Sgt. Briggs's War

Bob Briggs got a head full of shrapnel in Iraq. Then he came home to more wars: to regain the use of his half-paralyzed body, and to get the U.S. government to pay for his medical care.

The day after the attack, Briggs was transported to Walter Reed Army Medical Center in Washington, D.C., where he arrived on life support and in a coma. No one was sure of his prognosis, or the extent of the brain injury. Owing to the metal fragments scattered throughout his body, doctors were unable to do an MRI. Michelle and Bob's parents flew up to Washington to be with him. His sister, Brenda Best, stayed back in Keokuk to take care of the kids.

"I had daily calls," Best remembers of that first week. "Sometimes two and three times. It did me good that day my mom called and said, 'He's asking for you.' He had woken up and come off life support. And he could talk to me."

The doctors said Briggs had suffered a penetrating brain injury from shrapnel. The shards of metal that pierced his frontal and temporal lobes caused brain bleeds, and—because they remained lodged in the tissue—subsequent small seizures. The shrapnel also tore up his right eye, forcing a later surgery to remove the remains of the eye from its socket, a procedure called nucleation. He also lost much of the sight in his left eye due to internal bleeding, though the vision in that eye has since improved. "This is a good prognostic factor," Dr. Kusar notes. "He can go a long way in terms of function and independence."

Along with suffering from a penetrating brain injury, Briggs also incurred what Kusar calls a diffuse brain injury from the blast, a widespread brain trauma that disrupts a whole range of cognitive functions. "This is becoming a common combat injury," she adds, "from a new mechanism of war."

SINCE THE INVASION of Iraq was launched in March 2003, Veterans Administration statistics have recorded a total of 2,310 patients with traumatic brain injuries, all of whom are still presently under treatment. The VA's four new "polytrauma" units in Minneapolis and elsewhere have cared for 219 severely injured Iraq war vets.

But you can't measure the burden those numbers represent without consulting another set of numbers: the VA budget. In April of this year, just as VA officials were reorganizing their hospital system to accommodate these new patients, the Minneapolis VA facility was facing a $7 million budget shortfall of its own. While the Department of Veterans Affairs notes that "the average cost of treating a TBI patient is $21,231 in their various stages of treatment...[and] 101 patients have exceeded $80,000 and two have exceeded $500,000," none of the brain injury or polytrauma facilities have received added funding to pay for the care of their most severely injured patients, many of whom face hospital stays of up to six months. The VA, which sought emergency funding from Congress back in July, is facing a dollars-and-cents crisis brought on partly by underfunding in wartime and partly by the growing incidence of injuries like Briggs's, which represent a challenge that neither war planners nor VA administrators were ready for.

The American public is well acquainted with the U.S. military's death toll in Iraq, which stood at 2,108 as of last Monday. Less familiar is the number of troops who have sustained serious and, in many cases, permanently life-altering, wounds: around 15,500, according to the Department of Defense. In fact, the ratio of killed to wounded in Iraq is about one to eight, or roughly twice the ratio of the Vietnam War. "The survivability rate is much higher," says Paul Rieckhoff, an Operation Iraqi Freedom vet who served as a platoon leader in Baghdad and later founded Operation Truth, a soldiers' and veterans' advocacy organization. "Guys who would have died in past wars are living because of the advances in body armor and in medical technology." But the heightened survivability of many war injuries also means more vets with problems such as serious brain deficits, full or partial paralysis, loss of vision, or loss of limbs. ("The amputation rate has almost doubled" in this war compared to past ones, Rieckhoff notes.)

Improved field medicine and triage care are not the only reasons for the heightened incidence of major traumatic injuries in the Iraq War. Critics (who are not all opponents of the war itself) have highlighted numerous other factors: The Defense Department left troops ill-equipped for guerrilla and street-to-street combat, they say. Humvees and other vehicles used by troops were not properly armored. Insurgents used an extraordinary volume of homemade IEDs filled with projectiles from bones to nails.

Nearly 65 percent of the injuries seen at Walter Reed in this war have been brain-related. And that figure does not account for an increasing number of soldiers suffering concussive brain injuries whose symptoms may take weeks or months to manifest themselves. "We're not seeing all the mild brain injuries, and that's what's happening more," concedes Kusar. "I think as people are getting out and figuring out they're suffering from concussive brain injuries, we're going to be seeing a lot more of those."

Rieckhoff says the 1.2 million U.S. troops who have served in Afghanistan and Iraq since September 11, 2001 are about to flood a VA system that the Bush administration has funded inadequately all along the way. "There's an old adage," Rieckhoff says, "that the Army is always built to fight the last war rather than the current one. There's a wave coming. And the [VA] is not ready for it."

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