Health Care

More | | | Editor

Group contends military service members with traumatic brain injuries deserve Purple Heart

  • Follow Health

It started to click in nurse Kate Froede's mind as she listened to the hulking Army Ranger run down a list of his symptoms -- lack of sleep, aggressiveness, ringing in his ears.

Kate Froede (center) watches over Medical College of Georgia nursing students as they learn how to draw blood. Froede says soldiers who have suffered traumatic brain injuries deserve medals for their sacrifice.  Jackie Ricciardi/Staff
Jackie Ricciardi/Staff
Kate Froede (center) watches over Medical College of Georgia nursing students as they learn how to draw blood. Froede says soldiers who have suffered traumatic brain injuries deserve medals for their sacrifice.

"I said, 'Have you ever been near a blast?' And he said, 'I stopped counting at nine,' " Froede said. "I said, 'Well have you ever been checked out for post-concussive symptoms or any kind of brain injuries?' And he said no."

When she began to set up appointments for him to get help, the big Ranger broke down crying.

"He said, 'I thought I turned into a monster. I thought the deployments had turned me into a monster,' " Froede said.

They have been called the signature injury of the wars in Iraq and Afghanistan -- traumatic brain injuries from explosive blasts, often subtle and without any visible outward sign of injury. The military has stepped up efforts to screen and treat them, and during the summer instituted mandatory guidelines for screening after a blast or accident. One official said the program already has produced "significant" results. But where the statistics are not showing up is among the ranks of those earning a Purple Heart.

Froede and Jayna Brooks -- both nurses and military spouses -- founded the group Recognize the Sacrifice to change that. The group helps service members navigate the Purple Heart process and also seeks to raise awareness about and advocate for greater attention to TBI.

Froede, a nursing instructor at Medical College of Georgia, is a doctoral candidate at Vanderbilt University whose work focuses on TBI. She and Brooks met in Germany in December 2007 while their spouses were deployed, and they started talking about TBI.

"We both felt really strongly about identifying the injury, because at that point there wasn't really any standard paradigm for doing that," Froede said.

They formed the group in 2008 and ran across the problem of those with TBI being able to receive a Purple Heart as recognition of their combat injury. Most soldiers who get a TBI probably won't seek a Purple Heart but those who do are running into a problem, Froede said.

"We're seeing over and over and over that, A, the record and the assessment isn't there, and, B, even if it is there, for some reason it is getting kicked back and kicked back and kicked back," she said. "So we're trying to figure out, in a very collaborative and nonconfrontational way, where's the disconnect? Why is it that we have such dedicated commanders, and vice chiefs and soldiers and health care providers who really, really are committed to this issue but somewhere down the line, something is happening where it is not getting through?"

Reports hard to get

Getting reports back from a combat zone is always a problem, officials said.

"Paper records in theater in a war zone and ensuring that we can get the full complete story is a challenge," said Katherine M. Helmick, the senior executive director for Traumatic Brain Injury and the director of the TBI Clinical Standards of Care for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

"It's very difficult to get medical records from the field," said Dr. Dennis Hollins, the medical director of the Active Duty Rehabilitation Unit at the Charlie Norwood VA Medical Center, which is a collaboration with the Department of Defense.

Despite the commitment from the very highest levels to TBI -- and Froede said the military is to be commended for that -- the breakdown points to a much more fundamental problem with TBI.

"If we can't figure out if these soldiers are eligible for a Purple Heart, then we haven't really figured out how to define this and how to assess this," she said. "And you can't move forward on anything if you don't know how to measure it, if you don't know how to assess it."

Numbers in dispute

It is perhaps for this reason that there is some uncertainty over just how many have suffered a TBI while deployed. The U.S. military said there have been 178,876 diagnosed cases of TBI between 2000 and May 20 of this year, according to the Defense and Veterans Brain Injury Center.

But a RAND Corp. survey estimated about 300,000, or 19 percent deployed, had suffered a TBI. Helmick said those numbers are just an estimate based upon telephone screening.

A 2009 study in the Journal of Head Trauma Rehabilitation , of which Helmick was a co-author, looked at 4,000 members of a U.S. Army Brigade Combat Team that served in Iraq and found 22.8 percent had suffered a TBI. But 15 percent of those had no lasting effects and only about 8 percent had any ongoing symptoms, Helmick said.

