Military Still Struggling to Treat Troops With Brain Injuries

Joaquin Sapien
ProPublica / Investigation Analysis
Published: Tuesday 27 December 2011
“More than 115,000 soldiers have sustained mild traumatic brain injuries, also called concussions, in the wars when shock waves from bombs rippled through their brains.”
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For the past two years, ProPublica and NPR have collaborated on an investigation that looks in-depth at the military's handling of traumatic brain injuries, a signature wound of the conflicts in Iraq and Afghanistan.

More than 115,000 soldiers have sustained mild traumatic brain injuries, also called concussions, in the wars when shock waves from bombs rippled through their brains. Most have recovered quickly, but some have suffered lasting cognitive problems, from headaches and dizziness to problems with memory and reasoning.

As a result of our work, Congress and government investigators have pressed the Defense Department to fix flaws that have prevented troops with TBIs from being properly diagnosed and treated.

In January, Sen. Claire McCaskill, D-Mo., questioned the Pentagon's decision to deny cognitive rehabilitation therapy to troops with brain injuries. Her inquiry came after a story we did about how the Pentagon based its decision not to pay for such care on a much-criticized report from the ECRI Institute. Following the story and McCaskill's inquiry, the Pentagon solicited the help of the Institute of Medicine, which released a report in October urging the Defense Department to do more research on the therapy before offering it more broadly.

Investigators at the U.S. Government Accountability Office have also scrutinized military programs developed to address brain injuries. In a February report, the GAO said that the Pentagon's Defense Centers of Excellence was plagued by weak leadership, uncertain priorities and flawed accounting. The DCOE, which was created after a 2007 Washington Post series exposed the poor living conditions of concussed troops at Walter Reed Army Medical Hospital, couldn't explain exactly how much taxpayer money it received or how it was spent, the GAO report said.

In March, the Army responded to a story we published last year about how soldiers had been denied Purple Hearts after suffering concussions on the battlefield. The Army issued new guidance, making it easier for brain-injured soldiers to get recognition.

Among the reasons the military has struggled to treat brain-injured troops, one of the most obdurate is a lack of neurologists, according to interviews and documents we obtained earlier this year. Policies issued in June 2010 requiring soldiers to receive a comprehensive evaluation when they suffer three or more mild traumatic brain injuries in one year have intensified the need for qualified doctors.

Plus, as we reported in May, more than half of all Iraq and Afghanistan veterans treated in Department of Veterans Affairs hospitals since 2002 have been diagnosed, at least preliminarily, with mental health problems.

One such veteran is Brock Savelkoul, a troubled young man who survived a blast in Iraq. Back home in North Dakota, he embarked on an equally harrowing journey that ended in an armed standoff with local law enforcement officers, who spent hours persuading him not to commit suicide.

Savelkoul, who we featured in a Kindle Single earlier this year, was one of about 300 troops examined in a study conducted by then-Lt. Col. Mike Russell, the Army's leading neuropsychologist. Russell presented his findings in November 2009 and concluded that a computer test being used to evaluate whether soldiers had suffered concussions was "only slightly better than a coin toss."

Russell was referring to the Automated Neuropsychological Assessment Metrics, or ANAM, which the military has given to 1 million troops since 2008 in response to an order from Congress.

Last month, we published a story about how the military came to spend $42 million on the ANAM program, despite the fact that the test was never scientifically proven to detect brain injuries. As part of our investigation, we released a withering report on the ANAM that Russell delivered to members of Congress, which was not previously available to the public. In his critique, Russell lambastes nearly every aspect of the program, saying that "the selection of ANAM was nepotistic, and the long delay in examining alternative instruments is baffling."

Following our story, McCaskill began an investigation into contracts surrounding the ANAM program. Rep. Bill Pascrell, D-N.J., co-chairman of the Congressional Brain Injury Task Force, proposed an amendment to the 2012 National Defense Authorization Act to help fix the beleaguered testing program, but it was pulled from the legislation. Pascrell is now pushing for a large increase in funding for the military's TBI services in this year's appropriations bill.



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ABOUT Joaquin Sapien

Joaquin Sapien has focused on environmental issues since he joined ProPublica in May 2008. In 2009 he was part of a team whose work on natural gas drilling won the Society of Professional Journalists award for online non-deadline investigative reporting. From 2005 until 2008 he was a reporter for the Center for Public Integrity, where he led a year-long investigative project, “Superfund’s Toxic Legacy,” which received the 2007 Society of Professional Journalists award for non-deadline online reporting. Before joining CPI, Sapien wrote for Environmental Media Services.

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6 comments on "Military Still Struggling to Treat Troops With Brain Injuries"

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Brian Glennie

December 28, 2011 9:59am

Washington will debate the issue in committee after committee for twenty years, then come solution after most of the VETS HAVE DIED. The military will search long and hard for any surplus funds, left over from buying sprees for drones, jets, other weapons, that they can throw the Vets way

rgail79

December 28, 2011 2:47am

As a veteran and a journalist I am saddened by the lack of press in mainstream media about this societal problem that will affect Americans for many years to come. While medical advances on the field has resulted in far less deaths, the "compassion" of Americans has fallen to only military families who are directly affected by the number of troops returning with TBIs. However, the DOD has been treating troops with TBIs since the mid 1980s, successfully, with oxygen inducing hyperbaric (sic) decompression chambers such as those used by U.S. Navy divers with the bends. I am not sure if this treatment is widespread but being associated with VAs in five Western states, it is not a viable solution as the treatment must be started immediately. The other aspect of these wars are the tremendous number of amputations. Those troops also will be under the care of the already cash-strapped VAs for the rest of their lives. Understandingly, the wounded troops also reduce the numbers of a viable workforce once their service is over.

usual suspects

December 27, 2011 8:06pm

The injured come home and they are to be forgotten if to many have the same issues, agent orange settlement was great for the attorney's back then. Let's see what they do with all these brain injuries. My guess, as much of nothing while lining their own pockets, for as long as possible.

usual suspects

December 27, 2011 8:04pm

The injured come home and they are to be forgotten if to many have the same issues, agent orange settlement was great for the attorney's back then. Let's see what they do with all these brain injuries. My guess, as much of nothing while lining their own pockets, for as long as possible.

Placido Salazar

December 27, 2011 6:19pm

I served in Vietnam in 1965, exposed to heavy artillery explosions while running to retrieve some of our sedated warriors, to the bunker. I was knocked off my feet (saw a flash) and I believe landed on my head, with several fractured vertebrae and herniated discs, with bone pushing into my spinal cord. In 2009, I had a metal plate fusion of C-4,5, and 7. Suffering with a constant headache 24/7 since then, but much worse in past weeks, my neurosurgeon ordered an MRI and a scan. An hour later, I received a call from the radiologist, that the MRI was abnormal, showing some bleeding - and asked me if I had received any shrapnel in my head. I cannot confirm or explore this condition, since Audie Murphy VA hospital is only taking Iraq and Afgh war veterans. It's as if no other Veterans matter, or even exist.