II

103D CONGRESS

1ST SESSION S. 1503

To expand services provided by the Department of Veterans Affairs for

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

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 30 (legislative day, SEPTEMBER 27), 1993

Mr. WELLSTONE introduced the following bill; which was read twice and

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 the

9 Veterans’ Health Care Amendments of 1983 (Public

10 Law 98–160; 97 Stat. 993) on the readjustment of
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1 Vietnam-era veterans estimated that approximately

2 479,000 Vietnam-theater veterans currently suffer

3 from full-blown post-traumatic stress disorder

4 (PTSD);

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

6 year in which such study was conducted only 10 per7 cent of the Vietnam-era veterans suffering from

8 post-traumatic stress disorder were provided services

9 by the Department of Veterans Affairs for post-trau10 matic stress disorder;

11 (3) that the conflict in the Persian Gulf re12 sulted in an increased demand for services provided

13 by the Department of Veterans Affairs for post-trau14 matic stress disorder;

15 (4) that expansion of the current programs of

16 the Department of Veterans Affairs to provide serv17 ices to veterans suffering from post-traumatic stress

18 disorder (including specialized inpatient PTSD

19 units, PTSD clinical teams, readjustment centers,

20 and other services) would be an effective means of

21 reaching those veterans who have not previously

22 been provided such services; and

23 (5) that implementing the recommendations of

24 the Special Committee on Post-Traumatic Stress

25 Disorder would be an effective means of reaching
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1 veterans suffering from post-traumatic stress dis2 order who have not been provided services.

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

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

7 of Veterans Affairs to implement the recommendations of

8 the Special Committee on Post-Traumatic Stress Disorder

9 with respect to the program of the Department of Veter10 ans Affairs to establish and operate specialized inpatient

11 post-traumatic stress disorder units (SIPUs) at Depart12 ment medical centers. In operating such units, the Sec13 retary shall ensure that the facilities and services of such

14 units are available to all eligible veterans, including veter15 ans of the Persian Gulf conflict.

16 (b) INCREASE IN NUMBER OF SIPUS.—The Sec17 retary shall increase the number of specialized inpatient

18 post-traumatic stress disorder units existing on the date

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

20 number—

21 (1) not less than five such units shall be estab22 lished by December 31, 1994;

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

24 be established by December 31, 1995;
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1 (3) not less than a total of 25 such units shall

2 be established by December 31, 1996; and

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

4 be established by December 31, 1997.

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

6 OUTREACH EFFORTS FOR VETERANS WITH

7 READJUSTMENT COUNSELING NEEDS.

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

9 The Secretary of Veterans Affairs, acting through the

10 Under Secretary for Health of the Department of Veter11 ans Affairs, shall direct the Special Committee on Post12 Traumatic Stress Disorder to identify areas of the country

13 in which there are significant needs for expanding the Vet

14 Center program, especially areas in which there are rel15 atively high numbers of veterans who are members of mi16 nority groups and areas that are currently not well-served

17 by Vet Centers.

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

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

20 40 areas as candidates for new Vet Centers to the Read21 justment Counseling Service of the Department of Veter22 ans Affairs not later than September 30, 1994.

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

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

25 Readjustment Counseling Service shall increase the num-
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1 ber of Vet Centers existing on the date of the enactment

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

3 (1) not less than five such centers shall be es4 tablished by December 31, 1994;

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

6 shall be established by December 31, 1995;

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

8 shall be established by December 31, 1996; and

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

10 shall be established by December 31, 1997.

11 (c) OUTREACH RECOMMENDATIONS.—The Advisory

12 Committee on Veteran Readjustment Counseling shall

13 prepare a report on recommendations to increase outreach

14 efforts to veterans of the Vietnam-era and periods after

15 the Vietnam-era who have readjustment counseling needs.

16 The Advisory Committee shall submit such report to the

17 Secretary not later than July 29, 1994. Not later than

18 60 days after receiving such report, the Secretary shall

19 transmit a copy of the report, together with the Sec20 retary’s comments and recommendations, to Congress.
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1 SEC. 5. EXPANSION OF ELIGIBILITY FOR READJUSTMENT

2 COUNSELING AND CERTAIN RELATED COUN3 SELING SERVICES.

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

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

6 amended to read as follows:

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

8 in the active military, naval, or air service served in a com9 bat theater of operations (as defined by the Secretary of

10 Defense), the Secretary shall furnish counseling to such

11 veteran to assist such veteran in readjusting to civilian

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

13 described in the preceding sentence, the Secretary shall,

14 within the limits of Department facilities, furnish counsel15 ing to such veteran to assist such veteran in readjusting

16 to civilian life.

