Where is the Department of Labor Watchdog?

The DoL’s OIG has been without a permanent Inspector General since July 13, 2009. 

Less than two weeks post IG  a video surfaced on this blog of Cabot Gosling, Vice President of Tangiers International, presenting an Injured War Zone Contractor that he was stalking a Photo ID when asked to identify himself.  The ID  clearly states that he is an agent of the US DoL.  

Under federal law, it is illegal to impersonate a government official, a crime punishable by up to three years in prison.

Wow, we finally caught these liars on video ! 

Michael Niss, former chief of the LHWCA, asked the DoL OIG to investigate after T Christian Miller published a story on the incident.

No report or decision was ever publicly issued.   Tangiers International continued doing business as usual, causing so many problems that even the ruthless AIG who funded them in the first place stopped using them.

We had to file a FOIA, Freedom of Information Act Request to find out what happened to this investigation.

What happened was not much. 

A few internal emails and phone calls within the DoL and one to Christopher Catrambone who owns Tangiers International.  Chez Catrambone stated that this was his US Department of Loss though he had previously stated in an email to the DoL that the US Embassy in Malta had authorized his use of the US Department of Labors’ logo and name.

The Injured War Zone Contractor who was stalked and took the video was never contacted.  Mark Munro shared his side of the story with one of our contributors:

Marc called me and told me that the AIG investigator called him at 5 am, asked his name, and then hung up and followed him and even went on the wrong side of the road in pursuit and almost wrecked.

Marc was in a bomb blast that killed 18, he has PTSD, and the AIG investigator placed Marc in great danger because PTSD patients are prone to outbursts when they are stressed, especially when it’s extremely negligent and intentional stress like the AIG investigator caused by calling Marc at 5 am and hanging up.

The investigation was limited to Tangiers side of the story despite how pitiful their cover was.  Even Miranda Chui stated that she thought they were probably lying.

Chris Catrambone and Tangiers International got a little slap on the wrist and a letter in their file.

Allowing AIG and Tangiers International to operate with such impunity and lack of oversight only emboldens them to cross the criminal/ethical lines as a matter of rule.  We are talking about seriously injured war zone contractors medical care here, peoples lives.  CNA and ACE are as guilty, if not more so.

Would the results of this “investigation” have been different with a permanent IG in place?  We doubt it.  The insurance companies carry more political weight than any IG could muster.  We saw this administration roll over for them within days of taking office.

Still, this lack of concern on the part of our Administration to the Oversight of the Department which holds Injured War Zone Contractors lives in their hands contributes to the criminal abuse by the insurance companies and their third party war profiteers Tangiers International, Tacticor, and Vetted International.

Project on Government Oversight:  Where are all the Watchdogs?

Office of the Inspector General Department of Labor

The Office of Inspector General (OIG) at the U.S. Department of Labor (DOL) conducts audits to review the effectiveness, efficiency, economy, and integrity of all DOL programs and operations, including those performed by its contractors and grantees. This work is conducted in order to determine whether: the programs and operations are in compliance with the applicable laws and regulations; DOL resources are efficiently and economically being utilized; and DOL programs achieve their intended results.

The OIG also conducts criminal, civil and administrative investigations relating to violations of Federal laws, rules or regulations, including those performed by DOL contractors and grantees; as well as investigations of allegations of misconduct on the part of DOL employees.

In addition, the OIG is unique among Inspectors General because it has an “external” program function to conduct criminal investigations to combat the influence of labor racketeering and organized crime in the nation’s labor unions. We conduct labor racketeering investigations in three areas: employee benefit plans, labor-management relations, and internal union affairs.

Why Having a Permanent IG Is Important

OIGs are best positioned to be effective when led by a highly qualified permanent IG, rather than an acting official or no IG at all. Permanent IGs undergo significant vetting—especially the IGs that require Senate confirmation—before taking their position. That vetting process helps to instill confidence among OIG stakeholders—Congress, agency officials, whistleblowers, and the public—that the OIG is truly independent and that its investigations and audits are accurate and credible.

In addition, a permanent IG has the ability to set a long-term strategic plan for the office, including setting investigative and audit priorities. An acting official, on the other hand, is known by all OIG staff to be temporary, which one former IG has argued “can have a debilitating effect on [an] OIG, particularly over a lengthy period.” Senator Charles Grassley (R-IA) has echoed that sentiment, saying “Even the best acting inspector general lacks the standing to make lasting changes needed to improve his or her office.”

