Making a Difference #10: Veterans with Traumatic Brain Injury

Learn why professionals need to treat TBIs in service members and veterans differently from those in civlians ... and how the VA can help.

[Module 10: Veterans with Traumatic Brain Injury] >>Welcome to the module about traumatic brain injury in the veteran population. It is an honor to help you as 2-1-1 specialists help those who have so bravely served this country. What I would like to achieve in this segment is to leave you with an image of the unique risks and causes of traumatic brain injury in veterans and provide referral information that will help you assist veterans and their families. Now as you know, traumatic brain injury is often referred to as the invisible injury. The reason for that is that most TBIs are mild and have no external evidence of injury. This is the hurdle we all must overcome in recognizing this type of injury. So in addition to the usual civilian causes of traumatic brain injury that I know you're familiar with such as motor vehicle accidents, falls, assaults, and sports injuries, veterans experience unique situations that place them at very high risk for a traumatic brain injury, which we'll be talking about more in a moment. It is especially important to recognize the signs and symptoms of brain injury since 22 percent of the Army hails from Texas. So this collaboration between the VA and the State of Texas is more important than ever as we all have to work together to recognize this common problem, especially at this time, when soldiers are returning from war. >>What you see before you is a brochure that was created at the Michael E. DeBakey VA Medical Center in Houston, Texas. Colleagues and I created this brochure to help clinicians at the VA recognize traumatic brain injury in veterans. We called the brochure "Making the Invisible Visible: A Clinical Guide for Recognizing Brain Injury." This was funded by a grant provided by the South Central Mental Illness Research and Clinical Center. This information, I think, will help you as 2-1-1 specialists help veterans and their families recognize what is wrong and steer them in the right direction. In the brochure, we list common causes of brain injury in the veteran population. The first is related to blast injury, which we'll discuss in more detail in a moment. Motor vehicle accidents are also quite common, as they are in the civilian sector, along with falls, but penetrating and blunt trauma have a particular signature, again, on the field of combat. So how common is traumatic brain injury in veterans? Well, it's interesting, because in prior conflicts in the military theater of war only about 14 to 20 percent of all injuries were traumatic brain injury in the surviving combatants. But in the war in Iraq, it's nearly twice as great in incidence. Traumatic brain injury is mostly due to blast explosions, which are used increasingly in contemporary warfare. So veterans are at very high risk for a traumatic brain injury due to combat experience and also a very high incidence of substance abuse. In fact, as many as 1 in 4 veterans struggles with addiction. Falls are also quite common, especially in the elderly population just as in civilian populations, where falls are the number one cause. We also want to consider that the VA is primarily composed of a male population, but it is important to remember that in contemporary warfare women now comprise 20 percent of active-duty forces. So they are at higher risk for traumatic brain injury than civilian women. So, again, what is the most common cause of traumatic brain injury in the military theater of war? It is blast injury. One reason for that is because the material you've heard about, Kevlar, is a protective material that is built into the helmets and into the protective vests so that, actually, many, many more soldiers are surviving the wounds that they sustain in combat. Kevlar helmets, however, do not protect a soldier from the effects of a blast because that is a closed head injury. That's going to be the primary mechanism for brain injury in veterans, and it's usually going to be mild, and that means it's usually going to be invisible. Over 50 percent of injuries sustained in combat result from explosive munitions such as bombs, grenades, land mines, missiles, artillery, mortars, and shells-- these instruments of destruction. I've included pictures for you to see some of these weapons that are most commonly causing such injuries in soldiers. First, the rocket-propelled grenade, which is something you have probably seen in the movies, where it rests up on the shoulder and fires a very large explosive--like a rifle. I also want you to understand what improvised explosive devices are--or IEDs. This is a term that you hear a lot about on the news, and it's also the reason why you can't bring your bottle of contact solution on an airplane. All you need to make a bomb is a container with a solid or liquid explosive, a fuse, and an ignition source. So the soldier doesn't ever really know if a benign object might be a bomb or not, and they have to assume that many things that they see will explode. Land mines are also a major problem because, again, they are invisible, and you never really get to see that trip wire unless you analyze every piece of ground that you're about to walk onto or drive onto. Now as far as how a blast affects the brain, what we know about that is there are three types of injuries that come from a blast. You can imagine with an explosion that there is a change in atmospheric pressures that blows everything out from the center of the explosion. So the first, or primary, injury is just that force that hits the body. And organs like the brain are very vulnerable because they sit in kind of like a bowl of fluid. Air-filled cavities like the ear or the lungs or the intestines are very much affected by blasts. The secondary injury from a blast is really from the force of the explosion sending debris into the air with great force, which can hit one's head and cause an injury. And then finally, the force of the explosion picking up a person and throwing them such that they will potentially hit their head on the ground or against another object and incur, usually, a closed head injury. So then we move on to screening questions, which may help you when you're on the telephone with a veteran or the family member and asking questions like "Did you hit your head?" or "Were you injured in a blast?" "Did you pass out or lose consciousness?" Similar to the types of questions you will ask with civilian injury. "Were you dazed or confused after the injury?" It's very helpful to find out if the veteran knows that people think that they are different after the injury occurred. If any screening question is positive, of course you will want to educate the veteran and the family member about traumatic brain injury. So what can the VA do to help veterans with brain injury? This, of course, will be a major part of your interaction with the veteran or family member as a 2-1-1 specialist. There is a web site that you may consult,, which will direct the person to the nearest VA hospital or clinic, of which there are many in Texas. Most veterans, when they arrive to the hospital, will consult with a primary care provider in their first appointment. Primary care providers and all clinicians in the VA Hospital have now been educated specifically about traumatic brain injury and, especially in those soldiers returning from the war, they will be specifically screening for traumatic brain injury. If that screen is positive, then one is referred to the mental health service, rehabilitation medicine, neurology, or a variety of other services that the VA has to offer such as speech therapy, physical therapy, occupational therapy, and vocational rehabilitation. The Michael E. DeBakey VA Medical Center in Houston is a very special site with special expertise in traumatic brain injury. We call it a polytrauma site, and it serves the Gulf Coast area. We created a traumatic brain injury clinic that is staffed by rehabilitation medicine experts as well as neuropsychiatrists and neuropsychologists, vocational rehab experts, and others to provide comprehensive services to those that have traumatic brain injury. There are four traumatic brain injury centers at VA hospitals in the United States, located in Tampa, Florida; Richmond, Virginia; the Palo Alto VA in California; and Minneapolis, Minnesota. These centers provide a comprehensive spectrum of traumatic brain injury services that are not available at every VA in the country. The Defense and Veterans Brain Injury Center, or DVBIC, is located in Washington, DC. The DVBIC provides state-of-the-art medical care to active-duty forces who have incurred brain injury in combat. The DVBIC is intensively engaged in cutting-edge research and educational efforts about traumatic brain injury. Visit their web site [] to obtain valuable educational tools that will help you and the citizens of Texas recognize the signs and symptoms of traumatic brain injury specific to the veterans. Thank you for your interest In the special needs of veterans, and I appreciate your service to all of those living in Texas. [End of Program]
Posted on BrainLine April 8, 2011.

Produced by Texas Department of State Health Services and the Texas Traumatic Brain Injury Advisory Council.