Comparison of “Wounded Warrior” Legislation: H.R. 1538 as Passed in the House and Senate
Order Code RL34110
Comparison of “Wounded Warrior” Legislation:
H.R. 1538 as Passed in the House and Senate
July 27, 2007
Sarah A. Lister and Sidath Viranga Panangala
Domestic Social Policy Division
Richard A. Best Jr.
Foreign Affairs, Defense, and Trade Division
Comparison of “Wounded Warrior” Legislation: H.R.
1538 as Passed in the House and Senate
Summary
This report compares certain provisions in legislation that has been considered
by Congress concerning programs, services (including medical care), and benefits for
injured military servicemembers returning from combat theaters. Relevant provisions
are compared in H.R. 1538 as passed by the House, titled the Wounded Warrior
Assistance Act of 2007, and as passed by the Senate, titled the Dignified Treatment
of Wounded Warriors Act.
Contents
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Summary of Provisions Affecting only the Department of Veterans Affairs . . . 23
H.R. 1538, Passed in Senate, Title I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
H.R. 1538, Passed in Senate, Title II — Veterans Matters . . . . . . . . . . . . . 23
H.R. 1538, Passed in House, Title II — Studies and Reports . . . . . . . . . . . 27
H.R. 1538, Passed in House, Title III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
List of Tables
Table 1. Description of H.R. 1538, Senate- and House-passed Versions . . . . . . . 3
Table 2. Provisions Requiring DOD and VA Coordination . . . . . . . . . . . . . . . . . 5
Table 3. Provisions Affecting only the Department of Defense . . . . . . . . . . . . . 14
Comparison of “Wounded Warrior”
Legislation: H.R. 1538 as Passed in the
House and Senate
Overview
This report compares certain provisions in legislation that has been considered
by Congress concerning programs, services (including medical care), and benefits for
injured military servicemembers returning from combat theaters. Relevant
provisions are compared in H.R. 1538 as passed by the House, titled the Wounded
Warrior Assistance Act of 2007, and as passed by the Senate, titled the Dignified
Treatment of Wounded Warriors Act.
The Senate passed H.R. 1538 in July 2007, as an amendment (S.Amdt. 2402)
in the nature of a substitute. The Senate reported a slightly different version of
S.Amdt. 2402 as S. 1606, the Dignified Treatment of Wounded Warriors Act, in June
2007. The Senate bill, as passed, contains three titles: Title I, Wounded Warrior
Matters; Title II, Veterans Matters; and Title III, Fiscal Year Increase in Military
Basic Pay.
The House passed H.R. 1538 in March 2007. A slightly different version of that
bill was also passed by the House as Title XIV of H.R. 1585, the National Defense
Authorization Act for FY2008, in May 2007. The House bill, as passed, contains
three titles: Title I, Wounded Warrior Assistance; Title II, Studies and Reports; Title
III, General Provisions.
Table 1 of this report presents descriptive information for each bill, as passed.
Table 2 of this report compares provisions in the two bills that require coordination
between the Department of Defense (DOD) and the Department of Veterans Affairs
(VA) — including provisions that would establish specific mechanisms to facilitate
such coordination — as well as provisions that would have direct effects upon both
departments. Table 2 does not include provisions that are almost solely within the
purview of one department, and require only consultation with the Secretary of the
other department. Table 3 compares provisions affecting only the Department of
Defense. Finally, provisions affecting only the Department of Veterans Affairs are
summarized. These provisions are primarily found in Title II of the Senate bill,
without comparable provisions in the House bill. A few VA-specific provisions in
Title I of the Senate bill, and in the House bill, are also described.
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Unless otherwise noted, references in this report and in the tables to activities
of “DOD” or “VA” are activities to be carried out by the Secretary of the stated
department. The following acronyms and abbreviations are used:
CBO: Congressional Budget Office
DD-214: Department of Defense form, Certificate of Release or Discharge from
Active Duty
DD-2808: Department of Defense form, Report of Medical Examination, used to
determine medical fitness for enlistment, induction, appointment and retention.
DD-2697: Department of Defense form, Report of Medical Assessment, used for
servicemembers separating or retiring from active duty.
GAO: Government Accountability Office
MTF: Military Treatment Facility
NAS: National Academy of Sciences
OEF: Operation Enduring Freedom
OIF: Operation Iraqi Freedom
PEBLO: Physical Evaluation Board Liaison Officer
PDES: the military Physical Disability Evaluation System
PTSD: Post-traumatic Stress Disorder
SGLI: Servicemembers’ Group Life Insurance
TBI: Traumatic Brain Injury
TDRL: Temporary Disability Retired List
VASRD: Veterans Administration Schedule for Rating Disabilities
WRAMC: Walter Reed Army Medical Center
For additional information, see Congressional Research Service (CRS) reports
regarding Health Care for Military Personnel and Veterans and Military Personnel
and Compensation at [http://apps.crs.gov/cli/level_2.aspx?PRDS_CLI_ITEM_ID=3].
Specific reports of interest include:
! RL33991, Disability Evaluation of Military Servicemembers;
! RL33993, Veterans Health Care Issues;
! RS22366, Military Support to the Severely Disabled: Overview of
Service Programs;
! RL33537, Military Medical Care: Questions and Answers;
! RL33323, Veterans Affairs: Benefits for Service-Connected
Disabilities;
! RL34063, Veterans’ Medical Care: FY2008 Appropriations;
! RL34055, Walter Reed Army Medical Center: Realignment Under
BRAC 2005 and Options for Congress;
! RL33571, The FY2007 National Defense Authorization Act:
Selected Military Personnel Policy Issues;
! RL33446, Military Pay and Benefits: Key Questions and Answers;
! RL33449, Military Retirement, Concurrent Receipt, and Related
Major Legislative Issues.
