The Veterans Health Administration's Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans

Through September 2011, about 740,000 veterans from overseas contingency operations in Iraq and Afghanistan had been treated by the Veterans Health Administration (VHA). That number is slightly more than half of all recent veterans eligible for care by VHA.

VHA spent about $2 billion in fiscal year 2010 to provide medical care to all recent combat veterans.

One in Four Recent Combat Veterans Treated at VHA from 2004 to 2009 Had a Diagnosis of PTSD; 7 Percent Had a Diagnosis of TBI

Using data for recent veterans treated by VHA from 2004 to 2009, CBO found that:

• 21 percent were diagnosed with post-traumatic stress disorder (PTSD) but not traumatic brain injury (TBI),
• 2 percent were diagnosed with TBI but not PTSD,
• An additional 5 percent had both PTSD and TBI, and
• The remaining 72 percent had neither diagnosis.

Treating Recent Combat Veterans Diagnosed with PTSD, TBI, or Both Was Much More Expensive Than Treating Other Recent Veterans

Those amounts do not include initial care provided by the Department of Defense (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 will be $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.

VHA’s Experience May Not Reflect the Rates of (or the Costs of Treating) PTSD or TBI in the Overall Population of Recent Combat Veterans

CBO’s study examines data from veterans who sought treatment at VHA. Those data may not be representative of the overall population of recent veterans. 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.