ProPublica: National Security

Newly Released Memo Inadvertently Reveals CIA Held (and Abused) Missing Prisoner

2011-05-03T14:57:03-05:00

Among the OLC memos released today, one appears to inadvertently reveal that a top al-Qaida suspect captured in northern Iraq in January 2004 was held by the CIA in a secret prison.

After Hassan Ghul was arrested in early 2004, President Bush told reporters: "Just last week we made further progress in making America more secure when a fellow named Hassan Ghul was captured in Iraq. Hassan Ghul reported directly to Khalid Sheik Mohammad, who was the mastermind of the September 11 attacks. He was captured in Iraq, where he was helping al Qaeda to put pressure on our troops."

Military officials and former CIA director George Tenet described Ghul as an al-Qaida facilitator who delivered money and messages to top leaders.

The U.S. government never publicly discussed Ghul again.

The 9/11 Commission report said Ghul was in "U.S. custody." But the government itself never discussed Ghul’s whereabouts. And the CIA has never acknowledged holding Ghul.

Three years after his capture, human rights groups were surprised when Ghul was not included among 14 high-value detainees who were transferred out of the CIA’s black sites program and sent to Guantanamo Bay, Cuba, in 2007.

Since then, he has been considered a missing, or ghost detainee. But in the heavily redacted OLC memo dated May 30, 2005, government censors appeared to have missed a single reference to his name and confinement during a lengthy description of the interrogation techniques used against him. The reference can be found at the bottom of Page 7 in the memo, where Ghul’s surname is spelled "Gul."

According to the memo, Ghul was one of 28 CIA detainees at the time who had been subjected to the agency’s "enhanced interrogation techniques." Specifically, the memo says he was subjected to "facial hold," "facial slap," "stress positions," "sleep deprivation," a technique called "walling," in which a detainee’s shoulders are repeatedly smashed against a wall, and the "attention grasp," in which the detainee is placed in a choke-hold and slapped.

So it appears we now have evidence Ghul was in a CIA prison. Where he is today is still a mystery.

We’ve called the CIA, and they declined to comment.

A Reading List to Put the WikiLeaks ‘War Logs’ in Context

2010-07-26T15:49:57-05:00

Nicholas Kusnetz and Karen Weise

Leader of Military’s Program to Treat Brain Injuries Steps Down Abruptly

2010-06-23T17:33:29-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

WASHINGTON, D.C.--The leader of the Pentagon's premiere program for treatment and research into brain injury and post traumatic stress disorders has unexpectedly stepped down from her post, according to senior medical and congressional officials.

Brig. Gen. Loree Sutton told staff members at the Defense Centers of Excellence, or DCOE, on Monday that she was giving up her position as director. Sutton, who launched the center in November 2007, had been expected to retire next year, officials with knowledge of the situation said. The center has not publicly announced her leaving.

Tell Us Your Story

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story. Tell us about your experiences with TBI.

Sutton's departure follows criticism in Congress over the performace of the center and in recent reports by NPR and ProPublica that the military is failing to diagnose and treat soldiers suffering from so-called mild traumatic brain injuries, also called concussions.

It comes just as the Pentagon prepares to open a new, multimillion-dollar showcase treatment facility outside Washington, D.C., for troops with brain injuries and post traumatic stress disorder, often referred to as the signature wounds of the wars in Iraq and Afghanistan.

Late Wednesday, in a sign of disarray within the program, Sutton cancelled a scheduled appearance at the opening of the National Intrepid Center of Excellence, a gleaming new facility of waving glass and futuristic virtual reality treatment rooms in Bethesda.

"The war in Iraq and Afghanistan could end tomorrow; our mission to restore health, hope and humanity will endure for decades," Sutton wrote in her farewell message. "We simply must uphold our commitment to all who have borne the burdens of war on our behalf."

Sutton did not respond to requests for comment. Her replacement, U.S. Army Col. Bob Saum, also declined to comment.

Cathy Haight, the acting spokeswoman for DCOE, said Sutton's departure, though apparently well ahead of schedule, was part of a routine command rotation. Haight said Sutton decided to leave after turning down the Army's offer to take a new position overseeing the military medical system in Europe.

