Just getting started

Since its first meeting in November 2010, The American Legion’s Ad Hoc Committee on Post-Traumatic Stress and Traumatic Brain Injury has listened to dozens of hours of presentations from experts in the health-care field. Members of the committee have also engaged the subject personally, going on site visits to talk with doctors using alternative forms of treatment.

After digesting all of the information, the committee has come to several conclusions, including the fact its work is far from over. With, according to the Department of Defense, more than 220,000 servicemembers and veterans diagnosed with TBI between 2000 and 2011, and with more than 438,000 treated for PTS in 2010 by the Department of Veterans Affairs, it’s evident that PTS and TBI are as pervasive as ever.

On Jan. 16-17, the committee wrapped up its first wave of meetings with a two-day gathering that included presentations from DoD and VA, a doctor from the National Intrepid Center of Excellence, and a representative of the RAND Corp. The committee also got a candid opinion of the way the military handles PTS and TBI from a current member of the service.

After all the presentations, the committee came up with several recommendations that it will make in the form of a report to the National Executive Committee in May. Foremost of those recommendations – which will be finalized by the committee and staff between now and May – is asking the NEC to continue the existence of the committee, in one form or another.

“I believe this committee needs to continue on or merge in with some other people, but we can’t just drop this, forget it and expect some other people who haven’t been associated with what we’ve gone through in the last two years to pick up on it ,” said Past National Commander Ron Conley, a member of the committee. “There has to be some continuity. But I think the mission really needs to be changed. I think we’ve gone past what the alternative methods are to treat TBI and PTS. I think the function more is what and how we can tell our government about the needs of those veterans who are suffering war and combat experiences. I think it’s imperative that we keep our thumb on this problem.”

The committee’s chairman, Past National Commander William Detweiler, agreed with Conley’s assessment. “I think (the committee) has evolved,” he said. “I think it has evolved based on the various briefings we’ve had. There’s still gaps that have not been filled, and that’s because of the fact we keep getting the party line.”

During its five meetings, the committee heard figures on those suffering from TBI and/or PTS, on methods of treatment used by DoD and VA, and on alternative treatments being used throughout the country. Conley said the information the Legion has gathered needs to be put in a report and given “to members of Congress, to the press, members of The American Legion and citizens of our country, and let the chips fall where they may,” he said. “If we’re going to maintain our responsibility as this committee, the information we’ve gotten and has been discussed has got to be put on the table for everybody to see and read.”

Past National Commander and Past National Adjutant Robert W. Spanogle, a member of the committee, suggested that as DoD faces budget cuts, the treatment of many PTS/TBI patients will shift to VA. He said that VA medical centers should all include Centers of Excellence for mental health care that use a holistic approach to dealing with PTS and TBI. Currently, VA has 14 Centers of Excellence; the lone mental health center is in Arkansas. “Not every type of treatment is going to work, but there needs to be a wide range of options,” Spanogle said. “This is a chronic condition. If it’s not taken care of, it just keeps on going. It’s a chronic condition of combat.”

While much of the two days was spent hearing from health-care officials, the speaker who generated the most discussion was a servicemember who was approaching the end of a nearly 20-year career and had been diagnosed with TBI. The servicemember gave a very candid view of dealing with TBI and PTS while serving.

“The stigma is alive and well,” he said. “I wouldn’t have gotten help for myself if I wasn’t close to retiring.”

The servicemember said he received treatment at the National Intrepid Center of Excellence (NICoE) in Maryland that worked, but “that care doesn’t follow you when you leave,” he said. “No acupuncture, no biofeedback, none of that is covered by TRICARE or CHAMPVA. And access to holistic medicine isn’t at all duty stations. When I went into the Center of Excellence, I was on 18 medications. When I left, I was only on nine. When I returned to duty, I was put back on 18.”

Capt. Robert Koffman, deputy director for Clinical Operations at NICoE, gave the committee a brief overview of NICoE’s mission but mainly focused on the broad range of care offered for PTS and TBI. For example, servicemembers being treated will be evaluated through at least 16 fields, including internal/family medicine, neurology, sleep therapy, art therapy, spirituality and occupational therapy.

Treatments such as acupuncture, biofeedback, group therapy, journaling and animal-assisted therapy may be used. Through the use of integrative medicine – a process of combining nutrition, movement and exercise, stress reduction, personal development and spirituality, communication and relationships, preventive services and substance use, treatments and procedures, and pharmaceuticals and supplements – NICoE has been able to successfully treat PTS and TBI.

“The current medical system works very well, but for the handful of chronic and non-responders, we need to approach their refractory in a very different way,” Koffman said. “We really almost need to discard what the diagnosis is and look at the whole individual ... within the whole system: in the context of their family, context of their command, context (of) not just what they want right here and now, but what do they want out of life throughout their entire life spectrum? We have an opportunity to know the person as opposed to the disease.

“It’s not because we’re better doctors. We just have the opportunity, the ability, the honor of working with these warriors in an incredibly intensive four-week environment where we can study them, where they can get to know us, and at the end of the day it really is about education and empowerment."

Koffman said his center doesn’t treat patients in large numbers (250-300 per year), but his hope is that with the results its treatment plan produces, along with the center’s extensive database, NICoE can create a baseline for treatment that can be used everywhere.

“The science that we’re engaged with – it’s probably going to take three to five years – but we are going to be the ones to be able to say, ‘You know all of those five clinical practice guidelines out there? Here’s one clinical practice guideline to deal with this very difficult population,” Koffman said. “It feels really good to save an individual at a time, but all of us realize that at the end of the day, it’s going to be our contribution to science that really turns this population around.”

Terri Tanielian of the RAND Center for Military Health Policy Research briefed the committee on RAND’s “PTSD, Depression and TBI among Iraq and Afghanistan Veterans” study. Among other findings, the study showed that about half who sought mental health care received minimally adequate care.

Tanielian also reported that RAND compiled a catalog of current programs either sponsored or run by DoD in the area of psychological health and TBI. Of the 211 programs, Tanielian said, only three had done any research to understand what they were doing was having an impact.

Katherine Helmick, deputy director for the Defense Centers of Excellence for Psychological Health and TBI, told the committee that alternatives for treating TBI, such as hyperbaric oxygen therapy, are being explored, and that, “the third DoD trial will be released in a year to determine if it can be added as a potential treatment approach.”

The committee also heard briefings from former Legion executive director John Sommer, and VA’s Mary Schohn, Bradley Karlin and David Carroll.