Marine Cpl. Wade Spann talks about his experience in Iraq and his traumatic brain injury
A war at home: Invisible wounds, big costs
by Elise Foleyand Hibah Yousuf
Mar 16, 2009
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Courtesy of IAVA
Click to enlarge: Symptoms of post-traumatic stress disorder and mild or moderate traumatic brain injury
Hibah Yousuf/MNS
Sources: IAVA, VA Harvard University and RAND
Related Links
MNS: Is better health care needed for veterans?Harvard University study on the long-term costs of providing medical care and benefits for veteransIraq and Afghanistan Veterans of America report on psychological and neurological injuriesNational Institute of Neurological Injuries and Stroke information on traumatic brain injuriesNational Center for PTSD information centerHe remembers the explosion. He remembers the fade to black. He remembers being handed a phone to call his parents in Fairfax, Va.
“I couldn’t remember the phone number,” he recalled. “My family has lived in the same house since I was born.”
Spann, a 26-year-old Marine corporal, suffered a traumatic brain injury that day in Fallujah, Iraq. But he wasn’t diagnosed until two years—and his third combat tour—later. Traumatic Brain Injury, or TBI, now an Iraq War buzzword, was previously thought of as a bad concussion. “Rest for a day, and we’ll get you back out there,” Spann said he was told after his injury.
But he continued to have trouble with his memory. In between his second and third tour, Spann began to suspect something more was wrong when he and the others in his unit failed to complete assignments, forgetting they had been given tasks at all. They adapted by carrying small notebooks where they kept to-do lists.
After leaving the military in 2005, Spann started school at George Washington University, where he is a senior. The young veteran struggled to adjust to campus life. As traumatic brain injuries became more recognizable, Spann realized he might have one and went to the Department of Veterans Affairs for a screening.
Though he was diagnosed, Spann felt overwhelmed by the bureaucracy—even scheduling appointments became too time-consuming. A year later, the VA noticed and assigned a case worker to help Spann schedule appointments around his classes and arranged for him to receive extended time on tests.
Spann is just one of 945,423 Operation Enduring Freedom and Operation Iraqi Freedom veterans who have left active duty and become eligible for health care since 2002, flooding the VA with new veterans to treat or at least screen for problems. As troops draw down in Iraq and more soldiers and Marines return to the U.S. , many worry that the VA will simply be unable to handle all of the wounded veterans.
The scope
Of the nearly 1 million veterans from the wars in Iraq and Afghanistan, 14 percent screen positive for post-traumatic stress disorder, according to a 2008 RAND study, and about 19 percent surveyed reported probable traumatic brain injuries.
The problems are difficult to diagnose and many don’t pursue treatment. About 57 percent of those reporting a probable brain injury had not been properly evaluated and only about half of those who screened positive for traumatic stress or major depression had sought help, according to the RAND study.
For those who do seek treatment, the costs to the government are staggering.
The Iraq and Afghanistan Veterans of America reported that the expense of treating new veterans for mental health concerns alone could be in the billions of dollars. And as the new administration seeks to expand eligibility for VA health care and return troops from Iraq, the number of patients who served in Operation Enduring Freedom and operation Iraqi Freedom will rise to more than 419,000 in 2010, Veterans Affairs Secretary Eric Shinseki told a Senate committee March 10.
The proposed budget from President Barack Obama aims to increase the VA’s outlay from $98 billion for this year to $113 billion for the fiscal year beginning Oct. 1. If approved, the money would improve the screening process for traumatic brain injuries and post-traumatic stress disorder, provide readjustment counseling services and finance a suicide prevention advertising campaign, Shinseki said. The budget also aims to use information technology to create a paperless benefits system by 2012 to improve efficiency and reduce the bureaucracy slog.
Steve Robinson, director of the National Legislative Commission of the American Legion, said his organization supports many of the recommendations in the president’s budget proposal.
But the budget is just a proposal—there is no guarantee that the funds will be approved by Congress. Four veteran service organizations—AMVETS, Disabled American Veterans, Paralyzed Veterans of America and Veterans of Foreign Wars of the United States—urged Congress to appropriate enough funding to the VA for it to make significant improvements in a timely manner.
Finding solutions
Without more money, some fear the influx of returning troops will strain the VA.
While the VA recently increased its mental health staff by more than 4,000 and developed public service announcements to broadcast on college campuses, those efforts are only a start.
Legislators and advocates are urging the government to focus more on treatment of veterans with traumatic brain injuries and post-traumatic stress disorder.
A bill introduced by Rep. Niki Tsongas, D-Mass., aims to improve the VA’s diagnoses of mental health conditions by training counselors on college campuses to identify the initial signs and refer students who are veterans to the VA.
To screen everyone for traumatic brain injuries, post-traumatic stress disorder and other mental health issues, the VA wants to create mandatory enrollment for all veterans, Shinseki said.
Raising awareness
In some cases, the problem is not the VA: it’s the stigma against asking for help for these kinds of wounds. To help those deterred from admitting a mental health problem, the VA has moved some mental health services to the primary care area of hospitals, Shinseki said.
In Iraq, Spann said he heard other Marines screaming in the middle of the night and then denying it in the morning.
“It’s a toughness thing,” Spann said. “In the infantry, you don’t really say, ‘Hey, I’ve got a problem’—it would be like, ‘Shut up, and keep walking.’”
Spann does not have post-traumatic stress disorder, and his brain injury is not bad enough to require intensive treatment, he said. But he has spoken out about helping veterans readjust to civilian life—especially school—and suicide prevention. Two friends from Spann’s unit committed suicide within weeks of each other last year. They were both receiving treatment for post-traumatic stress disorder, he said, but it was not enough.
Spann said he wants the VA to continue to make sure it is accessible to those who want help.
Still, he said he understands the limitations the VA faces.
“I think they should spend more money on it, but times are tough,” Spann said. “Good luck.”
