I 
118TH CONGRESS 
1ST SESSION H. R. 4400 
To direct the Secretary of Veterans Affairs to conduct an independent review 
of the deaths of certain veterans by suicide, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 30, 2023 
Mr. BUCHANAN (for himself and Mr. CONNOLLY) introduced the following bill; 
which was referred to the Committee on Veterans’ Affairs 
A BILL 
To direct the Secretary of Veterans Affairs to conduct an 
independent review of the deaths of certain veterans by 
suicide, and for other purposes. 
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 ‘‘Veteran Overmedica-
tion and Suicide Prevention Act of 2023’’. 
SEC. 
2. 
DEPARTMENT 
OF 
VETERANS 
AFFAIRS 
INDE-
PENDENT REVIEW OF CERTAIN DEATHS OF 
VETERANS BY SUICIDE. 
(a) REVIEW REQUIRED.— 
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(1) IN GENERAL.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary 
of Veterans Affairs shall seek to enter into an agree-
ment with the National Academies of Sciences, En-
gineering, and Medicine under which the National 
Academies shall conduct a review of the deaths of all 
covered veterans who died by suicide during the five- 
year period ending on the date of the enactment of 
this Act, regardless of whether information relating 
to such deaths has been reported by the Centers for 
Disease Control and Prevention. 
(2) ELEMENTS.—The review required by para-
graph (1) shall include the following: 
(A) The total number of covered veterans 
who died by suicide during the five-year period 
ending on the date of the enactment of this Act. 
(B) The total number of covered veterans 
who died by a violent death during such five- 
year period. 
(C) The total number of covered veterans 
who died by an accidental death during such 
five-year period. 
(D) A description of each covered veteran 
described in subparagraphs (A) through (C), in-
cluding age, gender, race, and ethnicity. 
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(E) A comprehensive list of prescribed 
medications and legal or illegal substances as 
annotated on toxicology reports of covered vet-
erans described in subparagraphs (A) through 
(C), specifically listing any medications that 
carried a black box warning, were prescribed for 
off-label use, were psychotropic, or carried 
warnings that included suicidal ideation. 
(F) A summary of medical diagnoses by 
physicians of the Department of Veterans Af-
fairs or physicians providing services to covered 
veterans through programs of the Department 
that led to the prescribing of medications re-
ferred to in subparagraph (E) in cases of post- 
traumatic stress disorder, traumatic brain in-
jury, military sexual trauma, and other anxiety 
and depressive disorders. 
(G) The number of instances in which a 
covered veteran described in subparagraph (A), 
(B), or (C) was concurrently on multiple medi-
cations prescribed by physicians of the Depart-
ment or physicians providing services to vet-
erans through programs of the Department to 
treat post-traumatic stress disorder, traumatic 
brain injury, military sexual trauma, other anx-
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iety and depressive disorders, or instances of 
comorbidity. 
(H) The number of covered veterans de-
scribed in subparagraphs (A) through (C) who 
were not taking any medication prescribed by a 
physician of the Department or a physician pro-
viding services to veterans through a program 
of the Department. 
(I) With respect to the treatment of post- 
traumatic stress disorder, traumatic brain in-
jury, military sexual trauma, or other anxiety 
and depressive disorders, the percentage of cov-
ered veterans described in subparagraphs (A) 
through (C) who received a non-medication 
first-line treatment compared to the percentage 
of such veterans who received medication only. 
(J) With respect to the treatment of cov-
ered veterans described in subparagraphs (A) 
through (C) for post-traumatic stress disorder, 
traumatic brain injury, military sexual trauma, 
or other anxiety and depressive disorders, the 
number of instances in which a non-medication 
first-line treatment (such as cognitive behav-
ioral therapy) was attempted and determined to 
be ineffective for such a veteran, which subse-
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quently led to the prescribing of a medication 
referred to in subparagraph (E). 
(K) A description and example of how the 
Department determines and continually updates 
the clinical practice guidelines governing the 
prescribing of medications. 
(L) An analysis of the use by the Depart-
ment, including protocols or practices at med-
ical facilities of the Department, of systemati-
cally measuring pain scores during clinical en-
counters under the Pain as the 5th Vital Sign 
Toolkit of the Department and an evaluation of 
the relationship between the use of such meas-
urements and the number of veterans concur-
rently on multiple medications prescribed by 
physicians of the Department. 
