Traumatic Brain Injury Among Veterans

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. As of FY2010, 1.25 million OEF/OIF veterans have left active duty and became eligible for Department of Veterans Affairs (VA) health care; half of them have obtained VA health care; and 45,606 have been diagnosed with TBIrelated conditions at VA medical facilities. 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 has engaged in outreach efforts to OEF/OIF veterans via mail, telephone, and television advertisements. In order to make contact with servicemembers before separation and conversion to veteran status, the VA participates in some Department of Defense (DOD) 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 (also known as “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 FY2010 budget for “TBI and Other Neurotrauma” research was $22 million (rounded). Before applying a 0.2% rescission for most non-defense items, the full-year continuing resolution for FY2011 maintained VA’s research funding at the FY2010 level. 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: May 5, 2011
Number of Pages: 23
Order Number: R40941
Price: $29.95

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