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WAR VETERANS' CONCUSSIONS ARE OFTEN OVERLOOKED
-- "We were at the point of getting ready
to lose the house
and the cars...I was planning to do suicide and
make it look
like an accident so my family would get the
insurance."
Former Staff Sgt. Kevin Owsley
struggles with memory loss and light sensitivity, symptoms of mild
traumatic brain injuries he sustained in 2004. (photo: J.D. Pooley
for The New York Times) |
For more about traumatic brain injury, use the VA
Watchdog search engine ... click here ...
http://www.yourvabenefits.org/sessearch.
php?q=traumatic+brain&op=ph
Story here ...
http://www.nytimes.com/2008/0
8/26/us/26tbi.html?_r=1&adxnnl=1&oref=slogin&re
f=us&adxnnlx=1219691119-4PVOGWhh
Ave3aBmQyEo77A
Story below:
NOTE: If you wish to post a comment, go to the
end of the story and use our new "Comment"
feature.
-------------------------
War Veterans’ Concussions Are Often
Overlooked
By LIZETTE ALVAREZ
Former Staff Sgt. Kevin Owsley is not quite sure what rattled his brain in
2004 — the roadside bomb that exploded about a yard from his Humvee or the
rocket-propelled grenade that flung him across a road as he walked to a
Porta Potti on base six weeks later.
After each attack he did what so many soldiers do in Iraq. He shrugged off
his ailments — headaches, dizzy spells, persistent ringing in his ears and
numbness in his right arm — chalking them up to fatigue or dehydration.
Given that he never lost consciousness, he figured the discomfort would
work itself out and kept it to himself.
“You keep doing your job with your injuries,” said Mr. Owsley, 47, an
Indiana reservist who served as a gunner for a year outside Baghdad in
March 2004. “You don’t think about it.”
But more than three years after coming home, Mr. Owsley’s days have been
irrevocably changed by the explosions. He struggles to unscramble his
memory and thoughts. He often gets lost on the road, even with directions.
He writes all his appointments down but still forgets a few. He wears a
hearing aid, cannot bear sunlight on his eyes, still succumbs to
nightmares and considers four hours of sleep a night a gift.
 Mr.
Owsley is part of a growing tide of combat veterans who come home from war
with mild traumatic brain injuries, or concussions, caused by powerful
explosions. As many as 300,000, or 20 percent, of combat veterans who
regularly worked outside the wire, away from bases, in Iraq or Afghanistan
have suffered at least one concussion, according to the latest Pentagon
estimates. About half the soldiers get better within hours, days or
several months and require little if any medical assistance. But tens of
thousands of others have longer-term problems that can include, to varying
degrees, persistent memory loss, headaches, mood swings, dizziness,
hearing problems and light sensitivity. These symptoms, which may be
subtle and may not surface for weeks or months after their return, are
often debilitating enough to hobble the lives and livelihoods of returning
soldiers.
To this day, some veterans — it is impossible to know how many — remain
unscreened, their symptoms undiagnosed. Mild brain injury was widely
overlooked by the military and the veterans health system until recently.
Even now, with traumatic brain injury called the signature injury of the
Iraq war, some soldiers and their advocates say that complications from
mild concussions often are not recognized in singular ways.
Mr. Owsley’s request for a Purple Heart, given to troops wounded or killed
in action, was denied by the military, a devastating blow. Others say that
their mild brain injury entitled them only to low disability payments, or,
if the diagnosis was inconclusive, to none at all.
This has happened in large part because there is no quantifiable
diagnostic test for the injury, and the language used by the Veterans
Affairs Department to rate traumatic brain injury, or T.B.I., is vague.
The military, in particular, seldom rates each symptom from a concussion
separately, which it is required to do, said Kerry Baker, associate
national legislative director for Disabled American Veterans.
“The criteria remains ambiguous,” Mr. Baker said. “The military way
underrates T.B.I. and its symptoms.”
Little is known medically by doctors or scientists about what happens to a
brain as a result of a powerful bomb blast, as opposed to car crashes on a
highway, blows to the head on a football field or a bullet wound.
