AFGHANISTAN, IRAQ VETS EXPECTED TO NEED LONG-TERM HEALTH CARE

The Veterans Administration lacks a mandate and resources to forecast the future health care and disability needs of Afghanistan and Iraq war veterans and their families, limiting the agency's ability to plan for infrastructure, work force, and other requirements where demand is likely to be greatest, says a report by the Institute of Medicine.

According to the report, the VA needs to institute a process of forecasting the amount and types of resources necessary to meet the needs of the veteran and their families in the next three decades or more when their demand for health care and disability compensation is likely to peak.

Requests for disability care and compensation by veterans of previous wars did not peak until 30 years or more after their service ended, suggesting that the maximum demand on support services for military personnel of current wars and their families may not occur until 2040 or later, the report notes.

Many wounds suffered in Afghanistan and Iraq will persist over veterans' lifetimes, the report points out, and some impacts of military service may not be felt until decades later.

Requested by Congress and sponsored by the U.S. Department of Defense, the study calls for the VA to institute annual projections of the future health and disability benefits of West Asia war veterans and their families.

Traumatic brain injury (TBI) has been identified as the signature wound of the Afghanistan and Iraq wars. But the VA lacks protocols to manage lifetime effects of TBI because the issue has not been studied in either military or civilian populations.

The report maintains that the VA should sponsor research to determine the efficacy and cost effectiveness of developing protocols for the long-term management of polytrauma and TBI.

To help current and former military personnel of ongoing wars and their families readjust to post-deployment life, the VA and the Department of Defense need to gather information to answer many uncertainties, the study contends.

The information required includes how many mental health care providers are needed and where, what works best in treatment of TBI over the long term, and whether giving service members time to decompress before returning home would be beneficial.

The report further calls for VA and DOD to oversee coordination and communication among the dozens of public and private programs created to serve current and former Iraq and Afghanistan service members, veterans and their families.

An independent evaluation of the programs should be organized by these two agencies, the report suggests, given that it is unclear whether they are effective and whether redundancy among te programs help ensure the needs of service members, veterans and their families.

The study represents preliminary findigs of the two-phase study of the readjustment needs of current and former service members deployed to Iraq and Afghanistan and their families.

In the first phase, the authors sought to identify the most pressing needs of this population through an initial review of the limited scientic literature available as well as reports and testimony from veterans and their families at town hall meetings.

The second phase report will present more detailed findings and recommendations based on an in-depth review of additional information, including data anticipated from several ongoing studies.

The committee that wrote the report was chaired by Dr. George W. Rutherford, Salvatore Pablo Lucia Professor and Vice Chair of the Department of Epidemiology and Biostatistics and Director of Prevention and Public Health Group, Global Health Sciences, University of California.

Members of the committe included representatives of the Harvard Medical School Department of Psychiatry; Duke University Medical Center; Johns Hopkins University Applied Physics Laboratory; Ohio State University Department of Physical Medicine and Rehabilitation; the National Bureau of Economic Research; Georgetown University Department of Psychiatry; George Washington University Department Neurology