Introducing Two New VA

Initiatives on Traumatic 

Brain Injury in Veterans

Informing and improving diagnosis and treatment of traumatic 

brain injury in Veterans

I N I T I AT I V E S

Traumatic Brain Injury Veterans Health Registry page 2

National Health Study for a New Generation of US Veterans/The MIND Study

(Markers for the Identification, Norming, and Differentiation of TBI and PTSD) page 3

Traumatic brain injury (TBI) may result from an impact to the head 

or a penetrating trauma. In military situations, TBI can also occur 

without any visible wounds when explosives jar the brain inside the 

skull. Symptoms of a TBI range from headaches, irritability, and sleep 

disorders to memory problems, slower thinking, and depression. More 

serious injury can result in more significant neurological problems. 

Because TBI can affect how a person thinks and acts, even mild brain 

injuries can significantly disrupt the lives of Veterans and their 

families. In addition, military events that cause TBI, typically blasts, 

are extremely stressful to experience. TBI can be present along with 

posttraumatic stress disorder (PTSD) and the symptoms can overlap. 

Accurate diagnosis of TBI and PTSD and effective treatments are 

essential.

The TBI Veterans Health Registry and New Generation/MIND study are part of the Department of Veterans Affairs 

efforts to improve the outcome of traumatic brain injuries in our Nation’s Veterans.

Images of the white matter tracts in the 

normal brain using diffusion tensor imaging 

tractography, an advanced technique that 

measures the movement of water molecules 

within brain cells.*

*Wakana S, Jiang H, Nagae-Poetscher LM, van Zijl PC, Mori S. “Fiber Tract-based Atlas of Human White Matter Anatomy.” Radiology. (January 2004);230(1):77-87. 

 Published online (November 2003). Accessed March 14, 2009.
Traumatic Brain Injury Veterans Health Registry

The TBI Veterans Health Registry will provide military and civilian researchers with data on a large number of 

well-documented cases of TBI in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OFI) Veterans. 

This data resource will allow for comparisons of screening, diagnostic methods, and treatment options with 

the goal of improving outcomes for Veterans who have experienced this injury.

The National Defense Authorization Act of Fiscal Year 2008, Public Law 110-181, Section 1704 (d), requires the Secretary of Veterans 

Affairs to establish and maintain a Traumatic Brain Injury (TBI) Veterans Health Registry. The registry must include information 

about each individual who served as a member of the Armed Forces in Operation Enduring Freedom or Operation Iraqi Freedom who 

exhibits symptoms associated with TBI and applies for care and services from VA or files a claim for compensation from VA on the 

basis of any disability. 

VA is to collaborate with the TBI rehabilitation research community, grantees of the National Institute of Disability and Rehabilitation Research (NIDRR) of the Department of Education, the Department of Defense and Veterans Brain Injury Center (DVBIC), and 

other Governmental entities engaged in TBI rehabilitation. VA is to notify individuals listed in the registry of significant developments in research on the health consequences of military service in OEF/OIF. 

VA signed an interagency agreement with NIDRR in August 2008 to develop an inclusive TBI Veterans Health 

Registry and to create and maintain a mechanism to include data from the four VA Polytrauma Rehabilitation 

Centers, VA Office of Patient Care Services, into the nationwide network of the TBI Model Systems (TBIMS) 

database. The TBIMS is a NIDRR project to systematically collect longitudinal data on TBI patients nationwide. 

Inclusion of VA patients into the TBIMS strengthens both NIDRR’s and VA’s ability to better understand TBI.

REGISTRY ELEMENTS

• Demographics – descriptive information such 

 as gender, age, race/ethnicity, education level

• Military service data

• Medical histories predating a TBI

• Causes and severity of injuries

• Treatment histories

• VA disability claim status

• Vital status and cause of death if applicable

RESEARCH USES OF THE REGISTRY

• Determine the number of TBI cases incurred during 

 Operation Enduring Freedom and Operation Iraqi 

 Freedom, as well as the medical resources accessed 

 by Veterans

• Compare the distribution of TBI cases across age, 

 sex, branch of military service, military occupation 

 category, and geographic region

• Evaluate treatment outcomes to guide future 

 research and policy development

• Compare symptoms, treatment, and outcomes of 

 war related TBI to TBI in civilian patients 

• Reconstruct timelines of symptom occurrence and 

 compare progression of moderate versus severe TBI

• Examine the association of TBI with other medical 

 conditions, including PTSD, depression, memory 

 loss, sensory deprivation, and seizure

Leading the TBI Veterans Health Registry: VHA Environmental Epidemiology 

Service, Office of Public Health and Environmental Hazards (Dr. Han K. Kang), 

and VHA Rehabilitation Service, Office of Patient Care Services 

(Dr. Lucille B. Beck).

I N I T I AT I V E 1

2

VA researchers study a Magnetoencephalography (MEG) scan of the 

brain, which captures electromagnetic signals from brain cells.
National Health Study for a New Generation of US Veterans/The MIND Study

(Markers for the Identification, Norming,* and Differentiation of TBI and PTSD)

The New Generation Study will use surveys and interviews to follow 60,000 Veterans—deployed and nondeployed— 

for 10 years. It will assess a variety of health conditions, including TBI and PTSD. The study is an unprecedented 

effort to better understand the health concerns and behavioral risk factors of Veterans who have served in the 

conflicts in Afghanistan and Iraq. The study’s special emphasis on TBI will allow for indepth followup of individuals 

who have experienced a TBI, or who have experienced symptoms of TBI, and the pursuit of clinical investigation 

into diagnostic methods, comorbid conditions, and treatments. 

