House Veterans Affairs Oversight and Investigations Subcommittee Holds Hearing on Incidence and Care for TBI-Related Vision Disorders
April 3, 2008
On April 2, the Subcommittee on Oversight and Investigations of the House Committee on Veterans’ Affairs held a hearing to investigate the incidence of combat-related eye injuries, particularly visual dysfunction associated with Traumatic Brain Injury (TBI).
Left to right: Cong. Eric Cantor (R-VA), who introduced constituent witnesses Angela and Bryan Pearce, Tom Zampieri (Blinded Veterans Association), and Glen Minney. In addition to significant visual impairment from TBI, both Mr. Pearce and Mr. Minney experience cognitive disorders.
TBI, often cited as the “signature injury” of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), comprises a wide range of physical, psychological, and emotional symptoms. Epidemiological studies indicate that 80 percent of the 3,900 troops reported by the Defense Veterans Brain Injury Center (DVBIC) with TBI have reported some visual problems. However, these studies are questioned, as often troops with other, more serious TBI symptoms do not have their vision measured for dysfunction. Additionally, since visual and cognitive issues may not appear short-term, the long-term impact of TBI in this conflict has been likened to the long-term impact of Agent Orange exposure in the Vietnam conflict.
Testimony was provided by two veterans—Bryan Pearce (U.S. Army Staff Sergeant, retired), accompanied by his wife Angela, and Glen Minney (U.S. Navy Petty Officer, retired)—coordinated by NAEVR contributor Blinded Veterans Association (BVA, which also testified), as well as by representatives of the Department of Defense (DOD) and Department of Veterans Affairs (VA).
After dramatic testimony by the veterans, who detailed their injuries, the aftermath of DOD and VA care, and the ongoing impact on their families, BVA’s Tom Zampieri summarized concerns that include:
The final panel of witnesses consisted of representatives from the VA and DOD. The VA witnesses emphasized efforts to address TBI-related injuries, citing the creation of four national Polytrauma Treatment Centers, which were described as uniquely positioned to address the complex needs of veterans suffering from the variety of disorders associated with TBI. The representatives cautioned that the VA research conducted to date should be classified as "preliminary," as much more needs to be done to better diagnose and treat veterans with vision dysfunction associated with TBI.
- Seamless transition from DOD to VA care, especially the current lack of portability of medical records;
- Lack of accurate numbers on combat-related eye injuries, especially visual disorders associated with TBI that can be short- and long-term; and
- The need for Congress to fund the Military Eye Trauma Center of Excellence and Eye Trauma Registry, which were provisions of the Military Eye Trauma Treatment Act authorized in the FY2008 Defense Authorization Act but not funded.
The DOD witnesses described the progress in creating the Military Eye Injury Registry, which is being developed jointly by the DOD and VA, citing a February 28 meeting between representatives of the two Departments to plan for the establishment of a Military Eye Trauma Center of Excellence. At this time, the DOD and VA representatives indicated their intent to manage the Eye Trauma Center of Excellence separately from other Centers (such as for TBI Post Traumatic Stress Disorder, or PTSD), although they would maintain a close collaboration. In response to a question by Subcommittee Chairman Harry Mitchell (D-AZ), who asked why the eye trauma Center of Excellence should be separate from a TBI Center, the DOD replied that, while the two Centers would certainly work closely, many vision-related problems are not TBI-related and, therefore, the eye trauma Center needs to be independent.
NAEVR’s James Jorkasky and Cong. David Hobson (R-OH), who introduced constituent Mr. Minney, who now serves as an advocate for veterans issues.
Chairman Mitchell, referring to the 10 month gap between injury and the TBI diagnosis described by Mr. Minney, asked if all troops with TBI resulting from exposure to blasts are tested for visual dysfunction. The DOD replied that, although it currently depended on the context of the blast, primarily a soldier’s proximity, a complete analysis of the exposure to blasts is needed to determine what screening is needed for individual troops. In addition, the DOD does both pre- and post-deployment health assessments, as well as follow-up assessments, which help identify health problems that might not get reported.
Finally, the DOD acknowledged that its vision research has focused primarily on eye disease, not on TBI-related visual dysfunction.
A final question concerned collaborative VA/DOD TBI-related eye trauma research, to which both the VA and DOD representatives responded was currently not extensive.