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Submission For The Record of Mr. Kimo S. Hollingsworth, American Veterans (AMVETS), National Legislative Director

Chairman Michaud, Ranking Member Miller, and members of the Subcommittee:

Thank you for the opportunity for American Veterans (AMVETS) to share its views on Traumatic Brain Injury.

Mr. Chairman, the term polytrauma has been utilized for years in the private medical sector.  Since 2001, the term has become common among U.S. military doctors in describing the seriously injured soldiers returning from Operation Iraqi Freedom (Iraq) and Operation Enduring Freedom (Afghanistan).  The fact that this Subcommittee is holding a hearing on the existence of polytrauma injuries is a tribute to improved protection for our servicepersonnel and also on the advancements in medicine.  In previous wars, personnel with multiple injuries did not have the prospects of surviving these types of injuries.

On today’s battlefield, polytrauma often results from blast injuries sustained by improvised explosive devices, or by other exploding devices such as a rocket-propelled grenade or landmines.  In many of these incidents the injuries are readily apparent because the injuries are directly related to exploding fragments or debris.  Often overlooked are injuries that result to the brain from high-pressure waves or other non-evasive blows to the head.  It has been reported that approximately 60 percent of injured servicepersonnel will have some degree of TBI.  There VA currently utilizes four clinics that specialize in polytrauma. - Minneapolis, Minnesota, Palo Alto, California, Richmond, Virginia and Tampa, Florida.

According to the VA, animal models of blast injury have demonstrated damaged brain tissue and consequent cognitive deficits.  The limited data available suggests that brain injuries are a common occurrence from blast injuries and often go undiagnosed and untreated as attention is focused on more “visible” injuries.  A significant number of casualties sustain emotional shock and may also develop Post Traumatic Stress Disorder (PTSD).  Individuals may sustain multiple injuries from the various types of explosions and the explosions will produce unique patterns of injury seldom seen outside combat.

The overarching problem for the Department of Defense (DOD) and the VA is identifying symptoms due to TBI or PTSD because the symptomology can be similar.  TBI is the result of a severe or moderate force to the head where physical portions of the brain are damaged and functioning is impaired.  PTSD is a psychological condition that affects those who have experienced a traumatizing or life-threatening event such as combat, natural disasters, serious accidents, or violent personal assaults.  Overall, TBI has its own unique medical origin that should be addressed through a multidisciplinary approach that recognizes TBI as physical injury to the brain.

VA is one of the world’s foremost-recognized authorities on PTSD and the DOD has made great strides in this area over the last several years.  VA’s focal point of excellence in PTSD has resulted in a comprehensive PTSD screening and treatment program.  VA now operates a network of more than 190 specialized Post Traumatic Stress Disorder (PTSD) outpatient treatment programs throughout the country.  Vet Centers are seeing a rapid increase in their enrollment.

However, AMVETS is extremely concerned about the lack of awareness and screening among health care professionals for Traumatic Brain Injury (TBI).  It has been reported that about 10 percent of all service personnel, and up to 20 percent of frontline personnel, suffer concussions during combat tours.  Studies show that multiple concussions can lead to permanent brain damage.  And, as previously discussed, PTSD and TBI clinically present many of the same symptoms - fatigue, headaches, memory loss, poor attention/concentration, sleep disturbances, dizziness/loss of balance, irritability-emotional disturbances, feelings of depression, etc.  The problem for medical personnel is trying to differentiae between PTSD and TBI.

According to the August 2006 Analysis of VA Health Care Utilization Among US Southwest Asian War Veterans: Operation Iraqi Freedom/Operation Enduring Freedom, 184,524 veterans have sought care from a VA Medical Center since the start of OEF in October 2001 through May 2006.  The August 2006 analysis reports 29,041 of the enrolled OIF/OEF veterans who visiting VA Medical Centers or Clinics had a probable diagnosis of PTSD.  During this time, 1,304 OIF/OEF veterans were identified as having been evaluated or treated for a condition possibly related to TBI.

Overall, VA’s approach to PTSD is to promote early recognition of this condition for those who meet formal criteria for diagnosis and those with partial symptoms. The goal is to make treatments available early to prevent a lasting medical condition.  The same must be done for TBI.  While VA is actively making progress in this area, there are unique challenges.  Fro example, there is no medical specific diagnostic code for TBI.  Because of the nature of polytrauma injuries, patients are given more than one medical diagnostic code.  AMVETS would recommend that the VA consider adopting or assigning a new medical code for TBI, similar to that of PTSD.  AMVEST is also asking Congress to increase funding for PTSD and TBI, with an emphasis on funding for VA to develop improved screening technique, specifically for TBI.

Mr. Chairman, VA has a long history of providing excellent specialty care.  However, further work and research are required in order to improve the nature of its treatments.  Overall, AMVETS believes that the medical community needs a better understanding of the effects of stress and trauma on the brain and how complications arise from these conditions.  While VA is pursuing a more detailed and thorough identification process for mild cases of TBI, there is still more to be done.   The advancements in protective armor, and science and medicine have created new and unique medical circumstances that will carry additional moral, legal, financial and other types of responsibilities.  Simply put, the very nature of polytrauma care is extremely slow, complicated and expensive.  AMVETS trusts that Congress will continue to uphold its obligations to “care for those that have borne the battle.”

This concludes my testimony.  Thank you.