"If a general officer declines (a new position)...they are in a transition to retire," Haight said.

In recent months, legislators have questioned Sutton's ability to carry out the mission of the centers, which is to catalyze research and treatment across the military for soldiers returning with brain injuries and psychological wounds.

Congress directed the military in 2008 to create the brain injury center and other facilities for wounded soldiers. At an April hearing of a House Armed Services subcommittee, Rep. Susan Davis, D-Calif., said that the center had failed to carry out its role.

"The Defense Center of Excellence, while having achieved some notable small scale successes, has not inspired great confidence or enthusiasm thus far. The great hope that it would serve as an information clearinghouse has not yet materialized," Davis said.

"The center has also made some serious management missteps that call into question its ability to properly administer such a large and important function," Davis continued.

Scrutiny of Sutton rose another notch earlier this month, when NPR and ProPublica reported on the military's problems in handling soldiers with mild traumatic brain injuries. Such injuries leave no visible scars, but can cause lasting mental and physical difficulties.

Military statistics show that about 115,000 troops have suffered such injuries since 2002, but in interviews, Army experts acknowledged the true toll may be far higher. Unpublished research we reviewed suggests that tens of thousands of soldiers may have gone undiagnosed. Our reporting also showed that even when soldiers were diagnosed, at one of America's largest Army bases, they have had to fight to receive appropriate treatment.

Still, some veterans' advocates were shocked and saddened that Sutton was leaving. They said she had been a forceful, visible advocate for wounded troops and their families who had never received the full support of the military's medical establishment.

Critics of the military's health system have noted a power vaccum at the top of the military medical structure. Four people in just over three years have rotated through the Pentagon's top health policy position, the assistant secretary of defense for health affairs.

"She was always there for the troops," said one veterans' advocate, who did not want to be named for fear of criticizing the military. "She's become the scapegoat."

In an April interview with NPR and ProPublica, Sutton shrugged off the criticism. "Leading change," she said, "is a journey not for the faint of heart."

"We are very proud of the team that we have built, the concept in terms of the center of centers, the network of networks," she said. "Are we anywhere close to where we want and need to be? No. Of course not."

Congress Questions Military Leaders on Suicides, Traumatic Brain Injury

2010-06-22T16:44:35-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

WASHINGTON, D.C.—Senators pressed senior military leaders today to improve their efforts to address traumatic brain injuries, suicide and other wounds suffered by soldiers returning from the wars in Iraq and Afghanistan.

Responding to what he called "disconcerting" reports by NPR and ProPublica, Sen. Carl Levin, D-Mich., said at a hearing before the Senate Armed Services Committee that the military needed to better address the wide range of medical and behavioral problems affecting troops.

Tell Us Your Story

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story. Tell us about your experiences with TBI.

Earlier this month, we reported that the military was failing to diagnose and adequately treat troops with brain injuries. Since 2002, official military figures show more than 115,000 soldiers have suffered mild traumatic brain injuries, also called concussions, which leave no visible scars but can cause lasting problems with memory, concentration and other cognitive functions.

But the unpublished studies that we obtained and the experts that we talked to said that military screens were missing tens of thousands of additional cases. We also talked to soldiers at one of the military's largest bases, who complained of trouble getting treatment.

"I am greatly concerned about the increasing number of troops returning from combat with post-traumatic stress and traumatic brain injuries, and the number of those troops who may have experienced concussive injuries that were never diagnosed," Levin, chairman of the committee, said as he opened today's hearing.

Gen. Peter Chiarelli, the Army's vice chief of staff, said the Army had made strides in identifying soldiers at risk of committing suicide, setting up new treatment centers and deploying a new system of "telemental health services," allowing soldiers to talk with counselors by computer video chat programs.

Chiarelli's remarks were echoed by other senior military commanders at the hearing from the Navy, Air Force and Marine Corps.

"Our success notwithstanding, we still have much more to do," said Chiarelli, who has emerged as the Army's point man on mental health issues. "We face an Army-wide problem that will be only be solved by the coordinated efforts of our commanders, leaders, soldiers and program managers and health providers. This is a holistic problem with holistic solutions and that is how we're approaching it."

