[House Report 113-247]
[From the U.S. Government Publishing Office]


113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    113-247

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



 
              TINNITUS RESEARCH AND TREATMENT ACT OF 2013

                                _______
                                

October 22, 2013.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 1443]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1443) to direct the Secretary of Veterans 
Affairs to recognize tinnitus as a mandatory condition for 
research and treatment by the Department of Veterans Affairs, 
and for other purposes, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Statement of Constitutional Authority............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     7
Disclosure of Directed Rulemaking................................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill as Reported.............     8

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Tinnitus Research and Treatment Act of 
2013''.

SEC. 2. FINDINGS.

  Congress makes the following findings:
          (1) Since 2006, the most prevalent service-connected 
        disability for which veterans have received compensation under 
        the laws administered by the Secretary of Veterans Affairs has 
        been tinnitus.
          (2) The number of veterans receiving such compensation for 
        tinnitus has risen each year since 2006, increasing the number 
        and cost of the compensation claims paid by the Secretary.
          (3) A growing body of peer reviewed literature indicates a 
        direct connection between traumatic brain injury, post 
        traumatic stress disorder, and tinnitus.
          (4) An analysis of data collected by the Department of 
        Veterans Affairs concluded that total amount of disability 
        compensation paid for tinnitus by the Department of Veterans 
        Affairs in 2012 was $1,500,000,000.
          (5) Based on projected rates of growth, the amount of 
        disability compensation payable to veterans for tinnitus is 
        expected to exceed $3,000,000,000 in 2017.

SEC. 3. RECOGNITION AND TREATMENT OF TINNITUS AT DEPARTMENT OF VETERANS 
                    AFFAIRS AUDITORY CENTERS OF EXCELLENCE.

  The Secretary of Veterans Affairs shall recognize tinnitus as a 
condition for research and treatment by the Department of Veterans 
Affairs Auditory Centers of Excellence.

SEC. 4. RESEARCH ON PREVENTION AND TREATMENT OF TINNITUS.

  (a) In General.--The Secretary of Veterans Affairs shall recognize 
the need to enhance the research and treatment of tinnitus and to 
ensure the allocation of appropriate resources directed at the research 
and enhanced treatment of tinnitus conducted by the Auditory Centers of 
Excellence of the Department of Veterans Affairs, commensurate with 
peer-review protocols. Such research shall include--
          (1) an assessment of the efficacy of multidisciplinary 
        tinnitus treatment modalities on different subsets of patients;
          (2) studies on the underlying etiology of tinnitus in veteran 
        populations that occur as a result of different causal factors, 
        including blast-related tinnitus where there is no measurable 
        hearing loss versus other forms of noise-induced tinnitus where 
        there is hearing loss; and
          (3) a study of the underlying mechanisms between hearing loss 
        and tinnitus, including cases in which one or the other 
        condition is present, but not both.
  (b) Relationship to Other Authorities.--Nothing in this section shall 
be construed as interfering with the discretion of the Secretary of 
Veterans Affairs to conduct research in accordance with peer-review 
protocols in order to ensure the quality and transparency of the 
research.

SEC. 5. INTERDEPARTMENTAL COOPERATION.

  The Secretary of Veterans Affairs shall ensure the cooperation of the 
Department of Veterans Affairs with the Hearing Center of Excellence 
established by the Department of Defense to further research on 
tinnitus.

                          PURPOSE AND SUMMARY

    H.R. 1443, the Tinnitus Research and Treatment Act of 2013, 
was introduced by Representative Michael H. Michaud of Maine, 
Ranking Member of the Committee on Veterans' Affairs, on April 
9, 2013. H.R. 1443, as amended, would: require the Department 
of Veterans Affairs (VA) to recognize the need to enhance the 
research and treatment of tinnitus; require VA to ensure the 
allocation of the appropriate resources directed at the 
research and treatment of tinnitus conducted by the VA Auditory 
Centers of Excellence, commensurate with peer-review protocols; 
and, require VA to ensure cooperation with the Hearing Center 
of Excellence established by the Department of Defense (DOD) to 
further research on tinnitus.

