II 

109TH CONGRESS 

2D SESSION S. 3984 

To improve programs for the identification and treatment of post-deployment 

mental health conditions, including post-traumatic stress disorder, in 

veterans and members of the Armed Forces, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 28, 2006 

Mr. HARKIN (for himself, Mr. LEAHY, Ms. MIKULSKI, and Mr. KERRY) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To improve programs for the identification and treatment 

of post-deployment mental health conditions, including 

post-traumatic stress disorder, in veterans and members 

of the Armed Forces, 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 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Comprehensive Assistance for Veterans Exposed to 

6 Traumatic Stressors Act of 2006’’. 

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

8 this Act is as follows: 


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Sec. 1. Short title. 

Sec. 2. Definition. 

TITLE I—VETERANS OF PAST DEPLOYMENTS 

Sec. 101. Six-year extension of eligibility for readjustment counseling services 

for Vietnam-era veterans. 

TITLE II—MILITARY ISSUES 

Sec. 201. Department of Veterans Affairs-Department of Defense Health Care 

Sharing Incentive Fund. 

Sec. 202. Collection of data from pre- and post-deployment health assessments. 

Sec. 203. Preventative maintenance post-deployment intervention. 

TITLE III—PREVENTION, EARLY DETECTION, AND TREATMENT 

FOR RETURNING TROOPS 

Sec. 301. Study to identify factors that decrease the likelihood of the development of chronic PTSD despite combat exposure. 

Sec. 302. Extension of period of enhanced eligibility for VA health services for 

veterans who served in combat theaters of operations. 

Sec. 303. Demonstration project to station Department of Veterans Affairs psychologists and psychiatrists at major demobilization sites and 

military treatment facilities. 

Sec. 304. Peer counseling program. 

Sec. 305. Model programs for post-deployment mental health practice. 

Sec. 306. Performance measures for Department of Veterans Affairs health 

care administrators. 

TITLE IV—DEPARTMENT OF DEFENSE/DEPARTMENT OF VETERANS AFFAIRS COUNCIL ON POST-DEPLOYMENT MENTAL 

HEALTH 

Sec. 401. Establishment of Council. 

Sec. 402. Duties of Council. 

TITLE V—CAPACITY BUILDING IN DEPARTMENT OF VETERANS 

AFFAIRS 

Sec. 501. Plan for expansion of Department of Veterans Affairs system to expand access to specialized PTSD care. 

Sec. 502. Additional Department of Veterans Affairs resources. 

TITLE VI—FAMILY THERAPY 

Sec. 601. Eligibility for family counseling and bereavement counseling. 

TITLE VII—EDUCATIONAL INITIATIVES 

Sec. 701. Training program for health-care providers. 

Sec. 702. Curriculum and protocols for cross-training of Department of Veterans Affairs clinicians. 

Sec. 703. Publication of state-of-the-art post-deployment mental health problems diagnosis and treatment. 

Sec. 704. Protocols for pain management for PTSD and war-related pain. 

Sec. 705. Protocols for treatment of substance use disorders. 

Sec. 706. Protocols for diagnosis of post-traumatic stress disorder. 


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TITLE VIII—NATIONAL STEERING COMMITTEE ON PTSD 

EDUCATION 

Sec. 801. National steering committee. 

Sec. 802. Funding support for National Center for PTSD. 

Sec. 803. Continuing education to mental health providers. 

Sec. 804. Web-based curriculum to sponsor clinician training initiatives. 

TITLE IX—BENEFITS 

Sec. 901. Identification of deficiencies in PTSD disability examinations. 

Sec. 902. Criteria for determining medical conditions associated with PTSD. 

TITLE X—PUBLIC AWARENESS 

Sec. 1001. Public awareness program. 

Sec. 1002. Web site and materials for general campaign of awareness of PTSD. 

1 SEC. 2. DEFINITION. 

2 In this Act, the term ‘‘PTSD’’ means post-traumatic 

3 stress disorder. 

