Category Archives: TBI

Traumatic Brain Injury – TBI and Spinal Cord Injury SCI

The VA says this about TBI and SCI: 

Due to the ongoing conflicts in Afghanistan and Iraq, Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) accounts for almost 25% of combat casualties.

Improvised explosive devices, blast (high pressure waves), landmines, and explosive fragments account for the majority of combat injuries in Afghanistan and Iraq. Although Kevlar helmets and advances in body armor have saved the lives of many soldiers, they do not protect against blasts and impacts to the head, face and cervical spinal cord.

Blast injuries often result in multiple traumas, including injuries to internal organs, limb loss, sensory loss, and psychological disorders. The term “polytrauma” has been coined to describe the co-occurring injuries.

The information above and below come from here which are part of an introduction and overview prepared by Joel Kupersmith, MD, Chief Research and Development Officer, VA for the purposes of a proposal solicitation.  I thought the overview might be of interest to those with these injuries and their families.

Traumatic Brain Injury:

Kevlar helmets have done much to protect the head but leave the forehead unprotected. The left and right frontal lobes, located behind the forehead control intellectual abilities such as the ability to plan and organize. This area of the brain also controls personality, behavior, and emotional control.

Concussion or mild TBI is the most common form of combat-related injury. Mild TBI can occur even in those not directly hit by the blast, without obvious external injuries, without loss of consciousness and without visible findings from acute Magnetic Resonance Imaging. Problems with memory, lack of concentration, increased anxiety and irritability are common hallmarks of mild TBI. Although evidence suggests that the majority of OIF/OEF soldiers who suffer mild TBI will recover over time, early diagnoses and treatment are critical so that aberrant behaviors due to TBI are not misinterpreted and soldiers are spared the risk of second impact syndrome. Appropriate recognition of TBI will facilitate quick return to pre-injury activity levels, including return to duty status.

In addition to mild TBI, soldiers close to the blasts are experiencing severe diffuse and contrecoup injuries. Soldiers with a moderate to severe TBI often show the similar symptoms as mild TBI yet also report: worsening headaches; repeated vomiting or nausea; seizures; inability to awaken from sleep; slurred speech; weakness, numbness and loss of coordination. Unlike mild TBI, these problems and others can persist long-term or result in permanent difficulties with memory, reasoning, emotion and expression making it impossible to return to duty, hold steady employment or regain pre-injury quality of life.

Penetrating focal injuries from mortar rounds or other forms of heavy artillery resulting in severe brain injury are not as prevalent. However, focal destruction of brain tissue is the most life-threatening, intractable type of brain injury causing permanent damage to the affected area and the functions it controls.

Spinal Cord Injury:

Current designs in military protective gear and advanced evacuation procedures have resulted in both a decrease in the percentage of spinal cord injured soldiers and an increase in the number of those that ultimately survive. Blast force and shrapnel injuries are most common. For those that survive, the cervical spinal cord, the unprotected and most mobile portion of the spinal cord, is the most common site of injury.

Soldiers with cervical SCI face short- and long-term consequences of losing motor and sensory function below the level of injury, coupled with a loss of autonomic regulation. Every organ system may be affected by cervical spinal cord injury. Alterations in the gastrointestinal, renal, skin and musculoskeletal organs are common, and respiratory problems are the overwhelming cause of morbidity and mortality. In addition, patients may experience chronic pain at or below the level of injury and, less frequently, above it.

Alterations in respiratory mechanics, and the development of alveolar hypoventilation, pneumonia, aspiration of gastric contents, pulmonary embolism, pulmonary edema, and sleep apnea are a few of the common respiratory complications associated with cervical SCI. Ultimately, dysfunction depends on the level and extent of injury. Lesions above C3 paralyze all respiratory muscles. When SCI involves C3 to C5 lesions, profound respiratory muscle dysfunction occurs leaving the patient unable to generate a cough or clear secretions. Because of this, neuroprotective strategies that rescue even one or two segments may be of significant functional benefit to veterans with SCI.

Let’s pray that this proposal results in research that leads to significant help for our injured veterans.    

