39–006 

113TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 113–247 

TINNITUS RESEARCH AND TREATMENT ACT OF 2013 

OCTOBER 22, 2013.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. MILLER of Florida, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 1443] 

[Including cost estimate of the Congressional Budget Office] 

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

bill (H.R. 1443) to direct the Secretary of Veterans Affairs to recognize tinnitus as a mandatory condition for research and treatment 

by the Department of Veterans Affairs, and for other purposes, 

having considered the same, report favorably thereon with an 

amendment and recommend that the bill as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Subcommittee Consideration .................................................................................. 4 

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

Committee Votes ...................................................................................................... 4 

Committee Oversight Findings ............................................................................... 5 

Statement of General Performance Goals and Objectives .................................... 5 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 5 

Earmarks and Tax and Tariff Benefits .................................................................. 5 

Committee Cost Estimate ....................................................................................... 5 

Congressional Budget Office Estimate ................................................................... 5 

Federal Mandates Statement ................................................................................. 6 

Advisory Committee Statement .............................................................................. 6 

Statement of Constitutional Authority .................................................................. 6 

Applicability to Legislative Branch ........................................................................ 6 

Statement on Duplication of Federal Programs .................................................... 7 

Disclosure of Directed Rulemaking ........................................................................ 7 

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

Changes in Existing Law Made by the Bill as Reported ...................................... 8 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


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SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Tinnitus Research and Treatment Act of 2013’’. 

SEC. 2. FINDINGS. 

Congress makes the following findings: 

(1) Since 2006, the most prevalent service-connected disability for which veterans have received compensation under the laws administered by the Secretary of Veterans Affairs has been tinnitus. 

(2) The number of veterans receiving such compensation for tinnitus has risen 

each year since 2006, increasing the number and cost of the compensation 

claims paid by the Secretary. 

(3) A growing body of peer reviewed literature indicates a direct connection 

between traumatic brain injury, post traumatic stress disorder, and tinnitus. 

(4) An analysis of data collected by the Department of Veterans Affairs concluded that total amount of disability compensation paid for tinnitus by the Department of Veterans Affairs in 2012 was $1,500,000,000. 

(5) Based on projected rates of growth, the amount of disability compensation payable to veterans for tinnitus is expected to exceed $3,000,000,000 in 2017. 

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

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

Excellence. 

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

(a) IN GENERAL.—The Secretary of Veterans Affairs shall recognize the need to 

enhance the research and treatment of tinnitus and to ensure the allocation of appropriate resources directed at the research and enhanced treatment of tinnitus conducted by the Auditory Centers of Excellence of the Department of Veterans Affairs, 

commensurate with peer-review protocols. Such research shall include— 

(1) an assessment of the efficacy of multidisciplinary tinnitus treatment modalities on different subsets of patients; 

(2) studies on the underlying etiology of tinnitus in veteran populations that 

occur as a result of different causal factors, including blast-related tinnitus 

where there is no measurable hearing loss versus other forms of noise-induced 

tinnitus where there is hearing loss; and 

(3) a study of the underlying mechanisms between hearing loss and tinnitus, 

including cases in which one or the other condition is present, but not both. 

(b) RELATIONSHIP TO OTHER AUTHORITIES.—Nothing in this section shall be construed as interfering with the discretion of the Secretary of Veterans Affairs to conduct research in accordance with peer-review protocols in order to ensure the quality and transparency of the research. 

SEC. 5. INTERDEPARTMENTAL COOPERATION. 

The Secretary of Veterans Affairs shall ensure the cooperation of the Department 

of Veterans Affairs with the Hearing Center of Excellence established by the Department of Defense to further research on tinnitus. 

PURPOSE AND SUMMARY

H.R. 1443, the Tinnitus Research and Treatment Act of 2013, 

was introduced by Representative Michael H. Michaud of Maine, 

Ranking Member of the Committee on Veterans’ Affairs, on April 

9, 2013. H.R. 1443, as amended, would: require the Department of 

Veterans Affairs (VA) to recognize the need to enhance the research and treatment of tinnitus; require VA to ensure the allocation of the appropriate resources directed at the research and treatment of tinnitus conducted by the VA Auditory Centers of Excellence, commensurate with peer-review protocols; and, require VA to 

ensure cooperation with the Hearing Center of Excellence established by the Department of Defense (DOD) to further research on 

tinnitus. 

BACKGROUND AND NEED FOR LEGISLATION

Tinnitus is the experience or sensation of hearing sound when no 

external sound is present. It is often characterized by a persistent 


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ringing in the ears and can range from merely distracting to wholly 

debilitating, depending on the severity of the condition. While noise 

overexposure either from a single impulse noise or cumulative exposure to noise is still the number one cause of tinnitus, it can also 

develop as a result of a head or neck injury. Further, a growing 

body of research has directly linked tinnitus as a co-morbid condition to both traumatic brain injury (TBI) and post-traumatic stress 

disorder (PTSD), indicating that tinnitus represents a larger problem than hearing loss in the blast-exposed population. 

