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[Senate Report 110-267]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 586
110th Congress                                                   Report
                                 SENATE
 2d Session                                                     110-267

======================================================================
 
                     VETERANS PAIN CARE ACT OF 2007

                                _______
                                

               February 28, 2008.--Ordered to be printed

                                _______
                                

   Mr. Akaka, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 2160]

    The Committee on Veterans' Affairs (hereinafter, ``the 
Committee''), to which was referred the bill (S. 2160), to 
amend title 38, United States Code, to establish a pain care 
initiative in health care facilities of the Department of 
Veterans Affairs, and for other purposes, having considered the 
same, reports favorably thereon, and recommends that the bill 
do pass.

                              Introduction

    On October 15, 2007, Committee Chairman, Senator Daniel 
Akaka, introduced S. 2160, the proposed ``Veterans Pain Care 
Act of 2007.'' The bill would require every Department of 
Veterans Affairs (hereinafter, ``VA'') health facility to have 
an initiative on pain care. VA would also be required to 
designate an appropriate number of facilities as cooperative 
centers on the research and education of pain. S. 2160 is 
cosponsored by Committee Member Senator Sherrod Brown.
    On October 24, 2007, the Committee held a hearing on 
pending veterans' health legislation, at which testimony on S. 
2160, among other bills, was offered by: Michael J. Kussman, 
MD, MS, MACP, VA Under Secretary for Health; Carl Blake, 
National Legislative Director, Paralyzed Veterans of America; 
Joy J. Ilem, Assistant National Legislative Director, Disabled 
American Veterans; and Brenda Murdough, MSN, RN-C, Military/
Veterans Initiative Coordinator, American Pain Foundation. The 
witnesses from Paralyzed Veterans of America, Disabled American 
Veterans, and the American Pain Foundation supported S. 2160. 
VA did not support the legislation, believing it to be 
superfluous and duplicative of existing VA programs on pain 
care management.

                           Committee Meeting

    After carefully reviewing the testimony from the foregoing 
hearing, the Committee met in open session on November 14, 
2007, to consider, among other legislation, S. 2160. The 
Committee agreed by voice vote to report favorably S. 2160 to 
the Senate.

                     Summary of S. 2160 as Reported

    S. 2160, as reported (hereinafter, ``the Committee bill''), 
would provide a Congressional mandate for VA's existing efforts 
in the area of pain care management and significantly enhance 
VA's pain management research and education. The Committee bill 
would require the establishment of a pain care initiative at 
each health care facility of the Department of Veterans 
Affairs. The Committee bill would also require the Secretary of 
Veterans Affairs (hereinafter, ``the Secretary'') to designate 
an appropriate number of facilities of the Department as 
cooperative centers for research and education on pain. 
Further, national oversight and leadership of VA's pain 
management efforts would be secured through the designation of 
an appropriate officer to manage the program's operations.
    Section 2 of the Committee bill contains eight of Congress' 
findings as follows:
    Paragraph (1) recognizes the prevalence of acute and 
chronic pain among the veteran population.
    Paragraph (2) finds that modern warfare, including the 
prevalence of improvised explosive devices, produces a 
substantial number of battlefield casualties with damage to the 
central and peripheral nervous system.
    Paragraph (3) notes that the success of military health 
care has resulted in high survival rates among severely injured 
military personnel. The higher survival rate is anticipated to 
result in the affliction of many survivors with significant 
pain disorders.
    Paragraph (4) finds that the failure to treat pain 
appropriately at the time of transition from the Department of 
Defense to receipt of care from the VA contributes to the 
development of long-term chronic pain syndromes and can be 
accompanied by long-term mental health and substance use 
disorders.
    Paragraph (5) observes that pain is a leading cause of 
short-term and long-term disability among veterans.
    Paragraph (6) recognizes that VA has implemented some 
worthwhile pain care initiatives, but has yet to adopt a 
comprehensive pain care program available to all patients in 
need.
    Paragraph (7) finds that the inconsistent and ineffective 
pain care provided by VA leads to pain-related impairments, 
occupational disability, and other complications for veterans 
with acute and chronic pain; and that these problems result in 
substantial long-term costs for both VA and society at large.
    Paragraph (8) finds that the research, diagnosis, 
treatment, and management of acute and chronic pain among 
veterans constitute a health care priority.
    Section 3(a) of the Committee bill would require the 
Secretary to carry out a pain care initiative at each VA health 
care facility.
    Section 3(b) of the Committee bill is a clerical amendment 
which would add a separate section on pain care at the 
beginning of chapter 17 of title 38.
    Section 3(c) of the Committee bill establishes a timeline 
for implementation of the pain care initiative by January 1, 
2008, for inpatient care and January 1, 2009, for outpatient 
care.
    Section 4(a) of the Committee bill would require the 
Secretary to carry out a program of research and training on 
pain.
    Section 4(b) of the Committee bill is a clerical amendment, 
which would add a new section on the program of research and 
training on acute and chronic pain in the appropriate tables of 
sections of title 38.

