COUNTERING MILITARY RECRUITMENT
Articles: Leaving Military: Veterans
Hidden Wounds
Kelley Beaucar Vlahos, The American Conservative
July 2, 2007
When Samuel Vaughan Wilson III speaks, he periodically stopsmidsentence to rub his jaw, still pained by the rocket-propelled
grenade that ripped through his vehicle, grazing his face and
singeing the nerves inside his mouth. It was one of several close
calls during that year in Afghanistan: after one IED attack, he
recalls with a medic's precision how, under heavy gunfire, he cut
open an Afghan police officer's throat to clear an air passage,
saving his life. He says with equal sobriety that his Army career is over.
"My father wants me to get screening [for Traumatic Brain Injury]. He
thinks something is wrong," said Wilson, who served as a combat medic
in Afghanistan with the 508th Parachute Infantry, survived four IED
incidents, numerous firefights, and that RPG near miss. According to
the recommendation for his Army Commendation Medal, Wilson was
credited, in one incident, with saving eight lives and maintaining
his composure under "the most extreme circumstances in a combat
environment. " But in September 2006, he left the military after 11
years under a rare medical discharge for post-traumatic stress disorder.
He now struggles to understand where his physical injuries leave off
and the mental ones begin. His anger, restlessness, and sleepless
nights are classic symptoms of both mild TBI and PTSD, which are
provoked regularly during his day job as an emergency paramedic in
Northern Virginia. "We've looked into it," he said, of possible TBI
screening, "but I've gotten nowhere in the VA system yet."
Red-headed Wilson, 36, says he looks like Howdy Doody, but nothing
about him is funny. The black ID bracelet of a platoonmate killed in
action firmly around his wrist, he is at one turn intimidating and
dark, at another vulnerable, self-deprecating, and visibly wracked
with survivor's guilt. He's outrun death, but doesn't quite feel alive.
"I love the Army I was born and raised in it," Wilson said,
reflecting, not for the first time, on his lineage, which includes a
grandfather, (Ret.) Lt. Gen. Samuel Vaughan Wilson Sr., who as one of
"Merrill's Marauders" fought behind enemy lines in Burma in World War
II. The grandson isn't the first in his family to bring home PTSD
along with medals for valor. His haunted nocturnal pacing when he
returned from Afghanistan forced his father, (Ret.) Army Lt. Col.
Samuel Vaughan Wilson Jr., to face down a reappearance of his own
demons, left over from the rice-paddy wars a generation ago.
"He and I walked in each other's shoes if you will. His war was very
similar to mine in that we both dealt with combat that was
asymmetrical at the least expected moments, [the fighting] would
flare up," said the elder Wilson, an infantry officer in Vietnam in
the early 1970s.
But one major difference between his war in the Mekong Delta and his
son's in Kandahar is that, thanks to improvements in body armor and
emergency medical response, today the military is bringing more
soldiers and Marines home alive battered, shattered, and transformed,
but not in the body bags that drove a nation to disenchanted
departure from Southeast Asia.
Yet by the thousands, they are also returning with horrifying
injuries, the most pervasive being the IED's especially vicious
souvenir: traumatic brain injury. Symptoms range from memory loss,
fatigue, irritability, mood swings, and a change in sleep patterns in
milder cases to loss of co-ordination and balance, seizures,
migraines, confusion, and agitation in more severe instances.
"TBI is going to be the worst story in terms of returning veterans,"
said Paul Sullivan, an advocate with Veterans for America. He
estimates that anywhere from 160,000 to 320,000 servicemembers and
veterans are suffering from some degree of TBI today, "most of which
are unscreened, undiagnosed, and untreated."
Wilson's story is hardly rare. Physically, soldiers like him look
healthy, but they come home changed, confused about their
circumstances and often too ashamed to seek help. If they are still
on active duty, they worry that their brain injury or PTSD will be
mistaken for a pre-existing personality disorder, which could result
in a bad discharge. They are anxious about getting a good disability
rating when they leave the military, as statistics show the Army is
lowballing ratings for PTSD, TBI, and other injuries, meaning there
is a good chance all they will get from Uncle Sam is a severance check.
Once out, they face a long waiting list at the Veterans'
Administration and a lack of mental healthcare access in rural areas.
Many contemplate or commit suicide, get divorced, leave their jobs,
and even walk the streets, homeless.
"The idea of okay, cheer them up, wave the flag, bring them home, and
forget about them … we're going to be paying for this for the rest of
their lives. It's going to be a horrible bill that we're going to
pay," said Wilson's dad, now a high-school teacher in quiet
Farmville, Virginia.
"If we've got any moral virtue left, we've got to pay it," he added.
"We really didn't anticipate, as a country, and as a nation, the
tremendous stresses on our medical system. It's a horrible thing."
