This bill amends Title 38 to improve the treatment and care of military personnel with traumatic brain injuries. It adds a new subchapter to the code: “Traumatic Brain Injuries.”

Some key points of this bill are:

• Mandatory screening of veterans for TBI
• Long-term rehab for soldiers who:
  • were in combat after November 11, 1998
  • were diagnosed with moderate to severe TBI
  • require daily supervision or assistance
• establishment of a “traumatic brain injury transition office” at each polytrauma center for veterans who require additional services, which are not available at their location
• Establish a “traumatic brain injury registry” with the names of everyone who was treated for TBI, plus their medical information, if they agree to provide it, or are deceased.
• Establish “centers for traumatic brain injury research, education, and clinical activities” to improve the treatment and care of TBI patients
• Establish a “Committee on Care of Veterans with Traumatic Brain Injury” to improve the care of TBI patients

Representative Michael Michaud (D-ME), who sponsored this legislation, wrote on his Web site:

“TBI is considered by many to be the signature injury of the wars in Iraq and Afghanistan,” said Michaud. “It is important to remember that not all the wounds from this war are visible. Severe TBI is often easily recognizable, but mild and moderate TBI can be harder to detect. Because of this, some veterans may not even know that they are suffering from TBI and may go untreated. Passing this bill is a huge step forward for the detection and treatment of this long-term injury.”

Michaud’s legislation, the Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007 (H.R. 2199), is the result of the efforts of members from both sides of the aisle to address TBI and to begin to improve the outreach and oversight of health care provided to our rural veterans. The bill requires screening of veterans for TBI; establishes a comprehensive program for long-term TBI rehabilitation to be located at four geographically dispersed locations; creates TBI transition offices at each of the polytrauma network sites; requires the development of a TBI registry; authorizes funds for the establishment of centers for TBI research, education, and clinical activities; and forms the Committee on Care of Veterans with TBI.

The Associated Press reported:

‘House Speaker Nancy Pelosi, D-Calif., in a meeting with veterans service organizations Wednesday, said Democrats promised a new direction when they captured the congressional majority and “nowhere is that more important than in our treatment of our troops and our veterans.”’

My Opinions

We have four polytrauma centers, this bill allocates funds for eight instead of the 21 which Representative Altmire proposed in The Veterans Traumatic Brain Injury Act. However, it will also create ten mobile centers in rural areas.

It is terrific that Title 38 was amended to recognize TBI, and this bill is certainly a step in the right direction.

Update: I misunderstood the finances until I read the Cost Estimate, so I included the Budget Cost Estimate to make everything clear.

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

May 22, 2007

H.R. 2199
Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007

As ordered reported by the House Committee on Veterans’ Affairs on May 15, 2007

SUMMARY

H.R. 2199 would expand the health care available to veterans with traumatic brain injuries and would create a pilot program to provide mental health care and services to veterans in rural areas.

CBO estimates that implementing this bill would cost the Department of Veterans Affairs (VA) $27 million in 2008 and $138 million over the 2008-2012 period, assuming the appropriation of the necessary amounts. Enacting the bill would not affect direct spending or revenues.

H.R. 2199 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA) and would impose no costs on state, local, or tribal governments.

ESTIMATED COST TO THE FEDERAL GOVERNMENT

The estimated budgetary impact of H.R. 2199 is shown in the following table. The costs of this legislation fall within budget function 700 (veterans benefits and services).

BASIS OF ESTIMATE

For this estimate, CBO assumes the legislation will be enacted near the end of fiscal year 2007, that the necessary funds for implementing the bill will be provided each year, and that the outlays will follow historical spending patterns for the VA medical services program. H.R. 2199 would require the Secretary of VA to create several programs that would enhance the care provided to veterans with traumatic brain injuries. The bill also would establish a pilot program that would use mobile centers to provide counseling and other health services to veterans in rural areas. CBO estimates that implementing H.R. 2199 would cost $27 million in 2008 and $138 million over the 2008-2012 period, subject to appropriation of the necessary amounts.

