TBI & blast injuries in veterans

If you were not knocked out, or were out for less than 30 minutes, the TBI was most likely mild. You may have felt dazed, confused or “seen stars” without losing consciousness at all.

Most people recover from a concussion within hours, days or weeks. Most concussion symptoms are temporary, even ones from a deployment.

Being knocked out for more than 30 minutes but less than 24 hours usually means a moderate TBI. More than 24 hours usually means a severe TBI. A severe TBI can also happen when an object pierces the brain.

• A nearby explosion: bombs, grenades or improvised explosive devices
• Falls and hard landings
• Firing certain weapons
• Sports and hand-to-hand training
• Vehicle crashes

Over the past twenty years, blast has been the most common cause of mild TBI in the military.

One mild TBI nearly doubles the chance of another. People who have had several mild TBIs tend to take longer to recover. Combat exposure also raises the risk of more than one TBI over a lifetime.

High-level blast comes from incoming munitions, such as improvised explosive devices or rocket-propelled grenades. It can cause sudden injuries, including TBI, hearing injury or the loss of a limb.

Low-level blast comes from firing weapon systems or setting off explosives in training or combat. A single exposure does not usually cause a mild TBI. Low-level blast is not the same thing as a TBI.

Symptoms people have reported

• Concentration or memory problems
• Difficulty hearing, or ringing in the ears (tinnitus)
• Dizziness or headaches
• Fatigue or sleep problems
• Irritability
• Slowed thinking or slower reaction time

These symptoms usually ease with time. Some show up right away, and some only after many exposures.

Higher-risk jobs include

• Armor, artillery and gunnery
• Combat engineers and breachers
• Explosive ordnance disposal
• Infantry
• Medical teams attached to expeditionary units
• Military training instructors
• Special operations forces

Weapons named include

• .50 caliber weapons
• Breaching explosives
• Indirect fire systems, such as mortars and howitzers
• Shoulder-mounted weapons

In August 2024, DoD set rules to manage brain health risks from blast. It uses 4 pounds per square inch as a health-based safety guideline, sets stand-off distances when weapons are fired, and requires tracking of service members’ blast exposures.

New service members now take a baseline cognitive (thinking) check during initial training, and high-risk active-duty members were required to take one in fiscal year 2025. A government review in 2026 found good progress, along with staffing gaps.

• Recognize: know which jobs and weapons carry more exposure, and that enclosed spaces and walls can make it stronger.
• Limit: keep your distance when you are not firing, wear hearing protection, follow firing limits and turn in unused rounds.
• Report: if symptoms last and get in the way of daily life, tell your command and a medical provider.

• Balance problems or dizziness
• Blurred vision
• Fatigue
• Headaches
• Ringing in the ears

Changes in the brain after a concussion can affect how it takes in, stores and finds information. Thinking can feel slower, focus can slip, and remembering can be harder.

TBI can bring irritability and changes in behavior. It is also linked with mental health conditions such as PTSD, depression, anxiety and substance use.

Sleep problems are common after a TBI. Restful sleep is also one of the most important things you can do to help the brain recover.

Most people recover from a concussion within hours to days or weeks. Sometimes symptoms last longer than expected. Healing time depends on the person, the injury, the number of concussions, and other conditions such as post-traumatic stress or depression.

Most health problems after a concussion can be handled by a primary care provider supported by a team of specialists.

In one research review, about half of service members and veterans with a mild TBI developed PTSD, compared with about 1 in 6 civilians. PTSD is more closely linked to combat-related mild TBI than to other mild TBI, and blast-related mild TBI may come with more severe PTSD symptoms.

Because the signs overlap, experts advise that people being checked for a mild TBI are also screened for PTSD. People with both often have stronger or longer-lasting symptoms, so a full picture matters.

The most effective PTSD therapies, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), work as well for people with a history of TBI as for those without. Some evidence suggests finishing CPT or PE may also ease some TBI symptoms.

Treating PTSD well has been linked to fewer brain-related symptoms, better sleep and less pain. Experts recommend a whole-person plan that combines mental health care and rehabilitation, with family involved when the veteran wants that.

VA’s Polytrauma System of Care is a network of specialized programs at many VA medical centers. Expert teams of doctors and therapists provide rehabilitation, including physical, occupational, speech-language and vocational therapy, plus mental health care.

