10 U.S.C. § 1074f — Medical tracking system for members de-

Page 1053 TITLE 10—ARMED FORCES § 1074f ticipated deployment conditions and various methods of contraception. ‘‘(2) During health care visits during deployment. ‘‘(3) During annual physical examinations.’’ DEFENSE WOMEN’S HEALTH RESEARCH PROGRAM Pub. L. 103–337, div. A, title II, § 241, Oct. 5, 1994, 108 Stat. 2701, provided for the continuance of the Defense Women’s Health Research Program established pursu- ant to the authority in section 251 of the National De- fense Authorization Act for Fiscal Year 1994 (Public Law 103–160; 107 Stat. 1606, formerly set out below) and appropriated funds to the program for fiscal year 1995. Pub. L. 103–160, div. A, title II, § 251, Nov. 30, 1993, 107 Stat. 1606, authorized the Secretary of Defense to es- tablish a Defense Women’s Health Research Center to serve as the coordinating agent for multidisciplinary and multi-institutional research within the Depart- ment of Defense on women’s health issues related to service in the Armed Forces and required the Secretary to report to Congress on the decision to establish the Center no later than May 1, 1994. REPORT ON PROVISION OF PRIMARY AND PREVENTATIVE HEALTH CARE SERVICES FOR WOMEN Pub. L. 103–160, div. A, title VII, § 735, Nov. 30, 1993, 107 Stat. 1698, directed the Secretary of Defense to prepare a report evaluating the provision of primary and pre- ventive health care services through military medical treatment facilities and the Civilian Health and Med- ical Program of the Uniformed Services to female members of the uniformed services and female covered beneficiaries eligible for health care under this chapter, and directed the Secretary, as part of such report, to conduct a study to determine the health care needs of female members and female covered beneficiaries, and to submit such report to Congress not later than Oct. 1, 1994, and a revised report not later than Oct. 1, 1999. § 1074e. Medical care: certain Reserves who served in Southwest Asia during the Persian Gulf Conflict (a) ENTITLEMENT TO MEDICAL CARE.—A mem- ber of the armed forces described in subsection (b) is entitled to medical care for a qualifying Persian Gulf symptom or illness to the same ex- tent and under the same conditions (other than the requirement that the member be on active duty) as a member of a uniformed service who is entitled to such care under section 1074(a) of this title. (b) COVERED MEMBERS.—Subsection (a) applies to a member of a reserve component who— (1) is a Persian Gulf veteran; (2) has a qualifying Persian Gulf symptom or illness; and (3) is not otherwise entitled to medical care for such symptom or illness under this chapter and is not otherwise eligible for hospital care and medical services for such symptom or ill- ness under section 1710 of title 38. (c) DEFINITIONS.—In this section: (1) The term ‘‘Persian Gulf veteran’’ means a member of the armed forces who served on ac- tive duty in the Southwest Asia theater of op- erations during the Persian Gulf Conflict. (2) The term ‘‘qualifying Persian Gulf symp- tom or illness’’ means, with respect to a mem- ber described in subsection (b), a symptom or illness— (A) that the member registered before Sep- tember 1, 1997, in the Comprehensive Clinical Evaluation Program of the Department of Defense and that is presumed under section 721(d) of the National Defense Authorization Act for Fiscal Year 1995 (10 U.S.C. 1074 note) to be a result of service in the Southwest Asia theater of operations during the Per- sian Gulf Conflict; or (B) that the member registered before Sep- tember 1, 1997, in the Persian Gulf War Vet- erans Health Registry maintained by the De- partment of Veterans Affairs pursuant to section 702 of the Persian Gulf War Veterans’ Health Status Act (38 U.S.C. 527 note). (Added Pub. L. 105–85, div. A, title VII, § 764(a), Nov. 18, 1997, 111 Stat. 1825.) Editorial Notes REFERENCES IN TEXT Section 721(d) of the National Defense Authorization Act for Fiscal Year 1995, referred to in subsec. (c)(2)(A), is section 721(d) of Pub. L. 103–337, which is set out as a note under section 1074 of this title. Section 702 of the Persian Gulf War Veterans’ Health Status Act, referred to in subsec. (c)(2)(B), is section 702 of Pub. L. 102–585, which is set out as a note under sec- tion 527 of Title 38, Veterans’ Benefits. § 1074f. Medical tracking system for members de- ployed overseas (a) SYSTEM REQUIRED.