Trump Is Wrong. U.S. Troops' Traumatic Brain Injuries Are Incredibly Serious | Opinion

This week, during an annual luncheon with members of the media at the White House, President Donald Trump reportedly again dismissed the increasing number of traumatic brain injuries incurred by U.S. service members after last month's Iranian missile attack on an Iraqi air base, saying he'd seen worse.

The president previously brushed off the injuries of the service members, who now number 64, at the World Economic Forum in Switzerland. "I heard they had headaches and a couple of other things, but I would say, and I can report, that it is not very serious," Trump said.

But the president is wrong. Traumatic brain injury is incredibly serious.

Traumatic brain injury is a term used to describe many different kinds of brain injury resulting from head trauma. TBI can range from concussion, which is the most underreported and underdiagnosed from of brain trauma, all the way to devastating injuries that cause coma and even death. However, all forms of TBI can have a long-lasting impact on the health of the individual, as well as society at large. According to the Brain Trauma Foundation, for persons under the age of 45, TBI is the leading cause of death and disability, and the economic impact has been estimated in the United States to be $76.5 billion.

In the military, TBI is an especially big problem. Since 2000, more than 400,000 members of the military have been victims of TBI, according to the Department of Defense. Of the 64 service members diagnosed with TBI from the Iranian missile attack so far, 39 have returned to duty after being treated, likely indicating a milder form of TBI, such as a concussion. However, even a mild TBI can result in long-lasting consequences, which must not be diminished.

Post-concussive syndrome is a common condition of mild TBI and can result in headaches, cognitive impairment and psychiatric and mood changes. It is not uncommon for patients to suffer from fatigue and an overall increase in irritability. For members of the military, these "not very serious" symptoms can slow reaction times and lead to sleep deprivation and an inability to perform assigned tasks—all symptoms that are particularly concerning considering the high-risk environments where they work.

Although, according to Joint Chiefs Chairman General Mark Milley, the majority of cases have been deemed mild TBI, the exact condition of the other military service members has not been disclosed. We do know, however, that 21 service members have been sent to Germany and the U.S. for further treatment, suggesting they may have endured much more significant trauma. Moderate to severe TBI as a result of blast injuries, penetrating head trauma or even blunt trauma can result in skull fractures, bleeding in various parts of the brain that can lead to brain swelling, paralysis, a comatose state and even death, despite the best medical and surgical care.

For victims of moderate to severe TBI, life is undoubtedly changed forever. As a neurologist and critical care doctor, I have seen patients have to relearn to walk, speak and feed themselves. For some, these basic tasks remain a constant struggle and are never regained. In fact, for those more severely affected, it is not uncommon to require life support via a breathing machine and feeding via tubes for months to years. In the United States alone, around 5 million people are estimated to have a long-term disability as a result of TBI, and this number does not even account for our military service members.

Still, it's not surprising that TBI did not receive the same level of attention from Trump as other combat injuries might have. The long-lasting effects of TBI can be delayed, and its victims can appear unchanged to the eye. Because of this, it is easy to dismiss mild TBI or concussion as a bump to the head, and the victims of TBI are often returned back to the field, the court, work or the battlefield all too soon without the necessary neuropsychological testing and subsequent treatment. They often deal silently with the increased incidence of depression, post-traumatic stress disorder and headaches, which are not typically deemed to be as serious as the injuries of those who have lost an arm or a leg.

Ain al-Asad military air base
A picture taken on January 13 shows some of the damage at Ain al-Asad military air base in the western Iraqi province of Anbar. Iran launched a wave of missiles at the sprawling air base in retaliation for the U.S. killing of Iranian General Qassem Soleimani. Ayman Henna/AFP/Getty

However, the consequences of TBI can be just as debilitating and have long-lasting effects on the ability to work and provide for oneself and one's family. The first step in caring for our military personnel and veterans who have been victims of TBI is to recognize its clinical severity and not dismiss the symptoms they experience as a result of it.

In the coming weeks, the number of service personnel diagnosed with TBI is likely to increase as its manifestations become more evident. In fact, more personnel should be screened for TBI to ensure that they are truly fit to return to the battlefield. In order for our service members to remain fit to serve and protect, the severity of TBI should certainly not be dismissed and minimized by the president.

Starane Shepherd, MD, is an assistant professor of neurology at Rush University Medical Center in Chicago, specializing in critical care neurology. He is a Public Voices fellow through the OpEd Project.

The views expressed in this article are the writer's own.