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Jack Sisson's TBI Blog

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'Red Tree Sky,' photo by Greg Olsen, copyright 2007
No matter your politics, I hope you'd agree that it's a strange world in which wars are said, dispassionately, to have "signature injuries." For the American Civil War, maybe this was battlefield amputations; for World War I, trench mouth or gas-attack symptoms; for Vietnam, I guess, post-traumatic stress; and for the original Gulf War, various Agent Orange-related afflictions.

Here at sossisson.com, we've noted before (recently, for example, here) that traumatic brain injury is widely regarded as the signature wound of the current war in Iraq. This sad state of affairs has at last received Federal attention, in the form of a Congressional ruling that soldiers must be tested for TBI before and after their Iraq deployments. This news came at the end of last week, in a report from USA Today. This comes roughly concurrently with a report from the Defense Department itself, per the Associated Press.

From USA Today:
The Pentagon must use computers to screen troops before and after they go to Iraq or Afghanistan to better determine whether they suffered traumatic brain damage in combat, according to a plan by a congressional brain-injury task force...

Congress has authorized a record $450 million for brain-injury treatment and research in the Iraq spending bill being negotiated by Congress and the White House. Legislators say the Pentagon acted slowly on this issue.

"The military was blindsided by the number of blast injury victims in Iraq and Afghanistan, and it is clear that the proper resources were never in place to care for them," says Rep. Bill Pascrell, D-N.J., co-chairman and founder of the 112-member Congressional Brain Injury Task Force.

And from the Associated Press:
Issuing an urgent warning, the Defense Department's Task Force on Mental Health chaired by Navy Surgeon General Donald Arthur said more than one-third of troops and veterans currently suffer from problems such as traumatic brain injury and post-traumatic stress disorder.

With an escalating Iraq war, those numbers are expected to worsen, and current staffing and money for military health care won't be able to meet the need, the group said in a preliminary report released Thursday.

"The system of care for psychological health that has evolved in recent decades is not sufficient to meet the needs of today's forces and their beneficiaries, and will not be sufficient to meet the needs in the future," the 14-member group says.
There have also been a couple of other recent news items on this issue:

As increasingly elaborate body armour protects the torso, and even the limbs, the brain is still vulnerable to shock waves that helmets cannot deter... And these "closed-head" injuries are harder to treat than even those commonly suffered by motorcyclists.
  • From the San Antonio Express-News, "Troops living with brain injury":
    ...untold thousands of U.S. troops [are] returning from the Middle East with a brain injury, the signature wound of the war in Iraq and a rising challenge stateside for everyone from doctors to lawmakers.

    Overtaxed military medical facilities have farmed out many cases [...] to private rehabilitation centers at an unprecedented pace, raising questions about oversight and quality of care and forcing the military to rethink preventing and screening for such injuries, many of which are hidden...

    In Iraq, modern body armor protects troops from bullets and shrapnel. Not even a padded helmet can keep a riveting blast from pounding the brain against the ridges inside the skull, causing bruising or swelling or stretching its nerve fibers. The injuries often aren't seen on CT scans or MRIs.

    But they can cause a loss of balance, memory or cognitive skills that might not appear until a year after deployment. Even civilians who don't live by the tough-and-ready ethos of the military are hesitant to seek help.

  • From Army Times, "Soldier says he was deployed with head injury":
An MRI later showed that Thurman had lesions on the right parietal lobe of his brain, a condition that led to a “don’t deploy” order — which the Army violated, according to Thurman. Worse, rather than providing compassionate understanding of the symptoms associated with traumatic brain injury, he said leaders at Fort Carson, Colo., have harassed him, refused him medication and pushed for an Article 15.

Thurman stepped forward Friday as one of the 18 soldiers whose cases were cited by six senators in a letter to the Government Accountability Office requesting a review of alleged improper handling of traumatic brain injuries, post-traumatic stress disorder and ungrounded personality disorder discharges.

The letter was sent after an Army surgeon general investigation into the cases said the soldiers were handled properly — but the soldiers involved said no one from the surgeon general’s office ever talked to them in the course of that investigation.
As an aside, if you -- like I -- were previously unfamiliar with the term "Article 15": It refers to a section of the Universal Code of Military Justice, or UCMJ. Generally, it's one of the UCMJ's "punitive articles." According to Rod Powers, about.com's "Guide to the US Military," Article 15 is one of several procedures
whereby the commanding officer or officer in charge may:
  • Make inquiry into the facts surrounding minor offenses allegedly committed by a member of his command;
  • afford the accused a hearing as to such offenses; and
  • dispose of such charges by dismissing the charges, imposing punishment under the provisions of Art. 15, UCMJ, or referring the case to a court-martial.
To initiate Article 15 action, a commander must have reason to believe that a member of his/her command committed an offense under the UCMJ. Article 15 gives a commanding officer power to punish individuals for minor offenses... The term "minor offense" ordinarily does not include misconduct which, if tried by general court-martial, could be punished by a dishonorable discharge or confinement for more than one year. The military services, however, have taken the position that the final determination as to whether an offense is "minor" is within the sound discretion of the commanding officer.
Note that the soldier whose case is covered in the Army Times piece claims about his post-TBI treatment that his superiors have "pushed for an Article 15." I understand that the military code of justice must be different than the civilian. But if this claim is at all true, I hope the military at least stops to reflect on ways in which Article 15 can be abused -- if not outright criminalizes the abuse.

[Updated 2007-05-09 7:56 pm]

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