• Brain, Spine & Nervous System Injury Screener V1.2

    A lifetime injury and neurological-pattern screener for veterans, service members, first responders, military families, survivors, and people in high-impact occupations

  • Behind The 22 is a mutual-aid and research group examining operational and institutional issues that harm those in high risk occupations.

    More Resrouces & Info Here 

    Skip to the TBI Operational Harm Screening for Vets/Active Duty Here

    If this tool is not accessible for you we have live virtual screening coming soon.

    For this screener (No email required) we dug deep into historical VA/Dod research from the Civil War to today to utilize the gold mine of information we already have on these types of injuries. Current DoD projects are working on recovering this historical data. One of the goals of BT22 is to utilize this research as well as our lived experience to help you better understand your injuries and how to self advocate. As we get deeper into our research this screener will improve. You can see the current version at the top. 

    The secondary goal of this screener is to get a more detailed picture of the operational function of brain injury care in modern times and whats missing. More indepth analysis is available but not required for this screening.

     

    One of our main focus points is recurring patterns involving traumatic brain injury, repeated head injury, blast exposure, spinal and cervical injury, hypoxic/anoxic injury, autonomic dysfunction, neurological symptoms, documentation, treatment, and long-term functional harm.

    You do not need to have deployed, served in combat, or been injured while on military duty to complete this screening.

    We are interested in the person's complete lifetime neurological injury history, including injuries or exposures that occurred:

    before military or occupational service
    during training
    during stateside service
    during deployment or combat
    during off-duty activities
    during civilian employment
    during first-responder work
    during sports or recreation
    after military separation
    or in any other setting

    A civilian injury can matter to understanding a person's neurological history just as much as a deployment injury. This project is interested in whether the complete history was recognized, documented, evaluated, and incorporated into later medical care.

    This questionnaire is a screening and pattern-identification tool only. It does not diagnose TBI, spinal cord injury, dysautonomia, hypoxic brain injury, endocrine disease, or another medical condition.

    If you don't know an answer, select Not sure rather than guessing.

    Privacy warning

    Please do not enter or upload:

    Social Security numbers, VA claim numbers, DoD ID numbers, full dates of birth, home addresses, medical-record numbers, photographs of identification, passwords, banking information, or complete medical records.

    If your screening appears relevant to an area BT22 is studying, we may invite you to complete a separate detailed intake or record review. This is not required in any way. You can choose to be contacted or not at the end of this form.

    Safety notice

    This questionnaire is not for medical emergencies.

    New or rapidly worsening weakness or paralysis, new loss of bladder or bowel control, repeated seizures, sudden severe confusion, sudden inability to speak, severe breathing difficulty, new loss of consciousness, or rapidly worsening neurological function should receive urgent medical evaluation.

  • Who Is This About?

  • Who are you completing this form about?*
  • Is this person: *Some later questions concern serious outcomes, including suicide. You may skip optional questions. BT22 will not assume that an injury caused a death simply because the injury occurred before the death.*

  • Military / Occupational Background

  • Which describe this person's background? Select all that apply.
  • Military branch, if applicable
  • Approximate service/occupational era

  • Where Did Injuries or Exposures Occur?

  • When did relevant injuries or exposures occur? Select all that apply.
  • Was any relevant injury or exposure associated with a military deployment?
  • Did this person ever work, train, deploy, or participate in an environment involving repeated blast, weapons fire, impacts, crashes, falls, acceleration/deceleration, or other substantial injury risk?

  • Lifetime Injury & Exposure History

  • Has this person ever experienced any of the following?
  • Approximately how many separate head, neck, spine, or blast-related events may have occurred over the person's lifetime?
  • Were some injuries outside military or occupational service?
  • Did any injury involve:

  • Blast Exposure

  • What kind of blast exposure occurred?
  • Approximately how often?
  • During or shortly afterward, did any of these occur?
  • Did symptoms become noticeably worse during periods of repeated firing/blast exposure?
  • Was blast exposure formally tracked?
  • Were baseline cognitive tests performed before or during high-blast duties?

  • Possible Hypoxic / Anoxic Events

  • Has this person experienced:
  • During or afterward:
  • Was possible hypoxic/anoxic brain injury ever evaluated?

  • Brain / Cognitive Symptoms

  • After an injury/exposure, did any of these begin or clearly worsen?

