[House Report 110-68]
[From the U.S. Government Publishing Office]
110th Congress
1st Session HOUSE OF REPRESENTATIVES Rept. 110-68
Part 1
_______________________________________________________________________
WOUNDED WARRIOR ASSISTANCE ACT OF 2007
__________
R E P O R T
of the
COMMITTEE ON ARMED SERVICES
HOUSE OF REPRESENTATIVES
on
H.R. 1538
together with
ADDITIONAL VIEWS
[Including cost estimate of the Congressional Budget Office]
[GRAPHIC NOT AVAIABLE IN TIFF FORMAT]
March 23, 2007.--Ordered to be printed
U.S. GOVERNMENT PRINTING OFFICE
59-006 WASHINGTON : 2007
HOUSE COMMITTEE ON ARMED SERVICES
One Hundred Tenth Congress
IKE SKELTON, Missouri, Chairman
JOHN SPRATT, South Carolina DUNCAN HUNTER, California
SOLOMON P. ORTIZ, Texas JIM SAXTON, New Jersey
GENE TAYLOR, Mississippi JOHN M. McHUGH, New York
NEIL ABERCROMBIE, Hawaii TERRY EVERETT, Alabama
MARTY MEEHAN, Massachusetts ROSCOE G. BARTLETT, Maryland
SILVESTRE REYES, Texas HOWARD P. ``BUCK'' McKEON,
VIC SNYDER, Arkansas California
ADAM SMITH, Washington MAC THORNBERRY, Texas
LORETTA SANCHEZ, California WALTER B. JONES, North Carolina
MIKE McINTYRE, North Carolina ROBIN HAYES, North Carolina
ELLEN O. TAUSCHER, California KEN CALVERT, California
ROBERT A. BRADY, Pennsylvania JO ANN DAVIS, Virginia
ROBERT ANDREWS, New Jersey W. TODD AKIN, Missouri
SUSAN A. DAVIS, California J. RANDY FORBES, Virginia
RICK LARSEN, Washington JEFF MILLER, Florida
JIM COOPER, Tennessee JOE WILSON, South Carolina
JIM MARSHALL, Georgia FRANK A. LoBIONDO, New Jersey
MADELEINE Z. BORDALLO, Guam TOM COLE, Oklahoma
MARK UDALL, Colorado ROB BISHOP, Utah
DAN BOREN, Oklahoma MICHAEL TURNER, Ohio
BRAD ELLSWORTH, Indiana JOHN KLINE, Minnesota
NANCY BOYDA, Kansas CANDICE S. MILLER, Michigan
PATRICK J. MURPHY, Pennsylvania PHIL GINGREY, Georgia
HANK JOHNSON, Georgia MIKE ROGERS, Alabama
CAROL SHEA-PORTER, New Hampshire TRENT FRANKS, Arizona
JOE COURTNEY, Connecticut THELMA DRAKE, Virginia
DAVID LOEBSACK, Iowa CATHY McMORRIS RODGERS, Washington
KIRSTEN GILLIBRAND, New York K. MICHAEL CONAWAY, Texas
JOE SESTAK, Pennsylvania GEOFF DAVIS, Kentucky
GABRIELLE GIFFORDS, Arizona
ELIJAH E. CUMMINGS, Maryland
KENDRICK B. MEEK, Florida
KATHY CASTOR, Florida
Erin Conaton, Staff Director
C O N T E N T S
----------
Page
Purpose and Background........................................... 13
Legislative History.............................................. 14
Hearings......................................................... 14
Section-by-Section Analysis...................................... 14
Section 1.--Short Title; Table of Contents................... 14
Section 2.--Definitions...................................... 15
TITLE I--WOUNDED WARRIOR ASSISTANCE.............................. 15
ITEM OF SPECIAL INTEREST....................................... 15
Report on Army Infrastructure Requirements............... 15
LEGISLATIVE PROVISIONS......................................... 15
Section 101.--Improvements to Medical and Dental Care for
Members of the Armed Forces Assigned to Hospitals in an
Outpatient Status.......................................... 15
Section 102.--Establishment of Toll-Free Hot Line for
Reporting Deficiencies in Medical-Related Support
Facilities and Expedited Response to Reports of
Deficiencies............................................... 15
Section 103.--Notification to Congress of Hospitalization of
Combat Wounded Service Members............................. 16
Section 104.--Independent Medical Advocate for Members Before
Medical Evaluation Boards.................................. 16
Section 105.--Training and Workload for Physical Evaluation
Board Liaison Officers..................................... 16
Section 106.--Standardized Training Program and Curriculum
for Department of Defense Disability Evaluation System..... 16
Section 107.--Improved Training for Health Care
Professionals, Medical Care Case Managers, and Service
Member Advocates on Particular Conditions of Recovering
Service Members............................................ 16
Section 108.--Pilot Program to Establish an Army Wounded
Warrior Battalion at an Appropriate Active Duty Base....... 16
Section 109.--Criteria for Removal of Member From Temporary
Disability Retired List.................................... 17
Section 110.--Improved Transition of Members of the Armed
Forces to Department of Veterans Affairs Upon Retirement or
Separation................................................. 17
Section 111.--Establishment of Medical Support Fund for
Support of Members of the Armed Forces Returning to
Military Service or Civilian Life.......................... 17
Section 112.--Oversight Board for Wounded Warriors........... 17
TITLE II--STUDIES AND REPORTS.................................... 17
LEGISLATIVE PROVISIONS......................................... 17
Section 201.--Annual Report on Military Medical Facilities... 17
Section 202.--Access of Recovering Service Members to
Adequate Outpatient Residential Facilities................. 18
Section 203.--Evaluation and Report on Department of Defense
and Department of Veterans Affairs Disability Evaluation
Systems.................................................... 18
Section 204.--Study and Report on Support Services for
Families of Recovering Service Members..................... 18
Section 205.--Report on Traumatic Brain Injury
Classifications............................................ 18
Section 206.--Evaluation of the Polytrauma Liaison Officer/
Non-Commissioned Officer Program........................... 18
TITLE III--GENERAL PROVISIONS.................................... 19
LEGISLATIVE PROVISIONS......................................... 19
Section 301.--Moratorium on Conversion to Contractor
Performance of Department of Defense Functions at Military
Medical Facilities......................................... 19
Section 302.--Prohibition on Transfer of Resources From
Medical Care............................................... 19
Section 303.--Increase in Physicians at Hospitals of the
Department of Veterans Affairs............................. 19
Communications from other Committees............................. 19
Committee Position............................................... 21
Congressional Budget Office Estimate............................. 21
Committee Cost Estimate.......................................... 26
Oversight Findings............................................... 26
Constitutional Authority Statement............................... 26
Earmarks......................................................... 26
Statement of Federal Mandates.................................... 27
Record Votes..................................................... 27
Changes in Existing Law Made by the Bill, as Reported............ 30
Additional Views................................................. 39
Additional views of Solomon P. Ortiz........................... 39
110th Congress Rept. 110-68
HOUSE OF REPRESENTATIVES
1st Session Part 1
======================================================================
WOUNDED WARRIOR ASSISTANCE ACT OF 2007
_______
March 23, 2007.--Ordered to be printed
_______
Mr. Skelton, from the Committee on Armed Services, submitted the
following
R E P O R T
together with
ADDITIONAL VIEWS
[To accompany H.R. 1538]
[Including cost estimate of the Congressional Budget Office]
The Committee on Armed Services, to whom was referred the
bill (H.R. 1538) to amend title 10, United States Code, to
improve the management of medical care, personnel actions, and
quality of life issues for members of the Armed Forces who are
receiving medical care in an outpatient status, and for other
purposes, having considered the same, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Wounded Warrior
Assistance Act of 2007''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--WOUNDED WARRIOR ASSISTANCE
Sec. 101. Improvements to medical and dental care for members of the
Armed Forces assigned to hospitals in an outpatient status.
Sec. 102. Establishment of toll-free hot line for reporting
deficiencies in medical-related support facilities and expedited
response to reports of deficiencies.
Sec. 103. Notification to Congress of hospitalization of combat wounded
service members.
Sec. 104. Independent medical advocate for members before medical
evaluation boards.
Sec. 105. Training and workload for physical evaluation board liaison
officers.
Sec. 106. Standardized training program and curriculum for Department
of Defense disability evaluation system.
Sec. 107. Improved training for health care professionals, medical care
case managers, and service member advocates on particular conditions of
recovering service members.
Sec. 108. Pilot program to establish an Army Wounded Warrior Battalion
at an appropriate active duty base.
Sec. 109. Criteria for removal of member from temporary disability
retired list.
Sec. 110. Improved transition of members of the Armed Forces to
Department of Veterans Affairs upon retirement or separation.
Sec. 111. Establishment of Medical Support Fund for support of members
of the Armed Forces returning to military service or civilian life.
Sec. 112. Oversight Board for Wounded Warriors.
TITLE II--STUDIES AND REPORTS
Sec. 201. Annual report on military medical facilities.
Sec. 202. Access of recovering service members to adequate outpatient
residential facilities.
Sec. 203. Evaluation and report on Department of Defense and Department
of Veterans Affairs disability evaluation systems.
Sec. 204. Study and report on support services for families of
recovering service members.
Sec. 205. Report on traumatic brain injury classifications.
Sec. 206. Evaluation of the Polytrauma Liaison Officer/Non-Commissioned
Officer Program.
TITLE III--GENERAL PROVISIONS
Sec. 301. Moratorium on conversion to contractor performance of
Department of Defense functions at military medical facilities.
Sec. 302. Prohibition on transfer of resources from medical care.
Sec. 303. Increase in physicians at hospitals of the Department of
Veterans Affairs.
SEC. 2. DEFINITIONS.
In this Act:
(1) Congressional defense committees.--The term
``congressional defense committees'' has the meaning given that
term in section 101(a)(16) of title 10, United States Code.
(2) Disability evaluation system.--The term ``disability
evaluation system'' means the Department of Defense system or
process for evaluating the nature of and extent of disabilities
affecting members of the armed forces (other than the Coast
Guard) and comprised of medical evaluation boards, physical
evaluation boards, counseling of members, and final disposition
by appropriate personnel authorities, as operated by the
Secretaries of the military departments, and, in the case of
the Coast Guard, a similar system or process operated by the
Secretary of Homeland Security.
(3) Family member.--The term ``family member'', with respect
to a recovering service member, has the meaning given that term
in section 411h(b) of title 37, United States Code.
(4) Recovering service member.--The term ``recovering service
member'' means a member of the Armed Forces, including a member
of the National Guard or a Reserve, who is undergoing medical
treatment, recuperation, or therapy, or is otherwise in medical
hold or holdover status, for an injury, illness, or disease
incurred or aggravated while on active duty in the Armed
Forces.
TITLE I--WOUNDED WARRIOR ASSISTANCE
SEC. 101. IMPROVEMENTS TO MEDICAL AND DENTAL CARE FOR MEMBERS OF THE
ARMED FORCES ASSIGNED TO HOSPITALS IN AN OUTPATIENT
STATUS.
(a) Medical and Dental Care of Members Assigned to Hospitals in an
Outpatient Status.--
(1) In general.--Chapter 55 of title 10, United States Code,
is amended by inserting after section 1074k the following new
section:
``Sec. 1074l. Management of medical and dental care: members assigned
to receive care in an outpatient status
``(a) Medical Care Case Managers.--(1) A member in an outpatient
status at a military medical treatment facility shall be assigned a
medical care case manager.
``(2)(A) The duties of the medical care case manager shall include
the following with respect to the member (or the member's immediate
family if the member is incapable of making judgments about personal
medical care):
``(i) To assist in understanding the member's medical status.
``(ii) To assist in receiving prescribed medical care.
``(iii) To conduct a review, at least once a week, of the
member's medical status.
``(B) The weekly medical status review described in subparagraph
(A)(iii) shall be conducted in person with the member. If such a review
is not practicable, the medical care case manager shall provide a
written statement to the case manager's supervisor indicating why an
in-person medical status review was not possible.
``(3)(A) Except as provided in subparagraph (B), each medical care
case manager shall be assigned to manage not more than 17 members in an
outpatient status.
