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Traumatic Brain Injuries

Invisible Wounds of War

By 1st Sgt. Anthony Carroll

304th Military Intelligence Battalion

October 8, 2021

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A simulated improvised explosive device

Since 2001, between 1.9 and 3 million service members have served in post-9/11 war operations in Afghanistan and Iraq, and over half of them have deployed more than once. Many times that number of Americans have borne the costs of war as spouses, parents, children, and friends cope with their loved ones’ absence, mourn their deaths, or greet the changed person who often returns. (U.S. Veterans & Military Families, 2021, para. 1)

The invisible wounds of war such as post-traumatic stress disorder (PTSD), depression, and traumatic brain injuries (TBIs) are serious issues that have been around as long as warfare. With medical budget cuts looming, there is a healthy fear the needed care and research for these types of injuries will be on the chopping block. This article centers around TBIs and their increased prevalence throughout the U.S. military, especially due to combat-related injuries, and the urgent need to better understand them and their long-term compounding effects.

Traumatic Brain Injuries

U.S. Army Sgt. Eric Puglio with 41st Field Artillery Regiment

According to a 2015 Centers for Disease Control and Prevention (CDC) Report to Congress, “A TBI is an injury that disrupts the normal function of the brain. It can be caused by a bump, blow, or jolt to the head or a penetrating head injury. Explosive blasts can also cause TBI, particularly among those who serve in the U.S. military” (CDC, 2015, para. 1). The Department of Defense (DOD) states that from 2000 to 2016, more than 339,000 service members were diagnosed with a TBI (Collins, 2016). This number could actually be higher since screening relied on self-initiation, likely reducing the number of cases accurately documented (Wagner, 2016). The primary cause of this drastic increase in TBIs is the widespread use of improvised explosive devices (IEDs) in combat. These weapons create a large explosive force and while modern day protective gear does a great job of protecting service members from shrapnel, it does little to protect their brains against the concussive force of an explosion.

TBIs are often accompanied by other injuries, physical and/or mental. This is commonly referred to as polytrauma. Common polytrauma from the Iraq and Afghanistan wars included PTSD and depression along with TBIs (Ord et al., 2020). In a recent clinical study of more than 16,000 veterans with deployments to Iraq or Afghanistan, nearly 25% suffered from PTSD, TBI, and chronic pain, more than any other singular condition or combination (Adams et al., 2019). This triad of PTSD, TBI, and chronic pain has also been associated with increased suicide rates among veterans.

Elizabeth Kirkpatrick, physical therapist for the Fort Drum Traumatic Brain
Injury (TBI) Clinic

The Problem

According to Boston University, “The U.S. veteran suicide rate per 100,000 has outpaced that of the public and reveals an increasingly severe crisis. The VA’s 2020 National Veteran Suicide Prevention Annual Report reveals the suicide rate of veterans overall and adjusted for age and sex is 1.5 times that of the general population” (Suitt, 2021, p. 5).

The major concern is that with projected DOD budget cuts and a reduction in TBI diagnoses due to lower combat deployment rates, TBI treatment development and research will be at risk. Currently, in an effort to reduce spending, the DOD plans to close several medical treatment facilities and cut 12,801 health care provider positions (Jowers, 2021b; Maucione, 2020). This will undoubtedly affect both medical research and treatments across the board, not just for TBIs.

Rep. Derek C. Kilmer, U.S. Representative for Washington's 6th congressional district, stated

Unfortunately, we’ve seen some of these changes come at the expense of improving health care outcomes for the folks that I represent, including veterans and active-duty military and their families. We’ve seen them lose access to quality care, so I’m concerned about the ability of local civilian providers to adequately cover the gaps in care.” (Jowers, 2021a, para. 5)

While TBIs might not be as hot a topic in the news as they once were, it is still vital to continue treating and researching these injuries. As recent as 2020, 50 U.S. troops were diagnosed with TBIs after an Iranian missile attack on Al-Asad Airbase (Choi, 2020).


More funding and research should be poured into recognizing and treating these “invisible wounds of war.” According to Terri Tanielian, researcher and policy analyst at the RAND Corporation, several developments occurred, and more funding would only improve care and treatment:

  • Technology is progressing and being used to treat and engage service members, veterans and their families. This includes tele-health access where patients can get access to providers over any distance, as well as appbased therapeutic tools.

  • Health care providers are now better educated and equipped to deal with the invisible wounds of war and deliver better, more thoroughly researched and effective therapies.

  • More mental health care providers are available at primary care facilities, providing rapid access to specialty care.

  • Non-traditional therapies such as acupuncture are being accepted and adopted (Tanielian, 2016).


While the U.S. has made great efforts to recognize and treat TBIs, it needs to continue to research and provide treatment to its service members and veterans. In the technology-driven battlefields of the future, with the likelihood of Soldier injuries increasing exponentially, learning how to treat physical and invisible wounds will be more important than ever.


Adams, R. S., Larson, M. J., Meerwijk, E. L., Williams, T. V., & Harris, A. (2019). Postdeployment polytrauma diagnoses among Soldiers and veterans using the Veterans Health Affairs polytrauma system of care and receipt of opioids, nonpharmacologic, and mental health treatments. The Journal of Head Trauma Rehabilitation, 34(3), 167–175.

Barnes, S. M., Monteith, L. L., Gerard, G. R., Hoffberg, A. S., Homaifar, B. Y., & Brenner, L. A. (2017). Problem-solving therapy for suicide prevention in veterans with moderate-to-severe traumatic brain injury. Rehabilitation Psychology, 62(4), 600-608.

Centers for Disease Control and Prevention. (2015). Centers for Disease Control and Prevention report to Congress: Traumatic brain injury in the United States: Epidemiology and rehabilitation. pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdf

Choi, D. (2020). 50 US troops diagnosed with traumatic brain injuries after Iranian missile attack. Business Insider. attack-at-iraq-base-2020-1

Collins, S. (2016). National Intrepid Center zeroes in on traumatic brain injury. Department of Defense. https://www. national-intrepid-center-zeroes-in-on-traumatic-brain-injury/ igphoto/2001888747/igphoto/2001888747/

Jowers, K. (2021a). Billet cuts affecting military medical facilities and patients, lawmaker says. Military Times. 2021/05/25/billet-cuts-affecting-military-medical-facilities- and-patients-lawmaker-says/

Jowers, K. (2021b). New plan scales back massive cuts in military medicine billets. Military Times. https://www. back-massive-cuts-in-military-medical-billets/

Maucione, S. (2020). House panel wants to slow military cuts to medical staff and facilities.. Federal News Network.

Ord, A. S., Lad, S. S., Shura, R. D., Rowland, J. A., Taber, K. H., & Martindale, S. L. (2020). Pain interference and quality of life in combat veterans: Examining the roles of posttraumatic stress disorder, traumatic brain injury, and sleep quality. Rehabilitation Psychology. Federal News Network.

Suitt, T. H. (2021). High suicide rates among United States service members and veterans of the Post9/11 wars. Boston University.

Tanielian, T. (2016). Invisible wounds: Closing the gaps to more effectively address these injuries. Rand Corporation. https:// the-gaps-to-more-effectively.html

US Veterans & Military Families. (2021). Brown University. https://

Wagner, R. (2016). Traumatic Brain Injury Among Military Personnel: Overview and Recommendations. Nova Science Publishers, Inc.


1st Sgt. Anthony Carroll currently serves as the first sergeant of D Company, 304th Military Intelligence Battalion. His previous assignments include various intelligence positions during multiple deployments in support of Operation Iraqi Freedom and Operation Enduring Freedom. He holds an associates degree from Cochise College

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