'The signature injury of the war in Iraq and Afghanistan'

'The signature injury of the war in Iraq and Afghanistan'
During his deployments, Harvey Leal lived through multiple mortar attacks, attacks that sent powerful blast waves through his helmet - and through his brain.

EUGENE, Ore. - Harvey Jay Leal remembers how and when Iraqi insurgents blew up his convoy, but it’s hard for him to remember how our conversation even started.

“I go off and can't remember the question,” said Leal. “I have no idea what I'm talking about."

Leal is an Oregon National Guardsman who is 100 percent disabled by The U.S. Department of Veterans Affairs standards. He served multiple times in Iraq and was only 20 meters from where a mortar landed on Aug. 10, 2004.
“It’s kind of hard to explain how it all went down,” said Leal. “I remember seeing white and then couldn’t see at all basically.”

During his deployments, Leal lived through multiple mortar attacks, attacks that sent powerful blast waves through his helmet - and through his brain.
Leal received disability for leg and back injuries immediately after returning home from Iraq but it would take four years and dozens of doctors to finally identify his most debilitating injury: Traumatic Brain Injury, or TBI. 

Leal said because TBI screenings for all returning service members didn’t become mandatory until 2005, he didn’t realize was suffering from brain injury. It wasn’t until a couple of months after he returned from Iraq when he began experiencing massive headaches.

Leal said family members were the first to notice a difference in his demeanor. He didn’t like things he used to like. He suffered mood swings that prevented him from holding down a job. The once avid hiker and outdoorsman couldn’t enjoy activities that he used to.

Leal eventually contacted the VA and sought treatment for what he believed was TBI. But in late 2004, TBI still mystified doctors. Leal said his brain injury couldn’t be detected by traditional methods. 

“When you have EEGs and cat scans and MRIs done and they don't show anything, they don't show conclusive evidence that you've had any brain injury whatsoever,” he said.

Despite records documenting Leal’s presence in mortar attacks, some doctors said Leal was lying about his injury. One wrote Leal presented “intentional exaggeration and fabrication” of his head injuries. 

It would take persistence and multiple doctors before Leal began receiving treatment for his brain injury.

Why undiagnosed?

According to the Department of Defense, about 150,000 soldiers are living with TBI. But in 2008, the independent research group Rand found that about 320,000 – or about twice the DOD’s numbers – are actually suffering from brain injury.

Oregon Sen. Ron Wyden said the difference in numbers means the soldiers aren’t getting the help they need.

“This is the signature injury of the war in Iraq and Afghanistan,” said Wyden. “There's no question in my mind that many of our service members are falling through the cracks, and to a great extent it’s because of funding and again the lack of research. Now it’s going to take modern medical approaches both in research and services to deal with that.”

According to the Rand study, only about half of TBI cases are treated. Guardsmen, brain injury specialist, and VA doctors said there are three reasons many are undiagnosed and untreated.

First, many service members don’t want to admit they have a brain injury. If a soldier goes through a TBI screening and says they may have symptoms, that person may be held for further testing that could take up to two months.

“You see, those screenings are just, you just want to go home,"  said National Guardsman Julio Najara, who is living with TBI. "You want to put this behind you and go home. You don’t want more testing, you just want to leave.” 

Second, the VA is trying to keep up with the flood of service members coming back with an injury they don’t know much about. 

“You tend to treat wounds of the previous war," said retired Col. Scott McGrea of the Oregon National Guard. "So, they were prepared to treat gunshot wounds, broken limbs, things like that, but weren't ready to treat traumatic brain injury."

Three, Post Traumatic Stress Disorder (PTSD) and TBI have similar symptoms, such as change in mood or depression. It’s difficult for doctors to distinguish between the two internal and invisible injuries.

“A traumatic brain injury is neurological damage to the brain. So the brain is physically damaged. That’s the difference,” said Brain Injury Association of Oregon Executive Director Sherry Stock. “Most people that had a traumatic brain injury don’t remember when they got it so memory lapse is one. Significant headaches and memory lapse and fatigue, those are all signs of a brain injury.”

Doctors, the VA and brain specialists say education is the key to getting a head of TBI. They more people know about it the sooner they can notice their symptoms.

“See when I came back it was before we were learning all this about TBI,” said Leal. “Unfortunately I’m changed forever, and it’s just too late for me.”