The center of excellence for hearing, for example, is focusing on addressing hearing loss. Tinnitus is the number one diagnosis of veterans from the conflicts in Iraq and Afghanistan, and tinnitus and hearing loss were the most prevalent service-connected disabilities for veterans who began receiving compensation during FY 2009, according to DoD officials. DoD and VA will collaborate on tracking hearing loss and auditory system injury by servicemembers on active duty through the hearing center of excellence.

DCoE is the most developed of the centers of excellence largely because DoD received a significant supplemental funding for psychological health and TBI late in FY 2007.

Dr Charles Rice, who is performing the duties of the assistant secretary of defense for Health Affairs, told the House subcommittee that they all “feel a sense of urgency,” in standing up the centers but also said that bringing the various disparate professionals together for the centers ’is a complex undertaking.”

In his written testimony, he acknowledged that initial stand up activities for the centers for excellence for vision, hearing, and traumatic extremity injuries and amputations “did not move at the pace expected.” For these three centers, DoD has thus far ’allocated funding, assigned provisional service responsibility for operational support, designated either interim or full-time directors, and begun to identify the registry requirements for the conditions covered.”

Organizing the Centers

Members of the subcommittee expressed concern that governance issues for the centers of excellence have not been worked out. Rice said that governance issues are critical, and that the department is seeking to exercise a consistent governance model across all the centers. “I plan to have our governance structure developed and approved by the end of May.”

Rep Vic Snyder, D-AR, asked military officials whether Congress might have made a mistake in mandating these centers in the first place, and whether a different way of addressing these injuries should have been considered. “Are we barking up the wrong tree here? Did we make a mistake by requiring these centers of excellence?”

Rice noted that the directive to create the centers galvanized DoD’s attention around a complex set of injuries that it had not really dealt with much in the past. He said that he did not think it was a mistake, but suggested that the centers be re-evaluated in five to seven years. “One of the things that has served most institutions well is to require somewhere around the five to seven year mark, a review to ask: Is this structure really still the right one, is it necessary for this to continue as is?”

Army Surgeon General Lt Gen Eric Schoomaker, MD, agreed that Congress did not make an error in directing that these centers be established. He added that the mandate for these centers highlighted areas that within the blast injury program are ’particularly vulnerable areas and where we were getting most of our concerns for patient care.”

He said that DCoE, for example, has already helped to establish battlefield protocols for how to identify and manage concussive injury on the battlefield at the point of injury. “Those kinds of standard protocols and standard practice guidelines are now being generated by these centers, and I anticipate that that’s going to be more and more the work.”

Still, Schoomaker conceded that execution of the centers has been a challenge. “I will concede that I don’t think we executed it flawlessly.”

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