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Publication Briefs

Prevalence and Severity of Neurobehavioral Symptoms is High among OEF/OIF Veterans with Traumatic Brain Injury

Evaluating service members for the "invisible" wounds of the Iraq and Afghanistan wars, including traumatic brain injury (TBI) and PTSD, has been a high priority for both VA and the DoD. The current wars have brought particular attention to the detection and treatment of mild TBI, also referred to as concussion, and mild TBI represents more than 75-80% of all deployment-acquired TBIs. The need to accurately identify and appropriately treat individuals with TBI as early as possible has led VA to establish a task force to develop uniform screening and evaluation tools for TBI. In April 2007, VA clinicians were mandated to use the new, four-section TBI screening instrument for all OEF/OIF Veterans. In order to be considered a "positive" screen and be referred for a comprehensive TBI evaluation by a TBI specialty clinician, a Veteran must answer "yes" to all four sections of the tool (i.e., exposure to physical trauma during deployment, subsequent impaired consciousness, onset or worsening of symptoms following the trauma, current TBI symptoms). Those answering "yes" to three or fewer sections are offered appropriate counseling or other services by the clinician completing the screen. This study presents an overview of post-concussive symptoms reported by Veterans evaluated for TBI using VHA's Comprehensive TBI Evaluation following a positive TBI screen. In addition, differences in symptom presentation were examined for those who were confirmed to have had a TBI vs. those who did not. Investigators identified all OEF/OIF Veterans evaluated using this Comprehensive TBI Evaluation between 10/07 and 6/10 (n = 55,070).


  • Of the 55,070 Veterans with a positive TBI screen who then received the Comprehensive TBI Evaluation, clinicians diagnosed TBI during deployment in 30,267 (55%), no TBI during deployment in 20,934 (38%), and indeterminant in the remaining 3,869 (7%).
  • Moderate to very severe post-concussive symptoms were common in those with and without clinician-diagnosed TBI. However, the odds of reporting moderate to severe symptoms — ranging from a high of 82% for symptoms of irritability and sleep problems to a low of 19% for changes in sense of taste and smell — were significantly higher in Veterans with TBI. Moreover, the odds of reporting that these symptoms moderately to extremely interfered with life was higher in those diagnosed with TBI.
  • Among those with TBI, clinicians believed that current symptoms were more likely due to TBI alone in 10% of participants, a combination of TBI and behavioral health conditions in 61%, and behavioral symptoms alone in 23%.


  • This study was based on retrospective data.
  • Clinicians assessed Veterans for historical diagnosis of TBI, often years after the initial trauma.

Study findings are part of a TBI Screening and Evaluation research fact sheet disseminated by PM&R.

This study was funded by VA/HSR&D's Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI). All authors are part of PT/BRI-QUERI.

PubMed Logo Scholten J, Sayer N, Vanderploeg R, Bidelspach D, and Cifu D. Analysis of U.S. Veterans Health Administration Comprehensive Evaluations for Traumatic Brain Injury in Operation Enduring Freedom and Operation Iraqi Freedom Veterans. Brain Injury 2012;26(10):1177-84. Epub 2012 May 30.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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