The ongoing conflict in the Middle East has renewed concerns about the lasting impact of traumatic brain injuries (TBIs) on U.S. service members. Nearly 700 American troops have been wounded by drone and missile attacks in the region, and military officials report that the majority of these injuries are TBIs. While many of these are classified as "mild concussions," experts warn that even seemingly minor initial symptoms can lead to persistent problems for months or years.
These lingering effects can include headaches, dizziness, and difficulties with memory and attention, a condition sometimes referred to as "brain fog." The unpredictable nature of these long-term consequences has led to medical debate over the continued use of the term "mild TBI." It is known that repeated head impacts increase the risk of lasting issues, including chronic traumatic encephalopathy (CTE), a degenerative brain disease.
Dr. David Okonkwo, a brain trauma specialist at the University of Pittsburgh, emphasized the importance of full recovery from a concussion before engaging in activities that could risk another. Researchers are also still working to understand how the specific injury mechanisms of explosive blasts differ from direct physical blows to the head. Dr. James Kelly, chief medical scientist at the Invisible Wounds Foundation, explained that blast waves can cause a distinct type of cellular injury compared to blunt force trauma.
Troops in the current conflict face a different warfare landscape than in Iraq and Afghanistan, with drones potentially exploding closer to personnel. This shift in tactics introduces new challenges in understanding and treating blast-related brain injuries.
Democratic lawmakers have called for investigations into the care provided to wounded troops. Senator Tammy Baldwin, for instance, has pressed the military for the findings of its investigation into a March 1 attack. "I spoke directly with Wisconsinites who sustained traumatic brain injuries from (President Donald) Trump’s war in Iran and went weeks without so much as a screening, let alone specialized care, for their injuries," Baldwin stated.
Defense Health Agency spokesman Peter Graves confirmed that it is military policy for service members to be screened for TBI. While the military has improved its screening and treatment protocols for TBIs, a signature injury from conflicts in Afghanistan and Iraq, advocates suggest that such injuries may still be undercounted. Symptoms of TBI can overlap with other conditions like post-traumatic stress disorder (PTSD), potentially masking the true extent of the problem.
Many service members, like Marine veteran Joe Shearer, have historically downplayed injuries to avoid being seen as weak or to remain with their units. Shearer, who experienced two blasts in Iraq in 2005, only recently received a diagnosis for TBIs linked to those events. He continues to struggle with symptoms including dizziness, migraines, and memory lapses that affect his daily life.
Army veteran Frank Sonntag also experienced a TBI from a mortar blast in Iraq in 2004. He delayed seeking treatment for years, enduring intensifying headaches and brain fog until his cognitive impairments significantly impacted his work and daily functioning. Speech therapy and medication eventually helped him manage his symptoms.
Kelly Parker, director of independent services at the Wounded Warrior Project, highlighted the individualized nature of TBI recovery. "If you've seen one TBI, you've seen one TBI," she said, underscoring the need for personalized treatment plans. Early screening, treatment, and ongoing support, including physical and speech therapies, are considered crucial for recovery. Parker expressed optimism, stating that the brain has a remarkable capacity to heal and adapt by creating new neural pathways.
Despite advancements in care, the long-term effects of TBI remain a significant concern for veterans like Spencer Milo, who has dealt with migraines, seizures, and forgetfulness years after leaving the service. His experiences with TBIs from an IED blast and a suicide bomber underscore the invisible nature of these injuries and the challenges in explaining their persistent impact to others.