They are the pride of America, returning soldiers from the conflict around the world. Just the sight of one of these brave heroes in uniform makes our hearts swell knowing the sacrifices and hardships they have given for our freedom. But at what price?

Just because the soldier next to you appears to show no outward wound, that may not mean everything is well. It’s quite possible he or she is suffering from what is pervading our returning soldiers who have experienced battle concussions — TBI or Traumatic Brain Injury. Sadly, they may not know themselves of the hidden demon that could be affecting their daily lives.

This is the disturbing world of TBI and more soldiers than ever are facing this diagnosis. Since September 11th, 2001, 1.6 million U.S. troops have been deployed in Afghanistan, Iraq, and the Persian Gulf with 17 percent returning with TBI and as many as 30 percent returning with symptoms of Post Traumatic Stress Disorder (PTSD).

How does one know they are experiencing TBI? The symptoms are different from case to case and not always obvious. A brain injury in itself can be difficult for the patient to be aware of the injury, and to make matters more complicated the addition of combat duty can create overlapping symptoms of PTSD. The two often go hand in hand with similar symptoms, but they are different conditions. TBI is a physical condition affecting the brain while PTSD is a psychological condition brought on by the stress of battle.

TBI is still being evaluated by scientists. This means the returning soldier most likely will go undiagnosed and under treated. TBI patients are at a heightened risk for developing a host of physical and mental symptoms including both short and long term PTSD; months or even a lifetime of depression, memory loss, inability to concentrate, irritability, sleep problems, flashbacks etc.

The Armed Forces Foundation (AFF) is working with Give an Hour to develop a national network of mental health professionals that will provide free counseling to Service Members and their families. Over 1,000 counselors have volunteered to donate an hour per week to aid the psychological needs of our nation’s armed forces community.

“Our partnership with Give an Hour allows our organization to address one of the most difficult problems confronting Service Members when they return from combat,” said Patricia Driscoll, President of the Armed Forces Foundation.” The Armed Forces Foundation is attempting to take a proactive stance to educate the public on the need to effectively treat TBI and PTSD within the military community.”

Each war has its signature wound, In World War I, it was poison gas damaged lungs, in World War II it was radiation that caused cancer, in Vietnam, it was Agent Orange that caused neurological damage and skin disorders and for the Afghanistan and Iraq conflicts it is TBI.

Roadside bombs, called improvised explosives (IEDs) account for almost 80% of all wounds to troops and 95% of TBI injuries. The shock wave from just one IED can damage brain tissue. Since August 2007, when screening for TBI, 83% of wounded troops were diagnosed with TBI, the largest group being 21 year olds.

The world took notice when Bob Woodruff, anchor for ABC News was injured in Iraq by an IED. His personal experience exposed the country to the issues of soldiers with TBI. Woodruff took up the cause for his fellow injured Americans and became an advocate for the soldiers. The Bob Woodruff Family Foundation assists service members injured while serving in the United States Armed Forces with special emphasis on the “hidden signature injuries” due to combat overseas, this includes TBI and PTSD.

How prevalent is TBI among returning Service members? Statistics show that more than 150,000 troops may have suffered head injuries in combat. Many are not reported.

Screenings at military bases nationwide are showing up to 20% of returning troops have suffered some level of TBI from mild to moderate to severe.

One in every nine American soldiers deployed to Iraq suffers a TBI.

The cost of treating someone with TBI can range as high as $5 million dollars during a lifetime.

What does a loved one with a returning soldier look for? Many TBI sufferers will have outward physical indicators, but what about the silent symptoms, the emotional and cognitive behaviors that can not be identified externally?

It is vital that family members become educated for what signs to look for in case of a TBI. Symptoms can include: fatigue, headaches, visual disturbances, memory loss, poor attention/concentration, sleep disturbances, dizziness/loss of balance, irritability-emotional disturbances, feelings of depression, seizures, nausea, loss of smell, sensitivity to light and sounds, mood changes, getting lost or confused and slowness of thinking. These symptoms may not be noticed at the time of injury and may be delayed for days or weeks before they appear. That’s why TBI is often missed by attending physicians because the person looks normal in spite of not feeling or thinking normal.

There is help. The Armed Forces Foundation was established in 2001 to assist the military community and their families with difficult circumstances by offering a variety of programs. The AFF is contacted by individuals and families from the military community who require some form of assistance or wish to utilize one of their 14 programs. AFF facilitates the process by referring them for clinical treatment. The foundation also provides additional assistance after treatment such as “Morale, Welfare and Recreation program” which offers fun activities that provide a therapeutic, morale boosting environment as well as their Outdoor Sports Program which offers wounded Service Members the opportunity to participate in hunts and fishing expeditions.

The sad part is many states do not have a single brain-injury rehabilitation center and of those, few that do provide little assistance even for the basic level of care. Thankfully Mississippi has a comprehensive rehabilitation hospital, Methodist Rehabilitation Center in Jackson which features programs specifically designed to treat people who have had a stroke, brain, or spinal injury. This facility has been named one of only 16 Traumatic Brain Injury Model Systems in the nation, putting Mississippi at the forefront of exciting improvements in the treatment of brain injuries.

The facility exists because of the late Sen. Clyde Woodfield from Gulfport, Mississippi who expedited the creation of the center. His son, Mike, was the first patient of the facility due to the injuries suffered in a motorcycle wreck which required him to need around the clock care.

The problem with TBI is that even with facilities and programs to assist, the victim of TBI may never seek out the help. We as a supportive community must be aware ourselves of the issues that face our young men and women as they return.

Can TBI be fatal? In a way, yes. The suicide rate among active duty soldiers for 2007 reached their highest level since records began. According to the Medical Journal of Australia, people with TBI have an increased risk of suicide, suicide attempts and suicide ideation compared with the general population.

If you or someone in your family has had a possibility of a TBI event, such as a fall, combat duty, a wreck, or even a stroke that may have not left physical scars, the person you love could be experiencing symptoms related to TBI.

The problem is, you have to be aware there is a problem.

Information for this article has been provided by Doug Stone, Public Affairs Specialist Armed Forces Foundation. Thanks to AFF and Give an Hour for their work with our American heroes!!

Tracy Williams is a freelance media consultant/columnist and can be reached at tracywilliams1999@comcast.net