I

103D CONGRESS

1ST SESSION H. R. 3193

To expand services provided by the Department of Veterans Affairs for

veterans suffering from post-traumatic stress disorder (PTSD).

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 30, 1993

Mr. EVANS (for himself, Mr. KENNEDY, Mr. GUTIERREZ, and Mr.

STRICKLAND) introduced the following bill; which was referred to the

Committee on Veterans’ Affairs

A BILL

To expand services provided by the Department of Veterans

Affairs for veterans suffering from post-traumatic stress

disorder (PTSD).

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Veterans PTSD Treat5 ment and Psychological Readjustment Act of 1993’’.

6 SEC. 2. FINDINGS.

7 The Congress finds—

8 (1) that a study carried out pursuant to Public

9 Law 98–160 on the readjustment of Vietnam-era
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1 veterans estimated that approximately 479,000 Viet2 nam-theater veterans currently suffer from full3 blown post-traumatic stress disorder (PTSD);

4 (2) that such study found that during the final

5 year in which such study was conducted only 10 per6 cent of the Vietnam-era veterans suffering from

7 post-traumatic stress disorder were provided services

8 by the Department of Veterans Affairs for post-trau9 matic stress disorder;

10 (3) that the conflict in the Persian Gulf re11 sulted in an increased demand for services provided

12 by the Department of Veterans Affairs for post-trau13 matic stress disorder;

14 (4) that expansion of the current programs of

15 the Department of Veterans Affairs to provide serv16 ices to veterans suffering from post-traumatic stress

17 disorder (including specialized inpatient PTSD

18 units, PTSD clinical teams, readjustment centers,

19 and other services) would be an effective means of

20 reaching those veterans who have not previously

21 been provided such services; and

22 (5) that implementing the recommendations of

23 the Under Secretary for Health’s Special Committee

24 on Post-Traumatic Stress Disorder would be an ef25 fective means of reaching veterans suffering from
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1 post-traumatic stress disorder who have not been

2 provided services.

3 SEC. 3. EXPANSION OF THE SPECIALIZED INPATIENT POST4 TRAUMATIC STRESS DISORDER UNIT PRO5 GRAM.

6 (a) POLICY.—(1) It shall be the policy of the Sec7 retary of Veterans Affairs to implement the recommenda8 tions of the Special Committee on Post-Traumatic Stress

9 Disorder with respect to the program of the Department

10 of Veterans Affairs to establish and operate specialized in11 patient post-traumatic stress disorder units (SIPUs) at

12 Department medical centers. In operating such units, the

13 Secretary shall ensure that the facilities and services of

14 such units are available to all eligible veterans, including

15 veterans of the Persian Gulf conflict.

16 (2) The special committee referred to in paragraph

17 (1) is the Special Committee on Post-Traumatic Stress

18 Disorder established by the Under Secretary for Health

19 pursuant to section 110 of Public Law 98–528 (38 U.S.C.

20 612A note).

21 (b) INCREASE IN NUMBER OF SIPUS.—The Sec22 retary shall increase the number of specialized inpatient

23 post-traumatic stress disorder units existing on the date

24 of the enactment of this Act by not less than 30. Of such

25 number—
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1 (1) not less than five such units shall be estab2 lished by December 31, 1994;

3 (2) not less than a total of 15 such units shall

4 be established by December 31, 1995;

5 (3) not less than a total of 25 such units shall

6 be established by December 31, 1996; and

7 (4) not less than a total of 30 such units shall

8 be established by December 31, 1997.

9 SEC. 4. EXPANSION OF THE VET CENTER PROGRAM AND

10 OUTREACH EFFORTS FOR VETERANS WITH

11 READJUSTMENT COUNSELING NEEDS.

12 (a) SPECIAL COMMITTEE RECOMMENDATION.—(1)

13 The Secretary of Veterans Affairs, acting through the

14 Under Secretary for Health of the Department of Veter15 ans Affairs, shall direct the Special Committee on Post16 Traumatic Stress Disorder to identify areas of the country

17 in which there are significant needs for expanding the Vet

18 Center program, especially areas in which there are rel19 atively high numbers of veterans who are members of mi20 nority groups and areas that are currently not well-served

21 by Vet Centers.

22 (2) The Special Committee, based on its findings

23 under paragraph (1), shall present a list of not less than

24 40 areas as candidates for new Vet Centers to the Read-
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1 justment Counseling Service of the Department of Veter2 ans Affairs not later than September 30, 1994.