(M) A description of the efforts of the De-
partment to maintain appropriate staffing levels 
for mental health professionals, such as mental 
health counselors, marriage and family thera-
pists, and other appropriate counselors, includ-
ing— 
(i) a description of any impediments 
to carry out the education, training, and 
hiring of mental health counselors and 
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marriage and family therapists under sec-
tion 7302(a) of title 38, United States 
Code, and strategies for addressing those 
impediments; 
(ii) a description of the objectives, 
goals, and timing of the Department with 
respect to increasing the representation of 
such counselors and therapists in the be-
havioral health workforce of the Depart-
ment, including— 
(I) a review of eligibility criteria 
for such counselors and therapists and 
a comparison of such criteria to that 
of other behavioral health professions 
in the Department; and 
(II) an assessment of the partici-
pation of such counselors and thera-
pists in the mental health profes-
sionals trainee program of the De-
partment and any impediments to 
such participation; 
(iii) an assessment of the development 
by the Department of hiring guidelines for 
mental health counselors, marriage and 
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family therapists, and other appropriate 
counselors; 
(iv) a description of how the Depart-
ment— 
(I) identifies gaps in the supply 
of mental health professionals; and 
(II) determines successful staff-
ing ratios for mental health profes-
sionals of the Department; 
(v) a description of actions taken by 
the Secretary, in consultation with the Di-
rector of the Office of Personnel Manage-
ment, to create an occupational series for 
mental health counselors and marriage and 
family therapists of the Department and a 
timeline for the creation of such an occu-
pational series; and 
(vi) a description of actions taken by 
the Secretary to ensure that the national, 
regional, and local professional standards 
boards for mental health counselors and 
marriage and family therapists are com-
prised of only mental health counselors and 
marriage and family therapists and that 
the liaison from the Department to such 
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boards is a mental health counselor or 
marriage and family therapist. 
(N) The percentage of covered veterans de-
scribed in subparagraphs (A) through (C) with 
combat experience or trauma related to combat 
experience (including military sexual trauma, 
traumatic brain injury, and post-traumatic 
stress). 
(O) An identification of the medical facili-
ties of the Department with markedly high pre-
scription rates and suicide rates for veterans re-
ceiving treatment at those facilities. 
(P) An analysis, by State, of programs of 
the Department that collaborate with State 
Medicaid agencies and the Centers for Medicare 
and Medicaid Services, including the following: 
(i) An analysis of the sharing of pre-
scription and behavioral health data for 
veterans. 
(ii) An analysis of whether Depart-
ment staff check with State prescription 
drug monitoring programs before pre-
scribing medications to veterans. 
(iii) A description of the procedures of 
the Department for coordinating with pre-
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scribers outside of the Department to en-
sure that veterans are not overprescribed. 
(iv) A description of actions that the 
Department takes when a veteran is deter-
mined to be overprescribed. 
(Q) An analysis of the collaboration of 
medical centers of the Department with medical 
examiners’ offices or local jurisdictions to deter-
mine veteran mortality and cause of death. 
(R) An identification and determination of 
a best practice model to collect and share vet-
eran death certificate data between the Depart-
ment of Veterans Affairs, the Department of 
Defense, States, and tribal entities. 
(S) A description of how data relating to 
death certificates of veterans is collected, deter-
mined, and reported by the Department of Vet-
erans Affairs. 
(T) An assessment of any patterns appar-
ent to the National Academies of Sciences, En-
gineering, and Medicine based on the review 
conducted under paragraph (1). 
(U) Such recommendations for further ac-
tion that would improve the safety and well- 
being of veterans as the National Academies of 
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Sciences, Engineering, and Medicine determine 
appropriate. 
(3) COMPILATION OF DATA.— 
(A) FORM
OF
COMPILATION.—The Sec-
retary of Veterans Affairs shall ensure that 
data compiled under paragraph (2) is compiled 
in a manner that allows it to be analyzed across 
all data fields for purposes of informing and 
updating clinical practice guidelines of the De-
partment of Veterans Affairs. 
(B) COMPILATION
OF
DATA
REGARDING 
COVERED VETERANS.—In compiling data under 
paragraph (2) regarding covered veterans de-
scribed in subparagraphs (A) through (C) of 
such paragraph, data regarding veterans de-
scribed in each such subparagraph shall be 
compiled separately and disaggregated by year. 
(4) COMPLETION OF REVIEW AND REPORT.— 
The agreement entered into under paragraph (1) 
shall require that the National Academies of 
Sciences, Engineering, and Medicine complete the 
review under such paragraph and submit to the Sec-
retary of Veterans Affairs a report containing the 
results of the review not later than 180 days after 
entering into the agreement. 
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(b) REPORT.—Not later than 30 days after the com-
pletion by the National Academies of Sciences, Engineer-
ing, and Medicine of the review required under subsection 
(a), the Secretary of Veterans Affairs shall— 
(1) submit to the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ 
Affairs of the House of Representatives a report on 
the results of the review; and 
(2) make such report publicly available. 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘black box warning’’ means a 
warning displayed on the label of a prescription drug 
that is designed to call attention to the serious or 
life-threatening risk of the prescription drug. 
(2) The term ‘‘covered veteran’’ means a vet-
eran who received hospital care or medical services 
furnished by the Department of Veterans Affairs 
during the five-year period preceding the death of 
the veteran. 
(3) The term ‘‘first-line treatment’’ means a po-
tential intervention that has been evaluated and as-
signed a high score within clinical practice guide-
lines. 
(4) The term ‘‘State’’ means each of the States, 
territories, and possessions of the United States, the 
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District of Columbia, and the Commonwealth of 
Puerto Rico. 
Æ 
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