Pentagon to expand brain trauma treatment for terror war veterans

The Defense Department plans to expand a program that transitions veterans of the war on terror in the Middle East from Pentagon health care to the Department of Veterans Affairs to include traumatic brain injuries, a signature wound of the 17-year war.

al-monitor US soldiers from the 2nd Brigade, 82nd Airborne Division clean the barrel of the artillery at a military base north of Mosul, Iraq, Feb. 14, 2017. Photo by REUTERS/Khalid al Mousily.
Jack Detsch

Jack Detsch

@JackDetsch_ALM

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Health and medicine

Oct 2, 2019

The Defense Department plans to expand a program that transitions veterans of the war on terror in the Middle East from Pentagon health care to the Department of Veterans Affairs to include traumatic brain injuries, a signature wound of the 17-year war.

In a letter sent to Congress over the summer, the Pentagon’s assistant secretary of defense for manpower and reserve affairs, James N. Stewart, said the United States would expand the so-called inTransition program, which aims to provide continued care to former US troops leaving the military.

Experts say expanding the inTransition program could allow for greater access to traumatic brain injury, or TBI, care as the Pentagon tries to ensure continued health care treatment for veterans, such as developing care plans and providing access to specialists.

“My sense is that the [Department of Defense] and [Veterans Affairs] have treated TBI seriously once they understood the magnitude and implications of this signature wound of the post 9/11 wars,” said Lt. Alex Balbir, a US Navy reservist who serves as the Wounded Warrior Project’s director of independence services. “I’m guardedly optimistic about the expansion of this program.”

The move comes as the United States has drawn down special forces in Syria and Afghanistan over the past year. The Donald Trump administration has tried to move away from the terror fight in the Middle East and prepare for potential conflicts with Russia and China.

Over the course of the terror fight, TBI — which can be difficult to detect in combat zones, as experts say it has similar symptoms to a variety of conditions — became a signature wound in Middle Eastern combat zones.

Since 2001, Iraqi, Syrian and Afghan insurgents have targeted American troops with increasingly sophisticated improvised explosive devices, or IEDs, that pummeled troops with shrapnel and blast waves that can bruise or damage brain tissue.

Alone, IEDs caused 63% of coalition deaths in the first four years of the Iraq War, and 66% of deaths in the 17-year war in Afghanistan.

But US forces are also vulnerable to brain injury on training ranges as they prepare to deploy for combat from eruptive weapons, such as the Carl Gustav recoilless rifle and hot charges used in close combat to break into locked doors and reinforced compounds, as a study from the Center for a New American Security found in 2018. Last year’s must-pass defense authorization bill also included language that would allow for mass surveillance of special forces to gather data on head injuries below the level of concussions.

As Al-Monitor reported in July, the Pentagon’s special forces community has attempted to take the lead within the military on treating service members with TBI, as Special Operations Command recently completed an eight-year baseline study to help treat mild neurological injuries.

But even as the Pentagon has made medical progress in diagnosing and treating TBI, experts believe the number of injured troops and veterans during post-9/11 US conflicts could remain significantly undercounted. The Defense Department says it diagnosed 383,947 US service members with traumatic brain injury between 2000 and the first quarter of 2018.

Meanwhile, Congress is asking for more answers on how the Department of Veterans Affairs will treat and house victims of severe TBI as the agency completed its first 24-month pilot program to provide assisted living for retired service members suffering from the disease.

In a letter to Veterans Affairs Secretary Robert Wilkie from Reps. TJ Cox, D-Calif., and John Rutherford, R-Fla., and reviewed by Al-Monitor, nearly 60 members of Congress are asking the agency to provide clarity on its efforts to extend access to trauma care to rural communities, and to clarify policies on supporting families and referrals.

The administration’s push to improve care for brain trauma comes as suicides have spiked among active-duty troops after nearly two decades of sustained combat in the Middle East, according to Pentagon data released last week. In 2018, 541 service members took their own lives, a 6% increase over the previous year, as deaths increased across three out of four US military services.

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