I 

109TH CONGRESS 

1ST SESSION H. R. 1588 

To improve programs for the identification and treatment of post-deployment 

mental health conditions, including post-traumatic stress disorder, in 

veterans and members of the Armed Forces, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 13, 2005 

Mr. EVANS (for himself, Mr. FILNER, Mr. GUTIERREZ, Ms. CORRINE BROWN

of Florida, Mr. MICHAUD, Ms. HERSETH, Mr. STRICKLAND, Ms. BERKLEY, Mr. UDALL of New Mexico, Mrs. DAVIS of California, Mr. BISHOP

of Georgia, Mr. DEFAZIO, Mr. LYNCH, Ms. DELAURO, Mr. GRIJALVA, 

Mr. VAN HOLLEN, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. 

MCDERMOTT, Mr. SCHIFF, Mr. ABERCROMBIE, Mr. CASE, Mr. MCGOVERN, Mr. PETERSON of Minnesota, Mrs. JONES of Ohio, Ms. BORDALLO, 

Mr. ORTIZ, Mr. GEORGE MILLER of California, Mr. ANDREWS, Mr. 

BAIRD, Mr. KENNEDY of Rhode Island, Mr. LANGEVIN, Mr. KUCINICH, 

Mr. EMANUEL, and Mr. TAYLOR of Mississippi) introduced the following 

bill; which was referred to the Committee on Veterans’ Affairs, and in 

addition to the Committee on Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To improve programs for the identification and treatment 

of post-deployment mental health conditions, including 

post-traumatic stress disorder, in veterans and members 

of the Armed Forces, and for other purposes. 

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

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Comprehensive Assistance for Veterans Exposed to 

4 Traumatic Stressors Act of 2005’’. 

5 (b) TABLE OF CONTENTS.—The table of contents for 

6 this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Definition. 

TITLE I—VETERANS OF PAST DEPLOYMENTS 

Sec. 101. Six-year extension of eligibility for readjustment counseling services 

for Vietnam-era veterans. 

TITLE II—MILITARY ISSUES 

Sec. 201. Department of Veterans Affairs-Department of Defense Health Care 

Sharing Incentive Fund. 

Sec. 202. Collection of data from pre- and post-deployment health assessments. 

Sec. 203. Preventative maintenance post-deployment intervention. 

TITLE III—PREVENTION, EARLY DETECTION, AND TREATMENT 

FOR RETURNING TROOPS 

Sec. 301. Study to identify factors that decrease the likelihood of the development of chronic PTSD despite combat exposure. 

Sec. 302. Extension of period of enhanced eligibility for VA health services for 

veterans who served in combat theaters of operations. 

Sec. 303. Demonstration project to station Department of Veterans Affairs psychologists and psychiatrists at major demobilization sites and 

military treatment facilities. 

Sec. 304. Model programs for post-deployment mental health practice. 

Sec. 305. Performance measures for Department of Veterans Affairs health 

care administrators. 

TITLE IV—DEPARTMENT OF DEFENSE/DEPARTMENT OF VETERANS AFFAIRS COUNCIL ON POST-DEPLOYMENT MENTAL 

HEALTH 

Sec. 401. Establishment of Council. 

Sec. 402. Duties of Council. 

TITLE V—CAPACITY BUILDING IN DEPARTMENT OF VETERANS 

AFFAIRS 

Sec. 501. Plan for expansion of Department of Veterans Affairs system to expand access to specialized PTSD care. 

Sec. 502. Additional Department of Veterans Affairs resources. 

TITLE VI—FAMILY THERAPY 
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Sec. 601. Eligibility for family counseling and bereavement counseling. 

TITLE VII—EDUCATIONAL INITIATIVES 

Sec. 701. Training program for health-care providers. 

Sec. 702. Curriculum and protocols for cross-training of Department of Veterans Affairs clinicians. 

Sec. 703. Publication of state-of-the-art post-deployment mental health problems diagnosis and treatment. 

Sec. 704. Protocols for pain management for PTSD and war-related pain. 

Sec. 705. Protocols for treatment of substance use disorders. 

Sec. 706. Protocols for diagnosis of post-traumatic stress disorder. 

TITLE VIII—NATIONAL STEERING COMMITTEE ON PTSD 

EDUCATION 

Sec. 801. National steering committee. 

Sec. 802. Funding support for National Center for PTSD. 

Sec. 803. Continuing education to mental health providers. 

Sec. 804. Web-based curriculum to sponsor clinician training initiatives. 

