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110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-722

======================================================================



 
                VETERANS' EPILEPSY TREATMENT ACT OF 2008

                                _______
                                

 June 19, 2008.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Filner, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2818]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2818) to amend title 38, United States Code, to 
provide for the establishment of Epilepsy Centers of Excellence 
in the Veterans Health Administration of the Department of 
Veterans Affairs, having considered the same, report favorably 
thereon with amendments and recommend that the bill as amended 
do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     7

                               Amendment

  The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans' Epilepsy Treatment Act of 
2008''.

SEC. 2. EPILEPSY CENTERS OF EXCELLENCE.

  (a) Requirement for Establishment of Epilepsy Centers of 
Excellence.--Subchapter II of chapter 73 of title 38, United States 
Code, is amended by adding at the end the following new section:

``Sec. 7330A. Epilepsy centers of excellence

  ``(a) Designation of Centers.--Not later than 120 days after the date 
of enactment of this section, the Secretary shall designate an epilepsy 
center of excellence at each of the 5 centers designated under section 
7327.
  ``(b) Expert Clinical and Research Staff.--Each center designated 
under subsection (a) shall employ such expert clinical and research 
staff, including board certified neurologists and neurosurgeons, as may 
be necessary to ensure that such center is capable of serving as a 
center of excellence in research, education, and clinical care 
activities in the diagnosis and treatment of epilepsy, including post-
traumatic epilepsy.
  ``(c) Requirements and Operation of Centers.--Each center designated 
under subsection (a) shall function as a center for--
          ``(1) research on the diagnosis, treatment, and long-term 
        effects of epilepsy, including epilepsy developed as a result 
        of combat, in order to support the provision of services for 
        such diagnosis and treatment in accordance with the most 
        current information on epilepsy;
          ``(2) the development of evidence-based methodologies for 
        treating individuals with epilepsy;
          ``(3) the continuous and consistent coordination of care from 
        the point of referral throughout the diagnostic and treatment 
        process and ongoing follow-up after return to home and 
        community;
          ``(4) the development of a national system of coordinated 
        care for veterans with epilepsy, including the development and 
        maintenance of a national network of Department health care 
        personnel with an interest and expertise in the care and 
        treatment of epilepsy and the establishment of a referral 
        system and procedure within each Veterans Integrated Service 
        Network;
          ``(5) assist in the expansion, where appropriate, of the 
        utilization of telehealth technology, including exploring the 
        use of such technology to develop, transmit, monitor, and 
        review neurological diagnostic tests and other applicable uses 
        of telehealth technology for the diagnosis, care, and treatment 
        of veterans with epilepsy; and
          ``(6) the dissemination of educational materials and research 
        regarding diagnosis, care, and treatment of epilepsy, 
        throughout the Department.
  ``(d) Administration.--In order to assist the Secretary in carrying 
out this section, the Secretary shall designate a national coordinator 
for epilepsy programs who shall report to the official responsible for 
neurology at the Veterans Health Administration and shall--
          ``(1) supervise the operation of the centers designated under 
        this section;
          ``(2) coordinate and support the national network of 
        Department health care professionals with an interest and 
        expertise in the care and treatment of epilepsy;
          ``(3) ensure that the education and research mission of such 
        centers is being accomplished; and
          ``(4) conduct regular evaluations of such centers to ensure 
        compliance with the requirements of this section.
  ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2009 through 2013.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
7330 the following new item:

``7330A. Epilepsy centers of excellence.''.

  Amend the title so as to read:

      A bill to amend title 38, United States Code, to provide 
for the establishment of epilepsy centers of excellence in the 
Veterans Health Administration of the Department of Veterans 
Affairs.''.

                          Purpose and Summary

    H.R. 2818 was introduced by Representative Ed Perlmutter of 
Colorado on June 21, 2007. This legislation would establish 
Epilepsy Centers of Excellence in the Veterans Health 
Administration of the Department of Veterans Affairs.

