Traumatic Brain Injuries (TBIs): A guide for veterans
More than 500,000 service members and veterans have been diagnosed with a traumatic brain injury (TBI) since 2000. Due to the challenges of diagnosis, including underreporting and misdiagnosis, the actual number is believed to be significantly higher.
Behind every one of those numbers is a veteran who deserves answers.
This page was built by DAV and the Invisible Wounds Foundation to bring together what is known about TBI in the military: what it is, why it’s been so difficult to diagnose, how to navigate confusing and often contradictory terminology, what the latest science and innovations in the field show, and where to find care that works. A 2025 RAND scoping review funded by the Invisible Wounds Foundation found that despite more than $2.1 billion invested in TBI research since 2015, efforts remain fragmented across agencies and specialties, with research siloed in ways that limit coordination and slow progress.
If you’ve been passed between providers, given diagnoses that didn’t fit, or told your scans came back normal, this page was written with you in mind. If you’re a caregiver or family member trying to understand what happened to someone you love, this was written for you, too.
If you or someone you know is in crisis, please reach out now:
Veterans Crisis Line: Dial 988, then press 1 | Text: 838255 | veteranscrisisline.net | Available 24/7
SECTION 1: WHAT IS A TBI?
TBI is a physical injury to the brain caused by the blast waves of high-powered weapons and explosives, wave-slamming (SWCC operators), acceleration/deceleration g-forces, or by blunt trauma from direct blows to the head. It’s not a character flaw. It’s not a mental health condition. It’s a wound, the same as any other sustained in service, and it deserves to be treated as one.
The brain is a physical organ. When it’s injured, the symptoms are real, measurable and treatable. For too many veterans, that simple fact has taken years—sometimes decades—to hear.
Terminology Reference
The language around TBI can be confusing. Here’s a plain-language guide to the terms you may encounter:
- Blast overpressure (BOP): The pressure wave generated by a high-powered weapon or explosion
- Low-level blast (LLB): Generated by firing weapon systems or detonating explosives in training or combat
- High-level blast (HLB): Generated by incoming munitions such as missiles, drones, mortar rounds or rocket-propelled grenades, primarily in combat environments
- Mild TBI (mTBI) / concussion: The most common form of TBI; typically resolves within 10 to 90 days with a single incident. Mild TBI, also known as a concussion, is the most common form of TBI experienced by service members and veterans.
- Chronic TBI: Lasting TBI symptoms from an earlier concussive event or repetitive subconcussive events
For specialized treatment programs that have proven effective in helping veterans manage or recover from chronic TBI symptoms, see the benefits and support resources in Section 4.
Types of Military Traumatic Brain Injury
There are two types of TBI: penetrating and non-penetrating.
Penetrating TBI occurs when an object breaks through the skull and hits the brain tissue.
Non-penetrating TBI is caused by an external force, such as a blast wave from an explosion or a blow to the head, that does not physically penetrate the skull but shakes the brain.
Non-penetrating TBIs range from mild to moderate to severe and are most often caused by blast waves from explosions and high-powered weapons systems, including improvised explosive devices (IEDs), mortar rounds, aerial rocket-propelled grenades and drones.
Understanding Blast TBI
TBI caused by exposure to multiple blasts over time is one of the most common forms of military brain injury. It’s referred to by many names (see Terminology section above) but is currently known in the medical field as blast TBI.
Blast TBI is caused by blast overpressure. There are two levels of blast overpressure, the pressure wave generated by a high-powered weapon or explosion. Low-level blasts are generated by firing weapon systems or detonating explosives, such as .50-caliber weapons or breaching charges, in training or combat environments. This means a service member can sustain repeated blast exposures and develop lasting TBI symptoms even outside of combat.
High-level blasts come from incoming munitions such as missiles, drones, mortar rounds, rocket-propelled grenades and other high-powered weapons systems, primarily in combat environments. As drone warfare has expanded, exposure to blast overpressure from unmanned aerial systems has become an increasingly significant source of TBI for service members.
Close proximity to blast overpressure at either level can cause a mild, moderate or severe TBI. Chronic TBI incurred from repetitive blast exposure is referred to in several ways including blast TBI, repetitive blast injury and repeated blast brain injury. All refer to the same condition.
According to a 2025 RAND review, special operations forces face a particularly high risk of blast TBI due to frequent blast exposures and repetitive neurological stress across both combat and training environments.
Understanding the Difference: TBI and CTE
Chronic TBI and chronic traumatic encephalopathy (CTE) are two conditions that are often confused as the same injury. They are not.
