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An airman who endured a long battle with physical and mental conditions from traumatic brain injury is grateful for the efforts of his Military Health System healthcare team whom he says saved his life. He’s now running 100 miles a week, taking part in marathons, and remains on active duty with the U.S. Air Force.
Often called the hidden disease of recent battlefields, any TBI can bring on balance, vision, and hearing injuries, which can be very difficult to detect and diagnose.
There could be “multiple different medical disciplines that are involved” in diagnosing and treating a service member with suspected TBI, said Chrystyna Rakoczy, an optometrist who has worked with TBI-injured service members since 2009 at the Defense Health Agency’s Vision Center of Excellence and the Department of Veterans Affairs James A. Haley Veterans' Hospital in Tampa, Florida. These experts diagnose through painstaking and thorough detective work that is individual to each patient.
“The dysfunctions that are caused by TBI you have to proactively look for,” explained Rakoczy. “The symptoms are not obvious, and routine testing does not easily elicit these dysfunctions.”
Airman’s Medical Issues
After he experienced a 30-meter fall in a parachute-training accident, “the airman had a lot of difficulty walking a straight line, he couldn't run anymore, he couldn’t move his head without getting dizzy or having his vision blurred, and he was having difficulty sleeping,” Rakoczy recalled. Over time, he also developed numbing pain in his hands and shoulder problems.
The airman dealt with sensory problems for a decade while he sought help for his symptoms.
“He had seen a number of ophthalmologists, neuro-ophthalmologists, neurologists, [and] optometrists,” Rakoczy said. “Eventually, they all sent him to psychiatry, and [he] was put on medications for mood and sleep disorders.”
‘Very Diagnosis-Driven Evaluation’
No single strategy works for TBI recovery, according to Rakoczy. “You have to work individually with every patient, and it has to be a multisensory approach; it has to be interdisciplinary teams working together.”
After an initial review at Tampa, the airman was diagnosed with a continuing mild TBI.
A physical therapy team found he had “benign positional paroxysmal vertigo, which is basically a dislocation of the otoliths within the inner ear canal,” Rakoczy said. Otoliths are gravity-sensitive organs that help orient your body’s awareness of space and movement.
A common symptom of BPPV is a spinning sensation (vertigo) or dizziness, triggered when the head is moved into certain positions.
Test Examines Sensory Interactions
A posturography test, which assesses balance by measuring a person's ability to remain in a stable position under different conditions, showed while walking the injured airman “would veer off to one side or another, and that his entire body composition was pretty stiff … he had no ability to right himself,” Rakoczy said.
The test helps to diagnose this type of balance disorder by placing the patient on a platform to evaluate their response to different movements on the platform—inner ear, vision, and touch.
The airman was sensing motion in his sight, but “his body would automatically feel the motion and he would not be able to keep his body in a straight position or in a stable position,” explained Rakoczy. Essentially, he would fall down if not attached to the equipment.
He was treated with the Epley maneuver, a series of simple side-to-side movements of the head while sitting, lying down quickly, and turning over 90 degrees, which can reposition the otoliths.
Vision Team’s Diagnosis
Rakoczy’s vision team examined the airman after he completed the maneuver because he reported continuing visual issues.
His ease in being able to converge and diverge his eyes to focus on a single object “was very poor,” said Rakoczy. Our eyes are constantly diverging and converging, which, when accurate, “gives us a sense of balance,” she said.
After considering all the data gathered through his treatment, including recreational and dance therapy, the vision team prescribed prescription eyeglasses that can bend light in one direction.
At a follow-up session, the airman “was completely normal” with all his vision and balance testing.
“His [eyes’] ability to converge and diverge and his efficiency to converge and diverge had normalized completely,” Rakoczy said. “His headaches went away. He was sleeping better.” He also no longer needed medication, Rakoczy added.
Latest TBI Numbers and Early Identification
TBIs range from mild (concussion) to severe and can happen on- or off-duty.
Stephanie Maxfield Panker, clinical affairs section chief of the DHA’s Traumatic Brain Injury Center of Excellence Research and Engineering Division, who holds doctorates in neuroscience and physical therapy, said there were 515,885 service members diagnosed with TBI between calendar years 2000–2024.
Further insights from a data subset of 135,853 service members diagnosed with first-time TBI between calendar years 2017-2023 illustrate the relationship between TBI diagnosis and vestibular, hearing, and vision issues:
• 26.1%, or 35,449 individuals, reported vestibular-related issues after their TBI diagnosis
• 21.8%, or 29,582 individuals, were diagnosed with hearing-related issues
• 18.9%, or 25,716 individuals, had visual issues
Mild TBIs may result from blows or jolts to the head during motor vehicle accidents, sports, and military training, among other causes. TBIs may resolve quickly, while others linger, depending on the individual, the source of the TBI, the person’s duties in their branch of the military, and the exact location of the injury in their brain.
While the airman’s case was worked up nearly 10 years after his initial TBI diagnosis, service members should report any suspected brain injury as soon as possible to avoid long-term issues.
“Early identification, evaluation, and appropriate management are keys to the best chance for a service member who has sustained a concussion to return to activity and duty as quickly as possible,” Panker said.
A TBICoE comorbidities dashboard for 2017–2019 is published on the CarePoint Information Portal, available via CAC. An updated dashboard with data from 2017 through 2023 is under development.
Select Resources
VA/DOD Clinical Practice Guideline for Tinnitus
VA/DOD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury Progressive Return to Duty Care for Acute Concussion Management
Vestibular Clinical Practice Guidelines
Aural Blast Injury and Trauma Clinical Practice Guidelines
Feeling Dizzy? Get Treated to Get Back in the Game
Vision and Hearing Health: Vital to Military Readiness
Assessment and Treatment of BPPV
2024 TBICoE Annual Report
2023 HCE Hearing Health Report
How Concussions Can Be Treated
| Date Taken: | 06.05.2025 |
| Date Posted: | 06.05.2025 15:15 |
| Story ID: | 499740 |
| Location: | US |
| Web Views: | 50 |
| Downloads: | 1 |
This work, Innovative Traumatic Brain Injury Care Leads to Service Member Recovery, by Janet A. Aker, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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