Journalism in the Public Interest

American Legion Pushes For Coverage of Treatment for Troops With Brain Injuries

Citing an investigation by ProPublica and NPR, the nation’s largest veterans group is demanding that Tricare, the Pentagon’s health plan, pay for cognitive rehabilitation therapy

2:11 p.m.: This post has been updated.

The American Legion, the nation’s largest veterans’ organization, is calling for the Pentagon’s health plan to cover cognitive rehabilitation therapy for troops with brain injuries, citing an NPR and ProPublica investigation.

Cognitive rehabilitation therapy is designed to retrain the brain to do basic tasks such as memorization and word recall. Tricare, which covers nearly 4 million service members and many veterans, refuses to pay for the treatment, pointing to a study it funded in 2009 that found a lack of scientific evidence showing the therapy is effective.

But a report by ProPublica and NPR showed that Tricare’s study came under attack from top brain specialists in confidential reviews. Some called the study “deeply flawed” and a “misuse” of science for failing to consider all the evidence. Our investigation also found that Tricare officials had ignored the recommendations of a Pentagon panel, federal health organizations and other studies, which endorsed the treatment.

In a press release Tuesday, officials with the American Legion urged Tricare to begin covering the therapy, which can cost more than $50,000 per patient. Tricare officials say budgetary concerns played no role in their decision not to cover the treatment.

“It is incomprehensible that TRICARE is refusing to cover such treatment for our wounded warriors,” said Jimmy Foster, the national commander of the American Legion. “Our troops have certainly earned their health-care benefits through their sacrifices and they deserve the best treatment available."

Legislators, including Rep. Bill Pascrell, (D-N.J.), who leads the Congressional Brain Injury Task Force, have also asked Tricare to review its policies in providing coverage for the treatment.

Tricare officials contacted Wednesday said the military would continue to research the effectiveness of cognitive rehabilitation. They noted that Tricare does cover speech, occupational and other types of therapy for brain injury which are often used in cognitive rehabilitation programs.

“The care and rehabilitation of our wounded service members is of utmost concern to the Department of Defense (DoD), the Military Services, and Tricare,” the agency said in a written statement. “Tricare patients are eligible for a multitude of rehabilitative therapies and the entire military health system is constantly seeking new ways to assist our wounded service members.”

I agree that this should be covered, but I wonder (out of curiosity) just how the right wing American Legion thinks the congress should pay for this. Are they suggesting budget offsets,  increased taxes, or increased premiums?

Gerald Greupner

Jan. 6, 2011, 5:13 p.m.

If we can send them to war, we can take care of them.  If that isn’t the case, then don’t send them to war.

‘Care’ is the operative word and there are clearly questions about the efficacy of ‘cognitive therapy’.Advocates of cognitive ‘therapies’ have latched onto them (including cognitive behavioural therapy)in an effort to ‘down’ psychoanalysis as the definitive treatment modality.Of course I am not suggesting that a severely brain damaged vet might have the ’ psychoeconomic resources’ to benefit from psychoanalysis(some lesser damaged vets may) but the USA could take heed of the fact that over the last 2-3 years the Australian Govt has lined the pockets of psychologists-to the tune of over a billion dollars for cognitive behavioural therapy for their patients to little or NO avail.Vets deserve the best and rather than pay 50,000 dollars each to those providing cognitive ‘therapy’ it would be better to make that cash payment to the Vet.There is plenty of evidence(it doesn’t need an expensive ‘study’ to show it)that computers are useful in retraining the brain and if all schoolchildren can get one so can the vets.Medically there is no better option than T-cell therapy.All the severely brain damaged at least should be receiving this now.There is nothing to lose.It is disgusting to see all of those with vested interests arguing over this like dogs over a bone.Do any of the Congress have a son or daughter in the brain damaged unit?

I am a brain injury survivor. Some of these comments show little understanding of cognitive rehabilitation or brain injury. Cognitive rehabilitation has little relationship to “cognitive behavioral therapy” or talk therapy. It is a medical intervention for a brutal, life-altering physical injury, comparable to surgery, physical therapy, and prostheses for those who have lost a limb. Its goal is not psychological well-being, but functional, productive survival.
    Cognitive rehab teaches how to compensate for deficits acquired from physical trauma to the brain. It saved my life and many of my peers, and helped me become an active member of society rather than living in a nursing home. No computer program could replace the doctors who treated me.
    TRICARE’s decision flies in the face of the evidence presented. The cost of NOT covering cognitive rehabilitation is many times greater than the cost of doing so—in suicides, broken families, nursing homes, SSDI, and prisons. Our servicemen and women with TBI are neglected because of ignorance and short-sighted budgeting. Doctors, scientists, and rehab experts—not an insurance company—should decide what the most effective treatment is.

