Understanding the Long-Term Effects of Traumatic Brain Injury in Military Personnel: Clayton Mucha, MD

Traumatic brain injuries (TBIs) remain an important concern among military personnel and veterans, with injuries potentially occurring through direct head impacts, concussions, and blast exposures. Although these injuries are typically associated with athletes participating in contact sports, military-related TBIs can present additional challenges, particularly when injuries occur alongside posttraumatic stress disorder (PTSD), chronic pain, sleep disturbances, and other physical injuries. These overlapping factors can complicate recovery and influence patients' cognitive function, physical abilities, and overall quality of life.

Research examining the long-term effects of TBI in service members and veterans has continued to provide insight into the relationship between deployment-related injuries, cognitive function, and other neurological outcomes. Longitudinal findings have also highlighted the importance of distinguishing an increased risk of persistent symptoms or neurodegenerative conditions from an inevitable outcome, emphasizing the need for comprehensive evaluations and continued follow-up.

In recognition of Veterans Day, NeurologyLive spoke with Clayton Mucha, DO, neurorehabilitation physiatrist at Burke Rehabilitation in New York, about the impact of TBI on military personnel and how these injuries may differ from those sustained in sports. In this interview, Mucha discusses recent research examining cognitive outcomes following deployment-related injuries, the role of interdisciplinary rehabilitation in supporting recovery, and why clinicians should remain attentive to the lasting effects of TBI, even years after an injury.

NeurologyLive: What impact can brain injuries have on military personnel, and how might their experiences differ from athletes who suffer from TBI or CTE?

Clayton Mucha, DO: There are certainly similarities between TBIs sustained during military service and those sustained in sports. Both can involve direct impacts to the head, concussions, and potentially repeated injuries. However, one important distinction in military personnel is the possibility of blast exposure, which can involve different mechanisms of injury compared with the blunt trauma we typically associate with sports-related concussions.

Another important consideration is the environment in which these injuries occur. Military personnel may experience repeated exposures, sometimes in combat settings, and recovery can be complicated by conditions such as PTSD, chronic pain, sleep disturbances, and additional physical injuries.

From a rehabilitation perspective, what matters most is understanding how all of these factors interact and how they affect an individual's cognition, physical abilities, and overall quality of life. Ultimately, while the mechanisms of injury may differ, our approach is still centered on understanding and treating the individual patient.

Is there any recent research specifically examining brain injuries in military personnel that has caught your attention and that clinicians should keep an eye on?

One area of research that I find particularly interesting is the work coming out of the Limbic Sync Research Consortium, which examines the long-term effects of traumatic brain injury in service members and veterans.

A study published in 2025 followed approximately 1,000 service members and veterans over 5 years. What was particularly interesting was that, although individuals with deployment-related mild TBI showed consistently worse outcomes on cognitive testing and measures of executive function, their cognitive performance tended to improve over time rather than progressively decline.¹

There was also another study published in 2026 that examined low-level blast exposure and its relationship with cognitive function. That study found that blast exposure alone was not independently associated with worse cognitive performance, but there were important interactions involving PTSD and TBI history.²

I think these studies highlight two important points. First, we should not assume that someone with a history of brain injury will inevitably experience progressive cognitive decline. Second, we really need to evaluate the patient as a whole. Cognitive symptoms can be influenced by multiple factors, not just a brain injury, but also PTSD, sleep disturbances, and chronic pain. From a rehabilitation perspective, that is why comprehensive evaluations and individualized treatments are so important.

What do we know about the potential consequences of repeated TBIs in military personnel, particularly regarding long-term cognitive function and neurological health?

We know that individuals who sustain repeated traumatic brain injuries may be at an increased risk for persistent neurological, cognitive, and behavioral symptoms. These can include difficulties with memory, attention, and executive function, along with somatic complaints such as headaches, dizziness, sleep disturbances, and difficulties with mood regulation.

There is also growing research examining associations between TBI and longer-term neurological conditions, such as dementia and other neurodegenerative disorders. However, I think it is important to distinguish an increased risk from an inevitable outcome. Not everyone who experiences repeated brain injuries will develop progressive cognitive decline or neurodegenerative conditions.

In fact, some of the recent longitudinal research we discussed suggests that cognitive performance can improve over time, even in individuals with a history of deployment-related mild TBIs. From a clinical standpoint, our priority is to recognize persistent or evolving symptoms, evaluate potentially treatable contributing factors, and ensure patients have access to appropriate rehabilitation and long-term follow-up. The goal is to help patients maintain their function, independence, and quality of life over time.

What are some of the key components of rehabilitation for military personnel recovering from TBI, and how can treatment be tailored to address each patient's symptoms and functional needs?

I think one of the most important principles of brain injury rehabilitation is that no two patients are exactly alike, even if they sustain similar injuries. First, we start with a comprehensive evaluation to understand the patient's cognitive symptoms, physical impairments, emotional health, and functional limitations. Equally important is understanding their personal goals and what activities they are hoping to return to.

Treatment often involves an interdisciplinary team. Physical therapy, for example, might focus on mobility, balance, and endurance. Occupational therapy would address daily living activities and functional independence. Speech-language pathology can help with cognitive and communication difficulties, and, at times, neuropsychology can assist with cognitive and behavioral concerns.

We pay close attention to the symptoms each veteran might have, whether they are physical, such as headaches, dizziness, sleep disturbances, or pain, because all of these can significantly influence recovery.

Here at Burke Rehabilitation, that interdisciplinary approach is central to how we manage patients with brain injuries. For one patient, the goal might be returning to independent walking. For another, it may be improving attention, memory, and organizational skills enough to return to work or manage daily responsibilities.

Ultimately, we are treating the individual, not just the injury. Our goal is to help patients regain their independence, participate in meaningful activities, and improve their overall quality of life.

As we recognize Veterans Day, what would you like clinicians to understand about the lasting impacts TBI can have on military personnel and the importance of continued care for these individuals?

If there is one message I would want people to take away this Veterans Day, it is that the effects of traumatic brain injuries are often not visible, and recovery does not necessarily end when someone leaves the hospital or returns home.

A veteran may appear physically recovered while continuing to experience difficulties with memory, concentration, headaches, or emotional regulation. These types of symptoms can have a meaningful impact on employment, relationships, and overall quality of life.

I think it is important that clinicians, families, and the public recognize these challenges, take them seriously, and understand that appropriate evaluation and treatment really can make a difference.

Even if an injury occurred years earlier, there may still be opportunities to address persistent symptoms, improve function, and help someone participate more fully in daily life. Ultimately, we want to make sure these veterans have access to the continued care and support they need and that they are not defined by their injuries.

Transcript edited for clarity.

REFERENCES
1. Martindale S, O’Connor V, Walker W, et al. Echoes of the Battlefield: Five-Year Longitudinal Cognitive Trajectories Show Trend of Recovery for Deployment-Related Mild TBI in the LIMBIC-CENC Cohort. Archives of Physical Medicine and Rehabilitation. 2025:106(10)1523-1530. doi: 10.1016/j.apmr.2025.04.009.
2. Martindale SL, Bailie JM, Miles SR, et al. Cumulative and Contextual Effects of Low-Level Blast Exposure on Cognitive Function in Military Personnel: Interactions With PTSD and Mild TBI. Journal of Head Trauma Rehabilitation. 2026;41(3)168–180. doi:10.1097/HTR.0000000000001107