Signing a check for Iraq's signature wound

We've know for some years now that traumatic brain injury (TBI) is the "signature wound" of the Iraq War (see here, here). We know it's true but we don't know its full extent. Nor has the Department of Defense bothered to find out how bad it is, despite the fact that they designed a screening test for TBI "years ago" according to USA Today:

The Pentagon must use computers to screen troops before and after they go to Iraq or Afghanistan to better determine whether they suffered traumatic brain damage in combat, according to a plan by a congressional brain-injury task force.
The Defense Department should also develop more brain-injury research and improve specialized care for what experts are calling the signature wound of these wars, one that often goes undetected until returning troops have memory or behavior problems.

Congress has authorized a record $450 million for brain-injury treatment and research in the Iraq spending bill being negotiated by Congress and the White House. Legislators say the Pentagon acted slowly on this issue.


From 125,000 to 150,000 U.S. troops may have suffered mild, moderate or severe brain injuries in Iraq and Afghanistan, Pascrell estimates. That's a hidden population of wounded that far exceeds the official casualty figures of 26,000.

Between 10% and 20% of the returning troops screened at a few individual military bases may have suffered brain injuries, Pentagon spokesman Chuck Dasey says. (Gregg Zoroya, USA Today)

Now the Department of Veterans Affairs (aka the VA) will be screening very Iraq and Afghanistan veteran for TBI. But DoD needs to screen soldiers before they leave for the Iraq theater, too. The sense of urgency in the military is partly genuine and partly generated by the increasing public exposure of the disgraceful way wounded veterans have been treated. The President and Republican Congress who mouthed "support for the troops" were really incredibly unsupportive in every way you can imagine except providing them the opportunity for combat experience. Now we have a possible 100,000 or more young men and women suffering memory loss, difficulty concentrating and irritability. The cascading consequences will be broken families, job loss and substance abuse. The costs of this horrendous debacle will go on for decades. Some of it will be paid by our children's and grandchildren's MasterCards.

Much more of it will be "priceless" -- in the worst possible way.


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TBI-Revere its a war. They cant fight one without a liver either but are they going to be doing those work ups too? I mean I'll give it to you that this is a serious thing and condition. But they fire a bullet, you fire an M79, they fire an RPG, you in turn call in an air strike which inevitably but initially were what was slung under the CAP which means either A-10's, F-18's or F-16's.

What you have to understand here is that they drop munitions that are designed to cause concussive damage. Saw more than one bad boy in my day that didnt have a mark on them, but they were dead. Just ruptured internally. The eyes were the giveaway. Pushed in or pushed out.

These guys that werent actually physically wounded could also have gotten injured by falling over and hitting their heads with that 4 pound hunk of tin and kevlar on their heads. The design lends itself to nothing if there is a close by strike of a bomb, grenade or a mortar or artie round. It collects the concussion under the helmet which is held on by the chin strap and wammo, lower pressure cranium being over pressured by concussion wave.

Yep, its a bad deal but its a war. Let them fix them up the best they can afterwards and let them press on with whatever they can do. Get somone else in there to take the place of the injured guy.

By M. Randolph Kruger (not verified) on 07 May 2007 #permalink

Randy: I don't think you understand this situation. This is the signature wound of this war. It isn't the same as other wars in that regard. And it is being ignored. And there will be hell to pay for these vets. Fro the rest of their lives. And you will pay for much of it, with your taxes and the social services required to deal with the consequences to their families.

Revere-If I understand you right you are saying that THIS particular item of injury is the big thing in this war? Make sure I understand that clearly. Melanie I read your link. I understand that head wounds are bad and injuries are pretty much a lobotomy to some. If I understand you correctly though you are saying that this will be the Agent Orange of this particular skirmish in our history?

By M. Randolph Kruger (not verified) on 07 May 2007 #permalink


You still are not getting the gravity of the situation. These wounds are difficult to diagnose, impossible to treat and they are common. Common. This will burden what is left of the VA and our social services for decades. It's not a lobotomy, what it does is make the victims untreatably mentally ill for the rest of their lives.

