Traumatic Brain Injury (TBI)

DISCLAIMER:This page is for informational purposes only and should not be taken as a substitute for professional advice or diagnosis. If you feel that you may need medical advice, please consult a qualified health care professional.

What is Traumatic Brain Injury (TBI)?

Traumatic brain injury (TBI) occurs in polytrauma, injuries to multiple body parts and organs that occur as a result of blast-related wounds seen in the conflicts in Afghanistan and Iraq. TBI frequently occurs in polytrauma with other conditions like amputation, auditory/visual impairments, spinal cord injury (SCI), PTSD, and other conditions. Veterans/Servicmembers with polytrauma may require extraordinary levels of coordinated and clinical care.

TBI occurs when an object or force outside body hits the head with significant force, when a piece of shrapnel enters the brain, or during the explosion of an improvised explosive device (IED).

When a traumatic brain injury (TBI) occurs, the injury can range from a mild case (a brief change in mental status or consciousness) to a severe case (an extended period of unconsciousness or memory loss after the injury).

Individuals who sustain a TBI may experience a variety of effects, such as an inability to concentrate, an alteration of the senses (hearing, vision, smell, taste, and touch), difficulty speaking, and emotional and behavioral changes.  Whether the TBI is mild, moderate, or severe, persistent symptoms can have a profound impact on the injured survivor and those who serve as caregivers.

  Concussion/Mild TBI    Moderate TBI    Severe TBI  Penetrating TBI or Open Head Injury
  • Confused or disoriented state lasting less than 24 hours;
  • Loss of consciousness for up to 30 minutes;
  • Memory loss lasting less than 24 hours and;
  • Structural brain imaging (MRI/CT scan) yielding normal results
  • Confused or disoriented state lasting more than 24 hours;
  • Loss of consciousness for more than 30 minutes, but less than 24 hours;
  • Memory loss lasting greater than 24 hours but less than seven days and;
  • Structural brain imaging yielding normal or abnormal results
  • Confused or disoriented state lasting more than 24 hours;
  • Loss of consciousness for more than 24 hours;
  • Memory loss for more than seven days and;
  • Structural brain imaging yielding normal or abnormal results
  • Head injury in which the dura mater, the outer layer of the meninges, is penetrated
  • Penetrating injuries can be caused by high-velocity projectiles or objects of lower velocity such as knives, or bone fragments from a skull fracture that are driven into the brain

Facts About TBI

  • For fiscal year 2009, there were 1,313 Veterans who received VA inpatient hospital care for TBI
  • From April 2007 through fiscal year 2009, 66,023 Veterans were identified as possibly having a TBI through outpatient screening of individuals presentingto the VA for health care following deployment in Operation Enduring Freedom or Operation Iraqi Freedom
  • Of those identified through screening, 24,559were confirmed to have sustained a TBI
  • Blasts in combination with other mechanisms are a leading cause of TBI for active duty military personnel in war zones
  • TBI has been called a “signature injury” of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF)
  • 33% of all patients with combat-related injuries and 60% of the patients with blast-related injuries seen at Walter Reed Army Medical Center have sustained a TBI
  • Mild TBI or concussion is one of the most common forms of combat-related injury
  • Based on self-report data, approximately 15% of troops engaged in active combat in Afghanistan and Iraq may have suffered a mild TBI
  • Additionally, a recent study of the Navy-Marine Corps Combat Trauma Registry revealed that battle-injured were more likely than those injured outside of battle to have multiple TBIs

Symptoms of TBI

This is a list of the most common effects of TBI in the physical, behavioral, and cognitive aspects. As stated in the disclaimer above, this is for informational purposes only and should not be used to self-diagnose. If you or someone you know indicates signs and symptoms of TBI, consult with a medical professional.

   Physical Effects*    Behavioral Effects*    Cognitive Effects*
  • Fractures
  • Fever
  • Difficulty eating and speaking
  • Degraded vision
  • Fatigue
  • Loss of hearing and sense of touch.
  • Anxiety
  • Agitation
  • Frustration
  • Impulsiveness
  • Repetitiveness
  • Depression
  • Regression (return to childlike behavior)
  • Disinhibition (inability to control impulsive behavior and emotions)
  • Lack of attention and concentration
  • Memory loss
  • Lack of judgment
  • Communication problems

* Many of these effects can be inter-related

If You Think You Have or Do Have A TBI, You Are Not Alone

There are resources available to provide support to you or the person you know who is affected by a TBI.

