Injured without scars: The hidden wounds of battle from traumatic brain injury and post traumatic stress disorder
December 2, 2007 – Laboran Pickens is fighting to get medical treatment for post-traumatic stress disorder after 10 years in the military and two tours in Iraq. His wife, Cyntia, back, stands with their children Derice, 13, left, Destiny, 7, center, and Devonte, 11, on Sunday in the backyard of their home in Hinesville.
Laboran Pickens sits inside the busy Savannah coffeehouse.
He flinches every time the grinders whine so strangers can walk away with frothy, caffeinated beverages.
He looks nervous. He assures his company he’s fine.
He’s on medication from Georgia Regional Medical Center.
It helps, but not always.
The Iraq nightmares still come, medicine or not.
Sometimes the spell is prompted by a loud noise or errant thought. It makes him space out. He moves like he’s in a dream. He often disappears from his Hinesville home, sometimes for hours.
His wife spends those hours frantic, wondering where he is. She worries each time will be his last. That he won’t come back to her and their three children.
He returns, but remembers nothing.
At 30, he is a shell of the man he once was.
It is estimated that up to 20 percent of the 1.5 million men and women who have served in Afghanistan and Iraq since America’s War on Terror began may suffer from post-traumatic stress disorder or traumatic brain injuries, according to the Defense and Veteran Brain Injury Center, which is part of the Walter Reed Medical Center.
And a 22-month study by Veterans for America of all soldiers returning to Fort Carson, Colo., found more than 17 percent of all servicemen and women who had deployed from the installation had some form of traumatic brain injury.
Veterans organizations fear that thousands of soldiers are living undiagnosed.
Many have left the military. Or, like Pickens, were asked to leave.
They carry invisible scars.
These wounds take the form of honorable discharges, public disturbances, police reports, missing memories, sleepless nights.
And their numbers are only increasing.
A report issued Nov. 7 by Veterans for America claimed that soldiers serving a second tour in Iraq have a 50 percent greater chance of developing mental health problems than first-time troops.
“Compounding these problems is the fact that 58 percent of the soldiers and Marines in Iraq who develop mental health problems will not seek treatment,” Veterans for America reported.
The group contends that the brain injuries have become the “signature wounds” of America’s wars in Iraq and Afghanistan.
And in many ways the medical mysteries surrounding what happens to humans standing near an IED – or improvised explosive device – when it detonates are still being discovered.
The very nature of IEDs is complicated, said Hal Lowder Jr., owner of Eagle Watch Investigations Inc. in Gainesville.
“We know what our grenades will do. We know what our mortar rounds will do,” said the first Gulf War veteran. “When you put together an IED, whether in combat or manufactured domestically, it’s really unpredictable.”
Lowder, a certified fire and explosions investigator, attributes part of that unpredictability to the randomness of the supplies used to build the devices and the varying conditions into which they are detonated on the battlefield.
“(Insurgents) are using old artillery shells and powder from old shells, whatever they can get their hands on,” Lowder said.
It’s a violent blast that happens in the space of nanoseconds.
Kevin Barry, chairman of the board of advisers for the International Association of Bomb Technicians and Investigators, said solids turn into gases in a blink of an eye, creating violent shock waves and shockfronts.
The waves in turn create positive and negative forces.
These airwaves can suck the air out of lungs, bruise organs and cause internal bleeding. Then there’s the nearby debris that turns into fatal projectiles and the fragmentations inside the bomb itself.
“Depending on the size of an IED, you can be a quarter of a mile away from a 1-pound blast, and it can still shake your insides,” Barry said.
Lowder compares the blast to the ripples that occur when a rock is thrown into a still pond.
Unlike water, solid objects around IEDs – such as buildings or armored vehicles – create walls that allow the waves to reflect and bounce back.
“Obviously, we’re seeing the trauma it causes, guys come home with no arms or legs or fingers. But there are a lot of brain injuries, too,” Lowder said.
The violent waves can jerk heads back and forth, bruising brain tissue and snapping nerve fibers.
The potential damage on a soldier is great – minus the evidence of a single scratch.
Barry said this internal damage doesn’t take into account the hearing loss involved with soldiers being repeatedly exposed to such blasts or the psychological impact that often leads to PTSD.
“People are just not prepared for that kind of trauma,” Barry said. “Will there be more cases of soldiers with TBI? Certainly. Will there be more cases of PTSD? Absolutely. Not everyone accepts the traumas of war the same way.”
A tale of loss
Retired Sgt. Pickens doesn’t know what triggered his actions that led to charges of disrespecting several non-commissioned officers.
Those are the charges the military leveled against the 10-year Army veteran during his second deployment to Iraq in 2005. Pickens was assigned to the 396th Transportation Co., 87th CSB at Camp Taji, Iraq.
According to military reports and the sworn statements of fellow officers, Pickens’ strange behavior started in late November of that year.
