II 

110TH CONGRESS 

1ST SESSION S. 1044 

To improve the medical care of members of the Armed Forces and veterans, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 29, 2007 

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

to the Committee on Armed Services 

A BILL 

To improve the medical care of members of the Armed 

Forces and veterans, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Effective Care for the 

5 Armed Forces and Veterans Act of 2007’’. 

6 SEC. 2. PROHIBITION ON COMPETITIVE SOURCING OF CER7 TAIN ACTIVITIES AT MEDICAL FACILITIES OF 

8 THE DEPARTMENT OF DEFENSE. 

9 (a) FINDINGS.—Congress finds the following: 


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1 (1) The health and recovery of wounded mem2 bers of the Armed Forces may be risked by competi3 tive sourcing of services at military medical facilities. 

4 (2) The provision of medical services to mem5 bers and former members of the Armed Forces who 

6 were injured while serving in Operation Iraqi Free7 dom or Operation Enduring Freedom is a basic serv8 ice that is the responsibility of the Government and 

9 any disruption is unacceptable when it risks the 

10 health of veterans and members of the Armed 

11 Forces. 

12 (3) The Department of Defense has attempted 

13 to implement competitive sourcing of services at 

14 military medical facilities despite the fact that doing 

15 so provides no improvement in the efficiency or ef16 fectiveness of such services. 

17 (b) PROHIBITION ON INITIATION OF COMPETITIVE

18 SOURCING ACTIVITIES AT MEDICAL FACILITIES OF DE19 PARTMENT OF DEFENSE DURING PERIOD OF MAJOR

20 MILITARY CONFLICT.— 

21 (1) IN GENERAL.—Except as provided in para22 graph (2), during a period in which the Armed 

23 Forces are involved in a major military conflict, the 

24 Secretary of Defense shall not take any action under 

25 the Office of Management and Budget Circular A– 


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1 76 or any other similar administrative regulation, di2 rective, or policy— 

3 (A) to subject work performed by an em4 ployee of a medical facility of the Department 

5 of Defense or employee of a private contractor 

6 of such a medical facility to public-private com7 petition; or 

8 (B) to convert such employee or the work 

9 performed by such employee to private con10 tractor performance. 

11 (2) EXCEPTION TO PREVENT NEGATIVE IMPACT

12 ON PROVISION OF SERVICES.—Paragraph (1) shall 

13 not apply to any action at a medical facility of the 

14 Department of Defense if the Secretary of Defense 

15 certifies to Congress that not initiating such action 

16 during such period would have a negative impact on 

17 the provision of services at such military medical fa18 cility. 

19 (c) STUDY ON COMPETITIVE SOURCING ACTIVITIES

20 AT MEDICAL FACILITIES OF DEPARTMENT OF DE21 FENSE.—The Comptroller General of the United States 

22 shall assess the efficiency and advisability of subjecting 

23 work performed by an employee of a medical facility of 

24 the Department of Defense or a private contractor of such 

25 a medical facility to public-private competition, or conVerDate Aug 31 2005 23:18 Apr 09, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1044.IS S1044

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1 verting such employee or the work performed by such em2 ployee to private contractor performance, under the Office 

3 of Management and Budget Circular A–76 or any other 

4 similar administrative regulation, directive, or policy. 

5 SEC. 3. MINIMUM BUDGET FOR MEDICAL SERVICES OF THE 

6 ARMED FORCES DURING PERIOD OF MAJOR 

7 MILITARY CONFLICT. 

8 (a) FINDINGS.—Congress finds the following: 

9 (1) Pressure to reduce the budget for the med10 ical services of the Department of Defense has con11 tributed to many of the current problems at Walter 

12 Reed Army Medical Center. 

13 (2) It is inappropriate to reduce the budget for 

14 medical services of the Department of Defense or 

15 the Department of Veterans Affairs while such serv16 ices are needed to treat members of the Armed 

17 Forces or veterans who were wounded in Iraq and 

18 Afghanistan. 

19 (b) MINIMUM BUDGET FOR MEDICAL SERVICES.— 

20 (1) IN GENERAL.—Except as provided in para21 graph (2), if the Armed Forces are involved in a 

22 major military conflict at the time the President 

23 submits the budget for a fiscal year to Congress, the 

24 President shall not include in that budget a total ag25 gregate amount allocated for medical services for the 


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1 Department of Defense and the Department of Vet2 erans Affairs that is less than the total aggregate 

3 amount allocated for such purposes in the budget 

4 submitted by the President to Congress for the pre5 vious fiscal year. 

