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Veterans and TBIs

Recent revelations in veteran well-being have uncovered a disconcerting trend. Suicide rates among post-9/11 veterans surged more than tenfold from 2006 to 2020, a stark contrast to the relatively steady rate among the general U.S. adult population (Military.com). Even more alarming, veterans diagnosed with traumatic brain injuries (TBIs) experienced suicide rates 56% higher than those without head injuries and three times higher than the general population. This crisis underscores the pressing need for greater awareness, understanding, and support for veterans, particularly those who face the complex interplay of TBIs and post-traumatic stress disorder (PTSD).


Veteran Sitting On A Couch and Holding His Head

Understanding the Magnitude: Veterans with TBIs


Traumatic Brain Injuries (TBIs) are a significant concern among veterans, particularly those who have served in combat zones or faced exposure to blasts and head injuries during their service. These physical injuries can have profound and long-lasting effects on an individual's cognitive and emotional well-being. According to the Defense and Veterans Brain Injury Center (DVBIC), over 400,000 service members have been diagnosed with TBIs since 2000. This staggering number highlights the pervasive nature of this issue within the veteran community. Additionally, this alarming figure is likely an underrepresentation, as not all TBIs are reported, meaning the actual number could be even higher.


Veterans often encounter unique circumstances that expose them to a higher risk of TBIs. Combat situations, training exercises, and exposure to explosive blasts can all lead to head injuries. The very nature of military service makes these injuries more common, highlighting the pressing need for accurate diagnosis and effective treatment strategies.


Previously, before 2007, during the height of the wars in Afghanistan and Iraq, there was no universal screening for TBI in the U.S. military. As a result, service members exposed to blast injuries during combat or training exercises often went without timely evaluation and treatment for TBI. This lack of screening and intervention during their service continues to haunt veterans today.


Understanding the long-term effects of military-related TBIs is increasingly crucial as research reveals that these injuries rarely occur in isolation. Many veterans grappling with TBIs also face polytrauma – a complex combination of physical and mental health issues that endure long after their military service concludes. This underlines the significance of investigating TBI's impact on veterans' lives and the critical need to ensure they receive the care and support they require.


Unique Obstacles in Diagnosing and Treating Veterans with TBIs


Diagnosing TBIs in veterans is a critical but often intricate process. It requires a thorough understanding of the veteran's medical history, their exposure to potential traumatic events, and a comprehensive evaluation of their symptoms. Furthermore, gathering data on TBIs and comorbid conditions necessitates a collaborative effort across various healthcare providers and organizations, including the Department of Defense, the Department of Veterans Affairs, and community-based care.


Diagnosing and treating TBIs in veterans come with unique challenges. The nature of military service often leads to underreporting of head injuries due to concerns about job security and potential stigmatization. Furthermore, the symptoms of TBIs can sometimes overlap with those of Post-Traumatic Stress Disorder (PTSD), making it essential for healthcare providers to differentiate between the two conditions for accurate diagnosis and treatment.


The stigma associated with reporting head injuries can discourage veterans from seeking help, as they fear it may hinder their careers or subject them to discrimination. Thus, many veterans suffer in silence, dealing with the debilitating effects of TBIs without receiving the support and care they need and deserve.


TBI and PTSD Overlapping Symptoms in Veterans


Understanding the full impact of TBIs on veterans requires acknowledging the often-overlooked connection between TBI and PTSD. While they are distinct conditions, their symptoms can significantly overlap, making diagnosis and treatment more challenging. For veterans, this overlapping territory can be a battleground of its own.TBIs and PTSD share many overlapping symptoms such as memory problems, irritability, mood swings, and sleep disturbances. Veterans may experience both TBI and PTSD, and their healthcare providers must carefully evaluate their symptoms to provide the most effective treatment.