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

18 and psychological assessment to ascertain whether such

19 veteran has mental or psychological problems associated

20 with readjustment to civilian life.’’.

21 (2) Subsection (c) of such section is repealed.

22 (b) OTHER COUNSELING.—Such section is further

23 amended by inserting after subsection (b) the following

24 new subsection (c):

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

26 services described in section 1701(6)(B)(ii) of this title to
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1 the surviving parents, spouse, and children of any member

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

3 or from a condition (as determined by the Secretary) in4 curred in or aggravated by such service.

5 ‘‘(2) The Secretary may make the facilities and serv6 ices of Vet Centers available to provide appropriate coun7 seling and other services to family members of any mem8 ber of the Armed Forces who is receiving combat pay.’’.

9 (c) AUTHORITY TO CONTRACT FOR COUNSELING

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

11 striking out ‘‘subsections (a) and (b)’’ each place it ap12 pears and inserting in lieu thereof ‘‘subsections (a), (b),

13 and (c)’’.

14 SEC. 6. ADVISORY COMMITTEE ON THE READJUSTMENT OF

15 VETERANS.

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

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

18 after section 1712B the following:

19 ‘‘§ 1712C. Advisory Committee on Veteran-Readjust20 ment Counseling

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

22 Committee on Veteran Readjustment Counseling (herein23 after in this section referred to as the ‘Committee’).

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

25 The members of the Committee shall be appointed by the
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1 Secretary and shall include individuals who are recognized

2 authorities in fields pertinent to the social, psychological,

3 economic, or educational readjustment of veterans. An of4 ficer or employee of the United States may not be ap5 pointed as a member of the Committee. At least 12 mem6 bers of the Committee shall be veterans of the Vietnam

7 era or other period of war. Appointments of members of

8 the Committee shall be made from among individuals who

9 have experience with the provision of veterans benefits and

10 services by the Department or who are otherwise familiar

11 with programs of the Department.

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

13 appointed to the Committee include persons from a wide

14 variety of geographic areas and ethnic backgrounds, per15 sons from veterans service organizations, minorities, and

16 women.

17 ‘‘(4) The Secretary shall determine the terms of serv18 ice and pay and allowances of the members of the Commit19 tee, except that a term of service may not exceed two

20 years. The Secretary may reappoint any member for addi21 tional terms of service.

22 ‘‘(b)(1) The Secretary shall, on a regular basis, con23 sult with and seek the advice of the Committee with re24 spect to the provision by the Department of benefits and
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1 services to veterans in order to assist veterans in the read2 justment to civilian life.

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

4 this subsection, the Committee shall—

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

6 the needs of veterans in readjusting to civilian life;

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

8 and character of psychological problems arising from

9 military service;

10 ‘‘(iii) provide an on-going assessment of the ef11 fectiveness of the policies, organizational structures,

12 and services of the Department in assisting veterans

13 in readjusting to civilian life; and

14 ‘‘(iv) provide on-going advice on the most ap15 propriate means of responding to the readjustment

16 needs of future veterans.

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

18 (A), the Committee shall take into special account veter19 ans of the Vietnam era, and the readjustment needs of

20 such veterans.

21 ‘‘(c)(1) Not later than March 31 of each year, the

22 Committee shall submit to the Secretary a report on the

23 programs and activities of the Department that relate to

24 the readjustment of veterans to civilian life. Each such

25 report shall include—
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1 ‘‘(A) an assessment of the needs of veterans

2 with respect to readjustment to civilian life;

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

4 the Department designed to meet such needs; and

5 ‘‘(C) such recommendations (including rec6 ommendations for administrative and legislative ac7 tion) as the Committee considers appropriate.

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

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

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

11 House of Representatives a copy of the report, together

12 with any comments and recommendations concerning the

13 report that the Secretary considers appropriate.

14 ‘‘(3) The Committee may also submit to the Sec15 retary such other reports and recommendations as the

16 Committee considers appropriate.

17 ‘‘(4) The Secretary shall submit with each annual re18 port submitted to the Congress pursuant to section 529

19 of this title a summary of all reports and recommendations

20 of the Committee submitted to the Secretary since the pre21 vious annual report of the Secretary submitted pursuant

22 to that section.

23 ‘‘(d)(1) Except as provided in paragraph (2), the pro24 visions of the Federal Advisory Committee Act (5 U.S.C.
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1 App.) shall apply to the activities of the Committee under

2 this section.

