This report examines legislation to improve treatment and support services for veterans suffering from traumatic brain injuries, a common service-related condition affecting many former military members. The bill aims to enhance access to specialized care, research, and rehabilitation programs through the Department of Veterans Affairs to better serve veterans dealing with this serious health issue. The Veterans' Affairs Committee reviewed the proposal to ensure veterans receive comprehensive and effective treatment for brain injuries sustained during military service.
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House Report 119-344 - VETERANS NATIONAL TRAUMATIC BRAIN INJURY TREATMENT ACT
[House Report 119-344]
[From the U.S. Government Publishing Office]
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-344
========================================================================
VETERANS NATIONAL TRAUMATIC BRAIN INJURY TREATMENT ACT
----------------
October 17, 2025.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
----------------
Mr. Bost, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 1336]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1336) to direct the Secretary of Veterans
Affairs to establish a pilot program to furnish hyperbaric
oxygen therapy to a veteran who has a traumatic brain injury or
post-traumatic stress disorder, having considered the same,
reports favorably thereon with an amendment and recommends that
the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Subcommittee Consideration....................................... 5
Committee Consideration.......................................... 5
Committee Votes.................................................. 6
Committee Oversight Findings..................................... 10
Statement of General Performance Goals and Objectives............ 10
Earmarks and Tax and Tariff Benefits............................. 10
Committee Cost Estimate.......................................... 10
Budget Authority and Congressional Budget Office Estimate........ 10
Federal Mandates Statement....................................... 13
Advisory Committee Statement..................................... 13
Applicability to Legislative Branch.............................. 14
Statement on Duplication of Federal Programs..................... 14
Section-by-Section Analysis of the Legislation................... 14
Changes in Existing Law Made by the Bill, as Reported............ 15
Minority Views................................................... 18
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans National Traumatic Brain
Injury Treatment Act''.
SEC. 2. PILOT PROGRAM TO FURNISH HYPERBARIC OXYGEN THERAPY TO A VETERAN
WITH TRAUMATIC BRAIN INJURY OR POST-TRAUMATIC STRESS DISORDER.
(a) Establishment.--The Secretary of Veterans Affairs shall implement
a pilot program to furnish HBOT to a veteran who has a traumatic brain
injury or post-traumatic stress disorder through a health care provider
described in section 1703(c)(5) of title 38, United States Code.
(b) Locations.--The Secretary shall select two Veterans Integrated
Service Networks in which to operate the pilot program.
(c) Accreditation Required.--The Secretary shall ensure that any
medical facility at which a veteran who has a traumatic brain injury or
post-traumatic stress disorder receives HBOT pursuant to the pilot
program is accredited by--
(1) the Joint Commission on Accreditation of Hospital
Organizations;
(2) the Undersea and Hyberbaric Medical Society; or
(3) another appropriate organization that has expertise and
objectivity comparable to that of the Joint Commission on
Accreditation of Hospital Organizations or the Undersea and
Hyberbaric Medical Society.
(d) Funding.--
(1) There is in the general fund of the Treasury a fund to be
known as the ``VA HBOT Fund'' (in this Act referred to as the
``Fund'').
(2) The sole source of monies for the Fund shall be donations
received by the Secretary for express purposes of the Fund.
(3) Amounts in the Fund shall be available to the Secretary
without fiscal year limitation to pay for HBOT under subsection
(a).
(4) The Fund shall terminate on the termination date under
subsection (e).
(e) Termination.--The pilot program shall terminate on the day that
is three years after the date of the enactment of this Act.
(f) HBOT Defined.--In this Act, the term ``HBOT'' means hyperbaric
oxygen therapy with a medical device--
(1) approved by the Food and Drug Administration; or
(2) issued an investigational device exemption by the Food
and Drug Administration.
SEC. 3. GAO REPORT ON THE USE OF HYPERBARIC OXYGEN THERAPY TO TREAT
TRAUMATIC BRAIN INJURY AND POST-TRAUMATIC STRESS DISORDER.
