While the number of OEF/OIF/OND veterans diagnosed with TBI, PTSD, or both has been substantial, from fiscal year 2009 through FY 11 only 9.6 percent (58,885) of veterans treated by the VA were diagnosed with TBI in at least one of those years. A higher number – 29.3 percent or 179,723 – was diagnosed with PTSD during that same period, while the full polytrauma triad (including head, neck, or back pain) was diagnosed in 6 percent (36,800). However, DOD reports more than 80 percent of the 300,000-plus service members who have sustained a traumatic brain injury since 2000 were in a non-deployed environment at the time.

In January 2014, the Defense and Veterans Brain Injury Center (DVBIC), the TBI operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, released a first-of-its-kind set of guidelines – “Progressive Return to Activity Following mTBI Clinical Recommendations” – tailored for primary care managers and rehabilitation providers.

Despite those numbers, the NIH report adds it is impossible to accurately quantify the incidence of TBI – or, to a lesser extent, PTSD – in the veteran population because some of the numbers were based on self-reported cases, which “may overestimate the rate of TBI compared with clinical assessment, just as they have been found to overestimate the rate of PTSD relative to gold standard interviews. On the other hand, clinical assessment is also subject to error and, in fact, these medical diagnoses may be under-reported in VA records.”

“In sum, while our findings describe the proportion of OIF/OEF/OND veteran VA users with TBI diagnosis in the VA FY2009–11 administrative data, they may not describe the actual incidence of TBI or the impairment or disability related to TBI in the population of all OIF/OEF/OND veterans,” the report concluded. It added, however, that the three-year investigation did demonstrate the wide extent of such cases among new Gulf War veterans, with the number turning to the Veterans Health Administration (VHA) for health care growing substantially.

“This investigation represents the first multiyear, system-wide analysis of TBI, mental health and pain-related comorbidities and triad diagnostic trends from the VHA … Among those with a TBI diagnosis, the majority had a clinician-diagnosed mental health disorder and approximately half of those with TBI had both PTSD and pain. Overall, while the absolute number of OIF/OEF/OND veterans increased by over 40 percent between FY2009 and FY2011, the relative proportion of veterans diagnosed with TBI and the high rate of comorbid PTSD and pain in this population remained relatively stable.”

Part of the data used came from a mandatory screening for TBI implemented by the VA in April 2007 for all OEF/OIF veterans during their first visit to the VA.

While exact numbers – even exact diagnoses – remain elusive, the confirmed high incidence of both TBI and PTSD, especially among ground forces, has been a driving factor in efforts to better understand, diagnose, treat, and even prevent brain injuries and related health problems in combat. The DOD and VA efforts in this regard are working closely with civilian researchers who have been focused on concussive injuries among athletes, especially football and soccer players, boxers, and martial artists who experience repeated blows to the head. It also has application to injuries sustained by children at play – or resulting from abuse – and those injured in automobile or other accidents.

This emphasis, however, also has resulted in a plethora of claims and counterclaims, from legitimate researchers and physicians to scam artists hoping to make a quick profit from those desperate for help and confused by the state of treatment. Even legitimate health care givers are struggling to find the best answers among all the claims – good, bad, and criminal – coming out almost every day.

For example, a listing of articles about brain injury by the Centre for Neuro Skills had links to more than 200 articles, from scientific journals to the popular media, for the first eight months of 2014 alone – excluding those specifically related to sports or children. The topics listed ranged from “Blueberries Could Help Heal Brain Injuries” to “Cortisol and Progesterone Levels and Outcomes Prediction after Traumatic Brain Injury.”

In January 2014, the Defense and Veterans Brain Injury Center (DVBIC), the TBI operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, released a first-of-its-kind set of guidelines – “Progressive Return to Activity Following mTBI Clinical Recommendations” – tailored for primary care managers and rehabilitation providers.