TITLE IX—BENEFITS 

Sec. 901. Identification of deficiencies in PTSD disability examinations. 

Sec. 902. Criteria for determining medical conditions associated with PTSD. 

TITLE X—PUBLIC AWARENESS 

Sec. 1001. Public awareness program. 

Sec. 1002. Web site and materials for general campaign of awareness of PTSD. 

1 SEC. 2. DEFINITION. 

2 In this Act, the term ‘‘PTSD’’ means post-traumatic 

3 stress disorder. 

4 TITLE I—VETERANS OF PAST 

5 DEPLOYMENTS 

6 SEC. 101. SIX-YEAR EXTENSION OF ELIGIBILITY FOR READ7 JUSTMENT COUNSELING SERVICES FOR 

8 VIETNAM-ERA VETERANS. 

9 Section 1712A(a)(1)(B)(ii) of title 38, United States 

10 Code, is amended by striking ‘‘January 1, 2004’’ and in11 serting ‘‘January 1, 2010’’. 
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1 TITLE II—MILITARY ISSUES 

2 SEC. 201. DEPARTMENT OF VETERANS AFFAIRS-DEPART3 MENT OF DEFENSE HEALTH CARE SHARING 

4 INCENTIVE FUND. 

5 (a) IN GENERAL.—The Secretary of Veterans Affairs 

6 and the Secretary of Defense shall jointly take such steps 

7 as necessary to implement the proposal of the Center for 

8 the Study of Traumatic Stress at the Uniformed Services 

9 University of the Health Sciences for a Department of 

10 Veterans Affairs-Department of Defense Health Care 

11 Sharing Incentive Fund. 

12 (b) TELECOMMUNICATIONS SUPPORT.—As part of 

13 the implementation of the proposal referred to in sub14 section (a), the two Secretaries shall provide for a system 

15 of telecommunications to support the following: 

16 (1) Continuing education and support for front17 line (forward-deployed) providers of health-care serv18 ices. 

19 (2) Enhanced treatment capacity for addressing 

20 acute episodes of PTSD and other mental health 

21 disorders in combat theaters, including— 

22 (A) real-time access to clinical specialty 

23 support; 
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1 (B) web-based information on state-of-the2 art protocols for the treatment and diagnosis of 

3 PTSD and other mental health disorders; and 

4 (C) educational programs concerning 

5 PTSD and other mental health disorders com6 monly associated with deployment. 

7 SEC. 202. COLLECTION OF DATA FROM PRE- AND POST-DE8 PLOYMENT HEALTH ASSESSMENTS. 

9 (a) DATA COLLECTION.—The Secretary of Defense 

10 shall take appropriate steps to assist the Secretary of Vet11 erans Affairs with the collection of data from pre- and 

12 post-deployment health assessments of members of the 

13 Armed Forces that may be relevant for identification and 

14 treatment by the Secretary of Veterans Affairs of PTSD 

15 and other post-deployment mental health issues. The Sec16 retary of Defense may provide such information in aggre17 gate, unidentified format and may provide such informa18 tion on a monthly basis or on such other schedule as the 

19 two Secretaries may agree to. 

20 (b) CONSENT FORMS.—The Secretary of Defense 

21 shall develop forms for use in obtaining the written con22 sent of members of the Armed Forces to allow the Depart23 ment of Veterans Affairs to collect data contained on pre24 deployment and post-deployment health assessment forms 

25 with relevant treatment information concerning PTSD 
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1 and other mental health problems that may be associated 

2 with combat stress or readjustment to civilian life from 

3 those members of the Armed Forces to be discharged or 

4 demobilized within 90 days. Such consent forms shall be 

5 developed and made available for use by members of the 

6 Armed Forces covered by the preceding sentence not later 

7 than 60 days after the date of the enactment of this Act. 

8 (c) IDENTIFICATION OF SUBSTANCE USE DIS9 ORDERS.—The Secretary of Defense shall include in pre10 deployment and post-deployment health assessments ques11 tions to assist in identification of existing or potential sub12 stance use disorders among members of the Armed 

13 Forces. 

14 SEC. 203. PREVENTATIVE MAINTENANCE POST-DEPLOY15 MENT INTERVENTION. 

16 (a) IN GENERAL.—The Secretary of Veterans Affairs 

17 shall conduct routine preventative maintenance interven18 tion for all members of the Armed Forces returning from 

19 deployment in a combat theater. Such intervention shall 

20 be conducted between 90 and 180 days after such mem21 bers return from such deployment. 

