[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.
     * * * * * * *

                   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

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

                  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.

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                 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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