March is Brain Injury Awareness month, and the wars in Iraq and Afghanistan have exposed U.S and coalition forces to countless explosions from many sources, often resulting in traumatic brain injury, or TBI.
The Defense Department has identified the leading causes of TBI in the military as blasts, fragments, bullets, motor vehicle crashes and falls.
Traumatic brain injuries are broken down into three levels of severity: mild, moderate and severe with a penetrating wound. The most common, and often overlooked, form of injury for soldiers is the mild traumatic brain injury, or mTBI.
"When a soldier hears 'traumatic brain injury,' that's the only thing that sticks in their minds when they leave the clinic. So it can shape the course of their care," said Dr. Jason Albano, Fort Sill Traumatic Brain Injury Clinic neuropsychologist.
"But, a lot of people have had a concussion. That's a term that people can better understand," Albano added.
A concussion is a type of mTBI caused by a bump, blow or jolt to the head that can change the way the brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.
"I would say that almost every soldier has been concussed at some time if they experienced blasts. They've had their head rattled around inside an MRAP (mine-resistant, ambush-protected vehicle) or such," said Public Health Service Lt. Dennis Ward, TBI clinic program director. "When a Soldier is told by his health-care provider that they sustained a traumatic brain injury, that scares them. So we've started telling Soldiers 'you had a concussion.'
"That's not to diminish the seriousness of the injury, but the Soldier needs to remember that concussions get better over time, period," Ward said. He added that if they are told they have sustained an mTBI, they believe that it is permanent.
"But in reality that's not the case, because with a concussion you get better with time and rest. Those factors heal the vast majority of concussions," he said.
Ward explained that a lot of concussion symptoms can overlap with other behavioral health indicators -- depression, anxiety, agitation, irritability, aggression and impulsiveness. These behaviors can mingle in with concussion issues and can cause a stigma.
"Nobody wants to hear that they have a behavioral health issue, to be told they are depressed, have anxiety or PTSD (post-traumatic stress disorder). But a concussion, that's a little more acceptable to them and they can hold onto that," Ward said.
The clinic uses perception and memory screenings to pinpoint what is most likely the issue, because they may not be related to a concussion if they persist.
"With a concussion, it's intense and then it gets better. An event can cause a concussion and also be related to, say, PTSD. But the concussion won't cause the PTSD. If the symptoms don't get better with time, or get worse, there are some other issues," Ward emphasized.
Not every soldier wants to seek treatment they need for a concussion.
"There are definitely some soldiers who are ignoring or denying their symptoms when it comes to concussion or behavioral health issues," Albano said, "and, it's a two-sided coin. On one hand they want to be promotable and deployable. Those are good things. It's about fitness to do your duties; the definition of 'Fit to Fight.'"
Albano said some soldiers are afraid to seek help for their behavior health issues, anger, depression or other problems because they are afraid to go down that road. They are afraid seeking help might lead to a medical board or possible discharge.
Albano said the 'other side of the coin' is those soldiers who are ready to get out.
"They say, 'I want out. Things are not working out for me,' or 'I've had a head injury and I want to get out.' So we do an assessment of their situation to pinpoint the best care for them," he said.
Ward said that if a soldier is suffering from behavior health issues, they should see their primary care physician as soon as possible. He also emphasized that one of the best ways Soldiers with issues can get help is from soldiers in their unit.
"Battle buddies should look for new or different behavior from guys who have been concussed," he said, adding it would be unusual if a Soldier's head injury that was a while ago got worse now. "If things are getting worse now, there are some other issues going on with the Soldier," he said.
As more Army personnel return home, Ward said they are treating a growing number of Soldiers, and are trying to speed up the process.
"We're cutting out the referral process. In the past, a primary care provider had to put in a referral, and we would test the soldier and then we would send a report back. If the issue wasn't concussion-related, but maybe PTSD-related, then they would be referred to behavioral health, that would test them and submit a report. Then they would get put into that system. That was too long a process. Now we're bypassing that," Ward said. "The Reynolds Army Community Hospital commander has tasked everyone in the medical community to make this process work better," he added.
Albano suggested soldiers and their family members who want to know more about dealing with a concussion or any behavioral health issues should go to the Defense and Veterans Brain Injury Center, or DVBIC website.
"It's a good resource for those surrounding the warfighters, the soldiers who are going through this,"he said. "It's for patients, medical providers and family members who want more information. Educating families is just as important as treating soldiers."
Ward has a message for soldiers with concussions.
"They do get better with time and rest, and just because you have had one doesn't label you for life. It is treatable and will get better," he said.