Stop Making DVA the Gatekeeper:

Toward a Practical Treatment Pathway for Warfighters and Veterans with Brain Injury and Functional Impairment

Abstract

Australia’s veteran care system is still shaped by a powerful assumption: that veterans with service-related injury should begin with the Department of Veterans’ Affairs (DVA). This paper argues that the assumption now needs to be tested, particularly for veterans with Traumatic Brain Injury (TBI), acquired brain injury, Blast-induced TBI (BiTBI) and permanent functional impairment.

DVA remains relevant for liability, compensation, service attribution, treatment cards, permanent impairment, incapacity and recognition. Those functions matter. But they are not the same as treatment, neurorehabilitation, functional support, employment participation, family scaffolding or daily-life care. The historical repatriation system once provided dedicated health infrastructure for veterans. That model has been progressively hollowed out.

DVA is now largely a claims, entitlement and purchasing bureaucracy operating within a broader care market. Evidence before the Royal Commission into Defence and Veteran Suicide, and analysis in the NDIS Review, point to a serious market-design problem: DVA fees and rules can make veterans less viable to treat than NDIS participants, workers’ compensation clients or private patients.

This paper argues that DVA should no longer be treated as the default gatekeeper for treatment. For eligible veterans with permanent functional impairment, the National Disability Insurance Scheme (NDIS) may offer a more practical pathway because it asks a different question. DVA asks whether a condition is service-related and what entitlement follows. NDIS asks whether a person has permanent impairment, reduced functional capacity and likely lifetime support needs.

This is not an argument against DVA. It is an argument for a practical shift: use DVA where it is the right tool, but stop allowing treatment to be delayed by compensation classification, institutional habit or sentimental attachment to the department carrying the veteran label.

For brain injury, function is often the treatment question.

Introduction: The Question Crystallised

This crystallised during a call about brain health. The thinking had been building for some time: through work on Blast Overpressure (BOP) exposure, Blast-induced TBI (BiTBI), veteran referrals, provider conversations, DVA fee comparisons, the Royal Commission into Defence and Veteran Suicide, the NDIS Review, the Repatriation Medical Authority process, and international engagement with civilian-led brain health programs. But the question became clearer during that call.

If the problem is brain injury and functional impairment, why are we still treating DVA as the necessary starting point? Over the past year, multiple veterans have reached out because the formal system has not provided useful answers. Their histories differed, but the pattern was familiar: blast exposure, impact-related concussion, blunt-force trauma, psychiatric diagnoses, medical discharge, poor continuity of care, and persistent symptoms that did not sit neatly inside one bureaucratic category. In several cases, Vigil helped connect them with trusted clinicians and providers.

The original instinct was often to find a better DVA-recognised neurologist, doctor or provider. That made sense at the time. If the person was a veteran, the obvious assumption was that the veteran system should be the pathway. DVA language kept pulling the problem back toward liability, accepted conditions, Statements of Principles, treatment cards and compensation. The providers who were moving veterans toward practical support were doing something different. They were assessing impairment, function, support need and daily-life impact. They were asking what the veteran could do safely, reliably, repeatedly and sustainably. They were using the language of function, not the language of entitlement.

This is not about compensation. It is about treatment. A veteran with a brain injury may still need DVA for liability, recognition, permanent impairment, incapacity payments or formal acceptance of service connection. But none of those functions proves that DVA should control the treatment pathway. Compensation and treatment are related. They are not the same. Vigil has also had to confront its own earlier framing. Much of our work asked why DVA, veterans and military brain injury were excluded from broader national conversations on brain injury, disability, allied health, research funding and care. That was a reasonable question.

It remains reasonable. The harder conclusion may be that DVA is not only difficult for veterans. Clinicians, researchers, providers and other parts of government may also experience DVA as slow, underpriced, administratively heavy or difficult to work with. If that is the case, the broader system may learn to move around it. That changes the strategic question. Instead of asking why DVA is not at the centre of these conversations, we should ask why we keep trying to put it there. The Home Base last year sharpened that conclusion. DVA’s exclusion of the people who had built the bridge to that model demonstrated the gatekeeper problem in practice.

Vigil will use DVA where DVA is the right tool: liability, compensation, service attribution, treatment cards, permanent impairment and formal recognition. But we will no longer treat DVA as the centre of gravity for treatment. The mistake may have been treating DVA as the terrain. It is a tool, and increasingly not the right one for care.

The older repatriation promise was not a promise of claims processing. It was a promise of care, restoration, participation and support after service. If another lawful pathway can better support function, the serious question is not whether it carries the veteran label. The serious question is whether it works.

