Brain Injury Lawyer - New York

Traumatic Brain Injury TBI in Iraq War Veterans Explored by MIT's Technology Review Magazine

Traumatic brain injury, or TBI, has been labeled the signature injury of the Iraq War. Estimates of the number of soldiers who have experienced concussions while deployed range as high as 20 percent. The long-term implications of TBI are unclear, and no treatments exist to cure long-lasting symptoms.

The cover story of the May issue of MIT's Technology Review magazine explores the symptoms of TBI in Iraq veterans through first-person interviews, and it examines new technology being developed to better explain the changes that occur in the brain from explosive shock waves.

The article entitled  "Brain Trauma in Iraq," looks at new methods to study the effects of TBI.

Accompanying the cover story online is a documentary-style video that includes interviews with all three research scientists, as well as soldiers suffering from TBI. They can be found by clicking here.   

Army Vets Not Receiving Adequate Care According to Audit of Veteran's Affairs

The Associated Press reports that a report of the VA's inspector general found that many Iraq war veterans with traumatic brain injury are not getting adequate health care and job assistance for their long-term recovery despite years of government pledges to do so.

The VA Inspector General reports that "Significant needs remain unmet," In one out of four patients, the the study reports that those suffering from traumatic brain damage were not receivign needed help for health care, vocational rehabilitation, family support or housing. Some  patients specifically cited trouble in getting primary or specialty eye care, while others reported gaps with family counseling for problems such as depression and anger.

"We continue to be concerned that all veterans discharged after inpatient rehabilitation for TBI receive case management, unless this has been explicitly denied by the patient," investigators stated, adding that they will continue monitoring the VA to ensure Iraq war veterans are receiving the care they need.

The failure to provide these brain injured veterans with necessary services is a national disgrace!  It is hard to believe that even after all of this publicity and all of the promises by the VA,  these veterans are still being deprived of necessary services.

19 % of Returning Iraq Service Members Suffer From Traumatic Brain Injury New Study Reports

A new study by the RAND Corporation reports that 19 percent of returning service members report that they have experienced a possible traumatic brain injury and nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of post traumatic stress disorder or major depression. 7 percent reporting both a probable brain injury and current PTSD or major depression.

The RAND study estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment.  The brain injuries span the spectrum form concussions to severe penetrating head injuries.  But, just 43 percent reported ever being evaluated by a physician for head trauma or brain injury.

Unfortunaely many service members said they do not seek treatment because they fear it will harm their careers.

"There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," said Terri Tanielian, the project's co-leader and a researcher at RAND, a nonprofit research organization. "Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need."

The findings are from the first large-scale, nongovernmental assessment of the psychological and cognitive needs of military service members who have served in Iraq and Afghanistan over the past six years. The RAND study is the first to comprehensively assess the current needs of returned service members from all branches of the military.

Researchers concluded that a major national effort is needed to expand and improve the capacity of the mental health system to provide effective care to service members and veterans. The effort must include the military, veteran and civilian health care systems, and should focus on training more providers to use high-quality, evidence-based treatment methods and encouraging service members and veterans to seek needed care.

The Rand Report suggests that thehe Department of Defense's newly created Defense Center for Excellence for Psychological Health and Traumatic Brain Injury may provide a historic opportunity to change the culture of psychological health within the military and to promote and monitor the use of high-quality care to service members. The RAND report provides information that the center could use to pursue these objectives through the use of innovative care models and performance measurement techniques.

One-year estimates of the societal cost associated with treated cases of mild traumatic brain injury range up to $32,000 per case, while estimates for treated moderate to severe cases range from $268,000 to more than $408,000. Estimates of the total one-year societal cost of the roughly 2,700 cases of traumatic brain injury identified to date range from $591 million to $910 million.

The report is titled "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." The full report and several summaries are available by clicking here.

Brain Injury Rehab Center To Offer Free Care to Returning Vets

Earlier this week, Shepherd Center, an Atlanta Georgia  brain injury and spinal cord rehabilitation hospital announced that they will provide free care to wounded military veterans who need brain or spinal cord injury services that aren't covered by the government.

The program is intended to provide a range of services including  testing, psychological evaluation, brain scans, long term care and rehabilitation.  It is being funded by Bernie Marcus, the co-founder of Home Depot Inc.

Shepherd Center and Mr. Marcus should be congratulated for their efforts.  But, the question remains, why isn't our government providing needed funding for these programs?  Why is the VA still refusing to provide care in non military facilities? 

Read the full Shepherd press release: Atlanta Rehab Hospital to Provide Free Care to Some Vets With Brain, Spinal Cord Injuries

Department of Defense Inexecusably Delays Brain Injury Screening of Reutrning Troops

An inexcusable policy of delaying screening of returning troops for mild traumatic brain injury because of fears concerning the number of soldiers who potentially had post concussion symptoms was revealed today in a story in USA Today.  The Pentagon wanted to avoid acknowledgment of the post concussion syndrome and its association with blast injuries.

It's shocking that the stated Pentagon reason for their failure to screen returning service members was an unsubstantiated fear that the returning soldiers would attempt to feign symptoms of brain injury because of articles they may have read in the news media or on the Internet.   However, in a January 2006 report, scientists at the federal Defense and Veteran Brain Injury Center urged that troops be screened for TBI "immediately."

Of course, if you blame the victim, excuse them of making up their symptoms and deny the existence of a casual relationship between head injury and mild traumatic brain injury, you are going to save a lot of money.  Sounds like the mentality of the insurance industry, doesn't it?

Here's how it goes:  The individual never sustained a head injury, if they did, they didn't sustain any brain damage, if they did, it was only temporary, if they still have complaints, they are exaggerating, if they are not exaggerating then then don't have a brain injury, they have post traumatic stress disorder. 

