Army Responds To NPR-ProPublica Brain Injury Investigation An NPR-ProPublica investigation found that the U.S. military often fails to diagnose mild traumatic brain injuries in troops who served in Iraq and Afghanistan. The investigation also revealed that many soldiers receive little or no treatment for lingering health problems after suffering brain injuries.
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Army Responds To NPR-ProPublica Brain Injury Investigation

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Army Responds To NPR-ProPublica Brain Injury Investigation

Army Responds To NPR-ProPublica Brain Injury Investigation

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This is TALK OF THE NATION. Im Neal Conan in Washington.

This week, NPR News, in partnership with ProPublica, reports on an investigation into the ways that the U.S. military diagnoses and treats brain injuries suffered by troops in Iraq and Afghanistan, an investigation that finds lots of problems from the battlefield to the high command.

TBI, traumatic brain injury, has been described as the signature injury of the wars in Iraq and Afghanistan. Troops caught in the explosions of rockets and roadside mines suffer concussive effects from the blast, as well as more obvious ones from shrapnel and fire.

Severe TBI is relatively easy to diagnose. The effects show up on brain scans, for one thing. But what's called mild traumatic brain injury is both more elusive and much more common.

Most of the time, troops recover fairly quickly, but a minority can suffer serious, persistent health problems. And the NPR-ProPublica investigation finds cultural hurdles, starting with soldiers who want to stay with their unit, technical problems with screening tests designed to detect mild TBI and systemic problems with medical records, which are too often inaccurate or missing altogether.

If you have experience with this issue as one of the troops, as a medic, as a commander, give us a call, 800-989-8255. Email us, You can also go to our website to see more on the investigation. The address is Click on TALK OF THE NATION.

Later in the program, what happens to our emails, Facebook pages and our avatars after we shuffle off this mortal coil. But first, NPR correspondent Danny NPR correspondent Daniel Zwerdling joins us here in Studio 3A. Danny, I'll get your name right soon.

(Soundbite of laughter)

DANIEL ZWERDLING: Neal, thanks for having me.

CONAN: And how many of these mild TBI cases are we talking about?

ZWERDLING: Okay, here's the astonishing thing, and this is one of the main things our investigation is about: Nobody in the U.S. government has any good idea what the answer is.

If you go to the Pentagon website, it will show that there have been about 150,000 traumatic brain injuries, most of those so-called mild, and we should talk about this in a few moments. Mild does not mean what it means in the lay language, that oh, there's no big it can affect you for the rest of your life.

On the other hand, senior military researchers told us, you know, we think based on our research that the number is way, way higher than the official number. And a study by the Rand Corporation, the independent think-tank, estimated that there have been about 400,000 traumatic brain injuries.

Now I have to do a little quick math. Here's the problem. Most people who get traumatic brain injuries recover spontaneously. Just give them rest for a few days or weeks, they'll be fine. But civilian studies show that a small percentage does not. How many? Nobody knows for sure, maybe five to 15 percent.

If you do the math, Neal, that means...

CONAN: Five to 15 percent of 400,000.

ZWERDLING: I mean, tens of thousands of troops have persistent symptoms of traumatic brain injury, which can affect them for years or the rest of their lives.

CONAN: Now, we first heard about traumatic brain injury what, five years ago or so, as the...

ZWERDLING: Before that, even. The first time we heard the phrase the signature injury, that was in 2005, that's right. And soon after that, the nation's leaders, members of Congress, Senator Barack Obama, Secretary of Defense Robert Gates, then President Obama, leaders started to say we are going to do something about it.

CONAN: Congress passed a law.

ZWERDLING: Hundreds of millions of dollars they voted to spend on national programs to diagnose and research and treat TBI. So we wanted to see, all right, when we go back - when we go down to the ground level, in the weeds, on the dirt, you know, how is that really affecting the troops? And the answer, we were distressed to find, is that there are huge problems.

I mean, the military, the whole system for diagnosing and recording and then treating traumatic brain injuries is broken at every step, from the battlefield to military bases back here at home.

CONAN: Well, tell us about one thing. One change that's been instituted has been a series of brain scans before you go overseas, while you're there, after an injury and after you come back.

ZWERDLING: Senior researchers in the military say it has been largely a fiasco. Congress ordered the Pentagon a few years ago to do this. Here's some quick numbers. They've done 550,000 screens before troops went overseas, and that's to get your baseline, Neal. What's Neal's brain working like today?

CONAN: Normal, so to speak.