``(B) The Secretary concerned may waive for up to 120 days the
requirement of subparagraph (A) if required due to unforeseen
circumstances.
``(4)(A) The medical care case manager office at each facility shall
be headed by a commissioned officer of appropriate rank and appropriate
military occupation specialty, designator, or specialty code.
``(B) For purposes of subparagraph (A), an appropriate military
occupation specialty, designator, or specialty code includes membership
in the Army Medical Corps, Army Medical Service Corps, Army Nurse
Corps, Navy Medical Corps, Navy Medical Service Corps, Navy Nurse
Corps, or Air Force Medical Service.
``(5) The Secretary of Defense shall establish a standard training
program and curriculum for medical care case managers. Successful
completion of the training program is required before a person may
assume the duties of a medical care case manager.
``(b) Service Member Advocate.--(1) A member in an outpatient status
shall be assigned a service member advocate.
``(2) The duties of the service member advocate shall include--
``(A) communicating with the member and with the member's
family or other individuals designated by the member;
``(B) assisting with oversight of the member's welfare and
quality of life; and
``(C) assisting the member in resolving problems involving
financial, administrative, personnel, transitional, and other
matters.
``(3)(A) Except as provided in subparagraph (B), each service member
advocate shall be assigned to not more than 30 members in an outpatient
status.
``(B) The Secretary concerned may waive for up to 120 days the
requirement of subparagraph (A) if required due to unforeseen
circumstances.
``(4) The service member advocate office at each facility shall be
headed by a commissioned officer of appropriate rank and appropriate
military occupation specialty, designator, or specialty code in order
to handle service-specific personnel and financial issues.
``(5) The Secretary of Defense shall establish a standard training
program and curriculum for service member advocates. Successful
completion of the training program is required before a person may
assume the duties of a service member advocate.
``(6) A service member advocate shall continue to perform the duties
described in paragraph (2) with respect to a member until the member is
returned to duty or separated or retired from the armed forces.
``(c) Semiannual Surveys by Secretaries Concerned.--The Secretary
concerned shall conduct a semiannual survey of members in an outpatient
status at installations under the Secretary's supervision. The survey
shall include, at a minimum, the members' assessment of the quality of
medical care at the facility, the timeliness of medical care at the
facility, the adequacy of living facilities and other quality of life
programs, the adequacy of case management support, and the fairness and
timeliness of the physical disability evaluation system. The survey
shall be conducted in coordination with installation medical commanders
and authorities, and shall be coordinated with such commanders and
authorities before submission to the Secretary.
``(d) Definitions.--In this section:
``(1) The term `member in an outpatient status' means a
member of the armed forces assigned to a military medical
treatment facility as an outpatient or to a unit established
for the purpose of providing command and control of members
receiving medical care as outpatients.
``(2) The term `disability evaluation system' means the
Department of Defense system or process for evaluating the
nature of and extent of disabilities affecting members of the
armed forces (other than the Coast Guard) and comprised of
medical evaluation boards, physical evaluation boards,
counseling of members, and final disposition by appropriate
personnel authorities, as operated by the Secretaries of the
military departments, and, in the case of the Coast Guard, a
similar system or process operated by the Secretary of Homeland
Security.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:
``1074l. Management of medical and dental care: members assigned to
receive care in an outpatient status.''.
(b) Effective Date.--Section 1074l of title 10, United States Code,
as added by subsection (a), shall take effect 180 days after the date
of the enactment of this Act.
SEC. 102. ESTABLISHMENT OF TOLL-FREE HOT LINE FOR REPORTING
DEFICIENCIES IN MEDICAL-RELATED SUPPORT FACILITIES
AND EXPEDITED RESPONSE TO REPORTS OF DEFICIENCIES.
(a) Establishment.--Chapter 80 of title 10, United States Code, is
amended by adding at the end the following new section:
``Sec. 1567. Identification and investigation of deficiencies in
adequacy, quality, and state of repair of medical-
related support facilities
``(a) Toll-Free Hot Line.--The Secretary of Defense shall establish
and maintain a toll-free telephone number (commonly referred to as a
`hot line') at which personnel are accessible at all times to collect,
maintain, and update information regarding possible deficiencies in the
adequacy, quality, and state of repair of medical-related support
facilities. The Secretary shall widely disseminate information
regarding the existence and availability of the toll-free telephone
number to members of the armed forces and their dependents.
``(b) Investigation and Response Plan.--Not later than 96 hours after
a report of deficiencies in the adequacy, quality, or state of repair
of a medical-related support facility is received by way of the toll-
free telephone number or other source, the Secretary of Defense shall
ensure that--
``(1) the deficiencies referred to in the report are
investigated; and
``(2) if substantiated, a plan of action for remediation of
the deficiencies is developed and implemented.
``(c) Relocation.--If the Secretary of Defense determines, on the
basis of the investigation conducted in response to a report of
deficiencies at a medical-related support facility, that conditions at
the facility violate health and safety standards, the Secretary shall
relocate the occupants of the facility while the violations are
corrected.
``(d) Medical-Related Support Facility Defined.--In this section, the
term `medical-related support facility' means any facility of the
Department of Defense that provides support to any of the following:
``(1) Members of the armed forces admitted for treatment to a
military medical treatment facility.
``(2) Members of the armed forces assigned to a military
medical treatment facility as an outpatient.
``(3) Family members accompanying any member described in
paragraph (1) or (2) as a nonmedical attendant.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding at the end the following new item:
``1567. Identification and investigation of deficiencies in adequacy,
quality, and state of repair of medical-related support facilities.''.
(c) Effective Date.--The toll-free telephone number required to be
established by section 1567 of title 10, United States Code, as added
by subsection (a), shall be fully operational not later than 180 days
after the date of the enactment of this Act.
SEC. 103. NOTIFICATION TO CONGRESS OF HOSPITALIZATION OF COMBAT WOUNDED
SERVICE MEMBERS.
(a) Notification Required.--Chapter 55 of title 10, United States
Code, is further amended by inserting after section 1074l the following
new section:
``Sec. 1074m. Notification to Congress of hospitalization of combat
wounded members
``(a) Notification Required.--The Secretary concerned shall provide
notification of the hospitalization of any member of the armed forces
evacuated from a theater of combat to the appropriate Members of
Congress.
``(b) Appropriate Members.--In this section, the term `appropriate
Members of Congress', with respect to the member of the armed forces
about whom notification is being made, means the Senators and the
Members of the House of Representatives representing the States or
districts, respectively, that include the member's home of record and,
if different, the residence of the next of kin, or a different location
as provided by the member.
``(c) Consent of Member Required.--The notification under subsection
(a) may be provided only with the consent of the member of the armed
forces about whom notification is to be made. In the case of a member
who is unable to provide consent, information and consent may be
provided by next of kin.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding at the end the following new item:
``1074m. Notification to Congress of hospitalization of combat wounded
members.''.
SEC. 104. INDEPENDENT MEDICAL ADVOCATE FOR MEMBERS BEFORE MEDICAL
EVALUATION BOARDS.
(a) Assignment of Independent Medical Advocate.--Section 1222 of
title 10, United States Code, is amended by adding at the end the
following new subsection:
``(d) Independent Medical Advocate for Members Before Medical
Evaluation Boards.--(1) The Secretary of each military department shall
ensure, in the case of any member of the armed forces being considered
by a medical evaluation board under that Secretary's supervision, that
the member has access to a physician or other appropriate health care
professional who is independent of the medical evaluation board.
``(2) The physician or other health care professional assigned to a
member shall--
``(A) serve as an advocate for the best interests of the
member; and
``(B) provide the member with advice and counsel regarding
the medical condition of the member and the findings and
recommendations of the medical evaluation board.''.
(b) Clerical Amendments.--
(1) Section heading.--The heading of such section is amended
to read as follows:
``Sec. 1222. Physical evaluation boards and medical evaluation
boards''.
(2) Table of sections.--The table of sections at the
beginning of chapter 61 of such title is amended by striking
the item relating to section 1222 and inserting the following
new item:
``1222. Physical evaluation boards and medical evaluation boards.''.
(c) Effective Date.--Subsection (d) of section 1222 of title 10,
United States Code, as added by subsection (a), shall apply with
respect to medical evaluation boards convened after the end of the 180-
day period beginning on the date of the enactment of this Act.
SEC. 105. TRAINING AND WORKLOAD FOR PHYSICAL EVALUATION BOARD LIAISON
OFFICERS.
(a) Requirements.--Section 1222(b) of title 10, United States Code,
is amended--
(1) in paragraph (1)--
(A) by striking ``establishing--'' and all that
follows through ``a requirement'' and inserting
``establishing a requirement''; and
(B) by striking ``that Secretary; and'' and all that
follows through the end of subparagraph (B) and
inserting ``that Secretary. A physical evaluation board
liaison officer may not be assigned more than 20
members at any one time, except that the Secretary
concerned may authorize the assignment of additional
members, for not more than 120 days, if required due to
unforeseen circumstances.'';
(2) in paragraph (2), by inserting after ``(2)'' the
following new sentences: ``The Secretary of Defense shall
establish a standardized training program and curriculum for
physical evaluation board liaison officers. Successful
completion of the training program is required before a person
may assume the duties of a physical evaluation board liaison
officer.''; and
(3) by adding at the end the following new paragraph:
``(3) In this subsection, the term `physical evaluation board liaison
officer' includes any person designated as, or assigned the duties of,
an assistant to a physical evaluation board liaison officer.''.
(b) Effective Date.--The limitation on the maximum number of members
of the Armed Forces who may be assigned to a physical evaluation board
liaison officer shall take effect 180 days after the date of the
enactment of this Act. The training program and curriculum for physical
evaluation board liaison officers shall be implemented not later than
180 days after the date of the enactment of this Act.
SEC. 106. STANDARDIZED TRAINING PROGRAM AND CURRICULUM FOR DEPARTMENT
OF DEFENSE DISABILITY EVALUATION SYSTEM.
(a) Training Program Required.--Section 1216 of title 10, United
States Code, is amended by adding at the end the following new
subsection:
``(e)(1) The Secretary of Defense shall establish a standardized
training program and curriculum for persons described in paragraph (2)
who are involved in the disability evaluation system. The training
under the program shall be provided as soon as practicable in
coordination with other training associated with the responsibilities
of the person.
``(2) Persons covered by paragraph (1) include--
``(A) Commanders.
``(B) Enlisted members who perform supervisory functions.
``(C) Health care professionals.
``(D) Others persons with administrative, professional, or
technical responsibilities in the disability evaluation system.
``(3) In this subsection, the term `disability evaluation system'
means the Department of Defense system or process for evaluating the
nature of and extent of disabilities affecting members of the armed
forces (other than the Coast Guard) and comprised of medical evaluation
boards, physical evaluation boards, counseling of members, and final
disposition by appropriate personnel authorities, as operated by the
Secretaries of the military departments, and, in the case of the Coast
Guard, a similar system or process operated by the Secretary of
Homeland Security.''.
(b) Effective Date.--The standardized training program and curriculum
required by subsection (e) of section 1216 of title 10, United States
Code, as added by subsection (a), shall be established not later than
180 days after the date of the enactment of this Act.
SEC. 107. IMPROVED TRAINING FOR HEALTH CARE PROFESSIONALS, MEDICAL CARE
CASE MANAGERS, AND SERVICE MEMBER ADVOCATES ON
PARTICULAR CONDITIONS OF RECOVERING SERVICE
MEMBERS.
(a) Recommendations.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to the
appropriate congressional committees a report setting forth
recommendations for the modification of the training provided to health
care professionals, medical care case managers, and service member
advocates who provide care for or assistance to recovering service
members. The recommendations shall include, at a minimum, specific
recommendations to ensure that such health care professionals, medical
care case managers, and service member advocates are able to detect
early warning signs of post-traumatic stress disorder (PTSD), suicidal
tendencies, and other mental health conditions among recovering service
members, and make prompt notification to the appropriate health care
professionals.
(b) Annual Review of Training.--Not later than 180 days after the
date of the enactment of this Act and annually thereafter throughout
the global war on terror, the Secretary shall submit to the appropriate
congressional committees a report on the following:
(1) The progress made in providing the training recommended
under subsection (a).