Traumatic Brain Injury Centers

Section 2 would require VA to establish and operate up to five centers for research, education, and clinical activities focused on traumatic brain injury. CBO expects that those centers would be located within existing VA medical centers and would be established after a facility submits a proposal to be designated as a traumatic brain injury center and a peer review panel determines that the proposal meets certain standards. H.R. 2199 would authorize the appropriation of $10 million in 2008 and $20 million in each of years 2009 through 2011 to support those centers. CBO estimates that implementing this provision would cost $9 million in 2008 and $70 million over the 2008-2012 period.

Long-Term Care for Traumatic Brain Injury

Section 2 also would require a program of long-term care, to include residential facilities, community-based care, and home-based care for veterans with moderate-to-severe traumatic brain injuries. The program would be carried out at four VA medical centers that already specialize in care for servicemembers with multiple injuries. VA already provides long-term care for veterans with severe traumatic brain injuries, either at a VA medical facility, at a state-run veterans’ nursing home, or through contract care provided in the veteran’s community. VA has indicated that it would meet the requirements of this section by creating four centers that would specialize in caring for veterans with brain injuries, in addition to the four centers that already exist. Based on information from VA regarding the number of employees needed to staff these centers and the renovation and equipment needed to establish a center, CBO estimates that implementing this provision would cost $11 million in 2008 and about $45 million over the 2008-2012 period, assuming appropriation of the necessary amounts each year.

Mobile Health Centers for Rural Veterans

Section 3 would authorize a three-year pilot program in which VA would use mobile health centers to provide readjustment counseling and related health services to veterans in rural areas. The bill would require the use of two mobile centers in each of five specific geographic areas. Other mobile centers could be established if the Secretary determined they were needed. In addition to counseling and mental health services, the mobile centers would advise veterans of other benefits they may be eligible for and, to the extent possible, would help the veterans to apply for those additional benefits.

H.R. 2199 would authorize the appropriation of $7.5 million a year for three years to fund the mobile centers. CBO estimates that implementing this section would cost $7 million in 2008 and about $22 million over the 2008-2012 period.

Other Provisions

Section 2 also would require VA to:

• Screen all veterans for signs and symptoms of traumatic brain injury—which VA has already begun;
• Establish a committee to assess VA’s traumatic brain injury programs;
• Create a registry of veterans being treated for traumatic brain injury; and Establish offices at polytrauma centers to assist veterans who need care outside of VA.

CBO estimates that implementing those additional provisions would have an insignificant impact on discretionary spending.

INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

H.R. 2199 contains no intergovernmental or private-sector mandates as defined in UMRA and would impose no costs on state, local, or tribal governments.

ESTIMATE PREPARED BY:

Federal Costs: Michelle S. Patterson
Impact on State, Local, and Tribal Governments: Melissa Merrell
Impact on the Private Sector: Victoria Liu

ESTIMATE APPROVED BY:

Peter H. Fontaine
Deputy Assistant Director for Budget Analysis

Representative Altmire introduced this bill to modify U.S. Code Title 38, “Veteran’s Benefits”, which was enacted on September 2, 1958, and signature injury of the war seems to be everywhere, so this is certain to pass.

FYI: I just found 884 references to “signature injury” on Google, and 537 on Yahoo, up from 883 and 479 yesterday!

Of course, this bill might be amended, but it should improve the chances of returning Vets receiving better TBI care, in whatever form passes.

What follows is Representative Altmire’s original press release, on April, 19, 2007, followed one week later, by his initial testimony, and then the VFW’s statement.

1. ALTMIRE INTRODUCES BILL TO IMPROVE VETERANS’ HEALTH CARE

   Bipartisan coalition supports essential health care legislation to screen and treat traumatic brain injury

   (Washington, DC)—Rep. Jason Altmire (PA-4) introduced bipartisan legislation to ensure the proper screening and treatment of traumatic brain injuries (TBI) for America’s returning veterans.

   The Veterans Traumatic Brain Injury Act, H.R. 1944, would require the Veterans Affairs Administration to institute a program to screen veterans for symptoms of TBI; develop and operate a comprehensive program of long-term care for post-acute TBI rehabilitation; establish a TBI transition office at each of the 21 polytrauma network sites nationwide; and create and maintain a TBI veteran health registry. This legislation is a continuation of Rep. Altmire’s advocacy on behalf of the nation’s veterans.

