[House Report 113-247]
[From the U.S. Government Publishing Office]
113th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 113-247
======================================================================
TINNITUS RESEARCH AND TREATMENT ACT OF 2013
_______
October 22, 2013.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Miller of Florida, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1443]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1443) to direct the Secretary of Veterans
Affairs to recognize tinnitus as a mandatory condition for
research and treatment by the Department of Veterans Affairs,
and for other purposes, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
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
Statement of Constitutional Authority............................ 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 7
Disclosure of Directed Rulemaking................................ 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill as Reported............. 8
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 ``Tinnitus Research and Treatment Act of
2013''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Since 2006, the most prevalent service-connected
disability for which veterans have received compensation under
the laws administered by the Secretary of Veterans Affairs has
been tinnitus.
(2) The number of veterans receiving such compensation for
tinnitus has risen each year since 2006, increasing the number
and cost of the compensation claims paid by the Secretary.
(3) A growing body of peer reviewed literature indicates a
direct connection between traumatic brain injury, post
traumatic stress disorder, and tinnitus.
(4) An analysis of data collected by the Department of
Veterans Affairs concluded that total amount of disability
compensation paid for tinnitus by the Department of Veterans
Affairs in 2012 was $1,500,000,000.
(5) Based on projected rates of growth, the amount of
disability compensation payable to veterans for tinnitus is
expected to exceed $3,000,000,000 in 2017.
SEC. 3. RECOGNITION AND TREATMENT OF TINNITUS AT DEPARTMENT OF VETERANS
AFFAIRS AUDITORY CENTERS OF EXCELLENCE.
The Secretary of Veterans Affairs shall recognize tinnitus as a
condition for research and treatment by the Department of Veterans
Affairs Auditory Centers of Excellence.
SEC. 4. RESEARCH ON PREVENTION AND TREATMENT OF TINNITUS.
(a) In General.--The Secretary of Veterans Affairs shall recognize
the need to enhance the research and treatment of tinnitus and to
ensure the allocation of appropriate resources directed at the research
and enhanced treatment of tinnitus conducted by the Auditory Centers of
Excellence of the Department of Veterans Affairs, commensurate with
peer-review protocols. Such research shall include--
(1) an assessment of the efficacy of multidisciplinary
tinnitus treatment modalities on different subsets of patients;
(2) studies on the underlying etiology of tinnitus in veteran
populations that occur as a result of different causal factors,
including blast-related tinnitus where there is no measurable
hearing loss versus other forms of noise-induced tinnitus where
there is hearing loss; and
(3) a study of the underlying mechanisms between hearing loss
and tinnitus, including cases in which one or the other
condition is present, but not both.
(b) Relationship to Other Authorities.--Nothing in this section shall
be construed as interfering with the discretion of the Secretary of
Veterans Affairs to conduct research in accordance with peer-review
protocols in order to ensure the quality and transparency of the
research.
SEC. 5. INTERDEPARTMENTAL COOPERATION.
The Secretary of Veterans Affairs shall ensure the cooperation of the
Department of Veterans Affairs with the Hearing Center of Excellence
established by the Department of Defense to further research on
tinnitus.
PURPOSE AND SUMMARY
H.R. 1443, the Tinnitus Research and Treatment Act of 2013,
was introduced by Representative Michael H. Michaud of Maine,
Ranking Member of the Committee on Veterans' Affairs, on April
9, 2013. H.R. 1443, as amended, would: require the Department
of Veterans Affairs (VA) to recognize the need to enhance the
research and treatment of tinnitus; require VA to ensure the
allocation of the appropriate resources directed at the
research and treatment of tinnitus conducted by the VA Auditory
Centers of Excellence, commensurate with peer-review protocols;
and, require VA to ensure cooperation with the Hearing Center
of Excellence established by the Department of Defense (DOD) to
further research on tinnitus.
BACKGROUND AND NEED FOR LEGISLATION
Tinnitus is the experience or sensation of hearing sound
when no external sound is present. It is often characterized by
a persistent ringing in the ears and can range from merely
distracting to wholly debilitating, depending on the severity
of the condition. While noise overexposure either from a single
impulse noise or cumulative exposure to noise is still the
number one cause of tinnitus, it can also develop as a result
of a head or neck injury. Further, a growing body of research
has directly linked tinnitus as a co-morbid condition to both
traumatic brain injury (TBI) and post-traumatic stress disorder
(PTSD), indicating that tinnitus represents a larger problem
than hearing loss in the blast-exposed population.
