Journalism in the Public Interest

Pentagon Told Congress It’s Studying Brain-Damage Therapy

The Pentagon told Congress last month that it was studying the efficacy of cognitive rehabilitation therapy for brain-injured soldiers, the same treatment the Pentagon’s health plan refuses to cover.


A U.S. Marine with the 2nd Marine Expeditionary Brigade, RCT 2nd Battalion 8th Marines Echo Co., reacts as dust blankets the area after an IED exploded while they were under enemy fire on July 17, 2009, in Mian Poshteh, Afghanistan. (Joe Raedle/Getty Images)

Last month, the Pentagon sent a soothing letter to members of Congress worried about the treatment of soldiers who suffered brain injuries in Iraq and Afghanistan.

The letter, previously unreported, told House and Senate members that the military was studying the efficacy of a treatment known as cognitive rehabilitation therapy. Cognitive rehabilitation is a lengthy, often expensive program designed to retrain troops with brain injuries to do everyday tasks from remembering grocery lists to recalling words and names.

The letter includes contradictions of previous Pentagon statements. Notably, it makes no promise that brain-damaged soldiers will receive cognitive rehabilitation any time soon.

In the letter, George Peach Taylor Jr., the acting assistant defense secretary for health, acknowledged that the military health care's plan for troops and many veterans, called Tricare, does not cover cognitive rehabilitation therapy. One of the main reasons? A contractor hired by Tricare found limited evidence it works.

But as NPR and ProPublica reported Monday, Tricare's review came under fire in a series of confidential reviews by leading brain specialists. Scientists criticized the study as "deeply flawed" and "unacceptable." One even called it a "misuse" of science designed to hold down costs by depriving soldiers of care.

Cognitive rehabilitation has been used for decades to help civilians with brain injuries. Some major insurance companies, including Aetna and Humana, cover the treatment. Several major peer-reviewed studies support its efficacy. The Pentagon's own specialists and a panel convened more than a decade ago by the Institutes for Medicine have recommended its use.

Taylor's letter, which was written before the NPR and ProPublica stories appeared, did not mention the critiques of the Tricare study. But Taylor did make passing reference to another issue: money.

Comprehensive cognitive rehabilitation therapy can cost more than $50,000 per patient -- potentially adding enormous bills to the military's medical system at a time when hundreds of thousands of soldiers have suffered traumatic brain injuries on the battlefield. Tricare officials told us that money played no part in their considerations to deny coverage for the treatment. But Taylor told Congress that cost was a factor in figuring out which therapies to provide.

"Establishing the effectiveness of cognitive rehabilitation is an important issue for reimbursement of clinical services within the healthcare industry," he wrote to the chairs of the House and Senate Armed Services and Appropriations committees.

Taylor's letter also discussed a second set of studies, funded by $10 million set aside by the congressional committees in last year's defense bill. He wrote that the Pentagon's Defense and Veterans Brain Injury Center, known as DVBIC, had launched its own studies on how to treat mild traumatic brain injury. One of the signature wounds of the wars, mild traumatic brain injuries are often a result of blast waves from roadside bombs. Most soldiers recover quickly, but studies suggest as many as 15 percent go on to suffer lingering cognitive problems.

For careful readers of the military spending bills, this represents a significant change from what Congress had asked. The defense spending bill for 2010 asked the Pentagon to assess the value of cognitive rehabilitative in treating "traumatic brain injury in members and former members of the armed forces" (for those who want to read this passage in its full PDF context, you can check out the language on page 232 of the 1,236-page bill).

The difference is crucial. Why? Because cognitive rehabilitation therapy is actually a pretty well proven treatment for those suffering from moderate to severe brain injury. So by focusing only on mild traumatic brain injury, the Pentagon has avoided having to acknowledge the efficacy of the therapy for those with severe injuries, while tying up decisions on how to treat soldiers with mild traumatic brain injuries in a series of new studies.

In the letter, Taylor did say that cognitive therapy has proved promising: "Cognitive rehabilitation is a long-standing and significant component of comprehensive rehabilitation for individuals with moderate and severe TBI. There is an accelerating, but still small, body of scientific literature supporting cognitive rehabilitation in mTBI," he says, referring to mild traumatic brain injury.

Taylor said it will take years to complete the necessary studies. One should be finished in 2011, another in 2013. By then, many more troops will have suffered brain injuries. And many more who have already suffered blows to the head will have gone without cognitive rehabilitation therapy.

