Services Improve Diagnosis of Brain Injuries, PTSD

By Lisa Daniel
American Forces Press Service

April 21, 2010 - 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 www.afterdeployment.org, 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.