The VA’s real surprise is the low number of diagnoses for traumatic brain injury (TBI),
which has become one of the signature injuries in the Iraqi/Afghanistan
conflict due to the large number of roadside bombs, mortars and
rocket-propelled grenades.

Four years ago, the Rand Corp. interviewed 1,965 vets and projected in its controversial
2008 report that 18.5 percent of all returning service members would meet the
criteria for either PTSD or depression (14 percent for each, but there’s some
overlap), and that another 19.5 percent would experience a probable TBI while
overseas. Again after taking into account that overlap, it said 31 percent of
all returning troops would suffer from one or all of those ailments.

The VA’s actual treatment figures show 28.5 percent of the returning vets are seeking
mental health care, which is right on track with the Rand Report. But while the
Rand Report projected that some 320,000 American soldiers would need help for
TBI, the VA says only 54,070 vets (a little over 4 percent of the returning
vets) qualified for that diagnosis.

“That’s absurd, preposterous, erroneous,” snorts Mike Zacchea, a Marine Corps
lieutenant colonel retired on a medical disability after service in Iraq, where
he survived a bomb in a mess hall, almost daily sniper attacks, mortar attacks
on his unit’s convoy, and a rocket wound during intense combat in Fallujah. All
of those took a huge physical and emotional toll on Zacchea.

As of last June, the VA had data on 544,481 vets whose brains might have been affected by
battlefield explosions, according to Dr. David Cifu, national director of the
VA’s Physical Medicine & Rehabilitation program. Of that number, he says,
“19.8 percent have screened positive for a mild TBI (concussion), that is were
exposed to explosions that might have caused traumatic brain injury.

“When those 19.8 percent of veterans were evaluated by one of the 100 TBI specialty
teams across the nation, approximately one third (or 7.8 percent of the original
544,481) tested positive for TBI with persistent symptoms,” says Cifu. “Another
approximately 2 percent were found to have a TBI that pre-dated their military
service. Those two figures (the 7.8 percent plus the 2 percent) add up to
54,070 veterans.”

The difference, says Cifu, is that the Rand Report used the total number of
injuries as its TBI figure while the VA used only the number of vets still
showing TBI symptoms a year after their injuries.

“The Rand Report was pretty accurate on the number of those who may have had injuries due to a
blast, but didn’t take into consideration that many of those may have injuries
that will fairly quickly get better over time,” says Cifu. “We know that up to
97 percent of those who experience concussions are normal without symptoms
within a year. So we’re tracking just the people who continue to have
difficulties.”

But Zacchea, a staunch member of Veterans for Common Sense, charges that the VA is trying hard to deny this
disability. “Today’s cutting edge neurology is that any symptoms that last
longer than two weeks indicate traumatic brain injury,” says Zacchea. “They’re
using the one-year time frame because that benefits them, but that’s just
medieval.”

Zacchea says he was quickly diagnosed with post-traumatic stress disorder after returning from combat, but
that he had to fight for his TBI diagnosis. “They wouldn’t even let me see a
neurologist,” he says. So he took his case to the Yale Medical School, got a
private diagnosis of TBI and challenged the VA to disprove it. After a number
of verification tests, he was finally granted a TBI diagnosis by the VA in
2008.

His ongoing symptoms include migraine headaches, sensitivity to light and noise, and loss of fine motor
skills. “My fingers are numb, and I’m always dropping things,” he says. “I have
difficulty tying my shoes so I usually wear slip-on shoes.” He also has a
distinct taste in his mouth. “I’ve lost most of my taste sensation,” he
explains, “so I put hot sauce on pretty much everything.”

A new book, The Concussion Crisis, concludes that even minor concussions repeated regularly can be
harmful, leading to impaired cognition and ultimately early-onset dementia
among athletes such as boxers and football players, as well as among soldiers.
In reviewing the book, Connie Goldsmith wrote: “There is no such thing as a minor
concussion. Every concussion is a potentially devastating injury. These stories
focus on concussions among athletes of all ages, as well as concussions among
soldiers and victims of auto accidents. Some of the stories are heartbreaking:
adolescents who suddenly die after what appear to be minor head injuries;
boxers and football players with early-onset Alzheimer’s disease and dementia;
and returning veterans left to wander through the medical system seeking
treatment for their unrecognized or misdiagnosed concussions.”

Dr. Allen Brown, head of the Mayo Clinic’s Brain Injury
Unit, defines a TBI as an external mechanical force impacting a body and
creating a brain injury. Thus, by definition, every concussion is a TBI and should
be part of the medical record.

But in the civilian world, he says, only about 8 percent
of brain injuries are severe enough to be labeled a “definite TBI,” as opposed
to a “probable TBI” which is milder or a “possible TBI” which is symptomatic. A
“definite TBI” involves any of the following: loss of consciousness for more
than 30 minutes, post-traumatic amnesia for more than 24 hours, significant
loss of motor skills as measured on the Glasgow Coma Scale, or intracranial
bruising or bleeding.

Brown agrees with Cifu that “an overwhelming majority” of brain injuries resolve themselves, although
repeated injuries increase the risk of significant damage. “It’s pretty clear
to me that the cumulative effect of any injury increases the risk for secondary
problems, including repeated TBIs that could lead to loss of cognition later in
life,” he told me. “It may not happen in every case, but the risk is whoppingly
high.”

And he calls the disparity between the Rand Report and the VA’s definitions of TBI “one of the most
argued-over controversies in medicine.”