Why the delay? That's the question raised by soldiers, their families and brain injury advocates: if a treatment has some proof that it works, and no proof that it hurts, why not move faster to provide it?

"There should be a way to provide TRICARE coverage for cognitive therapy while further studies are ongoing," Sen. Mark Udall, D-Colo., who serves on the Senate Armed Services Committee, told us in a written statement. "We can't ignore the fact that many studies and experts have determined that cognitive therapy is effective for brain injured patients and the fact that the Department of Veterans Affairs already recognizes its value."

Rep. Bill Pascrell, D-N.J., co-chair of the Congressional Brain Injury Task Force, promised to send a letter to the Pentagon protesting its slow progress on cognitive rehabilitation therapy.

"It's unfortunate that this kind of foot-dragging has been what many have come to expect from the Pentagon when it comes to soldiers who have sustained traumatic brain injuries," Pascrell told us. "Brave Americans who risked everything for their country and sustained traumatic brain injuries -- the signature injury of the wars in Iraq and Afghanistan -- deserve cognitive rehabilitation therapy to help them secure the best futures possible. It is unacceptable that the United States has been at war for nearly a decade and there is still no plan to treat these soldiers."

What happened to no man left behind? We aren’t supposed to leave our comrades on the battlefield, but these men and women with TBI are still there, fighting for normalcy. The Pentagon, Congress, POTUS, and to a degree the American people have abandoned those soldiers.

The military, the families, some of the providers needs to get over the seemingly subtle change that mild TBI gives to outsides.  It devastates the whole person and their families.  While the Pentagon, Congress, and others conduct studies and tests, real families and real soldiers continue to suffer.

I have had the most serious reservations about US policies in Iraq and Afghanistan and, as a taxpayer, find the costs of these policies intimidating if not wasteful. What I have never questioned is our national obligation to support our soldiers. That the Pentagon would seek to stop or slow the availability of any widely-used therapy is morally repugnant and the Congress’s failure to address the issue evidences its amorality and irresponsibility. I call on the President to direct his DOD to make available cognitive therapies to the both active military and veterans before the new year and to submit legislation to increase income taxes to pay for it.

The Israeli government, some years ago, did many, many studies on blast injuries, including TBI and the so-called “White Butterfly.” The reports of their research are available, and very worthwhile reading.

Part of the cognitive rehabilitation therapy package so criticized by the Tricare report, was actually developed by the staff at the Knoxville Veterans Hospital, Knoxville, Iowa. Said hospital has since been closed as “superfluous” and “redundant.”

In short, the VA, Dept. of Defense, Tricare, all have adopted the policy of “$***w the Veteran.”

Our loved ones are sent to war, they do the jobs required of them.  They are exposed to dangers that no one should ever have to endure.  The horrors of war may not wound them physically, but the emotional wounds are there.  These young people see their friends killed or seriously injured…..they themselves may experience this.

As the mother and wife of sevice members, I have seen the aftermath of what war has done, not only to the member, but the families as well.

Just go to Walter Reed and you will see young people and their families going through so much pain.  A loved one is a vegetable, others have lost more than one limb, a young man survives a direct hit to his face…..the list goes on.  I was devestated to see what I saw when I spent time with my Son, who was a patient at Walter Reed for over two years.

How can our Government not do whatever is needed to help those it sent to war heal as much as possible!

This does not surprise me.  I am a military spouse and my husband just had major chest surgery.  Interestingly enough, after this surgery was done TRICARE FAILED to pay for the prescriptions that my husband needed, and the doctor’s office that my husband was sent to by TRICARE FAILED to fill out the necessary paperwork for my husband to receive his prescriptions because they were ‘too busy’ seeing other patients.  Translation:  we already cut you open and got our TRICARE reimbursement to the tune of around 6% of what was billed… we have other patients with better health insurance that we are more concerned about.  So we had to pay for his prescriptions out of pocket which TRICARE claimed would be reimbursed before we paid for it, but afterwards when I requested the paperwork they changed their tune.  I had to submit a claim which took 6 weeks to process and was then denied.  I appealed the claim and I have over 40 letters sent to me (sometimes I get 2 a day) at a cost of .36 a piece that have been coming since November informing me that they have denied my claim.  I suspect that by February they will have spent enough money informing me that they don’t want to pay for my husband’s medical care… to have effectively covered the cost of the prescription.  Also, the military doctor who referred my husband for the surgery has since been suspended from practice for reasons which are unknown, but it happened basically right after my husband got out of the hospital.  Coincidence?  Maybe.  I think not.  Also, I have spent a lot of time trying to get my husband’s medical needs taken care of through the military and they too have so far… FAILED.  I have no idea what is going to happen to my husband and it makes me sad to see him treated this way but I will not FAIL him like so many others have done.