Tinnitus is one of the top five reported complaints from veterans 

of all eras of service and is particularly prevalent among veterans 

of Iraq and Afghanistan. Since 2006, the number of service-connected disability claims for tinnitus has risen at a rate of 15 percent each year, making it the most frequent service-connected disability. 

To care for these veterans, VA audiology clinics provide a Progressive Tinnitus Management (PTM) program. According to VA, 

‘‘[t]he focus of PTM is to teach patients how to manage their reactions to tinnitus.’’ The PTM program encompasses five hierarchical 

tiers: triage; audiologic evaluation; group education; interdisciplinary evaluation; and, individualized support. Services offered to 

veterans with tinnitus through the PTM program include: hearing 

aids, group educational counseling, individual counseling, drug 

therapy, sound-based therapy, cognitive behavioral therapy, and relaxation techniques. 

Tinnitus-related research and educational resources are provided 

through the National Center for Rehabilitative Auditory Research 

(NCRAR), a VA Rehabilitation Research and Development Center 

of Excellence that is located on the campus of the Portland VA 

medical center. The NCRAR collaborates with the VA Audiology 

Program to develop and evaluate the PTM program at VA medical 

centers. VA also conducts research related to tinnitus in collaboration with DOD through the Defense Center of Excellence for Hearing Loss and Auditory System Injuries, which was mandated by 

section 721 of Public Law 110–417 (122 Stat. 4356, 4506), the Duncan Hunter National Defense Authorization Act for Fiscal Year 

2009. VA’s total investment in tinnitus-related research totals approximately $1.2 million, about one-tenth of the total national research dollars devoted to tinnitus. 

While recognizing VA’s efforts both within the Department and 

in collaboration with DOD, the Committee is concerned with the increasing number of veterans who report experiencing tinnitus and 

the amount of VA research dollars dedicated to understanding, 

treating, and preventing it. Further, the Committee believes that 

greater knowledge of tinnitus could lead to more effective treatments for veterans and a better understanding of the link between 

tinnitus and both TBI and PTSD. 

H.R. 1443, as amended, would address the Committee’s concerns 

by requiring VA to conduct further research regarding this condition. 

HEARINGS

On July 9, 2013, the Subcommittee on Health conducted a legislative hearing on various bills introduced during the 113th ConVerDate Mar 15 2010 04:17 Oct 24, 2013 Jkt 039006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR247.XXX HR247

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gress, including Draft Legislation, the Long-Term Care Veterans 

Choice Act; H.R. 1443; H.R. 1612; H.R. 1702; and, H.R. 2065. 

The following witnesses testified: 

The Honorable Mike Rogers of Alabama; the Honorable David 

McKinley of West Virginia; Jacob Gadd, the Deputy Director for 

Health Care for the Veterans Affairs and Rehabilitation Commission of the American Legion; Susan E. Shore, Ph.D., the Chair of 

the Scientific Advisory Committee for the American Tinnitus Association; Adrian Atizado, the Assistant National Legislative Director 

for the Disabled American Veterans; Robert Drexler, Member of 

the Board of Directors for the International Code Council, Raymond C. Kelley, Director of the National Legislative Service for the 

Veterans of Foreign Wars; and Robert L. Jesse, M.D., Ph.D., the 

Principal Deputy Under Secretary for Health for the Veterans 

Health Administration of the U.S. Department of Veterans Affairs, 

accompanied by Susan Blauert, the Deputy Assistant General 

Counsel for the U.S. Department of Veterans Affairs. 

Statements for the record were submitted by the following: 

The Honorable Ron Barber of Arizona; the Iraq and Afghanistan 

Veterans of America; Tuskegee University; the National Association of State Fire Marshals; the National Coalition for Homeless 

Veterans; the Paralyzed Veterans of America; the Vietnam Veterans of America; and the Wounded Warrior Project. 

SUBCOMMITTEE CONSIDERATION

On July 23, 2013, the Subcommittee on Health met in open session, a quorum being present, and favorably forwarded to the full 

Committee H.R. 1443, as amended, by voice vote. 

During consideration of H.R. 1443, the following amendment was 

considered and agreed to by voice vote: 

An amendment offered by Ms. Brownley of California that would: 

strike any reference to ‘‘mandatory’’ research; require VA to recognize the need to enhance the research and treatment of tinnitus; 

and specify that nothing in this legislation shall be construed as 

interfering with VA’s existing research peer-review protocols. 

COMMITTEE CONSIDERATION

On August 1, 2013, the full Committee met in an open markup 

session, a quorum being present and ordered H.R. 1443, as amended, reported favorably to the House of Representatives by voice 

vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report the legislation and amendments thereto. There were no 

record votes taken on amendments or in connection with ordering 

H.R. 1443, as amended, reported to the House. A motion by Ranking Member Michael H. Michaud of Maine to report H.R. 1443, as 

amended, favorably to the House of Representatives was agreed to 

by voice vote. 


