In May, the Congressional Brain Injury Task Force announced that the Department of Defense should screen US troops for traumatic brain injury (TBI) both before and after their deployment to Iraq or Afghanistan. Screening would help improve assessment of TBI, which is often undetected among returning soldiers and has been considered the “signature wound” of the Iraq and Afghanistan wars.
Additionally, the task force is urging improved brain-injury research and specialized care. Currently a supplemental war appropriations bill that would supply $450 million for the research and treatment of brain injuries is being negotiated by Congress and the White House.
Barbara Sigford, MD, PhD, national program director for physical medicine and rehabilitation at the Department of Veterans Affairs (VA), told Neurology Today that the VA started TBI screening on April 2 for every Iraq or Afghanistan veteran at its hospitals. The screening efforts, she said, will supplement those of the Department of Defense (DOD), which will also have access to the screening tool used by the VA.
“It is important to understand that the patient group that the VA screens for TBI will not be identical to the group of service members being screened by the DOD,” Dr. Sigford said. “The TBI screenings by the DOD and VA occur in different settings, and at different times post-deployment. Further, not all service members enter the VA system of care following active duty service. Results from these TBI screenings cannot necessarily be generalized from one setting to the other.”
The VA is only collecting data on vets who served in Iraq and Afghanistan seeking care within its health-care system, she said.
As to what generated the VA's initiation of TBI screening, Dr. Sigford noted that the VA has recognized the inability of soldiers with TBI to function properly for many years, and specialized programs for treatment have been established since the mid-1980s. “With the noted increase of veterans with TBI from Iraq and Afghanistan, and recognition that some mild TBIs might not be recognized at the time due to battlefield settings, the VA began education of all providers on recognition of TBI.”
She said she could not comment on the Pentagon's statement that the brain-injury screening system developed by the Department of Defense several years ago has not been used for all returning troops. “The VA has taken methodological steps to develop and deploy the TBI screening tool, given the need to maintain a consistent integration of care across this major health-care system. Screening tests often carry the potential for negative effects as well as benefits, so we want to be as certain as possible that any potential downside to the veteran from screening is minimal.”
James P. Kelly, MD, visiting professor of neurosurgery and physical medicine and rehabilitation at the University of Colorado School of Medicine and associate director of the Colorado Area Health Education Center System, said that he had proposed that the Denver VA provide TBI care and research, but learned that local leadership decided not to pursue it “These are very good people who I assume are up to their necks in so much already. Without clear directives from Washington with money attached, I doubt a given VA can do much,” he said.
Figure. Dr. Barbara ...Image Tools
Dr. Kelly has participated in several meetings on blast-related TBI injuries at the National Naval Medical Center in Bethesda and the Walter Reed Army Medical Center, where screening and treatment protocols for TBI were generated. “The Army protocol was applied in Iraq and Afghanistan in December 2006,” he said. “My experience has been that the US military medical personnel have been on top of this and expressed concern long before the civilian leadership took note.”
Presently bills on TBI screening and treatment are being considered in both the House and Senate, including Senator Hillary Clinton's (D-NY) bill, which the AAN was involved in drafting — The Heroes at Home Act of 2007— focusing on improved VA TBI services. Specifically, Senate bill 1233 calls for more Department of Defense and VA funding and for pre-deployment testing to better serve TBI patients.
Dr. Kelly said that “members of the House have been drafting companion legislation, which I hope will include funding for non-governmental entities (such as rural health centers and Area Health Education Centers) to provide education on the screening and management of TBI in those who have returned home to outlying areas of the country where VA services are not readily available.”