Our Most-Vulnerable Veterans Need Support

After Vietnam, a vet being "shell-shocked" was the common diagnosis. With today’s Iraq and Afghanistan wars, it is traumatic brain injury (TBI).

Unfortunately, the heroes who choose to serve our country have a high risk of sustaining a TBI while defending it. Last September, the United States Department of Veterans Affairs acknowledged for the first time that a significant number of Iraq and Afghanistan War veterans were in fact suffering from brain injuries.

Numbers released at that time showed that of the veterans who had been screened, 20 percent showed symptoms of a brain injury. Blast injuries – caused by explosions such as those from car bombs – have been common among U.S. soldiers throughout the Middle East since the fighting began in 2003.

"Traumatic brain injuries are often insidious but always devastating. Those few among us who wear the cloth of the nation deserve our thanks and admiration, to be sure, but they also deserve the best care we can provide," Retired U.S Army Colonel and Medal of Honor recipient, Jack H. Jacobs said.

What most people don’t realize is the vast difference between TBIs sustained by older soldiers as compared to younger ones – and in the Iraq/Afghanistan war, far more younger soldiers are being killed and seriously injured than their older counterparts.

Dr. Ron Savage, President of the North American Brain Injury Society, explained, "Too many people lump all veterans with TBI into the same category, but the truth is an 18-year-old veteran who sustained a TBI from a blast injury has much more in common with an 18-year-old who was injured in a car accident than with a 40-year-old fellow vet also injured in that same blast."

Brain injuries sustained by those less than 25 years of age are considered Pediatric Traumatic Brain Injuries (PTBIs), a form of Pediatric Acquired Brain Injury (PABI), according to experts in the field of neurology.

"Young adults are included due to the fact that their brains are still developing, as indicated by biological measures such as brain metabolism and myelination as well as neurocognitive measures like executive functions or inhibitions, and social measures such as the beginnings of independence, transition to adult privileges and responsibilities," noted Dr. Christopher Giza, who is an Associate Professor in the Department of Neurosurgery at the David Geffen School of Medicine at UCLA and Mattel Children’s Hospital.

Both Savage and Giza, along with more than 50 other top medical professionals from across the country, make up the National Advisory Board of the Sarah Jane Brain Foundation, a non-profit organization whose mission is to help children and young adults with PABIs.

Blast injuries in veterans are known to cause deficits in memory, attention and decision-making and often occur in conjunction with post-traumatic stress disorder (PTSD), depression, anxiety disorders, and substance abuse.

These issues in younger veterans with PTBI can cause problems in quite different areas as compared to adults with TBI.

"The 19-year-old veteran with PTBI faces a different set of challenges upon attempting to reintegrate into the community following an injury than does a 35-year old," stated Dr. Shari Wade of Cincinnati Children’s Hospital Medical Center.

Wade continued, "While a 35-year-old might return home to a stable family system with good supports in place, the 19-year-old may be coming home to live alone – these developmental considerations must be taken into account when constructing treatment and reintegration plans for young veterans."

All veterans with TBIs – even seemingly "mild" ones – face challenges reintegrating into their communities after returning from war post-injury.

Dr. Roberta DePompei, Professor and Chairman in the Department of Speech-Language Pathology at the University of Akron, noted, "People don’t understand the difference in people with TBIs from before their injury as compared to after, and this may be even more magnified with veterans. You have a group of young people returning from war, speaking and acting very differently than they were before they left, and people simply attribute it to things they saw – whereas in many cases it is actually because they have sustained a brain injury."

Veterans with TBI, particularly younger ones, also face additional challenges in reintegrating into school or work upon being discharged after returning home.

"Most colleges, universities and vocational training systems are generally not set up to support military-trained TBI vets," stated Dr. Ann Glang, Research Scientist at Oregon Center for Applied Science and Senior Fellow at the Teaching Research Institute.

"Who will be the PTBI-vet’s advocate in the school system?" questioned Dr. Bonnie Todis, Associate Research Professor at the Teaching Research Institute. She continued, "This is something that desperately needs to be addressed, given the number of young brain-injured veterans now returning home."

Additionally, it was noted that current Veteran Administration (VA) out-patient facilities are not set up for the special care those veterans with PTBI require.

"There is a lack of services within the VA that target veterans with PTBI. This is a huge population constituting over half of veterans with brain injury, and there is nothing to distinguish one from the other despite that the younger and older groups clearly have different needs on multiple levels," stated Dr. Drew Davis, Assistant Professor in the Department of Pediatrics and Physical Medicine and Rehabilitation at the University of Alabama at Birmingham and Children’s Hospital of Alabama.

Dr. Gerard Gioia, Director of the Pediatric Neuropsychology Program at Children’s National Medical Center and George Washington University, expressed concern over whether veterans were being adequately screened for brain injuries upon being released from service.

"Many people have been pushing for better screenings of veterans after returning from Iraq, but there are worries that it is not being done properly, and we need to make sure this is done and done correctly and thoroughly to ensure these heroes are receiving the best possible medical care," Gioia noted.

Dr. David Mooney, Assistant Professor at Harvard Medical School, remarked, "We must not leave our youngest veterans’ injuries unaddressed on the battlefield but instead maintain them as part of the family of TBI survivors who must band together, while still acknowledging their unique needs."

"This must be addressed in a comprehensive, integrative fashion with the rest of the TBI community, and we must also make sure the efforts to do so are evidence-based," stated Dr. Wayne Gordon, Professor in the Department of Rehabilitation Medicine at Mount Sinai School of Medicine.

Sarah Jane Brain Project founder Patrick Donohue wants to make sure that is exactly the case. He brought the above-quoted doctors and their colleagues to New York City in January to draft the 62-page National PABI Plan, which creates the proper continuum of care for children and young adults suffering from PABI including these young veterans suffering from TBI. Donohue provided the first draft of the National PABI Plan to President Barack Obama’s administration on January 20, 2009.

"It is our responsibility as Americans to make sure those who fight for our freedom are taken care of, which is why it is important for veterans with PTBI to receive the best possible care," he stated.

To read the National PABI Plan in full or to learn more about the Sarah Jane Brain Project, visit www.TheBrainProject.org.