Brain injuries remain undiagnosed in thousands of soldiers

By T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR

WASHINGTON, D.C.–The military medical system is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan, many of whom receive little or no treatment for lingering health problems, an investigation by ProPublica and NPR has found.

So-called mild traumatic brain injury has been called one of the wars’ signature wounds. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.

Photo: U.S. Army

Officially, military figures say about 115,000 troops have suffered mild traumatic brain injuries since the wars began. But top Army officials acknowledged in interviews that those statistics likely understate the true toll. Tens of thousands of troops with such wounds have gone uncounted, according to unpublished military research obtained by ProPublica and NPR.

“When someone’s missing a limb, you can see that,” said Sgt. William Fraas, a Bronze Star recipient who survived several roadside blasts in Iraq. He can no longer drive, or remember simple lists of jobs to do around the house. “When someone has a brain injury, you can’t see it, but it’s still serious.”

In 2007, under enormous public pressure, military leaders pledged to fix problems in diagnosing and treating brain injuries. Yet despite the hundreds of millions of dollars pumped into the effort since then, critical parts of this promise remain unfulfilled.

Over four months, we examined government records, previously undisclosed studies, and private correspondence between senior medical officials. We conducted interviews with scores of soldiers, experts and military leaders.

Among our findings:

• From the battlefield to the home front, the military’s doctors and screening systems routinely miss brain trauma in soldiers. One of its tests fails to catch as many as 40 percent of concussions, a recent unpublished study concluded. A second exam, on which the Pentagon has spent millions, yields results that top medical officials call about as reliable as a coin flip.

• Even when military doctors diagnose head injuries, that information often doesn’t make it into soldiers’ permanent medical files. Handheld medical devices designed to transmit data have failed in the austere terrain of the war zones. Paper records from Iraq and Afghanistan have been lost, burned or abandoned in warehouses, officials say, when no one knew where to ship them.

• Without diagnosis and official documentation, soldiers with head wounds have had to battle for appropriate treatment. Some received psychotropic drugs instead of rehabilitative therapy that could help retrain their brains. Others say they have received no treatment at all, or have been branded as malingerers.

In the civilian world, there is growing consensus about the danger of ignoring head trauma: Athletes and car accident victims are routinely tested for brain injuries and are restricted from activities that could result in further blows to the head.

But the military continues to overlook similarly wounded soldiers, a reflection of ambivalence about these wounds at the highest levels, our reporting shows. Some senior Army medical officers remain skeptical that mild traumatic brain injuries are responsible for soldiers’ troubles with memory, concentration and mental focus.

To learn more:

• Read the full series at ProPublica.org

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Traumatic Brain Injury in Theater: When Blasts Damage the Brain

Graphic by Al Granberg, Special to ProPublica, and Krista Kjellman Schmidt, ProPublica – June 7, 2010 10:00 pm EDT

Traumatic brain injuries have been called the “signature wound” of the wars in Iraq and Afghanistan. While improvements in armor and battlefield medicine mean more soldiers are surviving bomb blasts that would have killed them in previous wars, the explosions are leaving some of them with permanent wounds. Mild traumatic brain injuries are difficult to detect as they leave behind no obvious signs of trauma. While many soldiers recover fully from the injury, others are left with persistent mental and physical problems.

Sources: Interviews with Dr. Ibolja Cernak, M.D., M.E., Ph.D., of the Johns Hopkins University Applied Physics Laboratory and Dr. Michael R. Yochelson, M.D., of the National Rehabilitation Hospital; “Traumatic Brain Injury: An Overview of Pathobiology With Emphasis on Military Populations” by Ibolja Cernak and Linda J. Noble-Haeusslein in the Journal of Cerebral Blood Flow & Metabolism; brainline.org; Defense and Veterans Brain Injury Center

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Tags: Concussion, Military, TBI, Traumatic Brain Injury, Veterans

Category: Brain & Nervous System, Injuries & Wounds, News, Veterans