ZWERDLING: Right. After you are in a blast, they're supposed to use that screen again to see, well, how have you changed? They have used - 1,500 times a doctor has said I want to diagnose this guy, and there have been thousands and thousands of blasts.

CONAN: So those numbers really don't compute one to the other.

ZWERDLING: No, so that screen has basically been ignored. There's another screen called the MACE. I always forget the oh, the Military Acute Concussion Evaluation. And if you are in a blast in Afghanistan or Iraq, the medical staff is supposed to give you this test. You have to remember numbers backwards, remember words, that sort of thing.

And senior researchers, again these are people in the Army telling us all this, they say that the medics and the doctors frequently coach soldiers how to cheat on that test because it's and it's a complicated problem. The soldiers want to go back to duty. But, you know, the question is...

CONAN: And the medics want to help them.

ZWERDLING: That's right. But isn't it the medical staff's responsibility? When you go to your doctor, you know, does the doctor just let you walk out of there when they think you have a serious illness?

And can I introduce you to a soldier who has traumatic brain injury?

CONAN: Well, I know you talked to several soldiers who wanted to complain about this down at Fort Bliss, Texas, talked to about a dozen soldiers about their conditions and if they felt they were receiving proper treatment.

Unidentified Man #1: I've been knocked unconscious six times, and it took me two years to where I was going to get the help I needed.

Unidentified Man #2: It's actually been kind of depressing as far as the treatment I have missed out on that I could have had.

Unidentified Man #3: They just don't want to listen to the soldier, and the soldiers are there, and they are crying for help.

ZWERDLING: You were crying for help.

Unidentified Man #3: I was, and they weren't listening to me.

Unidentified Woman #1: I still can't make sense of it. There is no help from the military.

CONAN: And Danny, those are just a few of the people. Obviously, this is after some of them may have wanted to go back to the units, after they've been feeling the effects, some of them for many years.

ZWERDLING: And let's meet a soldier well, let me tell you briefly what it means to have mild traumatic brain injury. When these soldiers come home, these are people who all got great evaluations. You know, we looked at their medical records, their Army records.

They come home, they can't read one paragraph or one page without forgetting what they read a minute later. One soldier, Victor Medina, talked about he would go to the supermarket with his wife, Roxana. He would disappear. She would find him in the cereal aisle, and he would look at her and say hey, when did you get here?

One soldier, Brandon Sanford, who was just in that montage, said he used to love to help his little kid with his homework. This is a little kid. And now he can't comprehend the homework.

Another soldier had to give the keys to his wife of the car because he realized: I don't know how to drive anymore.

So this so-called mild traumatic brain injury can have huge impacts on these soldiers' daily lives, on their families, on their jobs, on the communities. It's, you know, it's remarkable.

CONAN: One of the people in charge of these issues at the Pentagon is General Peter Chiarelli. He's the U.S. Army's vice chief of staff, and General Chiarelli joins us now from NPR's booth at the Pentagon.

And General, I know you've taken pains to make yourself available today. We appreciate your effort.

General PETER CHIARELLI (Vice Chief of Staff, United States Army): Appreciate it, appreciate being on.

CONAN: And I know the Pentagon has been working on programs to deal with the issue of mild traumatic brain injuries. Our investigation suggests some of them are need more help.

Gen. CHIARELLI: Well, I guess I'd take exception with the basic premise. First of all, if I look at a special population of soldiers that I have called Army wounded warriors, these are soldiers that we identify from the time they're injured in the battlefield or later who have a single disqualifying injury of 30 percent or greater, what we find is the real signature wound of this war is not TBI, it's PTS.

Forty-three percent of a population of over 7,000 of those soldiers have PTS.

CONAN: That's post-traumatic stress.

Gen. CHIARELLI: Post-traumatic stress. The next injury is TBI at 17 percent, and below that at 12 percent is amputations.

When we talk about the signature wounds of this war, we talk about PTS and TBI as the signature wounds of this war. And what's important to understand, and what Dan has done here that I dont disagree that I disagree with is he's tried to separate out those two and somehow think or say that there's something - reason why would not want to diagnose TBI as a form of injury, as opposed to anything else.

There's no reason for us not to try to diagnose it, and as you can see, we've diagnosed 17 percent of that population with TBI.

CONAN: He does say in his reporting that, indeed, sometimes the symptoms are hard to distinguish between PTS and mild traumatic brain injury.

