TBI: Hidden Wounds Plague Iraq War Veterans

Denver Post

Colorado Springs – After the 5-ton Army truck stopped tumbling down an embankment in Iraq, Gary Watts found himself standing on his head, upside down in the cab of the truck.

“All I had was a sore neck and a bad, bad headache,” Watts said.

He rested for a couple of days after the July 24, 2003, accident, then went back to work. He would listen to his commander’s directions but hear only pieces of sentences. Twice, he ended up in the wrong convoy in Iraq, driving a truckload of supplies to the wrong place. His bosses chewed him out, and fellow soldiers made fun of him.

It took nearly three years for doctors to diagnose Watts with what is now known as the signature wound of this war – traumatic brain injury.

“Unfortunately, this may be what we are now creating, a whole population of people who are going to be mildly to moderately brain-injured,” said Dr. Sheldon Goldberg, medical director of Porter Adventist’s rehabilitation unit. “Just as Christopher Reeve’s spinal-cord injury brought spinal- cord injury into the limelight for the public to try and understand, I think very sadly our returning Iraq veterans are going to be bringing traumatic brain injury into the limelight now.”

Last week, Fort Carson revealed that 17.8 percent of troops who returned to the mountain post from Iraq in the past two years had a traumatic brain injury, or TBI.

Of 13,400 soldiers screened in the past two years, nearly 2,400 of them had brain injuries. Of those, 13 percent were not fit to return to Iraq. In many cases, those soldiers were medically discharged from the Army.

Camp Pendleton in California, Fort Bragg in North Carolina and Fort Hood in Texas found that between 10 percent and 20 percent of returning soldiers suffered brain injuries, most from improvised explosive devices, according to Charles Dasey, spokesman for the U.S. Army Medical Research and Materiel Command. At Walter Reed Medical Center in Washington, D.C., 30 percent of soldiers admitted had a brain injury.

“When you consider that 1.5 million people have served in Iraq [and Afghanistan], that’s 150,000 to 300,000 people who have TBI, and that’s an enormous, enormous problem that requires immediate action,” said Paul Sullivan, executive director of Veterans for Common Sense, a nonprofit advocacy group for vets.

Damage can be cumulative

In high-velocity, concussive-type accidents, the brain is like molded Jell-O tossed around in a wooden box. For soldiers who are exposed to dozens of blasts from improvised explosive devices, the likelihood of more damage increases with each event.

The severity of traumatic brain injuries varies, and it affects each person differently. Many soldiers recover within hours or in one to three months. For some, the brain may never heal.

“What happens to these people is, they don’t become stupid. It’s not that these people lose their cognitive ability; they just lose the ability to get the messages from one part of the brain to the other as fast as they used to,” Goldberg said.

Watts, 35, now receives 100 percent disability from the Department of Veterans Affairs. He lives with his wife, Danelle, 32, and their 10-month-old daughter, McKenna, in the mountain community of Divide.

After his injury, Watts knew something was wrong with his brain. He blew up at other soldiers when he thought they had moved his belongings.

Before he left Iraq and headed home in March 2004, a doctor did a checkup. Watts told him during the exam that he had an accident and memory loss, but at the time, brain injuries were not on the radar of Army doctors.

“They said: ‘Well, that’s kind of common over here in a war environment. Once you get back home, you should straighten out, so let your doctor know when you get back,’ ” Watts said.

In recent months, veterans advocacy groups have been critical of the military’s medical community because the Pentagon has not released hard numbers on how many troops have suffered from traumatic brain injuries.

Dr. Jonathan Jaffin, an Army colonel and acting commander of the Army’s Medical Research and Materiel Command, said the difficulty comes from a diagnostic dilemma.

“The question is: ‘Who has had a brain injury?’ The severe ones, that’s easy. … When you think about football players, how many football players get their bell rung? If you really look, a lot of them do. So getting that exact number of the mild ones can be tough,” Jaffin said.