For some veterans with TBI, acquired brain injury or BiTBI, that pathway may involve the NDIS. Not because NDIS is perfect. Not because every veteran will qualify. Not because DVA has no role. But because NDIS starts from impairment, function, participation and support need. For veterans living with permanent functional impairment, that may be the question that matters most.

1. The Gatekeeper Problem Is Not Theoretical

The problem is not only that DVA is experienced as slow, difficult or underpowered in the treatment space. The problem is that DVA can become the gatekeeper to conversations, relationships and models it did not build.

Australia does not currently have a dedicated national pathway for military brain injury. It does not have an equivalent to Home Base, the Marcus Institute for Brain Health, or the National Intrepid Center of Excellence. It does not have a national veteran brain injury centre. It does not have a coordinated civilian-led pathway for warfighters and families dealing with brain injury, trauma, moral injury, transition and functional impairment. So when a pathway is built from outside the system, the question becomes whether DVA helps it form, or controls it once it becomes visible.

In August 2025, Vigil helped bring Home Base’s leadership to Canberra to expose decision-makers to one of the most developed civilian-led veteran and family brain health models in the world. We designed and self-funded a 72-hour program that placed the Home Base delegation before senior parliamentarians, Army leadership, DVA, the Australian War Memorial, the National Centre for Veterans’ Healthcare, the Australian Veteran’s Brain Bank and the veteran sector. A veteran and I, both of whom had participated in Home Base programs earlier in 2025, were included in every major engagement across that visit except one: the DVA meeting.

That exclusion was not incidental. It happened even though we had created the opportunity, connected the people, built the program, travelled for the engagement and brought direct lived and subject-matter experience to the table. The issue is not that two individuals were left outside a meeting. The issue is what that exclusion revealed. DVA did not create the Home Base relationship. It did not fund the visit. It did not build the program. It did not connect Home Base to Parliament, the Army or the wider veteran sector. Yet once the conversation reached DVA’s door, DVA could still decide who was allowed in the room.

Six months after that exclusion, Vigil coordinated the visits of a senior ADF official and a senior DVA official to Home Base in Boston, James A. Haley Veterans’ Hospital in Tampa, and the National Intrepid Centre of Excellence in Washington, DC. Vigil built that access and did not gatekeep it. The model examined in those visits is now being considered a reference point for what a national approach to warfighter and veteran brain health in Australia could look like.

We will use DVA when it is the right tool. There are areas where it remains relevant: liability, compensation, service attribution, permanent impairment, incapacity, treatment cards, accepted conditions and formal recognition. But treatment is different. Vigil will not keep wasting energy trying to make DVA the centre of gravity for treatment when DVA has repeatedly demonstrated that it is not structured, priced or culturally positioned to deliver that role. The point is not to exclude DVA because we can. The point is to stop allowing DVA to control pathways it has not built and cannot sustain.

DVA may be a mechanism. It should not be the terrain.

2. Repatriation Was Care. DVA Is Not.

The emotional attachment to DVA is understandable. It comes from the older idea of repatriation. That idea was not simply about claims. It was not only about compensation. It was a national obligation to support those who served when they returned. It included care, restoration, rehabilitation, work, family stability and reintegration into civilian life.

Australia once built institutions around that obligation. Repatriation hospitals were dedicated public institutions for returned service personnel. They developed specialist expertise and formed part of a broader national system of veteran health care. That system is now gone.

The Royal Commission into Defence and Veteran Suicide records the historical shift. Repatriation hospitals were progressively integrated into the mainstream hospital system in the 1980s and 1990s. Apart from Open Arms, this marked the end of DVA’s direct provision of health care and the shift toward DVA purchasing services from mainstream providers (Royal Commission into Defence and Veteran Suicide 2024).

A direct care system owns capacity. A purchasing system buys access from the broader market. But a purchasing system can work only if the market is willing and able to provide the care. It depends on price, administrative load, referral rules, clinical complexity and provider willingness. If the price is too low, the paperwork is too heavy, gap fees are prohibited, or the population is too complex for the reimbursement model, providers will rationally move elsewhere.

The old repatriation model created a dedicated care pathway. The current DVA model often leaves veterans trying to navigate a fragmented market of private providers, public systems, Medicare, DVA schedules, state systems, NDIS, workers’ compensation schemes and self-funded care. That is not repatriation in the original sense. It is outsourced access.

The veteran community may still attach the idea of repatriation to DVA. But the mechanism that once delivered repatriation no longer exists in the same form. That does not mean repatriation should be abandoned. It means we need to stop confusing repatriation with DVA.

Repatriation is the obligation. DVA is only one mechanism. If that mechanism is no longer fit for treatment, then the obligation must be pursued through other lawful pathways.

