Armed Forces in Operation
Enduring Freedom or Operation Iraqi Freedom who
exhibits symptoms associated with traumatic brain
injury and who--
(A) applies for care and services from the
Department under this chapter; or
(B) files a claim for compensation under
chapter 11 of this title on the basis of any
disability which may be associated with such
service; and
(2) any relevant medical data relating to the health
status of an individual described in paragraph (1) and
any other information the Secretary considers relevant
and appropriate with respect to such an individual if
the individual--
(A) grants permission to the Secretary to
include such information in the Registry; or
(B) is deceased at the time such individual
is listed in the Registry.
(c) Notification.--The Secretary shall notify individuals
listed in the Registry of significant developments in research
on the health consequences of military service in the Operation
Enduring Freedom and Operation Iraqi Freedom theaters of
operations.

Sec. 1795. Centers for traumatic brain injury research, education, and
clinical activities

(a) Purpose.--The purpose of this section is to provide for
the improvement of the provision of health care to eligible
veterans with traumatic brain injuries through--
(1) the conduct of research (including research on
improving facilities of the Department concentrating on
traumatic brain injury care and on improving the
delivery of traumatic brain injury care by the
Department);
(2) the education and training of health care
personnel of the Department; and
(3) the development of improved models and systems
for the furnishing of traumatic brain injury care by
the Department.
(b) Establishment of Centers.--(1) The Secretary shall
establish and operate centers for traumatic brain injury
research, education, and clinical activities. Such centers
shall be established and operated by collaborating Department
facilities as provided in subsection (c)(1). Each such center
shall function as a center for--
(A) research on traumatic brain injury;
(B) the use by the Department of specific models for
furnishing traumatic brain injury care;
(C) education and training of health-care
professionals of the Department; and
(D) the development and implementation of innovative
clinical activities and systems of care with respect to
the delivery of traumatic brain injury care by the
Department.
(2) The Secretary shall, upon the recommendation of the Under
Secretary for Health, designate the centers under this section.
In making such designations, the Secretary shall ensure that
the centers designated are located in various geographic
regions of the United States. The Secretary may designate a
center under this section only if--
(A) the proposal submitted for the designation of the
center meets the requirements of subsection (c);
(B) the Secretary makes the finding described in
subsection (d); and
(C) the peer review panel established under
subsection (e) makes the determination specified in
subsection (e)(3) with respect to that proposal.
(3) Not more than five centers may be designated under this
section.
(4) The authority of the Secretary to establish and operate
centers under this section is subject to the appropriation of
funds for that purpose.
(c) Proposals for Designation of Centers.--A proposal
submitted for the designation of a center under this section
shall--
(1) provide for close collaboration in the
establishment and operation of the center, and for the
provision of care and the conduct of research and
education at the center, by a Department facility or
facilities in the same geographic area which have a
mission centered on traumatic brain injury care and a
Department facility in that area which has a mission of
providing tertiary medical care;
(2) provide that no less than 50 percent of the funds
appropriated for the center for support of clinical
care, research, and education will be provided to the
collaborating facility or facilities that have a
mission centered on traumatic brain injury care; and
(3) provide for a governance arrangement between the
collaborating Department facilities which ensures that
the center will be established and operated in a manner
aimed at improving the quality of traumatic brain
injury care at the collaborating facility or facilities
which have a mission centered on traumatic brain injury
care.
(d) Finding of Secretary.--The finding referred to in
subsection (b)(2)(B) with respect to a proposal for designation
of a site as a location of a center under this section is a
finding by the Secretary, upon the recommendation of the Under
Secretary for Health, that the facilities submitting the
proposal have developed (or may reasonably be anticipated to
develop) each of the following:
(1) An arrangement with an accredited medical school
that provides education and training in traumatic brain
injury care and with which one or more of the
participating Department facilities is affiliated under
which medical residents receive education and training
in traumatic brain injury care through regular rotation
through the participating Department facilities so as
to provide such residents with training in the
diagnosis and treatment of traumatic brain injury.
(2) An arrangement under which nursing, social work,
counseling, or allied health personnel receive training
and education in traumatic brain injury care through
regular rotation through the participating Department
facilities.
(3) The ability to attract scientists who have
demonstrated achievement in research--
(A) into the evaluation of innovative
approaches to the design of traumatic brain
injury care; or
(B) into the causes, prevention, and
treatment of traumatic brain injury.
(4) The capability to evaluate effectively the
activities of the center, including activities relating
to the evaluation of specific efforts to improve the
quality and effectiveness of traumatic brain injury
care provided by the Department at or through
individual facilities.
(e) Peer Review Panel.--(1) In order to provide advice to
assist the Secretary and the Under Secretary for Health to
carry out their responsibilities under this section, the
official within the central office of the Veterans Health
Administration responsible for traumatic brain injury care
shall establish a peer review panel to assess the scientific
and clinical merit of proposals that are submitted to the
Secretary for the designation of centers under this section.
(2) The panel shall consist of experts in the fields of
traumatic brain injury research, education and training, and
clinical care. Members of the panel shall serve as consultants
to the Department.
(3) The panel shall review each proposal submitted to the
panel by the official referred to in paragraph (1) and shall
submit to that official its views on the relative scientific
and clinical merit of each such proposal. The panel shall
specifically determine with respect to each such proposal
whether that proposal is among those proposals which have met
the highest competitive standards of scientific and clinical
merit.
(4) The panel shall not be subject to the Federal Advisory
Committee Act (5 U.S.C. App.).
(f) Award of Funding.--Clinical and scientific investigation
activities at each center established under this section--
(1) may compete for the award of funding from amounts
appropriated for the Department of Veterans Affairs
medical and prosthetics research account; and
(2) shall receive priority in the award of funding
from such account insofar as funds are awarded to
projects and activities relating to traumatic brain
injury.
(g) Dissemination of Useful Information.--The Under Secretary
for Health shall ensure that information produced by the
research, education and training, and clinical activities of
centers established under this section that may be useful for
other activities of the Veterans Health Administration is
disseminated throughout the Veterans Health Administration.
Such dissemination shall be made through publications, through
programs of continuing medical and related education provided
through regional medical education centers under subchapter VI
of chapter 74 of this title, and through other means. Such
programs of continuing medical education shall receive priority
in the award of funding.
(h) Supervision of Centers.--The official within the central
office of the Veterans Health Administration responsible for
traumatic brain injury care shall be responsible for
supervising the operation of the centers established pursuant
to this section and shall provide for ongoing evaluation of the
centers and their compliance with the requirements of this
section.
(i) Authorization of Appropriations.--(1) There are
authorized to be appropriated to the Department of Veterans
Affairs for the basic support of the research and education and
training activities of centers established pursuant to this
section such sums as may be necessary.
(2) In addition to funds appropriated for a fiscal year
pursuant to the authorization of appropriations in paragraph
(1), the Under Secretary for Health shall allocate to such
centers from other funds appropriated for that fiscal year
generally for the Department of Veterans Affairs medical
services account and the Department of Veterans Affairs medical
and prosthetics research account such amounts as the Under
Secretary for Health determines appropriate to carry out the
purposes of this section.
(j) Annual Reports.--Not later than February 1 of each of
year, the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the status and activities of the
centers for traumatic brain injury research, education, and
clinical activities during the preceding fiscal year. Each such
report shall include the following:
(1) A description of the activities carried out at
each center and the funding provided by the Department
for such activities.
(2) A description of the advances made at each of the
participating facilities of the center in research,
education and training, and clinical activities
relating to traumatic brain injury care and treatment.
(3) A description of the actions taken by the Under
Secretary for Health pursuant to subsection (g) to
disseminate information derived from such activities
throughout the Veterans Health Administration.
(4) The evaluation of the Secretary as to the
effectiveness of the centers in fulfilling the purposes
of this section.
(k) Authorization of Appropriations.--(1) There are
authorized to be appropriated to the Department of Veterans
Affairs for the basic support of the research and education and
training activities of centers established pursuant to this
section amounts as follows:
(A) $10,000,000 for fiscal year 2008.
(B) $20,000,000 for each of fiscal years 2009 through
2011.
(2) In addition to funds appropriated for a fiscal year
pursuant to the authorization of appropriations in paragraph
(1), the Under Secretary for Health shall allocate to such
centers from other funds appropriated for that fiscal year
generally for the Department of Veterans Affairs medical
services account and the Department of Veterans Affairs medical
and prosthetics research account such amounts as the Under
Secretary for Health determines appropriate to carry out the
purposes of this section.

