On December 16th, 2013, the Veterans Administration (VA) took a major step forward in addressing the issues veterans face in their lives after experiencing combat related brain injuries. It was announced through the office of Eric K. Shinseki, Secretary of Veterans Affairs. Veterans already receiving benefits for traumatic brain injury (TBI), identified with secondary illnesses of Parkinson’s disease, certain types of dementia, depression, unprovoked seizures, or certain diseases of the hypothalamus and pituitary glands, will receive additional service connected disability benefit compensation consideration. This move is a step in the right direction in regards to identifying additional issues in the transitioning of veterans who are adjusting to life after brain injuries. However, there are additional findings identified in the study behind this resolution by the VA, that warrant further investigation as possible additions to this list of secondary illnesses.
This decision was inspired by a 2008 report of the “Long-Term Consequences of Traumatic Brain Injury”, published by the National Academy of Sciences, Institute of Medicine (IOM). All five of the newly recognized (presumptive) secondary illnesses to combat related TBI were deemed to have “sufficient evidence” through the research gathered for this report. Though the report was assembled in 2008, a majority of the areas studied were based on research performed prior to 2001. Most of the findings were more focused on Persian Gulf War veterans with shorter terms of combat exposure, fewer reported TBI’s, and less prevalence of multiple deployments. There were a few medical issues not considered for the list identified as having “limited suggestive evidence” that could warrant further additions as presumptive illness to TBI. The areas identified as having “limited suggestive evidence” include: alcohol and drug abuse, PTSD, psychosis, and the development of ocular and visual motor deterioration. What is troubling about the exclusions of psychosis is the study acknowledges that psychosis becomes more prevalent in the years following a severe TBI. The ocular and visual motor oversight is a bit confusing considering that current VA TBI screening practices include detailed examinations from an audiologist and ophthalmologist. Another area of concern is that the report recognized “strong evidence” of a connection of aggressive behaviors and TBI, yet it was not addressed as an identified secondary illness in the VA announcement.
The most interesting part of the study though was the “social functioning” with TBI section beginning on page 301. At the bottom of this page is the beginning of a research project published in 1996 that determined that discharged military personnel who had sustained TBI were more likely to be discharged because of behavior compared to the total discharge population. That information could be useful in researching the nature of the recently highly recognized issues with “other than honorable discharges” of veterans reporting combat trauma issues in the past 10 years. More remarkable was that in regards to Social Functioning the report found there was sufficient evidence of an association between sustaining a moderate to severe TBI and long-term adverse social function outcomes, particularly unemployment and diminished social relationships. To its credit from July to October 2013, the VA conducted Mental Health Summits inviting local community agencies and care providers into preliminary discussions regarding the impacts of combat trauma to society. National Guard and Reservists constitute almost 30% of the veterans who served in post 9/11 combat efforts. In addition to further considerations to the TBI secondary illness list, it’s becoming evident that the socialization and management of the long-term residuals of TBI and other combat trauma could be more transparent and cost effective by developing continuum of care relationships with local care providers.