3 (b) VET CENTER PROGRAM EXPANSION.—Based on

4 the requirements identified pursuant to subsection (a), the

5 Readjustment Counseling Service shall increase the num6 ber of Vet Centers existing on the date of the enactment

7 of this Act by not less than 40. Of such number—

8 (1) not less than five such centers shall be es9 tablished by December 31, 1994;

10 (2) not less than a total of 20 such centers

11 shall be established by December 31, 1995;

12 (3) not less than a total of 30 such centers

13 shall be established by December 31, 1996; and

14 (4) not less than a total of 40 such centers

15 shall be established by December 31, 1997.

16 (c) OUTREACH RECOMMENDATIONS.—The Advisory

17 Committee on Veteran Readjustment Counseling estab18 lished under section 1720C of title 38, United States Code

19 (as added by section 6(a)), shall prepare a report on rec20 ommendations to increase outreach efforts to veterans of

21 the Vietnam-era and periods after the Vietnam-era who

22 have readjustment counseling needs. The Advisory Com23 mittee shall submit such report to the Secretary not later

24 than July 29, 1994. Not later than 60 days after receiving

25 such report, the Secretary shall transmit a copy of the
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1 report, together with the Secretary’s comments and rec2 ommendations, to Congress.

3 SEC. 5. EXPANSION OF ELIGIBILITY FOR READJUSTMENT

4 COUNSELING AND CERTAIN RELATED COUN5 SELING SERVICES.

6 (a) READJUSTMENT COUNSELING.—(1) Subsection

7 (a) of section 1712A of title 38, United States Code, is

8 amended to read as follows:

9 ‘‘(a)(1) Upon the request of any veteran who while

10 in the active military, naval, or air service served in a com11 bat theater of operations (as defined by the Secretary of

12 Defense), the Secretary shall furnish counseling to such

13 veteran to assist such veteran in readjusting to civilian

14 life. Upon the request of any veteran other than a veteran

15 described in the preceding sentence, the Secretary shall,

16 within the limits of Department facilities, furnish counsel17 ing to such veteran to assist such veteran in readjusting

18 to civilian life.

19 ‘‘(2) Such counseling shall include a general mental

20 and psychological assessment to ascertain whether such

21 veteran has mental or psychological problems associated

22 with readjustment to civilian life.’’.

23 (2) Subsection (c) of such section is repealed.
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1 (b) OTHER COUNSELING.—Such section is further

2 amended by inserting after subsection (b) the following

3 new subsection (c):

4 ‘‘(c)(1) The Secretary may provide the counseling

5 services described in section 1701(6)(B)(ii) of this title to

6 the surviving parents, spouse, and children of any member

7 of the Armed Forces who dies while serving on active duty

8 or from a condition (as determined by the Secretary) in9 curred in or aggravated by such service.

10 ‘‘(2) The Secretary may make the facilities and serv11 ices of Vet Centers available to provide appropriate coun12 seling and other services to family members of any mem13 ber of the Armed Forces who is receiving combat pay.’’.

14 (c) AUTHORITY TO CONTRACT FOR COUNSELING

15 SERVICES.—Subsection (e) of such section is amended by

16 striking out ‘‘subsections (a) and (b)’’ each place it ap17 pears and inserting in lieu thereof ‘‘subsections (a), (b),

18 and (c)’’.

19 SEC. 6. ADVISORY COMMITTEE ON THE READJUSTMENT OF

20 VETERANS.

21 (a) IN GENERAL.—(1) Subchapter II of chapter 17

22 of title 38, United States Code, is amended by inserting

23 after section 1712B the following:
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1 ‘‘§ 1712C. Advisory Committee on Veterans Readjust2 ment Counseling

3 ‘‘(a)(1) There is in the Department the Advisory

4 Committee on Veteran Readjustment Counseling (herein5 after in this section referred to as the ‘Committee’).

6 ‘‘(2) The Committee shall consist of 18 members.

7 The members of the Committee shall be appointed by the

8 Secretary and shall include individuals who are recognized

9 authorities in fields pertinent to the social, psychological,

10 economic, or educational readjustment of veterans. An of11 ficer or employee of the United States may not be ap12 pointed as a member of the Committee. At least 12 of

13 the Committee shall be veterans of the Vietnam era or

14 other period of war. Appointments of members of the

15 Committee shall be made from among individuals who

16 have experience with the provision of veterans benefits and

17 services by the Department or who are otherwise familiar

18 with programs of the Department.