                       Background and Discussion

    The Committee bill was developed in response to the need 
for better pain management of veterans. Pain can be a cause of 
short-term and long-term disability among veterans of all eras.
    Modern warfare has produced a new range of battlefield 
injuries. This is due to factors such as the use of body armor, 
the prevalence of improvised explosive devices, and 
improvements in battlefield medicine. Today's servicemembers 
are surviving injuries that would have been fatal in previous 
conflicts. Traumatic brain injury and polytrauma are among the 
hallmark injuries of the military operations in Iraq and 
Afghanistan. In many cases, these wounded servicemembers suffer 
from damage to the central and peripheral nervous system, 
necessitating a better understanding of pain and more effective 
management techniques.
    A study of Iraq and Afghanistan veterans found that 47% 
reported at least a mild level of pain, and 28% reported 
experiencing pain of moderate to severe intensity. The study 
concluded that a substantial percentage of these veterans will 
experience clinically significant pain following their military 
service. (Gironda, Ronald J. PhD, et. al, ``Pain among Veterans 
of Operations Enduring Freedom and Iraqi Freedom.'' Pain 
Medicine, Vol. 7, No. 4, 2006).
    Another study, focused broadly upon veterans of all eras, 
found a correlation between pain and other conditions such as 
depression and PTSD. Nearly three-fourths of participants in 
the study said that pain has ``very much'' interfered with 
their quality of life and ability to work. Additionally, only 
6% of participants rated their pain care management as ``very 
effective,'' while nearly twice as many rated their pain care 
as ``very ineffective.'' (``Survey of Veterans and Pain,'' 
American Pain Foundation, November 2006).
    Research led by Robyn L. Walker, a clinical psychologist at 
the James A. Haley VA Medical Center in Tampa, Florida, 
revealed that 96 percent of polytrauma patients experienced 
more than one pain problem during rehabilitation, and 70 
percent of the patients experienced pain in more than one site. 
The study also found that 56 percent of patients were diagnosed 
with PTSD and other mental health conditions. The study 
concluded that ``pain needs to be consistently assessed, 
treated, and documented.'' Further, the study found the need 
for consistency of pain assessment and treatment across the 
continuum of care. (Walker, Robyn L., Ph.D., ``Pain Problems, 
Pain Related Impairments, and Emotional Problems in Polytrauma 
Patients,'' 2007).
    Further, the testimony of Brenda Murdough of the American 
Pain Foundation at the Committee's October 24, 2007, hearing on 
this bill indicated that failure to treat pain appropriately at 
the outset of the injury, or when pain carries on into the 
rehabilitation period, is a leading cause of long-term chronic 
pain syndromes. In turn, mismanaged or unmanaged pain 
oftentimes leads to or accompanies long-term mental health and 
substance use disorders.
    VA has had a pain management program in place for some 
time, although the program's focus was initially directed 
towards pain associated with end-of-life care. It is the 
Committee's view, however, that the program has not received 
necessary priority for full implementation via the 
establishment of consistent standards for assessment that are 
practiced uniformly across the VA health care system. The 
Committee seeks to expedite that process with this legislation.
    The lack of standardized implementation of VA's own pain 
care management strategy has limited the effectiveness of pain 
