With Traumatic Brain Injuries, Soldiers Face Battle For Care Even when traumatic brain injury is diagnosed in soldiers, many find they have to fight to get adequate treatment. Medical records show brain-injured soldiers at Fort Bliss have been told that their main problems are psychological, not related to blasts. Some soldiers have turned to clinics outside the military to get help.

With Traumatic Brain Injuries, Soldiers Face Battle For Care

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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.


And I'm Robert Siegel.

The fighting in Iraq and Afghanistan has created a signature injury. It is largely an invisible wound, and as we heard yesterday, it affects tens of thousands of American troops. It's called mild traumatic brain injury.

An NPR investigation, in collaboration with ProPublica, has found that commanders and doctors at one of the nation's top Army bases are still neglecting troops with mild TBIs or concussions. As we reported yesterday, studies suggest that those concussions can lead to long-lasting disabilities, and many troops who suffer from them have to fight to get help.

Our story continues today with NPR's Daniel Zwerdling, he reported it with T. Christian Miller of ProPublica.

DANIEL ZWERDLING: Victor Medina's nightmare began June 29th last year. You can see the explosion on his laptop. There was a camera in a vehicle behind him and Medina is showing us the video.

(Soundbite of video)

ZWERDLING: As we are watching, Medina is sitting at his dining room table in El Paso, Texas. He's back at Fort Bliss. It's one of the biggest Army bases in America. But that morning last June, Medina was leading a convoy in southern Iraq.

Sergeant VICTOR MEDINA (Combat Veteran): I was a staff sergeant. I was in charge of about close to 60 soldiers.

ZWERDLING: It's hard to understand Medina when he talks. He's been stuttering since the explosion.

Medina is tall and bald. He's 34 years old, but in some ways he's become an old man. He points to his vehicle on the video. His arm shakes like he has Parkinson's.

Sgt. MEDINA: I'm in front of that vehicle rider.

ZWERDLING: They're passing palm trees and scrubby fields on the right. Suddenly there's a yellow flash near Medina's door.

(Soundbite of video)

Unidentified Man #1: (unintelligible) IED.

ZWERDLING: Then a mean black and gray cloud. Medina's fellow soldiers say he tore off his seatbelt and he checked his men to make sure they were okay. Then Victor Medina collapsed.

(Soundbite of video)

ZWERDLING: And the record suggests that since that moment, people throughout the Army: medics, doctors, commanders, many of them have treated Medina's brain injury like a minor problem.

We don't know don't know if treatment at Fort Bliss is better or worse than anywhere else in the Army, but we're using it as an example because the Pentagon has said that Fort Bliss should have one of the best programs for treating TBI.

Sgt. MEDINA: The doctors, they have hurt me.

ZWERDLING: You say the doctors here have hurt you?

Sgt. MEDINA: Yeah. The warrior ethos says: I will never leave a fallen comrade. I feel that the system left me behind.

(Soundbite of cheering)

ZWERDLING: The nation's leaders keep promising the troops like Victor Medina won't be left behind.

President BARACK OBAMA: Thank you.

(Soundbite of cheering)

President OBAMA: Thank you. Thank you...

ZWERDLING: In fact, traumatic brain became an issue in the last presidential campaign. Here is Barack Obama, the candidate...

President OBAMA: And we need to dramatically improve screening and treatment for the other signature injury of war, traumatic brain injury.

Unidentified Woman: Yeah.

President OBAMA: That's why I passed measures in the Senate to increase screening...

ZWERDLING: The Pentagon's policy says that whenever troops are in a blast, you have to check them as soon as possible for brain injuries. Yet, Victor Medina had trouble getting help starting right after the explosion. Medina's fellow soldiers say he was unconscious for about 20 minutes and the medics did rush him to an emergency station. But Medina says they mainly made sure he wasn't bleeding and didn't have broken bones.

Sgt. MEDINA: They asked me a few questions and there, you're good to go.

ZWERDLING: Then one week after the blast, Medina and his wife Skyped. Roxana had gotten into bed around midnight and she cradled her laptop so they could see each other, and she was stunned.

Ms. ROXANA MEDINA: It was his left side was like droopy face. His eye would go down. His smile would go down. His cheeks in the left side would go down.

ZWERDLING: So you're describing a little bit what people look like after they've had a stroke.

Ms. MEDINA: That's how he looked like. Then he started mentioning, I have headaches, I'm having memory problems, I cannot concentrate. And I said, what is going on? He said, this is so overwhelming. That's what he said. This is so overwhelming, I feel like I'm not in my body. And I said, okay, so tomorrow morning as soon as you get up, you go to the doctor.

ZWERDLING: Medina told his wife: I have been going to the Army doctor and they keep giving me pills.

They gave you Tylenol.

