Advisory Committee on Rural Veterans Act of 2007

Mr. Speaker, I yield myself such time as I may consume.

Let me first take this opportunity to thank the chairman of the Subcommittee on Health, Mr. Michaud, as well as the subcommittee's ranking member, Mr. Miller, for their leadership in developing this legislation.

H.R. 2199, as amended, the Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007, seeks to improve the treatment of veterans suffering with traumatic brain injuries, often referred to as TBI, and the care for veterans who live in rural communities.

However, I would comment that several of the provisions included in this legislation are similar to initiatives that already exist or are getting underway. For example, section 2 of the bill would require the VA to screen eligible veterans for symptoms of traumatic brain injury and create a TBI registry. These are also the recommendations of the President's task force on returning global war on terror heroes. In addition, in March 2007, Secretary Nicholson directed a number of changes to improve the way the VA provides care to our newest combat veterans.

These veterans initiatives include screening all OEF and OIF combat patients for TBI and for PTSD; providing each polytrauma patient with an advocate to assist them and their family; mandatory training for all VA health care personnel to recognize and care for patients with TBI; and establishing an outside panel of clinical experts to review the VA polytrauma system of care.

Additionally, the bill would provide five new centers for TBI research, education, and clinical activities. During the 108th Congress, we recognized the frequency and unique nature of the polytrauma/blast injuries resulting from the global war on terror. These injuries require an interdisciplinary program to handle the medical, psychological, rehabilitation, and prosthetic needs of the injured servicemember.

Public Law 108-422, the Veterans' Health Programs Improvement Act of 2004, directed VA to establish ``an appropriate number of centers for research, education, and clinical activities to improve and coordinate rehabilitative services for veterans suffering from complex multitrauma from combat injuries, and to coordinate these services with the Department of Defense.''

The centers required in Public Law 108-422 became the Polytrauma System of Care. There are four centers located in Richmond, VA; Tampa, FL; Minneapolis, MN; and Palo Alto, CA. The committee strongly recommends that the new TBI centers be colocated with the VA's polytrauma rehabilitation centers. In this way, we can capitalize on the experience and expertise available at the polytrauma centers and enhance the ability to understand and treat the entire spectrum of the TBI injury from mild to most severe.

I want to thank Mr. Michaud for recognizing that we can actually get some benefits by the colocation of these services where TBI is already located. Because we take and concentrate such expertise, the colocation can only have benefits. And the gentleman worked with me, and I think because TBI have a number of comorbidities such as PTSD, depression, anxiety disorders, and while these issues may appear with TBI, they may also exhibit themselves separately from TBI, and I think that is exactly what Mr. Michaud is trying to get to. So I want to thank the gentleman for his leadership and for bringing this bill to the committee, along with your staff, for their good work.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I would like to thank Mr. Michaud because he did his committee work. He did his committee work because we brought a bill to the floor. Yes, under suspension, Mr. Filner, but he did his committee work. He filed a report which allowed us to work with him. When you don't file a report, you deny the minority their opportunity to be heard.

So I want to thank Mr. Michaud for working with us and for his leadership.

Mr. Speaker, I yield such time as he may consume to the gentleman from Arkansas (Mr. Boozman).

Mr. Speaker, I would also like to express my support for a provision in the bill that would require the VA to establish a TBI transition office at each of the polytrauma network sites. Not only is this vital for the DOD and the VA to provide for a seamless transition from active duty to veteran status, but it is also important for VA to aid in the coordination of veteran care between VA and other health care providers for services that could possibly not be provided by the VA. These transition offices would help coordinate veterans care for services not offered by the VA, and have the authority to arrange care with public or private entities to establish long-term neurobehavioral rehabilitation and recovery programs.

The bill also includes two rural health initiative provisions, one of which would establish a pilot program for vet centers in rural areas. H.R. 2199, as amended, included an amendment

offered by Mr. Lamborn of Colorado, the ranking member of the Subcommittee on Disability Assistance and Memorial Affairs. This amendment will expand the role of the mobile vet center pilot program to include helping veterans in need of assistance in the filing of benefits claims.

Mr. Speaker, I yield such time as he may consume to the gentleman from Colorado (Mr. Lamborn).

Mr. Speaker, I reserve my time.

Mr. Speaker, I want to thank the gentleman who just spoke. As a retired sergeant major, we benefit by his expertise not only on the Veterans' Affairs Committee, but also in Congress. We have a lot of people here who have been enlisted, and we have had officers and generals and admirals, but when you get a sergeant major, they speak softly. And there's a reason the sergeant major speaks softly, because he doesn't have to speak loudly because they are so well respected. And so, Sergeant Major, your contributions to the committee are recognized and appreciated.

