Looking decades ahead, the Institute of Medicine is urging the Veterans Affairs Department to begin planning now for the long-term health care needs of the estimated 1.9 million veterans of the Iraq and Afghanistan wars.
Specifically, the institute says in a report released Wednesday, not enough is known about what works best in the long term to treat veterans with traumatic brain injuries, often caused by roadside bombs.
While a multitude of public and private programs is available to help the men and women who have served in the recent conflicts, there is little coordination and sparse information about which ones are effective, the report said.
A 16-member panel coordinated by the Institute of Medicine instigated the review of the readjustment needs of troops, veterans and their families at the request of Congress. The institute is part of the National Academies, an independent organization chartered by Congress to advise the government on scientific matters.
Dr. Victoria Cassano, the VA's liaison to the institute, said many of the report's recommendations are "right on." Cassano said it covers important issues the VA is either already working on or will consider.
The report urged Congress to direct the VA to produce more detailed annual projections of the needs of veterans and their families, so more thorough planning can be done to prepare for an uptick in disability claims and health needs in the decades ahead as the veterans age.
Based on a review of disability claims from past wars, the report says the number of disability claims from recent veterans should peak around 2040.
"It's going to get worse before it gets any better," said Ryan Edwards, an economics professor from the City University of New York, who served on the panel. "We're going to see a larger burden ... and it will continue to expand."
The report praised the VA's work to establish rehabilitation services for those with traumatic brain injury, which is often called the signature wound of the Iraq war. But it said the VA should sponsor research into protocols for long-term care for those with traumatic brain injury because little research is available.
"It's an evolving area, and it's going to need to evolve more to keep up with the patient population," said Dr. George Rutherford, the panel chairman, who is a professor of epidemiology and biostatistics at the University of California, San Francisco.
Overall, the report said, the VA and Defense Department should better coordinate services available to veterans. It held up as a successful model Military OneSource, a one-stop online and telephone information source for military personnel and their families.
The study said the Defense Department needs to better address troops' reluctance to report mental health problems and should review how it handles confidentiality when a service member seeks help. It also encouraged the Defense Department and VA to hire more mental health professionals.
It could be helpful for service members returning home from war if there's an interim place they can go following time in combat to rest and prepare for the adjustment back to the U.S., the report said.
Navy Capt. Edward Simmer said the Defense Department is already looking for ways to address some of the problems discussed in the report. "The things we need to work on, we'll definitely get started with," Simmer said.
Simmer is the senior executive for psychological health at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Rosslyn, Va.
Next month, the panel starts a second, two-year examination of veterans' health issues.
On the Net:
Institute of Medicine: http://www.iom.edu/
Veterans Affairs Department: http://www.va.gov/
Military OneSource: http://www.militaryonesource.com/
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