4 TITLE I—VETERANS OF PAST 

5 DEPLOYMENTS 

6 SEC. 101. SIX-YEAR EXTENSION OF ELIGIBILITY FOR READ7 JUSTMENT COUNSELING SERVICES FOR 

8 VIETNAM-ERA VETERANS. 

9 Section 1712A(a)(1)(B)(ii) of title 38, United States 

10 Code, is amended by striking ‘‘January 1, 2004’’ and in11 serting ‘‘January 1, 2010’’. 

12 TITLE II—MILITARY ISSUES 

13 SEC. 201. DEPARTMENT OF VETERANS AFFAIRS-DEPART14 MENT OF DEFENSE HEALTH CARE SHARING 

15 INCENTIVE FUND. 

16 (a) IN GENERAL.—The Secretary of Veterans Affairs 

17 and the Secretary of Defense shall jointly take such steps 

18 as necessary to implement the proposal of the Center for 


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1 the Study of Traumatic Stress at the Uniformed Services 

2 University of the Health Sciences for a Department of 

3 Veterans Affairs-Department of Defense Health Care 

4 Sharing Incentive Fund. 

5 (b) TELECOMMUNICATIONS SUPPORT.—As part of 

6 the implementation of the proposal referred to in sub7 section (a), the two Secretaries shall provide for a system 

8 of telecommunications to support the following: 

9 (1) Continuing education and support for front10 line (forward-deployed) providers of health-care serv11 ices. 

12 (2) Enhanced treatment capacity for addressing 

13 acute episodes of PTSD and other mental health 

14 disorders in combat theaters, including— 

15 (A) real-time access to clinical specialty 

16 support; 

17 (B) web-based information on state-of-the18 art protocols for the treatment and diagnosis of 

19 PTSD and other mental health disorders; and 

20 (C) educational programs concerning 

21 PTSD and other mental health disorders com22 monly associated with deployment. 


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1 SEC. 202. COLLECTION OF DATA FROM PRE- AND POST-DE2 PLOYMENT HEALTH ASSESSMENTS. 

3 (a) DATA COLLECTION.—The Secretary of Defense 

4 shall take appropriate steps to assist the Secretary of Vet5 erans Affairs with the collection of data from pre- and 

6 post-deployment health assessments of members of the 

7 Armed Forces that may be relevant for identification and 

8 treatment by the Secretary of Veterans Affairs of PTSD 

9 and other post-deployment mental health issues. The Sec10 retary of Defense may provide such information in aggre11 gate, unidentified format and may provide such informa12 tion on a monthly basis or on such other schedule as the 

13 two Secretaries may agree to. 

14 (b) CONSENT FORMS.—The Secretary of Defense 

15 shall develop forms for use in obtaining the written con16 sent of members of the Armed Forces to allow the Depart17 ment of Veterans Affairs to collect data contained on pre18 deployment and post-deployment health assessment forms 

19 with relevant treatment information concerning PTSD 

20 and other mental health problems that may be associated 

21 with combat stress or readjustment to civilian life from 

22 those members of the Armed Forces to be discharged or 

23 demobilized within 90 days. Such consent forms shall be 

24 developed and made available for use by members of the 

25 Armed Forces covered by the preceding sentence not later 

26 than 60 days after the date of the enactment of this Act. 


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1 (c) IDENTIFICATION OF SUBSTANCE USE DIS2 ORDERS.—The Secretary of Defense shall include in pre3 deployment and post-deployment health assessments ques4 tions to assist in identification of existing or potential sub5 stance use disorders among members of the Armed 

6 Forces. 

7 SEC. 203. PREVENTATIVE MAINTENANCE POST-DEPLOY8 MENT INTERVENTION. 

9 (a) IN GENERAL.—The Secretary of Veterans Affairs 

10 shall conduct routine preventative maintenance interven11 tion for all members of the Armed Forces returning from 

12 deployment in a combat theater. Such intervention shall 

13 be conducted between 90 and 180 days after such mem14 bers return from such deployment. 

15 (b) PERSONNEL.—For purposes of such intervention, 

16 the Secretary of Veterans Affairs may use— 

17 (1) staff of the Department of Veterans Affairs, 

18 including readjustment counseling staff; and 

19 (2) persons trained by the Department of Vet20 erans Affairs, including volunteers from military 

21 unit associations, veteran service organizations, or 

22 other nonprofit organizations. 

23 (c) SIZE.—Such intervention shall be conducted with 

24 no more than six returning servicemembers at a time. 


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1 (d) PURPOSE.—The purpose of such intervention 

2 shall be the following: 

3 (1) To identify and distinguish symptoms of 

4 ‘‘common’’ acute stress reactions from those of 

5 chronic and severe post-traumatic stress disorder. 

6 (2) To discuss concerns of combat personnel 

7 and those expressed by their family members. 

8 (3) To refer returning servicemembers to ap9 propriate services, as necessary. 

10 (4) To disseminate educational materials about 

11 post-deployment mental health issues, including 

12 PTSD to servicemembers. 

13 (5) To provide follow-up educational materials 

14 by mail to family members. 

15 (6) To provide information concerning home16 lessness, including risk factors, awareness assess17 ment, and contact information for preventative as18 sistance associated with homelessness. 

