Journalism in the Public Interest

Gov’t Watchdog Criticizes Pentagon Center for PTSD, Brain Injuries

The Pentagon’s Defense Centers of Excellence are plagued by management weakness and obscure finances, according to recent Government Accountability Office reports.


(Chris Hondros/Getty Images)

If you want more explanation about the military’s troubles in treating troops with traumatic brain injuries and post-traumatic stress, read no further than two recent but largely unnoticed reports from the Government Accountability Office.

It turns out the Pentagon’s solution to the problems is an organization plagued by weak leadership, uncertain priorities and a money trail so tangled that even the GAO’s investigators couldn’t sort it out. The GAO findings on the Pentagon’s Defense Centers of Excellence (DCOE) echo our own series on the military’s difficulty in handling the so-called invisible wounds of war.

“We have an organization that exists, but we have considerable concern about what it is that it’s actually accomplishing,” said Denise Fantone, a GAO director who supervised research on one of the reports. She added: “I can’t say with any certainty that I know what DCOE does, and I think that’s a concern.”

First, some background. After the 2007 scandal over poor care delivered to soldiers at the Walter Reed Army Medical Center, Congress ordered the Pentagon to do a better job treating soldiers suffering from post-traumatic stress disorder and traumatic brain injury. The Pentagon’s answer was to create DCOE. The new organization was supposed to be a clearinghouse to foster cutting-edge research in treatments.

DCOE was rushed into existence in late 2007. Since then, it has churned through three leaders, including one let go after alleged sexual harassment of subordinates. It takes more than five months to hire each employee because of the federal government’s glacial process. As a result, private contractors make up much of the center’s staff.

“DCOE’s development has been challenged by a mission that lacks clarity and by time-consuming hiring processes,” according to the first report in the GAO series, focusing on “management weakness” at DCOE.

Just as concerning, the GAO says that it can’t quite figure out how much money DCOE has received or where it has all gone. DCOE has never submitted a budget document that fully conformed to typical federal standards, according to a GAO report released last month. In one year, the center simply turned in a spreadsheet without detailed explanations.

The Defense Department says that DCOE got $168 million beginning in fiscal year 2010—but the GAO isn’t buying that number: “Because of unresolved concerns with the reliability of funding and obligations data provided by DOD (Department of Defense), we cannot confirm the accuracy of figures related to DCOE.” The GAO report reproduces this disclaimer no fewer than five times.

DCOE concurred with the bulk of the GAO’s findings and promised to fix its accounting errors and prevent them from happening again.

In its defense, DCOE has never had an easy job. It was created on the fly and tasked to deal with some of the most complicated mental-health issues in the military’s history. In addition, it has faced stiff bureaucratic resistance, with some Pentagon officials questioning its usefulness..

The Pentagon said that DCOE was conducting a “comprehensive review” to improve its operations.

“There is still substantial work to be done,” said Cynthia O. Smith, a Pentagon spokeswoman. “We must ensure we are properly allocating resources and establishing priorities to take care of our service members.”

One telling GAO footnote suggests the extent of the obstacles the organization has faced. In Pentagon war games, the enemy is generally represented by the color red. When Congress ordered up its improvements in 2007, the Pentagon created a special committee to push through reforms that led to DCOE’s creation.

The special committee decided to call itself the “Red Cell.” Why? “The daunting task facing this team would likely make them the enemy of everyone else in the bureaucracy they sought to change,” the GAO says.

Traumatic brain injury is a neurological disorder, not a psychological problem - although psychological issues can arise as part of TBI. Maybe part of the problem is that TBI is under the wrong center. When all you are holding is a hammer, every problem looks like a nail.

DCOE falls under TRICARE which is the military’s medical service system.It’s not a question of what discipline or “center”. Read the report.

I did. Thanks for clarification on TRICARE insurance.

Warner Anderson MD

July 11, 2011, 2:58 p.m.

Congress often tells DoD what to do by passing laws, and DoD always tries to do it. Now, imagine you are trying to work for a committee of 535 Type A “alpha” individuals, the House + Senate.

Is this any way to run a medical or mental health program? Nevertheless, DoD is making some important scientific and clinical progress in prevention, identification, treatment, and rehabilitation. It’s a long way from perfect, but it’s about as good as the science and the infrastructure allow. The important thing is a trend of improvement and progress.

