II 

108TH CONGRESS 

2D SESSION S. 2524 

To amend title 38, United States Code, to improve the provision of health 

care, rehabilitation, and related services to veterans suffering from trauma relating to a blast injury, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 16, 2004 

Mr. GRAHAM of Florida introduced the following bill; which was read twice 

and referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to improve the 

provision of health care, rehabilitation, and related services to veterans suffering from trauma relating to a 

blast 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. CENTERS FOR RESEARCH, EDUCATION, AND 

4 CLINICAL ACTIVITIES ON BLAST INJURIES OF 

5 VETERANS. 

6 (a) IN GENERAL.—(1) Subchapter II of chapter 73 

7 of title 38, United States Code, is amended by adding at 

8 the end the following new section: 
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1 ‘‘§ 7327. Centers for research, education, and clinical 

2 activities on blast injuries 

3 ‘‘(a) PURPOSE.—The purpose of this section is to 

4 provide for the improvement of the provision of health care 

5 services and related rehabilitation and education services 

6 to eligible veterans suffering from multiple traumas asso7 ciated with a blast injury through— 

8 ‘‘(1) the conduct of research to support the pro9 vision of such services in accordance with the most 

10 current evidence on blast injuries; 

11 ‘‘(2) the education and training of health care 

12 personnel of the Department; and 

13 ‘‘(3) the development of improved models and 

14 systems for the furnishing of services by the Depart15 ment for blast injuries. 

16 ‘‘(b) ESTABLISHMENT.—(1) The Secretary shall es17 tablish and operate at least one, but not more than three, 

18 centers for research, education, and clinical activities on 

19 blast injuries. 

20 ‘‘(2) Each center shall function as a center for— 

21 ‘‘(A) research on blast injury to support the 

22 provision of services in accordance with the most 

23 current evidence on blast injuries, with such re24 search to specifically address injury epidemiology 

25 and cost, functional outcomes, blast injury taxonomy 
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1 and measurement system, and longitudinal out2 comes; 

3 ‘‘(B) the development of a rehabilitation pro4 gram for blast injuries, including referral protocol, 

5 post-acute assessment, and coordination of com6 prehensive treatment services; 

7 ‘‘(C) the development of protocols to optimize 

8 linkages between the Department and the Depart9 ment of Defense on matters relating to research, 

10 education, and clinical activities on blast injuries; 

11 ‘‘(D) the creation of innovative models for edu12 cation and outreach on health-care and related reha13 bilitation and education services on blast injuries, 

14 with such education and outreach to target those 

15 who have sustained a blast injury and health care 

16 providers and researchers in the Veterans Health 

17 Administration, the Department of Defense, and the 

18 Department of Homeland Security; 

19 ‘‘(E) the development of educational tools and 

20 products on blast injuries, and the maintenance of 

21 such tools and products in a resource clearinghouse 

22 that can serve as resources for the Veterans Health 

23 Administration, the Department of Defense, the De24 partment of Homeland Security, and other depart25 ments and agencies of the Federal Government; 
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1 ‘‘(F) the development of interdisciplinary train2 ing programs on the provision of health care and re3 habilitation care services for blast injuries that pro4 vide an integrated understanding of the continuum 

5 of care for such injuries to the broad range of pro6 viders of such services, including first responders, 

7 acute-care providers, and rehabilitation service pro8 viders; and 

9 ‘‘(G) the implementation of strategies for im10 proving the medical diagnostic coding of blast inju11 ries in the Department to reliably identify veterans 

12 with blast injuries and track outcomes over time. 

13 ‘‘(3) The Secretary shall designate a designate a cen14 ter or centers under this section upon the recommendation 

15 of the Under Secretary for Health. 

16 ‘‘(4) The Secretary may designate a center under this 

17 section only if— 

18 ‘‘(A) the proposal submitted for the designation 

19 of the center meets the requirements of subsection 

20 (c); 

21 ‘‘(B) the Secretary makes the finding described 

22 in subsection (d); and 

23 ‘‘(C) the peer review panel established under 

24 subsection (e) makes the determination specified in 

25 subsection (e)(3) with respect to that proposal. 
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1 ‘‘(5) The authority of the Secretary to establish and 

2 operate centers under this section is subject to the appro3 priation of funds for that purpose. 

4 ‘‘(c) PROPOSAL REQUIREMENTS.—A proposal sub5 mitted for the designation of a center under this section 

6 shall— 

7 ‘‘(1) provide for close collaboration in the estab8 lishment and operation of the center, and for the 

9 provision of care and the conduct of research and 

10 education at the center, by a Department facility or 

11 facilities (in this subsection referred to as the ‘col12 laborating facilities’) in the same geographic area 

13 that have a mission centered on the care of individ14 uals with blast injuries and a Department facility in 

15 that area which has a mission of providing tertiary 

16 medical care; 

17 ‘‘(2) provide that not less than 50 percent of 

18 the funds appropriated for the center for support of 

19 clinical care, research, and education will be pro20 vided to the collaborating facilities with respect to 

21 the center; and 

22 ‘‘(3) provide for a governance arrangement 

23 among the facilities described in paragraph (1) with 

24 respect to the center that ensures that the center 

25 will be established and operated in a manner aimed 
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1 at improving the quality of care for blast injuries at 

2 the collaborating facilities with respect to the center. 

3 ‘‘(d) FINDINGS RELATING TO PROPOSALS.—The 

4 finding referred to in subsection (b)(4)(B) with respect to 

5 a proposal for the designation of a site as a location of 

6 a center under this section is a finding by the Secretary, 

7 upon the recommendation of the Under Secretary for 

8 Health, that the facilities submitting the proposal have de9 veloped (or may reasonably be anticipated to develop) each 

10 of the following: 

11 ‘‘(1) An arrangement with an affiliated accred12 ited medical school or university that provides edu13 cation and training in disaster preparedness, home14 land security, and biodefense. 

