I
103D CONGRESS
1ST SESSION
H. R. 3193
To expand services provided by the Department of Veterans Affairs for
veterans suffering from post-traumatic stress disorder (PTSD).
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 30, 1993
Mr. EVANS
(for himself, Mr. KENNEDY, Mr. GUTIERREZ, and Mr.
STRICKLAND) introduced the following bill; which was referred to the
Committee on Veterans’ Affairs
A BILL
To expand services provided by the Department of Veterans
Affairs for veterans suffering from post-traumatic stress
disorder (PTSD).
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Veterans PTSD Treat-
ment and Psychological Readjustment Act of 1993’’.
SEC. 2. FINDINGS.
The Congress finds—
(1) that a study carried out pursuant to Public
Law 98–160 on the readjustment of Vietnam-era
veterans estimated that approximately 479,000 Viet-
nam-theater veterans currently suffer from full-
blown post-traumatic stress disorder (PTSD);
(2) that such study found that during the final
year in which such study was conducted only 10 per-
cent of the Vietnam-era veterans suffering from
post-traumatic stress disorder were provided services
by the Department of Veterans Affairs for post-trau-
matic stress disorder;
(3) that the conflict in the Persian Gulf re-
sulted in an increased demand for services provided
by the Department of Veterans Affairs for post-trau-
matic stress disorder;
(4) that expansion of the current programs of
the Department of Veterans Affairs to provide serv-
ices to veterans suffering from post-traumatic stress
disorder (including specialized inpatient PTSD
units, PTSD clinical teams, readjustment centers,
and other services) would be an effective means of
reaching those veterans who have not previously
been provided such services; and
(5) that implementing the recommendations of
the Under Secretary for Health’s Special Committee
on Post-Traumatic Stress Disorder would be an ef-
fective means of reaching veterans suffering from
post-traumatic stress disorder who have not been
provided services.
SEC. 3. EXPANSION OF THE SPECIALIZED INPATIENT POST-
TRAUMATIC STRESS DISORDER UNIT PRO-
GRAM.
(a) POLICY.—(1) It shall be the policy of the Sec-
retary of Veterans Affairs to implement the recommenda-
tions of the Special Committee on Post-Traumatic Stress
Disorder with respect to the program of the Department
of Veterans Affairs to establish and operate specialized in-
patient post-traumatic stress disorder units (SIPUs) at
Department medical centers. In operating such units, the
Secretary shall ensure that the facilities and services of
such units are available to all eligible veterans, including
veterans of the Persian Gulf conflict.
(2) The special committee referred to in paragraph
(1) is the Special Committee on Post-Traumatic Stress
Disorder established by the Under Secretary for Health
pursuant to section 110 of Public Law 98–528 (38 U.S.C.
612A note).
(b) INCREASE IN NUMBER OF SIPUS.—The Sec-
retary shall increase the number of specialized inpatient
post-traumatic stress disorder units existing on the date
of the enactment of this Act by not less than 30. Of such
number—
(1) not less than five such units shall be estab-
lished by December 31, 1994;
(2) not less than a total of 15 such units shall
be established by December 31, 1995;
(3) not less than a total of 25 such units shall
be established by December 31, 1996; and
(4) not less than a total of 30 such units shall
be established by December 31, 1997.
SEC. 4. EXPANSION OF THE VET CENTER PROGRAM AND
OUTREACH EFFORTS FOR VETERANS WITH
READJUSTMENT COUNSELING NEEDS.
(a) SPECIAL COMMITTEE RECOMMENDATION.—(1)
The Secretary of Veterans Affairs, acting through the
Under Secretary for Health of the Department of Veter-
ans Affairs, shall direct the Special Committee on Post-
Traumatic Stress Disorder to identify areas of the country
in which there are significant needs for expanding the Vet
Center program, especially areas in which there are rel-
atively high numbers of veterans who are members of mi-
nority groups and areas that are currently not well-served
by Vet Centers.
(2) The Special Committee, based on its findings
under paragraph (1), shall present a list of not less than
40 areas as candidates for new Vet Centers to the Read-
justment Counseling Service of the Department of Veter-
ans Affairs not later than September 30, 1994.
