Soldiers' brain trauma cases disputed

Two years ago, McRaney, a reservist, was in Afghanistan when a mortar shell landed on his bunker, killing three civilian contractors who were with him. McRaney survived, but his brain was damaged in the explosion, diminishing his memory, ability to follow directions and process speech.

Traumatic brain injury, or TBI, has been called the “signature injury” of the wars on terror. The insurgent style of fighting, with roadside bombs and mortars blasting unsuspecting troops, have rattled an untold number of brains. As soldiers return home from stints in Iraq and Afghanistan, thousands of families are struggling to deal with the long-term effects of TBI.

Usually the result of a violent blow or jolt to the head, TBI occurs when the brain collides with the inside of the skull or when a bullet or shrapnel penetrates the skull. Serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain that can lead to long-term complications or death.

But detecting traumatic brain injuries can be difficult. They are frequently “invisible,” meaning soldiers often go untreated until their symptoms worsen with time.

In recent years, the military, responding to severe criticism, has changed the way it evaluates such injuries, moving quickly to take soldiers with possible head trauma out of action. Since the attack, McRaney has lived at the Walter Reed National Military Medical Center in Bethesda, Md., while he and medical teams toil to get his mind back in working order.

“I know my brain doesn’t work the way it used to,” said McRaney, 39, during a recent visit to his home in Paulding County.

A congressional report in February said studies indicate between 15 percent and 23 percent of the 2 million who have served in wars in Iraq and Afghanistan have experienced a TBI, which would mean 300,000 to 460,000 cases.

Army experts say those figures are too high. Gen. Peter Chiarelli, then the Army vice chief of staff, told the Army News Service earlier this year, “We have diagnosed so far into this war 126,000 cases of TBI throughout the 10-plus years of this war.”

Five years before McRaney was blown up, Army Sgt. Rodney Merriweather absorbed a blast from a roadside bomb.

At first, it seemed he was OK, even though he had been briefly knocked unconscious. The veteran who led long-haul convoys to bring supplies into the war zone was soon back out there commanding a dozen more missions.

The former high school defensive end likened it to football. “You go out on the field and get knocked out, the coach asks you, ‘Are you OK?’ Then you go back in. You don’t want the coach to pull you out.”

Merriweather didn’t ask for help because of macho pride, but he was never the same confident leader. He had suffered a traumatic brain injury.

Seven years later, the 2005 blast still echoes through Merriweather’s life. His concentration is poor, and he has been unable to hold on to a job.

‘A battle mind’

If diagnosed quickly and treated, so-called mild forms of TBI can be cured, say experts. Symptoms can include dizziness, vertigo, headaches, mood swings, memory loss or reduced reasoning.

But diagnosing and quickly treating TBI — especially during the first years of the wars — has proved to be difficult. Some wounds, severe head traumas like McRaney’s, are obvious. He had shrapnel in his skull, and CAT scans show trauma to his brain. But brain injuries are often hard to quantify with CAT scans. Sometimes, soldiers often don’t report the injury. Most figure they got their “bell rung” and just soldier on.

“There’s a battle mind,” said Dr. Inge Thomas, coordinator of the TBI Injury Program at the Atlanta Veterans Affairs Medical Center. “Instead of going and getting rest, they go back in. They don’t want to be seen as sissies.”

The brain is complex and mysterious, she said. It is surrounded by liquid and, when there’s external force like an explosion, the fluid and brain absorb a shock wave. Thomas describes the effect on the brain by balling her fists, one atop the other, and twisting as if wringing water from a sponge.

Earlier this year, Thomas convened a support group at the Atlanta VA of former servicemen who suffered TBI. Sitting up front was Merriweather. He didn’t say much during the meeting but attends because he is comforted by the support of those who have endured the same.

‘It’s hidden’

A veteran in the meeting complained his mother-in-law had said she didn’t think anything was wrong with him. To her, it didn’t look like there was anything physically wrong with him.

Merriweather, like others, nodded at his comrade’s words.

Though Merriweather still looks like he could jump in his Humvee to lead a mission or even take down a halfback, what others don’t see is a hesitant man who worries he is not up to the job.

Before the blast, Merriweather could digest his convoy’s route during a pre-mission briefing and would barely need to glance at a map again. Afterward, he could not take his eyes off the route map, always worrying he’d forget where he was, afraid he’d get someone killed.

He got a Bronze Star for the 2005 attack but not a Purple Heart. Last year, the military issued a directive that would make it easier for more TBI soldiers to receive a Purple Heart.

In 2007, he retired after 20 years of service. He didn’t make a big deal of the injury. “I didn’t want to go out saying I couldn’t do it any more,” he said. A year later, he landed a job at UPS as a dispatcher, which was perfect. He knew all about keeping supply lines running.