care for veterans. VA's current program is decentralized and 
has languished since its inception in 2003, despite the growing 
need for pain care management and research. For example, VA has 
stopped holding regular conferences at the national level on 
pain and distributing educational materials. However, the 
existing program provides a foundation for the renewed focus 
upon pain that the Committee bill would require. Some Veterans 
Integrated Service Networks (hereinafter, VISN's), such as VISN 
23 and VISN 4, still have health care professionals 
participating in internal quarterly phone conferences, 
utilizing an e-mail list serve, and informally sharing 
information on pain care. Accordingly, some VISN's have better 
developed pain management strategies and more proficient 
personnel than others.
    Medical professionals familiar with VA's pain management 
efforts provided the Committee with input that underscored the 
need for VA to focus upon and assume a leadership position in 
the field of pain management. This need is heightened by the 
distinct demographic characteristics of veterans and the unique 
challenges some face. For example, men make up a greater 
proportion of the veteran population than the civilian 
population, and some of the injuries suffered by veterans, 
including blast injuries and shrapnel wounds, tend to be much 
more prevalent among veterans than their civilian cohorts. The 
Pain Forum, and other groups, have formally and informally 
identified research opportunities on co-morbidity with 
substance use disorder, and alcoholism, and on co-morbidity 
with mental health issues, including depression and post-
traumatic stress disorder.
    The Committee bill has broad support among experts in the 
pain care management field. It has been endorsed by the Pain 
Forum, which consists of over 25 health care and health care 
advocacy groups, including the American Academy of Pain 
Management, American Academy of Pain Medicine, Alliance of 
State Pain Initiatives, American Cancer Society, American 
Chronic Pain Association, American Hospice Foundation, American 
Pain Foundation, American Pain Society, American Pharmacists 
Association, American Society for Pain Management Nursing, 
Federation of State Medical Boards, National Coalition for 
Cancer Survivorship, National Hospice & Palliative Care 
Organization, and the National Pain Foundation.
    Pain Initiatives at VA Health Care Facilities. Section 3(a) 
of the Committee bill would add a new section to title 38, 
proposed section 1720F, entitled ``Pain Care,'' that would 
require VA to implement a comprehensive pain management 
program. Under this new section 1720F, the Secretary would be 
required to develop and carry out an initiative on pain care at 
every VA health care facility, and to assess every patient for 
pain at the time of their admission or initial treatment, and 
periodically thereafter. Under this new section, VA would be 
required to utilize a ``professionally recognized pain 
assessment tool or process.'' In practice, this would require 
VA to adopt a uniform pain assessment tool or process. VA has 
done work in this area before, notably through the ``fifth 
vital sign'' education project, first implemented in 1999, that 
added a screening for pain to the traditional assessment of 
blood pressure, temperature, and other vital signs at check-in. 
However, inconsistencies remain system-wide in the practical 
implementation of this internal policy.
    At the Committee's October 24, 2007, hearing, Brenda 
Murdough of the American Pain Foundation spoke of the benefits 
of a pain management program for veterans. According to Ms. 
Murdough:

