PTSD and TBI (Traumatic Brain Injury) A Hidden Connection?

According to the Office of the Surgeon General of the Army, 64% of Veterans wounded in combat sustained “blast” injuries (attacks with rocket-propelled grenades, improvised explosive devices, or vehicle born improvised explosive devices). Many others have sustained blast injuries without obvious outward wounds. As a former Army wife, I cannot name one soldier I know who has not been hit at least a few times at close range by one of these devices.

Blast-related attacks can cause TBI (Traumatic Brain Injury) or MTBI (Mild Traumatic Brain Injury). According to the Defense and Veterans Brain Injury Center (DVBIC), “Blast injuries are injuries that result from the complex pressure wave generated by an explosion. . . Air-filled organs such as the ear, lung, and gastrointenstinal tract and organs surrounded by fluid-filled cavities such as the brain and spinal are especially susceptible to primary blast injury (Elsayed, 1997;Mayorga, 1997). The overpressurization wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion. “

Though there is much that is unknown about brain injuries, a study of returning soldiers done at Walter Reed Medical Center in 2003 by the DVBIC identified that 61% of the soldiers who had sustained blast-related attacks, had brain injury. P. Steven Macedo, a neurologist and former doctor at the Veterans Administration (quoted by Ronald Glasser in a March 2007 Washington Post article) estimated that at least one-third of all Veterans who had served in Iraq or Afghanistan likely had sustained brain injury.

With the nearly 2 million soldiers, sailors, airmen, and marines that have served in Iraq or Afghanistan to date, that estimate would mean approximately 670,000 returning heroes are suffering from a brain injury. This is far short of the mere 12,274 reported cases of combat-related TBI as of March 2007. Such a drastic discrepancy in numbers would indicate, perhaps, that current military and Veteran’s Administration screening and diagnostic procedures are not adequate.

It is also possible that the majority of our heroes are being diagnosed with PTSD (Post Traumatic Stress Disorder) when they should actually be receiving a diagnosis of TBI, MTBI, or a combination of PTSD and brain injury. Many symptoms of brain injury, mild or otherwise, mirror symptoms of PTSD. Individuals experiencing either injury typically experience one or more of the following: memory loss, difficulty concentrating, shortened attention spans, slower thinking processes, irritability, difficulty sleeping, depression, and impulse control problems. With so many shared symptoms, it is impossible for many, even trained professionals, to determine from which ailment (or both) a soldier is suffering.

It is necessary, however, in order to ensure proper long-term care of our nation’s heroes for medical providers to do the necessary testing in order to determine if brain injury exists. This is paramount because, according to the Brain Injury Association of America (BIAA), brain injury causes and accelerates many diseases including respiratory, circulatory, digestive, and neurological diseases. Without proper initial care, Veterans will not receive follow-up screenings and treatment to prevent or mitigate further harm.

Our family’s personal experience with TBI/MTBI screening through the Veteran’s Administration medical system has not been entirely favorable. My husband sustained more than twelve blasts (a combination of RPG’s and IED’s) while serving in Iraq. His neurological symptoms following one attack fall directly under the diagnostic criteria for brain injury (available on the BIAA’s website at
) because he had an intermittent loss of consciousness for a period of time following the blast. He received one initial screening at our local VA outpatient clinic followed by one “Second Level Evaluation” at our regional VA hospital. The second evaluation was so unprofessional and seemingly dependent on the clinician’s opinions, that I sought counsel from the BIAA. It was through them that I learned that my husband did, indeed, at the very least have a MTBI and should receive follow-up care and testing under “civilian” care guidelines. However, based on the opinion of the VA clinician, my husband’s mental, behavioral, and physical changes have been attributed only to PTSD.

There are many current military and VA procedures and policies that will have to be adapted and improved in order to properly care for and diagnose our many returning heroes. The current level of care given to soldiers in regards to brain injury is definitely an example of this. If you or a loved one served in Iraq or Afghanistan and have experienced any of the symptoms of TBI or MTBI listed below, please push for a proper, complete diagnosis. Hopefully, if enough Veterans and family members stand up and ask for more, we will make the road ahead easier for our other returning brothers and sisters.

Neurological Symptoms of TBI include: memory loss; concentration or attention problems; slowed learning; and difficulty with planning, reasoning, or judgment.

Emotional and Behavioral Consequences of TBI include: depression, anxiety, impulsivity, aggression, and thoughts of suicide.

Physical Symptoms of TBI include: nausea, vomiting, dizziness, headache, blurred vision, sleep disturbance, quickness to fatigue, lethargy, or other sensory loss.

Glasser, Ronald. “A Shock Wave of Brain Injuries. ” April 8, 2007. Washington Post (View complete text of this revealing article at:

Brannan P. Vines
Proud Wife of an OIF Vet

Information and resources for OIF/OEF Families:

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