Defense and veterans brain injury center: peacetime and wartime missions.

Congress created the Defense and Veterans Brain Injury Center (DVBIC) (previously known as the Defense and Veterans Head Injury Program) in 1992 during the Persian Gulf war to integrate specialized traumatic brain injury (TBI) care, research, and education across the military and veteran medical care systems [1]. TBI is a major cause of civilian and military death and disability among Americans, particularly among males and individuals in the young adult and elderly age groups. By the mid-1990s, the annual economic costs of TBI in the civilian sector, including direct costs of medical care, work loss, and disability and lost income resulting from premature deaths due to TBI, have been conservatively estimated at $56.3 billion [2]. This estimate was based on hospital-treated civilians with TBI during calendar year 1995 and did not include the treatment and work-loss costs for individuals with TBI who were treated in emergency departments or doctors’ offices or did not receive treatment. Moreover, this estimate did not adjust for undercounts of TBI in hospitalized patients [3]. And, of course, the overwhelming costs of reduced quality of life for survivors and family members cannot be captured in economic terms. As large a problem as TBI is in the civilian sector, it is even more a concern in military settings for several reasons. First, by virtue of the sex and age distributions of military personnel, they are at higher risk for TBI than the total civilian population, even in peacetime. Second, certain military occupations, such as parachuting, carry higher than average risks for TBI [4]. Third, war considerably increases combatants’ rate of both closed and penetrating TBIs. And fourth, military personnel, like committed athletes, may underreport mild TBIs, thereby decreasing unit or team efficiency and perhaps increasing risk of further injury. One concern of policy makers over time has been ensuring that military service members and veterans receive the best possible acute and ongoing care for TBI, whether received in peacetime or in combat.