It is a disgusting attempt to deny benefits to those suffering from a traumatic brain injury.

According to the USA Today article, an Army mental health report last month indicated that 11% of 2,195 soldiers surveyed in Iraq and Afghanistan show signs of mild brain injury, but fewer than half were identified and evaluated in the field.

The full article can be obtained by clicking here: DOD Delayed Brain Injury Scans

Senators Clinton and Mikulski Protest Zero Funding for Traumatic Brain Injury Programs

Earlier this week I reported on the failure on the part of president Bush to seek funding for the federal Traumatic Brain Injury Program in his latest budget submitted to Congress. What follows is the correspondence sent by Senators Clinton and Mikulski to president Bush in protest.

February 12, 2008

The Honorable George W. Bush
The White House
Washington, D.C. 20500

Dear Mr. President:

During this time of war, we were deeply troubled to learn of your plan to eliminate the Traumatic Brain Injury (TBI) program administered by the Health Resources and Services Administration. As co-sponsors of legislation to improve the assessment, detection and treatment of TBI, as well as to expand support systems for members and former members of the Armed Services with TBI and their families, we are deeply concerned by the potential elimination of this program for all individuals affected by TBI. The TBI Program serves as a critical component of our efforts to address TBI across the country, and is an essential complement to our services for the significant number of servicemen and women returning from combat with TBI. We urge you to work with us, and other concerned members of Congress, to ensure full funding for the TBI Program in the HHS budget for Fiscal Year 2009.

Current estimates state that at least 5.3 million Americans have a long-term or lifelong need for help to perform activities of daily living as a result of TBI, with 1.4 million Americans sustaining a traumatic brain injury each year. An extremely complex injury, TBI encompasses a broad range of symptoms and disabilities, creating severe strain on the individual and his or her family. Depending on the part of the brain affected and the extent of the damage, individuals with brain injuries vary greatly in their level of need, requiring access to a broad array of services.

Recognizing the large number of individuals and families struggling to access appropriate and community-based services for TBI, Congress authorized the Federal TBI Program in the TBI Act of 1996. The program assists states in operating coordinated services for individuals with TBI and their families, encouraging the replication of best practices, and improving state service delivery systems. Two-year planning grants allow states to build infrastructure, three-year implementation grants permit states to improve access to services, and additional implementation partnership grants allow increased flexibility to meet state needs to address TBI. Currently, 47 states receive TBI grants.

In addition to the acute medical needs of individuals suffering from TBI, families also have to address the social and emotional issues that come with diminished mental capacity. The nature of the disease has also changed over time; the needs of returning soldiers suffering from TBI present new strains on state service delivery systems. Now more than ever, we must provide states with the funding and support to provide effective, person-centered services to support individuals and their families. To cut funding now will jeopardize the ability of our health care system to address the needs of all Americans impacted by TBI. We urge you to reconsider this shortsighted decision, and join us in our efforts to restore full funding to the TBI program.

Sincerely,

Hillary Rodham Clinton

Barbara Mikulski

I urge all my readers to lend their voice to the calls to restore funding to the TBI programs.  Please write and call the White House and your congressional representatives as soon as possible.

APA to Address Congress on Post Traumatic Stress Disorder Following Brain Injury

A study published in the Jan. 30, 2008 New England Journal of Medicine found that mild head injuries sustained by soldiers in Iraq are the cause of a variety of neurological deficits and are a major factor in stress-related disorders.

As the number and duration of military deployments increase, so do the behavioral health needs of service members and their families. To better meet the demand for deployment-related mental health care for service members and their families, the Center for Deployment Psychology (CDP), a Department of Defense training consortium, has been established. The CDP, spearheaded by the American Psychological Association, is a tri-service center funded by Congress to train military and civilian psychologists, psychiatrists, social workers and other behavioral health professionals to provide high quality deployment-related behavioral health services to military personnel and their families.

On Wednesday, Feb. 13, 1:30 p.m. - 3:00 p.m. in Room HC-8 of the U.S. Capital, a panel of military and mental health experts sponsored by the American Psychological Association will address the impact of trauma facing the returning soldier and its effect on family members. The experts will also discuss the need for training military and civilian psychologists and other health professionals on the latest treatment approaches to help wounded soldiers deal with post-traumatic stress disorder, traumatic brain injury or issues in readjusting to civilian life following deployment to Iraq or Afghanistan.

Criticism of Proposed New Rules on Classifying Brain Damage

Formal comments criticizing regulations proposed by the Department of Veterans Affairs governing compensation of veterans with traumatic brain injury has been submitted by U.S. Sen. Daniel K. Akaka (D-HI), Chairman of the Veterans' Affairs Committee who was joined by Senators Rockfeller, Murray, Obama, Tester, Brown, and Sanders.

"The new rules must provide for a fair evaluation of the veteran's disabilities. Unfortunately, the proposed regulations do not," said Sen. Akaka.

Under current regulations, compensation for symptoms attributable to TBI, such as headaches, dizziness, or insomnia is limited to "10 percent and no more." While VA recognizes that this requirement is outdated, it remains in effect pending the release of new rules. Chairman Akaka and majority members asked that this outdated rule be withdrawn immediately.

Akaka also objected to a section of the proposed rule which would not consider the severity or frequency of TBI symptoms, only count the number of symptoms.

The proposed brain injury regulations and the formal comment letter sent by Chairman Akaka and majority members can be found  by clicking here .

Coma: The Toll on Families

This Sunday's New York Times has an article,  Holding on to Hope which captures the toll that severe brain injury including coma and the persistent vegetative state has on parents and other loved ones.

The article describes the difficulties faced by three families of army veterans attempting to get the best care for the severe brain damage sustained by their son's who were injured in the Iraq and Afghanistan conflict. 

