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White Paper: Research and Treatment for PTSD and TBI in Combat Veterans
With every war comes casualtymen and women who have sacrificed life and limb to
protect our freedoms and liberties and preserve the American way of life. The American Legion
is proud to call these brave individuals our brothers and sisters. The injuries of combat vets are
widely varied, from shrapnel to burns, amputation to exposure-related diseases that show up
years after the conflict has ended. For the veterans of Operation Enduring Freedom (OEF) and
Operation Iraqi Freedom (OIF), the two largest injuries are often unseen, unreported, and
subsequently untreated. Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder
(PTSD) are two issues that todays veterans are facing in great numbers, and it is time that the
Federal Government step up their research of these conditions and provide this generation of
warriors with more adequate testing and funding for treatment options.
The National Council on Disability has estimated that of the 1.6 million troops that have
deployed to the Middle East in conjunction with OEF/OIF that an estimated 25-40
percent have less visible woundspsychological and neurological injuries
associated with post traumatic stress disorder (PTSD) or traumatic brain injury
(TBI), which have been dubbed signature injuries of the Iraq War (Invisible
Wounds 1). The overlap in symptoms from these conditions make them hard to
discern from one another, and in many cases the two exist together in patients.
Traumatic brain injury is a common injury experienced by millions of
military members and civilians alike. The most common form of TBI, mild TBI, is
more commonly referred to as a concussion. The majority of TBI falls under the
mild category, where recovery takes place over a matter of days with all
symptoms resolved in a couple of weeks. Moderate and severe TBI, on the other
hand, cause significant damage to the brain and a full recovery may not be

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possible. The Department of Veterans Affairs does note that the severity of the
initial injury does not correlate in a linear fashion with the severity of the brain
damage, and that some of these patients can make remarkable recoveries with
prolonged therapy (Summerall). For military these injuries are often the result of
blast injuries, mortar attacks, vehicle accidents, gunshot wounds, and airborne
operations.
Post-Traumatic Stress Disorder is a condition that occurs following a
traumatic event. It is often characterized by hypervigilance, flashbacks,
nightmares, insomnia, memory loss, chronic pain, headaches, and depression.
Several of these symptoms are also found in TBI sufferers. The most prevalent
symptoms, memory loss, sleep disturbances, and depression overlap to the
point that diagnosticians are often at a loss in finding a definitive diagnosis.
These overlaps have caused veterans a loss of disability rating and
compensation because one diagnosis is favored over the other, rather than
rated as two separate coexisting conditions.
Primary diagnosis of TBI is performed by a neurological survey and the
use of the Glasgow Coma Score (GCS). There are several problems with this
approach. Injuries on the battlefield are often delayed in being reported, making
the GCS less accurate, if they are reported at all. Symptoms reported may also
be incomplete, especially if loss of consciousness occurs and is not witnessed by
another person. The overlap of PTSD symptoms can also further complicate a
TBI diagnosis, and neurological testing of a patient with PTSD can produce a
false positive result for TBI and vice versa. Most troubling of all, the current

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diagnostic testing equipment used by the military, CT scans and MRI, will not
accurately diagnose any but the most severe TBI cases.

Neuroimaging is advancing, however, and recent studies have shown that new equipment
can show changes in the brain caused by TBI that previously went undetected. The use of
diffusion MRI and functional MRI technology have showed some promising results in
diagnosing and tracking the effectiveness of treatment in TBI patients, yet has remained passed
by in the government sector. Being able to not only gain a visual of the initial effects of the
injury but to have a pattern to follow in the weeks and months after injury would be invaluable to
doctors in terms of knowing when a service member is able to perform all duties again without
risking a setback in recovery.
Alternative treatments have also garnered little attention, yet have shown promising
results in treating symptoms in TBI patients. Interestingly enough, many of these treatments also
help to provide relief to those suffering with PTSD as well. Once such alternative is hypobaric
chamber treatments. A study conducted on 15 PTSD/TBI patients by Dr. Paul Hatch in New
Orleans revealed the following results: [an] Average IQ improvement of nearly 15 points.
Thirteen out of those 15 reported fewer headaches. Nine of the 12 who had insomnia before the
treatments cited improved sleep. Seven of the 11 subjects on prescription medication for their
conditions cut back on or quit the medications (American Legion 36). Other alternative
treatments that have proven effective in assisting cognitive function and alleviating symptoms of
both PTSD and TBI include martial arts, yoga, art therapy, music therapy, and pet therapynone
of which are approved by TRICARE coverage outside intensive inpatient treatment programs.
Our brothers and sisters deserve the best from their leaders, and as advocates, we at the
American Legion intend to see that their pleas do not go unheard. With the wealth of information
regarding treatments and diagnostic tools to improve recovery from those suffering from these

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injuries, it is time for the government to take notice. The men and women that have served this
country deserve the best possible care, and Congress has dropped the ball in providing it. The
American Legion urges the legislators of this nation to look into these studies, talk to veterans
that have been helped by these programs, and work with TRICARE to ensure that funding is
available to get these service members on the road to recovery.

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Works Cited

National Council on Disability. Invisible Wounds: Serving Service Members and Veterans with
PTSD and TBI 1. 2009. Web. 14 January 2016.
The American Legion TBI/PTSD Ad Hoc Committee. The War Within: Treatment of Traumatic
Brain Injury and Post-Traumatic Stress Disorder 36. 2007. Web. 15 January 2016.
Summerall, E. Lanier MD. Traumatic Brain Injury and PTSD. National Center for PTSD.
Department of Veterans Affairs. 2015. Web. 15 January 2016.