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Friday, March 02, 2007

Traumatic Brain Injury: IAVA's Rieckhoff and VA's Nicholson Square Off

If you haven't seen it yet, head over to IAVA's website to view PBS Newshour's discussion on traumatic brain injury,the signature wound of the Iraq War. Tuesday night's ABC News special, To Iraq and Back, has sharpened our focus on this war wound, which often follows an improvised explosive device attack.

Reporter Bob Woodruff, who suffered TBI following an IED attack last year in Iraq, submitted disturbing evidence that suggests this is yet another area where we appear to be falling behind in providing our troops the care that they need to fully and successfully make their way back to civilian life. IAVA's Executive Director Paul Rieckhoff and VA Sectretary Jim Nicholson cross swords. Powerful.

Click on 'Article Link' below tags for transcript snippets...

From PBS:

LT. PAUL RIECKHOFF: [O]ur country in general is unprepared. The Department of Defense, the Department of V.A., they're all unprepared for the over 1.6 million veterans who have been through Iraq and Afghanistan, are going to be coming home with injuries, traumatic brain injury. One in three returning veterans will face post-traumatic stress disorder or other mental health issues. We've got a flood of people coming home. And the president's new budget actually proposes cuts to the V.A. budget for 2009 and 2010. There are caps after that.

They're introducing co-pays and trying to double the prescription costs for veterans. They're actually cutting prosthetics research in the future. And in a time of war, this is really unconscionable. And it shows that the administration and the V.A. is right now unable to accurately project for future demand or meet the demand we have right now.

JUDY WOODRUFF: Well, I just want to put out one number out there. Today, we were told by the secretary of Veterans' Affairs Office, 319 veterans have been diagnosed with -- I'm sorry, with traumatic brain injury. There's a number.

LT. PAUL RIECKHOFF: They said how many?

JUDY WOODRUFF: Three hundred and nineteen.

LT. PAUL RIECKHOFF: I think that number is extremely conservative. That may be the number they've treated so far, but I think that that's really the tip of the iceberg. And I think we have the larger question about whether or not resources have been allocated, whether or not the V.A. is understanding the magnitude and the scope of what's facing our veterans coming home.

And you saw Secretary Nicholson last night. He said, "Well, some of them come in for dental work." This is not dental work. This is amputations, traumatic brain injury. These are serious wounds. And these folks aren't getting the care they need at Walter Reed, right in the backyard of the capital, or in the localized VAs.

And I think what America is finally starting to understand is that this is a serious problem, it's a growing problem, and we've only started to scratch the surface with these recent reports from ABC and the Washington Post and others. ...

JUDY WOODRUFF: Paul Rieckhoff, what are you saying needs to happen? Is this a matter of more money? I mean, you mentioned that the Bush administration, the president's new budget is proposing cuts. Of course, Congress is part of that decision-making process, too. What are you saying needs to happen?

LT. PAUL RIECKHOFF: Well, I think it's a combination. I mean, it can start with oversight. Of the money allocated to the V.A. for mental health last year, according to a recent GAO report, only about 50 percent of it actually got down to the local VAs. So we need to ask some very tough questions. We need to investigate where the existing money is going and why it's not getting down to those local VAs?

But I think, in general, we are short of where we need to be. The independent budget, which is put together by leading veterans organizations and mental health care workers, project that we're billions of dollars short of where we need to be to meet existing demand and to project for future demand.

So we really need a newfound urgency in this country to understand that veterans' issues need to be a priority. The president, in his State of the Union address, recently talked about the tens of thousands of troops that we're going to surge into Baghdad. But he didn't talk at all about how we're going to care for them when they come home. And we need that type of presidential attention to these issues every day of the year.


JIM NICHOLSON: We see over a million veteran patients a week in our system of health care. That's veterans coming back from the war in Iraq, Afghanistan, we even have a few World War I veterans. So it's very large, and we've got some things that have come to light that we have got to make sure, because any one of these cases is unacceptable to me, because I know the pain and suffering that these people go through.

