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Traumatic brain injury became the signature wound of the post-9/11 wars because the battlefield changed. Improvised explosive devices changed the nature of American combat injuries. But the medical and legal systems that followed — including the Department of Veterans Affairs’ own adjudication frameworks — took years to catch up.
Drone warfare is doing it again. And the gap between battlefield reality and the systems meant to support veterans may be widening faster than the last time.
As a veterans disability appellate law firm, Chisholm Chisholm & Kilpatrick has represented tens of thousands of veterans in situations like this — instances where the law and the processes have not yet caught up with the realities on the ground. With the conflicts in Ukraine and Iran, we again see warning signs that we urge lawmakers, veteran advocates, and the Department of Veterans Affairs to address as proactively as possible.
A word about where we sit: The three of us are partners at the firm and our practice represents veterans in Veterans Affairs disability claims and appeals. The changes we argue for — a presumptive framework for cumulative blast exposure and broader screening at the point of service — would increase the volume of claims and appeals Veterans Affairs has to adjudicate, and firms like ours represent appellants in that system. Readers should weigh what follows with that in mind. We have tried to make it possible to do so: The argument rests on regulatory text, published rulemaking, and Veterans Affairs’ own record, all of it verifiable.
By the third year of war in Ukraine, drones accounted for an estimated 70 to 80 percent of all casualties, according to Western and Ukrainian military officials. The pattern is not confined to that conflict. Within the first weeks of the U.S.-Iranian conflict, traumatic brain injury emerged as the signature wound: Reports indicate that of roughly 200 servicemembers wounded as of March 2026, about 140 had traumatic brain injuries. By August 2026, the total wounded grew to nearly 700, and military officials said most of those servicemembers had sustained traumatic brain injuries.
Drone-Related Traumatic Brain Injuries Are Different
What makes this generation of drone-related injuries different from traumatic brain injuries caused by improvised explosive devices during the Global War on Terror is both the mechanism and the geometry of the threat.
Improvised explosive devices exploded from below. Servicemembers learned to watch the ground when going “outside the wire.” Drone munitions arrive from above, often with little warning and at any location, not only along known routes or front-line positions. Furthermore, a servicemember need not operate in a forward-operating environment to be exposed. Drones can strike supply depots, logistics hubs, embassies, and hotels. For example, the Iranian-used Shahed-136 drone can fly over 1,200 miles guided by satellite navigation, making the threat effectively omnipresent within the theater.
The physical consequence is a different constellation of injuries. Studies from the Ukraine conflict show that drone-delivered explosives produce a wider range and higher severity of traumatic injury compared to conventional weapons. The blast signature — detonating at close range from above — creates a particular pattern of upper body, neck, and head trauma, combined with limb amputations and severe burns. These are not the same injuries that even the post-9/11, traumatic brain injury-aware system was built to evaluate.
Drone-Related Post-Traumatic Stress Disorder Is Different
Beyond physical injuries, drone warfare is producing a psychological injury profile that existing frameworks are poorly equipped to evaluate.
In Ukraine, clinicians have begun to document a specific and debilitating form of anxiety keyed to the presence and sound of drones. A case report published in November 2025 in the Primary Care Companion for CNS Disorders — co-authored by Ukrainian military and civilian psychiatrists as well as clinicians from Massachusetts General Hospital’s Home Base program — records that some Ukrainian clinicians have begun using the term “dronophobia” for these presentations, marked by hypervigilance, hyperarousal, and avoidance behaviors organized around the sound of an approaching drone. Even when soldiers detect a drone, they cannot distinguish surveillance from targeting. They should constantly monitor their movements and exposure. They cannot evacuate without exposing rescue personnel to the same threat. The drone is a sustained condition, not a discrete traumatic event.
Significantly, the threat extends beyond forward positions. For example, in the U.S.-Iranian conflict, one-way attack drones struck American personnel at bases across the Middle East, including in Kuwait, Saudi Arabia, and Bahrain. Rear areas that once offered a reprieve offer less of one now, and that chronic dread carries serious, lasting mental health consequences.
