An Unused Resource for Veterans with TBI

 Posted on July 30, 2007 in Uncategorized

Houston's TIRR (The Institution for Rehabilitation and Research) is the fourth-highest rated rehabilitation hospital in the U.S. (No VA hospital even made the top 25.) So why is it that TIRR's Project Victory, designed to help veterans with traumatic brain injuries "reintegrate into family, school, work and community life" with "a three-year, $3 million budget, plus equipment, space, and perhaps most importantly, three decades of institutional experience in treating brain injuries" has no patients?

Well, the Houston Chronicle reports that the Houston VA hospital, which was supposed to funnel patients to Project Victory, has started its own "community reentry program".

It sounds like a bit of a turf war over veterans recovering from TBI. On the one hand:

Dr. Helene Henson, in charge of rehabilitation services at the Houston VA hospital, said the staff was not reacting to any sort of criticism and had not reneged on its agreement with Memorial Hermann/TIRR.Part of delivering good patient care, Henson said, was adding the day treatment program for veterans with mild brain injuries.Henson said the VA promised to refer vets with moderate to severe brain injuries to Memorial Hermann/TIRR, and that the hospital staff simply doesn't have any patients with those levels of impairment."They're not coming to us," Henson said. "We're seeing a very different type of impairment than we originally thought we'd be managing."

On the other, Cynthia Adkins, executive director of The Institute for Rehabilitation and Research Foundation, has a different take:

Adkins said the VA staff is quibbling over semantics, and that officials there originally agreed to share their brain-injured patients without regard to mild, moderate or severe diagnoses."I don't want to challenge the VA," Adkins said. "We think there are hundreds of vets who can use our help, and we are ready to serve at no cost to them or taxpayers, either."

That sounds pretty good: rehabilitation for brain-injured veterans, at one of the top rehabilitation hospitals in the country, free to the veterans and at no expense to the taxpayers. If TIRR is willing to take them, why isn't the VA willing to refer them? I would conjecture that the VA hospital's budget depends (as government budgets often depend) on the number of customers served, and that that budget might suffer from patients being referred to TIRR's private grant-funded program.

The article contained a statistic interesting to our understanding of TBI in OIF veterans:

According to the Defense and Veterans Brain Injury Center, a collaboration between the U.S. Departments of Defense and Veterans Affairs, 2,414 returning service personnel have been treated for brain injuries in the past 3 1/2 years.Henson said roughly 450 of those patients have severe injuries.

According to the epidemiological data, about 18% of all medically-attended brain injuries in the U.S. are severe. Dr. Henson's estimate comports with those date (she may well have based her estimate on those data), which suggests that OIF TBI follows the same pattern as civilian TBI. If it does, then 27% of servicemen treated for TBI, or about 660, have moderate brain injuries. If the Houston VA hospital doesn't have any of these 1,110 veterans with moderate-to-severe brain injury, perhaps it could tell Project Victory where to find them.

The overall number - 2,414 - is suspect; it is likely much lower than the number of actual brain injuries. VA clinical neuropsychologist Dr. Harriet Zeiner estimated in September 2006 that there might be 8,000 brain-injured veterans; "neurologists affiliated with the U. S. military now estimate that up to 30% of troops who have been on active duty for 4 months or longer (in both Iraq and Afghanistan) are at risk of some form of disabling neurological damage," which might mean up to 150,000 brain-injured soldiers.

The problem of finding and treating brain-injured veterans is complicated by the fact that the military has discharged 22,500 troops in the last six years because of "personality disorders." TBI can present as a personality disorder. The number of 5-13 discharges rises every day, which calls into question the motivation of the military in issuing these discharges. The government doesn't pay benefits to troops receiving "5-13" personality disorder discharges. The VA doesn't have to treat them. It is likely that soldiers with TBI-related personality changes are getting shunted out of the military with 5-13 discharges, and therefore out of the veterans' support system.

Do we trust the government to treat our injured veterans? Or should the VA be letting Project Victory do what it is supposed to do?

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