II 

110TH CONGRESS 

1ST SESSION S. 1233 

To provide and enhance intervention, rehabilitative treatment, and services 

to veterans with traumatic brain injury, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 26, 2007 

Mr. AKAKA (for himself and Mr. CRAIG) introduced the following bill; which 

was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To provide and enhance intervention, rehabilitative treatment, and services to veterans with traumatic brain injury, 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; TABLE OF CONTENTS. 

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

5 ‘‘Veterans Traumatic Brain Injury Rehabilitation Act of 

6 2007’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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Sec. 2. Sense of Congress on Department of Veterans Affairs efforts in the rehabilitation and reintegration of veterans with traumatic brain 

injury. 

Sec. 3. Individual rehabilitation and community reintegration plans for veterans 

and others with traumatic brain injury. 

Sec. 4. Use of non-Department of Veterans Affairs facilities for implementation 

of rehabilitation and community reintegration plans for traumatic brain injury. 

Sec. 5. Research, education, and clinical care program on severe traumatic 

brain injury. 

Sec. 6. Pilot program on assisted living services for veterans with traumatic 

brain injury. 

Sec. 7. Age-appropriate nursing home care. 

Sec. 8. Research on traumatic brain injury. 

1 SEC. 2. SENSE OF CONGRESS ON DEPARTMENT OF VET2 ERANS AFFAIRS EFFORTS IN THE REHABILI3 TATION AND REINTEGRATION OF VETERANS 

4 WITH TRAUMATIC BRAIN INJURY. 

5 It is the sense of Congress that— 

6 (1) the Department of Veterans Affairs should 

7 have the capacity and expertise to provide veterans 

8 who have a traumatic brain injury with patient-cen9 tered health care, rehabilitation, and community in10 tegration services that are comparable to or exceed 

11 similar care and services available to persons with 

12 such injuries in the academic and private sector; 

13 (2) rehabilitation for veterans who have a trau14 matic brain injury should be individualized, com15 prehensive, and multidisciplinary with the goals of 

16 optimizing the independence of such veterans and 

17 reintegrating them into their communities; 

18 (3) family support is integral to the rehabilita19 tion and community reintegration of veterans who 


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1 have sustained a traumatic brain injury, and the De2 partment should provide the families of such vet3 erans with education and support; 

4 (4) the Department of Defense and Department 

5 of Veterans Affairs have made efforts to provide a 

6 smooth transition of medical care and rehabilitative 

7 services to individuals as they transition from the 

8 health care system of the Department of Defense to 

9 that of the Department of Veterans Affairs, but 

10 more can be done to assist veterans and their fami11 lies in the continuum of the rehabilitation, recovery, 

12 and reintegration of wounded or injured veterans 

13 into their communities; and 

14 (5) in planning for rehabilitation and commu15 nity reintegration of veterans who have a traumatic 

16 brain injury, it is necessary for the Department of 

17 Veterans Affairs to provide a system for life-long 

18 case management for such veterans. 

19 SEC. 3. INDIVIDUAL REHABILITATION AND COMMUNITY RE20 INTEGRATION PLANS FOR VETERANS AND 

21 OTHERS WITH TRAUMATIC BRAIN INJURY. 

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

23 title 38, United States Code, is amended by inserting after 

24 section 1710B the following new section: 


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1 ‘‘§ 1710C. Traumatic brain injury: plans for rehabili2 tation and reintegration into the commu3 nity 

4 ‘‘(a) PLAN REQUIRED.—The Secretary shall, for each 

5 veteran or member of the Armed Forces who receives inpa6 tient rehabilitation care from the Department for a trau7 matic brain injury— 

8 ‘‘(1) develop an individualized plan for the re9 habilitation and reintegration of such individual into 

10 the community; and 

11 ‘‘(2) provide such plan to such individual before 

12 such individual is discharged from inpatient care. 

13 ‘‘(b) CONTENTS OF PLAN.—Each plan developed 

14 under subsection (a) shall include, for the individual cov15 ered by such plan, the following: 

16 ‘‘(1) Rehabilitation objectives for improving the 

17 physical, cognitive, vocational, and psychosocial 

18 functioning of such individual with the goal of maxi19 mizing the independence and reintegration of such 

20 individual into the community. 

