TBI in the Military

At age 27, former Army sergeant Jordan Edwards should be in the prime of his life. He served two tours of duty in Iraq before retiring from the service and returning to his home and family in the Midwestern US.
However, all is not well. Jordan has daily headaches, sees spots in his vision, has lost part of his hearing, and frequently forgets things. He struggles with regulating his emotions and mood, and is often irritable. Since returning from Iraq, Jordan divorced his wife, attempted suicide multiple times, and is currently living with his mother because he can’t keep a job. Even worse are the legal fees and jail time incurred from his reckless and irresponsible behavior. What went wrong?
When Jordan was in combat in Iraq, he was present during explosions of rockets, mortars, and IED (improvised explosive devises). The blasts of these explosions caused him to have a TBI—traumatic brain injury. The force of the blasts jostled his brain in his head, damaging areas of it that will remain impaired indefinitely.
Since the US wars in Afghanistan and Iraq began over a decade ago, reports of TBI in soldiers like Jordan have risen sharply. Estimates inside and outside the US government show that approximately 12%-20% of soldiers returning from these tours have a TBI or should be diagnosed with one. Getting care for these injuries has been a difficult process, marked by considerable lag in both recognition of the condition and research into treatment options. The sheer volume of returning soldiers reporting TBI symptoms, however, has forced Veterans’ Affairs and the medical community to address the demand for treatment and compensation for these injuries.
What is TBI?
“TBI” is a broad term that covers basically any brain injury due to a biomechanical force. A concussion is generally considered to be a mild TBI, with mild symptoms that eventually go away. More severe TBIs, however, can result in long-lasting physical, behavioral, cognitive, and/or emotional problems. Common effects include loss of function or movement of a limb (or side of the body), loss of a sense like vision or hearing, memory impairment, depression, and irritability. While symptoms like movement or memory problems are easily recognized, others—like altered judgment and depression—are not. This makes diagnosing and treating the full symptoms of TBI very difficult for physicians.
Exactly how a blow to the head causes the diverse outcomes of TBI isn’t known completely yet. What we do know, however, is that the force of the blow can definitely damage blood vessels and tissue due to the motion of the brain against the skull, possibly twisting and stretching fibers deep in the brain. This can cause cellular structures to break down and chemicals called neurotransmitters to be released abnormally in the brain.

One neurotransmitter, called glutamate, is the main chemical that causes brain activity. It is “excites” nerve cells to send chemical and electrical signals throughout the brain, increasing activity. After a TBI, there is too much glutamate in the brain at first. This can be damaging to cells because too much activity wears them out and can kill them. What happens next is that too much activity uses up the brain’s supply of energy and oxygen. The brain slows down as tissues swell, acid builds up in cells, and the system “powers down” due to malfunctions. The result is more cell damage and death.

This power failure and dysfunction affects many other neurotransmitters, chemicals, and minerals like calcium and magnesium, substances that are vitally important not only for a healthy brain but also for things like learning, memory, attention, clear thinking, emotion, and good judgment. Damage to specific cells and tissues can permanently alter a person’s functioning in these areas.

Doctors determined that Jordan Edwards’ TBI included damage to cells in the frontal lobes. After returning from Iraq, Jordan had been involved in alarmingly risky incidents: he had crashed his motorcycle at 155 mph on the highway and had gotten deeply involved in dealing drugs, landing him in jail. An assessment of his brain suggested that his TBI had damaged his ability to make good decisions and grasp moral and social values, leading to his law-breaking activities. Jordan’s case is only one example of how the cell damage in TBI can lead to BIG problems with brain function.
Treating TBI
With a serious health concern like TBI, the main question is how to treat this problem. Unfortunately, while physical therapy and rehabilitation can help people with less severe TBIs get some of their functions back after brain injury, so far little has been found that can stop the cell damage and chemical dysfunction from occurring in the brain. The most damage happens not at the impact of the trauma but seconds later, when chemicals start building up and the brain runs out of resources. If a treatment could target this process, it could be given right after injury to prevent cellular damage from occurring. Researchers are still working on this question and, due to the complex nature of TBIs, will be probably working on it for a while.
Other types of treatment target the social, emotional, and behavioral damage of TBI. Since depression and PTSD commonly occur along with TBI in veterans returning from war, counseling and therapy can help them learn to cope with their traumas and become productive members of society again. Some newly-developed cognitive-behavioral therapies aim to target behavioral and neurological problems including aggression, memory dysfunctions, and attention deficit by “reteaching” patients how to use manage these skills. However, the results of these interventions have not been definite, and more research is needed investigate their effectiveness further.

Legal issues in treating TBI in the military
For veterans returning home to the US with TBI, it has not always been easy for them to get proper care. Next to PTSD, TBI is also commonly overlooked and under-diagnosed. Frequently, while in combat soldiers are not aware that they experienced a TBI, or, if they knew they were injured, would re-enter combat or be ordered back into combat too soon. Not enough rest after an injury can make the damage even worse. Once back in the US and away from the hectic battlefield, however, soldiers were still not getting the proper attention for TBI.
The US Department of Veterans’ Affairs has been sharply criticized as being neglectful due to its slowness to fully recognize a wide spectrum of TBI. Certainly, diagnosing TBI can be very difficult since some injuries can appear more like psychiatric conditions. But a lot of the issue comes down to money: what kind of treatments should government insurance pay for? What kind of TBIs should the US grant disability compensation for? A soldier that had his leg blown off by a mine would have no problem securing treatment and disability, as would probably a veteran with a severe TBI who lost function on one side of his body and needs rehabilitation. However, soldiers like Jordan Edwards who have suffered profound cognitive and psychological disturbances and, as a result, can’t hold a job and function well in society have had difficulty getting a VA doctor to even look at them, much less their application for disability compensation to be accepted.
As awareness of TBI has increased over the last few years, the VA has come around. Currently trying to improve their image in brain injury treatment and make up for their past failures, they are launching TBI initiatives that include partnerships with brain trauma research groups, a TBI registry program, and the creation of the Polytrauma/TBI System of Care, a program that attempts to recognize the wide variety of symptoms and disabilities resulting from brain injury. Additionally, they have widened the criteria for disability compensation in the case of brain injury. As awareness and research into the mechanisms and treatments for TBI continue to increase, US veterans can look forward to better, more comprehensive care for their injuries.