Topic: House: Veterans Commission designed to toughen service connected disability rules. cherryread Posted Wed 24 August 2005 00:00 H.R.1588 Comprehensive Assistance for Veterans Exposed to Traumatic Stressors Act of 2005 (Introduced in House) --------------------------------------------------------- SEC. 301. STUDY TO IDENTIFY FACTORS THAT DECREASE THE LIKELIHOOD OF THE DEVELOPMENT OF CHRONIC PTSD DESPITE COMBAT EXPOSURE. (a) Study- The Secretary of Veterans Affairs shall provide for a study, to be conducted by an entity other than the Department of Veterans Affairs and the Department of Defense, to identify factors that decrease the likelihood of the development of chronic post-traumatic stress disorder (PTSD) in servicemembers and veterans who have had combat exposure, including exposure to guerilla warfare. (b) Report- The Secretary shall provide for the entity conducting the study under subsection (a) to submit a report on the results of the study to the Secretary and the Congress not later than one year after the date of the enactment of this Act. SEC. 302. EXTENSION OF PERIOD OF ENHANCED ELIGIBILITY FOR VA HEALTH SERVICES FOR VETERANS WHO SERVED IN COMBAT THEATERS OF OPERATIONS. Section 1710(e)(3)(C) of title 38, United States Code, is amended by striking `2 years' and inserting `five years'. SEC. 303. DEMONSTRATION PROJECT TO STATION DEPARTMENT OF VETERANS AFFAIRS PSYCHOLOGISTS AND PSYCHIATRISTS AT MAJOR DEMOBILIZATION SITES AND MILITARY TREATMENT FACILITIES. (a) Demonstration Project- The Secretary of Defense and the Secretary of Veterans Affairs shall jointly provide for the conduct of a demonstration project under which Department of Veterans Affairs psychologists and psychiatrists are stationed at major demobilization sites and military treatment facilities. (b) Purpose- The purposes of the demonstration project shall be as follows: (1) Identify, on an aggregate level, need for mental health services among active-duty, Reserve, and National Guard members. (2) Provide such services or refer members for necessary services. (3) Advise servicemembers of the need for continuous services. (4) Identify the obstacles servicemembers have in seeking appropriate mental health care. (c) Funding- There is authorized to be appropriated such sums as may be necessary for each of fiscal years 2006, 2007, and 2008 for the conduct of the demonstration project. Amounts for the conduct of the project shall be provided equally by the Secretary of Veterans Affairs and the Secretary of Defense. (d) Eligibility Criteria- Based on the results of the demonstration project, the Secretaries shall identify appropriate eligibility criteria for programs to best respond to the needs of veterans, servicemembers, and their families for post-deployment mental health services. The criteria identified shall be included in the report under subsection (e). (e) Report- The Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report providing the results of the demonstration project. The report shall be submitted not later than 18 months after the date of the enactment of this Act. SEC. 304. MODEL PROGRAMS FOR POST-DEPLOYMENT MENTAL HEALTH PRACTICE. (a) Model Programs- The Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall develop model programs to respond to a variety of mental health disorders prevalent among veterans of service in Operation Iraqi Freedom and Operation Enduring Freedom. The program shall be implemented at three sites selected by the Secretary, of which-- (1) at least one site shall assign case managers to veterans receiving care under such program; and (2) at least one site shall use an integrated mental health and primary care model for post-deployment mental health practice. (b) Purpose- The purpose of the model program shall be as follows: (1) Development of training protocols for involved clinicians. (2) Identification of medical conditions which may be associated with post-deployment mental health problems including PTSD. (3) Identification of `best practices' for treatment of post-deployment mental health problems including PTSD. (4) Dissemination of results to the Veterans Health Administration and the Veterans Benefits Administration of the Department of Veterans Affairs. (c) Authorization- There is authorized to be appropriated for the purposes of subsection (a) the amount of $5,000,000 for each of fiscal years 2006, 2007, and 2008. SEC. 305. PERFORMANCE MEASURES FOR DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE ADMINISTRATORS. (a) Performance