Randy: Yes, that is what everyone, including DoD, is saying.

Why is this so prevalent?
What is different about this war and what is the primary cause of this type of injury? Is it being in a 'protective environment' e.g. an APC when a road side bomb goes off, protected from shrapnel but not the pressure wave?

Hundreds of thousands of families left to struggle with a system that doesn't know how to, and doesn't really want to pay to, treat them, and people that are "untreatably mentally ill for the rest of their lives"; this is going to cause hell for generations.

And these people, who will have sacrificed too much, will look like they should be able to function normally; hold a job, raise a family, but they won't be able to,
and they won't need to hear the military saying, well, you had these "personality" problems when we let you join, so, now you're so out of luck.

(These currently unpreventable/incurable brain injuries will weaken the nation more than Saddam ever could have.)

By crfullmoon (not verified) on 08 May 2007 #permalink

JJ: Apparently it is the combination of concussive blast injury coupled with body armor and prompt and effective battlefield treatment that allows soldiers who would otherwise have died to survive.


Your statement that "Hundreds of thousands of families left to struggle with a system that doesn't know how to, and doesn't really want to pay to, treat them..."

Is blatently false.

My oldest daughter works for the VA and is one of those folks who has the responsibility of determining that a vets injuries were in fact caused by them serving their country, that those injuries require some level of compensation to the vet, and, then determines what that level of compensation should be.

Not blaming your daughter personally. So, is she is a brain injury specialist?
And the VA hospitals are all funded and staffed and knowlegeable enough, even though we've never had a war send back high a proportion of wounded who normally would have died, that the vets aren't being kept waiting, and are getting proper brain imaging, diagnosis, and effective treatment?
(That's not what was going on with parts of Walter Reed.)

And are the veteran's (and their spouses') accounts, that people are being told they did not get their injury in service, but must have been this addled - "personality problems" -when they enlisted; pay back the signing bonus, because you were sent right over and are back damaged already, all untrue?

They do not know how to treat this kind of traumatic brain injury
to cure these veterans

Where are the statistics on how many have committed suicide over there (if they haven't been covered up) or over here, once they come back and are trying to deal with bureaucracy, and hospitals that didn't have enough mental health beds even before 9/11?

How many misdiagnosed or untreated TBI cases are getting in trouble in subsequent combat, or coming back here and getting into driving accidents, or drug and alcohol problems, or domestic violence?
Look at what percentage of our homeless on the streets have been veterans.
The system is far better at breaking people than getting them the ability to have normal lives back. Mental health care, and what the average doctor knows about brain chmistry or injury, is probably where the cancer field was 50 years ago.

By crfullmoon (not verified) on 08 May 2007 #permalink

Revere/Mel... guys I think they are all signature wounds and not just head injuries.

For those of you who never served you have to understand that they all know about this kind of stuff before they go. Its not an education any more.... Its a war. You arent going to go into the NG and not see Iraq unless you are in an admin position somewhere or your classification doesnt permit you to enter a combat zone...e.g. women. There are a bunch of women there and only because of the designation but they all understand that this isnt a game. They nearly all believe in what they are doing and to get wounded, maimed, blinded or take a concussive to the head area is my interpretation of "signature wounds" and they all carry the same weight for me. I wouldnt single out one head against one blinding.

They also are evaluated Revere and that is where the real test is going to come. Me, I think that GWS is from the anthrax shots they were given or maybe exposure to hydrogen sulfide and burning crude oil. Might be a combi of both.

I would be interested Revere to determine if you think any war is necessary? If so, what would be the thing that did or does it for you and puts you over the line to go to war. Would it be a bombing of Pearl Harbor or rape of Nanking? Just asking. Its well known you are opposed to this war and to Gulf War 1. But I would like to know.

MIND you folks out there, I find Revere to be a pretty good citizen and likely a patriot in his own right so dont start Revere bashing if he answers with something you dont like or want to hear. I just want to know where he stands on it.

