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Letter to Secretary Shinseki and Secretary Gates

The Senate Committee on Veterans' Affairs recently held a hearing on treatment for servicemembers and veterans with traumatic brain injury (TBI). We, the undersigned members, sit on both the Veterans' Affairs and Armed Services Committees of the Senate, and include the Chairman and Ranking Member of the Senate Committee on Veterans' Affairs, who are also a senior member and a subcommittee ranking member of the Armed Services Committee respectively.

At the outset, we commend both Departments for the progress that has been made to improve health care over the past nine years while the nation has been at war, particularly with respect to TBI, a signature injury of the current conflicts. However, as the hearing demonstrated, there are still several areas in which both Departments must improve if those impacted by TBI are to receive needed care and assistance. The most critical requirement is effective and comprehensive communication between the Departments of Deffense and Veterans Affairs. it is essential that all data to include medical records and post-deployment health assessments and post-deployment health reassessment (PDHA/PDHRA) results, be available to both Departments.

The Department of Defense must enhance its care for servicemembers who have sustained traumatic brain injuries. We have received testimony, in addition to several reports, that servicemembers who were exposed to blasts or potentially TBI-inducing events were not cared sufficiently. Repeatedly, we have heard from veterans and servicemembers that they were never screened for TBI, never treated for TBI, and even sent for subsequent deployments without being evaluated or treated for this injury. Additionally, we have heard from servicemembers who have been repeatedly turned away from military treatment facilities when they sough evaluation and treatment for TBI. We have also received numerous accounts in which PDHRA results were not subsequently addressed by the Department.

We commend the development of the Department's dfrat policy that will mandate evaluation and rest periods for those believed to have suffered a TBI, or were exposed to an event that could cause TBI. However, we remain concerned that the Department's existing policies, including requirements for documentation of TBI and follow-up during PDHAs/PDHRAs, are not being consistently applied. The notion that a servicemember would be turned away from treatment or even sent back into harm's way without being evaluated is unacceptable. We request that you take prompt action to finalize and implement the Department's draft policy and to ensure that existing policies are being adhered to by each military service.

Considering the frequent comorbidity of post-traumatic stress disorder (PTSD) and TBI, we request that both Departments increase the level of research on the dual treatment of these conditions. There is not enough basic clinical research being done on this comorbidity, though these two injuries are among those most frequently experienced during operations in Iraq and Afghanistan. Both Departments have high-quality research programs on each of these conditions, so we request that the Departments take steps to make collaboration more robust, comprehensive, and seamless.

Research into comorbidity has found that TBI is often present concurrently with other injuries, including vision impairment, hearing loss, tinnitus, and amputations or other polytrauma. The National Defense Authorization Act (NDAA) for Fiscal Year 2008 required DoD to establish a center of excellence for military eye injuries. The FY09 NDAA required DoD to establish centers of excellence for hearing loss and amputations. Despite this legal mandate and sufficient funding provided by Congress, there has been little discernable progress in establishing any of these centers. Allowing such critically needed specialty care services to languish for up to two years, especially when such services were Congressionally mandated, is unacceptable. We request that the establishment of these centers be immediately expedited.

We request that both Departments provide quarterly updates on progress made to address these issues until they are completed. Thank you for your prompt attention to this letter. We look forward to working with you to improve the care and services available to veterans and servicemembers.


Daniel Akaka

Jim Webb

Mark Begich

Scott Brown

Richard Burr

Roger Wicker

Lindsey Graham

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