Invisible Wounds

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TBI Challenge

Vet takes on the VA over TBI disability ratings

A University of Montana graduate student and his wife are taking on the Veterans Administration, both to right a perceived injustice and to make the system work better for other former soldiers.

Their mission is to force the VA to diagnose, treat and properly compensate vets for traumatic brain injuries.

TBIs are one of the signature wounds for soldiers returning home from Iraq and Afghanistan, but the VA has diagnosed far fewer of them in Afghan/Iraqi former soldiers than the Department of Defense has diagnosed among active-duty soldiers.

Charles Gatlin, a 38-year-old Ranger-qualified former infantry captain and Purple Heart recipient now attending UM in Missoula, is one of those who fell through the cracks. After extensive testing, the Army sent him into civilian life with a 70 percent disability due to TBI. After a brief screening exam at Fort Harrison in Helena, the VA dropped his TBI disability rating to 10 percent.

Gatlin is appealing that ruling and has a hearing Wednesday in Washington, D.C. The director at Fort Harrison has defended Gatlin’s diagnosis and said the psychologist who examined him observed the proper procedures.

An Alabama native, Gatlin enlisted in the Army in 1998 and attended jump school at Fort Benning, Ga. He went from there to the Third U.S. Infantry known as the Army “Old Guard,” the ceremonial drill unit dating back to 1784 that performs military funerals in Washington, D.C. and that escorts the president.

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As part of that assignment, he was attached to the Pentagon and was in the building when the plane hit on 9/11.    

After four years with the “Old Guard,” he received Ranger training and other educational courses and was selected for a “Green to Gold” scholarship at the University of Montana that allowed him to finish a bachelor’s degree in history in 2003. Then he was assigned to the 25th Infantry Division as a second lieutenant in 2005 and was deployed to Iraq the following year.

Gatlin commanded a scout/sniper platoon that did cleared routes, gathered intelligence, assessed and alleviated threats, cordoned off suspicious buildings, and served as a battalion-level liaison with Kurdish nationals.

“We were getting ready to conduct a raid,” he remembers. “We had gathered some intell that a compound near town could be producing VBIEDs (vehicle-borne improvised explosive devices). We went out there and, BAM, we got hit.”

Gatlin’s wife, Ariana Del Negro, testified before the Senate Committee on Veterans Affairs that her husband was standing less than 20 yards away from a very large VBIED on Sept. 28, 2006, when it was detonated, causing Gatlin to suffer a closed-head TBI.

“He was exposed to three concussive forces: first, the explosion; then the engine block from the vehicle which struck him in the back of the head as he was thrown into the air; and finally when he hit his head again after falling to the ground on his back, where he remained unconscious for at least 10 minutes,” she testified.

Gatlin was medevacced to Balad Medical Hospital in serious condition and remained in the intensive care unit for three days. Then he insisted on returning to his unit.

“During the four weeks my husband spent back at Kirkuk, he had to depend on his medic and roommate, Cpl. Joshua Harmon,” Del Negro told the Senate committee. “Cpl. Harmon tended to him, helped him to dress, assisted him when moving from room to room, and checked his pupils each night.” Harmon died of combat wounds shortly thereafter.

“After spending approximately four weeks in Kirkuk without resolution of his symptoms, my husband was returned back to his home base in Hawaii,” Del Negro said. “He could barely keep his balance, let alone figure out where he was supposed to go and whom he was supposed to see for his medical care. Unfortunately, the system he reported to, Tripler Army Medical Center, did not know either.”

Gatlin notes that the medical system wasn’t prepared yet for TBIs, and Tripler didn’t have a head injury unit.

“When he first returned home from Iraq, my husband complained of debilitating headaches, chronic vertigo, memory lapses, anxiety, and hearing loss,” Del Negro testified. “He leaned to the left, developed hand and facial tics, and could not maintain eye contact when speaking. Two weeks later, as some symptoms worsened, new symptoms emerged. He developed a significant stutter, had difficulty recalling words, and frequently dropped objects.

“Unable to drive, this fiercely independent man lost his autonomy and was forced to depend upon others for his basic needs,” she said. “It was also at this time that he began to withdraw socially, avoiding public and busy areas. His time was mostly spent sitting, staring blankly. Watching my husband, an exceptionally accomplished and strong man, struggle with such simple tasks was very difficult.”

After 14 frustrating weeks, Del Negro finally managed to get the docs to transfer her husband to Balboa Naval Medical Center in San Diego, Calif., where she says Gatlin received excellent care. He received intensive rehabilitation seven hours a day and four days a week and learned a lot about brain injuries. He also underwent extensive neuropsychological testing.

