Erin Bagalman
Analyst in Health Policy
Traumatic Brain Injury (TBI) has been defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force.” In the general population, TBI results mainly from falls, motor vehicle/traffic accidents, assaults, and other instances in which the head is struck by or strikes against an object. In military servicemembers, TBI may also result from improvised explosive devices, mortars, grenades, bullets, or mines.
Traumatic brain injury has become known as a “signature wound” of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), because the incidence of TBI is higher in these conflicts than it has been in previous conflicts. From FY2002 through FY2011, 1.4 million OEF/OIF veterans (including members of the Reserve and National Guard) left active duty and became eligible for VA health care; by the end of FY2011, 53% of them had obtained VA health care. The total number of OEF/OIF veterans with TBI is not known, in part because some OEF/OIF veterans have not accessed VA health care services.
The VA reaches out to OEF/OIF veterans to inform them of their benefits by participating in DOD activities (in order to make contact with servicemembers before separation and conversion to veteran status), contacting OEF/OIF veterans through the Combat Veterans Call Center, and using social media and other Internet-based outreach, among other activities. Some OEF/OIF veterans may choose not to enroll in VA health care because they have health coverage from other sources or because they do not perceive a need for health care; others may experience barriers to accessing VA care.
Servicemembers who sustain mild TBI (concussion), which accounts for the majority of injuries, may walk away from the event, seemingly unharmed; thus mild TBI may go unnoticed and untreated. Accordingly, VA policy requires that all OEF/OIF veterans receiving medical care in the VA health care system must be screened for possible TBI, and that those who screen positive must be offered further evaluation and specialized treatment. The VA and the DOD have jointly developed evidence-based clinical practice guidelines for treatment of mild TBI.
Servicemembers who sustain moderate to severe TBI (i.e., recognizable injuries) require immediate treatment, which begins at the site of the event and continues at a military treatment facility. Once stabilized, servicemembers may remain at a military treatment facility or be transferred to the VA Polytrauma System of Care. Transfers from DOD to VA facilities require coordination between the two systems, and several programs have been developed to facilitate coordination of care.
The VA’s budget for “Traumatic Brain Injury and Other Neurotrauma” research was $21 million in FY2011 (actual), $24 million in FY2012 (current estimate), and $29 million in FY2013 (request). The large number of studies conducted by the VA and the DOD, as well as the Department of Health and Human Services (HHS), raises questions for some about potential duplication of effort, gaps in the research, dissemination of research findings, and translation of research into practice.
Date of Report: January 4, 2013
Number of Pages: 20
Order Number: R40941
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