Gen. CHIARELLI: And that's exactly right, and that's what makes it so difficult. So the supposition that somehow a doctor enters the United States Army, and he has some reason not to diagnose a soldier with TBI when those that is what the symptoms are indicating, I just find tremendous fault with that supposition.

What would be the reason that a doctor in the United States Army, who is accepting far less than his civilian counterparts, for not properly diagnosing if he thought it was TBI and not PTS or some kind of other behavioral health issue?

CONAN: One reason might be that there's no record of concussive incidents on a soldier's file because recordkeeping has been, as the investigation also shows, spotty at best.

Gen. CHIARELLI: Recordkeeping has been an issue, but it's the symptom that allows you to diagnose what's the matter with the individual. And many of the people that Danny talked to, as I understand it, were first diagnosed with PTS, which I think points out in many of these instances the tremendous difficulty in separating the two.

And there is tremendous difficulty. I also take exception with the fact that PTS is not an injury. It is an injury. The frontal lobe of the brain stops working the way it's supposed to work. So both of these are injuries.

CONAN: I'm not sure anybody has said General, I'm not sure anybody said it wasn't an injury, but Danny can speak for himself.

ZWERDLING: I think General Chiarelli, we never said in the investigation that in general I stress that - that in general, the doctors in the military don't want to diagnose TBI. What we found is a very complex web of problems, which is tends to minimize the problem and tends to allow many, many soldiers, perhaps, you know, many thousands, tens of thousands of soldiers, to fall through the cracks.

The first is that many doctors simply don't diagnose it, and as you said to me when we talked, the doctors, you know, the main thing they're looking for is: Are there broken bones? Is there bleeding? Is there something acute? And then they tend to overlook the concussion or the traumatic brain injury.

We talked to a senior researcher in the Army who went to Iraq just last year, and he was at Camp Liberty, near Baghdad. A mortar hit the trailer where there were a bunch of soldiers, and, you know, their medical charts the next morning showed, you know, cuts and abrasions. And he examined them and found that they all had classic symptoms of traumatic brain injury. So it's a combination...

Gen. CHIARELLI: They had classic symptoms of a concussion, and a concussion leads to TBI. Successive concussions lead to TBI. The majority of the cases in the United States Army where we have TBI is because an individual has gone through successive concussions.

Most importantly, that concussion takes place, the second one, before the first one has had the opportunity to heal itself. That is why in the National Football League you find football players are pulled out of the game after a concussion and put down for two to three weeks.

That happened to Tim Tebow last year and Ben Roethlisberger. That's what we're doing in the Army.

CONAN: And we'll hear more about that program when we come back from a short break. General Chiarelli, thank you very much. He'll stay with us, also Daniel Zwerdling will stay with us. We also want to hear from those of you with experience on this issue, whether you were soldiers or medics or commanders, 800-989-8255. Email us, Stay with us, TALK OF THE NATION, NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. Im Neal Conan in Washington.

This week, in a series of reports by NPR News and ProPublica, NPR's Daniel Zwerdling describes a array of problems the U.S. military has had in recognizing and treating mild traumatic brain injuries. Military doctors told some soldiers their main problems were psychological. Others weren't treated at all.

Today, we're talking with Danny about the investigative series. Also with us is the Army's second in command, Vice Chief of Staff Peter Chiarelli. If you have experience with this issue as one of the troops, as a medic, as a commander, give us a call, 800-989-8255. Email us, And you can go to our website to see more on this investigation. The address Click on TALK OF THE NATION.

General Chiarelli, I know you're not going to be able to be with us for the entire time we have on this issue, but I basically wanted to ask you: Is you recognize this as a major issue. It's something you're working very hard on.

As you mentioned just a moment ago, you're working on a new program to that would take troops off the battlefield if they have three concussions?

Gen. CHIARELLI: No, not three concussions. We're not doing the three concussions and out. After three concussions, even if the individual does not, we do not believe him to have TBI, he will get a full neurological diagnosis.

But what we're saying is any soldier who finds himself in a situation where he's in a vehicle that is damaged, outside a vehicle within 50 yards of an explosion or inside a building that has an explosion in it will be taken as soon as possible after the event and evaluated, held out for 24 hours and evaluated a second time.

If they pass both of those exams as not having a concussion, we feel comfortable that no concussion occurred. If either one of the exams in that 24-hour period indicates the individual had a concussion, they are pulled out of the fight until the concussion has an opportunity to heal.

And again, that's not unlike what happened to Ben Roethlisberger or Tim Tebow and what the National Football League is in fact doing.