(2) The quality of training provided to health care
professionals, medical care case managers, and service member
advocates, and the number of such professionals, managers, and
advocates trained.
(c) Tracking System.--The Secretary shall develop a system to track
the number of notifications made by medical care case managers and
service member advocates to health care professionals regarding early
warning signs of post-traumatic stress disorder and suicide in
recovering service members assigned to the managers and advocates.
SEC. 108. PILOT PROGRAM TO ESTABLISH AN ARMY WOUNDED WARRIOR BATTALION
AT AN APPROPRIATE ACTIVE DUTY BASE.
(a) Pilot Program Required.--
(1) Establishment.--The Secretary of the Army shall establish
a pilot program, at an appropriate active duty base with a
major medical facility, based on the Wounded Warrior Regiment
program of the Marine Corps. The pilot program shall be known
as the Army Wounded Warrior Battalion.
(2) Purpose.--Under the pilot program, the Battalion shall
track and assist members of the Armed Forces in an outpatient
status who are still in need of medical treatment through--
(A) the course of their treatment;
(B) medical and physical evaluation boards;
(C) transition back to their parent units; and
(D) medical retirement and subsequent transition into
the Department of Veterans Affairs medical system.
(3) Organization.--The commanding officer of the Battalion
shall be selected by the Army Chief of Staff and shall be a
post-command, at O-5 or O-5 select, with combat experience in
Operation Iraqi Freedom or Operation Enduring Freedom. The
chain-of-command shall be filled by previously wounded junior
officers and non-commissioned officers when available and
appropriate.
(4) Facilities.--The base selected for the pilot program
shall provide adequate physical infrastructure to house the
Army Wounded Warrior Battalion. Any funds necessary for
construction or renovation of existing facilities shall be
allocated from the Department of Defense Medical Support Fund
established under this Act.
(5) Coordination.--The Secretary of the Army shall consult
with appropriate Marine Corps counterparts to ensure
coordination of best practices and lessons learned.
(6) Period of pilot program.--The pilot program shall be in
effect for a period of one year.
(b) Reporting Requirement.--Not later than 90 days after the end of
the one-year period for the pilot project, the Secretary of the Army
shall submit to Congress a report containing--
(1) an evaluation of the results of the pilot project;
(2) an assessment of the Army's ability to establish Wounded
Warrior Battalions at other major Army bases.
(3) recommendations regarding--
(A) the adaptability of the Wounded Warrior Battalion
concept for the Army's larger wounded population; and
(B) closer coordination and sharing of resources with
counterpart programs of the Marine Corps.
(c) Effective Date.--The pilot program required by this section shall
be implemented not later than 180 days after the date of the enactment
of this Act.
SEC. 109. CRITERIA FOR REMOVAL OF MEMBER FROM TEMPORARY DISABILITY
RETIRED LIST.
(a) Criteria.--Section 1210(e) of title 10, United States Code, is
amended by inserting ``of a permanent nature and stable and is'' after
``physical disability is''.
(b) Effective Date.--The amendment made by subsection (a) shall apply
to any case received for consideration by a physical evaluation board
after the date of the enactment of this Act.
SEC. 110. IMPROVED TRANSITION OF MEMBERS OF THE ARMED FORCES TO
DEPARTMENT OF VETERANS AFFAIRS UPON RETIREMENT OR
SEPARATION.
(a) Transition of Members Separated or Retired.--
(1) Transition process.--Chapter 58 of title 10, United
States Code, is amended by inserting after section 1142 the
following new section:
``Sec. 1142a. Process for transition of members to health care and
physical disability systems of Department of
Veterans Affairs
``(a) Transition Plan.--(1) The Secretary of Defense shall ensure
that each member of the armed forces who is being separated or retired
under chapter 61 of this title receives a written transition plan
that--
``(A) specifies the recommended schedule and milestones for
the transition of the member from military service; and
``(B) provides for a coordinated transition of the member
from the Department of Defense disability system to the
Department of Veterans Affairs.
``(2) A member being separated or retired under chapter 61 of this
title shall receive the transition plan before the separation or
retirement date of the member.
``(3) The transition plan for a member under this subsection shall
include information and guidance designed to assist the member in
understanding and meeting the schedule and milestones for the member's
transition.
``(b) Formal Transition Process.--(1) The Secretary of Defense, in
cooperation with the Secretary of Veterans Affairs, shall establish a
formal process for the transmittal to the Secretary of Veterans Affairs
of the records and other information described in paragraph (2) as part
of the separation or retirement of a member of the armed forces under
chapter 61 of this title.
``(2) The records and other information to be transmitted under
paragraph (1) with respect to a member shall include, at a minimum, the
following:
``(A) The member's address and contact information.
``(B) The member's DD-214 discharge form, which shall be
transmitted electronically.
``(C) A copy of the member's service record, including
medical records and any results of a Physical Evaluation Board.
``(D) Whether the member is entitled to transitional health
care, a conversion health policy, or other health benefits
through the Department of Defense under section 1145 of this
title.
``(E) Any requests by the member for assistance in enrolling
in, or completed applications for enrollment in, the health
care system of the Department of Veterans Affairs for health
care benefits for which the member may be eligible under laws
administered by the Secretary of Veterans Affairs.
``(F) Any requests by the member for assistance in applying
for, or completed applications for, compensation and vocational
rehabilitation benefits to which the member may be entitled
under laws administered by the Secretary of Veterans Affairs,
if the member is being medically separated or is being retired
under chapter 61 of this title.
``(3) The transmittal of information under paragraph (1) may be
subject to the consent of the member, as required by statute.
``(4) With the consent of the member, the member's address and
contact information shall also be submitted to the department or agency
for veterans affairs of the State in which the member intends to reside
after the separation or retirement of the member.
``(c) Meeting.--(1) The formal process required by subsection (b) for
the transmittal of records and other information with respect to a
member shall include a meeting between representatives of the Secretary
concerned and the Secretary of Veterans Affairs, which shall take place
at a location designated by the Secretaries. The member shall be
informed of the meeting at least 30 days in advance of the meeting,
except that the member may waive the notice requirement in order to
accelerate transmission of the member's records and other information
to the Department of Veterans Affairs.
``(2) A member shall be given an opportunity to submit a written
statement for consideration by the Secretary of Veterans Affairs.
``(d) Time for Transmittal of Records.--The Secretary concerned shall
provide for the transmittal to the Department of Veterans Affairs of
records and other information with respect to a member at the earliest
practicable date. In no case should the transmittal occur later than
the date of the separation or retirement of the member.
``(e) Armed Forces.--In this section, the term `armed forces' means
the Army, Navy, Air Force, and Marine Corps.''.
(2) Table of sections.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1142 the following new item:
``1142a. Process for transition of members to health care and physical
disability systems of Department of Veterans Affairs.''.
(b) Uniform Separation and Evaluation Physical.--Section 1145 of such
title is amended--
(1) by redesignating subsections (d) and (e) as subsections
(e) and (f), respectively; and
(2) by inserting after subsection (c) the following new
subsection:
``(d) Uniform Separation and Evaluation Physical.--The joint
separation and evaluation physical, as described in DD-2808 and DD-
2697, shall be used by the Secretary of Defense in connection with the
medical separation or retirement of all members of the armed forces,
including members separated or retired under chapter 61 of this title.
The Secretary of Veterans Affairs shall adopt the same separation and
evaluation physical for use by the Department of Veterans Affairs.''.
(c) Interoperability of Medical Information Systems and Bi-
Directional Access.--The Secretary of Defense and the Secretary of
Veterans Affairs shall establish and implement a single medical
information system for the Department of Defense and the Department of
Veterans Affairs for the purpose of ensuring the complete
interoperability and bi-directional, real-time exchange of critical
medical information.
(d) Co-Location of VA Benefit Teams.--
(1) Co-location.--The Secretary of Defense and the Secretary
of Veterans Affairs shall jointly determine the optimal
locations for the deployment of Department of Veterans Affairs
benefits team to support recovering service members assigned to
military medical treatment facilities, medical-related support
facilities, and community-based health care organizations.
(2) Military medical treatment facility defined.--In this
subsection, the term ``medical-related support facility'' has
the meaning given that term in subsection (b) of section 490 of
title 10, United States Code, as added by section 201(a) of
this Act.
(e) Repeal of Superseded Chapter 61 Medical Record Transmittal
Requirement.--
(1) Repeal.--Section 1142 of such title is amended by
striking subsection (c).
(2) Section heading.--The heading of such section is amended
to read as follows:
``Sec. 1142. Preseparation counseling''.
(3) Table of sections.--The table of sections at the
beginning of chapter 58 of such title is amended by striking
the item relating to section 1142 and inserting the following
new item:
``1142. Preseparation counseling.''.
(f) Effective Dates.--Section 1142a of title 10, United States Code,
as added by subsection (a), and subsection (d) of section 1145 of such
title, as added by subsection (b), shall apply with respect to members
of the Armed Forces who are separated or retired from the Armed Forces
on or after the first day of the eighth month beginning after the date
of the enactment of this Act. The requirements of subsections (c) and
(d), and the amendments made by subsection (e), shall take effect on
the first day of such eighth month.
SEC. 111. ESTABLISHMENT OF MEDICAL SUPPORT FUND FOR SUPPORT OF MEMBERS
OF THE ARMED FORCES RETURNING TO MILITARY SERVICE
OR CIVILIAN LIFE.
(a) Establishment and Purpose.--There is established on the books of
the Treasury a fund to be known as the Department of Defense Medical
Support Fund (hereinafter in this section referred to as the ``Fund''),
which shall be administered by the Secretary of the Treasury.
(b) Purposes.--The Fund shall be used--
(1) to support programs and activities relating to the
medical treatment, care, rehabilitation, recovery, and support
of wounded and injured members of the Armed Forces and their
return to military service or transition to civilian society;
and
(2) to support programs and facilities intended to support
the families of wounded and injured members of the Armed
Forces.
(c) Assets of Fund.--There shall be deposited into the Fund any
amount appropriated to the Fund, which shall constitute the assets of
the Fund.
(d) Transfer of Funds.--
(1) Authority to transfer.--The Secretary of Defense may
transfer amounts in the Fund to appropriations accounts for
military personnel; operation and maintenance; procurement;
research, development, test, and evaluation; military
construction; and the Defense Health Program. Amounts so
transferred shall be merged with and available for the same
purposes and for the same time period as the appropriation
account to which transferred.
(2) Addition to other authority.--The transfer authority
provided in paragraph (1) is in addition to any other transfer
authority available to the Department of Defense. Upon a
determination that all or part of the amounts transferred from
the Fund are not necessary for the purposes for which
transferred, such amounts may be transferred back to the Fund.
(3) Notification.--The Secretary of Defense shall, not fewer
than five days before making a transfer from the Fund, notify
the congressional defense committees in writing of the details
of the transfer.
(e) Authorization.--There is hereby authorized to be appropriated to
the Medical Support Fund, from an emergency supplemental appropriation
for fiscal year 2007 or 2008, $50,000,000, to remain available through
September 30, 2008.
SEC. 112. OVERSIGHT BOARD FOR WOUNDED WARRIORS.
(a) Establishment.--There is hereby established a board to be known
as the Oversight Board for Wounded Warriors (in this section referred
to as the ``Oversight Board'').
(b) Composition.--The Oversight Board shall be composed of 12
members, of whom--
(1) two shall be appointed by the majority leader of the
Senate;
(2) two shall be appointed by the minority leader of the
Senate;
(3) two shall be appointed by the Speaker of the House of
Representatives;
(4) two shall be appointed by the minority leader of the
House of Representatives;
(5) two shall be appointed by the Secretary of Veterans
Affairs; and
(6) two shall be appointed by the Secretary of Defense.
(c) Qualifications.--All members of the Oversight Board shall have
sufficient knowledge of, or experience with, the military healthcare
system, the disability evaluation system, or the experience of a
recovering service member or family member of a recovering service
member.
(d) Appointment.--
(1) Term.--Each member of the Oversight Board shall be
appointed for a term of three years. A member may be
reappointed for one or more additional terms.
