Invisible wounds now seen

Invisible wounds now seen

March 20th, 2011 in Opinion Times

The scandal that emerged in 2007 at the Walter Reed Army Medical Center over neglect and maltreatment of veterans with brain injuries suffered in Iraq and Afghanistan has resulted in greatly improved care for those injured by the ubiquitous IEDs - improvised explosive devices - and other types of explosives that haunt soldiers in those wars. Yet somehow, the invisible wound of concussion injuries to military personnel that drew no blood in such explosions has frequently gone unrecognized, at least in terms of the singular award - the Purple Heart - to which every member of the armed services is entitled if injured by an enemy action.

That is about to change in the Army, and rightly so. Following a lengthy review prompted by an investigative report issued last September by ProPublica and National Public Radio, Gen. Peter Chiarelli, the Army's second in command, announced last week that the Army would issue a new guidance standard to clarify when Purple Hearts should be awarded for concussions.

His action marks a welcome step toward fairness for soldiers who suffer invisible wounds. The guidelines will provide a checklist that makes it clear that any soldier who suffers a concussion that is caused by an enemy action and that requires any medical treatment by a medical professional becomes eligible for a Purple Heart. The treatments that qualify a concussion for the award include over-the-counter medications and/or bed rest, and they may be proscribed by nurses and physician assistants as well as by doctors.

The new guidance will overrule a prevailing memorandum written in 2008 by a senior medical officer in Iraq, Brig. Gen. Joseph Caravalho. His memo effectively disqualified concussions for a Purple Heart if they required only "minimum medical intervention." That confirmed the old mindset, which still holds sway in the Marines and other branches of the military, that concussions that fail to immediately disable a soldier do not constitute sufficient injury for the Purple Heart, as compared to other types of injuries.

In fact, concussions even of seemingly mild levels can produce pain, cognitive impairment and a range of other symptoms, some of which may last for days, weeks or months. Civilian studies cited by NPR have shown that while most people recover from relatively mild concussions within days or weeks, about 5 percent to 15 percent of victims suffer long-term cognitive problems.

The apparent ability of some soldiers who attempt to carry on their duties despite symptoms of concussion may well have led to the reluctance of both injured soldiers and their commanders to acknowledge concussion as an injury that merits a Purple Heart. That's been wrong all along.

The Army's lack of systematic record keeping of concussions, moreover, has made it harder for the Army to determine how many soldiers with concussions have applied for a Purple Heart, and the number who have been turned down. As a result, the Army has pledged to ask every soldier who has applied for, and been denied, a Purple Heart for a battlefield concussion to reapply.

The Army's director of soldier programs and services, Col. Tom Quinn, has promised that such new applications for the nation's signature medal for personal sacrifice in combat will be "aggressively and impartially" pursued to ensure that every veteran who merits a Purple Heart receives one.

That's a welcome reversal of policy. It should be adopted, as well by the Marines and other service branches. It should also lay the groundwork for the Pentagon to revise treatment standards by Tricare, the public health insurance program for veterans, for the larger unmet need for more serious brain injuries - the provision of cognitive rehabilitation therapy. Veterans who have suffered more serious brain trauma and have still been denied access to cognitive rehabilitation therapy are being cheated of the care they need. That's even worse than missing a medal.