Iran war renews concerns about the lasting toll of traumatic brain injuries to US troops

WASHINGTON (AP) — When Joe Shearer was a Marine fighting in Iraq, a blast from an enemy mortar round knocked him down and made him vomit. He got up and kept going despite a searing headache.

When a roadside bomb struck his Humvee convoy months later, the explosion’s shock wave swept through his body before headaches and sleeplessness set in for days.

“As long as you got back up and could go back on patrol, that’s kind of what you did,” he said.

Shearer, 40, of Colorado Springs, Colorado, links both events in 2005 to traumatic brain injuries, which were only recently diagnosed. He’s still plagued with symptoms ranging from dizziness and migraines to forgetting daily tasks and responsibilities to his wife and children.

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EDITOR’S NOTE — This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

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The lasting effects of traumatic brain injuries are raising fresh concerns about the toll of the Iran war on American troops who are suffering those wounds during a conflict without a clear end. Nearly 700 U.S. service members have been wounded by drone and missile attacks on bases in the Middle East and other fighting. Most have experienced traumatic brain injuries and returned to duty, according to public statements from military officials.

The Pentagon’s chief spokesman, Sean Parnell, last month called the vast majority of injuries over a two-week period “minor concussions.”

Doctors can’t predict who may have lasting effects from a TBI

Concussions often are termed “mild” TBIs, and many people recover within weeks. But sometimes those with seemingly mild initial symptoms go on to have problems persisting for months or years, such as headaches, dizziness or difficulties with memory or attention that’s sometimes called “brain fog.”

Doctors have no way to predict who will suffer lasting problems, a vexing enough question that there’s medical debate over whether to retire the term “mild TBI.” Repeated blows are known to increase the chances of lasting problems, including a degenerative brain disease called chronic traumatic encephalopathy, or CTE. It has gained attention for links to deaths in the National Football League and other sports.

It’s imperative that people recover from a concussion before doing activities that put them at increased risk of another, said Dr. David Okonkwo, a University of Pittsburgh brain trauma specialist.

Doctors also are still learning how explosive blasts injure the brain versus a physical blow.

“The blast wave itself can be injurious,” said Dr. James Kelly, an emeritus professor of neurology at the University of Colorado School of Medicine and chief medical scientist at the Invisible Wounds Foundation, which is focused on military brain injuries. “It’s a different cellular injury. Blast is a different thing than a blunt injury to the head.”

Troops have been facing a new type of warfare with Iran in which drones may explode closer to their heads, as opposed to the ground-level roadside bombs and improvised explosives that were more common in the wars in Iraq and Afghanistan.

Democratic lawmakers are calling for an Iranian drone strike in Kuwait that killed six U.S. soldiers early in the war. Wisconsin Sen. Tammy Baldwin pressed the military in a letter on Wednesday to release the findings of its investigation into the March 1 attack.

“I spoke directly with Wisconsinites who sustained traumatic brain injuries from (President Donald) Trump’s war in Iran and went weeks without so much as a screening, let alone specialized care, for their injuries,” Baldwin said in a statement.

Defense Health Agency spokesman Peter Graves said in an email that “it is policy that service members are screened for TBI.”

Experts say the military has made strides in screening and treating TBIs, a signature injury in Afghanistan and Iraq. More than 500,000 service members were diagnosed between 2000 and 2025, with 82% of cases considered mild and not all of them related to combat. But advocates say the injuries could still be undercounted because symptoms often overlap with post-traumatic stress disorder and other conditions.

A TBI diagnosis can emerge years later

Neither of the two blasts Shearer experienced in Iraq produced obvious injuries, and medics prioritized Marines who were more badly hurt.

“You don’t want to be the guy who goes to sick call or says, ‘Oh, I’m hurt,’ because you’re away from your team,” Shearer said. “There’s this culture of you don’t want to be seen as lesser or weak, so you hide injuries inherently.”

When he came home at age 19, he denied he had PTSD and didn’t know what a TBI was. Plagued by nightmares, sleeplessness and headaches, he initially turned to drugs to self-medicate and considered suicide.

Shearer eventually got help for PTSD, but it took years for him to consider that he suffered traumatic brain injuries. He was working for the Wounded Warrior Project and screening fellow vets for TBIs when he realized he checked many of the same boxes.

He’s since been diagnosed and received treatment. But challenges remain, including vertigo and light sensitivity. He also forgets important conversations with his family.

“I know that some of that stuff is stereotypical, but for me, it’s got a different ring to it,” Shearer said. “There will be no memory of the conversation happening.”

The brain can adapt with treatments and therapies

Memory loss is something Army veteran Frank Sonntag also experienced following a TBI from a mortar blast in Iraq in 2004.

He was in his 50s and training reservists when he felt a blast of wind against his ear from an explosion 70 feet (21 meters) away. He didn’t know he was hurt and didn’t seek treatment for two years, ignoring intensifying headaches and brain fog.

It got to the point where it took 30 minutes to write an email, while colleagues told him he spoke one word every 10 seconds. He considered suicide and was diagnosed only after he got lost driving home. Neurologists prescribed medication for his migraines, among other treatments.

“Speech therapy was one of the greatest things I had,” added Sonntag, 75, of Queen Creek, Arizona. “They taught me how to practice the words I was speaking and how to put sentences together again.”

Kelly Parker, director of independent services at the Wounded Warrior Project, said it’s hard to predict an injury’s trajectory.

“If you’ve seen one TBI, you’ve seen one TBI,” she said.

Screening, early treatment and support can be crucial to returning to a more normal life. Physical, speech and art therapies can lead to improvements, she said.

“There’s still so much we don’t know about the brain, but one thing that we do know is it can heal itself,” Parker said. “We know that new neural pathways can be created, and we absolutely believe that the brain can adapt. We’ve seen it happen.”

Army veteran Spencer Milo said some people struggle to understand why he’s still dealing with migraines, seizures and forgetfulness after so many years out of uniform.

His first TBI occurred in Iraq in 2008, when his Humvee smashed into a wall to evade fire. His second came from the blast of a suicide bomber in Afghanistan in 2011.

“I’ve had fellow service members that were even with me on those days, and they’re like, ‘Dude, why can’t you just kick it?’” said Milo, 41, of Parker, Colorado. “I really wish it was that simple. It’s tough because when you can’t see something, it’s hard to believe that it’s really there.”