Make The Connection: Make the Connection is a public awareness campaign by the U.S. Department of Veterans Affairs (VA) that provides personal testimonials and resources to help Veterans discover ways to improve their lives. Many of our Nation’s Veterans—from those who served in World War II to those involved in current conflicts—return not only with physical wounds but also mental health issues they may not recognize.

The Make the Connection campaign encourages Veterans and their families to “make the connection”— with information and resources, with the strength and resilience of Veterans like themselves, with other people, and with available sources of support including mental health treatments.

Central to this campaign is, a one-stop resource where Veterans and their families and friends can privately explore information about physical and mental health symptoms, challenging life events, and mental health conditions. On this site, Veterans and their families and friends can learn about available resources and support.

Click here to be taken to the Make The Connection site…


Now Available at the Apple App Store, and Coming to Google Play in 2014: Concussion Coach is a mobile phone application for Veterans, Servicemembers, and others who have experienced a mild to moderate concussion.  It provides portable tools to assess symptoms and to facilitate use of coping strategies.

Concussions often come with physical problems (such as headaches, balance problems, and dizziness), emotional challenges (such as getting angry more easily), and cognitive problems (such as difficulties with concentration and memory).  The nature and range of symptoms can cause considerable distress and frustration, and training in different coping strategies is often necessary.

The features of Concussion Coach include:

– A self-assessment tool for measuring symptoms, with feedback and a graph for tracking symptoms over time

– Symptom relief tools and relaxation exercises for managing problems associated with concussion

– Planning tools to build resilience

– Educational materials about concussion and options for treatment by brain injury professionals

– Immediate access to crisis resources, personal support contacts, or professional healthcare resources

Concussion Coach is intended to support treatment with a healthcare professional by providing portable, convenient tools for the user to assess symptoms and cope with concussion-related problems.  The app can also be used on its own, but is not intended to replace professional diagnosis, medical treatment, or rehabilitation therapies for those who need them.


After Deployment – TBI: Take an online symptom management assessment to evaluate  how you are handling your TBI symptoms and hear from other Veterans and Service members dealing with TBI.

America’s Heroes At WorkA U.S. Department of Labor (DOL) project that addresses the employment challenges of returning Service Members and Veterans living with Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD).

Brain Injury Association of America: The Brain Injury Association of California (BIACAL) is a non-profit membership organization providing information, resources, education, advocacy and support for those affected by brain injury.

BrainLine: BrainLine is a national multimedia project offering information and resources about preventing, treating, and living with TBI. BrainLine includes a series of webcasts, an electronic newsletter, and an extensive outreach campaign in partnership with national organizations concerned about traumatic brain injury. BrainLine serves anyone whose life has been affected by TBI. That includes people with brain injury, their families, professionals in the field, and anyone else in a position to help prevent or ameliorate the toll of TBI.

Centers for Disease Control and Prevention – TBI: Information from the CDC on TBI

Defense and Veterans Brain Injury Center – TBI: The Defense and Veterans Brain Injury Center (DVBIC) is a part of the U.S. Military Health System. Specifically, it is the traumatic brain injury (TBI) operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). Founded in 1992 by Congress, DVBIC’s responsibilities have grown as its network of care and treatment sites has grown.

Defense Centers of Excellence (DCoE) – TBI: The mission of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) is to improve the lives of our nation’s service members, families and veterans by advancing excellence in psychological health and traumatic brain injury prevention and care.

DoD Deployment Health Clinical Center – TBIContains information and links to VA/DoD programs and resources designed to assist Veterans with deployment-related health concerns

Make The Connection – Effects of TBI: The Make the Connection campaign encourages Veterans and their families to “make the connection”— with information and resources, with the strength and resilience of Veterans like themselves, with other people, and with available sources of support including mental health treatments.

North American Brain Injury Society: The North American Brain Injury Society (NABIS) comprises professionals involved in either the care or the issues surrounding brain injury. NABIS provides education programs, scientific updates, and a platform for communication and professional exchange.

VA Polytrauma/TBI System of Care: The VA Polytrauma System of Care provides comprehensive care and tailored rehabilitation for Veterans and returning Service members with TBI and other injuries to more than one physical region or organ system of the body.

VA Public Health – TBI: Traumatic brain injury (TBI) caused by exposure to explosions is common among Veterans who have served in Iraq and Afghanistan. TBI is an injury to the head that disrupts the normal functioning of the brain. If you suspect that you have a TBI, go to your nearest VA health care facility for TBI screening.

Vet Centers: If you are a combat Veteran or possibly experienced head injury during your military service, bring your DD214 to your local Vet Center and speak with a counselor or therapist—many of whom are Veterans themselves—for free, without an appointment, and regardless of your enrollment status with VA.