Responding to reports of American soldiers with traumatic brain injuries being denied essential treatment, U.S. Reps. Bill Pascrell, Jr. (D-NJ-8) and Todd Platts (R-PA-19), co-chairs of the Congressional Brain Injury Task Force, along with U.S. Sens. Mark Udall (D-CO) and Jim Inhofe (R-OK), led more than 70 members of Congress in signing a bipartisan letter to Defense Secretary Robert Gates. The letter urges the Secretary to provide soldiers with cognitive rehabilitation therapy – widely recognized as effective treatment for TBI victims – and the TRICARE insurance coverage to pay for it.

Without a specific waiver, TRICARE does not cover cognitive rehabilitation when billed as a separate service.  A RAND study found that nearly 20 percent of returning service members reported experiencing a probable TBI during deployment.

Today’s letter follows a September 2008 letter to Secretary Gates that also called TRICARE coverage of cognitive rehabilitation therapy for soldiers. Rep. Pascrell gathered support for the letter in the House, while former U.S. Sens. Barack Obama (D-IL) and Evan Bayh (D-IN) led the effort in the Senate.

“We are calling upon the Pentagon to, at long last, take action in correcting the gross neglect of our wounded soldiers,” said Pascrell, a House Ways and Means Committee member who succeeded in getting better-defined requirements for TBI testing of soldiers in the past two defense authorization bills. “Every man and woman who wears the uniform of the United States armed services has sworn to be willing to lay down their lives in defense of their country. The least we can do is to help them recover after they sustain injuries on the battlefield and help restore them to active, productive lives after their service. It’s time we start honoring the contract we made with these brave men and women.”

“Congress has acknowledged that traumatic brain injuries (TBI) from blast exposures are the signature injury of the wars in Iraq and Afghanistan,” said Congressman Platts, a member of the U.S. House of Representatives Armed Services Committee.  “Cognitive rehabilitation therapy is widely recognized as a proven treatment for improving the health and functionality of TBI patients.  While the Department of Defense continues its study of this important issue, it is imperative that they put forth plans to ensure that service members returning from the battlefield today receive the treatment they deserve.”

"With so many of our service members returning home with traumatic brain injuries, both severe and more mild cases, we should ensure that they are provided with broad and consistent access to cognitive therapy,” said Sen. Udall, a member of the Senate Armed Services and Intelligence committees. “Those who have sacrificed for our freedom deserve the best care for the visible injuries they sustained -- as well as for the invisible wounds."
 
“This is a critical issue for our military, their families and our Nation.  Brain injuries are one of the signature wounds of this war.  We must ensure our service members returning from the battlefield are properly diagnosed, treated and rehabilitated,” said Sen. Inhofe, a senior member of the Senate Armed Services Committee. “This includes full and consistent coverage under TRICARE for returning service members suffering from mild to severe traumatic brain injuries.”

The text of the letter follows:

Dear Secretary Gates,

As you may know, members of the Congressional Brain Injury Task Force, as well as other supportive Members of Congress, have written in the past in support of TRICARE covering cognitive rehabilitation for service members with brain injuries.  In 2008, then-Senator Obama and then-Senator Bayh led letters with eight members of the Senate and over 65 House members.  Two years later, the Department is still studying the issue and does not expect to make a decision on the results of a study mandated by the National Defense Authorization Act for Fiscal Year 2010 anytime soon.

We hope you share our concern that service members returning from the battlefield today cannot wait to receive treatment for their injuries.  Yet without a specific waiver applicable only under very unusual and limited circumstances, TRICARE does not cover cognitive rehabilitation – therapy programs that aid in the management of specific problems in thinking and perception – when billed as a separate service.  Considering that our service members have been deployed in two conflicts for nearly a decade, it is our hope that there exists some contingency plan to provide cognitive rehabilitation for service members who are returning home today, particularly those with mild traumatic brain injuries.  While TRICARE clearly pays for rehabilitation for physical injuries, brain injuries—the invisible wounds of this war—are not given the same therapy if not treated as part of a comprehensive brain injury rehabilitation program.  Recent stories by NPR and ProPublica give examples of providers at civilian clinics who have tried to help soldiers with their cognitive rehabilitation, only to be informed by TRICARE that they cannot receive payment for their services.

As this issue is studied, we ask that you share with us your plans to ensure that our service members with brain injuries are not only identified, but also able to receive treatment such as cognitive rehabilitation to restore their cognitive functions.  Cognitive rehabilitation is widely recognized as a proven treatment for traumatic brain injury by experts and groups, including the National Institutes of Health, the Brain Injury Association of America, and the National Academy of Neuropsychology.  Many states pay for cognitive rehabilitation under their Medicaid programs, and most private insurers cover this service.  In light of this consensus from a wide variety of organizations, experts and government agencies, we hope that TRICARE will find some way to provide access to cognitive rehabilitation for our returning service members who would benefit from this therapy – both those with more severe and mild traumatic brain injuries – and to ensure that care decisions are made consistently.  We also respectfully request a meeting with appropriate officials at the Department to discuss TRICARE’s plans to ensure treatment coverage for our service members with brain injuries.  

Thank you for your consideration of this request.  Please let us know how you plan to expedite new treatments for traumatic brain injured soldiers as soon as possible.  We look forward to working with you to provide the best care to our service members. 

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