(2) Vacancies.--Any vacancy in the Oversight Board shall be
filled in the same manner in which the original appointment was
made.
(e) Duties.--
(1) Advice and consultation.--The Oversight Board shall
provide advice and consultation to the Secretary of Defense and
the Committees on Armed Services of the Senate and the House of
Representatives regarding--
(A) the process for streamlining the disability
evaluation systems of the military departments;
(B) the process for correcting and improving the
ratios of case managers and service member advocates to
recovering service members;
(C) the need to revise Department of Defense policies
to improve the experience of recovering service members
while under Department of Defense care;
(D) the need to revise Department of Defense policies
to improve counseling, outreach, and general services
provided to family members of recovering service
members;
(E) the need to revise Department of Defense policies
regarding the provision of quality lodging to
recovering service members; and
(F) such other matters relating to the evaluation and
care of recovering service members, including
evaluation under disability evaluation systems, as the
Board considers appropriate.
(2) Visits to military medical treatment facilities.--In
carrying out its duties, each member of the Oversight Board
shall visit not less than three military medical treatment
facilities each year, and the Board shall conduct each year one
meeting of all the members of the Board at a military medical
treatment facility.
(f) Staff.--The Secretary shall make available the services of at
least two officials or employees of the Department of Defense to
provide support and assistance to members of the Oversight Board.
(g) Travel Expenses.--Members of the Oversight Board shall be allowed
travel expenses, including per diem in lieu of subsistence, at rates
authorized for employees of agencies under subchapter I of chapter 57
of title 5, United States Code, while away from their homes or regular
places of business in the performance of service for the Oversight
Board.
(h) Annual Reports.--The Oversight Board shall submit to the
Secretary of Defense and the Committees on Armed Services of the Senate
and the House of Representatives each year a report on its activities
during the preceding year, including any findings and recommendations
of the Oversight Board as a result of such activities.
TITLE II--STUDIES AND REPORTS
SEC. 201. ANNUAL REPORT ON MILITARY MEDICAL FACILITIES.
(a) In General.--
(1) Report requirement.--Chapter 23 of title 10, United
States Code, is amended by adding at the end the following new
section:
``Sec. 490. Annual report on military medical facilities
``(a) Annual Report.--Not later than the date on which the President
submits the budget for a fiscal year to Congress pursuant to section
1105 of title 31, the Secretary of Defense shall submit to the
Committees on Armed Services of the Senate and the House of
Representatives a report on the adequacy, suitability, and quality of
medical facilities and medical-related support facilities at each
military installation within the Department of Defense.
``(b) Response to Hot-Line Information.--The Secretary of Defense
shall include in each report information regarding--
``(1) any deficiencies in the adequacy, quality, or state of
repair of medical-related support facilities raised as a result
of information received during the period covered by the report
through the toll-free hot line maintained pursuant to section
1567 of this title; and
``(2) the investigations conducted and plans of action
prepared under such section to respond to such deficiencies.
``(c) Medical-Related Support Facility.--In this section, the term
`medical-related support facility' is any facility of the Department of
Defense that provides support to any of the following:
``(1) Members of the armed forces admitted for treatment to
military medical treatment facilities.
``(2) Members of the armed forces assigned to military
medical treatment facilities as an outpatient.
``(3) Family members accompanying any member described in
paragraph (1) or (2) as a nonmedical attendant.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:
``490. Annual report on military medical facilities.''.
(b) Effective Date.--The first report under section 490 of title 10,
United States Code, as added by subsection (a), shall be submitted not
later than the date of submission of the budget for fiscal year 2009.
SEC. 202. ACCESS OF RECOVERING SERVICE MEMBERS TO ADEQUATE OUTPATIENT
RESIDENTIAL FACILITIES.
(a) Required Inspections of Facilities.--All quarters of the United
States and housing facilities under the jurisdiction of the Armed
Forces that are occupied by recovering service members shall be
inspected on a semiannual basis for the first two years after the
enactment of this Act and annually thereafter by the inspectors general
of the regional medical commands.
(b) Inspector General Reports.--The inspector general for each
regional medical command shall--
(1) submit a report on each inspection of a facility
conducted under subsection (a) to the post commander at such
facility, the commanding officer of the hospital affiliated
with such facility, the surgeon general of the military
department that operates such hospital, the Secretary of the
military department concerned, the Assistant Secretary of
Defense for Health Affairs, the Oversight Board for Wounded
Warriors established pursuant to section 112, and the
appropriate congressional committees; and
(2) post each such report on the Internet website of such
regional medical command.
SEC. 203. EVALUATION AND REPORT ON DEPARTMENT OF DEFENSE AND DEPARTMENT
OF VETERANS AFFAIRS DISABILITY EVALUATION SYSTEMS.
(a) Evaluation.--The Secretary of Defense and the Secretary of
Veterans Affairs shall conduct a joint evaluation of the disability
evaluation systems used by the Department of Defense and the Department
of Veterans Affairs for the purpose of--
(1) improving the consistency of the two disability
evaluation systems; and
(2) evaluating the feasibility of, and potential options for,
consolidating the two systems.
(b) Relation to Veterans' Disability Benefits Commission.--In
conducting the evaluation of the disability evaluation systems used by
the Department of Defense and the Department of Veterans Affairs, the
Secretary of Defense and the Secretary of Veterans Affairs shall
consider the findings and recommendations of the Veterans' Disability
Benefits Commission established pursuant to title XV of the National
Defense Authorization Act for Fiscal Year 2004 (Public Law 108-136; 38
U.S.C. 1101 note).
(c) Report.--Not later than 180 days after the date of the submission
of the final report of the Veterans' Disability Benefits Commission,
the Secretary of Defense and the Secretary of Veterans Affairs shall
submit to Congress a report containing--
(1) the results of the evaluation; and
(2) the recommendations of the Secretaries for improving the
consistency of the two disability evaluation systems and such
other recommendations as the Secretaries consider appropriate.
SEC. 204. STUDY AND REPORT ON SUPPORT SERVICES FOR FAMILIES OF
RECOVERING SERVICE MEMBERS.
(a) Study Required.--The Secretary of Defense shall conduct a study
of the provision of support services for families of recovering service
members.
(b) Matters Covered.--The study under subsection (a) shall include
the following:
(1) A determination of the types of support services that are
currently provided by the Department of Defense to family
members described in subsection (c), and the cost of providing
such services.
(2) A determination of additional types of support services
that would be feasible for the Department to provide to such
family members, and the costs of providing such services,
including the following types of services:
(A) The provision of medical care at military medical
treatment facilities.
(B) The provision of job placement services offered
by the Department of Defense to any family member
caring for a recovering service member for more than 45
days during a one-year period.
(C) The provision of meals without charge at military
medical treatment facilities.
(3) A survey of military medical treatment facilities to
estimate the number of family members to whom the support
services would be provided.
(4) A determination of any discrimination in employment that
such family members experience, including denial of retention
in employment, promotion, or any benefit of employment by an
employer on the basis of the person's absence from employment
as described in subsection (c), and a determination, in
consultation with the Secretary of Labor, of the options
available for such family members.
(c) Covered Family Members.--A family member described in this
subsection is a family member of a recovering service member who is--
(1) on invitational orders while caring for the recovering
service member;
(2) a non-medical attendee caring for the recovering service
member; or
(3) receiving per diem payments from the Department of
Defense while caring for the recovering service member.
(d) Report.--Not later than 180 days after the date of the enactment
of this Act, the Secretary of Defense shall submit to the Committees on
Armed Services of the Senate and the House of Representatives a report
on the results of the study, with such findings and recommendations as
the Secretary considers appropriate.
SEC. 205. REPORT ON TRAUMATIC BRAIN INJURY CLASSIFICATIONS.
(a) Interim Report.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to the
Committees on Armed Services of the Senate and the House of
Representatives an interim report describing the changes undertaken
within the Department of Defense to ensure that traumatic brain injury
victims receive a proper medical designation concomitant with their
injury as opposed to the current medical designation which assigns a
generic ``organic psychiatric disorder'' classification.
(b) Final Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to the
Committees on Armed Services of the Senate and the House of
Representatives a final report concerning traumatic brain injury
classifications and an explanation and justification of the
Department's use of the international classification of disease (ICD) 9
designation, recommendations for transitioning to ICD 10 or 11, and the
benefits the civilian community experiences from using ICD 10.
SEC. 206. EVALUATION OF THE POLYTRAUMA LIAISON OFFICER/NON-COMMISSIONED
OFFICER PROGRAM.
(a) Evaluation Required.--The Secretary of Defense shall conduct an
evaluation of the Polytrauma Liaison Officer/Non-Commissioned Officer
program, which is the program operated by each of the military
departments and the Department of Veterans Affairs for the purpose of--
(1) assisting in the seamless transition of members of the
Armed Forces from the Department of Defense health care system
to the Department of Veterans Affairs system; and
(2) expediting the flow of information and communication
between military treatment facilities and the Veterans Affairs
Polytrauma Centers.
(b) Matters Covered.--The evaluation of the Polytrauma Liaison
Officer/Non-Commissioned Officer program shall include evaluating the
following areas:
(1) The program's effectiveness in the following areas:
(A) Handling of military patient transfers.
(B) Ability to access military records in a timely
manner.
(C) Collaboration with Polytrauma Center treatment
teams.
(D) Collaboration with Veteran Service Organizations.
(E) Functioning as the Polytrauma Center's subject-
matter expert on military issues.
(F) Supporting and assisting family members.
(G) Providing education, information, and referrals
to members of the Armed Forces and their family
members.
(H) Functioning as uniformed advocates for members of
the Armed Forces and their family members.
(I) Inclusion in Polytrauma Center meetings.
(J) Completion of required administrative reporting.
(K) Ability to provide necessary administrative
support to all members of the Armed Forces.
(2) Manpower requirements to effectively carry out all
required functions of the Polytrauma Liaison Officer/Non-
Commissioned Officer program given current and expected case
loads.
(3) Expansion of the program to incorporate Navy and Marine
Corps officers and senior enlisted personnel.
(c) Reporting Requirement.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Defense shall submit to
Congress a report containing--
(1) the results of the evaluation; and
(2) recommendations for any improvements in the program.
TITLE III--GENERAL PROVISIONS
SEC. 301. MORATORIUM ON CONVERSION TO CONTRACTOR PERFORMANCE OF
DEPARTMENT OF DEFENSE FUNCTIONS AT MILITARY MEDICAL
FACILITIES.
(a) Findings.--Congress finds the following:
(1) The conduct of public-private competitions for the
performance of Department of Defense functions, based on Office
of Management and Budget Circular A-76, can lead to dramatic
reductions in the workforce, undermining an agency's ability to
perform its mission.
(2) The Army Garrison commander at the Walter Reed Army
Medical Center has stated that the extended A-76 competition
process contributed to the departure of highly skilled
administrative and maintenance personnel, which led to the
problems at the Walter Reed Army Medical Center.
(b) Moratorium.--During the one-year period beginning on the date of
the enactment of this Act, no study or competition may be begun or
announced pursuant to section 2461 of title 10, United States Code, or
otherwise pursuant to Office of Management and Budget Circular A-76
relating to the possible conversion to performance by a contractor of
any Department of Defense function carried out at a military medical
facility .
(c) Report Required.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to the
Committee on Armed Services of the Senate and the Committee on Armed
Services of the House of Representatives a report on the public-private
competitions being conducted for Department of Defense functions
carried out at military medical facilities as of the date of the
enactment of this Act by each military department and defense agency.
Such report shall include--
(1) for each such competition--
(A) the cost of conducting the public-private
competition;
(B) the number of military personnel and civilian
employees of the Department of Defense affected;
(C) the estimated savings identified and the savings
actually achieved;
(D) an evaluation whether the anticipated and
budgeted savings can be achieved through a public-
private competition; and
(E) the effect of converting the performance of the
function to performance by a contractor on the quality
of the performance of the function;
(2) a description of any public-private competition the
Secretary would conduct if the moratorium under subsection (b)
were not in effect; and
(3) an assessment of whether any method of business reform or
reengineering other than a public-private competition could, if
implemented in the future, achieve any anticipated or budgeted
savings.
