Casey Urges Review of TRICARE’s Lack of Coverage for Brain Damage Therapy

WASHINGTON, DC—U.S. Senator Bob Casey (D-PA), Chairman of the Senate Foreign Relations Subcommittee on Near East and Central and South Asian Affairs, today urged Secretary of Defense Robert Gates and Veterans Affairs Secretary Eric Shinseki to address recent reports concerning the Department of Defense’s refusal to provide cognitive rehabilitation therapy to injured servicemembers under TRICARE.  

“An investigation by National Public Radio and ProPublica has brought to my attention that TRICARE will not cover a form of brain damage therapy known as cognitive rehabilitation therapy even though many studies have proven its efficacy,” Senator Casey wrote today in a letter sent to Secretary Gates and Secretary Shinseki. “With more than 178,000 servicemembers and veterans diagnosed with traumatic brain injuries since 2000, it is my sincerest hope that we continue to provide the latest innovative treatments that will allow these men and women to fully rehabilitate.”

In the letter, Senator Casey calls on Secretary Gates and Secretary Shinseki to provide information on a clinical trial on cognitive rehabilitation required by the FY 2010 National Defense Authorization Act and to address allegations in the NPR and ProPublica report that the study TRICARE used in its decision to deny coverage for cognitive therapies was flawed.

Cognitive rehabilitation therapy seeks to help patients overcome difficulties by identifying and changing dysfunctional thinking, behavior and emotional response. A recent Department of Defense panel of civilian and military experts unanimously agreed that cognitive therapy is effective at treating brain injuries, calling into question the decision to exclude this treatment from TRICARE coverage.  

Senator Casey has worked to restrict the flow of ingredients used to make improvised explosive devices (IED’s), the top killer of troops in Afghanistan and the cause of scores of debilitating injuries like traumatic brain injuries.

The full text of the letter is below:

Dear Secretary Gates and Secretary Shinseki,

An investigation by National Public Radio and Pro Publica has brought to my attention that TRICARE will not cover a form of brain damage therapy known as cognitive rehabilitation therapy even though many studies have proven its efficacy.  With more than 178,000 servicemembers and veterans diagnosed with traumatic brain injury since 2000, it is my sincerest hope that we continue to provide the latest innovative treatments that will allow these men and women to fully rehabilitate.

As the Chairman of the Senate Foreign Relations Subcommittee on Near East and Central and South Asian Affairs, I have been focused on combating the precursor ingredients, like ammonium nitrate, used in improvised explosive devices (IED).  As you are well aware, IEDs are the most lethal threat to our servicemembers in Afghanistan which have resulted in scores of debilitating injuries, like traumatic brain injury.    

It is my understanding that on April 28, 2009, a working group of members from the Defense Centers of Excellence for Psychological Health and Traumatic Brian Injury and Defense and Veterans Brain Injury Center unanimously concluded, that cognitive therapy was an effective treatment.  They recommended that the Department of Defense “further discuss cognitive rehabilitation as a separate reimbursable rehabilitation technique for the traumatic brain injured with persistent cognitive deficits.” However, TRICARE determined that it could not cover this therapy because its study showed that cognitive therapy was not a well proven therapy.

As a nation, we must remain committed to providing rehabilitative care.  According to the Defense and Veterans Brain Injury Center’s May 20, 2010 report, by the first quarter of this year, more than 7,600 cases of traumatic brain injury were diagnosed.   The FY’10 National Defense Authorization required the Department of Defense to conduct a clinical trial on cognitive rehabilitation and to submit a report on the outcome of that trial.  I would ask that you provide the Department’s assessment and conclusions for that pilot program.

I would also ask you to address the allegations in the enclosed article relating to internal and external reviewers’ findings significant flaws in the TRICARE study.

I want to thank both of you for your leadership to ensure the health and well-being of returning servicemembers.  I look forward to working with you on this issue.

                                                            Sincerely,                     

                                                            Robert P. Casey, Jr.
                                                            United States Senate

                                                                        
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