Our latest edition of our Bergmann & Moore’s quarterly newsletter is headed out to our subscribers. Our Spring 2012 Veterans Quarterly discusses important topics like traumatic brain injuries, substitution in claims before the Department of Veterans Affairs as well as the latest Veterans law and Veterans legislation before Congress.
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For the first time ever, researchers at the University of California, Los Angeles (UCLA) have found evidence of a causal link between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
An association between TBI and PTSD – the “signature wounds” of the Iraq and Afghanistan wars – has been observed for several years.
A 2008 study found that 44 percent of soldiers with a TBI were also diagnosed with PTSD. The connection between the two conditions seemed to some to be quite simple – the event that results in the TBI is also very frightening, leading to PTSD.
However, in light of the UCLA study, published in the journal Biological Psychology, some researchers now believe the link is deeper. The study indicates that the physical damage from the TBI alters the brain in a way that makes the victim more likely to develop PTSD.
The study was conducted in rats, where the researchers were able to separate physical from emotional traumas.
The rats were divided into two groups, and one group was subject to brain trauma. Then, 2 days after the brain trauma, all the rats underwent “fear conditioning.”
The researchers found that rats with the earlier TBI became more fearful than the control group of rats.
Michael Fanselow, senior author of the study, described that “it was as if the injury primed the brain for learning to be afraid.”
After examining the rats’ brains, the researchers found that the amygdala – which regulates the fear response in the brain – of the rats who had the TBI was in a more excitable state.
Their research indicates that when a person is exposed to a traumatic event, the brain is more capable of learning fear. It further suggests that if two soldiers were exposed to the same psychological trauma and one had previously suffered a TBI, the one who had suffered the TBI would be more likely to develop PTSD than the soldier with the uninjured brain.
Examining Veterans’ Access to VA Treatment
Recent studies have shown that the Department of Veterans Affairs is struggling to keep up with the increasing need for mental health care among Veterans.
According to a survey by the Government Accountability Office, the number of Veterans receiving treatment for mental health conditions has increased from about 900,000 in 2006 to 1.2 million in 2010. This number is expected to increase as soldiers currently serving in Iraq return home at the end of the year.
In a VA survey released last month, social workers, doctors and nurses who work in VA facilities expressed concerns that the department was unable to meet the needs of its patients.
VA policy requires that when a Veteran requests treatment for a mental disorder, their first appointment occurs within 14 days of that first request. Although the VA claims to meet this deadline 95 percent of the time, 37 percent of respondents reported being unable to schedule an appointment for their patients within that time frame.
The same survey also found that 70 percent stated that they think the VA lacks the resources and staff to effectively care for the growing numbers of Veterans needing mental health treatment – despite the fact that VA has hired additional mental health professionals – increasing the staff by nearly 50 percent in the last five years.
Encountering Another Road Block
Even if Veterans receive their first appointment within two weeks of their first request for treatment, they may have to wait much longer for subsequent appointments.
When the Senate Veterans Affairs Committee held a hearing this past summer to examine the VA mental health care system, retired Army Spec. Daniel Williams, who suffers from post-traumatic stress disorder and traumatic brain injury, explained how difficult it can be for a Veteran to receive the care he or she needs. Williams told the committee that when he attempted to reschedule an appointment in order to attend the hearing, he was told he would have to wait four months.
After describing how much he and his wife had to fight to get him treatment, he said, “The VA system makes you want to give up and try something else.”
The Tragic Consequences of Delayed Treatment
While he was waiting to receive psychiatric help, Williams attempted suicide – his gun misfiring was all that saved his life. Unfortunately, Jonathan Schulze wasn’t so lucky.
According to Newsweek, Schulze returned home from Iraq in 2005. He began suffering from flashbacks and panic attacks and had begun drinking heavily. When he sought to check himself into a VA inpatient program for his PTSD, he was told there were no openings – even after explaining that he was suicidal. Four days later, Schulze took his own life.
Lawmakers Take Notice
Sen. Patty Murray (D-Wash.), Senate Veterans Affairs Committee chairman, wrote a letter to the VA when the department’s findings were released, encouraging them to take immediate action to remedy to deficiencies in mental health care.
“The sad truth is that veterans who call to get a VA appointment have at least made the decision to reach out to VA for help,” she wrote. “That is the critical step in accessing care, and it is not acceptable to have Veterans, who have stepped up and shown the courage to ask for help, be denied that care.”
Traumatic brain injury (TBI) has been one of the most prevalent disabilities for Veterans serving in Iraq and Afghanistan. These injuries often occur as a result of roadside bombs. One 2009 estimate indicated that up to 360,000 Iraq and Afghanistan Veterans may have suffered brain injuries; 45,000 to 90,000 of these Veterans had symptoms that persisted and warranted specialized care.
While many veterans recover from concussions, or mild TBI, some later develop what doctors call persistent post-concussive injuries. They may experience symptoms such as headaches, irritability, poor sleep, memory loss and imbalance. In some cases it is difficult to determine if the symptoms involved are the result of TBI or PTSD resulting from the same incident.
The Marine Corps has been begun a research study to determine if treatments of pure oxygen will help heal those suffering from traumatic brain injuries. Medical researchers suspect that pure oxygen might help heal injured brain cells, and other recent studies show promising results for concussion sufferers.
Medical investigators plan for 96 Marines, sailors and other service members to participate in the initial 10-week trial involving treatments of hyperbaric oxygen therapy, with 24 participants each at Camp Pendleton Naval Hospital, Calif., and Camp Lejeune Naval Hospital, N.C.
The trial began in early October and should be completed by year’s end. If the results are positive, it may lead to a larger study involving 300 to 400 participants, said Cmdr. James Caviness, an occupational and environmental medicine physician and principal investigator for the study at Camp Pendleton Naval Hospital.
Researchers at the National Institutes of Health (NIH) have developed a new treatment tool for traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
The NIH researchers recently began using a whole-body scanner, called a Biograph mMR, which simultaneously performs positron emission topography (PET) and magnetic resonance imaging (MRI).
A PET scan reveals how the body is functioning internally. It involves injecting a radioactive chemical tracer into the bloodstream. An MRI creates images of internal body parts – such as soft tissues, organs, and bones – by using radio waves.
The Biograph mMR is the first of its kind, having been approved by the FDA in June. It provides better information on metabolic activity than when the MRI and PET are performed separately. Additionally, it requires less radiation than the PET scan.
NIH plans to use the Biograph mMR to also study patients with other conditions, including brain disorders, heart disease, and cancer. Patients benefit from faster and more thorough results than the traditional process of performing the two procedures separately. Plus, patients only go through one procedure rather than two.
