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Memo: DoD lacks brain injury treatment plan

The Pentagon lacks a comprehensive plan to identify and treat tens of thousands of troops who may suffer from traumatic brain injury, the signature wound of the Iraq war, according to a previously undisclosed Defense Department memorandum obtained by USA Today.

The memo was released this week in response to a Freedom of Information Act request. Troops with mild and moderate brain injury are of greatest concern, the Armed Forces Epidemiological Board, now part of a new Defense Health Board, said in the Aug. 11 memo.

The board’s finding has surfaced as the Army’s medical care for Iraq veterans comes under harsh criticism in Congress following disclosures by Military Times and The Washington Post of soldiers facing bureaucratic delays and substandard housing at Walter Reed Army Medical Center.

The memo said the Pentagon should take the lead in “tackling the issue of TBI (traumatic brain injury) given our current wartime challenges.” It was signed by Wayne Lednar, an epidemiologist, and Gregory Poland, chief of the Defense Health Board.

”There remains a need to better understand the unique characteristics of blast-associated TBI and to reduce the health risk and complications from mild or moderate forms of brain injury,” the memo said. Lednar and Poland did not return calls for comment.

The panel drafted the report after receiving evidence of traumatic brain injury during a closed hearing in March 2006.

The Pentagon’s best work on TBI was on the most severe cases, the memo said. It noted that mild cases are hard to spot and can limit mental performance. Multiple concussions, the report said, can cause permanent damage.

Among the panel’s recommendations: improved protective gear, standardized battlefield methods to spot brain injuries, better ways to determine when an injured soldier can return to duty and screening all returning troops for brain injury.

In response, the Pentagon said Wednesday it is spending $14 million for more research on blast injuries and giving medics in combat zones evaluation forms to diagnose mild brain injury. “Our goal is to identify TBI as soon as possible,” said Pentagon spokeswoman Cynthia Smith.

Sen. Patty Murray, D-Wash., an advocate of improved brain injury treatment, called the panel’s finding ”outrageous.” She added, “Four years into the war and we still don’t have a systemwide plan.”

Without a comprehensive approach, it is left to family members to notice something mentally wrong with a loved one back from combat, said Janice Ruoff, a brain injury expert at George Washington University.