19 ‘‘(3) The Secretary shall seek to ensure that members

20 appointed to the Committee include persons from a wide

21 variety of geographic areas and ethnic backgrounds, per22 sons from veterans service organizations, minorities, and

23 women.

24 ‘‘(4) The Secretary shall determine the terms of serv25 ice and pay and allowances of the members of the Commit26 tee, except that a term of service may not exceed two
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1 years. The Secretary may reappoint any member for addi2 tional terms of service.

3 ‘‘(b)(1) The Secretary shall, on a regular basis, con4 sult with and seek the advice of the Committee with re5 spect to the provision by the Department of benefits and

6 services to veterans in order to assist veterans in the re7 adjustment to civilian life.

8 ‘‘(2)(A) In providing advice to the Secretary under

9 this subsection, the Committee shall—

10 ‘‘(i) assemble and review information relating to

11 the needs of veterans in readjusting to civilian life;

12 ‘‘(ii) provide information relating to the nature

13 and character of psychological problems arising from

14 military service;

15 ‘‘(iii) provide an on-going assessment of the ef16 fectiveness of the policies, organizational structures,

17 and services of the Department in assisting veterans

18 in readjusting to civilian life; and

19 ‘‘(iv) provide on-going advice on the most ap20 propriate means of responding to the readjustment

21 needs of future veterans.

22 ‘‘(B) In carrying out its duties under subparagraph

23 (A), the Committee shall take into special account veter24 ans of the Vietnam era, and the readjustment needs of

25 such veterans.
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1 ‘‘(c)(1) Not later than March 31 of each year, the

2 Committee shall submit to the Secretary a report on the

3 programs and activities of the Department that relate to

4 the readjustment of veterans to civilian life. Each such

5 report shall include—

6 ‘‘(A) an assessment of the needs of veterans

7 with respect to readjustment to civilian life;

8 ‘‘(B) a review of the programs and activities of

9 the Department designed to meet such needs; and

10 ‘‘(C) such recommendations (including rec11 ommendations for administrative and legislative ac12 tion) as the Committee considers appropriate.

13 ‘‘(2) Not later than 90 days after the receipt of each

14 report under paragraph (1), the Secretary shall transmit

15 to the Committees on Veterans’ Affairs of the Senate and

16 House of Representatives a copy of the report, together

17 with any comments and recommendations concerning the

18 report that the Secretary considers appropriate.

19 ‘‘(3) The Committee may also submit to the Sec20 retary such other reports and recommendations as the

21 Committee considers appropriate.

22 ‘‘(4) The Secretary shall submit with each annual re23 port submitted to the Congress pursuant to section 529

24 of this title a summary of all reports and recommendations

25 of the Committee submitted to the Secretary since the pre-
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1 vious annual report of the Secretary submitted pursuant

2 to that section.

3 ‘‘(d)(1) Except as provided in paragraph (2), the pro4 visions of the Federal Advisory Committee Act (5 U.S.C.

5 App.) shall apply to the activities of the Committee under

6 this section.

7 ‘‘(2) Section 14 of such Act shall not apply to the

8 Committee.’’.

9 (2) The table of sections at the beginning of chapter

10 17 of such title is amended by inserting after the item

11 relating to section 1712B the following:

‘‘1712C. Advisory Committee on Veteran Readjustment Counseling.’’.

12 (b) ORIGINAL MEMBERS.—(1) Notwithstanding sub13 section (a)(2) of section 1712C of title 38, United States

14 Code (as added by subsection (a)), the members of the

15 Advisory Committee on the Readjustment of Vietnam and

16 Other War Veterans on the date of the enactment of this

17 Act shall be the original members of the advisory commit18 tee established under that section.

19 (2) The original members shall so serve until the Sec20 retary of Veterans Affairs carries out appointments under

21 such subsection (a)(2). The Secretary shall carry out such

22 appointments as soon as is practicable. The Secretary may

23 make such appointments from among such original mem24 bers.
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1 SEC. 7. PILOT PROGRAM FOR TREATMENT OF POST-TRAU2 MATIC STRESS DISORDER.