Tinnitus is one of the top five reported complaints from
veterans of all eras of service and is particularly prevalent
among veterans of Iraq and Afghanistan. Since 2006, the number
of service-connected disability claims for tinnitus has risen
at a rate of 15 percent each year, making it the most frequent
service-connected disability.
To care for these veterans, VA audiology clinics provide a
Progressive Tinnitus Management (PTM) program. According to VA,
``[t]he focus of PTM is to teach patients how to manage their
reactions to tinnitus.'' The PTM program encompasses five
hierarchical tiers: triage; audiologic evaluation; group
education; interdisciplinary evaluation; and, individualized
support. Services offered to veterans with tinnitus through the
PTM program include: hearing aids, group educational
counseling, individual counseling, drug therapy, sound-based
therapy, cognitive behavioral therapy, and relaxation
techniques.
Tinnitus-related research and educational resources are
provided through the National Center for Rehabilitative
Auditory Research (NCRAR), a VA Rehabilitation Research and
Development Center of Excellence that is located on the campus
of the Portland VA medical center. The NCRAR collaborates with
the VA Audiology Program to develop and evaluate the PTM
program at VA medical centers. VA also conducts research
related to tinnitus in collaboration with DOD through the
Defense Center of Excellence for Hearing Loss and Auditory
System Injuries, which was mandated by section 721 of Public
Law 110-417 (122 Stat. 4356, 4506), the Duncan Hunter National
Defense Authorization Act for Fiscal Year 2009. VA's total
investment in tinnitus-related research totals approximately
$1.2 million, about one-tenth of the total national research
dollars devoted to tinnitus.
While recognizing VA's efforts both within the Department
and in collaboration with DOD, the Committee is concerned with
the increasing number of veterans who report experiencing
tinnitus and the amount of VA research dollars dedicated to
understanding, treating, and preventing it. Further, the
Committee believes that greater knowledge of tinnitus could
lead to more effective treatments for veterans and a better
understanding of the link between tinnitus and both TBI and
PTSD.
H.R. 1443, as amended, would address the Committee's
concerns by requiring VA to conduct further research regarding
this condition.
HEARINGS
On July 9, 2013, the Subcommittee on Health conducted a
legislative hearing on various bills introduced during the
113th Congress, including Draft Legislation, the Long-Term Care
Veterans Choice Act; H.R. 1443; H.R. 1612; H.R. 1702; and, H.R.
2065.
The following witnesses testified:
The Honorable Mike Rogers of Alabama; the Honorable David
McKinley of West Virginia; Jacob Gadd, the Deputy Director for
Health Care for the Veterans Affairs and Rehabilitation
Commission of the American Legion; Susan E. Shore, Ph.D., the
Chair of the Scientific Advisory Committee for the American
Tinnitus Association; Adrian Atizado, the Assistant National
Legislative Director for the Disabled American Veterans; Robert
Drexler, Member of the Board of Directors for the International
Code Council, Raymond C. Kelley, Director of the National
Legislative Service for the Veterans of Foreign Wars; and
Robert L. Jesse, M.D., Ph.D., the Principal Deputy Under
Secretary for Health for the Veterans Health Administration of
the U.S. Department of Veterans Affairs, accompanied by Susan
Blauert, the Deputy Assistant General Counsel for the U.S.
Department of Veterans Affairs.
Statements for the record were submitted by the following:
The Honorable Ron Barber of Arizona; the Iraq and
Afghanistan Veterans of America; Tuskegee University; the
National Association of State Fire Marshals; the National
Coalition for Homeless Veterans; the Paralyzed Veterans of
America; the Vietnam Veterans of America; and the Wounded
Warrior Project.
SUBCOMMITTEE CONSIDERATION
On July 23, 2013, the Subcommittee on Health met in open
session, a quorum being present, and favorably forwarded to the
full Committee H.R. 1443, as amended, by voice vote.
During consideration of H.R. 1443, the following amendment
was considered and agreed to by voice vote:
An amendment offered by Ms. Brownley of California that
would: strike any reference to ``mandatory'' research; require
VA to recognize the need to enhance the research and treatment
of tinnitus; and specify that nothing in this legislation shall
be construed as interfering with VA's existing research peer-
review protocols.
COMMITTEE CONSIDERATION
On August 1, 2013, the full Committee met in an open markup
session, a quorum being present and ordered H.R. 1443, 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. 1443, as amended, reported to the House. A
motion by Ranking Member Michael H. Michaud of Maine to report
H.R. 1443, as amended, 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. 1443, 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.
