DoD Divvying Med Centers of Excellence

An expected Pentagon plan to split oversight of the medical centers of excellence for orthopedics, traumatic brain injury, vision and hearing among the service branches has some vet advocates worried that effective care could become be a casualty of interservice rivalries.
 
Tom Zampieri, director of government relations for the Blinded Veterans Association, told Military.com that placing the centers under different branches could hurt cooperation among the facilities and with their partner, the Veterans Health Administration.
 
"This fragments things, because having chain of command suddenly in charge of these ... centers of excellence may make it harder in working across branches," Zampieri said.
 
The Pentagon has not confirmed the move, but Zampieri said it has already been approved.

The various medical centers of excellence were sparked by the 2007 Wounded Warriors Act that sought to create one for cutting edge research and treatment of traumatic brain injury.
 
Zampieri said the Army will have responsibility for the orthopedics and the Navy for the traumatic brain injury and vision centers. A center for hearing injuries has yet to be fully established, but Zampieri said that will be going to the Air Force.
 
Another change will be the rank of the officers overseeing the centers. Currently, the senior officers are colonels, with the exception of traumatic brain injury which has a brigadier general in charge.
 
Under the Pentagon plan, the surgeon general of each branch will be in charge -- boosting responsibility up to a three-star general or flag officer. Zampieri acknowledges that there could be a plus side to that -- with the centers getting a higher-ranking advocate to fight for their needs.
 
But the retired career Soldier said he also knows that rivalries come into play, as each service branch lobbying for its own needs and budgets.

Officials with DoD health services did not respond to Military.com’s request for comment or explanation on the plan to divide the centers among the service branches.
 
The wars in Iraq and Afghanistan have seen high numbers of head injuries, with a significant number of them resulting in vision damage.

The House Committee on Veterans Affairs in March revealed that between 1998 and 2008 there were about 4,970 perforating or penetrating eye injuries among service members, 4,298 chemical or thermal burns to eyes and 686 damaged optic nerves; most of the injuries were from the wars in Iraq and Afghanistan, the committee said.
 
About 13 percent of troops wounded or requiring medical attention early in the Iraq invasion had eye trauma, according to the committee. In addition, many patients who suffer traumatic brain injury also may incur vision impairment, as well.

Last year the Veterans Health Administration reported 8,747 diagnosed cases of traumatic brain injury, with another 7,500 possible cases, the committee added.

The committee said then that the Pentagon and VA had "let down" veterans with eye injuries by not moving quickly to get the Vision Center for Excellence up and running.

The Vision Center of Excellence was appropriated about $6.9 million in late 2008 but is principally a two-man operation that uses some clerical staff and office space on loan from the Tricare Management Activity, located at the DoD's Military Health System offices in Falls Church, Va. But the two doctors and clerks principally are involved in prep work for the center -- including developing a concept of operations between the Pentagon and VA and working on a registry of all vision impairment.

The center of excellence for orthopedics is located at Walter Reed Army Medical Center in Washington, D.C. The center for traumatic brain injury is at the National Naval Medical Center in Bethesda, Md.
 
The Center of Excellence for Hearing has yet to be established. The Army and VA have unofficially worked together on hearing research and treatments out of Walter Reed for years, though the new center -- when it is established -- will be managed by the Air Force and moved to Wilford Hall Medical Center in San Antonio, according to Zampieri.