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Brain screenings for vets may be flawed

/ Source: The Associated Press

Thousands of Iraq war veterans who could have suffered traumatic brain injury may be getting unnecessary or inadequate health care because Veterans Affairs officials have yet to determine whether their initial screening tests are reliable, investigators say.

A draft report by the Government Accountability Office, obtained this week by The Associated Press, highlights the Bush administration's continuing difficulties in treating traumatic brain injury, a leading problem among soldiers struck by roadside bombs in the Iraq war. It also comes as a provocative military study this week found that symptoms of memory loss and irritability that have been tied to brain injury might be more accurately attributed to post-traumatic stress and depression.

The GAO review of nine VA medical centers found that months after former VA Secretary Jim Nicholson in April promoted new screenings for brain injury and pledged personal responsibility in seeing them through, the department was still struggling to determine how to best gauge the clinical accuracy of its screenings.

In the report, the VA also acknowledged problems with follow-up appointments after veterans initially tested positive under the VA's screening tool. One medical center reported 27 cases in which their doctors failed to notify patients for additional evaluation because of glitches in the computerized program.

The department has since put in place safeguards to help track whether such patients are given follow-up appointments, but it was not immediately clear how many other veterans who might have needed care were missed at dozens of other VA centers around the country, the report said.

Two VA medical centers also acknowledged they did not follow department protocol for up to three months after procedures were established when they failed to use a symptom checklist. The centers said they either did not know the checklist existed or did not have adequate staffing to follow protocol.

"Until VA evaluates the TBI screening tool's validity and reliability, VA providers will continue to use the screening tool without knowing how effective the tool is in identifying which veterans are and are not at risk for having mild TBI," GAO investigators wrote.

Such false results, the investigators said, could result not only in injured veterans failing to receive proper care, but also in VA medical centers facing growing, unmanageable workloads due to high numbers of veterans being unnecessarily referred for follow-up and treatment.

A group representing disabled veterans expressed frustration with the continuing problems.

"The Department of Defense and the Department of Veterans Affairs are nowhere near where they need to be in screening, evaluating and treating vets from Iraq and Afghanistan with mild or moderate traumatic brain injury," said Dave Autry, spokesman for Disabled American Veterans.

In recent weeks, President Bush has released at the request of Congress $3.7 billion in emergency money for additional case workers and services for injured veterans. A defense bill recently signed by Bush also provides money for research, screening and care for those who might have PTSD or traumatic brain injury, which in its mild form is known as a concussion.

As many as 20 percent of U.S. combat troops who fought in Iraq or Afghanistan are believed to leave with signs of possible brain injury, and as of last August, VA officials said about 61,000 Iraq war veterans who sought VA care had been screened. A study being published in Thursday's New England Journal of Medicine found that brain injury may be less to blame for soldiers' symptoms than doctors once thought.

Other GAO findings:

  • Inconsistent follow-up. Iraq war veterans face greater burdens in keeping appointments because they tend to be younger than other VA patients, with daytime work, school or child-care commitments. Some Iraq veterans also said they were under the impression that VA facilities catered to an elderly population and did not want to treat younger patients.
  • Poor rural access. Two medical centers reported no-show rates of 50 percent or greater for Iraq war veterans with possible brain injury, in part because they lived in small towns or farms and would have to drive 100 miles or so to reach a VA facility.

Last April, a presidential task force chaired by Nicholson announced the new VA screenings and other measures in the wake of disclosures of poor outpatient treatment at the Pentagon-run Walter Reed Army Medical Center.

Nicholson later submitted his resignation in July, and former Army surgeon general James Peake became the new VA secretary last month. Peake has said he wants to improve collaboration between the Pentagon and VA, which hold joint responsibility in treating veterans.

The nine VA medical facilities reviewed by GAO are in Decatur, Ga.; Augusta, Ga.; Baltimore; Dublin, Ga.; Richmond, Va.; Washington, D.C.; Hines, Ill.; Iron Mountain, Mich.; and Tomah, Wis. They were chosen based on high usage by Iraq war veterans as well as geographical representation.