19 (e) VA PARTICIPATION IN ADDITIONAL DEMOBILIZA20 TION ACTIVITIES.—The Secretary of Defense shall provide 

21 for the Secretary of Veterans Affairs to participate in ad22 ditional demobilization activities, including the Transi23 tional Assistance Program, that are conducted within the 

24 Department of Defense for the purposes specified in sub25 section (d). 


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1 TITLE III—PREVENTION, EARLY 

2 DETECTION, AND TREAT3 MENT FOR RETURNING 

4 TROOPS 

5 SEC. 301. STUDY TO IDENTIFY FACTORS THAT DECREASE 

6 THE LIKELIHOOD OF THE DEVELOPMENT OF 

7 CHRONIC PTSD DESPITE COMBAT EXPOSURE. 

8 (a) STUDY.—The Secretary of Veterans Affairs shall 

9 provide for a study, to be conducted by an entity other 

10 than the Department of Veterans Affairs and the Depart11 ment of Defense, to identify factors that decrease the like12 lihood of the development of chronic post-traumatic stress 

13 disorder (PTSD) in servicemembers and veterans who 

14 have had combat exposure, including exposure to guerilla 

15 warfare. 

16 (b) REPORT.—The Secretary shall provide for the en17 tity conducting the study under subsection (a) to submit 

18 a report on the results of the study to the Secretary and 

19 the Congress not later than one year after the date of the 

20 enactment of this Act. 


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1 SEC. 302. EXTENSION OF PERIOD OF ENHANCED ELIGI2 BILITY FOR VA HEALTH SERVICES FOR VET3 ERANS WHO SERVED IN COMBAT THEATERS 

4 OF OPERATIONS. 

5 Section 1710(e)(3)(C) of title 38, United States 

6 Code, is amended by striking ‘‘2 years’’ and inserting ‘‘five 

7 years’’. 

8 SEC. 303. DEMONSTRATION PROJECT TO STATION DEPART9 MENT OF VETERANS AFFAIRS PSYCHOLO10 GISTS AND PSYCHIATRISTS AT MAJOR DEMO11 BILIZATION SITES AND MILITARY TREAT12 MENT FACILITIES. 

13 (a) DEMONSTRATION PROJECT.—The Secretary of 

14 Defense and the Secretary of Veterans Affairs shall jointly 

15 provide for the conduct of a demonstration project under 

16 which Department of Veterans Affairs psychologists and 

17 psychiatrists are stationed at major demobilization sites 

18 and military treatment facilities. 

19 (b) PURPOSE.—The purposes of the demonstration 

20 project shall be as follows: 

21 (1) Identify, on an aggregate level, need for 

22 mental health services among active-duty, Reserve, 

23 and National Guard members. 

24 (2) Provide such services or refer members for 

25 necessary services. 


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1 (3) Advise servicemembers of the need for con2 tinuous services. 

3 (4) Identify the obstacles servicemembers have 

4 in seeking appropriate mental health care. 

5 (c) FUNDING.—There is authorized to be appro6 priated such sums as may be necessary for each of fiscal 

7 years ø2006, 2007, and 2008¿ for the conduct of the dem8 onstration project. Amounts for the conduct of the project 

9 shall be provided equally by the Secretary of Veterans Af10 fairs and the Secretary of Defense. 

11 (d) ELIGIBILITY CRITERIA.—Based on the results of 

12 the demonstration project, the Secretaries shall identify 

13 appropriate eligibility criteria for programs to best re14 spond to the needs of veterans, servicemembers, and their 

15 families for post-deployment mental health services. The 

16 criteria identified shall be included in the report under 

17 subsection (e). 

18 (e) REPORT.—The Secretary of Veterans Affairs 

19 shall submit to the Committees on Veterans’ Affairs of 

20 the Senate and House of Representatives a report pro21 viding the results of the demonstration project. The report 

22 shall be submitted not later than 18 months after the date 

23 of the enactment of this Act. 


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1 SEC. 304. PEER COUNSELING PROGRAM. 

2 (a) PROGRAM REQUIRED.—The Secretary of Vet3 erans Affairs shall carry out a program to facilitate the 

4 provision by veterans of peer counseling services to other 

5 veterans on mental health matters. 

6 (b) PEER COUNSELING AS SUPPLEMENTAL SERV7 ICE.—Any support provided by peer counseling under the 

8 program required by subsection (a) shall be in addition 

9 to any other mental health services provided by the De10 partment of Veterans Affairs, including any services pro11 vided under other provisions of this Act. 