TBI is the injury itself, caused by blast exposure or a blow to the head. CTE is a degenerative brain disease associated with memory loss, depression and dementia that develops from repeated head trauma—physical impacts to the head. Originally called “punch-drunk syndrome” in the 1920s, CTE was first noticed in boxers. Today, professional football players are considered the group most impacted by CTE, although other contact sport athletes are also at risk.
At the present time, CTE can only be diagnosed post-mortem, by autopsy. A 2022 study published in the New England Journal of Medicine examined the brains of 225 veterans, out of which only 10 showed signs of CTE, and all 10 had played football prior to their military service. There was no evidence of CTE found in the other 215 brains.
One important note: service members who develop chronic TBI may also have CTE. However, if CTE is found post-mortem in a veteran who did not serve in a branch particularly susceptible to repeated physical impacts, the CTE was likely incurred from playing football or other impact sports prior to their service.
In military settings, service members enduring constant bodily or head impacts, such as U.S. Navy Special Warfare Combatant-craft Crewmen who experience wave slamming, have been identified as a population at greater risk for developing CTE.
SECTION 2: HOW COMMON IS TBI AMONG VETERANS?
Since 2001, more than 556,000 veterans have been diagnosed with a TBI. Because of the challenges of diagnosis—including underreporting and misdiagnosis—the actual number is believed to be significantly higher.
TBI is not just a health crisis. For too many veterans, an undiagnosed or misdiagnosed brain injury has been a matter of life and death.
According to the Department of Veterans Affairs, veterans with TBI diagnoses died by suicide at a rate of 77.6 per 100,000 in 2023, almost double the rate of veterans without a TBI diagnosis. The reasons are many, and they’re not inevitable.
The Connection Between Misdiagnosis of TBI and Suicide Risk
TBIs are often misdiagnosed as a mental health condition, such as PTSD, due to the similarities in symptoms and the lack of advanced medical assessment and diagnostic tools. Consequently, veterans suffering from chronic TBI symptoms can be diagnosed with mental health conditions and prescribed medications for their symptoms, some of which can exacerbate the symptoms rather than relieve them.
A misdiagnosis that doesn’t lead to an improvement of a veteran’s symptoms, such as insomnia or depression, can also lead to despair or a sense of personal responsibility for one’s symptoms. The fact is that TBI is a physical injury to the brain. When veterans are treated for the right condition, outcomes improve.
There are effective treatments available that have proven to alleviate or reduce the symptoms of TBI. Understanding what is actually happening in the brain, and finding the right care for it, can be a critical step in preventing suicide. For a full list of available TBI treatment options, see the benefits and support resources in Section 4.
If You or Someone You Know Is in Crisis
Understanding brain injury and what to do about it can be a critical step in preventing suicide. If you or someone you know is in crisis, please reach out now.
Veterans Crisis Line: Dial 988, then press 1 | Text: 838255 | veteranscrisisline.net | Available 24/7
SECTION 3: WHAT ARE SOME TBI SYMPTOMS?
TBI symptoms can follow a blast exposure, a blow to the head, or other head trauma—and they can appear long after the injury itself. Common TBI symptoms include persistent headaches, blurred vision, dizziness, insomnia, memory problems and mood changes such as depression and irritability.
A single mild TBI will typically resolve within 10 to 90 days. But exposure to repetitive blasts over a period of months or years, including those experienced during training and deployments, can create lasting changes to the brain that lead to persistent and debilitating health consequences, including persistent headaches, blurred vision, dizziness and mood changes such as depression, irritability, substance misuse, insomnia and suicidal ideation.
These symptoms can appear psychological in nature, and in some cases service members do suffer parallel conditions such as post-traumatic stress disorder (PTSD), anxiety or depression. But they’re often not the result of a mental health condition. They’re the result of an injury to the brain.
If you’ve spent years being told your symptoms are psychological, watching medications come and go without improvement, or being handed a diagnosis that never quite fit, you’re not the problem.
The difficulty of diagnosing TBI is not a failure of the veteran. It’s a failure of the tools available to medicine, and a consequence of more than a century of misunderstanding about what this injury actually is.
The Diagnostic Gap
The medical community doesn’t yet have a precision scanning device or diagnostic tool capable of detecting TBI at the necessary microscopic levels. This is why an MRI scan may come back normal even when a significant injury is present below the detection threshold of existing technologies.
The current standard TBI screening protocol also requires the patient to recall a specific blast event or blow to the head. The screening protocol asks three questions: Did the patient experience an identifiable traumatic event? Did they lose consciousness or experience an altered state at the time? And are they still experiencing symptoms?
