Operation Enduring Freedom Research Articles

Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts: A Randomized Clinical Trial.

Despite the prevalence and the functional, psychological, and economic impact of chronic pain, few intervention studies of treatment of chronic pain in veterans have been performed. To determine whether a stepped-care intervention is more effective than usual care, as hypothesized, in reducing pain-related disability, pain interference, and pain severity. We performed a randomized clinical trial comparing stepped care with usual care for chronic pain. We enrolled 241 veterans from Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn with chronic (>3 months) and disabling (Roland Morris Disability Scale score, ≥7) musculoskeletal pain of the cervical or lumbar spine or extremities (shoulders, knees, and hips) in the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial from December 20, 2007, through June 30, 2011. The 9-month follow-up was completed by April 2012. Patients received treatment at a postdeployment clinic and 5 general medicine clinics at a Veterans Affairs medical center. Step 1 included 12 weeks of analgesic treatment and optimization according to an algorithm coupled with pain self-management strategies; step 2, 12 weeks of cognitive behavioral therapy. All intervention aspects were delivered by nurse care managers. Pain-related disability (Roland Morris Disability Scale), pain interference (Brief Pain Inventory), and pain severity (Graded Chronic Pain Scale). The primary analysis included 121 patients receiving the stepped-care intervention and 120 patients receiving usual care. At 9 months, the mean decrease from baseline in the Roland Morris Disability Scale score was 1.7 (95% CI, -2.6 to -0.9) points in the usual care group and 3.7 (95% CI, -4.5 to -2.8) points in the intervention group (between-group difference, -1.9 [95% CI, -3.2 to -0.7] points; P=.002). The mean decrease from baseline in the Pain Interference subscale score of the Brief Pain Inventory was 0.9 points in the usual care group and 1.7 points in the intervention group (between-group difference, -0.8 [95% CI, -1.3 to -0.3] points; P=.003). The Graded Chronic Pain Scale severity score was reduced by 4.5 points in the usual care group and 11.1 points in the intervention group (between-group difference, -6.6 [95% CI, -10.5 to -2.7] points; P=.001). A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain. clinicaltrials.gov Identifier: NCT00386243.

Personalized drinking feedback intervention for veterans of the wars in Iraq and Afghanistan: a randomized controlled trial.

Research has shown that U.S. military veterans are at risk relative to the general adult population for excessive alcohol consumption, and veterans of the wars in Afghanistan and Iraq (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and Operation New Dawn [OND]) particularly so. The purpose of this study was to examine the efficacy of a brief personalized drinking feedback intervention tailored for veterans. All veterans who presented to the OEF/OIF/OND Seamless Transition Clinic at the Harry S. Truman Memorial Veterans' Hospital (Columbia, MO) were eligible to participate. Participants were 325 veterans (93% male; 82% White, 75% Army, M(age) = 32.20 years) who were randomly assigned to one of two conditions: personalized drinking feedback (PDF) or educational information (EDU). Those in the PDF condition received personalized information about their alcohol use, including social norms comparisons, risks associated with reported drinking levels, and a summary of their alcohol-related problems. Follow-up assessments were completed at 1 and 6 months after intervention (response rates = 93% and 86%, respectively). Results indicated a significant (p < .05) Omnibus Group × Time effect for estimated peak blood alcohol concentration, although tests of simple main effects did not indicate between-group differences at the individual follow-up points. Among baseline abstainers, those in the PDF condition were more likely than those in the EDU condition to remain an abstainer at 6-month follow-up (p < .05). These findings provide preliminary support for the efficacy of a brief, inexpensive alcohol prevention/intervention for young adult military veterans.