The key here is not to have that second concussion while the brain has not recovered from the first. That, doctors tell me, is what causes a majority of traumatic brain injury.

CONAN: And do you feel confident that the cultural issues you talked about with Danny, and we played a cut of that tape earlier, that those, the difficulty and that we don't want to recognize injuries we can't see, that that can be overcome?

Gen. CHIARELLI: I tell you, that is the hardest thing we're trying to do. But, you know, you look at the Army, and you say it's hard for us. It's hard for everyone.

AP did a study of 160 National League football players and found out that 30 of them indicated that they had downplayed concussions in order to continue playing football.

We have a similar kind of thing with our soldiers. Young E-7 out on patrol feels that he is responsible for the lives of those soldiers, and when he has an injury that, you know, I just don't really think, I think I'm really okay. I feel a little weird, but I think I'm okay. When he goes back out there into that fight before that concussion has an opportunity to heal, that's when we have the problems, that's when we get the TBI.

CONAN: Danny?

ZWERDLING: Some of the soldiers and researchers we talked with say, I mean, they agree with General Chiarelli that this is a society-wide problem, not just military, except that there's a difference between fighting a war and playing football - in that, you know, people, the soldiers we talked to and the researchers in the Army, said look, we expect the military to be doing, you know, more than the National Football League for blasts.

And there are some studies now. You know, this is all, the research keeps evolving, but there are studies that suggest that blast injuries from the shockwave are much more complex than the usual concussion on the battlefield.

But I just want to raise one sort of bigger point. I think people are sometimes confused. Why is it that some people in the military seem to take this very seriously, others seem to shrug it off, traumatic brain injury or post-traumatic stress disorder, whatever issue we're talking about?

It's important to remember that the military is like a country of millions of people. You know, the population of the military, General Chiarelli, what is now? How many million?

Gen. CHIARELLI: One-point-one million in the United States Army.

ZWERDLING: And, you know, the Marines, Navy, Air Force, it's a bigger population that some countries. So even though there are people like General Peter Chiarelli who are totally devoted from all we understand, to working on these issues, there are many you know, it's like having a vice president of a country saying we shall do that. But there's a lot of people in the government, you know, down in the bureaucracy, who just do not believe in it.

CONAN: And General Chiarelli, we know you've got to leave in a couple of minutes to go to a meeting, but if you wanted to state what steps you're going to be taking next, in addition to the program you just described, and where this issue, where that you think this issue goes?

Gen. CHIARELLI: Well, I would argue that we are taking it more seriously than the National Football League. In fact, what we're saying is any soldier that finds himself into an event like I described before, in a vehicle that's damaged, inside a building where an explosion goes off or outside, within 50 meters of an explosion, is going to be held out of the fight for 24 hours, given two evaluations before we allow him to go back in to ensure that they don't have a concussion.

So we're taking this extremely seriously, but the cultural issues are there, and we as a nation have got to understand that these signature wounds, and I would call PTS and TBI the signature wounds of this war, because they're not seen, are particularly difficult for us.

And we've got to change the culture of our soldiers. They're like football players. They want to go back into the fight. Now, the protocols have not only been put downrange, but we've got observer controllers at our national training centers that do the big exercises for units before they deployed. They are integrating them into their training so that we get across to soldiers the importance of this.

I went and spoke the other day at the graduation of the command sergeants majors of the Army, 600 of them. And rather than give them the basic hooah(ph) speech that a four star general would give as they go off to do great things in our Army, I got up and talked to them about TBI because I couldn't pass up the opportunity to talk to 600 leaders in the United States Army and say: Guys, it's time we realize that TBI and PTS are real injuries, and we've got to ensure our soldiers get the care that they need.

CONAN: And quickly, in addition to those going forward, what about those who have already been? Are you committed to making sure their diagnoses are correct and accurate?

Gen. CHIARELLI: Well, we are. We are. And that's why I say to you, out of that population of 7,000 soldiers, I'm telling you we've diagnosed 60 percent with PTS or TBI.

And that's why Dan calls them the signature wounds of this war, not just TBI, but PTS. And when you talk to the specialists, you will find although there's a lot of disagreement... One of things that's frustrated me in this area, is that this is not like heart surgery where everybody opens you up in the same way and does what they need to do to you. The fact of the matter is, we don't know a lot about the brain, and it's very, very difficult to do the kind of treatments that were going to work in every single person.