15 ‘‘(2) Comprehensive and effective treatment 

16 services for head injury, spinal cord injury, audi17 ology, amputation, gait and balance, and mental 

18 health. 

19 ‘‘(3) The ability to attract scientists who have 

20 demonstrated achievement in research— 

21 ‘‘(A) into the evaluation of innovative ap22 proaches to the rehabilitation of blast injuries; 

23 or 

24 ‘‘(B) into the treatment of blast injuries. 
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1 ‘‘(4) The capability to evaluate effectively the 

2 activities of the center, including activities relating 

3 to the evaluation of specific efforts to improve the 

4 quality and effectiveness of services on blast injuries 

5 that are provided by the Department at or through 

6 individual facilities. 

7 ‘‘(e) DEPARTMENTAL SUPPORT ON EVALUATION OF

8 CENTER PROPOSALS.—(1) In order to provide advice to 

9 assist the Secretary and the Under Secretary for Health 

10 to carry out their responsibilities under this section, the 

11 official within the central office of the Veterans Health 

12 Administration responsible for blast injury matters shall 

13 establish a peer review panel to assess the scientific and 

14 clinical merit of proposals that are submitted to the Sec15 retary for the designation of centers under this section. 

16 ‘‘(2) The panel shall consist of experts in the fields 

17 of research, education and training, and clinical care on 

18 blast injuries. Members of the panel shall serve as consult19 ants to the Department. 

20 ‘‘(3) The panel shall review each proposal submitted 

21 to the panel by the official referred to in paragraph (1) 

22 and shall submit to that official its views on the relative 

23 scientific and clinical merit of each such proposal. The 

24 panel shall specifically determine with respect to each such 

25 proposal whether or not that proposal is among those pro-
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1 posals which have met the highest competitive standards 

2 of scientific and clinical merit. 

3 ‘‘(4) The panel shall not be subject to the Federal 

4 Advisory Committee Act (5 U.S.C. App.). 

5 ‘‘(f) AWARD OF FUNDING.—Clinical and scientific in6 vestigation activities at each center established under this 

7 section— 

8 ‘‘(1) may compete for the award of funding 

9 from amounts appropriated for the Department for 

10 medical and prosthetics research; and 

11 ‘‘(2) shall receive priority in the award of fund12 ing from such amounts insofar as funds are awarded 

13 from such amounts to projects and activities relating 

14 to blast injuries. 

15 ‘‘(g) DISSEMINATION OF INFORMATION.—(1) The 

16 Under Secretary for Health shall ensure that information 

17 produced by the centers established under this section that 

18 may be useful for other activities of the Veterans Health 

19 Administration is disseminated throughout the Adminis20 tration. 

21 ‘‘(2) Information shall be disseminated under this 

22 subsection through publications, through programs of con23 tinuing medical and related education provided through 

24 regional medical education centers under subchapter VI 

25 of chapter 74 of this title, and through other means. Such 
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1 programs of continuing medical education shall receive 

2 priority in the award of funding. 

3 ‘‘(h) SUPERVISION.—The official within the central 

4 office of the Veterans Health Administration responsible 

5 for blast injury matters shall be responsible for super6 vising the operation of the centers established under this 

7 section and shall provide for ongoing evaluation of the cen8 ters and their compliance with the requirements of this 

9 section. 

10 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—(1) 

11 There are authorized to be appropriated to the Depart12 ment of Veterans Affairs for the centers established under 

13 this section amounts as follows: 

14 ‘‘(A) $3,125,000 for fiscal year 2005. 

15 ‘‘(B) $6,250,000 for each of fiscal years 2006 

16 through 2008. 

17 ‘‘(2) In addition to amounts authorized to be appro18 priated by paragraph (1) for a fiscal year, the Under Sec19 retary for Health shall allocate to each center established 

20 under this section, from other funds authorized to be ap21 propriated for such fiscal year for the Department gen22 erally for medical and for medical and prosthetics re23 search, such additional amounts as the Under Secretary 

24 for Health determines appropriate to carry out the pur25 pose of this section.’’. 
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1 (2) The table of sections at the beginning of chapter 

2 73 is amended by inserting after the item relating to sec3 tion 7326, the following new item: 

‘‘7327. Centers for research, education, and clinical activities on 

blast injuries’’. 

4 (b) DESIGNATION OF CENTERS.—The Secretary of 

5 Veterans Affairs shall designate at least one center for re6 search, education, and clinical activities on blast injuries 

7 as required by section 7327 of title 38, United States Code 

8 (as added by subsection (a)), not later than January 1, 

9 2005. 

10 (c) ANNUAL REPORTS.—(1) Not later than February 

11 1 of each of 2006, 2007, and 2008, the Secretary shall 

12 submit to the Committees on Veterans’ Affairs of the Sen13 ate and House of Representatives a report on the status 

14 and activities during the previous fiscal year of the center 

15 for research, education, and clinical activities on blast in16 juries established under section 7327 of title 38, United 

17 States Code (as so added). Each such report shall include 

18 the following: 

19 (A) A description of the activities carried out at 

20 each center, and the funding provided for such ac21 tivities. 

22 (B) A description of the advances made at each 

23 of the participating facilities of the each center in 
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1 research, education and training, and clinical activi2 ties on blast injuries . 

3 (C) A description of the actions taken by the 

4 Under Secretary for Health pursuant to subsection 

5 (g) of that section (as so added) to disseminate in6 formation derived from such activities throughout 

7 the Veterans Health Administration. 

8 (D) The assessment of the Secretary of the ef9 fectiveness of the centers in fulfilling the purposes of 

10 the centers. 

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