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Critical Shortage of Army Neurologists for U.S. Troops in Iraq and Afghanistan

A military memorandum says that new requirements for diagnosing and treating brain injury has resulted in a shortage of Army neurologists on battlefields of Iraq and Afghanistan.

The Army is facing a "critical" shortage of neurologists, partly because of recent policy changes designed to improve diagnosis and treatment of mild traumatic brain injuries, according to a new military medical memorandum.

The policies, issued last June, require soldiers who have suffered three or more mild traumatic brain injuries in a year to receive a comprehensive evaluation by a neurologist or similarly qualified doctor. The military also set up a clinic in Afghanistan last year specifically to treat traumatic brain injury and mandated rest periods for soldiers exposed to blasts.

The new initiatives have "increased dramatically" the need for neurologists on the battlefield, according to the memo, which was issued in March and obtained recently by ProPublica and NPR.

"The shortage is far more acute than they want to admit," said one Army doctor, who did not want to be identified for fear of damaging his career. "This is an ideal doctrine which was promulgated but not fulfilled due to a lack of resources."

Army officials have long complained about a lack of neurologists, neuropsychologists and other medical professionals needed to diagnose and treat mild traumatic brain injuries, also known as concussions.

At a hearing last June, Army Gen. Peter Chiarelli, the vice chief of staff, told Congress that the Army had a total of 52 neurologists, though only 40 were practicing -- a figure, he said, that included child neurologists.

"I have a shortage in neurologists, a tremendous shortage," Chiarelli told NPR and ProPublica in an interview last year. Chiarelli said the problem was not a lack of funding, but recruiting neurologists willing to be deployed to war zones.

Also, under the military's system for deploying doctors, some neurologists act as general practitioners, serving as the primary medical officers for combat units sent overseas rather than as specialists. The new memo aims to stop that practice and funnel neurologists to help troops with brain injuries.

"There has always been a shortage of board certified neurologists; neurologists are in short supply in civilian practices as well," Cynthia Vaughan, a spokesman for the Army’s Surgeon General, wrote in response to questions. "The change was made to ensure we have neurologists who are deployed working as neurologists and available to treat concussive injuries vs. deploying as general medical officers."

It is unclear whether other military services are having similar trouble finding neurologists to deploy abroad. A spokesman for Central Command, which oversees the fighting in Iraq and Afghanistan, did not immediately return a request for comment.

Official military figures show that more than 155,000 troops have suffered concussions since the beginning of the wars in Iraq and Afghanistan, many of them caused by blasts from roadside bombs, a common insurgent weapon. Researchers outside the military say the true figure could be at least twice that number. The Pentagon says nearly 50,000 others have suffered more severe brain injuries.

Previous ProPublica and NPR stories found studies showing that as many as 40 percent of mild traumatic injuries go undiagnosed. Such injuries do not leave visible scars and can be difficult to detect.

Most concussions heal quickly, usually within a matter of weeks. But civilian studies show that 5 percent to 15 percent of those who sustain concussions may suffer long-lasting cognitive issues, such as problems with memory, reading, doing simple math, or following directions.

Research has shown that the danger of long-term damage increases with the number of concussions. Studies have indicated an increased risk for a dementia-like condition among football players and other athletes who suffered numerous mild head injuries over their careers.

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