3. Compensation Is Not Treatment

DVA still matters. It matters for liability. It matters for service attribution. It matters for compensation, permanent impairment, incapacity, treatment cards, accepted conditions and formal recognition. These functions are not trivial. For many veterans, they are financially and symbolically important. But they are not treatment.

A treatment card does not create a provider. An accepted condition does not create a multidisciplinary brain injury pathway. A compensation decision does not provide neurorehabilitation, support coordination, employment support, family education, vestibular therapy, speech pathology, cognitive rehabilitation or daily-life scaffolding.

For veterans with TBI, acquired brain injury or BiTBI, the problem is often not one clean diagnosis. It may involve cognition, sleep, pain, mood, fatigue, vestibular impairment, visual dysfunction, headaches, memory, executive function, emotional regulation, family strain and reduced work capacity. Some of this may overlap with PTSD. Some may overlap with moral injury. Some may relate to blast exposure or other trauma. Some may sit across several domains at once. A compensation system wants a category. A treatment system needs a pathway.

The Repatriation Medical Authority process illustrates the risk. In its 2025 briefing paper on blast-induced mild TBI, the RMA recorded that there were no current Statements of Principles for the condition. The original request for a new SoP arose because existing SoPs for concussion, moderate-to-severe TBI and dementia pugilistica did not capture cumulative exposures from heavy weaponry, combatives and parachuting (Repatriation Medical Authority 2025). Existing explosive blast injury, concussion and moderate-to-severe TBI SoPs are directed to single explosive blast injury events. At the same time, the issue under investigation was repeated low-level exposure and possible cumulative effects over time. That may be a difficult problem for compensation law. It should not become a treatment delay.

DVA’s 9 February 2026 update to fees for compensation claim medical assessments and reports makes the same distinction visible. The update increased fees for medical assessments and reports requested by DVA to support the investigation of a veteran’s eligibility for benefits. But the guidance states that the fees relate to compensation purposes and do not apply to treatment services. Fees are payable on a per-request basis rather than per condition. Payment is not guaranteed for reports or information not requested by DVA. Above-rate fees require prior written approval (Department of Veterans’ Affairs 2026a; Department of Veterans’ Affairs 2026b).

That may be appropriate for compensation integrity. It is not a care pathway.

If a veteran presents with cognitive, neurological, vestibular, visual, psychological, sleep, pain or self-management impairment, the first treatment question should not be whether the compensation system has settled the label or requested the right report. The first question should be what the veteran needs to function. DVA can continue to assess liability and compensation. The RMA can continue to assess whether the evidence supports a Statement of Principles. Defence and DVA can continue to develop exposure recording and prevention frameworks under Recommendation 61. But veterans who need care should not have to wait for those processes to mature.

Treatment should begin with clinical need and functional impairment. Compensation can run beside it. It should not sit in front of it.

4. The Provider Market Has Already Moved

The most immediate reason to stop treating DVA as the default treatment pathway is practical: the provider market has already moved. Veterans do not receive care from a dedicated repatriation health system. In most cases, they receive care from the same broader market as everyone else: GPs, psychologists, physiotherapists, occupational therapists, speech pathologists, psychiatrists, exercise physiologists, rehabilitation providers and other allied health professionals.

That market responds to price, complexity, administration and opportunity cost. DVA may authorise treatment. It may issue a card. It may maintain a schedule of fees. But if providers cannot sustainably deliver care under those settings, access becomes theoretical.

The Royal Commission into Defence and Veteran Suicide identified this directly. It found that DVA fees have been affected by indexation freezes, that providers cannot charge a gap fee or co-payment for DVA-funded services, and that DVA fees are not competitive with workers’ compensation or NDIS arrangements (Royal Commission into Defence and Veteran Suicide 2024).

That no-gap rule is central. Under DVA-funded care, the DVA fee is the full payment. Providers cannot charge the veteran a gap to make the service commercially viable. In a low-complexity case, some providers may absorb that difference. In a complex veteran brain injury, the calculation is different. The work is not only the appointment. It can include reviewing long histories, reading prior reports, managing comorbid PTSD, pain, sleep disturbance, vestibular dysfunction, family strain, work impairment, medication issues, alcohol use, cognitive symptoms and compensation-related stress. It can include report writing, case coordination, functional assessment and communication with GPs, specialists or rehabilitation providers. If the rate does not support that work, providers have three choices: accept the lower return, cross-subsidise the veteran from other patients, or stop taking DVA patients.

