In­vis­i­ble war wounds of­ten dis­missed upon re­turn

Antelope Valley Press - - FRONT PAGE - By ROBERT BURNS

WASHINGTON — The spot­light on brain in­juries suf­fered by Amer­i­can troops in Iraq this month is an ex­am­ple of Amer­ica’s episodic at­ten­tion to this in­vis­i­ble war wound, which has af­fected hun­dreds of thou­sands over the past two decades but is not yet fully un­der­stood.

Un­like phys­i­cal wounds, such as burns or the loss of limbs, trau­matic brain in­juries aren’t ob­vi­ous and can take time to di­ag­nose. The full im­pact — phys­i­cally and psy­cho­log­i­cally — may not be ev­i­dent for some time, as stud­ies have shown links be­tween TBI and men­tal health prob­lems. They can­not be dis­missed as mere “headaches” — the word used by Pres­i­dent Don­ald Trump as he said the in­juries suf­fered by the troops in Iraq were not nec­es­sar­ily se­ri­ous.

Gen. Mark Mil­ley, chair­man of the Joint Chiefs of Staff and a vet­eran of com­bat in Iraq and Afghanista­n, told re­porters Thurs­day that the num­ber of ser­vice mem­bers di­ag­nosed with TBI from the Jan. 8 Ira­nian mis­sile at­tack in Iraq has now grown be­yond the 50 re­ported ear­lier this week, al­though he pro­vided no spe­cific num­ber. Mil­ley said all are cat­e­go­rized as “mild” in­juries, but in some cases the troops will be mon­i­tored “for the rest of their lives.”

Speak­ing along­side Mil­ley, De­fense Sec­re­tary Mark Esper said the Pen­tagon is vig­or­ously study­ing ways to pre­vent brain in­juries on the bat­tle­field and to im­prove di­ag­no­sis and treat­ment. Mil­ley said it’s pos­si­ble, in some cases, that symp­toms of TBI from the Ira­nian mis­sile at­tack on an air base in Iraq on Jan. 8 will not be­come ap­par­ent for a year or two.

“We’re early in the stage of di­ag­no­sis, we’re early in the stage of ther­apy for these troops,” Mil­ley said.

Wil­liam Sch­mitz, na­tional com­man­der for the Veter­ans of For­eign Wars, last week cau­tioned the Trump ad­min­is­tra­tion against tak­ing the TBI is­sue lightly.

“TBI is known to cause de­pres­sion, mem­ory loss, se­vere headaches, dizzi­ness and fa­tigue,” some­times with long-term ef­fects,” he said, while call­ing on Trump to apol­o­gize for his “mis­guided re­marks.”

When it an­nounced ear­lier this week that the num­ber of TBI cases in Iraq had grown to 50, the Pen­tagon said more could come to light later. No one was killed in the mis­sile at­tack, which was an Ira­nian ef­fort to avenge the killing of Qassem Soleimani, its most pow­er­ful gen­eral and leader of its para­mil­i­tary Quds Force, in an Amer­i­can drone strike in Bagh­dad.

De­tails of the U.S. in­juries have not been made pub­lic, al­though the Pen­tagon said Tues­day that 31 of the 50 who were di­ag­nosed with trau­matic brain in­jury have re­cov­ered enough to re­turn to duty. The sever­ity of the other cases has not been dis­closed.

The Pen­tagon did not an­nounce the first con­firmed cases un­til more than a week af­ter the Ira­nian at­tack; at that point it said there were 11 cases. The ques­tion of Amer­i­can ca­su­al­ties took on added im­por­tance at the time of the Ira­nian strike be­cause the de­gree of dam­age was seen as in­flu­enc­ing a U.S. de­ci­sion on whether to coun­ter­at­tack and risk a broader war with Iran. Trump chose not to re­tal­i­ate, and the Ira­ni­ans then in­di­cated their strike was suf­fi­cient for the time be­ing.

The arc of at­ten­tion to TBI be­gan in earnest, for the U.S. mil­i­tary, in the early years af­ter it in­vaded Iraq in 2003 to top­ple Pres­i­dent Sad­dam Hus­sein. His demise gave rise to an in­sur­gency that con­founded the Amer­i­cans with crude but dev­as­tat­ingly ef­fec­tive road­side bombs. Sur­vivors of­ten suf­fered not just griev­ous phys­i­cal wounds but also con­cus­sions that, along with psy­cho­log­i­cal trauma, be­came known as the in­vis­i­ble wounds of war.

“For generation­s, bat­tle­field trau­matic brain in­juries were not un­der­stood and of­ten dis­missed,” said Sen. Jeanne Sha­heen, a New Hamp­shire Demo­crat.

The in­juries have of­ten been dis­missed in part be­cause the prob­lem is not fully un­der­stood, al­though the Pen­tagon be­gan fo­cus­ing on the prob­lem in the early 1990s when it es­tab­lished a head in­jury pro­gram that grew into today’s De­fense and Vet­eran’s Brain In­jury Cen­ter. Among its work, the cen­ter pro­vides pub­lished re­views of re­search re­lated to TBI, in­clud­ing links be­tween se­vere TBI and be­hav­ioral is­sues such as al­co­hol abuse and sui­cide.

A study pub­lished this month by Uni­ver­sity of Mas­sachusetts Amherst health ser­vices re­searchers con­cluded that mil­i­tary mem­bers who suf­fered a mod­er­ate or se­vere TBI are more likely than those with other se­ri­ous in­juries to ex­pe­ri­ence men­tal health dis­or­ders.

Con­cern about TBI has re­cently given rise to ques­tions about whether mil­i­tary mem­bers may suf­fer long-term health dam­age even from low-level blasts away from the bat­tle­field, such as dur­ing train­ing with ar­tillery guns and shoul­der-fired rock­ets.


An Amer­i­can sol­dier flashes a vic­tory sign Sun­day near the town of Tel Tamr, north Syria.

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