22 (b) PERSONNEL.—For purposes of such intervention, 

23 the Secretary of Veterans Affairs may use— 

24 (1) staff of the Department of Veterans Affairs, 

25 including readjustment counseling staff; and 
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1 (2) persons trained by the Department of Vet2 erans Affairs, including volunteers from military 

3 unit associations, veteran service organizations, or 

4 other nonprofit organizations. 

5 (c) SIZE.—Such intervention shall be conducted with 

6 no more than six returning servicemembers at a time. 

7 (d) PURPOSE.—The purpose of such intervention 

8 shall be the following: 

9 (1) To identify and distinguish symptoms of 

10 ‘‘common’’ acute stress reactions from those of 

11 chronic and severe post-traumatic stress disorder. 

12 (2) To discuss concerns of combat personnel 

13 and those expressed by their family members. 

14 (3) To refer returning servicemembers to ap15 propriate services, as necessary. 

16 (4) To disseminate educational materials about 

17 post-deployment mental health issues, including 

18 PTSD to servicemembers. 

19 (5) To provide follow-up educational materials 

20 by mail to family members. 

21 (6) To provide information concerning home22 lessness, including risk factors, awareness assess23 ment, and contact information for preventative as24 sistance associated with homelessness. 
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1 (e) VA PARTICIPATION IN ADDITIONAL DEMOBILIZA2 TION ACTIVITIES.—The Secretary of Defense shall provide 

3 for the Secretary of Veterans Affairs to participate in ad4 ditional demobilization activities, including the Transi5 tional Assistance Program, that are conducted within the 

6 Department of Defense for the purposes specified in sub7 section (d). 

8 TITLE III—PREVENTION, EARLY 

9 DETECTION, AND TREAT10 MENT FOR RETURNING 

11 TROOPS 

12 SEC. 301. STUDY TO IDENTIFY FACTORS THAT DECREASE 

13 THE LIKELIHOOD OF THE DEVELOPMENT OF 

14 CHRONIC PTSD DESPITE COMBAT EXPOSURE. 

15 (a) STUDY.—The Secretary of Veterans Affairs shall 

16 provide for a study, to be conducted by an entity other 

17 than the Department of Veterans Affairs and the Depart18 ment of Defense, to identify factors that decrease the like19 lihood of the development of chronic post-traumatic stress 

20 disorder (PTSD) in servicemembers and veterans who 

21 have had combat exposure, including exposure to guerilla 

22 warfare. 

23 (b) REPORT.—The Secretary shall provide for the en24 tity conducting the study under subsection (a) to submit 

25 a report on the results of the study to the Secretary and 
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1 the Congress not later than one year after the date of the 

2 enactment of this Act. 

3 SEC. 302. EXTENSION OF PERIOD OF ENHANCED ELIGI4 BILITY FOR VA HEALTH SERVICES FOR VET5 ERANS WHO SERVED IN COMBAT THEATERS 

6 OF OPERATIONS. 

7 Section 1710(e)(3)(C) of title 38, United States 

8 Code, is amended by striking ‘‘2 years’’ and inserting ‘‘five 

9 years’’. 

10 SEC. 303. DEMONSTRATION PROJECT TO STATION DEPART11 MENT OF VETERANS AFFAIRS PSYCHOLO12 GISTS AND PSYCHIATRISTS AT MAJOR DEMO13 BILIZATION SITES AND MILITARY TREAT14 MENT FACILITIES. 

15 (a) DEMONSTRATION PROJECT.—The Secretary of 

16 Defense and the Secretary of Veterans Affairs shall jointly 

17 provide for the conduct of a demonstration project under 

18 which Department of Veterans Affairs psychologists and 

19 psychiatrists are stationed at major demobilization sites 

20 and military treatment facilities. 

21 (b) PURPOSE.—The purposes of the demonstration 

22 project shall be as follows: 

23 (1) Identify, on an aggregate level, need for 

24 mental health services among active-duty, Reserve, 

25 and National Guard members. 
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1 (2) Provide such services or refer members for 

2 necessary services. 

3 (3) Advise servicemembers of the need for con4 tinuous services. 

5 (4) Identify the obstacles servicemembers have 

6 in seeking appropriate mental health care. 

7 (c) FUNDING.—There is authorized to be appro8 priated such sums as may be necessary for each of fiscal 

9 years 2006, 2007, and 2008 for the conduct of the dem10 onstration project. Amounts for the conduct of the project 

11 shall be provided equally by the Secretary of Veterans Af12 fairs and the Secretary of Defense. 

