Job Description and Practice Guidelines for Forensic Psychologists in TBI Assessments

Traumatic brain injury (TBI), often called the “signature wound” of war, refers to severe pathophysiological effects on the brain and central nervous system resulting from strong impacts and penetrating wounds caused by blast exposure, gunshot wounds, and motor vehicle injuries, among others. Although there is nothing new about TBI, it has come to light and become part of public discourse in the past 15 years because it has affected so many American soldiers in the wars in Afghanistan and Iraq.

The difficulty in recognizing, identifying, diagnosing and treating TBI has created challenges in healthcare delivery, rehabilitation, and veteran compensation. Forensic psychologists are just one of many clinicians involved in the medical-legal aspects of TBI, providing necessary assessments of military personnel when civil or criminal issues arise.

A study published by the Defense and Veterans Brain Injury Center revealed the following;

  • TBI is a major cause of lifelong disability and death
  • Blast injuries are a growing cause of TBI in combat
  • Over 7,000 Americans with TBI enter military and veterans hospitals every year
  • Estimates show the presence of TBI in more than 20 percent of surviving combat casualties

TBI and blast-related concussions significantly impact the health and safety of service members, and have been known to occur during times of both peace and war. The Defense and Veterans Brain Injury Center reports that each branch of the U.S. military, as well as the healthcare systems maintained by both the Department of Defense and the Department of Veterans Affairs, feel the effects of TBI.

The Forensic Psychologist’s Role in Assessing TBI for Military Personnel

Many changes in forensic health assessment have taken place in the past 15 years due to the sheer number of service members receiving disability for TBIs and psychological disorders like post-traumatic stress disorder.

Forensic psychologists are frequently involved in disability evaluations, suicide investigations, and correctional issues associated with TBI. Military competency and criminal responsibility boards—often called 706 boards, or sanity boards—also require the services of forensic psychologists to assess traumatic brain injuries.

Complex legal and ethical problems may arise with TBI patients, particularly those who experience personality changes or difficulties in:

  • Mood regulation
  • Memory
  • Orientation
  • Consciousness
  • Judgment
  • Insight
  • Impulse control

Research suggests a strong correlation between brain injuries and aggressive behavior and violence, as well. For example, the U.S. Department of Health recognizes the following symptoms of brain injuries:

  • Depression
  • Anxiety
  • Irritability
  • Paranoia
  • Anger
  • Violence
  • Noncompliance
  • Social inappropriateness
  • Egocentrism
  • Aggression

As a result, military personnel with TBI are at a greater risk to be involved in criminal, civil, or administrative legal situations, whether as disability claimants or criminal defendants.

Forensic psychologists may complete forensic assessments for any number of criminal and civil proceedings for military personnel, such as:

  • Pretrial sentencing
  • Death penalty evaluations
  • Guardianship cases
  • Workers’ compensation cases
  • Personal injury cases
  • Fitness for duty assessments

Forensic psychologists provide testimony on the effects of the TBI in the service member, they predict future behaviors as a result of the TBI, and they provide estimations on whether malingering is taking place.

When assessing TBIs in military personnel for medical-legal purposes, forensic psychologists evaluate the ways TBI may affect behavior, personality, and cognitive functioning. Depending on the purpose of the assessment, they may address causality, competency, or chronicity.

Forensic Psychologists Specializing in TBI for Military Personnel: Training and Education Options

Forensic psychologists with an interest in assessing TBIs in military personnel often seek specialized education and/or training designed to complement their doctoral training and education to become a state licensed clinical psychologist. More specifically, students of doctoral programs (PsyD or PhD) often choose to concentrate their doctoral studies on brain injuries within a forensic context.

For example, coursework in neuropsychology allows forensic psychology majors to better understand the relationship between the nervous system and cognitive function and to learn about the assessment, management, and rehabilitation of people with neurocognitive problems due to illness or brain injury. Internships and post-doctoral fellowships also provide ample opportunity for doctoral students in psychology to study TBIs.

A few post-doctoral fellowship programs, like the Walter Reed National Medical Military Center Postdoctoral Fellowship Training Program in Forensic Psychology, provide students with the unique opportunity to study forensic psychology in a military context.

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