69–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–722 

VETERANS’ EPILEPSY TREATMENT ACT OF 2008 

JUNE 19, 2008.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. FILNER, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 2818] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 2818) to amend title 38, United States Code, to provide 

for the establishment of Epilepsy Centers of Excellence in the Veterans Health Administration of the Department of Veterans Affairs, having considered the same, report favorably thereon with 

amendments and recommend that the bill as amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 1 

Purpose and Summary ............................................................................................ 3 

Background and Need for Legislation .................................................................... 3 

Hearings ................................................................................................................... 4 

Committee Consideration ........................................................................................ 4 

Committee Votes ...................................................................................................... 5 

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 

Constitutional Authority Statement ...................................................................... 7 

Applicability to Legislative Branch ........................................................................ 7 

Section-by-Section Analysis of the Legislation ...................................................... 7 

Changes in Existing Law Made by the Bill, as Reported ..................................... 7 

AMENDMENT

The amendments are as follows: 

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Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Veterans’ Epilepsy Treatment Act of 2008’’. 

SEC. 2. EPILEPSY CENTERS OF EXCELLENCE. 

(a) REQUIREMENT FOR ESTABLISHMENT OF EPILEPSY CENTERS OF EXCELLENCE.—

Subchapter II of chapter 73 of title 38, United States Code, is amended by adding 

at the end the following new section: 

‘‘§ 7330A. Epilepsy centers of excellence 

‘‘(a) DESIGNATION OF CENTERS.—Not later than 120 days after the date of enactment of this section, the Secretary shall designate an epilepsy center of excellence 

at each of the 5 centers designated under section 7327. 

‘‘(b) EXPERT CLINICAL AND RESEARCH STAFF.—Each center designated under subsection (a) shall employ such expert clinical and research staff, including board certified neurologists and neurosurgeons, as may be necessary to ensure that such center is capable of serving as a center of excellence in research, education, and clinical 

care activities in the diagnosis and treatment of epilepsy, including post-traumatic 

epilepsy. 

‘‘(c) REQUIREMENTS AND OPERATION OF CENTERS.—Each center designated under 

subsection (a) shall function as a center for—

‘‘(1) research on the diagnosis, treatment, and long-term effects of epilepsy, 

including epilepsy developed as a result of combat, in order to support the provision of services for such diagnosis and treatment in accordance with the most 

current information on epilepsy; 

‘‘(2) the development of evidence-based methodologies for treating individuals 

with epilepsy; 

‘‘(3) the continuous and consistent coordination of care from the point of referral throughout the diagnostic and treatment process and ongoing follow-up after 

return to home and community; 

‘‘(4) the development of a national system of coordinated care for veterans 

with epilepsy, including the development and maintenance of a national network of Department health care personnel with an interest and expertise in the 

care and treatment of epilepsy and the establishment of a referral system and 

procedure within each Veterans Integrated Service Network; 

‘‘(5) assist in the expansion, where appropriate, of the utilization of telehealth 

technology, including exploring the use of such technology to develop, transmit, 

monitor, and review neurological diagnostic tests and other applicable uses of 

telehealth technology for the diagnosis, care, and treatment of veterans with 

epilepsy; and 

‘‘(6) the dissemination of educational materials and research regarding diagnosis, care, and treatment of epilepsy, throughout the Department. 

‘‘(d) ADMINISTRATION.—In order to assist the Secretary in carrying out this section, the Secretary shall designate a national coordinator for epilepsy programs who 

shall report to the official responsible for neurology at the Veterans Health Administration and shall—

‘‘(1) supervise the operation of the centers designated under this section; 

‘‘(2) coordinate and support the national network of Department health care 

professionals with an interest and expertise in the care and treatment of epilepsy; 

‘‘(3) ensure that the education and research mission of such centers is being 

accomplished; and 

‘‘(4) conduct regular evaluations of such centers to ensure compliance with the 

requirements of this section. 

‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated 

to carry out this section $5,000,000 for each of fiscal years 2009 through 2013.’’. 

(b) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter 

is amended by inserting after the item relating to section 7330 the following new 

item: 

‘‘7330A. Epilepsy centers of excellence.’’. 

