Letter To Honorable Robert Gates, Secretary, United States Department Of Defense

Letter

U.S. Senator Dick Durbin (D-IL) today sent a letter to Defense Secretary Robert Gates asking for the Department of Defense to explain the progress its made toward implementing programs that identify and care for members of the Armed Forces who have suffered from a traumatic brain injury (TBI) due to a combat or combat-related injury.

"The Defense Department and the military services have made important progress in the effort to identify service members affected by TBI," wrote Durbin. "Much more remains to be done to ensure that service members receive the care they need for TBI."

Durbin is specifically concerned with the implementation of the TBI provisions of the 2008 National Defense Authorization Act and the following issues:

* The creation of a comprehensive registry of the service members and veterans with TBI and post-traumatic stress disorder (PTSD);
* The dissemination of information regarding quality of care guidelines;
* The establishment of public-private partnerships with the Rehabilitation Institute of Chicago and other top-quality brain injury treatment facilities to allow service members and veterans to be treated for TBI and PTSD;
* The implementation of new TBI and PTSD screening tools and a consistent screening policy to reduce screening disparities between units and help ensure that service members get brain injury screenings when needed.

Text of the letter appears below:

December 11, 2008

The Honorable Robert Gates
Secretary, U.S. Department of Defense
1000 Defense Pentagon
Washington, DC 20301

Dear Secretary Gates:

I am writing to request answers to several concerns regarding the Defense Department's progress in implementing programs to identify and care for members of the Armed Forces who have suffered from a traumatic brain injury (TBI) due to a combat or combat-related injury.

The Defense Department (DoD) and the military services have made important progress in the effort to identify service members affected by TBI. Much more remains to be done to ensure that service members receive the care they need for TBI. I would appreciate an update on your progress in implementing the TBI provisions of the 2008 National Defense Authorization Act (NDAA) and your plans for addressing the following areas of concern.

Registry. DoD and the VA do not yet have a comprehensive registry of the service members and veterans with TBI and PTSD. What is the target date for creating this registry and what steps are being taken to meet this goal?

Quality of Care. The 2008 NDAA requires that members of the Armed Forces with TBI or PTSD be provided "the highest quality, evidence-based care in facilities that most appropriately meet the specific needs of the individual." It also requires that members "be rehabilitated to the fullest extent possible using up-to-date evidence-based medical technology, and physical and medical rehabilitation practices and expertise."

Please describe the clinical practice guidelines that will be released soon by the Defense and Veterans Brain Injury Center (DVBIC), how those guidelines comply with the quality of care requirements in the 2008 NDAA, and how they will be implemented.

The Department's TBI and PTSD informational materials do not adequately inform service members and their families of the right to receive the highest quality of care in the facility that most appropriately meets their specific needs. The Military OneSource website, for example, provides information about TBI treatment and rehabilitation but does not inform describe this right and does not allow a search for the VA and TRICARE-authorized providers in their area where they can receive care for a brain injury. I urge you to update the Department's website and materials and would like a summary of the steps the Department is taking to inform service members and their families of the right to receive the highest quality of care in the facility that most appropriately meets their specific needs.

Partnerships. DoD and the VA should take further steps to work with private-sector medical experts and facilities with brain injury expertise to ensure that service members receive the most appropriate care when they suffer from a traumatic brain injury. The best rehabilitation hospital in the country since 1991, according to U.S. News and World Report, is the Rehabilitation Institute of Chicago (RIC). RIC, a TRICARE-authorized provider, stands ready and willing to work with DoD and the VA to provide state-of-the-art treatment for brain injury. RIC is particularly well equipped to treat severe TBI cases. Yet DoD and the VA have offered very little collaboration with the hospital. Other well-equipped rehabilitation facilities across the country are available to help serve wounded service members, but are equally underutilized.

I urge you to make every effort to expand DoD's relationships with RIC and other top-quality private-sector facilities that can care for service members with brain injuries. Specifically, I ask the Department to explore a possible partnership between DVBIC and RIC. Please provide an update on your efforts to date to include these types of partnerships in the range of services provided to our severely injured troops and plans to further explore such partnerships.

Appropriate Screening for TBI. A consistent DoD screening policy could reduce screening disparities between units and help reduce the stigma sometimes associated with brain injury. Current in-theater screening policies depend largely on the ability and willingness of a service member or other personnel to identify that the service member has been exposed to a blast. Is DoD developing additional guidelines that would use objective evidence of exposure to a blast (for example, from helmet sensors) in determining whether to screen a service member for TBI?

TBI Assessments. One of the first recommendations of the Army's TBI Task Force Report, completed in May 2007, was that the Army should perform both baseline and post-injury neuropsychological evaluations using the Automated Neuropsychological Assessment Metrics (ANAM) exam. The Army is using the ANAM for baseline tests but is only now preparing an in-theater study to test the validity of using the ANAM as a post-injury evaluation tool, as it relies on another evaluation tool for assessing concussions.

The 2008 NDAA requires that DoD develop and use diagnostic criteria for TBI uniformly across all the services. Is completion of the Army study necessary before the ANAM can be used widely as an in-theater, post-injury screening tool?

I look forward to your prompt response to these concerns.

Sincerely,
Richard J. Durbin
United States Senator

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