The other challenge is that most traumatic brain injuries heal without medical care. If a soldier shows no symptoms, screening for a TBI does not occur at the nation’s Army installations. Veterans organizations want the military to document when a soldier has been exposed to a blast, should symptoms arise in the future.

Last week, a nine-member independent review group selected by Defense Secretary Robert Gates to respond to deficiencies in outpatient care at Walter Reed Army Medical Center recommended that the military adopt a policy for recording any exposure to a blast in a patient’s medical record, develop a coding system to record TBI, and screen troops before and after deployment to measure functional/cognitive abilities.

Symptoms only got worse

As Watts continued fighting the war in Iraq, his symptoms became worse. He couldn’t dismantle and assemble his Army rifle, a task that used to be as simple as tying his shoes. The Army sent Watts – considered a “go-to” guy – to Fort Hood to take a course and a test he needed for promotion. Watts failed the written test twice.

Before he left Fort Hood, two roommates told him they noticed something wasn’t right with him.

“I broke down, and I said: ‘Hey, I had an accident in Iraq. My head bounced all over the cab, and ever since then my memory has just been useless. I don’t even remember your name, and you’re my roomie. … If you don’t have it on your shirt, I don’t know.”‘

Back at Fort Carson, doctors diagnosed him with traumatic brain injury, but a medical board wanted more tests. He received a final diagnosis in late April 2006.

Danelle Watts said her husband becomes irritable because he is frustrated that he can’t remember what used to be automatic.

“He doesn’t remember what day of the week it is, when holidays are,” she said.

On a white, dry erase board, she reminds him: “Today is Wednesday, April 4.”

Before he was discharged from the Army in July, Watts got lost going to work at Fort Carson. After their daughter was born, Danelle had to quit the Army because her husband was not able to care for the girl himself.

Goldberg, the rehabilitation doctor, said there is no cure for traumatic brain injury. Whether Watts will fully recover is not known, but since he left the Army, he has begun to feel better.

He tries to manage his days and limit the unexpected.

“I’m not lazy, but I try to do as little as possible. If something pops up that I can’t control, that I can’t predict is going to happen, it throws a wrench in the works and I don’t know how to handle it,” Watts said.

The key to helping people with brain injuries is providing a safe, supportive environment, Goldberg said.

For the Watts family, that help came from Debra Berthold, a retired Army colonel who works with the Army’s Wounded Warrior Program.

Berthold called the family in August, when the Wattses were down to the last $30 in their checking account. Watts was out of the Army, and veterans’ benefits hadn’t kicked in.

The Wounded Warrior Program is designed “to make sure that we don’t do to these soldiers what we’ve done to our Vietnam soldiers,” Berthold said. Anyone who is given a ranking of 30 percent or more disability from the VA is eligible for help. Berthold has a caseload of 60 soldiers, and 80 percent of them have a brain injury.

It’s where Watts has received vocational-rehabilitation benefits.

For at least 30 hours a week, he works with Carl Reif, president of Advanced K-9 Training Inc., to learn to train dogs to detect drugs, bombs and cadavers and find lost people.

Training a dog requires repetition, and that repetition – giving the same commands again and again – will help strengthen Watts’ brain.

“If the brain is a connection of millions and billions of circuits, and all of a sudden a whole bunch of these circuits are torn or damaged in a very minute way,” Reif said, “… what you need to do is to keep sending the same message through on those circuits, to either help heal up those circuits or create new circuits within the brain that go around the injured area.”

Watts trains two times a month with Denver-area police officers in the hope that one day he’ll be able to have his own dog-training business. Over and over again, he practices.

“There’s not a prosthetic brain out there, so no, it’s never going to be normal again,” Danelle said. “Can he work ways around it? Yes. Are there ways to make it better? Yes. Is it going to take a long time? Sometimes.”

Staff writer Erin Emery can be reached at 719-522-1360 or eemery@denverpost.com.

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