—The Secretary of De- fense shall establish a system to assess the med- ical condition of members of the armed forces (including members of the reserve components) who are deployed outside the United States or its territories or possessions as part of a contin- gency operation (including a humanitarian oper- ation, peacekeeping operation, or similar oper- ation) or combat operation. (b) ELEMENTS OF SYSTEM.—(1)(A) The system described in subsection (a) shall include the use of predeployment medical examinations and postdeployment medical examinations (includ- ing the assessment of mental health and the drawing of blood samples) and postdeployment health reassessments to— (i) accurately record the health status of members before their deployment; (ii) accurately record any changes in their health status during the course of their de- ployment; (iii) identify health concerns, including men- tal health concerns, that may become mani- fest several months following their deploy- ment; and (iv) accurately record any exposure to occu- pational and environmental health risks dur- ing the course of their deployment. (B) The postdeployment medical examination shall be conducted when the member is rede- ployed or otherwise leaves an area in which the system is in operation (or as soon as possible thereafter). (C) The postdeployment health reassessment shall be conducted at an appropriate time dur- ing the period beginning 90 days after the mem- ber is redeployed and ending 180 days after the member is redeployed. (2) The predeployment medical examination, postdeployment medical examination, and postdeployment health reassessment of a mem- ber of the armed forces required under para- graph (1) shall include the following: Page 1054 TITLE 10—ARMED FORCES § 1074f (A) An assessment of the current treatment of the member and any use of psychotropic medications by the member for a mental health condition or disorder. (B) An assessment of traumatic brain injury. (C) An assessment of post-traumatic stress disorder. (D) An assessment of whether the member was— (i) based or stationed at a location where an open burn pit, as defined in subsection (c) of section 201 of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note), was used; or (ii) exposed to toxic airborne chemicals or other airborne contaminants, including any information recorded as part of the registry established by the Secretary of Veterans Af- fairs under such section 201. (3)(A) The Secretary shall establish for pur- poses of subparagraphs (B) and (C) of paragraph (2) a protocol for the predeployment assessment and documentation of the cognitive (including memory) functioning of a member who is de- ployed outside the United States in order to fa- cilitate the assessment of the postdeployment cognitive (including memory) functioning of the member. (B) The protocol under subparagraph (A) shall include appropriate mechanisms to permit the differential diagnosis of traumatic brain injury in members returning from deployment in a combat zone. (c) RECORDKEEPING.—The results of all medical examinations and reassessments conducted under the system, records of all health care services (including immunizations and the pre- scription and administration of psychotropic medications) received by members described in subsection (a) in anticipation of their deploy- ment or during the course of their deployment, and records of events occurring in the deploy- ment area (including the results of any assess- ment performed by the Secretary of occupa- tional and environmental health risks for such area) that may affect the health of such mem- bers shall be retained and maintained in a cen- tralized location to improve future access to the records. (d) QUALITY ASSURANCE.