	Traumatic Brain Injury (TBI) Overview

Traumatic brain injury (TBI) has become known as a "signature wound" of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Relevant VA Programs and Services

Although the early stages of TBI treatment may occur within the military health care system if the initial injury occurs during military service, a description of the military health care system is beyond the scope of this report, which focuses on the VA health care system. In FY2015, VA spending for TBI is estimated to be $234 million (including $61 million for OEF/OIF veterans). The VA projects the 10-year (FY2016–FY2025) costs of TBI to be $2.2 billion (including $0.5 billion for OEF/OIF veterans). Most cases of mild TBI, however, resolve without medical attention. In the case of servicemembers, treatment begins at the site of the event and continues at a military treatment facility. Once stabilized, servicemembers may remain at a military treatment facility or be sent to VA medical facilities for continuing treatment, rehabilitation, and transitional care. Three VA and joint VA/DOD programs seek to address the transition from DOD to VA health care facilities: (1) the VA Liaison Program, (2) OEF/OIF Care Management, and (3) the Federal Recovery Coordinator Program. These programs are available to veterans with TBI as well as other qualified veterans and servicemembers. Screening and Evaluation

Moderate or severe TBI is likely to be recognized immediately at the time of the initial injury; however, mild TBI may go unnoticed if an individual walks away from an injury seemingly unharmed. Despite repeated assessments of servicemembers by the DOD, veterans may enter the VA health care system with undiagnosed TBI. Since 2007, VA policy has required that all OEF/OIF veterans receiving medical care in the VA health care system be screened for possible TBI (to identify cases of TBI that might otherwise go untreated). Those who screen positive must be offered further evaluation and specialized treatment. Acute and Post-Acute Care: VA Polytrauma/TBI System of Care

Veterans with moderate or severe TBI may receive care through the VA Polytrauma/TBI System of Care (PSC), which is also available to veterans with other traumatic injuries. Like the larger VISN structure, the PSC is geographically dispersed, thereby making the specialized treatment more accessible to veterans, regardless of where they live. The PSC operates as a "hub and spoke" model with four components: (1) Polytrauma Rehabilitation Centers, (2) Polytrauma Network Sites, (3) Polytrauma Support Clinic Teams, and (4) Polytrauma Points of Contact. Long-term services and supports have historically been provided in institutional settings (e.g., nursing homes); however, if a veteran is able to live in the community and receive home or community-based treatment, this arrangement is generally preferable to institutional care. The VA has an ongoing pilot program providing assisted living services to veterans with TBI. In addition to institutional and noninstitutional services for veterans, the VA offers services for some caregivers. The VA is collaborating with the Department of Education's National Institute on Disability and Rehabilitation Research (NIDRR) to develop the Traumatic Brain Injury Veterans Health Registry, which is intended to facilitate future research by providing longitudinal data on the demographics, military service, injury, and treatment of all OEF/OIF veterans with TBI. The VA is also working with the NIDRR to establish a database similar to the institute's existing TBI Model System National Database (established in 1989), which is intended to facilitate research collaboration and program evaluation.
In recent years, Congress, the Department of Defense (DOD), and the Department of Veterans Affairs (VA) have increased attention to traumatic brain injury (TBI), which is known as a "signature wound" of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although the early stages of TBI treatment may occur within the military health care system (if the injury occurs during military service), this report focuses on the VA health care system. In FY2015, VA spending for TBI is estimated to be $234 million. The VA projects the 10-year (FY2016–FY2025) costs of TBI to be $2.2 billion (including $0.5 billion for OEF/OIF veterans).
The type of treatment needed depends on the severity of the injury. Most cases of mild TBI—representing the majority of injuries—resolve without medical attention. Moderate or severe TBI requires immediate treatment. In the case of servicemembers, treatment begins at the site of the event and continues at a military treatment facility. Once stabilized, servicemembers may remain at a military treatment facility or be sent to VA medical facilities.
When servicemembers transfer from DOD to VA facilities, coordination between the two systems is necessary. Three VA and joint VA/DOD programs seek to address the transition from DOD to VA health care facilities: (1) OEF/OIF Care Management, (2) the VA Liaison Program, and (3) the Federal Recovery Coordinator Program. These programs are available to veterans with TBI as well as other qualified veterans and servicemembers.
Mild TBI may go unnoticed if an individual walks away from an injury seemingly unharmed. Despite repeated assessments of servicemembers by the DOD, veterans may enter the VA health care system with undiagnosed TBI. Thus, VA policy requires that all OEF/OIF veterans receiving medical care in the VA health care system be screened for possible TBI and that those who screen positive be offered further evaluation and specialized treatment.
Veterans with moderate or severe TBI may receive care through the VA Polytrauma/TBI System of Care (PSC), which is also available to veterans with other traumatic injuries. The PSC is geographically dispersed, thereby making specialized treatment more accessible to veterans, regardless of where they live. The PSC operates as a "hub and spoke" model with four components: (1) Polytrauma Rehabilitation Centers, (2) Polytrauma Network Sites, (3) Polytrauma Support Clinic Teams, and (4) Polytrauma Points of Contact.
The VA provides a range of long-term services and supports, most of which are available to veterans who have TBI as well as other qualified veterans. Long-term services and supports have historically been provided in institutional settings (e.g., nursing homes); however, if a veteran is able to live in the community and receive home- or community-based treatment, this arrangement is generally preferable to institutional care. The VA has an ongoing pilot program providing assisted living services to veterans with TBI and has requested authority to pay for care in Medical Foster Homes. The VA also offers services for some caregivers for veterans with TBI.
The VA conducts and collaborates on TBI research. For example, the VA is collaborating with the Department of Education's National Institute on Disability and Rehabilitation Research to develop the Traumatic Brain Injury Veterans Health Registry, and to establish a database similar to the institute's existing TBI Model System National Database.