II 

110TH CONGRESS 

1ST SESSION S. 1349 

To ensure that the Department of Defense and the Department of Veterans 

Affairs provide to members of the Armed Forces and veterans with 

traumatic brain injury the services that best meet their individual needs, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 9, 2007 

Mr. DURBIN (for himself, Mr. WARNER, Mrs. MURRAY, Mr. OBAMA, Mr. 

GRAHAM, Mr. WEBB, and Ms. CANTWELL) introduced the following bill; 

which was read twice and referred to the Committee on Armed Services 

A BILL 

To ensure that the Department of Defense and the Department of Veterans Affairs provide to members of the 

Armed Forces and veterans with traumatic brain injury 

the services that best meet their individual needs, 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 ‘‘Military and Veterans 

5 Traumatic Brain Injury Treatment Act’’. 

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1 SEC. 2. PROGRAM OF SERVICES FOR TRAUMATIC BRAIN IN2 JURY FOR MEMBERS OF THE ARMED FORCES 

3 AND VETERANS. 

4 (a) TRAUMATIC BRAIN INJURY PROGRAM RE5 QUIRED.—The Secretary of Defense and the Secretary of 

6 Veterans Affairs shall jointly establish a program meeting 

7 the requirements of subsections (c) through (f) under 

8 which each member of the Armed Forces or veteran who 

9 incurs a traumatic brain injury during service in the 

10 Armed Forces— 

11 (1) is enrolled in the program; and 

12 (2) receives, under the program, treatment and 

13 rehabilitation meeting the standard of care specified 

14 in subsection (b). 

15 (b) STANDARD OF CARE.—The standard of care for 

16 treatment and rehabilitation specified in this subsection 

17 is that each individual who is a member of the Armed 

18 Forces or veteran who qualifies for care under the pro19 gram established under subsection (a) shall— 

20 (1) be provided the highest quality of care pos21 sible based on the medical judgment of qualified 

22 medical professionals in facilities that most appro23 priately meet the specific needs of the individual; 

24 and 

25 (2) be rehabilitated to the fullest extent possible 

26 using the most up-to-date medical technology, medmstockstill on PROD1PC66 with BILLS

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1 ical rehabilitation practices, and medical expertise 

2 available. 

3 (c) REFERRALS.— 

4 (1) IN GENERAL.—If a member of the Armed 

5 Forces or a veteran participating in the program es6 tablished under subsection (a) determines that care 

7 provided to such participant by the Department of 

8 Defense or the Department of Veterans Affairs, as 

9 the case may be, does not meet the standard of care 

10 specified in subsection (b), the Secretary of Defense 

11 or the Secretary of Veterans Affairs, as the case 

12 may be, shall, upon request of the participant, pro13 vide to such participant a referral to a public or pri14 vate provider of medical or rehabilitative care for 

15 consultation regarding the care that would meet the 

16 standard of care specified in subsection (b). 

17 (2) LIMITATION ON REFERRALS.—The Depart18 ment of Defense shall bear the cost of referrals 

19 under paragraph (1), except that the Secretary of 

20 Defense shall not be required to pay for more than 

21 one referral for each participant in any consecutive 

22 three month period. 

23 (d) SCREENING FOR TRAUMATIC BRAIN INJURY.— 

24 (1) PROTOCOLS FOR DETECTION AND DIAG25 NOSIS OF TRAUMATIC BRAIN INJURY.— 

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1 (A) IN GENERAL.—The Secretary of De2 fense shall, in cooperation with the Secretary of 

3 Veterans Affairs, establish protocols for the de4 tection and diagnosis of traumatic brain injury, 

5 including the use of various types of screening 

6 tools as appropriate. 

7 (B) FREQUENCY.—The protocol required 

8 by subparagraph (A) shall provide that exami9 nations shall be administered at least once to 

10 each member of the Armed Forces— 

11 (i) before deployment to a combat the12 ater; and 

13 (ii) during the period beginning on the 

14 30th day after the member returns from 

15 such deployment and ending on the 90th 

16 day after the date on which such member 

17 returns to the member’s permanent duty 

18 station after such deployment. 