Not later than one year after the date of the enactment of this Act,
the Comptroller General of the United States shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives an update to the report titled ``Research on Hyperbaric
Oxygen Therapy to Treat Traumatic Brain Injury and Post-Traumatic
Stress Disorder'' (GAO-16-154). Such report shall include the
assessment of the Comptroller General of clinical trials conducted,
since the publication of such report--
(1) regarding the use of hyperbaric oxygen therapy to treat
traumatic brain injury and post-traumatic stress disorder; and
(2) by--
(A) the Secretary of Veterans Affairs;
(B) the Secretary of Defense; and
(C) private entities.
SEC. 4. EXTENSION OF CERTAIN LIMITS ON PAYMENTS OF PENSION.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``November 30, 2031'' and inserting ``October 30, 2034''.
Purpose and Summary
H.R. 1336, the ``Veterans National Traumatic Brain Injury
Treatment Act,'' was introduced by Representative Gregory F.
Murphy of North Carolina on February 13, 2025. This bill, as
amended, would establish a three-year pilot program at the
Department of Veterans Affairs (VA) to furnish hyperbaric
oxygen therapy (HBOT) to veterans who have traumatic brain
injury (TBI) or post-traumatic stress disorder (PTSD) as a
result of their military service.
Background and Need for Legislation
Section 1: Short title
Section 1 would establish the name of the Act as the
``Veterans National Traumatic Brain Injury Treatment Act.''
Section 2: Pilot program to furnish hyperbaric oxygen therapy to a
veteran with traumatic brain injury or post-traumatic stress
disorder
This section would require the creation of a VA pilot
program to provide HBOT to veterans with TBI or PTSD. The pilot
would last for three years and would be implemented at two
Veterans Integrated Service Networks (VISNs).
Studies show that certain types of injuries require more
than atmospheric oxygen for the healing process. HBOT is
designed to increase the supply of oxygen in humans' blood and
tissues. The U.S. Food and Drug Administration (FDA) has
cleared HBOT for treating several types of injuries, such as
wound healing, necrotizing infections, radiation injury, carbon
monoxide poisoning, and burns. Because microscopic and
macroscopic wounds to the white matter of the brain have been
attributed to PTSD and TBI, HBOT has been explored as a
possible means of therapy for these conditions.
Studies have suggested HBOT is an effective treatment for
veterans suffering from PTSD and TBI. It has shown promising
results in accelerating the brain's healing process by
providing the bloodstream with elevated oxygen levels to reach
and repair damaged tissue and restore function.
When HBOT chambers are used for indications cleared by the
FDA, HBOT is generally safe, and serious complications are
rare. This section would require that a medical facility
providing HBOT under the VA pilot program would be accredited
by the Joint Commission on Accreditation of Hospital
Organizations, the Undersea and Hyperbaric Medical Society, or
other comparable organizations. The Committee directs the VA
Secretary to consider Hyperbaric Oxygen Therapy for Post-
Traumatic Stress Disorder: Comprehensive Clinical Practice
Guidelines, published in March 2025 by the Sagol Center for
Hyperbaric Medicine and Research at Shamir Medical Center, Tel-
Aviv University in Israel. These guidelines offer a rigorous,
evidence-based framework that outlines treatment pressure and
duration standards, symptom tracking protocols, and long-term
outcome measures. The Committee encourages the Department to
incorporate the core elements of these protocols into the pilot
program's clinical design and implementation, as appropriate
for the overall veteran population.
This section would also authorize donations to pay for the
pilot program, though the program would be fully offset by
other means. Funds from donations would be available without
fiscal year limitation to pay for HBOT therapy. There has been
a donation effort for at least one state-level HBOT program,
but that program is likewise primarily, if not entirely,
government-funded.\1\
---------------------------------------------------------------------------
\1\See, e.g., Victor Skinner, HBOT for Vets gets half-million in
assistance from state budget, The Center Square (Sept. 29, 2023),
https://www.thecentersquare.com/north_carolina/
article_6e49658c-5e44-11ee-bd10-cbce78c76064.html.
---------------------------------------------------------------------------
According to the VA 2024 National Veteran Suicide
Prevention Annual Report, there were an average of 17.6 veteran
suicides per day in 2022. The Committee believes it is
necessary to continue to explore alternative treatments for
PTSD and TBI in order to address the tragically high rates of
suicide among veterans. HBOT has the potential to significantly
improve veteran wellbeing.
