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REHABILITATION

INSUFFICIENCIES DISABILITY AND COMPENSATION

Tens of thousands of troops have been wounded in the wars in Iraq and Afghanistan, and brain injuries are being noticed more than ever before. Added to the physical difficulties of rehabilitation is a backlogged Veterans Affairs system and an inefficient bureaucracy that sometimes keeps injured veterans from getting the best help.

MEDICAL EVACUATION

PostTraumatic Stress Disorder

COST

QUALITY OF CARE

ELIGIBILITY AND ENROLLMENT

Wounded Action BY WILL DORAN

A

When shrapnel ripped through the left side of Chris Ray’s body while he led a patrol in Afghanistan, he considered himself lucky. Lucky he was alive, despite the wounds covering his body. Lucky he managed to roll into a ditch, escaping the small arms fire pouring in from the ambushing Taliban fighters. But, he says, mainly just

lucky that he was the only one in his squad who was hurt. That concern for those around him is a trait that Ray, a corporal in the U.S. Marine Corps, says is one of his most important. It’s what allowed him to make it through months of combat, leading soldiers who were sometimes no more than 20 years old. It’s one of the things he prides himself on as a leader. FEBRUARY 2012 | 30


But it’s also a trait that disturbed him as he recovered from his injuries in various hospitals around the world, mainly at Camp Lejeune in North Carolina, while his squad continued patrolling. “I felt guilty for going back home,” he says. “It wasn’t too fun being back in Lejeune when your guys are back in Afghanistan.” As more and more men and women like Ray come back from their military service injured, many will undoubtedly experience similar emotions. And while dealing with those emotions takes time more than anything else, they will all also have pressing medical issues that local Veterans Health Administration hospitals will have to deal with on levels not seen since the Vietnam War. And sometimes those hospitals can’t keep up.

Inefficiencies and worse

In 2007, The Washington Post began releasing a series of articles and photos documenting neglect of patients at Walter Reed Army Medical Center in Washington, D.C. Patients were often kept in decrepit, moldy rooms full of dead bugs and mouse droppings after being discharged from the hospital but waiting interminably on the military bureaucracy to process them through the system. Interviews with both those receiving care and those giving it out reflect the general view that medical care for veterans was topnotch. But the administrative side of it was ruining many recoveries. 29 | HOMEFRONT MAGAZINE

There’s just something about the VA… I don’t have many good things to say about it. According to one Post story: Danny Soto, a national service officer for Disabled American Veterans who helps dozens of wounded service members each week at Walter Reed, said soldiers “get awesome medical care and their lives are being saved,” but, “Then they get into the administrative part of it and they are like, ‘ You saved me for what?’ The soldiers feel like they are not getting proper respect. This leads to anger.” Ray’s views on the system are similar. He stayed at Walter Reed for a short time before it closed in 2011 and has been to several other VA hospitals — mainly the one in Durham, N.C., where he is from. “Every time I go [to Walter Reed], it’s so inefficient,” he says. “But the Durham VA is actually one of the best,” which he attributes to help from Duke University and its acclaimed med Ray says the care he receives in his monthly visits is stellar, but the administration on local and national levels lags far behind, frustrating him to no end. His main frustration, one echoed by veterans all over the country, is the wait time for the military to determine just how injured he actually is so he can start receiving disability pay. Ray has been waiting more than a year, and that’s not too much longer than the typical wait time.

“Active duty guys, they get taken care of all right, but once you get out, that’s where you could see some improvements,” he says. “There’s something about the VA… I don’t have many good things to say about them.” Susan Watkins, the program manager for veterans returning from Iraq and Afghanistan at the Durham VA, says the issue of backlog and wait time is a problem, but can’t be blamed purely on VA administrators. “That is a valid concern, and I wouldn’t say it has been completely made over,” she says. “But it has improved.” She says that some soldiers come to the VA without having already started the process with the military, which is the first step. She also says the nature — and especially amount — of claims is rising, due in large part to increased awareness and medical advances. “Claims are more complex than in the past,” she says, adding: “The workload is busy. But that means we’ve been doing our job well to do outreach.”