19 (C) PROTOCOL FOR DETERMINATION OF

20 BASELINE COGNITIVE FUNCTIONING.—The pro21 tocols required by subparagraph (A) shall in22 clude a protocol— 

23 (i) for the assessment and documenta24 tion of the cognitive functioning of each 

25 member of the Armed Forces before each 

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1 such member is deployed in a combat the2 ater, in order to facilitate the detection 

3 and diagnosis of traumatic brain injury of 

4 such member upon return from such de5 ployment; and 

6 (ii) for the comparison of the cognitive 

7 functioning determined under clause (i) 

8 with the cognitive functioning of the mem9 ber upon return from deployment. 

10 (D) ADMINISTRATION OF COMPUTER11 BASED EXAMINATIONS.—The protocol required 

12 by subparagraph (C) shall include the adminis13 tration of computer-based examinations to 

14 members of the Armed Forces. 

15 (2) INCIDENTAL DETECTION.—If, while deliv16 ering health care services to a member of the Armed 

17 Forces or a veteran who is not a participant in the 

18 program established under subsection (a), the Sec19 retary of Defense or the Secretary of Veterans Af20 fairs, as the case may be, discovers that such mem21 ber or veteran may have incurred a service-con22 nected traumatic brain injury, the Secretary con23 cerned shall test such member or veteran for trau24 matic brain injury. 

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1 (3) REFERRALS.—If the Secretary of Defense 

2 or the Secretary of Veterans Affairs receives a refer3 ral for the testing of a member of the Armed Forces 

4 or a veteran for traumatic brain injury, the Sec5 retary concerned shall test such member or veteran 

6 for traumatic brain injury expeditiously. 

7 (4) ENROLLMENT.—If a member of the Armed 

8 Forces or a veteran is diagnosed under this sub9 section with a traumatic brain injury that was in10 curred during service in the Armed Forces, such 

11 member or veteran shall be enrolled in the program 

12 required by subsection (a). 

13 (e) OUTREACH.— 

14 (1) OUTREACH TO MEMBERS OF THE ARMED

15 FORCES AND VETERANS.—The Secretary of Defense 

16 and the Secretary of Veterans Affairs shall conduct 

17 a program of outreach to members of the Armed 

18 Forces and veterans to inform such members and 

19 veterans of— 

20 (A) the program required by subsection 

21 (a); 

22 (B) the availability of screening for the di23 agnosis of traumatic brain injury under sub24 section (d); 

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1 (C) the consequences, with regard to the 

2 treatment and care of traumatic brain injury, of 

3 separation, discharge, and retirement from the 

4 Armed Forces; and 

5 (D) the rights of such members or vet6 erans described in subsection (f). 

7 (2) JOINT MANUAL OF BENEFITS.—As part of 

8 the program of outreach under paragraph (1), the 

9 Secretary of Defense and the Secretary of Veterans 

10 Affairs shall annually and jointly publish and dis11 tribute a manual explaining the benefits available to 

12 participants in the program required by subsection 

13 (a) and their families. 

14 (f) RIGHTS OF MEMBERS OF THE ARMED FORCES

15 AND VETERANS WITH TRAUMATIC BRAIN INJURY.—The 

16 Secretary of Defense and the Secretary of Veterans Af17 fairs shall inform members of the Armed Forces and vet18 erans with traumatic brain injury and their families of 

19 their rights with respect to the following: 

20 (1) The receipt of medical care from the De21 partment of Defense and the Department of Vet22 erans Affairs. 

23 (2) The options available to such members and 

24 veterans for treatment of traumatic brain injury. 

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1 (3) The options available to such members and 

2 veterans for rehabilitation. 

3 (4) Referrals under subsection (c)(1). 

4 (5) The right to any administrative or judicial 

5 appeal of any agency decision with respect to the 

6 program established under subsection (a). 

7 (6) Reviews of decisions under section 4. 

