• Are brain injuries from IED blasts causing the military suicide crisis?

    By Bill Briggs, NBC News contributor

    Traumatic brain injuries sustained by more than 200,000 U.S. troops may be fueling the military’s suicide crisis, according to a letter co-signed by 53 congressional members who are seeking additional data to investigate the new theory.


    In the letter, sent Tuesday to Defense Secretary Chuck Hagel and Veterans Affairs Secretary Eric Shinseki, the lawmakers urged both agencies to provide Congress with a raft of figures, including the number of Iraq and Afghanistan service members and veterans who committed suicide or tried to end their lives after being brain injured by the detonation of an improvised explosive device — “the weapon of choice” in both wars.

    “Evidence has suggested that blast injuries, including but not limited to those causing damage to vision or hearing, can have a severe psychological impact ... that can play a major contributing role in suicides,” read the bi-partisan letter.

    Between November 2011 and October 2012, there were more than 15,000 IED attacks against U.S. service members in Afghanistan, and 58 percent of all coalition casualties during that span were caused by the hidden bombs, the letter states.

    At least three veterans groups, including the Blinded Veterans Association, are backing the congressional push to — as the letter to DOD and VA states — “get a better understanding of the connection between blast injuries and suicide.”

    “I’ve talked to a lot of neurologists, military neurosurgeons and trauma surgeons who have all started to ponder if the IEDs that have caused the TBIs are the real cause of the suicides, versus the traditional approach that suicides are all caused by the psychological stresses of combat,” said Thomas Zampieri, head of government relations for the Blinded Veterans Association.

    “Let’s collect more information and maybe the epidemiologists will find a way to unlock some of this mystery: Are military suicides actually more related to the brain injuries? I think there may be a big connection,” added Zampieri, who served as a Vietnam-era Army medic. “As the numbers of TBIs go up, the numbers of suicides continue to go up.”

    The portion of U.S. service members who sustained TBIs increased each year from 2001 to 2011 — with a total of 266,810 brain injuries diagnosed in American troops between 2000 and 2012, according to the Defense and Veterans Brain Injury Center, part of the DOD. More than 80 percent of those injuries were not deployment-related cases, with many occurring amid crashes of privately owned cars and military vehicles. 

    Army soldiers account for the vast majority of diagnosed TBI cases, and those injuries range from “mild” (a concussion) to “severe.” Within the Army, the suicide rate among active-duty members has risen from 9 per 100,000 in 2001 to nearly 23 per 100,000 in 2011, according to the American Foundation for Suicide Prevention.

    During that same span, according to the DOD’s brain injury center, the number of annual TBI diagnoses among American troops has ballooned from 11,580 in 2001 to 32,609 in 2011 — an increase of 182 percent.

    “What is significant is that we are looking at a potential paradigm shift of significant proportion if the link between low-level TBI from IEDs emerges,” said retired Army Col. Bob Morris, founder of the Global Campaign against IEDs.

    “The current automatic approach is to connect everything to Post Traumatic Stress Disorder and look at it all as psychological when it may be a physiological,” Morris added. 

    The lawmakers additionally asked the DOD and VA to supply "specific autopsy findings (of service members or veterans) potentially indicative of prior TBI." The members said they want to know whether such post-mortems found "chronic traumatic encephalopathy", which has been detected in the brains of a number of NFL players who recently committed suicide. 

    Numerous Iraq and Afghanistan veterans have been diagnosed with both TBIs and PTSD, as well as with hearing loss — the most common disability among the men and women who served in those wars. 

    "There is no higher priority for VA than the mental health and well-being of our courageous men and women who have served the nation," said a VA spokesman, responding to the congressional letter. "Under the leadership of Secretary Shinseki, VA has made significant progress in providing increased access to mental health care services and strengthening our suicide prevention efforts, but there is more work to do. VA is committed to providing all Veterans the care and benefits they have earned and deserve.”

    A Pentagon spokeswoman said Hagel "responds directly to correspondence received" and that it would inappropriate for her comment on the letter. 

    Rep. Dan Benishek, R-Mich., a surgeon who worked at a VA medical center for 20 years, led the effort to collect congressional signatures for the letter to Hagel and Shinseki.

    “Far too many of our veterans and military personnel have taken their own life after bravely serving our nation. Frankly, it’s tragic and unacceptable,” Benishek said in a statement Tuesday. “I am hopeful that by working together we can make sure our guys and gals in the military and the VA have the support they need to recover from the damaging psychological effects of war.”

    "There is particular evidence linking suicide to those wounded by IEDs," added Rep. Richard Hanna, R-N.Y. "It is my hope that through additional research we will be able to identify and reverse this painful trend. One suicide is too many and we should do all we can to address this as quickly as possible."

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  • Hearing loss the most prevalent injury among returning veterans

    By Bill Briggs, NBC News contributor

    After a decade of war, America is well schooled on post-traumatic stress, lost limbs and traumatic brain injury, but the most common injury sustained by U.S. troops is literally a silent wound: hearing loss.

    Mark Brogan, a retired Army captain, can speak quite personally about almost all of those examples of combat carnage – he suffered a brain injury, a spinal injury and a nearly severed right arm when a suicide bomber on foot detonated his weapon near Brogan six year ago in Iraq.

    Courtesy of Mark Brogan

    Mark Brogan sustained a spinal injury, a brain injury, a nearly severed arm - and severe hearing loss - when a suicide bomber blew himself up not far from Brogan in Iraq six years ago.