These are the first wars in which soldiers, protected by strong armor and
rapid medical care, routinely survive explosions at close range, and then
return to combat.
The bomb blasts, which throw off energy waves — atmospheric overpressures
and underpressures — that are absorbed by the body, add a little-studied
dimension to the trauma. Scientists only now are beginning to study the
extent of the damage.
That soldiers are sometimes exposed to multiple blasts during a
deployment, or can suffer from a vast combination of wounds, including
shrapnel, burns, blows to the head, blast waves, lost limbs or internal
injuries, can exacerbate brain trauma in ways unseen among civilians. “It
is the black box of injuries,” said Dr. Alisa D. Gean, the chief of
neuroradiology at San Francisco Hospital and a traumatic brain injury
expert who spent time treating soldiers at Landstuhl Regional Medical
Center in Germany. “We’re at the tip of the iceberg of understanding it.
It is one of the most complicated injuries to one of the most complicated
parts of the body.”
These mild concussions, which do not necessarily lead to loss of
consciousness, are easy to dismiss, simple to misdiagnose and difficult to
detect. The injured soldiers can walk and talk. Their heads usually show
no obvious signs of trauma. CT scans cannot see the injuries. And the
symptoms often mirror those found in post-traumatic stress disorder,
making it hard to distinguish between them. In fact, the two ailments
often go hand in hand.
But the consequences of these seemingly small concussions can be
far-reaching, leading to serious financial problems, job losses, divorce
and mental health problems. The ramifications often go unseen by the
military since symptoms often worsen once troops leave the structure of
the Army or Marine Corps for the unpredictability of civilian life.
Take the case of Mr. Owsley, a father of three, whose brain injury so
impaired his reaction time and memory that doctors advised him not to
work.
“I almost lost everything,” said Mr. Owsley, whose wife brought home the
family paycheck for two years, working at a nursing home. “We were at the
point of getting ready to lose the house and the cars. Then you start
planning out things. I was planning to do suicide and make it look like an
accident so my family would get the insurance.”
At first, he said, doctors missed his traumatic brain injury. “She told me
nothing was wrong with me, but she gave me like 18 different medications,
for pain, to go to sleep, for lots of other things,” he said of his first
visit to a Veterans Affairs doctor at a facility in Fort Wayne, Ind.
Later that year, another veterans hospital said he had mild traumatic
brain injury, post-traumatic stress disorder, anxiety, hearing loss and
injuries to his hand, ankles, eye and back. He was rated 100 percent
disabled by the Veterans Affairs Department and now receives a regular
monthly check for $2,711, easing the financial pressure somewhat.
Yet Mr. Owsley, referring to his Purple Heart denial letter, said he feels
his injuries have gone unrecognized by the military “because there was no
blood” and because he chose to work through his pain.
“They said it was because I didn’t report it in the field and seek medical
attention at the time, and there was no proof” of any obvious injury, Mr.
Owsley said. “I had guys write statements for me to prove it had happened.
As a soldier with 23 years in the Army, them badges mean more than
anything. When you get injured, you should be recognized, even if you
don’t see it over there.”
It was not until 2006, three years into the war in Iraq, that the
Department of Defense and the Veterans Affairs Department began to pay
close attention to mild traumatic brain injuries. The Pentagon last year
opened the Defense Centers of Excellence for Psychological Health and
Traumatic Brain Injury, a clearinghouse for treatment, training,
prevention, research and education. This year it is spending a record $300
million on research for traumatic brain injury and post-traumatic stress
disorder.
“We are more attuned to brain injuries now,” said Lt. Col. Michael Jaffee,
the director of the Defense and Veterans Brain Injury Center. “There has
not been as aggressive an effort before.”
That effort begins with screening. As of May, service members who deploy
longer than 30 days will undergo neurocognitive testing before leaving to
establish a baseline for changes that may occur later. (The same test is
administered again upon return.) At the same time, soldiers in battle who
lose consciousness or feel dazed after a blast or other incident must be
screened by a medical provider and are either approved for duty in the
field, told to rest for several days on base or sent to Landstuhl for
further evaluation.
