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Military’s focus on brain-injury criticized

WASHINGTON – The Pentagon and Department of Veterans Affairs are overemphasizing mild traumatic brain injury among combat troops at the expense of other medical problems that are going untreated, two Army mental health researchers say in an article that has raised intense objections from other scientists studying the condition.

Cols. Charles Hoge and Carl Castro said the military should scrap screening questions meant to uncover cases of mild TBI among troops returning from combat. Most troops who suffered a concussion in battle recovered within days of the injury, they said.

Symptoms blamed on TBI after troops return home likely are due to depression, post-traumatic stress disorder (PTSD) or substance abuse, Hoge and Castro said, and the overemphasis on mild TBI keeps troops with those conditions from being properly treated.

Their article, published Thursday in the New England Journal of Medicine, says the Pentagon and VA are relying on flawed science to identify what the Pentagon estimates may be 360,000 cases of brain injury suffered by veterans of the wars in Iraq and Afghanistan. Hoge and Castro have conducted some of the military’s early and influential research on conditions such as PTSD.

Their arguments have convinced the Army’s surgeon general, Gen. Eric Schoomaker, that the screening should be changed, said Schoomaker’s spokeswoman, Cynthia Vaughan. But they also drew criticism from government and private brain-injury researchers who disagree with their findings and recommendations, which they said could leave injured troops without proper care.

It’s too early to say most troops with mild TBI recover as Hoge and Castro assert, said John Corrigan, an Ohio State University psychiatrist and researcher who advised the VA on its screening process.

Without screening, troops with mild TBI risk may wind up like former professional football players who developed long-term neurological problems after suffering too many concussions, said David Hovda, director of the Brain Injury Research Center at the University of California, Los Angeles.

With the advent of body armor and armor-plated vehicles, troops survive roadside bomb blasts in Iraq and Afghanistan, but return home with issues ranging from headaches to problem-solving difficulties.

From 2005 forward, a rising chorus of experts, such as the Defense and Veterans Brain Injury Center, urged that troops be screened for brain injury and if diagnosed, funneled into specialized care.

The Pentagon initially resisted. Last year USA TODAY reported that the delay was the result of fears that veterans would blame vague ailments on the little-understood wound caused by exposure to bomb blasts.

With nearly a $1 billion in funding from Congress for brain-injury treatment and research in 2007-08, the Pentagon began screening all troops returning from war zones last year.

This screening, Hoge and Castro write, causes troops needless worry and may prompt them wrongly to blame symptoms such as headaches on brain injury. Instead, they write, those symptoms may have a simple cause, such as sleep deprivation.

Dr. Michael Kilpatrick, a Pentagon health affairs official, said the department identifies and treats TBI based on consensus from the “best scientists … inside and outside the military.”

Katie Roberts, VA press secretary, said its policy reflects widely accepted scientific standards.

Rep. Bill Pascrell, D-N.J., chairman of the Congressional Brain Injury Task Force, urged caution proceeding with “efforts that might restrict the Department of Defense’s ability to identify affected individuals and provide them with the proper care and compensation they deserve.”

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