Sgt. MEDINA: Yeah, and that was it.

ZWERDLING: Brain specialists say here's why it's crucial to diagnose and treat soldiers fast. Most people with mild traumatic brain injuries get better on their own in a few days or weeks. But studies suggest that five to 15 percent do not, and the faster you send them to rehab the better the chance that they can retrain their brains.

But weeks went by, Medina's hands started trembling. When people gave him instructions, he couldn't wrap his brain around the information. Medina kept going to the doctor.

Ms. MEDINA: And I tell him, but why more Tylenol? They need to check you out. And my husband got mad at me and he said, well, he's the doctor and he knows what he's doing. Actually, he was returned to duty and they did another mission and there was another explosion.

ZWERDLING: Medina says there's only one reason why doctors and commanders in Iraq gave him a closer look: Roxana. Roxana understands how things work in the Army. She works at the Fort Bliss Medical Center. So, Roxana pressured her contacts, one thing led to another and six weeks after the explosion, the Army Medevaced Medina back to his base.

Unidentified Man #2: Welcome to Fort Bliss in El Paso, Texas...

ZWERDLING: This is the official website for soldiers and their families.

Unidentified Man #2: At Fort Bliss, health care for our soldiers and their families is the number one priority...

ZWERDLING: So Medina and Roxana thought he'd finally get intensive care. But another month went by, no treatment. Medina's commanders told him he could stay home because he was sick. But Medina felt depressed at home, so he volunteered to file folders at the medical center. He thought maybe this will help me get my brain back.

Before the explosion, he and Roxana were always going to the bookstore. He'd devoured a couple of thrillers a week - not anymore.

Sgt. MEDINA: When I had to turn the page, I forgot what I read.

ZWERDLING: Before the explosion, he and Roxana would do Sudoku puzzles together every night in bed - advanced ones. Now, Medina was struggling with the beginner versions. And watch one of the vacation videos they shot before he went to Iraq. They mainly spoke Spanish, but listen how he used to talk.

(Soundbite of video)

Sgt. MEDINA: (Spanish language spoken)

ZWERDLING: Compare that to today. Medina is reading what his commander wrote about him before the explosion.

Sgt. MEDINA: This is a superb leader who motivated the entire class to strive for maximum results, they displayed a can-do attitude throughout the course.

ZWERDLING: So after Medina came home, he and Roxana kept wondering when will he get to see the top brain specialist at Fort Bliss - the neurologist? Three months after the blast, Medina got the appointment with Dr. Bret Theeler(ph) -Roxana went, too. They say Theeler examined him for 15 minutes.

Ms. MEDINA: And the neurologist, he said - and I will never forget that because he said: Do I think you have a TBI? No.

ZWERDLING: Dr. Theeler wrote in the medical records that Medina had, quote, "multiple cognitive symptoms, including poor concentration, short-term memory loss, and difficulty multi-tasking," unquote. Theeler said the explosion might possibly be involved, but he wrote that Medina's symptoms were likely caused by chronic headaches and anxiety. He wrote that Medina's stuttering was probably caused by anxiety, too.

Medina saw Theeler again last December. And this time, the neurologist wrote that Medina seems to be, quote, "playing the sick role," unquote. Medina was shattered.

Ms. MEDINA: He would look at the mirror every morning and he said: Look at me. What if I'm getting crazy and this is not a real condition, it's just that I'm crazy? And he was stuttering so much and he couldn't put his words together that I would tell him, oh, I'm going to take a bath and I would just cry in the shower. But I didn't want him to see me cry. He never saw me crying.

Unidentified Man #3: First set of battle buddies, get ready.

(Soundbite of conversations)

Unidentified Man #4: Shut up. Everybody will attempt every obstacle, all right? You can't do it, you can't do it.

ZWERDLING: We went to Fort Bliss one morning, so we could talk with commanders and doctors about soldiers like Victor Medina. As we drove through the base there were squads of soldiers repelling down walls.

Unidentified Man #3: Get ready. Get set. Go.

ZWERDLING: When we got to the medical center, there was a group of officers sitting around a long conference table.

Colonel JIM BAUNCHALK (Commander, William Bauman Army Medical Center): So by way of introductions, I'm Colonel Jim Baunchalk, and I'm the commander of William Bauman Army Medical Center. And then over here, Dr. Theeler. We also have Dr. John...

ZWERDLING: Before we could ask any questions about Victor Medina, Baunchalk showed us a PowerPoint.

Col. BAUNCHALK: Okay, next slide. Our goal is to recognize mild traumatic brain injury early to get soldiers, sailors, airmen and Marine into programs that will identify their requirements and give them that multi-disciplinary, integrated approach to treatment, you know, that will get them back standing shoulder...

ZWERDLING: After the PowerPoint, we asked: but what's going on with soldiers like Victor Medina? He says doctors are shrugging off his problems.

