“YOU ARE YOUNG, YOU HAVE A WHOLE FUTURE AHEAD OF YOU.

2012 ANNUAL REPORT

BRAIN INJURY CENTER

DEFENSE AND VETERANS 

 WE NEED TO GET YOU WELL RIGHT NOW SO YOU CAN PREPARE FOR IT.”
DVBIC’s mission is to serve active duty military, their 

beneficiaries, and veterans with traumatic brain injuries 

through state-of-the-art clinical care, innovative 

clinical research initiatives and educational programs, 

and support for force health protection services.

The cover quotation by Cynthia Boyd, Ph.D., co-senior scientific director at DVBIC’s Naval Medical 

Center San Diego (NMCSD) site, demonstrates the importance she – and everyone at DVBIC – places 

on our mission. This annual report details DVBIC’s 2012 efforts on behalf of our nation’s service 

members.

Cover photos courtesy of Defense Video & Imagery Distribution System (DVIDS). Although the 

persons depicted in this report have all experienced TBI, they have not necessarily been treated by, 

nor are they affiliated with, DVBIC personnel.

Photo credits (left to right): Marine Corps Cpl. Chelsea Anderson, Marine Corps Cpl. Bryan Nygaard, 

U.S. Navy Petty Officer 1st Class Demetrius Kennon, Army Sgt. Ida Irby, Marine Corps Cpl. 

Lucas Vega
Letter from the National Director .......................................................................................................... 2

Clinical Affairs..................................................................................................................................... 4

Research .............................................................................................................................................. 6

Education ............................................................................................................................................. 8

Looking Ahead.................................................................................................................................... 10

Network Sites .................................................................................................................................... 12

Publications ....................................................................................................................................... 16

Resources .......................................................................................................................................... 18

TABLE OF CONTENTS
LETTER FROM THE NATIONAL DIRECTOR

Dear Colleagues:

In 2012, the Defense and Veterans Brain Injury Center, or DVBIC, commemorated 20 years of service. 

We have grown and expanded since 1992, but our focus on the mission of helping service members and 

veterans has stayed the course.

In 2011, I deployed as the theater neurologist to Afghanistan for six months. This connection to advancing theater concussion systems of care helped enhance DVBIC’s TBI tools and resources to better support 

concussion care in the deployment setting and was the catalyst, with the Army surgeon general’s support, to launch the fourth update of Military Acute Concussion Evaluation (MACE) in 2012. 

Significant external and internal changes impacted DVBIC in 2012. We issued the fourth version of the 

MACE, with changes requested by medics, corpsmen and other providers. In September the Department 

of Defense (DoD) issued new policy guidance related to TBI in the deployed setting, DoDI 6490.11, which 

replaced the previously used Directive-Type Memorandum 09-033. 

At our own organizational level, we prepared for a governance change from Tricare Management Activity 

to that of the Army’s Medical Research and Materiel Command (MRMC). We and our higher headquarters, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, or DCoE, 

used the opportunity of organizational realignment to undertake an organizational restructuring. We 

reviewed our mission and staffing plan, and identified areas for improvement of function and efficiency 

within each division. In October the DCoE TBI Clinical Standards of Care Directorate, and various other 

staff whose mission was TBI operational, were moved to DVBIC, for a total change of 33 positions. We 

anticipate these changes will strengthen both organizations and, ultimately, TBI initiatives. 

DVBIC’s network and central office went through operational changes as well in 2012. DVBIC assigned 

a regional education coordinator to Joint Base Elmendorf-Richardson near Anchorage, Alaska, thereby 

expanding our network to 18 sites. In addition, we re-launched our website, started a series of webinars 

and developed two online courses. We truly are breaking new ground, both literally and virtually. 
2012 DVBIC Annual Report | 3 |

Col. Jamie Grimes shares the latest TBI research 

during a panel discussion as part of the U.S. Army 

All-American Bowl in San Antonio, Texas, January 

4, 2013. Army photo by Sgt. Keith Anderson

DVBIC’s staff throughout our network and in our central office showed their ingenuity and perseverance 

this year when federal budget constraints imposed changes on us. Instead of hosting the DVBIC Annual 

Summit as we had the previous five years, we creatively repurposed its keynote address into a lecture 

honoring our former national director, Dr. Deborah Warden, having now-retired Col. Geoffrey Ling deliver 

the Deborah Warden Lecture in August, which was held at the Walter Reed National Military Medical 

Center. The creativity continued with the hosting of smaller meetings in which separate DVBIC teams 

met and focused on strengthening their productivity and communication. I am proud of my colleagues for 

finding alternate ways to collaborate, communicate and improve, no matter what challenges arise.

Through all of these changes, DVBIC experts continued to perform research, deliver care and educate 

providers, service members and the public. You will read more about these ongoing, seemingly ever-expanding efforts on the following pages, and as you do, I know you will be as inspired as I am to continue 

working on behalf of our nation’s service members, veterans and their families. I will be moving on in 

2013, confident that the incoming National Director will be a tremendous successor to further advance 

our TBI mission, and comforted to know that DVBIC’s impactful efforts continue.

With my humblest thanks and deepest respect,

Col. Jamie Grimes, MD

National Director, DVBIC
CLINICAL AFFAIRS

DVBIC’s clinical affairs team operates out of 

DVBIC’s central office, working to identify best 

practices and create resources and tools for use 

by clinicians. DVBIC’s surveillance efforts are part 

of the clinical affairs office. The clinical affairs 

team has also established and currently supports 

a team of regional care coordinators (RCCs). They 

work at the network sites, ensuring that service 

members who are changing duty stations, moving 

to the VA system or returning to civilian life after 

service transition smoothly and receive care and 

treatment if and as needed. They follow up with 

service members at several points post-injury to 

offer connections and resources.