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COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are reflected in the descriptive portions of this report. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 1443, as amended, does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9 of rule XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 1443 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

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

of Representatives, the following is the cost estimate for H.R. 1443, 

as amended, provided by the Congressional Budget Office pursuant 

to section 402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, August 8, 2013. 

Hon. JEFF MILLER, Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 1443, the Tinnitus Research and Treatment Act of 2013. 

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

to provide them. The CBO staff contact is Ann E. Futrell. 

Sincerely, 

DOUGLAS W. ELMENDORF. 

Enclosure. 


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

H.R. 1443 would require the Department of Veterans Affairs 

(VA) to treat tinnitus as a condition for research and treatment at 

VA Auditory Centers of Excellence. Tinnitus, the medical term for 

the sensation of hearing sound when no external sound is present, 

is the most common disability among veterans and may be caused 

by exposure to loud sounds during military service. The VA already 

provides tinnitus treatment at all its audiology clinics. 

Furthermore, VA’s National Center for Rehabilitation Auditory 

Research (NCRAR) at the Portland VA Medical Center conducts research and provides educational resources for tinnitus. NCRAR has 

several research projects currently under way on tinnitus (for example, the Clinical Trial of Transcranial Magnetic Stimulation for 

Relief of Tinnitus, Telephone Tinnitus Education for Patients with 

TBI, and Multi-Site Evaluation of Progressive Tinnitus Management). Additionally, the VA Research Enhancement Award Program at Mountain Home Veterans Affairs Medical Center in Tennessee is conducting tinnitus-related research projects. 

VA is currently collaborating with the Department of Defense 

Hearing Center of Excellence in maintaining a joint registry, providing treatment and conducting research for tinnitus. Since this 

bill would codify VA’s current practices regarding tinnitus, CBO estimates that implementing H.R. 1443 would have no significant 

cost over the 2014–2018 period. 

Enacting this bill would not affect direct spending or revenues; 

therefore, pay-as-you-go procedures do not apply. 

H.R. 1443 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would 

impose no costs on state, local, or tribal governments. 

The CBO staff contact for this estimate is Ann E. Futrell. The 

estimate was approved by Peter H. Fontaine, Assistant Director for 

Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of federal mandates regarding H.R. 1443, as amended, prepared by the Director 

of the Congressional Budget Office pursuant to Section 423 of the 

Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

H.R. 1443, as amended, creates no advisory committees within 

the meaning of section 5(b) of the Federal Advisory Committee Act. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to Article I, section 8 of the United States Constitution, 

the reported bill is authorized by Congress’ power to ‘‘provide for 

the common Defense and general Welfare of the United States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of the Congressional Accountability Act § 102(b)(3), 2 U.S.C. § 24 (1995). 


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STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

Pursuant to section 3(j) of H. Res. 5, 113th Cong. (2013), the 

Committee finds that no provision of H.R. 1443, as amended, establishes or reauthorizes a program of the Federal Government known 

to be duplicative of another Federal program, a program that was 

included in any report from the Government Accountability Office 

to Congress pursuant to section 21 of Public Law 111–139, or a 

program related to a program identified in the most recent Catalog 

of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(k) of H. Res. 5, 113th Cong. (2013), the 

Committee estimates that H.R. 1443, as amended, does not require 

any directed rule makings. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would provide the short title of H.R. 1443, 

as amended, as the ‘‘Tinnitus Research and Treatment Act of 

2013.’’ 

Section 2. Findings 

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

tinnitus. 

Section 3. Recognition and treatment of tinnitus at Department of 

Veterans Affairs Auditory Centers of Excellence 

Section 3 of the bill would require VA to recognize tinnitus as a 

condition for research and treatment by the VA Auditory Centers 

of Excellence. 

Section 4. Research on prevention and treatment of tinnitus 

Section 4(a) of the bill would require the Secretary of Veterans 

Affairs to recognize the need to enhance the research and treatment of tinnitus and to ensure the allocation of appropriate resources directed at the research and enhanced treatment of 

tinnitus conducted by the VA Auditory Centers of Excellence, commensurate with peer review protocols. 

Section 4(a)(1) of the bill would require such research to include 

an assessment of the efficacy of multidisciplinary tinnitus treatment modalities on different subsets of patients. 

Section 4(a)(2) of the bill would require such research to include 

studies on the underlying etiology of tinnitus in veteran populations that occur as a result of different causal factors, including 

blast-related tinnitus that does not result in hearing loss and other 

forms of noise-induced tinnitus that does result in hearing loss. 

Section 4(a)(3) of the bill would require such research to include 

a study of the underlying mechanisms between hearing loss and 

tinnitus, including cases in which only one such condition is 

present. 

Section 4(b) of the bill would require that nothing in the bill be 

construed as interfering with VA’s discretion to conduct research in 

accordance with peer-review protocols in order to ensure the quality and transparency of the research. 


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Section 5. Interdepartmental cooperation 

Section 5 of the bill would require VA to ensure cooperation with 

the Hearing Center of Excellence established by DOD to further research on tinnitus. 

CHANGES IN EXISTING LAW MADE BY THE BILL AS REPORTED

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

Æ 


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