          [While] many of our military and veterans treatment 
        facilities offer the highest level of skill and 
        expertise in treating these painful conditions suffered 
        by our wounded armed service men and women, we need to 
        ensure that all of our veterans' facilities are 
        consistently providing the highest level of effective, 
        comprehensive pain management to prevent long term 
        suffering and disability.

    Carl Blake of Paralyzed Veterans of America provided 
insight on the positive impact of pain management upon 
individuals suffering spinal cord injuries:

          We have seen firsthand the benefits of pain care 
        programs, as each VA facility that supports a spinal 
        cord injury (SCI) unit also maintains a pain care 
        program. Veterans with spinal cord injury know all too 
        well the impact that pain, including phantom pain, can 
        have on their daily life. The pain care programs that 
        SCI veterans have access to have greatly enhanced their 
        rehabilitation and improved their quality of life.

    As such, this section of the Committee bill would require 
that each patient be provided appropriate pain care, and when 
necessary, be provided access to specialty pain management 
services, including individualized counseling and psychological 
support, anesthesiology, and other tools as needed.
    Implementation of Pain Care Initiatives. Section 3(c) of 
the Committee bill would require the Secretary to ensure that 
the implementation of the pain care initiative at all health 
care facilities occurs no later than January 1, 2008, for 
inpatient care; and January 1, 2009, for outpatient care.
    Research and Training Programs. Section 4(a) of the 
Committee bill would add a new section 7330A to title 38, 
entitled ``program of research and training on acute and 
chronic pain,'' that would require VA to carry out, within the 
Medical and Prosthetic Research Service of the Veterans Health 
Administration, a program of research and training on acute and 
chronic pain. It is the Committee's view that there is a need 
for expanded research and education of VA's health care workers 
in how to assess and treat pain.
    Subsection (b) of proposed section 7330A would describe the 
program's goals, including the identification of research 
priorities, promotion and coordination of research 
opportunities, and education of VA's health care personnel. It 
is the Committee's understanding, based on informal input from 
commentators familiar with current VA pain management efforts, 
that while there has been a slow decline of the pain management 
program at VA, there is also enthusiasm about the prospect of a 
renewed focus upon pain research. Some contributors suggested 
that VA could explore research opportunities focused upon co-
morbid substance use disorder, post-traumatic stress disorder, 
multiple chronic pain, and other conditions that have a higher 
incidence among veterans than comparable civilian cohorts.
    Subsection (c) of proposed section 7330A would provide for 
the designation of an appropriate number of health centers to 
serve as cooperative centers for research and education on 
pain. The Secretary would also be required to select a lead 
center for research on pain attributed to central and 
peripheral nervous system damage, and another for the 
coordination of research activities of all other centers. The 
center designated to do so would be required to review and 
evaluate research, collect and disseminate information, and 
develop educational materials and products.

                      Committee Bill Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the CBO, estimates that enactment of 
the Committee bill would increase spending by $2 million in 
2008 and by $17 million over the 2009-2013 period. Enactment of 
the Committee bill would not affect direct spending or 
receipts, and would not affect the budget of state, local or 
tribal governments.
    The cost estimate provided by CBO, setting forth a detailed 
breakdown of costs, follows:

                               Congressional Budget Office,
                                   Washington, DC, January 15, 2008
Hon. Daniel K. Akaka,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 2160, the Veterans 
Pain Care Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                           Peter R. Orszag,
                                                          Director.
    Enclosure.

    S. 2160 would require the Department of Veterans Affairs 
(VA) to implement an initiative on pain care at all VA health 
care facilities, under which VA would assess and appropriately 
treat acute and chronic pain. In addition, the bill would 
require VA to establish a program of research and training on 
treatment for acute and chronic pain--including centers for 
research and education on pain--and to appoint a national 
coordinator to oversee those programs.
    According to VA, the department has already implemented 
appropriate pain assessment and management protocols at its 
medical facilities. Based on information from VA regarding 
similar research programs, CBO expects that under S. 2160, VA 
would establish three pain research and training centers at an 
estimated annual cost of about $1 million each. Therefore, CBO 
estimates that implementing the provisions on research, 
training, and education would cost $2 million in 2008 and $17 
million over the 2009-2013 period, assuming appropriation of 
the estimated amounts. This estimate further assumes that 
outlays will follow historical spending patterns for similar 
programs and that the bill will be enacted this spring. 
Enacting the bill would have no effect on direct spending or 
revenues.
    S. 2160 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Sunita D'Monte. 
This estimate was approved by Peter H. Fontaine, Assistant 
Director for Budget Analysis.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee has made an 
evaluation of the regulatory impact that would be incurred in 
carrying out the Committee bill. The Committee finds that the 
Committee bill would not entail any regulation of individuals 
or businesses or result in any impact on the personal privacy 
of any individuals and that the paperwork resulting from 
enactment would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7 of rule XXVI of the Standing 
Rules of the Senate, the following is a tabulation of votes 
cast in person or by proxy by members of the Committee at its 
November 14, 2007 meeting. On that date, the Committee, by 
voice vote, ordered S. 2160 reported favorably to the Senate.