Exploring the physiological correlates of chronic mild traumatic brain injury symptoms

Source: (A): Bar graph representing the percentage of mTBI patients having specific symptoms from the HISQ 1-20 questionnaire. Blue bars represent somatic/physical symptoms, red bars represent mood/emotional/affective symptoms and green bars represent cognitive symptoms. (B): PCL_C scores in mTBI patients (X axis) vs. number of reported mTBI symptoms (measured by HISQ 1-20 questionnaire) in mTBI patients (Y axis). (C): CES-D scores in mTBI patients (X axis) vs. number of reported mTBI symptoms in mTBI patients (Y axis). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.”


For example, difficulties with memory and concentration can be attributed to both conditions. Identifying whether these issues stem from a TBI, PTSD, or a combination of the two is a complex diagnostic challenge. This overlap underscores the necessity of comprehensive and specialized care that accounts for the multifaceted nature of these co-occurring conditions.


PTSD, a condition that arises in response to a traumatic event, can lead to symptoms such as flashbacks, nightmares, irritability, and a heightened state of arousal. These symptoms can also emerge in veterans with TBI, creating a complex web of psychological and emotional challenges.


In fact, according to recent studies, 83% of post-9/11 wounded veterans report living with the symptoms of PTSD. These symptoms include destabilizing thoughts, feelings, or dreams related to the traumatic events, mental or physical distress, difficulty sleeping, and changes in how a person thinks and feels. The overlap between TBI and PTSD can sometimes make it challenging for veterans to discern the root cause of their struggles, leading to delayed diagnosis and treatment.


VA TBI Disability Rating


The Department of Veterans Affairs (VA) plays a central role in addressing the needs of veterans with TBIs. They offer disability ratings based on the severity of a TBI, ensuring that veterans receive appropriate compensation and access to treatment. However, navigating the VA system can be a complex and overwhelming process, and some veterans may not receive the support they require.


Organizations like the Wounded Warrior Project® (WWP) have been instrumental in filling the gaps in support and treatment for veterans. WWP Talk, a telephonic emotional support program, is one such initiative that provides veterans and their families with much-needed assistance for improving their mental health and well-being. By offering a space for veterans to discuss their experiences and challenges, programs like these contribute significantly to breaking the silence and stigma surrounding TBIs and PTSD.


Moreover, advancements in research and treatment are critical to enhancing the care available to veterans. High-quality research, particularly in veteran populations, is essential for understanding the most effective interventions for improving outcomes after TBI. This includes both innovative and traditional treatments. Identifying biomarkers for TBI severity and chronic traumatic encephalopathy, a degenerative brain disease linked to repeated head trauma, is also an area that holds promise for improved diagnostics and treatment.


The study findings underscore the demand and need for high-quality research on veterans with TBI and the corresponding treatments and outcomes. Longitudinal studies examining outcomes and variations among different populations are essential to gain a better understanding of the long-term effects of TBI on veterans.


Furthermore, there's a need for research into evidence-based treatments, including holistic approaches, for TBIs. Expanding basic science research to identify biomarkers for TBI severity and chronic traumatic encephalopathy (CTE) would contribute to improved diagnostics and treatment.


In an era of advanced medical technology, we have the tools and knowledge to make a difference in the lives of veterans with TBIs. It's a moral and societal obligation to invest in research that can unlock the doors to better care, treatment, and support for those who have sacrificed so much for our nation.


The Ongoing Consequences of TBI in Veterans' Lives


TBIs can have far-reaching consequences in veterans' lives. Beyond the immediate physical and cognitive effects, TBIs can lead to difficulties in employment, relationships, and overall quality of life. Many veterans face ongoing challenges and require long-term support and resources to cope with their injuries.


The consequences of TBIs often extend beyond the individual and impact their families and communities. Spouses, children, and caregivers also grapple with the challenges of providing care and support to veterans with TBIs, which can be emotionally and physically demanding. These ripple effects underscore the importance of comprehensive and accessible support systems.


The Ongoing Battle for Support and Awareness


Efforts are underway to improve the diagnosis and treatment of TBIs in veterans, but there is still much work to be done.


Support and awareness for veterans with TBIs are crucial. Initiatives, organizations, and individuals are working tirelessly to improve the lives of those affected by TBIs. As we approach Veterans Day, it's an opportunity to acknowledge the sacrifices of our veterans and redouble our efforts to provide the support and care they deserve.