Allen McQuarrie

July 11, 2011, 3:52 p.m.

I have followed discussions or the lack thereof on this subject since my son’s injury two decades ago.  Glaciers move faster than the policy makers inside or outside the military.  In the interim, military personnel and veterans have suffered and paid for the consequences of combat or combat related training with little or not even minimal help by any competent standard. 

I have sat in veterans’ court and watched disabled warriors get the respect they deserved and avoid incarceration because a civilian court did for them what a grateful nation should have done sooner. 

I have read disgraceful comments by military members and veterans with no medical training stigmatizing wounded warriors for being awarded the Purple Heart for TBI and PTSD, or opposing such awards on the basis of clinically untutored judgments.

I have watched veterans at Stand Down gatherings after years of neglect finally get a diagnosis and treatment for combat wounds they sustained decades prior. They and their loved ones have paid the maximum price and the nation owes them a deep debt of gratitude.

This neglect of those who served honorably, faithfully and with distinction should change before sunset today. All veterans of current and prior wars who have been neglected should be treated and compensated for harm done because of their service.

Tammie Severs

July 11, 2011, 8:06 p.m.

My son came home from Afganistan with ptsd and tbi and spent several months in Walter Reed. He was released back to post and wanted to redeploy. After some problems with his ptsd he asked to go to rehab. He was put into a 28 day civilian hospital contracted thru the Army~approxmately one week later my soldier passed away~he was given a fatal cocktail of prescription meds! My 23 year old son died of a drug overdosed given to him in a controlled enviroment! The Army quit sending soldiers there after my son passed away~a little to late for us! The drs do not know how to treat ptsd and my son died as a result of their ignorance. Someone needs to be held accordable for the loss of my soldier and how many more soldiers has this happened to that is not spoke of! My soldier was Infantry 10th mt div Fort Drum New York and was in Holliswood Hospital Hollis NY. Our soldiers are dying at the hands of the drs that are suppose to be treating them~please help them and their families!!!

Forrest Breyfogle

July 12, 2011, 9:25 a.m.

Traditional ways of managing an organization and creating policies often no longer work.  This article describes just one sad example of that failure. What is needed is a management system for moving toward achievement of Edwards Deming’s profound knowledge and 14 points’ philosophy.  An Integrated Enterprise Excellence (IEE) business management system provides the framework for this objective’s achievement.  Hopefully our government will start looking into this methodology as an opportunity for addressing the challenges of the day.

Tammie:  I weep for your loss.  As an Army veteran myself (no injuries, thank God), I find it very difficult to believe that such a thing could happen!  This is incredible and, without a doubt, very troubling!  I thank you for your sacrifice to our nation, and I thank your son for serving.  I know it’s too late for him, but please know that there are SOME of us out here that DO appreciate our veteran’s and hope and pray they get the care they need for war-induced injuries!  This hiding behind a curtain and pretending not to see what’s in front of your faces is not acceptable!!!  These young men and women have gone overseas in a stupid war and given their lives and their health to keep us safe….they deserve EVERYTHING we can give them to make them whole and healthy again.  Thank you all veterans for your service… strong!

Chrissy Blaschko

July 18, 2011, 2:02 p.m.

There is no question in the minds of anyone who has attempted to get help though the DCOE that the organization is flawed and in serious need of reform. The GAO has released reports showing the lack of weak leadership, unorganized procedures, and little fiscal accountability. All of this no doubt due to the lack on planning before the DCOE was formed. So where do we go from here?
We cannot simply wish the problems facing the DCOE away, action must be taken to fix them. The first step in fixing any problem is figuring out where the problems are in the system. After finding the problems ways to address these problems must be established. Just pointing out the problems is not enough; we must fix them if we hope to help our veterans. This may seem like a daunting task to many Americans, and truth be told it is.
I found an interesting book called Faces of Combat: PTSD & TBI by Eric Newhouse. It did exactly just that. It points out issues in out current system and offers ways of fixing these problems. It also did something else I found amazing; it shared some stories of the returning veterans and how their lives were affected by PTSD and TBI. This book made it easy to understand the policies that are currently in place in the DCOE and why they aren’t working. I found this book to be a call to action.

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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