                             Agency Report

    On October 24, 2007, Michael J. Kussman, MD, MS, MACP, the 
Department of Veterans Affairs' Under Secretary for Health, 
appeared before the Committee and submitted testimony on, among 
other things, the Veterans Pain Care Act of 2007. Excerpts from 
this statement are reprinted below:

              Statement of the Views of the Administration

                    Michael J. Kussman, MD, MD, MACP

   Under Secretary for Health for the Department of Veterans Affairs

    Good morning Mr. Chairman and Members of the Committee:
    Thank you for inviting me here today to present the 
Administration's views on several bills that would affect 
Department of Veterans Affairs (VA) programs that provide 
veterans benefits and services. With me today is Walter A. 
Hall, Assistant General Counsel. I will address the five bills 
on today's agenda and then I would be happy to answer any 
questions you and the Committee members may have.

               s. 2160 ``veterans pain care act of 2007''

    S. 2160 would require the Secretary to carry out an 
initiative on pain care management at each VA health care 
facility. Under the initiative, each individual receiving 
treatment in a VA facility would receive: (1) a pain assessment 
at the time of admission or initial treatment and periodically 
thereafter, using a professionally recognized pain assessment 
tool or process; and (2) appropriate pain care consistent with 
recognized means for assessment, diagnosis, treatment, and 
management of acute and chronic pain, including, when 
appropriate, access to specialty pain management services. The 
initiative would have to be implemented at all VA health care 
facilities by not later than January 1, 2008, in the case of 
inpatient care and by not later than January 1, 2009, in the 
case of outpatient care.
    The bill would further require the Secretary to carry out a 
program of research and training on acute and chronic pain 
within VHA's Medical and Prosthetic Research Service. These 
programs would be directed to meet the purposes specified in 
the bill. The Secretary would also be required to designate an 
appropriate number of facilities as cooperative centers for 
research and education on pain. Each such center would focus on 
research and training in one or more of the following areas: 
acute pain; chronic pain, or a research priority identified by 
VHA. The Secretary would also need to designate at least one of 
those centers as a lead center for research on pain 
attributable to central and peripheral nervous system damage 
commonly associated with the battlefield injuries 
characteristic of modern warfare. Another center would be the 
lead for coordinating the pain care research activities 
conducted by the centers and responsible for carrying out a 
number of other duties specified in the bill.
    The measure would permit these centers to compete for 
funding from amounts appropriated to the Department each year 
for medical and prosthetics research. It would also charge the 
USH with designating an appropriate official to oversee their 
operation and to evaluate their performance.
    VA health care is delivered in accordance with patient-
centered medicine. Fundamental to this is effective pain 
management. In 2003 VHA established a National Pain Management 
Strategy to provide a system-wide approach to pain management 
to reduce pain and suffering for veterans experiencing acute 
and chronic pain associated with a wide range of illnesses. The 
national strategy uses a system-wide standard of care for pain 
management; ensures that pain assessment is performed in a 
consistent manner; ensures that pain treatment is prompt and 
appropriate; provides for continual monitoring and improvement 
in outcomes of pain treatment; uses an interdisciplinary, 
multi-modal approach to pain management; and ensures VA 
clinicians are prepared to assess and manage pain effectively. 
The national strategy also called for pain management protocols 
to be established and implemented in all clinical settings and 
directed all VHA medical facilities to implement processes for 
measuring outcomes and quality of pain management.
    To oversee implementation of the National Pain Management 
System, VHA established an interdisciplinary committee. Part of 
the committee's charge is to ensure that every veteran in every 
network has access to pain management services. The committee 
is also responsible for making certain that national employee 
education is provided to VHA clinicians so that they have the 
needed expertise to provide high quality pain assessment and 
treatment and for identifying research opportunities and 
priorities in pain management. It also facilitates 
collaborative research efforts and ensures that VHA pain 
management standards have been integrated into the curricula 
and clinical learning experiences of medial students, allied 
health professional students, interns, and resident trainees.
    Because pain management is already a subject of systematic 
and system-wide attention in the VHA health care system, S. 
2160 is superfluous and duplicative of what is already 
happening in VA healthcare. We would be very happy to meet with 
the Committee to discuss VA's ongoing pain management program 
and activities.

