Army Task Force Finds Major Gaps in Care of Traumatic Brain Injuries

There are "major gaps" in identifying and treating traumatic brain injuries in servicemembers, according to an Army task force report released on Thursday, USA Today reports. According to the report, which was completed in May 2007, the gaps "were created by a lack of coordination and policy-driven approaches." The task force found gaps in the identification and treatment of soldiers who have mild traumatic brain injuries often resulting from exposure to roadside bomb blasts, despite the fact that researchers at the Defense and Veterans Brain Injury Center in 2004 developed ways of identifying the injuries.

According to the Army, 10% to 20% of Marines and soldiers returning from Afghanistan and Iraq might have experienced brain injuries, which often have no outward signs of injury. According to USA Today, at least 20,000 servicemembers from the wars in Iraq and Afghanistan have been diagnosed with or have shown signs of brain injury (Zoroya, USA Today, 1/18). More than 80% of servicemembers who have mild brain injuries and receive proper treatment completely recover, the task force said. According to Col. Robert Labutta, a neurosurgeon with the Army surgeon general's office, less than half of servicemembers who have experienced a mild traumatic brain injury in combat have persistent symptoms associated with it (Hefling, AP/Contra Costa Times, 1/18).

The task force in May made 48 recommendations to improve the diagnosis, treatment and research into brain injury. Nine of those recommendations have been implemented, and 31 are being addressed. Recommendations that have not been addressed include establishing better ways of tracking the incidents of brain injury and identifying former soldiers who may have experienced a brain injury, but left the service; expanding baseline testing of a soldier's brain functions; and standardizing care and treatment for soldiers with brain injuries at all Army hospitals.

Judith Ruiz, a task force member and program manager for traumatic brain injury, said, "Since the release of the report (in May), we've been working arduously to put these recommendations into action." Brig. Gen. Donald Bradshaw, the task force's chair, said, "This is a very complex process and so the fact that we've made headway on all of these recommendations is really very, I think, laudatory" (USA Today, 1/18). He added that, although the Army has a handle on treating more severe brain injuries, it is "challenged to understand, diagnose and treat military personnel who suffer with mild" traumatic brain injuries (AP/Contra Costa Times, 1/18).

Mandatory Spending
The Commission on the Future for America's Veterans this summer is planning to release a report that will call for a "government-chartered entity" funded by mandatory spending to provide health care for U.S. veterans, members said at a New America Foundation forum on Wednesday, CQ HealthBeat reports. Commission member Kenneth Kizer, a former undersecretary of health at the Department of Veterans Affairs, said the new organization, which was given the working title of the Veterans' Healthcare Service, would have a bureaucratic structure similar to that of the U.S. Postal Service. The commission is recommending that veterans' health care switch from funding by discretionary spending to mandatory spending to provide the new organization with a predictable stream of revenue and more control over how to spend funds. Commission members also expressed concerns about the possibility of cuts to veterans' health care as mandatory spending for long-term entitlements, such as Medicare and Social Security, require more federal funding (Yoest, CQ HealthBeat, 1/17).

Legislation
Gerald Cross, principal deputy undersecretary of Veterans' Health, on Thursday during a hearing of the House Veterans' Affairs Subcommittee on Health said he supports several veterans' health bills, but he criticized some of the measures because they duplicate, overlap with or do less than established programs, CQ HealthBeat reports.

Cross said that he "strongly supports" a bill (HR 3819) backed by veterans' groups that would prevent veterans from paying high out-of-pocket costs for emergency care not received at VA facilities. However, he said that he opposes a bill (HR 3458) to improve traumatic brain injury treatment in rural areas by establishing pilot programs in five states. He said, traumatic brain injuries "cannot be treated in a vacuum." Cross also said VA opposes a bill (HR 4231) that would establish a pilot program to test the use of vouchers for mental health care services in areas at least 30 miles from a VA facility.

According to Cross, VA opposes legislation (HR 4053) that would require comprehensive treatment for substance abuse disorders and the designation of at least six "centers of excellence" nationally for treating post-traumatic stress disorder and substance abuse disorders. He said, "We cannot support its prescriptive approach of mandating forms of treatment, treatment settings and composition of treatment teams," adding, "VA has previously expressed its difficulties with the concept of centers of excellence as opposed to the achievement of an overall standard of delivery of excellent care on a national basis" (Reichard, CQ HealthBeat, 1/17).