But some people did anticipate it, and veterans from previous and
current wars call them "warriors for the wounded" have been working
endlessly and aggressively to ensure today's veteran isn't betrayed.
Take Sullivan, a Gulf War veteran who left his job as a senior
researcher at the VA in March 2006, frustrated his distress signals
were being ignored. "They went on record with the Boston Globe that I
was 'alarmist,'" he said of a March feature on the perils of the VA
system. "I had no other choice but to pull the alarm." The VA does
not refute Sullivan's research but winces at his interpretation.
With an estimated 5.5 million veterans being treated at the nation's
1,400 hospitals and clinics each year 230,000 of them from
Afghanistan and Iraq and an estimated 470,000 more yet to move into a
system that is experiencing a backlog of 400,000 disability claims
and a six-month average wait for a medical appointment, it is hard
not see fire on the mountain.
"Everyone is giving lip service, but Walter Reed is just the tip of
the iceberg," Sullivan said, referring to the recent scandal at
Walter Reed Army Medical Center, where soldiers were found
languishing in moldy conditions, outflanked by a seemingly
unsympathetic bureaucracy. Surveying the hundreds of thousands of new
claims coming in, staff shortages, inefficiencies, and the increased
needs of older veterans, he declares, "The VA is in a crisis right now."
Enter TBI, which doesn't always render a person physically disabled
and fully dependent but if left untreated, can devastate lives.
Thousands of times in this war soldiers close to a bomb blast have
shaken themselves off and walked away to patrol another day. Months
later, they return home and do not recognize the face in the mirror.
"It's like slamming a laptop against the wall," said Patrick
Campbell, 29, a National Guardsman who served in the 256th Infantry
Brigade as a medic in Iraq from November 2004 to October 2005. While
the computer may seem functional afterwards, small quirks like a
broken backspace key or a jagged line down one side of the screen
soon become obvious and render use slow, frustrating, and intolerable
for the long term.
"The concussive event the wind and the pressure changes it's more
damaging than the force of getting hit," said Campbell.
He will tell you that in a single incident, an IED explosion causes
an intense shockwave of pressure. When close enough, it can form
tiny, destructive air bubbles in the brain and blow out precious
wiring inside a soldier's skull. Those not affected by the blast wave
may be hurtled through the air, slammed around in a vehicle, or hit
in the head with debris. Their Humvee might overturn. As described by
some, any of this could throttle the brains like Jell-O.
In Vietnam, one soldier was killed for every 2.5 wounded; in Iraq the
survival rate is one killed for every 16 wounded. But the effects of
TBI may take hours, days even weeks to surface.
While at first glance Campbell looks as if he would be more
comfortable in an armored Humvee than a downtown D.C. office space,
but it's soon clear his new posting is a good fit. Working fulltime
for the Iraq and Afghanistan Veterans of America, which is steadily
becoming the generational equivalent of such scrappy advocates as the
National Gulf War Resource Center or Vietnam Veterans of America, his
goal is to cast a floodlight on TBI's effect on returning service members.
"There are a lot of people out there who have never been 'right'
after an IED," said Campbell, recalling one case in which a veteran
had to carry around a notebook to write down everything he did, said,
or had to accomplish because his short-term memory was shot. "Now
they are at home and wondering why they are different."
He recalls his own multiple "concussive events" in Iraq. One, an IED
blast, left his ears bleeding and he and his buddy laughing over
their luck. He went right back on patrol. Today, he plans to take
advantage of the new mandatory TBI screening at the VA, wondering if
those events contributed to his own diagnosis of PTSD.
"Not all people want to acknowledge that they have a problem. The
symptoms are extremely close to PTSD," which still carries a stigma,
particularly among peers and the chain of command. It took Campbell a
year and losing his best friend over his changed personality to
finally seek help.
Thanks to lobbying efforts by groups like the IAVA, the VA announced
in April that it will begin screening all incoming veterans from Iraq
and Afghanistan for TBI. Now the pressure is on the Department of
Defense, which only offers comprehensive TBI screening for the
wounded coming into their hospitals, like Walter Reed.
If TBI is the silent affliction of this war, the casualty count
should be the canary in the coal mine. As of mid-May, the military in
Iraq suffered 14,804 injuries that required medical transport off the
battlefield. This included 7,628 combat wounded and 7,176 non-hostile
injuries, plus 19,589 "diseases," which cover everything from a
bacterial infection and mental disorder to cancer and pregnancy, that
also required medical air transport. In Afghanistan, 6,213 injured
soldiers were evacuated from the field, including 743 combat-related,
1,458 non-hostile, and 4,012 diseases.