Two features of the pattern matter for adjudication. First, the threat does not switch off behind the lines. The same case report describes soldiers on leave hundreds of miles from the front who keep curtains drawn and lights low, push furniture to the walls to keep movement paths clear, and scan the sky from windows during air raid alerts. Second, the observation is not confined to one clinical team. The U.S. Army’s Operational Environment Enterprise reached a parallel conclusion in a December 2024 assessment, attributing elevated fear and anxiety among Ukrainian and Russian soldiers to the ubiquity of drones, their distinctive sound, and the circulation of strike footage on social media.
The American Psychiatric Association’s Psychiatric News, reporting in March 2026 on the same Ukrainian collaboration, described “sound-linked hypervigilance” as a defining feature and noted that Ukrainian soldiers asked whether their vigilance points forward, downward, or upward answer uniformly that it points upward.
Drone-related presentations appear to sit within the standard Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for post-traumatic stress disorder but produce distinctive patterns inside them. The published case material shows patients diagnosed with post-traumatic stress disorder, with anxiety disorders including panic and phobic reactions, or with both.
What recurs is a clinical picture that is anticipatory rather than retrospective: dread of a strike that has not yet occurred, rather than a re-experiencing of one that has. That distinction does not change the diagnostic label. It changes the legacy evidentiary provisions a claim should meet. And that is where the adjudication problem starts.
Veterans Affairs’ disability compensation framework requires veterans to connect a current condition to a specific, documentable incident or period of service. For many of the injuries emerging from drone-era conflicts, that architecture could create several immediate challenges.
No Single Incident to Document
Many drone-related traumatic brain injuries result from cumulative blast exposure — multiple, lower-level exposures over an extended period — rather than a single, documented event. Service records may note a general deployment location without identifying individual blast exposures. Where no single incident is captured in a contemporaneous record, establishing the factual predicate for service connection becomes significantly harder.
Symptom Overlap Complicates Rating
The symptoms of blast-induced traumatic brain injury and drone-environment post-traumatic stress disorder overlap substantially, concerning sleep disruption, chronic headaches, memory loss, irritability, and hypervigilance. Veterans Affairs’ rating schedule addresses both conditions, but distinguishing their relative contribution in a given veteran’s presentation requires clinical tools and examiner training that have not yet been calibrated for this injury profile. A rating that underweights either condition — or collapses distinct conditions into a single, lower rating through avoidance of perceived “pyramiding” — understates the actual disability.
Delays in Diagnosis Create Evidentiary Gaps
Anecdotal reports from the current conflict with Iran indicate that servicemembers with traumatic brain injury symptoms have gone weeks without diagnosis or documented treatment, even after reaching medical facilities in Germany and the United States. Gaps in early medical records are among the most common bases for Veterans Affairs to question service connection. When the treating system fails to document what happened, the claims system bears the brunt of that failure.
The Stressor-Corroboration Rule
Per 38 CFR § 3.304(f), service connection for post-traumatic stress disorder requires evidence of a specific stressor. Since 2010, paragraph (f)(3) has relaxed that requirement to include “fear of hostile military or terrorist activity.” If a Veterans Affairs-affiliated psychiatrist or psychologist confirms the stressor is adequate to support a post-traumatic stress disorder diagnosis and the veteran’s symptoms align — and the stressor is consistent with the places, types, and circumstances of service — the veteran’s personal (lay) testimony alone may establish that the stressor occurred. At first glance, that provision appears to address the type of problems raised here. But the regulation currently relies on examples of specific events: “an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft.” Adjudicators often read enumerated lists as checklists. Veterans Affairs could address this by adding unmanned aircraft and loitering-munition attack to the examples in § 3.304(f)(3) or by clarifying the point in Veterans Affairs’ M21-1 Adjudication Procedures Manual.