Testing Program Fails Soldiers, Leaving Brain Injuries Undetected

A version [1] of this story was co-produced with NPR and aired on All Things Considered [2]. (Check here for local listings [3].)

by T Christian Miller and Joaquin Sapien at ProPublica and Daniel Zwerdling at NPR

About 40 uniformed soldiers take the ANAM test inside this squat rectangular building on the Fort Lewis-McChord military base near Tacoma, Wash., in early September, weeks before they deploy to Afghanistan. (Joaquin Sapien/ProPublica)

In 2007, with roadside bombs exploding across Iraq, Congress moved to improve care for soldiers who had suffered one of the war’s signature wounds, traumatic brain injury

Lawmakers passed a measure requiring the military to test soldiers’ brain function before they deployed and again when they returned. The test was supposed to ensure that soldiers received proper treatment.

Instead, an investigation by ProPublica and NPR has found, the testing program has failed to deliver on its promise, offering soldiers the appearance of help, but not the reality.

Racing to satisfy Congress’ mandate, the military chose a test that wasn’t actually proven to detect TBI: the Automated Neuropsychological Assessment Metric, or ANAM.

Four years later, more than a million troops have taken the test at a cost of more than $42 million to taxpayers, yet the military still has no reliable way to catch brain injuries. When such injuries are left undetected, it can delay healing and put soldiers at risk for further mental damage.

Based on corporate and government records, confidential documents, scores of interviews and emails obtained under the Freedom of Information Act, our investigation found:

• The people who invented ANAM and stood to make money from it were involved in the military’s decision to use it, prompting questions about the impartiality of the selection process. No other tests received serious consideration. A report [4] by the Army’s top neuropsychologist circulated last year to key members of Congress labeled the selection process “nepotistic.”
• The Pentagon’s civilian leadership has ignored years of warnings, public and private, that there was insufficient scientific evidence the ANAM can screen for or diagnose traumatic brain injury. The military’s highest-ranking medical official said the test was “fraught with problems.” Another high-ranking officer said it could yield misleading results.
• Compounding flaws in the ANAM’s design, the military has not administered the test as recommended and has rarely used its results. The Army has so little confidence in the test that its top medical officer issued an explicit order [5] that soldiers whose scores indicated cognitive problems should not be sent for further medical evaluation.
• Top Pentagon officials have misrepresented the cost of the test, indicating that because the Army invented the ANAM, the military could use it for free. In fact, because the military licensed its invention to outside contractors, it has paid millions of dollars to use its own technology.
• The military has not conducted a long-promised head-to-head study to make sure the ANAM is the best available test, delaying it for years. Instead, a series of committees have given lukewarm approval to continue using the ANAM, largely to avoid losing the data gathered so far.

Several current and former military medical officials criticized the Defense Department’s embrace of a scientifically unproven tool to use on hundreds of thousands of soldiers with TBIs

Please read this article in it’s entirety at ProPublica

Injured War Contractors Sue Over Health Care, Disability Payments

T Christian Miller ProPublica September 27, 2011

Private contractors injured while working for the U.S. government in Iraq and Afghanistan filed a class action lawsuit [1] in federal court on Monday, claiming that corporations and insurance companies had unfairly denied them medical treatment and disability payments.

The suit, filed in district court in Washington, D.C., claims that private contracting firms and their insurers routinely lied, cheated and threatened injured workers, while ignoring a federal law requiring compensation for such employees. Attorneys for the workers are seeking $2 billion in damages.

The suit is largely based on the Defense Base Act, an obscure law that creates a workers compensation system for federal contract employees working overseas. Financed by taxpayers, the system was rarely used until the wars in Iraq and Afghanistan, the most privatized conflicts in American history.

Hundreds of thousands of civilians working for federal contractors have been deployed to war zones to deliver mail, cook meals and act as security guards for U.S. soldiers and diplomats. As of June 2011, more than 53,000 civilians have filed claims for injuries in the war zones. Almost 2,500 contract employees have been killed, according to figures [2]kept by the Department of Labor, which oversees the system.

An investigation by ProPublica, the Los Angeles Times and ABC’s 20/20 [3] into the Defense Base Act system found major flaws, including private contractors left without medical care and lax federal oversight. Some Afghan, Iraqi and other foreign workers for U.S. companies were provided with no care at all.

