Former Staff Sgt. Kevin Owsley is not quite sure what rattled his brain in 2004: the roadside bomb that exploded about a yard from his Humvee or the rocket-propelled grenade that flung him across a road six weeks later.
After each attack, he did what so many soldiers do in Iraq. He shrugged off his ailments – headaches, dizzy spells, persistent ringing in his ears and numbness in his right arm – chalking them up to fatigue or dehydration. Given that he never lost consciousness, he figured the discomfort would work itself out.
“You keep doing your job with your injuries,” said Owsley, 47, an Indiana reservist who served as a gunner for a year outside Baghdad beginning in March 2004. “You don't think about it.”
But more than three years after coming home, Owsley's days have been irrevocably changed by the explosions. He struggles to unscramble his memory and thoughts. He often gets lost on the road, even with directions. He writes down all his appointments but still forgets a few. He wears a hearing aid, cannot bear sunlight on his eyes, still has nightmares and considers four hours of sleep a night a gift.
Owsley is part of a growing tide of combat veterans who come home from Iraq and Afghanistan with mild traumatic brain injuries, or concussions, caused by powerful explosions. As many as 300,000 combat veterans have suffered at least one concussion, according to the latest Pentagon estimates. About half require little if any medical assistance. But tens of thousands of others have long-term problems that can include, to varying degrees, persistent memory loss, headaches, mood swings, dizziness, hearing problems and light sensitivity.
These symptoms, which may not surface for weeks or months after their return, are often debilitating enough to hobble lives and livelihoods.
Mild brain injury was widely overlooked by the military and the veterans health system until recently. Even now, with traumatic brain injury called the signature injury of the Iraq war, some soldiers and their advocates say that complications from mild concussions often are not recognized.
Little is known medically by doctors or scientists about what happens to a brain as a result of a powerful bomb blast, as opposed to car crashes on a highway, blows to the head on a football field or a bullet wound. These are the first wars in which soldiers, protected by strong armor and rapid medical care, routinely survive explosions at close range and then return to combat.
Mild concussions, which do not necessarily lead to loss of consciousness, are easy to dismiss, simple to misdiagnose and difficult to detect. The injured soldiers can walk and talk. Their heads usually show no obvious signs of trauma. CT scans cannot see the injuries. And the symptoms often mirror those found in post-traumatic stress disorder, making it hard to distinguish between them. In fact, the two ailments often go hand in hand.
But the consequences of these seemingly small concussions can be far-reaching, leading to financial problems, job losses, divorce and mental health issues.
It was not until 2006, three years into the Iraq war, that the Departments of Defense and Veterans Affairs began to pay close attention to mild traumatic brain injuries. The Pentagon last year opened the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, a clearinghouse for treatment, training, prevention, research and education. This year it is spending a record $300 million on research for traumatic brain injury and post-traumatic stress disorder.
“We are more attuned to brain injuries now,” said Lt. Col. Michael Jaffee, the director of the Defense and Veterans Brain Injury Center.
For years most troops with mild concussions stayed on the job, immersing themselves in combat again and re-exposing themselves to additional blasts with little or no time to rest and recover. This pattern only heightened the risk of brain injury and post-traumatic stress disorder, doctors say.
Civilians with brain injury, on the other hand, are given time to recuperate for long periods in a safe environment, which may explain why they respond differently to stress.