                  BACKGROUND AND NEED FOR LEGISLATION

    Tinnitus is the experience or sensation of hearing sound 
when no external sound is present. It is often characterized by 
a persistent ringing in the ears and can range from merely 
distracting to wholly debilitating, depending on the severity 
of the condition. While noise overexposure either from a single 
impulse noise or cumulative exposure to noise is still the 
number one cause of tinnitus, it can also develop as a result 
of a head or neck injury. Further, a growing body of research 
has directly linked tinnitus as a co-morbid condition to both 
traumatic brain injury (TBI) and post-traumatic stress disorder 
(PTSD), indicating that tinnitus represents a larger problem 
than hearing loss in the blast-exposed population.
    Tinnitus is one of the top five reported complaints from 
veterans of all eras of service and is particularly prevalent 
among veterans of Iraq and Afghanistan. Since 2006, the number 
of service-connected disability claims for tinnitus has risen 
at a rate of 15 percent each year, making it the most frequent 
service-connected disability.
    To care for these veterans, VA audiology clinics provide a 
Progressive Tinnitus Management (PTM) program. According to VA, 
``[t]he focus of PTM is to teach patients how to manage their 
reactions to tinnitus.'' The PTM program encompasses five 
hierarchical tiers: triage; audiologic evaluation; group 
education; interdisciplinary evaluation; and, individualized 
support. Services offered to veterans with tinnitus through the 
PTM program include: hearing aids, group educational 
counseling, individual counseling, drug therapy, sound-based 
therapy, cognitive behavioral therapy, and relaxation 
techniques.
    Tinnitus-related research and educational resources are 
provided through the National Center for Rehabilitative 
Auditory Research (NCRAR), a VA Rehabilitation Research and 
Development Center of Excellence that is located on the campus 
of the Portland VA medical center. The NCRAR collaborates with 
the VA Audiology Program to develop and evaluate the PTM 
program at VA medical centers. VA also conducts research 
related to tinnitus in collaboration with DOD through the 
Defense Center of Excellence for Hearing Loss and Auditory 
System Injuries, which was mandated by section 721 of Public 
Law 110-417 (122 Stat. 4356, 4506), the Duncan Hunter National 
Defense Authorization Act for Fiscal Year 2009. VA's total 
investment in tinnitus-related research totals approximately 
$1.2 million, about one-tenth of the total national research 
dollars devoted to tinnitus.
    While recognizing VA's efforts both within the Department 
and in collaboration with DOD, the Committee is concerned with 
the increasing number of veterans who report experiencing 
tinnitus and the amount of VA research dollars dedicated to 
understanding, treating, and preventing it. Further, the 
Committee believes that greater knowledge of tinnitus could 
lead to more effective treatments for veterans and a better 
understanding of the link between tinnitus and both TBI and 
PTSD.
    H.R. 1443, as amended, would address the Committee's 
concerns by requiring VA to conduct further research regarding 
this condition.

                                HEARINGS

    On July 9, 2013, the Subcommittee on Health conducted a 
legislative hearing on various bills introduced during the 
113th Congress, including Draft Legislation, the Long-Term Care 
Veterans Choice Act; H.R. 1443; H.R. 1612; H.R. 1702; and, H.R. 
2065.
    The following witnesses testified:
    The Honorable Mike Rogers of Alabama; the Honorable David 
McKinley of West Virginia; Jacob Gadd, the Deputy Director for 
Health Care for the Veterans Affairs and Rehabilitation 
Commission of the American Legion; Susan E. Shore, Ph.D., the 
Chair of the Scientific Advisory Committee for the American 
Tinnitus Association; Adrian Atizado, the Assistant National 
Legislative Director for the Disabled American Veterans; Robert 
Drexler, Member of the Board of Directors for the International 
Code Council, Raymond C. Kelley, Director of the National 
Legislative Service for the Veterans of Foreign Wars; and 
Robert L. Jesse, M.D., Ph.D., the Principal Deputy Under 
Secretary for Health for the Veterans Health Administration of 
the U.S. Department of Veterans Affairs, accompanied by Susan 
Blauert, the Deputy Assistant General Counsel for the U.S. 
Department of Veterans Affairs.
    Statements for the record were submitted by the following:
    The Honorable Ron Barber of Arizona; the Iraq and 
Afghanistan Veterans of America; Tuskegee University; the 
National Association of State Fire Marshals; the National 
Coalition for Homeless Veterans; the Paralyzed Veterans of 
America; the Vietnam Veterans of America; and the Wounded 
Warrior Project.

                       SUBCOMMITTEE CONSIDERATION

    On July 23, 2013, the Subcommittee on Health met in open 
session, a quorum being present, and favorably forwarded to the 
full Committee H.R. 1443, as amended, by voice vote.
    During consideration of H.R. 1443, the following amendment 
was considered and agreed to by voice vote:
    An amendment offered by Ms. Brownley of California that 
would: strike any reference to ``mandatory'' research; require 
VA to recognize the need to enhance the research and treatment 
of tinnitus; and specify that nothing in this legislation shall 
be construed as interfering with VA's existing research peer-
review protocols.

                        COMMITTEE CONSIDERATION

    On August 1, 2013, the full Committee met in an open markup 
session, a quorum being present and ordered H.R. 1443, as 
amended, reported favorably to the House of Representatives by 
voice vote.

