II 

113TH CONGRESS 

2D SESSION S. 2182 

To expand and improve care provided to veterans and members of the Armed 

Forces with mental health disorders or at risk of suicide, to review 

the terms or characterization of the discharge or separation of certain 

individuals from the Armed Forces, to require a pilot program on loan 

repayment for psychiatrists who agree to serve in the Veterans Health 

Administration of the Department of Veterans Affairs, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 27, 2014 

Mr. WALSH (for himself and Mr. TESTER) introduced the following bill; which 

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

A BILL 

To expand and improve care provided to veterans and members of the Armed Forces with mental health disorders 

or at risk of suicide, to review the terms or characterization of the discharge or separation of certain individuals 

from the Armed Forces, to require a pilot program on 

loan repayment for psychiatrists who agree to serve in 

the Veterans Health Administration of the Department 

of Veterans Affairs, 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 This Act may be cited as the ‘‘Suicide Prevention for 

3 American Veterans Act’’. 

4 SEC. 2. EXTENSION OF ELIGIBILITY FOR DOMICILIARY 

5 CARE FOR CERTAIN VETERANS WHO SERVED 

6 IN A THEATER OF COMBAT OPERATIONS. 

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

8 Code, is amended by striking ‘‘period of five years’’ and 

9 inserting ‘‘period of 15 years’’. 

10 SEC. 3. REVIEW OF CHARACTERIZATION OR TERMS OF DIS11 CHARGE FROM THE ARMED FORCES OF INDI12 VIDUALS WITH MENTAL HEALTH DISORDERS 

13 ALLEGED TO AFFECT TERMS OF DISCHARGE. 

14 (a) IN GENERAL.—The Secretaries of the military 

15 departments shall each provide for a process by which a 

16 covered individual may challenge the terms or character17 ization of the individual’s discharge or separation from the 

18 Armed Forces. 

19 (b) COVERED INDIVIDUALS.—For purposes of this 

20 section, a covered individual is any individual as follows: 

21 (1) An individual who was discharged or sepa22 rated from the Armed Forces for a personality dis23 order. 

24 (2) An individual who— 


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1 (A) was discharged or separated from the 

2 Armed Forces on a punitive basis, or under 

3 other than honorable conditions; and 

4 (B) who alleges that the basis for such dis5 charge or separation was a mental health injury 

6 or disorder incurred or aggravated by the indi7 vidual during service in the Armed Forces. 

8 (c) DISCHARGE OF PROCESS THROUGH BOARDS OF

9 CORRECTIONS OF RECORDS.—The Secretary of a military 

10 department shall carry out the process required by sub11 section (a) through boards for the correction of military 

12 records of the military department concerned. 

13 (d) CONSIDERATIONS ON MODIFICATION OF TERMS

14 OF DISCHARGE OR SEPARATION.—In deciding whether to 

15 modify the terms or characterization of an individual’s dis16 charge or separation pursuant to the process required by 

17 subsection (a), the Secretary of the military department 

18 concerned shall instruct boards to give due consideration 

19 to any mental health injury or disorder determined to have 

20 been incurred or aggravated by the individual during serv21 ice in the Armed Forces and to what bearing such injury 

22 or disorder may have had on the circumstances sur23 rounding the individual’s discharge or separation from the 

24 Armed Forces. 


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1 SEC. 4. IMPROVEMENT OF MENTAL HEALTH CARE PRO2 VIDED BY DEPARTMENT OF VETERANS AF3 FAIRS AND DEPARTMENT OF DEFENSE. 

4 (a) EVALUATIONS OF MENTAL HEALTH CARE AND

5 SUICIDE PREVENTION PROGRAMS.— 

6 (1) IN GENERAL.—Not less frequently than 

7 once each year, the Secretary concerned shall pro8 vide for the conduct of an evaluation of the mental 

9 health care and suicide prevention programs carried 

10 out under the laws administered by such Secretary. 

11 (2) ELEMENTS.—Each evaluation conducted 

12 under paragraph (1) shall— 

13 (A) use metrics that are common among 

14 and useful for practitioners in the field of men15 tal health care and suicide prevention; 

16 (B) identify the most effective mental 

17 health care and suicide prevention programs 

18 conducted by the Secretary concerned; and 

19 (C) propose best practices for caring for 

20 individuals who suffer from mental health dis21 orders or are at risk of suicide. 

22 (3) THIRD PARTY.—Each evaluation conducted 

23 under paragraph (1) shall be conducted by an inde24 pendent third party unaffiliated with the Depart25 ment of Veterans Affairs and the Department of De26 fense. 


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1 (b) TRAINING OF PROVIDERS.— 

2 (1) IN GENERAL.—The Secretary concerned 

3 shall train all providers of health care under the 

4 laws administered by such Secretary on the fol5 lowing: 

6 (A) Recognizing if an individual is at risk 

7 of suicide. 

8 (B) Treating or referring for treatment an 

9 individual who is at risk of suicide. 