The lawsuit, believed to be the first of its kind, charges that major insurance corporations such as AIG and large federal contractors such as Houston-based KBR deliberately flouted the law, thereby defrauding taxpayers and boosting their profits. In interviews and at Congressional hearings, AIG and KBR have denied such allegations and said they fully complied with the law. They blamed problems in the delivery of care and benefits on the chaos of the war zones

Gov’t Watchdog Criticizes Pentagon Center for PTSD, Brain Injuries

By T Christian Miller and Joaquim Sapien at ProPublica  July 11, 2011

If you want more explanation about the military’s troubles in treating troops with traumatic brain injuries and post-traumatic stress, read no further than two recent but largely unnoticed reports from the Government Accountability Office.

It turns out the Pentagon’s solution to the problems is an organization plagued by weak leadership, uncertain priorities and a money trail so tangled that even the GAO’s investigators couldn’t sort it out. The GAO findings on the Pentagon’s Defense Centers of Excellence (DCOE) echo our own series [1] on the military’s difficulty in handling the so-called invisible wounds of war.

“We have an organization that exists, but we have considerable concern about what it is that it’s actually accomplishing,” said Denise Fantone, a GAO director who supervised research on one of the reports. She added: “I can’t say with any certainty that I know what DCOE does, and I think that’s a concern.”

First, some background. After the 2007 scandal over poor care delivered to soldiers at the Walter Reed Army Medical Center, Congress ordered the Pentagon to do a better job treating soldiers suffering from post-traumatic stress disorder and traumatic brain injury. The Pentagon’s answer was to create DCOE [2]. The new organization was supposed to be a clearinghouse to foster cutting-edge research in treatments.

DCOE was rushed into existence in late 2007. Since then, it has churned through three leaders, including one let go after alleged sexual harassment of subordinates [3]. It takes more than five months to hire each employee because of the federal government’s glacial process. As a result, private contractors make up much of the center’s staff.

“DCOE’s development has been challenged by a mission that lacks clarity and by time-consuming hiring processes,” according to the first report in the GAO series [4], focusing on “management weakness” at DCOE.

Just as concerning, the GAO says that it can’t quite figure out how much money DCOE has received or where it has all gone. DCOE has never submitted a budget document that fully conformed to typical federal standards, according to a GAO report released last month [5]. In one year, the center simply turned in a spreadsheet without detailed explanations

Please read the entire article at ProPublica

PTSD, Ethics and Honor in the Warzone

General Petraeus’ Link to Troubling Suicide in Iraq: The Ted Westhusing Story

Before putting a bullet through his head, Westhusing had been deeply disturbed by abuses carried out by American contractors in Iraq, including allegations that they had witnessed or even participated in the murder of Iraqis.

See Also  Journey That Ended in Anguish by T Christian Miller

The scourge of suicides among American troops and reservists in Iraq and Afghanistan remains a serious and seriously underreported problem.

Last month they hit a new high in the US Army, despite intensive new efforts to prevent them. One of the few high-profile cases emerged six years ago this month, and it involves a much-admired Army colonel and ethicist named Ted Westhusing — who, in his suicide note, pointed a finger at a then little-known U.S. general named David Petraeus.

Westhusing’s widow, asked by a friend what killed this West Point scholar, replied simply: “Iraq.”

‘Something he saw [in Iraq] drove him to this,’ one Army officer who was close to Westhusing said in an interview. ‘The sum of what he saw going on drove him’ to take his own life.

‘It’s because he believed in duty, honor, country that he’s dead.’”

Please read the entire story at The Nation

Epidemic: Over 400,000 Traumatic Brain Injuries for Vets Coming from Iraq and Afghanistan

With like numbers of Contractors in Iraq and Afghanistan, similar casualty rates though we do not know who they are, why are contractors not receiving screening and medical treatment for Traumatic Brain Injuries? 

The Defense Base Act Insurance Companies deny diagnoses and treatment for TBI for the precious years that are so vital to the injured contractors recovery.  Years that no amount of money can ever bring back.

“We now know that the brain can heal. It has an intrinsic plasticity that allows it to recover, and this is particularly true for the young brain.”

A recent study by the Massachusetts Institute of Technology found that “neurons in the adult brain can remodel their connections,” thus “overturning a century of prevailing thought.”

The DOD has long resisted the diagnosis of mTBI, as it has avoided paying for a successful – but expensive – way to treat it. The price of that resistance is escalating suicide rates and domestic violence incidents among returning soldiers. In 2010, almost as many soldiers committed suicide as fell in battle.

By Conn Hallinan at AlertNet

America faces a huge challenge in caring for the shocking number of traumatized war vets.