                  Background and Need for Legislation

    Epilepsy is a neurological condition, which affects the 
nervous system and causes seizures. Epilepsy is usually 
diagnosed after a person has had at least two seizures that 
were not caused by some known medical condition. There is not 
one single cause of epilepsy and, in up to half of the epilepsy 
cases, it is not possible to specify the cause of the seizures. 
Research indicates that children may be born with a defect in 
the structure of their brain, or they may suffer a head injury 
or infection that causes epilepsy. Severe head injury and other 
neurological conditions such as strokes, tumors, and 
degenerative conditions such as Alzheimer's disease are also 
known causes of epilepsy.
    According to the Veterans Health Administration (VHA) there 
are approximately 89,000 veterans with epilepsy enrolled in the 
Department of Veterans Affairs (VA) Health Care System. Of 
those veterans enrolled with epilepsy, about 42 percent, or 
37,000, are service-connected for epilepsy.
    In testimony presented to the Senate Committee on Veterans' 
Affairs on May 23, 2007, on behalf of the American Academy of 
Neurology, Dr. John Booss stated that in 1972, the VA created 
Health Centers which specialized in research and treatment of 
epilepsy. These VA Health Centers partnered with medical 
schools to assist in treating veterans with seizures, and build 
a body of knowledge around the diagnosis and treatment of 
epilepsy. However, in the early 1990's, funding dissipated and 
the Centers were curtailed.
    At this time, the VA operates seven Epilepsy Monitoring 
sites. According to the Department of Veterans Affairs, the 
seven sites have the following capabilities: (1) an epilepsy 
monitoring unit; (2) capacity to perform invasive monitoring; 
(3) ability to implant vagus nerve stimulators; and, (4) 
ability to perform resection of epileptic foci. Five additional 
sites have the capacity to perform epilepsy surgery but not all 
of the other components listed above.
    The use of improvised explosive devices (IEDs) in Iraq and 
Afghanistan and the prevalence of the types of blast injuries 
they inflict on the servicemembers are devastating. Loss of 
limb, traumatic brain injury (TBI), eye injuries, and other 
polytrauma injuries present new challenges to medicine and the 
overall treatment modalities within VA. The long-term effect of 
blast exposures is not known. Although there is no data on 
post-traumatic epilepsy in the current conflicts, during 
Vietnam, a number of men and women returned home with head 
wounds and head injuries. According to the 1985 report of the 
Vietnam Head Injury Study published in Neurology, of 421 
veterans who had penetrating brain wounds in Vietnam 15 years 
ago, 53 percent had post-traumatic epilepsy, and one-half of 
those still had seizures 15 years after injury.
    H.R. 2818, as amended, would establish Epilepsy Centers of 
Excellence within the Department of Veterans Affairs. The 
Epilepsy Centers of Excellence would function as centers for 
research on the diagnosis, treatment and long-term effects of 
epilepsy. These Centers would develop evidence-based 
methodology for treatment of epilepsy, coordinate care for 
veterans with epilepsy, develop a national referral system for 
veterans with epilepsy, expand telehealth technology for 
treatment of veterans with epilepsy and disseminate educational 
materials on the diagnosis and treatment of epilepsy.
    H.R. 2818 would further require that the Epilepsy Centers 
of Excellence be co-located with the five VA Polytrauma 
Rehabilitation Centers located in Palo Alto, California; 
Minneapolis, Minnesota; Richmond, Virginia; Tampa, Florida; 
and, San Antonio, Texas. Co-locating the Epilepsy Centers of 
Excellence and the Polytrauma Rehabilitation Centers will allow 
VA to optimize its already-existing resources and 
infrastructure to more effectively carry out the mission of the 
Centers.
    The Committee generally supports the establishment of 
Centers of Excellence for conditions that effect veterans. 
However, given the resources of the VA, the Committee feels 
that any new Centers of Excellence should be established to 
give VA the ability to leverage already existing Department 
infrastructure and resources. Integration of resources will 
allow the VA to offer veterans a full continuum of 
comprehensive care throughout the VA healthcare system.