    What does Brogan, 32, consider the worst of the physical trauma? “Hearing loss and the brain injury,” he said from his home in Knoxville, Tenn. He has “profound unusable hearing” in his right ear and severe hearing loss in his left, he said, along with constant ringing, or tinnitus, in his ears.

    After the insurgent's bomb killed a soldier just behind Brogan – along with the person who was wearing the device – other U.S. troops quickly rushed Brogan's side and saw blood streaming from both ears, he said.

    “You’ve been to a concert – you know how your ears are ringing afterward? It’s just like that my entire life,” Brogan said. “A lot of guys get home and they probably don’t even think about getting their hearing checked.

    According the Department of Veterans Affairs, the most prevalent service-connected disabilities for veterans receiving federal compensation in 2011 were tinnitus and hearing loss, respectively, followed by PTSD.

    "I suspect today’s generation of veterans – those who have been in a combat environment – probably have a higher severity of hearing loss (than past generations), especially with the explosions and the IEDs and the ruptured ear drums they’ve sustained,” said Brett Buchanan, a VA-accredited claims agent with Allsup, a national provider of services with disabilities.


    Allsup recently organized a one-day Web expo where younger veterans had a chance to log in and seek advice on how and where to get treatment — including a primer on how to successfully access and steer through the monolithic VA system.

    While chatting online with dozens of veterans, Buchanan repeatedly was told about their hearing loss, he said.

    To Buchanan, a former Army artillery officer who was among the first wave of U.S. troops to invade Iraq in 2003, the massive scope of the disability is simple to grasp.

    “The military, in general, is just a high noise-producing environment,” Buchanan said. In the Navy, where most sailors work only below deck, there is " the constant drumming of the engines and metal-on-metal noise.”

    And in the Army and Marines, many personnel, he added, spend hours inside “military vehicles that are not quiet,” including tanks and personnel carriers.

    In addition, service members typically devote time to practicing at firing ranges.

    “In those cases, hearing protection negates the loud noise to a large degree. But when you’re in these environments for years upon years, that negation you do with hearing protection may not be enough to prevent injury long term,” Buchanan said.

    “Then you get into the combat environment where weapons are going off, explosions are going off. In combat, you can’t call time out and say, ‘Hey, I need to put in my earplugs.’ ”

    Service-related injuries in veterans are assessed and rated by VA doctors to determine how much monthly compensation those veterans will be paid for their physical sacrifices. Those ratings span scores of 0 to 100 depending on the severity of the wounds. (Brogan, who due to the partial spinal injury has weakness on his right side and a lack of sensation on his left side – but no paralysis – is classified as 100 percent disabled by the VA, he said).

    Through earphone-tone exams and other diagnostic means, the VA also rates hearing loss and tinnitus in veterans who come in for checkups.

    “For hearing loss, the ratings I usually deal with for my clients are 0 percent, meaning they’ve had some hearing loss but it doesn’t quite meet the criteria to get the minimum VA disability rating, which is 10 percent,” Buchanan said. “Tinnitus is a simple 10 percent rating. There’s nothing above that. My tinnitus might be worse than yours but there’s no test for that.

    For Brogan, post-military life has included mastering subtle tricks and new technology to adapt to his muffled hearing. For example, his phone transcribes conversations as they take place. “And in a loud restaurant with background noise, I pretty much can’t understand anybody’s voice,” Brogan said. “I have to tell somebody, ‘Hey, can you repeat that? Can you speak slower so that I can understand you?’ There are techniques, over time, that you learn.”

    But his world is not devoid of pretty sounds. At age 5, he learned the piano. Six years after a bomb bloodied the insides of his ears, someone donated a new piano to the veteran. Brogan tickles those black-and-white keys as physical therapy for his brain and for the weakness in his right hand. He's mastering covers of popular tunes. And he's even composed his own melody, captured on video.

    Finally, he's making music again. 

    Original composition. Just sat down one day and this sort of just poured out.

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  • Military study finds training concussions for some troops

    By Rebecca Ruiz, NBC News

    A study conducted by the military has found that nearly 6 percent of soldiers experienced concussions during combat-training courses at Fort Hood, according to a report from ProPublica and NPR.


    The study raises questions about the safety of standard training classes and whether or not soldiers had deployed to combat without realizing they suffered a mild traumatic brain injury.

    The results are preliminary and rely on data gathered from hand-to-hand combat classes taken by nearly 2,000 soldiers at the Texas base. The post is one of the Army's main centers for basic training where soldiers spend more than 20 hours learning fighting techniques that include boxing, wrestling and Brazilian Jiu-Jitsu, according to the report.

    Experts told ProPublica and NPR that they were concerned that brain injuries suffered prior to combat could have made soldiers more vulnerable to the long-term consequences of additional concussions, including frequent headaches and memory loss.

    “Even 1 percent of soldiers would concern me,” Col. Carl Castro, the director of the Military Operational Medicine Research Program, told ProPublica and NPR. “I’d say we need to do something. We don’t want soldiers getting injured while training, if we can prevent it.”

    There have been at least 244,000 traumatic brain injuries as a result of explosions and accidents since 2000, but previous reports from ProPublica and NPR found that number may be much higher due to underreporting and missed diagnoses.

    Reporters who were permitted to observe advanced students learn how to teach combat-training classes in Fort Benning in Georgia witnessed one student get kicked in the head during a sparring match. That student appeared dazed, was evaluated by a medic and did not participate in the remainder of the class. He was later sent to a clinic for evaluation.

    The ProPublica/NPR report said that hundreds of thousands of soldiers had taken the combat courses at bases nationwide in the past decade before deploying.

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