Oldtimer

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Surge Seen in Number of Homeless Veterans

Surge Seen in Number of Homeless Veterans

 Oldtimer’s Comment:  I’ve seen a number of these types of articles.   Although the estimates vary depending on the subject area from 400 to about 1500, the word on the street is that the returning soldiers from Iraq and Afghanistan are showing up in shelters much faster than in previous wars.  The problem stems from higher rates of PTSD and TBI (traumatic brain injury) which still take too long to diagnose, and which are resulting from the combined effect of IED’s and higher survival rates.    The VA has long under diagnosed these problems and only recently, after much heat, begun to actively pursue it. 

Photo by Jeff Swensen for The New York Times
Frederick Johnson, a veteran of the Iraq war, lives in temporary housing provided by the V.A. after spending a year on the streets.

By ERIK ECKHOLM

WASHINGTON, Nov. 7 – More than 400 veterans of the Iraq and Afghanistan wars have turned up homeless, and the Veterans Affairs Department and aid groups say they are bracing for a new surge in homeless veterans in the years ahead.

 

Photo by Brendan Smialowski for The New York Times
Joe Williams lives in a homeless shelter in Washington.

Experts who work with veterans say it often takes several years after leaving military service for veterans’ accumulating problems to push them into the streets. But some aid workers say the Iraq and Afghanistan veterans appear to be turning up sooner than the Vietnam veterans did.

“We’re beginning to see, across the country, the first trickle of this generation of warriors in homeless shelters,” said Phil Landis, chairman of Veterans Village of San Diego, a residence and counseling center. “But we anticipate that it’s going to be a tsunami.”

With more women serving in combat zones, the current wars are already resulting in a higher share of homeless women as well. They have an added risk factor: roughly 40 percent of the hundreds of homeless female veterans of recent wars have said they were sexually assaulted by American soldiers while in the military, officials said.

“Sexual abuse is a risk factor for homelessness,” Pete Dougherty, the V.A.’s director of homeless programs, said.

Special traits of the current wars may contribute to homelessness, including high rates of post-traumatic stress disorder, or PTSD, and traumatic brain injury, which can cause unstable behavior and substance abuse, and the long and repeated tours of duty, which can make the reintegration into families and work all the harder.

Frederick Johnson, 37, an Army reservist, slept in abandoned houses shortly after returning to Chester, Pa., from a year in Iraq, where he experienced daily mortar attacks and saw mangled bodies of soldiers and children. He started using crack cocaine and drinking, burning through $6,000 in savings.

“I cut myself off from my family and went from being a pleasant guy to wanting to rip your head off if you looked at me wrong,” Mr. Johnson said.

(…)  Read more about Fredrick at the link above

Poverty and high housing costs also contribute. The National Alliance to End Homelessness in Washington will release a report on Thursday saying that among one million veterans who served after the Sept. 11 attacks, 72,000 are paying more than half their incomes for rent, leaving them highly vulnerable.

Mr. Dougherty of the V.A. said outreach officers, who visit shelters, soup kitchens and parks, had located about 1,500 returnees from Iraq or Afghanistan who seemed at high risk, though many had jobs. More than 400 have entered agency-supported residential programs around the country. No one knows how many others have not made contact with aid agencies.

More than 11 percent of the newly homeless veterans are women, Mr. Dougherty said, compared with 4 percent enrolled in such programs over all.

Veterans have long accounted for a high share of the nation’s homeless. Although they make up 11 percent of the adult population, they make up 26 percent of the homeless on any given day, the National Alliance report calculated.

Oldtimer’s comment:   My studies show that homeless male veterans make up 43% of the homeless male population, far in excess of what would be expected.

According to the V.A., some 196,000 veterans of all ages were homeless on any given night in 2006. That represents a decline from about 250,000 a decade back, Mr. Dougherty said, as housing and medical programs grew and older veterans died.

Oldtimer’s comment:  Oops!  That is a deliberately misleading statement.   A GAO report states that the drop from 250,000 a decade ago was due to a major change in how homeless veterans are counted.   While it is true that our older veterans are dieing off, many more veterans are joining the ranks of the homeless and make up for it.  There has been no real decline, and actually there has been a steady increase in the percentage of homeless veterans vs the overall population of veterans.