   “More than 24,000 American troops have been wounded in Iraq and Afghanistan, many of whom have sustained multiple injuries due to confronting suicide bombers and improvised explosive devises,” said Rep. Altmire. “More than half of combat casualties in Iraq have associated brain injuries. Most of them include mild TBI, which often goes undiagnosed and is subsequently left untreated.”

   According to the National Institute of Neurological Disorders and Strokes, TBI occurs when a sudden trauma causes damage to the brain. Symptoms of TBI vary depending on the extent of damage to the brain, but include headaches, confusion, dizziness, blurred vision, fatigue, and behavioral and mood changes. Cases of mild TBI are under-diagnosed, especially when a service member has an external injury such as a burn or other life-threatening condition that requires immediate medical attention.

   “Traumatic brain injury has become the signature injury of both Operation Enduring Freedom and Operation Iraqi Freedom. Among veterans and service members returning from combat overseas, 65 percent have TBI,” said Rep. Altmire. “. The Veterans Traumatic Brain Injury Act will help the VA better coordinate care for our wounded warriors to ensure that veterans are properly screened, diagnosed and receive the treatment that they deserve.”

2. House Committee on Veterans’ Affairs
   Statement of the Honorable Jason Altmire, a Representative in Congress from the State of Pennsylvania

   Testimony Before the Subcommittee on Health of the House Committee on Veterans’ Affairs

   April 26, 2007
   I would like to thank Chairman Michaud, Ranking Member Miller and members of the committee for the opportunity to testify today about H.R. 1944, the Veterans Traumatic Brain Injury Act of 2007, bipartisan legislation that I introduced to increase the screening and treatment of traumatic brain injuries (TBI) for our nation’s veterans.

   Mr. Chairman, we are facing an impending crisis in this country. Our brave men and women are returning from Iraq and Afghanistan with TBI at an alarming rate. Of those treated at Walter Reed Army Medical Center, 65 percent have been diagnosed with TBI as a primary or co-morbid diagnosis.

   Many now consider TBI to be the signature injury of the wars in Iraq and Afghanistan.

   I am concerned that the Veterans Affairs Administration may not be properly identifying and treating TBI among the nation’s veterans.

   It is estimated that more than half of all combat casualties have associated brain injuries. Most of them include mild TBI, which is often missed in initial exams as physicians attend to other more apparent injuries.

   The Veterans Traumatic Brain Injury Act improves the coordination of TBI care for our nation’s veterans by requiring the Veterans Affairs Administration to screen veterans for symptoms, develop and operate a comprehensive program of long-term care for post-acute TBI rehabilitation, establish TBI transition offices at all poly-trauma network sites, and create and maintain a TBI veteran health registry.

   In our first four months, the 110th Congress has taken enormous strides in meeting its commitment to veterans. We have provided more than $11 billion in increased funding for veterans health care and passed the Wounded Warrior Assistance Act to improve the management of their medical care.

   I believe that we owe no greater debt than to our veterans and, while we have made some progress, we can do more to improve their health care. To this end, the bipartisan Veterans Traumatic Brain Injury Act will allow us to properly screen America’s returning heroes for TBI and improve their treatment.

   Thank you for the opportunity to speak today.

3. H.R. 1944

   The VFW offers our strong support for this legislation which would require VA to implement a screening program for traumatic brain injuries (TBI).

   TBI is the signature wound of this war, as thousands of our men and women in uniform are being exposed to blasts and other traumas which are doing great damage to their brains. This is an area where this nation clearly must do more to care for our sick and disabled, the wounded warriors of this war.

   TBI manifests itself in a number of ways. While some are able to live with its effects, it makes life extremely difficult for others. We know much about its causes and immediate symptoms, but we most know more about it. We have repeatedly called for more studies to fully understand the injuries, their causes, their effects, and especially their long-term impacts.

   This legislation considers the long-term impact, and for those who need it, it would establish programs to provide long-term care and rehabilitation. This is sorely needed.

   Further, it fosters the development of partnerships with other health care institutions through the creation of a TBI transition office, which is charged with coordinating services that are not readily available through VA.

   Given the difficulties we have sadly seen with some of these wounded warriors receiving the care they need, especially for those who live far from the polytrauma centers, this is an excellent step. Many of these clinics and specialty care facilities have great experience with brain injuries and can provide these patients the care they desperately need, and VA with the expertise and training it needs to fulfill its most sacred of missions.