“We are facing a massive mental health problem as a result of our wars in Iraq and Afghanistan. As a country we have not responded adequately to the problem. Unless we act urgently and wisely, we will be dealing with an epidemic of service related psychological wounds for years to come.” — Bobby Muller, President Veterans for America

According to official Defense Department (DOD) figures, 332,000 soldiers have suffered brain injuries since 2000, although most independent experts estimate that the number is over 400,000. Many of these are mild traumatic brain injuries (mTBI), a term that is profoundly misleading.

As David Hovda, director of the Brain Injury Research Center at the University of California at Los Angeles, points out, “I don’t know what makes it ‘mild,’ because it can evolve into anxiety disorders, personality changes, and depression.” It can also set off a constellation of physical disabilities from chronic pain to sexual dysfunction and insomnia.

MTBI is defined as any incident that produces unconsciousness lasting for up to a half hour or creates an altered state consciousness. It is the signature wound for the wars in Iraq and Afghanistan, where roadside bombs are the principal weapon for insurgents.

Most soldiers recover from mTBI, but between five and 15 percent do not. According to Dr. Elaine Peskind of the University of Washington Medical School, “The estimate of the number who returned with symptomatic mild traumatic brain injury due to blast exposure has varied from the official VA [Veterans Administration] number of 9 percent officially diagnosed with mTBI to over 20 percent, and, I think, ultimately it will be higher than that.”

Serious consequences from mTBI are increased when troops are subjected to multiple explosions and “just get blasted and blasted and blasted,” in the words of Maj. Connie Johnmeyer. Out of two million troops who have served in Iraq and Afghanistan, over 800,000 have had multiple deployments, many up to five times or more.

But mTBI is difficult to diagnose because it does not show up on standard CAT scans and MRIs. “Our scans show nothing,” says Dr. Michael Weiner, professor of radiology, psychiatry and neurology at the University of California at San Francisco and director of the Center for Imaging Neurodegenerative Disease at the Veteran’s Administration Medical Center.

They do now.

An MRI set to track the flow of water through the brain’s neurons, has turned up anomalies that indicate the presence of mTBI. However, the military has blocked informing patients of results of the research, and if history is any guide, the Pentagon will do its best to shelve or ignore the results.

The DOD has long resisted the diagnosis of mTBI, as it has avoided paying for a successful – but expensive – way to treat it. The price of that resistance is escalating suicide rates and domestic violence incidents among returning soldiers. In 2010, almost as many soldiers committed suicide as fell in battle.

MTBI is hardly new. Some 5.3 million people in the U.S. are currently hospitalized or in residential facilities because of it, and its social consequences are severe.  Please read the entire story at AlertNet

U.S. Insurance Firm CNA Neglects Survivors of Iraqi Translators, May Face Criminal Charges

U.S. insurer faces criminal probe over Iraqis’ unpaid death benefits

By T Christian Miller at ProPublica   May 23, 2011  and The LA Times

An administrative law judge has referred a U.S. insurance company for criminal investigation after the firm failed to pay benefits owed to survivors of Iraqi translators killed while working for the American government.

Under a federally funded program, Chicago-based CNA Financial Corp. provides insurance coverage to contractors killed or injured while working overseas for the United States. The slain translators were helping to train Iraqi police recruits.

Instead of paying out benefits, however, CNA withheld information from the federal government and avoided making payments to nine families who lost relatives in a 2006 attack, according to court files and interviews. One widow lost her home, unable to keep up payments after her son and other translators were ambushed by insurgents in the southern city of Basrah, one of her attorneys said.

In a ruling this week, administrative law Judge Daniel Solomon ordered CNA to begin making payments to the families. In an unusual move highlighting the government’s concern over potential fraud, the judge also told the Labor Department, which oversees the program, to investigate whether the insurance carrier should face criminal charges. A Labor spokesman said the agency would “fully investigate” the allegations to determine whether to ask the Justice Department to prosecute the case.

CNA said it was also looking into the case.

“We are investigating the matter and will take all appropriate actions,” said Katrina Parker, a company spokeswoman.

Attorneys for the families said they believe CNA withheld documents to avoid making payments.

“These were people who helped the U.S. in Iraq,” said Agnieszka Fryszman, an attorney for the families. “Their families were kicked to the curb when they were most in need of help.”

CNA’s failure to pay out benefits underscores the continuing problems with the Defense Base Act, essentially the workers compensation system for overseas federal contractors.

The system was little-used until the wars in Iraq and Afghanistan sent hundreds of thousands of private contractors onto the battlefield. All told, the government has paid out nearly $1.5 billion in premiums since 2001.

