Traumatic Brain Injury: Hidden Peril for U.S. Soldiers in Combat

By John Wendle / Kabul

Monday, Mar. 19, 2012

It was mid-October 2011 and first platoon had already been fighting for its life for a few days. The 10 Afghans and 26 Americans had withstood repeated assaults by an estimated 300 to 500 insurgents who had crossed the border from bases in Pakistan. Fighters got within five meters of the platoon’s battle positions — with some coming through the perimeter wire. They almost overran the position four times — something that has happened before in Kunar province, with deadly consequences. Now the insurgents had the position dialed in on their 82mm mortars.

“Sgt. Sanes got hit with two rounds simultaneously on his position within five meters,” platoon Staff Sgt. Anthony Fuentes told TIME a few days after the fight. The rounds landed just as an Afghan Army sergeant was firing a recoilless rifle. The blast knocked him to the ground and his round exploded inside their position. After that, “our weapons squad leader [Sanes] was giving fire commands to a rock. That’s what happened in our case. They got nauseous, they couldn’t vomit (but they wanted to), they couldn’t focus and they had double vision,” says Fuentes.

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His eyes still somewhat glassy after coming off the mountaintop position of Outpost Shal just four days before, Staff Sgt. Michael Sanes said, “I was a little out of it and I was screaming for my [machine] gunner to get back on the gun and shoot. I was like… ‘shoot and shoot,’ and he was already shooting. I was a little out of it from the blast. I got my bell rung.” It was Sanes’ third combat tour. The heavy fighting to take the mountaintop position lasted some eight days and the platoon had to call in multiple danger close artillery missions and airstrikes in which heavy ordnance was dropped within 300 meters of their positions. VIDEO: New Hope for Brain Trauma Victims

The pounding that Sanes and his men took may have been intense but multiply it by hundreds and thousands of incidents over a range of severity and you have the potential causes for what may be a murkily diagnosed set of symptoms affecting U.S. servicemen and veterans. Rep. Bill Pascrell (D-N.J.), co-chairman of the Congressional Brain Injury Task Force, has called Traumatic Brain Injury (TBI) “the signature injury of the wars in Iraq and Afghanistan.” Though no clear statistics exist for TBI, it is estimated that there are between 115,000 and 400,000 veterans who now suffer from at least mild versions of it.

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TBI may have a role in the case of staff sergeant Robert Bales who allegedly killed 16 civilians. According to his Seattle lawyer, Bales supposedly suffered a concussive brain injury. He reportedly lost part of a foot in another battle-sustained injury. The sergeant was averse to returning to duty, said the lawyer, who described his client as “decorated.” Bales, the lawyer said, had just seen his best friend lose a leg the day before. Sources talking to the New York Times described the suspect as having marriage, alcohol and stress related problems and “just snapped.” The lawyer, however, denied that alcohol and marital issues were involved in the incident.

On Tuesday, Rep. Pascrell sent a letter on Tuesday to Secretary of Defense Leon Panetta seeking information on the staff sergeant’s injury, diagnosis and treatment. “Over the years I have become increasingly concerned about that the [Defense] Department’s system for identifying service members with traumatic brain injuries has not been working,” Pascrell wrote. “It is critical that we know whether the systems the Department has in place to identify these injuries and provide treatment are adequate and that the needs of our injured soldiers are being properly met,” The Star-Ledger reported.

Though the military has made some improvements over the past decade in diagnosing and treating TBI and post-traumatic stress disorder (PTSD), much more needs to be done, particularly because President Barack Obama has made it clear that the U.S. will stay in Afghanistan until scheduled 2014 deadline, ensuring that thousands more soldiers will suffer physical and emotional trauma.

The Veterans Affairs Department says that because protective and lifesaving technologies have advanced, soldiers who would have died from their wounds are living today — but they are living with TBI and PTSD. The VA defines TBI as the result of something striking the head with “significant force.” This can happen, for example, after an improvised explosive device explodes under a vehicle. The VA says, “individuals who sustain a TBI may experience a variety of effects, such as an inability to concentrate, an alteration of the senses, difficulty speaking, and emotional and behavioral changes.” The VA defines PTSD as an anxiety disorder occurring after living through a life-threatening or traumatic event. Symptoms include flashbacks, avoiding situations that remind the survivor of the event, feeling emotionally numb or feeling keyed up and jittery. All of these have led veterans to higher rates of drug and alcohol abuse, suicide and relationship and employment problems.

“The military has a long way to go in addressing the mental health needs of soldiers. Young people come into the military at an age when mental health problems are often first emerging, and then are thrust into situations that even the healthiest person would find traumatic and destabilizing,” says Heather Barr, Human Rights Watch’s researcher in Afghanistan, who spent seven years working with mentally impaired prisoners in the U.S.

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Part of the failure comes from a simple lack of mental health professionals in theater. Captain David Weller, a social worker in Regional Command East, the war torn area that covers most of Afghanistan’s violent border with Pakistan, was flown from his offices at Jalalabad Airbase to Combat Outpost Monti to counsel the Sgt. Sanes’ platoon just days after the battle to take OP Shal. Weller tells TIME that, besides himself, there is one psychiatrist, one psychologist, a second social worker and four technicians to look after the mental health of around 33,000 troops at 21 forward operating bases and combat outposts in one of Afghanistan’s most violent commands. “There are only a few of us for a big area.” By mid-October 2011, Cpt. Weller had seen close to 200 people one-on-one and “a lot more off the cuff.” He had been deployed for two months at that point. “I spend all my time counseling soldiers. But they need it.”

When asked if the soldiers could be scarred for their whole lives, Weller said, “if they don’t deal with it and they don’t learn how to deal with the emotional side of everything and learn how to process that. That’s why we have the stress team and we’re forward deployed. We try to get out there as quickly as possible and talk to them about what they’ve seen. Cause it doesn’t take a six day or ten day event. It could be one event. A rollover. An explosion. Seeing somebody dying. We don’t know what will trigger it. Everybody’s different.” Says Weller, “a lot of [first platoon’s soldiers] were very overwhelmed with what they’ve seen and what they’ve experienced. The adrenaline rush. What we experience on a normal basis lasts 30 seconds to a couple minutes here and there. And they went through days of it at a time.”

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Cpt. Weller says he sees, “issues related to insomnia and nightmares, a lot of guys that tend to avoid crowds. They feel like they’ve always got to check their surroundings. They feel like they need to check places where an IED might be, or they might check places where a sniper might be. And this could all be going on while they’re sitting in a restaurant back home. Or sitting at a ballgame, if they go to a ballgame. You see a lot of avoidance. We see a lot of people turn to drugs and alcohol, just cause its so difficult to deal with. And, if it’s bad enough, we see paranoia, and different things like that.”

Back in October 2011, Fuentes said that his soldiers were “having a hard time sleeping. It was our sister element who took the casualty, [when a helicopter’s rotor blade beheaded a medic who came in to collect the wounded Afghan sergeant and others], and it was our guys who stepped in and cleaned up all the… aftermath, and they’re having some problems with that. Not being able to wind down. Winding down’s the hardest thing.” Staff Sgt. Everett Bracey said, “just being in such a high stress environment for nine days has definitely taken its toll on everybody in this platoon.” Captain Michael Kolton, the company commander, said he had already evacuated around 25 soldiers diagnosed with TBI out of around 200 in the company by mid-October, just seven months into a yearlong deployment.

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This article originally appeared at TIME at http://www.time.com/time/world/article/0,8599,2109277,00.html.