Last year, the Veterans Affairs Department started screening all Iraq and
Afghanistan war veterans who come in for clinical help. So far, 33,000 of
227,015, about 15 percent, have screened positive for mild brain injury
since April 2007.
It is unclear how many service members, particularly those who fought
earlier in the war, remain unscreened and whose injuries go undiagnosed.
“No doubt that there are significant numbers out there,” said Dr. Barbara
Sigford, director of physical medicine and rehabilitation for the
Department of Veterans Affairs.
Bryan Lane, 31, a former sergeant first class in Special Forces, did not
zero in on his head injury until more than a year after a bomb exploded
next to him in a house in Baghdad in 2005. The reasons were
understandable. He lost a huge chunk of his right arm in the explosion and
was fortunate not to have lost it altogether.
He did not realize that his brain had taken a hard hit until five months
later, when he saw the gaping hole in the front of his helmet. He never
lost consciousness after the blast, but the soldier next to him was
knocked out for two hours.
The possibility that he might have suffered a concussion was never
mentioned during his many months of surgeries to save his arm at Womack
Army Medical Center in Fort Bragg, N.C. Six months after he was medically
discharged, when he was putting in a Veterans Affairs disability claim for
his arm injury, a V.A. doctor brought up the possibility overlooked at
Womack: he might still be suffering symptoms from a concussion.
It explained his shortened attention span, his frequent search for the
right word during conversation and his forgetfulness. “I hear things but
it doesn’t throw it in the memory box,” he said.
“I was completely honest and said I don’t think I have T.B.I.,” said Mr.
Lane, who is still articulate, though less so today, he said. “A lot of
guys, myself included, fight the label of T.B.I. no matter how mild. In a
way, it’s like people are calling you stupid or retarded, and I know
that’s not PC.”
The Veterans Affairs Department, which has become increasingly vigilant
about mild traumatic brain injury, thought otherwise and did something
unusual. It attached a brain injury claim alongside one for post-traumatic
stress disorder, covering all bases. “Since no one understands the
relation they have to each other, they said, If you have one you have the
other,” said Mr. Lane, who receives benefits for mental injuries and
physical ones. He now works for the Armed Forces Foundation, a nonprofit
group that provides troops, many of them injured, with financial support,
among other things.
Post-traumatic stress disorder and traumatic brain injury are closely
tied, although the precise relationship between the two is unknown.
This connection was most recently established in a study in The New
England Journal of Medicine in January by Col. Charles W. Hoge, an Army
psychiatrist leading efforts to identify mental health problems among
combat troops. His survey of 2,500 Army infantry soldiers found that more
than 40 percent of those who reported loss of consciousness also met the
criteria for post-traumatic stress disorder. That was a much higher
percentage than those who had suffered other injuries, like Humvee
accidents or falls.
Dr. Hoge cautioned, though, that some of the symptoms — anger, headaches,
depression, sleeplessness, mood swings — may in fact stem solely from
combat stress, a psychiatric disorder, and not traumatic brain injury.
Combat, he emphasized, often goes hand in hand with traumatic experiences,
including a near loss of life or the death or injury of others.
For years most troops with mild concussions stayed on the job, immersing
themselves in combat again and re-exposing themselves to additional blasts
with little or no time to rest and recover. This pattern only heightened
the risk of brain injury and post-traumatic stress disorder, doctors say.
Civilians with brain injury, on the other hand, are given time to
recuperate for long periods in a safe environment, which may explain why
they respond differently to stress.
Dr. Ibolja Cernak, a brain injury expert who is medical director of the
applied physics laboratory at Johns Hopkins University and is conducting
research into blast injuries, said she has noted other differences between
blast-injured soldiers and mildly brain-injured civilians.
Soldiers, she said, can develop symptoms two years after the blast. Some
also have greater difficulty walking or talking, or with aggression.
“Civilians don’t have the frequency of these symptoms,” Dr. Cernak said.
