Brain injuries from Iran air strike highlight military’s failure to care for its own – USA TODAY

Stephen N. Xenakis, Opinion contributor Published 5:00 a.m. ET Feb. 1, 2020 | Updated 12:42 p.m. ET Feb. 4, 2020

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First the Pentagon said no U.S. troops were injured in Iran's missile strikelastmonth on an Iraqi air base hosting Americans. Then it rose to11with brain injuries, then 34, then 50, and by Thursday the numberwas up to 64.That's upsetting, as was President Donald Trump's recent comment that "it's not very serious."

This is consistent with a decades long tradition of downplaying the significance of traumatic brain injury. Senior government leadership and the departments of Defense andVeterans Affairs havefailed utterly in caring for the mental health of war fighters. Later labeled the signature injury of the wars in Afghanistan and Iraq, the U.S. military was not prepared in the early days of 2003-4 to either defend againstimprovised explosive devices (IEDs) or treat the injuries they caused.

AlthoughtheCIA operated a station in Afghanistan in the 1980ssupporting the mujahedeenin fighting against the Soviets,it failed to learn that IEDs had been a weapon of choice.If thefighters and medics had paid attention, there should have been no surprises about the seriousness of the injuries and impact on brain health.

Many years passed before the Pentagonacknowledged IED blasts as a game-changing combat injury. In 2004, I alerted the senior leadership in Army medicine.The young amputees at Walter Reed Army Medical Center complained of headaches, sleep problemsand not thinking right. Any blast powerful enough to take the legs off a ground trooper would certainly rattle his brains.But, then again, the conventional mentality across the country did not acknowledge the damage from repeated concussions, as too many professional football players have tragically experienced.

It wasnt until 2010 that the Army took the minimal step of giving 24 hours restto soldiers whohad been hit by IED blasts before sending them back out on patrol.

Historically, mental health services get shortchanged in funding and support across the country, but the failure to care for the war fighters has been notably shameful. Looking back 18 years, we find that the medical campaign to treat psychological problems and brain injury has largely failed.Hundreds of thousandsof veterans and service members suffer with the invisible injuriesof war.

US Marine Sergeant Anthony Zabala runs to safety as an IED explodes in Helmand Province, Afghanistan, on July 13, 2009.(Photo: MANPREET ROMANA, AFP/Getty Images)

These men and women carry the burden of intractable emotional problems, traumatic brain injury, sleep disturbances, chronic pain and moral injury. Up to 20% of combat veterans develop significant post-traumatic stress disorder, and another 10% to 15% develop post-concussion symptomsmuch like the professional football players. On top of that, many incurred injuries that cause chronic pain and exposed them to opioid addiction.

Tragically, suicide by serving military members and veterans has been the most devastating phenomenon. According to a Defense Department report last fall, 541 active military committed suicide in 2018. The Veterans Administration reported in September thatmore than 6,000 veterans committed suicide each year from 2008 to 2017. The Army set up amajor research study in 2010 and awarded $50 millionto an academic consortium, but there are no findings that have significantly changed the treatments or programs. The suicide rates have continued unabated.

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The medical establishment across the Departmentof Defense failed fromthe beginning to acknowledge and respond to the mental health impacts of combat even as the fighting in Iraq intensified horrifically. There have been no significant developments in assessing and caring for the brain injuries from IEDs nor the mental health consequences following combat.DoD Health dragged its feet in gearing up until the problems became glaringly apparent.

It took the media to spotlight the shortcomings in mental health care to the soldiers and the epidemic in suicide and invisible wounds that increasingly burdened them.An Army secretary was forced outfor failing to notice and act on inadequate support to outpatients at Walter Reed.

When Mike Mullen was chairman of the Joint Chiefs of Staff and I was a senior adviser to him, senior medical leadershiprepeatedly blocked proposals and initiativesto better diagnose and treat blast concussions and profound emotional problems. Few if anynew medications or diagnostic tests have been studiedand put into practice.

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As the injuries and debilitation mounted, the military needed programs and initiatives that fast-tracked potential diagnostic tests and treatments for PTSD, brain injury, sleep and suicide. To do that, the leadership needed to shift gears, exercise initiative, and challenge medical researchers tied to tradition, legacy processesand time-honored procedures. Fielding treatments to soldiers and veterans expeditiously requires transformation and thoughtful risk-taking. That never happened, and there have beenfew improvementsin day-to-day care. And, judging by a lack of published reportsabout better treatments,anyserious criticism has been discouraged.

Our inadequate medical care for combat veterans is particularly poignant at this time when both the DoD and VA are working to outsource more treatment to insurers and the private sector.That will further weaken military medicine and set it up for failure in the future.Military medicine has unique features and requirements. Supporting and caring for our war fighters requires that the help they need comefrom dedicated doctors and medical teams, in uniform.The shortfalls in treating the invisible wounds of war should be another lesson learned from the wars in Iraq and Afghanistan.

Stephen N. Xenakis, a psychiatrist and retired Army Brigadier General, serves on the executive boards of The Center for Ethics & the Rule of Law at the University of Pennsylvania and is an Adjunct Professor at the Uniformed Services University of Health Sciences. Follow him on Twitter:@SteveXen

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Brain injuries from Iran air strike highlight military's failure to care for its own - USA TODAY