I 

111TH CONGRESS 

2D SESSION H. R. 6211 

To direct the Secretary of Veterans Affairs to establish a pilot program 

to evaluate the effectiveness of treating veterans with spinal, back, and 

musculoskeletal injuries and pain using non-invasive techniques. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 23, 2010 

Ms. MARKEY of Colorado introduced the following bill; which was referred to 

the Committee on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to establish a 

pilot program to evaluate the effectiveness of treating 

veterans with spinal, back, and musculoskeletal injuries 

and pain using non-invasive techniques. 

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 Back and 

5 Spinal Therapy Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) One in five members of the Armed Forces 

2 who were wounded and evacuated from Afghanistan 

3 during the summer and early fall of 2009 suffered 

4 a spinal injury, and at least 14 of such members 

5 were left paralyzed or with loss of sensation. 

6 (2) In Afghanistan, members of the Armed 

7 Forces routinely carry up to 33 percent more than 

8 the suggested maximum weight and up to nearly 75 

9 percent of a member’s own body weight—routinely 

10 hefting combat gear that can exceed 120 pounds, 

11 causing large numbers of spinal, back, and musculo12 skeletal injuries and pain. 

13 (3) The use of massive improvised explosive de14 vices by insurgents against heavily armed mine re15 sistant ambush protected vehicles has significantly 

16 increased the number of spinal, back, and musculo17 skeletal injuries and pain. 

18 (4) Advances in both body armor protection and 

19 medical treatment have drastically decreased the 

20 number of deaths among deployed members of the 

21 Armed Forces, but there has been an increase in the 

22 number of members with spinal, back, and musculo23 skeletal injuries and long-term pain. 

24 (5) Members of the Armed Forces returning 

25 from Iraq are more likely to suffer lingering, debiliVerDate Mar 15 2010 06:56 Sep 25, 2010 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6211.IH H6211

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1 tating injuries from back and musculoskeletal pain 

2 than from battle wounds, according to statistics 

3 compiled by the Secretary of Veterans Affairs. 

4 (6) Diagnoses of ruptured spinal discs, com5 pressed discs, degenerative disc disease, and 

6 myofascial pain syndrome are common in members 

7 of the Armed Forces returning from Afghanistan 

8 and Iraq. 

9 (7) Spinal and back injuries are the most ex10 pensive musculoskeletal disorder to treat. 

11 (8) Certain facilities of the Department of Vet12 erans Affairs offer outstanding non-invasive tech13 nologies for treating spinal, back, and musculo14 skeletal injuries as well as any accompanying mental 

15 health issues. 

16 (9) Traditional medical approaches to spinal, 

17 back, and musculoskeletal injuries typically involve a 

18 combination of long-term medication, surgery, and 

19 short-term physical therapy. 

20 (10) Using non-invasive techniques to treat vet21 erans with spinal, back, and musculoskeletal injuries 

22 can improve the health outcomes for such veterans 

23 and drastically reduce the long-term costs of care for 

24 such veterans by breaking the cycle of expensive sur25 gery followed by long-term pain medication that 


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1 often leads to addiction, depression, anxiety, and 

2 weight gain. 

3 (11) Non-invasive techniques that are not wide4 ly available in medical facilities of the Department 

5 of Veterans Affairs, including manual physical ther6 apy, core strengthening and stabilization therapy, 

7 water exercise therapy, group exercise therapy, and 

8 pain management therapy, should be evaluated in an 

9 evidence-based medicine framework to assess their 

10 effectiveness. 

11 SEC. 3. PILOT PROGRAM TO PROVIDE VETERANS WITH 

12 NON-INVASIVE TECHNIQUES FOR SPINAL, 

13 BACK, AND MUSCULOSKELETAL INJURIES. 

14 (a) ESTABLISHMENT.—The Secretary of Veterans 

15 Affairs shall establish a pilot program to— 

16 (1) provide covered veterans with non-invasive 

17 techniques to treat spinal, back, and musculoskeletal 

18 injuries and pain; and 

19 (2) use an evidence-based medicine framework 

20 to assess the effectiveness of such non-invasive tech21 niques. 

22 (b) SCOPE.— 

23 (1) SIZE.—The pilot program shall include a 

24 representative sample of covered veterans that is of 

25 sufficient size for the Secretary to determine— 


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1 (A) the effectiveness and feasibility of pro2 viding veterans with non-invasive techniques to 

3 treat spinal, back, and musculoskeletal injuries 

4 and pain; and 

5 (B) the unique considerations that exist 

6 with respect to providing such treatment— 

7 (i) to female veterans; 

8 (ii) to veterans of various ages; and 

9 (iii) to veterans located in various re10 gions of the United States, including both 

11 urban and rural locations. 