Mr. Speaker, I reserve my time.

Mr. Speaker, I appreciate the gentleman's comments that he just made. Before you take off, this issue, and I appreciate your interest in it because this is one of our great challenges. We've got the best helmet that we put on our soldiers and marines in the field and even some of the Air Force personnel, Navy personnel. And it protects them against ballistics, and it's the best in the world. But when it comes to blasts and crash, what it does to the brain, we're now on the forefront, and we are pushing the boundary of our knowledge.

And some of the world's experts now are not only at the polytrauma centers, but in particular, when these soldiers end up at Landstuhl, Germany, that's where they are. So they can immediately deal with these neurotraumas.

And when the gentleman said that there could possibly be thousands, what we do know is that at the polytrauma centers, those who are actually being treated for traumatic brain injury, there's less than 400 cases.

But the gentleman is right with regard to individuals who may have had a concussion. Yet, how severe is the concussion?

And if the science is unknown, and we're trying to understand that. That's the purpose of Mr. Michaud's bill. And I appreciate the gentleman's interest, would love to continue to work with you in your interest.

I'd bring to your attention the Veterans Health Administration Directive 2007-013 released April 13, 2007, establishes the VA policy and procedure for screening and evaluation of possible TBI in OEF and OIF veterans. This directive states, ``Not all patients who screen positive have TBI. It is possible to respond positively to all four sections due to the presence of other conditions such as PTSD, cervical cranial injury with headaches and inner ear injury, for example. Therefore, it's critical that patients not be labeled with a diagnosis of TBI on the basis of a positive screening test. Patients need to be referred for further evaluation.''

So we are in an area of science whereby the sand shifts directly under our feet, and I would look forward to working with the gentleman.

Mr. Speaker, I reserve my time.

Mr. Speaker, I yield myself such time as I may consume.

At the May 9, 2007, full committee hearing on the results of the President's Task Force on Returning Global War on Terror Heroes, in response to my questioning about the actual number of TBI cases treated in VA as inpatients, Secretary Nicholson responded that VA has treated 369 veterans in its polytrauma centers so far for TBI.

Secretary Nicholson also commented that the VA has the capacity in their polytrauma centers, and that many of the patients in the polytrauma centers are active duty military.

Mr. Speaker, I continue to reserve my time.

Mr. Speaker, I believe that it is conceivable that at some point one of these needed Traumatic Brain Injury Centers of Excellence could be located in the Department of Veterans Affairs Medical Center in Albuquerque, New Mexico, which could be named the Raymond G. ``Jerry'' Murphy Department of Veterans Affairs Medical Center, if Chairman Filner would clear either H.R. 474 or take up Senate bill 229 for consideration on the floor of which that Senate bill, Mr. Speaker, sits at your desk.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 2199) to amend title 38, United States Code, to direct the Secretary of Veterans Affairs to provide certain improvements in the treatment of individuals with traumatic brain injuries, and for other purposes, as amended.

Mr. Speaker, I yield myself 3 minutes.

Mr. Speaker, I would point out this is one of the most important bills on the floor today or at any time. It's called the Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007.

The wounded from wars in Afghanistan and Iraq are returning with multiple injuries due to the use of improvised explosive devices, or IEDs. This often results in servicemembers and veterans needing polytrauma care, and has caused an increase in veterans with brain injury, or TBI.

We are going to have tens of thousands of these young men and women with these injuries. Among veterans and servicemembers that return from OEF and OIF and treated at Walter Reed for injuries of any type, approximately 65 percent have TBI or a comorbid, as they call it, diagnosis. Survivors of TBI experience physical, cognitive, emotional and community integration issues. Because of their injury, their capacity and initiative to seek appropriate care on their own is diminished.

We are also faced with thousands of veterans returning from Iraq and Afghanistan with milder cases of brain injury. This milder case often is missed and goes untreated, and symptoms may often mirror that of PTSD. Indeed, according to the Defense and Veterans Brain Injury Center, in prior military conflicts, TBI was present in up to 14 to 20 percent of surviving casualties. The numbers for operations in OEF/OIF are predicted to go much, much higher.