In 2012, DVBIC RCCs conducted or 

worked with:

• 1,000 patient intakes

• 565 patients for three-month follow-ups

• 365 patients for six-month follow-ups

• 84 patients for nine-month follow-ups

• 251 patients for 12-month follow-ups

• 41 patients for 18-month follow ups

• 99 patients for 24-month follow-ups

• 41 patients for nonstandard follow-ups

U.S. Army Sgt. Nathan Martucci of Mount Arlington, N.J., shares his experiences coping with brain injury during 

Brain Injury Awareness Month at Joint Force Base McGuire-Dix-Lakehurst, N.J., March 11, 2013. Army photo by 

Sgt. Manda Walters
2012 DVBIC Annual Report | 5 |

In 2012, the DCoE Clinical Standards of Care team 

that transitioned to DVBIC from DCoE released 

the following new TBI clinical tools that represent 

best practices in TBI treatment:

• Military Acute Concussion Evaluation (MACE) 

(version 4.0) 

• Concussion Management Algorithms in the Deployed Setting (version 4.0)—provides clinical 

management of service members with concussions at various points

• Combat Medic/Corpsman Algorithm—guides 

in-field assessment and management by combat 

medics

• Initial Provider Algorithm—guides providers 

located at the forward operating bases on how 

to further manage service members with head 

injury or concussion

• Comprehensive Concussion Algorithm—guides 

more definitive care that involves referral to 

and management at MTFs with neuroimaging 

capabilities 

• Recurrent Concussion Algorithm—guides providers through a more comprehensive evaluation 

and specialty assessments for neurobehavioral 

symptom inventory, neuropsychological assessment, neuroimaging, balance, and functional 

assessment

• Neuroendocrine Dysfunction Screening Post-mTBI—guides providers through a process to 

identify patients with mTBI presenting with 

persistent symptoms such as fatigue, weight 

gain, low blood pressure, low libido, etc., who 

may benefit from further endocrine evaluation 

and care

• Assessment and Management of Dizziness Associated with mTBI—guides providers through 

evaluation of dizziness after mTBI; utilized for 

differential diagnosis for vertigo, disequilibrium 

and light headedness, and appropriate referrals 

for management of each condition.

In 2012, DVBIC continued its mission of TBI data 

surveillance, collaborating with other components 

of the military health system and implementing 

the Department of Defense Instruction 6490.11, 

“DoD Policy Guidance for Management of Mild 

Traumatic Brain Injury/Concussion in the Deployed 

Setting,” which went into effect September 2012. 

The surveillance team performs thorough analysis 

of the data to track trends in severity of injury, 

delivery of care, medical evacuations, and identification of high-risk groups. The team has completed a separate analysis by military occupational specialty and unit to help inform senior leaders 

of concussion threat and contribute to mitigation 

strategies.

DVBIC’s 2012 Surveillance Reports:

• TBI Surveillance Quarterly Reports; Direct and 

Purchased Care—a quarterly report from the 

Office of Surveillance that provides an overview 

of TBI-related medical encounters, both direct 

and purchased care for all service members in 

the continental United States, and excludes Guam 

and Puerto Rico as well as outside the continental 

United States.

• Non-Deployment Associated TBIs and Mechanism 

of Injury

• Blast Exposure Concussion Incident Report 

(BECIR) Quarterly Report—a quarterly report from 

the Office of Surveillance that presents data from 

BECIR providing analysis of the reporting variables 

and historical comparison of previous quarters 

reported. 

Below is a list of reports derived from more in-depth 

analysis using BECIR as well as other data sources:

• Medically Evacuated mTBI Incidents by Service 

(BECIR data)

• DTM Data by Event by Country (Iraq – Afghanistan)

• DTM-BECIR Annual Surveillance Report (Inaugural 

for 2011)

• Type of Event Exposures for Concussed Service 

Members (BECIR data) 

• DTM Unit Type Analysis for USA, USMC and USN 

• DTM Occupational Specialty Analysis for USA, 

USMC, USN

• Concussion Care Center Admissions for mTBI 

(BECIR data)
DVBIC’s research division develops and conducts 

clinical investigations in TBI. The team oversees 

65 active research protocols, some of which are 

mandated by Congress. Following are notable 

achievements from 2012:

• DVBIC published 31 peer-reviewed manuscripts 

in 2012 (see list of publication citations at the 

end of this report).

• “Head-to-Head” Study: Phase one of this

study, determining test-retest reliability of four 

commercially available computerized neuropsychological assessment tools (NCATs), was 

completed, and results have been written up in 

a manuscript that has been submitted for publication in a peer-reviewed journal. Enrollment 

is ongoing for phase two, which will test the 

validity of the four NCATs.

• 1 5-Year Longitudinal Study:

The Natural History of TBI within a Military 

Cohort—this study will improve our understanding of the natural history of recovery from

TBI in a military cohort by developing a data

repository that contains information related to 

service members’ health/medical status, quality 

of life, and healthcare needs that will be used 

to document long-term outcomes over 15 years. 

Enrollment in the comprehensive pathway, in 

which participants undergo one to two days of 

intensive evaluation/testing every three years,

with phone evaluations annually, is ongoing. 

DVBIC received final regulatory approval to 

begin enrollment in the brief pathway, where 

data is collected by phone annually for up to 15 

years.