12 SEC. 305. MODEL PROGRAMS FOR POST-DEPLOYMENT MEN13 TAL HEALTH PRACTICE. 

14 (a) MODEL PROGRAMS.—The Secretary of Veterans 

15 Affairs, in consultation with the Secretary of Defense, 

16 shall develop model programs to respond to a variety of 

17 mental health disorders prevalent among veterans of serv18 ice in Operation Iraqi Freedom and Operation Enduring 

19 Freedom. The program shall be implemented at three sites 

20 selected by the Secretary, of which— 

21 (1) at least one site shall assign case managers 

22 to veterans receiving care under such program; and 

23 (2) at least one site shall use an integrated 

24 mental health and primary care model for post-de25 ployment mental health practice. 


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1 (b) PURPOSE.—The purpose of the model program 

2 shall be as follows: 

3 (1) Development of training protocols for in4 volved clinicians. 

5 (2) Identification of medical conditions which 

6 may be associated with post-deployment mental 

7 health problems including PTSD. 

8 (3) Identification of ‘‘best practices’’ for treat9 ment of post-deployment mental health problems in10 cluding PTSD. 

11 (4) Dissemination of results to the Veterans 

12 Health Administration and the Veterans Benefits 

13 Administration of the Department of Veterans Af14 fairs. 

15 (c) AUTHORIZATION.—There is authorized to be ap16 propriated for the purposes of subsection (a) the amount 

17 of $5,000,000 for each of fiscal years ø2006, 2007, and 

18 2008¿. 

19 SEC. 306. PERFORMANCE MEASURES FOR DEPARTMENT OF 

20 VETERANS AFFAIRS HEALTH CARE ADMINIS21 TRATORS. 

22 (a) PERFORMANCE MEASURES.—The Secretary of 

23 Defense and the Secretary of Veterans Affairs, acting 

24 through the Department of Defense/Department of Vet25 erans Affairs Council on Post-Deployment Mental Health 


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1 established under section 401, shall develop performance 

2 measures for Department of Veterans Affairs regional 

3 health-care directors (referred to as VISN directors) and 

4 Department of Defense TRICARE regional managers to 

5 ensure the appropriate deployment of resources to imple6 ment the treatment protocols referred to as ‘‘Iraq War 

7 Clinical Practice Guidelines’’. 

8 (b) USE OF PERFORMANCE MEASURES.—The per9 formance measures under subsection (a) shall be designed 

10 to assess— 

11 (1) access and availability of PTSD treatment 

12 for servicemembers returned from deployment in a 

13 combat theater; and 

14 (2) implementation of protocols referred to in 

15 subsection (a). 

16 TITLE IV—DEPARTMENT OF DE17 FENSE/DEPARTMENT OF VET18 ERANS AFFAIRS COUNCIL ON 

19 POST-DEPLOYMENT MENTAL 

20 HEALTH 

21 SEC. 401. ESTABLISHMENT OF COUNCIL. 

22 The Secretary of Defense and the Secretary of Vet23 erans Affairs shall jointly establish a council to be known 

24 as the Department of Defense/Department of Veterans Af25 fairs Council on Post-Deployment Mental Health. The 


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1 council shall be composed of leadership of the two depart2 ments in the areas of mental health, PTSD, substance 

3 abuse, and military sexual trauma. The council shall be 

4 established not later than 120 days after the date of the 

5 enactment of this Act. 

6 SEC. 402. DUTIES OF COUNCIL. 

7 (a) DUTIES.—The Department of Defense/Depart8 ment of Veterans Affairs Council on Post-Deployment 

9 Mental Health shall have the following duties: 

10 (1) Review of the continuum of care between 

11 the Department of Defense and the Department of 

12 Veterans Affairs for mental health, PTSD, sub13 stance abuse, and military sexual trauma. 

14 (2) Identification of gaps in the treatment capa15 bility of the health-care systems of the Department 

16 of Defense and Department of Veterans Affairs for 

17 mental health, PTSD, substance abuse, and military 

18 sexual trauma and expected gaps in such continuum, 

19 with emphasis on access to services in rural areas, 

20 to meet the expected demand from current users and 

21 servicemembers returning from Operation Iraqi 

22 Freedom and Operation Enduring Freedom and 

23 other deployments. 


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1 (3) Promotion, within both systems, of an edu2 cational program to implement the jointly developed 

3 Iraq War Clinical Practice Guidelines. 

4 (4) Development of outcome monitors and qual5 ity improvement instruments to ensure that internal 

6 policy regarding PTSD is implemented (including 

7 TRICARE and VISN directors’ performance meas8 ures under section 307). 

9 (5) Recommendation of policies to reduce the 

10 stigma associated with the seeking of mental health 

11 care by active-duty, Reserve, and National Guard 

12 members. 