13 (d) ELIGIBILITY CRITERIA.—Based on the results of 

14 the demonstration project, the Secretaries shall identify 

15 appropriate eligibility criteria for programs to best re16 spond to the needs of veterans, servicemembers, and their 

17 families for post-deployment mental health services. The 

18 criteria identified shall be included in the report under 

19 subsection (e). 

20 (e) REPORT.—The Secretary of Veterans Affairs 

21 shall submit to the Committees on Veterans’ Affairs of 

22 the Senate and House of Representatives a report pro23 viding the results of the demonstration project. The report 

24 shall be submitted not later than 18 months after the date 

25 of the enactment of this Act. 
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1 SEC. 304. MODEL PROGRAMS FOR POST-DEPLOYMENT MEN2 TAL HEALTH PRACTICE. 

3 (a) MODEL PROGRAMS.—The Secretary of Veterans 

4 Affairs, in consultation with the Secretary of Defense, 

5 shall develop model programs to respond to a variety of 

6 mental health disorders prevalent among veterans of serv7 ice in Operation Iraqi Freedom and Operation Enduring 

8 Freedom. The program shall be implemented at three sites 

9 selected by the Secretary, of which— 

10 (1) at least one site shall assign case managers 

11 to veterans receiving care under such program; and 

12 (2) at least one site shall use an integrated 

13 mental health and primary care model for post-de14 ployment mental health practice. 

15 (b) PURPOSE.—The purpose of the model program 

16 shall be as follows: 

17 (1) Development of training protocols for in18 volved clinicians. 

19 (2) Identification of medical conditions which 

20 may be associated with post-deployment mental 

21 health problems including PTSD. 

22 (3) Identification of ‘‘best practices’’ for treat23 ment of post-deployment mental health problems in24 cluding PTSD. 

25 (4) Dissemination of results to the Veterans 

26 Health Administration and the Veterans Benefits 
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1 Administration of the Department of Veterans Af2 fairs. 

3 (c) AUTHORIZATION.—There is authorized to be ap4 propriated for the purposes of subsection (a) the amount 

5 of $5,000,000 for each of fiscal years 2006, 2007, and 

6 2008. 

7 SEC. 305. PERFORMANCE MEASURES FOR DEPARTMENT OF 

8 VETERANS AFFAIRS HEALTH CARE ADMINIS9 TRATORS. 

10 (a) PERFORMANCE MEASURES.—The Secretary of 

11 Defense and the Secretary of Veterans Affairs, acting 

12 through the Department of Defense/Department of Vet13 erans Affairs Council on Post-Deployment Mental Health 

14 established under section 401, shall develop performance 

15 measures for Department of Veterans Affairs regional 

16 health-care directors (referred to as VISN directors) and 

17 Department of Defense TRICARE regional managers to 

18 ensure the appropriate deployment of resources to imple19 ment the treatment protocols referred to as ‘‘Iraq War 

20 Clinical Practice Guidelines’’. 

21 (b) USE OF PERFORMANCE MEASURES.—The per22 formance measures under subsection (a) shall be designed 

23 to assess— 
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1 (1) access and availability of PTSD treatment 

2 for servicemembers returned from deployment in a 

3 combat theater; and 

4 (2) implementation of protocols referred to in 

5 subsection (a). 

6 TITLE IV—DEPARTMENT OF DE7 FENSE/DEPARTMENT OF VET8 ERANS AFFAIRS COUNCIL ON 

9 POST-DEPLOYMENT MENTAL 

10 HEALTH 

11 SEC. 401. ESTABLISHMENT OF COUNCIL. 

12 The Secretary of Defense and the Secretary of Vet13 erans Affairs shall jointly establish a council to be known 

14 as the Department of Defense/Department of Veterans Af15 fairs Council on Post-Deployment Mental Health. The 

16 council shall be composed of leadership of the two depart17 ments in the areas of mental health, PTSD, substance 

18 abuse, and military sexual trauma. The council shall be 

19 established not later than 120 days after the date of the 

20 enactment of this Act. 