 Health-Related Quality of Life in Caregivers of 

• The Study of Cognitive Rehabilitation Effectiveness in Mild TBI (SCORE!) will evaluate the 

effectiveness of cognitive rehabilitation in Operation Enduring Freedom/Operation Iraqi Freedom 

(OEF/OIF) service members with a history of mild 

TBI and persistent cognitive complaints. A supporting study to SCORE!, the Imaging Support of 

the Study of Cognitive Rehabilitation Effectiveness for mild TBI (iSCORE) will investigate longitudinal structural and functional neuroimaging 

changes over time that correlate with outcome 

following the trial of cognitive rehabilitation. 

RESEARCH

ê ê 20 YEAR TIMELINE ê ê

1992 - 2000

1992

• The Defense and Veterans Head Injury 

Program, or DVHIP, begins in February as 

the result of a $3.2 million congressional 

mandate to treat troops with head and 

neck injuries.

• DVHIP receives joint grant from DoD/VA 

for first randomized trial of TBI rehabilitation. Patient recruitment begins at Walter 

Reed Army Medical Center.

• Five DVHIP sites open.

1993-2000 

• DVHIP documented incidences of TBI

during peacetime.
2012 DVBIC Annual Report | 7 |

Marine Corps Lance Cpl. Blake Bibbins of Brooklyn, Mich., concentrates down-range during the Marine Corps 

Wounded Warrior Trials at Camp Pendleton, Calif., February 17, 2012. Marine Corps photo by Cpl. Chelsea 

Anderson

The SCORE! and iSCORE studies are ongoing 

and collecting data, with the SCORE! study 

enrolling more than 50 percent of the target 

number of participants in 2012.

• ProTECT III – Progesterone for the Treatment of 

TBI—This trial will determine if progesterone, 

a hormone normally found in the human body, is 

useful in limiting the amount of brain damage 

from TBI. DVBIC is participating in this national, 

multi-center trial through a protocol that is ongoing at our site at Brooke Army Medical Center 

in San Antonio.
DVBIC’s education team provided information and 

resources to hundreds of thousands of people, 

both in person and online, in 2012. The team:

• Distributed more than 764,500 educational

items through the websites.

• Created and managed the first TBI online course

for civilian providers.

• Began a webinar series in partnership with

DCoE for medical providers, offering CE/CME 

credit.

• Launched a Family Needs Line comprising four

booklets for family members and caregivers of 

people with TBI.

• Developed six training slide decks for deploying

service members, providers, and leaders related 

to DoDI 6490.11 for in-theater concussion care.

• Developed provider training slide decks for visual disturbances following mTBI to accompany a 

new clinical recommendation.

EDUCATION

Key DVBIC REC statistics: 

• 735 presentations, delivered or facilitated by the 

RECs, reached over 65,000 people.

• 151 exhibits at conferences and events were visited by 67,000 people.

• 18 exhibits at Yellow Ribbon Reintegration Events 

(U.S. Army Reserve and National Guard) reached 

11,400 people.

• 15 TBI briefs were provided at yellow ribbon 

events.

DVBIC redesigned its organizational website in 

2012, and maintained content support of Brainline.org and BrainlineMilitary.org; both launched 

mobile sites. All three websites won awards in 

2012. DVBIC’s new website offers a new shopping 

cart tool that visitors can use to order print materials, and the two Brainline sites boast two new 

online courses for providers. DVBIC’s education 

team also began a TBI webinar series.

Regional education coordinators (RECs) serve as 

outreach TBI experts for DVBIC. They speak at 

DoD, VA, and public health and training events, 

Yellow Ribbon Reintegration Events and other 

activities, and provide information and generate 

awareness about TBI and remain available to help 

service members and their families.

ê ê 20 YEAR TIMELINE ê

1999 - 2002

1999

• Recruitment begins for Ft. Bragg paratrooper study. 

2000 

• The Journal of the American Medical

Association publishes results of the first 

randomized controlled trial of multidisciplinary post-acute rehabilitation for TBI.

2001 

• The Journal of Neurology publishes a

study performed by DVBIC and the U.S. 

Military Academy at West Point associating concussion with slowed reaction 

time.

2002

• DVHIP changes its name to the Defense

and Veterans Brain Injury Center, or 

DVBIC.

ê
2012 DVBIC Annual Report | 9 |

Retired Marine Corps Staff Sgt. Vincent Gizzarelli looks on with his adopted son during the dedication ceremony 

of his new house in Jacksonville, N.C., April 28, 2012. The house was built using supplies and donations from 

local businesses and various veterans’ groups. Marine Corps photo by Cpl. Bryan Nygaard

ê ê 20 YEAR TIMELINE ê ê

2005 - 2007

2005

• DVBIC funds first in-theater study of TBI 

in Balad, Iraq.

• At the direction of the Assistant Secretary of Defense for Health Affairs and the 

Army surgeon general, DVBIC takes on 

the mission of TBI surveillance for the 

DoD.

2007 

• DVBIC deploys the first in-theater guidance for evaluating concussion: the 

Military Acute Concussion Evaluation, or 

MACE.

• DVBIC holds its first TBI summit to provide training and education to military 

providers.
LOOKING AHEAD

In 2013, DVBIC will focus on strengthening its 

core infrastructure and network, as DCoE’s operational TBI components realign with DVBIC to 

create a TBI Center of Excellence and the entire 

DCoE organization transitions to MRMC.

ê ê 20 YEAR TIMELINE 

2008 - 2010

ê ê

2008

• DVBIC is designated the primary oper

ational TBI component of the Defense 

Centers of Excellence for Psychological 

Health and Traumatic Brain Injury, or 

DCoE.

•

ment of service members’ cognitive 

functioning, using the Automated Neuro

psychological Assessment Metrics tool, 

begins.

A program for pre-deployment assess

-

2010 

• The DoD releases landmark guidance 

on the treatment of mTBI in-theater that 

requires use of the MACE.

