Treatment of PTSD and Traumatic Brain Injury by the Veterans Health Administration

February 10, 2012

More than 2 million service members have deployed in support of overseas contingency operations (OCO) in Iraq and Afghanistan since October 2001. Two combat-related conditions that affect some OCO veterans and that have generated widespread concern among policymakers are post-traumatic stress disorder (PTSD, an anxiety disorder induced by exposure to a traumatic event, such as witnessing injury or death) and traumatic brain injury (TBI, which is caused by sudden trauma to the head and is commonly sustained by service members exposed to explosions).

Some observers contend that the Veterans Health Administration (VHA), the health care system within the Department of Veterans Affairs, and the health care system for active-duty personnel within the Department of Defense (DoD) may not adequately screen, diagnose, and treat OCO service members and veterans affected by PTSD and mild TBI.

In a study requested by the Ranking Member of the House Committee on Veterans’ Affairs, CBO analyzes VHA’s care of OCO patients diagnosed with PTSD or TBI and compares the reported rates of occurrence of those conditions within VHA with estimates of the prevalence of those conditions in the broader population of service members who have deployed to recent overseas contingency operations. The study also examines the costs that VHA has incurred in treating patients diagnosed with PTSD and TBI.

CBO’s Findings

Through September 2011, about 740,000 recent veterans had been treated at VHA—approximately half of all recent veterans eligible for care within that health system. VHA spent about $2 billion in fiscal year 2010 (in 2011 dollars) to provide medical care to all recent combat veterans.

CBO finds that:

  • One in four recent combat veterans treated at VHA from 2004 to 2009 had a diagnosis of PTSD. About 7 percent had a diagnosis of TBI. (Those figures include veterans who had both diagnoses.) Nearly three-quarters of recent combat veterans treated at VHA had neither diagnosis.
  • The average cost for OCO patients in the first year of their treatment was about four to six times greater for patients with a diagnosis of PTSD, TBI, or both than for patients without those conditions.
  • VHA’s experience may not reflect the rates or the costs of treating PTSD or TBI in the overall population of recent combat veterans. A great deal of uncertainty surrounds the prevalence of PTSD and TBI within the OCO population and, hence, the number of veterans with those conditions that DoD, VHA, and other health care providers may encounter in the future.

More about Treatment Costs

  Average Costs for
First Year of Treatment
Recent Veterans  
    With PTSD $8,300
    With TBI $11,700
    With PTSD and TBI $13,800
   
Recent Veterans with Neither Condition $2,400

The amounts above do not include initial care provided by DoD or care by other providers outside of VHA. For comparison, VHA estimates that the average cost of care in 2011 for veterans of all eras was $9,100.

VHA’s average costs for patients were highest during the first year of their care and declined and then stabilized in subsequent years. In the data CBO analyzed, VHA’s average costs for patients with TBI (including those with both TBI and PTSD) appear to increase in the third and fourth years. That result is probably generated by a policy change (occurring in the middle of the period CBO analyzed) related to screening for mild TBI. Without that change, costs for those patients would probably also have been highest during the first year of care and declined and stabilized thereafter.

Those results exclude about 500 patients with severe multiple injuries that received treatment in VHA’s polytrauma centers; costs for those patients were significantly higher.

Uncertainly of the Prevalence of PTSD and TBI

CBO’s study examines data from veterans who sought treatment at VHA. Those data may not be representative of the prevalence of PTSD and TBI in the overall population of recent veterans. Prevalence estimates gauge the proportion of cases of a disease or condition in a population, whether or not people have received a diagnosis from a medical professional.

A great deal of uncertainty surrounds the prevalence of PTSD and TBI within the population that deployed to Iraq and Afghanistan. Other researchers have estimated that:

  • Between 5 percent and 25 percent of those deployed to Iraq and Afghanistan may have PTSD when screened for the disorder after returning from deployment, and
  • Between 15 percent and 23 percent have experienced a TBI (the vast majority of which are mild TBIs, also known as concussions), though the proportion still symptomatic when screened after returning to the United States is much lower—between 4 percent and 9 percent—because most mild TBIs get better within a few months.

This study was prepared by Elizabeth Bass and Heidi Golding of CBO’s National Security Division.