Audit: Vets With Brain Injury Still Not Getting Proper Care


May 1, 2008 – Many Iraq war veterans with traumatic brain injury are not getting adequate health care and job assistance for their long-term recovery despite years of government pledges to do so, Veterans Affairs Department investigators say.

“Significant needs remain unmet,” according to the report released Thursday by the VA’s inspector general. It is the first to examine the Bush administration’s long-term efforts in supporting veterans with traumatic brain injury, a leading problem among soldiers struck by roadside bombs that often causes lasting emotional and behavioral difficulties.

The study tracked a group of 52 patients who received VA treatment after sustaining brain injury during a seven-month period in 2004. An initial review by the IG in 2006 found gaps in follow-up care and family counseling 16 months after the injury and urged the VA to improve long-term case management.

The VA pledged to coordinate the necessary follow-up care with the Pentagon, but the latest audit concludes that efforts are still falling short for roughly one in four patients.

It found that 10 of the 41 veterans who agreed to be interviewed said they weren’t getting needed help for health care, vocational rehabilitation, family support or housing. At least four patients specifically cited trouble in getting primary or specialty eye care, while others reported gaps with family counseling for problems such as depression and anger.

“This is very troubling,” said Michael O’Rourke, assistant director for veterans health policy at Veterans of Foreign Wars. “The fact of the matter is from the very beginning VA and Defense went in with too little, too short (on resources), because they weren’t expecting this to be a prolonged conflict of war.

“I’ve seen a lot of effort to correct problems that exist. But constant vigilance is required,” he said. “Veterans deserve to be treated for problems they may or may not know of.”

The report included a VA response in which the department acknowledged problems with case management but stated that with recent improvements it now had “systems in place to ensure that all veterans with TBI are being followed as their clinical needs require.”

For example, the VA pointed to plans announced last week to start calling 570,000 recent combat veterans to make sure they know what services are available to them.

In the audit, investigators praised the new measures as “positive steps” but questioned whether the VA’s latest promise to keep watch over veterans would prove to be a reality. They said that “at least 8 of 49 veterans we contacted had significant unmet needs and no evidence of VA case management in the previous year.”

“We continue to be concerned that all veterans discharged after inpatient rehabilitation for TBI receive case management, unless this has been explicitly denied by the patient,” investigators stated, adding that they will continue monitoring the VA to ensure Iraq war veterans are receiving the care they need.

Other findings based on the sample group:

— Eighteen of the 41 interviewed veterans with brain injury, or 44 percent, said anger was “a problem” for them.

— Twenty-one veterans, or 51 percent, reported receiving adequate counseling and support for their behavioral or emotional problems.

The report comes amid renewed scrutiny of the Bush administration’s efforts in treating veterans with traumatic brain injury, which in its mild form is known as a concussion, as well as post-traumatic stress disorder in light of a prolonged Iraq war. About 19 percent — or an estimated 320,000 — of U.S. combat troops who fought in Iraq or Afghanistan may have suffered head injuries, according to a recent RAND Corp. study.

Earlier this year, the Government Accountability Office found that thousands of Iraq war veterans who could have suffered traumatic brain injury may be getting unnecessary or inadequate health care because VA officials have yet to determine whether their initial screening tests are reliable.

The VA also has faced complaints that a backlog in claims and bureaucratic hurdles have prevented some recent veterans from getting proper mental and physical care. Last week, Sens. Daniel Akaka, D-Hawaii, and Patty Murray, D-Wash., accused the VA’s top mental health official of trying to cover up the number of veterans’ suicides and said he should resign.

“While VA has made progress since the last investigation, the inspector general continues to find that too many veterans with TBI and their loved ones are not receiving all the assistance and support they need,” said Akaka, who chairs the Senate Veterans Affairs Committee. “This does not appear to be due to a lack of funding, but rather reflects a failure to give these veterans and their loved ones the priority attention they are due.”

Active-duty troops who sustain traumatic brain injury are treated for rehabilitation at one of the VA’s four specialized medical centers located in Tampa, Fla., Richmond, Va., Minneapolis and Palo Alto, Calif.

“We are now in the sixth year of this war and it is clear that the VA is still struggling to meet the needs of our veterans today — it will take more than just promises to get it right,” said Murray, a member of the Veterans Affairs Committee.

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