IL Chief of Vets Affairs Tammy Duckworth Testifies on TBI and PTSD

Illinois Veterans Affairs Director Tammy Duckworth, the Iraq War veteran who lost both legs following the downing of her helicopter in November 2004, testified at a Senate hearing on Capitol Hill on Monday. She spoke of the need to update the skills and devices used in national and local VA amputee prosthetics programs. The woman who returned home to lead an unsuccessful -- but inspiring -- campaign for national office also spoke of the challenges that veterans returning home with traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD) face:

Any Seamless transition program must also include comprehensive screening for Traumatic Brain Injury (TBI), Post Traumatic Stress Disorder (PTSD) and vision loss by both the DOD and the USDVA Health Care systems. I know that efforts are underway to strengthen these assessments by both the DOD and the USDVA. However, there is no standard procedure in place to insure that all war wounded are screened nation-wide.

Currently, there is an issue with TBI screenings. Some service members who are not screened for TBI, are being identified as suffering only from PTSD. However, it is possible to have both PTSD and TBI or either condition alone. My concern is that service members with TBI are not diagnosed and then return to civilian life without this medical condition noted on their records. The symptoms of TBI can result in inability to work or even aggression that results in homelessness and entry into the criminal justice system. At that time, these veterans are then often diagnosed as having PTSD and treated for PTSD even though the main injury is TBI. What is significant about this situation is that TBI and PTSD have many treatment methods that are the exact opposites.

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First, as an introduction, a segment from the Today Show on Major Duckworth's 2006 race for the Congressional seat in Illinois' 6th District (the audio is a bit off from the video, but the piece is informative nonetheless):

Continuing her testimony:

One additional screening criteria that is critical is testing for vision loss. At the Hines USDVA Hospital, all poly-trauma patients are routinely screened for vision loss as soon as they enter the facility. The result of these screenings is that 60% of the poly-trauma patients at Hines have been found to have some form of functional vision loss. Vision loss, an acute injury on its own terms, can also negatively affect how patients perform on tests for TBI, which are heavily reliant on vision. Hines is the only USDVA facility in the nation that conducts routine screening of patients in its poly-trauma centers. This is because it is the initiative of the excellent Blind Rehabilitation program at Hines.

I would like to close by saying that I have had a surprisingly positive transition to the VA system. I also understand that this may not be the same across the board for all returning service members. There are problems that can be resolved such as the establishment of standard screening criteria for major injuries such as TBI, PTSD and vision loss. I would also strongly urge this committee to consider eliminating the two year window for free VA care for OIF/OEF veterans. This is a new time limit that will limit veterans’ ability to access care for injuries such as PTSD, which may not become evident until over two years after their service. We have more work ahead of us, but much of it can be resolved through information sharing, use of patient advocates, and a willingness to access private healthcare specialists.

Duckworth has also been busy locally, fighting for veterans care. From last week's Daily Herald:

Duckworth arrived at the shelter [Midwest Shelter for Homeless Veterans in Wheaton] with a new political war to wage: improved health care for veterans. Having lost her congressional bid to Republican Peter Roskam of Wheaton last year, Duckworth is now the director of the Illinois Department of Veterans Affairs. The shelter staff believes her firsthand knowledge of the physical and mental wounds of war will bring needed change.

Duckworth delivered the promise of a $128,000 check for the shelter Wednesday. It will be the first facility in the state to reap the benefits of a state scratch-off lottery ticket game earmarked for veterans. She had already visited the facility last summer. At the time, she was in a wheelchair, and the facility hadn’t yet opened. Wednesday, she navigated steps with the aid of a new, $100,000 prosthetic right leg.

The shelter has been open for two months and is already at capacity with five residents and a waiting list. Shelter officials want to expand to 20 residents as soon as next year. To do that, they’ll need more money and an easier process to get veterans enrolled in entitled benefits. Ideally, the shelter would like to become a line item in the state budget.

Duckworth said such a move must come from the state Legislature. On her end, she’s in the process of hiring a grant writer for the veterans affairs department, a position that hasn’t existed. She believes it will bring more federal dollars to Illinois veterans and facilities like the one in Wheaton.

She’s also developing a single form to guide Illinois veterans through all the programs they may qualify for. She’d also like to see a relaxing of medical privacy laws so the state can obtain names of veterans as they return home and enroll them in benefit programs faster.

Illinois especially has been very supportive of its veterans. In her Capitol Hill testimony, Duckworth spoke of two of the programs unique to the state:

In addition to medical treatment, Seamless Transition is also the passing from one administrative program to another. The Seamless Transition initiative needs to be expanded to each state’s VA, and more importantly, local counties and municipalities. The current model for Seamless Transition focuses on transition from the DOD to the USDVA entities within the state. It is also important to involve each state’s VA agency as there are many state programs that are unique to the state. For example, in Illinois we provide Veterans’ Care, a health insurance plan for veterans. We also provide additional funds for accessibility modifications to disabled veterans’ homes. New benefits are added at the state level more quickly than can be tracked by the USDVA. For example, as of January this year, Illinois gives up to a $600 rebate on employer’s state taxes for each Persian Gulf War, OIF or OEF veteran that they hire.

Duckworth has been nominated by Senator Dick Durbin for a possible seat on a presidential commission, headed by Democrat Donna Shalala and Republican Bob Dole, tasked with investigating problems at Walter Reed Army Medical Center. Yet her days of having a direct connection to the battlefield are far from over; Duckworth's husband is preparing for deployment to Iraq:

Tammy Duckworth says that while the American public has been supportive of the troops the government has failed them by not planning for their long-term care. She says, not only is Walter Reed an example of that, but possibly Brooks and Bethesda medical centers. She also agrees with setting deadlines to draw troops out of Iraq. Now, one of the latest people to head to the Middle East is her husband. "I get to see what it's like to be the person who gets left at home, and sometimes, I think that's almost more difficult," said Duckworth.

Tammy Duckworth is preparing herself for a day next month when her husband of 14 years, Brian Bowlsby, will be deployed to Iraq for at least a year. He will help to run convoys on the roads, a dangerous assignment that makes her anxious.

Duckworth was in Iraq three years ago when insurgents shot down the helicopter she was piloting and she lost both legs. But, she says that while her husband is away, there is a lot on her plate to keep her busy. "I absolutely want to start a pilot program for post-traumatic stress disorder here in Illinois. We would be the first state in the country to do it," Duckworth said.

Duckworth is director of the Illinois Department of Veteran's Affairs. Her priority is to make comprehensive, affordable health care available to vets. But, she is also taking on the federal government, speaking out against the Iraq war and criticizing President Bush for what she says is the lack of a plan to take care of the increasing number of injured veterans. She says that is why solders face dilapidated and unsanitary conditions at Walter Reed Hospital. "But when I was there, in the second year of the war, there were only a couple hundred of us who were living in an outpatient basis. I think there are now 700 outpatients and they've had to reopen buildings that have been closed down," said Duckworth.

An incredible range of service to country...