Traumatic Brain Injuries
Invisible Wounds of War
By 1st Sgt. Anthony Carroll
304th Military Intelligence Battalion
October 8, 2021
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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
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.
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).
Solution
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).
Conclusion
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.
References
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. https://doi.org/10.1097/HTR.0000000000000481
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. https://doi.org/10.1037/rep0000154
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. https://www.cdc.gov/traumaticbraininjury/
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. https://www.businessinsider.com/tbi-cases-us-troopsiran-
attack-at-iraq-base-2020-1
Collins, S. (2016). National Intrepid Center zeroes in on traumatic
brain injury. Department of Defense. https://www.
defense.gov/News/News-Stories/Article/Article/842262/
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. https://www.militarytimes.com/pay-benefits/mil-money/
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.
militarytimes.com/pay-benefits/2021/09/10/new-planscales-
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. https://federalnewsnetwork.com/defense-main/2020/06/house-panelwants-to-slow-military-cuts-to-medical-staff-and-facilities/
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. https://doi.org/10.1037/rep0000333
Suitt, T. H. (2021). High suicide rates among United States
service members and veterans of the Post9/11 wars. Boston University. https://watson.brown.edu/costsofwar/files/cow/imce/papers/2021/Suitt_Suicides_Costs%20of%20War_June%2021%202021.pdf
Tanielian, T. (2016). Invisible wounds: Closing the gaps to more
effectively address these injuries. Rand Corporation. https://
www.rand.org/blog/2016/09/invisible-wounds-closing-
the-gaps-to-more-effectively.html
US Veterans & Military Families. (2021). Brown University. https://
watson.brown.edu/costsofwar/costs/human/veterans
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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