Col. BAUNCHALK: I'm not prepared to talk about individual cases.

ZWERDLING: Dr. Theeler said he wouldn't talk about them either. They said they want to protect the soldiers' medical privacy, even though Medina signed a waiver saying they could talk about his case.

And then Colonel Baunchalk said: If any soldiers have fallen through the cracks, it's because they don't want to go to doctors.

Col. BAUNCHALK: These are high-performing folks. These are America's best, quite frankly, and it's tough for them to step forward and say, I need some help.

ZWERDLING: We talked to a dozen soldiers at Fort Bliss who were in explosions, and when we told soldiers what Baunchalk had said, they were astonished. Talk to Brandon Sanford and his family.

Mr. BRANDON SANFORD: It's actually been kind of depressing as far as the treatment that I've missed out on that I could've had.

ZWERDLING: The Army's records show that back in 2008 Sanford was working in Iraq with a bomb-sniffing dog. He was in two explosions. By the time he came back to Fort Bliss last year, Sanford was having seizures and he couldn't make sense of the world. His wife would open the laundry cabinet and her husband had put the milk carton next to the bleach.

Mr. SANFORD: It's kind of sad, I think, because I used to try to help my son with homework and just by the questions being asked, I just don't grasp it anymore.

ZWERDLING: Sanford's son, Jacob, is 10 years old.

What do you notice, anything different?

Mr. JACOB SANFORD: Yeah, a lot of things have been different since...

ZWERDLING: Like what?

Mr. J. SANFORD: Like sometimes, like, when we're going somewhere, sometimes he forgets where we're going.

ZWERDLING: And go see William Frost and his wife Marie. Frost says he was in so many explosions that he marked them with a black grease pencil on the windshield - he stopped marking them at 10. Frost came back to Fort Bliss more than two years ago, and he realized, I don't know how to drive anymore, so he gave his keys to his wife and he tried to get help so he could think again.

Mr. WILLIAM FROST: I called and called and called. I was hurting.

ZWERDLING: You would think commanders would listen to Frost. He got a Bronze Star with valor. The citation reads like a movie. His unit was pinned down in a seven-hour battle and he helped save his major and a group of Iraqi troops.

Mr. FROST: I'm a senior non-commissioned officer and I couldn't get help, I couldn't get help.

Ms. MARIE FROST: I still can't make sense of it. There's no help from the military.

Mr. FROST: You know, the top officials of the Pentagon say we have started programs around the world to help soldiers with traumatic brain injury.

Ms. FROST: Can I swear? It's (beep).

(Soundbite of music)

SIEGEL: And our story continues in just a moment with soldiers at Fort Bliss who end up going outside the Army for help.


(Soundbite of music)

SIEGEL: From NPR News, it's ALL THINGS CONSIDERED. I'm Robert Siegel.

BLOCK: And I'm Melissa Block.

Back now to Fort Bliss in Texas, where some commanders and doctors have shrugged off soldiers' traumatic brain injuries as minor problems. But a few troops have found that if they protest loud enough they can find help outside the Army.

NPR's Daniel Zwerdling continues our story, reported with T. Christian Miller of ProPublica.

ZWERDLING: Soldiers say you can actually see how little commanders here seem to care about treating troops with traumatic brain injuries. They say, just tour the base.

(Soundbite of beeping)

ZWERDLING: As you drive across Fort Bliss, there are bulldozers and cranes everywhere. They're bringing in thousands of new soldiers, so Fort Bliss will always be ready to send an Army to war.

Mr. ROB WEATHERLY: Fort Bliss is 1.1 million acres of land, which is bigger actually than the state of Rhode Island.

ZWERDLING: Rob Weatherly is one of the planners. He says they're building new communities for the soldiers almost overnight. They truck in prefab barracks and shopping malls.

Mr. WEATHERLY: So, just a few years ago, this was nothing but desert and sand dunes. Units used to come out here and run through the desert for physical training. Now, you've got another city out here.

ZWERDLING: Now, compare that to the new Center for Traumatic Brain Injuries. About three years ago, the Pentagon told Fort Bliss to set up an advanced program to treat TBI, but today the long-awaited screening clinic is an empty one-story building. It looks like a 7-Eleven covered with adobe. They finished the TBI building more than one year ago and they still haven't opened it.

James Baunchalk, the commander of the medical center, says they keep waiting for the contractor to install the computer lines.

Col. BAUNCHALK: You have to have infrastructure in place, and so that's kind of the phase that we're in right now with this building, is bringing some of that infrastructure here, the IT hookups into this building.

ZWERDLING: It's not as if the soldiers we talked to didn't get any treatment for their problems. Doctors gave them pills for headaches, others got counseling to deal with anger. And their medical records show that doctors at Fort Bliss sent some of them to what they call occupational and speech therapies.