• DVBIC and DCoE launch the first modules 

of the congressionally mandated multime

dia tool, the Family Caregiver Curriculum.

-

U.S. Army Pfc. Hope Clark of Ionia, Mich., reaches high during aquatic therapy at the Bowling Family YMCA in El 

Paso, Texas, February 2012. Army photo by Sgt. Ida Irby

-

-
2012 DVBIC Annual Report | 11 |

Rocky, the service dog for Marine Corps Staff Sgt. Matthew Benack of St. Louis, Mo., sits on the sidelines during 

the Marine Corps Wounded Warrior Trials at Camp Pendleton, Calif., February 16, 2012. Marine Corps photo by 

Cpl. Lucas Vega

ê ê 20 YEAR TIMELINE 

2011 - 2012

ê ê

2011

• DVBIC and television network WETA 

launch mobile sites for BrainLine.org and 

BrainLineMilitary.org.

2012

• 2012 DVBIC network marks 20 years of 

service, and expands to 18 sites with the 

addition of Joint Base Elmendorf-Richard

son in Alaska.

-
NETWORK SITES

MTFs

Landstuhl Regional Medical Center 

Landstuhl Regional Medical Center (LRMC) is 

the only Level I Trauma Medical Treatment Facility outside the continental U.S. and the largest 

medical facility in the European Regional Medical 

Command. Highlights of DVBIC’s work at LRMC in 

2012 include more than 10,000 patient encounters 

and more than 5,185 screenings. TBI research 

continues to be an important aspect of the LRMC 

team’s work with multiple ongoing trials including 

continuing work on a large, multi-site biomarker 

assay trial funded by the Congressionally Directed 

Medical Research Program. 

Marine and Sailor Concussion Recovery Center, 

Camp Lejeune

The DVBIC team at Camp Lejeune served 5,466

patients in 2012, providing evaluations, plans of 

care, occupational and speech/language therapy, 

vestibular rehabilitation, psychological evaluations, case management, care coordination and 

alternative medicine therapies such as biofeedback and iRest. An onsite occupational therapist 

secured a gift from the Semper Fi Fund of $12,000 

for biofeedback equipment that was presented to 

the clinic in January 2013. In 2012, DVBIC-Camp 

Lejeune RECs reached 144,000 people, including 

service members, veterans, command officials, 

providers, and the surrounding community through 

education and exhibit booths. In addition, another 

onsite team member received recognition of outstanding service from the Captain of the Medical 

Corps at Camp Lejeune for delivering high-quality, 

compassionate, patient-centered care.

Camp Pendleton 

In 2012 DVBIC-Camp Pendleton had 861 new 

referrals. Clinicians completed 669 initial intakes, 

more than 150 neuropsychological evaluations,

and saw a total of 1261 patients for a variety of 

appointments. Additionally, this site continued 

to provide post-deployment screening support in 

collaboration with I Marine Expeditionary Force 

and Marine Special Operations Battalion. DVBICCamp Pendleton further integrated services within 

Naval Hospital Camp Pendleton and the new 

Warrior Recovery Center, including generating a 

local memorandum of agreement and standard 

operating procedure with the command. With regard to education, DVBIC-Camp Pendleton’s team 

provided more than 2,600 educational materials 

and clinical tools to nearly 400 DoD providers, 

service members, family members, and the surrounding community. For our annual Brain Injury 

Awareness month event, DVBIC-Camp Pendleton 

hosted neuropsychologist Dr. Grant Iverson. Dr. 

Iverson is a world-renowned speaker, and the talk 

generated a large audience of multi-disciplinary 

providers. Research endeavors included multiple 

publications, abstracts, and collaborative projects 

both locally and nationally.

Fort Bragg

DVBIC-Fort Bragg’s mission is to return service 

members to their parent units as quickly as possible, and ensure that, if cleared for duty, they are

able to perform basic level skill requirements. The 

team strives to effectively treat and rehabilitate 

service members with persistent postconcussive 

symptoms, and to ensure that when they return 

to duty, they have been accurately evaluated and 

have the ability to meet the standards leadership 

requires of them. In 2012, DVBIC-Fort Bragg clinical personnel provided treatment and testing to 

740 soldiers during 940 office visits. The “Headto-Head” research study team tested 201 participants in 2012. As part of its ongoing TBI educational mission, DVBIC-Fort Bragg conducted 3,250 

in-processing briefings to soldiers during the year.

Evans Army Community Hospital, Fort Carson

The DVBIC team at Fort Carson is situated within 

the Warrior Recovery Center at the Evans Army

Community Hospital, the primary clinic for the 

treatment of TBI at the Mountain Post. This embedded site allows a high level of soldier contact 

by DVBIC staff. In 2012 DVBIC-Fort Carson's research team conducted research on an Interactive 

Metronome Study and completed enrollment in the 

Warrior Strong study, reviewing long-term effects 

of combat-related mild TBI. The local RECs provided classes and briefs to 24,877 individuals, and 

the care coordination program served as a point of 
2012 DVBIC Annual Report | 13 |

contact for ongoing care during geographic relocation for nearly 100 service members.

Carl R. Darnall Army Medical Center, Fort Hood

Home to more than 70,000 troops, Fort Hood is 

the largest deploying base in the continental U.S.

and is home to IIICORPS, 1st Cavalry Division and 

First Army Division West. DVBIC staff is embedded within the TBI clinic, collaborating with 

medical care, care coordination and education 

for service members, family, and staff. To assist 

the TBI clinic, where approximately 600 active 

patients receive care, DVBIC provides educational 

information to staff and service members on signs 

and symptoms of concussion, pamphlets on mood 

changes, sleep hygiene and memory improvement. 

