Since 1914, more than 100 years following the introduction of high explosives on the modern battlefield, we are still handicapped in our ability to diagnose the consequence of battle and exposure to blast. The recent discovery of a new pattern of microscopic level of brain injury, related to military blast exposure is calling into question our past approach for treating the poly-trauma effects of PTS, TBI, moral injury and use disorders. Presently, this pattern of microscopic blast TBI can only be qualified in post-mortem examination.
There is an urgent need to develop reliable diagnostic imaging and blood markers for TBI in a living person. Early identification of this injury manifestation and disease evolution is necessary to effectively treat the underlying brain injury that may be complicating the treatment of other combat related conditions, such as TBI, moral injury, use disorders and the nexus to suicides. The historic course of action for treating these abnormal presentations has defaulted toward psychiatric or behavioral health focused disorders and treatments that have largely incorporated the use of mood stabilizing medications. We urgently need to confirm or deny the presence of TBI in order to accurately characterize the variables challenging the veterans we are seeking to help.