We must ensure that the health care and services that meet the needs of returning servicemembers are available and accessible, while never forgetting the needs of veterans from previous conflicts. This bill provides for mandatory screening of veterans for traumatic brain injury. It requires the Secretary to establish a comprehensive program of long-term care, of postacute traumatic brain injury rehabilitation at four geographically disbursed polytrauma network sites. It provides for the establishment of TBI transition offices at each Department polytrauma network site to coordinate health care and services to veterans who suffer from moderate to severe traumatic brain injuries. It requires the Secretary to establish a registry of those who served in Iraq who exhibit symptoms associated with TBI.

This legislation establishes centers for TBI research, education and clinical activities, and requires the Secretary to establish a committee on the care of veterans with TBI. In addition to the provisions that address health care, research and treatment for veterans, this legislation also provides for veterans who reside in rural areas.

Mr. Speaker, it is a very important bill. We will hear soon from Mr. Michaud, the chairman of our Health Subcommittee, who was the primary author of this, who has been a leader to make sure that we serve the veterans who come back with these incredible injuries, that they receive the proper care that they need.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I recognize the chairman of our subcommittee who has taken such a great leadership role on these issues, the gentleman from Maine (Mr. Michaud) for 4 minutes.

Mr. Speaker, I yield 1\1/4\ minutes to the chairwoman of our Economic Opportunity Subcommittee, the gentlelady from South Dakota, Stephanie Herseth Sandlin.

Mr. Speaker, we have had many people contribute to this legislation, as Mr. Michaud said. I would like to recognize a great new Member from Indiana who has worked hard on this legislation, Mr. Donnelly, for 2 minutes.

Mr. Speaker, I would like to yield 2 minutes to another hard-working new member from our committee, the gentleman from California (Mr. McNerney).

Mr. Speaker, I would like to yield 2 minutes to another hard-working new member of our committee, the highest-enlisted man ever to be elected to Congress, Command Sergeant Major Tim Walz from Minnesota.

Mr. Speaker, how much time do we have left?

I would now recognize another great new Member from Pennsylvania (Mr. Altmire) for 2 minutes. He has taken the lead on dealing with traumatic brain injury.

Mr. Speaker, I'd like to yield 2 minutes to the fighting gentleman from New Jersey (Mr. Pascrell), who we like to call an honorary member of the Veterans' Committee since he fights so hard for veterans and is cochair of the Traumatic Brain Injury Caucus in the Congress.

Mr. Speaker, I'd like to yield 2 minutes to another great new Member fighting for veterans, Congressman Welch from Vermont.

Mr. Speaker, let me just conclude by saying like everything else about this war, the administration did not prepare either for the fighting, the aftermath, or the treatment of the

veterans coming back. We simply left thousands of our veterans without adequate resources to treat these brain injuries or PTSD or other issues that arise. No matter what denial that comes from the minority party, no matter what denial comes from the administration, we have not prepared for adequate treatment of these veterans. We are passing legislation today to do that, and we will not deny that there will be thousands and thousands of brain-injured veterans. We should bring them home now and we should treat them well when they get back.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I thank the chairman for yielding.

H.R. 2199 is a bipartisan effort to address the challenges presented by traumatic brain injury and to improve the quality of care for our rural veterans.

TBI is considered to be the signature wound of this war. TBI is complex and frequently overlooked or misdiagnosed.

We also have very little understanding of the long-term consequences of TBI. We must make sure that the VA is doing all they can to provide for these wounded soldiers. This is only the beginning, we still have more work to do, but this is a good first step.

H.R. 2199 also includes two provisions to improve the quality of care provided

to our rural veterans. With so many veterans from Iraq and Afghanistan living in rural areas, and an already existing population of older veterans in these areas, we need to explore innovative ways to improve VA accessibility and quality of care, especially on mental health issues. You heard both from the chairman and ranking member as far as what this legislation does.

I would like to recognize the hard work of a group of Members on both sides of the aisle who helped craft this legislation. This truly is bipartisan legislation. I do want to start with my good friend, Mr. Miller of Florida, who is the ranking member of the Health Care Subcommittee, who has been extremely helpful in getting this legislation introduced and moved through the full committee; also, Mr. Altmire of Pennsylvania, who has taken a real leadership role in traumatic brain injury, and for his focus on TBI with his legislation, H.R. 1944, which is included in H.R. 2199; Mr. Walz of Minnesota, for his legislation to establish centers for TBI research, education, and clinical activities, which are now also included in H.R. 2199, who also served on the Veterans' Affairs Committee; and Mr. McNerney of California, his legislation was included in H.R. 2199 to create the Committee on Care for Veterans with TBI; Mr. Donnelly, who sits on the Veterans' Affairs Committee, of Indiana, for his bill which was included in section 4 of H.R. 2199, to create an advisory committee on rural veterans; Mr. Welch of Vermont, for his bill and efforts to establish a pilot program for mobile vet centers, which are extremely important for rural areas; Mr. Lamborn of Colorado, for his amendment to include providing benefits outreach and assistance with claims for benefits as part of the mission of mobile vet centers. He also sits on the committee and was very helpful in making this bill a better bill.