They play memory games a couple of hours a week, they'd also work on their stuttering. But top brain specialists say a lot of soldiers who've been in explosions need more than that.

Dr. KEITH CICERONE (JFK Medical Center): These are people who go on to live a lifelong chronic disability.

ZWERDLING: That's Doctor Keith Cicerone. He runs the brain rehab program at JFK Medical Center in New Jersey. Cicerone has served on advisory panels for the Pentagon, and he says when people with mild TBIs come to his clinic they get intensive cognitive rehabilitation. They might go 15 hours a week for months.

Dr. CICERONE: What's happening in a lot of the military centers, the kind of cognitive rehab at a, to me, it's kind of the difference between junior high school and graduate school. I don't know. It's - you're denying people services that they need in order to function.

ZWERDLING: Most of the soldiers we talk to say Fort Bliss has betrayed them, and some of their families have raised hell.

Brandon Sanford can't comprehend his 10-year-old's homework anymore, and his mother got so upset with his treatment that she flew to Fort Bliss to complain. William Frost got the Bronze Star for valor, but his wife is so furious about his lack of treatment that she asked their congressman to investigate. She prints out a copy of her letter.

Ms. FROST: I'm just an Army wife trying to take care of my wounded soldier. We have three kids, two boys, ages 15 and 12, and a girl, seven years old. This has affected the whole family.

ZWERDLING: And Victor Medina's wife didn't just write their congressman, Roxanna asked everybody she could think of to investigate the TBI program at Fort Bliss, all the way up the chain of command. She even wrote generals at the Pentagon. She said: How can the Army's brain specialists say that my husband's stuttering and his problems thinking are emotional? Roxanna keeps stacks of these emails on their dining room table.

Ms. MEDINA: That's your only witness. You can tell your story many, many times, but unless you have something to document, nobody would even consider you that you're telling the truth.

ZWERDLING: But the chief of the medical system at Fort Bliss, Dr. James Baunchalk, he says he's never heard a single complaint.

Dr. BAUNCHALK: I can tell you, over the past two years that I have been here, I have not had any soldier or any family member, to my recollection, who has stepped forward and said, your TBI program isn't getting me what I need.

ZWERDLING: No matter what Baunchalk says, somebody eventually heard the kicking and screaming. It took Victor Medina months of protesting; it took Sanford and Frost more than a year - but they finally got Fort Bliss to pay to send them to a clinic that specializes in TBI.

(Soundbite of shoveling)

ZWERDLING: It's outside the Army. And that's where we find Brandon Sanford on a recent morning. He and other patients are building a garden at the Mentis Neuro Rehabilitation Center.

Mr. SANFORD: Okay. What we have here, bushes and different types of shrubs. On the other side from where we're standing, we're going to have a walkway.

ZWERDLING: It turns out that during all that time that the soldiers were struggling at Fort Bliss, there was this private rehab center in town. Therapists here say the best way to help people with mild TBIs isn't just to play memory games like at Fort Bliss. Wendy Halt says you teach them to drive again, you teach them how to find a plumber, you teach them how to function in the world again.

Ms. WENDY HALT: They came up with all of the ideas. They problem-solved and planned and used their memory strategies all to design the garden, buy the plans, set up the watering system, just everything.

Mr. SANFORD: I think it's a great program here at Mentis.

ZWERDLING: What is so different here?

Mr. SANFORD: At Fort Bliss, you know, you walk into the clinic or the hospital, it's just, yeah, yeah, yeah, you know, just kind of blow you off. What's so different here is the amount of care that this place puts into your treatment.

ZWERDLING: Victor Medina says since he came to Mentis, he's been feeling hope for the first time since the explosion. He's getting cognitive rehabilitation as much as 15 hours a week. We follow Medina to a session with a speech therapist, Claudia Mendoza. She asks him, what do you want to accomplish here?

Ms. CLAUDIA MENDOZA (Therapist): We want to know what your goals are and that way we can target that.

Mr. MEDINA: You're showing me the level of caring you have, it's making a difference in me today.

Ms. MENDOZA: Thank you.

ZWERDLING: And now the therapist wants Medina to do something since the blast: try to say one word clearly.

Ms. MENDOZA: If I gave you the word baby, then I would want you to say it baby, okay?

Mr. MEDINA: Baby.

Ms. MENDOZA: Even the E.

Mr. MEDINA: Baby.

ZWERDLING: Victor Medina at the Mentis Neuro Rehabilitation Center in El Paso, Texas.

Daniel Zwerdling, NPR News.

(Soundbite of music)

BLOCK: You can watch a video of Victor Medina and learn more about mild traumatic brain injuries at NPR.org and at ProPublica.org.

(Soundbite of music)


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