For a service member whose injury developed gradually through years of repeated blast exposure, there may be no single event to point to. As Dr. James Kelly, Chief Medical Scientist at the Invisible Wounds Foundation, has noted, the assumption that a veteran must have been rendered unconscious to sustain a concussion is simply not true. An alteration in mental status, from a blast exposure, a blow to the head or a whiplash mechanism, is itself the threshold injury to the brain.
There are blood biomarker tests that can help detect the presence of TBI, but they’re not available at every medical facility. Without an approved diagnostic machine or evidence of a single blast-induced episode, medical practitioners will often make a mental health diagnosis to try to alleviate the symptoms that patients are experiencing. That misdiagnosis can have lasting consequences, including being prescribed medications that worsen symptoms, delayed access to effective treatment, and in too many cases, despair.
A Century of Misunderstanding of Military Traumatic Brain Injury
The difficulty veterans face today in getting a TBI diagnosis didn’t begin with the wars in Iraq and Afghanistan. It began in the trenches of World War I.
Described as a war of artillery, the French and German armies fired 1 million shells during the first day alone at the Battle of Verdun in 1916. Soldiers began developing a curious condition, originally called “Not Yet Diagnosed, Neurologic” and later referred to as shell shock. The symptoms were familiar: headaches, sleeplessness, mood disturbance, depression and irritability. Often, soldiers would die by suicide.
At the time, two competing frameworks emerged to explain what was happening. Royal Army Medical Corps of the British Army Major Frederick Mott, a neurologist and pathologist at Maudsley Hospital outside London, believed the condition had a physical origin and recommended postmortem autopsies to understand the underlying neuropathology. Doctors at Liverpool’s Moss Side Military Hospital, working within a psychiatric framework, saw shell shock as a psychoneurosis connected to buried emotional issues and combat stress.
After World War I, the British Government formed the War Office Committee of Enquiry into Shell Shock to produce a definitive classification. The committee determined that shell shock was “a convenient evasion of duty, if not disguised malingering,” and shouldn’t be classified as a wartime injury. As researchers Drs. Sharon Shively and Daniel Perl later wrote, the field of psychiatry had won the dispute over shell shock.
Over the next 45 years, through World War II, the Korean War and the Vietnam War, the condition was renamed repeatedly: combat stress reaction, battle fatigue, Post-Vietnam Syndrome and post-traumatic stress disorder (PTSD). In each case, it was understood as a psychic rather than a physical affliction.
This historical misunderstanding continues to shape how military brain injury is diagnosed and treated today. It’s the reason so many veterans are still waiting for answers that should already exist.
What Veterans Can Do about Traumatic Brain Injury
The Department of Veterans Affairs (VA) screens veterans for TBI at all healthcare facilities. If you screen positive, you’ll be referred for further assessment, which may include brain imaging scans and cognitive assessments. Veterans should follow up on all recommended assessments and treatment options.
If symptoms persist or you suspect you may have a TBI, reach out to one of the specialty treatment centers listed in Section 4 (What Benefits and Support are Available for Veterans With TBI?) for an assessment.
If a veteran experiences persistent problems after going through TBI diagnostic tests and treatment, they should return to their assigned primary care practitioner for further guidance within the VA or request a referral to a community-based TBI program. If a referral is not made available, you can contact a community-based TBI program directly and self-refer.
Contact the VA here: https://www.va.gov/
SECTION 4: WHAT BENEFITS AND SUPPORT ARE AVAILABLE FOR VETERANS WITH TBI?
Finding the right care for TBI can be overwhelming, particularly when symptoms have gone undiagnosed or misdiagnosed for years. You don’t have to have a diagnosis to start. You don’t have to navigate this alone.
The resources below include both VA and private sector options. Those seeking intensive evaluation and treatment may have different needs than those looking for ongoing support or caregiver resources. The list is organized accordingly.
One important note: a formal diagnosis isn’t always required to begin seeking care. Several programs listed below will work with veterans and service members who are experiencing symptoms but haven’t yet received a diagnosis.
A note on reimbursement: if the VA doesn’t provide a specific treatment, care received at another location may still be reimbursable. Veterans shouldn’t assume that private sector care is out of reach. DAV’s benefits advocates can help veterans understand and access reimbursable care options: visit benefitsquestions.org or call 877-426-2838.
If you or someone you know is in immediate crisis: Veterans Crisis Line: Dial 988, then press 1 | Text: 838255 | Chat: veteranscrisisline.net | Available 24/7 and confidential.
