Key Takeaways
- •Russell Gore (Chief Medical Officer, Avalon Action Alliance) warned that veterans with TBI are over five times more likely to commit suicide than the general American population.
- •Alan Johnson (Retired Lieutenant Colonel and Flight Surgeon, U.S. Army) testified that current screening tools often miss delayed injuries caused by massive percussion waves from ballistic missile attacks.
- •Rep. Gregory Murphy (R, NC-3) pressed Joel Scholten (Executive Director, Physical Medicine and Rehabilitation Services, U.S. Department of Veterans Affairs) on the VA’s refusal to utilize hyperbaric oxygen therapy.
- •Rep. Julia Brownley (D, CA-26) expressed concerns that the BEACON Act would fracture care continuity, while Rep. Jack Bergman (R, MI-1) argued the bill would supplement VA capacity.
- •The subcommittee will continue evaluating the BEACON Act to determine if public-private partnerships can effectively scale TBI treatment capacity and address long-term military occupational blast exposure.
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Hearing Analysis
Overview
The House Veterans' Affairs Subcommittee on Health held a hearing titled "Hidden Wounds: Effectively Supporting Veterans with TBI" to evaluate the Department of Veterans Affairs (VA) current protocols for Traumatic Brain Injury (TBI) and discuss legislative efforts to expand treatment options. Chairwoman Mariannette Miller-Meeks (R, IA-1) convened the hearing to address the evolving nature of TBI, particularly "low blast exposure" and the long-term chronic effects of brain injuries sustained during service. The committee specifically examined the BEACON Act, a proposal to establish grant programs for TBI research and treatment through partnerships with non-VA entities.
Key Testimony
The first panel featured VA officials Dr. Joel Scholten, Executive Director of Physical Medicine and Rehabilitation Services, and Dr. Rachel McArdle, Deputy Executive Director of Rehabilitation and Prosthetic Services. They testified that the VA utilizes a "polytrauma system of care" consisting of over 110 clinical teams and five specialized Polytrauma Rehabilitation Centers. Dr. Scholten emphasized that the VA now views TBI as a chronic condition requiring longitudinal care rather than a one-time event. He noted that the VA screens all post-9/11 veterans for TBI and has integrated mental health services into physical rehabilitation to address high comorbidity with PTSD.
The second panel provided personal and clinical perspectives on the limitations of current VA care. Mr. Al Johnson, a retired U.S. Army Lieutenant Colonel and flight surgeon, detailed his experience during the 2020 Iranian missile attack on Al-Asad Airbase in Iraq. He argued that current screening tools like the MACE 2 often miss delayed cumulative blast injuries and called for a formal medical surveillance program for veterans exposed to both blasts and toxic chemicals. Mr. Buster Miscusi, a former U.S. Marine Corps Sergeant, shared how the VA's standard care failed to address his "stroke-like" episodes until he received intensive, family-inclusive treatment through UCLA Operation Mend. Dr. Rusty Gore, Chief Medical Officer at Avalon Action Alliance, advocated for the BEACON Act, arguing that the VA currently treats fewer than 100 veterans per year in its most intensive neurorehabilitation programs, leaving thousands without adequate care.
Policy Proposals
Policy discussions centered on the BEACON Act and the use of Hyperbaric Oxygen Therapy (HBOT). Rep. Gregory Murphy (R, NC-3) engaged in a sharp exchange with Dr. Scholten, accusing the VA of being "negligent" and "stuck in 1970s science" for refusing to offer HBOT for TBI and PTSD despite clinical data from organizations like HBOT for Heroes and researchers at the University of Pittsburgh and in Israel. Dr. Scholten maintained that current clinical guidelines from the VA and the Department of Defense (DoD) do not find sufficient evidence to support HBOT for TBI.
Partisan dynamics were evident regarding the funding and implementation of the BEACON Act. Ranking Member Julia Brownley (D, CA-26) and Rep. Sheila Cherfilus-McCormick (D, FL-20) expressed concerns that the bill would "divert" $60 million from existing VA mental health programs to private entities, potentially undermining the VA’s internal research infrastructure and "cultural competency." Conversely, Rep. Jack Bergman (R, MI-1) and Chairwoman Miller-Meeks defended the bill, arguing it does not mandate a diversion of funds but provides a mechanism for public-private partnerships to scale life-saving treatments. Rep. Bergman criticized opponents of the bill for using the word "privatize," stating that a "all hands on deck" approach is necessary to solve the TBI crisis.
Overview
The hearing also highlighted the intersection of TBI and toxic exposures. Rep. Kimberlyn King-Hinds (R-MP) and Rep. Pete Stauber (R-MN) questioned witnesses about the link between burn pits, ballistic missile chemicals, and worsening brain health. Mr. Johnson noted that many veterans from the Al-Asad attack are developing thyroid nodules and cancers, suggesting that TBI and toxic exposure must be treated as a combined cohort.
Key Testimony
Organizations identified in the hearing include: - Department of Veterans Affairs (VA): Discussed regarding its polytrauma system, research funding, and TBI screening protocols. - UCLA Operation Mend: Praised by Witness Miscusi for its intensive, interdisciplinary, and family-centered TBI treatment model. - Avalon Action Alliance: Represented by Dr. Gore, who advocated for the BEACON Act to establish new standards of care. - HBOT for Heroes: Cited by Rep. Murphy as a successful provider of hyperbaric oxygen therapy for veterans. - Department of Defense (DoD): Referenced regarding its collaboration with the VA on clinical TBI guidelines and the National Intrepid Center of Excellence (NICoE). - Wounded Warrior Battalion: Mentioned by Witness Miscusi as the site of his initial TBI diagnosis during medical retirement. - Shepherd Center: Identified as a model for the VA’s intensive evaluation and treatment programs. - National Center for PTSD: Mentioned in the context of potential funding shifts under the BEACON Act.
Overview
The hearing concluded with Chairwoman Miller-Meeks emphasizing the need for "choice" and "access" for veterans. While no immediate deadlines were set, the subcommittee indicated that the BEACON Act remains a priority for the Republican majority, while Democrats signaled a desire to amend the funding mechanisms to protect core VA services.
Transcript
...VA's funding to private companies. Not only is this wasteful and duplicative, but it could lead to a further fracturing of continuity of care for veterans. On that note, I ask unanimous consent to enter into the hearing record this article from the American Prospect that expands on many of the concerns I have just raised.
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