Section 3: GAO report on the use of hyperbaric oxygen therapy to treat
traumatic brain injury and post-traumatic stress disorder
This section would require that the Government
Accountability Office (GAO) assess HBOT use for PTSD and TBI
and update the report on such use published by GAO in 2015.\2\
---------------------------------------------------------------------------
\2\GAO, Research on Hyperbaric Oxygen Therapy to Treat Traumatic
Brain Injury and Post-Traumatic Stress Disorder (Dec. 18, 2015),
https://www.gao.gov/products/gao-16-154.
---------------------------------------------------------------------------
Section 4: Extension of certain limits on payments of pension
Under current law (38 U.S.C. Sec. 5503(d)), the amount of
VA pension paid to a veteran with no spouse or child, a
veteran's surviving spouse with no children, or a veteran's
child, who are admitted to a VA or Medicaid sponsored nursing
facility is capped at $90 a month. Section 4 would cover the
costs of the other sections of this bill by extending this cap
from November 30, 2031, to October 30, 2034. Because they
receive government sponsored care in a nursing home, these
pension beneficiaries do not require the full amount of pension
to cover their cost of living. The Committee believes this
short-term extension of the current limit on pension payments
is a reasonable way to cover the costs associated with the
other sections of this bill.
While donations are permitted to pay for the pilot as
authorized, the pilot is fully funded by this pension offset.
Hearings
On March 11, 2025, the Committee on Veterans' Affairs
Subcommittee on Health held a legislative hearing on H.R. 1336
and other bills that were pending before the subcommittee.
The following witnesses testified:
The Honorable Jack Bergman, U.S. House of
Representatives, 1st Congressional District, Michigan;
The Honorable Gregory F. Murphy, U.S. House of
Representatives, 3rd Congressional District, North
Carolina; The Honorable Steve Womack, U.S. House of
Representatives, 3rd Congressional District, Arkansas;
The Honorable Don Bacon, U.S. House of Representatives,
1st Congressional District, Nebraska; The Honorable
Sylvia R. Garcia, U.S. House of Representatives, 29th
Congressional District, Texas; The Honorable Lauren
Underwood, U.S. House of Representatives, 14th
Congressional District, Illinois; The Honorable
Christopher R. Deluzio, U.S. House of Representatives,
17th Congressional District, Pennsylvania; Dr. Thomas
O'Toole, Deputy Assistant Under Secretary for Health
for Clinical Services, Quality and Field Operations,
Veterans Health Administration (VHA), VA; Dr.
Antoinette Shappell, Deputy Assistant Under Secretary
for Health for Patient Services, VHA, VA; Dr. Thomas
Emmendorfer, Executive Director, Pharmacy Benefits
Management, VHA, VA; Dr. Jeffrey Gold, President,
University of Nebraska System; Ms. Sue Morris,
President, Veterans Trust; Mr. Brian Dempsey, Director
of Government Affairs, Wounded Warrior Project; Dr.
Andrew Kozminski, Medical Director of Hyperbaric
Medicine, University of Iowa Health Care; Mr. Ed
Harries, President, National Association of State
Veterans Homes; Mr. Jon Retzer, Deputy National
Legislative Director, Disabled American Veterans.
The following individuals and organizations submitted
statements for the record:
Veterans Healthcare Policy Institute; Paralyzed Veterans of
America; American Federation of Government Employees;
Representative Murphy; Trajector Medical; American Association
for Marriage and Family Therapy.
Subcommittee Consideration
On March 25, 2025, the Subcommittee on Health met in an
open markup session to consider H.R. 1336. During consideration
of the bill, the following amendments were considered:
An amendment to H.R. 1336 was offered by Ranking Member
Julia Brownley of California. This amendment would require that
providers have certification from the Joint Commission on
Accreditation of Hospital Organizations, the Undersea and
Hyperbaric Medical Society, or a comparably expert and
objective accrediting body. This amendment passed by voice
vote.
An amendment to H.R. 1336 was offered by Representative
Kelly Morrison of Minnesota. This amendment would require VA to
create a report of research on HBOT as a treatment for PTSD and
TBI prior to implementation. This amendment failed by a
recorded vote of 5 ayes, 7 noes.