21 SEC. 402. DUTIES OF COUNCIL. 

22 (a) DUTIES.—The Department of Defense/Depart23 ment of Veterans Affairs Council on Post-Deployment 

24 Mental Health shall have the following duties: 
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1 (1) Review of the continuum of care between 

2 the Department of Defense and the Department of 

3 Veterans Affairs for mental health, PTSD, sub4 stance abuse, and military sexual trauma. 

5 (2) Identification of gaps in the treatment capa6 bility of the health-care systems of the Department 

7 of Defense and Department of Veterans Affairs for 

8 mental health, PTSD, substance abuse, and military 

9 sexual trauma and expected gaps in such continuum, 

10 with emphasis on access to services in rural areas, 

11 to meet the expected demand from current users and 

12 servicemembers returning from Operation Iraqi 

13 Freedom and Operation Enduring Freedom and 

14 other deployments. 

15 (3) Promotion, within both systems, of an edu16 cational program to implement the jointly developed 

17 Iraq War Clinical Practice Guidelines. 

18 (4) Development of outcome monitors and qual19 ity improvement instruments to ensure that internal 

20 policy regarding PTSD is implemented (including 

21 TRICARE and VISN directors’ performance meas22 ures under section 307). 

23 (5) Recommendation of policies to reduce the 

24 stigma associated with the seeking of mental health 
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1 care by active-duty, Reserve, and National Guard 

2 members. 

3 (6) Identification of the highest post-deploy4 ment mental health research priorities for the two 

5 departments. 

6 (7) Communications to inform active-duty 

7 servicemembers and veterans of matters relating to 

8 PTSD. 

9 (b) ANNUAL MEETING WITH STAKEHOLDERS.—The 

10 Council shall meet at least annually with stakeholder 

11 groups comprised of veterans, veterans service organiza12 tions, and family members of veterans receiving care from 

13 the Department of Veterans Affairs mental health pro14 grams, and mental health associations. 

15 (c) REPORT.—The Council shall prepare a report 

16 based on the reviews under paragraphs (1) and (2) of sub17 section (a) to identify the necessary resources to create 

18 or enhance PTSD treatment capabilities. The report shall 

19 be made available to the Secretary of both Departments 

20 for comment. The Secretaries shall indicate recommenda21 tions in which they concur or disagree and include specific 

22 plans for implementation of any recommendations accept23 ed. The report, with the comments and recommendations 

24 of the two Secretaries shall be submitted to the Commit25 tees on Veterans’ Affairs and the Committees on Armed 
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1 Services of the Senate and House of Representatives not 

2 later than one year after the date of the enactment of this 

3 Act. The report shall include priority listing of sites which 

4 require investments according to the greatest perceived 

5 need for PTSD services. 

6 TITLE V—CAPACITY BUILDING 

7 IN DEPARTMENT OF VET8 ERANS AFFAIRS 

9 SEC. 501. PLAN FOR EXPANSION OF DEPARTMENT OF VET10 ERANS AFFAIRS SYSTEM TO EXPAND ACCESS 

11 TO SPECIALIZED PTSD CARE. 

12 (a) DEVELOPMENT OF PLAN.—Based upon the re13 port under section 402(b), the Secretary of Veterans Af14 fairs shall develop a plan for the Department of Veterans 

15 Affairs to expand access to specialized PTSD care 

16 through— 

17 (1) Readjustment Counseling Service centers 

18 operated under section 1712A of title 38, United 

19 States Code; 

20 (2) community-based outpatient clinics; and 

21 (3) telemedicine. 

22 (b) INSPECTOR GENERAL INVESTIGATION.—The In23 spector General of the Department of Veterans Affairs 

24 shall investigate specialized programs of the Department 
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1 of Veterans Affairs for the treatment of post-traumatic 

2 stress disorder in order to determine— 

3 (1) the current workloads of those programs; 

4 (2) staff associated with each of those pro5 grams; 

6 (3) funds obligated for those programs; and 

7 (4) any waiting times associated with those pro8 grams. 

9 (c) REPORT.—The Inspector General shall submit to 

10 the Committees on Veterans’ Affairs of the Senate and 

11 House of Representatives a report containing the Inspec12 tor General’s findings under subsection (b), together with 

13 an assessment of the ability of the Department of Vet14 erans Affairs to address such findings, along with rec15 ommendations for accommodating— 

16 (1) the current workload of the Department in 

17 specialized treatment program; 

18 (2) 102 percent of the current workload of the 

19 Department; and 

20 (3) 110 percent of the current workload of the 

21 Department. 
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1 SEC. 502. ADDITIONAL DEPARTMENT OF VETERANS AF2 FAIRS RESOURCES. 

3 In order to improve access to mental health services, 

4 the Secretary of Veterans Affairs shall provide the fol5 lowing: 

6 (1) 100 additional full-time equivalent employ7 ees to Readjustment Counseling Service outstations. 

