I 
111TH CONGRESS 
2D SESSION 
H. R. 6211 
To direct the Secretary of Veterans Affairs to establish a pilot program 
to evaluate the effectiveness of treating veterans with spinal, back, and 
musculoskeletal injuries and pain using non-invasive techniques. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 23, 2010 
Ms. MARKEY of Colorado introduced the following bill; which was referred to 
the Committee on Veterans’ Affairs 
A BILL 
To direct the Secretary of Veterans Affairs to establish a 
pilot program to evaluate the effectiveness of treating 
veterans with spinal, back, and musculoskeletal injuries 
and pain using non-invasive techniques. 
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 Back and 
Spinal Therapy Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) One in five members of the Armed Forces 
who were wounded and evacuated from Afghanistan 
during the summer and early fall of 2009 suffered 
a spinal injury, and at least 14 of such members 
were left paralyzed or with loss of sensation. 
(2) In Afghanistan, members of the Armed 
Forces routinely carry up to 33 percent more than 
the suggested maximum weight and up to nearly 75 
percent of a member’s own body weight—routinely 
hefting combat gear that can exceed 120 pounds, 
causing large numbers of spinal, back, and musculo-
skeletal injuries and pain. 
(3) The use of massive improvised explosive de-
vices by insurgents against heavily armed mine re-
sistant ambush protected vehicles has significantly 
increased the number of spinal, back, and musculo-
skeletal injuries and pain. 
(4) Advances in both body armor protection and 
medical treatment have drastically decreased the 
number of deaths among deployed members of the 
Armed Forces, but there has been an increase in the 
number of members with spinal, back, and musculo-
skeletal injuries and long-term pain. 
(5) Members of the Armed Forces returning 
from Iraq are more likely to suffer lingering, debili-
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tating injuries from back and musculoskeletal pain 
than from battle wounds, according to statistics 
compiled by the Secretary of Veterans Affairs. 
(6) Diagnoses of ruptured spinal discs, com-
pressed 
discs, 
degenerative 
disc 
disease, 
and 
myofascial pain syndrome are common in members 
of the Armed Forces returning from Afghanistan 
and Iraq. 
(7) Spinal and back injuries are the most ex-
pensive musculoskeletal disorder to treat. 
(8) Certain facilities of the Department of Vet-
erans Affairs offer outstanding non-invasive tech-
nologies for treating spinal, back, and musculo-
skeletal injuries as well as any accompanying mental 
health issues. 
(9) Traditional medical approaches to spinal, 
back, and musculoskeletal injuries typically involve a 
combination of long-term medication, surgery, and 
short-term physical therapy. 
(10) Using non-invasive techniques to treat vet-
erans with spinal, back, and musculoskeletal injuries 
can improve the health outcomes for such veterans 
and drastically reduce the long-term costs of care for 
such veterans by breaking the cycle of expensive sur-
gery followed by long-term pain medication that 
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often leads to addiction, depression, anxiety, and 
weight gain. 
(11) Non-invasive techniques that are not wide-
ly available in medical facilities of the Department 
of Veterans Affairs, including manual physical ther-
apy, core strengthening and stabilization therapy, 
water exercise therapy, group exercise therapy, and 
pain management therapy, should be evaluated in an 
evidence-based medicine framework to assess their 
effectiveness. 
SEC. 3. PILOT PROGRAM TO PROVIDE VETERANS WITH 
NON-INVASIVE 
TECHNIQUES 
FOR 
SPINAL, 
BACK, AND MUSCULOSKELETAL INJURIES. 
(a) ESTABLISHMENT.—The Secretary of Veterans 
Affairs shall establish a pilot program to— 
(1) provide covered veterans with non-invasive 
techniques to treat spinal, back, and musculoskeletal 
injuries and pain; and 
(2) use an evidence-based medicine framework 
to assess the effectiveness of such non-invasive tech-
niques. 
(b) SCOPE.— 
(1) SIZE.—The pilot program shall include a 
representative sample of covered veterans that is of 
sufficient size for the Secretary to determine— 
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(A) the effectiveness and feasibility of pro-
viding veterans with non-invasive techniques to 
treat spinal, back, and musculoskeletal injuries 
and pain; and 
(B) the unique considerations that exist 
with respect to providing such treatment— 
(i) to female veterans; 
(ii) to veterans of various ages; and 
(iii) to veterans located in various re-
gions of the United States, including both 
urban and rural locations. 