                                Hearings

    On April 15, 2008, the Subcommittee on Health held a 
legislative hearing on a number of bills introduced in the 
110th Congress, including H.R. 2818. The following witnesses 
testified: The Honorable Bob Filner of California; The 
Honorable Michael H. Michaud of Maine; The Honorable Ginny 
Brown-Waite of Florida; The Honorable Ed Perlmutter of 
Colorado; The Honorable Christopher P. Carney of Pennsylvania; 
The Honorable Brad Ellsworth of Indiana; Joseph L. Wilson, 
Deputy Director, Veterans Affairs and Rehabilitation 
Commission, The American Legion; Joy J. Ilem, Assistant 
National Legislative Director, Disabled American Veterans; 
Christopher Needham, Senior Legislative Associate, National 
Legislative Service, Veterans of Foreign Wars of the United 
States; Richard F. Weidman, Executive Director for Policy and 
Government Affairs, Vietnam Veterans of America; Gerald M. 
Cross, MD, FAAFP, Principal Deputy Under Secretary for Health, 
Veterans Health Administration, U.S. Department of Veterans 
Affairs, accompanied by Walter Hall, Assistant General Counsel, 
U.S. Department of Veterans Affairs. Those submitting 
statements for the record included: American Veterans (AMVETS) 
and the Paralyzed Veterans of America.

                        Committee Consideration

    On June 5, 2008, the Subcommittee on Health met in open 
markup session and ordered favorably forwarded to the full 
Committee H.R. 2818, as amended, by voice vote. During 
consideration of the bill the following amendment was 
considered:

          An amendment in the nature of a substitute by Mr. 
        Salazar of Colorado to require that the Epilepsy 
        Centers of Excellence be co-located with the 5 
        polytrauma centers in the Department of Veterans 
        Affairs was agreed to by voice vote.

    On June 11, 2008, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 2818, as 
amended, reported favorably to the House of Representatives, by 
voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 2818 reported to the House. A motion by Mr. 
Buyer of Indiana to order H.R. 2818, as amended, reported 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 2818 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the 
House of Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
2818 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 2818 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 18, 2008.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2818, the Veterans 
Epilepsy Treatment Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 2818--Veterans Epilepsy Treatment Act of 2008

    H.R. 2818 would require the Secretary of the Department of 
Veterans Affairs (VA) to establish five centers of excellence 
for epilepsy research, education, and clinical care at VA 
health care facilities, and to appoint a national coordinator 
for those centers and for other epilepsy programs at the 
Veterans Health Administration. The bill would authorize the 
appropriation of $5 million each year over the 2009-2013 
period.
    In total, CBO estimates that implementing H.R. 2818 would 
cost $25 million over the 2009-2013 period, assuming that the 
specified amounts are appropriated and that outlays follow 
historical spending patterns for similar programs. Enacting the 
bill would have no effect on direct spending or revenues.
    H.R. 2818 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    On November 30, 2007, CBO transmitted a cost estimate for 
S. 2004, a similar bill that was ordered reported by the Senate 
Committee on Veterans' Affairs on November 14, 2007. S. 2004 
would authorize the appropriation of $6 million a year for the 
centers of excellence and such sums as may be necessary for the 
national coordinator over the 2008-2012 period. CBO estimated 
that implementing S. 2004 would cost $31 million over the 2008-
2012 period, assuming appropriation of the specified and 
estimated amounts.
    The CBO staff contact for this estimate is Sunita D'Monte. 
This estimate was approved by Peter H. Fontaine, Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2818 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2818.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 2818 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This section would provide the short title of H.R. 2818 as 
the ``Veterans'' Epilepsy Treatment Act of 2008.''