Traumatic brain injury -and it’s common sequel post-traumatic stress disorder has only 2 potential chances of being adequately addressed.Medically,T-cell therapy should be instituted in probably all cases and psychologically,for those who are assessed as likely to benefit,psychoanalysis.Cognitive therapy-ie re-teaching simple tasks in order to improve day to day coping is a given and doesn’t need a fancy name to describe it-nor does it require highly paid persons to ‘administer’.This not a new story.It is the tragedy of the war and the lack of commitment of many in VA.Choosing persons for psychoanalysis would not be easy-only those assessed as’having the psychoeconomic resources’  to benefit should be chosen,Dream analysis would revisit the traumas and undoubtedly dreaming would be ‘torture’(Otto Fenichel ‘The Psychoanalytic Theory of Neurosis’).This would not be an easy task..Not the least of the problem is who might be available to conduct these analyses?Just how many thousand cases are there?‘Cognitive therapy’ is not therapy per se however much some might insist it is These injured war HEROES deserve the best and it is a travesty that all this talk has been going on for years and the level of dissatisfaction with their rehab remains extreme.Medication-sure,where appropriate.Concentrated and prolonged effort-YES.The Pentagon is ‘studying brain damage therapy’-holy cow-are they after a degree or maybe they are thinking about their own brain damage.If staff shortages are the problem look no further than the unemployment offices. 10% unemployed.Should be no trouble filling all vacancies for general staff-even if on the job training is needed.If Americans wont do it, call for willing people from outside America.Maybe another wave of people across the Arizona border would do..Some thing has got to be done to help these injured veterans now.It is a national scandal.and the MOST IMPORTANT thing on the plate of Pres Obama and the Congress.If the nation fails these vets the way they did many after Vietnam the only way is DOWN.Who wants to do the work?Who can Congress get to do the work?Private contractors may be the only way to go to cut out the ‘feather bedding’.by the public sector unionists-mostly Democrats who don’t support the war effort anyway.Stop studying Congress and get your finger out.

So glad my son is not going back over with 2/8 Echo this time out. I back our Marines 100%. Lets send our representatives, and senators over there. See what happens about carre once they get injured.

To any of you who know of a beloved, injured Veteran suffering from traumatic brain injury, please check out Project Share.  The founder of Home Depot was upset about the tragic lack of care for those who suffered without treatment, and did something about it.  If you feel bad about it, you can help our Vets NOW, when they need it.  Shepherd’s in Atlanta is providing the care through Project Share, and that care is funded by caring citizens and their donations.  I don’t know about the rest of you, but my confidence in the Pentagon owning this and providing the necessary care is below zero.  They deny everything they can and always have throughout history.  I don’t know of a single American citizen who thinks this is right or proper.  Thank you for this investigative coverage…and stay on them full press.

Where is Bill Gates,Warren Buffett etc.?They can throw money at Malaria etc. in Africa-what about at home?Psychoanalysts in New York have been donating a day a week working with homeless and disadvantaged-what about private psychologists and psychiatrists etc-in fact ANY relevant rehab people-donating a day a week to work with these veterans?.If they can be corralled into that, the old American armed forces spirit of ‘everybody helps his buddy’ can be brought to bear.The heart and soul of America CAN be restored but only human effort can do it.I’m sorry, I am 9000 miles away already doing a similar job..

Governments historically abuse their troops and our Government has abused our troops for far too long.
The ultimate abuse is lying them into illegal wars of aggression with bogus intel, to defend the profits of the top 1%. Our men and women are giving their lives not for the protection of our freedoms (which are under attack by none other than our elected yet corporate controlled “representatives”) but for the protection and expansion of the corporate empire they label “American interests”. This twisted Corporate controlled Government only “supports the troops” when the soldier is fighting to make enhance and or protect their ill gained profits. Once a soldier is off the battle field and no longer of use they are a liability and must be removed from the profit and loss spread sheet asap.

There are so many millions good men and women whos lives have been destroyed for rich mens wars. I can only hope that more of them wake the fact that These Masters of War are the ultimately the true enemy of us all.

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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