—(1) The Secretary of Defense shall establish a quality assurance pro- gram to evaluate the success of the system in ensuring that members described in subsection (a) receive predeployment medical examina- tions, postdeployment medical examinations, and postdeployment health reassessments and that the recordkeeping requirements with re- spect to the system are met. (2) The quality assurance program established under paragraph (1) shall also include the fol- lowing elements: (A) The types of healthcare providers con- ducting postdeployment health assessments and reassessments. (B) The training received by such providers applicable to the conduct of such assessments and reassessments, including training on as- sessments and referrals relating to mental health. (C) The guidance available to such providers on how to apply the clinical practice guide- lines developed under subsection (e)(1) in de- termining whether to make a referral for fur- ther evaluation of a member of the armed forces relating to mental health. (D) The effectiveness of the tracking mecha- nisms required under this section in ensuring that members who receive referrals for further evaluations relating to mental health receive such evaluations and obtain such care and services as are warranted. (E) Programs established for monitoring the mental health of each member who, after de- ployment to a combat operation or contin- gency operations, is known— (i) to have a mental health condition or disorder; or (ii) to be receiving treatment, including psychotropic medications, for a mental health condition or disorder. (F) The diagnosis and treatment of trau- matic brain injury and post-traumatic stress disorder. (e) CRITERIA FOR REFERRAL FOR FURTHER EVALUATIONS.—The system described in sub- section (a) shall include— (1) development of clinical practice guide- lines to be utilized by healthcare providers in determining whether to refer a member of the armed forces for further evaluation relating to mental health (including traumatic brain in- jury); (2) mechanisms to ensure that healthcare providers are trained in the application of such clinical practice guidelines; and (3) mechanisms for oversight to ensure that healthcare providers apply such guidelines consistently. (f) MINIMUM STANDARDS FOR DEPLOYMENT.—(1) The Secretary of Defense shall prescribe in regu- lations minimum standards for mental health for the eligibility of a member of the armed forces for deployment to a combat operation or contingency operation. (2) The standards required by paragraph (1) shall include the following: (A) A specification of the mental health con- ditions, treatment for such conditions, and re- ceipt of psychotropic medications for such conditions that preclude deployment of a member of the armed forces to a combat oper- ation or contingency operation, or to a speci- fied type of such operation. (B) Guidelines for the deployability and treatment of members of the armed forces di- agnosed with a severe mental illness, trau- matic brain injury, or post traumatic stress disorder. (3) The Secretary shall take appropriate ac- tions to ensure the utilization of the standards prescribed under paragraph (1) in the making of determinations regarding the deployability of members of the armed forces to a combat oper- ation or contingency operation. (g) ADDITIONAL REQUIREMENTS FOR POSTDEPLOYMENT MEDICAL EXAMINATIONS AND HEALTH REASSESSMENTS.—(1) The Secretary of Defense shall standardize and make available to a provider that conducts a postdeployment med- ical examination or reassessment under the sys- Page 1055 TITLE 10—ARMED FORCES § 1074f tem described in subsection (a) questions relat- ing to occupational and environmental health exposure. (2) The Secretary, to the extent practicable, shall ensure that the medical record of a mem- ber includes information on the external cause relating to a diagnosis of the member, including by associating an external cause code (as issued under the International Statistical Classifica- tion of Diseases and Related Health Problems, 10th Revision (or any successor revision)). (Added Pub. L. 105–85, div. A, title VII, § 765(a)(1), Nov. 18, 1997, 111 Stat. 1826; amended Pub. L. 109–364, div. A, title VII, § 738(a)–(d), Oct. 17, 2006, 120 Stat. 2303; Pub. L. 110–181, div. A, title XVI, § 1673(a)(1), (b), (c), Jan. 28, 2008, 122 Stat. 482, 483; Pub. L. 111–84, div. A, title X, § 1073(a)(9), Oct. 28, 2009, 123 Stat. 2472; Pub. L. 111–383, div. A, title VII, § 712, Jan. 7, 2011, 124 Stat. 4247; Pub. L. 116–92, div. A, title VII, §§ 704(c), 705(a), (b), Dec. 20, 2019, 133 Stat. 1438–1440.) Editorial Notes AMENDMENTS 2019—Subsec. (b)(1)(A)(iv). Pub. L. 116–92, § 705(a)(1), added cl. (iv). Subsec. (b)(2)(D). Pub. L. 116–92, § 704(c), added subpar. (D). Subsec. (c). Pub. L. 116–92, § 705(a)(2), inserted ‘‘(in- cluding the results of any assessment performed by the Secretary of occupational and environmental health risks for such area)’’ after ‘‘deployment area’’. Subsec. (g). Pub. L. 116–92, § 705(b), added subsec. (g). 