How Injury Occurred

Traumatic brain injury (TBI) may happen from “impact” such as a blow or jolt to the head or an object penetrating the brain. It can also happen from blasts or exposures. We talked with Veterans who had impact injuries, Veterans who were injured in blasts and explosions, and some who experienced both. There is more information about TBI on our Resources page.

Impact injuries

Impact injuries can occur from a blow to the head during an accident or fall.

 

Andrew describes what he remembers about the vehicle accident that caused his brain injury.

Andrew describes what he remembers about the vehicle accident that caused his brain injury.

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It was during Reforger, which is a big exercise where they redeploy all the United States forces to Germany in preparation for the Russians coming over the border if it was ever going to happen. There was a vehicle accident. I was a tank commander. I was actually a tank platoon leader, and my tank got hit with a tree, believe it or not, and took me out. Basically, it cracked open my skull, brain exposed to air, blood everywhere, and my crew drove me in a tank to the hospital at about 50 miles an hour with a whole bunch of other people wondering why they were driving so fast and why there was blood all over the top of the tank. I did not regain consciousness for seven days, and when I did - I don’t want to make it sound like it’s really weird, but in high school I had taken German, and I spoke not native German but pretty good. 

When I woke up I was in a German hospital with no one who spoke English, so I spoke German for the first couple of weeks, and I don’t remember speaking a lick of English until my wife showed up at the hospital. But basically, I had damage to one of the cranial nerves; my eyes were stuck crossed, and I had a big black gash across the forehead. The result from it is that this lobe right here is flattened, and then you know how you take a boiled egg and you squeeze it a little hole will appear in the middle? I have one of those nice little holes right about - if you intersect those two lines.

 

John hit his head on the dashboard during a head-on auto collision and broke his face in 178 places.

John hit his head on the dashboard during a head-on auto collision and broke his face in 178 places.

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I was in a head-on collision, I was wearing a seatbelt. It broke my face in 178 places. I have nine plates, six titanium teeth, Kevlar mesh under my check, a silicone mesh eye socket. And at first, they said I would never work, then they said I would probably only be able to work in a limited way. And I was rebuilt by a plastic surgeon. I remember the accident well, but after the ambulance got there and everything it starts to become a little murky. I got out a lot quicker than they said I would. They said I’d be in the hospital per a minimum of three months, and then they said six weeks, and I was out in seventeen days. They found two of my teeth here, of my original teeth, and they found one other up here in the cheek. So, I have titanium teeth, they’re permanent. They told me, the plastic surgeon said you will always have sinus problems, because my sinuses were smashed, and I would always have pain, headache pain. 

 

Roger talks about the helicopter crash that caused his injury.

Roger talks about the helicopter crash that caused his injury.

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I was shot down in Vietnam on May the 8th of ’67.  When we crashed into the trees, actually before probably, but the, the, the main rotor came off. And it just spun right to my cockpit and tried to cut me, my head off. As far as I know, I am the only Vietnam Veteran to survive a motor, a rotor dislocation. And I’ve been blessed in many ways. I mean, I’ve been on Hour of Power with Bobby Schuller, Unsolved Mysteries, and Reader’s Digest and weird papers all over the world. And so, I am the most widely, widely known. But most people have no idea who I was - if they saw me again, they wouldn’t know. But that’s life, that’s life.

 

Carlos sustained a head injury in a Jeep accident during an annual training for the National Guard.

Carlos sustained a head injury in a Jeep accident during an annual training for the National Guard.

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Oh my head injury, like I said, I was in the, after I got out of the Army I was in the National Guard and we did annual training. And this happened on my annual training in Fort Hood, Texas. We were out there for two weeks and in the two weeks we were kind of gathering up, we were mostly out in the field. Once we got there, we set up in the field and we went through the drills and everything else. And we were in the process of kind of heading back towards the barracks, and in doing, I was a gunner with a 106 Jeep, and the driver and a passenger and me sitting on the back. And we were heading through the woods back to Fort Hood and to the base you know and there was a curve with downhill slope and that’s where we rolled over. And I was unconscious, I don’t know for how long, but we had kind of like gone ahead of everybody and then, by the time I came to there was all kinds of people in the ambulances and everything you know. So that was kind of like the main experience. And it was a non-open head injury.

