Traumatic Brain Injury

TBI can be defined as a disruption in brain function that is caused by a head injury. Injuries can be penetrating or closed and classified as mild, moderate or severe. The severity level of TBI is determined by using a Glasgow Coma Scale (CGS) score, length of loss of consciousness (LOC) and length of post-traumatic amnesia (PTA). The total number of service members diagnosed with penetrating, severe, moderate, mild and/or classifiable TBI from the DVBIC as of May 20, 2010 from 2000 to 2009 were 178,876.

It is essential that service members/veterans are screened for mild Traumatic Brain Injury (TBI) as early as possible, because the similarities between TBI and Post Traumatic Stress Disorder (PTSD) become more difficult to treat the longer the condition goes unscreened. To identify veterans who may have a mild TBI, VA medical facilities have implemented a computer-based screening tool. This screening tool consists of a series of questions that VA providers are required to ask veterans, especially, Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, when seeking care at a VA medical facility. VA issued a policy requiring providers at VA medical facilities to use the TBI screening tool to screen all veterans, including all OEF/OIF who present themselves for care in any clinic in the medical facility, including the primary care clinic, dental clinic, urgent care clinic, or any specialty clinic.

There is currently a lack of evidence based research in combat-related TBI and most of what research is available concentrates on concussions, automobile accidents and falls. Most existing research on brain injury focuses on injuries sustained from automobile accidents and more research is needed on combat-related traumatic brain injuries, where service members may experience more than one blast episode. TBI can cause various neurological outcomes and diseases and increases the veteran's risk for Alzheimer's disease, Parkinson's disease. Both DoD and VA have acknowledged the lack of research on brain injuries and the difficulties of diagnosing PTS and TBI because of the co-morbidity of symptoms between the two. As a result, in 2009 VA began the Mind Study (Markers for the Identification, Norming and Differentiation of TBI and PTS) to develop evidence based diagnostic criteria and distinguish between TBI and PTS.