Post Traumatic Stress Disorder (PTSD) was the most unrecognized disorder for returning Vietnam veterans as well as for the veterans of all previous wars. Not reacting to this disorder cost thousands of lives due to suicide, mental illness and chronic health issues aggregated by PTSD. The outlook started to change in the early 1980s when the VA finally recognized PTSD and started treating it.

Gulf War Syndrome was another illness where the medical community was late to address its long-term effects on service members. The first responders to 9/11 in New York have had a much higher percentage of their peers contracting lung and other types of cancer at an alarming rate. Police, EMTs, and firefighters have been dying prematurely due to the toxic nature of the attack.

The wars in Irag and Afghanistan have the been the genesis of the major reason many veterans are having invisible health problems. The culprit is TBI or traumatic brain injury. When an IED

(improvised explosive device) damages a servicemember limbs beyond repair, it's apparent to the public. However, when a soldier suffers a head injury, they tend to "shake it off" and return to the battle since their buddies are lying on the ground bleeding and dying.

In the above scenario, the soldiers who have had "their bell rung" by an explosion may have had a loss of situational awareness, a severe headache or other TBI symptoms which may have disappeared by the time the action subsided. The servicemember's commitment to the unit's objective may have prevented a potential TBI injury from being reported. It's not until the injured servicemember returns home and the change in behavior is observed by a loved one.

A TBI injury may be sustained by being near an explosion, being hit by a bat or similar object, or by a flying projectile. The range of TBI injuries begins with mild TBI; the major symptom is a loss of consciousness for 30 minutes or less. Since 2007, the VA has begun to screen combat veterans for TBI, an effort which should be applauded. The VA has been the target of a great deal of bad press, most of it well deserved. But this move to screen veterans will go a long way to prevent the downstream effects people living with PTSD had to encounter. The results of a CAT scan or MRI may be negative in the case of mild TBI but should be monitored for changes. Cases of mild TBI may lead to the post-concussion syndrome or PCS. Retired pro football players have been diagnosed with this condition.

The most observable symptom of mild TBI is an abuse of alcohol and other addictive drugs. The scenario is predictable since there aren't any new plays in the alcoholic's playbook. Some of the most popular alcoholic abuser's excuses are; "I can quit anytime," "You would drink too if you had seen the crap I have," and "Everybody in my unit drinks a lot." Or "It's my money, and I will spend it where I want to." Confronting the veteran alone is a waste of time. You can try loving the addiction away, ignoring the behavior or bitching about it., but you are doomed to failure. An addict's drug of choice moves to the number one position in their life. So, what's a loved one to do? First is to seek some consulting for yourself until you can approach the situation with clinical eyes. Remember, you don't have the problem and the person you care about is no longer inside that body lying next to you at night. That person is inside there somewhere. It's the job of a trained professional with no emotional ties to attack the veteran's issues. Your support is paramount but remember; "It ain't about you, princess."

Be careful and be aware that substance abuse and physical abuse co-exist, but the onset isn't always at the same time. Early diagnoses are important to recovery. However, the veteran may not want any help so that early intervention may be your only course of action. An affected servicemember may discover they feel the effects of alcohol sooner than before the injury. Some other warning signs to be cognizant of are increased fatigue, insomnia, and development of cognitive issues (ADD, memory loss, and processing issues) and ED (erectile dysfunction).

Mild TBI has been highlighted because more advanced cases can be detected by MRIs and CAT scans. Hopefully, the VA's screening process will result in cases of TBI from progressing.

With the VA's help and the support of the veterans community including our great service organizations, we will hopefully prevent the personal destruction that occurred in the past by delayed recognition of so many disorders that were service related.

For more detailed information, go to VA.gov and military.com. From these two sites, you can follow hyperlinks to many other resources to combat this problem.

Until next month, the Major is RTB.

Mike Dryden is a retired Army Major and current Older Persons Action Group, Inc., board member.