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Table 1. Description of H.R. 1538, Senate- and House-passed Versions
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Short Title
Dignified Treatment of Wounded Warriors Act
Wounded Warrior Assistance Act of 2007
Introduced
7/25/2007
3/15/2007
Status
Agreed to in Senate by Unanimous Consent, 7/25/2007, as S.Amdt. 2402
Passed in House by unanimous roll call vote, 3/28/2007
Bill Titles and
Title I, Wounded Warrior Matters:
Title I, Wounded Warrior Assistance
Subtitles
- Subtitle A: Policy on Care, Management, and Transition of
Title II, Studies and Reports
Servicemembers with Serious Injuries or Illnesses
Title III, General Provisions
- Subtitle B: Health Care
- Subtitle C: Disability Matters
- Subtitle D: Improvement of Facilities Housing Patients
- Subtitle F: Other Matters
Title II, Veterans Matters
Title III, Fiscal Year Increase in Military Basic Pay
Committee Reports
No Senate report.
H.Rept. 110-68, Wounded Warrior Assistance Act of 2007, Report of the
House Committee on Armed Services, March 23, 2007, 39 pp.
Key definitions
§101. Covered member of the Armed Forces (henceforth “covered
§ 2. Recovering service member means a member of the Armed Forces,
servicemember”) means a member of the Armed Forces, including a
including a member of the National Guard or Reserve, who is undergoing
member of the National Guard or Reserve, who is undergoing medical
medical treatment, recuperation, or therapy, or is otherwise in medical
treatment, recuperation, or therapy, is otherwise in medical hold or
hold or holdover status, for an injury, illness, or disease incurred or
medical holdover status, or is otherwise on the Temporary Disability
aggravated while on active duty in the Armed Forces.
Retired List (TDRL) for a serious injury or illness.
§ 2. The term medical care includes mental health care.
Serious injury or illness is defined in §101, with respect to provisions in
Title I, in the case of a member of the Armed Forces, to mean “an injury
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
or illness incurred by the member in line of duty on active duty in the
Armed Forces that may render the member medically unfit to perform the
duties of the member’s office, grade, rank, or rating.” Severe injury or
illness is defined for the purposes of §121 as “any serious injury or
illness that is assigned a disability rating of 30 percent or higher under
the schedule for rating disabilities in use by the Department of Defense.”
Notes
Most of the required coordinating activities in Title I are to be developed
The bill emphasizes DOD programs, with fewer coordinating or
through a joint comprehensive policy process to be undertaken by the
transition provisions with VA. The bill includes numerous specific
Secretaries of DOD and VA pursuant to §111. The bill lays out a number
directives to DOD, such as specific staffing ratios.
of specific responsibilities or activities that must be addressed in the
policy process, but generally does not stipulate how those responsibilities
or activities are to be addressed.
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Table 2. Provisions Requiring DOD and VA Coordination
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Joint Planning and Policy Development
Required policy
§§111(a) and 111(c). Requires, not later than Jan. 1, 2008, and updated
No comparable provisions.
process
at least annually, DOD and VA, in consultation with heads of other
relevant federal departments and agencies, to jointly develop and
implement a comprehensive policy on the care and management of
covered servicemembers. Scope shall include care and management,
medical and disability evaluation, return to duty when appropriate, and
transition from DOD to VA; and consider findings of several listed
committees, task forces and other sources.
§112. In implementing provisions in §111, including reporting
provisions, DOD and VA shall take into account and fully address any
unique specific needs of women members of the Armed Forces and
women veterans.
§134. DOD and VA shall, within 120 days after enactment, jointly
develop a comprehensive policy to address the treatment and care needs
of female members of the Armed Forces and veterans who experience
mental health problems and conditions, including PTSD. The policy shall
take into account and reflect the results of the review required by
subsection (a).
Required reports on
§111(e). Joint DOD/VA report to congressional committees re:
No comparable provision.
policy process
development of the policy required by this section, not later than Jan. 1,
2008, and reports on required updates.
§111(f). GAO report regarding implementation of this section, within six
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
months of enactment and annually thereafter.
New Positions or Entities
DOD Oversight
No comparable provision.
§113. Establishes an Oversight Board for Wounded Warriors to provide
Board for Wounded
advice and consultation to the Secretary of Defense and congressional
Warriors
committees. The Secretary of VA is involved in selecting members of
the Board.
Defense-wide
§111(d)(1)(Q). Included in development of joint comprehensive policy,
§102. Establishment of Defense-wide Ombudsman Office within the
Ombudsman Office
requires the establishment of a Defense-wide Ombudsman Office within
Office of the Secretary of Defense, with responsibilities to include
the Office of the Secretary of Defense to provide oversight of the
developing policy guidance regarding transfer of servicemembers to the
ombudsman offices in the military departments and policy guidance to
care of VA.
such offices with respect to providing assistance to, and answering
questions from, covered servicemembers and their families. VA
transition issues are not explicitly mentioned.
Interagency
§141(b). Establishes a joint entity of the DOD and the VA, the
No comparable provision.
Program Office for a
Department of Defense-Department of Veterans Affairs Interagency
Joint Electronic
Program Office for a Joint Electronic Health Record; establishes
Health Record
leadership, membership, staffing, funding, other matters.
Army Wounded
No comparable provision.
§109. The Secretary of the Army shall establish a pilot program, known
Warrior Battalion
as the Army Wounded Warrior Battalion, at an appropriate active duty
base with a major medical facility, based on the Wounded Warrior
Regiment program of the Marine Corps. When applicable, the Battalion
shall track and assist members of the Armed Forces in an outpatient
status who are still in need of medical treatment through medical
retirement and subsequent transition into the VA medical system.
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Reviews and Evaluations
Comprehensive
§111(b). Requires, within 90 days of enactment, the Secretaries of DOD
No comparable provision.
evaluation
and VA to, jointly and separately, review all policies and procedures of
each department relevant in developing the aforementioned policy.
Polytrauma
No comparable provision.
§206. DOD shall conduct an evaluation of the Polytrauma Liaison
Liaison Officer/
Officer/Non-Commissioned Officer program, which is the program
Non-Commissioned
operated by each of the military departments and the VA for the purpose
Officer program
of: (1) assisting in the seamless transition of servicemembers from DOD
to VA health care systems; and (2) expediting the flow of information
and communication between MTFs and VA Polytrauma Centers. DOD
shall report the findings of such evaluation to Congress within 90 days of
enactment.