8 (g) COORDINATION OF CASE MANAGEMENT AND

9 HEALTH CARE SERVICES FOR PROGRAM PARTICI10 PANTS.— 

11 (1) LEAD CASE MANAGERS.—The Secretary of 

12 Defense and the Secretary of Veterans Affairs shall 

13 assign a qualified lead case manager to each member 

14 of the Armed Forces or veteran, as the case may be, 

15 that participates in the program required by sub16 section (a). Each lead case manager shall, with re17 spect to a participant in the program under sub18 section (a) to whom the lead case manager has been 

19 assigned— 

20 (A) coordinate the work of any other case 

21 managers associated with such participant; 

22 (B) help the participant and the family of 

23 such participant manage the stress associated 

24 with receiving treatment and rehabilitative serv25 ices for traumatic brain injury; 

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1 (C) present the participant with options 

2 for the receipt of medical and rehabilitative 

3 care, including options for such care outside the 

4 Department of Defense and the Department of 

5 Veterans Affairs, that meet the standard of 

6 care specified in subsection (b); 

7 (D) help the participant find and receive 

8 the care, including care from outside the De9 partment of Defense and the Department of 

10 Veterans Affairs, to which the participant is en11 titled under subsection (a); and 

12 (E) ensure that providers of care to par13 ticipants in the program required by subsection 

14 (a) provide consistent guidance to such partici15 pants. 

16 (2) PRIMARY CARE PHYSICIANS.—The Sec17 retary of Defense and the Secretary of Veterans Af18 fairs shall assign a lead primary care physician to 

19 each member of the Armed Forces or veteran, as the 

20 case may be, who participates in the program re21 quired by subsection (a). Such lead primary care 

22 physician shall coordinate and oversee the care pro23 vided to the participant, including all treatment, re24 habilitation, and medications. 

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1 (3) REPORT.—Not later than 6 months after 

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

3 of Defense and the Secretary of Veterans Affairs 

4 shall report to Congress on the steps taken to co5 ordinate care, as required by this subsection, along 

6 with recommendations, if any, for legislation to im7 prove such coordination. 

8 (h) RESOURCES.— 

9 (1) FACILITIES.—The Secretary of Defense and 

10 the Secretary of Veterans Affairs may provide treat11 ment and rehabilitation in accordance with sub12 section (a) in any of the facilities as follows: 

13 (A) Facilities of the Department of De14 fense. 

15 (B) Facilities of the Department of Vet16 erans Affairs. 

17 (C) Public or private medical facilities ac18 credited or otherwise qualified to provide treat19 ment and rehabilitation. 

20 (2) ACCESS TO EQUIPMENT.—The Secretary of 

21 Defense and the Secretary of Veterans Affairs shall 

22 ensure, by procurement, contract, or agreement, that 

23 the program established under subsection (a) has ac24 cess to all specialized programs, services, equipment, 

25 and medical expertise required to ensure that each 

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1 participant receives the standard of care specified in 

2 subsection (b). 

3 (3) COOPERATIVE AGREEMENTS, CONTRACTS, 

4 OR PARTNERSHIPS WITH PRIVATE AND PUBLIC MED5 ICAL CENTERS.—The Secretary of Defense and the 

6 Secretary of Veterans Affairs shall, separately or 

7 jointly, enter into cooperative agreements, contracts, 

8 or partnerships with private or public medical cen9 ters with expertise in the treatment or rehabilitation 

10 of individuals with traumatic brain injury to provide 

11 consultation, treatment, or rehabilitation to members 

12 of the Armed Forces or veterans as required by sub13 section (a). 

14 (4) TRAINING PROGRAM.—The Secretary of De15 fense and the Secretary of Veterans Affairs shall, 

16 separately or jointly, provide grants to, or enter into 

17 contracts or agreements with, private or public med18 ical centers with expertise in the treatment or reha19 bilitation of individuals with traumatic brain injury 

20 to provide training, education, or other assistance to 

21 personnel of the Department of Defense and the De22 partment of Veterans Affairs to ensure that such 

23 personnel are consistently using the most up-to-date 

24 and best practices and procedures for the screening, 

25 treatment, and rehabilitation of members of the 

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1 Armed Forces and veterans with traumatic brain in2 jury. 

3 (5) OVERLAP OF BENEFITS.— 

4 (A) IN GENERAL.—During the 24-month 

5 period beginning on the date that a member of 

6 the Armed Forces or a veteran is enrolled in 

7 the program required by subsection (a), the 

8 member or veteran shall be entitled to all of the 

9 benefits otherwise available to a veteran (in the 

10 case of a member) or member (in the case of 

11 a veteran), including participation in the 

12 TRICARE program under chapter 55 of title 

13 10, United States Code, and care provided in a 

14 facility of the Department of Defense, the De15 partment of Veterans Affairs, or other public or 

16 private facility, regardless of the active duty 

17 status of such member or veteran. 