DVBIC staff provided mild TBI/concussion awareness education and training to over 24,000 troops 

and providers, and train-the-trainer education for 

Medics and providers at Fort Hood.

Fort Belvoir Community Hospital, Fort Belvoir

Fort Belvoir Community Hospital’s Traumatic Brain 

Injury Department provided return-to-duty and

flight status assessments for wounded warriors 

with TBI as well as access to the TBI Rehabilitation Intake Clinic. Services were provided to 

approximately 600 patients in 2012. Care coordinators serve as liaisons for TBI patients, working 

with practitioners of various types of therapies 

including occupational, physical, speech, and 

recreational. Patients are invited to participate in 

TBI research protocols within the department. TBI 

clinicians actively collaborate with The Ohio State 

University, VA, Uniformed Services University of 

the Health Sciences, National Intrepid Center of 

Excellence, and other entities.

Naval Medical Center San Diego (NMCSD)

In 2012, the team at DVBIC-NMCSD started data 

entry efforts for the clinical tracking form study, 

in which 1,090 clinical tracking forms have been 

entered, of which 1,017 were delivered for the 

Walter Reed Army Medical Center/Brooke Army 

Medical Center merger. The site’s co-senior scientific director led DVBIC’s first ever webinar, with a 

presentation titled, “The Battle Within: TBI, PTSD 

and Violence Risk.” Staff increased understanding 

of TBI among 3,924 DoD, VA, and civilian providers, service and family members through presentations and workshops, and distributed to DoD, 

VA, and civilian providers 7,389 educational items 

such as toolkits, handouts, fact sheets, brain helmets, and pocket guides. Team members conducted site visits throughout southern California and 

Nevada at 13 unique locations that included VA 

hospitals, military bases, and Wounded Warrior 

battalions. Staff at DVBIC-NMCSD performed 

nearly 245 clinical interviews, feedback sessions, 

and telephone consultations; administered 148 

neuropsychological testing batteries; and completed more than 50 neurocognitive assessments for 

medical disability.

San Antonio Military Medical Center (SAMMC)

During 2012, DVBIC-SAMMC staff reviewed 

post-deployment questionnaires and screened

medical records of more than 1,400 service members for TBI, identifying 138 individuals as TBI 

positive for the DVBIC TBI database and enrolling 

128 of those members in the DVBIC Prospective 

TBI Tracking Protocol. DVBIC-San Antonio also 

updated more than 2,494 providers with the latest 

TBI information. DVBIC personnel are involved 

in eight ongoing research protocols, including a 

congressionally mandated cognitive rehabilitation 

trial for OEF/OIF service members and an associated longitudinal neuroimaging study.

Walter Reed National Military Medical Center 

(WRNMMC)

DVBIC staff at WRNMMC provided more than 

1,100 outpatient diagnoses and 2,000 inpatient

diagnoses in 2012. They collaborated with the 

U.S. Military Academy at West Point and U.S. 

Naval Academy to assess and treat concussions 

at WRNMMC, provided high-level, comprehensive team-based evaluations and follow-ups, and 

improved patient care through use of the Brain 

Fitness Center and the TBI Rehabilitation Intake 

Clinic to improve cognitive functioning. Twelve 

TBI staff lectures were presented; topics included 

cognitive-communication deficits following TBI, 

sleep, memory, and dreams from the bed to the 

field, and targeting functional deficits from mTBI 

in the presence of chronic co-morbidities. DVBIC 
staff at WRNMMC provided TBI education to more 

than 2,800 inpatients and their family members; 

educated more than 1,500 providers through headache seminars; continued research collaborations 

with Spaulding Rehabilitation at Harvard University, The Ohio State University, the VA, Uniformed 

Services University of the Health Sciences, and 

other organizations; implemented 13 research protocols; and published five peer-reviewed journal 

articles, four book chapters, nine abstracts, and 

nine poster/conference presentations.

Joint Base Elmendorf-Richardson (JBER)

DVBIC-JBER is located in the 673rd Medical Group 

Hospital and is the sole Air Force-run TBI Clinic.

DVBIC-JBER’s main mission is to provide care, education, and prevention services to Army service 

members assigned to the 4-25 Airborne Infantry 

Brigade and any DoD or VA beneficiaries. The TBI 

clinic began operations in 2009 and opened its 

new facility in February 2012. The team is creating and making use of existing opportunities to 

provide education and vital services to DoD and 

VA beneficiaries, and collaborating with community members, military, VA, and civilian health 

care providers. Working alongside providers in the 

TBI clinic, DVBIC's regional education coordinator 

(REC) provided 13 awareness briefs to Commanders and line leaders, service members, hospital 

medical staff, and community groups. The REC 

developed and taught a multiple-evening course 

to family members of service members who have 

sustained TBIs, as well as a warriors and concussion class series for injured service members. 

Additionally, the REC taught six TBI basics classes 

for chaplains, VA outpatient counselors, VA claims 

processors and other key contacts, and shared 

information with base PAOs that reached the public through social and traditional media outlets; 

they exhibited at more than a dozen public events 

and displays. DVBIC-JBER’s REC presented “TBI in 

the Military: The Basics” to the first Alaska Brain 

Institute statewide conference, and frequently 

collaborates with community-based advocacy 

groups. The REC gives individual attention to service members and spouses as needed to help them 

obtain relevant services and assistance.