In 2009, he underwent a similar battery of tests at Fort Benning in which he was found to be suffering from a number of lasting effects from his injury. Even three years later, he still had chronic headaches, problems with memory and concentration, difficulty using his hands, and problems with depth perception.

The neuropsychologist at Fort Benning concluded Gatlin’s results “are consistent with previous assessments in 2006 and 2007 and thus suggest stability of dysfunction in executive performance, motor functions, processing speed and attention.” On the basis of those test findings, Army’s physical evaluation rated Gatlin’s TBI as a 70 percent disability and recommended him for permanent disability retirement.

After leaving the Army, the couple went back to Alabama for a while, then returned to Missoula where Gatlin enrolled in graduate school for masters’ degrees in public administration and political science. Del Negro, a native of Washington, D.C., is a free-lance medical writer.

Gatlin registered with the VA at Fort Harrison and his medical records were received by the VA hospital on Jan. 18, 2012, but were apparently ignored. Gatlin was invited down to Fort Harrison for further evaluation.

“It was a very quick exam, under an hour, some q & a (question-and-answer), nothing like the battery of tests I was given by the Army,” Gatlin remembers. “It did incorporate elements of some of the other neurological testing, but it was more about recognition. I had to look at pictures compare shapes.

“Then they asked me to do a memory drawing of a picture with 45 degree angles and 90 degree angles,” he says. “You had to look at it for 30 or 45 seconds, then draw it from memory. But it was a shape I’d seen a thousand times in previous tests, and I probably really could have drawn it from memory without seeing it.”

Del Negro was worried by the brief exam, but assumed that the VA would rely on the more extensive neuropsychological testing done by the Army. Wrong! When the VA disability report came back, Gatlin received a 10 percent disability for TBI. However, the VA assigned some of his difficulties to PTSD and gave him a 30 percent disability rating for that.

PTSD and TBI frequently share a common cause and similar symptoms. The difference is that a TBI represents physical injury to the brain, while PTSD is the brain’s reaction to an abnormal situation, such as combat. But they are frequently confused, according to John Medina, developmental molecular biologist and author of the best-selling book, “Brain Rules.”

“It is easy to confuse PTSD and TBI, especially when thinking about combat-induced trauma, and many journalists conflate them. But they are different conceptually, and probably, neurologically as well,” Medina said in a recent interview. 

“Encounters with IEDs (improvised explosive devices) are instructive,” he added. “As a concussive blast wave passes through the brain, the subsequent fluidic turbulence can cause structural damage associated with classic TBIs (torn tissue, bleeding, persistent dizziness, mood changes, sensory problems). But IEDs are almost always associated with horrific experiences, too: agonized screaming, disembodied limbs/bowels and smells a person has probably never previously encountered.

“All by itself this can lead to anxieties and depressions, uncontrollable, invasive thoughts, nightmares and flashbacks that last for years. This isn't TBI. This is PTSD. So, even though a single traumatic event has occurred (the explosion) it has triggered two differentiated responses. Another great example – one of thousands - that the brain was never designed to go to war.” 

In addition to the lower score, Del Negro sees a concerted campaign by the VA to shift the cause of many problems from TBI to PTSD. “It’s a convenient and economically attractive excuse,” she says.  “If it’s PTSD, it’s psychological and it’s your problem, but if it’s TBI, it’s an organic issue that requires medical treatment. There’s a profound overlap between the two injuries, but in my husband’s case, there’s so much medical evidence of cognitive impairment that it’s wrong to ignore it.” 

Equally important to Gatlin and his wife is to stand up for the rights of all veterans and to prevent the VA from intentionally lowering the disability rating for others.

“I’m not an 18-year-old private,” says Gatlin. “I’ve got resources that I can bring to bear. But I’m really worried about those guys that don’t have the benefit of an education or other resources. I’ve done my part. I’d like just to go back to school and enjoy it, but that’s not happening. I’ve become an advocate because I want to make the system work not only for myself, but for others.”

After two years of trying to rectify the situation within the VA at Fort Harrison, Gatlin and his wife filed the appeal that set the stage for Wednesday’s appearance before the Board of Veterans’ Appeals.

For more details, you can read the full story at www.greatfallstribune.com

Eric Newhouse is a Pulitzer Prize-winning journalist and the author of Alcohol: Cradle to Grave and Faces of Combat: PTSD and TBI.

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