  • Vision, Hearing & Vestibular

  • After injury/exposure:

  • Spine / Spinal Cord / Peripheral Nerves

  • After injury:
  • Was a neck/spinal/vertebral injury documented?
  • Was cervical/spinal imaging performed?
  • Was specialty follow-up provided?

  • Autonomic / Body Regulation

    The autonomic nervous system helps control automatic body functions such as heart rate, blood pressure, temperature, sweating, digestion, bladder function, and aspects of breathing and sleep.
  • After injury/exposure, did any of these begin or significantly worsen?
  • Did these begin or clearly worsen after a head, neck, spinal, blast or hypoxic event?
  • Has a clinician documented:

  • Endocrine / Pituitary Signals

    Hormonal symptoms can have many causes. These questions do not determine whether someone has pituitary injury.
  • After injury, did any of these begin or significantly worsen?
  • Was pituitary/hormone function evaluated after injury?
  • Was the testing limited to basic hormone bloodwork, or was pituitary reserve testing also performed? (Some pituitary deficiencies cannot be ruled out by a single normal screening lab. Growth hormone deficiency, for example, generally requires stimulation testing when clinically suspected; IGF-1 alone does not reliably exclude it.)

  • Timing & Progression

  • When did these first become noticeable?
    Rows
  • Over time, problems have:

  • Function

  • Did overall functioning decline after injury/exposure?
  • If Yes/Maybe: Which areas changed?
  • Did other people notice changes?
  • After injury or neurological symptoms, did any of these occur?

  • Serious Outcomes

    Some neurological injuries and care gaps can have major effects on a person's health, independence, employment, safety, and family.The questions on this page help BT22 understand the seriousness of the outcome. They do not establish that a brain, spinal, autonomic, hypoxic, or other neurological injury caused the outcome.You may select Prefer not to answer.
  • Did any of the following serious outcomes occur after the injury or exposure?

  • About Suicide-Related Outcomes

    Behind The 22 does not assume that TBI, spinal injury, autonomic dysfunction, hypoxic injury, or another neurological condition caused a suicide attempt or death simply because both occurred.

    If this case later receives detailed review, BT22 will distinguish between:

    what the medical and military records document;
    what injuries occurred before the suicide-related event;
    what neurological symptoms were documented;
    what evaluation or treatment was provided;
    what evaluation or treatment was recommended but not completed;
    what clinicians, investigators, medical examiners, or other qualified professionals concluded;
    possible contributing factors;
    and what remains unknown.

  • Before the suicide attempt or death, was a brain, spinal, hypoxic, autonomic, or other neurological injury already documented or suspected?
  • Before the suicide attempt or death, do the available records appear to show neurological evaluation, referral, treatment, rehabilitation, or follow-up that was recommended but not completed or significantly delayed?
  • Before the suicide attempt or death, were ongoing neurological or functional problems documented?
  • Did any clinician, medical examiner, investigator, or official report specifically discuss brain injury, neurological injury, neurological symptoms, or neurological impairment as potentially relevant to the person's suicide risk or death?

  • Records

    Do not upload these records into this screening form.
  • Do records exist that may support some of this history?
  • What may exist?

  • What Your Answers May Be Worth Following Up On

    The information below is not a diagnosis or medical result. It is a personal advocacy guide based on areas you identified in this questionnaire. You can use these suggestions to organize your history, locate records, and prepare questions for healthcare appointments. You may see several sections below because neurological injuries can affect more than one system at the same time.

  • This page gives you your self advocacy results. To fully submit your screening tool for BT22 research and or follow up make sure to click submit on the next page. 

    To save the results on this page click the print option in your browser. You can print it out or it should allow you to save it as a PDF.

     

    Records That May Be Worth Locating

    Depending on your history, useful records may include:

    emergency or trauma records;
    military service-treatment records;
    deployment medical records;
    civilian accident or hospital records;
    ambulance/EMS records;
    brain imaging reports;
    cervical or spinal imaging reports;
    TBI screening records;
    Comprehensive TBI Evaluation records;
    neurology notes;
    neuropsychological testing;
    rehabilitation records;
    speech-language records;
    vision or vestibular records;
    hearing/audiology records;
    endocrine laboratory testing;
    cardiology or autonomic testing;
    C&P examinations;
    VA disability decisions;
    line-of-duty or accident reports;
    and other official investigations.
    You do not need to find everything at once.

