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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.




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