Amend the title so as to read: 

A bill to amend title 38, United States Code, to provide for the establishment 

of epilepsy centers of excellence in the Veterans Health Administration of the Department of Veterans Affairs.’’. 

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PURPOSE AND SUMMARY

H.R. 2818 was introduced by Representative Ed Perlmutter of 

Colorado on June 21, 2007. This legislation would establish Epilepsy Centers of Excellence in the Veterans Health Administration 

of the Department of Veterans Affairs. 

BACKGROUND AND NEED FOR LEGISLATION

Epilepsy is a neurological condition, which affects the nervous 

system and causes seizures. Epilepsy is usually diagnosed after a 

person has had at least two seizures that were not caused by some 

known medical condition. There is not one single cause of epilepsy 

and, in up to half of the epilepsy cases, it is not possible to specify 

the cause of the seizures. Research indicates that children may be 

born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes epilepsy. Severe head injury and other neurological conditions such as strokes, tumors, and 

degenerative conditions such as Alzheimer’s disease are also known 

causes of epilepsy. 

According to the Veterans Health Administration (VHA) there 

are approximately 89,000 veterans with epilepsy enrolled in the 

Department of Veterans Affairs (VA) Health Care System. Of those 

veterans enrolled with epilepsy, about 42 percent, or 37,000, are 

service-connected for epilepsy. 

In testimony presented to the Senate Committee on Veterans’ Affairs on May 23, 2007, on behalf of the American Academy of Neurology, Dr. John Booss stated that in 1972, the VA created Health 

Centers which specialized in research and treatment of epilepsy. 

These VA Health Centers partnered with medical schools to assist 

in treating veterans with seizures, and build a body of knowledge 

around the diagnosis and treatment of epilepsy. However, in the 

early 1990’s, funding dissipated and the Centers were curtailed. 

At this time, the VA operates seven Epilepsy Monitoring sites. 

According to the Department of Veterans Affairs, the seven sites 

have the following capabilities: (1) an epilepsy monitoring unit; (2) 

capacity to perform invasive monitoring; (3) ability to implant 

vagus nerve stimulators; and, (4) ability to perform resection of epileptic foci. Five additional sites have the capacity to perform epilepsy surgery but not all of the other components listed above. 

The use of improvised explosive devices (IEDs) in Iraq and Afghanistan and the prevalence of the types of blast injuries they inflict on the servicemembers are devastating. Loss of limb, traumatic brain injury (TBI), eye injuries, and other polytrauma injuries present new challenges to medicine and the overall treatment 

modalities within VA. The long-term effect of blast exposures is not 

known. Although there is no data on post-traumatic epilepsy in the 

current conflicts, during Vietnam, a number of men and women returned home with head wounds and head injuries. According to the 

1985 report of the Vietnam Head Injury Study published in Neurology, of 421 veterans who had penetrating brain wounds in Vietnam 15 years ago, 53 percent had post-traumatic epilepsy, and onehalf of those still had seizures 15 years after injury. 

H.R. 2818, as amended, would establish Epilepsy Centers of Excellence within the Department of Veterans Affairs. The Epilepsy 

Centers of Excellence would function as centers for research on the 

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diagnosis, treatment and long-term effects of epilepsy. These Centers would develop evidence-based methodology for treatment of 

epilepsy, coordinate care for veterans with epilepsy, develop a national referral system for veterans with epilepsy, expand telehealth 

technology for treatment of veterans with epilepsy and disseminate 

educational materials on the diagnosis and treatment of epilepsy. 

H.R. 2818 would further require that the Epilepsy Centers of Excellence be co-located with the five VA Polytrauma Rehabilitation 

Centers located in Palo Alto, California; Minneapolis, Minnesota; 

Richmond, Virginia; Tampa, Florida; and, San Antonio, Texas. Colocating the Epilepsy Centers of Excellence and the Polytrauma Rehabilitation Centers will allow VA to optimize its already-existing 

resources and infrastructure to more effectively carry out the mission of the Centers. 

