Journalism in the Public Interest

Scientific Review Kicks Off to Weigh Treatment for Brain-Injured Soldiers

The National Institutes of Medicine convened the first of what’s expected to be a series of public panels to help determine whether cognitive rehabilitation therapy could help heal troops who suffered traumatic brain injuries in Afghanistan and Iraq.


U.S. Army soldiers on patrol in the Zari district of Kandahar province on Oct. 24, 2010. The Institutes of Medicine kicked off its yearlong study of cognitive rehabilitation therapy to determine whether the Pentagon's health plan should cover the treatment for troops who have suffered brain injuries in Iraq and Afghanistan. (Massoud Hossaini/AFP/Getty Images)

The Institutes of Medicine kicked off its yearlong study of cognitive rehabilitation therapy on Monday, a process that will help the Pentagon decide whether its health plan will cover the treatment for troops who have suffered brain injuries in Iraq and Afghanistan.

We've previously reported that Tricare, which covers troops and many veterans, relied on a controversial study to deny coverage for the treatment, which helps rewire soldiers' brains to perform basic tasks such as memorizing lists and following orders. Tricare said the study showed there wasn't enough evidence to support paying for the treatment, which can cost more than $50,000 per soldier. The Pentagon says nearly 200,000 troops have suffered traumatic brain injuries since the wars began, though our own reporting shows the numbers are probably a lot higher.

The IOM panel of experts will review scientific literature and ultimately render a decision on whether it supports the efficacy of cognitive rehabilitation therapy. If the experts reach this conclusion, they will hardly be the first to do so. In April 2009, a consensus panel assembled by the Pentagon said the therapy works, especially for soldiers suffering more severe forms of brain injury. Other groups, such as the Brain Injury Association of America, have weighed in to support it. Even some major private insurance companies pay for it.

The head of the IOM panel, Georgetown University neurologist Ira Shoulson, pointedly quizzed Tricare on this issue at Monday's session, asking what the current review would produce that previous reviews had not.

Capt. Robert DeMartino, Tricare's director of behavioral health, said he hoped the panel would be able to pinpoint what types of cognitive rehabilitation works best, and what kind of civilian doctors and clinicians were best qualified to provide it. He noted that stories published last year by ProPublica and NPR have cast a "shadow" over the issue, prompting congressional committees and lawmakers to pressure Tricare to provide cognitive rehabilitation therapy.

"For us, we know that we're in a field like a gray zone," said DeMartino, who addressed the panel by speakerphone. "We want to make sure the [treatments] that work are the ones we are going to use."

The IOM review will continue through the end of the year, and the panel expects to convene other public sessions to help them arrive at a determination.

They deserve to have this available just as any other government employee would have, namely the congresswoman. They sacrifice and risk their lives everyday.

Barbara Hanson

Feb. 7, 2011, 5:21 p.m.

It sounds like Tricare didn’t take much care in the first place when they relied on a controversial study which led them to deny treatment to our troops and veterans.At a cost of $50,000 per soldier, this is a bargain in exchange for what they do to protect this country. With all the waste and foreign aid that taxpayers pay for, this is one worthwhile project that I would like to see my tax dollars be used for. There is no excuse to delay access to cognitive rehab for our military any longer.

Jeannine Richardson

Feb. 7, 2011, 5:26 p.m.

We spend more money on mosquito nets to prevent malaria in Africa than on our own people maimed while fighting for their country?  Where are the priorities?  Shame on you

Marylin Copeland, MSW, CBIS

Feb. 7, 2011, 6:08 p.m.

I have spoken, at a recent Town Hall Meeting, with our newly elected Congressman (Rigell-VA-2) about this issue. He has been appointed to the Armed Services Committee and, since he is from a heavyly military impacted district(Hampton Roads, Virginia) , he should be very outspoken on this. I have alerted the legislative section of the Brain Injury Association of America about this conversation and asked them to follow-up with a briefing on the subject, which I’m sure is new to him as a Freshman congressman, at least judging from his lack of specific knowlesge in his answer. I hope to have an opportunity to speak to his District staff about this and, generally, local services and programs available to veterans returning with brain injuries. Thank you for your journalism on this subject.

Do not let us forget, as too many generations before us have forgotten, the sacrifice that our young men and women make in defense of us.  We deploy our children around the world to stand for our beliefs.  They stand, and they die, and they come home injured beyond our ability to heal them.  Please let us recognize this, and please let us deploy our best to save them.  I am a Mother of a serviceman who will be deployed.  To all the parents who cannot fight and serve on the front lines, let us serve on the back lines to make sure our children receive all the help and all the care they deserve for the sacrifices they make at our request.  They are all all our children,  save them, help them, and preserve them.  They have done this for us.  We cannot do less by them.
God bless them, God bless us, and God bless our World and our Country.  For those who suffer and for those who give it all.

There is rhetoric and then there is real science. A decade ago, people said women should use hormone replacement therapy. Now we know better. I think veterans deserve the honor of giving them treatments that work. The NPR and Pro Publica reporting on this topic has not been very probing.

Of course they should have the best treatment
available, but research should have begun a long
time ago.I agree with Natalie, hope the congress-
woman recovers, our soldiers deserve the same.

It was not rhetoric to those who replied.  I know there is real science.  I know that cognitive-behavioral therapy can and does help those who have closed brain injury and variants of PTSD. I know that further “scientific research” can take us farther into solutions and must be pursued at the cost of taxpayers dollars.  I also know that there is value in an emotional plea that brings salience to the implementation of scientific and medical intervention in terms of real dollars and real attention to the problem.  We have a volunteer military.  These people have chosen their course, and have not been drafted; they have put their lives and futures on the line by their own decision.  Do not let us fail them.  For if we do so, if we ignore this supreme sacrifice which is death without dying; we have failed as parents, as a society,  and as a nation.  Our veterans deserve the best treatment, but they are languishing without the care that we provide our most indigent citizens.  If not criminal, this is indeed, sinful.  We have the capacity to provide the best treatment for our wounded, that we do not is a stain of shame upon all of us.

They refuse CRI, which has some early and real evidence of help, but they enthusiastically approve without question acupuncture,  a treatment with many many years of proper trials that show it every bit as effective as massage or many other common physical therapeutic real and placebo approaches ... priorites indeed…

I am a Traumatic Brain Injury Surviver going on 39 years with a TBI and my Traumatic Brain Injury has not repaired its self if i would have had the proper cognitive Treatment i sure would Have Better Skills Than i have with no Therapy Done For my injury Even though i am not a Veteran i am still a person with Traumatic Brain Injury That i had no control over i was only 10 years old their were no COGNITIVE Treatments in 1972 i was on the sympathy of a Step mothers antagonizing Therapy that was CRUEL TO me

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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