8 (2) A PTSD clinical team at every medical cen9 ter of the Veterans Health Administration. 

10 (3) A family therapist at each Vet Center under 

11 section 1712A of title 38, United States Code. 

12 (4) A PTSD coordinator in each regional net13 work referred to as a Veterans Integrated Service 

14 Network (VISN ) whose duties shall include— 

15 (A) development of plans for meeting 

16 PTSD and other post-deployment mental health 

17 treatment needs consistent with the report 

18 under section 402(b); 

19 (B) assurance of implementation of clinical 

20 practice guidelines throughout the VISN; 

21 (C) liaison among all health-care sites in 

22 the VISN and the Department Central Office 

23 on matters relating to PTSD. 

24 (5) A PTSD coordinator in each regional office 

25 of the Readjustment Counseling Service whose du26 ties shall include liaison with regional office staff 
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1 and medical centers for veterans seeking service-con2 nection for PTSD. 

3 TITLE VI—FAMILY THERAPY 

4 SEC. 601. ELIGIBILITY FOR FAMILY COUNSELING AND BE5 REAVEMENT COUNSELING. 

6 (a) COUNSELING FOR FAMILY MEMBERS OF VET7 ERANS BEING TREATED FOR SERVICE-CONNECTED DIS8 ABILITIES.—Section 1782(a) of title 38, United States 

9 Code, is amended by adding at the end the following new 

10 sentence: ‘‘In addition, the Secretary shall provide to an 

11 individual described in subsection (c) such professional 

12 counseling and mental health services as are necessary as 

13 a consequence of a disability of a veteran described in the 

14 preceding sentence. Counseling and mental health services 

15 under the preceding sentence shall be provided (if so re16 quested by the individual) for a period of two years from 

17 the date on which the individual first receives such coun18 seling or mental health services under the preceding sen19 tence.’’. 

20 (b) BEREAVEMENT COUNSELING.—Section 1783 of 

21 such title is amended— 

22 (1) by striking ‘‘may provide’’ in subsections (a) 

23 and (b) and inserting ‘‘shall, upon request, provide’’; 

24 and 
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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(d) DURATION OF COUNSELING.—Counseling under 

4 subsection (a) or with respect to the death of a veteran 

5 or under subsection (b) with respect to the death of a 

6 member who dies in the active military, naval, or air serv7 ice shall be provided to an individual eligible for such 

8 counseling (if so requested by that individual) for a period 

9 of two years from the date on which the individual first 

10 receives counseling under this section with respect to that 

11 death.’’. 

12 TITLE VII—EDUCATIONAL 

13 INITIATIVES 

14 SEC. 701. TRAINING PROGRAM FOR HEALTH-CARE PRO15 VIDERS. 

16 The Secretary of Veterans Affairs and the Secretary 

17 of Defense shall jointly develop a broad training program 

18 for all health-care providers in the Department of Vet19 erans Affairs and the Department of Defense to famil20 iarize those providers with mental health-care issues that 

21 are likely to arise among persons deployed to combat thea22 ters during the five years after such a deployment. 
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1 SEC. 702. CURRICULUM AND PROTOCOLS FOR CROSS2 TRAINING OF DEPARTMENT OF VETERANS 

3 AFFAIRS CLINICIANS. 

4 The Secretary of Veterans Affairs shall develop a cur5 riculum and required protocols for cross-training to allow 

6 the following clinicians of the Department of Veterans Af7 fairs to screen for post-deployment mental health prob8 lems, including PTSD, and, as appropriate, provide infor9 mation and appropriate referral to— 

10 (1) primary care providers; 

11 (2) practitioners assigned as Gulf War points12 of-contact; and 

13 (3) clinicians assigned as case managers. 

14 SEC. 703. PUBLICATION OF STATE-OF-THE-ART POST-DE15 PLOYMENT MENTAL HEALTH PROBLEMS DI16 AGNOSIS AND TREATMENT. 

17 The Secretary of Veterans Affairs and the Secretary 

18 of Defense shall jointly develop a plan for the production 

19 and dissemination of publications to advise clinicians on 

20 state-of-the-art diagnosis and treatment of PTSD and 

21 other mental health disorders experienced after deploy22 ment, including any medical conditions associated with 

23 such disorders. 
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1 SEC. 704. PROTOCOLS FOR PAIN MANAGEMENT FOR PTSD 

2 AND WAR-RELATED PAIN. 

3 The Secretary of Veterans Affairs and the Secretary 

4 of Defense shall jointly develop protocols for pain manage5 ment for PTSD and war-related pain. 