The Committee generally supports the establishment of Centers 

of Excellence for conditions that effect veterans. However, given the 

resources of the VA, the Committee feels that any new Centers of 

Excellence should be established to give VA the ability to leverage 

already existing Department infrastructure and resources. Integration of resources will allow the VA to offer veterans a full continuum of comprehensive care throughout the VA healthcare system. 

HEARINGS

On April 15, 2008, the Subcommittee on Health held a legislative 

hearing on a number of bills introduced in the 110th Congress, including H.R. 2818. The following witnesses testified: The Honorable 

Bob Filner of California; The Honorable Michael H. Michaud of 

Maine; The Honorable Ginny Brown-Waite of Florida; The Honorable Ed Perlmutter of Colorado; The Honorable Christopher P. Carney of Pennsylvania; The Honorable Brad Ellsworth of Indiana; Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, The American Legion; Joy J. Ilem, Assistant National Legislative Director, Disabled American Veterans; Christopher Needham, Senior Legislative Associate, National Legislative 

Service, Veterans of Foreign Wars of the United States; Richard F. 

Weidman, Executive Director for Policy and Government Affairs, 

Vietnam Veterans of America; Gerald M. Cross, MD, FAAFP, Principal Deputy Under Secretary for Health, Veterans Health Administration, U.S. Department of Veterans Affairs, accompanied by 

Walter Hall, Assistant General Counsel, U.S. Department of Veterans Affairs. Those submitting statements for the record included: 

American Veterans (AMVETS) and the Paralyzed Veterans of 

America. 

COMMITTEE CONSIDERATION

On June 5, 2008, the Subcommittee on Health met in open markup session and ordered favorably forwarded to the full Committee 

H.R. 2818, as amended, by voice vote. During consideration of the 

bill the following amendment was considered: 

An amendment in the nature of a substitute by Mr. 

Salazar of Colorado to require that the Epilepsy Centers of 

Excellence be co-located with the 5 polytrauma centers in 

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the Department of Veterans Affairs was agreed to by voice 

vote. 

On June 11, 2008, the full Committee met in open markup session, a quorum being present, and ordered H.R. 2818, 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. 2818 reported to the House. A motion by Mr. Buyer of Indiana 

to order H.R. 2818, as amended, reported 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. 2818 does not contain any congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined in clause 9(d), 9(e), 

or 9(f) of rule XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 2818 

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. 2818 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

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U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, June 18, 2008. 

Hon. BOB FILNER, 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 2818, the Veterans Epilepsy Treatment Act of 2008. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Sunita D’Monte. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

Enclosure. 

H.R. 2818—Veterans Epilepsy Treatment Act of 2008 

H.R. 2818 would require the Secretary of the Department of Veterans Affairs (VA) to establish five centers of excellence for epilepsy 

research, education, and clinical care at VA health care facilities, 

and to appoint a national coordinator for those centers and for 

other epilepsy programs at the Veterans Health Administration. 

The bill would authorize the appropriation of $5 million each year 

over the 2009–2013 period. 

In total, CBO estimates that implementing H.R. 2818 would cost 

$25 million over the 2009–2013 period, assuming that the specified 

amounts are appropriated and that outlays follow historical spending patterns for similar programs. Enacting the bill would have no 

effect on direct spending or revenues. 

H.R. 2818 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. 

On November 30, 2007, CBO transmitted a cost estimate for S. 

2004, a similar bill that was ordered reported by the Senate Committee on Veterans’ Affairs on November 14, 2007. S. 2004 would 

authorize the appropriation of $6 million a year for the centers of 

excellence and such sums as may be necessary for the national coordinator over the 2008–2012 period. CBO estimated that implementing S. 2004 would cost $31 million over the 2008–2012 period, 

assuming appropriation of the specified and estimated amounts. 

The CBO staff contact for this estimate is Sunita D’Monte. This 

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. 2818 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 2818. 

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CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 2818 is provided by Article I, section 8 of the Constitution 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 section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

This section would provide the short title of H.R. 2818 as the 

‘‘Veterans’’ Epilepsy Treatment Act of 2008.’’

