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Question: What is TBI, and is it really the “signature wound of this war”?
 

Paul Reickhoff:
Traumatic brain injury, TBI, is a signature wound of the war.  It may have impacted hundreds of thousands of people who have cycled through Iraq and Afghanistan.  And for the most part, it's experienced when a roadside bomb, sometimes called an IED (improvised explosive device), blows up near or in the vicinity of a service member.  So, that concussive blast literally rattles your head and causes your brain to smack against the inside of your skull kind of like a super-concussion.  Sometimes it's an open head wound, often it's not.

And over time, there have been a number of veterans, thousands of veterans literally, who haven't been diagnosed.  They think, “Well, maybe I'm just a little slow today, or I'm having some minor vision problems,” and they don't necessarily make the connection to the fact that they were around five, six, 50 blasts over the course of a deployment.  So the screening at the outset has been woefully inadequate.  The VA only started doing mandatory screenings for traumatic brain injury—I think it was in 2006.

But keep in mind, only half of Iraq and Afghanistan vets are going to the VA, so that means half of our population isn't being screened; half of our population may not be aware of the long-term symptoms of traumatic brain injury, so we have a lot of work to do around public education.  We have a lot of work to improve the screening and treatment.

This is still very much a groundbreaking area.  For the most part, the research around traumatic brain injury has come from car accidents and professional football.  So we need more research, we need more treatment development.  And there are folks like Bob Woodruff from ABC who has also started a traumatic brain injury foundation called ReMIND who have been incredibly powerful public advocates for us while at the same time are supporting the research we need.

But this could be like our generation's Agent Orange.  Over the next decades, these symptoms and problems associated with traumatic brain injury will start to reveal themselves and start to emerge, and we need to understand that traumatic brain injury is just one example of how our commitment to veterans needs to be a life-long one.  This may be 20 years before people start to really show signs or problems associated with their service, and as a public... as a group of leaders in Washington, our country has a commitment to honor that service all the way through their entire life.

Question:
Does the VA do a good enough job of serving our veterans?

Paul Rieckhoff:  Yeah, I would start by re-framing it.  So this is Big Think, right?  So, here's the big idea, is that the government can't handle Veterans Affairs alone.  And that's a message that I have been trying to communicate and others who are really inside this have been trying to communicate for years now.  The VA is gonna be a key component in supporting veterans over the next generation—but it's a component.

Less than half the folks are going to the VA, so what about that other half of the folks?  They're gonna go to church groups, they're gonna go into the YMCA, they're gonna go into private community-based nonprofits, they're gonna come to veterans groups like ours. But it needs to be a coordinated effort that involves the federal government, the VA, and all these other groups working in concert together to tackle the problem.

We didn't just send the Federal government down to deal with Katrina.  Yeah, they were a huge part of it, but there were local community groups.  There were a lot of other spokes in the wheel that were critical to a response, whether it was effective or not.  That's how we need to think about Veterans Affairs.  When the President stands up and says, “I am doing this for veterans, and our VA is doing this,” that's great.  But that's only impacting half of Iraq and Afghanistan veterans coming home.  Why?

The quality of care at the VA is generally good.  Most of our members and most folks say the quality of care at the VA is very good.  Outreach stinks.  They are not getting out into rural areas, they're not using the Internet, they're not using earned and paid media in any way to reach new veterans.  They are just not present where my generation of veterans lives.  If you're on Facebook, you're not gonna see the VA very often.  If you go to VA.gov right now—if you're watching this on the internet, pop up the VA's Web site and compare and contrast that to a lot of other websites.  You see, for the most part, it looks like a Web site that was built in the Gulf War, not Iraq and Afghanistan.

So there's a long way to go in empowering the VA to be more effective in their outreach, but at the same time there has to be a reality here—a ground truthing—that the VA is not gonna reach everybody.  It might be a local church group, it might be a veterans group like ours, and those groups need to be empowered, they need to be supported, and there also needs to be a marketplace for them.

There hasn't been a history of philanthropy supporting Veterans Affairs.  Almost every corporation and philanthropic organization in the nation has a list of things they work with every year: poverty, AIDS, homelessness... We need to put veterans on the national consciousness forever so they understand when you send folks to war there's a moral obligation to care for them coming home, and the federal government and the President do not have it under control.  They cannot do it alone, and they need to ask the American people, and all of our resources as a nation, to get involved to help.

Recorded August 2, 2010
Interviewed By Max Miller

 

TBI Could Be the Next Agent...

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