VA and Spinal Cord Injury
By: the U.S. Department of Veterans Affairs
Recent estimates in the United States indicate that approximately 248,000 people have some type of spinal cord injury or disorder that significantly affects their life activities, and 11,000 more sustain these injuries every year. Nearly 44,000 are veterans eligible for Department of Veterans Affairs (VA) medical care. Many veterans with spinal cord injuries are eligible not only for health care but also for monetary or other benefits because they have a service-connected disability, meaning a condition that occurred or worsened during military service. Veterans with spinal cord injury unrelated to their military service may still receive VA medical care because of their catastrophic disability. Among health care workers and veterans’ advocates, spinal cord injuries are commonly referred to by the acronym, SCI.
What Is It?
The spinal cord is the main pathway for transmitting information between the brain and the nerves that lead to muscles, skin, internal organs and glands. Injury to the spinal cord disrupts movement, sensation and function. Paraplegia results from injury to the lower part of the spinal cord, causing paralysis of the lower part of the body, including the bowel and bladder. Quadriplegia (sometimes called tetraplegia) results from injury to the spinal cord, in the neck area, causing paralysis to the lower body, upper body and arms. SCI requires ongoing management of impairments and prevention of related problems.
About a third of veterans with SCI are compensated $2,299 per month for being 100 percent disabled. A veteran rated by VA as 100 percent disabled may receive additional compensation if the injury resulted in loss of use of hands or feet or in other disabilities. The rating may include other service-connected disabilities not related to their spinal injury. Many veterans with service-connected disabilities are also entitled to vocational counseling, grants for adapted housing and automobiles, a clothing allowance and payment for home and attendant care.
Health Care for Veterans with SCI
VA has the largest single network of SCI care in the nation. It provided a full range of care to 22,800 veterans with spinal cord injury and disorders in 2004 and specialty care to 12,257 of these veterans. A study conducted by a major consulting firm in 2000 comparing VA's SCI services to those funded by several private and public health insurers showed that VA's coverage was more comprehensive. It integrates vocational, psychological and social services within a continuum of care and addresses changing needs throughout the veteran's life. VA provides supplies, preventive health care and education for veterans with SCI. VA also maintains their medical equipment.
The average age of a person at time of injury is increasing, perhaps because the general population of the United States has increased. VA’s system of care provides a coordinated lifelong continuum of services for eligible veterans with SCI of all ages. VA’s system of care provides, or formally links with, sources of care that address the lifelong needs of eligible veterans with SCI, including, but not limited to: emergency care, medical and surgical stabilization, rehabilitation, primary care, preventive care, specialty sustaining care, surgical care, outpatient care, home care and long-term care. VA SCI specialty care focuses on the prevention or early detection of complications of SCI, with multidisciplinary teams providing annual comprehensive evaluations.
VA services are delivered through a "hub and spoke" system of care, extending from 23 regional SCI centers offering primary and specialty care by multidisciplinary teams to the 135 SCI primary care teams or support clinics at non-SCI local VA medical centers. Each primary care team has a physician, nurse and social worker, and those with support clinics may have additional team members. Newly injured veterans and active-duty members are referred to a VA SCI center for rehabilitation after being stabilized at a trauma center. Each year, approximately 400 newly injured veterans and active duty members receive rehabilitation at VA's SCI centers
The 23 VA SCI centers are at the following locations:
Long Beach, Palo Alto and San Diego, Calif.; Miami and Tampa, Fla.; Augusta, Ga.; Hines, Ill.; West Roxbury, Mass.; St. Louis; East Orange, N.J.; Albuquerque, N.M.; Bronx and Castle Point, N.Y.; Cleveland; San Juan, P.R.; Memphis, Tenn.; Dallas, Houston and San Antonio, Texas; Seattle; Milwaukee; and Hampton and Richmond, Va.
The SCI center nearest to a veteran can provide the name of the SCI coordinator in the SCI primary care team at the nearest VA facility.
VA leads the health care profession in defining new methods of rehabilitation through research and engineering. In fiscal year 2004, VA spent nearly $19 million on more than 100 research projects dealing with SCI. VA investigators received $8.2 million from non-VA sources for an additional 128 studies. VA research on SCI focuses on areas such as functional electrical stimulation, wheelchair and other adaptive technology, cell transplantation, treatment of medical side effects of SCI and rehabilitation methods and outcomes.
National Recreational Events
Staying active is as important to the physical and emotional well-being of people with SCI as it is to other people. VA sponsors two annual athletic events that offer camaraderie with other SCI veterans and the opportunity to enjoy and participate in competitive sports. These are the National Veterans Wheelchair Games, which is cosponsored with the Paralyzed Veterans of America (PVA), and the National Disabled Veterans Winter Sports Clinic, cosponsored with the Disabled American Veterans. Many participants in these events are veterans with SCI.
Bringing Research to Treatment
In the late 1990s, VA began a special effort to identify gaps in knowledge about SCI treatment and to share findings with its clinicians nationwide. The goal is to improve the quality, effectiveness and efficiency of care by translating research findings into improved care.
VA is one of 20 professional organizations in the Consortium for Spinal Cord Medicine, which was founded by VA to develop guidelines that improve care for all Americans with SCI. The Consortium represents physicians and other health care providers, consumers and insurers and has disseminated clinical practice guidelines. Among them are guidelines for preventing skin breakdown and blood clots in the legs. One of the results expected from using the guidelines is more consistent treatment and greater awareness by veterans of how to care for themselves.
VA clinicians nationwide have access to a computer database for sharing treatment and outcome information that enhances the coordination of health care. This registry also helps make referrals to treatment locations.
In addition to identifying research on the best approaches to treatment, VA continually strives to improve its expertise. The Rehabilitation Accreditation Commission, the standard setting and accrediting authority for organizations providing rehabilitation services, has accredited all 20 VA SCI centers that provide acute rehabilitation.
Thirteen of these centers are training sites certified by the Accreditation Council on Graduate Medical Education, which accredits post-graduate medical training programs in the United States. All VA physicians can take an independent study course on medical care for people with SCI. Two SCI training programs are held annually for VA health care professionals.
For veterans, VA prepared a guide published by PVA that explains how to handle problems and where to turn for help. It is called "Yes, You Can!" and is available at VA's SCI Centers and from PVA.