Brain injuries more prevalent among US troops than earlier estimates

By Naomi Spencer
1 October 2007

The number of US troops who have sustained traumatic brain injuries from bomb blasts in Iraq may be far higher than previously estimated, new research suggests.

The political establishment has been well aware of the mounting brain injury rate for years. However, the Pentagon has refused to release figures on brain injuries, claiming that publishing data on tests it has conducted would put soldiers at risk.

Bombs frequently cause concussions, or a bruising of the brain. According to a September 23 article in USA Today, however, research has found that the shock wave from an explosion can also damage brain tissue in the middle of the brain, causing a change in cellular metabolism and cell death. Unlike a concussion, the cellular damage does not heal.

The USA Today article is based on research being carried out by a team led by Johns Hopkins University scientist Ibolja Cernak into the effect of blasts on animals. The researchers have found that metabolic changes create a “cascading effect” leading to the premature aging and death of surrounding tissue, resulting in worsening brain damage over time.

Similar effects are being seen in humans as well. The symptoms of this brain tissue death, including loss of memory functioning, headaches, and dizziness, may not surface or be diagnosed for years. In more severe cases, those with brain injuries suffer seizures, numbness in the limbs, loss of coordination and vomiting. Some soldiers must re-learn such basic skills as walking and talking.

Because troops are exposed to multiple bomb blasts, traumatic brain injury is considered the “signature wound” of the Iraq war in the same sense that Agent Orange exposure was a major source of medical problems among Vietnam veterans.

Cernak told USA Today that the number of brain-injured troops in Iraq may actually be far higher than reported because soldiers may appear unhurt following a blast and be returned to duty. “These soldiers could have hidden injuries with long-term consequences,” she said.

Since October 2001, the Defense and Veterans Brain Injury Center has diagnosed some 3,000 cases of traumatic brain injury. Some neurologists within the Veterans Administration estimate the number of undiagnosed cases to be more than 7,500. In 2005, doctors at Walter Reed hospital screened every wounded soldier and found 60 percent had brain injuries. A similar screening at the National Naval Medical Center found 83 percent of the arriving wounded had brain damage.

“It’s the so-called invisible injury,” Dr. Alisa Gean, a neurosurgeon at the University of California, San Francisco, told the Associated Press. “It’s where a troop takes 10 times the normal time to pack his rucksack ... a complicated injury to the most complicated part of the body.”

Advances in medical technology and the use of body armor have made the US fatality rate in Iraq and Afghanistan substantially lower than those of Vietnam, Korea, and World War II. Yet the survival of so many seriously injured troops in Iraq has created a higher proportion of severely disabled veterans than any other war.

Since the 2003 invasion, more than 3,800 US troops have been killed, and over 27,700 have been wounded in hostile circumstances. The military has performed another 28,645 non-hostile related medical air transports in Iraq, according to Defense Department figures.

The war presents a staggering social burden in the form of its human and financial costs. Based on 2006 records from the Department of Veterans’ Affairs, the veteran advocacy group Veterans for America estimated that current active duty soldiers could file 400,000 disability claims in the coming years. Given that this estimate was made before the addition of 30,000 troops, that the political establishment has no plans to end the occupation of Iraq, and that new war plans are being drawn up against Iran, the number of disabled veterans will likely be much higher.

Soldiers returning with devastating physical and psychological wounds are dependent upon military-administered medical care. The VA facilities are overcrowded and understaffed, leading to poor sanitation, neglect, complications due to infection, and psychological withdrawal.

The parents of one soldier suffering from a traumatic brain injury told the Boston Globe in an article published September 9 that they had no choice but to remove their son from the VA’s polytrauma center in Richmond, Virginia. “The conditions on the floor were horrible,” the soldier’s mother said. “It was dirty. Our son developed a bedsore from not being moved enough and then it became infected.”

“I came one day and found my son sitting in his own feces,” she said. “The nurses would not allow us to change him because of the IV and the monitors. So he was made to just wait .... They made him wait an hour and a half .... We knew we had to get him out of there.”

Yet private care is out of reach of most families. Many states have no brain injury rehabilitation centers at all, and where they are available, few provide any specialized care. For serious cases of brain injury, rehabilitation costs more than $1,000 a day. The recommended minimum rehabilitation period is 90 days, and care over a lifetime for severe brain injury is estimated at $17 million or more.

As concern for rising numbers of brain-injured veterans grows, some politicians have sought to posture as advocates for wounded soldiers. Congress authorized $150 million for brain injury research as part of the war-spending bill passed in May.

This year, Democrat presidential candidate Hillary Clinton introduced a slew of bills bearing names such as “Heroes at Home Act,” “Restoring Disability Benefits for Injured and Wounded Warriors Act,” and “Protecting Military Family Financial Benefits Act.”

These bills are largely symbolic, and unwittingly do more to reveal the deplorable conditions wounded troops face than to alleviate them. The reality is that when soldiers are wounded, they are not guaranteed coverage for their care, they are neglected, and their injuries are not acknowledged by the military.

The cynical posturing of Democratic politicians such as Clinton comes as they continue to support the occupation of Iraq. In a debate last week, Clinton and the other major Democratic Party presidential candidates said they could not guarantee that US troops would be out of Iraq by 2013. Responsibility for the deaths and injuries of Iraqis and US soldiers lies with the entire political establishment, which launched the Iraq war, and is now preparing for war against Iran.