Section 2. Epilepsy Centers of Excellence

    This section would amend chapter 73 of title 38, United 
States Code, to establish Epilepsy Centers of Excellence at 
each of the five polytrauma rehabilitation centers within the 
Department of Veterans Affairs. It requires that each center 
employ expert clinical and research staff. It also requires 
each center to function as a center for research on diagnosis, 
treatment and long-term effects of epilepsy; development of 
evidence-based methodology for treatment of epilepsy; 
coordination of care for veterans with epilepsy; development of 
a national referral system for veterans with epilepsy; 
expansion of telehealth technology for treatment of veterans 
with epilepsy; and dissemination of educational materials on 
the diagnosis and treatment of epilepsy. This section 
authorizes appropriations in the amount of $5,000,000 for each 
fiscal year from 2009 through 2013.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *



PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *



CHAPTER 73--VETERANS HEALTH ADMINISTRATION - ORGANIZATION AND FUNCTIONS

           *       *       *       *       *       *       *



                       SUBCHAPTER I--ORGANIZATION

Sec.
7301.  Functions of Veterans Health Administration: in general.
     * * * * * * *

           SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION

7311.  Quality assurance.
     * * * * * * *
7330A.  Epilepsy centers of excellence.

           *       *       *       *       *       *       *


SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION

           *       *       *       *       *       *       *


Sec. 7330A. Epilepsy centers of excellence

  (a) Designation of Centers.--Not later than 120 days after 
the date of enactment of this section, the Secretary shall 
designate an epilepsy center of excellence at each of the 5 
centers designated under section 7327.
  (b) Expert Clinical and Research Staff.--Each center 
designated under subsection (a) shall employ such expert 
clinical and research staff, including board certified 
neurologists and neurosurgeons, as may be necessary to ensure 
that such center is capable of serving as a center of 
excellence in research, education, and clinical care activities 
in the diagnosis and treatment of epilepsy, including post-
traumatic epilepsy.
  (c) Requirements and Operation of Centers.--Each center 
designated under subsection (a) shall function as a center 
for--
          (1) research on the diagnosis, treatment, and long-
        term effects of epilepsy, including epilepsy developed 
        as a result of combat, in order to support the 
        provision of services for such diagnosis and treatment 
        in accordance with the most current information on 
        epilepsy;
          (2) the development of evidence-based methodologies 
        for treating individuals with epilepsy;
          (3) the continuous and consistent coordination of 
        care from the point of referral throughout the 
        diagnostic and treatment process and ongoing follow-up 
        after return to home and community;
          (4) the development of a national system of 
        coordinated care for veterans with epilepsy, including 
        the development and maintenance of a national network 
        of Department health care personnel with an interest 
        and expertise in the care and treatment of epilepsy and 
        the establishment of a referral system and procedure 
        within each Veterans Integrated Service Network;
          (5) assist in the expansion, where appropriate, of 
        the utilization of telehealth technology, including 
        exploring the use of such technology to develop, 
        transmit, monitor, and review neurological diagnostic 
        tests and other applicable uses of telehealth 
        technology for the diagnosis, care, and treatment of 
        veterans with epilepsy; and
          (6) the dissemination of educational materials and 
        research regarding diagnosis, care, and treatment of 
        epilepsy, throughout the Department.
  (d) Administration.--In order to assist the Secretary in 
carrying out this section, the Secretary shall designate a 
national coordinator for epilepsy programs who shall report to 
the official responsible for neurology at the Veterans Health 
Administration and shall--
          (1) supervise the operation of the centers designated 
        under this section;
          (2) coordinate and support the national network of 
        Department health care professionals with an interest 
        and expertise in the care and treatment of epilepsy;
          (3) ensure that the education and research mission of 
        such centers is being accomplished; and
          (4) conduct regular evaluations of such centers to 
        ensure compliance with the requirements of this 
        section.
  (e) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $5,000,000 for each 
of fiscal years 2009 through 2013.

           *       *       *       *       *       *       *