Journalism in the Public Interest

Congress to Investigate Pentagon Decision to Deny Coverage for Brain Injured Troops

Sen. Claire McCaskill’s committee wants to examine a contract between Tricare, the Pentagon’s health plan, and ECRI Institute, which found insufficient evidence to support cognitive rehabilitation therapy.


Sen. Claire McCaskill, D-Mo. (Brendan Smialowski/Getty Images)

WASHINGTON, D.C.--A key congressional oversight committee announced today that it was opening an investigation into the basis of a decision by the Pentagon's health plan to deny a type of medical treatment to troops with brain injuries.

Sen. Claire McCaskill, D-Mo., the chairman of the subcommittee on contracting oversight, said she wanted to examine a contract issued by Tricare, an insurance-style program used by soldiers and many veterans, to a private company to study cognitive rehabilitation therapy for traumatic brain injury. Such injuries are considered among the signature wounds of the wars in Afghanistan and Iraq.

The study, by Pennsylvania-based ECRI Institute, found insufficient or weak evidence to support the therapy. Often lengthy and expensive, cognitive rehabilitation programs are designed to rewire soldiers' brains to conduct basic life tasks, such as reading books, remembering information and following instructions. ECRI's findings ran counter to several other studies, including ones sponsored by the Pentagon and the National Institutes of Health, which concluded that cognitive rehabilitation was beneficial.

In a letter to Defense Secretary Robert Gates, McCaskill cited an investigation by ProPublica and NPR in December, which found that top scientific experts had questioned the Tricare-funded study in confidential reviews, calling it "deeply flawed" and "unacceptable."

"If true, these reports raise significant questions regarding the Department's award and management of the contract with ECRI Institute, and may have profound implications for hundreds of thousands of injured service members and their families," McCaskill wrote. "We owe it to our brave service members to find the truth."

The ProPublica and NPR investigation also found that senior Pentagon officials have worried about the high price of the care, which can cost more than $50,000 per patient. Some studies estimate that as many as 400,000 troops have suffered traumatic brain injuries in the war zones, though only a small percentage of them would need a full-scale program of cognitive rehabilitation therapy.

McCaskill joins a growing chorus demanding that Tricare reconsider its decision to deny coverage for cognitive rehabilitation. In recent weeks, the American Legion, the nation's largest veterans' organization, called on Tricare to provide treatment. Sen. Bob Casey, D-Penn., chairman of the Senate Foreign Relations subcommittee with oversight of the Middle East, sent a letter to Gates asking for an explanation of Tricare's stance.

McCaskill was also one of the senators who signed a letter in 2008 asking Gates to direct Tricare to begin providing cognitive rehabilitation to troops. This November, the Pentagon sent a response to Congress informing them of the Tricare study's findings. George Peach Taylor Jr., then-acting assistant secretary of defense for health affairs, said the Pentagon would continue to study the treatment, with another report expected later this year.

In strongly worded response on Jan. 19, McCaskill said that the senators who signed the original letter believed that enough evidence existed on the treatment's benefits to justify covering the cost for brain-damaged soldiers.

She asked for Gates to provide her committee with a series of documents on the contract and critical scientific reviews by Feb. 18.

"While we agreed that further research on cognitive rehabilitation therapy was appropriate, we also called on the Defense Department to err on the side of providing this proven treatment to service members," McCaskill wrote.

ProPublica and NPR have filed a similar request under the Freedom of Information Act, but Tricare has denied access to the documents, giving contradictory explanations for why. ProPublica and NPR have appealed.

Tricare officials have said their decision to deny cognitive rehabilitation is based on regulations requiring scientific proof of the efficacy and quality of treatment. They have said that the study by ECRI highlighted a lack of rigorous evidence proving the therapy's benefits.

Tricare officials also noted that the agency does cover some types of treatment considered part of cognitive rehabilitative therapy. For instance, Tricare will pay for speech and occupational therapy, which plays a role in cognitive rehabilitation. Tricare officials deny that cost played any role in their decision. In a statement, Tricare said the care of troops was their "utmost" concern.

Tricare did not immediately return requests for comment on McCaskill's investigation.

ECRI defended its study. The non-profit institute, which has carried out numerous health reviews for Tricare, other agencies and hospital and medical groups, said they applied standard protocols in reviewing scientific literature about the efficacy of cognitive rehabilitation therapy. ECRI provided a document explaining its review here.

"The issue of how well cognitive rehabilitation therapy works for traumatic brain injury is important," said Jeffrey C. Lerner, the president and CEO of ECRI Institute. "ECRI Institute is fully committed to providing information to the U.S. Senate on our report and methodology."

Two points: 
First: the military uses up its people, then dumps them out without adequate medical care.  It happened to Vietnam veterans, and it happens now.  Shame on us as a nation, if we cannot care for our veterans.

