The Veterans Health Administration S Treatment Of Ptsd And Traumatic Brain Injury Among Recent Combat Veterans A Cbo Study

Two combat-related conditions that affect some veterans who have served in Iraq and Afghanistan and that have generated widespread concern among policymakers are posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). In response to a request from the Ranking Member of the House Committee on Veterans' Affairs, this Congressional Budget Office (CBO) study examines the following: - The clinical care that the Veterans Health Administration (VHA), the health care system within the Department of Veterans Affairs, provides for recent combat veterans; - VHA's coordination with the Department of Defense for the care of service members returning from Iraq and Afghanistan; - The prevalence of PTSD and TBI among veterans of those conflicts and the occurrence of those conditions among recent combat veterans using VHA's services; and - The costs to VHA of providing care to recent combat veterans for those conditions. In keeping with CBO's mandate to provide objective, impartial analysis...

T wo combat-related conditions that affect some veterans who have served in Iraq and Afghanistan and that have generated widespread concern among policymakers are post- traumatic stress disorder (PTSD) and traumatic brain injury (TBI). In response to a request from the Ranking Member of the House Committee on Veterans' Affairs, this Congressional Budget Office (CBO) study examines the following: The clinical care that the Veterans Health Administration (VHA), the health care * system within the Department of Veterans Affairs, provides for recent combat veterans; VHA's coordination with the Department of Defense for the care of service members * returning from Iraq and Afghanistan; The prevalence of PTSD and TBI among veterans of those conflicts and the occurrence * of those conditions among recent combat veterans using VHA's services; and The costs to VHA of providing care to recent combat veterans for those conditions. * In keeping with CBO's mandate to provide objective, impartial analysis, this study makes no recommendations. Elizabeth Bass and Heidi Golding of CBO's National Security Division prepared the study under the general supervision of David Mosher and Matthew Goldberg. Allison Percy served as the internal reviewer. Lindsay Coleman, Juan Contreras, Sunita D'Monte, and Ann Futrell provided thoughtful comments on a draft of the study, as did external reviewer Rajeev Ramchand of RAND Corporation. (The assistance of an external reviewer implies no responsibility for the final product, which rests solely with CBO.) Adebayo Adedeji fact- checked the manuscript. The authors wish to thank the Department of Veterans Affairs and the Department of Defense for providing data used in the analysis. Juyne Linger edited the study, and John Skeen proofread it. Cindy Cleveland produced drafts of the manuscript. Maureen Costantino prepared the paper for publication and designed the cover. Monte Ruffin printed the initial copies, and Linda Schimmel handled the print distri- bution.

More than 2 million service members have deployed in support of overseas contingency operations (OCO) in Iraq and Afghanistan since October 2001. Two combat-related conditions that affect some OCO veterans and that have generated widespread concern among policymakers are post-traumatic stress disorder (PTSD, an anxiety disorder induced by exposure to a traumatic event, such as witnessing injury or death) and traumatic brain injury (TBI, which is caused by sudden trauma to the head and is commonly sustained by service members exposed to explosions).In a study requested by the Ranking Member of the House Committee on Veterans' Affairs, CBO analyzes VHA's care of OCO patients diagnosed with PTSD or TBI and compares the reported rates of occurrence of those conditions within VHA with estimates of the prevalence of those conditions in the broader population of service members who have deployed to recent overseas contingency operations. The study also examines the costs that VHA has incurred in treating patients diagnosed with PTSD and TBI.

Posttraumatic stress disorder (PTSD) is one of the signature injuries of the U.S. conflicts in Afghanistan and Iraq, but it affects veterans of all eras. It is estimated that 7-20% of service members and veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom may have the disorder. PTSD is characterized by a combination of mental health symptoms - re-experiencing of a traumatic event, avoidance of trauma-associated stimuli, adverse alterations in thoughts and mood, and hyperarousal - that last at least 1 month and impair functioning. PTSD can be lifelong and pervade all aspects of a service member's or veteran's life, including mental and physical health, family and social relationships, and employment. It is often concurrent with other health problems, such as depression, traumatic brain injury, chronic pain, substance abuse disorder, and intimate partner violence. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide a spectrum of programs and services to screen for, diagnose, treat for, and rehabilitate service members and veterans who have or are at risk for PTSD. The 2010 National Defense Authorization Act asked the Institute of Medicine to assess those PTSD programs and services in two phases. The Phase 1 study, Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment, focused on data gathering. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment is the report of the second phase of the study. This report analyzes the data received in Phase 1 specifically to determine the rates of success for each program or method. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment considers what a successful PTSD management system is and whether and how such a system is being implemented by DoD and VA. This includes an assessment of what care is given and to whom, how effectiveness is measured, what types of mental health care providers are available, what influences whether a service member or veteran seeks care, and what are the costs associated with that care. This report focuses on the opportunities and challenges that DoD and VA face in developing, implementing, and evaluating services and programs in the context of achieving a high-performing system to care for service members and veterans who have PTSD. The report also identifies where gaps or new emphases might be addressed to improve prevention of, screening for, diagnosis of, and treatment and rehabilitation for the disorder. The findings and recommendations of Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment will encourage DoD and VA to increase their efforts in moving toward a high-performing, comprehensive, integrated PTSD management strategy that addresses the needs of current and future service members, veterans, and their families.

