Report: U.S. military misdiagnoses and mistreats brain injuries

NPR and ProPublica have teamed up to produce a startling report about gaps in the U.S military’s diagnosis and treatment of brain injuries. Their investigation calls fresh attention to the plight of so-called "walkie talkies" — service men and women who by all external indicators appear to be hale and hearty, but who in fact suffer from debilitating mental ailments.

Combat-related brain injuries no longer receive the short shrift they once did: since the start of U.S operations in Afghanistan and Iraq, once unfamiliar terms like post-traumatic stress disorder (PTSD) have entered the lexicons of medical specialists and newspaper readers alike. The ProPublica report, however, reveals that even seemingly straightforward — and seemingly innocuous — injuries are all too often slipping under the military’s medical radar screen. The most common injuries experienced by U.S soldiers are known as mild traumatic brain injuries — what some doctors continue to refer to by the name anyone who never got the hang of snow-boarding will recognize: a plain old concussion.  (Of course, soldiers typically incur brain damage after weathering the shock of road-side bombs, not the impact of a ski-slope tumble.) You might think that identifying and treating these injuries would, by the standards of army medics facing far more catastrophic cases, be more or less a piece of cake. Unfortunately, Lt. Gen. Eric Schoomaker, the Army’s Surgeon General, admitted that one exam used by the military to detect concussions and other brain trauma is about as accurate as "a coin flip."

Even if the exams succeed, accurate testing rarely leads to a responsible follow-up. Often, diagnoses never find their way into a soldier’s medical files. If they do, there’s no guarantee they won’t simply be abandoned — or, even worse, burned — in obscure, warzone warehouses:

"The reality is that for the first several years in Iraq everything was burned. If you were trying to dispose of something, you took it out and you put it in a burn pan and you burned it," said [Lt. Col. Mike] Russell, who served two tours in Iraq. "That’s how things were done."

(And that’s a troubling quote for many reasons.)

Treatment procedure is equally disheartening to read about. There’s general consensus among specialists that victims of mild brain injuries should undergo rehabilitative therapy. In reality, it’s far more common for patients to be prescribed psychotropic drugs (a response, perhaps, to the intense media coverage of psychological trauma, like PTSD) — or to be ignored altogether.

The serious consequences of these oversights are driven home by the harrowing stories of victims like Michelle Dyarman, a former reserve soldier whose life was utterly transformed by two roadside bombs and a Humvee accident. After misdiagnosis and mistreatment by military medics, Dyarman’s brain doesn’t function the way it used to:

Today, the former dean’s list student struggles to read a newspaper article. She has pounding headaches. She has trouble remembering the address of the farmhouse where she grew up in the hills of central Pennsylvania…

Dyarman has returned to her civilian job inspecting radiological devices for the state, but colleagues say she turns in reports with lots of blanks; they cover for her.

Meanwhile, she — and we — are left to wish the army had offered her the same kind of support.