This is not theoretical. The Royal Commission heard evidence that veterans were being told clinicians’ books were closed, while NDIS-funded clients could access the same clinicians because of the different rates paid. Dr Bernadette Boss CSC, the former Interim National Commissioner for Defence and Veteran Suicide Prevention, reported hearing that issue repeatedly. Dr Kieran McCarthy, a veteran and operator of GO2 Health, gave similar evidence across psychology, psychiatry, physiotherapy, exercise physiology, allied health and general practice (Royal Commission into Defence and Veteran Suicide 2024).

The Australian Physiotherapy Association also raised the issue publicly. The Royal Commission records the APA’s evidence that physiotherapists were struggling to keep up with the cost of DVA client sessions, that the DVA physiotherapy fee sat chronically low, and that 91 per cent of surveyed physiotherapists stated that current DVA funding did not enable them to sustain care for veterans. The market fee for general physiotherapy was described as more than double the DVA fee (Royal Commission into Defence and Veteran Suicide 2024).

This aligns with what Vigil has heard directly from providers. Some no longer treat DVA patients. Others still do, but absorb the gap. That is not a sustainable treatment model. It is goodwill disguised as system design. Many providers continue to treat veterans because they believe in the population, because they have long-standing relationships, or because they are willing to carry the financial and administrative burden. But a system that depends on provider goodwill is not a system.

A veteran may have served the country. They may carry a DVA card. They may have accepted conditions. But to the provider market, they can still represent a lower-paid, higher-complexity, administratively heavier client.

A treatment card does not create a provider.

5. The Civilian Care Pathway Was Already the Direction

This paper should not be read as a sudden pivot to NDIS. The direction had already been forming through Vigil’s international brain health work. During the 2025 visit to Home Base, the Marcus Institute for Brain Health and the National Intrepid Center of Excellence, the central lesson was not simply that Australia needs better post-service treatment. It was that care has to begin earlier, be trusted by the person receiving it, include families, and focus on function, sustainment and long-term capacity.

The conclusion in those reflections was direct: proactive care may need to sit outside the military health system. It should be civilian-led, protected by clear confidentiality boundaries, and focused on warfighter brain health, function, family impact and sustained performance. The same reflections noted that many warfighters already seek civilian providers off the books when they do not trust military systems enough to disclose symptoms or concerns (Vigil Australia 2025a).

The problem is not just DVA. It is the broader habit of treating military and veteran bureaucracies as the natural owners of care, even when they are not trusted, not clinically equipped, not priced to sustain care, or not designed around functional recovery. A civilian-led pathway can be clinically grounded without being captured by command, claims or entitlement logic. It can focus on the person’s functional needs rather than the institution’s category. It can involve the family earlier. It can make room for neuropsychology, occupational therapy, vestibular assessment, physiotherapy, speech pathology, psychology, sleep, pain, employment and support coordination.

Many serving personnel and veterans do not speak honestly when they believe the consequences will be punitive, career-limiting, dismissive or bureaucratic. They learn to mask. They learn to manage around the system. They seek help quietly, privately, inconsistently or too late. A trusted civilian pathway does not solve every problem. But it changes the conditions under which veterans and warfighters might finally tell the truth about what is happening to them.

The missing piece was not the care concept. It was the funding pathway. For eligible veterans with permanent functional impairment, NDIS may provide a lawful mechanism to fund part of a civilian-led, function-based model. It will not fund everything. It will not replace health care. It will not replace compensation. It will not resolve service causation. But it may fund supports that DVA is not practically delivering and that the provider market may be more willing to supply through NDIS settings.

This is not simply DVA versus NDIS. It is DVA versus a civilian-led pathway that veterans can trust, providers can sustain, and families can navigate.

6. The NDIS Review Confirms the Distortion

The NDIS Review is useful here precisely because it was not written as a report on veteran health. Veterans appear in it as part of the broader care-and-support market. That is the correct frame. Veterans are not outside the market. They are inside it, competing for the same providers as NDIS participants, aged care clients, workers’ compensation clients, private patients and Medicare patients.

The Review’s Supporting Analysis identifies a pricing problem across the care and support sector. It notes that price caps are used in aged care and veterans’ care, but that there is no coordinated approach to setting prices across these sectors. It warns that price differences can leave the Australian Government effectively competing with itself (NDIS Review 2023).

The Care and Support Economy Taskforce put the problem more directly: government programs are, in effect, competing with each other to secure services for their target cohorts. The policy and program settings for the NDIS and aged care, especially service pricing, put pressure on the market for veterans’ services. The unintended consequence of this misaligned pricing can be underservicing of the veteran population (NDIS Review 2023).