21 ‘‘(2) A description of specific interventions, re22 habilitative treatments, and other services to achieve 

23 the objectives described in paragraph (2), which de24 scription shall set forth the type, frequency, dura25 tion, and location of such interventions, treatments, 

26 and services. 


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1 ‘‘(3) The name of the case manager designated 

2 in accordance with subsection (d) to be responsible 

3 for the implementation of such plan. 

4 ‘‘(4) Dates on which the effectiveness of the 

5 plan will be reviewed in accordance with subsection 

6 (f). 

7 ‘‘(c) COMPREHENSIVE ASSESSMENT.— 

8 ‘‘(1) IN GENERAL.—Each plan developed under 

9 subsection (a) shall be based upon a comprehensive 

10 assessment, developed in accordance with paragraph 

11 (2), of— 

12 ‘‘(A) the physical, cognitive, vocational, 

13 and psychosocial impairments of such indi14 vidual; and 

15 ‘‘(B) the family education and family sup16 port needs of such individual after discharge 

17 from inpatient care. 

18 ‘‘(2) FORMATION.—The comprehensive assess19 ment required under paragraph (1) with respect to 

20 an individual is a comprehensive assessment of the 

21 matters set forth in that paragraph by a team, com22 posed by the Secretary for purposes of the assess23 ment, from among individuals with expertise in trau24 matic brain injury as follows: 

25 ‘‘(A) A neurologist. 


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1 ‘‘(B) A rehabilitation physician. 

2 ‘‘(C) A social worker. 

3 ‘‘(D) A neuropsychologist or 

4 neuropsychiatrist. 

5 ‘‘(E) A physical therapist. 

6 ‘‘(F) A vocational rehabilitation specialist. 

7 ‘‘(G) An occupational therapist. 

8 ‘‘(H) A rehabilitation nurse. 

9 ‘‘(I) Such other health care professionals 

10 as the Secretary considers appropriate, includ11 ing— 

12 ‘‘(i) an audiologist; 

13 ‘‘(ii) a blind rehabilitation specialist; 

14 ‘‘(iii) a recreational therapist; 

15 ‘‘(iv) a speech language pathologist; 

16 and 

17 ‘‘(v) a low vision optometrist. 

18 ‘‘(d) CASE MANAGER.—The Secretary shall designate 

19 a case manager for each individual described in subsection 

20 (a) to be responsible for the implementation of the plan 

21 required by such subsection for such individual. 

22 ‘‘(e) PARTICIPATION AND COLLABORATION IN DE23 VELOPMENT OF PLANS.—(1) The Secretary shall involve 

24 each individual described in subsection (a), and the family 

25 of such individual, in the development of the plan for such 


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1 individual under that subsection to the maximum extent 

2 practicable. 

3 ‘‘(2) The Secretary shall collaborate in the develop4 ment of a plan for an individual under subsection (a) with 

5 an individual with expertise in the protection of, and advo6 cacy for, individuals with traumatic brain injury if— 

7 ‘‘(A) the individual covered by such plan re8 quests such collaboration; or 

9 ‘‘(B) if such individual is incapacitated, the 

10 family or guardian of such individual requests such 

11 collaboration. 

12 ‘‘(3) In the case of a plan required by subsection (a) 

13 for a member of the Armed Forces who is on active duty, 

14 the Secretary shall collaborate with the Secretary of De15 fense in the development of such plan. 

16 ‘‘(4) In developing vocational rehabilitation objectives 

17 required under subsection (b)(2) and in conducting the as18 sessment required under subsection (c), the Secretary 

19 shall act through the Under Secretary for Health in co20 ordination with the Vocational Rehabilitation and Employ21 ment Service of the Department of Veterans Affairs. 

22 ‘‘(f) EVALUATION.— 

23 ‘‘(1) PERIODIC REVIEW BY SECRETARY.—The 

24 Secretary shall periodically review the effectiveness 

25 of each plan developed under subsection (a). The 


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1 Secretary shall refine each such plan as the Sec2 retary considers appropriate in light of such review. 

