ABOUT THE AUTHORS: Mariannette Miller-Meeks, a Republican, represents Iowa’s 1st Congressional District in the U.S. House of Representatives. Jen Silva is the chief program officer of Wounded Warrior Project.
“I began to fall into a depression, believing that I was a burden and that the meaning I had built my life around — service, responsibility, and usefulness — was lost.”
With those words, Marine Corps veteran Buster Miscusi described a reality far too familiar to many veterans. Despite diagnoses, medications, and appointments, his life was unraveling under the weight of severe headaches, cognitive decline, emotional instability, and a mind that no longer functioned the way it once had prior to his injury in uniform. His story resonated deeply as he testified before the House Committee on Veterans’ Affairs subcommittee on Health in March, illuminating the hidden brain injuries as a result of his service that reshaped his life.
Buster is not alone. His experience reflects the growing understanding that traditional definitions of brain injury have not kept pace with the demands and exposures of modern military service. For decades, traumatic brain injury (TBI) meant only one thing: a severe blast that caused someone to black out and left obvious, visible signs of injury. Just as critical, and completely unseen at the time, were the invisible injuries caused by low-level blast pressure. This is exactly what Buster described as he recounted his service. He had never been knocked unconscious by an explosion and never imagined he could have a TBI.
What he experienced was something far more common and far less understood: years of repeated exposure to blast overpressure. Thousands of mortar rounds. Countless detonations. Low-level blasts once considered routine and harmless. Headaches were dismissed. Confusion was minimized. Symptoms were often attributed to stress or culture rather than injury.
Today, emerging science is validating what veterans like Buster have long described. Brain injuries do not always result from a single event. Repeated low-level blast exposure can cumulatively disrupt brain function, leaving lasting cognitive, emotional, and neurological effects. Yet despite growing evidence, research has not fully translated into the answers, diagnostics, and treatments veterans urgently need.
Providers are doing their best within the bounds of current science, but a gap remains between the lived experiences of veterans and the medical certainty needed to diagnose and treat these invisible injuries effectively.
That gap was brought into sharp focus during the Subcommittee on Health’s recent hearing, when veterans spoke openly about years of misdiagnosis, frustration, and decline before finally receiving appropriate care. Their testimony was clear: research, policy, and practice must evolve to reflect the consequences of modern military service and modern warfare.
Similarly, as veterans began to experience post-traumatic stress disorder, the invisible wounds of service were dismissed or mischaracterized because science had not yet caught up with the lived experiences of those who served. Only after listening to veterans did the nation — and the Department of Veterans Affairs — begin to recognize PTSD as a legitimate, diagnosable condition that demanded research and treatment and could be cured, or at the very least mitigated so that veterans can live comfortably after their service in uniform.
The effects of TBI deserve the same attention from a modern VA. Evidence is already emerging that injuries caused by repeated, low-level blast exposure carry real and lasting consequences on a veteran’s overall health.
In coordination with the Department of War — and VA — today’s service members do have access to better prevention and exposure tracking as a result of their military service. However, for the thousands of post-9/11 veterans already living with the effects of repeated blast exposure we must continue to raise awareness on this issue and ensure that VA, and DOW, have the right tools at their disposal to continue to effectively research, track, and treat brain injuries.
The Precision Brain Health Research Act builds on that progress. With our backing, this bill would direct the VA, in partnership with the National Academies, to continue to look at how repetitive, low-level blast exposure affects veterans’ brain function. Its goal is to deepen understanding of blast exposure, improve diagnostics for patients, and better equip clinicians to care for today’s and tomorrow’s veterans — like Buster — who will live with these injuries.
Through access to programs like UCLA’s Operation Mend, Wounded Warrior Project’s Warrior Care Network, and supported by VA, Buster Miscusi and thousands of other veterans living with brain injuries can get the care that recognizes the reality of their brain injury. Buster’s symptoms did not disappear, but they were understood. By developing a comprehensive treatment plan that worked for Buster and his family, his injury from his military service was better understood, and treated as a survivable wound — not a death sentence.
That care, attention, and understanding gave Buster his life back. We must continue to build up programs like these — both inside and outside VA — so that veterans like Buster can access the care they need to live their lives to the fullest.
Modern warfare has changed, and the resources service members and veterans rely on both in uniform and after they hang up their uniform must evolve with it. Brain health is not a niche concern; it affects readiness, long-term health, family stability, and the futures of those who have served.
The wounds may be invisible, but the responsibility to address them is not.
America’s veterans served without hesitation. Our nation has an obligation to ensure that science, care, and policy meet veterans where they are, so that no veteran is left struggling in the dark with an injury from their service that we have the power to understand.
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