The National Academies of Science, Engineering, and Medicine (NASEM) released a report titled “Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans” in April 2019. This report analyzes how the Department of Veterans Affairs handles disability compensations with a particular focus on veterans requiring traumatic brain injury (TBI) related compensation. NASEM released this report as commissioned by the Jeff Miller and Richard Blumenthal Veterans Health Care and Benefits Improvement Act of 2016 (Public Law 114-315), which in part called for this study. The stated task was to make “(A) a determination of the adequacy of the tools and protocols used by the Veterans Administration to provide examinations; and (B) a determination of which credentials are necessary for health care specialists and providers to perform such portions of such examinations that relate to an assessment of all disabling effects.”
The report highlights the following recommendations:
- The VA should permit TBI diagnosis from healthcare professionals with proper TBI training, education, and experience, in addition to the required specialists (neurologist, neurosurgeon, physiatrist, or psychiatrist);
- The VA should retain up-to-date clinical training that is in line with the scientific understanding of TBI;
- The VA should enlist individuals familiar with diagnosing TBI from the Veterans Health Administration and Veterans Benefits Administration to assist in updating VA diagnosis procedures such as the Veteran Affairs Schedule for Rating Disabilities and the Disability Benefits Questionnaires (DBQs);
- The VA should augment their DBQs to include residuals of TBI (e.g., insomnia, vestibular system dysfunction);
- The VA should ensure transparency at all levels; and
- The VA should incorporate means to test for reliability and validity of their processes, and remain open to opportunities for outcome improvements.
TBI occurs as a consequence of external force to the head, resulting in cognitive, physical, and/or psychosocial symptoms. Symptoms of TBI can be either temporary or permanent, and vary in severity.