Armed Forces News

Veterans would benefit if the Department of Veterans Affairs would expand the criteria used to assess the capabilities of the caregivers who treat traumatic brain injury (TBI), according to a recent study conducted by the National Academies of Science, Engineering and Medicine.

In an April 10 report to Congress, the experts stated that providers’ training and experience should weigh heavily in assessing their ability to produce an accurate TBI diagnosis. VA currently accepts such diagnoses from four medical specialists – neurologists, neurosurgeons, psychiatrists and physiatrists.
The report cites statistics that show 384,000 reported TBI cases among service members that occurred between 2000 and 2018, largely sustained during combat operations in Iraq and Afghanistan.


Veterans who seek VA disability ratings and compensation for TBI must complete a six-step process, which begins with them filing a claim with the agency. At some point, a specialist would examine them and provide a diagnosis that spells out the degree of impairment, functional limitation and disability.

The report’s authors note that because of the increased awareness of TBI, largely due to the ongoing war, the medical community has expanded the number of accredited programs for diagnosing and treating the condition, and rehabilitating those who suffer from it. Given the extent of this growth in interest among medical professionals, the committee that conducted the study recommended that VA “allow health care professionals who have specific TBI training and experience, in addition to the approved specialists, to make TBI diagnoses.”

The committee also would like to see VA conduct “pertinent and ongoing clinical training” that would ensure its providers are in touch with current TBI treatment protocols.

The panel also recommended that VA implement improvements to the adjudication process. Veterans should be granted more “transparency” at every step, to include “full access” to the details and outcomes of their examinations. VA also should take steps to measure the quality of the adjudication process, and make changes should improvements be warranted.

“Our scientific understanding of TBI has increased dramatically in recent years, and that understanding needs to be incorporated into the VA’s disability determination process,” said Dan Blazer, a retired psychiatrist with Duke University Medical Center, who chaired the committee. “Shifting from a focus on the consistency of the process to a focus on the reliability and validity of the evaluations’ outcomes will identify areas for improvement. Making those modifications will have the greatest impact on improving outcomes for veterans.”