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Thursday, January 05, 2006

Malingering as Vet Brain Injury Cases Soar

A brief respite from my post-traumatic stress disorder [PTSD] series to call attention to a somewhat related piece of reporting appearing in Salon today.

More U.S. soldiers than ever are sustaining serious brain injuries in Iraq. But a significant number of them are being misdiagnosed, forced to wait for treatment or even being called liars by the Army.

Being called liars?!

Click on 'Article Link' below tags for more...

Mark Benjamin's Salon piece introduces us to 24-year old Spc. James Wilson. He's a proud soldier who's served two tours in Iraq - including heavy combat in the opening days of the invasion.

In the fall of 2004, his 1st Cavalry Division was mostly fighting in Sadr City, a volatile sector of Baghdad. On Sept. 6, Wilson was manning a .50-caliber machine gun atop a Humvee when a bomb or bombs went off directly under the vehicle, rocking his head forward and slamming it into the machine gun. A fellow soldier told Wilson that his Kevlar helmet had been split open by the impact. The heat from one blast felt like "a hair dryer" on his skin, multiplied "times 20," Wilson later wrote in his diary. To the best of his recollection, the force of the blast also knocked the gun from its mount, smashing it into his leg.

From all outward appearances, he miraculously survived the incident.

Two weeks later, however, he was on his way to Walter Reed Hospital; Wilson's dazed, light-headed symptoms had led Army medics to believe that he was suffering from post-traumatic stress disorder [PTSD]. But the medics turned out to be wrong.

Wilson's symptoms included:

  • seizures
  • short-term memory loss
  • severe headaches with eye pain
  • dizzy spells that lead to vomiting
The above symptoms it would seem (when coupled with the documented head injury he'd suffered during the attack) should have clearly been enough for the doctors at Walter Reed to diagnose a case of traumatic brain injury, right? Wrong. A visit to the Pentagon in which Wilson threw up all over Paul Wolfowitz' carpet apparently wasn't enough evidence, either.

Despite Wilson's description of his injury and his symptoms, Walter Reed officials repeatedly questioned his mental state and the authenticity of his combat story. In a June 2005 memorandum from an Army Physical Evaluation Board, some Walter Reed doctors stated that Wilson exhibited "conversion disorder with symptoms of traumatic brain injury." Conversion disorder holds that symptoms such as seizures arise from a psychological conflict rather than a physical disorder.

Col. James F. Babbitt, president of the Physical Evaluation Board, accused Wilson of being a liar. "I believe that the preponderance of the evidence available to the Board supports an alternative diagnosis ... one of malingering," Babbitt wrote in that memo.


Defined: Evading duty or work by pretending to be incapacitated.

Spc. Wilson and his wife, Heidi, weren't going to just roll over and take the malingering charge without a fight. They strongly opposed the diagnosis, and worked vehemently to get the proper medical treatment. The malingering charge also stung this proud veteran. "I want my dignity, pride and respect back," Wilson says. After serving his country, being accused of misleading doctors, he says, "is the worst thing in the world."

Is this the proper care that our soldiers should be receiving upon their return to us? A year spent dealing not only with physically debilitating symptoms, but with the added burden of fighting the very government that sent them to war?

On Dec. 19, 2005, more than a year after he was admitted, Walter Reed finally sent Wilson to a neurological center to be treated for traumatic brain injury. Neuropsychological testing done at Walter Reed on Oct. 11, 2005, led officials to conclude that "there was no indication of malingering."

According to a neurosurgeon with extensive experience treating combat head injuries, an October 2004 MRI of Wilson, combined with a description of his symptoms, showed that he should have been treated for a traumatic brain injury right then. Medical experts say the failure to treat a brain-injury victim promptly could hinder recovery.

Unfortunately, Wilson isn't the only one getting this type of `treatment'.

Salon conducted interviews with other soldiers suffering from brain injuries at Walter Reed. They are as frustrated and anguished by the delays and suggestions that their problems are a result of mental or hereditary illnesses.

Salon also interviewed military doctors and examined medical records and found Walter Reed is swamped with brain-injury cases. " [A] significant number of brain-injury patients are falling through the cracks from a lack of resources, know-how, and even blatant neglect."

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