More than 142,000 post-9/11 veterans who screened positive for a possible deployment-related brain injury, and who agreed to the follow-up exam that determines whether they actually have one, never received it.
The finding comes from a national review released August 5 by the Department of Veterans Affairs Office of Inspector General and first reported by Military.com. Investigators found that 301,177 veterans agreed to a comprehensive traumatic brain injury evaluation after screening positive between September 11, 2001 and March 31, 2025. Only 158,907 received one, leaving 142,270 without the assessment.
For the households behind those numbers, the gap is not administrative. A positive screen is the point at which a veteran is told something may be wrong. The evaluation is what determines whether it is, and what treatment follows.
Screening Worked. The Handoff Did Not.
The review examined roughly 2.9 million veterans who left active duty after 9/11 and received VA medical care. The VA started TBI screening for 2.7 million of them, or 94.4%, which investigators described as largely successful.
Of roughly 1.7 million veterans who completed the full screening, 347,650 screened positive. The VA offered comprehensive evaluations to more than 95% of that group, and about 91% accepted. Only 52.8% of those who accepted ultimately received the exam.
Investigators reviewed the records of 100 veterans from the fiscal 2024 group who agreed to an evaluation and did not get one. In 65% of those cases, the veteran canceled the appointment or did not respond to scheduling attempts.
In 15% of sampled records, the breakdown was inside the VA. Staff never placed the required consultation. More than a third of facility officials interviewed said some nurses and other employees who perform the initial screening could not enter those consults themselves and had to notify another provider to place the order.
Another 14% appeared to have received an evaluation, but staff did not use the required electronic template, so the exam never registered in the department's performance data.
Completion rates have improved. Veterans screened during fiscal 2024 completed evaluations 61.1% of the time, about eight percentage points above the historical average. Investigators concluded veterans nonetheless remained at risk of missing needed treatment.
A Positive Screen Is Not a Diagnosis
This distinction is the one the inspector general itself draws, and getting it wrong in either direction causes harm.
The VA screen is a short set of questions about deployment events and symptoms. Answering yes does not mean a veteran has a brain injury. It indicates that assessment by a specialist is warranted, which is why VA policy, as described in earlier federal oversight work, directs that a positive result leads to a specialist evaluation rather than a diagnosis. Conditions with overlapping symptoms, particularly post-traumatic stress disorder, can also contribute to a positive screen.
It also means the 142,270 figure does not describe that many undiagnosed brain injuries. It describes that many unanswered questions, in a population where the answer changes what care a person is offered.
Brain injury became a signature injury of the Iraq and Afghanistan wars, largely through repeated blast exposure from roadside bombs and other explosive weapons. The Defense Department recorded 515,885 service members diagnosed with TBI between 2000 and 2024, according to figures cited by the inspector general.
The inspector general cautioned that its findings span more than two decades and do not necessarily reflect the VA's current performance.
Wait Times, Vacancies and a Template That Locks
Getting an evaluation eventually was only part of the problem. Fewer than half of veterans who completed evaluations following fiscal 2024 screenings received them within 28 days of the positive screen.
Under VA community care rules, specialty care that cannot be scheduled within the applicable access standard can make a veteran eligible for care outside the VA. Every facility representative interviewed said that route was not being used for TBI evaluations. Officials cited difficulty finding outside providers with TBI expertise and trouble getting community documentation back into VA systems.
The VA's national director for Physical Medicine and Rehabilitation Services told investigators that facilities should still follow policy and seek community care when the wait-time requirement cannot be met.
At one unnamed facility, a staff member canceled 135 pending TBI evaluation consults after unsuccessful attempts to find help during a year-long vacancy in the provider position responsible for the exams. Another facility began working through that backlog in mid-2025, and 93 of the 135 had been completed by that December.
Investigators also found the electronic evaluation template was designed for single use. A VA official said that once completed for a veteran, it effectively locks down, creating problems for those who returned to service, deployed again and screened positive a second time. The inspector general identified 41 such veterans. Nine never received the new evaluation because a consult was never placed, and for 13 others, providers documented the appointment by other means because they could not use the standard template. The VA disputed some of these concerns, saying clinicians can use a separate follow-up assessment containing the same standardized material and that it plans to educate clinicians about that option.
Steps for Veterans and the Families Around Them
A veteran who screened positive and never had the follow-up exam can request it. The practical route is to contact the local VA facility or a patient advocate and ask specifically whether a comprehensive TBI evaluation consult was placed, since the review found consults that were never entered. Facilities in the Polytrauma and TBI System of Care are the ones equipped to perform these evaluations and to connect veterans with rehabilitation services.
Family members often notice what a veteran does not. Persistent headaches, memory or concentration problems, irritability, light or noise sensitivity, sleep disruption and balance trouble are worth writing down with dates, because a specialist evaluation depends heavily on history.
Symptoms warranting urgent evaluation rather than a scheduled appointment include worsening headache, repeated vomiting, seizure, one-sided weakness or numbness, slurred speech, confusion or loss of consciousness. Those signal a possible acute problem, not a chronic one.
Veterans facing scheduling delays can ask whether they qualify for community care under access standards. The inspector general found facilities were not offering that route for these exams, so asking may be necessary.
The inspector general issued three recommendations, including a review of the referral process after positive screenings and consideration of a uniform system for directing veterans to available specialists. The VA agreed with the first two and agreed in principle with the third, with target completion dates of June 2027 for referral and outreach changes and March 2027 for a uniform referral process and a national tele-TBI hub. The inspector general said it will keep tracking the changes until the recommendations close.
Key Questions Answered
What did the report find? That 301,177 post-9/11 veterans agreed to a comprehensive TBI evaluation after a positive screen and only 158,907 received one, leaving 142,270 without it.
Does a positive screen mean a veteran has a brain injury? No. It indicates that specialist assessment is warranted, not that a diagnosis has been made.
Why did veterans not get the exam? In a 100-record sample, 65% involved cancellation or no response from the veteran, 15% involved consults VA staff never placed, and 14% were documented outside the required template.
How long should the evaluation take? The VA aims for 28 days after a positive screen. Fewer than half of evaluations following fiscal 2024 screenings met that mark.
Can a veteran get the exam outside the VA? Community care eligibility can apply when access standards are not met, though every facility interviewed reported not using it for these evaluations.
What should a veteran do now? Contact the local VA facility or patient advocate and ask directly whether a comprehensive TBI evaluation consult was placed.
What happens next? The VA has target dates of March and June 2027 for referral, outreach and tele-TBI changes, with inspector general follow-up until completion.