And it's horrible for the families, because they see a soldier come back from battle, he looks exactly like he or she looked before, but they're just not there because of TBI or PTS. That's what's so frustrating about this.

CONAN: General, we thank you for your time. And we know you had to move some things around to be with us today, and we thank you for that.

Gen. CHIARELLI: Well, I thank you for the opportunity to be with you today.

CONAN: General Peter Chiarelli, the Army vice chief of staff, second in command of the Army. Well, let's see if we can get some callers in on the conversation. There are people waiting to talk about this, 800-989-8255. Email is Paula(ph) is with us from Iowa City.

PAULA (Caller): Yes, I'm here.

CONAN: Go ahead, you're on the air.

PAULA: Thank you very much. My son was in Iraq for nine months during 2005. He was with transportation, so he was on many, many, many, many missions. And they had IEDs many times. He's had he hasn't described the worst of it. There were body parts blown up all over him.

He wound up with a broken neck on one of these excursions. The medic said he hadn't anything wrong with him. And on that same one, he was knocked out cold.

He came back to the United States. He was unable to get any medical attention the entire time he was in the Army. So he finally left. The VA here in Iowa City has taken him seriously, and he was able to get assessments done.

And then when it went to get the compensation, he was given compensation for the verifiable physical injuries, but he was refused 100 percent, no compensation at all for his brain damage or for his PTS. And these are by far his worst injuries.

CONAN: And I'm so sorry for the problems that he's having. But I just wanted to bring Danny into this. In some cases you report on, the Veterans Administration seems to have been able to get to diagnoses that the Army doctors were not able to get to.

ZWERDLING: It's a very spotty picture, and we hear thank you for calling, by the way.

PAULA: Now, the Army doctors wouldn't even look at him.

ZWERDLING: There seems it's like two different worlds; the military, where the active-duty troops are; and the world of the Department of Veterans Affairs, where the people who have left the military are.

Some VAs are supposed to be, you know, terrific, you know, give excellent care. But even people in the VA say to us that many, many, many VAs, unfortunately, especially, you know, out in the hinterlands, give very spotty and sometimes very bad care.

In fact, one top VA person said to me: there are maybe a third of the VAs in the country no, I'm sorry. He said: there are a handful of VAs in the country that I would go to if I had a traumatic brain injury, and most of them, I'm sad to say, I would not.

CONAN: How's your son doing, Paula?

PAULA: He is slowly getting better, and I want to put a plug in for the Iowa City VA. They are very good. We have been happy with what they have been doing with him. It's slow, but they're on top of it.

What I object to is that there's a continuing attitude with the Army that says okay, yes, it's documented that you have Traumatic Brain Injury, it's documented that you have posttraumatic stress disorder, but since it's not in your Army records that it happened there, it didn't happen while you were in service with the Army.

CONAN: And this goes back to the record keeping issue that Danny describes in this investigative report where some - it was the practice in Iraq, I think as late as 2005, that some of these records, Danny, as you describe it - and Paula, thanks very much for your call - were routinely taken out and burned.

ZWERDLING: That's right. And even just last year, one of the senior brain specialists in the Army told us that he was in Iraq, Mike Russell, and he said he found all kinds of file cabinets filled with medical records from previous units who had already left Iraq. And this may sound incredible, Neal, but a number of doctors have told us we simply do not know where to send the records when we're leaving Iraq.

CONAN: Here's an email from Leah(ph). I'm a speech language pathologist and completed my hospital internship at the Palo Alto Veterans Administration Hospital in 2008. While there I was in a PTSD-TBI unit and we saw a huge influx of soldiers coming back with PTSD-TBI blast injuries. The increase of soldiers with such injuries has created a great need for intensive speech language services to rehabilitate cognition and communication skills. Many soldiers indicated they didn't know they were having problems and often were embarrassed to admit they were having difficulty because they were afraid of leaving their troops. I would hope that the culture of the military would allow for the appropriate care and rehabilitation of the soldiers.

ZWERDLING: One of the soldiers we interviewed, Victor Medina, his wife was telling me that when he came home, for the first months he acted goofy a lot and he didn't realize it. He - she said he would just do things that were inappropriate. But part of the brain injury often is that the inhibition centers and the centers that can stand aside and look at our own behavior, they just weren't working.

CONAN: And - but one of the things General Carelli said, all of these injuries seemed to be different. It's very difficult to diagnose a lot of these things.