13 (6) Identification of the highest post-deploy14 ment mental health research priorities for the two 

15 departments. 

16 (7) Communications to inform active-duty 

17 servicemembers and veterans of matters relating to 

18 PTSD. 

19 (b) ANNUAL MEETING WITH STAKEHOLDERS.—The 

20 Council shall meet at least annually with stakeholder 

21 groups comprised of veterans, veterans service organiza22 tions, and family members of veterans receiving care from 

23 the Department of Veterans Affairs mental health pro24 grams, and mental health associations. 


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1 (c) REPORT.—The Council shall prepare a report 

2 based on the reviews under paragraphs (1) and (2) of sub3 section (a) to identify the necessary resources to create 

4 or enhance PTSD treatment capabilities. The report shall 

5 be made available to the Secretary of both Departments 

6 for comment. The Secretaries shall indicate recommenda7 tions in which they concur or disagree and include specific 

8 plans for implementation of any recommendations accept9 ed. The report, with the comments and recommendations 

10 of the two Secretaries shall be submitted to the Commit11 tees on Veterans’ Affairs and the Committees on Armed 

12 Services of the Senate and House of Representatives not 

13 later than one year after the date of the enactment of this 

14 Act. The report shall include priority listing of sites which 

15 require investments according to the greatest perceived 

16 need for PTSD services. 

17 TITLE V—CAPACITY BUILDING 

18 IN DEPARTMENT OF VET19 ERANS AFFAIRS 

20 SEC. 501. PLAN FOR EXPANSION OF DEPARTMENT OF VET21 ERANS AFFAIRS SYSTEM TO EXPAND ACCESS 

22 TO SPECIALIZED PTSD CARE. 

23 (a) DEVELOPMENT OF PLAN.—Based upon the re24 port under section 402(b), the Secretary of Veterans Af25 fairs shall develop a plan for the Department of Veterans 


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1 Affairs to expand access to specialized PTSD care 

2 through— 

3 (1) Readjustment Counseling Service centers 

4 operated under section 1712A of title 38, United 

5 States Code; 

6 (2) community-based outpatient clinics; and 

7 (3) telemedicine. 

8 (b) INSPECTOR GENERAL INVESTIGATION.—The In9 spector General of the Department of Veterans Affairs 

10 shall investigate specialized programs of the Department 

11 of Veterans Affairs for the treatment of post-traumatic 

12 stress disorder in order to determine— 

13 (1) the current workloads of those programs; 

14 (2) staff associated with each of those pro15 grams; 

16 (3) funds obligated for those programs; and 

17 (4) any waiting times associated with those pro18 grams. 

19 (c) REPORT.—The Inspector General shall submit to 

20 the Committees on Veterans’ Affairs of the Senate and 

21 House of Representatives a report containing the Inspec22 tor General’s findings under subsection (b), together with 

23 an assessment of the ability of the Department of Vet24 erans Affairs to address such findings, along with rec25 ommendations for accommodating— 


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1 (1) the current workload of the Department in 

2 specialized treatment program; 

3 (2) 102 percent of the current workload of the 

4 Department; and 

5 (3) 110 percent of the current workload of the 

6 Department. 

7 SEC. 502. ADDITIONAL DEPARTMENT OF VETERANS AF8 FAIRS RESOURCES. 

9 In order to improve access to mental health services, 

10 the Secretary of Veterans Affairs shall provide the fol11 lowing: 

12 (1) 100 additional full-time equivalent employ13 ees to Readjustment Counseling Service outstations. 

14 (2) A PTSD clinical team at every medical cen15 ter of the Veterans Health Administration. 

16 (3) A family therapist at each Vet Center under 

17 section 1712A of title 38, United States Code. 

18 (4) A PTSD coordinator in each regional net19 work referred to as a Veterans Integrated Service 

20 Network (VISN ) whose duties shall include— 

21 (A) development of plans for meeting 

22 PTSD and other post-deployment mental health 

23 treatment needs consistent with the report 

24 under section 402(b); 


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1 (B) assurance of implementation of clinical 

2 practice guidelines throughout the VISN; 

3 (C) liaison among all health-care sites in 

4 the VISN and the Department Central Office 

5 on matters relating to PTSD. 

6 (5) A PTSD coordinator in each regional office 

7 of the Readjustment Counseling Service whose du8 ties shall include liaison with regional office staff 

9 and medical centers for veterans seeking service-con10 nection for PTSD. 

