Neurobehavioral consequences of mild traumatic brain injury in military service members and veterans
Traumatic brain injury (TBI) is a continuing concern for military treatment facilities operated by the Department of Defense (DoD), the Veterans Health Administration (VHA), and civilian health care providers who deliver services to U.S. active duty service members and veterans. Improvements in body armor and other protective gear worn in the combat environment have dramatically increased the likelihood of survival after blast exposure and other related injuries. Blast-related exposures and other mechanisms of sustaining TBI in both the deployed and nondeployed setting can be the source of an array of physiological, neurocognitive, and psychological disorders in military service members and veterans. The goals of this chapter are primarily threefold: 1) to describe common aftereffects of blast-related exposures in military personnel and other events that produce TBI, 2) to describe the many co-occurring disorders that complicate the medical and psychological symptom picture for those who have had blast exposures and deployment to war zones, and 3) to discuss the current approach for polytrauma rehabilitation and integrated care for U.S. active duty service members and 632veterans who have served in Operation Enduring Freedom (Afghanistan 2001-2014), Operation Iraqi Freedom (Iraq 2003-2011), and Operation New Dawn (Iraq 2011-present), hereafter referred to as OEF/OIF/OND. This chapter also focuses on mild traumatic brain injury (MTBI) as opposed to those who suffered moderate and severe TBI, given that the vast majority of military TBI falls into the mild category. In addition, this chapter underscores the clinical situation of “polytrauma” as relevant to military and veteran populations given the high frequency of co-occurring disorders that are seen in military and veteran treatment environments.