"We believe the rates to be anywhere from 5 to 10 percent of those that continue to have symptoms when they come back home and require intervention," she said.

The military does have a comprehensive TBI plan in place and on June 21 a directive went out that made assessments mandatory for everyone in certain situations, such as being in a vehicle hit by a blast or within 50 meters of a blast. The new requirements, which took effect Sept. 1, are already having a "significant" impact, Helmick said. While she said she wasn't authorized to release the results yet, "We are pleased with the impact that it's already had in theater in just a month," Helmick said.

Test is challenged

By the time the patients get to Augusta and rehab here, problems or suspicions are usually already noted in the records, Hollins said.

"They'd at least screened them or at least looked at them to determine (their status)," he said. "So I think the military is doing a lot better job than they were at the start of the war. My suspicion is that if you have milder symptoms, or if you have more subtle findings, I think that maybe some of those are getting through."

While Froede acknowledges that the military plan is thorough, it is not based on good science. She called the Military Acute Concussion Evaluation test often used in the field "unvalidated and unproven." A Perspective article in the New England Journal of Medicine in 2009 said the military's clinical definition of TBI was "inadequate for achieving the objectives of these well-intentioned initiatives." That article also sparked a couple of letters from experts questioning its findings.

The military is investing a lot in trying to come up with more objective measures of TBI, Helmick said.

"We are very excited that this investment into the future of TBI care is already beginning to bear some fruit and have strong expectations for the next 5-7 years that that's only going to continue," she said.

For her part, Froede is sacrificing personally for the cause. In addition to her teaching duties and doctoral work, she is working on the issue through her group while also raising two children under the age of 5.

"If sleeping 15 minutes a night is what I have to go through and my kids eat Cheerios for dinner sometimes then yeah, I think it's worth it," she said. "I think that's how everybody working on this issue feels."

Purple Heart

The U.S. military decoration is awarded to members of the armed forces wounded or killed in action by or against an enemy.

Learn more

To learn more about Recognize the Sacrifice and the struggle those with traumatic brain injury have in receiving a Purple Heart, go to recognizethesacrifice.org/index.html.

Comments (19) Add comment
ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Posts and comments do not reflect the views of this site. Posts and comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Flag as offensive" link below the comment.
Brad Owens
4287
Points
Brad Owens 10/18/10 - 06:11 am
0
0
I think if we can show that

I think if we can show that the soldier was wounded, even on the inside, that they should get a PH.

It will be a tough one, but if scans medical testing shws a soldier wa injured by direct action from the enemy, then I say give it to them for sure.

Brad

mable8
2
Points
mable8 10/18/10 - 07:53 am
0
0
Kudos for Froede's work on

Kudos for Froede's work on TBI. Any military person who has been affected by TBI deserves the Purple Heart just as much as the individual who suffered a visible, bleeding wound.

Little Lamb
45281
Points
Little Lamb 10/18/10 - 08:05 am
0
0
Brad wrote: It will be a

Brad wrote:

It will be a tough one, but if scans medical testing shows a soldier was injured by direct action from the enemy, then I say give it to them for sure.

This is a bad idea. There is no way that "medical scans" months or years away from the theatre can conclusively prove that a medical condition was cause by direct action from the enemy. The soldier in question above said his symptoms back here in the States were “lack of sleep, aggressiveness, ringing in his ears.” Those can be cause by many things. If we go down this slippery slope, we will eventually be giving out purple hearts to middle-aged ex-service people for high blood pressure, adult-onset diabetes, and arthritis.

RAWR
0
Points
RAWR 10/18/10 - 11:53 am
0
0
They also deserve respect. I

They also deserve respect. I was recently at Subway on Walton Way and you could tell one of the workers was mentally handicapped. A young guy claiming to be the manager there was ridiculing him in front of customers. We later found out he served in Iraq and probably became handicapped from injuries suffered while serving.

InChristLove
22459
Points
InChristLove 10/18/10 - 12:00 pm
0
0
First off, someone should

First off, someone should call the home office and report this "manager" of Subway. Whether this young man was born handicapped or suffered injuries during his service in Iraq.....NO ONE deserves to be ridiculed in front of customers. If he has a problem with the young man's work abilities, it's best done in private.

My nephew suffers from TBI and I can tell you since he has been back from Iraq, his personality has definitely changed. Aggressive and although he is seeing a professional, the whole family has to deal with these mood changes.

