The Burden of Proof: One Colorado Soldier's Fight for Mild Traumatic Brain Injury Diagnosis...
Editor's Note: This article was originally published on 2010-12-01 on an older version of KUNC.org.
Shawn Lynch is the shell of the "hard charging" Army staff sergeant his superiors once praised, as we discovered during our first interview with him at a Starbucks outside Fort Carson in Colorado Springs. The sergeant, wearing his regulation camouflage, almost sunk into the background of the bustling cafe. He made little eye contact, wearing his dark sunglasses inside. He said they help keep the headaches at bay.
"Sorry," he said, taking a deep breath, furrowing his brow before starting his long story--a story of how he had to fight Army doctors for the last three years to get them to acknowledge his brain injury before his discharge. He's no longer as fit, he admits, and finds being in public difficult. He also has trouble remembering things, like turning off the stove or making appointments. And he speaks with a wavering, light voice that at times rises in anger at the Army he once loved.
"I felt safer over in Iraq in the war than I did back in the States," he said, complaining that Fort Carson's Warrior Transition Unit neither cured him nor prepared him for civilian life. He resents that he had to fight the Army along the way, turning to outside advocates, including a pro bono lawyer.
We followed the staff sergeant more than six months, on and off the Army post, getting to know his life, his wife, Dawn, and their very personal fight for recognition for a traumatic brain injury that Lynch says happened during his second deployment to Iraq.
Two Powerful Blasts
In 2006, Lynch was stationed at Forward Operating Base Paliwoda and went on patrol with Charlie Company, which is part of Fort Carson's 4th Infantry Division. On May 8, he was acting as a gunner in a Humvee when it sustained a "direct" hit by an improvised explosive device, or IED.
When an IED blast occurs, experts say it sends a wave of pressure through the brain that can cause damage and conditions like mild, moderate or severe traumatic brain injury. Of those that develop mild TBI, civilian researchers estimate that up to 15 percent of people face ongoing disabling problems.
Later, the Army would identify the explosives behind the IED: two powerful 155-millimeter artillery rounds. Lynch felt shaken and dazed by the blasts, but after being checked by a medic, he was ready to keep fighting according to a commander.
Weeks later, Lynch again found himself in the gunner's role and on July 16, 2006, there was another powerful IED blast, again striking Lynch's Humvee. Lynch felt well enough to soldier on. Besides, he didn't want to let his comrades down.
When Lynch finally returned to Fort Carson from Iraq in late 2006, he did something that would later come back to haunt him. He failed to report the blasts when completing a Post-Deployment Health Assessment and TBI form. He wasn't feeling any major symptoms and admitted he had only "sometimes" been exposed to excessive vibrations while in Iraq, according to his medical records. And, on a separate TBI questionnaire, Lynch didn't mention being near any blasts.
It turns out how soldiers answer this quiz matters a lot when it comes to receiving help later down the line. If a soldier, who may already have issues thinking clearly, says he was exposed to an injury event, he's prompted to fill out another section. And that could trigger what's considered one of the most important things doctors need to make a TBI diagnosis: a structured clinical interview.
Lynch said he wasn't sure whether he was hurt at the time he filled in the form and he wanted to keep being tough: "You go by what you're told by your chain of command. If you can walk, talk, you have fingers toes, you are OK. You don't report anything."
Besides, he said he felt more comfortable sharing his medical issues directly with doctors.
'People Just Don't Care'
Though Lynch saw mental health workers just weeks after returning to Fort Carson, his focus was on anxiety. He'd seen a lot of bloodshed while in Iraq, including the loss of a war buddy, and trauma from his past was now seeping into his dreams, turning into nightmares.
But Lynch lingered in the system for months and eventually was prescribed a growing list of pills, including strong narcotics. His stuttering came suddenly in August 2007, one day after he suffered a lapse in his ability to concentrate. He got angry with an underling, lost control and then became disoriented and confused and was rushed to an emergency room. By the end of that day, his voice was shaky. A few weeks later he was hospitalized. His voice has been wavering ever since.
Andrew Pogany, who at the time was an investigator for the National Veteran's Legal Services Program, intervened in 2008. He said it seemed Lynch was mistreated by doctors. "When I saw his case it was like every shade of f*cked up," he said.
For instance, Lynch was taken to an inpatient detoxification facility in Pueblo to get off of drugs like morphine that he'd been prescribed by doctors at Fort Carson. Lynch was also suffering from seizure-like events.
The Army continued to maintain Lynch's stuttering was a psychological problem--linked somehow to his Post Traumatic Stress Disorder. That meant a potential disability retirement from the Army, but one that omitted mention of any possible brain injury and one that might result in an improper level of care for Lynch.
Lynch meanwhile was building a case with Fort Carson officials that he had indeed been injured in blasts. But it was frustrating for him.
He had received two brain scans from Army doctors in 2008 and 2009 that appeared to link his symptoms to a TBI. Audio cell phone recordings reveal the difficulties Lynch faced during a meeting he had with two radiologists at Fort Carson, Reed Kelly Smith and Matthew Hudkins. The doctors tossed out technical medical jargon such as "fiber tracking" and "grey white matter junction" but evaded linking it to a TBI. Lynch began to cry during the meeting, telling doctors, "People just don't care. It's like, beat around the bush and toss you around like some sort of number."
When the doctors were pressed to answer whether evidence indicated Lynch had a brain injury, the reply was, "in the right clinical context."
An Emotional Toll
Lynch felt that his own doctors considered him a liar and seemed to be going to extraordinary lengths to deny the most plausible explanation for his problems: he was involved in bomb blasts while in Iraq and his brain was injured. He felt that the initial assessment he filled out in 2006 was somehow being held over his head, but couldn't see why it should have been since his problems emerged surfaced slowly after his return.
By 2009, Lynch felt devalued and defeated. He was deemed at risk for suicide, medical records show.
"His experience is being invalidated," Pogany said, adding that Lynch felt betrayed by the very doctors who were supposed to have his back.
The stress also took its toll at home. "It was starting to weigh on our marriage and nothing has come between Shawn and I ever," Lynch's wife, Dawn, said.
Despite these setbacks, Lynch finally obtained what he believed to be the documentation he needed from a commander he served under in Iraq: a 2009 letter saying he was exposed to blasts.
Col. Heidi Terrio, a doctor and chief of clinical investigations and deployment health at Fort Carson's medical department, said she would review his case as a "favor" to Lynch and his attorney. But a favorable outcome wasn't in the cards for Lynch. The letter from the commander didn't make it to the right desks.
In February of this year, Terrio wrote in her assessment to a Medical Evaluation Board that she was unable to conclude that Lynch had a TBI because there was no information corroborating his story about surviving explosions in Iraq.
Terrio wrote that, "without a documented history of an injury event and an associated alteration in consciousness, it would be unlikely that the findings are from concussion in theater."
In other words, Terrio could not say that any specific event in Iraq led to Lynch's injury because there was no documentation in his medical records of the blasts.
The finding only cemented Lynch's feeling that his treatment at Fort Carson was Kafkaesque. His case is difficult because TBI and PTSD have symptoms that are similar and may overlap. But Lynch felt that not only did medical officials believe he must be lying about his experiences in Iraq, but that they were moreover denying that his experiences ever happened.
After that review, at the urging of his attorney, Lynch saw a civilian medical expert at Craig Hospital in Denver for an outside evaluation. The neuropsychologist there concluded that Lynch's symptoms were likely caused by blasts. And that Lynch's condition warranted more attention for a TBI.
But it took another four months for the Army to concede on the matter.
What made the difference in the end was a simple phone call to Fort Carson and letter from Lynch's former commander, Shane Chapman, who holds Lynch in the highest regard. Chapman, now a sergeant major, confirmed that the IED attacks occurred in 2006 and highlighted the difficult deployment Lynch and Charlie Company had faced. "Our company was attacked well over 500 times in a one-year tour of duty in Iraq," Chapman wrote, adding that "every solider saw more than their share of combat and the harsh realities of war."
As for Lynch, Chapman stated in the May 20, 2010, letter that he "appeared to be normal and fully functional when we returned from Iraq in November 2006. We went to the Soldier Readiness Processing Center and answered all questions to the best of our knowledge. It was not until several months later that Sergeant Lynch began having issues." More than three disheartening years had passed for Lynch, however. But the medical board at Fort Carson finally acknowledged that blasts in Iraq played a factor in the staff sergeant's medical problems, offering Lynch a 70 percent permanent disability rating, meaning he will receive benefits for the rest of his life and have access to health care. But for the Lynch couple, the victory was hollow. In what Lynch and his wife consider the last offense, the board did not acknowledge a traumatic brain injury on Lynch's paperwork. Instead, the board wrote that Lynch developed migraines in Iraq "where [in] he was exposed to IED blasts."
A New System, New Challenges
In reflecting on his experience, Staff Sergeant Lynch said he feels like the system never gave him the benefit of the doubt until his final appeal. But that's not how the Army sees it. When asked about Lynch's long and winding case, Col. Terrio at Fort Carson said: "That's exactly what we were working for is to make sure that if there was this chance that he could have possibly of sustained a traumatic brain injury that that would get documented for him."
Terrio offered to sit down with Lynch and his wife to hear about their experience.
But after fighting for so long, the couple declined the offer. Dawn said she's surprised to hear herself say it, but she can't trust anyone in the Army anymore. As for Lynch, he said, "It's been nothing but heartache, that's all I know."
There is one postscript to the story. In June, the Army adopted new guidelines for identifying and treating soldiers with TBI, requiring mandatory evaluations and reporting of soldiers within 50 meters of a blast.
However, the new guidelines were issued almost nine years after the war in Afghanistan began and only two months before combat operations in Iraq were officially declared over by President Barack Obama.
And more than three and a half years after Lynch was exposed to his IED blasts. Now Former Staff Sergeant Lynch is now awaiting an official assessment for a TBI through the U.S. Department of Veterans Affairs.