An amendment to H.R. 1336 was offered by Representative
Sheila Cherfilus-McCormick of Florida. This amendment would
require a GAO report with an assessment about the use of HBOT
to treat TBI and PTSD and with an update to the report,
Research on Hyperbaric Oxygen Therapy to Treat Traumatic Brain
Injury and Post-Traumatic Stress Disorder (GAO-16-154), within
one year of enactment of the bill. This amendment was adopted
by voice vote.
A motion by Representative Derrick Van Orden to report H.R.
1336, as amended, favorably to the full Committee on Veterans'
Affairs was agreed to by voice vote.
Committee Consideration
On May 6, 2025, the Committee on Veterans' Affairs met in
open markup session to consider H.R. 1336, as amended. During
consideration of the bill, the following amendments were
considered:
An amendment in the nature of a substitute to H.R. 1336, as
amended, was offered by Representative Murphy. This amendment
would reduce the amount of VISNs in the pilot program from
three to two, reduce the pilot program length from five years
to three years, and provide an offset for the cost of the bill.
This amendment passed by voice vote.
An amendment to the amendment in the nature of a substitute
to H.R. 1336, as amended, was offered by Representative Herb
Conaway of New Jersey. This amendment would make veterans
eligible for priority group 6 of the annual system for VA's
patient enrollment system if those veterans became ineligible
for Medicaid coverage between the period beginning on January
20, 2025, and ending on January 19, 2029. This amendment failed
by a recorded vote of 11 ayes, 13 noes.
An amendment to the amendment in the nature of a substitute
to H.R. 1336, as amended, was offered by Representative Herb
Conaway. This amendment would require the VA Secretary to
report on all clinical trials cancelled during the period
beginning of January 20, 2025, and ending on the date of
enactment of the bill. This amendment failed by a recorded vote
of 11 ayes, 13 noes.
A motion by Representative Bergman to report H.R. 1336, as
amended, favorably to the House of Representatives, was agreed
to by voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, two recorded votes were taken on
amendments, or in connection with, ordering H.R. 1336, as
amended, reported to the House.
An amendment to the amendment in the nature of a substitute
to H.R. 1336 offered by Mr. Conaway was not agreed to by a
recorded vote of 11 ayes, 13 noes. The names of Members voting
for and against follow:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
An amendment to the amendment in the nature of a substitute
to H.R. 1336 offered by Mr. Conaway was not agreed to by a
recorded vote of 11 ayes, 13 noes. The names of Members voting
for and against follow:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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 of H.R. 1336, as amended, are to furnish
HBOT as a treatment for veterans with TBI or PTSD and further
explore the benefits of this treatment for veterans' healing.
Earmarks and Tax and Tariff Benefits
H.R. 1336, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 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.
1336, as amended, prepared by the Director of the Congressional
Budget Office.
Budget Authority and 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. 1336, as amended, provided by the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The bill would:
Require the Department of Veterans Affairs
(VA) to implement a temporary program to provide
hyperbaric oxygen therapy (HBOT) to veterans diagnosed
with post-traumatic stress disorder or traumatic brain
injury
Require the Government Accountability Office
to report on HBOT research
Extend the reduction of pensions that VA
pays to veterans and survivors residing in Medicaid
nursing homes
Estimated budgetary effects would mainly stem from:
Providing HBOT to eligible veterans
Reducing pension payments
Areas of significant uncertainty include:
Estimating the number of veterans who would
receive HBOT
Bill summary: H.R. 1336 would require the Department of
Veterans Affairs (VA) to provide hyperbaric oxygen therapy
(HBOT) to veterans diagnosed with post-traumatic stress
disorder or traumatic brain injury. The bill also would require
the Government Accountability Office (GAO) to update its report
on HBOT therapy. Finally, the bill would extend a statutory
limitation on pension payments to veterans in Medicaid nursing
homes through October 2034.
Estimated Federal cost: The estimated budgetary effects of
H.R. 1336 are shown in Table 1. The costs of the legislation
fall within budget functions 550 (health) and 700 (veterans
benefits and services).