3 ‘‘(2) REQUEST FOR REVIEW BY VETERANS.—In 

4 addition to the periodic review required by para5 graph (1), the Secretary shall conduct a review of 

6 the plan of a veteran under paragraph (1) at the re7 quest of such veteran, or in the case that such vet8 eran is incapacitated, at the request of the guardian 

9 or the designee of such veteran.’’. 

10 (b) CLERICAL AMENDMENT.—The table of sections 

11 at the beginning of chapter 17 of such title is amended 

12 by inserting after the item relating to section 1710B the 

13 following new item: 

‘‘1710C. Traumatic brain injury: plans for rehabilitation and reintegration into 

the community.’’. 

14 SEC. 4. USE OF NON-DEPARTMENT OF VETERANS AFFAIRS 

15 FACILITIES FOR IMPLEMENTATION OF REHA16 BILITATION AND COMMUNITY REINTEGRA17 TION PLANS FOR TRAUMATIC BRAIN INJURY. 

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

19 title 38, United States Code, is amended by inserting after 

20 section 1710C, as added by section 3 of this Act, the fol21 lowing new section: 


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1 ‘‘§ 1710D. Traumatic brain injury: use of non-Depart2 ment facilities for rehabilitation 

3 ‘‘(a) IN GENERAL.—Subject to section 1710(a)(4) of 

4 this title and subsection (b) of this section, the Secretary 

5 shall provide intervention, rehabilitative treatment, or 

6 services to implement a plan developed under section 

7 1710C of this title at a non-Department facility with 

8 which the Secretary has entered into an agreement for 

9 such purpose, to an individual— 

10 ‘‘(1) who is described in subsection (a) of such 

11 section; and 

12 ‘‘(2)(A) to whom the Secretary is unable to pro13 vide such intervention, treatment, or services at the 

14 frequency or for the duration prescribed in such 

15 plan; or 

16 ‘‘(B) who resides at such distance, as deter17 mined by the Secretary, from a Department medical 

18 facility as to make the implementation of such plan 

19 through a Department facility infeasible or impracti20 cable. 

21 ‘‘(b) STANDARDS.—The Secretary may not provide 

22 intervention, treatment, or services as described in sub23 section (a) at a non-Department facility under such sub24 section unless such facility maintains standards for the 

25 provision of such intervention, treatment, or services es26 tablished by an independent, peer-reviewed organization 


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1 that accredits specialized rehabilitation programs for 

2 adults with traumatic brain injury.’’. 

3 (b) CLERICAL AMENDMENT.—The table of sections 

4 at the beginning of chapter 17 of such title is amended 

5 by inserting after the item relating to section 1710C, as 

6 added by section 3 of this Act, the following new item: 

‘‘1710D. Traumatic brain injury: use of non-Department facilities for rehabilitation.’’. 

7 SEC. 5. RESEARCH, EDUCATION, AND CLINICAL CARE PRO8 GRAM ON SEVERE TRAUMATIC BRAIN IN9 JURY. 

10 (a) PROGRAM REQUIRED.—Subchapter II of chapter 

11 73 of title 38, United States Code, is amended by inserting 

12 after section 7330 the following new section: 

13 ‘‘§ 7330A. Severe traumatic brain injury research, 

14 education, and clinical care program 

15 ‘‘(a) PROGRAM REQUIRED.—The Secretary shall es16 tablish a program on research, education, and clinical care 

17 to provide intensive neuro-rehabilitation to veterans with 

18 a severe traumatic brain injury, including veterans in a 

19 minimally conscious state who would otherwise receive 

20 nursing home care. 

21 ‘‘(b) COLLABORATION REQUIRED.—The Secretary 

22 shall establish the program required by subsection (a) in 

23 collaboration with the Defense and Veterans Brain Injury 

24 Center of the Department of Defense and academic instiVerDate Aug 31 2005 21:40 Apr 27, 2007 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1233.IS S1233

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1 tutions selected by the Secretary from among institutions 

2 having an expertise in research in neuro-rehabilitation. 

3 ‘‘(c) EDUCATION REQUIRED.—As part of the pro4 gram required by subsection (a), the Secretary shall con5 duct educational programs on recognizing and diagnosing 

6 mild and moderate cases of traumatic brain injury. 