The battles with the VA to obtain placement in a private brain injury rehabilitation facility with a national reputation as well as the day to day struggles that these families face are highlighted in the story.

I have spoken many times on the need to address the second patient in brain damage, that being the family.  Mothers, fathers, spouses and children are in many ways equally in need of assistance following a brain injury.  Yet, their needs are often not addressed by the medical community.  It is important to remember that these family members often need counseling and other assistance to enable them to continue with the journey following a traumatic brain injury.

Brain Injury Association of America Condemns President's Budget Requests

The Brain Injury Association of America has requested that I circulate the following press release concerning the proposed elimination of the Federal Traumatic Brain Injury (TBI) Program in President Bush's budget submission to Congress:

Brain Injury Association of America Condemns President’s Fiscal 2009 Budget

(Washington, D.C.) – For the third year in a row, The White House has proposed the complete elimination of the Health Resources and Services Administration (HRSA) Federal TBI Program, which provides grants to state agencies and protection and advocacy organizations to improve access to health and other services for individuals with traumatic brain injury (TBI) and their families. 

Increasingly, national policymakers and the American public are coming to understand the dramatic implications of TBI on active duty service members, veterans and civilians alike.  In his State of the Union speech last week, President Bush pledged his dedication to meeting the health care needs “of a new war and a new generation.”

“As more service members and veterans join the 1.4 million civilian children and adults who sustain TBIs in the U.S. each year, the lack of priority given to TBI in the President’s budget is deeply disappointing,” said Susan Connors, president and CEO of the Brain Injury Association of America (BIAA), adding, “President Bush just doesn’t get it.”

“My family’s experience demonstrates the interdependence of military and civilian systems of care,” said Dave Woodruff, a member of the BIAA Board of Directors whose brother, ABC anchor Bob Woodruff suffered a severe TBI while covering the war in Iraq.  The Federal TBI Program supports coordination among state government agencies and public and private organizations to improve TBI care from trauma to community re-integration.  Most military and civilian patients end up living in the community where a complex maze of service systems, if it exists, must be coordinated.

BIAA will work vigorously to restore funding for HRSA's TBI Program, joining with coalition partners at the national level and calling on the highly effective Congressional Brain Injury Task Force to educate their colleagues in Congress and The White House on the need for and value of the Federal TBI Program.

Concussions complicated by post traumatic stress disorder and depression

A new study published this week in the New England Journal of Medicine links the persistent problems following a concussion to the development of post traumatic stress disorder and depression.

According to a summary of the study reported in today's New York Times, the new report finds that soldiers who had concussions were more likely than those with other injuries to report a variety of symptoms in their first months back home, including headaches, poor sleep and balance problems. But they were also at higher risk for the stress disorder, known as PTSD, and that accounted for most of the difference in complaints. Symptoms of the disorder include irritability, sleep problems and flashbacks.

You can read the full Times story by clicking here.

Full Military Traumatic Brain Injury Task Force Report

My earlier post today concerned the Military Traumatic Brain Injury Task Force Report.

The full report can be read by clicking here.

Army Study Reports One In Five Brain Injuries Go Unrecognized

In a study released yesterday, the Army has confirmed that Up to 20 percent of U.S. troops returning from Iraq and Afghanistan may have suffered mild concussions but were unaware of them and did not get treatment.

The study reports that the Army has a hard time identifying and treating affected troops because the soldiers and Marines don't recognize the symptoms and don't report them.

"The Army is challenged to understand, diagnose and treat military personnel who suffer with mild TBI," said Brig. Gen. Donald Bradshaw, who leads the Army's TBI task force.

In addition to recognizing the common symptoms of a concussion such as headaches, dizziness, sleep disorders, nausea or memory problems, the Army is now alerting soldiers and their families to the psychological consequences of closed head injury such as irritability, anxiety and depression.

The earlier that these soldiers recognize and report their symptoms, the earlier that they can get treatment.  Just as important, soldiers who are still on active duty need to know that these symptoms are important to report so that they are not exposed to a second head injury before they fully recover from the initial injury they received.

 

Brain Injury Webcast: "Veterans with TBI"

A web cast which will  provide an overview of the Veterans Health System and address the structure and services available for veterans with TBI and their families by the  Program Manage of the Department Veterans Affairs will take place on Friday, February 1, 2008, from 2:00 pm to 3:30 pm  "Veterans with TBI - The Veterans Health System." 

According to the Department of Veteran Affairs, this Web cast will be useful as a first step in understanding the VA system.  As service members with TBI are identified in State and community systems, it will provide an idea on where to refer them so that appropriate benefits are received.  Ideas for outreach and potential partnerships might also be a potential outcome.

The web-cast REQUIRES PRIOR on-line registration to ensure that your computer meets all technical requirements.  To register click here   You should register well in advance of February 1st to resolve any potential technical issues before the web-cast.  Should you experience any technical difficulties while registering, please submit a question to them by clicking here .   On February 1st, be sure to use the same computer to view the Web cast that you used to register. Connect 20 minutes in advance of the web-cast to ensure your connection and to download the Power Point slides.

For anyone who can't be present for the February 1st web-cast, there will be an archived copy available about one week after the event by clicking here .

Brain Injury Disability Rating System For Vets: New Proposals

The department of veterans affairs has proposed a new rating schedule for the evaluation of traumatic brain injury.  The proposal appears in the Federal Register, Vol 73 no 2, 38 CFR Part 4.

The proposal is a far reaching analysis of the consequences of traumatic brain injury.  Significantly, the veterans administration has recognized that there is nothing mild about mild traumatic brain injury. However, after making some very important statements about traumatic brain injury, its  diagnosis, symptoms and consequences, the VA then fails to classify these disabilities as rendering the individual 100 percent disabled.  The proposed disability rating ranges from 10 percent to 40 percent.