1443 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. 1443, as amended, 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, August 8, 2013.
Hon. Jeff Miller,
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. 1443, the Tinnitus
Research and Treatment Act of 2013.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Douglas W. Elmendorf.
Enclosure.
H.R. 1443--Tinnitus Research and Treatment Act of 2013
H.R. 1443 would require the Department of Veterans Affairs
(VA) to treat tinnitus as a condition for research and
treatment at VA Auditory Centers of Excellence. Tinnitus, the
medical term for the sensation of hearing sound when no
external sound is present, is the most common disability among
veterans and may be caused by exposure to loud sounds during
military service. The VA already provides tinnitus treatment at
all its audiology clinics.
Furthermore, VA's National Center for Rehabilitation
Auditory Research (NCRAR) at the Portland VA Medical Center
conducts research and provides educational resources for
tinnitus. NCRAR has several research projects currently under
way on tinnitus (for example, the Clinical Trial of
Transcranial Magnetic Stimulation for Relief of Tinnitus,
Telephone Tinnitus Education for Patients with TBI, and Multi-
Site Evaluation of Progressive Tinnitus Management).
Additionally, the VA Research Enhancement Award Program at
Mountain Home Veterans Affairs Medical Center in Tennessee is
conducting tinnitus-related research projects.
VA is currently collaborating with the Department of
Defense Hearing Center of Excellence in maintaining a joint
registry, providing treatment and conducting research for
tinnitus. Since this bill would codify VA's current practices
regarding tinnitus, CBO estimates that implementing H.R. 1443
would have no significant cost over the 2014-2018 period.
Enacting this bill would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
H.R. 1443 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.
The CBO staff contact for this estimate is Ann E. Futrell.
The 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. 1443, as amended, prepared by the
Director of the Congressional Budget Office pursuant to Section
423 of the Unfunded Mandates Reform Act.
ADVISORY COMMITTEE STATEMENT
H.R. 1443, as amended, creates no advisory committees
within the meaning of section 5(b) of the Federal Advisory
Committee Act.
CONSTITUTIONAL AUTHORITY STATEMENT
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
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 the
Congressional Accountability Act Sec. 102(b)(3), 2 U.S.C.
Sec. 24 (1995).
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to section 3(j) of H. Res. 5, 113th Cong. (2013),
the Committee finds that no provision of H.R. 1443, 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.
DISCLOSURE OF DIRECTED RULEMAKING
Pursuant to section 3(k) of H. Res. 5, 113th Cong. (2013),
the Committee estimates that H.R. 1443, as amended, does not
require any directed rule makings.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill would provide the short title of H.R.
1443, as amended, as the ``Tinnitus Research and Treatment Act
of 2013.''
Section 2. Findings
Section 2 of the bill would make a number of findings
related to tinnitus.
Section 3. Recognition and treatment of tinnitus at Department of
Veterans Affairs Auditory Centers of Excellence
Section 3 of the bill would require VA to recognize
tinnitus as a condition for research and treatment by the VA
Auditory Centers of Excellence.
Section 4. Research on prevention and treatment of tinnitus
Section 4(a) of the bill would require the Secretary of
Veterans Affairs to recognize the need to enhance the research
and treatment of tinnitus and to ensure the allocation of
appropriate resources directed at the research and enhanced
treatment of tinnitus conducted by the VA Auditory Centers of
Excellence, commensurate with peer review protocols.
Section 4(a)(1) of the bill would require such research to
include an assessment of the efficacy of multidisciplinary
tinnitus treatment modalities on different subsets of patients.
Section 4(a)(2) of the bill would require such research to
include studies on the underlying etiology of tinnitus in
veteran populations that occur as a result of different causal
factors, including blast-related tinnitus that does not result
in hearing loss and other forms of noise-induced tinnitus that
does result in hearing loss.
Section 4(a)(3) of the bill would require such research to
include a study of the underlying mechanisms between hearing
loss and tinnitus, including cases in which only one such
condition is present.
Section 4(b) of the bill would require that nothing in the
bill be construed as interfering with VA's discretion to
conduct research in accordance with peer-review protocols in
order to ensure the quality and transparency of the research.
Section 5. Interdepartmental cooperation
Section 5 of the bill would require VA to ensure
cooperation with the Hearing Center of Excellence established
by DOD to further research on tinnitus.
CHANGES IN EXISTING LAW MADE BY THE BILL AS REPORTED
H.R. 1443, as amended, would not make any amendments to
existing law.