           *       *       *       *       *       *       *

          Changes in Existing Law Made by the Committee Bill, 
                              as Reported

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, changes in existing law made by the 
Committee bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                      TITLE 38--VETERANS' BENEFITS

                       PART II--GENERAL BENEFITS

   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

Subchapter II--Hospital, Nursing Home, or Domiciliary Care and Medical 
Treatment

           *       *       *       *       *       *       *

SEC.

1720F. PAIN CARE

           *       *       *       *       *       *       *

SEC. 1720F. PAIN CARE

    (a) In General.--The Secretary shall carry out at each 
health care facility of the Department an initiative on pain 
care.
    (b) Elements.--The initiative at each health care facility 
of the Department shall ensure that each individual receiving 
treatment in such health care facility receives the following:
          (1) An assessment for pain at the time of admission 
        or initial treatment, and periodically thereafter, 
        using a professionally recognized pain assessment tool 
        or process.
          (2) Appropriate pain care consistent with recognized 
        means for assessment, diagnosis, treatment, and 
        management of acute and chronic pain, including when 
        appropriate, access to specialty pain management 
        services.

           *       *       *       *       *       *       *

             PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS

           *       *       *       *       *       *       *

SEC.

7330A. PROGRAM OF RESEARCH AND TRAINING ON ACUTE AND CHRONIC PAIN.

           *       *       *       *       *       *       *

    (a) In General.--The Secretary shall carry out within the 
Medical and Prosthetic Research Service of the Veterans Health 
Administration a program of research and training on acute and 
chronic pain.
    (b) Purposes.--The purposes of the program shall include 
the following:
          (1) To identify research priorities most relevant to 
        the treatment of the types of acute and chronic pain 
        suffered by veterans.
          (2) To promote, conduct, and coordinate research in 
        accordance with such research priorities--
                  (A) through the facilities and programs of 
                the Department; and
                  (B) in cooperation with other agencies, 
                institutions, and organizations, including the 
                Department of Defense.
          (3) To educate and train health care personnel of the 
        Department with respect to the assessment, diagnosis, 
        treatment, and management of acute and chronic pain.
          (c) Designation of Centers.--(1) The Secretary shall 
        designate an appropriate number of facilities of the 
        Department as cooperative centers for research and 
        education on pain. Each such center shall be designated 
        with a focus on research and training on one or more of 
        the following:
                  (A) Acute pain.
                  (B) Chronic pain.
                  (C) A research priority identified under 
                subsection (b)(1).
          (2) The Secretary shall designate at least one of the 
        centers designated under paragraph (1) as a lead center 
        for research on pain attributable to central and 
        peripheral nervous system damage commonly associated 
        with the battlefield injuries characteristic of modern 
        warfare.
          (3) The Secretary shall designate one of the centers 
        designated under paragraph (1) as the lead center for 
        coordinating the pain care research activities of the 
        centers designated under this subsection. The functions 
        of such center shall be the following:
                  (A) To review and evaluate periodically the 
                research of the centers designated under this 
                subsection and to ensure that such research is 
                conducted in accordance with the research 
                priorities identified pursuant to subsection 
                (b)(1).
                  (B) To collect and disseminate the results of 
                the research of the centers designated under 
                this subsection.
                  (C) To develop and disseminate educational 
                materials and products--
                          (i) to enhance the assessment, 
                        diagnosis, treatment, and management of 
                        acute and chronic pain by the health 
                        care professionals and facilities of 
                        the Veterans Health Administration; and
                          (ii) for veterans suffering from 
                        acute or chronic pain and their 
                        families.
    (d) Award of Funding.--Centers designated under subsection 
(c) may compete for the award of funding from amounts 
appropriated to the Department each fiscal year for medical and 
prosthetics research.
    (e) National Oversight.--The Under Secretary of Health 
shall designate an appropriate officer--
          (1) to oversee the operation of the centers 
        designated under subsection (c); and
          (2) to review and evaluate periodically the 
        performance of such centers.

                                  
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