Iatrogenic Risk in the Management of Mild Traumatic Brain Injury among Combat Veterans: A Case Illustration and Commentary

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The assessment of mild traumatic brain injury (mTBI) among combat veterans of the Iraq and Afghanistan wars is a major challenge. Recently, clinicians within the United States Veterans Administration Health System have expressed concern for potential iatrogenic disability related to outreach efforts to identify veterans with possible mTBI.

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We describe a veteran with a history of mTBI sustained during combat who underwent repeated examination for cognitive symptoms reportedly due to mTBI, and with variable descriptions of severe peri-trauma characteristics attributed to blast exposure over multiple assessments. Repeat neuropsychological (NP) testing indicated, in general, minimal cognitive impairment and probable invalid performance on testing (e.g., poor effort). The consensus conclusion of several NP examinations attributed his cognitive complaints to psychiatric disturbance, including posttraumatic stress disorder, rather than brain dysfunction. Despite this, the veteran’s treating medical practitioners continued to infer mTBI as a source for his cognitive complaints and self-reported disability.

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