Table 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1336
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
---------------------------------------------------------------------------------------------------------
2025- 2025-
2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2030 2035
--------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES OR DECREASES (-) IN DIRECT SPENDING
Estimated Budget Authority * * 16 18 0 0 0 -40 -48 -48 -3 34 -105
Estimated Outlays * * 14 18 2 0 0 -40 -48 -48 -3 34 -105
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
EstimatedPAuthorization * 1 61 62 0 0 0 0 0 0 0 124 124
Estimated Outlays * 1 55 62 6 0 0 0 0 0 0 124 124
--------------------------------------------------------------------------------------------------------------------------------------------------------
* = between zero and $500,000.
Basis of estimate: For this estimate, CBO assumes that H.R.
1336 will be enacted in fiscal year 2025 and that outlays will
follow historical spending patterns for affected programs.
Provisions that affect spending subject to appropriation
and direct spending: Section 2 would require VA to provide HBOT
to veterans diagnosed with post-traumatic stress disorder or
traumatic brain injury in two of the department's regional
health care networks during the three-year period following
enactment.
Using data from VA about the prevalence of those conditions
among veterans and published literature on the costs of HBOT,
CBO estimates that roughly 6,000 veterans would participate in
the program at an average cost of $27,000 for a course of 40
treatments.
The bill would establish a fund to accept donations for the
program; however, CBO anticipates that contributions would be
minimal and would not significantly offset the costs of the
program. In total, CBO estimates that the temporary program
would cost $158 million over the three-year period.
CBO expects that some of the costs of implementing the bill
would be paid from the Toxic Exposures Fund (TEF) established
by Public Law 117-168, the Honoring our PACT Act. The TEF is a
mandatory appropriation that VA uses to pay for health care,
disability claims processing, medical research, and IT
modernization that benefit veterans who were exposed to
environmental hazards.
Additional spending from the TEF would occur if legislation
increases the costs of similar activities that benefit veterans
with such exposure. Thus, in addition to increasing spending
subject to appropriation, enacting section 2 would increase
amounts paid from the TEF, which are classified as direct
spending. CBO projects that the proportion of costs paid by the
TEF will grow over time based on the amount of formerly
discretionary appropriations that CBO expects will be provided
through the mandatory appropriation as specified in the
Honoring our PACT Act.\1\
---------------------------------------------------------------------------
\1\For additional information about estimated spending from the
TEF, see Congressional Budget Office, ``Toxic Exposures Fund--January
2025 Baseline'' (January 2025), https://www.cbo.gov/system/files/2025-
01/60044-2025-01-tef.pdf.
---------------------------------------------------------------------------
CBO estimates that over the 2025-2035 period, implementing
section 2 would increase spending subject to appropriation by
$124 million and direct spending by $34 million.
Direct spending: In addition to expanding benefits that
would partly be covered by the TEF, enacting H.R.1336 would
affect direct spending by extending a statutory limitation on
VA pension payments. In total, enacting the bill would decrease
net direct spending by $105 million over the 2025-2035 period
(see Table 2).
Under current law, VA reduces pension payments to veterans
and survivors who reside in Medicaid nursing homes to $90 per
month. That required reduction expires November 30, 2031.
Section 4 of the bill would extend the reduction for 35 months,
through October 31, 2034. CBO estimates that extending that
requirement would reduce VA benefits by $10 million per month.
(Those benefits are paid from mandatory appropriations and are
therefore considered direct spending.) As a result of that
reduction in beneficiaries' income, Medicaid would pay more of
the cost of their care, increasing spending for that program by
$6 million per month.
In total, enacting section 4 would reduce direct spending
by $139 million over the 2025-2035 period, CBO estimates.
TABLE 2.--ESTIMATED CHANGES IN DIRECT SPENDING UNDER H.R. 1336
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
--------------------------------------------------------------------------------------------------
2025- 2025-
2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2030 2035
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hyperbaric Oxygen Therapy:
Estimated Budget Authority......................... * * 16 18 0 0 0 0 0 0 0 34 34
Estimated Outlays.................................. * * 14 18 2 0 0 0 0 0 0 34 34
Pensions:
Estimated Budget Authority......................... 0 0 0 0 0 0 0 -40 -48 -48 -3 0 -139
Estimated Outlays.................................. 0 0 0 0 0 0 0 -40 -48 -48 -3 0 -139
Total Changes:
Estimated Budget Authority......................... * * 16 18 0 0 0 -40 -48 -48 -3 34 -105
Estimated Outlays.................................. * * 14 18 2 0 0 -40 -48 -48 -3 34 -105
--------------------------------------------------------------------------------------------------------------------------------------------------------
* = between zero and $500,000.