But on the job, he was absent-minded. He would forget conversations and endured migraines. Names, places, information from meetings? All a fog. Again, he tried to hide his deficiencies. He wrote notes to himself to remember just about all he had to do each day. But he kept it to himself; he figured no one wanted to hear his excuses about why he couldn’t keep up.

“I’m not missing an arm or a leg,” he said. “People assume you’re fine. It’s hidden.”

Finally, he had to leave the job.

About three years ago, he went to the VA. Tests indicated he had suffered a TBI and still had symptoms. He was judged 80 percent disabled and now gets by on his pension and a disability check.

Merriweather, who lives in Locust Grove with a 15-year-old son, wants to return to work but is realistic about his limitations. “I can’t drive a truck or be a cop carrying a gun,” he said. “Right now, I’m in the recovery stage.”

Merriweather’s “put-me-in-coach” outlook is common and is something the military is trying to change, said Maj. Sarah Goldman, director of the Army Medical Specialist Corps traumatic brain injury program.

“Service members and athletes have a lot in common,” she said. “They are team members and extremely dedicated to their mission and to their battle buddies. They don’t want to be taken out of the fight, just like athletes don’t like to be taken out of the game.”

The rash of TBI injuries has caused the military to immerse itself in studies, more than 200 in all, costing $633 million, she said. The military is partnering with the NFL in an education campaign “reducing the stigma to seek care for concussion and TBI,” said Goldman. “We’re working on a campaign to educate soldiers and athletes that it takes courage to seek care for concussion.”

But despite all the study, knowledge comes slowly.

“We have so much more to learn about the brain,” she said. “It’s not a ‘one size fits all.’”

Things have changed since Merriweather was injured. Soldiers caught near a blast are evaluated for a concussion and are pulled out of duty for at least 24 hours. “That policy takes the decision out of their hands,” Goldman said. “It’s easier if the decision is out of their hands.”

She said the overwhelming number of those suffering mild TBI can recover with proper rest and medical management. But many injuries early on in the wars went unreported, meaning those injuries lingered untreated or soldiers often suffered a second or third head trauma, which can greatly increase long-term problems.

“That’s why changing the culture is so important,” she said, “so the soldier will come forward.”

‘Good enough’

McRaney has an advocate in his struggle with TBI: his wife, Jennifer, an emergency room nurse. She has questioned doctors on treatments, fought for his benefits and requested second opinions. Too often, TBI patients settle for less than they deserve, she said.

“It’s easy for [the bureaucracy] to say, ‘It’s good enough,’” she said. “We see all these young soldiers 19 or 20 years old, they don’t know what to fight for. It’s an invisible injury. It’s almost like people with back pain. ‘Oh, you’re fine,’ ” she said, waving dismissively to make her point.

McRaney’s long road back has included physical therapy, occupational therapy, speech therapy, psychological counseling and sessions with a social worker. He lives by Android phone, which acts as a second brain. It reminds him of appointments and even has an alarm with his own voice, “Take your medicine, David.”

McRaney, like many who have had TBI, also suffers from post-traumatic stress disorder, an emotional condition that includes anxiety, nightmares and flashbacks that are triggered by memories of a horrific event.

The sound of a helicopter brings him back to the evacuation chopper right after the attack. So do large crowds and the sight and sounds of Mideastern immigrants, walking reminders of his tenure in harm’s way.

PTSD and TBI symptoms are often similar and hard to separate. Three-quarters of those 35,300 service members treated by the Department of Veterans Affairs for TBI also have PTSD.

McRaney finds the best cure for his ailments is to plow forward. He has started an internship to see if he can still hack it as a nurse, both mentally and physically. And he’s taking business classes, earning his master’s, in the event he can’t.

His studies are taxing but just what he needs. “I need to keep challenging myself,” he said. “This pushes me hard.”

He came to nursing after taking care of his grandfather in the hospital. He enjoys doing little things for patients to help them cope, like finding a colorful blanket for a woman in hospice dying of cancer. The personal touch comforted her at the end.

“It’s nice to make a difference,” he said.

McRaney’s internship at Walter Reed has him shadowing nurses. He must see if he can handle 12-hour shifts — presently, he can’t — and if he’s up to the mental requirements. He works on the Wounded Warrior floor at Walter Reed. But there is one area he still can’t enter.

“I don’t want to work with the guys who are TBI yet,” he said. “I’m just not ready for that yet. The guys with TBI are too close to home.”

About the series

In the coming months, an estimated 23,000 Americans will return home from deployment in Afghanistan. For some, homecoming will be joyous. Others will struggle to find work, maintain relationships, deal with injuries. In an occasional series, the AJC will examine some of the homecoming issues Georgia veterans will face.