Traumatic Brain Injury and Soldiers

TBI and Soldiers Information

 A traumatic brain injury (TBI) is an injury caused by an external force that impacts one or more parts of the brain which impacts normal brain functions. The human brain controls our physical, cognitive, and behavioral functions.

TBIs are caused by falls, accidents, motor vehicle accidents, assaults, or shock wave blasts from improvised explosive devices (IEDs).

Soldiers are at risk for blast injuries from, rocket propelled grenades, IEDs and land mines. It has been estimated that more than 50% of all combat injuries are blast injuries occurring in Iraq and Afghanistan.¹

If the head is hit or violently shaken (from a blast or explosion), a concussion or closed head injury can result.²

Shock wave blasts from IEDs, rocket propelled grenades, and land mines are the leading cause of TBI for active duty military personnel in combat zones.

As of November 15, 2010, there were 195,547 military personnel since 2000 who have suffered a TBI. It is important to note that this number is all personnel not just injuries sustained in the combat zone.³

TBI Screenings for Soldiers

In theater, screening should occur immediately following the injury event or as soon as possible. A Military Acute Concussion Evaluation tool is used to measure four cognitive domains: orientation, immediate memory, concentration, and memory recall. This tool is used with clinical information to determine if a higher level of care is needed.

Post deployment screenings of active duty service members are conducted during post deployment health assessments (PDHA). Four questions from the Brief Traumatic Brain Injury Survey appear on the PDHA. Positive responses on all four questions prompt a clinical interview for further evaluation.

Screening for TBI also occurs upon entry into the Veterans Health Administration (VHA) system, using a TBI clinical reminder tracking system. Veterans, who confirm Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) theater deployments and do not have a prior TBI diagnosis, are asked a series of four sequential sets of questions based on the Brief Traumatic Brain Injury Survey. Those who screen positive for TBI are arranged to have further evaluation.⁴

Signs and Symptoms of TBI

• Difficulty organizing daily tasks
• Blurred vision or eyes tire easily
• Headaches or ringing in the ears
• Feeling sad, anxious or listless
• Mood changes
• Easily irritated or angered
• Feeling tired all the time
• Feeling light headed or dizzy
• Lack of motivation
• Relationship troubles
• Trouble with memory, attention or concentration
• Balance problems
• Sensitive to sounds, lights or distractions
• Impaired decision making or problem solving
• Difficulty inhibiting behavior- Impulsive
• Slowed thinking, moving, speaking or reading
• Easily confused, feeling easily overwhelmed
• Change in sexual interest or behavior
• Getting Lost
• Loss of sense of smell and taste

Recovery Following TBI

Speed of recovery varies. Most people with mild TBI recover fully, but it can take time. People with a previous injury may find it takes longer to recover from their current injury. Some symptoms can last for days, weeks or longer. Talk to your health care provider about any troubling symptoms or signs. Improvement of symptoms typically occurs over the first 1-3 months after the injury; however, possibilities for improvement are limitless. (Please note the disclaimer at the beginning of the manual).

Things that Help Recovery

• Get plenty of rest and sleep
• Increase activity slowly
• Carry a notebook- Write things down
• Establish a regular daily routine
• Do only one thing at a time if you are easily distracted
• Check with someone you trust when making decisions

Things that "May" Slow Recovery

• Assess activities that could lead to another brain injury and make a healthy plan for protection
• Inquire about how alcohol might slow healing of the injury or pose a risk to other behavioral functioning
• Ask your healthcare provider about caffeine or "energy-enhancing" products as they may increase symptoms⁵
• Discuss all over the counter medications with your health care provider as they may impact your recovery process in a negative manner.

