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Aftershock: The Ticking Time Bomb of Soldiers' Traumatic Brain Injuries

Soldiers returning from Iraq and Afghanistan are a generation of warriors whose fight has shifted from external combat zones to invisible internal battlefields.

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The lack of clarity has frustrated battlefield commanders trying to navigate the debate in the middle of a war. "I don't feel comfortable on where the science is right now," said Gen. Peter Chiarelli, the vice chief of staff for the Army. "It's an extraordinarily tough nut to crack."

Chiarelli has worked relentlessly to change that, convening conferences of top neurologists and flying them to his wood-paneled office in the Pentagon's inner ring to hammer out possible treatments. He has encouraged researchers to find biomarkers to better diagnose brain injury. He envisions a system that, with enough data, could one day help commanders predict which soldiers were at greatest risk of committing suicide.

Although he acknowledges there is more work ahead, Chiarelli's temper flares at the suggestion that the Army is not trying hard enough to improve how it diagnoses and treats soldiers with brain trauma. He points to a directive issued last year[11] that mandated rest periods for soldiers involved in blasts and thorough neurological examinations for those suffering three or more concussions. He also notes that the military has spent millions of dollars on research that has generated promising new technologies to identify and treat injuries related to PTSD and TBI.

"Our doctors are doing everything they can to come up with the best techniques possible to insure they get better at the initial diagnosis of these injuries," Chiarelli said. "But it is extremely difficult because the science is not as developed as it is with the mechanical nature of this war."

Call of Duty

Though the men of Psycho platoon returned to duty shortly after the explosion, several continued to experience aftereffects.

Hollingshead remembered stumbling across the base, unable to keep his balance on the white gravel that lined the ground between buildings. His ears rang constantly. He had difficulty keeping track of what his sergeants were telling him to do. "I just could not remember it. I'd ask three different times. It's a very unusual feeling, not being able to remember all of a sudden." Hopkins had similar trouble. "I just didn't feel right. I could barely walk a straight line," he said. "I was forgetting things, my attention span was shot, someone would be directly talking to me and I would not even really be paying attention. I couldn't recall or say back what they said to me. It was like I was paying attention but I wasn't gathering the information." Junge had splitting headaches, so he popped ibuprofen and Tylenol PM to help get to sleep.

In March, the Army held a ceremony to award the men combat action badges, given to soldiers who have attacked or been attacked by the enemy. For the wound to his leg, Savelkoul also received a Purple Heart, one of the military's most revered symbols of sacrifice, an honor dating back to George Washington. The other men, however, were turned down, even though Army regulations specifically list concussion as an injury deserving recognition. Hopkins was incensed. He began firing off appeals[12] on behalf of himself and his men, with no success. "They don't consider [concussions] to be an injury that is going to stay with you for the long term," he said. "That's a big slap in the face."

For most of the men, some symptoms improved. Their balance got better, the headaches were not as severe -- a typical recovery from mild traumatic brain injury. But the symptoms did not go away entirely. Fuller's ears kept ringing. Hollingshead's headaches remained painful, sometimes disabling. Still, the men continued providing security details for senior commanders, patrolling villages, or protecting fuel and food convoys racing across the desert. "After we saw Dr. Russell, that was it. It was back to work," Hollingshead said. "Nobody ever came back to us to follow up."

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