By M. Randolph Kruger (not verified) on 08 May 2007 #permalink

Those who serve our country deserve our support. They deserve the support for as long as needed. There should never have been such a problem caring for vets after the Vietnam war that the image of a legless vet begging on the street or that of a vet haunted by PTSD stands so clearly in our cultural awareness, yet it did. This is a chance for our country to do things RIGHT and offer those returning diagnosis and treatment, instead of it taking years to get on the public horizon, as with PTSD. We know this is happening a great deal. The government needs to do the right thing, and that requires the rest of us to let them know it matters, otherwise they push it under the rug and focus on other priorities (there are always other priorities).

Randolph - I don't think any 18 year old really understands that life it not a game. I imagine they wake up to reality very soon after arriving, or perhaps before departing (like in boot camp), but agreeing to fight for our country does not for a moment suggest that we don't hold responsibility to care for those who are wounded in any way when doing so. That seems like the least we can do for them.
I'm surprised to find that I'm so strongly for caring for the vets when I am in the anti-war crowd, while you, Randolph, argue against it, and you are a vet. Did I misunderstand your view?

By admitted lefty (not verified) on 09 May 2007 #permalink

Randy: Get on board the liberal bandwagon, then, because we're all opposed to it. My guess is it won't happen, but if it does, it's bad. Of course not as bad as what Bush did -- throwing the vets on the garbage heap. But still bad.

So from what I understand from an email that was sent out to the veterans that after a very frank discussion that the head of the VFW pretty much called the guy a traitor to his country. But very likely he isnt a US citizen so that wont float.

The stink on this guy is getting louder. So just as they did under Carter, they are going to tank these guys. I want to hear lawsuit and if the Congress tries to pass a law allowing it then everyone is going to get the bills squared for this putz and his policies.

Private insurance has absolutely NOTHING to do with the veterans of the US and its a taking pure and simple. Just like the compensation at AIG. They'll bluster and make noise and our little girlfriend Barney and his crony Dodd are going to find themselves on the wrong end of an expensive lawsuit. Its legal what they did and its contractual... Guess that doesnt matter to this idiot either. So now what a disabled vet has to make a co-pay when he cant get a job? Sack of shit.

Liberal bandwagon? Are you on medication? Not enough sleep for a week? Detained in Gitmo? Please Revere...thats insulting!

By M. Randolph Kruger (not verified) on 17 Mar 2009 #permalink

Randy: Don't talk so stupid. Make your point (which I agree with) and have done with it. The proposal, though, as I understand it, was to charge any private insurance they had for VA services. It's a bad idea, but not so bad as abandoning them, which is what Bush did. Liberals are up in arms about this, so you are just agreeing with us. A little late, but agreeing with us. Get over it. And please be more civil. You sound juvenile and slightly unhinged. BTW, when was the last time you used the VA system? It's got nowhere to go but up.

No the proposal is to force private insurance to pay for their war injuries without any back compensation from the VA... I got the email today and its basically what is happening with Medicare that is covering it. The VA should be paying Medicare for it.

Hate touching nerves Revere but this guy is going turn it all upside down and the government is going to control everything. He just wants to create a half a billion dollars because he cant afford to do anything that he wants to do. Gotta steal it from someone. Sure as hell not going to get it from income taxes unless he raises them in the middle of a recession.... One term Obama.

I havent had to use it thankfully but its the ace in the hole if I ever have a problem. Most of the indigent vets end up in there. Memphis is a bit different I think. We actually have accountability here and the inspection processes are a lot nastier on the people who dont perform.

When it comes to this juvenile is my middle name. Elected the wrong toad Revere... We are now 11 trillion in the hole already and that takes us to 112 trillion in long term mandates and programs... Not counting the off the budget ear marks that are sending us into the toilet. Dodd is one of the biggies, so is Barney. Some Republicans too.

By M. Randolph Kruger (not verified) on 17 Mar 2009 #permalink