USA — Services Improve Diagnosis of Brain Injuries, PTSD

WASHINGTON — Bet­ter under­stand­ing of post-com­bat brain injuries and psy­cho­log­i­cal trau­ma, cou­pled with a host of mea­sures to diag­nose and treat such dis­or­ders, are pre­vent­ing ser­vice­mem­bers from being unfair­ly dis­charged due to undi­ag­nosed con­di­tions, Defense Depart­ment offi­cials told Con­gress mem­bers yes­ter­day.
Dr. Charles L. Rice, who is per­form­ing the duties of the assis­tant sec­re­tary of defense for health affairs, acknowl­edged that such prob­lems exist­ed ear­ly in the wars in Iraq and Afghanistan, but said the ser­vices had alle­vi­at­ed the prob­lem with improved under­stand­ing and out­reach to treat post-trau­mat­ic stress dis­or­der and trau­mat­ic brain injury. “There were con­cerns ear­ly in the con­flicts that mem­bers suf­fer­ing PTSD or TBI might be sep­a­rat­ed under the non-com­pens­able, exclu­sive diag­no­sis of a per­son­al­i­ty dis­or­der,” Rice said in tes­ti­mo­ny before the House Armed Ser­vices Committee’s mil­i­tary per­son­nel sub­com­mit­tee. “Such con­cerns were rea­son­able, giv­en our nascent under­stand­ing of these sig­na­ture injuries.”

Rice — who also serves as pres­i­dent of the Uni­formed Ser­vices Uni­ver­si­ty of the Health Sci­ences and act­ing direc­tor of the Tri­care Man­age­ment Activ­i­ty — tes­ti­fied along with William J. Carr, deputy under­sec­re­tary of defense for mil­i­tary per­son­nel pol­i­cy. They told the sub­com­mit­tee about how the ser­vices are imple­ment­ing a new law – Sec­tion 512 of the 2010 Defense Autho­riza­tion Act – requir­ing them to con­duct med­ical exams before sep­a­rat­ing a com­bat vet­er­an under less-than-hon­or­able con­di­tions.

“As the body of knowl­edge of PTSD and TBI has matured, per­son­nel poli­cies have also evolved to ensure ser­vice­mem­bers are thor­ough­ly eval­u­at­ed pri­or to con­sid­er­a­tion of dis­charge from mil­i­tary ser­vice,” Rice and Carr said in a joint state­ment sub­mit­ted to the sub­com­mit­tee. “The department’s sep­a­ra­tion poli­cies offer many lev­els of over­sight to pro­tect against inap­pro­pri­ate dis­charge.”

Rice read the state­ment out­lin­ing steps the depart­ment and ser­vices are tak­ing to avoid dis­charg­ing some­one for undi­ag­nosed con­di­tions masked as behav­ioral prob­lems. They include: — Award­ing more than $500 mil­lion in research stud­ies on trau­mat­ic brain injuries and psy­cho­log­i­cal health;

— Invest­ing in pre-deploy­ment resilien­cy train­ing;

— Con­duct­ing acute con­cus­sion screen­ing for all patients evac­u­at­ed from com­bat the­aters with head and neck injuries; — An effort to revamp pre- and post-deploy­ment screen­ings to make them more com­pre­hen­sive;

— A new pro­gram designed to help pri­ma­ry care providers rec­og­nize warn­ing signs of PTSD;

— Manda­to­ry phys­i­cal exams with­in 12 months of a servicemember’s sep­a­ra­tion – a depart­ment pol­i­cy adopt­ed in Octo­ber 2005 – that are waived only with the con­sent of both the ser­vice­mem­ber and the unit com­man­der;

— The addi­tion of more than 2,000 men­tal health providers to mil­i­tary treat­ment facil­i­ties, with plans to imple­ment a new mod­el to bet­ter deter­mine staffing needs; and

— Estab­lish­ing direc­tor of psy­cho­log­i­cal health posi­tions in mil­i­tary units, and the 2006 cre­ation of the Cen­ter for Deploy­ment Psy­chol­o­gy at the Uni­formed Ser­vices Uni­ver­si­ty of the Health Sci­ences.

In addi­tion, Rice said, the depart­ment and ser­vices have done much to reduce the stig­ma attached to seek­ing men­tal health treat­ment, and have cre­at­ed more and improved ways for ser­vice­mem­bers and their fam­i­lies to access self-help resources, such as a web­site called, and the abil­i­ty to receive psy­chi­a­try ser­vices through phone calls.

New Jer­sey Rep. Bill Pascrell, co-chair of the Con­gres­sion­al Brain Injury Task Force and a mem­ber of the sub­com­mit­tee, said an esti­mat­ed 360,000 vet­er­ans of the Iraq and Afghanistan wars, or 20 per­cent, are believed to return with brain injuries. He called it “absolute­ly inad­e­quate” to not have a con­sis­tent met­ric to eval­u­ate them before and after deploy­ment. In response, Rice said pre- and post-deploy­ment tests are incon­sis­tent because pro­fes­sion­als who assess brain injuries dis­agree about the best eval­u­a­tion tools.

“There is no gold-stan­dard diag­nos­tic study for TBI,” he said, adding that the depart­ment has part­nered with the Nation­al Insti­tute for Men­tal Health to deter­mine if bio­log­i­cal mark­ers or some oth­er indi­ca­tors can improve the tests’ valid­i­ty.

“If we take a screen­ing test, what do we mea­sure it against? What is the yard­stick?” Rice said. “I believe all three ser­vices have engaged their experts in intense dis­cus­sion about what the right psy­cho­me­t­ric eval­u­a­tion should be and the right tools to deploy it.”

Defense Depart­ment offi­cials plan to release a report June 25 to update how the ser­vices will meet the new man­date, Carr said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)