JUDY WOODRUFF: You're saying it's top, it's first-rate medical care, and yet Mr. Rieckhoff and others are pointing out there's not the screening. We're here tonight principally to talk about traumatic brain injury, but there's not the screening for these soldiers and Marines when they come out of Iraq and Afghanistan, and not the screening when they leave active duty and become veterans.

JIM NICHOLSON: Well, that's a point, and it was that there was not the screening. As Dr. Scott said last night on the program, this is an evolving medical science. And not very much is known about traumatic brain injury. Most of what was known in this country was out of incidents of athletes, and so everybody is learning as we go.

What we are doing now at the V.A. is, we're going to screen every veteran, every returnee from the combat zone for brain injury, every one of them. And those that we've detected with traumatic brain injury come into the finest polytrauma brain treatment centers in the world that we have. Then, after they become more stable, we put them out into 17 regional centers, but a lot of them want to go home. You can't blame them for that, especially after they get relatively stabilized.

What we have to do now is make sure that, when they go out to the next level and are being served by a V.A. medical facility, that there we have the trained clinicians, the case workers, and everybody that gives them the attention and the continued therapy that they need to progress.

We're taking steps, as we speak, literally, to make sure that no one falls through the cracks...If one [veteran] -- if one -- is not being well-treated, especially a young combatant, that is unacceptable, and that just breaks my heart.

JUDY WOODRUFF: But, Mr. Secretary, there have been reports going back, by our account, over a year, in some cases two years, noting that there are high numbers -- there were high numbers of soldiers and Marines coming out of Iraq and Afghanistan with what appeared to be traumatic brain injury, and there weren't the facilities to treat them. This is not a new problem.

Why is the screening just starting now?

JIM NICHOLSON: Well, first of all, the facilities, these really wonderful facilities, these polytrauma centers, they've been in place for more than two years. And they do a phenomenal job. And all the disciplines are there, for burn, amputations, brain injuries, and so forth. We've now added 17 more. As I said, we are -- this is an evolving phenomenon of brain injury. And he projected a number. I don't know what the number is.

But I know that we need to be alert to it, screen for it, and then be able to treat it, whatever it is, because he is right. People that raise their hand and go off to serve our country and are injured as a result of that service, either mentally or physically, are entitled to the best health care that this country can provide. And that is at the V.A., and that's what the people of this country want.

JUDY WOODRUFF: Again, we saw -- there was a report over a year ago, quoting a physician at Walter Reed -- now, again, this is active duty -- telling the reporter, "There is a distressing number of patients there who are not getting adequate screening and care. Many doctors," he said, "know little about traumatic brain injury and are prone to making the wrong diagnosis."

This is not new, is my question?

JIM NICHOLSON: Well, it is quite new. I mean, I can't speak for Walter Reed, which is a Department of Defense facility. But the number that you used there for people that have had acute brain injury has been 312 people. And they have come to these centers that we established for that. Now, I'd like, if I could...

JUDY WOODRUFF: But out of 200,000 troops that have come out of Iraq and Afghanistan, it's hard for people to believe only 320 or so have been diagnosed with this.

JIM NICHOLSON: Well, that's the number that has been diagnosed with very acute brain injury. I'd like, if I could, to clarify that 200,000 number, because that was quoted kind of out of context. But 206,000 people that have come to the V.A. are people who have come back from the combat zone, and that is people for all reasons, but they were not the people that, you know, have been -- who are wounded in theater.

JUDY WOODRUFF: They were not all necessarily severely injured.

JIM NICHOLSON: That's about 26,000, I think about half of those very seriously wounded. This is the number of people, because this grateful country of ours is giving these people, the National Guardsmen and Reserve, the right to come to the V.A. now for health care. And that is new.

After sending them to foreign combat zone for extensive and multiple tours, who else should treat the National Guard or Reserve troops, if not the VA? There's more there; please watch it and contact your elected officials to make them aware that we support our troops -- even when they come home from war. And then email Paul Rieckhoff and IAVA a nice word or two for a job well done, too.

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