LONGWOOD STUDENT VETERANS

What You Don't Know CAN Hurt You: How the VA Picks Up on Hidden Conditions
by Harriet Katz Zeiner, PhD, Clinical-Neuropsychological Assessment Clinic, Palo Alto VA Healthcare System

If you come to the VA for any reason, to get your blood pressure checked, to get new eyeglasses, or to have a sprained ankle looked at, you are going to be asked some unusual questions. "Unusual" in the sense that they are not about what you came to the VA to have checked. What are these unusual questions?

• During your military deployment, did you have any injuries from a fall, a blast or a vehicle crash?
• Did you ever feel dazed, confused or "see stars?"
• Have you had any nightmares about your deployment time?
• Are you easily startled, or watchful, or guarded?

If the answer is "yes" to any of these, then your doctor will schedule you for a screening for either brain injury or Post Traumatic Stress Disorder(PTSD).

So what are these conditions? They are potentially common occurrences for people who have been in combat zones. If may surprise you to know that someone could have a mild traumatic brain injury (TBI) or PTSD and not know it. You would notice the symptoms, even if you didn't know what caused it. You might notice the effects on your social life, your work or at school. Of, a family member may notice the symptoms and tell you that you seem "different."

What are the symptoms related to a head injury, and how did they happen? Well, if you fell, were hit in the head or were exposed to (that is, you were close to or near) a blast in the form of a bomb, an improvised explosive device (IED), a Rocket-Propelled Grenade (RPG), a land mine, a grenade--any explosive device--then you might have suffered a brain injury, but not be aware of it. That is because there are invisible pressure waves, energy waves that move through the body, through body armor, clothing, and have the potential to cause little tears or tiny bubbles in soft tissue, like brain tissue.

What you would be aware of is that you might have come back from deployment with any of the following:

• Headaches
• Irritability
• Feeling on guard
• Dizziness
• Sleep problems
• Memory problems
• Feeling numb
• Balance problems
• Startling easily
• Ringing in the ears
• Having nightmares

Some of these could be the result of a head injury. Or, they could be the result of unusual and sometimes horrific experiences that happen to people in war, such as seeing others killed or hurt, being exposed to constant bombardment, or living in a state of constant vigilance. That's what PTSD is--beyond-the-norma-range-of-experiences that keep a person in a state of constant readiness to survive if they are in a life-threatening situation. But sometimes the state of readiness does not turn off. And being constantly on guard to protect yourself and your loved ones from harm is draining when there is no threat. PTSD is being ready to protect yourself on the battlefield--when, in fact, you are at the mall or the dining room table with your family.

The symptoms of both mild brain injury and PTSD can seem the same; they cannot be separated out as to which is which except by a longer examination by a psychologist.

So if you have any of these symptoms, why should you care which they are, TBI or PTSD? Well, you should care, because both mild TBI and PTSD are treatable, but the treatments are different.

Neither you nor members of your family who see you in distress have to continue suffering from these symptoms. They are treatable and the effects of these acquired injuries can be reduced. If you have not come to the VA and been asked the "unusual" questions, but you think you might answer "yes" to any of them, contact your local VA facility by calling 1-800-827-1000 or by contacting The Polytrauma Call Center at 1-888-827-4824 and help will be on the way. Additional information is available at www.polytrauma.va.gov