VA Medical Centers

Boston

DVBIC-Boston is actively conducting research in 

the areas of TBI and other combat-related mental

health disorders. DVBIC works closely with the 

VA’s TBI Center of Excellence at Boston: the Translational Research Center for Traumatic Brain Injury 

and Stress Disorders (TRACTS). Ongoing research 

protocols include behavioral and neuroimaging 

characterization of TBI and comorbid deployment-related mental health conditions as well as 

measuring the functional outcomes (e.g., driving 

safety) among the OEF/OIF cohort.

Minneapolis

The DVBIC-Minneapolis team in conjunction 

with the Minneapolis VA Department of Physical 

Medicine and Rehabilitation continues to leverage existing relationships in order to collect and 

organize accessible data from multiple sources to 

create a multi-user relational database comprising 

clinically relevant data. These data are being used 

to support the internal assessment and subsequent improvement of patient care, improve processes and procedures, collect clinical outcome 

measures, and provide Commission on Accreditation of Rehabilitation Facilities-focused tracking. 

Additionally, this DVBIC team has developed new 

research protocols that explore the relationships 

between TBI and neurodegenerative disease and 

TBI and cognitive control.

Palo Alto

DVBIC-Palo Alto is an integral part of the clinical research, care coordination and education/

outreach success of the Polytrauma System of

Care at VA Palo Alto Health Care System. In 2012 

the research team continued their work on one 

multi-site DVBIC study and several local studies. 

DVBIC-Palo Alto hosted the TBI Research Forum 

for the second year under the theme, TBI and 

Co-morbidities: PTSD and Spinal Cord Injury. More 

than 130 attendees from across Northern California and the western U.S. VA system, University of 

California, San Francisco, and community hospitals participated; 29 posters were presented, 

NETWORK SITES
2012 DVBIC Annual Report | 15 |

followed by three invited speakers and a panel 

discussion. DVBIC-Palo Alto education and outreach programs focused on community colleges for 

returning veterans, family caregivers, and justice-involved veterans.

Richmond

DVBIC-Richmond continues to be an integral 

component of the Polytrauma System of Care at

McGuire VA Medical Center. The REC and RCC 

made a total of 3,230 contacts with active duty 

service members and veterans for their TBI care 

and educational needs. Research is also very 

active; in 2012, DVBIC-Richmond led five projects 

and participated in two multi-site studies with a 

total of 183 new participants. Projects focus on a 

range of issues including social competence, pain, 

olfactory and taste dysfunction, and postconcussion syndrome. New studies projected to begin in 

2013 will examine spatial and vestibular disorders 

after TBI and neuroplasticity following cognitive 

rehabilitation. 

Tampa

The 9th Annual Blast Injury Conference was presented at the Special Operations Medical Association’s meeting in December. The conference 

provided DoD, VA, and civilian provider communities with the latest best practices in blast-induced 

TBI care, ranging from the front lines through 

rehabilitation. At the James A. Haley VA, a focus 

is placed on family caregivers of the Polytrauma 

Rehabilitation Center’s inpatient population. A 

weekly Family Caregiver Education Series provides 

information on all aspects of moderate to severe 

TBI rehabilitation such as seizure awareness, 

brain anatomy 101 and the importance of sleep 

for TBI recovery. The 3rd Annual Family Caregiver 

Conference, “MISSION: Hope, Care and Support,” 

was held in November and hosted more than 100 

participants. DVBIC-Tampa has also played a 

key role in the TBI-related education of ongoing 

student classes at the Joint Special Operations 

University Senior Enlisted Academy at MacDill 

AFB, providing expert TBI lectures and briefings 

about DVBIC services.

Charlottesville and Johnstown

DVBIC operates two Residential Neurorehabilitation and Community Reintegration Centers: 

DVBIC-Charlottesville and DVBIC-Johnstown. Both 

sites are accredited by the Commission on Accreditation of Rehabilitation Facilities and provide 

intensive and structured short-term neurorehabilitation and community reintegration therapies 

for active duty service members and activated 

National Guard and reserve members with mild 

traumatic brain injuries, in the post-acute period 

of clinical care, whose recovery is complicated by 

significant co-morbid conditions. A full interdisciplinary clinical-team approach is utilized. These 

service members represent the minority of those 

patients who sustain a mild TBI and continue to 

have ongoing problems as a result of their injury. Care models are based on currently accepted 

practices in the field of TBI neurorehabilitation, 

incorporating research, clinical practice guidelines, and innovative and emerging best practices. 

Both sites can treat up to 10 service members 

at a time for a maximum treatment period of 16 

weeks and have cooperative arrangements with 

businesses and governmental agencies within the 

local community, where service members can gain 

practical, real-world skills in preparation for a 

return to duty. Additionally, DVBIC-Charlottesville 

conducts briefings on the complexities of TBI and 

behavioral health conditions at The Judge Advocate General’s Legal Center and School to educate DoD’s senior leaders who are preparing for 

deployments, as well as other service members 

who attend the school.

At DVBIC-Charlottesville, 15 service members 

were treated by the program during 2012. Of these 

service members, 73 percent returned to their 

military commands, and 27 percent separated from 

the military.

At DVBIC-Johnstown, of the 21 service members 

in the program during 2012, dispositions of 17 are 

currently determined. Of these service members, 

67 percent returned to their military commands, 

and 33 percent separated from the military.
PUBLICATIONS

DVBIC produced 27 peer-reviewed publications 

in 2012, which highlighted research and clinical 

practice:

Belanger, H. G., Vanderploeg, R. D., Soble, J. R., 

Richardson, M., & Groer, S. (2012). Validity of the 

Veterans Health Administration’s traumatic brain 

injury screen. Archives of Physical Medicine and 

Rehabilitation, 93(7), 1234-1239.

