Journalism in the Public Interest

More Than 70 Members of Congress Demand Cognitive Treatment for Troops With Traumatic Brain Injuries

Citing an investigation by ProPublica and NPR, 74 members of Congress have signed a letter demanding that Tricare, the Pentagon’s health plan, provide treatment for troops with traumatic brain injuries.


U.S. Army soldiers with Task Force Thor Route Clearance Patrol from 23rd Engineering Company, Airborne detonate an IED that they discovered during a day-long route clearance mission in July 2010 near Khakriz, Afghanistan. (Justin Sullivan/Getty Images)

A bipartisan group of 74 lawmakers issued a letter Friday demanding that the Pentagon's health plan cover a treatment for brain-injured soldiers known as cognitive rehabilitation therapy.

Rep. Bill Pascrell, D-N.J., and Rep. Todd Platts, R-Pa., the leaders of the Congressional Brain Injury Task Force, cited an investigation by ProPublica and NPR revealing that Tricare, an insurance-style plan covering soldiers and many veterans, had relied on a controversial study to avoid paying for the intensive and often expensive treatment.

"We hope that you share our concern that service members returning from the battlefield cannot wait to receive treatment for their injuries," the letter states. "It is our hope that there exists some contingency plan to provide cognitive rehabilitation for service members who are returning home today."

Official Pentagon figures show that nearly 200,000 troops have suffered traumatic brain injuries since 2001, though our investigation found evidence suggesting the true toll is far higher. Although the majority of soldiers recover from the most common form of head trauma, known as mild traumatic brain injury or concussion, some suffer lifelong mental difficulties, with trouble remembering words or following directions.

Pascrell and Platts first wrote a letter, also signed by scores of lawmakers, demanding that Tricare provide cognitive rehabilitation more than two years ago. In response, Tricare contracted a study that found insufficient evidence to justify providing the treatment.

In confidential reviews obtained by ProPublica and NPR, however, leading brain specialists blasted the study for ignoring evidence that the therapy helped, calling the study "deeply flawed." Top Pentagon health officials have also expressed concern about the high cost of the treatment, our reporting found.

Tricare has said that it will cover many aspects of cognitive rehabilitation, which typically includes physical and speech therapy. But soldiers, families and civilian clinics told us they have had trouble convincing Tricare to pick up the tab.

Tricare’s stance stands in contrast to some major private insurance companies and some state Medicaid programs, which cover the treatment. Expert panels convened by the Pentagon and the Institutes of Medicine have also endorsed the therapy, which can cost more than $50,000 per soldier.

Tricare has since commissioned the Institutes of Medicine to carry out another review of cognitive rehabilitation. The review kicks off on Monday but is not expected to be complete until the end of this year.

Pascrell urged the Pentagon to react more quickly to Congressional concerns.

"Clearly, the Pentagon is overdue in responding to our nation's wounded warriors," Pascrell said in a statement. "It's time to act."

Sen. Claire McCaskill, D-Mo., who signed Friday’s letter, also has begun an investigation into the contract between Tricare and ECRI, a nonprofit firm that reviews medical treatments. ECRI has defended its study as scientifically sound and pledged to cooperate with the inquiry.

McCaskill chairs a Senate subcommittee on contracting oversight.

Head-injury is an invisible disability, not easily seen from the outside like a wheelchair or crutches. However, it’s still a disability known profoundly from the inside.
You can cultivate your mind’s inherent strengths.  I speak from personal experience. Learning this self-generating long-term practice that will enhance your life, with satisfaction and way more smiles.  Really!

Let me share my experience.  Returning to college thirty years ago, I was involved in a serious car wreck. I had facial laceration and a skull fracture.  I was in a coma, Jaws-of-Life were required to free me from the vehicle. When I came to I had amnesia, diplopia (double-vision), and TBI (traumatic brain injury). In short, I was not who I used to be.  My life was forever changed.  Since that time I have lived with the challenges of TBI.  I know the devastation of this condition from the inside, and wish to share what I’ve found to be a powerful healing benefit for me, and possibly for you.

TBI has often been misdiagnosed and thus poorly treated. I struggled to complete my degree at the University and to get on with my life, very unsure of what I could be or do. Within a few years I experienced frustrating failure in the loss of several jobs before learning that this was the result of my TBI. There is light at the end of this tunnel.

In top-of-the line and expensive rehabilitation programs I was taught ‘compensatory coping strategies’ for the ‘cognitive deficits’ of my brain injury. These strategies are well-intended rehab but fell short of addressing my inner well being.  They didn’t work for me; I had to learn the necessary inner transformation for myself.  This is cleansing the mind and knowing the gold within. 

I discovered Insight Meditation (Vipassana). This simple practice of sitting mindfully has me be clear-eyed and capable of sustained attention, knowing that as obstacles arise I have the capacity to face them directly from a calm and steady place of clear seeing, in the present moment.  This practice is based on the intent to relieve suffering and dissatisfaction, cleansing the mind of illusions, and grounding us in a sense of dignified inner wellness, at peace beyond the physical damage.

With steady practice you’ll learn exactly what is most needed for you. Healing will become a possibility and mindfulness practice can lead to brain healing (neuroplasticity). I am choosing to live my life intentionally and more skillfully, making peace with this malady.  You can too.  This is the start of a new path!

Had C. Walmer .(JavaScript must be enabled to view this email address)

Why can’t it be Viet Nam or WWII veterans?  Are they too old?

No, noone is too old. Only requirement is to be breathing!

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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