                            COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 1443, as amended, reported to the House. A 
motion by Ranking Member Michael H. Michaud of Maine to report 
H.R. 1443, as amended, favorably to the House of 
Representatives was agreed to by voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

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

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

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

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 1443, as amended, does not contain any congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
1443 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 1443, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, August 8, 2013.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1443, the Tinnitus 
Research and Treatment Act of 2013.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 1443--Tinnitus Research and Treatment Act of 2013

    H.R. 1443 would require the Department of Veterans Affairs 
(VA) to treat tinnitus as a condition for research and 
treatment at VA Auditory Centers of Excellence. Tinnitus, the 
medical term for the sensation of hearing sound when no 
external sound is present, is the most common disability among 
veterans and may be caused by exposure to loud sounds during 
military service. The VA already provides tinnitus treatment at 
all its audiology clinics.
    Furthermore, VA's National Center for Rehabilitation 
Auditory Research (NCRAR) at the Portland VA Medical Center 
conducts research and provides educational resources for 
tinnitus. NCRAR has several research projects currently under 
way on tinnitus (for example, the Clinical Trial of 
Transcranial Magnetic Stimulation for Relief of Tinnitus, 
Telephone Tinnitus Education for Patients with TBI, and Multi-
Site Evaluation of Progressive Tinnitus Management). 
Additionally, the VA Research Enhancement Award Program at 
Mountain Home Veterans Affairs Medical Center in Tennessee is 
conducting tinnitus-related research projects.
    VA is currently collaborating with the Department of 
Defense Hearing Center of Excellence in maintaining a joint 
registry, providing treatment and conducting research for 
tinnitus. Since this bill would codify VA's current practices 
regarding tinnitus, CBO estimates that implementing H.R. 1443 
would have no significant cost over the 2014-2018 period.
    Enacting this bill would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    H.R. 1443 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was approved by Peter H. Fontaine, Assistant 
Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of federal 
mandates regarding H.R. 1443, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to Section 
423 of the Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    H.R. 1443, as amended, creates no advisory committees 
within the meaning of section 5(b) of the Federal Advisory 
Committee Act.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of the 
Congressional Accountability Act Sec. 102(b)(3), 2 U.S.C. 
Sec. 24 (1995).

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to section 3(j) of H. Res. 5, 113th Cong. (2013), 
the Committee finds that no provision of H.R. 1443, as amended, 
establishes or reauthorizes a program of the Federal Government 
known to be duplicative of another Federal program, a program 
that was included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance.

                   DISCLOSURE OF DIRECTED RULEMAKING

    Pursuant to section 3(k) of H. Res. 5, 113th Cong. (2013), 
the Committee estimates that H.R. 1443, as amended, does not 
require any directed rule makings.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would provide the short title of H.R. 
1443, as amended, as the ``Tinnitus Research and Treatment Act 
of 2013.''

Section 2. Findings

    Section 2 of the bill would make a number of findings 
related to tinnitus.

Section 3. Recognition and treatment of tinnitus at Department of 
        Veterans Affairs Auditory Centers of Excellence

    Section 3 of the bill would require VA to recognize 
tinnitus as a condition for research and treatment by the VA 
Auditory Centers of Excellence.

Section 4. Research on prevention and treatment of tinnitus

    Section 4(a) of the bill would require the Secretary of 
Veterans Affairs to recognize the need to enhance the research 
and treatment of tinnitus and to ensure the allocation of 
appropriate resources directed at the research and enhanced 
treatment of tinnitus conducted by the VA Auditory Centers of 
Excellence, commensurate with peer review protocols.
    Section 4(a)(1) of the bill would require such research to 
include an assessment of the efficacy of multidisciplinary 
tinnitus treatment modalities on different subsets of patients.
    Section 4(a)(2) of the bill would require such research to 
include studies on the underlying etiology of tinnitus in 
veteran populations that occur as a result of different causal 
factors, including blast-related tinnitus that does not result 
in hearing loss and other forms of noise-induced tinnitus that 
does result in hearing loss.
    Section 4(a)(3) of the bill would require such research to 
include a study of the underlying mechanisms between hearing 
loss and tinnitus, including cases in which only one such 
condition is present.
    Section 4(b) of the bill would require that nothing in the 
bill be construed as interfering with VA's discretion to 
conduct research in accordance with peer-review protocols in 
order to ensure the quality and transparency of the research.

Section 5. Interdepartmental cooperation

    Section 5 of the bill would require VA to ensure 
cooperation with the Hearing Center of Excellence established 
by DOD to further research on tinnitus.

          CHANGES IN EXISTING LAW MADE BY THE BILL AS REPORTED

    H.R. 1443, as amended, would not make any amendments to 
existing law.

                                  
