Charles Edmund Degeneffe
Section Editor: Emre Umucu
SEPTEMBER 11, 2021 MARKS THE 20TH ANNIVERSARY of acts of terrorism against the United States at the World Trade Center, the Pentagon, and the fields of Shanksville, Pennsylvania. In response, the United States and its allies engaged in the Global War on Terrorism, with military operations focused on Afghanistan (Enduring Freedom, Freedom Sentinel) and Iraq (Iraqi Freedom, New Dawn, Inherent Resolve). Across these operations, as of September 6, 2021, a total of 7,053 US service members have been killed in action (US Department of Defense, 2021). With the departure of the last remaining troops from the Hamid Karzai International Airport on August 30, 2021, all military operations in Afghanistan ended.
Going forward, the United States will no longer maintain a major military presence in Iraq and Afghanistan. However, what remains is the significant number of military personnel who will continue to face the cost of their service with lifelong combat-related traumatic brain injuries (TBI) and associated polytrauma injuries due to improvised explosive devices and other blast generating weapons. At the height of combat operations, from 2001 to 2015, approximately 2.5 million US military personnel were deployed to both countries (Sim et al., 2015), with an estimated 15% to 20% incurring mild TBI (Baldassarre et al., 2015). According to the Defense Medical Surveillance System (2021), from 2000 to the first quarter of 2021, there were 439,609 medically diagnosed TBIs among all military personnel worldwide. Because TBI is so common, it carries a moniker as the signature injury of military operations in Iraq and Afghanistan (Lindquist et al., 2017).
TBI incurred during military service in combat differs from civilian-incurred injuries by the overlay of posttraumatic stress disorder (PTSD) and other polytrauma injuries. Because of dramatic improvements in battlefield medicine, many who would have died in previous conflicts now survive (Degeneffe et al., 2015), but often with lifelong disabilities. Improvised explosive devices and other explosive devices result in an array of primary, secondary, tertiary, and quaternary impacts that cause TBI and polytrauma injuries because of simultaneous damage to multiple body systems (Burke et al., 2009). While both diagnoses can occur independently, TBI creates a higher risk for PTSD when injury to the brain reduces the capacity to respond effectively to the chronically high-stress environment of combat. Veterans with TBI and PTSD face the stigma of asking for help while encountering challenges with reintegrating with family and other areas of civilian life (Burke et al., 2009). [Continue…]