11 TITLE VI—FAMILY THERAPY 

12 SEC. 601. ELIGIBILITY FOR FAMILY COUNSELING AND BE13 REAVEMENT COUNSELING. 

14 (a) COUNSELING FOR FAMILY MEMBERS OF VET15 ERANS BEING TREATED FOR SERVICE-CONNECTED DIS16 ABILITIES.—Section 1782(a) of title 38, United States 

17 Code, is amended by adding at the end the following new 

18 sentence: ‘‘In addition, the Secretary shall provide to an 

19 individual described in subsection (c) such professional 

20 counseling and mental health services as are necessary as 

21 a consequence of a disability of a veteran described in the 

22 preceding sentence. Counseling and mental health services 

23 under the preceding sentence shall be provided (if so re24 quested by the individual) for a period of two years from 

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1 seling or mental health services under the preceding sen2 tence.’’. 

3 (b) BEREAVEMENT COUNSELING.—Section 1783 of 

4 such title is amended— 

5 (1) by striking ‘‘may provide’’ in subsections (a) 

6 and (b) and inserting ‘‘shall, upon request, provide’’; 

7 (2) by redesignating subsection (c) as sub8 section (d); and 

9 (3) by inserting after subsection (b) the fol10 lowing new subsection (c): 

11 ‘‘(c) DURATION OF COUNSELING.—Counseling under 

12 subsection (a) or with respect to the death of a veteran 

13 or under subsection (b) with respect to the death of a 

14 member who dies in the active military, naval, or air serv15 ice shall be provided to an individual eligible for such 

16 counseling (if so requested by that individual) for a period 

17 of two years from the date on which the individual first 

18 receives counseling under this section with respect to that 

19 death.’’. 

20 TITLE VII—EDUCATIONAL 

21 INITIATIVES 

22 SEC. 701. TRAINING PROGRAM FOR HEALTH-CARE PRO23 VIDERS. 

24 (a) IN GENERAL.—The Secretary of Veterans Affairs 

25 and the Secretary of Defense shall jointly develop a broad 


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1 training program for all health-care providers in the De2 partment of Veterans Affairs and the Department of De3 fense to familiarize those providers with mental health4 care issues that are likely to arise among persons deployed 

5 to combat theaters during the five years after such a de6 ployment. 

7 (b) FAMILY EDUCATION.—Training under the pro8 gram required by subsection (a) shall include training to 

9 assist family members of veterans in— 

10 (1) understanding issues that arise in the read11 justment of veterans to civilian life; 

12 (2) identifying signs and symptoms of mental 

13 health problems; and 

14 (3) encouraging veterans to seek assistance for 

15 such problems. 

16 SEC. 702. CURRICULUM AND PROTOCOLS FOR CROSS17 TRAINING OF DEPARTMENT OF VETERANS 

18 AFFAIRS CLINICIANS. 

19 The Secretary of Veterans Affairs shall develop a cur20 riculum and required protocols for cross-training to allow 

21 the following clinicians of the Department of Veterans Af22 fairs to screen for post-deployment mental health prob23 lems, including PTSD, and, as appropriate, provide infor24 mation and appropriate referral to— 

25 (1) primary care providers; 


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1 (2) practitioners assigned as Gulf War points2 of-contact; and 

3 (3) clinicians assigned as case managers. 

4 SEC. 703. PUBLICATION OF STATE-OF-THE-ART POST-DE5 PLOYMENT MENTAL HEALTH PROBLEMS DI6 AGNOSIS AND TREATMENT. 

7 The Secretary of Veterans Affairs and the Secretary 

8 of Defense shall jointly develop a plan for the production 

9 and dissemination of publications to advise clinicians on 

10 state-of-the-art diagnosis and treatment of PTSD and 

11 other mental health disorders experienced after deploy12 ment, including any medical conditions associated with 

13 such disorders. 

14 SEC. 704. PROTOCOLS FOR PAIN MANAGEMENT FOR PTSD 

15 AND WAR-RELATED PAIN. 

16 The Secretary of Veterans Affairs and the Secretary 

17 of Defense shall jointly develop protocols for pain manage18 ment for PTSD and war-related pain. 

19 SEC. 705. PROTOCOLS FOR TREATMENT OF SUBSTANCE 

20 USE DISORDERS. 

21 The Secretary of Defense shall develop appropriate 

22 substance use disorder treatment protocols for assistance 

23 in combat areas of operations and on return to the United 

24 States. 


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1 SEC. 706. PROTOCOLS FOR DIAGNOSIS OF POST-TRAU2 MATIC STRESS DISORDER. 

3 (a) FINDINGS.—Congress makes the following find4 ings: 

5 (1) The symptoms of post-traumatic stress dis6 order are often similar to those of traumatic brain 

7 injury and some neurological disorders. 