Measures- The Secretary of Defense and the Secretary of Veterans Affairs, acting through the Department of Defense/Department of Veterans Affairs Council on Post-Deployment Mental Health established under section 401, shall develop performance measures for Department of Veterans Affairs regional health-care directors (referred to as VISN directors) and Department of Defense TRICARE regional managers to ensure the appropriate deployment of resources to implement the treatment protocols referred to as `Iraq War Clinical Practice Guidelines'. (b) Use of Performance Measures- The performance measures under subsection (a) shall be designed to assess-- (1) access and availability of PTSD treatment for servicemembers returned from deployment in a combat theater; and (2) implementation of protocols referred to in subsection (a). TITLE IV--DEPARTMENT OF DEFENSE/DEPARTMENT OF VETERANS AFFAIRS COUNCIL ON POST-DEPLOYMENT MENTAL HEALTH SEC. 401. ESTABLISHMENT OF COUNCIL. The Secretary of Defense and the Secretary of Veterans Affairs shall jointly establish a council to be known as the Department of Defense/Department of Veterans Affairs Council on Post-Deployment Mental Health. The council shall be composed of leadership of the two departments in the areas of mental health, PTSD, substance abuse, and military sexual trauma. The council shall be established not later than 120 days after the date of the enactment of this Act. SEC. 402. DUTIES OF COUNCIL. (a) Duties- The Department of Defense/Department of Veterans Affairs Council on Post-Deployment Mental Health shall have the following duties: (1) Review of the continuum of care between the Department of Defense and the Department of Veterans Affairs for mental health, PTSD, substance abuse, and military sexual trauma. (2) Identification of gaps in the treatment capability of the health-care systems of the Department of Defense and Department of Veterans Affairs for mental health, PTSD, substance abuse, and military sexual trauma and expected gaps in such continuum, with emphasis on access to services in rural areas, to meet the expected demand from current users and servicemembers returning from Operation Iraqi Freedom and Operation Enduring Freedom and other deployments. (3) Promotion, within both systems, of an educational program to implement the jointly developed Iraq War Clinical Practice Guidelines. (4) Development of outcome monitors and quality improvement instruments to ensure that internal policy regarding PTSD is implemented (including TRICARE and VISN directors' performance measures under section 307). (5) Recommendation of policies to reduce the stigma associated with the seeking of mental health care by active-duty, Reserve, and National Guard members. (6) Identification of the highest post-deployment mental health research priorities for the two departments. (7) Communications to inform active-duty servicemembers and veterans of matters relating to PTSD. (b) Annual Meeting With Stakeholders- The Council shall meet at least annually with stakeholder groups comprised of veterans, veterans service organizations, and family members of veterans receiving care from the Department of Veterans Affairs mental health programs, and mental health associations. (c) Report- The Council shall prepare a report based on the reviews under paragraphs (1) and (2) of subsection (a) to identify the necessary resources to create or enhance PTSD treatment capabilities. The report shall be made available to the Secretary of both Departments for comment. The Secretaries shall indicate recommendations in which they concur or disagree and include specific plans for implementation of any recommendations accepted. The report, with the comments and recommendations of the two Secretaries shall be submitted to the Committees on Veterans' Affairs and the Committees on Armed Services of the Senate and House of Representatives not later than one year after the date of the enactment of this Act. The report shall include priority listing of sites which require investments according to the greatest perceived need for PTSD services. TITLE V--CAPACITY BUILDING IN DEPARTMENT OF VETERANS AFFAIRS SEC. 501. PLAN FOR EXPANSION OF DEPARTMENT OF VETERANS AFFAIRS SYSTEM TO EXPAND ACCESS TO SPECIALIZED PTSD CARE. (a) Development of Plan- Based upon the report under section 402(b), the Secretary of Veterans Affairs shall develop a plan for the Department of Veterans Affairs to expand access to specialized PTSD care through-- (1) Readjustment