6 (2) EXCEPTION.—Paragraph (1) shall not 

7 apply if the President— 

8 (A) certifies to Congress that submitting a 

9 total aggregate amount allocated for medical 

10 services for the Department of Defense and the 

11 Department of Veterans Affairs that is less 

12 than that required under paragraph (1) is in 

13 the national interest; and 

14 (B) submits to Congress a report on the 

15 reasons for the reduction described by subpara16 graph (A). 

17 SEC. 4. LIMITATION ON IMPLEMENTATION OF REC18 OMMENDATION TO CLOSE WALTER REED 

19 ARMY MEDICAL CENTER. 

20 (a) FINDINGS.—Congress finds the following: 

21 (1) The final recommendations of the Defense 

22 Base Closure and Realignment Commission under 

23 the 2005 round of defense base closure and realign24 ment include recommendations to close Walter Reed 

25 Army Medical Center and to build new, modern faVerDate Aug 31 2005 23:18 Apr 09, 2007 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1044.IS S1044

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1 cilities at the National Naval Medical Center at Be2 thesda and at Fort Belvoir to improve the overall 

3 quality of and access to health care for members of 

4 the Armed Forces. 

5 (2) These recommendations include the transfer 

6 of medical services from the Walter Reed Army 

7 Medical Center to the National Naval Medical Cen8 ter at Bethesda and at Fort Belvoir, but they do not 

9 adequately provide for housing for the families of 

10 wounded members of the Armed Forces who will re11 ceive treatment at such new facilities. 

12 (3) The recommended closure of the Walter 

13 Reed Army Medical Center has impaired the ability 

14 of the Secretary of Defense to attract the personnel 

15 required to provide proper medical services at such 

16 medical center. 

17 (b) LIMITATION ON IMPLEMENTATION OF REC18 OMMENDATIONS.—The Secretary of Defense shall not 

19 take any action to implement the recommendations of the 

20 Defense Base Closure and Realignment Commission under 

21 the 2005 round of defense base closure and realignment 

22 relating to the transfer of medical services from Walter 

23 Reed Army Medical Center to the National Naval Medical 

24 Center at Bethesda and at Fort Belvoir during the period 

25 beginning on the date of the enactment of this Act and 


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1 ending on the date that is 60 days after the date on which 

2 Congress receives the plan required under subsection (c). 

3 (c) PLAN REQUIRED.—Not later than one year after 

4 the date of the enactment of this Act, the Secretary of 

5 Defense shall submit to Congress a plan that includes an 

6 assessment of the following: 

7 (1) The feasibility and advisability of providing 

8 current or prospective employees at Walter Reed 

9 Army Medical Center a guarantee that their employ10 ment will continue in the Washington, DC, metro11 politan area for more than two years after the date 

12 on which Walter Reed Army Medical Center is 

13 closed. 

14 (2) Detailed construction plans for new medical 

15 facilities and family housing at the National Naval 

16 Medical Center at Bethesda and at Fort Belvoir to 

17 accommodate the transfer of medical services from 

18 Walter Reed Army Medical Center to the National 

19 Naval Medical Center at Bethesda and at Fort 

20 Belvoir. 

21 (3) The costs, feasibility, and advisability of 

22 completing all of the construction planned for the 

23 transfer of medical services from Walter Reed Army 

24 Medical Center to the National Naval Medical Cen25 ter at Bethesda and at Fort Belvoir before any paVerDate Aug 31 2005 23:18 Apr 09, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1044.IS S1044

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1 tients are transferred to such new facilities from 

2 Walter Reed Army Medical Center as a result of the 

3 recommendations of the Defense Base Closure and 

4 Realignment Commission under the 2005 round of 

5 defense base closure and realignment. 

