More Than a Bump on the Head

Capt. Brendan Meehan was stationed at Al Asad Air Base on Jan. 8, 2020, when he received intel of a potential imminent Iranian attack on the base in western Iraq.

The platoon leader and pilot with the New Hampshire Army National Guard’s C Company, 3rd Battalion, 238th Aviation Regiment (MEDEVAC) immediately began calling units from the operations tent, warning them to seek shelter.

Not long after, Iran fired a barrage of 27 missiles in retaliation for the U.S. strike days earlier that killed Iranian commander Qassem Soleimani. Eleven struck the base.

“The force of the blast moved the earth,” Meehan says “You could feel the ripples. For the briefest second, the ground was like liquid.”

He saw the first missile blow up a motor pool, hurling trucks and Humvees into the air. He started running, then two more missiles touched down.

“I was about to turn when the missile aimed for the helicopter [we] left behind blew up,” he says. “The force of blast compressed me like a spring.” He was thrown 15 feet but pulled himself to safety.

“Guys in the bunker saw me, without any help, crawl into the bunker and flip on my back … All of a sudden, I came to like nothing happened,” says Meehan, one of more than 100 U.S. troops diagnosed with a traumatic brain injury after the attack.

He is one of over 518,000 U.S. service members diagnosed with a TBI since 2000, Chair and Professor of Neurology University of Florida College of Medicine according to the Defense Health Agency’s most recent data. Guardsmen account for 10.1% of the Air Force’s nearly 73,000 TBI diagnoses since 2000 and 15.2% of the Army’s more than 300,000 diagnoses.

TBIs are the so-called signature wound of the wars in Iraq and Afghanistan. Powerful roadside bombs, rocket-propelled grenades, landmines and blasts from other explosives are responsible for many. But brain injuries also occur during training. In addition, auto accidents, falls, other mishaps and contact sports can result in TBIs.

The effects can last for years, sometimes longer.

Retired Air Force Col. Michael Jaffee, the chair and professor of neurology at the University of Florida College of Medicine, says TBI is an “umbrella term” used to describe a force applied to the head directly or “transmitted through the body.”

That force can be accompanied by an alteration in, or loss of, consciousness and result in myriad symptoms (see below), including headache, visual disturbances, ringing in the ear, dizziness, nausea and difficulty concentrating.

“When someone is dealing with symptoms of [TBI] weeks later, the term might be mild traumatic injury, but it might not be mild to them,” said Jaffee, the former chief of the medical staff at Joint Base Balad’s Air Force Theater Hospital in Iraq.

But when it comes to military blast injuries, Jaffee says they are “rarely a pure blast injury.” A blast’s effects can be compounded by the impact itself — also known as “blast plus,” meaning more than one injury occurred close together.

There’s also the concept of “blast overpressure,” which is an area that needs more focus, adds Rodger Pinto, the policy and advocate associate for Iraq and Afghanistan Veterans of America who served from 2008 to 2014 in the 82nd Airborne Division.

“If you think back to old movies, if you think back to old cartoons, when you see that nuclear bomb explosion and the wave that follows it, the wave that follows it is the blast pressure,” Pinto says. “Now, it’s certainly not as pronounced as in those particular examples. [But] whenever you have an explosion, there’s a force behind that moves outward, and that force is something that travels through anything that is exposed to it.”

Persistent symptoms after a TBI diagnosis, according to Jaffee, could come in clusters or present as continuous issues.

“There is a body of evidence that does suggest, particularly in people with repetitive or moderate to severe injuries, there can be increased risk of developing neurodegenerative [issues later in life],” he says.

Much of what I learned about TBI was through self-discovery.

—Capt. Brendan Meehan of the New Hampshire Army National Guard

Deployed troops must take at least 24 hours off duty after a potentially concussive event.

In 2011, the first combined policy between the medical corps and line command corps was established, requiring medical evaluations based on incidents rather than symptoms.

“Before that policy existed, [some service members] wouldn’t get evaluated unless they raised their hand, and said, ‘I don’t feel well,’” Jaffee says. “With the new policies, it took that subjective aspect out of it.”

If a service member is within 50 meters of a blast, or a similar incident, standard protocols call for a medical screening using the Military Acute Concussion Evaluation checklist once the individual is in a safe environment, according to Jaffee.

“I think having the standardized approach was very helpful,” says Jaffee, who also served as the national director of the Defense and Veterans Brain Injury Association.

Just last year, the Food and Drug Administration approved an in-the-field rapid blood test for TBI detection. The Army and Abbott, a global health care leader, announced in April that the i-STAT® TBI cartridge can produce “lab-quality results” within 15 minutes.

Army Lt. Col. Bradley Dengler, neurosurgical consultant to the Office of the Surgeon General, said in a 2024 news release that the test is a significant step in treatment for TBIs. One year later, an updated joint-trauma system clinical practice guide was published, reflecting changes based on the blood test.

Meehan says that after the Jan. 2020 attack those with a suspected TBI were put on bed rest. That formal order ended up being critical to five members of the unit being presented with the Purple Heart.

The MACE exam determined that he had suffered a mild TBI. He later became sensitive to light, particularly blue light, and couldn’t even glance at a computer screen. When he submitted a unit member for the Purple Heart, a medic had to type it for him. When he had to coordinate an aircraft, his commander assisted.

“I was in Iraq for two months injured,” Meehan says. “I just would lay somewhere covering my eyes and tell people how to do the work for me. And so eventually, they were like, ‘OK, you’re not getting better. We can do this without you now.’”

Meehan was medically evacuated to Landstuhl Regional Medical Center in Germany. From there, he had the option to undergo extended care at Landstuhl or transition to Walter Reed National Military Medical Center in the states.

