The Brain Injury Alliance of Oregon recognizes veterans returning from Iraq and Afghanistan with the complex traumatic brain injury issues. Called the “invisible wound” because a very serious injury can be sustained without visible indicators, TBI has been named the “Signature Wound” of the War on Terror. Reports indicate that up to 20% of returning veterans exhibit symptoms of having sustained TBI.

Returning home from an intensive combat environment is difficult. Understanding and patience is required on the home front as our troops work to get back to their previous lives. Many may never be completely the same. It is even tougher for those with a TBI from combat, especially if they do not seek diagnosis and treatment. No brain injury is too small or severe to ignore or lose hope.

What is TBI or Post-Concussive Syndrome?

A Traumatic Brain Injury (TBI) occurs when a person’s brain is physically injured, usually by a sudden force. With military members, this is often the result of a concussive blast or explosion. It can also be caused by falls, motor vehicle accidents, assaults, or any sudden blow to the head. Because the damage is internal, there may be no visible head wound. Most mild injuries to the brain improve to baseline within 3 months of injury, but in some can have lasting impairments which should be evaluated. A TBI resulting in lasting impairment(s) is referred to/SAME AS a “Post-concussive Syndrome”.

Primary Causes of Traumatic Brain Injury (TBI) are:

• Blasts (IED’s, RPG’s, Land Mines)
• Penetrating Injuries (Wounds to the head neck and face)
• Acceleration / Deceleration (Vehicular)
• Impact (Falls / Assaults)

What are the Symptoms of TBI?

Brain injury can vary widely. Damage to different parts of the brain will result in different symptoms. TBI shares symptoms with other physical and mental health conditions, such as Post Traumatic Stress Disorder, which complicates diagnosis. Below are some of the symptoms but does not necessarily mean a person has Post-Concussive Syndrome. Only a doctor can definitively identify and diagnose a TBI.


Common Symptoms Immediately After Injury

• Being Dazed, confused, or “seeing stars”
• Not remembering the injury
• Losing consciousness (being knocked out)

Common Symptoms Later On

• Persistent headache or neck pain
• Sensitivity to light and noise
• Loss of balance
• Changes in sleep patterns
• Feeling tired all the time, lacking energy
• Ringing in the ears
• Loss of sense of smell and taste
• Slowness in thinking, acting, speaking or reading
• Symptoms that may appear to be mental health conditions
• Sudden mood changes for little or no reason
• Difficulty managing relationships
• Chronic anxiety, depression, apathy
• Short term memory loss
• Getting lost or easily confused
• Having more trouble than usual with
  – Paying attention or concentrating
  – Organizing daily tasks
  – Making decisions

How to Find Out if You Have a TBI

TBI Screening through the VA

The first step is screening you to see if you have experiences or symptoms indicating that you may have had an event causing traumatic brain injury (TBI). The screener will ask a series of “Yes” or “No” questions, which takes about 5 minutes to complete. This can be done by your VAMC primary care or other clinics. Two possible outcomes of the screening: “I have not had a TBI” or “I need to be evaluated by a doctor for final determination.” When you are referred to a doctor, it only means that you are in a higher risk based on your military exposures and symptoms.

Who Should Be Screened For TBI?

Veterans should be screened for TBI if they experienced any of the following:

• Close to a blast or explosion (IED, RPG, Land Mine, Grenade, etc.)
• Fragment wound or bullet wound above the shoulders
• Vehicular accident or crash (aircraft, tank, personnel carrier, etc.)
• Assault / Blow to the head
• Fall

PTSD vs. TBI

Post-Traumatic Stress Disorder (PTSD) can occur as the result of exposure to events that involve actual or threatened death, intense fear, extreme stress or violence, or feeling helpless. You may have been exposed to these events daily. Both PTSD and Traumatic Brain Injury (TBI) symptoms can include: insomnia, irritability, depression, problems remembering or concentrating, avoiding family or friends.

The differences are often subtle. PTSD exclusive symptoms can include: feeling jumpy, inability to recall details of the trauma, reliving the trauma, flashbacks, and feeling detached or disconnected from emotions. TBI exclusive symptoms can include: anxiety, mood changes, feeling like you are losing it. It is not unusual for people to experience both diagnoses.  If you are experiencing any of these symptoms from either, it is important to talk to a professional who can help.

Who Can Help treat my TBI?

A variety of programs in the state that can help you. If you have a diagnosis from a medical doctor that you have TBI,  take advantage of whatever programs are best suited for your particular situation. Regardless of who you choose to provide care, Veterans with a TBI should make contact with the VA Polytrauma Clinic and the Brain Injury Association of Oregon (BIAOR). That way they will stay informed of the resources available and will have a broader support network. Every TBI is unique, there is no one-size-fits-all approach for treatment.