(b) VET CENTER PROGRAM EXPANSION.—Based on
the requirements identified pursuant to subsection (a), the
Readjustment Counseling Service shall increase the num-
ber of Vet Centers existing on the date of the enactment
of this Act by not less than 40. Of such number—
(1) not less than five such centers shall be es-
tablished by December 31, 1994;
(2) not less than a total of 20 such centers
shall be established by December 31, 1995;
(3) not less than a total of 30 such centers
shall be established by December 31, 1996; and
(4) not less than a total of 40 such centers
shall be established by December 31, 1997.
(c) OUTREACH RECOMMENDATIONS.—The Advisory
Committee on Veteran Readjustment Counseling estab-
lished under section 1720C of title 38, United States Code
(as added by section 6(a)), shall prepare a report on rec-
ommendations to increase outreach efforts to veterans of
the Vietnam-era and periods after the Vietnam-era who
have readjustment counseling needs. The Advisory Com-
mittee shall submit such report to the Secretary not later
than July 29, 1994. Not later than 60 days after receiving
such report, the Secretary shall transmit a copy of the
report, together with the Secretary’s comments and rec-
ommendations, to Congress.
SEC. 5. EXPANSION OF ELIGIBILITY FOR READJUSTMENT
COUNSELING AND CERTAIN RELATED COUN-
SELING SERVICES.
(a) READJUSTMENT COUNSELING.—(1) Subsection
(a) of section 1712A of title 38, United States Code, is
amended to read as follows:
‘‘(a)(1) Upon the request of any veteran who while
in the active military, naval, or air service served in a com-
bat theater of operations (as defined by the Secretary of
Defense), the Secretary shall furnish counseling to such
veteran to assist such veteran in readjusting to civilian
life. Upon the request of any veteran other than a veteran
described in the preceding sentence, the Secretary shall,
within the limits of Department facilities, furnish counsel-
ing to such veteran to assist such veteran in readjusting
to civilian life.
‘‘(2) Such counseling shall include a general mental
and psychological assessment to ascertain whether such
veteran has mental or psychological problems associated
with readjustment to civilian life.’’.
(2) Subsection (c) of such section is repealed.
(b) OTHER COUNSELING.—Such section is further
amended by inserting after subsection (b) the following
new subsection (c):
‘‘(c)(1) The Secretary may provide the counseling
services described in section 1701(6)(B)(ii) of this title to
the surviving parents, spouse, and children of any member
of the Armed Forces who dies while serving on active duty
or from a condition (as determined by the Secretary) in-
curred in or aggravated by such service.
‘‘(2) The Secretary may make the facilities and serv-
ices of Vet Centers available to provide appropriate coun-
seling and other services to family members of any mem-
ber of the Armed Forces who is receiving combat pay.’’.
(c) AUTHORITY TO CONTRACT
FOR COUNSELING
SERVICES.—Subsection (e) of such section is amended by
striking out ‘‘subsections (a) and (b)’’ each place it ap-
pears and inserting in lieu thereof ‘‘subsections (a), (b),
and (c)’’.
SEC. 6. ADVISORY COMMITTEE ON THE READJUSTMENT OF
VETERANS.
(a) IN GENERAL.—(1) Subchapter II of chapter 17
of title 38, United States Code, is amended by inserting
after section 1712B the following:
‘‘§ 1712C. Advisory Committee on Veterans Readjust-
ment Counseling
‘‘(a)(1) There is in the Department the Advisory
Committee on Veteran Readjustment Counseling (herein-
after in this section referred to as the ‘Committee’).
‘‘(2) The Committee shall consist of 18 members.
The members of the Committee shall be appointed by the
Secretary and shall include individuals who are recognized
authorities in fields pertinent to the social, psychological,
economic, or educational readjustment of veterans. An of-
ficer or employee of the United States may not be ap-
pointed as a member of the Committee. At least 12 of
the Committee shall be veterans of the Vietnam era or
other period of war. Appointments of members of the
Committee shall be made from among individuals who
have experience with the provision of veterans benefits and
services by the Department or who are otherwise familiar
with programs of the Department.