The most troubling face of homelessness has been the chronic cases, those who live in the streets or shelters for more than year. Some 44,000 to 64,000 veterans fit that category, according to the National Alliance study.

On Wednesday, the Bush administration announced what it described as “remarkable progress” for the chronic homeless. Alphonso R. Jackson, the secretary of housing and urban development, said a new policy of bringing the long-term homeless directly into housing, backed by supporting services, had put more than 20,000, or about 12 percent, into permanent or transitional homes.

Oldtimer’s comment:  I’m not sure where these numbers come from.  It appears the HUD secretary is talking about all chronic homeless, not just veterans.   20,000 is 12% of 166,000, which is about right for the chronic homeless for the entire homeless population. To get a feel for progress among veterans, see the following two paragraphs.

Veterans have been among the beneficiaries, but Mary Cunningham, director of the research institute of the National Alliance and chief author of their report, said the share of supported housing marked for veterans was low.

A collaborative program of the Department of Housing and Urban Development and the V.A. has developed 1,780 such units. The National Alliance said the number needed to grow by 25,000.

Mr. Dougherty described the large and growing efforts the V.A. was making to prevent homelessness including offering two years of free medical care and identifying psychological and substance abuse problems early.

Oldtimer’s Comment:  ‘Bout Time!

(…)

PTSD vets soon coming like tsunami

There is a scary article in the San Francisco Chronicle.  The article predicts a flood of new stressed out veterans as they return form Iraq and Afghanistan, many of whom are on the fast track to PTSD, depression, and other mental health disorders compared to previous wars.   I’ve reprinted a little of it below, but you can find the rest at this link where it is reproduced in SGate.com.   

A flood of stressed vets is expected

C.W. Nevius

Sunday, December 9, 2007

(…) omitted illustrative story about a vet (Tim Chapman) contemplating suicide, find it at the link. 

First a few facts. Bobby Rosenthal, regional manager for homeless programs at the Department of Veterans Affairs, estimates that one third of the more than 6,000 homeless people – about 2,100 – in San Francisco are veterans.

And no wonder the number is so high. California leads the nation in homeless veterans by a mile, according to the National Coalition for Homeless Veterans. The 2006 numbers showed 49,724 homeless vets in California. The next nearest state was New York with 21,147.

Now here’s the scary part. Compared with what’s coming, that’s nothing.

Roughly 750,000 troops served in the wars in Iraq and Afghanistan, often with multiple tours of duty. Many are only now returning home. But unlike Vietnam veterans, who didn’t begin to demonstrate post-war trauma until five or 10 years after they left the war, this group seems to be on a fast track.

“Everything is speeded up,” said Michael Blecker, executive director of San Francisco’s Swords to Ploughshares program. “What we’re seeing in San Francisco is guys in their 20s with the kind of stress and trauma that makes it impossible to go on with their lives.”

It’s been called a health care tsunami. Because not only are the Iraq vets prone to post-traumatic stress disorder (something Chapman has battled) but with improved battlefield health care, far more are surviving traumatic injury. On one hand, that’s good news, but it also means many more vets who are severely disabled, having lost arms and legs. Both factors increase the chances that the returning troops will join the sad ranks of homeless veterans.

Cities all over the country are bracing themselves, although some, like San Francisco, are bound to be hit harder. Mayor Gavin Newsom says that at a recent conference of mayors, the group passed a resolution asking the VA “to tell us what you are going to do.”   “It’s great lip service,” Newsom said, “but show me the money.”

If history holds, the mayors shouldn’t hold their breath. If anything, benefits for veterans have been restricted. To take one example, many of us think of the World War II G.I. Bill as a shining example of a reward for service, paying for college for vets. But Blecker, of Swords for Ploughshares, says the current version “is in no way, shape, or form near enough” to pay for a degree.

As Newsom says, “Yeah, support the troops – as long as they are young, healthy and a great photo op.”

