BALAD, Iraq — Pvt. Hosea Pierce has been hit by roadside bombs six times. Another 18 explosions have hit near him.

But the resulting “headaches” weren’t enough to get him to the doctor, said the 1st Battalion, 8th Cavalry Regiment soldier.

“This was decided for me,” said Pierce of his visit to the Air Force Theater Hospital in Balad and follow-up trip to Kuwait. “I was stubborn.”

He doesn’t want to leave Iraq until his time’s up in December, said the 25-year-old from West Palm Beach, Fla. “I just want to do my job. I’m holding out.”

This is a familiar story, said Maj. Connie Johnmeyer. Soldiers exposed to multiple blasts are often reluctant to leave the war — even if they may be suffering from traumatic brain injury, said the 54-year-old Air Force psychologist from Fayette, Mo.

“Some of the soldiers have been sitting on symptoms quite a while,” said Johnmeyer. “They have really lost functioning, but are set on not leaving their people.”

Soldiers have even gone so far as to try and memorize the answers on the aptitude tests to pass and return to their unit, she said. “They get very upset when we change the questions or change the order that we ask them,” Johnmeyer said. “You can see them struggling.”

Johnmeyer and the 332nd Medical Group staff at the Air Force Theater Hospital’s mental health clinic see all of Iraq’s TBI cases. There were 105 cases in September. Another 630 cases were seen in the six months between March and August.

TBI is a fancy term for concussions, Johnmeyer said, and symptoms include headaches, dizziness, memory loss, visual problems, irritability and temporary or permanent loss of brain function.

It has become “the signature injury of the war” for several reasons, she said. Most combat injuries are the result of roadside bombs, and — depending where they are stationed — soldiers may have several run-ins during a deployment. And while up-armored vehicles and body armor help soldiers survive them, the soldiers are still taking explosions at close-range.

“The multiple nature of it is unprecedented,” Johnmeyer said. “People just get blasted, and blasted and blasted.”

Maj. Barbara Severson-Olson also calls TBI the war’s “hidden injury.”

“People walk away from these attacks. They’re not bleeding and they don’t appear cut,” said Severson-Olson, who also works with TBI patients. “They don’t want to see the doctor. Sure, everyone wants to go home, but they want to go home when their unit goes home.”

This contradicts the belief held by soldiers that TBI isn’t a “real” injury or that those who seek treatment are trying to get out of their service, said Sgt. Gary Scott. “I haven’t seen any fakers,” said Scott, 38, of Bay City, Texas. “The overwhelming majority — 98 percent — wants to return to the field.”

While there is always some “malingering,” there are far more cases of those trying to downplay their illness, Johnmeyer said. Diagnosis is often reliant on aptitude tests, as CT scans aren’t sensitive enough to show a mild concussion, Johnmeyer said.

To further quantify the injury, the Army, and now the Air Force, is giving servicemembers brain scans before they deploy.

Scott has worked with patients who can’t even remember their children’s names weeks after the blasts, he said.

“I see how they function and I feel so bad,” Scott said. “I watch them struggle to remember because they know it’s important to them.”

“It’s heart wrenching,” Johnmeyer said. “These young people all have plans for what they want to do after the war. And when they find they can’t learn as quickly, it worries them a lot.”

The older patients want to return to the front to “keep their units out of danger,” said Severson-Olson, 48, of Salinas, Calif.

“They are very loyal to younger people in their unit,” said Severson-Olson. “But they need to care for themselves now, while they still can.”

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