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Tbi): Progress in Treating the Sig- Nature Wounds of the Current Conflicts S. HRG. 111–866 OVERSIGHT HEARING ON TRAUMATIC BRAIN IN- JURY (TBI): PROGRESS IN TREATING THE SIG- NATURE WOUNDS OF THE CURRENT CONFLICTS HEARING BEFORE THE COMMITTEE ON VETERANS’ AFFAIRS UNITED STATES SENATE ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION MAY 5, 2010 Printed for the use of the Committee on Veterans’ Affairs ( Available via the World Wide Web: http://www.access.gpo.gov/congress/senate U.S. GOVERNMENT PRINTING OFFICE 64–440 PDF WASHINGTON : 2011 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN COMMITTEE ON VETERANS’ AFFAIRS DANIEL K. AKAKA, Hawaii, Chairman JOHN D. ROCKEFELLER IV, West Virginia RICHARD BURR, North Carolina, Ranking PATTY MURRAY, Washington Member BERNARD SANDERS, (I) Vermont LINDSEY O. GRAHAM, South Carolina SHERROD BROWN, Ohio JOHNNY ISAKSON, Georgia JIM WEBB, Virginia ROGER F. WICKER, Mississippi JON TESTER, Montana MIKE JOHANNS, Nebraska MARK BEGICH, Alaska SCOTT P. BROWN, Massachusetts ROLAND W. BURRIS, Illinois ARLEN SPECTER, Pennsylvania WILLIAM E. BREW, Staff Director LUPE WISSEL, Republican Staff Director (II) VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN CONTENTS MAY 5, 2010 SENATORS Page Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 2 Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 4 Murray, Hon. Patty, U.S. Senator from Washington ........................................... 28 Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 31 Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 35 Brown, Hon. Scott, U.S. Senator from Massachusetts ......................................... 144 WITNESSES Beck, Lucille B., Ph.D. Chief Consultant, Office of Rehabilitation Services, Office of Patient Care Services, Veterans Health Administration, U.S. De- partment of Veterans Affairs; accompanied by Karen Guice, M.D., Director, Federal Recovery Coordination Program; Joel Scholten, M.D., Associate Chief of Staff for Physical Medicine and Rehabilitation, Washington, DC, VA medical center; and Sonja Batten, Ph.D., Deputy Director, U.S. Depart- ment of Defense Center of Excellence for Psychological Health and Trau- matic Brain Injury ............................................................................................... 6 Prepared statement .......................................................................................... 7 Response to written questions submitted by: Hon. Daniel K. Akaka .................................................................................. 13 Hon. Sherrod Brown ..................................................................................... 16 Response to request arising during the hearing by: Hon. Patty Murray ........................................................................................ 29 Hon. Jon Tester ......................................................................................... 34,41,42 Hon. Mark Begich ......................................................................................... 36 Jaffee, Col. Michael S., M.D., National Director, Defense and Veterans Brain Injury Center (DVBIC), Traumatic Brain Injury Program, U.S. Department of Defense; accompanied by Katherine Helmick, Interim Senior Executive Director for TBI, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury ................................................................................ 16 Prepared statement .......................................................................................... 19 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 22 Bohlinger, Karen L., Second Lady, State of Montana .......................................... 43 Prepared statement .......................................................................................... 46 Barrs, Jonathan W., Operation Iraqi Freedom Veteran ....................................... 47 Prepared statement .......................................................................................... 49 Gans, Bruce M., M.D., Executive Vice President and Chief Medical Officer, Kessler Institute for Rehabilitation .................................................................... 50 Prepared statement .......................................................................................... 53 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 57 Dabbs, Michael F., President, Brain Injury Association of Michigan ................. 59 Prepared statement .......................................................................................... 61 Attachment 1—CARF Statistics Table for Michigan ............................. 65 Attachment 2—State of Michigan map identifying CARF accredited providers ................................................................................................. 66 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 67 Enclosure—TBI-ROC Brain Injury Navigator ........................................ 70 (III) VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN IV Page LaPlaca, Michelle C., Ph.D., Associate Professor, Wallace H. Coulter Depart- ment of Biomedical Engineering, Georgia Institute of Technology and Emory University, Institute of Bioengineering and Bioscience, Laboratory of Neuroengineering, Atlanta, GA ...................................................................... 73 Prepared statement .......................................................................................... 75 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 78 Attachments ............................................................................................... 80 APPENDIX Wade, Sarah, Wounded Warrior Project; prepared statement ............................. 151 National Association of State Head Injury Administrators; prepared state- ment ...................................................................................................................... 156 Poe, Charles M. ‘‘Mason’’, SSGT USMC (Ret.); prepared statement ................... 159 Poe, Kristin M.; letter .............................................................................................. 161 VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN OVERSIGHT HEARING ON TRAUMATIC BRAIN INJURY (TBI): PROGRESS IN TREATING THE SIGNATURE WOUNDS OF THE CURRENT CONFLICTS WEDNESDAY, MAY 5, 2010 U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. The Committee met, pursuant to notice, at 9:30 a.m., in room 418, Russell Senate Office Building, Hon. Daniel K. Akaka, Chair- man of the Committee, presiding. Present: Senators Akaka, Murray, Tester, Brown of Massachu- setts, Begich, Burr, and Isakson. OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, U.S. SENATOR FROM HAWAII Chairman AKAKA. This hearing will come to order. Aloha and welcome to all of you here today. Today we will be discussing the progress that has been made in providing care and services to veterans with Traumatic Brain In- jury. Differences in tactics, such as the use of IEDs, and significant advances in battlefield medicine and protective equipment from prior wars have resulted in an unprecedented number of service- members sustaining and surviving TBIs, making this the signature physical wound of the conflicts in Iraq and Afghanistan. It is esti- mated that up to 360,000 servicemembers have sustained a brain injury in Iraq or Afghanistan. The Government must do all it can to treat these wounded veterans. In 2007, in response to this trend, I convened a hearing of this Committee on diagnosing and treating TBI. That hearing led to the introduction and ultimate passage of legislation I authored to en- hance TBI services in VA. Today we revisit this topic to determine how completely that law is being implemented and how effective the steps we have taken have been in making sure veterans with TBI are receiving necessary and appropriate care. Today, we will explore the relationship between VA and outside entities in providing treatment and rehabilitation services for TBI. I have visited the Richmond, Virginia, polytrauma center, and was very impressed with what I saw, but I believe that there is a need to expand the geographic availability of care. It is a burden for family members to have to travel several hours to visit their loved ones in the hospital or to take them to rehabilitation appointments. (1) VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN 2 In addition to partnering with community and other non-VA pro- viders, VA must do more to involve family members in providing care for their wounded veterans. We must recognize and support family members appropriately, as they are our partners in this shared mission. The Legislation I authored to provide a comprehensive
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