The Long-Term Effects of a Mild Combat-Related TBI

The Long-Term Effects of a Mild Combat-Related TBI

Even a Traumatic Brain Injury that does not cause a loss of consciousness doubles the risk of dementia later in life, according to a recent study.

Researchers already knew the link between concussions and more serious TBIs and dementia. The mild TBI-dementia link is new information, however. To reach their conclusions, researchers discounted other factors such as age and medical conditions, and focused exclusively on mild TBIs. Lead researcher Deborah Barnes speculated that mild TBIs destroyed white matter, creating an opening for dementia-causing neurofibrillary tangles and plaques.

“This study provides the best information to date that military veterans are at risk for dementia as a consequence of injuries sustained during their service to the United States,” opined Dr. Kimbra Kenney of the U.S. Uniformed Services University.

The Roots of Combat-Related Brain Injuries

TBIs have mystified medical and military professionals for over a century. Doctors, generals, and insurance company adjusters are just now beginning to understand how these injuries work. The learning curve is a little steeper for some people than others.

The first combat-related brain injuries may have occurred in the American Civil War. Some soldiers suffered from personality changes and other symptoms that we now associate with concussions and Traumatic Brain Injuries.

In the 1860s, doctors usually diagnosed these individuals with “nostalgia,” which was basically advanced homesickness. The preferred treatment was a vigorous offensive operation. Ironically, that level of activity is probably what caused the injury in the first place. But, the field doctors did not have any of that knowledge.

In pre-World War I Europe, an increasing number of soldiers developed what was called “Railway Spine” after experiencing combat. Doctors diagnosed the same injury in train wreck victims who experienced what we today call “whiplash.” Some believed that the impact somehow knocked the victim’s body out of alignment and caused injury; others opined that the condition was simply psychosomatic. That same debate continues in some quarters today.

Similarly, there was a vigorous debate as to whether combat-related railway spine was a physical injury or a processing disorder. The debate intensified during World War I with its onset of “shell shock” victims. Symptoms ranged from mild tremors to near-debilitating physical problems to bizarre and truly heartbreaking phobias. One case involved a man who was terrified of a French officer’s red cap. Another one involved an English soldier who was in a catatonic state until someone yelled “bomb.” At that point, he dove under the nearest table and refused to come out.

No research exists as to the later-in-life consequences of these injuries. Given what we know now, it would be interesting to know how these individuals fared. Did the ones who were “cured” truly get better, or did they suffer from dementia and other problems later on?

Reconsidering Combat-Related Brain Injuries

The physical-vs-psychological debate as to brain injuries in general, and Post Traumatic Stress Disorder in particular, continues to this day, but mounting evidence points to the former as opposed to the latter. That is good news for soldiers and contractors who need not feel ashamed of their brain injuries. That is also good news in the injury compensation field, as outlined below.

As for the physical cause, one school speculates that explosive blasts trigger shock waves which disrupt brain functions. In other words, an IED or other device sets off something like a biological electromagnetic pulse. But instead of shutting down electronic devices, this pulse shuts down parts of the brain.

This theory helps to explain the prevalence of brain injuries in Iraq and Afghanistan. According to some estimates, as many as 20% of the veterans of these Southwest Asia wars return home with some form of brain injury.

Other researchers speculate that combat stress affects the delicate interplay between the amygdala on one end and the hippocampus and neocortex on the other end. The amygdala is the “wild stallion” portion of the brain. This area controls emotional responses. In contrast, the neocortex and hippocampus are the brain’s “rider.” These areas keep the amygdala in check by controlling logical responses.

If combat stress erodes the hippocampus and neocortex, as some believe, the amygdala obtains too much power. That imbalance explains traditional PTSD symptoms like:

  • Heightened awareness,
  • Nightmares,
  • Flashbacks, and
  • Personality changes.

These symptoms make it difficult or impossible to function at work or at home.

The military community has been slow to accept this new evidence, but there is progress. Recently, the Canadian Armed Forces abandoned the PTSD moniker and replaced it with OSI (Operational Stress Injury). If a soldier is diagnosed with OSI, the soldier has a physical injury which makes him/her eligible for the Sacrifice Medal, which is Canada’s version of a Purple Heart.

Injury Compensation Available

Eligibility for Defense Base Act compensation is something like eligibility for a Purple Heart. Both require a physical injury. Doctors do not need to know all the diagnostic details. They just need to know that the injury is physical and not psychological. Whatever TBI school you follow, that clearly seems to be the case.

Most victims receive two-thirds of their average weekly wage for the duration of a temporary disability. The AWW calculation is not always as easy as it seems. Many contractors receive substantial non-cash compensation, and that soft money must be accounted for. Furthermore, some contractors were injured so quickly that they had little wage history in that job. In that situation, the AWW is calculated differently, sometimes using the wages of a similar employee, and sometimes using wages from similar, prior employment. Replacement for lost future wages is part of the compensation available to qualified injured overseas contractors.

In addition to an income stream for their families, the DBA pays medical bills. All reasonably necessary expenses are covered, including things like:

  • Emergency care,
  • Follow up treatment,
  • Physical rehabilitation, and
  • Medically-related costs, like transportation, medical devices, and modifications to a dwelling.

Most injured overseas contractors can choose their own physicians and can change doctors under specific circumstances during the course of treatment.

For more information about DBA eligibility, contact Barnett, Lerner, Karsen & Frankel, P.A.