Половина ветеранов с положительным скринингом на ТБИ не получили комплексную оценку в системе Ветеранских дел

The Department of Veterans Affairs successfully screened the overwhelming majority of eligible post-9/11 veterans for possible traumatic brain injury. That’s the good news. What happened after some veterans screened positive is much more concerning. A new nationwide review from the VA Office of Inspector General found that the Veterans Health Administration screened 94.4 percent of eligible post-9/11 veterans in the population it reviewed for possible deployment-related traumatic brain injury. But approximately half of the veterans who screened positive, agreed to further evaluation, and should have received a comprehensive TBI evaluation never received that assessment. The findings raise an obvious question: What good is identifying veterans who may have a brain injury if the system doesn’t consistently get them to the next step? VA’s TBI Screening Program The VA has required traumatic brain injury screening for certain post-9/11 veterans since 2007. The initial screening consists of four questions designed to identify veterans who experienced events that could have caused a TBI and who currently experience symptoms potentially associated with those events. A positive screening does not mean a veteran has been diagnosed with traumatic brain injury. Instead, it means further evaluation may be warranted. Veterans who screen positive are supposed to be offered a Comprehensive Traumatic Brain Injury Evaluation, or CTBIE, conducted by a specialty provider. That evaluation is where clinicians can dig deeper into the veteran’s history, symptoms, possible injuries, and current medical needs. And that’s where the Inspector General found significant problems. Approximately Half Didn’t Receive the Evaluation The VA Office of Inspector General launched its national review in December 2024 after concerns about the screening and evaluation process. Investigators examined post-9/11 veterans who had separated from active duty and received VA medical care through March 31, 2025. Overall, VA’s screening rate was impressive. 94.4 percent of veterans who should have been screened received the initial TBI screening. But among veterans who screened positive and agreed to receive a comprehensive TBI evaluation, approximately half did not ultimately receive one. That’s not a minor administrative detail. The initial screening cannot diagnose a traumatic brain injury. Without the comprehensive evaluation, a veteran who screens positive may never receive the clinical assessment designed to determine whether a TBI occurred and whether rehabilitation or additional treatment is appropriate. Even Completed Evaluations Were Often Late … The Inspector General also examined more recent VA performance to determine whether the situation had improved. There was progress. From October 1, 2023, through September 30, 2024, the VA improved the rate at which comprehensive TBI evaluations were completed. But another problem remained. More than half of the completed evaluations were not performed within the required timeframe. In other words, even when veterans eventually received the assessment, many waited longer than VA policy required. For someone experiencing headaches, memory problems, dizziness, difficulty concentrating, sleep disturbances, mood changes, or other symptoms potentially connected to a brain injury, delays matter. Why Were Veterans Falling Through the Cracks? The Inspector General identified several problems … In some cases, VA staff failed to place the necessary referral for a comprehensive evaluation. Scheduling difficulties also interfered with veterans receiving timely assessments. The OIG additionally found that VA’s Polytrauma System of Care had resources, including telehealth capabilities, that could help expand access to specialized evaluations. Those resources weren’t being used to their full potential. That finding is especially noteworthy because VA has recently highlighted TeleTBI, a program designed specifically to connect veterans with specialized traumatic brain injury care through telehealth. The technology and clinical expertise exist. The challenge is making sure veterans actually reach them. There’s Another Problem With Repeat Screenings The OIG discovered a more technical flaw that could also have real consequences for veterans. VA’s comprehensive TBI evaluation template is designed for one-time use after a positive screening. That can become a problem when a service member separates, enters VA care, screens positive, and is evaluated, then later returns to active duty.If that individual subsequently separates again and screens positive following another deployment or potential brain injury, the existing system may prevent clinicians from using the comprehensive evaluation template again. The Inspector General recommended that VA review this limitation and consider allowing additional evaluations to be documented when veterans screen positive after a subsequent separation. Why a Comprehensive Evaluation Matters … Traumatic brain injuries can be complicated. Symptoms can overlap with PTSD, depression, chronic pain, sleep disorders, and other conditions common among veterans. Some injuries are obvious immediately. Others are not. That’s precisely why a positive screening is only the beginning. A comprehensive evaluation gives specialty providers an opportunity to examine the circumstances surrounding a possible injury, assess current symptoms, determine whether a TBI diagnosis is appropriate, and recommend treatment or rehabilitation when necessary. Depending on the veteran’s needs, that may involve professionals from physical rehabilitation, occupational therapy, speech-language pathology, psychology, social work, and other specialties. Missing that evaluation can mean missing an important opportunity to understand what is happening. VA’s Watchdog Wants Changes The Office of Inspector General issued three recommendations. First, VA should review its referral process and make sure veterans with positive TBI screens who want further assessment actually receive referrals for comprehensive evaluations. Second, VA should consider creating a uniform referral process for using resources available through its Polytrauma System of Care. Third, VA should review the one-time restriction on its comprehensive evaluation template so veterans who screen positive after another period of active-duty service can receive and document another assessment. VA leadership concurred with the first two recommendations and concurred in principle with the third. Now comes the important part: Implementation. What Veterans Should Do Veterans should understand that a positive TBI screen is not the same as a diagnosis. If you’ve previously screened positive for possible deployment-related TBI but don’t remember receiving a comprehensive evaluation afterward, it’s worth asking your VA healthcare team what happened next. You can ask whether: A Comprehensive Traumatic Brain Injury Evaluation was ordered. The evaluation was completed and documented in your medical record. A referral to a TBI or Polytrauma specialist is appropriate. TeleTBI services could help if distance or transportation makes specialty care difficult. Veterans experiencing symptoms they believe may be connected to a previous head injury or blast exposure should also discuss those concerns directly with their healthcare provider. Final Thoughts … The VA deserves credit for screening 94.4 percent of the post-9/11 veterans who should have been screened in the population examined by investigators. That’s a significant accomplishment. But screening is only useful when the system responds to what the screening finds. When a veteran screens positive for a possible traumatic brain injury, agrees to further evaluation, and then never receives it, the process has stopped at exactly the point where deeper clinical care should begin. The Inspector General’s report doesn’t suggest every veteran who missed an evaluation had a traumatic brain injury. That’s precisely the problem. Without the evaluation, clinicians may never have had the opportunity to determine whether they did. Finding a possible problem is step one. Making sure the veteran receives the care needed to understand it has to be step two. If you previously screened positive for a possible traumatic brain injury through the VA but aren’t sure whether you received a Comprehensive TBI Evaluation, contact your VA healthcare team and ask. Veterans facing barriers to specialized TBI care can also ask whether VA’s Polytrauma System of Care or TeleTBI services may be available. And continue following DisabledVeterans.org as we track VA watchdog investigations, healthcare developments, disability benefits, and the systems responsible for delivering the care veterans earned.