Little Lamb I might agree that years down the road it would be hard to prove but only after a few months we knew something wasn't right with my nephew's behavior.

RAWR
0
Points
RAWR 10/18/10 - 12:07 pm
0
0
I agree InChrist and it was

I agree InChrist and it was called in to corporate.

tigerlily01
0
Points
tigerlily01 10/18/10 - 12:26 pm
0
0
I believe ALL veterans should

I believe ALL veterans should receive the PH for TBI, even the ones for wars that were fought in the past.

Little Lamb
45281
Points
Little Lamb 10/18/10 - 12:51 pm
0
0
I believe ALL veterans should

I believe ALL veterans should receive the PH when they leave the service, even if they were not injured.

Sargebaby
4693
Points
Sargebaby 10/18/10 - 12:51 pm
0
0
I usually agree with Little

I usually agree with Little Lamb, but this is not a bad idea. Military medical and personnel records will verify these kinds of injuries, and if the service member was injured due to the causes, it would not be hard to prove, even thirty years down the road! He is certainly deserving of the Purple Heart award.

In addition, the signature injury of the war in Vietnam, was the exposure to Agent Orange, reslulting in illnesses, deaths, and severe birth defects of countless thousands of Military, and civilian men and women, and their children. Anyone on active duty who served in Vietnam, and has become ill, or died from the results of exposure to Agent Orange, also deserves the Purple Heart Award!

Sargebaby
4693
Points
Sargebaby 10/18/10 - 12:53 pm
0
0
Sorry LL, the PH award is

Sorry LL, the PH award is only awarded in the event of being wounded, or killed, in combat!

Little Lamb
45281
Points
Little Lamb 10/18/10 - 12:54 pm
0
0
Yeah, but if you give one to

Yeah, but if you give one to everybody, it will raise their self-esteem.

Sargebaby
4693
Points
Sargebaby 10/18/10 - 01:17 pm
0
0
They already have awards for

They already have awards for that purpose, LL, they are called Commendation awards, and are awarded to those most deserving. Also, the countries where our Military members are deployed, give out commendations. They are sometimes awarded just for being there, but there are those to do a little extra, and are awarded for their efforts. Again, the Purple Heart is only awarded for an injury/wound, and death in combat!

Brad Owens
4287
Points
Brad Owens 10/18/10 - 01:31 pm
0
0
LL, Come on now, you are

LL,

Come on now, you are being a bit too obtuse on thius very serious problem.

If you look into what causes this you would not be joking about these wounded warriors and their condition.

I think you are being a bit harsh because this is a REAL injury caused by direct attack form the enemy in combat.

I was lucky enough to never be close enough to the fighting to get wounded and I was out of the combat area before IED's started happening.

However, I have seen the results of blasts on fellow soldiers and it is a REAL problem.

And YES, some scans can show internal damage and they deserve PH in my opinion.

I really can't understand your stance on this,

Brad

Sargebaby
4693
Points
Sargebaby 10/18/10 - 01:33 pm
0
0
Sorry about your nephew, ICL,

Sorry about your nephew, ICL, I pray he is receiving the help he needs. I am, and have been assisting Vietnam Veterans, with their claims due to Agent Orange exposure. Some have died before we could get them approved. I'm finishing up on one right now, who went to Vietnam with me, on my first deployment. He has just received his award from the VA, and it was almost too late. He was diagnosed with terminal cancer on the first of this month.

Many Veterans are not aware that they can still file claims. Two years ago, I helped a WWII Veteran file his claim and he received a full 100% total and permanent award.

I will assist any Veteran in filing a claim. Henry, the WWII Vet, did not believe he was eligible, for all these years, only because he thought he had to be a Military retiree. The VA does not seek out eligible service members who might be able to file a claim, as they are overwhelmed as it is. It makes me sick, that there are still Veterans from WWII, Korea, and Vietnam, who are eligible for help, but don't know it! There are just way too many slipping through the cracks, and never get help!

InChristLove
22459
Points
InChristLove 10/18/10 - 01:57 pm
0
0
He says he's getting help for

He says he's getting help for the PTSD and TBI now but it's been a year since he's been home. The young'un thought he could handle it on his own until his marriage started falling apart. He realizes now he needs help and hopefully he will pull through this (my niece has stuck by him this far, with prayer they will make it).