8 (2) Some veterans with PTSD have co9 morbidities that may mask or compound the symp10 toms associated with PTSD. 

11 (3) Correct diagnosis of PTSD and other dis12 orders is critical to effective treatment of those dis13 orders. 

14 (b) CLINICAL PRACTICE GUIDELINES.—The Sec15 retary of Veterans Affairs shall develop clinical practice 

16 guidelines to ensure that clinicians are able to effectively 

17 distinguish between diagnoses with similar symptoms that 

18 may manifest as post-traumatic stress disorder. 

19 TITLE VIII—NATIONAL STEER20 ING COMMITTEE ON PTSD 

21 EDUCATION 

22 SEC. 801. NATIONAL STEERING COMMITTEE. 

23 (a) ESTABLISHMENT.—There is a National Steering 

24 Committee on PTSD Education, to be appointed by the 

25 joint council established under section 401. The committee 

26 shall be comprised of mental health and other health proVerDate Aug 31 2005 06:30 Sep 30, 2006 Jkt 049196 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S3984.IS S3984

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1 fessionals and health educators involved in the care of vet2 erans of a deployment to a theater of combat on or after 

3 the date of the enactment of this Act. 

4 (b) PURPOSE.—The committee shall review training 

5 protocols for health-care providers and plans for dissemi6 nation of educational materials to veterans, their families, 

7 and other relevant parties and shall identify the resources 

8 available to provide for those purposes. 

9 (c) MEETINGS.—The committee shall meet at least 

10 once annually. 

11 SEC. 802. FUNDING SUPPORT FOR NATIONAL CENTER FOR 

12 PTSD. 

13 There is authorized to be appropriated to the Sec14 retary of Veterans Affairs for the National Center for 

15 PTSD to assist in carrying out a joint educational initia16 tive with the Uniformed Services University of the Health 

17 Sciences the amount of $5,000,000 for each of fiscal years 

18 ø2005 through 2014¿. 

19 SEC. 803. CONTINUING EDUCATION TO MENTAL HEALTH 

20 PROVIDERS. 

21 The National Steering Committee established under 

22 section 801 shall provide continuing education to mental 

23 health providers in the Department of Veterans Affairs 

24 and the Department of Defense. 


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1 SEC. 804. WEB-BASED CURRICULUM TO SPONSOR CLINI2 CIAN TRAINING INITIATIVES. 

3 The National Steering Committee established under 

4 section 801 shall develop a Web-based curriculum to spon5 sor clinician training initiatives. 

6 TITLE IX—BENEFITS 

7 SEC. 901. IDENTIFICATION OF DEFICIENCIES IN PTSD DIS8 ABILITY EXAMINATIONS. 

9 (a) EVALUATION OF ADJUDICATION OF CLAIMS.— 

10 The Secretary of Veterans Affairs, in consultation with the 

11 National Center for PTSD, shall obtain an evaluation of 

12 the quality and consistency of adjudication of claims for 

13 PTSD, including the adequacy of service-connected com14 pensation examinations for rating purposes and the extent 

15 to which veterans who are service-connected for PTSD are 

16 actually employed and employable. 

17 (b) REPORT.—Not later than 12 months after the 

18 date of the enactment of this Act, the Secretary shall sub19 mit to the Committees on Veterans Affairs of the Senate 

20 and House of Representatives a report that includes the 

21 following information and recommendations: 

22 (1) The types of evidence sufficient to confirm 

23 combat experience for veterans filing claims for 

24 PTSD based on combat. 


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1 (2) The policies and procedures used to obtain 

2 confirmation of a stressor, including documentation 

3 of service in combat for claims based on PTSD. 

4 (3) Based on a representative national sample, 

5 the number and percentage of veterans for each pe6 riod of war whose claims for PTSD have been de7 nied based upon the lack of a credible stressor. 

8 (4) Based on a representative national sample, 

9 the number and percentage of veterans for each pe10 riod of war whose claims for PTSD have been de11 nied based upon the lack of a diagnosis of PTSD. 

12 (5) Based on a representative national sample, 

13 the number and percentage of veterans for each pe14 riod of war whose claims for PTSD have been grant15 ed and the rating which was initially awarded for 

16 that claim. 

17 (6) The number of initial and subsequent 

18 claims and average time to process claims for PTSD 

19 which have been granted (including the rating as20 signed and any determination as to employability) 

21 and denied for each regional office for a consecutive 

22 six month period. 

23 (7) The number and percentage of initial claims 

24 for PTSD selected from a representative national 

25 sample during a consecutive six month period which 


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1 had a compensation and pension examination con2 ducted in compliance with best practices for PTSD 

3 examinations. 