BIAOR has over 40 Brain Injury Support Groups and Veterans and their family members are encouraged to attend. We also have a Toll-free Helpline for Veterans and family members to call for information, referral and support (800) 544-5243. Professionals are also encouraged to call us!

Within the national Polytrauma System of Care, Portland is designated a Polytrauma Support Team Clinic. Their mission is to provide rehabilitation and care coordination for combat-injured Operation Iraqi Freedom, Operation Enduring Freedom veterans and active duty service members.

The Portland Polytrauma team provides interdisciplinary care for military service members and veterans who have sustained multiple and severe injuries. In addition, we are able to coordinate care to and from higher level acuity Polytrauma centers and with Military Treatment Facilities (MTF).

The Polytrauma team serves patients who have experienced injuries to the brain and other body parts, sustained in the same incident, resulting in physical, cognitive, psychological or psychosocial impairments and functional disabilities.

Patients that are served are ready for active participation in a comprehensive outpatient rehabilitation program, and require treatment by more than one type of therapist. Participation by caregivers and family members is encouraged and supported throughout the rehabilitation process.

To fully address the complexity of Polytrauma injuries, a team consisting of a medical doctor specializing in rehabilitation, nurse, rehabilitation psychologist, social worker, physical therapist, occupational therapist and speech language pathologist works together to design each patient’s rehabilitation treatment plan. You are not alone!

Polytrauma Brochure      www.polytrauma.va.gov

Post Deployment Drop-in Support Group Flyer

Common Traumatic Injuries at Polytrauma Clinic:

• Traumatic brain injury with cognitive impairment (Post-concussive syndrome)
• Amputations
• Severe burns
• Peripheral nerve injuries
• Functionally impairing Orthopedic (bone) injuries and Limb pain
• Spasticity management
• Auditory and visual impairments needing specialized rehabilitation services

Full range of Rehabilitation Services available:

• Medical Doctors specializing in Physical Medicine and Rehabilitation
  (restoring function and quality of life to patients with physical disabilities)
• Rehabilitation Psychology (evaluating and treating a range of mental health & rehabilitation issues)
• RN Case management (coordinating individual patient medical treatment plans)
• Social Work Case management (coordinating community, Veterans and military resources)
• Physical Therapy (Large Joint/muscle therapy and Balance & Walking therapy)
• Occupational Therapy (Activities of Daily Living, Functional cognition and Hand therapy)
• Safe Driving evaluations through occupational therapy
• Speech/Language/Cognition therapy (thinking, speaking & swallowing therapy)
• Audiology (hearing)
• Prosthetics (medical equipment, artificial limbs)

Services You have Earned

We offer a wide range of services to help you successfully transition from military to civilian life. Having Served in any Combat Zone, you are entitled to help. Vet Centers will help you and your family with readjustment counseling and outreach services:

• individual & group counseling
• marital and family counseling
• bereavement counseling
• medical & benefits referrals
• employment counseling

What is Readjustment Counseling?

Readjustment counseling is a wide range of psycho social services offered to eligible Veterans and their families in the effort to make a successful transition from military to civilian life. They include:

• Individual and group counseling for Veterans and their families
• Family counseling for military related issues
• Bereavement counseling for families who experience an active duty death
• Military sexual trauma counseling and referral
• Outreach and education including PDHRA, community events, etc.
• Substance abuse assessment and referral
• Employment assessment & referral
• VBA benefits explanation and referral
• Screening & referral for medical issues including TBI, depression, etc.

Does VA have Readjustment Counseling for Family members?

Yes! Family members of combat veterans have been eligible for Vet Center readjustment counseling services for military related issues since 1979.

Am I eligible for Vet Center Readjustment Counseling?

Yes if you, or a family member, served in any combat zone and received a military campaign ribbon (Vietnam, Southwest Asia, OEF, OIF, etc.) then your family is eligible for Vet Center services.

Where is counseling offered?

