June 14, 2010WASHINGTON (USA TODAY) -- The Pentagon has failed to comply with a congressional directive to give all troops tests before and after they serve in combat to measure their thinking abilities and uncover possible brain injuries, military records show.
More than 562,000 tests of troops taken before they deployed have not been readministered on their return by military health officials, the records show. That means the Pentagon could be missing thousands of cases of brain injury, says Rep. Bill Pascrell, D-N.J., who helped write the 2008 order.
"This is a total failure," says Pascrell, co-chairman of the bipartisan Congressional Brain Injury Task Force. "We're failing to find TBI (traumatic brain injury) and post-traumatic stress disorder in an era when the military is trying to find and assist folks who need it."
Lt. Gen. Eric Schoomaker, the Army surgeon general, and other Army officials say the test is flawed and no better than a "coin flip."
The test, called the Automated Neuropsychological Assessment Metrics (ANAM), produces too many false positive results, said Lt. Col. Michael Russell, head of the Army's ANAM program.
The test "was promised ... as a sort of 'pregnancy test' for (mild) TBI. It has failed to deliver," says Russell, adding that false results could be triggered by medication, such as Benadryl.
This misrepresents the test, which is designed only to alert doctors that a soldier's thinking process has declined and further evaluation is necessary, says Tresa Roebuck-Spencer, a neuropsychologist with the University of Oklahoma, which develops and distributes the testing program for the Army. She says research shows that false positives drop significantly when the post-deployment test is compared with the original exam.
In that role, this kind of test would be a useful tool for screening all returning troops as Congress intended, say two military neurologists, Air Force Col. Michael Jaffee, director of the Defense and Veterans Brain Injury Center, and Cmdr. Jack Tsao, director of TBI programs for the Navy and Marines.
"Anything that would help us to better diagnose ... servicemembers who may need further care or follow-up is welcome," Tsao says.
ANAM is a roughly 20-minute computerized test that scores areas such as reaction time, learning speed, short-term memory and mathematical processing. It also gauges a servicemember's mood, fatigue and history of any head injury.
Congress passed the test order in January 2008. Ward Casscells, then the military's top medical officer, ordered in May 2008 that the ANAM test be given pre-deployment while military experts studied it and other tests for both pre- and post-deployment use. That study is not expected to be completed until 2013.
In November 2008, Schoomaker barred post-deployment screening with ANAM.
About 575,000 pre-deployment tests have been gathered at a cost of about $30 each. Only 12,000 to 13,000 tests have been used for follow-up comparisons, most for a study at Fort Campbell, Ky.
The military relies largely on self-reporting symptoms in diagnosing mild TBI suffered in combat. About 5% to 15% suffer persistent problems.
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