Hidden wounds of war

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At the five-year anniversary of the war in Iraq, the federal government remains unprepared to address one of the most pressing needs of the men and women who have served in Operation Iraqi Freedom and Operation Enduring Freedom.

The Departments of Defense (DoD) and Veterans Affairs (VA) have an obligation to provide our soldiers and veterans the best care anywhere but are falling short of the mark on screening and treatment of traumatic brain injury (TBI).

Some 1.6 million Americans have served in Iraq and Afghanistan, more than 31,000 have been wounded in action and many more have sustained noncombat injuries or illness. TBI has been called the "signature injury" of this war, and the improvised explosive device (IED) is the leading cause of fatalities and brain injuries among U.S. servicemembers in Iraq and Afghanistan.

These powerful devices inflict severe damage and blast shock waves through the body, including sudden and violent impact to the skull causing damage to brain tissue. The resulting TBI can be fatal, or require immediate hospitalization.

But more often the result of exposure is a less obvious concussion. Current estimates are that 10 percent to 20 percent of all U.S. military personnel in Iraq suffer concussion. Army studies show less than half of those exposed to IED blasts receive any evaluation.

Concussion or "mild" TBI may or may not involve a loss of consciousness. Its mildest form may result only in cognitive and functional symptoms rather than visible, easily recognized injuries. TBI symptoms may not appear until days or weeks following the injury. Confusion, a stunned stare, slowness in following instructions or distractibility are common but subtle changes in consciousness after exposure to TBI.

In the environment of war, such symptoms can go unnoticed and unreported. Experience from sports and other noncombat injuries has shown that if an injured individual sustains a second concussion before resolving symptoms from a previous injury, a "second impact syndrome" can occur with dire, even life-threatening consequences. Repeated concussions cause cumulative damage and slow recovery.

The bad news is that there is no current consensus among specialists in this field on how many concussions in an individual would be "too many." The good news is that simple computerized screening tools are available to identify those with concussions and mild TBI, to prevent more serious and persistent problems.

Congress has mandated that DoD develop a plan for baseline pre-deployment assessments, as well as in-theater and post-deployment testing for so-called "mild" TBI. The tools are available and the need is clear, but our military is dragging its feet. Without a comprehensive screening program, those invisible wounds will remain hidden and their victims go untreated. Lack of documentation in their records denies servicemembers and veterans access to the health care and disability benefits they have earned through their service and sacrifice for our nation.

The Defense Department must take immediate steps to implement effective, comprehensive TBI screening programs as mandated by Congress. Our brave men and women deserve no less.

David W. Gorman is the executive director of Disabled American Veterans.