As I was watching the news over Veteran's Day there was a big story on Traumatic Brain Injury (TBI) and how the Veterans Administration (VA) has been mis-handling the signature injury of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). I have seen similar issues with my clients and the VA when we have discussed the possibility of them having TBI. There have been multiple occasions where I have encouraged my clients to talk to the VA about possibly suffering from TBI. Most have come back and told me that they were tested for TBI by the VA years ago and were told that they did not have it.
I was discussing with William the possibility of him having TBI because of his Anxiety, Aggression, Depression, and sleep disturbance. William has been treated for Post-Traumatic Stress Disorder (PTSD) for a while and appears to be struggling making progress. William had two tours in Iraq and is struggling with impulse control and making good decisions. I was aware of his exposure to explosions because of his PTSD. William had been “blown up” on three different occasions increasing the possibility of him having TBI or Mild TBI (mTBI).
I know from experience that medical issues encountered while deployed do not always end up in permanent medical records. It never dawned on me that Williams incidents was never documented in his medical records until recently. On top of that William is not the type to report headaches or perceived minor issues for fear of being considered weak by his unit, especially since his buddies were killed or maimed. The fear of being perceived as weak was solidified when President Trump stated that no one was injured during the Iranian attack on US troops in Iraq. He called the medevacked troops injuries as nothing serious, they just had headaches. These types of explosions are what can cause TBI and mTBI, minimizing the injuries continues to fuel the flames of these unseen injuries. These troops injuries were probably documented but it makes me wonder how many troops that had been knocked out or had a loss of consciousness did not have their incidents documented in their medical records. The lack of documentation could lead the VA to struggle diagnosing TBI or mTBI.
As a mental health provider for veterans I often see the signs of TBI or mTBI. But since I am not a “medical doctor” I cannot diagnose either TBI or mTBI because it is considered a physical injury and not a mental disorder. Part of the problem doctors face is the inability for some brain damage to be seen on the standard CT scan which is commonly used to look for brain damage. It is possible that the damage done years ago will not show up by traditional means or not severe enough to show up but is still there.
Every person that has had a concussion has had a case of mTBI. MTBI is an issue that is misunderstood and not discussed very often. The difference is the severity of the event. Multiple incidents often happen during combat or in the war zone. From what I have seen from some medical doctors is they cannot see the injury in the CT or MRI scan, so it does not exist to them and discount the symptoms as PTSD. A person may have had a concussion or a “bruised brain” that is not detectable under a CT or MRI but still suffer from the symptoms causing their mTBI to be confused with PTSD. There are a lot of similarities in the symptoms between mTBI and PTSD but mTBI takes special treatment due to the brain damage. With PTSD the negative behaviors can be changed with compliance and treatment, but it is harder to change the negative behaviors if the brain is damaged. Mislabeling PTSD as mTBI can cause veterans and their families a lot of pain because mTBI is so misunderstood.
One of the VA's issues is the fear of people cheating the system and getting a disability claim that may not exist. This is a problem with every bureaucracy, but it appears to be a large part of the system. As I stated earlier the lack of documentation in the theater can cause this to become a bigger issue then it should be. Some of the issues that can linger with mTBI include sleep issues, poor time management, unable to get things done, deficits in attention and concentration, depression, anxiety, aggression, and personality change. When you put this all together it sure looks like PTSD. But if the veteran has been in treatment for PTSD an extended period and does not improve the VA needs to start looking at TBI or mTBI as a possibility.
For questions or comments you can contact me at afterdutyvets@gmail.com or visit our website at www.afterdutyvets.com. I also have 2 books on Amazon if anyone wants to read more about veterans and their struggles. Living the Dream: Nightmares of Military Re-integration and Living the Dream II: Nightmares of Navigating the VA System.