It is important that all advocates for individuals with a traumatic brain injury including neuropsychologists, neuropsychiatrists, social workers and others involved in the brain injury rehabilitation process make their opinions heard and oppose these limited ratings.

This proposed disability rating for a traumatic brain injury is just wrong and needs to be changed.  What the VA fails to understand is that a brain injury affects every aspect of a person's life.  To rate a brain injury as only a ten percent disability fails to take into account the day to day disabilities suffered by a person following brain damage.   

Here is what the proposal states:

We propose to include the information that mild, moderate and severe  refer to a classification of TBI at, or close to, the time of injury rather than to the current level of functioning in the regulation itself to make it clear to raters that these designations that may appear in the medical records refer only to the initial evaluation and not to current functioning.

The proposal also  acknowledges that mental disorders are common consequences of a traumatic brain injury.  The VA states that the most common co existing mental disorder is depression, which may occur in up to 60 percent of those with TBI, but anxiety and post traumatic stress disorder also commonly occur.

In discussing post concussion syndrome, the proposal acknowledges the this condition may become permanent in a proportion of the population and lists the symptoms of the post concussion syndrome as headache, dizziness or vertigo, fatigue, malaise, sleep disturbance, cognitive impairment, difficulty concentrating, delayed reaction time, behavioral changes (such as irritability, restlessness, apathy, inappropriate social behavior, aggression, impulsivity), emotional changes (such as mood swings, anxiety, depression), tinnitus or hypersensitivity to sound, hypersensitivity to light, blurred vision, double vision, decreased sense of smell and taste, and difficulty hearing in noisy situations or competing sounds in the absence of objective hearing loss.

Comments regarding the VA proposal must be submitted on or before February 4, 2008.  Written comments can be submitted by clicking here. Comments should indicate that they are submitted in response to RIN 2900-AM75-"Schedule for Rating Disabilities: Evaluation of Residuals of Traumatic Brain Injury (TBI). Comments can also be sent by mail to the Director, Regulations Management, (00REG), Department of Veterans Affairs, 810 Vermont Avenue, NW., Rm 1068, Washington, DC 20420.

For further information on these proposed regulations you can contact, Maya Ferrandino, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW Washington, DC 20420. (727) 319 5847

CDC Traumatic Brain Injury Webcast

The Center for Injury Research and Control at the University of Pittsburgh has announced a  live webcast event entitled  “TBI Outcomes: Overview and Implications for Returning Military Personnel” to be presented by Jean A. Langlois, ScD, MPH,  Senior Epidemiologist at the Centers for Disease Control and Prevention National Center for Injury Prevention and Control Atlanta, Georgia.

The broadcast is scheduled to take place on Wednesday, January 16th, 2008 at 2:00 p.m. Eastern Time.  You will need to register in advance to participate.  Since seats are limited, you are urged to register without delay.  You can obtain full information by clicking here.

Legislative Update from Brain Injury Association of America

The following is a legilstaive update provided by the Brain Injury Association of America:
 
SENATE PASSES TBI ACT REAUTHORIZATION BILL

Earlier today (Tuesday, December 11, 2007), the Senate passed by voice vote S. 793, legislation to reauthorize the TBI Act.  The reauthorization includes provisions to continue and hopefully expand TBI Act programs, such as the HRSA State Grant and CDC surveillance programs. 

This is a big victory, as the authorization for TBI Act programs officially lapsed in 2005 and advocacy efforts to renew this authority have been vigorous.  Stay tuned to BIAA for further information and analysis as developments progress.

APPROPRIATIONS HANG-UP

Unfortunately, as of press time on Tuesday, December 11, 2007, Congressional leadership had still not made a final decision regarding floor consideration of a “split-the-difference” omnibus appropriations bill, and thus, a conference report for this bill has not been filed.  Stay tuned to BIAA for the latest updates on this situation.

DEFENSE AUTHORIZATION BILL – INCLUDING TBI CARE PROVISIONS  - SET FOR PASSAGE

Congress is expected to pass the National Defense Authorization Act for Fiscal Year 2008 - including key wounded warrior provisions related to TBI care - this week.  The House of Representatives is expected to adopt the conference report tomorrow (Wednesday) or Thursday, followed by predicted swift passage in the Senate.

According to CQ Today (Dec. 11, 2007), “Several dozen House members might vote against the bill because of its war authorization, but they are likely to prove only a bump in an otherwise smooth road to adoption. And despite the conferees’ differences with the White House on a wide range of issues including military pay and overseeing contractors, they have sufficiently modified provisions to avert a veto threatened by the administration, members and aides predict.”

BIAA has lobbied actively this year on many of the TBI care provisions contained in the final version of the bill, and grassroots activity on the part of TBI advocates helped ensure that these TBI provisions were included in the conference report.