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

4 Committee.’’.

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

6 17 of such title is amended by inserting after the item

7 relating to section 1712B the following:

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

8 (b) ORIGINAL MEMBERS.—(1) Notwithstanding sub9 section (a)(2) of section 1712C of title 38, United States

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

11 Advisory Committee on the Readjustment of Vietnam and

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

13 Act shall be the original members of the advisory commit14 tee established under that section.

15 (2) The original members shall so serve until the Sec16 retary of Veterans Affairs carries out appointments under

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

18 appointments as soon as is practicable. The Secretary may

19 make such appointments from among such original mem20 bers.

21 SEC. 7. PILOT PROGRAM FOR TREATMENT OF POST-TRAU22 MATIC STRESS DISORDER.

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

24 II of chapter 17 of title 38, United States Code, is amend25 ed by adding at the end the following:
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1 ‘‘§ 1720E. Treatment and rehabilitation for post-trau2 matic stress disorder; pilot program

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

4 home, and domiciliary care and medical and rehabilitative

5 services under this chapter, shall conduct a pilot program

6 under which the Secretary may contract for care and

7 treatment and rehabilitative services in halfway houses,

8 therapeutic communities, psychiatric residential treatment

9 centers, and other community based treatment facilities,

10 for eligible veterans suffering from post-traumatic stress

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

12 and conducted by the Under Secretary for Health, with

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

14 medical advantages and cost effectiveness that may result

15 from furnishing such care and services to veterans with

16 post-traumatic stress disorder in contract facilities as au17 thorized by this section, rather than in facilities over which

18 the Secretary has direct jurisdiction.

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

20 veteran through a contract facility as authorized by para21 graph (1), the Secretary shall approve (in accordance with

22 criteria which the Secretary shall prescribe by regulation)

23 the quality and effectiveness of the program operated by

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

25 be furnished such care and services.
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1 ‘‘(b) The Secretary, in consultation with the Sec2 retary of Labor and the Director of the Office of Person3 nel Management, shall take appropriate steps to—

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

5 private and public firms, organizations, agencies,

6 and persons to provide appropriate employment and

7 training opportunities for veterans who have been

8 provided treatment and rehabilitative services under

9 this title for post-traumatic stress disorder and have

10 been determined by competent medical authority to

11 be sufficiently rehabilitated to be employable; and

12 ‘‘(2) provide all possible assistance to the Sec13 retary of Labor in providing such veterans with such

14 employment and training opportunities.

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

16 rehabilitative services under this title for post-traumatic

17 stress disorder from any individual who has been dis18 charged or released from active military, naval, or air serv19 ice but who is not eligible for such treatment and services,

20 the Secretary shall—

21 ‘‘(1) provide referral services to assist such in22 dividual, to the maximum extent practicable, in ob23 taining treatment and rehabilitative services from

24 sources outside the Department; and
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1 ‘‘(2) if pertinent, advise such individual of such

2 individual’s rights to apply to the appropriate mili3 tary, naval, or air service and the Department for

4 review of such individual’s discharge or release from

5 such service.

6 ‘‘(d) The capacity of the pilot program under sub7 section (a) shall be maintained at 500 eligible individuals.

8 ‘‘(e) The Secretary may not furnish care and treat9 ment and rehabilitative services under subsection (a) after

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

11 during which the pilot program authorized by that sub12 section is begun.

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

14 shall submit to the Committees on Veterans’ Affairs of

15 the Senate and House of Representatives a report on the

16 findings and recommendations of the Secretary pertaining

17 to the operation through September 30, 1997, of the pilot

18 program authorized by subsection (a).

19 ‘‘(g) The authority of the Secretary to enter into con20 tracts under this section shall be effective for any fiscal

21 year only to such extent or in such amounts as are pro22 vided in appropriation Acts.’’.

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

24 17 of such title is amended by inserting after the item

25 relating to section 1720D the following:
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‘‘1720E. Treatment and rehabilitation for post-traumatic stress disorder; pilot

program.’’.

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

2 Affairs may not furnish care and treatment and rehabilita3 tion services under subsection (a) of section 1720E of title

4 38, United States Code, as added by subsection (a), before

5 October 1, 1993.

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

7 CONTRACT CARE.

8 (a) EXAMINATION OF EFFECTIVENESS.—The Special

9 Committee on Post-Traumatic Stress Disorder, in con10 sultation with the Advisory Committee on Veterans Read11 justment Counseling, shall examine the effectiveness of

12 contracts for the treatment of post-traumatic stress dis13 order with private facilities and therapists under section

14 1712A(e) of title 38, United States Code.