 

After being shoved off a pier by the mast of a ship, Kevin fell over 30 feet and “landed head first on a log.”

After being shoved off a pier by the mast of a ship, Kevin fell over 30 feet and “landed head first on a log.”

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On November 27, 1980, a shipmate and myself were given an order to perform a simple, common and ordinary task that changed my life forever. On this miserable, rainy Seattle day, we carried forth a command to transfer a 350-pound tarp from the pier to our ship. As we lifted the tarp, my partner tripped. Letting go, the mast fell against me, shoving me off the pier, falling 30 feet, landing head first on a log that prevents the ship from surging against the pier. By God’s grace, and a glancing blow, I woke up in the water, no air in my lungs, sinking 40 feet, while unconscious, laden by my zipped-up foul-weather jacket and work boots. Seeing no blood in the water and finding where up was, by a single shiny spot glimmering through the murky abyss I was descending to, I started kicking with all my might, wanting to take a breath of air that was only water, when suddenly my head popped to the surface. I missed the log. I’m still alive. My training worked. In subsequent denial and shock, I told the command I felt no pain, and resumed my duties without medical care, for there was no medical staff on board, and civilian care was no option under the circumstances.

 

Jessica sustained her first severe concussion after slipping and falling on the ice during basic training.

Jessica sustained her first severe concussion after slipping and falling on the ice during basic training.

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So, we do PT tests, physical training. You do your two-mile run, push-ups, sit-ups, and it was Tennessee, January, it was icy out and during our PT test, we weren’t supposed to be running that day yet we all were in trouble so they had us do it anyway and I slipped and fell on ice. With that being said, I fell backwards and my head was the first thing to hit the concrete, and the last thing I remember. I didn’t know my name. Apparently, the people who found me were all people I knew very well. I do remember people being around me, I just I couldn’t even tell you who it was. And they eventually took me to the hospital and told me I had a severe concussion.

A few were injured after being hit with a heavy object. One Veteran was injured while in Afghanistan, when an enormous rock “rolled up and struck me in the base of my skull,” another lost consciousness after hitting his head on a metal submarine hatch, and a third was simply walking home from work in his neighborhood, when he was mugged and struck on the head with a brick.

 

Marcus sustained a concussion after being mugged and beaten by two men as he was coming home from work.

Marcus sustained a concussion after being mugged and beaten by two men as he was coming home from work.

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I was coming home from work, I was pretty close to my residence, and I was accosted by two gentlemen who proceeded to rob me. There was a fight, there was a struggle, I was hit in the head with a brick, more than a couple of times. I was kicked and beaten about my head, so that’s where that injury occurred. I was, I’m sure I lost consciousness, but I was in such a state of shock or whatever, you know there is just so much I don’t remember and so much I do remember, but…eventually they were apprehended and they were charged with the crime.

 

While deployed in Afghanistan, Theo was struck by a large rock the size of the “dictionaries we grew up with.”

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While deployed in Afghanistan, Theo was struck by a large rock the size of the “dictionaries we grew up with.”

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The best that we can figure is that the injuries I sustained in Afghanistan, I was involved in a riot in the first primary elections and what happened for us was we were personal protection for civil affairs. Civil affairs are the small groups that go and spend money to develop the country for stability, schools, wells, women’s centers, things of that nature. Well, while we were there the elections happened and during the elections there was rioting in our town and they were burning down the United Nations compounds and other foreign aid buildings and with the intent of killing those inside. So, we went out and evacuated those personnel to our compound and then [evacuated] them from our base with helicopters. Our base wasn’t set up for this. We didn’t have the personnel and the equipment to handle that large of an influx of people. During the process of evacuating other individuals I was injured and part of the issue we dealt is that they weren’t using lethal force per say, they were using bricks, Molotov cocktails, as degrading as it sounds but bottles of feces, bottles of urine, throwing them at us. What I was hit with was a large rock about the size of the dictionaries that we grew up with and it struck me behind my left shoulder. Typical posture for a right-handed shooter would be your left side forward. So, best that we can figure is that it hit me behind my left shoulder and rolled up and struck me in the base of my skull. I don’t recall my left arm doing the work, what I remember happening is getting up off the ground off of one knee and my left arm not working. As a matter of how, I don’t know. There was so much being thrown at us. You could identify a few but when there is so much in the air there is so much you’re going to miss.

