Posts Tagged ‘TBI’

by Maj. Ben Richards

Traumatic Brain Injury and Post Traumatic Stress Disorder are injuries that apparently only afflict second-class soldiers. These soldiers are S#!%-bags, f*&#-ups, weak, can’t hack it, malingerers. At least that ‘s how I felt by the time I was diagnosed with TBI more than three years after a literal run-in with a suicide car bomb on the Al Qaeda-controlled streets of Baqubah, Iraq. And since then, I’ve observed countless other invisibly-wounded warriors treated the same way—as no-account dirt bags.

Part of the problem is inherent in the nature of the wounds themselves: They only become visible through a sustained pattern of behavior that interferes with a soldier’s professional and personal life. If a soldier is not having a problem, goes the logic, then he or she is not invisibly wounded—even though many struggle to conceal any problems out of fear of the consequences of being found out.

I would like to share some of the reasons for this unfortunate reality that I’ve both experienced and observed.

First, invisible injuries are extraordinarily difficult to diagnose. According to the guidelines established by the Defense and Veterans Brain Injury Center, a closed-head TBI (aka a concussion) where no bullets, fragments, or objects have penetrated through the skull, is diagnosed and classified as either mild, moderate or severe entirely by the symptoms displayed in the first 24-hours after the injury. That’s the easy part. But this limited classification system has only marginal relevance to how much lasting damage the TBI did to the brain. A soldier with a severe TBI (unconscious for 30 minutes or more) may appear to recover to full function, while a soldier with a mild TBI may have sustained significant lasting damage that is permanently disabling. The problem is further complicated by the fact that behavioral symptoms of brain damage from blast-TBIs mimic the symptoms of PTSD.

Even advanced diagnostic tools like MRIs, if a soldier is lucky enough to get one, may not “see” the brain damage. Military hospitals are under-resourced with brain imaging tools, and the scans are expensive, so the military has been reluctant to use them unless there is already evidence of damage from other sources. Diagnosis of brain damage often relies on performance and behavioral problems consistent with Post-Concussive Syndrome because a negative scan does not at all preclude the possibility of brain damage. TBI diagnoses therefore often remain tentative and based on circumstantial medical evidence (something Physical Evaluation Boards and the VA Benefits administration

are more than happy to exploit to the detriment of the wounded). Many doctors appear to be content to just label the problem PTSD in order to avoid the time and cost of a TBI investigation.

PTSD, though technically easier to identify, also depends on the subjective recognition or admission of a pattern of problematic behaviors over an extended period of time. In fact, when I returned to Fort Lewis from Iraq, we were told not to seek behavioral health assistance for ninety days (unless we were at risk of harming ourselves or others) because everyone was expected to experience symptoms of post-traumatic stress after returning home. Only if you continued to experience problems after this waiting period would the doctors consider evaluating PTSD and attempt to help you. However, many soldiers move on to other assignments or leave the military before they are willing to recognize that they have a problem and need help.

Consider the case of one of my friends, a West Point classmate. When we graduated he became an infantry officer, and a few days later he married a beautiful young lady. Shortly after the Hussein-regime toppled, he deployed to Iraq as a lieutenant in an infantry company.  He spent a dangerous and stressful year trying to stabilize a failing society while fighting off an emerging insurgency. Shortly after returning home to his wife and two young children, he decided to leave the Army. He resigned, went to graduate school and found employment as a promising young professional.

Except that he had returned home in one piece, but not entirely whole. He was struggling at work—and it’s likely he was struggling at home. Then he was fired from his job. With that black mark on his resume, he felt like a failure, lost all confidence and had difficulty finding suitable employment. Soon he couldn’t afford the payments on their modest suburban home. Eventually delayed diagnosis of PTSD brought him a paltry $500-a-month disability payment from the VA—small recompense for the price he and his family continue to pay every day for his service to the nation.

A second reason is the unforeseen by-product of the Army’s “Life-Cycle Manning” system. Under this policy, soldiers are brought into a unit to serve together for a two- or three-year “life cycle” that culminates with a combat deployment in the last year. After returning home the majority of soldiers in the unit are quickly reassigned elsewhere. The policy was implemented at the beginning of the wars and was successful in fostering effective and cohesive combat units. However, leaders failed to anticipate, and may still not recognize, the negative impact this policy has on soldiers struggling to deal with invisible combat injuries.