6 SEC. 705. PROTOCOLS FOR TREATMENT OF SUBSTANCE 

7 USE DISORDERS. 

8 The Secretary of Defense shall develop appropriate 

9 substance use disorder treatment protocols for assistance 

10 in combat areas of operations and on return to the United 

11 States. 

12 SEC. 706. PROTOCOLS FOR DIAGNOSIS OF POST-TRAU13 MATIC STRESS DISORDER. 

14 (a) FINDINGS.—The Congress finds as follows: 

15 (1) The symptoms of post-traumatic stress dis16 order are often similar to those of traumatic brain 

17 injury and some neurological disorders. 

18 (2) Some veterans with PTSD have co19 morbidities that may mask or compound the symp20 toms associated with PTSD. 

21 (3) Correct diagnosis of PTSD and other dis22 orders is critical to effective treatment of those dis23 orders. 

24 (b) CLINICAL PRACTICE GUIDELINES.—The Sec25 retary of Veterans Affairs shall develop clinical practice 

26 guidelines to ensure that clinicians are able to effectively 
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1 distinguish between diagnoses with similar symptoms that 

2 may manifest as post-traumatic stress disorder. 

3 TITLE VIII—NATIONAL STEER4 ING COMMITTEE ON PTSD 

5 EDUCATION 

6 SEC. 801. NATIONAL STEERING COMMITTEE. 

7 (a) ESTABLISHMENT.—There is a National Steering 

8 Committee on PTSD Education, to be appointed by the 

9 joint council established under section 401. The committee 

10 shall be comprised of mental health and other health pro11 fessionals and health educators involved in the care of vet12 erans of a deployment to a theater of combat on or after 

13 the date of the enactment of this Act. 

14 (b) PURPOSE.—The committee shall review training 

15 protocols for health-care providers and plans for dissemi16 nation of educational materials to veterans, their families, 

17 and other relevant parties and shall identify the resources 

18 available to provide for those purposes. 

19 (c) MEETINGS.—The committee shall meet at least 

20 once annually. 

21 SEC. 802. FUNDING SUPPORT FOR NATIONAL CENTER FOR 

22 PTSD. 

23 There is authorized to be appropriated to the Sec24 retary of Veterans Affairs for the National Center for 

25 PTSD to assist in carrying out a joint educational initia-
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1 tive with the Uniformed Services University of the Health 

2 Sciences the amount of $5,000,000 for each of fiscal years 

3 2005 through 2014. 

4 SEC. 803. CONTINUING EDUCATION TO MENTAL HEALTH 

5 PROVIDERS. 

6 The National Steering Committee established under 

7 section 801 shall provide continuing education to mental 

8 health providers in the Department of Veterans Affairs 

9 and the Department of Defense. 

10 SEC. 804. WEB-BASED CURRICULUM TO SPONSOR CLINI11 CIAN TRAINING INITIATIVES. 

12 The National Steering Committee established under 

13 section 801 shall develop a Web-based curriculum to spon14 sor clinician training initiatives. 

15 TITLE IX—BENEFITS 

16 SEC. 901. IDENTIFICATION OF DEFICIENCIES IN PTSD DIS17 ABILITY EXAMINATIONS. 

18 (a) EVALUATION OF ADJUDICATION OF CLAIMS.— 

19 The Secretary of Veterans Affairs, in consultation with the 

20 National Center for PTSD, shall obtain an evaluation of 

21 the quality and consistency of adjudication of claims for 

22 PTSD, including the adequacy of service-connected com23 pensation examinations for rating purposes and the extent 

24 to which veterans who are service-connected for PTSD are 

25 actually employed and employable. 
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1 (b) REPORT.—Not later than 12 months after the 

2 date of the enactment of this Act, the Secretary shall sub3 mit to the Committees on Veterans Affairs of the Senate 

4 and House of Representatives a report that includes the 

5 following information and recommendations: 

6 (1) The types of evidence sufficient to confirm 

7 combat experience for veterans filing claims for 

8 PTSD based on combat. 

9 (2) The policies and procedures used to obtain 

10 confirmation of a stressor, including documentation 

11 of service in combat for claims based on PTSD. 

12 (3) Based on a representative national sample, 

13 the number and percentage of veterans for each pe14 riod of war whose claims for PTSD have been de15 nied based upon the lack of a credible stressor. 