 

Scott was hit with a metal hatch while going up a ladder on a submarine.

Scott was hit with a metal hatch while going up a ladder on a submarine.

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OK. So, my TBI happened in January of 2010. And I was in the Navy and on a submarine, so it’s probably not the same as a lot of TBIs that are more like people over in Iraq or something like that, who had IEDs or something to that effect. But what had happened was, so there’s, there’s like multiple levels on the submarine, you know, in various spaces. And then you get up those by going up ladders. And at the top of each ladder, there’s a little – like, well, not little - it’s a big metal hatch that you can put down so that way if you need to do work above where the ladder is, then you can, you can do that.

And so, I was just going up on one of these ladders, and this happened like nine million times a day, but somebody had had it down, the hatch down and when they put it up, before that – or after they were done - they didn’t latch it in properly. So, I just unwittingly went up the ladder just like normal. And I grabbed onto the wrung of the hatch and it came out and I don’t know how much these metal hatches weigh but it’s a lot. And so, I, it came out and I pulled it down with my bodyweight and slammed my head in-between it and like the floor on the level above. And I blacked out. I don’t know exactly how long I was out of consciousness. But the impact just immediately, you know, pretty hazy after that.

And so, somebody saw what had happened right away, like there was somebody in the area. And so, I was told that they just kind of ran over and grabbed me up and like pulled me up, you know, to the next level. Got the hatch open or whatever. And then I was laying on the deck again. I don’t really know how long I was out of consciousness. Not – it wasn’t like super long, like less than a minute I think. But then kind of just after that, it was like very hazy when I came to. You know, throbbing headache at that exact time and just feeling like disoriented in like place and person. You know I mean, but I still knew I was me and I still knew I was alive and, and whatnot. But I didn’t know what was happening.

So, I was laying there on the ground for seemed like hours, but it was probably, you know, thirty minutes or maybe even less. And then they kind of helped me move along to, to see the ship’s doctor. And he sent me home for the day with a friend who drove me home. But I guess the – so, so that day, you know I mean I just don’t really remember much after that. I have flashes, I remember kind of proceeding through the boat and I was awake and cognizant, but not really.

Some Veterans with impact injuries to the head received immediate medical attention after their injury.  One Veteran – who was in an automobile accident - was hospitalized for over three weeks after his injury, and underwent extensive reconstructive surgery. Andrew was unconscious for seven days after sustaining an open head injury after his tank was hit by a tree; when he regained consciousness, he was in a German hospital with nobody who spoke English, “so I spoke German for the first few weeks.”  Richard was taken to the emergency room right after his injury and was released in a matter of hours, but by the next day he was back in the hospital. 

 

After being released from emergency care, Richard experienced brain swelling and returned to the hospital for an additional week.

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After being released from emergency care, Richard experienced brain swelling and returned to the hospital for an additional week.