Clinical Care Programs for Military Traumatic Brain Injury
These organizations directly provide medical or therapeutic treatment.
Bush Institute Veteran Wellness Alliance: Check-In
- Location: National
- Website: veterancheckin.org
- Phone: 630-522-4904
- Serves: Veterans, service members, families, caregivers and survivors
- A free navigation and referral service that connects veterans and their families to vetted, outcomes-driven mental and brain health care providers. After an initial intake, a trained care coordinator is assigned within 72 hours to develop a personalized care plan and match the individual to the right programs and services. Includes providers across all 50 states.
Marcus Institute for Brain Health (MIBH)
- Location: Aurora, Colorado
- Website: medschool.cuanschutz.edu/mibh
- Phone: 303-724-4824
- Serves: Veterans, first responders and active duty on terminal leave
- Comprehensive evaluation and treatment for mild to moderate TBI, PTSD and related conditions through an intensive four-week program.
Shepherd Center: SHARE Military Initiative
- Location: Atlanta, Georgia
- Website: shepherd.org/patient-programs/share
- Phone: 404-603-4314
- Email: [email protected]
- Serves: Veterans and active-duty service members
- Rehabilitation program specializing in mild to moderate TBI and PTSD with strong reintegration and family support services.
Virginia High Performance (VHP)
- Locations: Virginia Beach, Virginia; San Diego, California
- Website: vhpmission.com
- Phone: 757-963-0229
- Serves: Active duty and retired special operations forces members
- Application-based program for active duty and retired special operations members. The four-to-six-week “Continue Mission Program” provides holistic physical, cognitive, and performance assessment and rehabilitation. Program costs are covered by sponsor partners for qualifying SOF members.
Avalon Action Alliance
- Location: National network, based in Atlanta
- Website: avalonactionalliance.org
- Serves: Veterans, service members and first responders
- Integrated assessment and treatment for TBI, post-traumatic stress and substance abuse through a network of partner centers. Also runs the Warrior PATHH (Progressive and Alternative Training for Helping Heroes) posttraumatic growth program for veterans and first responders.
Tulane University Center for Brain Health
- Location: New Orleans, Louisiana
- Website: tucbh.tulane.edu
- Phone: 504-988-5195
- Serves: Veterans of any discharge status and their spouses
- Intensive outpatient evaluation and treatment for TBI and PTSD. No formal diagnosis required.
Cohen Veterans Network (CVN)
- Location: Clinics in 20+ states
- Website: cohenveteransnetwork.org
- Phone: 844-336-4226
- Email: [email protected]
- Serves: Veterans, service members, and families
- Nationwide network providing outpatient mental health care for veterans, service members, and their families, including telehealth.
Home Base
- Location: Nationwide, based in Boston, locations also in Fort Myers, Florida, Phoenix and Houston
- Website: homebase.org
- Phone: 617-724-5202
- Email: [email protected]
- Serves: Special operations veterans, service members, families and survivors
- Nationwide network providing brain health assessments, treatment and care coordination.
Support Services and Resources for Military Traumatic Brain Injury
These organizations help you navigate and advocate for TBI services and provide support to you and your family.
DAV (Disabled American Veterans)
- Location: National
- Website: dav.org
- Phone: 877-426-2838 (877-I AM-A-VET)
- Serves: Veterans
- Free support for VA benefits claims, disability documentation and navigating access to health and financial benefits.
Operation Homefront
- Location: National
- Website: opertaionhomefront.org
- Contact via website form
- Serves: Military families and veterans
- Provides short-term financial assistance (rent, utilities, food, emergency needs) and transitional housing for military families and veterans experiencing hardship.
For additional information on military TBI research, brain health, clinical care guidelines and treatment resources, visit the TBI Center of Excellence at health.mil/TBICoE.
Resources for Caregivers
Caring for a loved one with a military brain injury is one of the most demanding and often overlooked roles in the veteran community. Those who step into this role, whether a spouse, parent, sibling or friend, provide critical support that makes recovery possible, often at significant personal cost.
Caring for someone with an invisible wound like TBI presents unique challenges. Symptoms such as irritability, memory loss, depression and personality changes can be difficult to understand and harder to navigate without guidance and support. Caregivers deserve resources of their own.