The Commonwealth has created competing care markets, and veterans may be losing that competition. This matters because it shifts the argument away from individual grievance. The problem is structural. Pricing, administration and market design are pushing providers toward some funded cohorts and away from others. If NDIS pricing is higher, if workers’ compensation is more viable, if private clients involve less paperwork, and if DVA prohibits gap fees while dealing with a high-complexity cohort, then the result is predictable: veterans become harder to place, providers narrow their books, access degrades, and families carry the consequences.

The Review also points toward a solution: more harmonised pricing, better use of government buying power, and pricing that does not deter providers from offering services in different sectors (NDIS Review 2023). That is a system-level fix. But veterans need pathways now. Until the Commonwealth fixes the pricing distortion, eligible veterans with permanent functional impairment should not be trapped in the weaker pathway simply because it carries the veteran label.

For some veterans, that pathway may be NDIS.

7. NDIS Asks a Different Question

The practical value of NDIS is not that it is a veteran system. It is not. Its value lies in the fact that it asks a different question.

DVA asks a service-causation question: was the injury caused by service? Is liability accepted? Does the condition fit a Statement of Principles? What entitlement follows? Those questions matter for compensation, recognition, permanent impairment, incapacity and institutional accountability. But they are not always the right first questions for treatment.

NDIS asks a function question: what is the impairment? Is it permanent, or likely to be permanent? Does it substantially reduce functional capacity? Does it affect communication, social interaction, learning, mobility, self-care or self-management? Does it affect social or economic participation? Is the person likely to require supports over their lifetime?

For veterans with TBI, acquired brain injury or BiTBI, that may be the more relevant treatment frame. Brain injury is often lived as function. It is the inability to reliably manage appointments. It is reduced tolerance for noise, light, crowds or stress. It is memory failure, executive dysfunction, poor sleep, vestibular disturbance, fatigue, irritability, emotional dysregulation, visual problems, cognitive slowing, poor self-management, loss of employment capacity and pressure on families.

A compensation model may ask whether those impairments can be attributed to the service. A treatment model should ask what needs to be done about them.

NDIS does not require DVA to accept liability before a veteran can be assessed for functional impairment. It does not require Defence to have properly recorded blast exposure. It does not require the veteran to win an argument about whether the condition falls within the correct compensation category.

That does not mean access is automatic. A diagnosis of TBI, ABI or BiTBI is not enough. The evidence still needs to demonstrate permanence, functional impact, participation restriction and support need. The boundary between health care and disability support can also be difficult, especially in neurorehabilitation.

For veterans whose practical problem is daily functioning, NDIS may ask a question that DVA is structurally less equipped to ask. If the first question is ‘will DVA accept this?’, the veteran is pulled toward causation, category, entitlement and delay. If the first question is ‘what function has been lost and what support is required?’, the pathway begins with assessment, evidence, support and care.

For brain injury, function is often the treatment question.

8. The Referral Pattern

This distinction became clearer through the veterans who have reached out directly.

Over the past year, warfighters and veterans have contacted Vigil because the formal system was not producing answers. Their histories differed, but the pattern was familiar: blast exposure, impact-related concussion, blunt-force trauma, psychiatric diagnoses, poor continuity of care, medical discharge, ongoing symptoms, and difficulty finding clinicians who understood the whole picture.

The original instinct was often to find a better DVA-recognised neurologist, psychiatrist, GP or allied health provider. That instinct made sense. If the person was a veteran, the obvious assumption was that the veteran system should be the pathway.

The more useful providers were not starting with DVA acceptance. They were not asking first whether the injury had been accepted under a Statement of Principles. They were not trying to force the presentation into a compensation category before doing anything else. They were assessing impairment. They were looking at the function. They were asking what the veteran could do safely, reliably, repeatedly and sustainably. They were documenting support need. They were translating symptoms into practical impacts: work capacity, self-management, memory, emotional regulation, sleep, mobility, social participation, family strain, appointment management, communication, fatigue and daily living. It is treatment language.

This does not mean DVA should disappear from the veteran’s life. In many cases, the DVA claim still matters. Liability, accepted conditions, compensation and recognition may remain essential. But those processes do not need to control the treatment sequence. DVA language pulled the problem back toward entitlement. NDIS language pulled it toward function. It changes what providers look for, what evidence is gathered, what supports are requested and what kind of care becomes possible.

If a veteran with a brain injury is assessed only through compensation language, the system may keep asking whether the injury can be accepted. If the same veteran is assessed using functional language, the system then asks how they live, what they cannot manage, what supports they need, and what would improve participation.

That is the treatment pathway.

9. If the Cohort Has TBI, Why Start with DVA?

The question crystallised during a recent brain health call about a possible pilot. As usual, the funding question surfaced. The assumption was that DVA would need to be involved. If the cohort has TBI, acquired brain injury, BiTBI or permanent functional impairment, why start with DVA?