Below is a summary of the key TBI provisions included in the bill:

Major TBI Provisions in the National Defense Authorization Act for Fiscal Year 2008 (H.R. 1585)

Overlap of DoD/VA benefits:  Allows severely ill or injured service members and veterans to access their health care - including TBI care - based on their medical condition, rather than on their status as active duty or medically retired.  For example, if implemented, this overlap of benefits would allow medically retired veterans to access TBI care at private/civilian facilities that are eligible TRICARE providers.  Currently, this access is limited to service members who have active duty status. Note: Some civilian TRICARE facilities provide cognitive rehabilitation therapy.  This provisions sunsets in 2012. (Sec. 1631)

DoD Comprehensive Plan To Address TBI: Requires DoD to submit within 180 days of enactment, in consultation with the VA, a comprehensive plan for programs and activities of the Department of Defense to prevent, diagnose, mitigate, treat, research and otherwise respond to TBI and PTSD.  Plans are directed to include provisions for making injured service members aware of options for different treatments. (Sec. 1618)

This plan is required to include a proposal for the development and deployment of evidence-based means of assessing traumatic brain injury, PTSD, and other mental health conditions in members of the Armed Forces, including a system of pre-deployment and post-deployment screenings of cognitive ability in members for the detection of cognitive impairment.  (Sec. 1618)

This plan is also required to include a proposal on the development and deployment of an education and awareness training initiative designed to reduce the negative stigma associated with TBI and PTSD, and a plan for the provisions of education and outreach to families of members of the Armed Forces with TBI, PTSD, or other mental health conditions. (Sec. 1618)

VA Individualized TBI Rehabilitation Plans/Use of Civilian Facilities for TBI Care: Requires the VA Secretary to develop an individualized plan for rehabilitation and reintegration into the community for each veteran or service member who receives inpatient or outpatient care at the VA for TBI (Sec. 1702).

Note:  Unfortunately, the final version of this defense authorization bill/conference report does NOT include the provision in the Senate version of the bill which would have required the Secretary of the VA to provide care in non-VA (civilian) facilities if the Secretary determines that the VA is unable to provide care at the frequency or duration prescribed in the individualized plan, for rehabilitation and reintegration, or if the Secretary determines it is optimal for the veteran to receive care in a non-VA facility. 

Similar – but weaker - language, was included, stating that, in implementing and carrying out the individualized plans, the Secretary of the VA “may provide hospital care and medical services through cooperative agreements with appropriate public or private entities that have established long-term neurobehavioral rehabilitation and recovery programs.” (Sec. 1703)

Procedures for Referrals to VA and Civilian Health Care Services: Requires a comprehensive policy on improvements to care, management, and transition of recovering service members to “provide for uniform policies, procedures, and criteria among the military departments on the referral of recovering service members to the Department of Veterans Affairs and other private and public entities (including universities and rehabilitation hospitals, centers, and clinics) in order to secure the most appropriate care for recovering service members, which policies, procedures, and criteria shall take into account, but not be limited to, the medical needs of recovering service members and the geographic location of available necessary recovery care services.” (Sec. 1611)

DoD TBI Center of Excellence: Requires the establishment of a Center of Excellence in the Prevention, Diagnosis, Mitigation, Treatment, and Rehabilitation of Traumatic Brain Injury, including mild, moderate, and severe TBI.  The Secretary of Defense is directed to enter into partnerships, to the maximum extent practicable, with the VA, institutions of higher education, and other appropriate public and private entities, to further the research efforts of the centers.   This DoD TBI Center of Excellence is responsible for implementing the DoD’s comprehensive plan to address TBI - as required by Sec. 1618 – once this plan is developed.  (Sec. 1621)

Collaboration Required in New VA TBI Research Efforts:  Requires new VA TBI research efforts to collaborate with facilities that conduct research on rehabilitation for individuals with TBI and receive grants for such research from the National Institute on Disability and Rehabilitation Research of the Department of Education (for example, the TBI Model Systems of Care program). (Sec. 1704) 

National Academy of Sciences DoD/VA TBI Study: Requires DoD, in consultation with the VA, to contract with the National Academy of Sciences to study the physical and mental health – specifically including the neurological, psychiatric, and psychological effects of TBI – of members and former members of the Armed Forces who are deployed in OEF or OIF, and their families as a result of such deployment.  Specifically, a comprehensive assessment is required - not later than three years after the date of legislative enactment – of “the full scope of the neurological, psychiatric, and psychological effects of traumatic brain injury on members of the Armed Forces, including the effects of such effects on the family members of such members and former members, and an assessment of the efficacy of current treatment approaches for traumatic brain injury in the United States and the efficacy of screenings and treatment approaches for traumatic brain injury within the Department of Defense and the Department of Veterans Affairs.  (Sec. 1661)

Comprehensive Long-Term TBI Rehabilitation Program in VA: Requires the Secretary of the VA to develop and carry out a comprehensive program of long-term care for post-acute traumatic brain injury rehabilitation that includes residential, community, and home-based components utilizing interdisciplinary treatment teams.  This program is to be developed and located in Department of VA polytrauma rehabilitation centers.  Eligibility is restricted to veterans diagnosed as suffering from “moderate to severe” traumatic brain injury (excludes mild) who are unable to manage routine activities of daily living without supervision or assistance, as determined by the Secretary. (Sec. 1702)

Pilot Program on Assisted Living Services for Veterans with TBI:  Requires the Secretary of the VA, in collaboration with the Defense and Veterans Brain Injury Center of the Department of Defense, to carry out a five-year pilot program to assess the effectiveness of providing assisted living services to eligible veterans with traumatic brain injury to enhance the rehabilitation, quality of life, and community integration of such veterans (Sec. 1705)

Report on TBI Classfications:  Requires the Secretary of Defense and the Secretary of Veterans Affairs to jointly submit a report – not later than 90 days after the date of legislative enactment - describing the changes undertaken within the Department of Defense and the Department of Veterans Affairs to ensure that traumatic brain injury victims receive a medical designation concomitant with their injury rather than a medical designation that assigns a generic classification (such as “organic psychiatric disorder.”) (Sec. 1664)

TBI Registry in VA:  Requires the Secretary of the VA to establish and maintain a registry of names of each individual who: 1) served as a member of the Armed Forces in Operation Enduring Freedom or Operation Iraqi Freedom; 2) exhibits symptoms association with TBI; 3) applies for care and services from the Department of Veterans Affairs or files a claim for compensation for disability associated with such service; and 4) grants permission to the Secretary to include such information in the registry. (Sec. 1704)

Department of Defense Establishes Center of Excellence to Address Traumatic Brain Injury

What follows is a press release from the Department of Defense regarding the opening of their Traumatic Brain Injury (TBI) Center of Excellence:

The Defense Center of Excellence (DCoE) for Psychological Health (PH) and Traumatic Brain Injury (TBI) began initial operations today. The DCoE will be fully functional by October 2009.   It is currently operating in temporary office spaces in Rosslyn, Va., as part of its initial phase.