Spending subject to appropriation: The discussion above in
``Provisions that Affect Spending Subject to Appropriation and
Direct Spending'' describes the costs of implementing a program
to provide HBOT to eligible veterans. Establishing the program
would increase spending subject to appropriation by $124
million over the 2025-2035 period.
Section 3 would require GAO to update its 2015 report on
the use of HBOT to treat post-traumatic stress disorder and
traumatic brain injury. Based on the costs of similar reporting
requirements, CBO estimates that preparing the report would
cost less than $500,000.
Uncertainty: CBO's estimate of the costs of H.R. 1336 is
subject to uncertainty, particularly with regard to the number
of veterans who would receive HBOT under the program. Costs
would differ if the number of participants is greater or less
than CBO estimates.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in Table 1.
Increase in long-term net direct spending and deficits: CBO
estimates that enacting H.R. 1336 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2036.
Mandates: The bill contains no intergovernmental or
private-sector mandates as defined in the Unfunded Mandates
Reform Act.
Estimate prepared by: Federal costs: Noah Callahan (for
veterans' health care), Logan Smith (for veterans' and
survivors' pensions); Mandates: Grace Watson.
Estimate reviewed by: David Newman, Chief, Defense,
International Affairs, and Veterans' Affairs Cost Estimates
Unit; Kathleen FitzGerald, Chief, Public and Private Mandates
Unit; Christina Hawley Anthony, Deputy Director of Budget
Analysis.
Estimate approved by: Phillip L. Swagel, Director,
Congressional Budget Office.
Federal Mandates Statement
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4), is inapplicable to H.R. 1336,
as amended.
Advisory Committee Statement
No advisory committee within the meaning of section 5(b) of
the Federal Advisory Committee Act would be created by H.R.
1336, as amended.
Applicability to Legislative Branch
The Committee finds that H.R. 1336, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodation within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 1336, as amended, establishes or reauthorizes a program
of the Federal Government known to be duplicative of another
Federal program, a program that was included in any report from
the Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
Section-by-Section Analysis of the Legislation
Section 1: Short title
This section would establish the short title as the
``Veterans National Traumatic Brain Injury Treatment Act.''
Section 2: Pilot program to furnish hyperbaric oxygen therapy to a
veteran with traumatic brain injury or post-traumatic stress
disorder
This section would require the VA Secretary to implement a
pilot program to furnish HBOT to a veteran who has a service-
connected TBI or PTSD and select two VISNs in which to operate
the pilot program. It would limit the pilot to three years
following enactment.
This section would require that medical facilities that
provide HBOT obtain accreditation from the Joint Commission on
Accreditation of Hospital Organizations, the Undersea and
Hyperbaric Medical Society, or other appropriate organization
with similar expertise and objectivity. It would also create
the ``VA HBOT Fund'' at Treasury, which would be funded solely
by donations to pay for HBOT through the pilot.
Finally, this section would define the term ``HBOT'' as
hyperbaric oxygen therapy with a medical device that is
approved by the FDA or issued an investigational device
exemption by the FDA.
Section 3: GAO Report on the use of hyperbaric oxygen therapy to treat
traumatic brain injury and post-traumatic stress disorder
This section would require a GAO report, within one year of
date of enactment, which would include an assessment of
clinical trials regarding the use of HBOT to treat TBI and PTSD
and an update to the GAO report, Research on Hyperbaric Oxygen
Therapy to Treat Traumatic Brain Injury and Post-Traumatic
Stress Disorder (GAO-16-154).
Section 4: Extension of certain limits on payments of pension
This section would extend the limitation of pension payable
to certain veterans, their surviving spouses, or their children
as established in section 38 U.S.C. Sec. 5503(d)(7) from
November 30, 2031, to October 30, 2034.
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 (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
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 (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 55--MINORS, INCOMPETENTS, AND OTHER WARDS
* * * * * * *
Sec. 5503. Hospitalized veterans and estates of incompetent
institutionalized veterans
(a)(1)(A) Where any veteran having neither spouse nor child
is being furnished domiciliary care by the Department, no
pension in excess of $90 per month shall be paid to or for the
veteran for any period after the end of the third full calendar
month following the month of admission for such care.