10 (C) Recognizing the symptoms of 

11 posttraumatic stress disorder. 

12 (2) DISSEMINATION OF BEST PRACTICES.—The 

13 Secretary concerned shall ensure that best practices 

14 for identifying individuals at risk of suicide and pro15 viding quality mental health care are disseminated to 

16 providers of health care under the laws administered 

17 by such Secretary. 

18 (c) SECRETARY CONCERNED DEFINED.—In this sec19 tion, the term ‘‘Secretary concerned’’ means— 

20 (1) the Secretary of Veterans Affairs with re21 spect to matters concerning the Department of Vet22 erans Affairs; and 

23 (2) the Secretary of Defense with respect to 

24 matters concerning the Department of Defense. 


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1 SEC. 5. COLLABORATION BETWEEN DEPARTMENT OF VET2 ERANS AFFAIRS AND DEPARTMENT OF DE3 FENSE ON HEALTH CARE MATTERS. 

4 (a) TIMELINE FOR IMPLEMENTING INTEROPERABLE

5 ELECTRONIC HEALTH RECORDS.— 

6 (1) IN GENERAL.—Section 1635 of the Wound7 ed Warrior Act (10 U.S.C. 1071 note) is amended 

8 by adding at the end the following new subsection: 

9 ‘‘(k) TIMELINE.—In carrying out this section, the 

10 Secretary of Defense and the Secretary of Veterans Af11 fairs shall ensure that— 

12 ‘‘(1) the creation of a health data authoritative 

13 source by the Department of Defense and the De14 partment of Veterans Affairs that can be accessed 

15 by multiple providers and standardizes the input of 

16 new medical information is achieved not later than 

17 180 days after the date of the enactment of this 

18 subsection; 

19 ‘‘(2) the ability of patients of both the Depart20 ment of Defense and the Department of Veterans 

21 Affairs to download the medical records of the pa22 tient (commonly referred to as the ‘Blue Button Ini23 tiative’) is achieved not later than 180 days after the 

24 date of the enactment of this subsection; 

25 ‘‘(3) the full interoperability of personal health 

26 care information between the Departments is 


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1 achieved not later than one year after the date of 

2 the enactment of this subsection; 

3 ‘‘(4) the acceleration of the exchange of real4 time data between the Departments is achieved not 

5 later than one year after the date of the enactment 

6 of this subsection; 

7 ‘‘(5) the upgrade of the graphical user interface 

8 to display a joint common graphical user interface is 

9 achieved not later than one year after the date of 

10 the enactment of this subsection; and 

11 ‘‘(6) each current member of the Armed Forces 

12 and the dependent of such a member may elect to 

13 receive an electronic copy of the health care record 

14 of the individual beginning not later than June 30, 

15 2015.’’. 

16 (2) CONFORMING AMENDMENTS.—Section 1635 

17 of such Act is further amended— 

18 (A) in subsection (a), by striking ‘‘The 

19 Secretary’’ and inserting ‘‘In accordance with 

20 the timeline described in subsection (k), the 

21 Secretary’’; and 

22 (B) in the matter preceding paragraph (1) 

23 of subsection (e), by inserting ‘‘in accordance 

24 with subsection (k)’’ after ‘‘under this section’’. 


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1 (b) ESTABLISHMENT OF UNIFORM PRESCRIPTION

2 FORMULARY.—The Secretary of Veterans Affairs and the 

3 Secretary of Defense shall jointly establish a uniform pre4 scription formulary for use in prescribing medication 

5 under the laws administered by the Secretary of Veterans 

6 Affairs and the laws administered by the Secretary of De7 fense. 

8 SEC. 6. PILOT PROGRAM FOR REPAYMENT OF EDU9 CATIONAL LOANS FOR CERTAIN PSYCHIA10 TRISTS OF VETERANS HEALTH ADMINISTRA11 TION. 

12 (a) ESTABLISHMENT.—The Secretary of Veterans 

13 Affairs shall carry out a pilot program to repay loans of 

14 individuals described in subsection (b) that— 

15 (1) were used by such individuals to finance 

16 education relating to psychiatric medicine, including 

17 education leading to— 

18 (A) an undergraduate degree; 

19 (B) a degree of doctor of medicine; or 

20 (C) a degree of doctor of osteopathy; and 

21 (2) were obtained from any of the following: 

22 (A) A governmental entity. 

23 (B) A private financial institution. 

24 (C) A school. 


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1 (D) Any other authorized entity as deter2 mined by the Secretary. 