Second: Just as in civilian life, private insurers are always looking for an out, any excuse not to treat, when treatment clearly would benefit the patient.  We’d be better off with a national health care system, like the British, rather than put our nation’s health in the hands of companies that care most about profits.

Daniel FitzGerald

Jan. 22, 2011, 9:18 a.m.

Every patient (military or civilian) coming from OIF or OEF to Landstuhl Regional Medical Center HAS to be screened for TBI during there trip to definitive care in the US. 
There is even a special unit that is part of Neurology that specifically identifies if patients have potential for TBI’s. 
This is medical business as usual; the caregivers understand that TBI’s are a problem related to exposure of blasts, but the insurers don’t. 
Who works for who?  The clinicians for the insurers or the insurers for the clinicians?

The DoD and its endless studies.  It’s DoD screening is nonsense. Don’t identify and don’t treat so we don’t pay.

Let’s see the TBI policy for screening that is supposed to be put forward by OSD on January 31, 2011.

My guess is that it will require more thought so DoD can sandbag the Congress for the next decade.
Congress will need to fire both civilian and military personnel to solve the problem.  10 years of delay, deny and let ‘em die is enough.

Gloria Grening Wolk

Jan. 23, 2011, 5:29 p.m.

More than 400,000 suffer from TBI and the cost for rehabilitation can be more than $50 thousand annually?

Why is the gov’t reluctant to spend this on our warriors? Compare that cost with the amounts stolen from US funds in Iraq and Afghanistan. It’s a cheap price to pay to restore these people who, ill or well, are bound to have an affect on many others.

Sally Johnson

Jan. 23, 2011, 9:34 p.m.

I received a brain injury in a car accident in 1997. Without cognitive therapy I wouldn’t be able to do so many of the things, I can do now. I had to relearn many things. My therapist “taught me how to live again.” So many things that we all do every day, easily, without even thinking much about them, have to be learned again.

There has got to be enough evidence of how well cognitive therapy works, from all the civilians that have gone through it with brain injuries. I don’t know what rehabilitation Congress Gabby Giffords will get in Houston, but I hope she will get cognitive therapy.
I say this not only as a survivor, but as a person who never wants someone with a brain injury, to not get all the help that they need, to live the best life that they can.

Our men and women of the Armed Services deserve everything that it takes, to give them their lives back. With cognitive therapy they will have that chance.

The Mental Health Industry has no science.  The mind drugging of the military and the addiction to medication has political and financial rewards for the Pharmacutical / Mental Health Industry.

Baltimore Sun’s article by Lisa Chedekel and Matthew Kauffman ” Policies on mentally troubled troops questioned” is informative to the problems of psychotropic drug usage on the war front.,0,3087343.story?page=1


There has been “No” biological defect found for any mental illness or any of the other made to order diagnoses by any neurological study.

Without a test for chemical imbalance the mental health (psychiatry) is limited in the ancillary tests of medicine like an EKG, EEG, blood work or other tests in the diagnoses of a patient. They aren’t needed in Psychiatry.

The psychiatric diagnosis is made on the basis of behavior and hearsay.

If we respect metabolic changes based on daily dietary habits, weight gain / loss , terms of the survival of the organisms as a person age along with physical conditioning, physical illness, electrolyte level, gender differences , body temperature, I don’t see how the Mental Health and Counseling Industry could conform to any consistency in data with consideration to the above to state a person has a mental disease or illness based on chemical imbalance.

In the past, the APA lied to the American Public and puts the society in danger to mind drug the population.

The Mental Health Industry is a fraud and can’t be trusted.  They are a threat to the democracy.


Deaths Murders and Suicides from mind drugs.

SSRI stories


Drug Peddling in the Military>

Can we get real here? Tom Sowell recently gave an excellent encapsulation of the Republican’s point of view here, simple extrapolation explains it all. Please consider: sowell advises bankruptcy for governments in trouble, because states need NEW YOUNG healthy firemen, policemen, etc…rather than throwing away money keeping agreements on retirement plans.

It’s the same principle here: you’re hurt, get lost, why waste OUR resources on fixing YOU who got hurt doing OUR missions?

The “right” doesn’t give two ounces of elephant sh8
for anybody who is no longer a profit center.

They need brain re-wiring, but they won’t get it either.
I got thumped in the head a few times in the service jumping out of planes in the dark for my Aunt Sammie, but otherwise I was very lucky.

To my mostly working mind, the blame for the brain injuries in Iraaq and Half-ASgoneistan belongs to the criminal geniuses who reversed the military
axiom about ambushes. Most iof you guys who served know,“We choose th eplace, let them choose the time” about ambushes, BECAUSE the ambushee always loses…but you can’t sell lots of unarmored vehicles, and later armored ones…unless you reverse that long-hekld, known by every military man worth his brass…so OUR boys had to drive up and down narrow streets, sitting ducks, while THEY could lay out cheap bombs that killed unknown number of good, clean, smart, young American patriotic brains…tp the profit of the truck makers.