If the purpose is liability, compensation or formal recognition, DVA may be necessary. But if the purpose is assessment, treatment, function, daily-life support, employment participation, family stability and long-term care, DVA may not be the right first door.

A GP can refer. A neuropsychologist can assess cognition. An occupational therapist can assess daily function, self-management and support needs. A physiotherapist can assess mobility, pain, balance and vestibular issues. A speech pathologist can assess cognitive-communication problems. A psychologist can assess behavioural, emotional and adjustment issues. An exercise physiologist can rebuild capacity. A functional capacity assessment can describe what the veteran can and cannot do in daily life. That evidence can then support an NDIS access request where the veteran meets the criteria.

This is not a workaround in the improper sense. It is the use of a lawful pathway designed around impairment and function. The veteran’s DVA claim can continue separately if needed. Compensation and recognition can keep running in the background. But the veteran should not be forced to wait for DVA before assessment and functional support begin. This is especially important in brain injury because delay has consequences. Function deteriorates. Families compensate. Employment fails. Symptoms become normalised. The veteran adapts to impairment. The system then mistakes survival strategies for recovery.

A DVA-first pathway can unintentionally reward delay. It asks the veteran to wait while categories, liability and entitlements are considered. A function-first pathway asks what is needed now. The point is not to move veterans into NDIS for its own sake. The point is to use NDIS only where it is lawful, clinically appropriate and aligned to permanent functional impairment.

The pathway should start with impairment and support need, not institutional habit.

10. The Sustainability Test

The case for an NDIS pathway should not be overstated. NDIS may be a lawful and practical route for some veterans with permanent functional impairment. It may also be a better fit for parts of the care problem than DVA, because it is built around impairment, function, participation and support need. But that does not make it automatically sustainable.

Before treating NDIS as the answer, we need to hear from the people who would have to make it work: GPs, neuropsychologists, occupational therapists, physiotherapists, speech pathologists, psychologists, exercise physiologists, rehabilitation physicians, support coordinators, plan managers, NDIS providers, veteran-focused clinicians, and families already carrying the load.

The first question is whether the provider market would actually behave differently. Would a clinician who no longer accepts DVA patients treat the same veteran under NDIS? If so, why? Is it the rate? The reporting structure? The ability to bill for non-face-to-face work? The scope for functional assessment? The reduced friction compared with DVA? Or is NDIS simply a different administrative burden with better pricing?

The second question is whether NDIS can properly support complex brain injury. TBI, acquired brain injury and BiTBI rarely present as a single clean impairment. They can involve cognition, vestibular function, sleep, fatigue, pain, emotional regulation, executive function, communication, social participation, employment capacity and family dynamics. These are not always easy to separate from PTSD, depression, anxiety, moral injury, substance use, chronic pain or medication effects. Some needs are health care. Some are disability supports. Some are rehabilitation. Some are psychosocial. Some are family support. Some are employment-related. Some still sit with DVA. If the boundary is not mapped properly, veterans may be moved from one confusing system into another.

The third question is evidence. What evidence-based pack actually works for a veteran with a brain injury seeking NDIS access? A diagnosis alone will not be enough. The evidence must translate clinical symptoms into functional impact. It must explain permanence or likely permanence. It must show reduced capacity in daily life. It must explain social and economic participation. It must identify the supports required. That means the pathway needs disciplined clinical documentation, including GP referral, neuropsychology, occupational therapy, physiotherapy, speech pathology, psychology, vestibular assessment, functional capacity assessment and supporting material from family members or carers. It also needs providers who understand how to write for function, not just diagnosis.

The fourth question is risk. NDIS is not risk-free. It has integrity, provider quality, access, and planning problems. Veterans with brain injury may be particularly vulnerable: impaired executive function, poor memory, reduced self-management, difficulty sequencing appointments, fatigue, emotional dysregulation or reduced capacity to challenge poor service. Families may already be exhausted. A poorly designed pathway could create new harm.

That is why any veteran brain injury NDIS pathway would need safeguards: trusted providers, clear clinical standards, functional evidence templates, a way to identify poor-quality or exploitative providers, support for families, and guidance on what belongs in NDIS, what belongs in Medicare or state health, and what remains DVA’s responsibility. The answer is not to distort diagnosis to open funding doors. The answer is to document the acquired brain injury, neurocognitive impairment, psychosocial impact and functional limitation properly.

The sustainability test is simple, but demanding: can NDIS provide a lawful, ethical, clinically sound and commercially sustainable pathway for eligible veterans with permanent functional impairment? Can providers deliver that care without relying on goodwill? Can veterans navigate it safely? Can families be supported rather than left to coordinate another system on their own?

