A New Disability for Rehabilitation Counselors: Iraq War Veterans with Traumatic Brain Injury and Post-Traumatic Stress Disorder

By Burke, Hillary S.; Degeneffe, Charles E. et al. | The Journal of Rehabilitation, July-September 2009 | Go to article overview

A New Disability for Rehabilitation Counselors: Iraq War Veterans with Traumatic Brain Injury and Post-Traumatic Stress Disorder


Burke, Hillary S., Degeneffe, Charles E., Olney, Marjorie F., The Journal of Rehabilitation


In 2002 and 2003, the George W. Bush Administration stressed that Iraq posed a danger to the safety and security of the United States through the fear that Iraq was developing an arsenal of chemical, biological, and nuclear weapons. The United States and its allies subsequently invaded Iraq in March 2003 and this conflict, commonly referred to as the "Iraq War," continues into its sixth year (Wong, 2008).

The United States has incurred massive human and financial expenditures through its involvement in Iraq. It is estimated that total spending on the Iraq war will cost the United States up to $3 trillion to fund current military operations along with the expenses of paying the long-term disability costs of injured military personnel, death benefits sent to the families of those killed in Iraq, and interest fees paid by the United States Treasury to borrow money to fund current expenditures (Bilmes & Stiglitz, 2008). More importantly, as of October 4, 2008, a total of 4,169 United States military service members have lost their lives in this conflict (U.S. Department of Defense, 2008). Further, the organization "Iraq Body Count" estimates that through mid October 2008, 88,373 to 96,466 Iraq citizens have been killed since the March 2003 invasion (Iraq Body Count, 2008).

The American public as well as rehabilitation professionals are increasingly developing awareness of these realities. In addition to television programs, newspaper stories, and radio shows, an especially effective source of awareness are first-hand accounts of the horrors and aftermaths of combat chronicled in such books as In An Instant: A Family's Journey of Love and Healing (Woodruff & Woodruff, 2007) and Rule Number Two." Lessons I Learned in a Combat Hospital (Kraft, 2007). Such accounts educate readers that those who are fighting in Iraq face the significant potential of incurring a chronic disability or illness. Two of the most common chronic conditions now experienced are traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

TBI and PTSD are commonly referred to as the "signature" injuries of military personnel serving in the Iraq War (Fairweather & Garcia, 2007). The need to develop and facilitate specialized care and rehabilitative services for veterans impacted by this modern disability is of paramount importance. An estimated 22% of all Operation Iraqi and Enduring Freedom (OIF/OEF) combat injuries involve some form of brain damage (Summerall, 2008). Also, the California Community Foundation (2008) estimates one in five service members who engaged in OIF/OEF military operations develop PTSD or major depression.

The unique nature of how military personnel incur combatrelated injuries presents the emergence of a new disability for rehabilitation counselors and other health professionals to confront. Many combat-injured military personnel are returning from the Iraqi conflict with the simultaneous onset of both TBI and PTSD. Volatile combat conditions, which frequently entail the infliction of blast-related polytrauma, increase military personnel's likelihood to experience both conditions (Kennedy et al., 2007). Living with both disabilities presents a unique array of challenges that is distinct from singularly living with either TBI or PTSD.

The purpose of this article is to help prepare rehabilitation counselors and other professionals to address the unique needs of this emerging client population for vocational rehabilitation, independent living, and family support. Specifically, we will provide (a) an overview of the injury sequelae of TBI and PTSD, (b) the challenges in living with TBI combined with PTSD, and (c) available interventions and support services.

An Overview of the Injury Sequelae of TBI and PTSD

With over 1.6 million military personnel deployed in coordination with Operations Iraqi and Enduring Freedom (California Community Foundation, 2008), and close to 30,000 troops wounded in action (Defense Link, 2008) the need for optimal, specialized rehabilitation services for veterans impacted by the combination of TBI and PTSD is imperative. …

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