There is no cure for those with prolonged concussion symptoms, only tricks
to help them learn to adapt.
Sgt. Tony Wood, 41, who is now based at Schofield Barracks in Hawaii,
keeps a large color-coded board by the door with reminders about his
appointments, his chores and his belongings, all part of the Brain Injury
Recovery Kit from a nonprofit group called the 10 in 10 Project. His wife
calls him with reminders all day and after losing his keys countless
times, he now attaches them to his pants. Little notebooks fill his
pockets.
In his view, the military is still failing to grasp the depths of his
injury, and those of other soldiers like him.
In July 2005, Sergeant Wood’s Humvee hit a lethal roadside bomb cemented
into the curb. The blast set off a chain reaction, triggering two American
fragmentation grenades inside the Humvee along with an antitank weapon and
countless rounds of ammunition. The two other soldiers riding with him
died in the blast. The explosion tore through Sergeant Wood’s arm and
abdomen and then ricocheted inside his body, leaving only his heart
untouched. His liver had a fist-size hole, he lost his spleen and part of
his stomach and he sustained damage to his lungs and diaphragm.
Sergeant Wood’s first memory after the bomb was opening his eyes at Walter
Reed about a month later, seeing his wife, and asking, “Why are you in
Iraq?”
Doctors patched up most of his physical wounds over five months. But his
wife, who was born with mild brain injuries, noticed that Sergeant Wood, a
military policeman, was not himself mentally. He did not remember someone
who had just walked out of the room. He forgot questions he had just
asked. He struggled to read one chapter of a book.
While he was at Walter Reed in December 2005, Sergeant Wood said doctors
gave him a brain injury test. But it was inconclusive. “They tried to say
I had A.D.D., I needed a good night’s sleep, you name it,” he said,
referring to attention deficit disorder.
As he later recovered in the Warrior Transition Unit at Tripler Army
Medical Center in Hawaii, Sergeant Wood struggled to decide whether to
stay in the military by switching to less physically and mentally taxing
jobs, an idea he hated, or to leave, collect his benefits and find a
civilian job. But his previous jobs — professional cowboy, scuba
instructor, construction worker — were out of the question. “My T.B.I. has
impacted my ability to get a good job,” he said. “I’ll be a greeter at
Wal-Mart.”
With four foster children, two biological children and a wife, he steered
the safe course and applied to try to stay in the military. The Army
Medical Board deemed him unfit for active duty and sent him to the
Physical Evaluation Board for a disability rating that would determine his
benefits package once discharged from the Army.
When he saw his rating in March, he was floored. Despite his extensive
wounds — brain injury, constant pain, failing hips, headaches, noise
sensitivity, no spleen, lung damage, liver damage, panic attacks and
chronic esophagitis — he received only a 50 percent rating. His brain
injury made up 10 percent of the total. A memorandum from the board said
that his “stated difficulties are more consistent with PTSD.”
As a last resort, Sergeant Wood can turn to the federal courts.
He is not the first soldier to receive a low rating for his injuries from
the Army since the Iraq war began. Congress was so distressed by the
ratings that as of last January it ordered the military to follow solely
the ratings schedule issued by the Veterans Affairs Department, which
consistently grants veterans more money for the same injuries.
“The Army was raking these guys over the coals,” said Mr. Baker, of
Disabled American Veterans.
Asked by The New York Times to review Sergeant Wood’s paperwork, Mr. Baker
said Sergeant Wood’s extensive injuries easily should have been rated 100
percent, according to the Veterans Affairs schedule.
“This was completely wrong,” Mr. Baker added.
Sergeant Woods has been permitted to stay in the Army for now under a
separate program for soldiers injured in combat. He sits at a desk at a
local Hawaiian jail and alerts the military when a soldier gets locked up.
He fears he will get an even lower rating the next time he goes before the
Army Medical Board, simply because he is doing his job well.
“You are still treated like you are trying to beat the government out of
money,” Sergeant Wood said. “It’s not like I fell off a bar stool.”
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