After three years, another delay in brain injury screening for US soldiers
by Bryant Furlow
June 7, 2007—It is the signature wound of the
Iraq war, but nobody is keeping track of how
many soldiers have suffered traumatic brain
injury (TBI), or who they are. Many—perhaps
most—soldiers with combat-related TBIs have
gone untreated. They face the possibility of
serious life-long health problems, including
After three years of lobbying by the Pentagon's
top brain injury experts, the Department of
Defense ordered that post-deployment screening
of soldiers for brain damage begin in June.
But that has not happened.
The order to begin screening soldiers for brain
injuries by June 1, 2007 was issued in March by
then-Assistant Secretary of Defense for Health
Affairs William Winkenwerder. He ordered that two
single-sentence questions be added to post-
deployment and redeployment health
assessment forms, asking whether soldiers
have suffered blows to the head or whiplash.
“The two questions have been added," a senior
US Department of Defense health official told
epiNews on Tuesday. "But we are delayed in
getting final approval for the change to the
electronic form." The official said the problem
would be remedied within a "matter of weeks."
But even the updated PDF ("paper") versions of
the health assessment forms were not available
at military web sites Tuesday. The electronic
version of the health assessment questionnaire
is an interactive form available only on a secure
military web site.
Asked about the delayed screening policy,
Dr Deborah Warden, National Director of the
Defense and Veterans Brain Injury Center
(DVBIC) in Washington, DC says only that she
is "not aware of the final decision regarding
Warden has lobbied for post-deployment TBI
screening since at least 2004, when
conversations with field hospital staff and
wounded soldiers led her to believe that many
cases of combat-related brain damage were
Number of soldiers returning to combat with brain injuries is unknown
Soldiers with TBIs can develop serious side-effects, including
memory problems, confusion, emotional problems, delayed
reaction times, and with time, even epilepsy. To date, no
systematic effort has been made to screen for brain injuries
among soldiers leaving combat duty or military service.
As Many Returned to Combat as Evacuated for Treatment?
In November 2004, Warden spoke to the Armed Forces
Epidemiological Board about the effects of combat TBIs.
She told the assembled experts that failing to promptly identify
and treat soldiers for TBI can lead to increased brain damage.
Of the blast injury patients seen at Walter Reed Army Medical
Center by August 2004, Warden told the audience, 59 percent
had sustained TBI.
In Iraq, Warden told military epidemiologists, just as many
soldiers treated for head injuries at military field hospitals in
Iraq were being "returned forward" to active duty as were being
evacuated out of theater for TBI evaluation and treatment.
Even mild TBIs are associated with "relatively large" changes in
soldiers' reaction times, Warden said at the time—a clear threat
to combat units' readiness and safety.