So this truly has been a real bipartisan piece of legislation that took a lot of components of other bills that were through, that were introduced and we had hearings on, to be part of this bill.

I also would like to thank Ranking Member Buyer for his focus on this issue, and for his understanding of the importance of long-term research and the pursuit of the best practices for TBI care. He definitely has been very helpful with this legislation.

And, finally, I would like to thank and congratulate Chairman Filner for his strong bipartisan leadership on this bill and other veterans bills on the floor as well, and look forward to tackling other veterans issues as we move forward in the 110th Congress.

I urge my colleagues to support H.R. 2199.

Mr. Speaker, I rise again today in support of H.R. 2199, the Traumatic Brain Injury Health Enhancement and Long-Term Support Act. This bill offers a comprehensive legislative solution to confronting our servicemembers' increasing suffering from Traumatic Brain Injury.

Our brave men and women who serve in Operation Iraqi Freedom and Operation Enduring Freedom are faced with daunting physical and mental challenges every day as they carry out their duties. Troops deployed in Iraq, specifically, encounter the widespread use of IEDs, which can cause Traumatic Brain Injury. Extended deployments put our troops at risk for longer periods of time.

H.R. 2199 brings together solutions to begin addressing the needs of our wounded warriors who have been diagnosed with TBI. The bill requires the VA to establish five centers for TBI research, education, and clinical activities. It also instructs the VA to establish a TBI screening program that would provide critical information to Congress regarding the number of veterans screened, the prevalence of TBI symptoms, and recommendations for improving care. H.R. 2199 dictates that the VA should create a comprehensive program for the long-term care and rehabilitation for veterans who suffer from TBI. The bill also requires the VA to create a Traumatic Brain Injury Veterans Health Registry to generate a list of those who served in Iraq and/or Afghanistan, who have symptoms of TBI, and who apply for VA medical care or file a disability claim. The VA can then notify those on the registry of significant developments in research on health consequences of serving in Iraq and/or Afghanistan.

Additionally, this bill authorizes funding for a pilot program of mobile VA centers for rural areas. These mobile VA centers would improve access to readjustment benefits as well as mental health services. The mobile centers would also assist veterans in making disability claims.

I represent a rural district comprised of small towns and villages. I know that my rural veterans' constituency desperately needs better access to VA services and care, and these mobile VA centers could be part of the solution.

I strongly urge my colleagues to support this bill because it makes great strides in providing comprehensive care for our Nation's wounded warriors suffering from Traumatic Brain Injury.

Mr. Speaker, I want to thank the Veterans' Affairs Committee, the openness of that committee, to let anyone with a good idea to help veterans to come in and have an opportunity to do that. Mr. Filner, Mr. Michaud, and, of course, Mr. Buyer and Mr. Miller, thank you.

Rural Americans have always served the Nation's armed services, National Guard and Reserves in very great numbers. In fact, though only 19 percent of the Nation lives in rural America, 44 percent of the current U.S. military recruits come from rural areas, and nearly one- third of those who died in Iraq are from small towns and communities across the Nation, Vermont very much among them.

And unfortunately, access to health care for many of our veterans in rural areas is limited by mileage, distance and just the difficulty of transportation. Especially true, the provision of mental health care in rural settings has historically been a challenge for all health care systems and providers, including the VA. And therefore, what we recognize in this legislation is that we need to help the VA develop innovative solutions to address the need for mental health services in remote areas, TBI being the big injury that's been discussed by my colleagues.

This legislation takes a significant step towards improving the mental health services available to geographically isolated veterans. It creates a pilot program where at least two mobile vet centers will provide readjustment counseling and mental health services to veterans in at least five Veterans Integrated Service Networks that have the highest concentration of rural veterans.

One of these covers New England and my home State of Vermont. These mobile vet centers will also provide information and outreach concerning veterans benefits and, when practicable, assistance with claims for benefits.

Rural individuals and their families have strong bonds and ties to their communities. These mobile vet centers will allow veterans to stay in their communities and prevent endless hours of car rides for the care they receive.

I urge support and passage of this legislation and thank the committee for its indulgence.