18 (B) ALLOCATION OF COSTS.—Costs associ19 ated with the provision of care under subpara20 graph (A) shall be borne by the Department of 

21 Defense. 

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1 SEC. 3. FACILITATION OF CONTINUITY OF CARE FROM DE2 PARTMENT OF DEFENSE TO DEPARTMENT OF 

3 VETERANS AFFAIRS. 

4 The Secretary of Defense and the Secretary of Vet5 erans Affairs shall establish protocols to ensure that mem6 bers of the Armed Forces receive, with regard to health 

7 care benefits and services from the Department of Vet8 erans Affairs and otherwise, a continuity of care and as9 sistance during and after the transition from military serv10 ice to civilian life, including protocols for the following: 

11 (1) The expeditious transfer of medical records 

12 from the Department of Defense to the Department 

13 of Veterans Affairs. 

14 (2) Continuity of health care services, treat15 ment, and coverage for members of the Armed 

16 Forces who are transitioning to civilian life, with 

17 particular emphasis on providing continued health 

18 care to participants in the program required by sec19 tion 2. 

20 (3) The development of a specific, individualized 

21 transition plan for each member, prior to discharge 

22 or release from the Armed Forces, outlining the 

23 member’s seamless continuity of care. 

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1 SEC. 4. REVIEW OF CERTAIN DECISIONS OF THE DEPART2 MENT OF DEFENSE AND THE DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) REVIEW OF OTHER THAN HONORABLE DIS5 CHARGE STATUS FOR FORMER MEMBERS OF THE ARMED

6 FORCES WITH TRAUMATIC BRAIN INJURY.— 

7 (1) REVIEW REQUIRED.—The Secretary of De8 fense shall, upon the request of any former member 

9 of the Armed Forces who served in the Armed 

10 Forces after October 6, 2001, and has been dis11 charged from the Armed Forces under other than 

12 honorable conditions, conduct a review (including a 

13 medical evaluation) to determine whether a trau14 matic brain injury was a cause of the actions of the 

15 member that precipitated the discharge under other 

16 than honorable conditions. Such request may also be 

17 made by an authorized representative of the mem18 ber. 

19 (2) RECONSIDERATION.—If the Secretary of 

20 Defense determines under this subsection that the 

21 traumatic brain injury of a member was a cause of 

22 the actions of the member that precipitated the dis23 charge under other than honorable conditions, the 

24 Secretary shall reconsider the discharge and redesig25 nate the status of such discharge if such action is 

26 warranted. 

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1 (b) REVIEW OF DECISIONS OF SECRETARY OF VET2 ERANS AFFAIRS AFFECTING VETERANS WITH TRAU3 MATIC BRAIN INJURY.—Upon the request of any veteran 

4 diagnosed with a traumatic brain injury, the Secretary of 

5 Veterans Affairs shall review and adjust as the Secretary 

6 considers appropriate, the disability rating of such vet7 eran. 

8 SEC. 5. TRAUMATIC BRAIN INJURY RESEARCH. 

9 (a) RESEARCH REQUIRED OF DEPARTMENT OF DE10 FENSE.—The Secretary of Defense shall conduct re11 search— 

12 (1) to improve the screening, diagnosis, and 

13 treatment of traumatic brain injury; 

14 (2) to improve rehabilitation of members of the 

15 Armed Forces with traumatic brain injury; 

16 (3) to improve best practices for the activities 

17 described in paragraphs (1) and (2); and 

18 (4) to identify the mechanisms of brain injury 

19 and ways to prevent or ameliorate secondary effects 

20 of brain injuries. 