    Start with records surrounding the major injury events and records showing the first appearance or worsening of neurological symptoms.

    Do not submit medical records through this screening form.

    One Useful Next Step *Free Templates for this coming soon!

    Before your next appointment, try creating a one-page summary containing:

    1. Major lifetime injuries/exposures

    2. Symptoms that appeared afterward

    3. What has objectively changed in daily function

    4. What neurological evaluations have already occurred

    5. What questions remain unanswered

    Bring that summary with you and ask that important injury history and functional changes be documented in your medical record.

    This screening summary is educational only. It does not establish that any particular injury caused your symptoms or that a particular test, diagnosis, treatment, or referral is medically required.

  • Questions About Previous Evaluation

    Based on your answers, you may want to clarify what has and has not already been evaluated.

    Click here to our TBI Opertaional Harm Screening Here (Will open second window)  TBI Operational Harm Screening VA/DoD Version

    Questions you may consider bringing to an appointment include:

    “Does my record contain my complete lifetime brain, neck, spine, blast, and other neurological injury history?”

    “What severity was assigned to each documented TBI, and what evidence was used?”

    “Was I given only a TBI screening questionnaire, or did I receive a comprehensive diagnostic evaluation?”

    “Could my symptoms involve both brain injury and cervical or spinal injury?”

    “Have my cognitive, language, visual, vestibular, hearing, autonomic, and functional symptoms been evaluated?”

    “Could any of my symptoms warrant neurological rehabilitation or another specialty referral?”

    “Are diagnoses being used to explain these symptoms before neurological causes have been adequately evaluated?”

    “Were any referrals recommended but never completed?”

    “What follow-up is appropriate if my neurological function is worsening instead of improving?”

  • Brain Injury / TBI History

    Your answers included head injury, blast exposure, loss of consciousness, memory loss, confusion, altered mental status, or neurological symptoms that may be worth documenting more clearly.

    Consider creating a lifetime head-injury timeline.

    For each major injury or exposure, write down:

    approximately when it happened;
    where and how it happened;
    whether there was a direct head impact;
    whether there was blast exposure or violent acceleration/deceleration;
    whether consciousness was lost;
    whether there was memory loss before or after the event;
    whether there was confusion, disorientation, or unusual behavior;
    what symptoms appeared afterward;
    whether medical care occurred;
    whether imaging or neurological testing occurred;
    and how later medical records describe the event.
    If multiple injuries occurred, consider asking:

    “Does my medical record contain my complete lifetime history of head injuries and neurological trauma, rather than only the most recent or best-documented event?”

    You may also want to ask:

    “What severity was assigned to each documented TBI, and what information was used to make that determination?”

  • Blast / Repeated Overpressure

    Your answers included blast, weapons-fire, breaching, or repeated overpressure exposure.

    It may help to document:

    the type of weapon, explosive, or exposure;
    approximately how often exposure occurred;
    whether exposure happened repeatedly during training or occupational duties;
    whether you felt the pressure wave;
    whether you were thrown, knocked down, or struck by debris;
    tinnitus, hearing changes, or ear pressure;
    headache;
    dizziness or balance changes;
    confusion or slowed thinking;
    memory or concentration changes;
    visual changes;
    whether symptoms became worse during periods of repeated exposure;
    and whether the exposures were ever formally documented or tracked.
    Consider asking:

    “Could my repeated blast or overpressure exposure be relevant to my neurological symptoms even when individual exposures were not diagnosed as concussions?”

    Also consider asking:

    “Does my record contain my actual lifetime blast-exposure history?”

  • Neck, Spine or Nerve Symptoms

    Your answers included neck or spinal trauma, or symptoms involving weakness, numbness, walking, hand function, sensation, bladder/bowel function, or other neurological changes.

    Consider locating any previous:

    cervical or spinal imaging;
    fracture records;
    emergency or trauma records;
    accident reports;
    neurology notes;
    neurosurgery notes;
    orthopedic records;
    rehabilitation records.
    Consider asking:

    “Could these symptoms require evaluation of my cervical spine, spinal cord, nerve roots, or peripheral nerves rather than being considered only a brain-injury symptom?”

    You may also want to ask:

    “Was my neck or spine evaluated at the same time as my head injury?”

