Journalism in the Public Interest

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.


U.S. Army soldiers walk through a field as an explosion occurs in Zari District of Kandahar province on Oct. 23, 2010. (Massoud Hossaini/AFP/Getty Images)

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.

No real surprise. A policy without resources seems the order of the day for the Army. It is only about appearances not action.

Hopefully, Dr. Woodson will take control of this mess and sort it out. OASG hasonly acted as an impediment in dealing with TBI and PTS.  It is time to take action from above and put the US Army on a leash. It has failed over and over so it is time to remove them from leadership.

As a former Army neurologist who was deployed to Afghanistan as a general medical officer in 2008, I can say that this story is exceptionally familiar.  Army neurologists were deployed with combat surgical hospitals (CSHs) as part of a neurology-neurosurgery combined team up until 2005.  At that time, under the oversight of Army Surgeon General Kevin Kiley (whose tenure was cut short by the Water Reed scandal), the decision was made that neurologists were no longer needed at the CSHs and that their role was that of a general medical officer.  Largely, this meant deployment to eschelon I (combat battalion-level) facilities, and since the choice of a highly specialized physician acting in the capacity of a general practictioner was not ideal for front-line troops, we were often sent as last-minute “filler” for immediate deployment when the original medical officer was incapacitated. 
  I myself was sent with three weeks notice to a combat battalion under the command of the 101st Airborne, where my unit was tasked with the safety of the local populace in a geographic region the size of West Virginia.  Our facilities and resources were quite austere, and lacked nurses, x-rays, blood products, and labs.  Our battalion physician assistant was sent to another base.  As a continuing gesture of goodwill toward local Afghan forces, we would accommodate any traumas that came through our front gate. Myself and my medics, who were excellent, would not infrequently be taking care of five or more Afghani victims of gunshot wounds and explosions, preparing for helicopter evacuation to our surgeons located some 30-60 minutes away, or pronouncing them on the table.  Most of my training for this kind of triage and emergency care was during medical school, with a several hour advanced-trauma and life-support class that I lobbied to take just before I was deployed.
    As a neurologist who further subspecialized in electrophysiological testing, I had relatively little opportunity to practice my skills while deployed.  The Army viewed me only as another body with a medical degree, when my obligation had concluded I was eager to leave the service, despite nine years on active duty.  I am told by my friends and colleagues who are still on active duty, that the time-frame for deployment is now every two years for a six to fifteen month deployment.  Last month, I knew of at least one neurologist currently deployed to be the medical officer to a combat unit (as well as several subspecialized neurologists who recently returned from a general medical officer deployment), and only recently, neurologists are being sent back to the CSHs to evaluate brain injuries.  These latter, more desirable assignments, have been distributed mostly on the basis of rank, with colonels getting first pick.
    So, is it a surprise that there is a shortage of Army neurologists?  Absolutely not.  We have been sent with little notice to the most dangerous assignments with minimal preparation.  Our skill set has not been valued by the medical command, even in the face of the “signature injury” of the wars in Afghanistan and Iraq (TBI).  There is little incentive to stay when our commitment is done, and those who stay do so only with the lure of retirement at 20 years of service, whereupon they return as paid civilian Government Service employees of the same military medical center, without the constant threat of deployment.

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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