7 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

8 is authorized to be appropriated to the Secretary for each 

9 of fiscal years 2008 through 2012, $3,000,000 to carry 

10 out the program required by subsection (a).’’. 

11 (b) CLERICAL AMENDMENT.—The table of sections 

12 at the beginning of chapter 73 of such title is amended 

13 by inserting after the item relating to section 7330 the 

14 following new item: 

‘‘7330A. Severe traumatic brain injury research, education, and clinical care 

program.’’. 

15 (c) REPORT.—Not later than 120 days after the date 

16 of the enactment of this Act, the Secretary of Veterans 

17 Affairs shall submit to Congress a report on the research 

18 to be conducted under the program required by section 

19 7330A of title 38, United States Code, as added by sub20 section (a). 


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1 SEC. 6. PILOT PROGRAM ON ASSISTED LIVING SERVICES 

2 FOR VETERANS WITH TRAUMATIC BRAIN IN3 JURY. 

4 (a) PILOT PROGRAM.—Not later than 90 days after 

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

6 Veterans Affairs shall carry out a pilot program to assess 

7 the effectiveness of providing assisted living services to eli8 gible veterans to enhance the rehabilitation, quality of life, 

9 and community integration of such veterans. 

10 (b) DURATION OF PROGRAM.—The pilot program 

11 shall be carried out during the five-year period beginning 

12 on the date of the commencement of the pilot program. 

13 (c) PROGRAM LOCATIONS.— 

14 (1) IN GENERAL.—The pilot program shall be 

15 carried out at locations selected by the Secretary for 

16 purposes of the pilot program. Of the locations so 

17 selected— 

18 (A) at least one shall be in each health 

19 care region of the Veterans Health Administra20 tion that contains a polytrauma center of the 

21 Department of Veterans Affairs; and 

22 (B) any other locations shall be in areas 

23 that contain high concentrations of veterans 

24 with traumatic brain injury, as determined by 

25 the Secretary. 


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1 (2) SPECIAL CONSIDERATION FOR VETERANS IN

2 RURAL AREAS.—Special consideration shall be given 

3 to provide veterans in rural areas with an oppor4 tunity to participate in the pilot program. 

5 (d) PROVISION OF ASSISTED LIVING SERVICES.— 

6 (1) AGREEMENTS.—In carrying out the pilot 

7 program, the Secretary may enter into agreements 

8 for the provision of assisted living services on behalf 

9 of eligible veterans with either of the following: 

10 (A) A provider of services that has entered 

11 into a provider agreement under section 

12 1866(a) of the Social Security Act (42 U.S.C. 

13 1395cc(a)). 

14 (B) A provider participating under a State 

15 plan under title XIX of such Act (42 U.S.C. 

16 1396 et seq.). 

17 (2) STANDARDS.—The Secretary may not place, 

18 transfer, or admit a veteran to any facility for as19 sisted living services under this program unless the 

20 Secretary determines that the facility meets such 

21 standards as the Secretary may prescribe for pur22 poses of the pilot program. Such standards shall, to 

23 the extent practicable, be consistent with the stand24 ards of Federal, State, and local agencies charged 


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1 with the responsibility of licensing or otherwise regu2 lating or inspecting such facilities. 

3 (e) CONTINUATION OF CASE MANAGEMENT AND RE4 HABILITATION SERVICES.—In carrying the pilot program 

5 under subsection (a), the Secretary shall continue to pro6 vide each veteran who is receiving assisted living services 

7 under the pilot program with rehabilitative services and 

8 shall designate Department health-care employees to fur9 nish case management services for veterans participating 

10 in the pilot program. 

11 (f) REPORT.— 

12 (1) IN GENERAL.—Not later than 60 days after 

13 the completion of the pilot program, the Secretary 

14 shall submit to the congressional veterans affairs 

15 committees a report on the pilot program. 

16 (2) CONTENTS.—The report required by para17 graph (1) shall include the following: 

18 (A) A description of the pilot program. 

19 (B) An assessment of the utility of the ac20 tivities under the pilot program in enhancing 

21 the rehabilitation, quality of life, and commu22 nity reintegration of veterans with traumatic 

23 brain injury. 


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1 (C) Such recommendations as the Sec2 retary considers appropriate regarding the ex3 tension or expansion of the pilot program. 

