Traumatic Brain Injury: The Signature Wound of the Iraq War

Traumatic Brain Injury, or TBI, is the signature wound of the Iraq War. It can be caused by bullets or shrapnel hitting the head or neck, but also by the blast injuries that often result from mortar attacks or roadside bombs. It is this second kind of injury that is especially prevalent in Iraq; about 65% of Iraq and Afghanistan veterans wounded in action were injured by explosive devices. Overall, between 10 and 20% of Iraq veterans, or 150,000 and 300,000 people, have suffered a TBI during the war.

TBI does not always cause an external wound; the pressure of a blast can overstretch or bruise the brain without leaving a visible trace. Moreover, the symptoms of TBI can be difficult to distinguish from combat stress and other related psychological injuries. Telltale signs of TBI include memory and emotional problems; vision, hearing, or speech problems; and sleep disorders. In addition, multiple mild TBIs can accumulate over time, leading to serious neurological problems that are not readily linked to one injury. As a result, TBI can often remain undiagnosed and untreated.

About 90% of TBIs are mild or moderate. But severe TBIs require a lifetime of care and rehabilitation. For the several thousand Iraq and Afghanistan veterans who have suffered this level of injury, the Pentagon and Department of Veterans Affairs have developed a nationwide network of hospitals and clinics. There are four major Polytrauma Rehabilitation Centers, in Tampa, FL, Richmond, VA, Minneapolis, MN, and Palo Alto, CA. These centers are supported by dozens of regional sites across the country.

Although treatment is improving for veterans with severe TBI, TBI screening continues to lag. The Army has improved education for soldiers to help identify the symptoms of a mild TBI, and has begun to test troops' brain activity before their deployments to record baseline data. In spring 2007, the VA began to offer TBI evaluation to all Iraq and Afghanistan veterans seen at a VA hospital or clinic. Until a universal screening program is in place in the military, however, thousands of combat veterans will continue to struggle with the effects of an undiagnosed brain injury.