With time quickly running out before Congress’ month-long recess in August, lawmakers were able to keep a small but critical program to help veterans with traumatic brain injuries (TBI) funded.
Would Congress Let Traumatic Brain Injury Care for Vets Expire?

Sadly, this critical program was already on life-support and Congress was about to let it expire. The recent scandals regarding the Veterans Administration (VA) treatment of veterans gave Congress and the President the political will to find funds to try to repair what’s broken at the VA.
Two legislators, in particular, grabbed the opportunity to slip in a provision that would keep this incredibly important TBI program funded. When this bill is signed into law, veterans living with TBI will be able to maintain their current level of care. The bill itself intends to better the VA health care system by expanding veteran access to private health care and by increasing the number of hospitals and medical staff who will treat the wounded warriors.
One of the invisible wounds of war, traumatic brain injury has affected more than 300, 000 American service members since 2000, according to Department of Defense reports. As improvised explosive devices detonated along roads and caught vehicle and foot patrols in their deadly fire, the head trauma experienced by wounded service men and women became the grim signature of the wars in Iraq and Afghanistan. To remedy the troubled Department of Veterans Affairs, Congress passed a bill to reform the VA and make efforts to rehabilitate veterans with TBI.
On Wednesday, July 30, the House of Representatives passed the VA reform bill with a 420-5 vote. The Senate passed the bill late on Thursday, July 31 with a 91-3 vote. President Obama signed the bill into law on Thursday, July 7 during an event at Fort Belvoir, Virginia. Although the main focus of the bill is the $16.3 billion VA overhaul, the bill also includes measures to aid veterans living with TBI.
The additional measure, sponsored by Senators Cory Booker, D-N.J. and Dean Heller, R-Nev., extends a VA pilot program for veterans with TBI an additional three years. The pilot program provides assisted living and therapy to veterans who suffer from moderate and severe TBI. In 2011 when the program began at the behest of Congress, the VA committed 20 certified residential brain injury providers to make services available at 150 sites across the nation.
“It is about giving [veterans] their practical skills that they need to return to their communities and live independently, ” Booker said in support of the bill. “That is what is so special about this program.”
The pilot program has helped veterans receive 24-hour team-based care at these facilities. The staff rehabilitates the wounded warriors both physically, by helping them walk independently, and mentally, by assisting them with speech therapy and improving their memory. Although this program has helped countless veterans, it was to expire in October if Congress could not gather enough support

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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