The next step is not another closed-door discussion between departments. It is a practical conversation with the providers who see the problem every week.

11. What This Does Not Mean

This argument needs boundaries. It does not mean every veteran should apply for NDIS. It does not mean every veteran with TBI, acquired brain injury or BiTBI will meet NDIS access criteria. It does not mean NDIS is simple, clean or risk-free. It does not mean DVA has no role. It does not mean Defence and DVA escape responsibility for exposure prevention, record keeping, health surveillance, research, Recommendation 61, or the long failure to understand and manage military brain injury.

The point is narrower and more practical: DVA should not be the default treatment gatekeeper where another lawful pathway can better support function. A veteran may still need DVA for liability, accepted conditions, compensation, permanent impairment, incapacity payments, treatment cards and formal recognition. Those are legitimate functions. For many veterans, they are essential. But those functions should not be confused with treatment.

If a veteran needs neurorehabilitation, occupational therapy, speech pathology, physiotherapy, vestibular assessment, psychology, support coordination, family education, employment participation or daily-life scaffolding, the starting point should be clinical and functional need. Not institutional habit. Not DVA permission. Not whether the compensation system has settled the category.

If veterans are moving toward NDIS because DVA is not fit for purpose in the treatment space, that is not a policy success. It is evidence of system failure. The Commonwealth should not be able to avoid responsibility by allowing one part of government to become unusable while another part absorbs the consequences.

Nor should DVA be allowed to step back from prevention and accountability.

Defence and DVA still need to record exposure, monitor affected cohorts, fund research, improve clinical guidance, implement Recommendation 61, and explain how Australia will prevent further harm from BOP exposure and military brain injury.

Recent announcements about expanded DVA rehabilitation and newer treatments, including social well-being supports and psychedelic-assisted therapies for eligible cohorts, may be useful. But where those supports remain tied to accepted claims and DVA plans and decision-making, they do not resolve the deeper question of whether DVA should be the first door for treatment (Evans 2026).

The argument is not that NDIS replaces DVA. DVA should be put back in its proper lane: DVA for liability, compensation, formal recognition and entitlement; health systems for clinical diagnosis and treatment; NDIS for eligible disability supports linked to permanent functional impairment; trusted providers for assessment, rehabilitation and support; and families included as part of the functional picture.

The veteran’s need should determine the pathway. The department’s label should not.

Moving care through another lawful pathway should not absolve DVA. It should stop DVA from being the bottleneck.

Practical Priorities

The point of this paper is not to argue endlessly about DVA. The point is to identify a practical treatment pathway for eligible veterans with brain injury and functional impairment. If DVA is useful, use it. If DVA is the bottleneck, do not wait for it.

Stop treating DVA as the default treatment pathway

DVA should no longer be treated as the automatic first door for treatment. It remains relevant for liability, compensation, service attribution, permanent impairment, incapacity, treatment cards and formal recognition. But those are entitlement functions. They should not control whether a veteran can access clinical assessment, neurorehabilitation, allied health, functional support or family scaffolding. The first treatment question should be simple: what does this veteran need to function? The pathway should then follow the answer.

Build a veteran brain injury NDIS access pathway

A dedicated pathway is needed for veterans with TBI, acquired brain injury or BiTBI who may meet NDIS access criteria because of permanent functional impairment. This should not be a generic information sheet. It should be a practical pathway that explains who should assess the veteran, what evidence is needed, how to document functional impairment, how to distinguish health treatment from disability support, how to involve family members and carers, and how DVA claims can continue separately without blocking care. The pathway should be built around impairment, function, participation and support need, not institutional habit.

Develop standard functional evidence packs

Veterans with brain injury need evidence that translates symptoms into function. A diagnosis is not enough. The evidence pack should show what the veteran can and cannot do safely, reliably, repeatedly and sustainably. It should document cognition, self-management, communication, mobility, social participation, emotional regulation, fatigue, sleep, pain, vestibular issues, visual issues, employment capacity and daily living. Standard templates should be developed for GP referral and summary, neuropsychology, occupational therapy, physiotherapy, vestibular assessment, speech pathology, psychology, exercise physiology, functional capacity assessment, and family or carer impact statements. The aim is to make functional impairment visible.

Create a trusted provider network

A pathway is only useful if providers can deliver it. A credible pathway would need to identify and test a trusted network of clinicians and providers who understand TBI, BiTBI, acquired brain injury, complex trauma, veteran culture, NDIS reporting, functional assessment and family impact. The standard should be practical competence, not branding. The question is not whether a provider says they support veterans. The question is whether they can properly assess, document, and support functional impairment.