Outcomes following Complex Combat-Related Lumbosacral Dissociation Injuries

Introduction As war injury patterns have changed throughout Operations Iraqi and Enduring Freedom (OIF/OEF), a relative increase in the incidence of complex lumbosacral dissociation (LSD) injuries has been noted. LSD injuries are an anatomic separation of the spinal column from the pelvis, and represent a manifestation of severe, high energy trauma. We assessed the clinical outcomes of combat-related LSD injuries after operative treatment. Methods We performed a retrospective review of all patients surgically managed for complex LSD injuries since the beginning of current combat operations in the Middle East. Results A total of 20 patients met inclusion criteria and were treated as follows: posterior spinal fusion (12), sacroiliac screw fixation (7), and combined anterior–posterior fusion (1). The mean age was 28.2 years. The most common mechanism of injury was mounted improvised explosive device (IED, 50%). On average, 2.2 spinal regions were injured per patient. Neurologic dysfunction was present in four patients. Three patients underwent operative stabilization of their injuries before evacuation to the United States. Median time to surgery from injury was 12 days (range, 0–111 days). There was a 20% wound infection rate. Median follow-up was 45.5 months (range, 23.2–105.3 months), and one-third of all patients were medically retired because of their injuries. At most recent follow-up, 45% complained of chronic low back pain and 35% had persistent neurologic deficits; however, 30% were actively engaged in strenuous physical activities, including swimming, distance running, and training for special forces. Conclusion This is the largest series of operatively managed lumbosacral dissociation patients currently reported. Our series suggests that combat-related lumbosacral dissociation injuries frequently result in persistent, long-term neurologic dysfunction, disability, and chronic pain. Operative management carries a high postoperative risk of infection. However, two-thirds of patients were able to remain on active duty after their injuries, and two patients were able to complete marathon training.

Auricular Acupuncture for Sleep Disturbance in Veterans With Post-Traumatic Stress Disorder: A Feasibility Study

The purpose of this study was to examine the feasibility and acceptability of an auricular acupuncture (AA) insomnia regimen among Operation Iraqi Freedom and Operation Enduring Freedom veterans with post-traumatic stress disorder and sleep disturbance. Secondarily, this study examined the effect of an AA insomnia regimen on objective sleep times by wrist actigraphy, subjective sleep times by sleep diary, and sleep quality ratings utilizing the Pittsburg Sleep Quality Index. Veterans (n = 30) were randomized to receive a 3-week AA insomnia regimen. Veterans receiving the AA insomnia regimen reported it as a more acceptable treatment for sleep disturbance than subjects in the control group (AA group median = 5 vs. control group median = 3, p = 0.004). Significant differences between groups were found on the sleep quality and daytime dysfunction components of the Pittsburgh Sleep Quality Index (p = 0.003, p = 0.004). No other significant differences between groups were found for objective and subjective sleep measures. These results suggest that an AA insomnia regimen may improve sleep quality and daytime dysfunction among veterans with post-traumatic stress disorder. Future, large-scale, prospective clinical trials are needed to examine AA effects on sleep.

Wartime paediatric extremity injuries: experience from the Kabul International Airport Combat support hospital.

Since the beginning of Operation Enduring Freedom, management of Afghan military or civilian casualties including children is a priority of the battlefield medical support. The aim of this study is to describe the features of paediatric wartime extremities injuries and to analyse their management in the Kabul International Airport Combat Support Hospital. A retrospective review was carried out using the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013. Paediatric patients were defined as those younger than 16 years old. Of the 220 injured children operated on, 155 (70%) sustained an extremity injury and were included. The mean age of the children was 9.1 ± 3.8 years. Among these children, 77 sustained combat-related injuries (CRIs) and 78 sustained noncombat-related injuries (NCRIs), with a total of 212 extremities injuries analysed. All CRIs were open injuries, whereas NCRIs were dominated by blunt injuries. Multiple extremities injuries and associated injuries were significantly more frequent in children with CRIs, whose median Injury Severity Score was higher than those with NCRIs. Debridement and irrigation was significantly predominant in the CRIs group, as well as internal fracture fixation in the NCRIs group. There were four deaths, yielding a global mortality rate of 2.6%. This study is the first to analyse specifically paediatric extremities trauma and their management at level 3 of battlefield medical facilities in recent conflicts. Except for severe burns and polytrauma, treatment of paediatric extremities injuries can be readily performed in Combat Support Hospitals by orthopaedic surgeons trained in paediatric trauma.