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The emergency care was horrible, terrible. I was released from the hospital after 14 hours, no special instructions and vomiting, basic biology text Victor and Adam's head injury, vomiting, 72-hours observation. The CAT scan didn’t show any damage, but it was taken too - right away, it takes. So, as you know, one of the sequela, one of the things that happens afterward, is that - well, if I hit here or you get hit here, it swells up, it goes down, everything's fine, but with the brain, the swelling has no place to go. And, if it's not treated, you run a serious risk of brain swelling and cutting off your brain stem, and you can either die that way or become a vegetable - it's not that unusual, and they don’t really know. So, I went back to where I was staying and did the worst thing I could do, fell asleep. Well, that morning, I had uncovered some dirty dealings with a mafia-run company for an investigative firm. The person I reported to called me up and said, where's your documentation you were going to bring us. I don’t remember what I said, and I went back to sleep, and immediately, the phone rang again and he said, "there's a taxi outside.  It's been blowing its horn for five minutes. It's going to take you to my doctor."  So, he did. I walked in the doctor's - he came out in his lobby, took one look at me and I think my eyes were crossed, and said, you're going to the hospital, and I went in and I was there for a week. The kind, warm surgeon came by and said, "Well, if the swelling doesn’t go down, we're going to put in a sieve," and I remembered from John Gardner's Death Be Not Proud about his son's brain tumor where he told a friend, "Yes, I could hear them drill." Anyway, but the steroids that they gave me prevented it from swelling too much. So, I got out after a week and I wasn’t feeling all that great.

 

John had reconstructive surgery to rebuild his face and struggled with pain and feeling uncoordinated and unable to focus.

John had reconstructive surgery to rebuild his face and struggled with pain and feeling uncoordinated and unable to focus.

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I went through - the surgery to rebuild my face was 12 and a half hours. Rebuilding my mouth took two years.

I: Do you look very different than you did before?

My nose is different. Everything else, except I’ve got this big lump, because I’ve got that big plate. But everything is pretty much the same. The nose is too broad, because they couldn’t make it - they didn’t have enough bone to support the way it should be, so they spread it out a little bit. He told me, you know, after it’s all healed, you can come back. I’ll pass, thank you very much. But the teeth were the worst, putting in the implants, because I had broken teeth, and they had to remove all those, and then stitch them closed, allow them to heal. Got two bone grafts on the bottom and the top. They pulled a bunch of them that were cracked - all of them cracked. I had like six crowns. Anyway, that took forever. So, you’re dealing with the pain, and then you’re dealing with the dental stuff, too. And I actually had people who would come in and check on me, because I was trying to do things like run, because I had been running. And of course, I couldn’t do it, I would just fall over. It was dreadful, you feel so uncoordinated.  Nothing seems to be working right, you can’t focus on anything. It’s not your eyes, your brain isn’t focusing on stuff. It just won’t do it.

Blast injuries

A large number of the people we talked to – especially those who were deployed to Iraq or Afghanistan – were injured during blast explosions. The use of improvised explosive devices (IEDs) in Iraq and Afghanistan led to a surge in blast-related injuries.

What does it feel like to be in a blast explosion?  One Veteran told us, “An IED is something they put together like a shoebox and it goes boom, but they hide it to where we can’t see it and they’ll sit over a way with like a cell phone or a pager or something that will fit and they wait until we ride by, and when we ride by, they hit, but it’s not always that way. Sometimes it’s timed. Sometimes there’s like a little wire and when you roll over the wire it blows up at you. Sometimes, they would set it up in a city and blow it up at you and then they would ambush you…”

Another Veteran said, “I took the full brunt of the concussive force right to the face. And I remember the explosion. I don’t remember a sound. And then I remember waking up laying down inside the striker and dust going all around me and making it really dark, so I thought I was going blind. Because I was like, ‘What the heck’s going on? Did I get something in my eyes?’ Said, ‘No, you got, you got knocked silly by the bomb.’ I was like, ‘Oh, okay.’ And that was the first one.”

 

Jake sustained his first TBI during an IED explosion in Iraq.

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Jake sustained his first TBI during an IED explosion in Iraq.

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OK, yeah. My first TBI was from an IED explosion in Iraq in 2008. When the IED went off in front of me, it blew up in front of me, about 20 meters, and I felt the concussion of the blast. It didn’t knock me out or anything, but I was really, you know, dazed, obviously concussed but you know adrenaline kind of took over. I didn’t think anything of it at the time, but my ears were ringing real bad. I was just, you know dizzy, disoriented, just kind of the memory, the best memory I can, the best word I can put to the memory, but again, adrenaline took over. I had a pretty significant role to play at the time, the command vehicle had been hit and I was pretty much the next person in charge to, to take over at that point and so I had, like I said, a pretty big job to be done at that point and it wasn’t until, later on that I started kind of feeling it, you know I was hurting. My head hurt. I didn’t, I can’t really think much of it beyond mentioning it, you know. No, no kidding, from what just happened, but there were guys that really got, you know, hurt from it and so you just kind of push on. You just kind of, well you know you pop some Motrin and you try and sleep it off.

