DoD must provide official Tri-Care coverage for Cognitive Rehabilitation Therapy

The issue of Tri-Care coverage for cognitive rehab therapy is so incredibly important for the long term care and recovery of our wounded warriors.  I’d like to share with you a letter to Robert M. Gates, Secretary, U.S. Department of Defense from some United States congressmen and woman who understand the importance of long term care for our wounded warriors.  Our military men and women honor our country and our government by putting their lives on the line without questioning the politics or motivation behind such orders.  Some of them pay the ultimate sacrifice by giving their lives.  Others will spend the rest of their lives trying to recover from the injuries they sustained from the sacrifice they made for their country.  As the letter below states, 320,000 troops (and counting) returning from OEF and OIF have experienced some form of traumatic brain injury (TBI).  We as a nation, MUST provide the best possible care and give these men and woman the best possible chance for recovery possible.  NO EXCUSES!

United States Senate
Washington, D.C. 20510

August 4, 2008

The Honorable Robert M. Gates
Secretary, U.S. Department of Defense
1000 Defense Pentagon
Washington, DC 20301-1000

Dear Secretary Gates:

A recent study conducted by the RAND Corporation found that 320,000 troops, or 19 percent of all service members, returning from Operations Enduring Freedom and Iraqi Freedom may have experienced a traumatic brain injury (TBI) during deployment.

We are concerned that at a time when TBI is recognized as the signature wound of the conflicts in Iraq and Afghanistan, one of the most widely accepted and critical rehabilitative treatments for this injury, known as cognitive rehabilitation therapy, is excluded by the military’s TRICARE health insurance program.

Cognitive rehabilitation is a proven regime of medical and therapeutic services designed to improve brain functioning.  Service members who sustain brain injuries frequently have difficulties in attention, concentration, memory, problem-solving, and decision-making that impede their ability to function in everyday activities.  Timely treatment of cognitive dysfunction is vital to the recovery process, as it impacts personal safety, functional independence, productive living, psychological health and social interaction.  Therefore, we urge you to provide official TRICARE coverage for cognitive rehabilitation as an instrumental therapy in the recovery process of America’s wounded warriors.

While the Department of Defense and Veterans Administration have made recent strides to improve our institutional capacity to treat TBI at military and VA hospitals, often the best care for this complex injury is available only from private providers at outside care facilities.  Given the rate of TBI among returning service personnel, we must redouble efforts to remove access barriers to proven therapies.  The Department of Defense Task Force on Mental Health last year issued a recommendation that TRICARE access standards be changed to consider basic mental health care in the same category as primary medical care.  Embracing this recommendation is central to any successful, time-sensitive strategy to treat the invisible wounds of war.  This is particularly true for our most gravely wounded combat veterans.  According to figures provided by your office, 19,922 service members were medically retired with serious injuries in 2007 alone.  We believe these soldiers should be able to access cognitive rehabilitation services at outside care facilities.

We understand that TRICARE authorities have cited a lack of evidence attesting to the efficacy of cognitive rehabilitation as a justification for not covering this treatment.  This assessment contradicts the clear clinical consensus of the American medical community, which recognizes the instrumental role that these therapies play in minimizing disability and maximizing recovery of function in patients with a TBI.  Access to cognitive rehabilitation is a basic element of the continuum of care for brain injury patients.  The National Institutes of Health, the National Academy of Neuropsychology, the Brain Injury Association of America, and the American Speech-Language-Hearing Association validate cognitive rehabilitation as a proven, not an experimental, treatment for TBI.  Numerous public and private insurers currently provide coverage for cognitive rehabilitation in recognition of its proven therapeutic value in treating severe brain injuries.  As of 2006, fourteen states included cognitive rehabilitation under the Medicaid Home and Community-Based Services Waivers.

Individuals who have incurred a traumatic brain injury while serving their country deserve nothing less than the appropriate level of care based on currently accepted and widely utilized treatment modalities.  As in every area of modern medicine, the research and evidence base for treatment of brain injuries continues to evolve.  Service members with a TBI need appropriate and timely treatment options to address cognitive impairments, and best practices must be based on the available body of knowledge at the current time.  While further research in this area is ongoing and appropriate, our military healthcare system should err on the side of providing proven treatment given the serious lifelong consequences of an untreated or under-treated brain injury.

The national media have reported many anecdotal cases of individuals who attest to the vital role that cognitive rehabilitation plays in facilitating meaningful recovery from brain injury. One such example is ABC News journalist Bob Woodruff, who was injured by a roadside bomb in January 2006 while reporting from Iraq.  His remarkable recovery from a severe TBI has been widely cited as a powerful example of the great innovations of our military healthcare system.  Mr. Woodruff has repeatedly emphasized that his cognitive rehabilitation therapy was a vital part of his healing process.  Yet the treatment made available to Mr. Woodruff may be denied to U.S. military personnel who are similarly afflicted.