Legitimizing the Wound: Mapping the Military's Diagnostic Discourse of Traumatic Brain Injury

ABSTRACTFollowing reports spanning from the beginning of the OEF (Operation Enduring Freedom) and OIF (Operation Iraqi Freedom) conflicts to the early 2010s, this rhetorical investigation analyzes the U.S. military's diagnostic practices used to identify mild traumatic brain injury (mTBI) in blast-affected troops. Considering the notion of “wound/injury” as a possible boundary object, this paper discusses how the conceptual framing of “invisible” injuries may produce interruptions of distrust that inhibit effective diagnosis.

War Profiteering Comparing Military-Industry Stock Portfolio Returns versus Market Returns During the Iraq and Afghan Wars

The Department of Defense (DoD) relies on a privatized defense industry for tools of war. Following the Cold War, the majority of this Defense Industry consolidated into 5 large corporations: Boeing, United Technologies Corporation, Honeywell, Raytheon, and Lockheed Martin. In this study, an equally weighted portfolio of the 5 aforementioned companies stocks is constructed, and then analyzed during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The equally weighted portfolio is then compared to the market to see whether or not a defense-industry portfolio can outperform the market during wartime. Both the portfolio and the market index are assessed by average monthly return and the Sharpes Slope. These metrics are compared between the portfolio and the market through a Difference in Means Statistical Test.

Social Support Throughout the Deployment Cycle for Women Veterans Returning From Iraq and Afghanistan

Social support throughout the deployment cycle and the challenges of readjustment to civilian life for veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom were explored. Eighteen participants from the New England and Indiana Veterans Administration catchment area were interviewed using a semi-structured interview guide. All participants identified perceptions of social support but their utilization of these supports was compromised due to the need to protect family and friends from the strain of war, post-traumatic stress symptoms, and depressive symptoms. Resilience, fortitude, and commitment to their military mission were evidenced by all the women of this study. Implications for future service delivery are identified.

Agreement Between the North Atlantic Treaty Organization and the Islamic Republic of Afghanistan on the Status of NATO Forces and NATO Personnel Conducting MutuallyAgreed NATO-led Activities in Afghanistan &amp; Security and Defense Cooperation Agreement Between the United States of America and the Islamic Republic of Afghanistan

On September 30, 2014, Afghanistan signed agreements with the United States and NATO providing for U.S. and NATO military presences in Afghanistan following termination in December 2014 of the post-9/11 U.S. “Operation Enduring Freedom” (OEF) and NATO-led International Security Assistance Force (ISAF) military missions.

Does Electoral Proximity Affect Security Policy?

How do approaching elections affect the security policy states conduct? We build on classic political economy arguments and theorize that one problem likely faced by democratic policy-makers near elections is that of time-inconsistency. The time-inconsistency problem arises when the costs and benefits of policy are not realized at the same time. We develop an application of the argument to the case of allied troop contributions to Operation Enduring Freedom (“OEF”) and the International Security Assistance Force (“ISAF”) mission in Afghanistan. In that case, we argue the expectation should be one of fewer troops committed close to elections. The exogenous timing of elections allows us to identify the effects of approaching elections on troop levels. Our finding of significantly lower troop contributions near elections is the first arguably identified effect of electoral proximity on security policy.

Analysis of Orthopaedic Research Produced During the Wars in Iraq and Afghanistan.

