Not all injuries visible to eye

Sixty-six percent of the most seriously wounded soldiers returning from Afghanistan and Iraq have “invisible” injuries of brain trauma or post-traumatic stress, which their families and society will be dealing with at great cost for decades, said Gen. Peter W. Chiarelli, the Army’s vice chief of staff.

“The truth is, because we don’t see these injuries…they don’t receive the same level of attention as amputations, burns, shrapnel injuries,” Chiarelli said.

Chiarelli made his remarks last week at Defense Forum Washington, a one-day conference on support for wounded warriors and families as they struggle to heal and regain stable lives.

Before Chiarelli spoke, April Marcum, wife of retired Air Force TSgt. Tom Marcum, described how her husband saw that bias from the medical community when he returned wounded from Iraq in 2008. A combat arms training and maintenance specialist with 12 years in service, Tom had been in charge of an armory on Ali Air Base Iraq when a mortar round fired by insurgents exploded 35 yards away, knocking him unconscious.

A medic told Tom he should rest a couple of days before returning to duty. When Tom’s tour ended several weeks later and he returned to Moody Air Force Base, Ga., April could tell he wasn’t himself.

“He still had the same headache. He was confused at simple things. He had short-term memory loss. The last straw for me was the day he called me on his way from work…and said, ‘I can’t remember how to get home,’” April recalled, tearing up. Tom, at her side, let April speak for the family.

“The local medical community, including the Air Force medical clinic doctor, seemed to be reluctant to help,” April continued. “Tom’s primary care doctor implied Tom was trying to get out of work.”

They pressed for an appointment with the medical group commander. Eventually Tom got a thorough evaluation at the poly-trauma unit of the VA Medical Center in Tampa, Fla. Doctors diagnosed traumatic brain injury with an orbital wall blowout fracture behind an eye. A shoulder required surgery. Tom also had hearing loss, vision deficit and post-traumatic stress disorder.

Three years after returning from war, Tom remains on the temporary duty retirement list awaiting word on whether the Air Force will retire him permanently. April said she had to quit her teaching job to care for her husband and raise their sons. While living on 70-percent disability payment from the Air Force, and Social Security Disability Insurance, the Marcums have exhausted their life savings, she said.

The National Institute of Health, he said, has estimated that the average length of time in this country between when an incident occurs that causes post-traumatic stress and the illness gets diagnosed is 12 years.

“And lots of bad stuff happens in that 12-year period,” he said, which can have lasting impact on individuals, their families and their careers.

Symptoms of both post-traumatic stress and traumatic brain injury can include difficulty concentrating, irritability, personality changes and memory impairment. Yet the physiology behind these types of injuries still is not well understood, Chiarelli said. Advocates at the forum said oftentimes only a family member can spot symptoms and arrange needed medical help.

Fortunately, he said, much has been achieved from studying invisible injuries from these wars toward more timely diagnoses and treatment. For example, researchers are perhaps just a year away from developing a biomarker to detect conclusively whether a patient has suffered a concussion, using a device similar to what diabetics use to test blood sugar.