Thanks for your service and also with helping other Vets. God's keeping you around longer to do His service. Hang in there........

Little Lamb
45281
Points
Little Lamb 10/18/10 - 02:06 pm
0
0
Brad, you cannot understand

Brad, you cannot understand when I say that if you allow post-discharge Purple Heart awards for this set of symptoms that you will have claims for purple hearts for all kinds of symptoms that appear in veterans long after their discharge? Just read Sarge's post up above where he says that people should be awarded purple heart medals for becoming ill after discharge if they might have been exposed to agent orange. It's happening, and there will be no end to the claims.

Little Lamb
45281
Points
Little Lamb 10/18/10 - 02:20 pm
0
0
Before he edits it, here is

Before he edits it, here is Sarge's post from 12:51:

In addition, the signature injury of the war in Vietnam, was the exposure to Agent Orange, reslulting in illnesses, deaths, and severe birth defects of countless thousands of Military, and civilian men and women, and their children. Anyone on active duty who served in Vietnam, and has become ill, or died from the results of exposure to Agent Orange, also deserves the Purple Heart Award!

Now, from a Google search, I have listed the symptoms of Agent Orange exposure:

Agent Orange Symptoms and Effects
The most distinguishing effects of dioxin poisoning are:

a. chloracne
b. liver dysfunction
c. severe personality disorders
d. cancers
e. birth defects

The following is a list of reported Agent Orange symptoms and effects:

1. Gastrointestinal:
loss of appetite (anorexia)
nausea
vomiting
diarrhea
constipation
yellowing of eyes, skin, and urine (Jaundice)
liver inflammation (Hepatitis)
vomiting blood (Hematemesis)
abdominal pain
gastric hyperplasia
gastric ulcers

2. Genitourinary:
stones
burning
bloody urine (Hermaturia)
dribbling
brown urine
bladder discomfort
kidney pain

3. Neurological:
tingling
numbness
dizziness
headaches
twitching, fidgeting, etc. (Automatic dyscontrol)
Suspension of breath (sleep apnea)
uncoordination
unnaturally drowsy (Hypersomnolence)
loss of sensation in extremities

4. Psychiatric:
violent
irritable
angry
severe depression
suicide
frenzied (Manic)
tremulous
memory loss
loss of concentration
severe personality changes

5. Metabolic:
fatigue
rapid weight loss
spontaneous fever
chills

6. Cardiovascular:
elevated blood pressure
blood deficiency

7. Skin:
chloracne
rash
increased sensitivity (heat)
increased sensitivity (sun)
altered skin color
loss of hair
brittle nails

8. Cancer:
tumors
liver
lung
testicular
ear duct

9. Family:
miscarriages child's deaths---birth defects
a. cleft palates
b. open eye
c. kidney abnormalities
d. enlarged liver
e. enlarged head
f. club foot
g. intestinal hemmorage
h. missing or abnormal fingers, toes
i. missing or abnormal reproductive organs
j. missing, abnormal, or displaced body parts

10.Endocrine:
enlarged male mammary glands (Gynecomastia)
excessive milk flow from nipples (Galactorrhea)
decreased sexual drive
difficulty maintaining an erection

11. Visual:
blurring
burning

12. Hearing Loss

13.Respiratory:
difficulty or painful breath (Dyspenea)
shortness of breath

So, by Sarge's argument, any veteran who was anywhere near an Agent Orange canister should get a Purple Heart if he has any one of the symptoms in the above list.

dvdbiggs
13
Points
dvdbiggs 10/18/10 - 02:30 pm
0
0
Sargebaby..........Thank you

Sargebaby..........Thank you for assisting these veterans,to include the WW II and Vietnam veterans. We know that the government is slow to acknowledge the problems that our soldiers suffer as a result of combat. Again a big thanks. I suspect that we do not have many WW II veterans left and I am sure that many of them were never diagnosed with many of the prolems that they suffered.

InChristLove
22459
Points
InChristLove 10/18/10 - 02:32 pm
0
0
No Little Lamb, I believe

No Little Lamb, I believe what Sarge said was "Anyone on active duty who served in Vietnam, and has become ill, or died from the results of exposure to Agent Orange, also deserves the Purple Heart Award!"

Just because someone has some of the same symptoms doesn't mean they have the disease.

Back to Top

Search Augusta jobs