Counseling Service centers operated under section 1712A of title 38, United States Code; (2) community-based outpatient clinics; and (3) telemedicine. (b) Inspector General Investigation- The Inspector General of the Department of Veterans Affairs shall investigate specialized programs of the Department of Veterans Affairs for the treatment of post-traumatic stress disorder in order to determine-- (1) the current workloads of those programs; (2) staff associated with each of those programs; (3) funds obligated for those programs; and (4) any waiting times associated with those programs. (c) Report- The Inspector General shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report containing the Inspector General's findings under subsection (b), together with an assessment of the ability of the Department of Veterans Affairs to address such findings, along with recommendations for accommodating-- (1) the current workload of the Department in specialized treatment program; (2) 102 percent of the current workload of the Department; and (3) 110 percent of the current workload of the Department. SEC. 502. ADDITIONAL DEPARTMENT OF VETERANS AFFAIRS RESOURCES. In order to improve access to mental health services, the Secretary of Veterans Affairs shall provide the following: (1) 100 additional full-time equivalent employees to Readjustment Counseling Service outstations. (2) A PTSD clinical team at every medical center of the Veterans Health Administration. (3) A family therapist at each Vet Center under section 1712A of title 38, United States Code. (4) A PTSD coordinator in each regional network referred to as a Veterans Integrated Service Network (VISN ) whose duties shall include-- (A) development of plans for meeting PTSD and other post-deployment mental health treatment needs consistent with the report under section 402(b); (B) assurance of implementation of clinical practice guidelines throughout the VISN; (C) liaison among all health-care sites in the VISN and the Department Central Office on matters relating to PTSD. (5) A PTSD coordinator in each regional office of the Readjustment Counseling Service whose duties shall include liaison with regional office staff and medical centers for veterans seeking service-connection for PTSD. TITLE VI--FAMILY THERAPY SEC. 601. ELIGIBILITY FOR FAMILY COUNSELING AND BEREAVEMENT COUNSELING. (a) Counseling for Family Members of Veterans Being Treated for Service-Connected Disabilities- Section 1782(a) of title 38, United States Code, is amended by adding at the end the following new sentence: `In addition, the Secretary shall provide to an individual described in subsection (c) such professional counseling and mental health services as are necessary as a consequence of a disability of a veteran described in the preceding sentence. Counseling and mental health services under the preceding sentence shall be provided (if so requested by the individual) for a period of two years from the date on which the individual first receives such counseling or mental health services under the preceding sentence.'. (b) Bereavement Counseling- Section 1783 of such title is amended-- (1) by striking `may provide' in subsections (a) and (b) and inserting `shall, upon request, provide'; and (2) by adding at the end the following new subsection: `(d) Duration of Counseling- Counseling under subsection (a) or with respect to the death of a veteran or under subsection (b) with respect to the death of a member who dies in the active military, naval, or air service shall be provided to an individual eligible for such counseling (if so requested by that individual) for a period of two years from the date on which the individual first receives counseling under this section with respect to that death.'. TITLE VII--EDUCATIONAL INITIATIVES SEC. 701. TRAINING PROGRAM FOR HEALTH-CARE PROVIDERS. The Secretary of Veterans Affairs and the Secretary of Defense shall jointly develop a broad training program for all health-care providers in the Department of Veterans Affairs and the Department of Defense to familiarize those providers with mental health-care issues that are likely to arise among persons deployed to combat theaters during the five years after such a deployment. SEC. 702. CURRICULUM AND PROTOCOLS FOR CROSS-TRAINING OF DEPARTMENT OF VETERANS AFFAIRS CLINICIANS. The Secretary of Veterans Affairs shall develop a curriculum and required protocols for cross-training to allow the following clinicians of the Department of Veterans