Thrown into the mix

Neither Ray nor Watkins says the system is perfect. Ray is more outwardly frustrated, but to comprehend his frustration, it’s important to understand more about his psyche, which probably isn’t much different from that of any other young man who has been


Right: Ray’s squadron, “Badger 1-2” before heading out on patrol in Marjah, a rural area in the Nad Ali District of Helmand Province in Afghanistan. Below: Corporal Austin Godwin (l), Ray (center), Sargeant Shane Burge (r) resting behind an embankment.

designated to lead and protect his fellow soldiers. It’s the combination of the concern for others he exhibited on his last day in Afghanistan and the willingness to step in and get things done he exhibited on his first day in Afghanistan. Barely moments after setting foot in Afghanistan for the first time,

Ray was told he would become his squadron’s leader the next day, and that they would be going on patrol in the morning. Ray was on his first combat tour and, as an enlisted man who was barely 21 years old, he had never held a command position before. He still laughs almost nervously recounting the experience of being

thrown into the ultimate on-thejob training experience. On day two in Afghanistan, while he was leading his very first patrol, his men got into a firefight. The squad didn’t sustain any casualties that day. But that luck would never continue, especially with the rate at which they faced violence. In just four months in Afghanistan, Ray says he was in nearly 60 firefights — a rate of about one every other day. But despite the ever-present threat (and reality) of violence, or perhaps because of it, Ray says the lessons he learned from those four months make up an integral part of his character now. “The responsibility that comes with that is amazing,” he says. “It was probably the greatest experience of my life… It was tough, but at the same time, it was the most rewarding thing.” Ray’s time carrying out his newfound responsibility was cut short though, on Oct. 14, 2010. FEBRUARY 2012 | 30


Traumatic Brain Injuries (TBIs) in the U.S. Military

178,876

30000 25000

TRAUMATIC BRAIN INJURIES

TBI incidents jump from 23,002 in 2007 to 28,557 in 2008

20000

DIAGNOSED

01/01/ 2000 03/01/ 2010 BETWEEN

TBI incidents drop from 13,271 in 2004 to 12,205 in 2005

15000

A N D

10000 2000

2009

MILD MODERATE SEVERE PENETRATING

A confused or disoriented state and/or memory loss lasting less than 24 hours; loss of consciousness for up to thirty minutes; memory loss lasting less than 24 hours; and structural brain imaging that yields normal results.

137,328

A confused or disoriented state lasting longer than 24 hours; loss of consciousness for more than 30 minutes; memory loss lasting more than 24 hours.

30,893

A confused or disoriented state and/or loss of consciousness that lasts more than 24 hours; memory loss for more than seven days; and structural brain imaging yielding normal or abnormal results.

1,891

Open head injury in which the dura mater, or outer layer of membranes that envelops the central nervous system, is penetrated.

3,175

Taking the point with his patrol, he noticed an old oil barrel on the side of the road with wires sticking out. Ray thought it looked too obvious to be a legitimate improvised explosive device, or IED, but protocol and safety dictated he check it out anyway. He approached and discovered that it was, as he had thought, a fake. As he turned to wave on his men, the earth by him exploded. 29 | HOMEFRONT MAGAZINE

The Defense and Veterans Brain Injury Center reports that 7,604 TBI cases were diagnosed from January to March of 2010.

The barrel was a fake, but it served a purpose. It was a ploy, intended to lead soldiers into the path of a nearby hidden directed IED. Smaller than a traditional IED, a directed IED is buried underground and filled with metal and explosives, and intended for troops instead of vehicles. Ray likens the device to a subterranean shotgun in a can. His sunglasses barely saved his

left eye, and the shock of the blast broke his left shoulder. He also suffered massive nerve damage in his left ear. He says the only reason he lived at all was that the device wasn’t aimed properly. But he had no time to think about his brush with death — immediately after the explosion, Taliban fighters ambushed his squad. He had enough of his wits about him to roll into a ditch and escape


Operation Enduring Freedom

Operation Iraqi Freedom

Partial Major limb

Conflicts

1,621 of

CASES

MAJOR LIMB OR PARTIAL

71.4% .44

3000.1% 330.1%

188.5% 118.5% 8 5%

AMPUTATIONS

01/01/ 2001 09/01/ 2010 BETWEEN

A N D

Partial amputations include, but are not limited to, amputations of the hands, feet, toes and fingers. ER OTH N EIG FOR CE FOR AIR