Cooper, D. B., Chau, P. M., Armistead-Jehle, P., 

Vanderploeg, R. D., & Bowles, A. O. (2012). Relationship between mechanism of injury and neurocognitive functioning in OEF/OIF service members 

with mild traumatic brain injuries. Military Medicine, 177(10), 1157-1160.

Eastvold, A. D., Belanger, H. G., & Vanderploeg, 

R. D. (2012). Does a third-party observer affect 

neuropsychological test performance? It depends. 

Clinical Neuropsychology, 26(3), 520-541.

Eastvold, A. D., Walker, W. C., Curtiss, G., 

Schwab, K., & Vanderploeg, R. D. (2013). The 

differential contributions of posttraumatic amnesia duration and time since injury in prediction of 

functional outcomes following moderate-to-severe 

traumatic brain injury. Journal of Head Trauma 

Rehabilitation, 28(1), 48-58.

Finkel, A. G., Yerry, J., Scher, A., & Choi, Y. S. 

(2012). Headaches in soldiers with mild traumatic 

brain injury: Findings and phenomenologic descriptions. Headache, 52(6), 957-965.

French, L. M., Lange, R. T., Iverson, G. L., Ivins, 

B., Marshall, K., & Schwab, K. (2012). Influence 

of bodily injuries on symptom reporting following 

uncomplicated mild traumatic brain injury in U.S. 

military service members. Journal of Head Trauma 

Rehabilitation, 27(1), 63-74.

Griffin, J. M., Friedemann-Sánchez, G., Jensen, A. 

C., Taylor, B. C., Gravely, A., Clothier, B., Simon, A. 

B., Bangerter, A., Pickett, T., Thors, C., Ceperich, 

S., Poole, J., & van Ryn, M. (2012). Invisible side 

of war: Families caring for U.S. service members 

with polytrauma. Journal of Head Trauma Rehabilitation, 27(1), 3-13.

Huang, M. X., Nichols, S., Robb, A., Angeles, A., 

Drake, A., Holland, M., Asmussen, S., D’Andrea, 

J., Chun, W., Levy, M., Cui, L., Song, T., Baker, 

D. G., Hammer, P., McLay, R., Theilmann, R. J., 

Coimbra, R., Diwakar, M., Boyd, C., Neff, J., Liu, 

T. T., Webb-Murphy, J., Farinpour, R., Cheung, C., 

Harrington, D.L., Heister, D., & Lee, R. R. (2012). 

An automatic MEG low-frequency source imaging 

approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes. 

Neuroimage, 61(4), 1067-1082.

Lange, R. T., Brickell, T. A., French, L. M., Merritt, 

V. C., Bhagwat, A., Pancholi, S., & Iverson, G. L. 

(2012). Neuropsychological outcome from uncomplicated mild TBI, complicated mild TBI, and 

moderate TBI in U.S. military personnel. Archives 

of Clinical Neuropsychology, 27(5), 480-494.

Lange, R. T., Iverson, G. L., & Brubacher, J. R. 

(2012). Clinical utility of the protein S100B to 

evaluate traumatic brain injury in the presence of 

acute alcohol intoxication. Journal of Head Trauma Rehabilitation, 27(2), 123-134.

Lange, R. T., Iverson, G. L., Brubacher, J. R., 

Madler, B., & Heran. M. K. (2012). Diffusion tensor 

imaging findings are not strongly associated with 

postconcussional disorder 2 months following mild 

traumatic brain injury. Journal of Head Trauma 

Rehabilitation, 27(3), 188-198.

Lange, R. T., Pancholi, S., Bhagwat, A., Anderson-Barnes, V., & French, L. M. (2012). Influence 

of poor effort on neuropsychological test performance in U.S. military personnel following mild 

traumatic brain injury. Journal of Clinical and 

Experimental Neuropsychology, 34(5), 453-466.

Lange, R. T., Pancholi, S., Brickell, T. A., Sakura, S., Bhagwat, A., Merritt, V., & French, L. M. 

(2012). Neuropsychological outcome from blast 

versus non-blast: Mild traumatic brain injury in 

U.S. military service members. Journal of the 

International Neuropsychological Society, 18(3), 

595-605.

Livingston, S. C., Goodkin, H. P., Hertel, J. N., 

Saliba, E. N., Barth, J. T., & Ingersoll, C. D. (2012). 

Differential rates of recovery after acute sport-related concussion: Electrophysiologic, symptomatic, and neurocognitive indices. Journal of Clinical 

Neurophysiology, 29(1), 23-32.
2012 DVBIC Annual Report | 17 |

Lucas, S., Hoffman, J. M., Bell, K. R., Walker, W. 

C., & Dikmen, S. (2012). Characterization of headache after traumatic brain injury. Cephalalgia, 

32(8), 600-606.

Marshall, K. R., Holland, S. L., Meyer, K. S., Martin, E. M., Wilmore, M., & Grimes, J. B. (2012). 

Mild traumatic brain injury screening, diagnosis, 

and treatment. Military Medicine, 177(8 Suppl.), 

67-75.

Meterko, M., Baker, E., Stolzmann, K. L., Hendricks, A. M., Cicerone, K. D., & Lew, H. L. (2012). 

Psychometric assessment of the Neurobehavioral 

Symptom Inventory-22: The structure of persistent 

postconcussive symptoms following deployment-related mild traumatic brain injury among 

veterans. Journal of Head Trauma Rehabilitation, 

27(1), 55-62.

Meyer, K. S., Boakye, M., & Marion, D. W. (2012). 

Effects of non-neurological complications on traumatic brain injury outcome. Critical Care, 16(3), 

128.

Miller, K. J., Ivins, B. J., & Schwab, K. A. (2013). 

