Care During the Transition from the DoD to the VA
Every service member transitioning from the DoD to the VA is screened for TBI. If detected, a comprehensive evaluation is performed.
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The VA has--there's a memorandum of understanding between the VA and Department of Defense, where the VA can provide rehabilitation for spinal cord injury, traumatic brain injury, and blindness. So that memorandum of understanding has been in place, I believe, since the late '80s, and so the VA has traditionally done the rehabilitation for the Department of Defense. In the VA we have an electronic medical health record, and so every service member that has separated from Department of Defense after September 11, 2001, has an electronic trigger, or a clinical reminder that is due, and it's expected that that will be completed during their first clinical visit to the VA. So that typically happens in either primary care, mental health, dental, the women's clinic--that's typically where the screen is completed. it's a 4-question screen, and if the individual answers "yes" to all 4 questions, it doesn't mean that they've had a traumatic brain injury but they may have and they need a more comprehensive evaluation. That then triggers a consultation to a TBI specialist within the VA, and that's typically within a polytrauma team. They come in for a very comprehensive evaluation which includes a thorough history trying to document the historical facts of what happened during the trauma and did they indeed sustain a traumatic brain injury? Then once that happens, they're either diagnosed with traumatic brain injury, or possibly some other diagnosis, and oftentimes multiple co-morbid conditions. And then the rehabilitation team then takes those diagnoses, works with the individual to develop an individualized treatment plan to help them meet their needs. So it's very much an individualized approach, which is really key to treating any traumatic brain injury.
Posted on BrainLine February 15, 2012.
Joel Scholten, MD is associate chief of staff for Rehab Services at the Washington, DC VA Medical Center. He also works in VA Central Office within the PM&R Program Office as the national director of Special Projects.
Produced by Ashley Gilleland and Victoria Tilney McDonough, BrainLine.