If you think you have a TBI, talk with your VA primary care provider or contact your local VA facility. Not enrolled yet? You can apply at VA.gov or call 877-222-8387.

• How long and how often you were around blasts
• Roughly how many blasts
• Symptoms, when they started and how long they last
• Years in a higher-risk job or unit

If symptoms after blast exposure last and affect your daily life, DoD advises telling your command and a medical provider. Keeping track of your symptoms helps your provider find causes and options.

A headache that starts within 7 days of a concussion, or an old headache that gets worse, is called a post-traumatic headache. The brain typically takes 2–3 weeks to heal from a concussion, and headaches usually ease on their own in that time. Pushing through symptoms may make them last longer.

What helps

• Keep a headache diary to share with your provider
• Keep healthy sleep habits
• Notice and avoid your common triggers
• Try relaxation exercises, such as those in free VA and DoD apps

If headaches last longer, work with your provider on practical goals. Treatment can reduce how often and how badly they come, even if it can’t always make them disappear.

• Aim for at least seven hours, regularly
• Avoid alcohol within two hours of bed
• Avoid caffeine, nicotine and energy drinks within six hours of bed
• Get natural light every morning
• Keep your room cool, dark and quiet
• Skip naps within seven hours of bedtime

• Cut distractions when you learn something new, and focus on what is being said
• Keep one list of what needs doing, in order of importance, and check things off

Free VA and DoD apps, such as Mindfulness Coach and Virtual Hope Box, can also help with focus, stress and relaxation.

Give yourself time to heal. Limit caffeine and energy products, and avoid contact sports that could cause another concussion. Activities like yoga, exercise, music or art can lower stress; talk with your provider about what fits you.

Drinking after a TBI is linked with problems in learning, memory, planning and speed of thinking, and with balance problems. Heavy drinking is also linked with slower recovery, seizures after injury, trouble returning to work, PTSD and suicide.

• People who drank heavily before the injury
• People with milder TBIs (the risk is higher than after moderate or severe TBIs)
• People also living with a mental health condition, such as PTSD or depression

Alcohol misuse can improve with proven support, such as cognitive behavioral therapy and mutual help groups. Your provider can help tailor treatment if memory or focus is affected.

Sometimes symptoms last longer than expected. Keep tracking them and share changes with your provider, so they can look for causes and options. Conditions like PTSD, depression, poor sleep or pain can keep symptoms going, and treating them can help.

Studies show that having 2 or more TBIs may raise the risk of conditions like Parkinson’s and Alzheimer’s disease later in life. A higher risk is not a certainty. Avoiding further head injuries and looking after your overall health still matter.

If a TBI or its effects are linked to your service, you may be able to file a VA disability claim. An accredited Veterans Service Organization (VSO) representative can help you gather evidence and file, and their help on VA claims is always free.

• Help set up reminders, calendars and lists
• Keep routines and sleep times steady
• Notice changes in mood, drinking or sleep, and talk about them calmly
• Offer to come along to appointments, if they want that
• Praise effort and progress, not just results

Caring for someone with a TBI is work. VA’s Caregiver Support Line, 1-855-260-3274 (Monday to Friday, 8 a.m. to 8 p.m. ET), helps family caregivers of veterans. DoD also publishes a free caregiver guide for TBI.

In a 2026 review, some service members said a strong drive to finish the mission made them slow to ask for care, and some worried about their careers. Leadership that encourages care, and providers embedded in units, made people more likely to seek help.

• “I’ve noticed the headaches are wearing you down. Want help setting up a check-up?”
• “You don’t have to push through this on your own.”
• “Let’s write down what you remember about the blasts, so the doctor has it.”

• A severe headache that feels different from any before, like the worst of your life
• Changes in speech or vision
• Repeated vomiting
• Weakness, numbness or tingling in your arms or legs

• Veterans Crisis Line: dial 988 then press 1, text 838255, or chat at VeteransCrisisLine.net
• Anyone in the U.S. can also call or text 988
• If a life is in danger, call 911

You don’t have to be enrolled in VA to use the Veterans Crisis Line.

• Ask your VA primary care provider about TBI screening or evaluation
• Call the VA health care hotline to enroll: 877-222-8387 (weekdays)
• Call the Vet Center Call Center, 24/7, to talk with a fellow veteran: 877-927-8387

The Veterans Crisis Line chat works from anywhere with internet, and its website lists numbers for calling from overseas. You can also find a free local helpline at findahelpline.com.