The Rating Criteria
Once service connection is established, Veterans Affairs rates mental disorders in severity (thus determining compensation) using the General Rating Formula at 38 CFR § 4.130, which currently assigns evaluations by degree of occupational and social impairment and illustrates each tier with examples of mood and psychotic symptomatology. Persistent hypervigilance, exaggerated startle, sleep-onset failure, and sound-triggered avoidance do not align well with these examples. Additionally, a veteran still holding a job can undercut their claim. Veterans Affairs has proposed replacing the formula with a five-pillar model — cognition, interpersonal interactions, task completion, navigating environments, and self-care — each scored zero to four. That model would capture this injury profile better than the current, but Veterans Affairs has not finalized the changes since proposing them in February 2022.
The rapid developments in drone warfare expose servicemembers to injuries Veterans Affairs’ current framework cannot recognize, such as new types of blast overpressure and sustained hypervigilance from operating under near-constant aerial threat. Detection science has not caught up, and neither have the adjudication processes that would let Veterans Affairs recognize and rate these injuries consistently. Three steps would close the most consequential gaps.
Research Investment Should Increase
There is major progress to be made in detecting traumatic brain injuries, assessing the risk after blasts, and mitigating negative consequences before they worsen. Investment should increase, especially into the effects of blast overpressure from drone-delivered munitions.
Screening Protocols Should Reflect the New Realities on the Ground (and Above It)
A servicemember who served in an active drone theater should be presumptively evaluated for cumulative blast exposure. A mechanism for this already exists: The Individual Longitudinal Exposure Record is a joint Department of Defense-Veterans Affairs system that compiles a servicemember’s occupational and environmental exposures across training, deployments, and duty assignments. Blast overpressure gauge data is among the sources it uses. The Department of Defense also already has a policy framework. The Deputy Secretary of Defense’s Aug. 8, 2024, memorandum, “Department of Defense Requirements for Managing Brain Health Risks from Blast Overpressure,” requires cognitive assessment at accession and at intervals for high-risk personnel. It also requires tracking of blast overpressure exposures. However, the memorandum does not treat service in an active drone environment as a tracked exposure condition. Two changes could close the gap: Extend the tracking requirement to enemy drone and loitering-munition engagements, and require the Department of Defense to write those engagements into the exposure record at the unit level where individual dosimetry is unavailable.
Presumptions Should Exist for Drone Exposure and Drone-Related Traumatic Brain Injuries
The legal framework for service connection should prepare for injuries that are cumulative, chronic, and psychological, even though they may not follow a single-incident model. The template here is the presumptive approach to toxic exposure from the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act passed in August 2022. Where science establishes a causal link between a type of service exposure and a type of injury — as it does for blast overpressure and traumatic brain injuries, and as it increasingly does for drone hypervigilance and post-traumatic stress disorder-like conditions — the evidentiary burden on individual veterans should reflect this.
As demonstrated during the multi-decade effort to respond to traumatic brain injury among veterans of the Global War on Terror, a number of challenges exist when implementing a response of this order. These challenges can range from political to budgetary to scientific, and are often interdependent. Here are three of the main objections that we foresee arising to our proposals.
“Presumption Is Expensive.”
The Congressional Budget Office estimated that the PACT Act, at enactment, could increase deficits by roughly $797 billion from 2022 through 2032. The Cost of War Toxic Exposures Fund it created has since become a contested budget instrument in its own right, with unresolved disputes over what the government may lawfully charge to it. Anyone offering the act as a template should be prepared to respond to concerns over cost.
To our mind, what this objection leaves out is the counterfactual. Adjudicating cumulative blast exposure one claim at a time under a single-incident evidentiary model is not a “free” option. The quest to secure an efficient, equitable traumatic brain injury response took decades to address, multiple congressional interventions, and thousands of appeals that the Board of Veterans’ Appeals and U.S. Court of Appeals for Veterans Claims absorbed at public expense. Presumption is also not a blank check. Its scope — theater, date range, and documented exposure tier — are all available limiting principles.
“Broad Presumption Weakens the Evidentiary Basis of the System.”