Reporting in 2009 by ProPublica, the Los Angeles Times and ABC’s 20/20 [1] revealed deep flaws in the program. Workers fought long battles for medical care, including such things as prosthetic devices and treatment for post-traumatic stress disorder. Foreign workers, including Iraqi and Afghan translators, often did not receive payments or treatment. The Labor Department seldom took action to enforce the law. One official called the system a “fiasco.”

Congress subsequently held hearings [2] that showed that American insurers were reaping large profits from the program. Documents showed that CNA reported the highest profits margins, taking in nearly 50 percent more in premiums than it paid out in benefits.

The case decided this week began on Oct. 29, 2006, when insurgents boarded a bus and killed 17 Iraqi-born translators working in Basrah for Sallyport Global Services, a logistics and security contractor. The insurgents later scattered their bodies around the city.

Under the law, CNA was responsible for paying death benefits to the translators’ dependents. CNA paid when translators had children and spouses, according to interviews and court records, but not to other survivors. Several translators had no children, but supported parents or other family members.

In such cases, the Labor Department demands proof that survivors relied on contractors’ earnings. CNA hired investigators who interviewed nine families, confirmed their eligibility, and even set up bank accounts. But CNA withheld portions of the investigators’ findings when it submitted the claims to the Labor Department, court records show.

One CNA file shows that the slain translator had supported his mother, a widow, since his father was killed in the Iraq-Iran war. The town council even issued a statement of support, confirming the translator was his mother’s “sole provider.” Another CNA file shows that another translator killed in the ambush was sole support for his family, which “could be described as very poor.”

But those pages were missing from the information CNA submitted to the Labor Department. As a result, Labor officials accepted CNA’s declaration that there were no dependents to pay in any of the nine cases.

The translators’ attorneys at Cohen Milstein, a well-known Washington firm doing pro bono work on the case, estimated that CNA owed a total of about $500,000 to the nine families. Instead, CNA paid about $45,000 into a special federal fund set up to help support the workers compensation system.

The company subsequently recovered some of that money plus additional fees under an obscure law—the War Hazards Compensation Act—that allows insurance carriers to recoup costs for contractors killed in hostile acts, court documents show.

In one case, CNA paid $5,000 into the special fund and $518 to a translator’s family for burial expenses, but was reimbursed $9,289 by the federal government for investigating and handling the claims.

A Sallyport official said the company believed that CNA had made payments to all of the translators’ families except one, which declined to accept money because of security concerns.

In an emailed statement, the company declined further comment due to the litigation. It said it would “continue to monitor the situation and support the families within our remit.”

Few Troops Exposed to Bomb Blasts Are Screened For Concussion

And very rarely are contractors Screened for TBI

By T Christian Miller ProPublica and Daniel Zwerdling NPR  May 10, 2011

More than half of U.S. combat troops in Afghanistan have been exposed to bomb blasts in the last year, but only about 1 in 5 of them said they were examined for concussions, according to a draft of a recent military survey [1].

Medical officials failed to screen about 80 percent of soldiers and Marines who reported being within 50 meters of a roadside blast during their tour of duty, according to combat troops surveyed in July and August of last year.

The survey noted, however, that the troops were quizzed before full implementation of a new military policy [2] in June mandating screening for troops exposed to such bombs.

The survey, which has not been finalized, but was obtained by ProPublica, NPR and USA Today, is conducted to assess the mental health and morale of America’s troops. Part of the survey examines the military’s efforts to treat traumatic brain injuries, also known as concussions.

Screenings for such wounds are important because concussions caused by blast waves are difficult to detect, yet may cause lasting cognitive issues, especially when soldiers absorb multiple injuries. Most soldiers recover within two weeks. But civilian and military studies have suggested that a minority of concussion victims, between 5 percent to 15 percent, go on to suffer cognitive problems, such as having difficulty reading or following instructions. Multiple concussions over a long period have been linked in athletes to a condition called chronic traumatic encephalopathy, which has dementia-like symptoms.

Official military figures [3] show that more than 155,000 troops have suffered concussions since the beginning of the wars in Afghanistan and Iraq, many of them caused by blasts from roadside bombs, a common insurgent weapon. Nearly 50,000 others have suffered more severe brain injuries. Previous ProPublica and NPR stories [4] cited studies showing that as many as 40 percent of mild traumatic brain injuries go undiagnosed.

