The following editorial first appeared in the St. Louis Post-Dispatch:
In February 2004, a roadside bomb tore through a Humvee assigned to the 82nd Airborne Division in Iraq.
The blast ripped off Sgt. Ted Wade's right arm above the elbow. The shock wave rattled his skull, causing severe brain damage.
In earlier conflicts, a blast like that would have killed Sgt. Wade. That's the good news - and the bad news.
Now retired from the Army, Wade is one of an estimated 322,000 soldiers, sailors and Marines thought to have suffered traumatic brain injury as a result of service in Iraq and Afghanistan. Traumatic brain injury - TBI caused by roadside bombs has been called the "signature wound" of the wars.
Many of these veterans would benefit from cognitive rehabilitation therapy. It involves long sessions in which brain-injury survivors relearn basic life tasks: speaking clearly, counting, cooking and sometimes even directions home from the hospital.
The therapy can cost between $15,000 and $50,000 a year. But Tricare, an insurance program that covers millions of military personnel and retirees, has refused to pay.
Tricare isn't heartless. Some soldiers, including Wade, have received cognitive rehabilitation therapy. But most of them got it only after a long fight.
Tricare has refused to allow all traumatic brain injury patients to receive it. Most of those who want it can't get it. Even Wade's approval is complicated: He wants to move closer to his family, but doesn't dare because he'd have to get approval all over again.
Tricare says it won't authorize the therapy for all TBI sufferers because the therapy's effectiveness has yet to be scientifically established. But a scientific advisory panel put together by Tricare voted last year to recommend coverage.
ProPublica, a nonprofit investigative reporting organization, and National Public Radio reported this week after the advisory panel met, Tricare paid an independent contractor to review the evidence.
That contractor excluded much of the research cited by Tricare's experts because it wasn't conducted in accordance with the very best scientific standards.
Those high standards often are a hazard for behavioral therapy researchers. Unlike in drug studies, in which an inactive sugar pill can be given secretly to test a medication's effectiveness, behavioral therapy either is given or it's not. You can't fake it.
NPR and ProPublica talked to insiders who suggested another possible factor for Tricare's reluctance to pay for cognitive rehabilitation therapy: cost.
Tricare officials say that cost played no role in the decision. It's easy to understand why it might.
The minimum cost of intensive therapy for the 322,000 people who could benefit is about $4.8 billion. That's almost 10 percent of the Pentagon's $50 billion a year (and growing) health care budget.
As the Pentagon wrestles with health care costs, it has been suggested that some retired military personnel without service-connected disabilities should be asked to pay more for Tricare insurance. Right now, they pay about $460 a year for family coverage. A similar employer-provided family policy would cost an average of about $13,800, of which the employee would pay about $4,000.
Perhaps the Navy could make do with one fewer expensive new carrier or the Air Force a few fewer fighter jets. We can't skimp on the men and women we've already sent into combat.
We can't make the wounded whole again, no matter how much we spend. But we have an obligation to do our best. They deserve no less for what they've already given.
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