SEC. 302. PROHIBITION ON TRANSFER OF RESOURCES FROM MEDICAL CARE.
Neither the Secretary of Defense nor the Secretaries of the military
departments may transfer funds or personnel from medical care functions
to administrative functions within the Department of Defense in order
to comply with the new administrative requirements imposed by this Act
or the amendments made by this Act.
SEC. 303. INCREASE IN PHYSICIANS AT HOSPITALS OF THE DEPARTMENT OF
VETERANS AFFAIRS.
The Secretary of Veterans Affairs shall increase the number of
resident physicians at hospitals of the Department of Veterans Affairs.
Purpose and Background
The purpose of H.R. 1538, the ``Wounded Warrior Assistance
Act of 2007,'' is to amend title 10, United States Code, and to
establish other new statutory requirements to provide the
people, training, and oversight mechanisms needed to ensure
that the nation's wounded warriors receive quality medical care
and efficient administrative processing in an environment that
reflects the highest quality of life standards. This
legislation also sets the stage for much needed reform of
administrative processes that will restore service member
confidence in the integrity and efficiency of the disability
evaluation system and begin the process of achieving a truly
seamless transition of service members to the Department of
Veterans Affairs' programs.
The committee devoted substantial attention during the
109th Congress to the emerging needs of active duty and reserve
wounded and disabled service members and their families. The
committee investigated a wide range of problems involving
transitional compensation, medical treatment, evaluation and
rating of disabilities, retention of members with disabilities
on active duty, and post separation programs to assist members
and families as they transition to civilian life.
As a result, the National Defense Authorization Act for
Fiscal Year 2006 (Public Law 109-163) and John Warner National
Defense Authorization Act for 2007 (Public Law 109-364)
included legislative provisions to address concerns that had
been brought to the attention of the committee. For example,
the John Warner National Defense Authorization Act for 2007
(Public Law 109-364) revamped the military services' physical
evaluation boards to ensure that members receive consistent,
fair, and timely judgments delivered by efficient, well-trained
personnel who are prepared to reach out to service members with
information and insight into the disability process.
The concerns about the treatment of wounded warriors at
Walter Reed Army Medical Center that were widely reported in
the media during February 2007, and after the March 12, 2007,
release of an Army Inspector General Report on the Army's
disability evaluation system provided new information on
medical care and administrative issues of longstanding concern,
and focused attention on the facilities that support members in
an outpatient status and their families.
Legislative History
H.R. 1538 was introduced on March 15, 2007, and referred to
the Committee on Armed Services, and in addition to the
Committee on Veterans' Affairs, for a period to be subsequently
determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the
committee concerned.
On March 20, 2007, the Committee on Armed Services held a
mark-up session to consider H.R. 1538. The committee ordered
H.R. 1538, as amended, reported to the House with a favorable
recommendation by a record vote of 59-0, a quorum being
present.
Hearings
Committee consideration of the matter contained in the
Wounded Warrior Assistance Act of 2007, results from one full
committee hearings conducted on March 8, 2007.
Section-by-Section Analysis
The following is a section-by-section analysis of those
sections of H.R. 1538, as amended, by the Committee on Armed
Services.
Section 1--Short title; table of contents
This section would establish the short title of the bill as
the ``Wounded Warrior Assistance Act of 2007.''
Section 2--Definitions
This section would include definitions of congressional
defense committees, disability evaluation system, family
member, and recovering service member.
TITLE I--WOUNDED WARRIOR ASSISTANCE
ITEM OF SPECIAL INTEREST
Report on Army Infrastructure Requirements
The committee directs the Secretary of the Army to submit
to the House Committee on Armed Services by January 31, 2008, a
report of the infrastructure requirements for supporting
wounded warriors at Army medical facilities and installations.
The report shall include the following:
(1) A description of current and projected military
facilities that support soldiers receiving medical treatment
and rehabilitation services including medical facilities,
dining facilities, barracks, family housing, and exercise and
rehabilitation facilities.
(2) An analysis of the parking situation at all army
medical centers to determine whether an adequate number of
parking spaces exist, and the walking time and distance on
average to and from the most remote parking spaces.
(3) An analysis of the infrastructure improvements to the
facilities described in items (1) and (2) to determine if
sufficient funds have been allocated for such improvements and
such other recommendations the Secretary considers appropriate.
LEGISLATIVE PROVISIONS
Section 101--Improvements to medical and dental care for members of the
armed forces assigned to hospitals in an outpatient status
This section would require the assignment of a medical care
case manager and a service member advocate to each service
member assigned to a military treatment facility in an
outpatient status or another unit designated to manage service
members receiving outpatient medical care. This section would
specify the duties of medical care case managers and service
member advocates, require standardized training curriculums be
developed for each, and would limit the number of cases that
may be assigned to each. This section would also require the
secretary concerned to conduct semiannual surveys of members in
an outpatient status to determine the quality of medical care,
adequacy of facilities, and effectiveness of disability
evaluation systems and to coordinate the results with
installation medical commanders and authorities.
Section 102--Establishment of toll-free hot line for reporting
deficiencies in medical-related support facilities and
expedited response to reports of deficiencies
This section would require the Secretary of Defense to
establish a toll-free hot line for reporting deficiencies in
facilities supporting medical patients and family members. This
section would require investigation and formulation of a plan
to remediate substantiated complaints within 96 hours, to
include relocation of occupants when health and safety
standards are violated.
Section 103--Notification to Congress of hospitalization of combat
wounded service members
This section would require the secretary of each military
service, with the service member's consent, to notify Members
of Congress of the hospitalization of a service member who has
been evacuated from a theater of combat.
Section 104--Independent medical advocate for members before medical
evaluation boards
This section would require assignment of independent health
care professionals to serve as counselors and advocates for
service members being considered by medical evaluation boards.
Section 105--Training and workload for physical evaluation board
liaison officers
This section would establish 20 cases as the maximum number
that may be assigned to a physical evaluation board liaison
officer or an assistant physical evaluation board liaison
officer. This section would also require the Secretary of
Defense to establish a standard training curriculum for
physical evaluation board liaison officers or assistant
physical evaluation board liaison officers.
Section 106--Standardized training program and curriculum for
department of defense disability evaluation system
This section would require the Secretary of Defense to
establish a standardized training program and curriculum for
persons involved in the disability evaluation system including,
commanders, enlisted supervisors, health care professionals,
and other persons with administrative, professional, or
technical responsibilities in the disability evaluation system.
Section 107--Improved training for health care professionals, medical
care case managers, and service member advocates on particular
conditions of recovering service members
This section would require the Secretary of Defense to
recommend annually, improvements to the training of health care
professionals, medical care case managers, and service member
advocates to increase their effectiveness in assisting
recovering wounded warriors. This section would, at a minimum,
require the Secretary to make recommendations about improving
training in the identification of post-traumatic stress
disorder, suicidal tendencies, and other mental conditions
among recovering service members and the timely reporting of
observations to appropriate health care professionals. This
section would also require the Secretary of Defense to develop
a system to track the number of notifications made by medical
care case managers and service member advocates to health care
professionals regarding the early warning signs of both suicide
and post-traumatic stress disorder.
Section 108--Pilot program to establish an army wounded warrior
battalion at an appropriate active duty base
This section would require the Secretary of the Army to
establish an Army Wounded Warrior Battalion pilot program at an
installation with a major medical facility modeled after the
Wounded Warrior Regiment program operated by the United States
Marine Corps.
The Secretary shall submit a report with the results of the
pilot program within 90 days after completion of a one-year
test.
Section 109--Criteria for removal of member from temporary disability
retired list
This section would require that service member medical
conditions must be permanent and stable before being removed
from the temporary duty retired list.
Section 110--Improved transition of members of the armed forces to
Department of Veterans Affairs upon retirement or separation
This section would require the Secretary of Defense to
provide disabled service members being separated or retired
from the armed forces with a written plan for transition of the
service member to programs operated by the Department of
Veterans Affairs and a formal process for the transmittal of
records and other information to the Department of Veterans
Affairs on or before the date of separation or retirement. This
section would require the service member's identification and
contact information to be provided to the applicable State
agency responsible for veterans' affairs, with the consent of
the service member. This section would also require the
Secretary of Defense and the Secretary of Veterans Affairs to
establish a joint separation and evaluation physical and a
fully interoperable medical information system.
Section 111--Establishment of medical support fund for support of
members of the armed forces returning to military service or
civilian life
This section would authorize a Treasury fund to be used to
support programs and activities relating to the medical
treatment, care, rehabilitation, recovery, and support of
wounded and injured members of the armed forces. This section
would authorize $50.0 million to be appropriated from emergency
supplemental appropriations for fiscal years 2007 and 2008, to
remain available through September 30, 2008.
Section 112--Oversight board for wounded warriors
This section would require the establishment of an
Oversight Board for Wounded Warriors to give oversight of
medical care, quality of life, administrative processing, and
family programs supporting wounded warriors and to provide
advice and counsel to Congress and the Department of Defense
about how the programs can be made more efficient and
effective. The Board would be composed of twelve members with
knowledge or experience of military health care, disability
evaluation systems, or the challenges faced by recovering
wounded warriors.
TITLE II--STUDIES AND REPORTS
LEGISLATIVE PROVISIONS
Section 201--Annual report on military medical facilities
This section would require the Secretary of Defense to
submit an annual report beginning with the budget submission
for fiscal year 2009 on the adequacy, suitability, and quality
of military medical facilities and medical-related support
facilities. This section would require that the report include
any facility deficiencies and accompanying response plans
identified through the toll-free hotline established in section
102 of this Act.
Section 202--Access of recovering service members to adequate
outpatient residential facilities
This section would require the inspectors general of the
regional medical commands to conduct semiannual inspections of
facilities housing recovering service members for the first two
years following the date of enactment of this Act and annually
thereafter. This section would require the inspection results
to be coordinated with local and service medical and civilian
leadership, reported to Congress, and posted on the Internet
website for the regional medical command.
Section 203--Evaluation and report on department of defense and
department of veterans affairs disability evaluation systems
This section would require the Secretary of Defense and the
Secretary of Veterans Affairs to conduct a joint evaluation of
the disability evaluation systems operated by both secretaries
for the purpose of improving the consistency of the two systems
and evaluating the feasibility of, and potential for,
consolidating the two systems. This section would require the
secretaries to consider the findings and recommendations of the
Veterans' Disability Benefits Commission.
Section 204--Study and report on support services for families of
recovering service members
This section would require the Secretary of Defense to
conduct a study of the support services provided to families of
recovering service members including, a survey of the services
currently provided; a determination of the services that may be
provided with the associated costs; an estimate of the number
of family members that would be eligible to receive the
services; and a determination of any employment discrimination
that the family members experience.
Section 205--Report on traumatic brain injury classifications
This section would require the Secretary of Defense to
report on the changes being undertaken to ensure that traumatic
brain injury victims receive a proper medical designation
concomitant with their injury. The committee is aware that the
Department of Defense recognizes that the current
classification of organic psychiatric disorder used to classify
traumatic brain injuries suffered by service members may
require further definition.
Section 206--Evaluation of the polytrauma liaison officer/non-
commissioned officer program
This section would require the Secretary of Defense to
conduct an evaluation of the Polytrauma Liaison Officer/Non-
commissioned Officer program operated by the military
departments and the Department of Veterans Affairs to assist
the transition of service members from the Department of
Defense health care system to the Department of Veterans
Affairs' system.
TITLE III--GENERAL PROVISIONS
LEGISLATIVE PROVISIONS
Section 301--Moratorium on conversion to contractor performance of
Department of Defense functions at military medical facilities
This section would prohibit the initiation or announcement
of a competition under Office of Management and Budget Circular
A-76 relating to the possible conversion to performance of
functions at a Department of Defense military medical facility
by a contractor. The prohibition would be effective during a
12-month period beginning on the date of enactment of this Act.
Section 302--Prohibition on transfer of resources from medical care
This section would prohibit the transfer of funds or
personnel from medical care functions to support the
administrative requirements imposed by this Act.