VY NA

E RIN MA

MY AR

ER OTH N EIG FOR CE FOR AIR

VY NA

E RIN MA

MY AR

ER OTH N EIG FOR CE FOR AIR

VY NA

E RIN MA

MY AR

Medical Evacuation Statistics for U.S. Military Personnel

Operation Iraqi Freedom

=

49,390 MEDICAL E VAC UAT I O N S

Operation Eduring Freedom

As of August 21, 2010

=

13,851 MEDICAL E VAC UAT I O N S As of August 21, 2010

Wounded in action

Non-hostile injury

Disease/Other medical

SOURCE: “U.S. MILITARY CASUALTY STATISTICS: OPERATION NEW DAWN, OPERATION IRAQI FREEDOM, AND OPERATION ENDURING FREEDOM”by HANNAH FISCHER, CONGRESSIONAL RESEARCH SERVICE, WWW.CRS.GOV

the bullets whizzing past, and once the enemy had been fought off, his men were able to get him medical help. He was rushed to a nearby hospital, then to two others in Afghanistan, one in Germany, and finally several in the U.S. in the ensuing month. After a short time back in Durham, N.C., with his family and some light physical therapy, he was

sent to Camp Lejeune, where he says his only task was to do rehab every day for six months.

Guilt, tedium and perspective

When Ray finally settled down in Camp Lejeune, he had already exacerbated his broken shoulder rushing through rehab at a hospital in Afghanistan under the false hope that he might get sent back to his base if he recovered quickly.

Doctors also diagnosed him with Traumatic Brain Injury, or TBI, which many refer to as the “signature wound” of the wars in Iraq and Afghanistan because of the large percentage of casualties from explosive blasts. Watkins, of the Durham VA, says TBI has only recently come to the forefront of healthcare. “The treatment didn’t use to exist, but now it does, and it’s here,” she FEBRUARY 2012 | 30


the Benefits Start Here Michael Redic, the transition patient advocate for the Durham Veterans Affairs Medical Center, believes the programs and services provided by the Durham VA makes an important difference in the lives of returning service members. And Redic knows firsthand — as a retired member of the Army, Redic describes helping veterans as “a calling.” Through Operation Enduring Freedom/Operation Iraqi Freedom, Redic and his team help veterans take advantage of benefits that range from health care to education. While the obvious adjustments involved in returning home include rehabilitation of mental and physical injuries suffered in combat, the adjustments regarding long-term health care, education, finances and employment after service can cause just as much stress and can be time consuming. As transition patient advocate, Redic is there to relieve that burden, helping direct veterans to the services they need. “We do everything that any other hospital would do for the veterans, with the exception that we go a step further,” says Redic. “We apply a military approach to care and it makes a great difference.”

Read more about the Durham VA on page XX

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says. “And it’s exciting.” In a 2006 summit held by the Navy, brain trauma took center stage, signaling an important recognition of the effect that the invisible injury can have on veterans. “Very few injuries…can have such devastating long-term consequences as undiagnosed traumatic brain injuries,” Commander James Dunne, lead trauma surgeon at the National Naval Medical Center, said at the summit. “These individuals may appear fine but have problems with relationships, holding down jobs and integrating back into society as a whole.” With that in mind, Ray says he is thankful the military has put a large emphasis on brain injuries, especially in his case, since he already had four or five concussions playing high school sports. But rehabilitating his brain wasn’t his only concern: He couldn’t walk on his own when he first arrived on base, having to rely on nurses even to help him out of bed. He used a cane for the first two months and wasn’t able to jog on a treadmill until nearly five months had passed. He also had to exercise his shoulder constantly or risk losing its mobility, and since the blast damaged balance-aiding nerves in his ear, he had to relearn how to walk straight and stand on one foot. Throughout the rehabilitation process, guilt nagged at Ray for not being with his squad. He says they called him every week to give him updates, but that didn’t shake his feelings of guilt until he heard of another member of his squad who was injured.

The young Marine lost both legs and several fingers to a 7-pound explosive. When Ray compared that to the 25-pound device that he had survived mostly intact, he says he developed a new perspective on his situation. “I feel guilty when I feel guilty ‘cause I should be grateful,” he says. “I can still do what I could do before this.” Ray’s doctors finally declared him fit in June 2011, and he went into the inactive Reserves. Two months later, he enrolled at UNC-Chapel Hill, North Carolina’s flagship university, for the start of his freshman year. Ray, now 23, says he has the desire — and experience — for a career in foreign policy. “We have a bunch of politicians who’ve never seen combat sending these kids off to fight, and [the kids are] coming back with missing limbs,” he says. “They don’t care, though.” Ray was able to play intramural flag football and pickup soccer during his spring semester, so he considers himself lucky. The most frustrating part of his life isn’t coping with injuries, but going to get them taken care of. He says there are a multitude of problems, from lazy administrators to overworked ones, as well as the red tape created by insurance and the federal government. He says the process needs to change, partly because of the incoming flood of younger veterans in need of treatment. “There’s this entire new generation of young combat vets that they’re going to have to deal with.”

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