Risk to Veterans

Meanwhile, while recent research already has highlighted the risk of CTE for athletes, new research has been emerging about the risk it poses to troops.

The U.S. Army and the NFL will work together to improve awareness about traumatic brain injuries, and Army Chief of Staff Gen. Raymond Odierno and NFL Commissioner Roger Goodell signed a letter Aug. 30 at the U.S. Military Academy before a joint panel discussion formalizing the joint initiative. Photo by Tommy Gilligan/USMA PAO

In May 2012, Ann McKee MD, a professor of neurology and pathology at VA Boston HealthCare System and Boston University School of Medicine, and her colleagues published a study finding that the brains of four dead veterans who served in Iraq and Afghanistan indicated they had CTE.1

Three of the four veterans had been exposed to an IED blast during combat, and two of the three had other head injuries earlier in life. The fourth suffered concussions from sports and military combat and from bicycle accidents.

This research follows a study published in 2011 by researcher Bennett Omalu of a 27-year-old Iraqi war veteran who had developed PTSD and committed suicide after two deployments. He had been exposed to mortar blasts and IED blasts less than 50 meters away. A study of his brain tissue after his death revealed CTE changes.2 Speaking to reporters at a media roundtable during the four-day Military Health System Research Symposium in August, McKee explained that, in addition to athletes, she has seen CTE in the brains of 21 total veterans.

Complicating CTE research is that the condition can only be diagnosed post-mortem, limiting knowledge of its true prevalence. McKee said the goal is to be able to identify CTE in the early stages in a living individual, possibly with enhanced neuroimaging and spinal taps.

“We have noticed in Alzheimer’s disease you can detect Alzheimer’s disease in the pre-clinical stages using spinal fluids, so we are hoping the same will apply to CTE,” she said.

Many questions abound, and the research is new. Not everyone who has had a head injury develops CTE, so who is at risk? Does the number of head injuries, the type of exposure to the head, the genetic makeup or age of an individual make a difference?

While further head injury research is needed to understand brain injury, researchers and policymakers agree that individuals should get off the battlefield or football field if they think they have sustained a mild concussion.

At the signing of the NFL and Army collaboration, Maj. Sarah Goldman, TBI program director for the Office of the Army Surgeon General, spoke about DoD’s policy regarding how soldiers should be treated in theater when they may have been involved in a blast or who may be at risk for TBI. The policy is called the Directive-Type Memorandum 09-033.

“If you are within 50 meters of a blast, if you have had a blow to the head or been involved in a vehicle collision or rollover, or if your commander is just concerned about you, there is a command-directed provision [that] there is a mandatory medical evaluation. There is a minimum of 24 hours of downtime. You must have medical clearance before returning to duty,” she said.

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1. Omalu B, Hammers JL, Bailes J, Hamilton RL, Kamboh MI, Webster G, Fitzsimmons RP. Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide. Neurosurg Focus. 2011 Nov;31(5):E3. PubMed PMID: 22044102.

2. Goldstein LE et al. “Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model.” Sci Transl Med. 2012 May 16;4(134):134ra60. PubMedPMID: 22593173