ZWERDLING: That is true. But I do want to make one qualifying statement. It's not as though it's impossible to diagnose. I mean, people - you know, the military - folks in the military often say this is something new, we didn't expect this. You know, going back, if you look in the literature, going back to the 1970s, Israeli and other doctors were seeing these very same similar brain injuries in - from the wars between, for example, Israel and Egypt.

And I've talked to a doctor who was in Israel at the time, who was leading a big project, and one of the main one of the main focuses was there are these blasts that are causing these weird brain injuries in soldiers without, you know, causing them to bleed or have broken bones. So it's not as though this is new.

CONAN: We're talking with NPR's Daniel Zwerdling about the NPR/ProPublica news investigation you're hearing this week on ALL THINGS CONSIDERED, "Brain Wars: How the Military is Failing its Wounded." You're listening to TALK OF THE NATION from NPR News.

And let's go to Robin, Robin with us from Franklin, Tennessee.

ROBIN (Caller): Hi. Thank you for having me.

CONAN: Go ahead.

ROBIN: I'm a physician at a veterans hospital here in Tennessee, and we're just starting to see patients with TBI, mostly because so many troops are obviously still deployed. I just wanted to offer another perspective of why the diagnosis might not be made. Your guests are arguing that doctors don't want to recognize those diagnoses that they can't physically see. I would submit that doctors don't want to recognize injuries that we can't readily treat. There's nothing more frustrating as a physician than just simply making a diagnosis and then feeling helpless to treat it.

So I was sort of curious to hear about the data for cost-effective treatment for some of the most - hardest symptoms such as things like headaches and memory problems, because right now I feel like I can make a diagnosis fairly readily using straightforward criteria but I feel somewhat helpless in terms of how to make the patients feel better.

ZWERDLING: Well, thank you, Robin. As a doctor you know much more about this than I do. But based on all the interviews we've done, that T. Miller of ProPublica and I have done with brain specialists around the country, there is, you know, this treatment called cognitive rehabilitation. It's been defined in medical journals. And about a year ago, just a little over a year ago, the Pentagon brought together 50 specialists from inside the military and outside the military. They called it the Consensus Conference. And they said to them, all right, tell us, what is the best way to treat so-called mild traumatic brain injuries. And the 50 specialists all agreed, no dissents, we need to assess them and treat them when appropriate with cognitive rehabilitation.

And this is a - I mean, I won't go into the details. You know it better than I. But you assess, you know, is it the person's - what part of their memory isn't working? What part of their attention isn't working? And you, you know, work out a program to treat them with speech and memory and focus and multitasking.

CONAN: And your reporting said the quicker you start that, the more effective it is. And I wanted to say, Robin, I've read all these scripts and the stuff that's on the Web. Nobody says doctors don't want to diagnose this.

ROBIN: Oh, no, I'm not - I was just sort of echoing the viewpoint that there is just a - a difficulty to diagnose, I supposed, but maybe I misspoke it - a difficulty in diagnosing that which we can't see.

CONAN: And is it legitimate to say you can confuse this with PTS?

ROBIN: You're asking me?

CONAN: Yeah.

ROBIN: I think it's totally overlapping syndromes. I mean, I believe they've shown that if you have traumatic brain injury, you are much more susceptible to PTS. And so there's huge overlap. And I think a lot of people, if you go back, who have posttraumatic stress symptoms, if you query them, a lot of them have had probably mild traumatic brain injury that wasn't recognized previously. So I think that they're just overlapping syndromes.

CONAN: Okay.

ROBIN: But my - I guess one thing I want to say is that the cognitive rehabilitation, it's sounds really good, but a lot of it is still very diagnostic. And I just haven't seen the data maybe that's out there to actually say we can really help these people in a way that's cost effective, that we can do to thousands and thousands of people. It's much more harder than giving them a pill. It's much more involved. And I think that is part of the frustration that you're going to see from providers like me.

CONAN: Robin, thanks very much for the call. We appreciate it.

ROBIN: Thank you.

CONAN: Danny, we just have a few seconds left. What's left to come on your series?

ZWERDLING: Tonight we're going to Fort Bliss, which is one of the biggest bases in America. It's in El Paso, Texas. And we're going to meet some of the soldiers we heard briefly earlier in the show who are going to describe in detail how they, you know, kicked and screamed, saying I need more help.

CONAN: And not got to get. Danny, thank very much for your time.

ZWERDLING: Thank you, Neal.

CONAN: NPR's Daniel Zwerdling telling us about the investigation by NPR News and ProPublica. Again, you can hear more of it later today on ALL THINGS CONSIDERED.

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