Military orthopaedic surgeons have published a substantial amount of original research based on our care of combat-wounded service members and related studies during the wars in Iraq and Afghanistan. However, to our knowledge, the influence of this body of work has not been evaluated bibliometrically, and doing so is important to determine the modern impact of combat casualty research in the wider medical community. We sought to identify the 20 most commonly cited works from military surgeons published during the Iraq and Afghanistan conflicts and analyze them to answer the following questions: (1) What were the subject areas of these 20 articles and what was the 2013 Impact Factor of each journal that published them? (2) How many citations did they receive and what were the characteristics of the journals that cited them? (3) Do the citation analysis results obtained from Google Scholar mirror the results obtained from Thompson-Reuters' Web of Science? We searched the Web of Science Citation Index Expanded for relevant original research performed by US military orthopaedic surgeons related to Operation Iraqi Freedom and Operation Enduring Freedom between 2001 and 2014. Articles citing these studies were reviewed using both Web of Science and Google Scholar data. The 20 most cited articles meeting inclusion criteria were identified and analyzed by content domain, frequency of citation, and sources in which they were cited. Nine of these studies examined the epidemiology and outcome of combat injury. Six studies dealt with wound management, wound dehiscence, and formation of heterotopic ossification. Five studies examined infectious complications of combat trauma. The median number of citations garnered by these 20 articles was 41 (range, 28-264) in Web of Science. Other research citing these studies has appeared in 279 different journals, covering 26 different medical and surgical subspecialties, from authors in 31 different countries. Google Scholar contained 97% of the Web of Science citations, but also had 31 duplicate entries and 29 citations with defective links. Modern combat casualty research by military orthopaedic surgeons is widely cited by researchers in a diverse range of subspecialties and geographic locales. This suggests that the military continues to be a source of innovation that is broadly applicable to civilian medical and surgical practice and should encourage expansion of military-civilian collaboration to maximize the utility of the knowledge gained in the treatment of war trauma. Level IV, therapeutic study.

Exploring the Relationship Between Mild Traumatic Brain Injury Exposure and the Presence and Severity of Postconcussive Symptoms Among Veterans Deployed to Iraq and Afghanistan

ObjectiveThe aim of this study was to describe the association between mild traumatic brain injury (mTBI) and persisting postconcussive symptoms according to symptom category, number, and severity. DesignThe study design was observational. ParticipantsThe study sample comprised veterans (≥18 years of age) deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment. MethodsVeterans were interviewed and completed testing in a single day. The Standard TBI Diagnostic Interview and the Clinician-Administered PTSD Scale were used. Testing included the Neurobehavioral Symptom Inventory and a full neuropsychological battery. Gold standard classification methods were utilized to determine presence/absence of mTBI. For each of the 5 symptom outcomes, an adjusted multiple linear regression model (negative binomial count models) accounting for effects of socio-demographic variables and behavioral health conditions was used. Main Outcome MeasuresSelf-report of neurobehavioral symptoms categorized as affective, cognitive, somatic, and vestibular symptoms, in addition to the instruments specified above. ResultsOEF/OIF veterans with mTBI, relative to veterans with no mTBI, were observed to have 30% more symptoms overall (P < .001), 34% more somatic symptoms (P < .001), 22% more cognitive symptoms (P = .008), 15% more affective symptoms (P = .017), and 59% more vestibular symptoms (P < .001). For adjusted models, variables significantly related to number of symptoms across all 4 symptom categories were anxiety (all P < .001) and insomnia (all P < .001). For the adjusted models, variables significantly related to symptom severity across all 4 symptom categories were insomnia (all P < .001), depression (P < .001-.05) and anxiety (all, P < .001). ConclusionsOEF/OIF veterans with mTBI, relative to veterans with no mTBI, have significantly more and significantly more severe persisting symptoms, with vestibular symptoms reported with the greatest frequency. After accounting for behavioral health conditions and socio-demographic factors, OEF/OIF veterans with mTBI compared to veterans without mTBI had significantly more cognitive, affective, vestibular, and somatic symptoms persisting 4.8 years after the mTBI event(s).

