AAN position: Securing necessary neurological care for military personnel and veterans with brain and nervous system injury
The 好色先生 (AAN) is the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members – and the leading voice of brain health. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care, and treatment of brain, spinal cord, and nervous system diseases. These neurological diseases and disorders affect over one in two people in the United States and include Alzheimer’s disease, stroke, concussion, epilepsy, Parkinson’s disease, multiple sclerosis, headache, and migraine.
The AAN supports provision of the best possible care and treatment to optimize brain health for those currently in active military service and Veterans. Brain injury, including repetitive and sub-concussive insult(s), may lead to cognitive dysfunction, epilepsy, headaches, sleep and circadian disorders, mood dysregulation, neurodegenerative diseases, along with other motor and sensory neurological complications, and is linked to increased rates of mental health disorders and risk for suicide. Some of these exposures are associated with an increased risk of developing neurological diseases, which may have a delayed onset and/or manifest over the course of a lifetime. Service members often faced multiple, compounding brain health risks. Participation in combat, military operations, and training is associated with exposures to chemicals, radiation, air pollutants, occupational hazards, and chemical and biological weapons. Since the federal Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (“the PACT Act”) became law and expanded eligibility for United States Veterans exposed to open burn pits and other toxins, there is growing interest in understanding the impact of military service exposures on general and brain health across military campaigns.
It is essential that the federal government allocate adequate resources to ensure all military service members and Veterans and have consistent and reliable access to the necessary interventions and the long-term treatment they require. Specifically, the AAN strongly advocates that Congress authorize and appropriate funds for:
- The Department of Defense (DoD) and the Department of Veterans Affairs (VA) to continue to promote a system-wide approach for disease monitoring and identification of individuals who sustain TBI and those with exposure to percussive/blasts and injuries, and subsequent monitoring for neurological illness related to TBI and other military related exposures throughout the course of military service.
- The DoD and the VA to support comprehensive efforts to evaluate, treat, and prevent repetitive low-level blast exposures and other sub-concussive injuries, with a focus on advancing the understanding and reducing the risk of potential long-term cognitive and behavioral sequelae.
- The DoD and the VA to ensure sleep disorders, including sleep apnea, insomnia, and circadian rhythm sleep disorders, which are common after TBI and can impair recovery, are routinely and promptly identified and treated in military personnel and Veterans with brain injury.
- The VA to fully integrate, coordinate, and expand the multi-disciplinary polytrauma and TBI programs that in addition to neurology, may include neurosurgery, sleep medicine, mental health, and rehabilitative services. These services should be recognized as equal partners in the delivery of brain injury care in polytrauma centers and related initiatives, ensuring coordinated and integrated support for individuals affected by brain injury.
- The VA to maintain and expand Neurology Centers of Excellence (Epilepsy, Headache, Multiple Sclerosis, and Parkinson’s disease) to ensure they are accessible to all Veterans with brain injury. The VA should also implement Epilepsy, Headache, Multiple Sclerosis, and Parkinson’s disease referral clinics in all Veterans Integrated Service Networks (VISNs).
- The VA to support telehealth, including tele-mental health and tele-rehabilitation services, to improve access to treatment. Services may include transmission and administration or review of a variety of tele-neurology services, including but not limited to: neuropsychological assessment; transmission of videonystagmography (VNG); or electroencephalogram (EEG) recordings to appropriate experts for interpretation. This should also include telehealth referrals to appropriate Centers of Excellence (e.g. Epilepsy Centers of Excellence) and aligned programs within the VA system (e.g. VA Polytrauma System of Care).
- The DoD and the VA, in partnership with other federal agencies, to build on the advancements in neuroimaging and electrophysiological technologies to enhance the detection of both structural and functional brain abnormalities, thereby improving diagnostic accuracy and informing targeted treatment strategies for brain injury and associated disorders.
- The DoD and the VA to conduct outreach efforts to military personnel and Veterans who had a potential brain injury, especially those who are discharged and returning to rural communities facing challenges in access to care.
- The VA to support programs to train Veterans, their families, caregivers, and personal care attendants in the skills necessary to manage the long-term consequences of brain injury and all associated neurological complications and care needs. The VA should continue to develop vocational rehabilitation programs for community reintegration of those Veterans with brain injury who are capable of contributions back into the workforce.
- The DoD and the VA to continue utilizing panels comprised of front-line medical providers and individuals with expert knowledge and specialty training in brain injury, including neurologists, neurosurgeons, psychiatrists, sleep and circadian rhythm specialists, and rehabilitation specialists, to assist in the implementation of these recommendations.
- The VA to support prevention services in addition to rehabilitation for Veterans with exposure to brain injury. In addition, the VA should continue to support prevention and other related services to optimize life-long brain health and reduce the risk of other neurological disorders (e.g. stroke, dementia).
- The DoD and the VA to invest in understanding best practices regarding the provision of comprehensive, effective, patient-centered care tailored to specific neurological conditions and the comorbidities known to be associated with neurotrauma and toxic exposures.
- The DoD and the VA to conduct research to explore which neurological conditions may be associated with individual and combinations of military exposures, including the breadth of neurotrauma (e.g. TBI, Spinal Cord Injury) and toxic exposures (e.g., open burn pits, chemical and biological weapons), as well as future developments in warfare.