The Veterans Affairs Department is uniquely positioned to take a major role in advancing traumatic brain injury research, given its access to thousands of affected patients and partnerships with the nation's top academic institutions, public health officials said during a two-day conference on military brain injuries in Washington, D.C.
Organized by VA, the TBI State of the Art Conference brought together public, nonprofit and private-sector researchers to share their work and discuss topics for future exploration.
Since 2000, more than 327,000 service members have been diagnosed with a traumatic brain injury, although the number is thought to be higher since troops often do not report an injury that may have caused a mild concussion.
VA organizers hoped the conference would generate collaboration among researchers and physicians from institutions as varied as Rand Corp., Carrick Brain Centers, the National Institutes of Health, Stanford University, Duke, Emory, Boston University and more, producing proposals that would move forward research and care for veterans.
In his opening remarks Monday, VA Secretary Bob McDonald told attendees that the VA needs help in driving forward brain injury treatment.
"We need you to tell us what resources you need for VA to be nationally and internationally acknowledged as the leader in TBI research, diagnosis and treatment," McDonald said.
VA spends roughly $32 million a year on research for TBI and other neurotrauma; the Defense Department was awarded $80 million in fiscal 2014 to study TBI and related conditions like post-traumatic stress disorder.
With its ability to track and treat patients over the long term, as well as its position to partner with researchers and the Pentagon, VA must take a major lead on brain research, said Dr. Walter Koroshetz, director of the National Institute of Neurological Disease and Stroke at the NIH Institute for TBI.
"There are things that can be done at VA that the National Institutes of Health will never be able to do," Koroshetz said. "VA has the ability to look at people over a long period of time. [VA] can develop — [it has] to develop — the best possible treatments."
But whether the VA has the resources or capability to take the lead remains in question.
As troops began arriving home from Iraq in 2003, VA struggled to treat those with the most severe injuries. Under pressure from Congress in 2005, VA transformed four hospitals focused on long-term care for brain-injured veterans into polytrauma centers designed to handle the influx of new veterans with head injuries. But family members complained that the care many received was woefully inadequate.
In 2007, VA received an influx of funds to boost traumatic brain injury research and, together with the Defense Department, hosted the first conference on military TBI. It also worked to improve its treatment and care of injured service members, developing clinical practice guidelines and accepting input from the private sector to improve in-house care.
Despite a $300 million commitment in 2014 by the White House to fund public and private neuroscience research, the pace of advancement has been frustrating, conference attendees said.
"The tragedy is, we haven't learned anything in the past eight years that's going to help the guy who goes into Syria and experiences a blast," Koroshetz said.
"[Researchers] literally pass out critical medical information in reference journals that are overpriced and people don't read," said retired Army Gen. Peter Chiarelli, CEO of One Mind for Research, a nonprofit organization created to energize the brain research community.
The VA conference focused on seven major areas of research underway in the public and private sector: modeling and research; other health conditions found in patients with TBI; detection and diagnosis; degenerative diseases linked to TBI; caregivers of veterans with brain injury; and best practices and treatments.
McDonald said VA needs to be proactive in deciphering the complex condition of traumatic brain injury, which can contribute to other issues many veterans face, including unemployment, homelessness and suicide.
To prevent a crisis similar to the scandals that rocked VA in 2014, the department must be able to treat veterans now and anticipate the long-term care they'll need in the future, McDonald said.
"We have an obligation to get this right, otherwise there's another axis problem lying in wait. Let's not leave another unresolved problem as our legacy. ... We owe it to all of our veterans," McDonald said.