Army of darkness: The jihadist training system in Pakistan and Afghanistan, 1996–2001

The current Islamic State in Iraq and Syria displays both Taliban and al Qaeda-like characteristics. We can expect IS to host international jihadists in the same way the Taliban did between 1996 and 2001. This study depicts the jihadist training and support network established in Afghanistan during those years prior to its dismantlement and exploitation by Operation ENDURING FREEDOM. Up to now this system was understood only in the abstract but with newly available information, the scope and scale of the international jihadist project in Afghanistan can be unveiled.

Differential impact of combat on postdeployment symptoms in female and male veterans of iraq and afghanistan.

We aimed to describe differences in combat experience for male and female veterans and characterize differential effects on postdeployment physical and mental health symptoms, including aggression. Retrospective cross-sectional health screening data from 554 Operation Enduring Freedom and Operation Iraqi Freedom veterans who enrolled for Veterans Affairs health care in San Diego were examined including measures of combat experience, pain intensity, traumatic brain injury symptoms, military sexual trauma, post-traumatic stress disorder, depression, alcohol use, and aggression. Although male veterans (n = 458) experienced significantly higher rates of combat than female veterans (n = 96), both experienced similar levels of postdeployment post-traumatic stress disorder and depression symptoms as well self-reported aggressive behavior compared to male veterans. Female veterans had higher rates of military sexual trauma and lower alcohol consumption than male veterans. All Operation Enduring Freedom and Operation Iraqi Freedom veterans returning from deployment may benefit from broad-based screening of physical and mental health symptoms, beyond those currently mandated by Veterans Affairs, including anger and aggression.

Characteristics of genitourinary injuries associated with pelvic fractures during operation Iraqi Freedom and operation Enduring Freedom.

Pelvic fractures are markers of severe injury and are often associated with lower genitourinary injuries. The purpose of this study was to investigate the incidence of lower genitourinary injuries and complaints associated with pelvic fractures sustained in combat among nonsurvivors and survivors. The Armed Forces Medical Examiner System and The Joint Theater Trauma Registry databases were searched to identify survivors and nonsurvivors who sustained a pelvic fracture in combat in 2008. Survivor and autopsy data consisted of injury mode and mechanism and associated organ and extremity injuries. Pelvic fractures were classified using the Tile system. The database search yielded 91 nonsurvivors and 10 survivors with pelvic fractures. Forty-one patients (40%) sustained 61 genitourinary injuries. The majority of genitourinary injuries in nonsurvivors were associated with Tile C pelvic fractures (70%). Twenty percent of survivors had genitourinary injuries, all of which were associated with Tile A fractures. A higher incidence of genitourinary injuries in patients with combat-related pelvic fractures (60%) was found than that of their civilian counterparts. Of the survivors, 100% of those with genitourinary injuries were being treated for erectile dysfunction at their last follow-up. Continued collaboration between orthopaedic surgeons and urologist is needed to address these concurrent injuries.

An 8-year review of operation enduring freedom and operation iraqi freedom resuscitative thoracotomies.

Appropriate indications for resuscitative thoracotomy (RT) in an austere environment continue to evolve; the aim of this study was to determine survival and to analyze demographics of survivors within U.S. military personnel undergoing RT. A retrospective review was performed of all U.S. soldiers who underwent thoracotomy in theater during Operation Iraqi Freedom and Operation Enduring Freedom. After individualized review, patients in extremis or who lost pulses and had their thoracotomy performed within 10 minutes of arrival to the emergency department were included. The primary outcome was survival at final hospital discharge, and secondary outcomes included demographics associated with survival. Between January 2003 and May 2010, 81 U.S. military personnel met inclusion criteria for RT in theater. As low as 6.7% (3/45) of patients receiving prehospital cardiopulmonary resuscitation were alive at final hospital discharge. Survival from RT after explosive/blast injury, penetrating (gunshot wound), and blunt trauma were 16.3% (8/49), 0% (0/28), and 0% (0/4), respectively. Patients with primary explosive/blast extremity trauma undergoing RT had a survival of 27.3% (6/22). Higher initial oxygen saturations, larger volume of crystalloids and blood products infused, and higher extremity abbreviated injury score were all associated with survival. Combat casualties who present pulseless or in extremis who were injured as a result of an explosive/blast injury mechanism resulting in a primary extremity injury may have a survival benefit from undergoing a RT in an austere environment.