How to Support a Loved One with TBI
- TBI Center of Excellence: Clinical guidance on supporting someone with TBI, including how symptoms may present and what to expect during treatment. health.mil/TBICoE
- BrainLine.org: Plain-language articles, videos and tools specifically for TBI caregivers, covering everything from managing behavioral changes to navigating the healthcare system. brainline.org
- Brain Injury Association of America (BIAA): Caregiver-specific resources and a national helpline for guidance and referrals. biausa.org | Helpline: 1-800-444-6443
- TBI Model Systems Knowledge Translation Center: Free, evidence-based fact sheets and educational materials on TBI recovery, caregiving and rehabilitation. msktc.org/TBI
Where to Get Support as a Caregiver
- DAV Caregivers Support: This no-cost program provides tailored support and resources to friends, family members and loved ones who provide care to those who served, or to veterans who may be caring for a loved one. davcaregivers.org
- Elizabeth Dole Foundation: A national organization supporting military caregivers, offering peer networks, resources and navigation help. elizabethdolefoundation.org | hiddenheroes.org
- VA Program of Comprehensive Assistance for Family Caregivers (PCAFC): Federal support program for caregivers of eligible post-9/11 veterans, including a monthly stipend, health insurance, respite care and mental health services. gov/family-and-caregiver-benefits/health-and-disability/comprehensive-assistance-for-family-caregivers
- Caregiver Action Network: Broad caregiver support network with resources, peer communities and guidance for caregivers across all conditions. caregiveraction.org
If you or someone you know is in crisis, help is available now. Veterans Crisis Line: Dial 988, then press 1 | Text: 838255 | veteranscrisisline.net | Available 24/7
SECTION 5: THE BIGGER PICTURE
The science of military TBI is moving. It is not moving fast enough, but it is moving, and the people pushing it forward deserve to be named.
The State of TBI Science
The current challenge for medical practitioners and veterans alike is that there is no imaging scan or MRI that can accurately detect a TBI, which is why an MRI scan may come back normal even when a significant injury is present.
The only way to definitively confirm certain blast-induced TBIs is post-mortem. There are also no FDA-approved treatments for TBI yet.
However, there are a variety of new technologies that assist clinicians in making a TBI diagnosis using objective biometric tests. Blood biomarker tests have been developed that can signal the high likelihood of TBI. As Dr. James Kelly, Chief Medical Scientist at the Invisible Wounds Foundation, has noted, we are getting close to the kind of technological advance that exists in other areas of medicine, where a blood test can objectively confirm whether an injury has occurred.
Interdisciplinary teams of specialists are also providing treatments to help patients with chronic TBI using a proven clinical care model, such as the one used at the National Intrepid Center of Excellence and others. Other treatment modalities, including psychedelic-assisted therapy, have been shown to have a positive mental health benefit for many veterans suffering from chronic TBI as well.
There are also organizations working to advance the science in a focused way to expedite diagnoses and treatment results more rapidly for veterans suffering from military TBI, including the Invisible Wounds Foundation. To learn more about their work, visit www.invisiblewounds.org
Research is advancing. Clinicians and scientists are working to develop the diagnostic tools and treatments that service members and veterans deserve. In the meantime, effective care options exist, and a formal diagnosis is not always required to access them.
Accelerating that progress requires sustained research funding and national attention.
What the Research Shows
A 2025 RAND scoping review mapped a decade of military brain injury research and found that despite more than $2.1 billion invested since 2015, efforts remain fragmented across agencies and specialties, with research siloed in ways that limit coordination and slow progress. Special operations forces, despite facing particularly high risk of blast TBI, remain among the most understudied populations in the field.
The review also found that nearly half of all studies focused on diagnosis, while only 9% addressed rehabilitation and long-term care. The Invisible Wounds Foundation commissioned this review specifically to identify where investment is needed most, and to help push the field toward the coordinated, targeted research that veterans deserve.
Recent TBI Legislation
DAV is taking an active advocacy role for veterans suffering from chronic brain injury issues. Read more about the action DAV is taking in Congress to help veterans here: dav.org/can.
What You Can Do
Research funding at the national level requires public pressure. As Dr. Kelly noted in a webinar with DAV, one of the most powerful things veterans, families and advocates can do is contact their members of Congress directly and make clear that military brain injury research deserves sustained federal investment. The DAV Commander’s Action Network makes that easy: visit dav.org/can to contact your representatives.
CONCLUSION
Military brain injury has been misunderstood for over a century. That is changing. Research is advancing, care is improving, and the organizations on this page exist specifically to help veterans and their families find their way through. You do not have to have a diagnosis to begin. You do not have to navigate this alone. Whenever you are ready, help is here.
This page has been medically reviewed by Dr. James Kelly, Chief Medical Scientist at the Invisible Wounds Foundation and founding director of the National Intrepid Center of Excellence at Walter Reed National Military Medical Center.