For San Francisco, the potential impact could be huge. An influx of traumatized, battle-scarred veterans presents a scary future. Consider the case of Scott Kehler, a veteran of the first Gulf War, who needed years to work through his demons. He recalls passing burned bodies and the constant fear that an explosion would suddenly erupt in the street.

“It was the things I didn’t want to see at night when I closed my eyes,” Kehler said. “I didn’t know what PTSD was. I only knew my dreams, my shame, my guilt, was all coming together.”

(…) omitted a few details, go to link to get the rest.

Kehler, who is mentoring Chapman, is testimony to the effectiveness of the Ploughshares slogan – “veterans helping veterans.”

“Especially now that we’ve got our veterans coming home from Iraq,” said Ploughshares counselor Tyrone Boyd, “we’re going to need people that have been in combat so they know what they are talking about.”

The challenges are unique. Wanda Heffernon, a program and clinical counselor for Ploughshares, said they had a new inductee who slept in the closet. It was the only place he felt safe.

It’s the sudden transition that gets them.  “One day they are fighting in a war,” said Kehler. “The next day they are sitting at their mother’s kitchen table.”

Is it any wonder they end up on the street? Kehler battled alcohol abuse, but Chapman is part of the new breed, who turn to methamphetamine. Married when he returned, he lost his wife and all contact with his parents. Eventually he ended up sleeping in an alley.Now drug-free, living at Treasure Island housing, holding down a full-time job, and reconnected with his mother, he is testimony to the idea that peer counseling seems to work. Ploughshares has earned support from Sens. Dianne Feinstein and Barbara Boxer and House Speaker Nancy Pelosi.

Imagine the impact it would have on the San Francisco homeless problem if one third of those on street were able to get help and housing.

But what the vets don’t have is funding.

“Why isn’t the federal government doing something about this? Why isn’t the Veterans Administration doing something?” Blecker asks. “The irresponsibility of our leaders, not to address this, makes me want to tear my hair out.”

The VA’s Rosenthal – who gets high marks from local leaders – says the problem is not being ignored.

“It’s a whole new set of challenges,” she said. “The VA is looking at it. Let’s hope we’ve learned our lesson from Vietnam.”

We can only hope.

“You know what scares me?” asks Boyd. “I haven’t heard a plan (from the federal government) about what they are going to do when the troops come home. What’s the plan?”

Well?

C.W. Nevius’ column appears Tuesday, Thursday, and Sunday. His blog C.W. Nevius.blog can be found at SFGate.com. E-mail him at cwnevius@sfchronicle.com.

Oldtimer’s comment:  This story illustrates what I’ve said all along.  PTSD and TBI are leading causes of homelessness among veterans.  It is a rapidly growing problem, approaching flash flood conditions for our heroes returning from Iraq and Afghanistan.   A tsunamis of real people, not just numbers, real people with real names.  Somebody’s sons and daughters, husbands and wives, fathers and mothers, brothers and sisters.  Real people, all in serious trouble, heroes in despair  … we should be crying.  We should be helping, we should be calling on congress, questioning our candidates. 

Where is your voice, America?

Oldtimer  

Barack Obama: Veterans/Poverty Headlines and Video

Barack and Veterans Issues

Ok, I’m not trying to influence any votes here, nor run off any readers.  It’s just that I’m impressed with what I’ve heard said by Senator Obama regarding homelessness and veterans and what the press and veterans advocates have said.  I don’t know if you have seen them.   He does have the advantage of being a member of the Senate Veterans’ Affairs Committe.   I acknowledge that there are other important issues than veterans and homelessness to consider in a campaign, but that is what we are about here, so that is my focus.

I do have an couple of links to the Clinton side.  There is an equal-time segment at the bottom that will give you a look see between the top two Democratic candidates on veterans issues.   I may come back with more of this and feature a Republican or two later.  We will see how this plays out with my readers first.  Are you interested in politics?

BarackObamadotcom  (Video) Dinner with Barack Obama:  Four grassroots donors talk to Barack Obama about veterans and poverty during dinner.