A rating schedule that fails to distinguish the injured from the uninjured loses credibility. But our proposal is not to presume more vaguely — it is to presume on better data: tie the presumption to measured or documented exposure rather than to mere presence in a theater.
“Wait Until the Science Settles and Veterans Affairs Has Capacity.”
Veterans Affairs adjudicatory capacity has been a historical concern. But Veterans Affairs’ reported backlog (claims pending more than 125 days) fell below 100,000 in February 2026 for the first time since 2020, and average time to decision was 78.6 days at the end of May 2026, down from 141.5 days in January 2025. Furthermore, “wait for the science” is the position the system took after 2001, and the result was a decades-long response to traumatic brain injuries, the Global War on Terror’s signature wound.
Finally, the science is further along than the objection assumes. The Department of Defense’s overpressure response has already identified the weapon systems posing the highest blast overpressure risk, adopted a four-pound-per-square-inch exposure threshold for risk-management purposes, and required cognitive assessment at accession and at intervals for high-risk personnel. Years of data from servicemembers in Ukraine, and now Iran, have already produced enough evidence for practitioners to articulate treatment recommendations, as described earlier.
The institutional machinery is in better shape than it was in 2003. Veterans Affairs has a modern traumatic brain injury rating framework, the Department of Defense and Veterans Affairs share a joint exposure record, the Department of Defense has a blast overpressure policy, and there is an open rulemaking docket in the right body system.
However, it took multiple decades to get here. Reports by the U.S. Government Accountability Office and Veterans Affairs’ Office of Inspector General have extensively documented examples of inconsistent, evolving traumatic brain injuries policies that continued to fall short years after implementation.
Furthermore, the rate of change in weapons technology makes delay urgent rather than unfortunate. In as little as three years, we have seen the use of improvised explosive devices advance from single-use roadside devices to loitering and swarming munitions that combatants can produce by the million per year. Veterans cannot wait decades for the “comprehensive, integrated, multidisciplinary strategy” that clinicians and researchers have called for, never mind the veterans disability benefits that protect former servicemembers from the chronic harm of service.
The injuries of this era may be new and harder to assess, but they are no less deserving of the frameworks needed to support them.
Robert Chisholm is a founding partner of Chisholm Chisholm & Kilpatrick, a national veterans disability law firm that has represented over 36,000 veterans or dependents before Veterans Affairs and the U.S. Court of Appeals for Veterans Claims since 1999. Chisholm has personally represented veterans with disabilities since 1990, serving as lead counsel in more than 7,500 appeals before the U.S. Court of Appeals for Veterans Claims. He was president of the National Organization of Veterans’ Advocates from 1999 to 2004, where he worked on the legislative effort that expanded veterans’ ability to retain paid counsel in Veterans Affairs claims. In 2016, the U.S. Court of Appeals for Veterans Claims awarded him its Hart T. Mankin Distinguished Service Award for 25 years of service to the court.
Zachary Stolz is a partner at Chisholm Chisholm & Kilpatrick, where he has represented veterans with disabilities since 2007, primarily in appeals before the U.S. Court of Appeals for Veterans Claims — which reviews Board of Veterans’ Appeals decisions — and the U.S. Court of Appeals for the Federal Circuit. He began his career in the judicial appeals office of Disabled American Veterans and is a past president of the Court of Appeals for Veterans Claims Bar Association. He has testified before the House Committee on Veterans’ Affairs on delays in the Veterans Affairs appeals system.
Brad Hennings is a partner at Chisholm Chisholm & Kilpatrick. He has over 20 years of legal experience, having previously served as a Veterans Law Judge at the Board of Veterans’ Appeals, the body that decides administrative appeals of Veterans Affairs benefits decisions, and earlier as an attorney law clerk at the U.S. Court of Appeals for Veterans Claims. He has published on veterans law in the Federal Circuit Bar Journal and the Veterans Law Review.
Image: RBC-Ukraine via Wikimedia Commons