21 (b) RESEARCH REQUIRED OF DEPARTMENT OF VET22 ERANS AFFAIRS.—Section 7303 of title 38, United States 

23 Code, is amended— 

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1 (1) in subsection (a)(2), by inserting ‘‘trau2 matic brain injury research,’’ after ‘‘mental illness 

3 research,’’; and 

4 (2) by adding at the end the following new sub5 section: 

6 ‘‘(e) Traumatic brain injury research shall include re7 search— 

8 ‘‘(1) to improve the screening, diagnosis, and 

9 treatment of traumatic brain injury; 

10 ‘‘(2) to improve rehabilitation of veterans with 

11 traumatic brain injury; 

12 ‘‘(3) to improve best practices for the activities 

13 described in paragraphs (1) and (2); and 

14 ‘‘(4) to identify the mechanisms of brain injury 

15 and ways to prevent or ameliorate secondary effects 

16 of brain injuries.’’. 

17 (c) GRANTS OR COOPERATIVE AGREEMENTS.—In 

18 conducting the research required by subsection (a) or in 

19 accordance with section 7303(e) of title 38, United States 

20 Code, the Secretary of Defense and the Secretary of Vet21 erans Affairs may provide grants to, or enter into coopera22 tive agreements with, private or public medical centers 

23 with expertise in research on traumatic brain injury, in24 cluding the treatment or rehabilitation of individuals with 

25 traumatic brain injury. 

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1 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated— 

3 (1) to the Secretary of Defense, $20,000,000 to 

4 carry out the provisions of subsection (a); and 

5 (2) to the Secretary of Veterans Affairs, 

6 $20,000,00 to carry out the amendments made by 

7 subsection (b). 

8 SEC. 6. REPORT. 

9 Not later than December 15 of each year, the Sec10 retary of Defense shall, in conjunction with the Secretary 

11 of Veterans Affairs, submit to Congress a report that con12 tains, with respect to the fiscal year ending in the year 

13 such report is submitted, the following: 

14 (1) Descriptions of the activities, accomplish15 ments, and limitations of the program on traumatic 

16 brain injury established under section 2. 

17 (2) Recommendations of the Secretary of De18 fense and the Secretary of Veterans Affairs, if any, 

19 for improving the program established under section 

20 2. 

21 (3) Information on the following: 

22 (A) The number of members of the Armed 

23 Forces and veterans tested for traumatic brain 

24 injury by the Department of Defense and the 

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1 Department of Veterans Affairs under section 

2 2(d). 

3 (B) The number of members of the Armed 

4 Forces and veterans diagnosed with a traumatic 

5 brain injury. 

6 (C) The number of members of the Armed 

7 Forces and veterans enrolled in the program on 

8 traumatic brain injury established under section 

9 2. 

10 (D) The types of treatment and rehabilita11 tion provided as part of the program estab12 lished under section 2. 

13 (E) The types of facilities in which services 

14 were provided under section 2 and how such fa15 cilities were chosen to meet the individual needs 

16 of individual patients. 

17 (F) The mechanisms used by the Depart18 ment of Defense and the Department of Vet19 erans Affairs to ensure continuity of care for 

20 members of the Armed Forces as they transi21 tion from receipt of health care services from 

22 the Department of Defense to the receipt of 

23 such services from the Department of Veterans 

24 Affairs. 

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1 (G) The number and nature of any cooper2 ative agreements engaged in under section 2(h). 

3 (H) The outreach activities carried out 

4 under subsections (e) and (f) of section 2. 

5 (4) A description of the expenditures associated 

6 with the outreach, screening, diagnosis, treatment, 

7 rehabilitation, and other services provided to mem8 bers of the Armed Forces and veterans under sec9 tions 2 and 3. 

10 SEC. 7. DEFINITION OF TRAUMATIC BRAIN INJURY. 

11 In this Act, the term ‘‘traumatic brain injury’’ means 

12 an acquired injury to the brain. Such term does not in13 clude brain dysfunction caused by congenital or degenera14 tive disorders, nor birth trauma, but may include brain 

15 injuries caused by anoxia due to trauma. The Secretary 

16 of Defense and the Secretary of Veterans Affairs may 

17 jointly revise the definition of such term as the Secretaries 

18 determine necessary, after consultation with the following: 

19 (1) The Secretary of Health and Human Serv20 ices. 

21 (2) Representatives of any organization recog22 nized by the Secretary of Veterans Affairs for the 

23 representation of veterans under section 5902 of 

24 title 38, United States Code. 

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1 (3) Such public or nonprofit private entities 

2 that the Secretary of Defense or the Secretary of 

3 Veterans Affairs considers appropriate. 

Æ 

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