NATIONAL HARBOR, Md., (Army News Service, Nov. 9, 2011) -- Army Vice Chief of Staff Gen. Peter Chiarelli said the biggest problem he sees in the force today is the "unseen traumas of war."

Chiarelli told attendees of the National Guard's 2011 Joint Senior Leadership Conference at National Harbor, Md., Nov. 8, that the Army is looking into research on tau protein, biomarkers and many other items that could affect traumatic brain injury and post-traumatic stress.

"This is my problem. I am looking at a snapshot of our population ... 9,390 Soldiers who are in a category called the Army Wounded Warrior program. Each one of those Soldiers has a single disqualifying injury as graded out by the VA of 30 percent, or greater," he said.

Chiarelli compared these numbers with something akin to the Gallup Poll -- it's a small portion of 1.1 million Soldiers when trying to understand the prevalent wounds of the past 10 years of war.

"If we look at the visible wounds of this war, they start as the third highest with amputations. Ten percent of that population has lost an arm, a leg or multiple limbs. Sixteen percent has traumatic brain injury ... no-kidding traumatic brain injury, as diagnosed by a doctor, being 30 percent or greater, and 50 percent have post-traumatic stress. So 66 percent of this small portion of a force of 1.1 million ... 66 percent of those who have been wounded in war have post-traumatic stress or traumatic brain injury.

"The impact on those Soldiers and their families is tremendous. And this is the tip of the iceberg," he said.

He used the analogy of a heart operation in trying to explain the complexity of TBI and PTS.

Surgeons, he said, all cut in the same place, they peel it back in the same place, they clamp it in the same place ... they basically do it in the same manner. One doctor may have graduated from Harvard, one from Stanford, one may have 10 years of experience, one may have 30 years of experience, but basically everybody would do it the same way.

"In this particular area (of TBI and PTS), we've got a thousand flowers blooming. There is no standardized care, even in our U.S. Army Medical Treatment Facilities ... because we just don't know enough. But we are really beginning to unlock the secrets and once we can unlock the secrets of the brain and how the brain works, we are going to be able to tell whether it is post-traumatic stress or traumatic brain injury, or whether that Soldier, Sailor, Airman, Marine or Coast Guardsman has both, as we see in so many cases," Chiarelli said.

He hopes, through research he cites below, that many of those thousand flowers will become understood:

• Research into the tau protein and the successive concussions that seems to mutate it and cause it to eat away at the brain, research that could lead to also understanding Alzheimer disease.

• Research into biomarkers, a simple tool that might be able to tell if a Soldier has experienced a concussion, or if he or she has TBI or PTS, or both

• A $50-million study called STARRS (Army Study to Assess Risk and Resilience in Service members) that's working with the National Institute of Mental Health to get at suicides and suicide prevention

One of the most important places for study, he said, is the National Intrepid Center of Excellence, or NICoE, an advanced facility dedicated to research, diagnosis and treatment of military personnel and veterans suffering from traumatic brain injury and psychological health issues. This center was officially turned over to the Department of Defense on June 24, 2010.

"I want to shine a light on NICoE that, I'm afraid, too many commanders don't know about and it's located right across the street from the new Walter Reed National Medical Center at Bethesda.

"It is an amazing place. It is a total change from the way we get at this kind of a problem. It sees 20 patients every four weeks, patients and their families. The most difficult cases we have in post-traumatic stress and traumatic brain injury are sent here," Chiarelli said.

The concept, he said, is not to treat everyone, but to take the most difficult cases, bring them to DC, put them in a four-week intensive program with researchers who are starting to unlock the secrets of the brain with scanning technology that is only found at this location. It has got the most high-speed equipment and some of the best doctors in the world.

At the end of this four-week intensive period, Chiarelli said he has not seen a single Soldier, Sailor, Airmen, or Marine who hasn't indicated it had been a life-changing event.

"The key here is the lessons learned are passed back to our MTFs (Military Treatment Facilities), so our MTFs can apply those same lessons learned.

"If you run into one of those Soldiers and families who are struggling with this, you need to talk to your medical professionals and see if you can't get them a consult at the NICoE. They'll do the evaluation and make the determination, but this truly is an amazing place and I want to make sure that everyone knows about it and knows it's available for all our Soldiers, Sailors, Airmen, Marines and Coast Guardsmen to use.

NICoE is a 72,000-square-foot, two-story facility, with close access to the Uniformed Services University, the National Institutes of Health, and the Veterans Health Administration.

It is designed to provide the most advanced services for diagnostics, initial-treatment plan and family education, introduction to therapeutic modalities, referral and reintegration support for military personnel and veterans with TBI, post-traumatic stress, and/or complex psychological health issues.

NICoE will also conduct research, test new protocols and provide comprehensive training and education to patients, providers and families while maintaining ongoing telehealth follow-up care across the country and throughout the world.

To find out more, visit