Section 303--Increase in physicians at hospitals of the Department of
Veterans Affairs
This section would require the Secretary of Veterans
Affairs to increase the number of resident physicians at
Department of Veterans Affairs' hospitals.
Communications From Other Committees
House of Representatives,
Committee on Veterans' Affairs,
Washington, DC, March 20, 2007.
Hon. Ike Skelton,
Chairman, Committee on Armed Services,
House of Representatives, Washington, DC.
Dear Chairman Skelton: I understand the Committee on Armed
Services plans to consider H.R.1538, the ``Wounded Warrior
Assistance Act of 2007,'' today. As you are aware, the
Committee on Veterans' Affairs was also referred the bill upon
introduction. However, in order to expedite consideration of
the bill, I will not exercise my Committee's right to schedule
a mark-up of the introduced bill.
I note the Committee on Veteran's Affairs' jurisdictional
interest in the four amendments attached hereto, which were
provided to the Committee for review on March 19, 2007.
However, to facilitate the House's timely consideration of the
bill, I agree that my Committee will, likewise, not consider
the amendments.
By agreeing to waive consideration of the bill, the
Committee on Veterans' Affairs does not waive its jurisdiction
over the subject matter contained in the bill or the
aforementioned amendments. The Committee also reserves the
right to seek appointment to any House-Senate conference on
this or similar legislation and requests your support if such a
request is made.
Sincerely,
Bob Filner, Chairman.
Attachments.
----------
House of Representatives,
Committee on Armed Services,
Washington, DC, March 21, 2007.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: Thank you for your letter regarding H.R.
1538, the Wounded Warrior Assistance Act of 2007. I agree that
the Committee on Veterans' Affairs has valid jurisdictional
claims to certain provisions in this important legislation, and
I am most appreciative of your decision not to schedule a mark-
up of this bill in the interest of expediting consideration. I
agree that by agreeing to waive consideration of certain
provisions of the bill, the Committee on Veterans' Affairs is
not waiving its jurisdiction over these matters.
This exchange of letters will be included in the committee
report on the bill.
Very truly yours,
Ike Skelton, Chairman.
----------
House of Representatives,
Committee on Oversight and Government Reform,
Washington, DC, March 22, 2007.
Hon. Ike Skelton,
Chairman, Committee on Armed Services,
House of Representatives, Washington, DC.
Dear Chairman Skelton: I am writing regarding the amendment
to H.R. 1538, the ``Wounded Warrior Assistance Act of 2007,''
proposed by Rep. Solomon Ortiz during the Tuesday, March 20,
2007, markup by the House Committee on Armed Services. The
Committee on Oversight and Government Reform has jurisdiction
over the subject matter of this amendment, which would create a
moratorium on a study or competition announced pursuant to
section 2461 of title 10, United States Code, or otherwise
pursuant to OMB Circular A-76, concerning the possible
conversion to performance by a contractor of any Department of
Defense function carried out at a military medical facility.
The Committee on Oversight and Government Reform will not
seek a referral of H.R. 1538 based on the inclusion of the
Ortiz Amendment. This accommodation is being provided to
expedite the consideration of the legislation and is not a
waiver of the Oversight Committee's jurisdiction over the
subject matter in future legislation. The Oversight Committee
will request an appropriate number of conferees should there be
a House-Senate conference on this or similar legislation.
Sincerely,
Henry A. Waxman, Chairman.
----------
House of Representatives,
Committee on Armed Services,
Washington, DC, March 22, 2007.
Hon. Henry A. Waxman,
Chairman, Committee on Oversight and Government Reform,
House of Representatives, Washington, DC.
Dear Mr. Chairman: Thank you for your letter regarding H.R.
1538, the Wounded Warrior Assistance Act of 2007. I agree that
the Committee on Oversight and Government Reform has a valid
jurisdictional claim to the amendment offered by Mr. Ortiz
regarding a moratorium on the implementation of A-76 guidelines
and which is included in this important legislation. I am most
appreciative of your decision not to request a sequential
referral on the basis of this amendment in the interest of
expediting consideration of this bill. I agree that by forgoing
a sequential referral, the Committee on Oversight and
Government Reform is not waiving its jurisdiction over this
matter.
This exchange of letters will be included in the committee
report on the bill.
Very truly yours,
Ike Skelton, Chairman.
Committee Position
On March 20, 2007, the Committee on Armed Services, a
quorum being present, ordered H.R. 1538, as amended, reported
with a favorable recommendation by a record vote of 59 ayes to
0 noes.
Congressional Budget Office Estimate
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, the cost estimate prepared by
the Congressional Budget Office and submitted pursuant to
section 402(a) of the Congressional Budget Act of 1974 is as
follows:
March 23, 2007.
Hon. Ike Skelton,
Chairman, Committee on Armed Services,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1538, the Wounded
Warrior Assistance 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.
Summary: H.R. 1538 would impose a number of new
requirements on the Department of Defense (DoD) intended to
improve the medical care and other services received by
servicemembers who are sick or wounded. Among other things, the
bill would increase the number of case managers and
servicemember advocates and improve their training, require
that medical personnel be available to advise servicemembers
whose cases are being reviewed by evaluation boards, and
establish a program to assist servicemembers who are separating
from DoD as they make the transition to the use of services
provided by the Department of Veterans Affairs (VA).
The bill also would require DoD and VA to establish a
single medical information system between the two departments.
CBO does not have sufficient information about how DoD and VA
might implement this requirement to estimate the cost, but we
expect that cost could amount to billions of dollars, subject
to appropriation of the necessary funds. CBO estimates that
implementing the remainder of H.R. 1538 would incur
discretionary costs of $66 million in 2008 and about $300
million over the 2008-2012 period, assuming appropriation of
the necessary amounts. Enacting the bill would not have a
significant impact on direct spending or revenues.
H.R. 1538 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 costs of this
legislation fall within budget functions 050 (national defense)
and 700 (veterans benefits and services).
The principal budgetary impact of H.R. 1538 would be
discretionary costs for developing and implementing a single
medical information system for DoD and VA. Such a system could
potentially cost billions of dollars, but CBO does not have
sufficient information at this time to complete an estimate of
those costs. Ultimately, the cost of such a new system would
depend on how the two departments choose to implement the
bill's requirements and would be subject to appropriation of
the necessary amounts.
CBO estimates that implementing the remainder of H.R. 1538
would require the appropriation of $100 million in 2008 and
$315 million over the 2008-2012 period. CBO estimates that
appropriation of those amounts would result in discretionary
outlays of $66 million in 2008 and about $300 million over the
2008-2012 period.
In addition, CBO estimates that H.R. 1538 would have an
insignificant effect on direct spending and would have no
effect on revenues.
Basis of Estimate: For this estimate, CBO assumes that H.R.
1538 would be enacted near the start of fiscal year 2008 and
that the necessary amounts will be appropriated for each year.
Most of the legislation's budgetary effects would fall within
the discretionary spending category, but one provision would
have a negligible effect on direct spending.
Spending subject to Appropriation: H.R. 1538 would require
DoD to hire additional personnel to ensure that sick, wounded,
and recovering servicemembers receive assistance in
coordinating medical treatment, resolving administrative
problems, and in preparing for the evaluation board that
determines if members will be allowed to remain on active duty.
It also would require the establishment of a single medical
information system for both DoD and VA, a transitional plan for
members leaving the service, the creation of a wounded warrior
battalion, and the preparation of several reports and studies.
CBO estimates that, in addition to potentially billions of
dollars in costs for the new medical information technology
system, implementing this bill would cost $66 million in 2008
and about $300 million over the 2008-2012 period, assuming
appropriation of the necessary amounts.
Medical Information Systems. Section 110 would require DoD
and VA to implement a single medical information system for the
exchange of critical medical information. CBO cannot estimate
the budgetary impact of implementing this provision because DoD
and VA have not yet determined how they would meet the
requirements of this section. If a new computer system would
have to be created by the departments to enable the transfer of
medical information, it could cost billions of dollars. If
improvements to current systems would suffice, the cost would
be much smaller.
Transition Plan. Section 110 also would require that DoD
establish a program to ensure that each servicemember who
retires or separates from the military due to physical
disability receive a written plan that outlines how the
transition to the provision of medical care and benefits by VA
should occur. The formal transition process also would include
the transmission of such information as the discharge form, a
copy of the medical records and findings of the disability
evaluation board, and information on the veterans' benefits
that each member is entitled to receive from VA. This section
also would require that the same physical evaluation be used by
DoD and VA, and for VA benefits teams to be optimally located
at DoD facilities.
The improved transition process would probably make use of
the new medical information system discussed above. CBO
believes that these additional requirements would not have any
significant additional cost.
Medical Support Fund. Section 111 would establish a DoD
Medical Support Fund to be used for programs and activities
related to medical care for wounded servicemembers and support
for their families. The bill would authorize the appropriation
of $50 million to remain available through fiscal year 2008.
That money could be transferred from the new fund to several
appropriations accounts, including construction, research, and
military personnel. Based on information from DoD, CBO
estimates that $25 million would be spent from the fund in
2008. Obligations made in that year would likely result in
outlays of $50 million over the 2008-2012 period.
Case Managers and Servicemember Advocates. Servicemembers
who are outpatients at military treatment facilities receive
the assistance of both medical care case managers and
servicemember advocates. The former are generally social
workers who help coordinate care for servicemembers. The latter
are military personnel who assist the patients with
administrative matters. Section 101 would clarify the roles of
each and establish the maximum workload that could be carried.
Based on information from DoD, CBO estimates that about 330
case managers would have to be hired initially to meet those
requirements. Fewer new case managers would be needed in the
future as fewer troops are expected to be in a combat
situation. With an average salary and benefits package of
$100,000 per person, the estimated cost of this provision is
about $100 million over the 2008-2012 period.
CBO cannot estimate the number of additional servicemember
advocates that would be required under this proposal without
additional information from DoD. However, since personnel for
those positions would come from within authorized personnel
levels, CBO expects that implementing this provision would not
increase overall personnel costs.
Independent Medical Advocates. Section 104 would require
that servicemembers being considered by medical evaluation
boards (MEBs) have access to an independent health care
professional to act as an advocate on their behalf. Based on
information from the military services, CBO estimates that MEBs
consider about 25,000 cases each year. Due to this large case
load, CBO believes it would be difficult for DoD to meet this
requirement without hiring additional personnel or using
private contractors. For this estimate, CBO assumes the
military services would enter into contracts with private-
sector nurses to perform this service. Based on information
from several firms that specialize in workers compensation and
veterans disability cases, CBO estimates the cost to hire a
registered nurse as an advocate for military personnel would be
about $500 per case. This would result in a cost to DoD of
about $5 million in 2008 and about $60 million over the 2008-
2012 period. Costs would be lower in 2008 than in later years
because of the time needed to establish procedures and program
resources to meet this new requirement, CBO estimates.
Physical Evaluation Board Liaison Officers. Section 105
would mandate that physical evaluation board liaison officers
(PEBLOs) be assigned to no more than 20 cases at any one time.
Based on information from the military services, there are
currently about 260 personnel that perform the role of PEBLOs
throughout the DoD medical system. Of those, CBO estimates
about 15 percent, or 40 liaison officers, currently have
caseloads of less than 20. Of the remaining 220 personnel, CBO
estimates the average caseload is about 28 per PEBLO.
Therefore, decreasing the average caseload to 20 would require
the hiring of an additional 90 PEBLOs. The current population
of PEBLOs is comprised of both military and civilian personnel.
For this estimate, CBO assumes the new PEBLOs would all be
civilians and each would cost about $60,000 per year, which is
the approximate cost of pay and benefits for a GS-8 on the
General Schedule. Therefore, CBO estimates that implementing
this section would average $6 million per year and $27 million
over the 2008-2012 period. The cost would only be about $3
million in 2008 because of the time needed to hire and train
the new personnel.