Strategies

General Tips

• Increase activity slowly
• Establish a regular daily routine to structure activities
• Make "To Do" lists
• Keep a written sheet of medications and appointments
• Keep a headache log to share with the doctor
• Buy ear plugs and sun glasses
• Exercise regularly
• Eat a healthy diet
• Use time outs to deal with emotions
• Use time outs for overwhelming situations
• Use visualizations
• Write down health questions in one place to share with doctors

Memory

• Write in a journal
• Carry a notebook
• Write it down
• Establish a regular daily routine to structure activities
• Get organized
• Place things in the same locations
• Get plenty of rest and sleep
• Set alarms and reminder notices

Fatigue, Sleeping and Not Sleeping

• Establish a regular daily routine to structure activities
• Get plenty of rest and sleep
• Keep your house warm/cool enough to sleep comfortably
• Go to bed at the same time every night
• Consider avoiding caffeine if it negatively effects you
• Consider how exercising late at night might impact your energy level and sleep pattern
• Practic progressive relaxation (including napping and other times without napping)

School/Work

• Find a study buddy in each class
• Carry a notebook
• Increase activity slowly
• Do only one thing at a time if you are easily distracted
• Check with someone you trust when making decisions
• Increase responsibilities slowly
• Get organized
• Break tasks into easy steps
• Make "To Do Lists". Break them down into manageable parts

Disability Benefits for Wounded Warriors

Military service members can receive expedited processing of disability claims from Social Security. Benefits available through Social Security are different from those from the Department of Veteran Affairs. It requires a separate application.

The expedited process is eligible for military service members who became disabled while on active duty on or after October 1, 2001 regardless of where the disability occurs.

Types of Benefits That Can Be Received

• Social Security Disability Insurance Programs- This program pays benefits to you and certain members of your family if you have worked long enough and paid Social Security taxes.
• Supplemental Security Income Program- This program pays benefits based on financial need.

What is Social Security's definition of disability?

By law, Social Security has a very strict definition of disability.

• You must be unable to do substantial work because of your medical condition (s) and
• Your medical condition(s) must have lasted or be expected to last longer than one year or be expected to result in death.

How does military pay affect eligibility for disability benefits?

You cannot engage in substantial work activity for pay or profit. Active duty status and receipt of military pay does not prevent payment of disability benefits. If you are receiving treatment at a medical facility and working in a designated therapy program or on limited duty, your eligibility for benefits can be evaluated by Social Security.

How do I apply?

You may apply for benefits at any time while having military status or after discharge, whether you are still hospitalized, in a rehabilitation program, or undergoing out-patient treatment in a military or civilian medical facility. You can apply online at www.socialsecurity.gov/woundedwarriors, in person at the nearest Social Security office, by mail or telephone at 800-772-1213.

What do I need to apply?

• Original certified copy of your birth certificate or proof of US citizenship
• Form DD 214 if discharged from the military
• W2 Form or Income Tax Return from last year
• Military or Workers Compensation to provide proof of income
• Social security numbers for your spouse and minor children
• Checking or savings account number
• Name, address and phone number of a contact person
• Medical records that you have or can easily get

Can my family get benefits?

This is based on your work history. Some family members may be eligible:

• A spouse over the age of 62
• A spouse at any age who is caring for your child who is under age 16 or is disabled
• Your unmarried child under the age of 18
• Your child age 18 or older with a disability that began before age 22

How does Social Security make a decision?

Your claim is sent to a state Disability Determination Service Office that makes disability decisions. The state has medical and vocational experts who contact your doctors and other places where you have received treatment to get your medical records. You may be asked to have an exam or a medical test. You will not have to pay for the exams, but MUST attend them.

How long does it take to get a decision?

The length of time it takes to receive a decision on your disability claim can vary, depending on several factors:

• The nature of your disability
• How quickly we obtain medical evidence is received from your doctor or medical sources
• Whether you need a medical exam to obtain evidence to support your claim

Contact Social Security at:

www.socialsecurity.gov
1-800-772-1213
Or if hard of hearing or deaf at
1-800-325-0778
From 7am to 7pm Monday thru Friday
Automated phone service available 24 hours a day.
All information is confidential.