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

16 the Special Committee shall submit to the Committees on

17 Veterans’ Affairs of the Senate and House of Representa18 tives a report of its findings and recommendations per19 taining to—

20 (1) establishing stable funding for post-trau21 matic stress disorder contract care, and

22 (2) the availability of post-traumatic stress dis23 order contract care for eligible individuals in rural

24 areas and such individuals who are not currently
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1 well-served by other Department of Veterans Affairs

2 medical services.

3 SEC. 9. USE OF SCHOLARSHIP AND TUITION REIMBURSE4 MENT PROGRAMS FOR MENTAL HEALTH PRO5 FESSIONALS.

6 In administering the Health Professionals Edu7 cational Assistance Program under chapter 76 of title 38,

8 United States Code, the Secretary of Veterans Affairs

9 shall seek to encourage the participation of individuals in

10 the program who desire to become psychologists, psychia11 trists, social workers, psychiatric nurses, and other profes12 sionals specializing in the treatment of post-traumatic

13 stress disorder. The Secretary shall designate, pursuant

14 to section 7612(b)(3) of that title, additional fields of edu15 cation or training that may be beneficial for the treatment

16 of veterans suffering from post-traumatic stress disorder.

17 SEC. 10. POST-TRAUMATIC STRESS DISORDER RESEARCH

18 PROGRAMS.

19 (a) INTERMODAL APPROACH.—The Under Secretary

20 for Health of the Department of Veterans Affairs shall

21 conduct a research program to consider the most effective

22 treatment modalities for the treatment of post-traumatic

23 stress disorder. The research program shall be conducted

24 at at least one specialized inpatient post-traumatic stress

25 disorder unit (SIPU), at least one post-traumatic stress
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1 disorder clinical team (PCT), and at least one veterans

2 readjustment center, as designated by the Under Sec3 retary. The Under Secretary shall report the findings of

4 such program to the Committees on Veterans’ Affairs of

5 the Senate and House of Representatives not later than

6 December 31, 1997.

7 (b) INVOLVEMENT OF FAMILY MEMBERS.—The

8 Under Secretary shall conduct a research program con9 cerning the effectiveness of involving the family in the

10 treatment of post-traumatic stress disorder. The Under

11 Secretary shall report the findings of such program to the

12 Committees on Veterans’ Affairs of the Senate and House

13 of Representatives not later than December 31, 1996.

14 (c) IMPLEMENTATION.—The Under Secretary shall

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

16 Center on Post-Traumatic Stress Disorder.

17 (d) ADVICE.—The Under Secretary shall carry out

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

19 Committee on Post-Traumatic Stress Disorder and the

20 Advisory Committee on Veterans Readjustment Counsel21 ing.

22 SEC. 11. EXPANSION OF THE POST-TRAUMATIC STRESS DIS23 ORDER CLINICAL TEAM PROGRAM.

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

25 of Veterans Affairs to implement the recommendations of
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1 the Special Committee on Post-Traumatic Stress Disorder

2 to establish and operate post-traumatic stress disorder

3 clinical teams (PCTs) at Department medical centers

4 which provide mental health services. In operating such

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

6 teams are available to all eligible veterans.

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

8 shall increase the number of clinical teams existing on the

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

10 Of such number—

11 (1) not less than 15 such units shall be estab12 lished by December 31, 1994;

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

14 be established by December 31, 1995;

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

16 be established by December 31, 1996; and

17 (4) not less than a total of 50 such units shall

18 be established by December 31, 1997.

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

20 post-traumatic stress disorder clinical teams pursuant to

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

22 medical centers that do not have a specialized inpatient

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

24 have an affiliated Vet Center.
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1 SEC. 12. DEFINITIONS.

2 For the purposes of this Act—

3 (1) The term ‘‘Special Committee on Post4 Traumatic Stress Disorder’’ means the Special Com5 mittee on Post-Traumatic Stress Disorder estab6 lished by the Under Secretary for Health pursuant

7 to section 110 of the veterans Health Care Act of

8 1984 (38 U.S.C. 1712A note).

9 (2) The term ‘‘Advisory Committee on Veteran

10 Readjustment Counseling’’ means the Advisory Com11 mittee on Veteran Readjustment Counseling estab12 lished under section 1712C of title 38, United States

13 Code (as added by section 6(a)).

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