Military Traumatic Brain Injury

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The United States went to war in Afghanistan in the fall of 2001, and then in Iraq in the spring of 2003. These wars are still ongoing, and Traumatic Brain Injury (TBI) has widely been called the “signature wound” of these wars, due to their prevalence among returning veterans. There are a number of factors that contribute to the large numbers of TBI among returning veterans, including improved body armor and medical interventions, both of which can help military personnel survive what would have previously been fatal injuries.

Severity of TBI can range from mild to severe, and is often called an invisible wound, because the physical damage is not readily apparent. Concussions can be caused by blast waves alone, without the impact of debris or shrapnel. A single TBI, such as one caused by a massive concussion or penetrating injury (bullet/shrapnel) can be immediately debilitating, as can the cumulative effect of multiple smaller concussions, such as those caused by exposure to a series of blasts. TBI is associated with depression, PTSD, and substance abuse.

Despite high profile cases such as Bob Woodruff of ABC News, at this time, no adequate tracking or diagnosis program is in place to monitor the incidence of TBI among returning service members and controversies have arisen around programs currently in place. There is no policy to address this major problem. Various small studies have been conducted, but there has been no accurate accounting of these injuries, and as a result the medical and financial needs of these returning veterans cannot even be estimated, let alone met. The Department of Defense and the Veteran’s Administration need to undertake a comprehensive study of the incidence of TBI among returning veterans in order to assess their needs as well as establish the connection or separation of veterans suffering from TBI from those with other mental health problems, such as PTSD and depression.

Links:

www.iava.org

www.va.gov

www.neuroskills.org

www.dvbic.org

www.rand.org

www.remind.org

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5 Responses to “Military Traumatic Brain Injury”

  1. pyntikova Says:

    This is a very interesting problem, particularly because the improvement in life-saving techniques and equipment seems to have led to a degradation of post-injury care. Is TBI a new diagnosis? How different is TBI from a single concussion from which an individual permanently recovers? I wonder if the US can use other countries’ approach to this issue as models. Also, I wonder if part of the problem is the difficulty of distinguishing TBI sufferers from non-sufferers. Given the average soldier’s exposure to extreme levels of sound and blast pressure, don’t all soldiers experience at least some TBI? If so, the first question may be in setting a threshold of what level of TBI is non-reversible without treatment.

    I completely agree with you that the VA and DOD have the responsibility of answering these questions, even from the research perspective alone. In addition to a moral obligation to our troops, the VA and DOD have expert knowledge in the types and frequency of blasts and noise that US troops have to withstand in combat.

  2. eljhsph Says:

    TBI isn’t necessarily a new diagnosis, but the current conflicts the U.S. is involved in are producing more TBIs than before. Part of the problem is that body armor and even armored vehicles can often protect soldiers from blast debris, etc. but the pressure wave from the blast can still cause what might almost be equated with blunt trauma, especially given the amount of explosives often used in IEDs. Because soldiers don’t necessarily show signs of injury, they are not treated or even evaluated. Additionally, the macho climate of the military leads many soldiers to hide or ignore their deficits for fear of being labeled a coward or some kind of “head case”. They end up sustaining multiple concussions and the damage becomes irreversible. Similar issues are coming out in regards to professional football players here in the U.S., and many of the same psycho-social issues reside in both scenarios (macho posturing, don’t want to be seen as weak, don’t want to let teammates/fellow soldiers down, etc.).
    In the same way that wars often spur rapid advances in emergency and trauma medicine, the military medical community has the (unfortunate) opportunity to greatly advance the diagnosis and treatment of TBI, both in the immediate post-injury phase, as well as the long-term rehabilitation phase.

  3. davidhorrocks Says:

    Eljhsph, it seems to me that if targeted funding could help improve TBI treatment for soldiers, this should be an issue for which you could win broad support. I believe the general public is deeply appreciative of the job our soldiers are doing, and there is an eagerness to support them. I’d expect politicians to jump on this issue if effectively presented.

    When problems at Walter Reed were made public a few years ago, it led to public outrage and congressional hearings. Likewise, healthcare coordination problems between DoD and VA created a public outcry a few years before that. It might be worth studying those two events, to see what media coverage, political pressure, etc. helped to jumpstart the activity.

  4. chatcher Says:

    As in noted in the previous comments, I agree that the DoD and VA have a responsibility to provide adequate support and medical care to soldiers. I also believe that the public would support them in dedicating more funds to achieve this. I would think that given the level of mental programming and deprogramming that occurs in the military, the soldiers themselves might be the ideal target for an education intervention. I am not, nor have been, in the military and would like anyone who reads this comment to know that I am in NO way intending to criticize, but soldiers are conditioned to withstand just about anything so recognizing TBI or any other mental illness may be especially difficult for this population. Trying to increase awareness and acceptability of TBI and mental illness could help to decrease the social stigma and teach soldiers to look for signs in themselves and others before they return home. I also believe that this might be incredibly difficult, considering showing signs of weakness, let alone mental instability, is probably contradictory of the most well-protected norms in the military. I would think that trying to change the cultural of the military, however challenging that may be, would give you the best chance of soldiers self-identifying TBI and seeking care.

  5. sandhiarajan Says:

    The DOD and VA does recognize the seriousness of the issue of TBI in our military. Funding has been given to various military hospitals unfortunately there has not been initiative within organizational structure to initiate programs addressing the issue of TBI. The two wars have been draining on military personnel especially our active duty medical who are not only treating and saving lives here in the US but are risking their lives in combat zones in order to save the lives of others. Injuries they are seeing are devastating in call capacities those that are more visible than other. They treat the wounded the amputee and move on to the next hundred that are continuously coming in. Unfortunately with the amount of loss it the visible wounds that are treated first. It is difficult to keep medical staff in the Army and Navy when most of them make much more in the civilian side. Regarding the “mental programming” of the military there may be some misconceptions. Our Marines, Soldiers, Sailors and Airmen especially Marines in Soldiers who deal in direct combat are taught to obey commands, combat arms and to work as a team in order to complete their mission and come out alive. In their conditioning to become more effective in combat does not include ignoring injury but rather a fear of letting down their peers who they have trained with and who will continue to fight when they are injured. You would be surprised to see how many want to return despite their injuries. I would say that is more human nature just as many of us would do that for those we consider family.

    The DoD has greatly increased their efforts to reduce the stigma related to PTSD through education, training and I agree it is an opportunity to include TBI and its association to mental illness. Military members are required to go through standard pre-deployment training before their deployment and Warrior transition training upon their return from combat areas. PTSD is addressed in these briefs as linked to experience of mental trauma, however, the connections between physical exposure to extreme sounds and illness needs to be stressed. If shown as symptom of physical trauma rather then an inability to deal with stress much of the stigma can be reduced.

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