Two combat-related conditions that affect some veterans who have served in Iraq and Afghanistan and that have generated widespread concern among policymakers are post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI). This book explores the clinical care that the Veterans Health Administration (VHA), the health care system within the Department of Veterans Affairs, provides for recent combat veterans; VHA's co-ordination with the Department of Defense for the care of service members returning from Iraq and Afghanistan; the prevalence of PTSD and TBI among veterans of those conflicts and the occurrence of those conditions among recent combat veterans using VHA's services; and the costs to VHA of providing care and management to recent combat veterans for these conditions.

Two combat-related conditions that affect some veterans who have served in Iraq and Afghanistan and that have generated widespread concern among policymakers are post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI). This book explores the clinical care that the Veterans Health Administration (VHA), the health care system within the Department of Veterans Affairs, provides for recent combat veterans; VHA's co-ordination with the Department of Defense for the care of service members returning from Iraq and Afghanistan; the prevalence of PTSD and TBI among veterans of those conflicts and the occurrence of those conditions among recent combat veterans using VHA's services; and the costs to VHA of providing care and management to recent combat veterans for these conditions.

As of December 2012, Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq have resulted in the deployment of about 2.2 million troops; there have been 2,222 US fatalities in OEF and Operation New Dawn (OND)1 and 4,422 in OIF. The numbers of wounded US troops exceed 16,000 in Afghanistan and 32,000 in Iraq. In addition to deaths and morbidity, the operations have unforeseen consequences that are yet to be fully understood. In contrast with previous conflicts, the all-volunteer military has experienced numerous deployments of individual service members; has seen increased deployments of women, parents of young children, and reserve and National Guard troops; and in some cases has been subject to longer deployments and shorter times at home between deployments. Numerous reports in the popular press have made the public aware of issues that have pointed to the difficulty of military personnel in readjusting after returning from Iraq and Afghanistan. Many of those who have served in OEF and OIF readjust with few difficulties, but others have problems in readjusting to home, reconnecting with family members, finding employment, and returning to school. In response to the return of large numbers of veterans from Iraq and Afghanistan with physical-health and mental-health problems and to the growing readjustment needs of active duty service members, veterans, and their family members, Congress included Section 1661 of the National Defense Authorization Act for fiscal year 2008. That section required the secretary of defense, in consultation with the secretary of veterans affairs, to enter into an agreement with the National Academies for a study of the physical-health, mental-health, and other readjustment needs of members and former members of the armed forces who were deployed in OIF or OEF, their families, and their communities as a result of such deployment. The study consisted of two phases. The Phase 1 task was to conduct a preliminary assessment. The Phase 2 task was to provide a comprehensive assessment of the physical, psychologic, social, and economic effects of deployment on and identification of gaps in care for members and former members, their families, and their communities. The Phase 1 report was completed in March 2010 and delivered to the Department of Defense (DOD), the Department of Veterans Affairs (VA), and the relevant committees of the House of Representatives and the Senate. The secretaries of DOD and VA responded to the Phase 1 report in September 2010. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families fulfills the requirement for Phase 2.

With the contribution from more than one hundred CNS neurotrauma experts, this book provides a comprehensive and up-to-date account on the latest developments in the area of neurotrauma including biomarker studies, experimental models, diagnostic methods, and neurotherapeutic intervention strategies in brain injury research. It discusses neurotrauma mechanisms, biomarker discovery, and neurocognitive and neurobehavioral deficits. Also included are medical interventions and recent neurotherapeutics used in the area of brain injury that have been translated to the area of rehabilitation research. In addition, a section is devoted to models of milder CNS injury, including sports injuries.