After three years, another delay in brain injury screening for US soldiers

June 7, 2007 — It is the signature wound of the Iraq war, but nobody is keeping track of how many soldiers have suffered traumatic brain injury (TBI), or who may have suffered such injuries.

Many—perhaps most—soldiers with combat-related TBIs have gone untreated.  They face the possibility of serious life-long health problems, including epilepsy.

After three years of lobbying by the Pentagon’s top brain injury experts, the U.S. Department of Defense finally ordered that post-deployment screening of soldiers for brain damage begin in June 2007.

But that has not happened.The order to begin screening soldiers for brain injuries by June 1, 2007 was issued in March by then-Assistant Secretary of Defense for Health Affairs William Winkenwerder. He ordered that two single-sentence questions be added to post-deployment and redeployment health assessment forms, asking whether soldiers have suffered blows to the head or whiplash.

“The two questions have been added,” a senior US Department of Defense health official told epiNewswire on Tuesday. “But we are delayed in getting final approval for the change to the electronic form.” The official said the problem would be remedied within a “matter of weeks.”

But even the updated PDF (“paper”) versions of the health assessment forms were not available at military web sites Tuesday. The electronic version of the health assessment questionnaire is an interactive form available only on a secure military web site.

Asked about the delayed screening policy, Deborah Warden, director of the Defense and Veterans Brain Injury Center (DVBIC) in Washington, DC, was circumspect when reached by epiNewswire, saying only that she is “not aware of the final decision regarding TBI screening.”

Warden has lobbied for post-deployment TBI screening since at least 2004, when conversations with field hospital staff and wounded soldiers led her to believe that many cases of combat-related brain damage were going undetected.

Number of soldiers returning to combat with brain injuries is unknown

Soldiers with TBIs can develop serious side-effects, including memory problems, confusion, emotional problems, delayed reaction times, and with time, even epilepsy. To date, no systematic effort has been made to screen for brain injuries among soldiers leaving combat duty or military service.

As Many Returned to Combat as Evacuated for Treatment?

In November 2004, Warden spoke to the Armed Forces Epidemiological Board about the effects of combat TBIs.

She told the assembled experts that failing to promptly identify and treat soldiers for TBI can lead to increased brain damage. Of the blast injury patients seen at Walter Reed Army Medical Center by August 2004, Warden told the audience, 59 percent had sustained TBI.

In Iraq, Warden told military epidemiologists, just as many soldiers treated for head injuries at military field hospitals in Iraq were being “returned forward” to active duty as were being evacuated out of theater for TBI evaluation and treatment. Even mild TBIs are associated with “relatively large” changes in soldiers’ reaction times, Warden said at the time—a clear threat to combat units’ readiness and safety.