Severe traumatic brain injury is a family injury in the sense that it converts the loved ones of the brain injured service members into caregivers and personal care attendants.  After acute rehabilitation, the family members must substitute their judgment, planning and memory functions for the cognitive abilities and emotional control that their loved one has lost.  Positive outcomes following severe traumatic brain injury are strongly associated with ongoing family support and involvement.  Unfortunately, providing care giving and a safe structure for the severely brain injured is associated with the experience of high levels of stress and very high divorce rates.  The civilian literature also establishes that brain injury substantially increases the frequency of bankruptcy.   

The vast majority of Americans would agree that supporting our troops includes helping families to successfully cope with the behavioral and adjustment challenges that persist following severe traumatic brain injury.  Americans want their military service members with severe brain injuries to have as much quality of life as possible.  This is clearly associated with keeping them with their families and in their own communities.  The Medicare cost literature amply documents that maintaining patients in the community is also cost effective.  The most expensive cases in terms of long-term medical costs are the chronically institutionalized disabled.  Thus, Representative Salazar’s Bill, H.R. 3051 not only reflects the loyalty we feel to our fellow citizen soldiers, but also represents a cost-effective approach to reduce healthcare costs (references available on request).  It should also be noted that divorce involving patients with severe brain injuries results in increased long-term costs to government agencies for establishing and managing guardianships and conservatorships.     

The literature on urban versus rural health-related quality of life establishes that the rural veteran population experiences lower physical and mental quality of life.  Numerous studies have established that members of the National Guard and Reserve experience higher rates of emotionally-based symptoms and problems related to alcoholism.  Fewer supports in rural communities contribute to poorer coping in all at-risk groups including soldiers with traumatic brain injury.  Rural VA clinics and Veteran Centers in rural communities constitute tremendous improvements for veterans but they usually do not include specialty care.  Therefore, in all states with dispersed rural populations, initiatives to improve telemedicine are needed.  Rural veterans with moderate to severe traumatic brain injuries will clearly be in need of ongoing consultation for the foreseeable future.  Given the difficulties that this group of brain injured veterans has with driving and transportation, telemedicine outreach projects to increase their access to services should be supported. 

I have had the experience of working with patients with severe traumatic brain injuries and spinal cord injuries for 26 years at Craig Hospital.  Our experience is that supporting and maintaining families in the community is the most cost effective approach to long-term care, and the approach that affords the highest quality of life.  There is literature from the Workers’ Compensation Reinsurance industry which establishes that maintaining brain injured patients with their families in the community is the most cost effective treatment approach.  Therefore, I strongly recommend that you consider passing H.R. 3051.  H.R. 3051 is superior to S. 2921 because it will help keep more families with a brain injured service member intact, and prevent the institutionalization of more soldiers with severe brain injury than the provisions of S. 2921

Respectfully submitted

James C. Schraa, Psy.D.
Neuropsychologist
Licensed Psychologist, State of Colorado
Craig Hospital, Englewood, CO