When you see the legislation that Congress passed in the last ten years you must believe that all of Congress has TBI! Veterans injuries are classified as collateral damage.

Many in Congress probably do in fact have TBI to some extent as so many do.It is easy to acquire small lesions from things like football(boxing is a given) or any sport or activity where there is any concussion of the brain,let alone being blown up with an IED.Multiple small lesions exist in the brains of schizophrenics and anyone looking for the neurological correlates of schizophrenia do not need to do ‘research’ unless they want the grant money to do work that has already been well covered.For those who are convinced for one reason or another that Cognitive’ therapy’ is the answer by all means let them have it and all those who are more lucid have psychoanalysis if available if they want it.Far be it for me to suggest that a TBI vet should not have what they want, including cognitive ‘therapy’-though I consider it may be a poor choice.None the less their own choice where possible may empower them towards a better rehab than having doctors and bureaucrats (and Congress) and others;deciding what they should or should not have..It may be though that a vet who was argumentative before acquiring TBI will still be argumentative after TBI-perhaps less or more and this may vary over the period of rehab.time..I presently manage such a case.(mva victim).I have also had TBI myself from mva and have been rendered unconscious several times from blows to the head.Less fortunate cases who have been so traumatised as to be intimidated and are in no shape to’ stand up for themselves’(no pun intended) will be those in need of special consideration.It is to these that army psychiatrists paid special attention to after WW2.They were introverted and whilst in many cases physically ‘whole’ were almost helpless-unable to ‘change’,and as award-winning neuroscientist Jonathan Cohen said ‘ill-prepared for the future,thanks to the past,‘This is a dictum that many if not most would relate to,‘Could have been champions’ they might cry.‘Fish or catch bait’ is the ultimate choice.Whatever the method-without wasting time on futile argument-which has been going on since the ‘cognitive’ brigade came on the scene,the VA must ensure the vets are not short changed. Medically,T-cell therapy may still provide the best chance of recovery and for those who may not make choices only then should someone else decide.Family is probably best after being adequately informed.

Kevin A. McDonald

Jan. 17, 2011, 12:33 a.m.

Tricare should pay for CRT.

If TRICARE sees the studies reported by Kaiser Permenente they wont want to pay for CRT and I expect the VA would not want that either..I don’t think they can be compelled to pay for it as it seems so many want. The matter is degenerating into a slanging match with rational perspective vying with simple minded slogan-like statements as from the rabble who cry ‘the workers united will never be defeated’. T-cell therapy is still these TBI victims best chance of any sort of recovery but strangely this is not part of the consideration for the Vets it seems..Doubtless CRT practitioners want it paid for-grist for their mill for sure..Now we have a brain injured Congresswoman-will she get T-Cell therapy?Or will she go for CRT?-or BOTH?Who will pay?It is important that she NOT receive any better ‘therapies’ than the Vets.If she were to they and their families would have reason to be really angry.Perhaps Propublica could keep an eye on that.What about the shooter? Is he brain damaged?What if any therapy will he receive? .

David Fillingham

Jan. 27, 2011, 1:49 p.m.

It has been estimated that the cost of caring for the damage we have done to our soldiers alone will be 3-4 billion dollars. This is the sin of these two wars - no pay as you go, it is all deferred to the future and it will bankrupt us.

It is the old Republican attempt to discredit the gov’t and run up enormous debt while pursuing military imperialism that benfits the rich and the military industrial complex.

American Legion has a history of strike breaking and blind support of over 247 wars since 1900. What has it gained us? Nothing but hatred, debt, and pain for our citizens.

It is the 26th anniversary for Veterans for Peace this year. and

This article is part of an ongoing investigation:
Brain Wars

Brain Wars: How the Military Is Failing Its Wounded

The military has failed to diagnose brain injuries in thousands of soldiers returning from overseas.

The Story So Far

Traumatic brain injury is considered the “signature wound” of soldiers fighting in Iraq and Afghanistan. Official military statistics show that more than 115,000 soldiers have suffered mild traumatic brain injuries since the wars began. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.

More »

Get Updates

Our Hottest Stories