2011—Subsec. (b)(1). Pub. L. 111–383, § 712(a), amended par. (1) generally. Prior to amendment, par. (1) read as follows: ‘‘The system described in subsection (a) shall include the use of predeployment medical examinations and postdeployment medical examinations (including an assessment of mental health and the drawing of blood samples) to accurately record the medical condi- tion of members before their deployment and any changes in their medical condition during the course of their deployment. The postdeployment examination shall be conducted when the member is redeployed or otherwise leaves an area in which the system is in oper- ation (or as soon as possible thereafter).’’ Subsec. (b)(2). Pub. L. 111–383, § 712(b), substituted ‘‘medical examination, postdeployment medical exam- ination, and postdeployment health reassessment’’ for ‘‘and postdeployment medical examination’’ in intro- ductory provisions. Subsec. (c). Pub. L. 111–383, § 712(c), inserted ‘‘and re- assessments’’ after ‘‘medical examinations’’ and ‘‘and the prescription and administration of psychotropic medications’’ after ‘‘including immunizations’’. Subsec. (d)(1). Pub. L. 111–383, § 712(d)(1), substituted ‘‘, postdeployment medical examinations, and postdeployment health reassessments’’ for ‘‘and postdeployment medical examinations’’. Subsec. (d)(2)(A). Pub. L. 111–383, § 712(d)(2)(A), in- serted ‘‘and reassessments’’ after ‘‘postdeployment health assessments’’. Subsec. (d)(2)(B). Pub. L. 111–383, § 712(d)(2)(B), in- serted ‘‘and reassessments’’ after ‘‘such assessments’’. 2009—Subsec. (f)(3). Pub. L. 111–84 substituted ‘‘con- tingency’’ for ‘‘continency’’. 2008—Subsec. (b)(2)(C). Pub. L. 110–181, § 1673(a)(1)(A), added subpar. (C). Subsec. (b)(3). Pub. L. 110–181, § 1673(a)(1)(B), added par. (3). Subsec. (d)(2)(F). Pub. L. 110–181, § 1673(b), added sub- par. (F). Subsec. (f). Pub. L. 110–181, § 1673(c)(1), struck out ‘‘Mental Health’’ after ‘‘Minimum’’ in heading. Subsec. (f)(2)(B). Pub. L. 110–181, § 1673(c)(2), sub- stituted ‘‘, traumatic brain injury, or’’ for ‘‘or’’. 2006—Subsec. (b). Pub. L. 109–364, § 738(a), designated existing provisions as par. (1) and added par. (2). Subsec. (d). Pub. L. 109–364, § 738(d), designated exist- ing provisions as par. (1) and added par. (2). Subsec. (e). Pub. L. 109–364, § 738(b), added subsec. (e). Subsec. (f). Pub. L. 109–364, § 738(c), added subsec. (f). Statutory Notes and Related Subsidiaries INCLUSION OF INFORMATION ON EXPOSURE TO OPEN BURN PITS IN POSTDEPLOYMENT HEALTH REASSESS- MENTS Pub. L. 116–283, div. A, title VII, § 721, Jan. 1, 2021, 134 Stat. 3698, provided that: ‘‘(a) IN GENERAL.—The Secretary of Defense shall in- clude in postdeployment health reassessments con- ducted under section 1074f of title 10, United States Code, pursuant to a Department of Defense Form 2796, or successor form, an explicit question regarding expo- sure of members of the Armed Forces to open burn pits. ‘‘(b) INCLUSION IN ASSESSMENTS BY MILITARY DEPART- MENTS.—The Secretary of Defense shall ensure that the Secretary of each military department includes a ques- tion regarding exposure of members of the Armed Forces to open burn pits in any electronic postdeployment health assessment conducted by that military department. ‘‘(c) OPEN BURN PIT DEFINED.—In this section, the term ‘open burn pit’ has the meaning given that term in section 201(c) of the Dignified Burial and Other Vet- erans’ Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note).’’ EXPOSURE TO OPEN BURN PITS AND TOXIC AIRBORNE CHEMICALS OR OTHER AIRBORNE CONTAMINANTS AS PART OF PERIODIC HEALTH ASSESSMENTS AND OTHER PHYSICAL EXAMINATIONS Pub. L. 116–92, div. A, title VII, § 704, Dec. 20, 2019, 133 Stat. 1438, provided that: ‘‘(a) PERIODIC HEALTH ASSESSMENT.