‘‘(3) The Secretary shall seek to ensure that members
appointed to the Committee include persons from a wide
variety of geographic areas and ethnic backgrounds, per-
sons from veterans service organizations, minorities, and
women.
‘‘(4) The Secretary shall determine the terms of serv-
ice and pay and allowances of the members of the Commit-
tee, except that a term of service may not exceed two
years. The Secretary may reappoint any member for addi-
tional terms of service.
‘‘(b)(1) The Secretary shall, on a regular basis, con-
sult with and seek the advice of the Committee with re-
spect to the provision by the Department of benefits and
services to veterans in order to assist veterans in the re-
adjustment to civilian life.
‘‘(2)(A) In providing advice to the Secretary under
this subsection, the Committee shall—
‘‘(i) assemble and review information relating to
the needs of veterans in readjusting to civilian life;
‘‘(ii) provide information relating to the nature
and character of psychological problems arising from
military service;
‘‘(iii) provide an on-going assessment of the ef-
fectiveness of the policies, organizational structures,
and services of the Department in assisting veterans
in readjusting to civilian life; and
‘‘(iv) provide on-going advice on the most ap-
propriate means of responding to the readjustment
needs of future veterans.
‘‘(B) In carrying out its duties under subparagraph
(A), the Committee shall take into special account veter-
ans of the Vietnam era, and the readjustment needs of
such veterans.
‘‘(c)(1) Not later than March 31 of each year, the
Committee shall submit to the Secretary a report on the
programs and activities of the Department that relate to
the readjustment of veterans to civilian life. Each such
report shall include—
‘‘(A) an assessment of the needs of veterans
with respect to readjustment to civilian life;
‘‘(B) a review of the programs and activities of
the Department designed to meet such needs; and
‘‘(C) such recommendations (including rec-
ommendations for administrative and legislative ac-
tion) as the Committee considers appropriate.
‘‘(2) Not later than 90 days after the receipt of each
report under paragraph (1), the Secretary shall transmit
to the Committees on Veterans’ Affairs of the Senate and
House of Representatives a copy of the report, together
with any comments and recommendations concerning the
report that the Secretary considers appropriate.
‘‘(3) The Committee may also submit to the Sec-
retary such other reports and recommendations as the
Committee considers appropriate.
‘‘(4) The Secretary shall submit with each annual re-
port submitted to the Congress pursuant to section 529
of this title a summary of all reports and recommendations
of the Committee submitted to the Secretary since the pre-
vious annual report of the Secretary submitted pursuant
to that section.
‘‘(d)(1) Except as provided in paragraph (2), the pro-
visions of the Federal Advisory Committee Act (5 U.S.C.
App.) shall apply to the activities of the Committee under
this section.
‘‘(2) Section 14 of such Act shall not apply to the
Committee.’’.
(2) The table of sections at the beginning of chapter
17 of such title is amended by inserting after the item
relating to section 1712B the following:
‘‘1712C. Advisory Committee on Veteran Readjustment Counseling.’’.
(b) ORIGINAL MEMBERS.—(1) Notwithstanding sub-
section (a)(2) of section 1712C of title 38, United States
Code (as added by subsection (a)), the members of the
Advisory Committee on the Readjustment of Vietnam and
Other War Veterans on the date of the enactment of this
Act shall be the original members of the advisory commit-
tee established under that section.
(2) The original members shall so serve until the Sec-
retary of Veterans Affairs carries out appointments under
such subsection (a)(2). The Secretary shall carry out such
appointments as soon as is practicable. The Secretary may
make such appointments from among such original mem-
bers.
SEC. 7. PILOT PROGRAM FOR TREATMENT OF POST-TRAU-
MATIC STRESS DISORDER.