Uniform or Single Physical/Medical Exam
§111(d)(2)(A). The joint DOD/VA policy process requires the
§111(b). Uniform Separation and Evaluation Physical - The joint
development of uniform processes, procedures, and standards for medical
separation and evaluation physical, (as described in DD-2808 and
evaluations of covered servicemembers, including standard processes,
DD-2697), shall be used by DOD in connection with the medical
criteria and timelines for medical evaluation, and dissemination of such
separation or retirement of all members of the armed forces. The VA
information to servicemembers and families. There is no additional
shall adopt the same separation and evaluation physical.
mention in this section of the effect of this provision on VA physical /
medical examinations.
§111(d)(2)(E). The joint DOD/VA policy process requires the
development, when appropriate, of a single physical exam to meet the
requirements of both DOD and VA for covered servicemembers who are
being retired, separated, or released from military service.
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Interoperable Health Records, Patient Tracking Systems
Establishment of new
§141(b). Establishes a joint entity of the DOD and the VA, the
No comparable provision.
joint entity (NOTE:
Department of Defense-Department of Veterans Affairs Interagency
this provision also
Program Office for a Joint Electronic Health Record; establishes
discussed above in
leadership, membership, staffing, funding, reporting requirements, and
section “New
other matters. The Office shall develop and prepare for deployment, not
Positions or
later than September 30, 2010, a joint electronic health record to be used
Entities”)
by both departments in the provision of medical care and treatment to
members of the Armed Forces and veterans. The joint electronic health
record shall comply with applicable interoperability standards,
implementation specifications, and certification criteria (including for the
reporting of quality measures) of the Federal Government.
Requires DOD and VA to contribute equally to the costs of the Office in
FY2008 and thereafter (up to $10 million from each department for
FY2008).
Interoperable health
§141(a). The Secretaries of DOD and VA shall jointly: (1) develop and
§111(c). DOD and VA shall jointly establish and implement a process to
records
implement a joint electronic health record (defined) for use by the
ensure an interoperable, bi-directional, real-time exchange of medical
departments; and (2) accelerate the exchange of health care information
information. (See Table note regarding CBO cost estimate for this
in order to support the delivery of health care by both departments.
provision.)
Within six months of enactment and every six months thereafter until the
completion of the implementation of the joint electronic health record,
GAO shall report to Congress regarding its assessment of the progress of
the departments in developing and implementing the joint electronic
health record. (See Table note regarding CBO cost estimate for a
comparable provision.)
Access to medical
§111(d)(2)(E). The joint DOD/VA policy process requires the
No comparable provision.
records, transfer of
development of policies to assure that VA has access to military health
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
records
records for covered servicemembers who are receiving care, or are
expected to receive care, in VA facilities.
§163. DOD and VA shall jointly develop and implement a mechanism to
provide for the electronic transfer from DOD to VA of any DOD
documents (including form DD-214) necessary to establish or support the
eligibility of a member of the Armed Forces for VA benefits for which
the member is eligible at the time of the retirement, separation, or release
of the member from the Armed Forces.
Patient tracking
§111(d)(1)(L). The joint DOD/VA policy process requires the
§208. Requires DOD to study the feasibility of establishing a patient
systems
development of a tracking system for covered servicemembers within the
tracking system — jointly among the service branches, but not involving
DOD system.
VA — and report to Congress within 180 days regarding its findings.
§111(d)(2)(D). The joint DOD/VA policy process requires the
development of processes, procedures and standards regarding the
transition of covered servicemembers from care and treatment through
the DOD to care and treatment through the VA, including procedures for
patient tracking during the transition.
Disability Evaluation
System evaluation
§111(d)(2)(B). The joint DOD/VA policy process requires the
§203. DOD and VA shall conduct a joint evaluation of their respective
and policy
development of processes, procedures, and standards for physical
disability evaluation systems, for the purpose of: (1) improving the
development
disability evaluations of covered servicemembers, including (1)
consistency of the two systems; and (2) evaluating the feasibility of, and
development of a non-adversarial process in both departments; (2) to the
potential options for, consolidating them. In their evaluation, DOD and
extent feasible, procedures to eliminate unacceptable ratings
VA shall consider the findings of the Veterans’ Disability Benefits
discrepancies among the DOD service branches and between DOD and
Commission, and report to Congress regarding their evaluation within
VA; (3) to the extent feasible, continued use by DOD of the VASRD; and
180 days after the date of publication of the Commission’s findings.
(4) additional standards for timeliness, personnel qualifications,
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
caseloads and related matters.
Requirements and
§152. DOD shall, to extent feasible in making a determination of
No comparable provision.
limitations on DOD
disability of a member of the armed forces for purposes of this chapter,
determinations of
utilize the VASRD. DOD may not deviate from the schedule or any such
disability
interpretation of the schedule, except that in making such a
determination, DOD may utilize in lieu of the VASRD such criteria as
the Secretaries of Defense and Veterans Affairs may jointly prescribe for
purposes of this subsection, if the utilization of such criteria will result in
a determination of a greater percentage of disability than would be
otherwise determined through the utilization of the VASRD. In making a
determination of the rating of disability of a member of the armed forces
for purposes of this chapter, the DOD shall take into account all medical
conditions, whether individually or collectively, that render the member
unfit to perform the duties of the member’s office, grade, rank, or rating.
Pilot programs
§154. DOD shall, in consultation with VA, carry out pilot programs with
No comparable provision.
respect to the DOD disability evaluation system. Pilot programs are as
follows:
(1) Disability determinations by DOD using VA assigned disability
ratings: Under this pilot program, upon a determination by the DOD (the
Secretary of the military department concerned) that the member is unfit
for duty, the VA shall conduct an evaluation of the member for physical
disability, and assign the member a rating of disability, according to the
VASRD, based on all medical conditions (whether individually or
collectively) that render the member unfit for duty; and the DOD (the
Secretary of the military department concerned) shall make the
determination of disability regarding the member utilizing the rating of
disability assigned by the VA.