From the participants in the New Generation Study, the MIND Study will take a sample of veterans who have 

symptoms of TBI and/or PTSD, and a comparison group of veterans, to receive further physical evaluation 

and diagnostic testing at one of the three VA War Related Illness and Injury Study Centers (WRIISCs). It will 

clarify differential diagnoses between TBI and PTSD and build objective, consistent, and operator-independent 

diagnostic criteria.

NATIONAL HEALTH STUDY FOR A NEW GENERATION OF US VETERANS

Assess the health status of 30,000 OEF/OIF deployed and 30,000 nondeployed veterans via 

mail surveys, online surveys, and telephone interviews every 3 years for 10 years 

Screen to determine those who are positive for TBI and/or PTSD

Select a subsample who have TBI and/or PTSD symptoms and a comparison group

THE MIND STUDY (MARKERS FOR THE IDENTIFICATION, NORMING, AND 

DIFFERENTIATION OF TBI AND PTSD)

Conduct an in-person clinical study that will include advanced diagnostics: neuroimaging of the 

brain, sleep studies, and neuroendocrine measures to clarify differential diagnoses between TBI 

and PTSD and build objective, consistent, and operator-independent diagnostic criteria

The New Generation study will begin to collect data in 2nd quarter FY 2009. By 3rd quarter 

FY 2010 the subsamples of veterans with TBI or PTSD will be identified and brought in to 

the WRIISCs in Washington, DC; East Orange, NJ; and Palo Alto, CA to begin the MIND Study.

Leading the New Generation and MIND Studies: VHA Environmental Epidemiology Service 

(EES), Office of Public Health and Environmental Hazards (OPHEH), and the War Related 

Illness and Injury Study Centers, OPHEH.

I N I T I AT I V E 2

3

*“Norming” refers to developing average or standard values (norms) of a health measure by studying that measure in a large number 

 of individuals. In the MIND Study, norms will be used to compare people with TBI or PTSD with people without these conditions. 

 Norms will also be used to study the severity of these conditions. 
RESOURCES

VA TBI/Polytrauma System of Care

www.polytrauma.va.gov/index.asp

VA National Center for Posttraumatic Stress Disorder 

www.ncptsd.va.gov/ncmain/index.jsp

VA Returning Service Members (OEF/OIF) Web Site

www.oefoif.va.gov

VA Office of Public Health and Environmental Hazards (OPHEH)

OPHEH includes the Environmental Epidemiology Service and the War Related Illness and Injury Study 

Centers program. 

www.publichealth.va.gov and www.warrelatedillness.va.gov

National Institute on Disability and Rehabilitation Research (NIDRR), Department of Education

www.ed.gov/about/offices/list/osers/nidrr/index.html

Defense Centers of Excellence (DCoE) for Psychological Health & Traumatic Brain Injury

This program leads a collaborative effort toward optimizing psychological health and traumatic brain injury (TBI) 

treatment for the Department of Defense (DoD). The Department of Defense and Veterans Brain Injury Center (DVBIC) 

is a component of DCoE. 

www.dcoe.health.mil/default.aspx

Brain Injury Association of America (BIAA)

This national organization serves individuals, families, and professionals touched by traumatic brain injury (TBI).

www.biausa.org

800-444-6443

OFFICE OF PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS

Environmental Epidemiology Service (EES): The EES conducts research whose 

results help health professionals and policymakers, including VA and Congress, 

improve health care practices and policies for Veterans.

War Related Illness and Injury Study Centers: The WRIISCs, pronounced “risks,” 

offer services to combat veterans, families, and health care providers on 

deployment-related health concerns. These services include clinical care, research, 

risk communication, and educational programs. 

OFFICE OF PATIENT CARE SERVICES

TBI/Polytrauma System of Care (PSC): The Department of Veterans Affairs has 

implemented an integrated nationwide network of care for Veterans and active 

duty service members recovering from traumatic brain injury and polytrauma. 

Due to the severity and complexity of their injuries, Veterans and service members 

with TBI and polytrauma require an extraordinary level of care coordination and 

integration of clinical and other support services. The Polytrauma System of Care 

includes four Polytrauma Rehabilitation Centers (PRC), 22 Polytrauma Network 

Sites (PNS), and 81 Polytrauma Support Clinic Teams (PSCT), as well as 49 Polytrauma 

Points of Contact (PPOC). Polytrauma/TBI Case Management and Care Coordination 

is integrated throughout the PSC. The Polytrauma System of Care is coordinated 

by the Rehabilitation Service, a part of the Office of Patient Care Services.

Environmental Epidemiology Service

Office of Public Health and Environmental 

Hazards (13)

202-266-4695

800-211-5272

TBI/Polytrauma System of Care 

Rehabilitation Service

Office of Patient Care Services (11)

Veterans Health Administration

DEPARTMENT OF VETERANS AFFAIRS

www.va.gov

March 2009