Self-reported mild TBI and postconcussive symptoms in a peacetime active duty military population: Effect of multiple TBI history versus single 

mild TBI. Journal of Head Trauma Rehabilitation, 

28(1), 31-38.

Nakase-Richardson, R., Whyte, J., Giacino, J. 

T., Pavawalla, S., Barnett, S. D., Yablon, S. A., 

Sherer, M., Kalmar, K., Hammond, F. M., Greenwald, B., Horn, L. J., Seel, R., McCarthy, M., Tran, 

J., & Walker, W. C. (2012). Longitudinal outcome 

of patients with disordered consciousness in the 

NIDDR TBI model systems programs. Journal of 

Neurotrauma, 29(1), 59-65.

Silva, M. A., Donnell, A. J., Kim, M. S., & Vanderploeg, R. D. (2012). Abnormal neurological exam 

findings in individuals with mild traumatic brain 

injury (mTBI) versus psychiatric and healthy controls. Clinical Neuropsychology, 26(7), 1102-1116.

Sullivan, K. W., Quinn, J. E., Pramuka, M., Sharkey, L. A., & French, L. M. (2012). Outcomes from 

a pilot study using computer-based rehabilitation 

tools in a military population. Studies in Health 

Technology and Informatics, 181, 71-77.

Tate, D. F., Shenton, M. E., & Bigler, E. D. (2012). 

Introduction to the brain imaging and behavior 

special issue on neuroimaging findings in mild 

traumatic brain injury. Brain Imaging and Behavior, 

6(12), 103-107.

Walker, W. C., Nichols, M., McDonald, S., 

Ketchum, J. M., & Cifu, D. X. (2013). Identification 

of transient altered consciousness induced by 

military related blast exposure and its relation to 

postconcussion symptoms. Journal of Head Trauma Rehabilitation, 28(1), 68-76.

Watanabe, T., Bell, K. R., Walker, W. C., & Schomer, K. (2012). Systematic review of interventions 

for post-traumatic headache. PM&R, 4(2), 129-

140.

Wortzel, H., Arciniegas, D., Anderson, C. A., 

Vanderploeg, R., & Brenner, L. (2012). A phase I 

study of low-pressure hyperbaric oxygen therapy 

for blast-induced postconcussion syndrome and 

post-traumatic stress disorder: A neuropsychiatric 

perspective. Journal of Neurotrauma, NA-Letter to 

the Editor.

Vanderploeg, R. D., Belanger, H. G., Horner, R. D., 

Spehar, A. M., Powell-Cope, G., Luther, S. L., & 

Scott, S. G. (2012). Health outcomes associated 

with military deployment: Mild traumatic brain 

injury, blast, trauma, and combat associations in 

the Florida National Guard. Archives of Physical 

Medicine and Rehabilitation, 93(11), 1887-1895.
DVBIC Web Cards

DVBIC Logo Stickers

DVBIC Fact Sheet

DVBIC CAPT Hancock Public Service Announcement (PSA)

DVBIC BrainlineMilitary.org PSA

DVBIC Family Caregiver Guide PSA

HEADS Poster

Brain Injury Awareness Poster – March 2013

BrainlineMilitary.org Bookmark

Brainline.org Bookmark

Brainline.org Postcard

Signs and Symptoms Fact Sheet (including eight 

available additional languages)

Moderate/Severe Signs and Symptoms Fact Sheet

Symptom Management – Improving Memory

Symptom Management – Healthy Sleep

Symptom Management – Mood Changes

Symptom Management – Headache and Neck Pain

Symptom Management – Head Injury and Dizziness

Acute Concussion Educational Brochure

For Use >1 Month After Injury or at Post Deployment Health Assessment (Not for Acute Period)

Warfighter Sleep Kit

Co-occurring Conditions Toolkit: Mild TBI and PH: 

Revised Sept 2011 (Second Edition)

Co-occurring Conditions Toolkit: Mild TBI and PH: 

Provider Training Video/DVD-April 2011

Mild Traumatic Brain Injury Pocket Guide (CONUS)

Department of Defense – ICD-9 Coding Guidance 

for Traumatic Brain Injury Pocket Card

Case Management of Concussion/mTBI Guidance 

Document

Neuroendocrine Dysfunction Screening Post mTBI 

Clinical Recommendation & Reference Card

Military TBI Case Management Quarterly Newsletter

Assessment and Management of Vision Associated with mTBI Clinical Recommendation & Reference Card

Assessment and Management of Dizziness Associated with mTBI Clinical Recommendation & 

Reference Card

Symptom Management – Vision Brochure

TBI.consult business card

HEADS Concussion Card

Military Acute Concussion Evaluation (MACE) 

Wallet Card

Military Acute Concussion Evaluation (MACE) 

Pocket Card

Concussion Management Algorithm (CMA) Pocket 

Card

Concussion Management Algorithm (CMA) Wallet 

Card

Acute Stress Reaction Fact Sheet

Winter Webinar Postcards

Neuro-rehab Site Brochure

Taking Care of Yourself While Caring for Others 

Brochure

Addressing Family Needs Brochure

Talking to Children About TBI Brochure

Talking to Children About Moderate or Severe TBI 

Brochure

Family Caregiver Guide Backpack

Family Caregiver Fact Sheet

Family Caregiver Poster

Family Caregiver Postcards

Our Daddy is Invincible Children’s Book 

Complementary and Alternative Medicine (CAM), 

Modalities and Interventions Fact Sheet

Neurocognitive Assessment Tool (NCAT) Clinical 

Recommendation

Line Leader Fact Sheet

RESOURCES

1335 East-West Highway, Suite 6-100 | Silver Spring, MD 20910 | 800.872.9244 | DVBIC.org