(a) ESTABLISHMENT OF PROGRAM.—(1) Subchapter
II of chapter 17 of title 38, United States Code, is amend-
ed by adding at the end the following new section:
‘‘§ 1720E. Treatment and rehabilitation for post-trau-
matic stress disorder; pilot program
‘‘(a)(1) The Secretary, in furnishing hospital, nursing
home, and domiciliary care and medical and rehabilitative
services under this chapter, shall conduct a pilot program
under which the Secretary may contract for care and
treatment and rehabilitative services in halfway houses,
therapeutic communities, psychiatric residential treatment
centers, and other community based treatment facilities
for eligible veterans suffering from post-traumatic stress
disorder. Such pilot program shall be planned, designed,
and conducted by the Under Secretary for Health, with
the approval of the Secretary, so as to demonstrate any
medical advantages and cost effectiveness that may result
from furnishing such care and services to veterans with
post-traumatic stress disorder in contract facilities as au-
thorized by this section, rather than in facilities over which
the Secretary has direct jurisdiction.
‘‘(2) Before furnishing such care and services to a
veteran through a contract facility as authorized by para-
graph (1), the Secretary shall approve (in accordance with
criteria which the Secretary shall prescribe by regulation)
the quality and effectiveness of the program operated by
such facility for the purpose for which such veteran is to
be furnished such care and services.
‘‘(b) The Secretary, in consultation with the Sec-
retary of Labor and the Director of the Office of Person-
nel Management, shall take appropriate steps to—
‘‘(1) urge all Federal agencies and appropriate
private and public firms, organizations, agencies,
and persons to provide appropriate employment and
training opportunities for veterans who have been
provided treatment and rehabilitative services under
this title for post-traumatic stress disorder and have
been determined by competent medical authority to
be sufficiently rehabilitated to be employable; and
‘‘(2) provide all possible assistance to the Sec-
retary of Labor in placing such veterans in such op-
portunities.
‘‘(c) Upon receipt of an application for treatment and
rehabilitative services under this title for post-traumatic
stress disorder from any individual who has been dis-
charged or released from active military, naval, or air serv-
ices but who is not eligible for such treatment and serv-
ices, the Secretary shall—
‘‘(1) provide referral services to assist such in-
dividual, to the maximum extent practicable, in ob-
taining treatment and rehabilitative services from
sources outside the Department; and
‘‘(2) if pertinent, advise such individual of such
individual’s rights to apply to the appropriate mili-
tary, naval, or air service and the Department for
review of such individual’s discharge or release from
such service.
‘‘(d) The capacity of the pilot program under sub-
section (a) shall be maintained at 500 eligible individuals.
‘‘(e) The Secretary may not furnish care and treat-
ment and rehabilitative services under subsection (a) after
the last day of the fifth fiscal year following the fiscal year
during which the pilot program authorized by that sub-
section is begun.
‘‘(f) Not later than March 31, 1998, the Secretary
shall submit to the Committee on Veterans’ Affairs of the
Senate and House of Representatives a report on the find-
ings and recommendations of the Secretary pertaining to
the operation through September 30, 1997, of the pilot
program authorized by subsection (a).
‘‘(g) The authority of the Secretary to enter into con-
tracts under this section shall be effective for any fiscal
year only to such extent or in such amounts as are pro-
vided in appropriation Acts.’’.
(2) The table of sections at the beginning of chapter
17 of such title is amended by inserting after the item
relating to section 1720D the following:
‘‘1720E. Treatment and rehabilitation for post-traumatic stress disorder; pilot
program.’’.
(b) EFFECTIVE DATE.—The Secretary of Veterans
Affairs may not furnish care and treatment and rehabilita-
tion services under subsection (a) of section 1720E of title
38, United States Code, as added by subsection (a), before
October 1, 1993.
SEC. 8. REPORT ON POST-TRAUMATIC STRESS DISORDER
CONTRACT CARE.
(a) EXAMINATION OF EFFECTIVENESS.—The Special
Committee on Post-Traumatic Stress Disorder of the
Under Secretary for Health, in consultation with the Advi-
sory Committee on Veteran Readjustment Counseling,
shall examine the effectiveness of contracts for the treat-
ment of post-traumatic stress disorder with private facili-
ties and therapists under section 1712A(e) of title 38,
United States Code.