4 (g) DEFINITIONS.—In this section: 

5 (1) The term ‘‘assisted living services’’ means 

6 services of a facility in providing room, board, and 

7 personal care for and supervision of residents for 

8 their health, safety, and welfare. 

9 (2) The term ‘‘case management services’’ in10 cludes the coordination and facilitation of all services 

11 furnished to a veteran by the Department of Vet12 erans Affairs, either directly or through contract, in13 cluding assessment of needs, planning, referral (in14 cluding referral for services to be furnished by the 

15 Department, either directly or through a contract, or 

16 by an entity other than the Department), moni17 toring, reassessment, and followup. 

18 (3) The term ‘‘congressional veterans affairs 

19 committees’’ means— 

20 (A) the Committee on Veterans’ Affairs of 

21 the Senate; and 

22 (B) the Committee on Veterans’ Affairs of 

23 the House of Representatives. 

24 (4) The term ‘‘eligible veteran’’ means a vet25 eran who— 


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1 (A) is enrolled in the Department of Vet2 erans Affairs health care system; 

3 (B) has received treatment for traumatic 

4 brain injury from the Department of Veterans 

5 Affairs; 

6 (C) is unable to manage routine activities 

7 of daily living without supervision and assist8 ance; and 

9 (D) could reasonably be expected to receive 

10 ongoing services after the end of the pilot pro11 gram under this section under another govern12 ment program or through other means. 

13 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to the Secretary of Veterans 

15 Affairs to carry out this section, $8,000,000 for each of 

16 fiscal years 2008 through 2013. 

17 SEC. 7. AGE-APPROPRIATE NURSING HOME CARE. 

18 (a) FINDING.—Congress finds that young veterans 

19 who are injured or disabled through military service and 

20 require long-term care should have access to age-appro21 priate nursing home care. 

22 (b) REQUIREMENT TO PROVIDE AGE-APPROPRIATE

23 NURSING HOME CARE.—Section 1710A of title 38, 

24 United States Code, is amended— 


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1 (1) by redesignating subsection (c) as sub2 section (d); and 

3 (2) by inserting after subsection (b) the fol4 lowing new subsection (c): 

5 ‘‘(c) The Secretary shall ensure that nursing home 

6 care provided under subsection (a) is provided in an age7 appropriate manner.’’. 

8 SEC. 8. RESEARCH ON TRAUMATIC BRAIN INJURY. 

9 (a) INCLUSION OF RESEARCH ON TRAUMATIC BRAIN

10 INJURY UNDER ONGOING RESEARCH PROGRAMS.—The 

11 Secretary of Veterans Affairs shall, in carrying out re12 search programs and activities under the provisions of law 

13 referred to in subsection (b), ensure that such programs 

14 and activities include research on the sequelae of trau15 matic brain injury, including— 

16 (1) research on visually-related neurological 

17 conditions; 

18 (2) research on seizure disorders; and 

19 (3) research on means of improving the diag20 nosis, treatment, and prevention of such sequelae. 

21 (b) RESEARCH AUTHORITIES.—The provisions of law 

22 referred to in this subsection are the following: 

23 (1) Section 3119 of title 38, United States 

24 Code, relating to rehabilitation research and special 

25 projects. 


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1 (2) Section 7303 of title 38, United States 

2 Code, relating to research programs of the Veterans 

3 Health Administration. 

4 (3) Section 7327 of title 38, United States 

5 Code, relating to research, education, and clinical ac6 tivities on complex multi-trauma associated with 

7 combat injuries. 

8 (c) COLLABORATION.—In carrying out the research 

9 required by subsection (a), the Secretary shall collaborate 

10 with facilities that— 

11 (1) conduct research on rehabilitation for indi12 viduals with traumatic brain injury; and 

13 (2) receive grants for such research from the 

14 National Institute on Disability and Rehabilitation 

15 Research of the Department of Education. 

16 (d) REPORT.—Not later than 90 days after the date 

17 of the enactment of this Act, the Secretary shall submit 

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

19 the House of Representatives a report describing in com20 prehensive detail the research to be carried out in order 

21 to fulfill the requirement in subsection (a). 

Æ 


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