(2) PREFERENCE.—In selecting covered vet-
erans to participate in the pilot program, the Sec-
retary shall give preference to covered veterans who 
served in Operation Enduring Freedom, Operation 
Iraqi Freedom, or Operation New Dawn. 
(c) ADMINISTRATION.—In administering the pilot 
program, the Secretary shall— 
(1) determine the type of non-invasive tech-
nique to provide to a covered veteran; 
(2) determine the effect of allowing self-referral 
by a veteran to receive non-invasive techniques com-
pared with requiring a veteran to receive a referral 
from a physician for non-invasive techniques; and 
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(3) ensure the use of telehealth technology to 
provide covered veterans who reside in rural loca-
tions (as determined by the Secretary) with non- 
invasive techniques to treat spinal, back, and mus-
culoskeletal injuries and pain. 
(d) PARTNERSHIP.— 
(1) UNIVERSITY.—In administering the pilot 
program, the Secretary shall seek to enter into an 
agreement with a university affiliated with the De-
partment of Veterans Affairs to carry out the pilot 
program. 
(2) SELECTION.—In entering into an agree-
ment with a university under paragraph (1), the 
Secretary shall ensure that the individuals who treat 
covered veterans with non-invasive techniques for 
spinal, back, and musculoskeletal injuries and 
pain— 
(A) are trained to— 
(i) effectively treat such veterans; and 
(ii) recognize the unique experiences 
of such veterans, including experiences re-
lated to serving in Operation Enduring 
Freedom, Operation Iraqi Freedom, or Op-
eration New Dawn; and 
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(B) use best practices and technologies 
with respect to the non-invasive technique being 
used to treat such veterans. 
(e) DURATION.—The pilot program shall begin not 
later than March 1, 2011, and shall continue for two 
years. 
(f) REPORTS.— 
(1) INITIAL REPORT.—Not later than June 1, 
2012, the Secretary shall submit to the Committee 
on Veterans’ Affairs of the House of Representatives 
and the Committee on Veterans’ Affairs of the Sen-
ate a report on the pilot program, including— 
(A) an analysis of the effectiveness and 
cost-effectiveness of each non-invasive technique 
provided under the pilot program; 
(B) an analysis of how the Secretary would 
incorporate non-invasive techniques to treat spi-
nal, back, and musculoskeletal injuries and pain 
at medical facilities of the Department of Vet-
erans Affairs; 
(C) the amount of cost-savings, if any, cre-
ated by providing veterans with non-invasive 
techniques to treat spinal, back, and musculo-
skeletal injuries and pain; 
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(D) a comparison of the non-invasive tech-
niques provided under the pilot program with 
other methods used by the Secretary to treat 
spinal, back, and musculoskeletal injuries and 
pain; and 
(E) recommendations of the Secretary with 
respect to— 
(i) continuing or expanding the pilot 
program; and 
(ii) any legislation or other actions to 
improve treating veterans with spinal, 
back, and musculoskeletal injuries and 
pain. 
(2) FINAL REPORT.—Not later than June 1, 
2013, the Secretary shall submit to the Committee 
on Veterans’ Affairs of the House of Representatives 
and the Committee on Veterans’ Affairs of the Sen-
ate a report containing updated information to the 
report submitted under paragraph (1). 
(g) DEFINITIONS.—In this section: 
(1) The term ‘‘covered veteran’’ means a vet-
eran who— 
(A) has a service-connected spinal, back, or 
musculoskeletal injury; or 
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(B) is eligible for hospital care, medical 
services, and nursing home care by virtue of 
section 1710(e)(1)(D) of title 38, United States 
Code. 
(2) The term ‘‘non-invasive techniques’’ means 
methods of treatment for spinal, back, and musculo-
skeletal injuries and pain other than surgery, includ-
ing— 
(A) 
manual 
physical 
therapy, 
core 
strengthening and stabilization therapy, water 
exercise therapy, group exercise therapy, and 
pain management therapy; 
(B) such methods (including recreational 
therapy) used by the War Related Illness and 
Injury Study Center of the Department of Vet-
erans Affairs located in Palo Alto, California, 
and the mindfulness based stress reduction pro-
gram of the Puget Sound Health Care System 
of the Department of Veterans Affairs that the 
Secretary determines to have been successful; 
and 
(C) such other methods not widely avail-
able in medical facilities of the Department of 
Veterans Affairs. 
Æ 
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