(B) Except as provided in subparagraph (D) of this paragraph,
where any veteran having neither spouse nor child is being
furnished nursing home care by the Department, no pension in
excess of $90 per month shall be paid to or for the veteran for
any period after the end of the third full calendar month
following the month of admission for such care. Any amount in
excess of $90 per month to which the veteran would be entitled
but for the application of the preceding sentence shall be
deposited in a revolving fund at the Department medical
facility which furnished the veteran nursing care, and such
amount shall be available for obligation without fiscal year
limitation to help defray operating expenses of that facility.
(C) No pension in excess of $90 per month shall be paid to or
for a veteran having neither spouse nor child for any period
after the month in which such veteran is readmitted for care
described in subparagraph (A) or (B) of this paragraph and
furnished by the Department if such veteran is readmitted
within six months of a period of care in connection with which
pension was reduced pursuant to subparagraph (A) or (B) of this
paragraph.
(D) In the case of a veteran being furnished nursing home
care by the Department and with respect to whom subparagraph
(B) of this paragraph requires a reduction in pension, such
reduction shall not be made for a period of up to three
additional calendar months after the last day of the third
month referred to in such subparagraph if the Secretary
determines that the primary purpose for the furnishing of such
care during such additional period is for the Department to
provide such veteran with a prescribed program of
rehabilitation services, under chapter 17 of this title,
designed to restore such veteran's ability to function within
such veteran's family and community. If the Secretary
determines that it is necessary, after such period, for the
veteran to continue such program of rehabilitation services in
order to achieve the purposes of such program and that the
primary purpose of furnishing nursing home care to the veteran
continues to be the provision of such program to the veteran,
the reduction in pension required by subparagraph (B) of this
paragraph shall not be made for the number of calendar months
that the Secretary determines is necessary for the veteran to
achieve the purposes of such program.
(2) The provisions of paragraph (1) shall also apply to a
veteran being furnished such care who has a spouse but whose
pension is payable under section 1521(b) of this title. In such
a case, the Secretary may apportion and pay to the spouse, upon
an affirmative showing of hardship, all or any part of the
amounts in excess of the amount payable to the veteran while
being furnished such care which would be payable to the veteran
if pension were payable under section 1521(c) of this title.
(b) Notwithstanding any other provision of this section or
any other provision of law, no reduction shall be made in the
pension of any veteran for any part of the period during which
the veteran is furnished hospital treatment, or institutional
or domiciliary care, for Hansen's disease, by the United States
or any political subdivision thereof.
(c) Where any veteran in receipt of an aid and attendance
allowance described in subsection (r) or (t) of section 1114 of
this title is hospitalized at Government expense, such
allowance shall be discontinued from the first day of the
second calendar month which begins after the date of the
veteran's admission for such hospitalization for so long as
such hospitalization continues. Any discontinuance required by
administrative regulation, during hospitalization of a veteran
by the Department, of increased pension based on need of
regular aid and attendance or additional compensation based on
need of regular aid and attendance as described in subsection
(l) or (m) of section 1114 of this title, shall not be
effective earlier than the first day of the second calendar
month which begins after the date of the veteran's admission
for hospitalization. In case a veteran affected by this
subsection leaves a hospital against medical advice and is
thereafter admitted to hospitalization within six months from
the date of such departure, such allowance, increased pension,
or additional compensation, as the case may be, shall be
discontinued from the date of such readmission for so long as
such hospitalization continues.
(d)(1) For the purposes of this subsection--
(A) the term ``Medicaid plan'' means a State plan for
medical assistance referred to in section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)); and
(B) the term ``nursing facility'' means a nursing
facility described in section 1919 of such Act (42
U.S.C. 1396r), other than a facility that is a State
home with respect to which the Secretary makes per diem
payments for nursing home care pursuant to section
1741(a) of this title.
(2) If a veteran having neither spouse nor child is covered
by a Medicaid plan for services furnished such veteran by a
nursing facility, no pension in excess of $90 per month shall
be paid to or for the veteran for any period after the month of
admission to such nursing facility.