4 (8) The number and percentage of examina5 tions selected from a representative national sample 

6 during a consecutive six month period in which the 

7 compensation and pension examinations for PTSD 

8 were judged to be inadequate. 

9 (9) The number and percentage of claims for 

10 PTSD selected from a representative national sam11 ple during that consecutive six month period for 

12 which the examination was returned as inadequate. 

13 (10) The maximum, minimum and average time 

14 based upon a representative national sample allo15 cated for completion of an initial compensation and 

16 pension examination for PTSD. 

17 (11) An assessment comparing the employment 

18 of veterans rated for psychiatric impairments with 

19 similar ratings based upon physical impairments in20 cluding, the number of veterans in each sample who 

21 are employed on a full time or part time basis, the 

22 average time such veterans have been unemployed 

23 and a comparison of the amount of work lost from 

24 employment due to disability and the average earn25 ings of veterans in each group. 


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1 (12) Taking into account criteria such as the 

2 information in the Dictionary of Occupational Titles 

3 (DOT), including its companion publication, the Se4 lected Characteristics of Occupations Defined in the 

5 Revised Dictionary of Occupational Titles (SCO), 

6 published by the Department of Labor, examples of 

7 the types of employment that an average veteran 

8 rated at 30 percent, at 50 percent, and at 70 per9 cent disabled for PTSD can be expected to obtain 

10 and retain. 

11 (13) The number of claims for PTSD appealed 

12 to the Board of Veterans Appeals during fiscal year 

13 ø2005¿, including the specific issue appealed (serv14 ice-connection, effective date, rating) and the results 

15 of such appeals (affirmed, denied, remanded, other 

16 disposition). 

17 (14) Recommendations for improving the accu18 racy and consistency of PTSD examinations, claim 

19 development and decisions. 

20 (15) Barriers to successful employment for vet21 erans who have been service-connected for PTSD. 

22 (16) Recommendations for removing barriers to 

23 employment for veterans who have been service-con24 nected for PTSD. 


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1 (17) Recommendations for legislative changes 

2 which could improve the potential for vocational re3 habilitation and employment of persons service-con4 nected for PTSD. 

5 SEC. 902. CRITERIA FOR DETERMINING MEDICAL CONDI6 TIONS ASSOCIATED WITH PTSD. 

7 The Secretary of Veterans Affairs shall develop— 

8 (1) criteria for determining those medical condi9 tions that are as likely as not to be associated with 

10 PTSD; and 

11 (2) standards for determining when secondary 

12 service-connection should be granted for those condi13 tions. 

14 TITLE X—PUBLIC AWARENESS 

15 SEC. 1001. PUBLIC AWARENESS PROGRAM. 

16 (a) PROGRAM REQUIRED.—The Secretary of Vet17 erans Affairs shall conduct an aggressive, comprehensive 

18 outreach program to enhance the awareness of veterans, 

19 and the public in general, of the symptoms of PTSD and 

20 of the services available for veterans with those symptoms. 

21 The Secretary of Defense shall provide the Secretary of 

22 Veterans Affairs with such assistance as may be required 

23 for the purposes of such program. To the extent prac24 ticable, the program shall be conducted through the joint 

25 council established under section 401. 


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1 (b) PROGRAM ON DE-STIGMATIZATION OF MENTAL

2 HEALTH.— 

3 (1) IN GENERAL.—The program required by 

4 subsection (a) shall include a national mental health 

5 campaign to increase awareness in the veteran com6 munity that mental health is essential to overall 

7 health and that very effective modern treatments 

8 can promote recovery from mental illness. 

9 (2) ELEMENTS.—The campaign under this sub10 section may include the following: 

11 (A) Activities targeted at veterans of Oper12 ation Iraqi Freedom and Operation Enduring 

13 Freedom and the families of such veterans. 

14 (B) Monthly messages on the Internet 

15 website of the Department of Veterans Affairs 

16 that express the theme that mental health is es17 sential to overall health. 

18 (C) Inclusion of the theme described in 

19 subparagraph (B) in public addresses, speeches, 

20 and veterans service organization convention 

21 addresses by the Secretary of Veterans Affairs 

22 and other senior officials of the Department. 


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1 SEC. 1002. WEB SITE AND MATERIALS FOR GENERAL CAM2 PAIGN OF AWARENESS OF PTSD. 

3 As part of the program under this title, the Secretary 

4 of Veterans Affairs shall develop and continually update 

5 a Web site and materials, including pamphlets, news re6 leases, fact sheets, and other materials, for the purposes 

7 of a general campaign of awareness of post-traumatic 

8 stress disorder. 

Æ 


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