Affairs to screen for post-deployment mental health problems, including PTSD, and, as appropriate, provide information and appropriate referral to-- (1) primary care providers; (2) practitioners assigned as Gulf War points-of-contact; and (3) clinicians assigned as case managers. SEC. 703. PUBLICATION OF STATE-OF-THE-ART POST-DEPLOYMENT MENTAL HEALTH PROBLEMS DIAGNOSIS AND TREATMENT. The Secretary of Veterans Affairs and the Secretary of Defense shall jointly develop a plan for the production and dissemination of publications to advise clinicians on state-of-the-art diagnosis and treatment of PTSD and other mental health disorders experienced after deployment, including any medical conditions associated with such disorders. SEC. 704. PROTOCOLS FOR PAIN MANAGEMENT FOR PTSD AND WAR-RELATED PAIN. The Secretary of Veterans Affairs and the Secretary of Defense shall jointly develop protocols for pain management for PTSD and war-related pain. SEC. 705. PROTOCOLS FOR TREATMENT OF SUBSTANCE USE DISORDERS. The Secretary of Defense shall develop appropriate substance use disorder treatment protocols for assistance in combat areas of operations and on return to the United States. SEC. 706. PROTOCOLS FOR DIAGNOSIS OF POST-TRAUMATIC STRESS DISORDER. (a) Findings- The Congress finds as follows: (1) The symptoms of post-traumatic stress disorder are often similar to those of traumatic brain injury and some neurological disorders. (2) Some veterans with PTSD have co-morbidities that may mask or compound the symptoms associated with PTSD. (3) Correct diagnosis of PTSD and other disorders is critical to effective treatment of those disorders. (b) Clinical Practice Guidelines- The Secretary of Veterans Affairs shall develop clinical practice guidelines to ensure that clinicians are able to effectively distinguish between diagnoses with similar symptoms that may manifest as post-traumatic stress disorder. TITLE VIII--NATIONAL STEERING COMMITTEE ON PTSD EDUCATION SEC. 801. NATIONAL STEERING COMMITTEE. (a) Establishment- There is a National Steering Committee on PTSD Education, to be appointed by the joint council established under section 401. The committee shall be comprised of mental health and other health professionals and health educators involved in the care of veterans of a deployment to a theater of combat on or after the date of the enactment of this Act. (b) Purpose- The committee shall review training protocols for health-care providers and plans for dissemination of educational materials to veterans, their families, and other relevant parties and shall identify the resources available to provide for those purposes. (c) Meetings- The committee shall meet at least once annually. SEC. 802. FUNDING SUPPORT FOR NATIONAL CENTER FOR PTSD. There is authorized to be appropriated to the Secretary of Veterans Affairs for the National Center for PTSD to assist in carrying out a joint educational initiative with the Uniformed Services University of the Health Sciences the amount of $5,000,000 for each of fiscal years 2005 through 2014. SEC. 803. CONTINUING EDUCATION TO MENTAL HEALTH PROVIDERS. The National Steering Committee established under section 801 shall provide continuing education to mental health providers in the Department of Veterans Affairs and the Department of Defense. SEC. 804. WEB-BASED CURRICULUM TO SPONSOR CLINICIAN TRAINING INITIATIVES. The National Steering Committee established under section 801 shall develop a Web-based curriculum to sponsor clinician training initiatives. TITLE IX--BENEFITS SEC. 901. IDENTIFICATION OF DEFICIENCIES IN PTSD DISABILITY EXAMINATIONS. (a) Evaluation of Adjudication of Claims- The Secretary of Veterans Affairs, in consultation with the National Center for PTSD, shall obtain an evaluation of the quality and consistency of adjudication of claims for PTSD, including the adequacy of service-connected compensation examinations for rating purposes and the extent to which veterans who are service-connected for PTSD are actually employed and employable. (b) Report- Not later than 12 months after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans Affairs of the Senate and House of Representatives a report that includes the following information and recommendations: (1) The types of evidence sufficient to confirm combat experience for veterans filing claims for PTSD based on combat. (2) The policies and procedures used to obtain confirmation of a stressor, including documentation of service in combat for claims based on PTSD.