Greater public awareness, funding for research, and improved healthcare resources are essential to addressing the complex needs of veterans dealing with TBIs and related conditions. These individuals have served our nation with dedication and valor, and it is our duty to ensure that they receive the care, understanding, and support they need.


Addressing the Evolving Needs of Veterans with TBI


To fully comprehend the complex and evolving challenges veterans face due to TBIs, it's vital to recognize that their needs are not uniform. The veteran population today is more diverse than ever, and improving outcomes requires a better understanding of how service-connected TBI can affect veterans' lives over time. Additionally, we need a deeper insight into what veterans living with TBI and their caregivers may require as they age and explore treatments that are effective or show promise.


An analysis of data from Wounded Warrior Project's (WWP) annual member survey, conducted between 2017 and 2020, revealed striking insights. Veterans who reported a head injury were much more likely to experience co-occurring conditions and challenges found in the research on long-term TBI effects. This included severe headaches, musculoskeletal problems, and mental health conditions, as well as a reduced ability to work. Furthermore, these veterans were almost twice as likely to indicate that they required caregiver support compared to those without a head injury. This underscores the considerable caregiving needs veterans with TBI have and the growing necessity for support programs targeting caregivers.


While the data provides valuable insights into the challenges veterans with TBI face, there is still a significant need for more support programs to cater to caregivers. As veterans age and experience chronic health issues, the demand for both treatment and caregiving support will increase. Additionally, as caregivers age and have reduced capacity to care for veterans, support programs need to adapt to these changing dynamics.


The Path Forward: A Call to Action


As a nation, we have an opportunity and a duty to support veterans with TBIs and their caregivers. The challenges they face are profound, and the long-term implications of their service require ongoing commitment.

  • Create Long-Term Support Systems: Policymakers must expand access to long-term care for veterans and increase caregiver support. A formal, comprehensive system of care is needed to alleviate the burden on informal caregivers.


  • Expand Multidisciplinary Treatment: Given the co-occurrence of TBI and conditions like PTSD, co-locating care and research is essential. Veterans need culturally appropriate, holistic care that takes into account the complexities of their experiences.


  • Promote Health-Enhancing Behaviors: Healthcare providers should encourage veterans to embrace wellness practices, including a healthy diet, regular exercise, sleep hygiene, mindfulness, and substance abstinence. These behaviors are integral to their treatment.


  • Continue Collecting and Integrating Data: To support veterans with TBI and comorbid conditions, data on TBI and its effects need to be continually collected and shared across different healthcare systems.


  • Invest in Research: The government, healthcare institutions, and foundations must invest in high-quality research focused on veterans with TBI. This research should encompass treatment outcomes, holistic interventions, and basic science studies on biomarkers.

In the United States, we hold our veterans in the highest regard. It's time we demonstrate our commitment to their well-being by addressing the silent battle they fight against TBIs. The scars may be invisible, but the consequences are all too real. Our veterans deserve nothing less than our unwavering support, understanding, and the promise of a better future.



Power of Patients - Providing Support for Veterans and Their Caregivers


Power of Patients is committed to supporting veterans with TBIs and their caregivers. Our platform offers a customized symptom tracker that allows veterans to monitor their symptoms and progress, providing valuable data that can assist healthcare providers in delivering the most effective care. We recognize the unique challenges veterans face and are dedicated to helping them on their journey to recovery. Visit our website to learn more and register today.


As we honor our veterans on Veterans Day, let us not forget those who bear the hidden wounds of TBIs and PTSD. By raising awareness, dispelling myths, and providing support, we can make a meaningful difference in the lives of these brave men and women who have served our nation. Together, we can ensure that no veteran faces the challenges of TBI and PTSD alone.



**If you are a servicemember or veteran in need of help, remember that assistance is available 24/7 through resources like the Veterans and the Military Crisis Line offering call, text, and online chat options. We also recommend the Elizabeth Dole Foundation for a caregiver initiative for spouses of veterans and Brain Line specifically for veterans. Reaching out for help is a sign of strength, and it is the first step toward healing and recovery.



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