Treatment for Vets’ Brain Injuries Should Be a No-Brainer

There is no question that Sgt. Darren Mischke is a wounded warrior. After two tours in Iraq, the 27-year-old Army vet suffers from nosebleeds, memory loss, mood swings, dizziness, blurred vision and severe headaches.

Only instead of treating him for what are classic symptoms of traumatic brain injury – or TBI – Mischke’s wife and father say the U.S. military has tried to force him from the service for domestic abuse.“He’d be out of the service if his wife hadn’t fought for him,” Tom Mischke said of his son.

Darren Mischke got knocked out in a wreck during his first tour in Iraq, said his wife, Teresa. He was riding on the turret of a military vehicle that got hit by a mortar in his second tour.

It was enough, his family claims, to turn Darren Mischke from a squared-away enlisted man into a pain-riddled head case. Mischke is among the estimated 20 percent of Iraq and Afghanistan veterans who return from war with traumatic brain injury. A report by USA Today estimates that 20,000 returning vets not classified as wounded actually had undiagnosed TBI.

The scope of the problem is huge. But the reaction to it is even more critical.

“A lot of the injuries in Iraq and Afghanistan are brain-related because of the kinds of weapons used,” Colorado Sen. Ken Salazar said last week as he toured Denver’s Craig Hospital.

Craig leads a national system of hospitals in developing innovative ways to treat traumatic brain injury.

“We’ve got to put some focus on it,” Salazar said.

The senator did his part by helping to shepherd $900,000 into the proposed current federal budget. The money would keep model programs for TBI treatment going at 14 hospitals across the country.

The Bush Administration tried to freeze funding in a way that would have forced two of those programs to close, said Craig Hospital’s Cindy Felix, the director of Traumatic Brain Injury Model Systems of Care.

But even after Salazar succeeded in getting the extra 900 grand for brain trauma treatment into the Labor-Health and Human Services Appropriations Act, President Bush vetoed the bill.

The president wasn’t aiming at TBI programs so much as overall spending. Still, as Salazar noted, “this is not the time to pull back on traumatic brain injury research and treatment.”

Darren Mischke’s case proves the point. Stationed at Fort Carson, Mischke has been back from Iraq for a year and still hasn’t gotten the treatment he needs, his family claimed.

The situation exploded in March.

“I told him to get help,” Teresa Mischke said. “He told me he’d get in trouble with his unit. He said one of his superiors had told him he’d make his life a living hell.”

Shortly thereafter, Darren Mischke, pain-riddled and confused, turned abusive, then suicidal. His wife, trying to save him, called 911.

The El Paso County Sheriff’s Department “arrested him for domestic violence and the District Attorney’s office fast-tracked him to plead guilty,” Teresa Mischke said.

The third-degree assault plea became the basis for an attempt by the Army to give Mischke a general discharge.

“He would have nothing, no insurance and limits on his VA coverage,” his wife said.

Working with the advocacy group Veterans for America, Teresa Mischke pushed the military to send her husband to a medical review board.

The medical board talked about depression and post traumatic stress, but not brain injury. The diagnosis didn’t help. Eventually, a military doctor decided Sgt. Mischke suffered from “post concussive syndrome,” but offered no regimen of treatment, his wife said.

“He’s actually worse now than when he came home from Iraq,” she added.

Because he is not their patient, officials at Craig Hospital did not address Mischke’s case specifically. They did, however, outline several general needs for brain trauma treatment that fit Mischke’s predicament.

The first is timely care. Rehabilitation from brain injuries works best when started soon after the trauma, said Jim Schraa, a clinical neuropsychologist in Craig’s TBI program.

Waiting for a bureaucratic or uninformed system – be it military or civilian – to make the call on traumatic brain injury puts victims at needless risk. When the Army plays macho with guys like Mischke and for-profit private insurance companies play bean counter by limiting care based on costs rather than outcomes, folks end up without enough treatment.

For instance, said Schraa, Tri-Care, the military’s health insurance program, won’t pay for cognitive therapy for members of the National Guard returning from Iraq and Afghanistan.

Communities also need help caring for brain-injured vets trying to re-integrate, Schraa added. Telemedicine, where doctors at hospitals such as Craig meet online or by phone with patients, is an option. Other forms of long-term care must be developed and funded.

Any solution starts with acknowledging the problem.

That’s why doctors and patients at Craig were so happy to see Salazar last week.

“Thanks for caring and supporting the cause,” Dr. Alan Weintraub, Craig’s medical director for brain trauma, told Salazar.

“I’m happy to help,” the senator replied. “As a result of the Iraq War there are going to be a lot more patients with traumatic brain injury.”

People like Darren Mischke.

On Nov. 5, almost a year after he returned from Iraq, a special scan finally showed his brain trauma, Mischke’s wife and father said, yet discharge procedures continue.

For anyone who still needs to put a face on this country’s failure to help its brain-injured vets, a portrait of the sergeant would work just fine.

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