WASHINGTON — Concerns are mounting over the lasting impact of traumatic brain injuries (TBIs) sustained by U.S. service members in the ongoing conflict with Iran, highlighting challenges in diagnosis, treatment, and long-term recovery. Nearly 700 American troops have been wounded by missile and drone attacks on bases in the Middle East since the conflict began, with most suffering TBIs, according to military officials.

Joe Shearer, a former Marine from Colorado Springs, Colorado, experienced multiple blast exposures during his deployment in Iraq in 2005. Despite initial symptoms such as headaches and vomiting, he returned to duty, embodying a military culture that often discourages reporting injuries perceived as minor. Years later, Shearer was diagnosed with TBIs linked to those incidents and continues to experience symptoms including dizziness, migraines, memory lapses, and sensitivity to light.

Traumatic brain injuries, often classified as concussions or "mild" TBIs, can be difficult to evaluate due to their variable symptoms and unpredictable recovery trajectories. While many individuals recover fully within weeks, some suffer persistent effects—such as cognitive difficulties, mood changes, and neurological impairments—that can last for years. Medical experts caution that repeated exposures to blast injuries increase risk of chronic conditions, including chronic traumatic encephalopathy (CTE), a degenerative brain disease linked to repeated head trauma.

Advancements in understanding the mechanics of blast-related brain injuries remain limited. Unlike blunt force trauma, blast waves from explosives result in distinct cellular damage, complicating diagnosis and treatment, said Dr. James Kelly, neurology professor emeritus at the University of Colorado and chief medical scientist at the Invisible Wounds Foundation. The evolving nature of warfare with Iran, involving close-proximity drone explosions, further complicates injury patterns compared to previous conflicts dominated by roadside bombs.

Legislators have called for greater oversight of care provided to troops injured during recent Iranian attacks. Wisconsin Senator Tammy Baldwin urged the military to disclose findings from an investigation following a March 1 drone strike in Kuwait that killed six U.S. soldiers and wounded others. Baldwin criticized delays in screening and specialized treatment for those affected, especially in light of reports that some service members went weeks without concussion evaluations. The Defense Health Agency affirmed that protocols require all service members to be screened for TBIs.

Since 2000, more than 500,000 service members have been diagnosed with TBIs, with the majority classified as mild and not exclusively combat-related. However, advocates highlight concerns about underreporting and symptom overlap with conditions such as post-traumatic stress disorder, which can complicate diagnoses. Treatment approaches vary but include medication, physical therapy, speech therapy, and psychological support, all aimed at facilitating brain recovery and adaptation.

Army veteran Frank Sonntag, who sustained a TBI from a mortar blast in Iraq in 2004, recounted struggles with memory and speech that went undiagnosed for years. He credits speech therapy with significant improvements in regaining communication skills. Similarly, Army veteran Spencer Milo, wounded in multiple blast incidents during deployments in Iraq and Afghanistan, described ongoing battles with seizures, migraines, and forgetfulness years after leaving service.

Experts emphasize that each brain injury is unique, making individualized assessment and care essential. While much remains unknown about the brain's response to trauma, research shows neural pathways can regenerate, offering hope for healing. Early detection and sustained treatment are considered vital in improving outcomes, but the stigma within military culture and the invisible nature of these injuries continue to hinder timely intervention and recovery for many service members.