—The Secretary of Defense shall ensure that any periodic health assess- ment provided to members of the Armed Forces in- cludes an evaluation of whether the member has been— ‘‘(1) based or stationed at a location where an open burn pit was used; or ‘‘(2) exposed to toxic airborne chemicals or other airborne contaminants, including any information re- corded as part of the Airborne Hazards and Open Burn Pit Registry. ‘‘(b) SEPARATION HISTORY AND PHYSICAL EXAMINA- TIONS.—[Amended section 1145 of this title.] ‘‘(c) DEPLOYMENT ASSESSMENTS.—[Amended this sec- tion.] ‘‘(d) SHARING OF INFORMATION.— ‘‘(1) DOD–VA.—The Secretary of Defense and the Secretary of Veterans Affairs shall jointly enter into a memorandum of understanding providing for the sharing by the Department of Defense with the De- partment of Veterans Affairs of the results of covered evaluations regarding the exposure by a member of the Armed Forces to toxic airborne chemicals or other airborne contaminants. ‘‘(2) REGISTRY.—If a covered evaluation of a mem- ber of the Armed Forces establishes that the member was based or stationed at a location where an open burn pit was used or that the member was exposed to toxic airborne chemicals or other airborne contami- nants, the member shall be enrolled in the Airborne Hazards and Open Burn Pit Registry unless the mem- ber elects to not so enroll. ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this section may be construed to preclude eligibility for benefits under the laws administered by the Secretary of Vet- erans Affairs by reason of the open burn pit exposure history of a veteran not being recorded in a covered evaluation. ‘‘(f) DEFINITIONS.—In this section: ‘‘(1) The term ‘Airborne Hazards and Open Burn Pit Registry’ means the registry established by the Sec- Page 1056 TITLE 10—ARMED FORCES § 1074g retary of Veterans Affairs under section 201 of the Dignified Burial and Other Veterans’ Benefits Im- provement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note). ‘‘(2) The term ‘covered evaluation’ means— ‘‘(A) a periodic health assessment conducted in accordance with subsection (a); ‘‘(B) a separation history and physical examina- tion conducted under section 1145(a)(5) of title 10, United States Code, as amended by this section; and ‘‘(C) a deployment assessment conducted under section 1074f(b)(2) of such title, as amended by this section. ‘‘(3) The term ‘open burn pit’ has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (Public Law 112–260; 38 U.S.C. 527 note).’’ SHARING BETWEEN DEPARTMENT OF DEFENSE AND DE- PARTMENT OF VETERANS AFFAIRS OF RECORDS AND INFORMATION RETAINED UNDER THE MEDICAL TRACK- ING SYSTEM FOR MEMBERS OF THE ARMED FORCES DEPLOYED OVERSEAS Pub. L. 112–239, div. A, title VII, § 723, Jan. 2, 2013, 126 Stat. 1805, provided that: ‘‘(a) IN GENERAL.—The Secretary of Defense and the Secretary of Veterans Affairs shall jointly enter into a memorandum of understanding providing for the shar- ing by the Department of Defense with the Department of Veterans Affairs of the results of examinations and other records on members of the Armed Forces that are retained and maintained with respect to the medical tracking system for members deployed overseas under section 1074f(c) of title 10, United States Code. ‘‘(b) CESSATION UPON IMPLEMENTATION OF ELECTRONIC HEALTH RECORD.—The sharing required pursuant to subsection (a) shall cease on the date on which the Sec- retary of Defense and the Secretary of Veterans Affairs jointly certify to Congress that the Secretaries have fully implemented an integrated electronic health record for members of the Armed Forces that is fully interoperable between the Department of Defense and the Department of Veterans Affairs.’’ COMPREHENSIVE POLICY ON CONSISTENT NEUROLOGICAL COGNITIVE ASSESSMENTS OF MEMBERS OF THE ARMED FORCES BEFORE AND AFTER DEPLOYMENT Pub. L. 111–383, div. A, title VII, § 722, Jan. 7, 2011, 124 Stat. 4251, provided that: ‘‘(a) COMPREHENSIVE POLICY REQUIRED.—Not later than January 31, 2011, the Secretary of Defense shall develop and implement a comprehensive policy on con- sistent neurological cognitive assessments of members of the Armed Forces before and after deployment. ‘‘(b) UPDATES.