Sec. 1796. Committee on Care of Veterans with Traumatic Brain Injury

(a) Establishment.--The Secretary shall establish in the
Veterans Health Administration a committee to be known as the
``Committee on Care of Veterans with Traumatic Brain Injury''.
The Under Secretary for Health shall appoint employees of the
Department with expertise in the care of veterans with
traumatic brain injury to serve on the committee.
(b) Responsibilities of Committee.--The committee shall
assess, and carry out a continuing assessment of, the
capability of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of veterans
with traumatic brain injury. In carrying out that
responsibility, the committee shall--
(1) evaluate the care provided to such veterans
through the Veterans Health Administration;
(2) identify systemwide problems in caring for such
veterans in facilities of the Veterans Health
Administration;
(3) identify specific facilities within the Veterans
Health Administration at which program enrichment is
needed to improve treatment and rehabilitation of such
veterans; and
(4) identify model programs which the committee
considers to have been successful in the treatment and
rehabilitation of such veterans and which should be
implemented more widely in or through facilities of the
Veterans Health Administration.
(c) Advice and Recommendations.--The committee shall--
(1) advise the Under Secretary regarding the
development of policies for the care and rehabilitation
of veterans with traumatic brain injury; and
(2) make recommendations to the Under Secretary--
(A) for improving programs of care of such
veterans at specific facilities and throughout
the Veterans Health Administration;
(B) for establishing special programs of
education and training relevant to the care of
such veterans for employees of the Veterans
Health Administration;
(C) regarding research needs and priorities
relevant to the care of such veterans; and
(D) regarding the appropriate allocation of
resources for all such activities.
(d) Annual Report.--Not later than June 1 of 2008, and each
subsequent year, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives
a report on the implementation of this section. Each such
report shall include the following for the calendar year
preceding the year in which the report is submitted:
(1) A list of the members of the committee.
(2) The assessment of the Under Secretary for Health,
after review of the initial findings of the committee,
regarding the capability of the Veterans Health
Administration, on a systemwide and facility-by-
facility basis, to meet effectively the treatment and
rehabilitation needs of veterans with traumatic brain
injury.
(3) The plans of the committee for further
assessments.
(4) The findings and recommendations made by the
committee to the Under Secretary for Health and the
views of the Under Secretary on such findings and
recommendations.
(5) A description of the steps taken, plans made (and
a timetable for the execution of such plans), and
resources to be applied toward improving the capability
of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of
veterans with traumatic brain injury.

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