Symptoms of TBI can turn up in any of the these categories. According
to various reports, of the 1.4 million who have rotated through Iraq
and Afghanistan, anywhere from 10 to 30 percent have been exposed to
a bomb blast or other head trauma, leaving them with at least mild
TBI. A recent study by doctors at Fort Carlson Army base in Colorado
found that 18 percent of their returning soldiers had incurred a
brain injury in Iraq.
Some 60 percent of the veterans in the VA's Polytrauma Rehabilitation
Center in Tampa, Florida, one of 21 centers handling vets with
severe, multiple injuries, have a brain injury, according to ABC
newsman Bob Woodruff in a February series he put together after his
own year-long recovery from an IED blast. Meanwhile, officials at the
Defense and Veterans Brain Injury Center, the military's primary
research and treatment facility for TBI, has treated 2,130 patients since 2003.
"That's just a small percentage of the total number, and the fact is,
nobody really knows how many have mild [TBI]," said Col. Jonathan
Jaffin, Commander of U.S Army Medical Research and Materiel Command
at Fort Detrick, Maryland and a spokesman for the DVBIC. He said 70
percent of their cases are mild and those affected may, with the
right treatment, recover or at least adjust to their disabilities.
But it is not clear, according to doctors, how soldiers with
cumulative concussive injuries will fare long-term. All seem to agree
the body of research on non-fatal blast injuries is thin.
"Mild head injury for years had been somewhat neglected," Jaffin
says, with standard testing for TBI often missing less severe cases.
"So people would be suffering and being told they are normal." As the
pervasiveness of TBI among returning service members became clear, he
said, the military and VA began developing better ways to detect
it though advocates will dispute their commitment.
VA officials say they are treating nearly 400 veterans diagnosed with
moderate to severe TBI, while overall they have seen more than 1,600
potential cases since 2002. They acknowledge, however, that the
system has yet to compile statistics for mild cases or outpatients.
Meanwhile, symptoms of mild to moderate TBI go unchecked, crowded out
by the more obvious injuries. Furthermore, misdiagnosing TBI most
likely mistaken for PTSD is commonplace.
"When it does occur, PTSD and TBI together can be especially
difficult to spot. The problem lies in the overlapping
symptoms increased anxiety, short attention span, limited
concentration, problems with memory. This overlap muddles things up,"
points out Ilona Meagher, author of Moving a Nation to Care:
Post-Traumatic Stress Disorder and America's Returning Troops. "Once
you have these kinds of errors on military records," she added, "it
creates a whole other level of problems down the road for the veteran
after they've returned home."
That road is paved with the stories of men and women who find that
the system is no more compassionate than it was for their
counterparts returning from Vietnam a generation ago. The PTSD label
is not only stigmatizing, but its symptoms are often mistaken for
personality disorders and are blamed for behavioral problems like
insubordination and substance abuse, resulting in a one-way ticket
out of the military with no retirement pay or benefits.
"This time it's all about money they just don't want to pay," insists
Sullivan. But unlike previous wars, there is a small army of
veterans' advocates, many who cut their teeth on behalf of Persian
Gulf soldiers in the 1990s.
Steve Robinson, also with Veterans for America, packed his experience
and reputation along with his bags and spent most of May around Fort
Carson, pulling together a massive case accusing the command of
erroneously discharging 276 soldiers for personality disorders. These
servicemembers all suffered from PTSD, and many had accompanying TBI
diagnoses. His organization is also investigating more than 40
current cases on the base. They include bad discharges but also
complaints from soldiers that their brain injuries and mental-health
problems were mishandled or ignored by superiors.
Robinson, who has been working tirelessly as an advocate since his
own stint in the Persian Gulf War, helped to attract a delegation of
congressional staff who met in a closed-door briefing with spouses.
His work also brought on a Government Accountability Office probe.
Spc. Paul Thurman, 24, is part of that investigation. After two head
injuries incurred during training at Fort Bragg and in Kuwait, even
under heavy medication he struggles daily with uncontrollable
shaking, intense headaches, short-term memory loss, twitching, and
the threat of seizures. His moment of terror came when he suffered a
seizure and threw up during a meeting with an Army lawyer.
He was waiting for his medical evaluation and discharge at Fort
Carson when he was given an Article 15 the non-judicial punishment
meted out by a commander for minor disciplinary offenses for cussing
and walking off formation when he was told he couldn't get his
seizure medication at the onset of an episode.
Robinson and company took up Thurman's case because they say he
should not have been deployed after the first head injury. He had
been diagnosed with lesions on the brain. "These guys came forward
and said, look, you can't push this dude around. They've been
unbelievably helpful," Thurman said of Robinson's crew. "They know
how to care for us."
Thurman's only mode of transportation before he joined the military
at the age of 18 was a bicycle. He thought, cycling daily past the
recruitment center, that the service would give him a job and his
life direction. Now he can't find a job because he can't drive a car
and the seizures aren't a selling point with employers. He's tired of
the emergency room particularly how he is made to feel that he's done
something wrong and he's scared that talking about it will put his
final discharge status at risk.