3 (a) ESTABLISHMENT OF PROGRAM.—(1) Subchapter

4 II of chapter 17 of title 38, United States Code, is amend5 ed by adding at the end the following new section:

6 ‘‘§ 1720E. Treatment and rehabilitation for post-trau7 matic stress disorder; pilot program

8 ‘‘(a)(1) The Secretary, in furnishing hospital, nursing

9 home, and domiciliary care and medical and rehabilitative

10 services under this chapter, shall conduct a pilot program

11 under which the Secretary may contract for care and

12 treatment and rehabilitative services in halfway houses,

13 therapeutic communities, psychiatric residential treatment

14 centers, and other community based treatment facilities

15 for eligible veterans suffering from post-traumatic stress

16 disorder. Such pilot program shall be planned, designed,

17 and conducted by the Under Secretary for Health, with

18 the approval of the Secretary, so as to demonstrate any

19 medical advantages and cost effectiveness that may result

20 from furnishing such care and services to veterans with

21 post-traumatic stress disorder in contract facilities as au22 thorized by this section, rather than in facilities over which

23 the Secretary has direct jurisdiction.

24 ‘‘(2) Before furnishing such care and services to a

25 veteran through a contract facility as authorized by para26 graph (1), the Secretary shall approve (in accordance with
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1 criteria which the Secretary shall prescribe by regulation)

2 the quality and effectiveness of the program operated by

3 such facility for the purpose for which such veteran is to

4 be furnished such care and services.

5 ‘‘(b) The Secretary, in consultation with the Sec6 retary of Labor and the Director of the Office of Person7 nel Management, shall take appropriate steps to—

8 ‘‘(1) urge all Federal agencies and appropriate

9 private and public firms, organizations, agencies,

10 and persons to provide appropriate employment and

11 training opportunities for veterans who have been

12 provided treatment and rehabilitative services under

13 this title for post-traumatic stress disorder and have

14 been determined by competent medical authority to

15 be sufficiently rehabilitated to be employable; and

16 ‘‘(2) provide all possible assistance to the Sec17 retary of Labor in placing such veterans in such op18 portunities.

19 ‘‘(c) Upon receipt of an application for treatment and

20 rehabilitative services under this title for post-traumatic

21 stress disorder from any individual who has been dis22 charged or released from active military, naval, or air serv23 ices but who is not eligible for such treatment and serv24 ices, the Secretary shall—
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1 ‘‘(1) provide referral services to assist such in2 dividual, to the maximum extent practicable, in ob3 taining treatment and rehabilitative services from

4 sources outside the Department; and

5 ‘‘(2) if pertinent, advise such individual of such

6 individual’s rights to apply to the appropriate mili7 tary, naval, or air service and the Department for

8 review of such individual’s discharge or release from

9 such service.

10 ‘‘(d) The capacity of the pilot program under sub11 section (a) shall be maintained at 500 eligible individuals.

12 ‘‘(e) The Secretary may not furnish care and treat13 ment and rehabilitative services under subsection (a) after

14 the last day of the fifth fiscal year following the fiscal year

15 during which the pilot program authorized by that sub16 section is begun.

17 ‘‘(f) Not later than March 31, 1998, the Secretary

18 shall submit to the Committee on Veterans’ Affairs of the

19 Senate and House of Representatives a report on the find20 ings and recommendations of the Secretary pertaining to

21 the operation through September 30, 1997, of the pilot

22 program authorized by subsection (a).

23 ‘‘(g) The authority of the Secretary to enter into con24 tracts under this section shall be effective for any fiscal
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1 year only to such extent or in such amounts as are pro2 vided in appropriation Acts.’’.

3 (2) The table of sections at the beginning of chapter

4 17 of such title is amended by inserting after the item

5 relating to section 1720D the following:

‘‘1720E. Treatment and rehabilitation for post-traumatic stress disorder; pilot

program.’’.

6 (b) EFFECTIVE DATE.—The Secretary of Veterans

7 Affairs may not furnish care and treatment and rehabilita8 tion services under subsection (a) of section 1720E of title

9 38, United States Code, as added by subsection (a), before

10 October 1, 1993.

11 SEC. 8. REPORT ON POST-TRAUMATIC STRESS DISORDER

12 CONTRACT CARE.

13 (a) EXAMINATION OF EFFECTIVENESS.—The Special

14 Committee on Post-Traumatic Stress Disorder of the

15 Under Secretary for Health, in consultation with the Advi16 sory Committee on Veteran Readjustment Counseling,

17 shall examine the effectiveness of contracts for the treat18 ment of post-traumatic stress disorder with private facili19 ties and therapists under section 1712A(e) of title 38,

20 United States Code.

21 (b) REPORT.—Not later than December 31, 1994,

22 the Special Committee shall submit to the Committees on

23 Veterans’ Affairs of the Senate and House of Representa-
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1 tives a report of its findings and recommendations per2 taining to—

3 (1) establishing stable funding for post-trau4 matic stress disorder contract care, and

5 (2) the availability of post-traumatic stress dis6 order contract care for eligible individuals in rural

7 areas and such individuals who are not currently

8 well-served by other Department of Veterans Affairs

9 medical services.