I’ve mentioned Obama and Veterans in a previous post where he discusses his plan to improve veterans care and help get the homeless veterans off the streets as reported by a wire service.

Here are a few more headlines and links on this subject:

SEN. OBAMA: VETERANS ADMINISTRATION DENIED HEALTH CARE SERVICES TO NEARLY 9,000 ILLINOIS VETERANS IN 2005

Sen. Barack Obama (D-IL) today announced that the Department of Veterans Affairs (VA) denied health care to 8,944 Illinois veterans last year as part of a Bush Administration cost-cutting policy begun in 2003. Nationally, more than 260,000 veterans were denied access to VA hospitals, clinics and medications in Fiscal
Year 2005

Clinton v. Obama, Veterans Version

The tit-for-tat between Sens. Hillary Rodham Clinton and Barack Obama has expanded to new territory:   veterans benefits.

This week, the “Commission on Care of America’s Wounded Warriors” issued recommendations for improving treatment for veterans who return injured from the front. Clinton and Obama responded the way members of Congress often do to government reports – with legislative language.  

(…)  explains different positions

Obama, McCaskill sponsor bill on care for veterans

Sens. Barack Obama (D-Ill.) and Claire McCaskill (D-Mo.) are sponsoring legislation to improve the lives of recovering veterans at Walter Reed, while Sen. John Kerry (D-Mass.), a cosponsor of the Obama-McCaskill legislation, said that he would explore ways to direct new funds to Walter Reed and make immediate improvements to its veteran housing.

Barack Obama Honors Sacrifice of America’s Veterans

Barack Obama has a record of helping the heroes who defend our nation today and the veterans who fought in years past. As a grandson of a World War II veteran who went to college on the G.I. Bill and a member of the Senate Committee on Veterans Affairs, Obama has successfully reached out to Republicans and Democrats to pass laws to combat homelessness among veterans, improve care for troops recovering from injuries, ease the transition of new veterans into society, and make the disability benefits process more equitable.

Veterans Issues  From Obama’s website

Homeless Veterans

Every year, 400,000 veterans across the country, including an estimated 38,000 in Chicago, spend some time living on the streets. Senator Obama has been a leader in fighting homelessness among veterans. He authored the Sheltering All Veterans Everywhere Act (SAVE Act) to strengthen and expand federal homeless veteran programs that serve over 100,000 homeless veterans annually. During the debate on the Fiscal Year 2007 budget, Senator Obama passed an amendment to increase funding for homeless veterans programs by $40 million. These funds would benefit programs that provide food, clothing, mental health and substance abuse counseling, and employment and housing assistance to homeless veterans.

Working with Senators Akaka and Craig, Senator Obama passed legislation in December 2006 to provide comprehensive services and affordable housing options to veterans through the Department of Veterans Affairs, Department of Housing and Urban Development and nonprofit organizations. This legislation was signed into law and is modeled on parts of the SAVE Act and the Homes for Heroes Act, a measure that Senator Obama had previously authored.

Benefits Disparities

The Bush Administration’s approach to handling veterans’ health care ignores the reality of increasing demands on the VA, and the additional burden placed on veterans. The Administration has established a means test for VA health care eligibility, and it has banned hundreds of thousands of veterans – some who make as little as $30,000 a year – from enrolling in the system. These changes affect both older and younger veterans, and Senator Obama has opposed them, fighting instead for greater funding for veterans’ health care.

Greater Funding for Veterans Health Care

In January 2007, Senator Obama reintroduced the Lane Evans Veterans Health and Benefits Improvement Act to improve the VA’s planning process to avoid budget shortfalls in the future. The bill requires the VA and the Department of Defense to work together and share data so that we know precisely how many troops will be returning home and entering the VA system.

Food for Recovering Soldiers

Senator Obama introduced an amendment that became law providing food services to wounded veterans receiving physical therapy or rehabilitation services at military hospitals. Previously, service members receiving physical therapy or rehabilitation services in a medical hospital for more than 90 days were required to pay for their meals.

Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI)
 

Senator Obama fought a VA proposal that would have required a reexamination of all Post Traumatic Stress Disorder (PTSD) cases in which full benefits were granted. He and Senator Durbin passed an amendment that became law preventing the VA from conducting a review of cases, without first providing Congress with a complete report regarding the implementation of such review. In November 2005, the VA announced that it was abandoning its planned review.

Senator Obama passed an amendment to ensure that all service members returning from Iraq are properly screened for Traumatic Brain Injury (TBI). TBI is being called the signature injury of the Iraq war. The blast from improvised explosive devices can jar the brain, causing bruising or permanent damage. Concussions can have huge health effects including slowed thinking, headaches, memory loss, sleep disturbance, attention and concentration deficits, and irritability.

Easing the Transition to the VA

Senator Obama passed an amendment that became law requiring the Department of Defense (DOD) to report to Congress on the delayed development of an electronic medical records system compatible with the VA’s electronic medical records system. DOD’s delay in developing such a system has created obstacles for service members transitioning into the VA health care system.

Part of the Lane Evans Veterans Health and Benefits Improvement Act, which Senator Obama reintroduced in January 2007, would help veterans transition from the DOD health system to the VA system by extending the window in which new veterans can get mental health care from two years to five years. The Lane Evans bill also would improve transition services for members of the National Guard and Reserves.

For Equal Time’s sake:

Compare Senator Obama’s site with Senator Clinton’s site, both on Veterans Issues.

Oldtimer

Wounded warriors battle with VA – Story and Videos

Wounded Warriors Battle With VA

I watched a horrifying story on CNN last night.  I missed it on regular programming, checked the programming guide and waited for the midnight repeat.   The CNN title of the story was:

Broken Government: Waging War on the VA

It repeats tonight, Sunday night (Nov 18) at 8 Eastern, so if you get a chance, please check your schedule.   It is a powerful indictment of the VA’s handling of disability claims.  It is the story of 3 wounded veterans trying to get justice and only able to do it by virtually going to war again to fight for their rights.

One of the wounded warriors and a really heartbreaking story was Ty Ziegel, 25 years old who had been severely injured by a suicide bomber, “sent back to the states to die”, but lived.  Despite losing nearly half of his skull and a large portion of his brain, penetrating shrapnel and bone fragments in his brain, with both ears, nose and lips burned off and impossible to replace,  loss of an eye and resulting enormous disfiguration, the VA listed him as having “10% head trauma”.  10% head trauma.  In addition the damage to the left lobe of his brain,  loss of an eye and jaw fracture as haveing 0% trauma.  0% for loss of 1/4 of his brain, loss of an eye? He also lost one arm at the elbow, and two fingers and a thumb from his other hand, plus numerous other injuries for which the bulk of his small disability payment was granted.    Far below the poverty line disability for a man disfigured and totally disabled.

Ty Ziegel before and after

Ty Ziegel, before and after.   CNN News photo

(Click on the picture or here to see the video).  These videos are short promo clips about 2 minutes long and I don’t know how long they will keep them up on their site.  Go to  CNN and see the real thing.  Click here for part 2

Another veteran, Garrett Anderson received a roadside bomb injury that sent shrapanel into his head and body, and he lost an arm while driving a truck in a convoy.  The VA initially rejected his claim, saying that it was “not service connected”.   He was also suffering from what he thought was PTSD.  In Garrett’s case the letter stating that there were “shrapnel wounds all over his body, not service connected” had the signature cut out of the letter with a knife.  Apparently the signer was not proud of his decision and knew it was wrong.  

Garrett Anderson

Garrett Anderson.  Click on the picture or here for the video clip.

In Ziegel’s case, within 48 hours of taping an interview with CNN, the VA changed his disability to 100%.  In Anderson’s case, his wife took a sneak peak at his case file while a nurse was out of he room and she discovered they had  him listed in their files a suffering from Traumatic Brain Injury (TBI), but had failed to tell him or give him any disability credit for it.   He went to Sen. Dick Durbin of Illinois who turned up the pressure on the VA and subsequently has been awarded disability for TBI.