6 SEC. 5. IMPROVING CASE MANAGEMENT SERVICES FOR 

7 MEMBERS OF THE ARMED FORCES. 

8 (a) FINDINGS.—Congress makes the following find9 ings: 

10 (1) Case managers are important for scheduling 

11 appointments and making sure recovering 

12 servicemembers get the care they need. 

13 (2) Many case managers are overwhelmed by 

14 the large number of wounded members of the Armed 

15 Forces returning from deployment in Iraq and Af16 ghanistan. 

17 (3) Regular contact between health care pro18 viders and members of the Armed Forces returning 

19 from deployment is important for the diagnosis of 

20 post traumatic stress disorder in such members. 

21 (4) It is inappropriate to require a wounded 

22 member of the Armed Forces or a family member of 

23 such member to provide a photo or a medal from de24 ployment in Iraq or Afghanistan to prove that such 


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1 member served in and was injured from such deploy2 ment. 

3 (5) Case managers are well qualified to assist 

4 recovering servicemembers and their families with 

5 the disability evaluation system and discharge proce6 dures of the Department of Defense. 

7 (b) CASE MANAGERS.— 

8 (1) IN GENERAL.—The Secretary of Defense 

9 shall assign at least one case manager for every 20 

10 recovering servicemembers to assist in the recovery 

11 of such recovering servicemember. 

12 (2) MINIMUM CONTACT.—The Secretary of De13 fense shall ensure that case managers contact each 

14 of their assigned recovering servicemembers not less 

15 than once per week. 

16 (3) TRAINING.—The Secretary of Defense shall 

17 ensure that case managers of the Department of De18 fense are familiar with the disability and discharge 

19 system of the Department of Defense and that such 

20 case managers are able to assist recovering 

21 servicemembers complete necessary and related 

22 forms. 

23 (c) RECOVERING SERVICEMEMBER.—In this section, 

24 the term ‘‘recovering servicemember’’ means a member of 

25 the Armed Forces, including a member of the National 


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1 Guard or a Reserve, who is undergoing medical treatment, 

2 recuperation, or therapy, or is otherwise in medical hold 

3 or holdover status, for an injury, illness, or disease in4 curred or aggravated while on active duty in the Armed 

5 Forces. 

6 SEC. 6. SCREENING FOR TRAUMATIC BRAIN INJURY. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) Many of the members of the Armed Forces 

9 deployed in Iraq and Afghanistan have brain inju10 ries. 

11 (2) In many cases, such injuries are not diag12 nosed because there is no external indication of such 

13 injury. 

14 (3) The Secretary of Veterans Affairs carries 

15 out programs to screen all recent combat veterans 

16 for traumatic brain injury; the Secretary of Defense 

17 does not do so. 

18 (b) SCREENING REQUIRED.—The Secretary of De19 fense shall screen every member of the Armed Forces re20 turning from deployment in Operation Iraqi Freedom or 

21 Operation Enduring Freedom for traumatic brain injury 

22 upon the return of each such member. 

23 (c) STUDIES ON TREATING TRAUMATIC BRAIN IN24 JURY AS PRESUMPTIVE CONDITION FOR DISABILITY COM25 PENSATION.— 


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1 (1) STUDY BY SECRETARY OF DEFENSE.— 

2 (A) IN GENERAL.—The Secretary of De3 fense shall conduct a study on the feasability 

4 and advisability of treating traumatic brain in5 jury as a presumptive condition for members of 

6 the Armed Forces who served in Operation 

7 Iraqi Freedom or Operation Enduring Freedom 

8 for the qualification for disability compensation 

9 under laws administered by the Secretary of 

10 Defense. 

11 (B) REPORT.—Not later than 180 days 

12 after the date of the enactment of this Act, the 

13 Secretary of Defense shall submit to Congress 

14 a report on the results of the study required by 

15 subparagraph (A). 