3 (b) ELIGIBLE INDIVIDUALS.— 

4 (1) IN GENERAL.—Subject to paragraph (2), an 

5 individual eligible for participation in the pilot pro6 gram is an individual who— 

7 (A) either— 

8 (i) is licensed or eligible for licensure 

9 to practice psychiatric medicine in the Vet10 erans Health Administration of the De11 partment of Veterans Affairs; or 

12 (ii) is enrolled in the final year of a 

13 residency program leading to a specialty 

14 qualification in psychiatric medicine that is 

15 approved by the Accreditation Council for 

16 Graduate Medical Education; and 

17 (B) demonstrates a commitment to a long18 term career as a psychiatrist in the Veterans 

19 Health Administration, as determined by the 

20 Secretary. 

21 (2) PROHIBITION ON SIMULTANEOUS ELIGI22 BILITY.—An individual who is participating in any 

23 other program of the Federal Government that re24 pays the educational loans of the individual is not el25 igible to participate in the pilot program. 


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1 (c) SELECTION.—The Secretary shall select not less 

2 than 10 individuals described in subsection (b) to partici3 pate in the pilot program for each year in which the Sec4 retary carries out the pilot program. 

5 (d) PERIOD OF OBLIGATED SERVICE.—The Sec6 retary shall enter into an agreement with each individual 

7 selected under subsection (c) in which such individual 

8 agrees to serve a period of obligated service for the Vet9 erans Health Administration in the field of psychiatric 

10 medicine, as determined by the Secretary. 

11 (e) LOAN REPAYMENTS.— 

12 (1) AMOUNTS.—Subject to paragraph (2), a 

13 loan repayment under this section may consist of 

14 payment of the principal, interest, and related ex15 penses of a loan obtained by an individual who is 

16 participating in the pilot program for all educational 

17 expenses (including tuition, fees, books, and labora18 tory expenses) of such individual relating to edu19 cation described in subsection (a)(1). 

20 (2) LIMIT.—For each year of obligated service 

21 that an individual who is participating in the pilot 

22 program agrees to serve under subsection (d), the 

23 Secretary may pay not more than $60,000 in loan 

24 repayment on behalf of such individual. 

25 (f) BREACH.— 


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1 (1) LIABILITY.—An individual who participates 

2 in the pilot program and fails to satisfy the period 

3 of obligated service under subsection (d) shall be lia4 ble to the United States, in lieu of such obligated 

5 service, for the amount that has been paid or is pay6 able to or on behalf of the individual under the pilot 

7 program, reduced by the proportion that the number 

8 of days served for completion of the period of obli9 gated service bears to the total number of days in 

10 the period of obligated service of such individual. 

11 (2) REPAYMENT PERIOD.—Any amount of dam12 ages that the United States is entitled to recover 

13 under this subsection shall be paid to the United 

14 States not later than one year after the date of the 

15 breach of the agreement. 

16 (g) REPORT.— 

17 (1) IN GENERAL.—Not later than 90 days after 

18 the date on which the pilot program terminates 

19 under subsection (i), the Secretary shall submit to 

20 the Committee on Veterans’ Affairs of the Senate 

21 and the Committee on Veterans’ Affairs of the 

22 House of Representatives a report on the pilot pro23 gram. 

24 (2) ELEMENTS.—The report required by para25 graph (1) shall include the following: 


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1 (A) The overall effect of the pilot program 

2 on the psychiatric workforce shortage of the 

3 Veterans Health Administration. 

4 (B) The long-term stability of the psy5 chiatric workforce of the Veterans Health Ad6 ministration. 

7 (C) Strategies of the Veterans Health Ad8 ministration to improve and increase the ability 

9 of the Administration to promote the physical 

10 and mental resiliency of all veterans. 

11 (h) REGULATIONS.—The Secretary shall prescribe 

12 regulations to carry out this section, including standards 

13 for qualified loans and authorized payees and other terms 

14 and conditions for the making of loan repayments. 

15 (i) TERMINATION.—The authority to carry out the 

16 pilot program shall expire on the date that is three years 

17 after the date on which the Secretary commences the pilot 

18 program. 

19 SEC. 7. COMPTROLLER GENERAL STUDY ON PAY DISPARI20 TIES OF PSYCHIATRISTS OF VETERANS 

21 HEALTH ADMINISTRATION. 

22 (a) STUDY.— 

23 (1) IN GENERAL.—Not later than one year 

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

25 Comptroller General of the United States shall conVerDate Mar 15 2010 04:59 Mar 29, 2014 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S2182.IS S2182

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1 duct a study of pay disparities among psychiatrists 

2 of the Veterans Health Administration of the De3 partment of Veterans Affairs. 

4 (2) ELEMENTS.—The study required by para5 graph (1) shall include the following: 

6 (A) An examination of laws, regulations, 

7 practices, and policies, including salary flexibili8 ties, that contribute to such disparities. 

9 (B) Recommendations for legislative or 

10 regulatory action to improve equity in pay 

11 among such psychiatrists. 

12 (b) REPORT.—Not later than one year after the date 

13 on which the Comptroller General completes the study 

14 under subsection (a), the Comptroller General shall sub15 mit to the Committee on Veterans’ Affairs of the Senate 

16 and the Committee on Veterans’ Affairs of the House of 

17 Representatives a report containing the results of the 

18 study. 

Æ 


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