Overall, the survey presented a bleak picture of an increasingly dangerous war in Afghanistan. One extraordinary statistic: Near the peak of violence in Iraq in 2006, from 12 percent to 15 percent of troops responding to a similar survey reported killing an enemy. In Afghanistan last year, 48 percent to 56 percent of combat troops surveyed reported being “directly responsible” for killing a combatant—a more than threefold increase.

In addition, about 50 percent to 60 percent of soldiers and Marines in Iraq in 2006 reported that a comrade had suffered a casualty. In Afghanistan, 73 percent of soldiers and almost 80 percent of Marines reported having a buddy who was wounded or died.

The Army has struggled to keep up with flood of soldiers suffering from so-called invisible wounds of war, such as traumatic brain injury and post-traumatic stress disorder. Last month, ProPublica and NPR reported [5] the Army is facing a “critical” shortage of neurologists to implement its new initiative to improve diagnosis and treatment of mild traumatic brain injuries.

At a hearing last June [6], Gen. Peter Chiarelli, the Army’s vice chief of staff, told Congress that the Army had a total of 52 neurologists, though only 40 were practicing—a figure, he said, that included child neurologists. “We’re an Army that’s in uncharted territory here,” Chiarelli recently told USA Today [7]. “We have never fought for this long with an all-volunteer force that’s 1 percent of the population.”

Please see the original here

ProPublica Honored With Two George Polk Awards

by Minhee Cho at ProPublica

ProPublica is pleased to announce that it has won two George Polk Awards this year, in collaboration with our partners NPR and Frontline, for the series “Brain Wars” and “Law & Disorder.”

A collaborative project by ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling and Susanne Reber, “Brain Wars ” found that the U.S. military was failing to diagnose and treat traumatic brain injuries suffered by soldiers. It has been selected for the George Polk Award for Radio Reporting.

ProPublica’s A.C. Thompson along with our partners Raney Aronson and Tom Jennings at Frontline and Laura Maggi and Brendan McCarthy at The Times-Picayune won the George Polk Award for Television Reporting for “Law & Disorder ,” which took an in-depth look at the controversial and often brutal actions taken by the New Orleans Police Department in the aftermath of Hurricane Katrina.

The George Polk Awards are conferred every year to honor special achievement in journalism, particularly investigative and enterprise reporting. ProPublica’s Abrahm Lustgarten was among the winners last year for his reporting on the dangers of drilling for natural gas.

Congratulations to all of the winners Please see the original here

Scientific Review Kicks Off to Weigh Treatment for Brain-Injured Soldiers

Perhaps one day diagnoses and treatment options will be made available to Injured Contractors.

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR Feb. 7, 2011

The Institutes of Medicine kicked off its yearlong study of cognitive rehabilitation therapy on Monday, a process that will help the Pentagon decide whether its health plan will cover the treatment for troops who have suffered brain injuries in Iraq and Afghanistan.

We’ve previously reported [1] that Tricare, which covers troops and many veterans, relied on a controversial study to deny coverage for the treatment, which helps rewire soldiers’ brains to perform basic tasks such as memorizing lists and following orders. Tricare said the study showed there wasn’t enough evidence to support paying for the treatment, which can cost more than $50,000 per soldier. The Pentagon says nearly 200,000 troops have suffered traumatic brain injuries since the wars began, though our own reporting [2] shows the numbers are probably a lot higher.

The IOM panel of experts will review scientific literature and ultimately render a decision on whether it supports the efficacy of cognitive rehabilitation therapy. If the experts reach this conclusion, they will hardly be the first to do so. In April 2009, a consensus panel assembled by the Pentagon said the therapy works, especially for soldiers suffering more severe forms of brain injury. Other groups, such as the Brain Injury Association of America, have weighed in to support it. Even some major private insurance companies pay for it.

The head of the IOM panel, Georgetown University neurologist Ira Shoulson, pointedly quizzed Tricare on this issue at Monday’s session, asking what the current review would produce that previous reviews had not.

Capt. Robert DeMartino, Tricare’s director of behavioral health, said he hoped the panel would be able to pinpoint what types of cognitive rehabilitation works best, and what kind of civilian doctors and clinicians were best qualified to provide it. He noted that stories published last year by ProPublica and NPR have cast a “shadow” over the issue, prompting congressional committees and lawmakers to pressure Tricare to provide cognitive rehabilitation therapy.

“For us, we know that we’re in a field like a gray zone,” said DeMartino, who addressed the panel by speakerphone. “We want to make sure the [treatments] that work are the ones we are going to use.”

The IOM review will continue through the end of the year, and the panel expects to convene other public sessions to help them arrive at a determination.