In late 2008, the U.S. Veteran’s Administration published a feature article entitled Brain-injury experts meet to shape agenda for care, research. The article discusses ongoing research efforts on traumatic brain injury in the U.S. military. MTBIFacts.com is in full support of such efforts.

Despite the interesting aspects of the article, the following section needs to be responded to: “TBI is estimated to affect some 20 percent of troops injured in Afghanistan or Iraq. The cause is usually a blast. Most of the injuries are considered mild, but even these cases can involve serious long-term effects on memory, mood, focus and other areas.”

As is explained in the feature article on this website about blast-induced brain injury, it is true that blast injuries can cause brain injury. However, while brain injury can be caused by projectiles striking the head or someone being thrown into a solid object due to the force of the blast, there are no published, peer reviewed, prospective research studies with human subjects that have demonstrated that the pressure from the blast alone can cause brain injury. Unfortunately, people may assume this from the article. This is particularly problematic in cases where there has been an explosion and post-traumatic stress disorder (PTSD) is present but not brain injury. When patients automatically assume that the blast exposure alone causes brain injury in humans, there is greater potential to incorrectly label PTSD symptoms as brain injury symptoms. I have seen this type of mistake made repeatedly. On a positive note, it is gratifying to see that the VA is trying to do more research on differentiating the two conditions.

The most problematic aspect of the article is the permanent impairment myth. The fact is that there are no prospective research studies supporting that a single concussive event can cause serious long-term effects on memory, mood, focus, and other areas. No research citation was supported to back up this claim in the article. The only data suggesting an increased long-term risk of cognitive impairment is cited in the MTBIFacts.com article above on the permanent impairment myth. That data shows an increased risk in professional football players who report a history of three or more concussions. In sum, veterans and their families should not automatically assume that exposure to a single blast explosion will automatically equate to brain injury and an increased risk of permanent symptoms.

Lastly, it is also worth pointing out that the committee of the Institute of Medicine (IOM) reported in December 2008 that "There is a paucity of information in the scientific literature regarding the sequelae of blast injury, and there is a need for prospective, longitudinal studies to confirm reports of long-term effects of exposure to blasts." The IOM report was commissioned by the Department of Veterans Affairs and based on an analysis of 1,900 peer-reviewed studies.

The VA was contacted on 1/3/09 about this article. A response will be awaited.