Allow me to illustrate this point with the story of a young soldier who served in my Cavalry Troop in Iraq. In the spring of 2007 our unit was sent to Baqubah– at the time the declared capital of Al Qaeda’s ‘Islamic Caliphate’– to help hold the line there until further reinforcements could be spared from the Surge in Baghdad. We were outnumbered four to one in a provincial capital almost entirely under AQ control. For three terrible months we were fighting every day, and almost every night we were saluting fallen comrades one last time as they began their final journeys home.  Through the worst of it, I watched this young warrior repeatedly volunteer to take the place of wounded comrades and go to the places of greatest danger.

At the end of our tour, he returned home in one piece, but he too was not entirely whole and quickly entered into a close relationship with the bottle. His performance declined. Then late one night he was arrested for a DUI. A few weeks later he was arrested for a second DUI. I didn’t need the military police reports to see he was struggling.

In the hierarchy of army organizations, our positions were separated by two non-commissioned officers and one junior officer. Army manning policy had rotated out all the men who’d filled these positions during our tour and replaced them with new junior leaders who had not known this young warrior as the stud and courageous hero he’d been. They only knew him as a discipline problem, a drunkard and a poor performer. The policy had also stripped away this soldier’s support structure. Most of his unit “family”, the people who he knew, trusted and could have turned to for support and encouragement to get help, was gone. The Army does not look kindly on DUIs, and military justice—untempered by earned and appropriate clemency—brought heavy punishment. He had gone from stud to dud just like that.

Consider this hypothetical scenario. Suppose you had a medical condition that was very uncomfortable, but unlikely to become fatal. A medical treatment was available that had been effective in helping other people with your problem only about 50 percent of the time with no guarantees of a cure and not very promising existing statistics of treatment outcomes. And the treatment has some seriously bad side effects. Like possibly ruining your career, resulting in the loss of your job, even leaving you and your family destitute. Suppose that if you get the treatment, almost everyone who finds out about your condition will ostracize you; That you might even die at your own hands after taking drugs during the course of treatment that according to the side effects labels “may cause suicidal thoughts or actions;” That at the end of the treatment, there’s a good chance you’ll still have the problem and be forced into poverty and dependence on a fickle, uncaring and dysfunctional bureaucracy for your pittance of a pension and continuing so-called “help.”

What would you do?

This is the conundrum invisibly-wounded warriors face. The third reason many invisibly-wounded warriors resist seeking “help” that too often turns into a very bitter medicine. Is it any wonder that many soldiers are reluctant to recognize their problems or try to fix them through the system?

Until a few years ago, “help” meant the certain end of your career because ‘mental illness’– which PTSD is still considered– would disqualify you from the security clearance necessary for promotions and service in many military career fields. Today “help” still means there’s a good chance you’ll lose your job or ruin your career. “Help” still means possibly being labeled as weak, incompetent or as a malinger faking a condition to get out of work. “Help” still means possibly being stripped away from your unit and sent to live in limbo among callous strangers in a Warrior Transition Unit. “Help” still means being judged as “mentally ill,” just like the psychos institutionalized because they are risks to themselves or society. “Help” still means being stamped with a stigma reinforced on the nightly news by stories of violent crimes committed by former service members who are unfailingly categorized as driven by PTSD whether they are or not. “Help” still means being thrown on the fickle and not-so-tender mercy of America’s most dysfunctional bureaucracy– the Veterans Affairs Administration.

Take the example of a young, former non-commissioned officer in the Marine Corps whom I got to know while we were both getting some “help.” He’d been promoted quickly to the rank of sergeant and had led an armored vehicle section in combat. He loved the Marine Corps and had planned on being a career Marine.

He had also returned home in one piece, but again not entirely whole. Not long after returning home his marriage ended. An explosive temper led to discipline problems which cost him his sergeants’ stripes. Only afterwards was he diagnosed with PTSD and exiled to a Warrior Transition Unit where he continued to be ill-treated. He was hurting and angry, stripped of everything that mattered to him. Only after both his marriage and career were in ruins

and he’d been deprived of his honor and dignity did doctors do an MRI that revealed damage to the area of the brain that controls emotional regulation—the consequence of too many IED hits in Iraq. His problem was a consequence of duty, honor and service to country, not a flawed character. Where was timely, respectful help?

For me, I have my own chapter in this story. After awhile, I began to see myself as a S#!%-bag, a f*&#-up, weak, dishonored and a failure in every aspect of my life. It is not a far journey from there to thinking your loved ones would be better off without the burden their relationship with you places upon them. From there it is not much further to the 349.

This column is dedicated to the 349 active-duty soldiers, sailors, airmen and marines who committed suicide in 2012. And the 22 Veterans who commit suicide every day.

Maj. Ben Richards