Congress recently enacted a historic GI bill to honor our responsibility to Iraq and Afghanistan veterans who return home seeking an education and a better future for their families. We have no less of a responsibility to maximize the potential of our wounded warriors returning from battle nursing the wounds of war. Given the prevalence of TBI among returning service personnel, it is difficult to comprehend why the military’s managed healthcare plan does not cover the very therapies that give our soldiers the best opportunities to recover and live full and productive lives.  We are committed to appropriating the necessary funding to ensure that injured service members receive the world-class healthcare they deserve.

Therefore, we urge the Department of Defense to provide official TRICARE coverage of cognitive rehabilitation therapies, so that all returning service personnel can benefit from the best brain injury care this country has to offer.

Thank you for your continued service.


Evan Bayh, United States Senator
Barack Obama, United States Senator
Hillary Rodham Clinton, United States Senator
Ken Salazar, United States Senator
Edward M. Kennedy, United States Senator
Joe Lieberman, United States Senator
Jeff Bingaman, United States Senator
John F. Kerry, United States Senator
Blanche L. Lincoln, United States Senator
Claire McCaskill, United States Senator
Cc:  Brigadier General Loree Sutton, Major General Elder Granger

Sam’s medical status: I just said hi to Sam over the phone a few  minutes ago–and of course, he said hi back to me!  He continues his steady improvement in talking and Imported Photos 00008continues his cognitive recovery.  Erin said that even though he has days when he’s feeling listless, when Sam gets into therapy, he really works hard to improve his previous days results.  Erin asked him yesterday why he tries so hard in therapy even when he’s not feeling well and he told her, “cuz I love you so much”.  The picture is Sam “going solo” in his motorized wheel chair in the halls of Kentfield Rehabilitation Hospital.  I believe he no longer needs to use the mask as of this week.  All the little micro-organisms that he brought back from Iraq should be out of his system.

Sam is still having seizure issues.  He had one this morning for 20 minutes and a few days ago he had one for 2 hours! According to Erin the seizures are “atypical”.  Normally after a seizure, the patient is very tired and sleepy.  After Sam’s seizures, he is actually wide awake and talkative.  His doctor is coordinating with an Epilepsy specialist from USF to set up a 72 hour EEG study for Sam.

Update! (my internet access has been down a few days!):  Erin said Sam will be going to the University of San Francisco Hospital tomorrow 8/21/08 and will be there for 3 or 4 days so his brain activity can be monitored closely.  Erin will be driving every day to San Francisco to be with Sam during his stay at USF from Kentfield.

100,000 Blog Hits: There is a “BLOG STATS” counter on the right side of this web blog that keeps a running count of how many times this site has been accessed since I started it in August of last year.  The count is now up to 103,988.  I know many of you receive email notifications with the latest blog entry (there are over 100), and don’t go directly to the blog—so that means there are many more than 100,000 hits.  Regardless, I wanted to thank you for your continued interest and prayers for Sam and Erin.  Your support and occasional comments (that Erin continues to read to Sam) really do touch all of Nichols and Neria family.  We don’t feel like we are going at this alone—you’re prayers and good wishes will continue to strengthen our faith, commitment and resolve.  But most of all, you are honoring a young man who had decided at a very young age, that he loves this country so much, he would give up his own life to defend it.  If that isn’t Christ like behavior, I don’t know what is!


5 Responses to DoD must provide official Tri-Care coverage for Cognitive Rehabilitation Therapy

  1. Lori Peoria says:

    It is good to see Sam on 2 wheels! Keep working hard for Erin, Sam!

  2. Diaz Family says:

    Hi Sam & Erin, God keep blessing you. Keep it up Sam. Erin you are an Angel on Earth. Good luck with your tests this week.
    Ricky and Crystal Diaz
    ROTC Casa Roble

  3. SCI says:

    Thank you for posting the letter, it’s a great resource. We’ll continue to keep you in our thoughts and check in periodically.

  4. Linda says:

    Still reading the emails and appreciating all the info you provide us with Tony. Watching God’s miricals @ work. Thank you.


  5. Carol Calloway says:

    Tony, I really appreciate the blog e-mailed to me each time. It lets see that God is with Sam and Erin and that my prayers and everyone else’s for Sam and Erin are being answered with great power. Both Sam and Erin are great examples for the youth of today; that things are not always easy but the good things are worth struggling for to achieve the goal.

    God bless both the Nichols and the Neria family. My prayers are with you all.


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