- The Washington Times - Thursday, April 1, 2010

Too little is known about how to care long term for veterans with a traumatic brain injury, the most common injury among Iraq and Afghanistan veterans, the Institute of Medicine said Wednesday.

It urged the Veterans Affairs Department to conduct research into developing protocols for caring for these veterans as they age. Roadside bombs are a common cause of traumatic brain injury, with side effects ranging from headaches to problems relating to others.

“It’s an evolving area, and it’s going to need to evolve more to keep up with the patient population,” said Dr. George W. Rutherford, a professor of epidemiology and biostatistics at the University of California at San Francisco.

Dr. Rutherford chaired a 16-member panel coordinated by the Institute of Medicine that at the request of Congress instigated the review of the readjustment needs of troops, veterans and their families. The institute is part of the National Academies, an independent organization chartered by Congress to advise the government on scientific matters.

The report praises the VA’s work to establish rehabilitation services for those with traumatic brain injury in the initial months or years after they are wounded. However, it says that “protocols to manage the lifetime effects of TBI are not in place and have not been studied for either military or civilian populations.”

The report notes that some studies have found that 10 percent to 20 percent of veterans returning from Iraq or Afghanistan have a traumatic brain injury, while others have found that such occurrences account for up to a third of all battlefield injuries.

Dr. Victoria Cassano, the VA’s liaison to the institute, said the VA has been at the forefront in caring for those with a traumatic brain injury and agreed with the institute’s recommendation for further research into long-term care.

“I think it will add to our portfolio on this very, very important subject,” Dr. Cassano said.

The report also urges Congress to direct the VA to produce more detailed annual projections of the needs of veterans and their families so more thorough planning can be done to prepare for an uptick in disability claims and health needs in the decades ahead as the veterans age.

Based on a review of disability claims from past wars, the report says the number of disability claims from recent veterans should peak around 2040.

“It’s going to get worse before it gets any better,” said Ryan Edwards, an economics professor from the City University of New York, who served on the panel. “We’re going to see a larger burden … and it will continue to expand.”

Overall, the report says, the VA and Defense Department should better coordinate services available to veterans. It holds up as a successful model Military OneSource, a one-stop online and telephone information source for military personnel and their families.

The study says the Defense Department needs to better address troops’ reluctance to report mental health problems and should review how it handles confidentiality when a service member seeks help. It also encourages the Defense Department and VA to hire more mental health professionals.

It could be helpful for service members returning home from war if there were an interim place they could go following time in combat to rest and prepare for the adjustment back to the U.S., the report says.

Navy Capt. Edward Simmer said the Defense Department is already looking for ways to address some of the problems discussed in the report. “The things we need to work on, we’ll definitely get started with,” Capt. Simmer said.

Capt. Simmer is the senior executive for psychological health at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Rosslyn, Va.

Next month, the panel starts a second, two-year examination of veterans’ health issues.

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