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The questionnaire should be revised and questions should be asked closer to the time of the incident, the authors said, and the military should refine its definition of concussion. They feel "concussion" better reflects the mild nature of the injury and promotes an expectation of recovery.
"It's a very, very, very mild physical injury" that often doesn't need medical treatment, Castro said.
The VA last year created a disability category for residual effects of traumatic brain injury that was based on subjective, poorly defined symptoms, Castro and his colleagues argued. More scientific diagnosis criteria are needed "to ensure that disability regulations do not generate disability," the authors wrote.
Treatment of mild traumatic brain injuries can cost up to $32,000 per case, the Rand report said. But if the diagnosis is wrong, patients are exposed to drug side effects and other risks, according to Hoge.
VA officials issued a statement this week saying they are proud of their efforts to treat traumatic brain injuries. Forrester, the veterans advocate, said estimates of concussions are probably low because some service members fear that being diagnosed with a neurological or psychological problem would hamper a military career.
Better assessment is needed for a complicated problems, he added. "These are the most difficult, thorny wounds of war," he said.
On the Net:
New England Journal: http://nejm.org/
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