“More than 115,000 soldiers have sustained mild traumatic brain injuries, also called concussions, in the wars when shock waves from bombs rippled through their brains.”
Article image

For the past two years, ProP­ub­lica and NPR have col­lab­o­rated on an in­ves­ti­ga­tion that looks in-depth at the mil­i­tary's han­dling of trau­matic brain in­juries, a sig­na­ture wound of the con­flicts in Iraq and Afghanistan.
More than 115,000 sol­diers have sus­tained mild trau­matic brain in­juries, also called con­cus­sions, in the wars when shock waves from bombs rip­pled through their brains. Most have re­cov­ered quickly, but some have suf­fered last­ing cog­ni­tive prob­lems, from headaches and dizzi­ness to prob­lems with mem­ory and rea­son­ing.
As a re­sult of our work, Con­gress and gov­ern­ment in­ves­ti­ga­tors have pressed the De­fense De­part­ment to fix flaws that have pre­vented troops with TBIs from being prop­erly di­ag­nosed and treated.
In Jan­u­ary, Sen. Claire Mc­Caskill, D-Mo., ques­tioned the Pen­ta­gon's de­ci­sion to deny cog­ni­tive re­ha­bil­i­ta­tion ther­apy to troops with brain in­juries. Her in­quiry came after a story we did about how the Pen­ta­gon based its de­ci­sion not to pay for such care on a much-crit­i­cized re­port from the ECRI In­sti­tute. Fol­low­ing the story and Mc­Caskill's in­quiry, the Pen­ta­gon so­licited the help of the In­sti­tute of Med­i­cine, which re­leased a re­port in Oc­to­ber urg­ing the De­fense De­part­ment to do more re­search on the ther­apy be­fore of­fer­ing it more broadly.
In­ves­ti­ga­tors at the U.S. Gov­ern­ment Ac­count­abil­ity Of­fice have also scru­ti­nized mil­i­tary pro­grams de­vel­oped to ad­dress brain in­juries. In a Feb­ru­ary re­port, the GAO said that the Pen­ta­gon's De­fense Cen­ters of Ex­cel­lence was plagued by weak lead­er­ship, un­cer­tain pri­or­i­ties and flawed ac­count­ing. The DCOE, which was cre­ated after a 2007 Wash­ing­ton Post se­ries ex­posed the poor liv­ing con­di­tions of con­cussed troops at Wal­ter Reed Army Med­ical Hos­pi­tal, couldn't ex­plain ex­actly how much tax­payer money it re­ceived or how it was spent, the GAO re­port said.
In March, the Army re­sponded to a story we pub­lished last year about how sol­diers had been de­nied Pur­ple Hearts after suf­fer­ing con­cus­sions on the bat­tle­field. The Army is­sued new guid­ance, mak­ing it eas­ier for brain-in­jured sol­diers to get recog­ni­tion.
Among the rea­sons the mil­i­tary has strug­gled to treat brain-in­jured troops, one of the most ob­du­rate is a lack of neu­rol­o­gists, ac­cord­ing to in­ter­views and doc­u­ments we ob­tained ear­lier this year. Poli­cies is­sued in June 2010 re­quir­ing sol­diers to re­ceive a com­pre­hen­sive eval­u­a­tion when they suf­fer three or more mild trau­matic brain in­juries in one year have in­ten­si­fied the need for qual­i­fied doc­tors.
Plus, as we re­ported in May, more than half of all Iraq and Afghanistan vet­er­ans treated in De­part­ment of Vet­er­ans Af­fairs hos­pi­tals since 2002 have been di­ag­nosed, at least pre­lim­i­nar­ily, with men­tal health prob­lems.
One such vet­eran is Brock Savelk­oul, a trou­bled young man who sur­vived a blast in Iraq. Back home in North Dakota, he em­barked on an equally har­row­ing jour­ney that ended in an armed stand­off with local law en­force­ment of­fi­cers, who spent hours per­suad­ing him not to com­mit sui­cide.
Savelk­oul, who we fea­tured in a Kin­dle Sin­gle ear­lier this year, was one of about 300 troops ex­am­ined in a study con­ducted by then-Lt. Col. Mike Rus­sell, the Army's lead­ing neu­ropsy­chol­o­gist. Rus­sell pre­sented his find­ings in No­vem­ber 2009 and con­cluded that a com­puter test being used to eval­u­ate whether sol­diers had suf­fered con­cus­sions was "only slightly bet­ter than a coin toss."
Rus­sell was re­fer­ring to the Au­to­mated Neu­ropsy­cho­log­i­cal As­sess­ment Met­rics, or ANAM, which the mil­i­tary has given to 1 mil­lion troops since 2008 in re­sponse to an order from Con­gress.
Last month, we pub­lished a story about how the mil­i­tary came to spend $42 mil­lion on the ANAM pro­gram, de­spite the fact that the test was never sci­en­tif­i­cally proven to de­tect brain in­juries. As part of our in­ves­ti­ga­tion, we re­leased a with­er­ing re­port on the ANAM that Rus­sell de­liv­ered to mem­bers of Con­gress, which was not pre­vi­ously avail­able to the pub­lic. In his cri­tique, Rus­sell lam­bastes nearly every as­pect of the pro­gram, say­ing that "the se­lec­tion of ANAM was nepo­tis­tic, and the long delay in ex­am­in­ing al­ter­na­tive in­stru­ments is baf­fling."
Fol­low­ing our story, Mc­Caskill began an in­ves­ti­ga­tion into con­tracts sur­round­ing the ANAM pro­gram. Rep. Bill Pascrell, D-N.J., co-chair­man of the Con­gres­sional Brain In­jury Task Force, pro­posed an amend­ment to the 2012 Na­tional De­fense Au­tho­riza­tion Act to help fix the be­lea­guered test­ing pro­gram, but it was pulled from the leg­is­la­tion. Pascrell is now push­ing for a large in­crease in fund­ing for the mil­i­tary's TBI ser­vices in this year's ap­pro­pri­a­tions bill.