Evolution of Pararescue medicine during operation Enduring Freedom.

This article highlights recent advances made in U.S. Air Force Pararescue Medical Operations in relation to tactical evacuation procedures. Most of these changes have been adopted and adapted from civilian medicine practice, and some have come from shared experiences with partner nations. Patient assessment includes a more comprehensive evaluation for hemorrhage and indications for hemorrhagic control. Ketamine has replaced morphine and fentanyl as the primary sedative used during rapid sequence intubation and procedural sedation. There has been an increasing use of the bougie to clear an airway or nasal cavity that becomes packed with debris. Video laryngoscopy provides advantages over direct laryngoscopy, especially in situations where there are environmental constraints such as the back of a Pave Hawk helicopter. Intraosseous access has become popular to treat and control hemorrhagic shock when peripheral intravenous access is impractical or impossible. Revisions to patient treatment cards have improved the efficacy and compliance of documentation and have made patient handoff more efficient. These improvements have only been possible because of the concerted efforts of U.S. Air Force and partner platforms operating in Afghanistan.

The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans.

United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment.

The importance of poetry, hip-hop, and philosophy for an enlisted aviator in the USAF (2000–2004) flying in support of Operation Enduring Freedom and Operation Iraqi Freedom

This special issue of Journal of Poetry Therapy focuses on the use of poetry and other forms of expressive writing to explore the transformative experiences of military veterans, and so in this article I discuss how the use of poetry, hip-hop, and philosophy positively influenced my life while I was serving in the United States Air Force (USAF) from 2000 through 2004. This article briefly reviews my reasons for enlisting and discusses the importance that poetry, hip-hop, and philosophy had for me during four different phases of my military history: (i) Basic Military Training, (ii) Aircraft Qualification, Combat Survival, and Water Survival Training, (iii) serving in the post 9/11 operations Operation Enduring Freedom and Operation Iraqi Freedom, and (iv) the period after fulfilling my time of service for the USAF. In discussing each phase, I explain the unique challenges that I encountered, how I used poetry, hip-hop, and philosophy to successfully overcome these challenges, point out relevant examples of poetry, hip-hop, and philosophy that were particularly influential, and include pictures of my experiences throughout.

Brain Network Disturbance Related to Posttraumatic Stress and Traumatic Brain Injury in Veterans

BackgroundUnderstanding the neural causes and consequences of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) is a high research priority, given the high rates of associated disability and suicide. Despite remarkable progress in elucidating the brain mechanisms of PTSD and mTBI, a comprehensive understanding of these conditions at the level of brain networks has yet to be achieved. The present study sought to identify functional brain networks and topological properties (measures of network organization and function) related to current PTSD severity and mTBI. MethodsGraph theoretic tools were used to analyze resting-state functional magnetic resonance imaging data from 208 veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, all of whom had experienced a traumatic event qualifying for PTSD criterion A. Analyses identified brain networks and topological network properties linked to current PTSD symptom severity, mTBI, and the interaction between PTSD and mTBI. ResultsTwo brain networks were identified in which weaker connectivity was linked to higher PTSD re-experiencing symptoms, one of which was present only in veterans with comorbid mTBI. Re-experiencing was also linked to worse functional segregation (necessary for specialized processing) and diminished influence of key regions on the network, including the hippocampus. ConclusionsFindings of this study demonstrate that PTSD re-experiencing symptoms are linked to weakened connectivity in a network involved in providing contextual information. A similar relationship was found in a separate network typically engaged in the gating of working memory, but only in veterans with mTBI.