 

William sustained a concussion and experienced vision loss after being caught in a rocket strike in Iraq.

William sustained a concussion and experienced vision loss after being caught in a rocket strike in Iraq.

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I went back to Iraq in 2007 during the surge. We had just come back from a mission and we were entering the FOB area where they have the main buildings, you know. There’s no such – we had tents. Tents for living quarters and places like that. And we had a tent for chow hall. And a rocket strike hit and I was entering the chow hall and the blast was about twelve feet from me. And when it blew up, I watched things – it was very weird. Things started to disintegrate in front of me. And then I got all loopy and I was like, I didn’t know what was going on. I kind of got knocked around a bit. You know, I landed on my butt on this side. And I’m sitting there. I can’t see, it hurts to see. And I hear somebody telling me, somebody came up to me and said you got to get out of here. But there’s no one there. It was really weird. And I came out, kind of you know, discombobulated, disoriented. And walked, you know, walked as best I could but I couldn’t see, I couldn’t see an inch in front of me. Then I got taken to the hospital and you know, we were under fire and we couldn’t get to Baghdad because it was too dangerous. And so, the next day or two, I finally got to Baghdad and saw an eye doctor because they were more worried about my vision loss than anything else. The doctor recommended that I probably had a concussion. He said you probably should go to Landstuhl and deal with that. But those guys were – I didn’t like it there when I went there before with a, you know, I mean I just didn’t like it. So, I was like, no I can go back.

 

Karen was in an IED explosion in Iraq.

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Karen was in an IED explosion in Iraq.

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So, an IED stands for Improvised Explosive Device, and I want to say back in the day but I’m not talking about like the 15th century, I’m talking about like five years ago, in Iraq, these Improvised Explosive Devices are the main threat to us over - were, I don’t know now. I don’t pay attention or watch the news. Evidently, our traitors are the biggest problem. An IED is something they put together like a shoebox and it goes boom, but they hide it to where we can’t see it and they’ll sit over a way with like a cell phone or a pager or something that will fit and they wait until we ride by, and when we ride by, they hit, but it’s not always that way. Sometimes it’s timed. Sometimes there’s like a little wire and when you roll over the wire it blows up at you. Sometimes, they would set it up in a city and blow it up at you and then they would ambush you while you’re trying to get your dead guy out. So, that’s what an IED is.

And the blast was so huge that I don’t know if it moved any of the trucks because I was in the first truck, and it hit right behind like the second or third truck, and the blast was so - you know those movies where the guy is running away from the blast, it blows up and they jump a little bit. It is so Hollywood, y’all, and you’re driving in this completely dark and it is just bright orange just light from the back and it just sucks you in and you see this light and whoa, and then you’re back into life and you’re like, “what the hell was that?!” And I heard over the radio a guy in the back who hadn’t seen any combat, that poor baby, and he was a team leader, he was a leader, he was an NCO, I made fun of him, and then he - but anyways, when that happened, we drove to a little camp and we all sat there and talked and smoked cigarettes or whatever and we made sure he was all right, and then we got in our trucks and we continued our mission, which was fine….

 

Peter talks about sustaining a blast injury from after an IED exploded less than 10 feet away.

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Peter talks about sustaining a blast injury from after an IED exploded less than 10 feet away.

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So - I was in a - I had a blast injury in 2005, IED. I was on a foot patrol. I was probably about ten feet or less from a bomb that killed another Marine, although it was a homemade deal and not - I mean if it was, if it was made out of an artillery shell or something, we’d all be dead for sure. But it was like an olive oil can and so probably had an inconsistent blast pattern. The – I mean the Marine that was killed - did not have a scratch on him and was entirely killed by overpressure and I wasn’t all that much further than he was. And there, there were two others of us who were thrown probably more than six feet by the, by the blast. And you know I had a bunch of injuries and the other Marine didn’t have any, any injuries and was also apparently fine.