—The Secretary shall revise the policy required by subsection (a) on a periodic basis in accord- ance with experience and evolving best practice guide- lines.’’ MENTAL HEALTH ASSESSMENTS FOR MEMBERS OF THE ARMED FORCES DEPLOYED IN CONNECTION WITH A CONTINGENCY OPERATION Pub. L. 111–84, div. A, title VII, § 708, Oct. 28, 2009, 123 Stat. 2376, which required the Secretary of Defense to issue guidance for the provision of mental health as- sessments for members of the Armed Forces deployed in connection with a contingency operation, was re- pealed by Pub. L. 112–81, div. A, title VII, § 702(b), Dec. 31, 2011, 125 Stat. 1471. ADMINISTRATION AND PRESCRIPTION OF PSYCHOTROPIC MEDICATIONS FOR MEMBERS OF THE ARMED FORCES BEFORE AND DURING DEPLOYMENT Pub. L. 111–84, div. A, title VII, § 712, Oct. 28, 2009, 123 Stat. 2379, provided that: ‘‘(a) REPORT REQUIRED.—Not later than October 1, 2010, the Secretary of Defense shall submit to the con- gressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a report on the implementa- tion of policy guidance dated November 7, 2006, regard- ing deployment-limiting psychiatric conditions and medications. ‘‘(b) POLICY REQUIRED.—Not later than October 1, 2010, the Secretary shall establish and implement a pol- icy for the use of psychotropic medications for de- ployed members of the Armed Forces. The policy shall, at a minimum, address the following: ‘‘(1) The circumstances or diagnosed conditions for which such medications may be administered or pre- scribed. ‘‘(2) The medical personnel who may administer or prescribe such medications. ‘‘(3) The method in which the administration or prescription of such medications will be documented in the medical records of members of the Armed Forces. ‘‘(4) The exam, treatment, or other care that is re- quired following the administration or prescription of such medications.’’ PILOT PROJECTS Pub. L. 110–181, div. A, title XVI, § 1673(a)(2), Jan. 28, 2008, 122 Stat. 482, directed the Secretary of Defense to conduct three pilot projects to evaluate mechanisms for use in developing the traumatic brain injury assess- ment protocol required by section 1074f(b)(3) of this title and, upon the completion of the projects, required a report to Congress within 60 days and implementa- tion of the selected mechanism within 180 days. IMPLEMENTATION Pub. L. 109–364, div. A, title VII, § 738(f), Oct. 17, 2006, 120 Stat. 2304, provided that: ‘‘The Secretary of Defense shall implement the requirements of the amendments made by this section [amending this section] not later than six months after the date of the enactment of this Act [Oct. 17, 2006].’’ INTERIM STANDARDS FOR BLOOD SAMPLING Pub. L. 108–375, div. A, title VII, § 733(b), Oct. 28, 2004, 118 Stat. 1998, as amended by Pub. L. 109–364, div. A, title X, § 1071(g)(9), Oct. 17, 2006, 120 Stat. 2402, provided that: ‘‘(1) TIME REQUIREMENTS.—Subject to paragraph (2), the Secretary of Defense shall require that— ‘‘(A) the blood samples necessary for the predeployment medical examination of a member of the Armed Forces required under section 1074f(b) of title 10, United States Code, be drawn not earlier than 120 days before the date of the deployment; and ‘‘(B) the blood samples necessary for the postdeployment medical examination of a member of the Armed Forces required under such section 1074f(b) of such title be drawn not later than 30 days after the date on which the deployment ends. ‘‘(2) CONTINGENT APPLICABILITY.—The standards under paragraph (1) shall apply unless the Joint Medical Readiness Oversight Committee established by section 731(b) [10 U.S.C. 1074 note] recommends, and the Sec- retary approves, different standards for blood sam- pling.’’ § 1074g. Pharmacy benefits program (a) PHARMACY BENEFITS.—(1) The Secretary of Defense, after consulting with the other admin- istering Secretaries, shall establish an effective, efficient, integrated pharmacy benefits program under this chapter (hereinafter in this section referred to as the ‘‘pharmacy benefits pro- gram’’). (2)(A) The pharmacy benefits program shall in- clude a uniform formulary of pharmaceutical agents, which shall assure the availability of pharmaceutical agents in the complete range of