And now the criminals don’tw ant to pay for the rehab for the survivors…typical, yes?

God, please destroy all greedy profiteers in military matters…
Republicans who have greedily privatized so much of government business and their pet equipment manufacturers are such hateful criminals.

Go ahead, call me names. But if you look at the situation, you might grow up and get focusedly angry at the

This is T. Miller, one of the reporters on the story. There’s a lot of interesting comments here. I’d like to make just two points.

First, cognitive rehabilitation therapy is not a drug-based treatment—though they may be used. Rather, it’s based on using physical, occupational and speech therapy to develop techniques to compensate for mental deficits. So over-medicating is not the main issue here.

Second, the military’s job here is complicated by the issue of post traumatic stress. Many of our troops who suffered a TBI did so in a terrifying moment, such as an ambush, that might also trigger PTSD. Thus you have two complicated conditions in some soldiers that must be untangled.

Gloria Macaloney

Jan. 24, 2011, 4:33 p.m.

Is this a new term for holocaust?

China will loan us money for war but not to help the disabled due to fighting our wars.
Obama must go to China a beg for their forgiveness & ask for more generosity to prop-up our failing nation.
Maybe O can sell them the Kennedy Space Center as we can no longer afford the space exploration business. SR 22-NOT
I think they like our national parks & we can’t afford them any more even though they show a small profit?
I think China can make america work best so lets sell it to them & pay rent?
Maybe after China pays off all our debt, we each will get a check- $1,000.?
China now owns our major interstate frontages so maybe we can sell them the highways & pay them a toll to use?

well, since IEDs were the main source of defeat for the technologically advanced “americans,” anyone, in any way related to the explosion of one of these devices personally is considered brain injured until ruled out by competent physicians.

If Gabrielle Giffords can get this kind of rehab therapy (well-deserved, I might add) through her federally-funded insurance, why can’t our troops?  They deserve it just as much as she does.

I would imagine, the little that I know of her, that she would advocate for their rehabilitation.

The first thing you have to do in these cases?  Find out who owns or runs ECRI Institute and who the owners or operators are socially and politically allied with.

Since Big Tobacco broke the path with the corruption of science and scientists, nothing emitted by a presumably scientific institute can be trusted if there is any indication of political thought or greed within or near said “institute”.

Oh, and keep this in mind:  The general officer level of our military is often as morally decadent as Corporate America in that they can hold a disdain for “the grunts” - the people who get the job done, whether it be with wrenches or rifles.

When you couple that attitude with greed and wrap it all in the illusion of patriotism, you wind up with “conservatives” who do not wish to pay taxes but who can still tell each other that the readiness of our military is so important to “their” country that - in a time of budget constraints - sacrifices must be made.

They will always sacrifice “the grunts” first - and without a twinge of conscience, for they have the amusing (if disgusting) ability to convince themselves that their greed is subordinate to their patriotism.

I have an idea.  Why don’t we kick out all the freeloading illegal invaders and the BILLIONS in American taxpayer dollars they are sucking up, and put this money towards caring for our injured vets?!?  That’d be nice, wouldn’t it?!? 

This is beyond disgusting.  I don’t care if there is even a minimal chance that the therapy may work, they deserve it for their sacrifie!  Remember this when you vote.


Jan. 25, 2011, 10:55 a.m.


This is a question of morality as a nation: the whole healthcare system is built on the principle of the rich get the best care and everyone else accepts second class or less, if they can afford it.

Shame on those whining, sniveling Republicans who would deny any of their countrymen or countrywomen adequate healthcare, especially those who have put their lives online.

Everyone should have exactly the same quality of healthcare—rich or poor—the Canadians, the British, the French, the Italians, the Japanese, and the Swiss have healthcare for all.  Even the Chinese are building a system of healthcare for all citizens.  Ask yourself WHY.

Congress, Insurance Companies, Big Pharma and the most greedy: the Wall Street Rip-Off Artists!

Jack E Lohman

Jan. 25, 2011, 1:36 p.m.

Maybe they should ask “Why are we in these f*cking wars anyway???”

Jack Lohman

It’s about time someone looked into the preferential treatment some civil servants and elected officials get over those who put themselves in harms way to protect us.  For to long the serviceman and woman has had to do without while others are taken care of.  I am sorry for the congresswoman and this is not directed against her.  But to be sure there are some sleazebags in congress.  Take Kuchinics suing for biting into an olive pit.  Disgusting behavior to be sure.

The Pentagon has faile the American service man and woman for way to long.  While those at the pentagon get preferential treatment.

Claire is my hero.

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.

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