10 SEC. 9. USE OF SCHOLARSHIP AND TUITION REIMBURSE11 MENT PROGRAMS FOR MENTAL HEALTH PRO12 FESSIONALS.

13 In administering the Health Professionals Edu14 cational Assistance Program under chapter 76 of title 38,

15 United States Code, the Secretary of Veterans Affairs

16 shall seek to encourage the participation of individuals in

17 the program who desire to become psychologists, psychia18 trists, social workers, psychiatric nurses, and other profes19 sionals specializing in the treatment of post-traumatic

20 stress disorder. The Secretary shall designate, pursuant

21 to section 7612(b)(3) of that title, additional fields of edu22 cation or training that may be beneficial for the treatment

23 of veterans suffering from post-traumatic stress disorder.
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1 SEC. 10. POST-TRAUMATIC STRESS DISORDER RESEARCH

2 PROGRAMS.

3 (a) INTERMODAL APPROACH.—The Under Secretary

4 for Health of the Department of Veterans Affairs shall

5 conduct a research program to consider the most effective

6 treatment modalities for the treatment of post-traumatic

7 stress disorder. The research program shall be conducted

8 at at least one specialized inpatient post-traumatic stress

9 disorder unit (SIPU), at least one post-traumatic stress

10 disorder clinical team (PCT), and at least one veterans

11 readjustment center, as designated by the Under Sec12 retary. The Under Secretary shall report the findings of

13 such program to the Committees on Veterans’ Affairs of

14 the Senate and House of Representatives not later than

15 December 31, 1997.

16 (b) INVOLVEMENT OF FAMILY MEMBERS.—The

17 Under Secretary shall conduct a research program con18 cerning the effectiveness of involving the family in the

19 treatment of post-traumatic stress disorder. The Under

20 Secretary shall report the findings of such program to the

21 Committees on Veterans’ Affairs of the Senate and House

22 of Representatives not later than December 31, 1996.

23 (c) IMPLEMENTATION.—The Under Secretary shall

24 carry out subsections (a) and (b) through the National

25 Center on Post-Traumatic Stress Disorder.
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1 (d) ADVICE.—The Under Secretary shall carry out

2 subsections (a) and (b) in consultation with the Special

3 Committee on Post-Traumatic Stress Disorder and the

4 Advisory Committee on Veterans Readjustment Counsel5 ing.

6 SEC. 11. EXPANSION OF THE POST-TRAUMATIC STRESS DIS7 ORDER CLINICAL TEAM PROGRAM.

8 (a) POLICY.—It shall be the policy of the Secretary

9 of Veterans Affairs to implement the recommendations of

10 the Special Committee on Post-Traumatic Stress Disorder

11 to establish and operate post-traumatic stress disorder

12 clinical teams (PCTs) at Department medical centers

13 which provide mental health services. In operating such

14 teams, the Secretary shall ensure that the services of such

15 teams are available to all eligible veterans.

16 (b) INCREASE IN NUMBER OF PCTS.—The Secretary

17 shall increase the number of clinical teams existing on the

18 date of the enactment of this Act by not less than 50.

19 Of such number—

20 (1) not less than 15 such units shall be estab21 lished by December 31, 1994;

22 (2) not less than a total of 30 such units shall

23 be established by December 31, 1995;

24 (3) not less than a total of 40 such units shall

25 be established by December 31, 1996; and
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1 (4) not less than a total of 50 such units shall

2 be established by December 31, 1997.

3 (c) LOCATIONS OF NEW PCTS.—In establishing new

4 post-traumatic stress disorder clinical teams pursuant to

5 subsection (a), the Secretary shall first locate teams at

6 medical centers that do not have a specialized inpatient

7 post-traumatic stress disorder unit (SIPU) and do not

8 have an affiliated Vet Center.

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