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 January 17, 2008 

This report details the Task Force's findings and recommendations from January 

through May 2007. It does not include the actions taken since May 2007 to 

correct the identified gaps or implement these recommendations. For 

information about actions already completed and underway, please see the 

following information paper. 

 

 BG Donald Bradshaw 

 Chairman 

Traumatic Brain Injury Task Force 
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Information Paper 

 DASG-HSZ 

 17 January 2008 

SUBJECT: Traumatic Brain Injury (TBI) Task Force Report Recommendation 

Summary 

1. Purpose: To provide information of the progress of TBI Task Force 

recommendations. 

2. Definition. 

 a. Implemented - Work with Inter-Agency (DoD/DVA) and Civilian groups on 

the definition and further the taxonomy of TBI. 

 b. In Progress - Develop a single academically rigorous, operationally sound 

definition for the case ascertainment of TBI (especially mild TBI) to facilitate 

accurate screening, evaluation, diagnosis, treatment, and education. 

3. Screening. 

 a. Implemented - Implement in theater TBI screening and documentation for 

all soldiers exposed to Blast. 

 b. Implemented - Add TBI specific screening questions to the PHA, PDHA 

and the PDHRA to assess for TBI. 

 c. In Progress - Develop an Army wide post-deployment TBI screening tool 

and implement/conduct post-deployment TBI screening at every de-mobilization 

site for all Soldiers. 

 d. In Progress - Develop an appropriate tool and conduct TBI screening for all 

patients who are evacuated from theater who are appropriate for screening. 

 e. In Progress - Develop and implement TBI screening policy at all echelons 

of care. The policy will encompass all mechanisms of TBI occurring both within 

and outside the theater of operations. 

 f. In Progress - Conduct screening with a consistent team trained to perform 

this function. 

4. Baseline Neuropsychological Evaluation. 

 a. In Progress - Implement a baseline (pre-deployment), post deployment 

and post-injury/exposure neuropsychological evaluation using the Automated 

Neuropsychological Assessment Metrics (ANAM). 
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 b. In Progress - Utilize ANAM for neuropsychological testing per Acute In 

Theater Care Clinical Practice Guidelines (CPG). 

5. Outreach Program. 

 a. In Progress - Propose outreach programs through the Deputy Chief of staff 

for Personnel (DCSPER) for soldiers separated from the Army since 2003 to 

facilitate identification of mild TBI and to initiate treatment if needed - possibly 

similar to Gulf War Registry. 

6. Traumatic Brain Injury Center of Excellence. 

 a. Implemented - Develop a proposal on the appropriate functions of a “TBI 

Center of Excellence (COE)” for MEDCOM to submit to HA. 

 b. Implemented - Propose the DVBIC as the core of a the new COE for DoD 

and DVA. 

 c. Implemented - Optimize the positioning of clinical, educational and 

research activities. 

 d. In Progress - Utilize the Defense and Veterans Brain Injury (DVBIC) model 

of a joint/interagency network for TBI. 

 e. In Progress - Evaluate the impact of expansion of DVBIC sites to all MTFS. 

 f. In Progress - Establish and utilize a proponency office to address TBI 

health integration and rehabilitation that serves as the main proponent for all TBI 

inquiries, issues, policy development and implementation for OTSG/MEDCOM 

and executes recommendations of the TBI Task Force through a process that 

includes timelines, tracking and interagency coordination of actions. 

6. Treatment. 

 a. In Progress - Develop a system-wide policy to institute identified best 

practices across the continuum of care for patients with all degrees of TBI. This 

system-wide effort should include development and implementation of in-theater 

concurrent screening protocol; acute in-theater management of mild TBI CPG; 

standardized early symptomatic treatment after identification; identification of a 

POC for TBI issues and deployment of a Neurologist with every CSH. 

 b. In Progress - Establish deployment/redeployment TBI programs including: 

primary care, social work, case management, and behavioral health programs 

based upon the Fort Carson model at each installation. Population needs may 

reveal the need for an enhanced or reduced version of the Fort Carson model. In 
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some cases a regionally based MEDCOM TBI Surge teams may meet the needs 

of sites with few and infrequent re-deployments. 

 c. In Progress - Develop and implement a policy to establish critical positions 

for TBI care at every MTF based upon added mission and available resources. 

At a minimum there will be two critical positions that will be essential: A TBI POC 

(the go-to person for “all issues related to TBI” at that facility) and a TBI specific 

care coordinator or clinical case manager. 

 d. In Progress - The DVA facilities should be the first option of care for 

inpatient and outpatient rehabilitation for Soldiers requiring care beyond the 

capability of the MTF. Exceptions to use of the DVA should be reviewed by the 

MTF Deputy Commander for Clinical Services (DCCS) with second level review 

by the nearest regional MTF DCCS to facilitate consistent, fair and equitable 

decision making across the AMEDD. 

 e. In Planning - Coordinate with DVA (VHA/VBA) to establish a utilization 

review of benefits. 

7. Case Management. 

 a. In Progress - Implement a population based model for CM support which is 

reflective of best practices across the DoD and DVA. Establish a standardized 

definition of military CM for the Army and start CM processes as early as 

possible from the point of injury across the continuum of care. 

 b. In Progress - Establish a standardized documentation template for TBI CM 

Army-wide according to the level of care. Provide accessible documentation 

systems needed to enhance communication in each care venue with a smooth 

transition to the next site or level of care. 