  • Autonomic / Body-Regulation Symptoms

    Your answers included symptoms involving automatic body functions such as heart rate, blood pressure, standing tolerance, temperature regulation, sweating, digestion, bladder function, breathing, sleep, or exercise tolerance.

    These symptoms can have many possible causes.

    Consider asking:

    “Could these symptoms represent an autonomic nervous-system problem, and should they be evaluated as a connected neurological pattern rather than one symptom at a time?”

    A short symptom log may help your care team see the pattern.

    Consider recording:

    what symptom occurred;
    time of day;
    what you were doing;
    whether you were lying, sitting, or standing;
    heart rate when available;
    blood pressure when available;
    temperature or sweating changes;
    meals;
    exertion;
    hydration;
    and how long the episode lasted.

  • Possible Oxygen/Blood-Flow-Related Brain Injury

    Your answers included an event involving possible interruption of oxygen or blood flow to the brain, such as cardiac arrest, resuscitation, severe breathing interruption, choking, strangulation, near-drowning, carbon monoxide exposure, severe blood loss, shock, or another major event.

    Make sure this event appears clearly in your neurological history.

    Consider documenting:

    what happened;
    approximately how long consciousness or breathing was affected, if known;
    whether CPR or resuscitation occurred;
    whether seizures occurred;
    what neurological symptoms appeared afterward;
    whether cognitive or language function changed;
    and whether possible hypoxic/anoxic brain injury was ever considered.
    Consider asking:

    “Could neurological changes after this event require consideration of hypoxic or anoxic brain injury in addition to, or instead of, traumatic brain injury?”

  • Hormonal / Pituitary Follow-Up

    Your answers included symptoms that can have many possible causes but may sometimes warrant endocrine evaluation after brain injury.

    A broad pituitary evaluation can involve more than a standard thyroid test.

    Depending on the person's symptoms and medical history, clinicians may consider evaluation involving:

    morning cortisol;
    ACTH;
    Free T4;
    TSH;
    IGF-1;
    LH;
    FSH;
    testosterone or estradiol, when appropriate;
    prolactin;
    sodium and other electrolytes;
    and blood or urine concentration testing when excessive thirst or urination is present.
    Some pituitary problems may require dynamic or stimulation testing rather than ordinary baseline bloodwork.

    Examples can include:

    ACTH/cosyntropin stimulation testing;
    growth-hormone stimulation testing;
    glucagon stimulation testing;
    or other testing selected by an endocrinologist.
    Consider asking:

    “Given my brain-injury history and ongoing symptoms, have the relevant pituitary hormone systems actually been evaluated, or have I only had basic hormone screening?”

    You may also want to ask:

    “Do any of my symptoms or previous laboratory results justify referral to endocrinology?”

  • Vision / Balance / Vestibular Symptoms

    Your answers included problems with vision, eye movement, dizziness, vertigo, balance, motion sensitivity, hearing, or related sensory function.

    Consider documenting whether these symptoms began or worsened after a specific injury.

    Examples worth describing clearly include:

    double vision;
    blurred vision;
    trouble focusing;
    one eye drifting or crossing;
    difficulty reading;
    difficulty tracking moving objects;
    dizziness;
    vertigo;
    motion sensitivity;
    unexplained falls;
    tinnitus;
    hearing changes;
    difficulty understanding speech in noisy environments.
    Consider asking:

    “Could these symptoms warrant evaluation by a neurological, rehabilitation, vestibular, audiology, neuro-optometry, ophthalmology, or other appropriate specialist?”

  • Functional Change

    Your answers suggest that the issue may involve changes in everyday functioning, not only individual symptoms.

    Before a medical appointment, consider writing down specific examples using a Before / After format.

    Before the injury:
    What could the person independently and safely do?

    After the injury:
    What became difficult, slower, unsafe, unreliable, or required help?

    Consider areas such as:

    employment or military duties;
    driving;
    walking;
    communication;
    managing medications;
    remembering appointments;
    managing finances;
    cooking;
    household tasks;
    personal care;
    judgment and decision-making;
    safety when alone;
    and ability to live independently.
    Concrete functional examples can help a healthcare professional understand the real-world impact better than a symptom list alone.

  • Would you be willing to complete a more detailed intake if BT22 believes this history may match an area being studied?
  • Select Answer *This does not authorize BT22 to contact VA, DoD, healthcare providers, attorneys, employers, family members, or anyone else on your behalf.
  • Should be Empty: