NPR

With Traumatic Brain Injuries, Soldiers Face Battle For Care

At the rapidly expanding base in Fort Bliss, Texas, along the U.S.-Mexico border, the military is racing to build new homes for 10,000 additional soldiers. Cranes stack prefabricated containers like children's blocks to erect barracks overnight. Bulldozers grind sagebrush desert into roads and runways.

Just down the street from the construction boom squats a tan, featureless building about the size of a convenience store. Completed nearly a year ago, it remains unopened, the doors locked.

Building 805 was supposed to house a clinic for traumatic brain injury, often called the signature wound of the wars in Iraq and Afghanistan. Instead, it has become a symbol for soldiers here of what they call commanders' indifference to their problems.

ProPublica is a nonprofit investigative news organization.

Based on dozens of interviews and access to previously unreleased military studies, documents and e-mails, NPR and ProPublica have found that from the battlefield to the homefront the military's doctors and screening systems routinely miss brain trauma in soldiers. As a result, soldiers haven't been getting treatment.

Part 1: The military medical system is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan.

Part 2: Even when traumatic brain injury is diagnosed, many soldiers have to fight for adequate treatment.

"The system here has no mercy," said Sgt. Victor Medina, a decorated combat veteran who fought to receive treatment at Fort Bliss after suffering a brain injury during a roadside blast in Iraq last June. Since the explosion, Medina has had trouble reading, comprehending and doing simple tasks. "It's struggle after struggle."

Previously, NPR and ProPublica reported that the military has failed to diagnose brain injuries in troops who served in Iraq and Afghanistan. Mild traumatic brain injuries, which doctors also call concussions, do not leave visible scars but can cause lasting mental and physical problems.

At Fort Bliss, we found that even soldiers who are diagnosed with such injuries often do not receive the treatment they need.

Most specialists say it is critical for patients who show lingering effects from head trauma to get intensive therapy as soon as possible. In the civilian world, such therapy is increasingly seen as the best way to minimize permanent damage, helping to retrain the mind to compensate for deficits.

Yet brain-injured soldiers at Fort Bliss have had to wait weeks and sometimes months just to get appointments with doctors, medical records show. Many have received far less therapy than is typical at well-regarded civilian clinics. In some instances, Fort Bliss medical officers have suggested that the soldiers are malingerers or that the main root of their cognitive problems is psychological.

"Here you have all these soldiers looking for help, and it was just getting swept under the carpet," said Sgt. Brandon Sanford, 28, a dog handler who survived two roadside blasts in Iraq. Sanford endured a year of balance problems and mental fog before Fort Bliss officials sent him for cognitive therapy. "I served my country. I've got an injury to prove it."

It is impossible for civilians to know how Fort Bliss' care for brain-injured soldiers compares in quality or scale to that of other bases. Base officials would not give NPR and ProPublica data on how many soldiers are being treated there and the Pentagon would not provide this information for bases elsewhere.

Fort Bliss — the third-largest base in the U.S. military and a vital nerve center for deploying and returning troops — is supposed to be among the best. In 2007, the Pentagon designated it as one of 20 bases nationally that would develop augmented treatment programs for traumatic brain injury.

Yet while base commanders have spent more than $3 billion to expand and improve Fort Bliss over the past several years, they have directed just $5 million to facilities and clinicians to treat TBI. The program had no full-time director until October 2009. A neuropsychologist was hired only recently, after a two-year search.

Fort Bliss' commander, Maj. Gen. Howard Bromberg, declined repeated requests for an interview. Col. James Baunchalk, the base hospital's commander, acknowledged that the TBI program had encountered some delays, but said that it now had 12 clinicians — four full-time and eight part-time — who were delivering comprehensive care.

"I honestly believe that we've done a good job of meeting the needs for the community," Baunchalk said.

He promised in April that Building 805 would open by the end of May, saying they were just waiting until computer cabling was installed.

Apparently, they missed their deadline. As of early June, the clinic to screen soldiers for traumatic brain injury had not opened its doors to a single patient.

The Soldiers

Traumatic brain injuries are among the most common wounds sustained in Iraq and Afghanistan. Shock waves from bombs can pass through helmets and through the brain. Secondary trauma can occur when soldiers are thrown up against vehicles or walls, shaking the brain again.

Officially, the military says about 150,000 soldiers have suffered some form of brain injury since the wars began. But a 2008 Rand study suggests the toll is much higher, perhaps more than 400,000 troops. The most common type are so-called mild traumatic brain injuries. Most people recover quickly from such injuries, but studies have shown between 5 percent and 15 percent of patients may suffer long-term problems.

NPR and ProPublica interviewed more than a dozen soldiers at Fort Bliss who are among that so-called miserable minority. All were diagnosed by military doctors with at least one mild traumatic brain injury. All had persistent symptoms, ranging from headaches and vertigo to difficulties with memory and reasoning.

They described the bewildering ways in which their injuries had changed them. A sergeant who once commanded 60 men in battle got lost in a supermarket. A soldier who once plotted sniper attacks could no longer assemble a bird house. Most of them did not want their names used, for fear of harm to their military careers.

All felt the treatment they received was inadequate. At leading neurocognitive rehabilitation centers, some patients with mild traumatic brain injury often receive three to six hours a day of therapy for months from teams of highly trained specialists.

By contrast, many soldiers at Fort Bliss attended two to four hours of cognitive treatment per week. For some soldiers, weeks passed by with little or no treatment. The therapists who provided the soldier with speech and occupational therapy for their brain injuries sometimes had only minimal training in cognitive rehabilitation, records show.

Staffing shortfalls also meant soldier had long waits before beginning rehabilitative therapies. While clinical research is still developing, the consensus recommendation of a group of military and civilian experts convened by the Pentagon last year was to provide rehabilitation therapy as promptly as possible.

"The longer you go without therapy, the greater likelihood there is of falling into what I would call a mental disuse syndrome, where the brain is not being used at the same level," said Keith Cicerone, a leading rehabilitation researcher and the director of neuropsychology at the JFK Johnson Rehabilitation Institute in New Jersey. The brain "is in essence going to develop bad habits."

Sgt. Raymond Hisey, 32, a convoy driver in the 1st Armored Division, survived a roadside blast in Iraq in July 2009. He remained in the field, but endured constant headaches and balance problems. His short-term memory suffered and he struggled to think of words to express himself.

When he returned to Fort Bliss in October, he was diagnosed as having suffered a mild traumatic brain injury and was prescribed several courses of therapy. But a speech therapist cancelled several appointments, he said, and he clashed with the occupational therapist. Hisey was suddenly left without any treatment at all for his symptoms.

"You just get lost in the system," he said. "I could have pushed more, sure. But people kept saying it gets better over time. I thought I was just losing my damn mind, to be honest with you."

Fort Bliss is supposed to provide treatment to troops at smaller bases in the surrounding area. But one such soldier who developed headaches and balance problems after working on a mining detail in Afghanistan was told that no therapists could make regular trips to see him. Instead, the soldier, whose base was about an hour away from Ft. Bliss, was given antidepressants, which he did not take. He recently deployed for a second tour.

"As much as the military is making of TBI and the effects it's having on the soldiers and their families, I think for something as big as Fort Bliss, there'd be more people" to treat it, said the soldier, a specialist who did not want his name used for fear of damaging his career. "I was told there were no resources, no facilities."

Baunchalk, the hospital commander, said he had never heard such complaints from soldiers or their spouses. Soldiers were often reluctant to seek care, he said, because they perceived a stigma attached to traumatic brain injury.

"It's tough for them to step forward and say ... I need some help," he said. "I don't think we have that many soldiers who have fallen through the cracks."

Several soldiers told NPR and ProPublica, however, that they and their families had reached out to base commanders, sent e-mails to generals throughout the Pentagon, and even written to members of Congress, pleading for care.

When their efforts proved futile, they felt abandoned. Nobody paid attention, they said, to a soldier with an injury that nobody could see.

"No one listens to the soldier," said Sgt. William Fraas, an 18-year military veteran and Bronze Star recipient who struggled for nearly two years to get help for problems with his balance and vision. "They are there and they are crying for help."

The Neurologist

Fort Bliss soldiers struggling with the effects of brain injuries were often sent to Capt. Brett Theeler, the base's sole neurologist. Theeler, records show, sometimes blamed psychological disorders rather than blast wounds as the likely source of soldiers' cognitive problems.

A convoy commander in the 121st Brigade of the 1st Armored Division, Sgt. Victor Medina can see the moment he suffered his invisible injury. He was rumbling down a highway in southern Iraq June 2009 in a convoy of fuel, ammunition and supplies. Just behind him, in another armored troop carrier, one of Medina's soldiers was videotaping. Suddenly, the screen shakes. Black smoke jets into the air. Noise, swearing, confusion erupts.

A roadside bomb had exploded directly beside Medina. Metal slag ripped through his vehicle's heavy armor, destroying radio equipment and blowing open Medina's door.

Outwardly, Medina did not appear seriously injured. But in the weeks and months that followed, his mind began to fail him. He slurred his words, then started stuttering. An avid reader, he struggled to get through a single page. A punctilious soldier, he began showing up late for missions.

Medina was sent to Germany in August, where Army doctors diagnosed him as suffering from a traumatic brain injury. But when he returned to Fort Bliss for treatment, he and his wife, Roxana, found themselves fighting for care.

Medina had his first appointment with Theeler a month after his return to Ft. Bliss. Afterwards, Theeler wrote that Medina had "multiple cognitive symptoms including poor concentration, short-term memory loss, and difficulty multi-tasking." Theeler said those symptoms were "possibly" related to lingering effects from his concussion, but were "likely" caused by "chronic headaches" and "anxiety." He wrote that Medina's stuttering was probably caused by anxiety, too.

After a follow-up session with Medina in December, Theeler wrote: "I am concerned that he may be slipping into a cycle of playing the sick role." He pointed to the fact that Medina was using crutches — apparently unaware that a physical therapist had asked Medina to use the crutches because of back pain.

To Medina, 34, a tall, broad-chested man with an intense stare, Theeler's words were insulting. Once praised by superiors for his leadership abilities, Medina worked relentlessly to overcome the staccato stutter that had made him difficult to understand. He was fighting to get better, fighting to remain in the Army. He said he felt was being labeled a liar.

"You have all these values that you live for and fight for. And you go to the medical side and you don't see those values," Medina said. "I can understand being injured by insurgents. But I can't understand being injured by my own people."

Other soldiers had similar experiences with Theeler.

By the time Spec. Ron Kapture got to Fort Bliss in July 2009, he had suffered six concussions in which he was knocked unconscious from blasts, according to medical records and his own recollections.

He was suffering headaches on a daily basis. He noticed that he could no longer do simple mental tasks. Before joining the Army, Kapture had gone to vocational school to learn cabinet making. After returning from Iraq, he struggled to put together a bird house with his son.

"It took us about a month," said Kapture, 28. "I could build a whole living room full of furniture in a day seven years ago. It took me a month to build a bird house. That is frustrating stuff."

Five months after his return, Kapture finally got an appointment to see Theeler after making repeated requests. Theeler noted that Kapture had a history of "mild concussions," but blamed his cognitive problems on "chronic headaches, sleep disorder and underlying mood anxiety disorders and depressions," records show.

Kapture received counseling and medication for post traumatic stress disorder, or PTSD, but his problems with memory and concentration persisted. He had planned to make the Army his career, but became so embittered at the handling of his care that he is applying for a medical dismissal.

"If that's the best help they ... can give us, then God help us all," Kapture said. "If that's the best they have to offer, I feel sorry for the guys coming home."

In an interview at the base, Theeler declined to comment on individual cases, even in cases where soldiers had signed a waiver of their privacy rights. He said, more generally, that he understood why soldiers like Medina and Kapture were frustrated. Mild traumatic brain injury can be difficult to pinpoint as a cause for soldiers' problems since there are no readily available biological markers to indicate that a concussion has occurred, he said.

Theeler said he concentrated on treating soldiers' symptoms regardless of the cause.

Soldiers "say, 'Sir, what's wrong with me?'" Theeler said. "We're honest. I say, 'I don't know what's wrong.' This is an area that we're working very hard at to get our hands around . I don't know the answers."

The PTSD Clinic

Some doctors and soldiers at Fort Bliss said medical commanders have placed a higher priority on treating post-traumatic stress disorder, a psychological condition, than on mild traumatic brain injury.

As evidence, they point to the fate of two clinics. While Building 805 remains unopened, the base has poured money and effort into an experimental PTSD clinic that has attracted widespread attention within the military, including a visit from Defense Secretary Robert Gates.

Known as the Restoration and Resilience Center, the clinic offers intensive, six-month-long treatment for chronic PTSD sufferers, including controversial techniques such as reiki, in which practitioners hover their hands over patients' bodies to improve the flow of "life energy," according to a pamphlet distributed at the center.

Brain injuries and PTSD sometimes share common symptoms and co-exist in soldiers, brought on by the same terrifying events. Neuropsychologists said that treatments for the conditions can differ, however. A typical PTSD program, for instance, doesn't provide cognitive rehabilitation therapy. Someone with nightmares associated with PTSD might be prescribed sleep medication, which could leave a brain-injured patient overly sedated without having a therapeutic effect.

One doctor at Ft. Bliss said that base commanders' focus on the PTSD clinic resulted in soldiers not getting adequate treatment for brain injuries.

"The way our philosophy is in this hospital ... we took away their belief that they truly have something," said the doctor, who did not want his name used for fear of retaliation from commanders. "I don't think we gave them the opportunity to heal and that's what I find really disgusting."

Some soldiers said they spent months receiving PTSD treatment while their cognitive problems went unaddressed.

Sgt. William Fraas, 38, the sergeant who was awarded the Bronze Star With Valor, served three tours in Iraq, helping to train the Iraqi soldiers as part of the 101st Airborne Division, 320th Field Artillery. He was given his medal after rescuing an Army major and six Iraqi soldiers pinned down by gunfire. Driving in his Humvee, he used to keep track of the roadside bombs with a black grease pencil on the windshield. After 10, he stopped counting.

When he was sent home to Fort Bliss in 2008, he was diagnosed with PTSD and entered the experimental clinic. He spent eight months there before being cleared to return to active duty.

But Fraas realized he was still having problems. He was constantly dizzy. He had debilitating headaches. He would call his wife when driving, so she could keep him oriented and awake.

He began having blackouts. Once, he awoke to find his 12-year-old son struggling to lift him after he collapsed in front of his home computer.

"They have these meetings for PTSD. But nowhere did they tell you anything about TBIs. We had no idea what was going on," he said. "It feels like my head is loose. Like my brain is loose. Like it's rattling inside my head."

Finally, last summer, Fort Bliss doctors sent him to see a physical therapist at the base to improve his balance. But the appointments were irregular. And with his inability to drive, he had trouble getting around the sprawling base. A case manager who was supposed to coordinate his care asked one of Fraas' friends if he was faking it. A second case manager never even contacted him.

After putting nearly 20 years into the military, he was stunned.

"I could not get help. I called and called and called. I was hurting," he said. "It was just terrible. I'm a senior non-commissioned officer and I couldn't get help. I couldn't help anywhere."

Mentis

Some Fort Bliss soldiers have discovered that if they protest long and loud enough about their care, base commanders occasionally will pay to send them for help — outside the military.

On a hot afternoon earlier this spring, Sgt. Brandon Sanford was digging a small trench in the black soil of a rose garden at Mentis, a private neurological rehabilitation facility perched on the mountains just outside of El Paso.

He was installing an irrigation drip line as part of a therapy program designed to help him follow instructions. He set in one line, then covered up the trench. Then, looking down, he suddenly realized that he had failed to install the second drip line he was holding in his hand.

It was a typical problem for a brain-injury patient. Concentration deficits can make even simple tasks complex and confusing. Sanford immediately began pulling up the first line, digging again.

"That can be frustrating," the therapist overseeing the exercise said sympathetically.

"Never," said Sanford cheerfully. "I ate my Wheaties this morning."

Almost two years ago to the day, Sanford, a dog handler working with the 4th Infantry Division, was inside his Stryker troop carrier near Taji in central Iraq when a bomb exploded. The blast sent Sanford and his dog, Rexo, hurtling against the walls. Both were awarded the Purple Heart for shrapnel wounds they received in the explosion. Although dazed, Sanford shrugged off the headaches and dizziness he experienced and continued working.

When Sanford returned to Fort Bliss in January 2009, he began having seizures, along with continued headaches and balance problems. He saw the base neurologist, Theeler, who diagnosed him as having "shaking syndrome," medical records show.

He entered the PTSD clinic, received counseling and was released, but was still so mentally foggy he couldn't understand his 10-year-old son's math homework. His wife would open the cupboard where they kept cleaning supplies and find that her husband had put the milk carton next to the bleach. Sanford's wife and mother badgered military commanders unrelentingly until, nearly a year after his return from Iraq, they finally sent him to Mentis.

There, Sanford is an in-patient: he spends eight hours a day, five days a week, on rehabilitation exercises. He goes on weekly outings to help him navigate the noise and confusion of public spaces, such as shopping malls. And he practices real-world tasks, like following cooking recipes — or laying out plans for a garden.

Today, Sanford said that he is able to finish making meals more quickly. He can now perform two tasks at once, instead of only one. He is getting better at managing his own medications and his balance has improved.

"You can only do so much sitting inside a hospital. It was like pulling teeth from a tiger to try to get in here. Once I got in here, it was like a whole new ray of light."

Eric Spier, Mentis' medical director, said he has asked the military to send him more patients. But base commanders have sent only a few dozen in almost three years.

"I've made sure to tell everyone I can tell that I'm ready to help, but that's all I can do," Spier said. The base has not sent "very many. It's surprisingly few."

Fraas and Medina now attend sessions at Mentis. They praised the facility, but expressed disappointment that they had had to go outside the Army to receive help.

Medina started in February. The staff at Mentis say his reading and concentration abilities are improving. His growing optimism is apparent in the blog he has started to chronicle his recovery.

"I might be slower right now, but I think it's all going to get better and I want to go back to what I love doing, which is soldiering," Medina said. "It's what I love to do."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

The fighting in Iraq and Afghanistan has created a signature injury. It is largely an invisible wound, and as we heard yesterday, it affects tens of thousands of American troops. It's called mild traumatic brain injury.

An NPR investigation, in collaboration with ProPublica, has found that commanders and doctors at one of the nation's top Army bases are still neglecting troops with mild TBIs or concussions. As we reported yesterday, studies suggest that those concussions can lead to long-lasting disabilities, and many troops who suffer from them have to fight to get help.

Our story continues today with NPR's Daniel Zwerdling, he reported it with T. Christian Miller of ProPublica.

DANIEL ZWERDLING: Victor Medina's nightmare began June 29th last year. You can see the explosion on his laptop. There was a camera in a vehicle behind him and Medina is showing us the video.

(Soundbite of video)

ZWERDLING: As we are watching, Medina is sitting at his dining room table in El Paso, Texas. He's back at Fort Bliss. It's one of the biggest Army bases in America. But that morning last June, Medina was leading a convoy in southern Iraq.

Sergeant VICTOR MEDINA (Combat Veteran): I was a staff sergeant. I was in charge of about close to 60 soldiers.

ZWERDLING: It's hard to understand Medina when he talks. He's been stuttering since the explosion.

Medina is tall and bald. He's 34 years old, but in some ways he's become an old man. He points to his vehicle on the video. His arm shakes like he has Parkinson's.

Sgt. MEDINA: I'm in front of that vehicle rider.

ZWERDLING: They're passing palm trees and scrubby fields on the right. Suddenly there's a yellow flash near Medina's door.

(Soundbite of video)

Unidentified Man #1: (unintelligible) IED.

ZWERDLING: Then a mean black and gray cloud. Medina's fellow soldiers say he tore off his seatbelt and he checked his men to make sure they were okay. Then Victor Medina collapsed.

(Soundbite of video)

ZWERDLING: And the record suggests that since that moment, people throughout the Army: medics, doctors, commanders, many of them have treated Medina's brain injury like a minor problem.

We don't know don't know if treatment at Fort Bliss is better or worse than anywhere else in the Army, but we're using it as an example because the Pentagon has said that Fort Bliss should have one of the best programs for treating TBI.

Sgt. MEDINA: The doctors, they have hurt me.

ZWERDLING: You say the doctors here have hurt you?

Sgt. MEDINA: Yeah. The warrior ethos says: I will never leave a fallen comrade. I feel that the system left me behind.

(Soundbite of cheering)

ZWERDLING: The nation's leaders keep promising the troops like Victor Medina won't be left behind.

President BARACK OBAMA: Thank you.

(Soundbite of cheering)

President OBAMA: Thank you. Thank you...

ZWERDLING: In fact, traumatic brain became an issue in the last presidential campaign. Here is Barack Obama, the candidate...

President OBAMA: And we need to dramatically improve screening and treatment for the other signature injury of war, traumatic brain injury.

Unidentified Woman: Yeah.

President OBAMA: That's why I passed measures in the Senate to increase screening...

ZWERDLING: The Pentagon's policy says that whenever troops are in a blast, you have to check them as soon as possible for brain injuries. Yet, Victor Medina had trouble getting help starting right after the explosion. Medina's fellow soldiers say he was unconscious for about 20 minutes and the medics did rush him to an emergency station. But Medina says they mainly made sure he wasn't bleeding and didn't have broken bones.

Sgt. MEDINA: They asked me a few questions and there, you're good to go.

ZWERDLING: Then one week after the blast, Medina and his wife Skyped. Roxana had gotten into bed around midnight and she cradled her laptop so they could see each other, and she was stunned.

Ms. ROXANA MEDINA: It was his left side was like droopy face. His eye would go down. His smile would go down. His cheeks in the left side would go down.

ZWERDLING: So you're describing a little bit what people look like after they've had a stroke.

Ms. MEDINA: That's how he looked like. Then he started mentioning, I have headaches, I'm having memory problems, I cannot concentrate. And I said, what is going on? He said, this is so overwhelming. That's what he said. This is so overwhelming, I feel like I'm not in my body. And I said, okay, so tomorrow morning as soon as you get up, you go to the doctor.

ZWERDLING: Medina told his wife: I have been going to the Army doctor and they keep giving me pills.

They gave you Tylenol.

Sgt. MEDINA: Yeah, and that was it.

ZWERDLING: Brain specialists say here's why it's crucial to diagnose and treat soldiers fast. Most people with mild traumatic brain injuries get better on their own in a few days or weeks. But studies suggest that five to 15 percent do not, and the faster you send them to rehab the better the chance that they can retrain their brains.

But weeks went by, Medina's hands started trembling. When people gave him instructions, he couldn't wrap his brain around the information. Medina kept going to the doctor.

Ms. MEDINA: And I tell him, but why more Tylenol? They need to check you out. And my husband got mad at me and he said, well, he's the doctor and he knows what he's doing. Actually, he was returned to duty and they did another mission and there was another explosion.

ZWERDLING: Medina says there's only one reason why doctors and commanders in Iraq gave him a closer look: Roxana. Roxana understands how things work in the Army. She works at the Fort Bliss Medical Center. So, Roxana pressured her contacts, one thing led to another and six weeks after the explosion, the Army Medevaced Medina back to his base.

Unidentified Man #2: Welcome to Fort Bliss in El Paso, Texas...

ZWERDLING: This is the official website for soldiers and their families.

Unidentified Man #2: At Fort Bliss, health care for our soldiers and their families is the number one priority...

ZWERDLING: So Medina and Roxana thought he'd finally get intensive care. But another month went by, no treatment. Medina's commanders told him he could stay home because he was sick. But Medina felt depressed at home, so he volunteered to file folders at the medical center. He thought maybe this will help me get my brain back.

Before the explosion, he and Roxana were always going to the bookstore. He'd devoured a couple of thrillers a week - not anymore.

Sgt. MEDINA: When I had to turn the page, I forgot what I read.

ZWERDLING: Before the explosion, he and Roxana would do Sudoku puzzles together every night in bed - advanced ones. Now, Medina was struggling with the beginner versions. And watch one of the vacation videos they shot before he went to Iraq. They mainly spoke Spanish, but listen how he used to talk.

(Soundbite of video)

Sgt. MEDINA: (Spanish language spoken)

ZWERDLING: Compare that to today. Medina is reading what his commander wrote about him before the explosion.

Sgt. MEDINA: This is a superb leader who motivated the entire class to strive for maximum results, they displayed a can-do attitude throughout the course.

ZWERDLING: So after Medina came home, he and Roxana kept wondering when will he get to see the top brain specialist at Fort Bliss - the neurologist? Three months after the blast, Medina got the appointment with Dr. Bret Theeler(ph) -Roxana went, too. They say Theeler examined him for 15 minutes.

Ms. MEDINA: And the neurologist, he said - and I will never forget that because he said: Do I think you have a TBI? No.

ZWERDLING: Dr. Theeler wrote in the medical records that Medina had, quote, "multiple cognitive symptoms, including poor concentration, short-term memory loss, and difficulty multi-tasking," unquote. Theeler said the explosion might possibly be involved, but he wrote that Medina's symptoms were likely caused by chronic headaches and anxiety. He wrote that Medina's stuttering was probably caused by anxiety, too.

Medina saw Theeler again last December. And this time, the neurologist wrote that Medina seems to be, quote, "playing the sick role," unquote. Medina was shattered.

Ms. MEDINA: He would look at the mirror every morning and he said: Look at me. What if I'm getting crazy and this is not a real condition, it's just that I'm crazy? And he was stuttering so much and he couldn't put his words together that I would tell him, oh, I'm going to take a bath and I would just cry in the shower. But I didn't want him to see me cry. He never saw me crying.

Unidentified Man #3: First set of battle buddies, get ready.

(Soundbite of conversations)

Unidentified Man #4: Shut up. Everybody will attempt every obstacle, all right? You can't do it, you can't do it.

ZWERDLING: We went to Fort Bliss one morning, so we could talk with commanders and doctors about soldiers like Victor Medina. As we drove through the base there were squads of soldiers repelling down walls.

Unidentified Man #3: Get ready. Get set. Go.

ZWERDLING: When we got to the medical center, there was a group of officers sitting around a long conference table.

Colonel JIM BAUNCHALK (Commander, William Bauman Army Medical Center): So by way of introductions, I'm Colonel Jim Baunchalk, and I'm the commander of William Bauman Army Medical Center. And then over here, Dr. Theeler. We also have Dr. John...

ZWERDLING: Before we could ask any questions about Victor Medina, Baunchalk showed us a PowerPoint.

Col. BAUNCHALK: Okay, next slide. Our goal is to recognize mild traumatic brain injury early to get soldiers, sailors, airmen and Marine into programs that will identify their requirements and give them that multi-disciplinary, integrated approach to treatment, you know, that will get them back standing shoulder...

ZWERDLING: After the PowerPoint, we asked: but what's going on with soldiers like Victor Medina? He says doctors are shrugging off his problems.

Col. BAUNCHALK: I'm not prepared to talk about individual cases.

ZWERDLING: Dr. Theeler said he wouldn't talk about them either. They said they want to protect the soldiers' medical privacy, even though Medina signed a waiver saying they could talk about his case.

And then Colonel Baunchalk said: If any soldiers have fallen through the cracks, it's because they don't want to go to doctors.

Col. BAUNCHALK: These are high-performing folks. These are America's best, quite frankly, and it's tough for them to step forward and say, I need some help.

ZWERDLING: We talked to a dozen soldiers at Fort Bliss who were in explosions, and when we told soldiers what Baunchalk had said, they were astonished. Talk to Brandon Sanford and his family.

Mr. BRANDON SANFORD: It's actually been kind of depressing as far as the treatment that I've missed out on that I could've had.

ZWERDLING: The Army's records show that back in 2008 Sanford was working in Iraq with a bomb-sniffing dog. He was in two explosions. By the time he came back to Fort Bliss last year, Sanford was having seizures and he couldn't make sense of the world. His wife would open the laundry cabinet and her husband had put the milk carton next to the bleach.

Mr. SANFORD: It's kind of sad, I think, because I used to try to help my son with homework and just by the questions being asked, I just don't grasp it anymore.

ZWERDLING: Sanford's son, Jacob, is 10 years old.

What do you notice, anything different?

Mr. JACOB SANFORD: Yeah, a lot of things have been different since...

ZWERDLING: Like what?

Mr. J. SANFORD: Like sometimes, like, when we're going somewhere, sometimes he forgets where we're going.

ZWERDLING: And go see William Frost and his wife Marie. Frost says he was in so many explosions that he marked them with a black grease pencil on the windshield - he stopped marking them at 10. Frost came back to Fort Bliss more than two years ago, and he realized, I don't know how to drive anymore, so he gave his keys to his wife and he tried to get help so he could think again.

Mr. WILLIAM FROST: I called and called and called. I was hurting.

ZWERDLING: You would think commanders would listen to Frost. He got a Bronze Star with valor. The citation reads like a movie. His unit was pinned down in a seven-hour battle and he helped save his major and a group of Iraqi troops.

Mr. FROST: I'm a senior non-commissioned officer and I couldn't get help, I couldn't get help.

Ms. MARIE FROST: I still can't make sense of it. There's no help from the military.

Mr. FROST: You know, the top officials of the Pentagon say we have started programs around the world to help soldiers with traumatic brain injury.

Ms. FROST: Can I swear? It's (beep).

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SIEGEL: And our story continues in just a moment with soldiers at Fort Bliss who end up going outside the Army for help.

BLOCK: You're listening to ALL THINGS CONSIDERED.

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SIEGEL: From NPR News, it's ALL THINGS CONSIDERED. I'm Robert Siegel.

BLOCK: And I'm Melissa Block.

Back now to Fort Bliss in Texas, where some commanders and doctors have shrugged off soldiers' traumatic brain injuries as minor problems. But a few troops have found that if they protest loud enough they can find help outside the Army.

NPR's Daniel Zwerdling continues our story, reported with T. Christian Miller of ProPublica.

ZWERDLING: Soldiers say you can actually see how little commanders here seem to care about treating troops with traumatic brain injuries. They say, just tour the base.

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ZWERDLING: As you drive across Fort Bliss, there are bulldozers and cranes everywhere. They're bringing in thousands of new soldiers, so Fort Bliss will always be ready to send an Army to war.

Mr. ROB WEATHERLY: Fort Bliss is 1.1 million acres of land, which is bigger actually than the state of Rhode Island.

ZWERDLING: Rob Weatherly is one of the planners. He says they're building new communities for the soldiers almost overnight. They truck in prefab barracks and shopping malls.

Mr. WEATHERLY: So, just a few years ago, this was nothing but desert and sand dunes. Units used to come out here and run through the desert for physical training. Now, you've got another city out here.

ZWERDLING: Now, compare that to the new Center for Traumatic Brain Injuries. About three years ago, the Pentagon told Fort Bliss to set up an advanced program to treat TBI, but today the long-awaited screening clinic is an empty one-story building. It looks like a 7-Eleven covered with adobe. They finished the TBI building more than one year ago and they still haven't opened it.

James Baunchalk, the commander of the medical center, says they keep waiting for the contractor to install the computer lines.

Col. BAUNCHALK: You have to have infrastructure in place, and so that's kind of the phase that we're in right now with this building, is bringing some of that infrastructure here, the IT hookups into this building.

ZWERDLING: It's not as if the soldiers we talked to didn't get any treatment for their problems. Doctors gave them pills for headaches, others got counseling to deal with anger. And their medical records show that doctors at Fort Bliss sent some of them to what they call occupational and speech therapies.

They play memory games a couple of hours a week, they'd also work on their stuttering. But top brain specialists say a lot of soldiers who've been in explosions need more than that.

Dr. KEITH CICERONE (JFK Medical Center): These are people who go on to live a lifelong chronic disability.

ZWERDLING: That's Doctor Keith Cicerone. He runs the brain rehab program at JFK Medical Center in New Jersey. Cicerone has served on advisory panels for the Pentagon, and he says when people with mild TBIs come to his clinic they get intensive cognitive rehabilitation. They might go 15 hours a week for months.

Dr. CICERONE: What's happening in a lot of the military centers, the kind of cognitive rehab at a, to me, it's kind of the difference between junior high school and graduate school. I don't know. It's - you're denying people services that they need in order to function.

ZWERDLING: Most of the soldiers we talk to say Fort Bliss has betrayed them, and some of their families have raised hell.

Brandon Sanford can't comprehend his 10-year-old's homework anymore, and his mother got so upset with his treatment that she flew to Fort Bliss to complain. William Frost got the Bronze Star for valor, but his wife is so furious about his lack of treatment that she asked their congressman to investigate. She prints out a copy of her letter.

Ms. FROST: I'm just an Army wife trying to take care of my wounded soldier. We have three kids, two boys, ages 15 and 12, and a girl, seven years old. This has affected the whole family.

ZWERDLING: And Victor Medina's wife didn't just write their congressman, Roxanna asked everybody she could think of to investigate the TBI program at Fort Bliss, all the way up the chain of command. She even wrote generals at the Pentagon. She said: How can the Army's brain specialists say that my husband's stuttering and his problems thinking are emotional? Roxanna keeps stacks of these emails on their dining room table.

Ms. MEDINA: That's your only witness. You can tell your story many, many times, but unless you have something to document, nobody would even consider you that you're telling the truth.

ZWERDLING: But the chief of the medical system at Fort Bliss, Dr. James Baunchalk, he says he's never heard a single complaint.

Dr. BAUNCHALK: I can tell you, over the past two years that I have been here, I have not had any soldier or any family member, to my recollection, who has stepped forward and said, your TBI program isn't getting me what I need.

ZWERDLING: No matter what Baunchalk says, somebody eventually heard the kicking and screaming. It took Victor Medina months of protesting; it took Sanford and Frost more than a year - but they finally got Fort Bliss to pay to send them to a clinic that specializes in TBI.

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ZWERDLING: It's outside the Army. And that's where we find Brandon Sanford on a recent morning. He and other patients are building a garden at the Mentis Neuro Rehabilitation Center.

Mr. SANFORD: Okay. What we have here, bushes and different types of shrubs. On the other side from where we're standing, we're going to have a walkway.

ZWERDLING: It turns out that during all that time that the soldiers were struggling at Fort Bliss, there was this private rehab center in town. Therapists here say the best way to help people with mild TBIs isn't just to play memory games like at Fort Bliss. Wendy Halt says you teach them to drive again, you teach them how to find a plumber, you teach them how to function in the world again.

Ms. WENDY HALT: They came up with all of the ideas. They problem-solved and planned and used their memory strategies all to design the garden, buy the plans, set up the watering system, just everything.

Mr. SANFORD: I think it's a great program here at Mentis.

ZWERDLING: What is so different here?

Mr. SANFORD: At Fort Bliss, you know, you walk into the clinic or the hospital, it's just, yeah, yeah, yeah, you know, just kind of blow you off. What's so different here is the amount of care that this place puts into your treatment.

ZWERDLING: Victor Medina says since he came to Mentis, he's been feeling hope for the first time since the explosion. He's getting cognitive rehabilitation as much as 15 hours a week. We follow Medina to a session with a speech therapist, Claudia Mendoza. She asks him, what do you want to accomplish here?

Ms. CLAUDIA MENDOZA (Therapist): We want to know what your goals are and that way we can target that.

Mr. MEDINA: You're showing me the level of caring you have, it's making a difference in me today.

Ms. MENDOZA: Thank you.

ZWERDLING: And now the therapist wants Medina to do something since the blast: try to say one word clearly.

Ms. MENDOZA: If I gave you the word baby, then I would want you to say it baby, okay?

Mr. MEDINA: Baby.

Ms. MENDOZA: Even the E.

Mr. MEDINA: Baby.

ZWERDLING: Victor Medina at the Mentis Neuro Rehabilitation Center in El Paso, Texas.

Daniel Zwerdling, NPR News.

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BLOCK: You can watch a video of Victor Medina and learn more about mild traumatic brain injuries at NPR.org and at ProPublica.org.

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SIEGEL: This is ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.

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