HR-8764-119
Referred to the House Committee on Armed Services.
Sponsored by Scott Perry (R-PA)
What it does
This bill would require the Department of Defense to cover stellate ganglion block (SGB) — a nerve block injection in the neck — as a treatment option for active-duty and reserve service members enrolled in TRICARE who have been diagnosed with PTSD and choose to receive it. It would also require the Secretary of Defense to update the VA/DoD Clinical Practice Guideline for PTSD management within 180 days to include SGB as a listed therapy option, with information on clinical indicators and contraindications. Both provisions would take effect 180 days after enactment.
Who benefits
Active-duty and reserve service members diagnosed with PTSD who want access to SGB but currently cannot obtain it through TRICARE. Estimated 500,000+ service members and veterans with PTSD diagnoses, though the bill covers only those currently enrolled in TRICARE. Providers who perform SGB procedures, who would gain a new covered patient population. Military families who may benefit indirectly from improved PTSD outcomes in service members. Researchers and clinicians advocating for broader recognition of SGB as a PTSD therapy.
Who is hurt
TRICARE and the DoD health system, which would bear the cost of covering a treatment not currently in standard guidelines. Taxpayers who fund the TRICARE program. Providers of existing, more established PTSD therapies (e.g., cognitive processing therapy, EMDR) who may face reduced patient volume if SGB is widely adopted. Potentially, service members who receive SGB based on congressional mandate before the full evidence base is established, if the treatment proves less effective or causes adverse effects in broader use.
Supporters argue
Supporters argue that PTSD affects an estimated 20% of post-9/11 veterans and that existing therapies leave a significant portion of patients without adequate relief, contributing to high rates of suicide and disability among service members. They contend that SGB has shown promising results in multiple clinical trials — including a 2019 randomized controlled trial published in JAMA Psychiatry — and that mandating its availability gives patients and providers a tool that is already being used successfully in some military medical centers, removing an arbitrary coverage barrier for those who could benefit.
Opponents argue
Opponents argue that the evidence base for SGB as a PTSD treatment remains limited and mixed, with the FDA not having approved it specifically for PTSD, and that Congress mandating coverage of a treatment that has not yet been incorporated into clinical guidelines bypasses the standard medical review process designed to protect patients. They contend that directing coverage through legislation rather than through evidence-based guideline updates sets a problematic precedent, potentially exposing service members to a procedure with known risks — including nerve damage, bleeding, and cardiovascular effects — before the full risk-benefit profile is established at scale.
Constitutional context
No significant constitutional tension exists here. Congress has broad authority under Article I, Section 8 to raise and support armies and to appropriate funds for military programs, which includes directing the structure of military healthcare benefits. The Appropriations Clause (Art. I, §9, cl. 7) is relevant insofar as the bill would create a new mandatory coverage obligation with fiscal implications for the TRICARE program.
Checks and balances
Congress gains authority by mandating a specific treatment coverage obligation on the DoD; the Secretary of Defense retains discretion over delivery method (military facilities or network providers), and congressional defense committees receive notification upon guideline updates.
Historical precedent
Congress has previously mandated specific treatment coverage within TRICARE, such as requiring coverage of autism spectrum disorder therapies under the National Defense Authorization Act of 2014, establishing a precedent for legislatively directed benefit expansions within the military health system.