Report sees long-term problems for troops who suffer traumatic brain injuries

Even mild brain injuries, the report found, appear to be associated with some of these outcomes.

The report is a wake-up call, said Dr. Michael Yochelson, who specializes in traumatic brain injury at National Rehabilitation Hospital in Washington, and used to work at the National Naval Medical Center.

"We need to be prepared to take care of these people, and we need to be observant," said Yochelson, who was not involved in the institute's report.

A recent Rand Corp. report, which Yochelson worked on, estimated that 19% of the troops returning from Iraq and Afghanistan, or more than 300,000 people, have come back with traumatic brain injuries. It estimated that treatments for such injuries and the loss in productivity have cost the nation, conservatively, about $554 million.

Traumatic brain injuries occur in a wide variety of ways, both predictable and unexpected -- gunshot or shrapnel wounds, strikes to the head or even exposure to an energy source. The brain can be harmed even when a person does not lose consciousness, doctors said.

The report by the nonprofit Institute of Medicine was the latest installment in a series of studies commissioned by the Department of Veterans Affairs on the health of veterans from the Gulf War and current conflicts.

The study was intended to aid VA officials in understanding what other conditions they should look out for in brain-injured patients and in determining disability benefits, said Dr. George W. Rutherford, chairman of the committee that wrote the report.

The authors reviewed 1,900 studies on traumatic brain injuries, looking for problems that persisted more than six months. Most of the research focused on civilians.

The report showed a "big hole" in medical knowledge about blast injuries, which have only recently come to doctors' attention because they are hallmarks of the Iraq and Afghanistan wars, Rutherford said.

"The good news is [that service members] are surviving injuries they had not survived in the past," Rutherford said. "The bad news is, since they didn't survive in previous conflicts, we don't have a lot of background experience."

The group found there was significant evidence connecting moderate or severe brain injuries to problems such as depression, unemployment and Parkinson's disease-like tremors.

Officials at the VA said they will "carefully review" the report's recommendations. The department has 60 days to determine whether the long-term problems should be connected to brain-injured veterans' military service.

Military officials said they were aware of the issues cited in the report and have dedicated $300 million in the last two years for research on traumatic brain injury. They have also recently started a long-term study on blast injuries.

"In terms of funding ... we have received tremendous support, and as we identify emerging requirements, we will continue to gain the support we need," said Army Brig. Gen. Loree K. Sutton, who heads the Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury.

She and Air Force Lt. Col. Michael S. Jaffee, who heads the Defense and Veterans Brain Injury Center, said they are prepared to deal with the long-term challenges.

"It's not that it's not that we completely have all the answers right now, but we are on a path of getting there," Jaffee said.

Paul Sullivan, who heads the group Veterans for Common Sense, hopes the VA and Department of Defense will follow through. The agencies "cannot deny that there is a TBI crisis," Sullivan said. "We can't let this get swept under the rug."

Chong is a Times staff writer.

jia-rui.chong@latimes.com