He was an inpatient for just under 30 days at Walter Reed. After transitioning to outpatient status, COVID-19 pandemic lockdowns hit the United States, and he was deemed a “noncritical patient.”

“Much of what I learned about TBI was through self-discovery because I didn’t really have appointments other than virtual checkins,” Meehan said.

The New Hampshire Guard put Meehan on medical orders, and he said it became his and his family’s “full-time job to find a way forward.”

“Because even at that point, I still had really crazy headaches, brain fog, not being able to focus completely on things,” Meehan recalls. “And so, it was really a weird sensation. And light, I was very light-sensitive.”

Eventually, he left Walter Reed, and with financial assistance from the Semper Fi and America’s Fund, received treatment at the International Institute for the Brain in New York. There, he found Dr. Victor Pedro, the institute’s chief innovation officer.

“He basically told me that the reason I was still having trouble was because of the connection between my brain and my eyes,” Meehan said.

He spent a year-and-a-half relearning how to focus as part of his recovery. This also was his path back to the pilot seat, along with an “eight-hour battery of neuro exams” at Walter Reed.

TBI is an ‘umbrella term’ used to describe a force applied to the head directly or ‘transmitted through the body.’

—Col. Michael Jaffee (Ret.), the chair and professor of neurology at the University of Florida College of Medicine

Not long ago, there were two very different schools of thought related to TBI, Jaffee says. Some believed it was a variant of post-traumatic stress, while others believed anything happening to an individual was related to a head injury.

“One of the things we went through early on was being able to recognize this was a legitimate concern and there were some people who weren’t as convinced,” Jaffee said.

But roughly half of the men and women injured in a combat setting met the criteria for both TBI and PTSD, according to Jaffee. “We found that what was needed was a treatment plan that addressed both,” he says.

Today, there is also a focus on battlefield monitoring and risk mitigation. During a May 2025 House Appropriations Committee Oversight Hearing, Rep. Joseph Morelle, D-N.Y., questioned Gen. Randy George. Army chief of staff, about blast overpressure, TBI and plans for “accelerating development” of deployable and reliable blast-monitoring devices.

“I know we’ve made some progress, but as I understand it there remains no standardized field deployable device to monitor or record blast exposure in real time,” Morelle said. “And that leaves Soldiers … vulnerable and under diagnosed as I understand it.”

George said special mission units and U.S. Special Operations Command are working on the issue, including testing.

“I think the biggest thing is figuring out how we change the training,” he said. “How can we adjust training? And then we are all looking at everything from helmets — how are helmets designed? What’s the padding inside the helmets, you know, what are the individual detectors?”

Pinto says regulations are being put in place, like reshaping breach charges for special operations and combat engineers, to “produce less of a blast impact.”

One challenge that accompanies TBIs is the lack of physical effects, according to Jaffee, which prompted the term “invisible wound.”

That’s where people like Army veteran Victor Medina, who founded the TBI Warrior Foundation, come in. His own life changed in June 2009 when an explosive projectile hit his vehicle during a resupply mission.

He had “hours of loss of consciousness” and was diagnosed with a moderate TBI. Though fully independent today, his rehabilitation took about three years.

“It was very challenging because at the beginning, I could barely do anything on my own, barely walk independently on my own,” says Medina, who served three combat tours and medically retired in 2012. “I could not eat on my own. I could not use the bathroom on my own.”

But he pushed through, returning to school and earning a master’s degree in rehabilitation counseling, because of support at home and from health care providers.

“It’s just to prove with the right support in place people can be successful,” he says.

Since its inception, Medina said his foundation has helped more than 13,000 people through providing assistive devices, assisting with healthcare and counseling, and aiding with caregiver respite.

For Meehan’s part, his advice related to TBI for incoming service members was simple — trust yourself.

“You’re the best advocate for yourself and knowing what’s going on,” he says. “So many people out there are willing to help you.”

He credited the New Hampshire Guard, doctors across military and civilian medical systems, veterans groups and others for assisting him through his own journey.

“It took an army of people to get me here, both my persistence and other people’s ability and knowledge that got me to be able to fly,” Meehan says.

KARI WILLIAMS is a freelance writer who specializes in military matters. She can be reached via [email protected]. 

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AT A GLANCE

TBI Signs, Symptoms &  Operational Consequences

Signs: What May be Seen at Time of Injury

• Slow to get up
• Confusion
• Blank or vacant look
• Stumbling
• Labored movements
• Inability to respond appropriately to questions

Symptoms: What a Service Member May Report

• Headache
• Visual disturbances
• Ringing in the ears
• Dizziness/balance problems
• Nausea/vomiting
• Memory problems
• Difficulty concentrating
• Irritability

Operational Consequences

• Poor marksmanship
• Slower reaction time
• Decreased concentration
• Decreased situational awareness
• Difficulty performing quickly under pressure
• Difficulty multitasking

Three Degrees of TBI

Mild TBI/Concussion: Confused or disoriented state that lasts less than 24 hours; or loss of consciousness for up to 30 minutes; or memory loss lasting less than 24 hours.

Moderate TBI: Confused or disoriented state that lasts more than 24 hours; or loss of consciousness for more than 30 minutes, but less than 24 hours; or memory loss lasting greater than 24 hours but less than seven days; or meets criteria for mild TBI except an abnormal CT scan is present.

Severe TBI: Confused or disoriented state that lasts more than 24 hours; or loss of consciousness for more than 24 hours; or memory loss for more than seven days.

Source: Defense Health Agency's Traumatic Brain Injury Center of Excellence