8. Research. 

 a. Implemented - Centralize evaluation of the scientific merit, clinical utility, 

and priority of new treatment strategies, devices or interventions (basic, clinical, 

applied research efforts). Clinical research will be synchronized with basic 

science and technology. All TBI research will be coordinated, integrated and 

vetted through USAMRMC. 

 b. In Progress - Conduct centralized, standardized reporting to determine the 

actual incidence and prevalence of TBI, with focus on mild TBI. The current 

disparate methods of identifying TBI at the point of occurrence or at other times 

in the care process suggest that any effort to gather this data without 

standardization will yield very questionable and easily challenged findings. 
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 c. In Planning - Develop a mechanism for collecting the frequency, severity, 

care and outcomes of TBI to provide adequate, reliable data for analysis to assist 

in care and decision-making. 

 d. In Planning - Coordinate, synchronize, and conduct multi-center clinical 

research on TBI under a centralized authority. 

9. Family Issues. 

 a. In Progress - Provide psychosocial supports for Soldier, family members 

and staff, to include: support groups (GWOT and TBI sensitive); individual and 

family counseling utilizing models of care adapted to the needs of family 

members of a brain injured individual. 

 b. In Progress - Recommend placement of military liaisons at the VA 

Polytrauma Network Sites. 

 c. Refer to another Agency - Review benefits packages provided by 

TRICARE, DVA and Medical Assistance (MA) (e.g. non-governmental 

organizations, advocacy groups, and volunteers) to determine optimal uniform 

package. 

 d. Refer to another Agency - Establish new uniform benefit sets that include 

both the entitlements and healthcare benefits to serve those with minimal needs 

as well as those with lifelong needs. Examples of areas that need to be 

addressed include: therapies required to meet the individualized treatment plan; 

housing, including supported living, home modifications, and long term care; 

healthcare, to include in-home and outpatient care as needed based on 

individual care plan; medical equipment; temporary transitional living; support for 

daily living to include independent living services, homemaking services, meals 

on wheels, and behavioral treatment plans; community participation, to include 

educational support services, vocational rehabilitation, structured day programs, 

sports and leisure activities, and social activities. 

 e. Refer to another Agency - Provide resources for family members who have 

chosen to leave their jobs to care for a service member. Consider provision of 

health insurance for family members who provide full-time care to an injured 

service member/veteran. 

 f. Refer to another Agency - Recommend placement of USAR chaplains at 

each of the four DVA Polytrauma Rehabilitation Centers for additional 

psychosocial support services. 

10. Education. 
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 a. In Progress - Develop and disseminate standardized education products 

that provides a practical overview of TBI to Soldiers, family members and unit 

commanders to increase their TBI proficiency and improve the positive, accurate 

identification of symptoms. This product will include general TBI information, 

other pre-deployment issues which may include living wills and powers of 

attorney, and a standardized explanation of all levels of care. Provide ongoing 

periodic refresher sessions to improve the retention of information. 

 b. In Progress - Educate and train providers on TBI specific screening tools, 

proper evaluation, appropriate treatment, documentation requirements 

(mechanism of injury/nature of injury, Glasgow Coma Scale (GCS), level of 

consciousness (LOC), Post Traumatic Amnesia (PTA)), models for grief and loss 

counseling and care giver support. Provide continuing medical education credit. 

 c. In Progress - Provide TBI education to medical providers at MEPS 

stations, everyone involved in the Physical Disability Evaluation System, and 

coders. 

 d. In Progress - Provide consistent, in-depth education throughout the 

continuum of care for family members, Soldiers and care professionals, to 

include the following: clinical condition (TBI); benefits and entitlements; and 

simplified understanding of the DoD PDES. 

 e. In Planning - Encourage and reinforce unit leaders to capture data about 

potential concussive events as a part of mission recovery and after action review. 

Correlate this information with Soldier, medic, combat lifesaver and buddy 

reporting. Identify Soldiers in need of observation as they may have had a TBI 

and require a short periodic “stand down” for full recovery. 

11. Marketing. 

 a. In Progress - Continually market TBI successes via command groups, 

Public Affairs Offices and as many media outlets as possible. Potential topics 

include DVA Polytrauma System of Care liaisons; DVA care educational videos; 

DVBIC consultation and educational offerings, outstanding examples of MTF 

care, personal accounts from Soldiers and their Families, and the positive care 

experiences received by noncombatants. 

 b. In Progress - Produce commercials briefly outlining the processes, 

improvement initiatives and preponderance of positive outcomes to provide a 

more balanced account. 

 c. In Progress - Keep Soldiers and their Families informed by actively 

marketing the methodology, status and outcomes of studies conducted within 

and external to DoD/DVA. 
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12. Documentation. 

 a. Implemented - Adapt the Military Acute Concussion Evaluation (MACE) 

overprint as an approved DA Form to document mild TBI closest to the point of 

injury. 

 b. In Progress - Develop and use an Electronic Medical Record (EMR) that 

follows a Soldier from the point-of-injury to the Veterans’ Affairs Healthcare 

System. When multiple electronic systems are in use, ensure data interface 

between systems. 

 c. In Progress - Standardize documentation for TBI to include capture of all 

data elements necessary for accurate classification of the injury, standard use of 

AHLTA templates, and uniform documentation of caregiver assistance (for 

TSGLI). 

 d. In Progress - Establish and formalize the procedure for all Army MTFs to 

report TBI data (utilizing a standardized definition and identification methodology) 

to DVBIC. Joint coordination required for Soldiers in non-Army MTFs. 

13. Physical Disability Evaluation System. 

 a. In Progress - Participate in a review of the PDES by the DA and DoD being 

conducted by specific process action teams. Monitor process improvement 

recommendations in the following categories: automation, counseling/training, 

medical evaluation board/physical evaluation board process, and transition. 

Evaluate and update AR 40-501, Standards of Medical Fitness to include specific 

guidance on TBI.