Hotline. Section 102 would require DoD to establish a toll-
free hotline to collect information about the condition of
medical facilities. Any deficiencies would have to be
investigated within 96 hours and a plan of action for
remediation developed. If the problems violate health or safety
standards then occupants of the building would have to be
relocated until the corrections are made. Based on information
from DoD, CBO estimates that implementing this section would
cost $6 million in 2008 and $35 million over the 2008-2012
period. This includes a cost of about $2 million per year for
operating the hotline and for relocating patients, and about $4
million per year for investigation of the complaints.
Standardized Training. Sections 101, 105, and 106 would
require the Secretary of Defense to establish standardized
training programs for personnel involved in the disability
evaluation system. Currently, each of the services specify
their own training requirements, which in some cases is limited
to on-the-job training. A report by RAND recommended that DoD
provide standardized training to personnel in the disability
evaluation system through a combination of computer-based
distance training and classroom training.\1\ Based on
information from that report, CBO estimates the cost to provide
such training would be about $1 million in 2008 and $6 million
over the 2008-2012 period.
---------------------------------------------------------------------------
\1\ Cheryl Y. Marcum and others, Methods and Actions for Improving
Performance of the Department of Defense Disability Evaluation System
(Santa Monica, CA: RAND, 2002).
---------------------------------------------------------------------------
Reports. The bill would require that DoD prepare several
reports and conduct surveys to gauge the adequacy and
efficiency of employee training programs, benefits for families
of wounded servicemembers, the disability evaluation system,
the quality of medical care for the combat-wounded, the medical
classification code for brain injuries, military medical
facilities, and certain liaison programs. Based on information
from DoD, CBO estimates that it would cost less than $1 million
to do each report or survey. The bill would require that some
of the reports or surveys be done only once while others would
have to be done each year. CBO estimates that the total cost to
do these reports and surveys would be $6 million in 2008 and
about $20 million over the 2008-2012 period.
Other Provisions. The following provisions would have an
insignificant impact on discretionary spending:
Section 112 would establish the Oversight Board
for Wounded Warriors, to be comprised of 12 appointed members
who would provide advice and consultation to the Secretary of
Defense and to the Congress. Board members would receive pay
for travel expenses for required visits to military medical
facilities.
Section 103 would require that DoD notify members
of the Congress when a servicemember from their state or
district is medically evacuated from a theater of combat.
Section 301 would place a one-year moratorium on
the conduct of any study or competition for the purposes of
transferring to a private-sector contractor the responsibility
for performance of any function currently performed by DoD
personnel at a military medical facility.
Section 302 would prohibit the transfer of funds
from DoD medical care accounts to administrative accounts for
the purpose of complying with the provisions of H.R. 1538.
Section 303 would require VA to increase the
number of resident physicians at its hospitals. Based on
information from VA, CBO estimates that this requirement can be
met at minimal cost.
Section 108 would establish a pilot program to
operate a Wounded Warrior Battalion for a period of one year.
The battalion would be dedicated to tracking and assisting
soldiers who require medical care while in an outpatient
status. Since personnel for this unit would come from within
authorized personnel levels, CBO anticipates this provision
would have an insignificant effect on discretionary spending.
Section 202 would require the regular inspection
of military housing facilities and quarters that are occupied
by recovering servicemembers.
Direct Spending: Section 109 would require DoD to verify
that the medical condition of servicemembers who are receiving
temporary disability retirement has stabilized before
separating them from the armed forces. Under current law, they
may be separated any time their degree of disability is rated
at less than 30 percent. Under this provision, some members
could receive temporary disability retirement annuities for up
to three and one-half years longer than they otherwise would
have.
CBO expects no significant budgetary impact from this
provision because it would likely affect few members. In
addition, many military retirement annuities are reduced, or
offset, by the amount of veterans disability compensation
received. CBO estimates that most or all of these temporary
retirees would be eligible for veterans disability benefits and
that any additional retirement benefits received under this
provision would be substantially reduced by the disability
compensation offset.
Intergovernmental and Private-sector Impact: H.R. 1538
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: Medical Care: Michelle S. Patterson;
Military Retirement: Mike Waters; Military Personnel: Matthew
Schmit; Operations and Maintenance: Jason Wheelock; 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.
Committee Cost Estimate
Pursuant to clause 3(d) of rule XIII of the Rules of the
House of Representatives, the committee generally concurs with
the estimate as contained in the report of the Congressional
Budget Office. However, with regards to section 110(c) of this
Act, the committee is reviewing the Congressional Budget Office
Estimate.
Oversight Findings
With respect to clause 3(c)(1) of rule XIII of the Rules of
the House of Representatives, the committee reports that the
findings and recommendations of the committee, based on
oversight activities pursuant to clause 2(b)(1) of rule X, are
incorporated in the descriptive portions of this report.
With respect to clause 3(c)(2) of rule XIII of the Rules of
the House of Representatives, this legislation does not include
any new spending or credit authority, nor does it provide for
any increase or decrease in tax revenues or expenditures.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the committee finds the authority for
this legislation in Article I, section 8 of the United States
Constitution.
Earmarks
Pursuant to clause 9 of rule XXI, H.R. 1538, the Wounded
Warrior Assistance Act of 2007, contains no congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9(d), 9(e), or 9(f) of rule XXI.
Statement of Federal Mandates
Pursuant to section 423 of Public Law 104-4, this
legislation contains no federal mandates with respect to state,
local, and tribal governments, nor with respect to the private
sector. Similarly, the bill provides no unfunded federal
intergovernmental mandates.
Record Votes
In accordance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, record votes were taken with
respect to the committee's consideration of H.R. 1538. The
record of these votes is attached to this report.
The committee ordered H.R. 1538, as amended, reported to
the House with a favorable recommendation by a record vote of
59-0, a quorum being present.
[GRAPHIC] [TIFF OMITTED] TR68.001
[GRAPHIC] [TIFF OMITTED] TR68.002
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 (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 10, UNITED STATES CODE
Subtitle A--General Military Law
PART I--ORGANIZATION AND GENERAL MILITARY POWERS
* * * * * * *
CHAPTER 23--MISCELLANEOUS STUDIES AND REPORTS
Sec.
480. Reports to Congress: submission in electronic form.
* * * * * * *
490. Annual report on military medical facilities.
* * * * * * *
Sec. 490. Annual report on military medical facilities
(a) Annual Report.--Not later than the date on which the
President submits the budget for a fiscal year to Congress
pursuant to section 1105 of title 31, the Secretary of Defense
shall submit to the Committees on Armed Services of the Senate
and the House of Representatives a report on the adequacy,
suitability, and quality of medical facilities and medical-
related support facilities at each military installation within
the Department of Defense.
(b) Response to Hot-Line Information.--The Secretary of
Defense shall include in each report information regarding--
(1) any deficiencies in the adequacy, quality, or
state of repair of medical-related support facilities
raised as a result of information received during the
period covered by the report through the toll-free hot
line maintained pursuant to section 1567 of this title;
and
(2) the investigations conducted and plans of action
prepared under such section to respond to such
deficiencies.
(c) Medical-Related Support Facility.--In this section, the
term ``medical-related support facility'' is any facility of
the Department of Defense that provides support to any of the
following:
(1) Members of the armed forces admitted for
treatment to military medical treatment facilities.
(2) Members of the armed forces assigned to military
medical treatment facilities as an outpatient.
(3) Family members accompanying any member described
in paragraph (1) or (2) as a nonmedical attendant.
PART II--PERSONNEL
* * * * * * *
CHAPTER 55--MEDICAL AND DENTAL CARE
Sec.
1071. Purpose of this chapter.
* * * * * * *
1074l. Management of medical and dental care: members assigned to
receive care in an outpatient status.
1074m. Notification to Congress of hospitalization of combat wounded
members.
* * * * * * *
Sec. 1074l. Management of medical and dental care: members assigned to
receive care in an outpatient status
(a) Medical Care Case Managers.--(1) A member in an
outpatient status at a military medical treatment facility
shall be assigned a medical care case manager.
(2)(A) The duties of the medical care case manager shall
include the following with respect to the member (or the
member's immediate family if the member is incapable of making
judgments about personal medical care):
(i) To assist in understanding the member's medical
status.
(ii) To assist in receiving prescribed medical care.
(iii) To conduct a review, at least once a week, of
the member's medical status.
(B) The weekly medical status review described in
subparagraph (A)(iii) shall be conducted in person with the
member. If such a review is not practicable, the medical care
case manager shall provide a written statement to the case
manager's supervisor indicating why an in-person medical status
review was not possible.
(3)(A) Except as provided in subparagraph (B), each medical
care case manager shall be assigned to manage not more than 17
members in an outpatient status.
(B) The Secretary concerned may waive for up to 120 days the
requirement of subparagraph (A) if required due to unforeseen
circumstances.
(4)(A) The medical care case manager office at each facility
shall be headed by a commissioned officer of appropriate rank
and appropriate military occupation specialty, designator, or
specialty code.
(B) For purposes of subparagraph (A), an appropriate military
occupation specialty, designator, or specialty code includes
membership in the Army Medical Corps, Army Medical Service
Corps, Army Nurse Corps, Navy Medical Corps, Navy Medical
Service Corps, Navy Nurse Corps, or Air Force Medical Service.
(5) The Secretary of Defense shall establish a standard
training program and curriculum for medical care case managers.
Successful completion of the training program is required
before a person may assume the duties of a medical care case
manager.
(b) Service Member Advocate.--(1) A member in an outpatient
status shall be assigned a service member advocate.
(2) The duties of the service member advocate shall include--
(A) communicating with the member and with the
member's family or other individuals designated by the
member;
(B) assisting with oversight of the member's welfare
and quality of life; and
(C) assisting the member in resolving problems
involving financial, administrative, personnel,
transitional, and other matters.
(3)(A) Except as provided in subparagraph (B), each service
member advocate shall be assigned to not more than 30 members
in an outpatient status.
(B) The Secretary concerned may waive for up to 120 days the
requirement of subparagraph (A) if required due to unforeseen
circumstances.
(4) The service member advocate office at each facility shall
be headed by a commissioned officer of appropriate rank and
appropriate military occupation specialty, designator, or
specialty code in order to handle service-specific personnel
and financial issues.
(5) The Secretary of Defense shall establish a standard
training program and curriculum for service member advocates.
Successful completion of the training program is required
before a person may assume the duties of a service member
advocate.
(6) A service member advocate shall continue to perform the
duties described in paragraph (2) with respect to a member
until the member is returned to duty or separated or retired
from the armed forces.
(c) Semiannual Surveys by Secretaries Concerned.--The
Secretary concerned shall conduct a semiannual survey of
members in an outpatient status at installations under the
Secretary's supervision. The survey shall include, at a
minimum, the members' assessment of the quality of medical care
at the facility, the timeliness of medical care at the
facility, the adequacy of living facilities and other quality
of life programs, the adequacy of case management support, and
the fairness and timeliness of the physical disability
evaluation system. The survey shall be conducted in
coordination with installation medical commanders and
authorities, and shall be coordinated with such commanders and
authorities before submission to the Secretary.
(d) Definitions.--In this section:
(1) The term ``member in an outpatient status'' means
a member of the armed forces assigned to a military
medical treatment facility as an outpatient or to a
unit established for the purpose of providing command
and control of members receiving medical care as
outpatients.
(2) The term ``disability evaluation system'' means
the Department of Defense system or process for
evaluating the nature of and extent of disabilities
affecting members of the armed forces (other than the
Coast Guard) and comprised of medical evaluation
boards, physical evaluation boards, counseling of
members, and final disposition by appropriate personnel
authorities, as operated by the Secretaries of the
military departments, and, in the case of the Coast
Guard, a similar system or process operated by the
Secretary of Homeland Security.
Sec. 1074m. Notification to Congress of hospitalization of combat
wounded members
(a) Notification Required.--The Secretary concerned shall
provide notification of the hospitalization of any member of
the armed forces evacuated from a theater of combat to the
appropriate Members of Congress.
(b) Appropriate Members.--In this section, the term
``appropriate Members of Congress'', with respect to the member
of the armed forces about whom notification is being made,
means the Senators and the Members of the House of
Representatives representing the States or districts,
respectively, that include the member's home of record and, if
different, the residence of the next of kin, or a different
location as provided by the member.
