Report | Nov. 1, 2021

Evaluation of Traumatic Brain Injuries in the U.S. Central Command Area of Responsibility (DODIG-2022-006)


Publicly Released: November 3, 2021



The objective of this evaluation was to determine whether the U.S. Central Command (USCENTCOM) tracked and reported potentially concussive events (PCEs) and DoD Service members involved in PCEs in order to provide the Joint Trauma Analysis and Prevention of Injury in Combat (JTAPIC) Program Office with PCE data to conduct actionable analysis to prevent or mitigate traumatic brain injuries (TBIs).



According to the DoD TBI Center of Excellence, TBI is a disruption of brain function, sustained as a result of a PCE, such as a blast event, vehicle collision, or direct blow to the head, that may impair thinking, memory, movement, vision, hearing, or emotional functioning. A PCE can, but does not always, result in a TBI. The TBI Center of Excellence stated that, since 2000, more than 413,858 Service members have been diagnosed with a TBI sustained in training or combat. According to the TBI Center of Excellence, the high rate of TBIs directly impacts the health and safety of Service members, unit readiness, and troop retention.

DoD Instruction (DoDI) 6490.11 provides unified guidelines to the Services for the management of mild TBIs in a deployed setting, with the intention of providing maximum protection for Service members. DoDI 6490.11 requires the combatant commands and the Services to report all PCEs to the JTAPIC Program Office in a monthly tracking report. The JTAPIC Program Office conducts research using the monthly reports to inform recommendations that may prevent or mitigate injuries to Service members in the deployed environment.



USCENTCOM and its Service Component Commands did not track or report PCEs or DoD Service members involved in PCEs, as required by DoDI 6490.11. This occurred because the Service Components thought the requirements in USCENTCOM Regulation 40-1 were unclear and because USCENTCOM relied on electronic health records to identify and track DoD Service members involved in PCEs.

Additionally, the Joint Staff did not monitor USCENTCOM compliance with the requirements in DoDI 6490.11, as required. This occurred because the Joint Staff did not designate an office of primary responsibility to monitor compliance with DoDI 6490.11.

As a result, the DoD cannot ensure actionable TBI analysis is conducted because the JTAPIC Program Office is lacking PCE and TBI data to inform the DoD's efforts to develop solutions to prevent or mitigate TBIs in the deployed environment. Additionally, according to JTAPIC, the DoD cannot determine whether all Service members are being properly diagnosed and treated for TBIs in deployed settings, due to the lack of PCE reporting. Furthermore, the JTAPIC Program Office may be unable to verify whether Service members were involved in a PCE. Therefore, the DoD may not know the number of Service members involved in PCEs in the USCENTCOM Area of Responsibility. Finally, without consistent and adequate information on PCEs, Service members may not be eligible to receive disability benefits or care associated with a PCE from the Department of Veterans Affairs after separating from the military.



We recommend that the Chairman of the Joint Chiefs of Staff appoint an Office of Primary Responsibility to monitor compliance with the requirements in DoDI 6490.11. Additionally, we recommend that the USCENTCOM Commander revise USCENTCOM Regulation 40-1 to:

  • Designate an office of primary responsibility to receive, review, and monitor USCENTCOM Service Components’ reporting of PCEs.
  • Include requirements for USCENTCOM to submit monthly PCE tracking reports and monitor Service Component compliance with the monthly reporting requirements.
  • Include specific details on the minimum required field for the monthly reporting.


Management Comments and Our Response

The Vice Director of the Joint Staff, responding on behalf of the Chairman of the Joint Chiefs of Staff, agreed with the recommendation to appoint an office [REDACTED].

The action taken by the Vice Director meets the intent of the recommendation; therefore, we consider this recommendation closed.

The Vice Director of the Joint Staff, responding on behalf of the USCENTCOM Commander, agreed with the recommendation to revise USCENTCOM Regulation 40-1. [REDACTED]. Therefore, we consider this recommendation resolved but open.


This report is the result of Proj. No. D2020-DEV0PD-0121.000.