(3) Notwithstanding any provision of title XIX of the Social
Security Act, the amount of the payment paid a nursing facility
pursuant to a Medicaid plan for services furnished a veteran
may not be reduced by any amount of pension permitted to be
paid such veteran under paragraph (2) of this subsection.
(4) A veteran is not liable to the United States for any
payment of pension in excess of the amount permitted under this
subsection that is paid to or for the veteran by reason of the
inability or failure of the Secretary to reduce the veteran's
pension under this subsection unless such inability or failure
is the result of a willful concealment by the veteran of
information necessary to make a reduction in pension under this
subsection.
(5)(A) The provisions of this subsection shall apply with
respect to a surviving spouse having no child in the same
manner as they apply to a veteran having neither spouse nor
child.
(B) The provisions of this subsection shall apply with
respect to a child entitled to pension under section 1542 of
this title in the same manner as they apply to a veteran having
neither spouse nor child.
(6) The costs of administering this subsection shall be paid
for from amounts available to the Department of Veterans
Affairs for the payment of compensation and pension.
(7) This subsection expires on [November 30, 2031] October
30, 2034.
* * * * * * *
MINORITY VIEWS
This bill, as amended, would require VA to establish a
five-year pilot program in three Veterans Integrated Service
Networks (VISN) to furnish hyperbaric oxygen therapy (HBOT) to
veterans with traumatic brain injuries or post-traumatic stress
disorder. This treatment would be furnished by community
providers and would be funded through donations.
Committee Democrats are pleased that this bill, as amended,
incorporates two amendments offered by Democratic members at
the Health Subcommittee markup on March 25, 2025: an amendment
offered by Rep. Cherfilus-McCormick to direct the U.S.
Government Accountability Office (GAO) to complete an update to
its 2015 report\1\ on HBOT as a treatment for TBI and PTSD; and
an amendment offered by Rep. Brownley to require any facility
where veterans receive HBOT to be accredited by the Joint
Commission, the Undersea & Hyperbaric Medical Society, or
another relevant accrediting body in order to participate in
the established pilot program.
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\1\U.S. Government Accountability Office, Defense Health Care:
Research on Hyperbaric Oxygen Therapy to Treat Traumatic Brain Injury
and Post-Traumatic Stress Disorder, GAO-16-154 (Washington, DC: Dec.
18, 2015).
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However, we remain concerned that Committee Republicans
rejected an amendment offered by Rep. Morrison at the Health
Subcommittee markup that would have directed VA to conduct a
systematic review of published studies on the efficacy of HBOT
as a treatment for PTSD and TBI before the pilot program could
commence. Committee Democrats would posit that we should ensure
the latest available literature supports the treatment before
veterans can access it. If HBOT is demonstrated as an effective
treatment, then the pilot program should move forward.
But the fact remains that the scientific literature, at
present, does not support VA establishing an HBOT pilot
program, and such a program would not be in keeping with VA's
clinical practice guidelines for treatment of TBI and PTSD. For
example, separate reviews conducted by GAO in 2015\2\ and VA in
2018\3\ suggest that the evidence regarding the effectiveness
of these treatments for both TBI and PTSD is mixed, at best. VA
concluded, ``In summary, the large treatment benefits
demonstrated for HBOT in uncontrolled case series have not been
easily replicated in well-controlled [randomized controlled
trials] RCTs.'' Additionally, VA submitted a congressionally
mandated report in 2021 that presented the findings of a
systematic review of published literature, which also found
little evidence to support the creation of a pilot program like
the one H.R. 1336, as amended, would establish.
Finally, the funding structure of the program--relying on
donations--is concerning to Committee Democrats. This structure
is not a typical way that VA provides care, and we remain
concerned by VA's testimony that donations may not cover the
cost of treatment for all veterans and that additional funding
may be required. It seems the majority agreed with this
assessment and with CBO's assessment that the bill may trigger
a cost since they included pay-for language in the A.N.S.
Committee Democrats are concerned that the pilot program will
put VA in the difficult position of choosing whether to expend
funds it may not have appropriated for this purpose, or denying
veterans care that may or may not help with their mental health
conditions.
For these reasons, Committee Democrats remain deeply
concerned about this legislation and would recommend work be
done to ensure that additional scientific due diligence be
completed before VA implements such a program.
Mark Takano,
Ranking Member.
[all]