(c) Consent of Member Required.--The notification under
subsection (a) may be provided only with the consent of the
member of the armed forces about whom notification is to be
made. In the case of a member who is unable to provide consent,
information and consent may be provided by next of kin.
* * * * * * *
CHAPTER 58--BENEFITS AND SERVICES FOR MEMBERS BEING SEPARATED OR
RECENTLY SEPARATED
Sec.
1141. Involuntary separation defined.
[1142. Preseparation counseling; transmittal of medical records to
Department of Veterans Affairs.]
1142. Preseparation counseling.
1142a. Process for transition of members to health care and physical
disability systems of Department of Veterans Affairs.
* * * * * * *
[Sec. 1142. Preseparation counseling; transmittal of medical records
to Department of Veterans Affairs]
Sec. 1142. Preseparation counseling
(a) * * *
* * * * * * *
[(c) Transmittal of Medical Information to Department of
Veterans Affairs.--In the case of a member being medically
separated or being retired under chapter 61 of this title, the
Secretary concerned shall ensure (subject to the consent of the
member) that a copy of the member's service medical record
(including any results of a Physical Evaluation Board) is
transmitted to the Secretary of Veterans Affairs within 60 days
of the separation or retirement.]
Sec. 1142a. Process for transition of members to health care and
physical disability systems of Department of
Veterans Affairs
(a) Transition Plan.--(1) The Secretary of Defense shall
ensure that each member of the armed forces who is being
separated or retired under chapter 61 of this title receives a
written transition plan that--
(A) specifies the recommended schedule and milestones
for the transition of the member from military service;
and
(B) provides for a coordinated transition of the
member from the Department of Defense disability system
to the Department of Veterans Affairs.
(2) A member being separated or retired under chapter 61 of
this title shall receive the transition plan before the
separation or retirement date of the member.
(3) The transition plan for a member under this subsection
shall include information and guidance designed to assist the
member in understanding and meeting the schedule and milestones
for the member's transition.
(b) Formal Transition Process.--(1) The Secretary of Defense,
in cooperation with the Secretary of Veterans Affairs, shall
establish a formal process for the transmittal to the Secretary
of Veterans Affairs of the records and other information
described in paragraph (2) as part of the separation or
retirement of a member of the armed forces under chapter 61 of
this title.
(2) The records and other information to be transmitted under
paragraph (1) with respect to a member shall include, at a
minimum, the following:
(A) The member's address and contact information.
(B) The member's DD-214 discharge form, which shall
be transmitted electronically.
(C) A copy of the member's service record, including
medical records and any results of a Physical
Evaluation Board.
(D) Whether the member is entitled to transitional
health care, a conversion health policy, or other
health benefits through the Department of Defense under
section 1145 of this title.
(E) Any requests by the member for assistance in
enrolling in, or completed applications for enrollment
in, the health care system of the Department of
Veterans Affairs for health care benefits for which the
member may be eligible under laws administered by the
Secretary of Veterans Affairs.
(F) Any requests by the member for assistance in
applying for, or completed applications for,
compensation and vocational rehabilitation benefits to
which the member may be entitled under laws
administered by the Secretary of Veterans Affairs, if
the member is being medically separated or is being
retired under chapter 61 of this title.
(3) The transmittal of information under paragraph (1) may be
subject to the consent of the member, as required by statute.
(4) With the consent of the member, the member's address and
contact information shall also be submitted to the department
or agency for veterans affairs of the State in which the member
intends to reside after the separation or retirement of the
member.
(c) Meeting.--(1) The formal process required by subsection
(b) for the transmittal of records and other information with
respect to a member shall include a meeting between
representatives of the Secretary concerned and the Secretary of
Veterans Affairs, which shall take place at a location
designated by the Secretaries. The member shall be informed of
the meeting at least 30 days in advance of the meeting, except
that the member may waive the notice requirement in order to
accelerate transmission of the member's records and other
information to the Department of Veterans Affairs.
(2) A member shall be given an opportunity to submit a
written statement for consideration by the Secretary of
Veterans Affairs.
(d) Time for Transmittal of Records.--The Secretary concerned
shall provide for the transmittal to the Department of Veterans
Affairs of records and other information with respect to a
member at the earliest practicable date. In no case should the
transmittal occur later than the date of the separation or
retirement of the member.
(e) Armed Forces.--In this section, the term ``armed forces''
means the Army, Navy, Air Force, and Marine Corps.
* * * * * * *
Sec. 1145. Health benefits
(a) * * *
* * * * * * *
(d) Uniform Separation and Evaluation Physical.--The joint
separation and evaluation physical, as described in DD-2808 and
DD-2697, shall be used by the Secretary of Defense in
connection with the medical separation or retirement of all
members of the armed forces, including members separated or
retired under chapter 61 of this title. The Secretary of
Veterans Affairs shall adopt the same separation and evaluation
physical for use by the Department of Veterans Affairs.
[(d)] (e) Definition.--In this section, the term ``conversion
health policy'' means a health insurance policy with a private
insurer, developed through negotiations between the Secretary
of Defense and a private insurer, that is available for
purchase by or for the use of a person who is no longer a
member of the armed forces or a covered beneficiary.
[(e)] (f) Coast Guard.--The Secretary of Homeland Security
shall implement this section for the members of the Coast Guard
and their dependents.
* * * * * * *
CHAPTER 61--RETIREMENT OR SEPARATION FOR PHYSICAL DISABILITY
Sec.
1201. Regulars and members on active duty for more than 30 days:
retirement.
* * * * * * *
[1222. Physical evaluation boards.]
1222. Physical evaluation boards and medical evaluation boards.
* * * * * * *
Sec. 1210. Members on temporary disability retired list: periodic
physical examination; final determination of status
(a) * * *
* * * * * * *
(e) If, as a result of a periodic examination under
subsection (a), or upon a final determination under subsection
(b), it is determined that the member's physical disability is
of a permanent nature and stable and is less than 30 percent
under the standard schedule of rating disabilities in use by
the Department of Veterans Affairs at the time of the
determination, and if he has less than 20 years of service
computed under section 1208 of this title, his name shall be
removed from the temporary disability retired list and he may
be separated under section 1203 or 1206 of this title,
whichever applies.
* * * * * * *
Sec. 1216. Secretaries: powers, functions, and duties
(a) * * *
* * * * * * *
(e)(1) The Secretary of Defense shall establish a
standardized training program and curriculum for persons
described in paragraph (2) who are involved in the disability
evaluation system. The training under the program shall be
provided as soon as practicable in coordination with other
training associated with the responsibilities of the person.
(2) Persons covered by paragraph (1) include--
(A) Commanders.
(B) Enlisted members who perform supervisory
functions.
(C) Health care professionals.
(D) Others persons with administrative, professional,
or technical responsibilities in the disability
evaluation system.
(3) In this subsection, the term ``disability evaluation
system'' means the Department of Defense system or process for
evaluating the nature of and extent of disabilities affecting
members of the armed forces (other than the Coast Guard) and
comprised of medical evaluation boards, physical evaluation
boards, counseling of members, and final disposition by
appropriate personnel authorities, as operated by the
Secretaries of the military departments, and, in the case of
the Coast Guard, a similar system or process operated by the
Secretary of Homeland Security.
* * * * * * *
[Sec. 1222. Physical evaluation boards]
Sec. 1222. Physical evaluation boards and medical evaluation boards
(a) * * *
(b) Liaison Officer (Peblo) Requirements and Training.--(1)
The Secretary of Defense shall prescribe regulations
[establishing--
[(A) a requirement] establishing a requirement for
the Secretary of each military department to make
available to members of the armed forces appearing
before physical evaluation boards operated by that
Secretary employees, designated as physical evaluation
board liaison officers, to provide advice, counsel, and
general information to such members on the operation of
physical evaluation boards operated by [that Secretary;
and
[(B) standards and guidelines concerning the training
of such physical evaluation board liaison officers.]
that Secretary. A physical evaluation board liaison
officer may not be assigned more than 20 members at any
one time, except that the Secretary concerned may
authorize the assignment of additional members, for not
more than 120 days, if required due to unforeseen
circumstances.
(2) The Secretary of Defense shall establish a standardized
training program and curriculum for physical evaluation board
liaison officers. Successful completion of the training program
is required before a person may assume the duties of a physical
evaluation board liaison officer. The Secretary shall ensure
compliance by the Secretary of each military department with
physical evaluation board liaison officer requirements and
training standards and guidelines at least once every three
years.
(3) In this subsection, the term ``physical evaluation board
liaison officer'' includes any person designated as, or
assigned the duties of, an assistant to a physical evaluation
board liaison officer.
* * * * * * *
(d) Independent Medical Advocate for Members Before Medical
Evaluation Boards.--(1) The Secretary of each military
department shall ensure, in the case of any member of the armed
forces being considered by a medical evaluation board under
that Secretary's supervision, that the member has access to a
physician or other appropriate health care professional who is
independent of the medical evaluation board.
(2) The physician or other health care professional assigned
to a member shall--
(A) serve as an advocate for the best interests of
the member; and
(B) provide the member with advice and counsel
regarding the medical condition of the member and the
findings and recommendations of the medical evaluation
board.
* * * * * * *
CHAPTER 80--MISCELLANEOUS INVESTIGATION REQUIREMENTS AND OTHER DUTIES
Sec.
1561. Complaints of sexual harassment: investigation by commanding
officers.
* * * * * * *
1567. Identification and investigation of deficiencies in adequacy,
quality, and state of repair of medical-related support
facilities.
* * * * * * *
Sec. 1567. Identification and investigation of deficiencies in
adequacy, quality, and state of repair of medical-
related support facilities
(a) Toll-Free Hot Line.--The Secretary of Defense shall
establish and maintain a toll-free telephone number (commonly
referred to as a ``hot line'') at which personnel are
accessible at all times to collect, maintain, and update
information regarding possible deficiencies in the adequacy,
quality, and state of repair of medical-related support
facilities. The Secretary shall widely disseminate information
regarding the existence and availability of the toll-free
telephone number to members of the armed forces and their
dependents.
(b) Investigation and Response Plan.--Not later than 96 hours
after a report of deficiencies in the adequacy, quality, or
state of repair of a medical-related support facility is
received by way of the toll-free telephone number or other
source, the Secretary of Defense shall ensure that--
(1) the deficiencies referred to in the report are
investigated; and
(2) if substantiated, a plan of action for
remediation of the deficiencies is developed and
implemented.
(c) Relocation.--If the Secretary of Defense determines, on
the basis of the investigation conducted in response to a
report of deficiencies at a medical-related support facility,
that conditions at the facility violate health and safety
standards, the Secretary shall relocate the occupants of the
facility while the violations are corrected.
(d) Medical-Related Support Facility Defined.--In this
section, the term ``medical-related support facility'' means
any facility of the Department of Defense that provides support
to any of the following:
(1) Members of the armed forces admitted for
treatment to a military medical treatment facility.
(2) Members of the armed forces assigned to a
military medical treatment facility as an outpatient.
(3) Family members accompanying any member described
in paragraph (1) or (2) as a nonmedical attendant.
* * * * * * *
ADDITIONAL VIEWS OF SOLOMON P. ORTIZ
The amendment as adopted today would impose a one-year
moratorium on all FUTURE A-76 competitions at the Department of
Defense for work performed at medical facilities.
Both the private and public sectors have identified flaws
in the process. And, the problems we discovered with the
contract at Walter Reed Army Medical Center are only the tip of
the iceberg. In a September 2006 memo, the garrison commander
admitted that he had difficulties in retaining and hiring
skilled personnel. This was because of the A-76 study, the
proposed RIFS that went with it and BRAC.
That is why we need to step back and review whether A-76
competitions are the right way to find cost savings and
efficiencies for military medical facilities. And we need to
make sure that we have not sacrificed service or performance of
the mission.
Let me make clear. This amendment addresses only FUTURE
contracts for services performed at medical facilities. It does
not overturn the Walter Reed contract. It would be
irresponsible to do that. The federal workforce has gone to
other federal jobs or hired by the private contractor, who is
now on the job and performing.
The amendment as approved also calls for a report that will
help us determine the value of the A-76 process.
Solomon P. Ortiz.