The Department of Defense (DoD), with support from the Department of Veterans Affairs (VA), is leading a national collaborative network to advance and disseminate PH/TBI knowledge, enhance clinical and management approaches, and facilitate other vital services to best serve the urgent and enduring needs of warrior families with PH and/or TBI.

“The center will integrate quality programs and advanced medical technology to give us unprecedented expertise in dealing with psychological health and traumatic brain injuries,” said Assistant Secretary of Defense for Health Affairs Dr. S. Ward Casscells. “In developing the national collaborative network, the DCoE will coordinate existing medical, academic, research, and advocacy assets within the services, with those of the VA and Health and Human Services, other federal, state and local agencies, as well as academic institutions.”
            
The Defense and Veterans Brain Injury Center (DVBIC) is now integrated into the center. DVBIC has DoD’s primary subject matter expertise on TBI and many of its functions are transitioning to the DCoE. The DoD Center for Deployment Psychology, currently at the Uniformed Services University of the Health Sciences, is also integrated into the training and education functions of the DCoE.

Military Still Lacks Understanding of Traumatic Brain Injury

An article in today's USA Today reports a survey  which they conducted of four military installations and the Department of Veterans Affairs, where combat veterans are routinely screened for brain injury.  What they found was about 20,000 people show signs of damage. However, these individuals  are not counted in the Pentagon's official tally of 30,000 war wounded.

The military lacks "a standardized definition of traumatic injury or a uniform process to report all TBI (traumatic brain injury) cases," Assistant Secretary of Defense Ellen Embrey wrote in a memo last month. As a result, it is hard to determine the scope of the problem, she wrote

What follows are portions of the story concerning one individual whose brain damage went undetected:

Marine Lance Cpl. Gene Landrus was hurt in a roadside bomb attack outside Abu Ghraib, Iraq, on May 15, 2006, and faces medical separation from the Corps. He's also up for a Purple Heart.
Along with 20,000 other veterans, he's not included in the Pentagon's official count of U.S. troops wounded in Iraq and Afghanistan.

That's because Landrus' wound was to his brain and hidden from view. Landrus, 24, of Clarkston, Wash., says he did not realize the nausea, dizziness, memory loss and headaches he suffered after the blast were signs of a lasting brain injury.

Army medics who examined him in the field didn't find the wound either. "They wanted to know if we had any holes in us, or if we were bleeding. We were in and out of there (the aid station) in 10 to 15 minutes," Landrus remembers.

For the balance of his combat tour, he tried to shake off the blast's effects and keep going. Now, "my goal is to get back to a normal life," he says.

Landrus was riding in an open-backed, armored Humvee when the roadside bomb detonated. It was his second exposure to a blast. An explosion a month before had "rung our bells a little bit, but no one was knocked unconscious."

In the attack May 15, 2006, Landrus and three other Marines blacked out for several seconds. After Landrus regained consciousness, "everything looked like it was going in slow motion," he recalls.

The battalion came home in August 2006 to Camp Pendleton, Calif., one of a few military installations that screens for brain injuries among returning troops. Landrus was referred to Navy doctors who diagnosed brain injury. With medication and rehabilitation training at nearby Scripps Memorial Hospital Encinitas, Landrus has improved.

"I still can't remember what I did the day before or stuff that I did earlier in the day," he says. He carries a Palm Pilot or a pad of paper to write down orders, numbers or dates, so he can remember them later. The headaches have never gone away.

Landrus will never fully recover, says Jessica Martinez, his lead therapist at Scripps.

"This is basically like an invisible injury," she says. "He looks like a normal guy. … But if you spend any amount of time with him … you would be able to notice that something's really happened."

Veteran's Traumatic Brain Injury Family Caregiver Panel To Be Established

The Department of Defense gave notice this week in the Federal Register that that it intends to establish the Traumatic Brain Injury Family Caregiver Panel, as a subcommittee of the Defense Health Board. [72 FR 64198]

According to the notice, "this non-discretionary advisory committee, which will operate as a subcommittee of the Defense Health Board, shall provide the Department of Defense and the Department of Veterans Affairs independent advice and recommendations on the development of training curricula to be used by family members of members and former members of the Armed Forces on techniques, strategies, and skills for care and assistance for such members and former members with traumatic brain injury."

Pursuant to section 744(a)(2) of Public Law 109-364, the Traumatic Brain Injury Family Caregiver Panel shall consist of 15 members appointed by the Secretary of Defense in consultation with the Secretary of Veterans Affairs. The Secretary of Defense in appointing members for the Traumatic Brain Injury Family Caregiver Panel shall consider members from among the following:

(a) Physicians, nurses, rehabilitation therapists, and other individuals with traumatic brain injury, including persons who specialize in caring for and assisting individuals with traumatic brain injury incurred in combat;

(b) Representatives of family caregivers or family caregiver associations;

(c) Health and medical personnel of the Department of Defense and the Department of Veterans Affairs with expertise in traumatic brain injury and personnel and readiness representatives of the Department of Defense with expertise in traumatic brain injury;

(d) Psychologists or other individuals with expertise in the mental health treatment and care of individuals with traumatic brain injury;

(e) Experts in the development of training curricula;

(f) Family members of members of the Armed Forces with traumatic brain injury; and

(g) Such other individuals the Secretary of Defense considers appropriate.