In a sworn statement dated Dec. 14, 2005, Staff Sgt. Ryan Westfall reported that 12 days earlier, Pickens ignored him when he called him after a motor pool inspection.
“Pickens was in a hyped-up mood,” Westfall recalled. “I waited for him to get done talking and then called his name. He never responded, I called his name five or six more times very loudly but no response.”
A fellow soldier got Pickens’ attention.
“His behavior seemed odd to me, like he wasn’t in his right frame of mind,” Westfall stated.
The staff sergeant noted that he had gone to Pickens’ room earlier in the day to get him to sign some paperwork. He found the soldier wearing headphones and talking at the top of his lungs.
“(Pickens said things) like, ‘You do not want this, I’m the real thing’ and something about Brunswick,” Westfall said in his sworn statement. “I’ve never seen Sgt. Pickens act like this.”
A day later, military records indicate, Pickens’ behavior got worse.
According to 1st Sgt. Felton Head, in a sworn statement dated Dec. 4, 2005, he was asked to deal with Pickens a day earlier. The visit was prompted after verbal reports surfaced of the soldier “causing problems with his roommate.”
Among the allegations, Pickens reportedly started listening to music and singing loudly, blaring the television early in the morning and picking fights.
Military reports show when Pickens was approached and asked by Sgt. 1st Class William Small “what was going on and why was he acting this way,” Pickens responded by raising his voice and acting threateningly toward his superior.
That’s when Head got involved.
“I explained to Sgt. Pickens that … I wanted to hear his side,” Head said in a sworn statement. “Sgt. Pickens stated to me in a very loud, disrespectful tone, ‘First of all, I’m blessed, how are you doing first sergeant?’
“I informed him that he needed to lower his voice and again asked for his side of the story. Once again in a very loud disrespectful tone he stated to me that he was ‘blessed and paperwork or the commander.’ “
Pickens allegedly demanded that Head “either put it in writing” or let him “see the commander.”
Military records show Pickens was sent to the unit commander, Capt. Nadine Terese.
According to Head, Terese told the soldier “… that if he was trying to get out of the Army then he was going about it the wrong way.”
Pickens declined offers to see a chaplain or seek mental health.
Ten days later, he was given a mental evaluation by Capt. Christopher Warner, a division psychiatrist with the 3rd Infantry Division, and was found to be “normal.”
The next day his “promotable” E-5 status was taken away.
In November 2006, Pickens was given an honorable discharge for what the military called a “personality disorder” and asked to move off Fort Stewart.
The man who dreamed of an Army career suddenly had no job, no future and no place for his family to live.
No physical scars
“It would have been better for him to lose a leg,” said his wife, Cyntia Pickens, “because then, you can see it (an injury) happened.”
Pickens tried to convince officers that something wasn’t right but was discharged before he got a proper diagnosis.
He tried to get help with the Department of Veterans Affairs, but is still waiting eight months later.
Frustrated, Laboran Pickens took drastic steps and admitted himself to Georgia Regional. A civilian doctor confirmed the former soldier has PTSD.
Unable to work, his wife’s job on-post barely supports the family. In November, a year after leaving the Army, the couple filed federal bankruptcy.
Cyntia Pickens even wrote U.S. Rep. Jack Kingston’s office seeking assistance.
“We’re working with the VA to get something done,” said Rob Asbell, a Kingston spokesman. “I can’t imagine why it has taken the VA this long to respond to a veteran, especially one that has served in Iraq, but you better believe we’re going to find out.”
Paul Sullivan, executive director with Veterans for Common Sense, contends Pickens is a veteran who has tragically fallen through the cracks in the system. And he fears the former soldier may be suffering from more than PTSD.
“All he needed to be is near an IED,” Sullivan said. “There are new military studies that show the blast wave from an IED … could actually cause mild TBI without any immediate open wounds.”
Pickens said his unit conducted convoys and carted supplies to soldiers across Iraq.
“There were lots of convoys, lots of dead people,” he said. “Never once was I hit, but I was shot at.”
And there were lots of IEDs.
“Almost every day, every mission,” he said. “It was always mission first.”
Pickens said he has no idea whether one particular blast shook him enough to cause brain damage or prompt the PTSD.
But the growing number of troops with psychological problems has prompted Veterans for America to argue that every soldier should receive a brain scan before entering the service and get re-scanned after each deployment.
“If left untreated, the veteran could develop a host of medical problems, including psychological problems that may appear to be PTSD,” Sullivan said. “It is very important for the doctors to determine suffering from actual brain damage and psychological damage.”
Sullivan argues this is “just the tip of the iceberg.”
“There was no plan for occupation, and there was no plan to take care of veterans either,” he said. “It is groups, like ours, that are saying ‘Not again.’
“We will not let the veterans twist in the wind waiting to see a doctor or benefit. We will get it right this time.”
For Laboran Pickens, for now, it feels as if he is still left hanging.
“(The Army) says ‘take care of family first,’ ” he said. “But it sure wasn’t that way once the fighting was over with.”