(b) REPORT.—Not later than December 31, 1994,
the Special Committee shall submit to the Committees on
Veterans’ Affairs of the Senate and House of Representa-
tives a report of its findings and recommendations per-
taining to—
(1) establishing stable funding for post-trau-
matic stress disorder contract care, and
(2) the availability of post-traumatic stress dis-
order contract care for eligible individuals in rural
areas and such individuals who are not currently
well-served by other Department of Veterans Affairs
medical services.
SEC. 9. USE OF SCHOLARSHIP AND TUITION REIMBURSE-
MENT PROGRAMS FOR MENTAL HEALTH PRO-
FESSIONALS.
In administering the Health Professionals Edu-
cational Assistance Program under chapter 76 of title 38,
United States Code, the Secretary of Veterans Affairs
shall seek to encourage the participation of individuals in
the program who desire to become psychologists, psychia-
trists, social workers, psychiatric nurses, and other profes-
sionals specializing in the treatment of post-traumatic
stress disorder. The Secretary shall designate, pursuant
to section 7612(b)(3) of that title, additional fields of edu-
cation or training that may be beneficial for the treatment
of veterans suffering from post-traumatic stress disorder.
SEC. 10. POST-TRAUMATIC STRESS DISORDER RESEARCH
PROGRAMS.
(a) INTERMODAL APPROACH.—The Under Secretary
for Health of the Department of Veterans Affairs shall
conduct a research program to consider the most effective
treatment modalities for the treatment of post-traumatic
stress disorder. The research program shall be conducted
at at least one specialized inpatient post-traumatic stress
disorder unit (SIPU), at least one post-traumatic stress
disorder clinical team (PCT), and at least one veterans
readjustment center, as designated by the Under Sec-
retary. The Under Secretary shall report the findings of
such program to the Committees on Veterans’ Affairs of
the Senate and House of Representatives not later than
December 31, 1997.
(b) INVOLVEMENT
OF
FAMILY
MEMBERS.—The
Under Secretary shall conduct a research program con-
cerning the effectiveness of involving the family in the
treatment of post-traumatic stress disorder. The Under
Secretary shall report the findings of such program to the
Committees on Veterans’ Affairs of the Senate and House
of Representatives not later than December 31, 1996.
(c) IMPLEMENTATION.—The Under Secretary shall
carry out subsections (a) and (b) through the National
Center on Post-Traumatic Stress Disorder.
(d) ADVICE.—The Under Secretary shall carry out
subsections (a) and (b) in consultation with the Special
Committee on Post-Traumatic Stress Disorder and the
Advisory Committee on Veterans Readjustment Counsel-
ing.
SEC. 11. EXPANSION OF THE POST-TRAUMATIC STRESS DIS-
ORDER CLINICAL TEAM PROGRAM.
(a) POLICY.—It shall be the policy of the Secretary
of Veterans Affairs to implement the recommendations of
the Special Committee on Post-Traumatic Stress Disorder
to establish and operate post-traumatic stress disorder
clinical teams (PCTs) at Department medical centers
which provide mental health services. In operating such
teams, the Secretary shall ensure that the services of such
teams are available to all eligible veterans.
(b) INCREASE IN NUMBER OF PCTS.—The Secretary
shall increase the number of clinical teams existing on the
date of the enactment of this Act by not less than 50.
Of such number—
(1) not less than 15 such units shall be estab-
lished by December 31, 1994;
(2) not less than a total of 30 such units shall
be established by December 31, 1995;
(3) not less than a total of 40 such units shall
be established by December 31, 1996; and
(4) not less than a total of 50 such units shall
be established by December 31, 1997.
(c) LOCATIONS OF NEW PCTS.—In establishing new
post-traumatic stress disorder clinical teams pursuant to
subsection (a), the Secretary shall first locate teams at
medical centers that do not have a specialized inpatient
post-traumatic stress disorder unit (SIPU) and do not
have an affiliated Vet Center.
Æ
HR 3193 IH——2