16 (2) STUDY BY SECRETARY OF VETERANS AF17 FAIRS.— 

18 (A) IN GENERAL.—The Secretary of Vet19 erans Affairs shall conduct a study on the 

20 feasability and advisability of treating traumatic 

21 brain injury as a presumptive condition for vet22 erans who served as members of the Armed 

23 Forces in Operation Iraqi Freedom or Oper24 ation Enduring Freedom for the qualification 


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1 for disability compensation under laws adminis2 tered by the Secretary of Veterans Affairs. 

3 (B) REPORT.—Not later than 180 days 

4 after the date of the enactment of this Act, the 

5 Secretary of Veterans Affairs shall submit to 

6 Congress a report on the results of the study 

7 required by subparagraph (A). 

8 (3) STUDY BY DIRECTOR OF NATIONAL INSTI9 TUTES OF HEALTH.— 

10 (A) IN GENERAL.—The Director of the 

11 National Institutes of Health shall conduct a 

12 study on traumatic brain injury, including the 

13 detection of traumatic brain injury and the 

14 measurement and classification of the severity 

15 of traumatic brain injury. 

16 (B) REPORT.—Not later than 180 days 

17 after the date of the enactment of this Act, the 

18 Director of the National Institutes of Health 

19 shall submit to Congress a report on the results 

20 of the study required by subparagraph (A). 


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1 SEC. 7. REQUIRING MEDICAL RECORDS MANAGEMENT SYS2 TEMS OF DEPARTMENT OF DEFENSE TO COM3 MUNICATE WITH MEDICAL RECORDS MAN4 AGEMENT SYSTEMS OF DEPARTMENT OF 

5 VETERANS AFFAIRS. 

6 (a) FINDINGS.—Congress makes the following find7 ings: 

8 (1) The electronic transfer of medical records of 

9 members of the Armed Forces from the medical 

10 records management systems of the Department of 

11 Defense to the medical records management systems 

12 of the Department of Veterans Affairs would be pru13 dent. 

14 (2) The Department of Veterans Affairs has 

15 been a leader in the implementation of electronic 

16 medical records management systems. 

17 (b) ELECTRONIC COMMUNICATION BETWEEN MED18 ICAL RECORDS MANAGEMENT SYSTEMS REQUIRED.— 

19 (1) IN GENERAL.—Not later than two years 

20 after the date of the enactment of this Act, the Sec21 retary of Defense shall ensure that the medical 

22 records management systems of the Department of 

23 Defense are capable of transmitting medical records 

24 to and receiving medical records from the medical 

25 records management systems of the Department of 

26 Veterans Affairs electronically. 


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1 (2) INITIATION OF ACTIVITIES.—Not later than 

2 one year after the date of the enactment of this Act, 

3 the Secretary of Defense shall begin any activities 

4 required to meet the requirements of paragraph (1). 

5 SEC. 8. DEPARTMENT OF VETERANS AFFAIRS ASSESSMENT 

6 OF LONG-TERM CARE NEEDS OF VETERANS. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) Multiple studies show that, in the next five 

10 years, the Department of Veterans Affairs will add 

11 hundreds of thousands of new veterans to the med12 ical records management systems of the Department 

13 of Veterans Affairs. 

14 (2) During such period, many veterans will 

15 have multiple medical care needs caused by complex 

16 medical conditions. 

17 (b) ASSESSMENT OF LONG-TERM CARE NEEDS.— 

18 The Secretary of Veterans Affairs shall assess the current 

19 ability of the Department of Veterans Affairs to meet 

20 long-term care needs of veterans during the 50-year period 

21 that begins on the date of the enactment of this Act. 

22 (c) DETERMINATION OF ACTIONS REQUIRED TO

23 MEET LONG-TERM CARE NEEDS.—The Secretary of Vet24 erans Affairs shall determine what actions are required 


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1 to ensure that the needs described in subsection (b) are 

2 satisfied. 

3 (d) REPORT REQUIRED.—Not later than one year 

4 after the date of the enactment of this Act, the Secretary 

5 of Veterans Affairs shall submit to Congress a report on 

6 the assessment required in subsection (b) and the deter7 mination required in subsection (c). 

Æ 


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