At least 20,000 U.S. troops who were not classified as wounded during combat in Iraq and Afghanistan have been found with signs of brain injuries, according to military and veterans records compiled by USA TODAY.
The data, provided by the Army, Navy and Department of Veterans Affairs, show that about five times as many troops sustained brain trauma as the 4,471 officially listed by the Pentagon through Sept. 30. These cases also are not reflected in the Pentagon's official tally of wounded, which stands at 30,327.
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The number of brain-injury cases were tabulated from records kept by the VA and four military bases that house units that have served multiple combat tours in Iraq and Afghanistan.
One base released its count of brain injuries at a medical conference. The others provided their records at the request of USA TODAY, in some cases only after a Freedom of Information Act filing was submitted.
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The data came from:
• Landstuhl Army Regional Medical Center in Germany, where troops evacuated from Iraq and Afghanistan for injury, illness or wounds are brought before going home. Since May 2006, more than 2,300 soldiers screened positive for brain injury, hospital spokeswoman Marie Shaw says.
• Fort Hood, Texas, home of the 4th Infantry Division, which returned from a second Iraq combat tour late last year. At least 2,700 soldiers suffered a combat brain injury, Lt. Col. Steve Stover says.
• Fort Carson, Colo., where more than 2,100 soldiers screened were found to have suffered a brain injury, according to remarks by Army Col. Heidi Terrio before a brain injury association seminar.
• Marine Corps Base Camp Pendleton, where 1,737 Marines were found to have suffered a brain injury, according to Navy Cmdr. Martin Holland, a neurosurgeon with the Naval Medical Center San Diego.
• VA hospitals, where Iraq and Afghanistan veterans have been screened for combat brain injuries since April. The VA found about 20% of 61,285 surveyed -- or 11,804 veterans -- with signs of brain injury, spokeswoman Alison Aikele says. VA doctors say more evaluation is necessary before a true diagnosis of brain injury can be confirmed in all these cases, Aikele says.
Soldiers and Marines whose wounds were discovered after they left Iraq are not added to the official casualty list, says Army Col. Robert Labutta, a neurologist and brain injury consultant for the Pentagon.
"We are working to do a better job of reflecting accurate data in the official casualty table," Labutta says.
Most of the new cases involve mild or moderate brain injuries, commonly from exposure to blasts.
More than 150,000 troops may have suffered head injuries in combat, says Rep. Bill Pascrell, D-N.J., founder of the Congressional Brain Injury Task Force.
"I am wary that the number of brain-injured troops far exceeds the total number reported injured," he says.
About 1.5 million troops have served in Iraq, where traumatic brain injury can occur despite heavy body armor worn by troops.