Appointments to ths committee are made by the Secretary of Defense.

FOR FURTHER INFORMATION CONTACT: Jim Freeman, DoD Committee Management Office, 703-601-2554, extension 128.

Online Veterans Mental Illness Resource Site

The National Alliance on Mental Illness (NAMI) has established an online Veterans Resource Center  to help support active duty military personnel, veterans and their families facing serious mental illnesses such as depression, posttraumatic stress disorder (PTSD) and schizophrenia.

Thanks to Anxiety Insights for providing this information.

Public Input Requested for the Brain Injury Summit

A Brain Injury Summit is scheduled for November 2-3, 2007 in Washington, DC jointly sponsored by the Brain Injury Association of America (BIAA) and the North American Brain Injury Society (NABIS).  You are invited to provide input into one or more of the focus areas listed below.  Your comments will be furnished to work group moderators who will write the final document. 

Acute Care
Sub-acute and Post-acute Care
Long-term, Community Integration & Case Management
Mild TBI & PTSD
Systems Issues
To provide input to the established work group questions, please click on this link.

The Summit will result in a white paper/position statement on improving the quality of care and long-term living for individuals with brain injury, including civilians, service members and veterans. Advocates at the federal and state levels and in the private sector will utilize the position paper for advocacy efforts. 

I encourage all those involved in the brain injury movement including persons with a brain injury, family members and professionals to participate in this important advocacy effort.

10-in-10 Project

I had the privilege this morning of having breakfast with Peter C. Kinney, the treasurer of a really good not for profit organization known as the 10 in 10 Project whose goal is to assist our brain injured troops and the civilian population who are living with brain injuries and are unable to afford or access the necessary assistance.

Through a fund raising program called Tickets of Hope they are raising funds to assist those in need and provide a kit known as the Brain Injury Recovery Kit produced by Day Timer which is a memory aid and planner for brain injured individuals.

Donations totaling $600 purchase one Ticket of Hope™

For each Ticket they sell the the 10 in 10 Project is able to provide:

• One Brain Injury Recovery Kit™ shipped to the individual's home,
• A support program for use of the Kit with the assistance of The Brain Injury Association of New Mexico, (BIANM)
• Membership to the Chartered Affiliate Brain Injury Association in the individual's state to be guided to additional resources.

I look forward to working with this dedicated group of individuals on this project.

You can get further information by visiting the 10 in 10 Project web site. You can also e mail them for further information and to request assistance.

New Report Calls for Improved Disability Benefits for War Veterans

A report issued on Wednesday by the Veterans’ Disability Benefits Commission recommended revising the disability-rating schedule to better take into account neurological disabilities, including TBI. Specifically, the Commission recommended tackling “post-traumatic stress disorder, other mental disorders and traumatic brain injury expeditiously” when revising the disability-rating schedule.

The report called for completing a revision of the current disability rating system within the next five years. In addition, the Commission found that, overall, the current disability benefits structure does not take into account the full impact of service-connected disabilities on veterans’ quality of life, and recommended that Congress provide a 25 percent increase in benefits until a new system is put into place.

Assistance Needed to Insure Funding Of Needed TBI Programs For Brain Injured Veterans

The Brain Injury Association of America has requested that I post this urgent request.

Earlier this week, the Senate passed its version of the defense authorization bill, including the text of the Dignified Treatment of Wounded Warriors Act, which contains critically important provisions to improve TBI care for returning service members.  The House of Representatives passed its defense authorization bill, which does not contain these critical TBI provisions, in May.  Conferees have now been appointed, as the House and Senate will work in conference to produce a final version of the legislation to send to President Bush.

Action Requested: Please contact your Representative today and urge them to sign on to the Congressional Brain Injury Task Force letter urging conferees to retain the Senate’s Dignified Treatment of Wounded Warriors Act provisions in the final version of the defense authorization bill. 

Click here to contact you representative.

Brain Injury and the Military: Report from Washington DC Town Hall Meeting

Yesterday's town hall meeting on brain injury and how the military is responding to the ever growing needs of our returning service members was well attended by all members of the brain injury community. Well over 100 individuals and groups participated ranging from wounded service members and concerned family members to consumer advocates from many state brain injury associations and other disability advocacy groups, members of the military from both the armed forces and the VA and brain injury rehabilitation experts from around the country.

The program consisted of several panel discussions which included audience participation.  These discussions attempted to set forth the multiple issues that need to be confronted in dealing with the epidemic of traumatic brain injury in our troops returning from Iraq and Afghanistan.

Interestingly, the issues discussed have been well known in the civilian population for many years and come as no great surprise to family members who have been waging the battle for needed brain injury rehabilitation services for their loved ones. What was encouraging was the general consensus that brain services must be more than a "medical model" and that quality of life issues must play a central role in determining services and outcomes.  This change in attitude has been long in coming and hopefully will lead to more patient and family centered services.  Above all, the need to treat those with brain injury and their families with RESPECT was also repeated on multiple occasions.

What follows are my notes taken during the course of the day.

Before a true plan can be developed to deal with TBI in the military, we still need to know the true number of returning service members with traumatic brain injuries.  This is difficult because of the lack of good screening prior to discharge and poor tracking of returning vets.  In fact, we heard that State VA offices are not even given the names of discharged troops so they are unable to contact them and offer screening or services.   We also need to know where these troops are returning to following discharge so that the entire array of services can be offered within these communities.

The current number of identified soldiers suffering from TBI is approximately 3,904.  However this number does not include those suffering from mild TBI and who never received diagnosis or services at the major military trauma centers.  Without question, if these troops were included, the numbers would be staggering.  The preliminary screening programs that have been undertaken estimate that between 20 to 25 percent of returning troops suffer from some level of traumatic brain damage.  Why they haven't been diagnosed and why they are not receiving any type of assistance must be addressed.

