The Politics Behind Treating Combat Veterans for Brain Injuries

Traumatic Brain Injury (TBI) has emerged to the top of the list of medical conditions that have long-term consequences on US veterans.
In another in-depth look on US veterans' health, The New York Times reported a story titled "War Veterans' Concussions Are Often Overlooked." The story documents the types of long-term health costs of the war in Iraq for American soldiers once they return home. The Pentagon estimates that as many as 300,000 combat veterans have suffered at least one concussion. Of those, tens of thousands are left with long term problems such as persistent memory loss, headaches, mood swings, dizziness, hearing problems and light sensitivity. Medically, the Army classifies these as Traumatic Brain Injury (TBI). Because of high rates of under-diagnosis, the Congress ordered the Army to follow only the Veterans' Affairs new set of diagnostic tools that tend to give veterans more disability pay. The Department of Defense invested $300 million into TBI research through the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The very diagnosis and treatment of TBI has become an economic and public policy issue, with significant distributive effects for veterans.

Very little is known scientifically about mild traumatic brain injuries and their long-term effects, and research on the effects of combat have emerged only recently. The same New York Times article reported on Charles W. Hodge's research at the Walter Reed Army Institute. Published in the New England Journal of Medicine, and available here, the research quantified the prevalence of TBI symptoms in soldiers returning from Iraq and Afghanistan. Importantly, only 23-40 percent of those with symptoms sought any kind of mental health care. The study was also the first to find that TBI, especially when patients lose consciousness as a result of a bomb blast for example, are associated with prevalence of the post-traumatic stress disorder (PTSD), suggesting a specific neurophysiologal mechanism behind PTSD in combat veterans. Here is their abstract:

Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.