VA’s readjustment counseling is provided at community-based Vet Centers located near veterans and their families. All Vet Center services are prepaid through military service. Contact your nearest Vet Center through information provided in the Vet Center Directory or listings in your local blue pages. Vet Center staff are available toll free during normal business hours at 1-800-905-4675 (Eastern) and 1-866-496-8838 (Pacific).  For Oregon click here va.gov/directory

Central Oregon Vet Center (Bend)
Eugene Vet Center
Grants Pass Vet Center
Portland Vet Center
Salem Vet Center

Military Quick Links

National Resource Directory

Oregon Department of Veteran Affairs

US Department of Veterans Affairs va.gov

US Navy navy.mil

US Marines usmc.mil

US Air Force www.af.mil

Oregon National Guard nationalguard.com

Military One Source militaryonesource.com

US Department of Defense Military Health System tricare.osd.mil

PTSD.VA.gov

Mesothelioma.net 
Military veterans are disproportionately diagnosed with Mesothelioma, especially Navy Veterans. Helping to bring you hope, faith, and action when navigating through mesothelioma.

Guide to Academic Success After Traumatic Brain Injury

The Back to School guide is an excellent resource for service members or veterans with ongoing symptoms from a traumatic brain injury to consult in the pursuit of higher education. Whether it is college, university or vocational school, this online resource helps with the following:

• navigating campus life
• managing ongoing symptoms
• learning strategies for success
• transitioning smoothly to a civilian setting
• advocating for personal improvement

Home of Defense & Veterans Head Injury Program
dvbic.dcoe.mil   Back to School Guide

Military Family Support

Bob Woodruff Foundation.org navigates a maze of more than 46,000 nonprofits to find, fund and shape innovative programs in our communities. To educate the public about the needs of injured service members, veterans and their families as they reintegrate into their communities.

My Army Life Too for Army Families myarmylifetoo.com

Deployment Health Support deploymentlink.osd.mil

Military Spouse milspouse.org

Military Spouse Support Network militaryspousesupport.net

National Military Family Association nmfa.org

MOM – Mothers of the Military mothersofthemilitary.com

Parents’ Guide to Talking With Their Children About War ems-c.org

Oregon National Guard Family Program
Directing individuals to resources for pay problems, legal issues, emergency assistance, finan­cial assistance, childcare, and counseling information. Family Assistance Centers are not limited to Guard use only – they are all joint service operations and will assist all military members or their families. Located in the Anderson Readiness Center (Salem) 1-877-881-5181  503-584-2389
Program Director: Carrie Froelich (503) 584-2245

New Benefits Program for Caregivers of Post-911 Veterans(info)

 VA Caregiver Support(info)

 Caregivers at a Glance*

• 54 Million adults in the US provide unpaid care to an adult family member or friend
• Over two-thirds are women
• 45% are age 18-49
• 40% are age 50-64
• More than half are married
• Approximately three-fourths have worked while caregiving
• Over 40% say they did not have a choice in taking on the caregiver role
• A majority assist their loved one with at least one activity of daily living (usually helping the person in and out or bed and chairs)
• Over 50% experience medium to high levels of stress as a result of the demands of their role as a caregiver
• One-quarter say they have a difficult time coordinating care with health care professionals or service providers
  *National Alliance for Caregiving & AARP Survey- 2009

Southern Oregon Rehabilitation Handbook.pdf

Reach the State of Oregon’s Reintegration 24-hour # 1-888-688-2264.

The Returning from the War Zone, A Guide for Military Personnel is a guide is for service members returning from deployment. It contains information to help military personnel understand what to expect when returning from a war zone, and to help them to better adapt back to home life. Reintegration is an adjustment for all involved. This information aims to make this process as smooth as possible and covers:

• A description of the common reactions that occur following deployment to a war zone
• Information about possible problems to watch out for, including PTSD
• How expectations about homecoming may not be the same for service members and family members
• The effects that war zone stress can have on your family and work life
• What you can do to help yourself with readjustment

Department of Defense Compensation & Benefits Handbook.pdf

Describes what service members and their families would be entitled to upon separation or retirement as a result of serious injury or illness. The handbook was compiled in cooperation with the Departments of Veterans Affairs, Labor, Health and Human Services, and Education and the Social Security Administration. Additionally, there are references to assistance provided by other governmental and non-governmental agencies and organizations.

After a brain injury, there are often difficult decisions to make. Fortunately, there are many resources available in Oregon to assist with the rehabilitation process.

Traumatic Injury Insurance(info)

Severely injured warriors in Iraq and Afghanistan also will get cash payments, of $25,000 to $100,000, under a rider to Service members’ Group Life Insurance (SGLI) approved as part of the Emergency Supplemental Wartime Appropriations Act signed May 11. The law directs the departments of Defense and Veterans Affairs to establish the traumatic injury rider by Dec. 1, and to make payments retroactive to Oct. 7, 2001, the start of Operation Enduring Freedom in Afghanistan. Payments will vary based on severity of injuries.