Mr. Chairman, Ranking Member Miller, Distinguished Members of this Subcommittee, and guests, Vietnam Veterans of America (VVA) thanks you for the opportunity to present our views on H.R. 3051, the “Heroes at Home Act of 2007,” that is designed to improve the diagnosis and treatment of TBI (traumatic brain injury) for service members and veterans, and to review and expand the tele-health and tele-mental health programs DoD and VA.  With your permission, I shall keep my remarks brief and to the point.

First, VVA thanks you, Mr. Chairman and Mr. Miller as well as distinguished Members of this Subcommittee for your active concern in regard to Traumatic Brain Injury (TBI) and related mental health problems of our troops and veterans, and for your leadership in holding this hearing today.

In general, Vietnam Veterans of America supports the intent of H.R. 3051.  However, medical experts say that traumatic brain injuries are the “signature wound” of the Iraq war in particular, a by-product of the explosions caused by I.E.D. roadside blasts and suicide bombers.  TBIs have become so commonplace that they, in fact, form the basis for today’s hearing.

Although TBI may share some symptoms with post traumatic stress disorder, it is markedly different than PTSD, which is triggered by extreme anxiety, and permanently resets the brain’s fight-or-flight mechanism.  Battlefield medics and corpsmen can often miss traumatic brain injuries, and many troops don’t know the symptoms or won’t discuss their problems for fear of being sent home stigmatized with mental illness.  The same is true for those who return to the U.S. for garrison duty or exit their term of military service and become veterans. 

Certain TBI symptoms, such as seizures, can be treated with medications, but the most devastating effects – depression, agitation and social withdrawal – are difficult to treat with medication, especially when there is loss of brain tissue.  In troops with documented TBI, the loss of brain functions is often compounded by other serious medical conditions that affect physical coordination and memory functions. These patients need a combination of psychological and physical treatment that is difficult to coordinate in a traditional medical setting, even when properly diagnosed at an early date.  And we must remember that both concussive and contusive brain injuries are never just isolated injures.  Over time without proper diagnoses, care and treatment, TBI can affect nearly everything about the survivor including one’s cognitive, motor, auditory, olfactory and visual skills, perhaps ultimately resulting in behavioral modifications, not a mental illness.

As more and more troops return home damaged from the war, their families must contend with not only the physical desolation of their loved ones, but come to grips with the new emotional reality of their lives which have changed drastically and not necessarily for the better.  Take for example, a 35-year old soldier or Marine who returns home with what is diagnosed with traumatic brain injury (TBI).  His/her impairment affects the future of the entire family.   His or her spouse and children have to deal with his/her ability to concentrate, the mood swings, the depression, the anxiety, even the loss of employment.  As you can well imagine, the economic and emotional instability of a family can be as terrifying and as real as focusing or simply waking in the middle of the night and crying because of nightmares.  In cases of severely brain-damaged casualties, spouses, parents and siblings may be forced to give up careers, forsake wages, and reconstruct homes to care for their wounded relatives, rather than to consign them to the anonymous care of a nursing home or assisted living facility.

Families say that they also struggle with military and VA medical systems that were unprepared for these wounded.  In some cases new equipment and specially trained staff needed for the most catastrophic cases are not available or have not kept pace with the advances in battlefield medicine that kept these service members alive and brought them home safely.  In addition, there are issues about the intensity and drain of needed family support that will be hard to sustain, as well as significant issues regarding the complexity of the medical and other specialized needs that need to be addressed.  Of all the war’s medically challenging injuries, brain injuries require the most personal involvement and cost over time.

TBI also presents a most puzzling challenge, especially in mild to moderate cases.  Symptoms can be hidden or delayed, diagnosis is difficult, and evidence-based treatments are as of yet largely undetermined.  Very few medical facilities are capable of providing even the most basic level of care for brain-injured patients, forcing most to seek treatment miles from home, if they can find it at all, and we must remember that over forty percent of our troops deployed in Iraq and Afghanistan come from rural America.

As you are well aware, one of the recommendations of the Dole-Shalala Commission was to “significantly strengthen support for families.”  This will not be an easy task, but VVA believes H.R. 3051 to be a key step in achieving this recommendation and providing a mechanism for empowering the families of brain-injured service members IF the VA can develop effective implementation strategies for certification, competency evaluations, and meaningful outcome measurements to carry it out.  As they say, “the devil remains in the details”. 

I thank you again for the opportunity to offer VVA’s views on this proposed legislation, and I shall be glad to answer any questions you might have.