WASHINGTON — Improvised bombs rattled former Army Spc. Adam Pittman a dozen times in his three tours in Iraq, most severely when his Bradley fighting vehicle ran over one hidden in the dirt in 2005.
Now, part of Pittman's brain has gone dormant, and on most days he can't think straight.
He leaves the room and forgets what he was searching for. He gets migraines so piercing that his right eye sometimes curls away from his left. Anger comes easily, inspiring rages that sometimes have his wife terrified for herself and their 3-year-old daughter.
Although Pittman, who lives in Lillington, N.C., left the military in July 2008 complaining of headaches and memory loss, it took nearly a year for him to get a brain scan and another five months to start getting temporary disability benefits.
"They were blowing me off," Pittman, 30, said of the Department of Veterans Affairs. "I feel like things that have to happen, they're dragging their feet on."
Nearly 30,000 veterans have suffered some kind of traumatic brain injury in the wars in Afghanistan and Iraq, an estimated 2,000 of them severe enough to put the warriors into comas or leave them with severe disabilities. Yet eight years into the wars, testimony before Congress shows that veterans still suffer yawning gaps in coverage for what's become the conflicts' signature wound.
"It requires someone screaming and fighting on behalf of that soldier," said Sen. Richard Burr of North Carolina, the top Republican on the Senate Veterans' Affairs Committee.
Many veterans and family members say that veterans with consistent help — a spouse or parent, usually — are best able to navigate the system. Others are left scrambling to seek assistance.
"There's almost a culture of no at the VA," Burr said.
"For the average service member or family member that asks, 'Can we do this?' the automatic answer is no," he said. "Can we get that service locally? No. Can we go to an outside rehabilitation facility? No."
Among the complaints, from advocates, veterans, family members and testimony to Congress:
- The military has yet to provide an accurate baseline measurement of individuals' brain function in order to determine later whether those people have TBI. For now, troops fill out online questionnaires.
- It can take more than a year for service members to transition from the Department of Defense to the VA, which delays treatment and the disability ratings that veterans need to receive financial benefits.
- The VA doesn't routinely refer patients to private providers who might live closer or be more expert in treating traumatic brain injuries.
- The VA has denied therapy to veterans who aren't continuing to make progress, when TBI patients need consistent therapy just to keep from sliding backward.
"They're just not getting what they deserve and what's available," said Karen Bohlinger, whose son suffers from a severe brain injury he sustained as a special forces officer in Iraq. She's married to Montana Lt. Gov. John Bohlinger.
The VA repeatedly denied Bohlinger's request to get a brain scan for her son, who now lives in a rehabilitation facility in Seattle. She eventually paid the bill herself.
"If it's available, why aren't our veterans getting it?" asked Bohlinger, who testified to the Senate Committee on Veterans' Affairs earlier this month.
Advances in roadside bombs and trauma medicine have left thousands of warriors seriously injured by improvised explosive devices — but alive.
For those with severe TBI, the injuries are obvious: They fall into comas or are left with debilitating speech and cognitive problems. Many, like Bohlinger's son, are steered to intensive rehabilitative care.
Harder to diagnose are soldiers and Marines who suffer from the more common mild or moderate traumatic brain injuries. Those come from concussions or repeated blasts, can often be mixed with post-traumatic stress disorder and leave veterans unable to complete basic tasks because of memory loss, disorientation or intense pain.
The military has said it's offering pre-deployment and post-deployment cognitive screenings for Marines and soldiers who are headed to war zones, but congressional staff members have found that the screenings amount to little more than filling in bubbles in online questionnaires.
"I'm just as worried about the mild TBI cases we're not picking up," Burr said.
Shannon Pittman said her husband made little progress with the VA until a friend recommended that the couple contact the office of Sen. Kay Hagan, D-N.C., who then paved the way for Adam Pittman to receive first an MRI and then temporary benefits.
Still, she'd like to see more services for her husband, whom the VA has told that he must return for another MRI in late 2011 to measure progress.
"He's not being given the tools to be taught how to live with it," Shannon Pittman said. "They act like it's going to go away. It's not going away."
Burr said he'd seen little improvement in services since Congress gave the VA new authority in 2008 to begin contracting with private care providers for TBI patients.
The VA said it had more than 300 agreements in place with private providers across the country, but it couldn't provide the number of veterans who've been referred to private care.
"It's disappointing to me, because I think they could have been doing so much to take advantage of existing capacity within the (brain injury) community," said Bruce Gans, the executive vice president and chief medical officer at the Kessler Institute for Rehabilitation in New Jersey. Gans testified before Congress this month.
The 2008 defense bill also authorized the creation of federal recovery care coordinators, VA workers who try to help veterans find the specialized care they need.
Two years later, there are about 30 federal recovery care coordinators working across the country, according to the VA.
However, the VA was unable to tell the Senate Veterans' Affairs Committee what each coordinator's caseload is now. A report to the committee about the VA's progress in treating TBI indicated that of three case studies in the report, only one had a federal recovery care coordinator.
In its report to the committee, VA Secretary Eric Shinseki said the agency paid $21.4 million last fiscal year for public and private medical services for 3,708 veterans with traumatic brain injuries. That averages less than $6,000 a patient.
The VA has begun a pilot program to develop assisted living facilities for veterans with traumatic brain injuries. So far, the VA has identified five veterans in need and has placed three of them, according to the agency.
In his report, Shinseki wrote that the agency has made "significant progress" in treating TBI. Several advocates and members of Congress agreed.
Former soldiers such as Pittman, however, say that more needs to be done. In a recent interview, he offered advice for other veterans:
"For everybody else that's going through this, to not give up. Because the way the system is set up, it's for you to get started, and get frustrated and quit. Keep trying."
More than 1.5 million American suffer traumatic brain injuries every year. They range from mild injuries such as concussions to severe wounds that pierce the brain and can lead to coma, paralysis or other debilitating injuries.
Nearly 30,000 veterans from the wars in Iraq and Afghanistan have suffered TBIs. Of those, some 2,000 are considered serious.
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