Department of Defense: Use of Neurocognitive Assessment Tools in Post-Deployment Identification of Mild Traumatic Brain Injury Page: 2 of 13
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cognitive performance areas that may be impaired by an mTBI such as attention,
judgment, and memory.
Identification of mTBI in servicemembers who served in Afghanistan and Iraq has
been the subject of recent media attention, with particular attention focused on the
proper use of neurocognitive assessment tools to screen all servicemembers post-
deployment for deficits or symptoms related to mTBI. In this context and in response
to your request, this report describes (1) DOD's post-deployment policy on the use
of neurocognitive assessment tools as a stand-alone initial screen to identify
servicemembers who may have sustained an mTBI during deployment; (2) what
informed DOD's decisions to establish this post-deployment policy; and (3) mTBI
experts' views on the science related to DOD's policy decision.3 Additionally, you
have expressed the importance of recording mTBI in a servicemember's medical
history to ensure proper treatment. In response to this concern, we are initiating a
review of DOD's in-theater documentation of servicemembers involved in potentially
To describe DOD's post-deployment policy on the use of neurocognitive assessment
tools as a stand-alone initial screen to identify servicemembers who may have
sustained an mTBI during deployment, and what informed DOD's decisions to
establish this post-deployment policy, we reviewed relevant DOD policy and
guidance and interviewed DOD officials involved in DOD TBI policy. We also
reviewed documents that DOD cited as support for its decision, such as task force
and expert panel reports, and scientific studies. To describe mTBI experts' views on
the science related to the policy decision, we interviewed 15 mTBI experts within
and outside of DOD in the fields of military concussion and sports concussion. We
selected experts through a snowball sampling method and through structured
searches of the military and sports concussion literature.4 We interviewed sports
concussion experts because the sports population has experience in the use of
neurocognitive assessment tools to help identify mTBI. The views of the experts we
interviewed cannot be assumed to be the views of all mTBI experts.
We conducted this performance audit from April 2011 through October 2011 in
accordance with generally accepted government auditing standards. Those
standards require that we plan and perform the audit to obtain sufficient, appropriate
evidence to provide a reasonable basis for our findings and conclusions based on
our audit objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
Results in Brief
DOD does not require that all servicemembers be screened post-deployment using
a neurocognitive assessment tool but does require that all servicemembers be
screened using a set of TBI screening questions. According to DOD officials, this
policy was informed by findings and recommendations from several task forces and
3For the purposes of this report, we define post-deployment as within 30 days after servicemembers' return from
4A snowball sample includes an initial list of cases, each of whom is asked for referrals to additional people, who
are then interviewed and asked for referrals, and so on. We repeated this process until we were consistently
receiving substantively similar information from each additional interview.
GAO-12-27R DOD Mild Traumatic Brain Injury
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United States. Government Accountability Office. Department of Defense: Use of Neurocognitive Assessment Tools in Post-Deployment Identification of Mild Traumatic Brain Injury, text, October 24, 2011; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc302484/m1/2/: accessed April 20, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.