 

David describes the blast that caused his TBI while he was deployed in Iraq.

David describes the blast that caused his TBI while he was deployed in Iraq.

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OK, so I was on my second time I toured to Iraq. I was assigned 1st armor division, an MP, so I was actually responsible for setting up one of the first Iraqi police stations in Ramadi, Iraq. And at that time, I guess it was called like the Wild West, on the news or something. So, I took a team of military police up there. We had about 225 Iraqi police officers that we trained, and then we basically built a police station out of a water pump, a water pumping station on the side of the Euphrates River. So, our goal was to train them and equip them like a regular police force and then teach them how to be cops for normal people. So, I was in charge of the entire operation there and, basically, we were given a mission and told to figure it out, because that was one of the actual police transition teams that Richmond created, and on the day that I got injured, a suicide truck bomb with about 100 tanks of propane was drove to my, front of my police station and the truck suicide bomber detonated that. And it created a fireball that they saw for about two miles away. I happened to be standing in the middle of the compound and wasn’t wearing any ballistic armor or anything like that so I took the brunt of most of the blast. Wounded 56, killed 16. I brought six of my MPs back to the U.S. because we were burnt so severely, to San Antonio, Brooke Army Medical Center. Most of us had severe burns. And I think that’s basically the single event that created my TBI.

Multiple blast injuries

Many of the people we talked to served more than one tour to Afghanistan and Iraq and sustained multiple blast injuries. Some told us that they had “dozens of concussions” during their deployments, mainly from “getting blown up from IEDs.” Others described several instances when they were within the distance of the blast radius or “inside that concussive wave.”

 

Mike has had a dozen or so concussions, mainly from getting blow up from IEDs, and or two confirmed TBIs.

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Mike has had a dozen or so concussions, mainly from getting blow up from IEDs, and or two confirmed TBIs.

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Well, geez, I’ve, been through a lot, probably, maybe like, a dozen or so concussions, one or two TBIs according to Air Force Medics. Mainly from IEDs just going off and rattling the truck and just getting blown, blown up to smitherins. Made CNN off of one incident.

 

Greg talks about the cumulative effect of repeated blast injuries.

Greg talks about the cumulative effect of repeated blast injuries.

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Well, it, actually my problem was a culmination, it was a cumulative effect of repeated injury. I was in the vicinity of and within the distance of the blast radius on several, we had a couple mortar attacks, IEDs, things like that, and I was inside that concussive wave. So, I never actually physically sustained injury, I never caught any shrapnel or anything like that, which I’m very happy for, but you know there were many times where I just, I got all goofy for a minute, you know I couldn’t focus, I was just kind of out of it for a little bit. And again, as far as I remember I never lost consciousness.

 

Erik suffered multiple concussions during his time serving as a combat engineer.

Erik suffered multiple concussions during his time serving as a combat engineer.

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OK. Well, there’s several instances. Of course, we never knew it was an issue until years after I got back from overseas. But I suffered multiple concussions overseas. The main incident, the one that they have on record is when I fell fifteen feet off of a truck. Broke my back, shattered my arm in two places. And they’re not sure, but probably pretty likely I hit my head at the same time. But other than that, I was in very close proximity to an incoming mortar that actually sent me airborne. That was a pretty big concussion. And my job as a combat engineer, I did a lot of explosives and sometimes we didn’t always get as far away as we would have liked to. So, the shockwave can do a pretty hefty amount of damage if you don’t – if you’re blowing up thirteen thousand pounds of stuff and you can’t get far enough away, it’s not fun. It’ll hit you. One time in particular, I remember, we did it and you could see the shockwave coming and it, we were - all the roads over in Iraq are built up on berms or levies, so we were taking cover behind that. We would have liked to have gotten further back, but that was the closest, well that was the only form of protection, of cover and concealment we had. So, going further back would have actually been – more likely we would have gotten hurt by any kind of projectile or anything that, you know, fragmentation. So that’s where we were and the shockwave came and actually moved the road. And everyone – my guys either lost their bowels or their bladder or – it was a pretty hard concussion, shockwave when it hit us. So those are the main instances of when I had, you know, head injuries.