16 (4) Based on a representative national sample, 

17 the number and percentage of veterans for each pe18 riod of war whose claims for PTSD have been de19 nied based upon the lack of a diagnosis of PTSD. 

20 (5) Based on a representative national sample, 

21 the number and percentage of veterans for each pe22 riod of war whose claims for PTSD have been grant23 ed and the rating which was initially awarded for 

24 that claim. 
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1 (6) The number of initial and subsequent 

2 claims and average time to process claims for PTSD 

3 which have been granted (including the rating as4 signed and any determination as to employability) 

5 and denied for each regional office for a consecutive 

6 six month period. 

7 (7) The number and percentage of initial claims 

8 for PTSD selected from a representative national 

9 sample during a consecutive six month period which 

10 had a compensation and pension examination con11 ducted in compliance with best practices for PTSD 

12 examinations. 

13 (8) The number and percentage of examina14 tions selected from a representative national sample 

15 during a consecutive six month period in which the 

16 compensation and pension examinations for PTSD 

17 were judged to be inadequate. 

18 (9) The number and percentage of claims for 

19 PTSD selected from a representative national sam20 ple during that consecutive six month period for 

21 which the examination was returned as inadequate. 

22 (10) The maximum, minimum and average time 

23 based upon a representative national sample allo24 cated for completion of an initial compensation and 

25 pension examination for PTSD. 
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1 (11) An assessment comparing the employment 

2 of veterans rated for psychiatric impairments with 

3 similar ratings based upon physical impairments in4 cluding, the number of veterans in each sample who 

5 are employed on a full time or part time basis, the 

6 average time such veterans have been unemployed 

7 and a comparison of the amount of work lost from 

8 employment due to disability and the average earn9 ings of veterans in each group. 

10 (12) Taking into account criteria such as the 

11 information in the Dictionary of Occupational Titles 

12 (DOT), including its companion publication, the Se13 lected Characteristics of Occupations Defined in the 

14 Revised Dictionary of Occupational Titles (SCO), 

15 published by the Department of Labor, examples of 

16 the types of employment that an average veteran 

17 rated at 30 percent, at 50 percent, and at 70 per18 cent disabled for PTSD can be expected to obtain 

19 and retain. 

20 (13) The number of claims for PTSD appealed 

21 to the Board of Veterans Appeals during fiscal year 

22 2005, including the specific issue appealed (service23 connection, effective date, rating) and the results of 

24 such appeals (affirmed, denied, remanded, other dis25 position). 
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1 (14) Recommendations for improving the accu2 racy and consistency of PTSD examinations, claim 

3 development and decisions. 

4 (15) Barriers to successful employment for vet5 erans who have been service-connected for PTSD. 

6 (16) Recommendations for removing barriers to 

7 employment for veterans who have been service-con8 nected for PTSD. 

9 (17) Recommendations for legislative changes 

10 which could improve the potential for vocational re11 habilitation and employment of persons service-con12 nected for PTSD. 

13 SEC. 902. CRITERIA FOR DETERMINING MEDICAL CONDI14 TIONS ASSOCIATED WITH PTSD. 

15 The Secretary of Veterans Affairs shall develop— 

16 (1) criteria for determining those medical condi17 tions that are as likely as not to be associated with 

18 PTSD; and 

19 (2) standards for determining when secondary 

20 service-connection should be granted for those condi21 tions. 

22 TITLE X—PUBLIC AWARENESS 

23 SEC. 1001. PUBLIC AWARENESS PROGRAM. 

24 The Secretary of Veterans Affairs shall conduct an 

25 aggressive, comprehensive outreach program to enhance 
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1 the awareness of veterans, and the public in general, of 

2 the symptoms of PTSD and of the services available for 

3 veterans with those symptoms. The Secretary of Defense 

4 shall provide the Secretary of Veterans Affairs with such 

5 assistance as may be required for the purposes of such 

6 program. To the extent practicable, the program shall be 

7 conducted through the joint council established under sec8 tion 401. 

9 SEC. 1002. WEB SITE AND MATERIALS FOR GENERAL CAM10 PAIGN OF AWARENESS OF PTSD. 

11 As part of the program under this title, the Secretary 

12 of Veterans Affairs shall develop and continually update 

13 a Web site and materials, including pamphlets, news re14 leases, fact sheets, and other materials, for the purposes 

15 of a general campaign of awareness of post-traumatic 

16 stress disorder. 

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