Fort Carson says there is another side to these stories. While the
base hasn't denied struggling with TBI and PTSD which according to
reports has increased from 32 cases to 539 in the last year
there officials say none of the soldiers chaptered out for
personality disorders were suffering from severe PTSD or TBI. Rather,
their behavior, backed by a pre-existing condition found in their
backgrounds, got them booted.
Robinson said his group chose Fort Carson as the first in five
fact-finding missions because it had the most documentation to back
up the soldiers' claims. However, "these problems are system-wide. "
The disability ratings game has become a gauntlet for soldiers
suffering from myriad physical and mental injuries. At the head is
the Physical Evaluation Board, which assesses whether an active
servicemember is still fit for duty and rates individual disabilities
to determine the type of discharge and whether it warrants lifetime
healthcare and retirement pay. A rating of 30 percent or more allows
the soldier to be medically discharged with pay and healthcare.
Anything beneath that buys a single severance check and a U.S. News
and World Report investigation found that nearly 93 percent of
disabled troops were receiving low ratings.
The Veterans Disability Benefits Commission is reviewing these
charges, and in April, it offered Congress some preliminary data that
compared combined disability ratings from both the DoD and VA. The
numbers showed that 81 percent of all disabilities between 2000 and
2006 were rated 0 to 20 percent by DoD. Out of 50,676 Army soldiers
deemed unfit for duty, 27 percent received 0 percent ratings.
What is more striking are the differences between DoD and the VA,
which uses its own ratings to assess healthcare and compensation.
Focusing on comparative data for both institutions, the commission
found that 59 percent of the time, DoD would give a soldier a
combined rating of 0 to 30 percent, while the VA would take that same
soldier and give him a rating of 30 to 100 percent. The disparity in
specific mental health ratings were even more glaring.
VDBC chairman James Terry Scott told the Senate on April 12, "It is …
apparent that DoD has strong incentive to assign less than 30 percent
so that only separation pay is required and continuing family health
care is not provided."
"We're very concerned," said Ron Smith, deputy general counsel for
the Disabled American Veterans. His job is to represent veterans
appealing their disability ratings. He is not lacking for work. He
said lowballing typically hits low-ranking servicemembers who get
smaller severance payments and are likely to spend them more quickly.
Then there is a lengthy gap before their new claims at the VA are processed.
"They are playing fast and loose with disability ratings," charged
Larry Scott, a staunch advocate who runs VAWatchdog.com, noting that
victims of PTSD and mild to moderate TBI are more likely than others
to get the bureaucratic boot out the door.
At the end of this bottleneck, there is the VA system, where Vaughan
Wilson waits today. After nearly nine months, the medication for PTSD
given to him following his discharge from the Army is nearly gone.
His six months of free health coverage through the military has
expired, and even when he had it, he had no luck in finding a PTSD
counselor in rural Virginia, where he was staying with his dad for
the first few months of civilian afterlife.
Beset by ongoing nightmares, bouts of panic and fury, Wilson is
slowly getting his life on track he and his fiancée Joy are expecting
a baby in October but he knows he needs treatment, including a much
delayed screening for TBI. Built to carry a soldier's legacy, he
looks anything but weak or insecure, but his eyes are sad and he's
wound like a top. He's no fool he has collected affidavits concerning
his many commendations, his medical evaluations, and photos of
carnage if anyone tries to question the validity of his story.
"The most frustrating thing for me are the reasons my claim has been
held up," he said, noting one case in which he mistakenly provided
the wrong Social Security number for his daughter on the forms. "The
people I've encountered at the VA are doing the best they can … but
there is too much of a paper trail" to manage and the bureaucracy is
too massive, too tricky to navigate. "The disconnect was, there
wasn't a good handoff from the military to the VA," he noted.
That disconnect is just one of the challenges facing the VA, which
has treated nearly one in three returning veterans since the war on
terror began. There is an average six-month wait for an initial
appointment and four-month wait for disability claims. Appeals
stretch over an additional year and a half, according to a March GAO report.
"I'm not a hate-the-VA guy," said Scott. "I've been in the system for
26 years and have gotten nothing but great care. … [but] we've been
fighting a war on the cheap and we are trying to care for our wounded
on the cheap, too."
VA officials say the new TBI screening is only a piece of an overall
effort to improve diagnosis and treatment, reduce the backlogs, and
close the VA-military gap. Paul Sullivan said advocates like himself
will be there to make sure they make good, particularly on promises
to respond to the challenges of TBI.
Ignoring brain injury while it destroys veterans won't do, he said.
"We will try to put people in jail this time if they try to go that route."
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