Their is a tremendous amount of red tape that impedes the ability of brain injured troops from receiving necessary services.  Entry into the rehabilitation and services system must be streamlined. The amount of paper work and the time it takes to get authorization for needed services must be decreased.

Their is a failure on the part of the military to properly document soldier exposure to potential brain injury.  Soldiers who have been exposed to "IED's" may not know they have a traumatic brain injury for many months.  Often the symptoms are only understood once they return home.  When they attempt to get disability connected services, it become difficult for them to prove their exposure since events are not properly documented in their service record.

Many service members find themselves becoming homeless since their health issues will impact their ability to sustain employment, their lack of skills and their inability because of brain damage to learn new skills impedes their ability to obtain gainful employment and the lack of affordable housing.  These homeless veterans need to rescued and assisted.

Although the military has limited experience with brain injury rehabilitation, their is a reluctance to send these brain injured vets to private facilities who have the experience to work with the person. It was repeatedly pointed out how crucial the involvement of family members is to the brain injury rehabilitation process.  Since civilian rehab centers are located in closer proximity to where veterans and their families actually reside, it is much easier for these family members to participate in the rehabilitation process if they are treated closer to home. Treatment at VA centers limits opportunities for family involvement which becomes impractical or impossible.

The federal government has not provided adequate funding for TBI rehabilitation services.

Their is poor integration between military brain injury services and civilian services making transition very difficult.

The military lacks sufficient numbers of medical personal with the necessary knowledge and skill to diagnose and treat traumatic brain injuries.

The military must establish goals for the rehab process.  These goals must include the return of individuals to a productive life; addressing and dealing with the psychiatric disability of family members as a result of their loved one's brain damage; dealing with the injured vet's psychiatric disability as a result of their brain injury and addressing the long term needs of this population.

Other speakers touched on the need for better ways to screen troops and identify the mild traumatic brain injuries and concussions to prevent further brain damage from occurring; and the need for pre-deployment base line screening.

The services available in each State vary widely.Their must be a better allocation of resources. 

The veteran's administration disability rating system does not adequately address and capture the disabilities and cognitive impairments associated with TBI.  As a result service members receive service disability rating which do not fairly reflect the true extent of their disability related to their brain damage.

I welcome further discussions, but more importantly, I hope that the message from this meeting gets heard by Congress, the armed forces and the VA and important reforms get instituted  without any further delay.

 

Veterans With Traumatic Brain Injury: Is America Meeting Their Needs

I'm still in Washington, DC, scheduled to participate today in a national town hall meeting convened to answer the pressing questions of how to respond to the immediate and long term needs of returning service members suffering from traumatic brain injury.

Some of this issues scheduled to be discussed in this all day program include important issues of how to identify returning vets suffering from brain damage; evaluation of proposed legislation; community reentry including vocational rehabilitation,education reentry and access to transportation.

Scheduled to participate in today's meeting are the leading policy maker's involved in public policy issues surrounding traumatic brain injury including members of Congress, representatives of the Center for Disease Control, members of the military and veteran's affairs as well as the leading groups in this Country that shape the debate regarding brain trauma including the Brain Injury Association of America, the National Association of State Head Injury Administrators, the Defense and Veterans Brain Injury Center and state brain injury associations.

I look forward to a lively discussion of the issues especially in light of the conclusions of a separate panel which was part of a day long Washington Defense Forum sponsored by the U.S. Naval Institute and the Military Officers Association of America.  The meeting which took place on Tuesday, concluded that the bureaucracies that are supposed to help brain-injured war veterans are too complex for them to navigate.  Specifically, the departments of Veterans Affairs and Defense need better coordination of their programs, according to the panel.

Virginia Faulted on Care to Brain Injured

A report issued by a Virginia legislative review commission concluded that tens of thousands of people in Virginia with traumatic-brain injuries lack adequate residential facilities, access to therapy, transportation or occupational help. 

Further jeopardizing the already taxed system of brain injury care in Virginia is the prospect of returning veterans with brain damage who will also require care with no plans on how to deal with this growing epidemic. 

Unfortunately, Virginia is not the only State that lacks the proper resources to adequately care for the thousands of individuals who must live with a traumatic brain injury on a daily basis. Most states do not maintain proper statistics on the number of individuals who sustain brain injury in a give year and lack proper support services for brain damaged individuals and their families.  Rehabilitative services in many places are fragmented and not easily accessible.  Most states have improper levels of funding to support brain injury services and most individuals do not receive the services they deserve.

In Virginia, most if not all facilities will not accept Medicaid to pay for residential care.  In fact, the only facility in the state that does accept Medicaid payments for residential care for traumatic brain injury victims will stop accepting these patients later this month.

But, Medicaid funding is not the only issue.  Issues of private insurance and why these health insurers are not paying for brain injury rehabilitation services needs to be addressed.

You can read more about this 130 page report by clicking here.

Taking on the VA For Brain Injury Rehabilitation

The Boston Globe in an important article reports on the success and failures of returning veterans and their families in obtaining brain injury rehabilitation services outside of the Veterans Administration network.

I have been saying for a long time that I can't understand why the VA will not allow brain damaged vets to obtain services in facilities that are not only close to their home but provide expertise that the VA still is incapable of providing.  It simply makes no sense that the VA is trying to reinvent the wheel.  Why not use the available services that are available in the community to provide care to returning vets.  The adamant attitude of do it our way or not at all simply needs to change!

Read the full story Families wage fight for brain injured.  Thanks to the Going Through the Motions blog for alerting me to this story.