Section 2. Epilepsy Centers of Excellence 

This section would amend chapter 73 of title 38, United States 

Code, to establish Epilepsy Centers of Excellence at each of the five 

polytrauma rehabilitation centers within the Department of Veterans Affairs. It requires that each center employ expert clinical 

and research staff. It also requires each center to function as a center for research on diagnosis, treatment and long-term effects of 

epilepsy; development of evidence-based methodology for treatment 

of epilepsy; coordination of care for veterans with epilepsy; development of a national referral system for veterans with epilepsy; expansion of telehealth technology for treatment of veterans with epilepsy; and dissemination of educational materials on the diagnosis 

and treatment of epilepsy. This section authorizes appropriations 

in the amount of $5,000,000 for each fiscal year from 2009 through 

2013. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (new matter is printed in italic 

and existing law in which no change is proposed is shown in 

roman): 

TITLE 38, UNITED STATES CODE 

* * * * * * * 

PART V—BOARDS, ADMINISTRATIONS, AND SERVICES 

* * * * * * * 

CHAPTER 73—VETERANS HEALTH ADMINISTRATION - 

ORGANIZATION AND FUNCTIONS 

* * * * * * * 

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SUBCHAPTER I—ORGANIZATION 

Sec. 

7301. Functions of Veterans Health Administration: in general. 

* * * * * * * 

SUBCHAPTER II—GENERAL AUTHORITY AND ADMINISTRATION 

7311. Quality assurance. 

* * * * * * * 

7330A. Epilepsy centers of excellence. 

* * * * * * * 

SUBCHAPTER II—GENERAL AUTHORITY AND 

ADMINISTRATION 

* * * * * * * 

§ 7330A. Epilepsy centers of excellence 

(a) DESIGNATION OF CENTERS.—Not later than 120 days after the 

date of enactment of this section, the Secretary shall designate an 

epilepsy center of excellence at each of the 5 centers designated 

under section 7327. 

(b) EXPERT CLINICAL AND RESEARCH STAFF.—Each center designated under subsection (a) shall employ such expert clinical and 

research staff, including board certified neurologists and neurosurgeons, as may be necessary to ensure that such center is capable 

of serving as a center of excellence in research, education, and clinical care activities in the diagnosis and treatment of epilepsy, including post-traumatic epilepsy. 

(c) REQUIREMENTS AND OPERATION OF CENTERS.—Each center 

designated under subsection (a) shall function as a center for— (1) research on the diagnosis, treatment, and long-term effects 

of epilepsy, including epilepsy developed as a result of combat, 

in order to support the provision of services for such diagnosis 

and treatment in accordance with the most current information 

on epilepsy; 

(2) the development of evidence-based methodologies for treating individuals with epilepsy; 

(3) the continuous and consistent coordination of care from 

the point of referral throughout the diagnostic and treatment 

process and ongoing follow-up after return to home and community; 

(4) the development of a national system of coordinated care 

for veterans with epilepsy, including the development and 

maintenance of a national network of Department health care 

personnel with an interest and expertise in the care and treatment of epilepsy and the establishment of a referral system and 

procedure within each Veterans Integrated Service Network; 

(5) assist in the expansion, where appropriate, of the utilization of telehealth technology, including exploring the use of such 

technology to develop, transmit, monitor, and review neurological diagnostic tests and other applicable uses of telehealth 

technology for the diagnosis, care, and treatment of veterans 

with epilepsy; and 

(6) the dissemination of educational materials and research 

regarding diagnosis, care, and treatment of epilepsy, throughout the Department. 

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(d) ADMINISTRATION.—In order to assist the Secretary in carrying 

out this section, the Secretary shall designate a national coordinator 

for epilepsy programs who shall report to the official responsible for 

neurology at the Veterans Health Administration and shall— (1) supervise the operation of the centers designated under 

this section; 

(2) coordinate and support the national network of Department health care professionals with an interest and expertise in 

the care and treatment of epilepsy; 

(3) ensure that the education and research mission of such 

centers is being accomplished; and 

(4) conduct regular evaluations of such centers to ensure compliance with the requirements of this section. 

(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to 

be appropriated to carry out this section $5,000,000 for each of fiscal years 2009 through 2013. 

* * * * * * * 

Æ 

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