 

Sam recalls two different explosions that contributed to his TBI.

Sam recalls two different explosions that contributed to his TBI.

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So, it’s hard to say when it first occurred. I was blown up – I was in strikers, and strikers are a pretty hardy vehicle for the, for – so you see pictures of like the torn-up Humvees and stuff like that. Well the same IED would strike a striker, and it wouldn’t hurt the vehicle. So, the people inside were relatively safe from shrapnel and all this other stuff. But the concussive blast will still affect you, shake you up, and all this other stuff. And especially if you’re in Air Guard where you’re not being, where the, where the wave doesn’t come through the actual armor, but it hasn’t, I guess an un-molested way to your head would be the best way of putting it.

And I was – during two explosions that I know of, because sometimes they get hazy thinking about it. I was in the air yard hatch, so I took the full brunt of the concussive force right to the face. And I remember the explosion. I don’t remember a sound. And then I remember waking up laying down inside the striker and dust going all around me and making it really dark, so I thought I was going blind. Because I was like, “What the heck’s going on? Did I get something in my eyes?” [Someone] said, “No, you got, you got knocked silly by the bomb.” I was like, “Oh, okay.” And that was the first one. And the second one I fell, I didn’t fall in, I bent backwards from the concussive. It pushed me backwards and knocked me out for about ten, fifteen seconds. And after those, and then I was inside the vehicle for a lot of explosions, too, which would rock me but they wouldn’t knock me out.

A few people - who experienced both blast and impact injuries - talked about the larger impact of the blast injury. Frank experienced an impact injury and a blast injury three years apart, but he attributes his lasting symptoms to the blast injury. “Even though I’d been injured in 2004 with the first TBI in the war with the armor and the bungee cord, I recovered quite well. It was more of a physiological. It was not, I don’t think there was any brain damage that I knew of. I mean naturally I didn’t do a neuropsych. The brain damage occurred after the rocket strike in April of 2007. That’s when, that’s when it really impacted me.”

 

Frank had three concussions, the first two from impact and the third “million-dollar wound” in a blast incident.

Frank had three concussions, the first two from impact and the third “million-dollar wound” in a blast incident.

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Then I joined the Marine Corps, and I got three concussions there. One I got – a guy hit me in the head with a rock. Took ten stitches here. And messed me up pretty bad, but you know, when you’re a Marine, I mean you shake it off. And the second concussion, I don’t know if it was my first or second tour, I just don’t remember. All I remember is I got hit, and I think it was from a 122. That’s 122-millimeter rocket that the enemy would engage us with. But the last one was my “million-dollar wound.” I got a, I sustained a concussion from an 82-millimeter mortar when we were overrun. Landed about four or five feet away, and the only thing that saved me was, a mortar has a trajectory, and so the shrapnel, the concussion, concentric with the shrapnel went this way. I was in my fighting hole, you know, with a guy over me, and he got killed. I got, I lost the hearing in this ear, and woke up in the hospital. And, and then that’s, that’s it, they sent me home.

 

Matt sustained both impact and blast injuries while deployed in Afghanistan.

Matt sustained both impact and blast injuries while deployed in Afghanistan.

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It originally happened June of 2003. We were doing the physical training over in Afghanistan. We had full gear. Roughly about 100, 150 extra pounds on me. We were doing pull ups, and I was doing some pull ups and all of the sudden my shoulder just gave out. I landed flat on my back and when I opened my eyes I had people standing around me. Probably had been out for a couple seconds. And went and got checked and they really didn’t do much about it at the time because it was just like, “Oh you just got a minor headache, slight concussion. Go on about your business.” And the last time I got a concussion, I was in the dining facility and a rocket hit probably about 25 feet from where I was sitting. Jarred me and my ears rang for about two weeks afterwards.

(See also: First Signs Something Was Wrong, TBI Screening & Diagnosis, Evolution of TBI Awareness)