The third story was about Tammy Duckworth who lost both legs and had severe injuries to one arm and her body.   She later ran for Congress with the hope of improving things for disabled veterans.  She lost but has been appointed by the Governor of Illinois to be the Director of the IL Department of Veterans’ Affairs.

Click here for the CNN news promo clip for her story.  Go to the link with Tammy’s name above and click on “veteran’s issues” to get a flavor of what she has learned about the Va while she was in their care and her run for Congress.

Our wounded warriors, our heroes, should not have to fight for our country, then fight for their life and still have to fight for their benefits!

Oldtimer

 

GAO Testimony – DOD and VA

Transition Field Unit staffingGAO Testimony – DOD and VA

This is a troubling situation.  We have our kids off at war and they become severely injured, physically and mentally.   Our country has pulled out all stops to provide the best possible care for them and still we have problems.  Due to the protective gear and terrific and speedy medical care, thankfully more and more are surviving.  This shift in the severity and long term recovery needs requires major adjustments in our programs for treatment and rehabitation, for our benefits and compensation programs.  The cause and effect has driven the case loads and delays out of sight at the expense of our wounded heroes.

The good news is that that there is a scramble going on to correct these problems as soon as possible. There are people in high places capable of fixing the problem that have a heart for our heroes and are working very hard to fix the problems.  There are people in our VA and in militray trauma centers that are just as frustrated as we are.  There is a continuum of care mentality for our soldiers starting at the battlefield and continuing through our VA system. There are programs under development to reduce the time required to make determinations before our heroes get the treatment and benefits they need.

The bad news is there are still more than 150,000 cases more than 6 months old among the pending 600,000 cases in the VBA system, and we have no idea how old these cases really are.  The GAO found that new programs designed to correct the problems are not yet fully off the ground and there are severe staffing problems in key places, both on the active duty side and the veteran side of the picture. It appears to me that some of it is due to needing to move physicians from one program to staff another, leaving both under staffed. 

(Download Here)

What the GAO found

Warrior Transition Unit

Challenges have emerged for staffing the Warrior Transition Unit in which servicemembers are assigned to three key staff – a physician care manager, a nurse care manager, and a squad leader. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. In addition the number of recovery coordinators and how many servicemembers each would serve have yet to be determined.

Transition Field Unit staffing

This table shows that in actuality we have only 35% perminent staffing for these teams.  More than 450 of the existing staff (19%) have been borrowed from elsewhere, likely reducing the staff, already short, in othere facilities.   The table below shows where those with less than 50% staffing are located. 

 Staffing problem locations

PTSD and TBI 

Three independent review groups examining the deficiencies found at Walter Reed identified a range of complex problems associated with DOD and VA’s screening, diagnosis, and treatment of TBI (Traumatic Brain Injury) and PTSD, signature injuries of recent conflicts. Both conditions are sometimes referred to as “invisible injuries” because outwardly the individual’s appearance is just as it was before the injury or onset of symptoms. In terms of mild TBI, there may be no observable head injury and symptoms may overlap with those associated with PTSD. With respect to PTSD, there is no objective diagnostic test and its symptoms can sometimes be associated with other psychological conditions (e.g., depression).

TBI and PTSD chart
 
This table outlines what is being implimented (or planned) for handling TBI and PTSD better.   However, according to Army officials and the Independent Review Group report, obtaining qualified health professionals, such as clinical psychologists, is a challenge, which is due to competition with private sector salaries and difficulty recruiting for certain geographical locations. 

Data Sharing

In addition, the Dole-Shalala Commission noted that while VA is considered a leader in PTSD research and treatment, knowledge generated through research and clinical experience is not systematically disseminated to all DOD and VA providers of care.

Data Sharing

This table shows the efforts being taken to improve the data sharing between organizations. 

Disability Evaluations

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks.   To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system. To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements:

(1) a single, comprehensive medical examination;

(2) a single disability rating done by VA; and

(3) a DOD-level evaluation board for adjudicating servicemembers’ fitness for duty.

DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

You are invited to download and read the entire report here:  GAO Report (pdf – 32 pages)

Oldtimer