12 (2) PREFERENCE.—In selecting covered vet13 erans to participate in the pilot program, the Sec14 retary shall give preference to covered veterans who 

15 served in Operation Enduring Freedom, Operation 

16 Iraqi Freedom, or Operation New Dawn. 

17 (c) ADMINISTRATION.—In administering the pilot 

18 program, the Secretary shall— 

19 (1) determine the type of non-invasive tech20 nique to provide to a covered veteran; 

21 (2) determine the effect of allowing self-referral 

22 by a veteran to receive non-invasive techniques com23 pared with requiring a veteran to receive a referral 

24 from a physician for non-invasive techniques; and 


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1 (3) ensure the use of telehealth technology to 

2 provide covered veterans who reside in rural loca3 tions (as determined by the Secretary) with non4 invasive techniques to treat spinal, back, and mus5 culoskeletal injuries and pain. 

6 (d) PARTNERSHIP.— 

7 (1) UNIVERSITY.—In administering the pilot 

8 program, the Secretary shall seek to enter into an 

9 agreement with a university affiliated with the De10 partment of Veterans Affairs to carry out the pilot 

11 program. 

12 (2) SELECTION.—In entering into an agree13 ment with a university under paragraph (1), the 

14 Secretary shall ensure that the individuals who treat 

15 covered veterans with non-invasive techniques for 

16 spinal, back, and musculoskeletal injuries and 

17 pain— 

18 (A) are trained to— 

19 (i) effectively treat such veterans; and 

20 (ii) recognize the unique experiences 

21 of such veterans, including experiences re22 lated to serving in Operation Enduring 

23 Freedom, Operation Iraqi Freedom, or Op24 eration New Dawn; and 


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1 (B) use best practices and technologies 

2 with respect to the non-invasive technique being 

3 used to treat such veterans. 

4 (e) DURATION.—The pilot program shall begin not 

5 later than March 1, 2011, and shall continue for two 

6 years. 

7 (f) REPORTS.— 

8 (1) INITIAL REPORT.—Not later than June 1, 

9 2012, the Secretary shall submit to the Committee 

10 on Veterans’ Affairs of the House of Representatives 

11 and the Committee on Veterans’ Affairs of the Sen12 ate a report on the pilot program, including— 

13 (A) an analysis of the effectiveness and 

14 cost-effectiveness of each non-invasive technique 

15 provided under the pilot program; 

16 (B) an analysis of how the Secretary would 

17 incorporate non-invasive techniques to treat spi18 nal, back, and musculoskeletal injuries and pain 

19 at medical facilities of the Department of Vet20 erans Affairs; 

21 (C) the amount of cost-savings, if any, cre22 ated by providing veterans with non-invasive 

23 techniques to treat spinal, back, and musculo24 skeletal injuries and pain; 


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1 (D) a comparison of the non-invasive tech2 niques provided under the pilot program with 

3 other methods used by the Secretary to treat 

4 spinal, back, and musculoskeletal injuries and 

5 pain; and 

6 (E) recommendations of the Secretary with 

7 respect to— 

8 (i) continuing or expanding the pilot 

9 program; and 

10 (ii) any legislation or other actions to 

11 improve treating veterans with spinal, 

12 back, and musculoskeletal injuries and 

13 pain. 

14 (2) FINAL REPORT.—Not later than June 1, 

15 2013, the Secretary shall submit to the Committee 

16 on Veterans’ Affairs of the House of Representatives 

17 and the Committee on Veterans’ Affairs of the Sen18 ate a report containing updated information to the 

19 report submitted under paragraph (1). 

20 (g) DEFINITIONS.—In this section: 

21 (1) The term ‘‘covered veteran’’ means a vet22 eran who— 

23 (A) has a service-connected spinal, back, or 

24 musculoskeletal injury; or 


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1 (B) is eligible for hospital care, medical 

2 services, and nursing home care by virtue of 

3 section 1710(e)(1)(D) of title 38, United States 

4 Code. 

5 (2) The term ‘‘non-invasive techniques’’ means 

6 methods of treatment for spinal, back, and musculo7 skeletal injuries and pain other than surgery, includ8 ing— 

9 (A) manual physical therapy, core 

10 strengthening and stabilization therapy, water 

11 exercise therapy, group exercise therapy, and 

12 pain management therapy; 

13 (B) such methods (including recreational 

14 therapy) used by the War Related Illness and 

15 Injury Study Center of the Department of Vet16 erans Affairs located in Palo Alto, California, 

17 and the mindfulness based stress reduction pro18 gram of the Puget Sound Health Care System 

19 of the Department of Veterans Affairs that the 

20 Secretary determines to have been successful; 

21 and 

22 (C) such other methods not widely avail23 able in medical facilities of the Department of 

24 Veterans Affairs. 

Æ 


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