Clarify the Health, NDIS and DVA boundary

The boundary between health care, disability support and compensation is one of the biggest risks in any NDIS-focused veteran pathway. Some needs belong in Medicare or state health. Some may belong in NDIS. Some remain DVA’s responsibility. Some may require private funding, philanthropy or another mechanism. This boundary needs to be mapped clearly so veterans are not pushed from one confusing system into another. The goal should be a simple operating model: DVA for liability, compensation, recognition and entitlement; health systems for clinical diagnosis and treatment; NDIS for eligible disability supports linked to permanent functional impairment; trusted providers for assessment, rehabilitation and support; and families included as part of the functional picture.

Protect veterans from poor-quality or exploitative providers

NDIS is not risk-free. Veterans with brain injury may be vulnerable to poor providers, inflated claims, weak coordination, unnecessary services, under-servicing, over-servicing or inappropriate diagnostic framing. A veteran brain injury NDIS pathway needs safeguards: clear provider standards, transparent referral logic, evidence-based practice, family awareness, escalation options and a way to identify providers who should not be used. The answer to DVA failure cannot be to send veterans into another system without protection.

Use DVA only where it is the right tool

DVA should be used deliberately. Where a veteran needs liability accepted, a condition recognised, compensation assessed, permanent impairment determined, incapacity considered or treatment-card access clarified, DVA remains relevant. But DVA should not be treated as the treatment strategy. The practical question should always be: what is DVA needed for in this case? If the answer is compensation or recognition, use DVA for that. If the answer is treatment and functional support, look first to the pathway that can actually deliver it.

Use Recommendation 61 for prevention and accountability

Recommendation 61 should drive exposure recording, health surveillance, longitudinal monitoring, screening, prevention, research and policy reform for military brain injury and BOP exposure. But it should not become another reason to delay care. Veterans already living with functional impairment need help now. The two efforts should run together: prevention and accountability through Defence, DVA and Recommendation 61; treatment and functional support through the pathway that works.

Conclusion

The purpose is not to abandon repatriation. It is to stop confusing repatriation with DVA. Repatriation was the obligation: to care for those who served, restore function where possible, support families, enable participation, and carry the consequences of service as a national responsibility. DVA is only one mechanism.

The current treatment pathway attached to DVA has failed the practical test. It does not own a dedicated national veteran health system. It does not operate a network of repatriation hospitals. It does not provide a specialist national brain injury pathway. It purchases care from the same provider market as everyone else, while often paying rates that make veterans less commercially viable to treat, a claims-and-purchasing system sitting inside a distorted care market.

This paper has argued for a more practical frame. DVA remains relevant for liability, compensation, service attribution, treatment cards, permanent impairment, incapacity and recognition. Those functions should continue. But they should not make DVA the default gatekeeper for treatment.

For veterans with TBI, acquired brain injury or Blast-induced TBI, the starting point should be impairment, function and support need. Not DVA acceptance. Not institutional habit. Not sentiment. Not a compensation classification process that may take years to catch up with lived impairment.

The provider market has already shown the problem. If clinicians can sustainably treat NDIS participants, workers’ compensation clients or private patients but cannot sustainably treat DVA patients under current settings, then veterans are being placed at a disadvantage in the care economy. That does not reflect their service. It reflects poor system design.

The NDIS Review confirms the broader distortion: government programs can effectively compete with each other for the same providers, and misaligned pricing can lead to underservicing of veterans. That is not an abstract policy issue. It affects whether a veteran can find a physiotherapist, psychologist, occupational therapist, speech pathologist, neuropsychologist, rehabilitation provider or support coordinator.

The answer is not to wait for DVA to become something it has repeatedly shown it is not. The answer is to use DVA where it is useful, and build other lawful pathways where DVA is the bottleneck.

For eligible veterans with permanent functional impairment, NDIS may be one of those pathways. It is not automatic. It is not simple. It is not risk-free. It will need to be tested with providers, include safeguards against poor practice, have clear evidence standards, promote family awareness, and reflect a disciplined understanding of the Health, NDIS, and DVA boundaries. But it asks a question DVA often does not ask first: what function has been lost, and what support is required?

The next step is practical: talk to providers; test the pathway; build standard evidence packs; identify trusted clinicians; map the boundary between health care, NDIS and DVA; protect veterans from poor-quality providers; keep DVA in its lane; and use Recommendation 61 to drive prevention, exposure recording, monitoring and accountability. But do not let compensation architecture delay treatment.

For some veterans with brain injury, the question is no longer how to persuade DVA to become a treatment system. The question is which lawful pathway can actually support their function, and whether the providers who treat them believe that pathway can hold.

The purpose is not to abandon repatriation. It is to make repatriation mean care again.

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