A first of its kind study is showing the devastating impacts of wartime brain injuries on service members.

A UW Medicine neurologist followed 50 soldiers starting just after they suffered a concussive blast injury and tracked their conditions through brain imaging and other techniques over several years.

Dr. Christine Mac Donald, associate professor of neurological surgery at the University of Washington School of Medicine, said her findings bring into question medical beliefs that individuals will stabilize within a year after their injury.

Instead, Mac Donald found these service members' mental health symptoms evolved and even worsened five years later.

"The takeaway for me that was so striking was the substantial number of service members who significantly declined in this population that was supposed to be the mildest of the mild and that even with help that so few experienced sustained resolution," Mac Donald said.

The findings pose a significant challenge for the Department of Veterans Affairs, which has struggled to treat or properly diagnose traumatic brain injuries in service members.

Already, the VA estimates nearly 1 in 5 of the more than 2 million soldiers who have served in Iraq and Afghanistan have suffered at least one traumatic brain injury, and Mac Donald anticipates the costs of those injuries may not peak for decades.

"When are they going to get better? And the honest truth is, we don't know," Mac Donald said. "We have an opportunity to be proactive instead of reactive on such a costly issue and that in so doing, we do right for these service members and their families."

Mac Donald said her findings call for a stronger emphasis at the VA and across other healthcare systems on continuity of care and a comprehensive long term treatment strategy.

"It's getting people on the same page and utilizing these well-informed experts and bringing them together," Mac Donald said.

Victor Lindenberg Lewis of Everett is one of the 50 injured soldiers Mac Donald has followed for more than five years.

Lewis said he was injured by backblast from an RPG while serving in Afghanistan in 2009.

"It felt like I got hit by a car like I had been in a car accident. My head was ringing, and I couldn't hear anything," Lewis said.

Eight years later, Lewis is unable to hold a traditional job.

Some days, the box medications he takes each day for pain and mental health struggles related to his brain injury and the Post Traumatic Stress Disorder he developed are nearly as debilitating as the symptoms themselves.

"It's like I'm a different person. I went to Afghanistan as Victor, and I came back as Bob," Lewis said. "They are all telling us it's your new life. It's your new normal, and there is no normal."

Lewis is one of the more than 80,000 service members who has served in Iraq and Afghanistan and been diagnosed with a traumatic brain injury by the Department of Veterans Affairs, many of whom have struggled to obtain care, which alleviates their symptoms.

"I have had patients tell me, 'I wish I had lost a leg. I wish I had lost an arm, because then there would be a reason and people could understand,'" Mac Donald said.

Dr. Murray Raskind, a psychiatrist at the VA Puget Sound Healthcare System, said the VA recognizes it has a lot to learn about these injuries.

"You have to remember this is a relatively new type of problem," Raskind said. "In prior wars, blast concussions have been frequent, but many of those who suffered head trauma didn't survive as well."

Raskind said his research into traumatic brain injuries at the VA Puget Sound supports Mac Donald's findings.

"I think that awareness is spread throughout the VA that this is a very big problem," Raskind said.

Raskind is now beginning a new clinical trial in the hopes of finding an effective treatment for the migraines service members often experience following a blast concussion.

Raskind said those migraines have not responded well to traditional treatments, and this trial will test whether Prazosin, originally a blood pressure medication, is an effective treatment.

"It's hoped that it will provide initial evidence for reducing the effects of excessive brain adrenaline to decrease the risk of dementia in veterans who have post-traumatic stress disorder and/or mild traumatic brain injury," Kimberly Wilkie, a spokesperson for the VA Puget Sound Health Care System, said.

Interested participants in the 12-week clinical trial can call (206) 277-3740 and ask for James O'Connell.

Lewis is holding onto hope that one day his injuries will be better understood and his recovery better supported by more effective treatments that allow his symptoms to subside without the side effects.

"This is just the hand I got dealt, you know," Lewis said. "Never give up on anything. The day you stop trying is the day you start dying. So, always give 100 percent, always."

Lewis spends much of his time now playing golf.

He hopes to attend PGA Tour qualifying school later this year and earn a spot on the PGA Tour to fulfill a personal dream and raise awareness about wounded warriors.