(2) Disability determinations using joint DOD/VA assigned disability
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
ratings: Under this pilot program, upon a determination by the DOD (the
Secretary of the military department concerned) that the member is unfit
for duty, the DOD (the Secretary of the military department concerned)
shall provide for the joint evaluation of the member for disability by the
DOD (the Secretary of the military department concerned) and the VA,
including the assignment of a rating of disability for the member,
according to the VASRD, based on all medical conditions (whether
individually or collectively) that render the member unfit for duty; and
shall make the determination of disability regarding the member utilizing
the rating of disability assigned in this manner.
This section also requires DOD to establish an information clearinghouse
regarding disability, and lays out certain additional requirements for
reporting and other matters.
TBI and PTSD Programs
§133(a) and (b). Centers of Excellence for TBI and for PTSD are to be
§115. Requires DOD to conduct, in consultation with VA and others,
established by DOD. The Secretary of Defense is authorized to enter into
certain activities to address PTSD, namely: (1) development of PTSD
partnerships, as appropriate, with the VA, to further the research efforts
prevention plans; and (2) studying the feasibility of developing a working
of the centers.
group to research and develop evidence-based approaches. Also requires
DOD to develop a peer-reviewed PTSD research program within the
§134. DOD and VA shall jointly conduct a review of the need for mental
Defense Health Program.
health treatment and services, and the efficacy and adequacy of existing
mental health treatment programs and services, for female members of
the Armed Forces and veterans. DOD and VA shall report to Congress
regarding such review within 90 days of enactment.
Other Transition Provisions
VA benefits teams at
§111(d)(2)(D). The joint DOD/VA policy process requires the
§111(d). DOD and VA shall jointly determine optimal sites for
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
MTFs
development of standards for the optimal location of DOD and VA
co-location of VA benefits teams at MTFs and related facilities (defined).
liaison and case management personnel at MTFs and related facilities
(defined).
Standards and
§111(d)(2)(D). The joint DOD/VA policy process requires the
§111(a). Requires the Secretary of Defense to: (1) ensure that each
processes for the
development of processes, procedures and standards regarding the
affected servicemember, upon separation or retirement, receives a written
transition of covered
transition of covered servicemembers from care and treatment through
transition plan, prior to the date of separation or retirement; and (2)
servicemembers
the DOD to care and treatment through the VA, including (1) a uniform
establish a formal process to transfer, prior to the date of separation or
from DOD to VA
policy to assure continuity and quality of care; (2) procedures for patient
retirement, and contingent upon approval of the servicemember, relevant
tracking during the transition, and cooperative case management; (3)
information to the VA. Specifies types of records and other information,
procedures for DOD to notify VA when the Physical Disability
including DD-214, member’s service record, medical records, and results
Evaluation Process begins for a covered servicemember; (4) procedures
of a Physical Evaluation Board. Such process shall include a meeting
and timelines re: enrollment or application for various VA benefits; (5)
with regard to the servicemember between DOD and VA personnel.
standards for integrated medical care management, including assignment
of VA personnel to DOD facilities; and (6) standards for the development
of detailed individual transition plans.
§163. The Secretaries of DOD and VA shall jointly develop and
implement a mechanism to provide for the electronic transfer from DOD
to VA of any DOD documents (including form DD-214) necessary to
establish or support the eligibility of a member of the Armed Forces for
VA benefits.
Patient and family
§111(d)(2)(E). The joint DOD/VA policy process requires the
No comparable provision.
satisfaction surveys
development of surveys and other mechanisms to measure patient and
family satisfaction with the provision of care and services to covered
servicemembers by DOD and VA.
Additional Required Studies and Reports
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Provision
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H.R. 1538, House Passed
§191. DOD shall contract with NAS to study the physical and mental
No comparable provision.
health and other readjustment needs of members and former members of
the Armed Forces who are deployed in OIF or OEF, and their families as
a result of such deployment. NAS shall have access to DOD and VA
records to conduct the study.
Not later than 90 days after the receipt of a report from NAS, DOD and
VA shall jointly develop a final DOD/VA plan to address NAS findings
and recommendations, and submit such plan to Congress.
Not later than 45 days after the submittal to Congress of the final
DOD/VA plan, GAO shall submit to Congress a report assessing the
contents of such report.
Note: §111 of House-passed H.R. 1538 is comparable to §110 of the House-reported version. CBO published a cost estimate of the House-reported version, noting the following with
respect to the requirement for DOD and VA to implement a single medical information system: “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.” CBO, “H.R. 1538,
Wounded Warrior Assistance Act of 2007, Cost estimate for the bill as ordered reported by the House Committee on Armed Services on March 20, 2007,” March 23, 2007, at
[http://www.cbo.gov/ftpdocs/79xx/doc7905/hr1538.pdf].
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Table 3. Provisions Affecting only the Department of Defense
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Report on reduction
§111(d)(3). DOD to report on number of instances in which a disability
No comparable provision.
in disability ratings
rating was reduced on appeal during the period October 7, 2001, to
September 30, 2006.
Extended MTF
§121. Former servicemembers severely injured since October 7, 2001 to
No comparable provision.
medical care
be made eligible for medical treatment, including treatment for PTSD
and TBI), including treatment in DOD medical treatment facilities, for
three years which can be extended to five years. DOD shall reimburse
covered services provided to these servicemembers or former
servicemembers (as well as travel expenses of an attendant who
accompanies the individual to non-local medical treatment.
Travel
§122. Severely wounded retirees and their authorized escorts to be
No comparable provision.
reimbursement
reimbursed for travel expenses to MTFs.
Medical care for
§126. A family member of a servicemember on invitational orders, while
No comparable provision.
family members
caring for the servicemember and receiving per diem, shall be eligible for
space-available medical care and for job placement services.
Extended benefits
§127. DOD to establish regulations to authorize extension of Tricare
No comparable provision.
under Tricare
benefits to primary caregivers of severely wounded servicemembers.
TBI and PTSD
§131. DOD to provide within 180 days of enactment, in consultation with
No comparable provision.
the VA, comprehensive plans to prevent, diagnose, mitigate, treat and
otherwise respond to TBI and PTSD. Plans to include provisions for
making injured servicemembers aware of options for different treatments.
Medical tracking
§132. DOD shall establish a protocol for predeployment assessment and
§208. DOD to study feasibility of developing joint soldier tracking
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Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
system
documentation of cognitive functioning of servicemembers. The
system for recovering servicemembers that can be accessed by
protocol shall permit differential diagnosis of TBI in servicemembers
servicemembers and family. The study would determine whether the
returning from combat. Up to three pilot programs to be conducted. $3
tracking system can be designed to ensure that commanders of medical
million authorized for pilot programs.
facilities can track appointments of patients to ensure they are meeting
timelines and other standards; and that servicemembers are able to know
when appointments are scheduled and the deadlines of medical
evaluation and physical evaluation boards. DOD to report on results of
the study within 180 days of enactment.
Centers of
§133. DOD to establish centers of excellence in the prevention,
No comparable provision.
Excellence
diagnosis, mitigation, treatment and rehabilitation of TBI and a separate
center for PTSD. The centers will undertake research and establish best
practices for treatment. A report on the establishment of the centers
required within 180 days. $5 million authorized for each center.
Review of health
§134. DOD and VA to conduct jointly a review of mental health
No comparable provision.
services for female
treatment and services for female servicemembers.
servicemembers
Authorizing funds
§135. $50 million authorized for improved diagnosis, treatment and
§112. Treasury to establish DOD Medical Support Fund to support
for treatment of TBI
rehabilitation of servicemembers with TBI and PTSD of which $17
medical treatment, care, rehabilitation, recovery of wounded and injured
and PTSD
million to be available for the DOD Defense and Veterans Brain Injury
servicemembers. $50 million is authorized for the fund in FY2008 of
Center. These amounts are in addition to amounts appropriated for the
which $10 million is to be transferred from the fund to support the
Defense Health Program. Annual reports required regarding amounts
Marine Corps Wounded Warrior Regiment.
expended on these efforts.
Reports
§136. Reports required from DOD within 90 days on compliance with
No comparable provision.
TBI, PTSD and other mental health provisions of P.L. 109-364; annual
reports to be required on expenditures by DOD on treatment of TBI and
PTSD.
CRS-16
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Enhanced authorities
§142. Grants DOD enhanced authority for appointment and pay of
No comparable provision.
to appoint and pay
civilian health care professionals with reports on strategies elected
civilian health care
required six months after enactment.
professionals
Recommendations
§143. DOD to submit to congressional committees within 45 days of
No comparable provision.
for initiatives to
enactment recommendations for legislative or administrative actions to
address shortages in
address shortages in health care professionals, including personnel in the
health care
mental health workforce.
professionals
Presumption of
§151. Establishes a presumption that disabilities are service-connected if
No comparable provision.
service-connection
they were not noted at the time of entrance and if the servicemember has
served six months (instead of the current requirement of eight years) of
active service.
DOD use of VA
§152. DOD shall “to the extent feasible” use the VA schedule for rating
No comparable provision.
disability schedules
disabilities. In making the determination of rating of disability DOD
shall take into consideration all medical conditions that “individually or
collectively” render the member unfit to perform the duties of office,
grade, rank or rating.
Board of review for
§153. DOD to establish a board of review to review the disability
No comparable provision.
disability
determinations by Physical Evaluation Boards between September 11,
determinations
2001 and December 31, 2009 which resulted in disability ratings of 20
resulting in less than
percent disabled or less. The board may recommend to the secretary
20% ratings
concerned the issuance of a new disability rating for the individuals
concerned (but not a reduction of the previous disability rating).
Pilot programs on
§154. DOD, in consultation with the VA, shall carry out pilot programs
No comparable provision.
CRS-17
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
disability evaluations
with respect to the DOD disability evaluation system. Pilot programs to
include (1) DOD using VA assigned disability ratings; (2) DOD using
joint DOD/VA assigned disability ratings; and (3) DOD to establish a
single Internet website for the DOD disability system. The pilot
programs are to be completed within one year after their commencement.
DOD to submit reports 90 days after enactment, 150 days subsequently,
and a final report 90 days after completion of the pilot programs.
Reports on PDES
§155. DOD to submit reports every 120 days on the implementation of
No comparable provision.
corrective measures with respect to the Physical Disability Evaluation
System (PDES).
Disability severance
§161. Disability severance pay enhanced.
No comparable provision.
pay enhancement
Servicemembers’
§162. Upon entry onto active duty servicemembers to designate a
No comparable provision.
Group Life
fiduciary for receipt of funds in case of mental incapacity or extended
Insurance (SGLI)
loss of consciousness; servicemember may elect to permit a court to
designate a fiduciary.
Electronic document
§163. DOD and the VA shall develop and implement mechanism for
No comparable provision.
transfer capabilities
electronic transfer of DOD documents necessary to establish eligibility
mandated
for VA benefits at the time of retirement, separation, or release.
DOD/GAO report on
§164. DOD and the GAO shall submit a report assessing the continuing
No comparable provision.
continuing utility of
utility of the temporary disability retired list in satisfying the purposes for
the TDRL
which the list was established.
Standards for DOD
§171. DOD to establish standards for quarters for medical facilities and
§202. Housing facilities under the jurisdiction of DOD occupied by
medical facilities and
facilities used to quarter individuals that may require medical
recovering servicemembers shall be inspected annually after enactment
CRS-18
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
quarters
supervision. Report on steps taken required by December 30, 2007.
by the inspectors general of the regional medical commands.
Reports on measures
§172. DOD to submit every 120 days a report on implementation of the
No comparable provision.
to correct
Army’s action plan to correct deficiencies at Walter Reed Army Medical
deficiencies at
Center.
WRAMC
Feasibility study on
§173. DOD to carry out assessment of feasibility of accelerating the
No comparable provision.
expediting new
construction of new facilities required by the closure of WRAMC. By
facilities required by
September 30, 2007 DOD shall certify that services and facilities at
WRAMC closure
WRAMC are maintained at the highest possible level until replacement
facilities are available. DOD to further certify that closure of WRAMC
will not result in a net loss of bed capacity in the National Capital
Region.
Handbook on
§181. DOD shall develop and maintain handbook containing a
No comparable provision.
benefits for ill or
comprehensive description of benefits available to a servicemember and
injured
to family members separated or retired from the Armed Forces as a result
servicemembers
of serious illness or injury.
National Academy of
§191. DOD, in consultation with the VA, shall enter into agreement with
No comparable provision.
Sciences study of
the National Academy of Sciences for a study on the physical and mental
health and
health and other readjustment needs of servicemembers and veterans of
readjustment needs
Operation Iraqi Freedom or Operation Enduring Freedom and their
of OIF/OEF
families. Preliminary phase of the study is to be completed within 180
servicemembers and
days; the second phase to be completed within three years of enactment.
veterans
Within fifteen days of receipt of the study DOD and the VA are to
provide a preliminary joint plan to address findings and
recommendations; final plan to be developed with 90 days. GAO to
submit within 45 days an assessment of the adequacy and sufficiency of
CRS-19
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
the DOD/VA plan.
Assignment of case
No comparable provision.
§101. Servicemembers in outpatient status are to be assigned medical
workers
care case managers who will conduct weekly reviews with
servicemembers. Each case manager to be assigned no more than 17
outpatients.
Assignment of
No comparable provision.
§101. Each servicemember in outpatient status to be assigned a service
servicemember
member advocate to communicate with servicemember and family,
advocates
assisting with oversight of servicemember’s welfare and quality of life
and to assist in resolving financial, administrative and transitional
problems. DOD to establish training program for service member
advocates. DOD to conduct semiannual surveys of outpatients to include
the servicemember’s assessment of the quality and timeliness of medical
care, the adequacy of living facilities, the adequacy of case management
support, and the fairness and timeliness of the PDES.
Establishment of
No comparable provision.
§103. Toll-free Hot Line to be established that will be accessible to
Toll-free Hot Line
servicemembers at all times to collect, maintain, and update information
on the adequacy, quality and state of repair of medical-related support
facilities. Servicemembers will be advised that they can provide
information confidentially. DOD to ensure, within 96 hours of a report
of deficiencies in adequacy, quality, or state of repair of a medical-related
support facility that such deficiencies are investigated and, if
substantiated, a plan of action for remediation is implemented.
Notification to
No comparable provision.
§104. DOD to notify appropriate congressional offices of hospitalization
Members of
of servicemembers evacuated from a theater of combat. Consent of
Congress of
servicemember is required.
wounded
CRS-20
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
constituents
Servicemember
No comparable provision.
§105. DOD to ensure that servicemembers appearing before medical
advocates before
evaluation boards have access to a physician or other health care
evaluation boards
professional who is independent of the evaluation board. The physician
shall serve as an advocate for the best interests of the servicemember and
provide him/her with advice and counsel regarding the findings and
recommendations of the evaluation board.
Limitation on client
No comparable provision.
§106. Requires that a physical evaluation board liaison officer (PEBLO)
load of PEBLOs
may not be assigned more than 20 patients at any one time. DOD
required to establish a standardized training program and curriculum for
PEBLOs.
Standardized
No comparable provision.
§107. DOD required to establish a standardized training program and
training for
curriculum for personnel involved in the disability evaluation system.
personnel involved in
disability evaluations
Recommendation
No comparable provision.
§108. Report with recommendations for improvement of training of
requested for
health care professionals, medical care case managers and servicemember
training in
advocates who provide care to recovering servicemembers particularly
recognizing signs of
with regard to recognizing early warning signs of PTSD, suicidal
PTSD
tendencies, or other mental health conditions. DOD to provide annual
reports on implementation of recommendations.
Army required to
No comparable provision.
§109. Secretary of Army to establish a pilot program at a base with a
establish Wounded
major medical facility to track and assist outpatients still needing medical
Warrior Regiment
treatment who will be assigned to the base. Pilot to be based on Marine
Pilot Program
Corps Wounded Warrior Regiment. The pilot program to be in effect for
CRS-21
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
one year with an evaluation to be submitted to Congress within 90 days
after its end.
Temporary
No comparable provision.
§110. Change in criteria for removal of a servicemember from temporary
Disability Retired
disability retired list.
List
Oversight Board for
No comparable provision.
§113. Oversight Board for Wounded Warriors to be established,
Wounded Warriors
composed of 12 members, two appointed by the Senate majority leader,
two by the Senate minority leader; two by the Speaker of the House, two
by the House minority leader, two by the Secretary of the VA, two by the
Secretary of Defense. All members must have knowledge or experience
with the military healthcare system, the disability evaluation system, or
the experience of a recovering servicemember. The board will submit
annual reports to Congress and DOD.
Outpatient treatment
No comparable provision.
§114. DOD to expand opportunities for recovering servicemembers to
at locales near
receive outpatient treatment at a military treatment facility closest to the
servicemember’s
servicemember’s home.
home
Annual report on
No comparable provision.
§201. DOD required to submit an annual report on the adequacy,
suitability and
suitability and quality of medical facilities and medical-related support
quality of medical
facilities at each military installation. The report will include information
treatment facilities
regarding any deficiencies reported through the toll-fee hot line.
Study on support
No comparable provision.
§204. DOD shall conduct a study of the provision of support services by
services for families
DOD for families of recovering servicemembers. Report on results of
study to be forwarded to Congress within 180 days of enactment.
CRS-22
Provision
H.R. 1538, Senate Passed
H.R. 1538, House Passed
Designation of TBI
No comparable provision.
§205. DOD to report on changes taken within DOD to ensure that TBI
Injuries
victims receive proper medical designation concomitant with their
injuries as opposed to the current medical designation which assigns a
generic “organic psychiatric disorder” classification. Report required
within 180 days of enactment.
Restriction on A-76
No comparable provision.
§301. No study or competition may be begun or announced pursuant to
competitions
OMB Circular A-76 relating to possible conversion to performance by a
contractor of any DOD function carried out at a military medical facility.
Report required within 180 days of enactment on public-private
competitions carried out at military medical facilities.
Prohibition on
No comparable provision.
§302. DOD may not transfer funds or personnel from medical care
transfer of health
functions to administrative functions in order to comply with new
care funds to meet
administrative requirements imposed by this title.
administrative
requirements
Military pay increase
Title III provides authorization for increasing basic pay for members of
No comparable provision.
the uniformed services by 3.5 percent beginning January 1, 2008. (For
additional discussion of pay raise issues, see CRS Report RL33446,
Military Pay and Benefits: Key Questions and Answers, by Charles A
Henning)
CRS-23
Summary of Provisions Affecting only the
Department of Veterans Affairs
Most provisions specifically affecting the Department of Veterans Affairs (VA)
in H.R. 1538, as passed by the Senate, are found in Title II. However, one provision
specifically affecting the VA is found in Title I. H.R. 1538, as passed by the House,
includes three provisions that are limited to the VA. All of these provisions are
summarized below.
H.R. 1538, Passed in Senate, Title I
Section 126. Medical Care and Services and Support Services for Families of
Members of the Armed Forces Recovering from Serious Injuries or Illnesses.
Section 126 requires the Secretary of Veterans Affairs (VA Secretary) to
prescribe in regulations the medical care and counseling services that will be
available at VA medical facilities to family members of injured servicemembers.
H.R. 1538, Passed in Senate, Title II — Veterans Matters
Section 201. Sense of Congress
Section 201 states that it is the sense of Congress that while (VA) is a leader in
the field of traumatic brain injury care, more could be done to rehabilitate veterans
who have a traumatic brain injury (TBI) with the goals of optimizing the
independence of such veterans and eventually reintegrating them into the community.
It also acknowledges that the Department of Defense (DOD) and the VA have made
efforts to provide a smooth transition of medical care and rehabilitative services to
servicemembers as they move from the DOD health care system to the VA health
care system. However, it states that more can be done to assist veterans and their
families.
Section 202. Individual Rehabilitation and Community Reintegration Plans for
Veterans and Others with TBI.
Section 202 amends chapter 17 of Title 38 United States Code (U.S.C.) and
adds a new section.
Individualized Plan for Rehabilitation and Reintegration. Requires the VA
Secretary to develop an individualized plan for rehabilitation and reintegration into
the community for each veteran or servicemember who receives inpatient or
outpatient care at the VA for TBI. This plan must be provided in writing to each
veteran or servicemember before such individual is discharged from inpatient care
at a VA medical facility, or as soon as practicable following diagnosis.
Contents of Plan. Requires that each individualized plan for rehabilitation
include the following:
CRS-24
(1) rehabilitation objectives for improving the physical, cognitive, and
vocational functioning of a veteran or servicemember with a TBI in order that such
individual regain independence and reintegrate into the community;
(2) access, as needed, to all appropriate rehabilitative components of the TBI
continuum of care;
(3) a description of specific rehabilitative treatments and other services. This
description must include the type, frequency, duration, and location of such
treatments and services;
(4) the name of the designated case manager responsible for the implementation
of the individualized plan; and
(5) the dates on which the effectiveness of the plan will be reviewed.
Comprehensive Assessment. Requires the Secretary to develop the
individualized plan based upon a comprehensive assessment of the physical,
cognitive, vocational, and neuropsychological, and social impairments of the veteran
or servicemember. The assessment must also take into consideration the family
education and family support needs of such individual after discharge from inpatient
care. The assessment will be performed by a team of individuals, with relevant
expertise stipulated.
Case Manager. Requires the VA Secretary to assign a case manager for each
veteran or servicemember with a TBI. The case manager will be responsible for the
implementation of the individualized plan, and the coordination of care. The
Secretary must ensure that such case manager has specific expertise, either through
experience, education, or training, in the care required by the individual to whom
such case manager is assigned.
Participation and Collaboration in Development of Plans. Requires the
Secretary, to the maximum extent practicable, to involve the family members or legal
guardian of the veteran or servicemember with a TBI in developing the
individualized plan. Section 202 also requires the Secretary to collaborate with a
state protection and advocacy system if: the veteran or servicemember covered by
such plan requests collaboration; or in the event that the individual is incapacitated,
the family or guardian of such individual requests collaboration. If the
servicemember is still on active duty the VA Secretary must collaborate with the
Secretary of Defense.
Evaluation. Requires the VA Secretary to periodically review the effectiveness
of each individualized plan and refine it as appropriate after review. The
individualized plan must also be reviewed at the request of the veteran with a TBI,
or in the case that the veteran is incapacitated, at the request of the guardian or the
designee of such veteran.
State Designated Protection and Advocacy System. Defines the “State
Protection and Advocacy System” as the system established in a state under subtitle
C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42
CRS-25
U.S.C. 15041 et seq.) to protect and advocate for the rights of persons with
developmental disabilities.
Section 203. Use of Non-VA Facilities for Implementation of Rehabilitation and
Community Reintegration Plans for Traumatic Brain Injury.
Section 203 amends chapter 17 of Title 38 U.S.C., and adds a new section.
Requires the VA Secretary to provide care in non-VA facilities if the VA is unable
to provide care at the frequency or duration prescribed in the individualized plan, for
rehabilitation and reintegration, or if the Secretary determines it is optimal for the
veteran to receive care in a non-VA facility. Requires the Secretary to enter into
contracts with non-VA facilities only if those facilities meet standards established by
an independent, accreditation organization that accredits specialized rehabilitation
programs for adults with a TBI.
Section 204. Research, Education, and Clinical Care Program on Severe TBI.
Section 204 amends chapter 73 of Title 38 U.S.C., and adds a new section.
Requires the Secretary to establish a program of research, education, and clinical care
that would provide intensive neuro-rehabilitation to veterans with a severe TBI,
including veterans in a minimally conscious state who would otherwise receive only
long-term residential care. This research program must collaborate with the Defense
and Veterans Brain Injury Center and other relevant programs of the federal
government.
Education: Requires the Secretary to conduct educational programs on
recognizing and diagnosing mild and moderate cases of TBI.
Authorization of Appropriations: Authorizes $10 million for the VA for each
fiscal year from FY2008 through FY2012, to carry out the research, education, and
clinical care programs.
Report to Congress: Requires the Secretary to submit a report to Congress not
less than 18 months after the enactment of the Act on the research, education, and
clinical care program.
Section 205. Pilot Program on Assisted Living Services for Veterans with TBI.
Pilot Program: Section 205 requires the Secretary to implement within 90 days
after the enactment of this Act, a pilot program to assess the effectiveness of
providing assisted living services to eligible veterans to enhance the rehabilitation,
quality of life, and community integration of such veterans.
Duration of Program. The pilot program must be carried out for a period of five
years.
Program Locations. Requires the Secretary to carry out the pilot program in
locations selected by the Secretary. However, at least one program must be located
in a Veterans Integrated Service Network (VISN) that has a VA polytrauma center.
Other locations must be in areas that contain high concentrations of veterans with
CRS-26
TBI. The Secretary must also give special consideration to rural areas when selecting
program locations.
Provision of Assisted Living Services. Authorizes the Secretary to enter into
agreements for the provision of assisted living services with a provider participating
in Medicaid (42 U.S.C. 1396 et seq.). Such assisted living facilities must meet
standards prescribed by the Secretary for the purposes of the pilot program.
Continuation of Case Management and Rehabilitation Services. Requires the
Secretary to continue to provide case management services for veterans participating
in the pilot program.
Report to Committees. Requires the Secretary to submit a report on the pilot
program to the House and Senate Veterans’ Affairs Committees. The report must
include information about the program, utility of the program, and recommendations
regarding the extension or expansion of the program. The report must be submitted
not less than 60 days after the completion of the pilot program.
Authorization of Appropriations. Authorizes $8 million for the pilot program
for each fiscal year from FY2008 through FY2013.
Section 206. Research on Traumatic Brain Injury.
Section 206 requires the Secretary under existing authorizations (section 3119
of Title 38, U.S.C., relating to rehabilitation research and special projects; section
7303 of Title 38 U.S.C., relating to research programs of the Veterans Health
Administration; and section 7327 of Title 38 U.S.C., relating to research, education,
and clinical activities on complex multi-trauma associated with combat injuries) to
include research on TBI, including research on the sequelae of mild to severe forms
of TBI. In conducting such research the Secretary is required to collaborate with
facilities that conduct research on rehabilitation for individuals with TBI; and
receive grants for such research from the National Institute on Disability and
Rehabilitation Research of the Department of Education.
Report to Committees. Requires the Secretary to submit a report to the House
and Senate Veterans’ Affairs Committees on the research program. The report must
be submitted not less than 90 days after the enactment of this Act.
Section 207. Age-Appropriate Nursing Home Care.
Section 207 amends section 1710A of Title 38 U.S.C., and adds a new provision
that requires the Secretary to provide age-appropriate nursing home care.
Section 208. Extension of Period of Eligibility for Health Care for Combat
Service in the Persian Gulf War or Future Hostilities.
Section 208 amends section 1710(e) and extends the period of eligibility to
enroll in the VA health care system from two years to five years following the date
of their separation. This applies only to veterans with service in a combat theater
during or after the Persian Gulf War.
CRS-27
Section 209. Mental Health: Service-connection Status and Evaluations for
Certain Veterans.
Section 209 amends section 1702 of Title 38 U.S.C. that pertains to presumption
of service-connection, and inserts the term “ mental illness” instead of “psychosis.”
Section 209 also requires the Secretary to provide a veteran who served in a
period of war after the Persian Gulf War, a preliminary mental health evaluation as
soon as practicable, but not later than 30 days after a request for such evaluation.
Section 210. Modification of Requirements for Furnishing Outpatient Dental
Services to Veterans with a Service-Connected Dental Condition or Disability.
Section 210 amends Section 1712 of Title 38 U.S.C and extends the eligibility
for outpatient dental treatment for a veteran who served on active duty during the
Persian Gulf War from 90 days to 180 days after discharge or release.
Section 211. Demonstration Program on Preventing Veterans at-risk of
Homelessness from Becoming Homeless.
Section 211 requires the Secretary to carry out a demonstration program to
identify members of the Armed Forces on active duty who are at risk of becoming
homeless after they are discharged or released from active duty, and to provide
referral, counseling, and supportive services, as appropriate, to help prevent them
becoming homeless. The demonstration program must be carried out in at least three
locations.
Expiration. The demonstration program will expire on September 30, 2011.
Section 212. Clarification of Purpose of the Outreach Services Program of the
Department of Veterans Affairs.
Section 212 amends section 6301 of Title 38 U.S.C. and includes National
Guard and Reserve components among those who are eligible for outreach services.
Section 212 adds a new provision defining the term “outreach” as the act or
process of reaching out in a systematic manner proactively to provide information,
services, and benefits counseling to veterans, and to the spouses, children, and
parents of veterans who may be eligible to receive benefits under the laws
administered by the Secretary, to ensure that such individuals are fully informed
about, and assisted in applying for, any benefits and programs under such laws.
H.R. 1538, Passed in House, Title II — Studies and Reports
Section 207. Study and Report on Waiting Periods for Appointments at
Department of Veterans Affairs Medical Facilities.
Section 207 requires the VA Secretary to conduct a study on the average length
of time, from the desired date for which any veteran seeks to schedule an
appointment at a VA medical facility, to the date of completion of the appointment.
CRS-28
The study must focus on appointments scheduled and completed at VA medical
facilities located in both rural and urban areas, and must contain recommendations
for decreasing the waiting time between the desired date of an appointment and the
completion of the appointment to a maximum of 15 days. The Secretary is required
to submit this report within 180 days of enactment of this Act.
H.R. 1538, Passed in House, Title III
Section 303. Increase in Physicians at Hospitals of the Department of Veterans
Affairs.
Section 303 requires the VA Secretary to increase the number of resident
physicians in VA hospitals.
Section 304. Veterans Beneficiary Travel Program.
Section 304 eliminates the current deductible charged to veterans traveling to
and from a VA facility or other place for the purpose of examination, treatment, or
care. Amends section 111 of Title 38 U.S.C., and requires that the mileage
reimbursement rate for veterans traveling to and from a VA facility or other place for
the purpose of examination, treatment, or care be based on the mileage
reimbursement rate provided to government employees using private vehicles for
official business. Stipulates that funds for mileage reimbursement be appropriated
separately from other amounts appropriated for the VA.
Effective Date. The revised mileage reimbursement rate would apply with
respect to travel expenses incurred after 90-days of enactment of this Act.