Chiarelli acknowledged that the Army continues to have problems with properly diagnosing soldiers with mild traumatic brain injuries, saying that it was an emerging area of medicine. And he acknowledged that soldiers at bases throughout the Army have sometimes had trouble receiving treatment for mild traumatic brain injuries and post-traumatic stress.

Chiarelli took issue with our reporting, however. He said the NPR and ProPublica reports were wrong to blame military doctors for failing to diagnose the problem, or to accuse senior military officials of not taking the issue seriously. He also said that NPR and ProPublica had tried to draw a distinction between traumatic brain injury, or TBI, and post-traumatic stress, or PTS, two conditions which frequently occur together.

"I think the great disservice that NPR did to everyone was to try to isolate TBI from PTS. And that is just not possible," Chiarelli said. "The co-morbidity of these two is what's giving us the difficulty today. And I also think that they did a disservice when they indicated that PTS is a psychological problem. It's not just at a psychological problem. It is a physical injury that occurs."

Chiarelli did not cite any factual errors in the stories and we stand by our reporting. But we also think he is mischaracterizing our reporting, which was based on dozens of interviews with senior military researchers, commanders and soldiers, and thousands of pages of unpublished studies, e-mails and medical records.

First, we did address the overlap of TBI and PTSD in our stories: "To be sure, brain injuries and PTSD sometimes share common symptoms and co-exist in soldiers, brought on by the same terrifying events," we wrote.

We also did not downplay the seriousness of PTSD -- a wound which NPR has reported on extensively in past stories.

We found several instances in which military doctors expressed skepticism about mild traumatic brain injury and its effects. Dr. Charles Hoge, one of the Army's senior health advisers, referred to the "illusory demands" of mild traumatic brain injury in an opinion piece in the New England Journal of Medicine last year. In an April 2010 e-mail that we obtained, he wrote: "What's the harm in missing the diagnosis of mild TBI?" In an interview, Hoge told us that he was concerned with treating soldiers' symptoms, no matter the cause.

We also turned up extensive evidence that military doctors weren't diagnosing mild traumatic brain injuries, both on the battlefield and when troops came home. Battlefield medics, overwhelmed by life-threatening wounds, can miss the signs of concussions. Screening tools now in place often fail to catch soldiers who have suffered concussions. Soldiers often try to hide their symptoms to return to battle with their comrades.

One of the Army's senior neuropsychologists told us of examining five soldiers who had survived a rocket attack in Iraq last year. Medical staff had treated their visible wounds, but failed to diagnose them as suffering from mild traumatic brain injury -- even though they were suffering "classic" symptoms, according to Lt. Col. Mike Russell.

It is important to diagnose mild traumatic brain injury and quickly provide treatment for any lingering effects, according to the Pentagon's own experts. While the majority of soldiers recover quickly from concussions, some report lasting mental and physical problems. Studies show that such soldiers can be helped by providing cognitive rehabilitative therapy, an intensive program to retrain the brain to perform mental tasks.

Sen. Mark Udall, D-Colo., asked Chiarelli several questions about the military's efforts to improve how it diagnoses traumatic brain injury. Afterwards, he said that he appreciated Chiarelli's efforts, but planned to continue pressing Army officials on the issue.

Udall "remains concerned about the impact of TBI and PTSD on our service members," Tara Trujillo, a Udall spokeswoman. "As discussed at the hearing, there is much still to learn, different approaches to take and ways to continue to improve."

After the hearing, Levin said he was convinced that the services were trying to properly diagnose mild traumatic brain injury.

"I remain concerned about the diagnosis of traumatic brain injuries, and especially of mild traumatic brain injuries, but it is not for lack of the services trying to do the best they can with existing science, tools, and methods," Levin said in a statement. "There is still much to be learned in both the military and civilian medical environments about the diagnosis, treatment, and care of traumatic brain injury, and its relationship to other combat-related injuries such as post traumatic stress. I believe each of the services is taking the issues of detection, tracking, and follow-up care very seriously, but there is still work to be done."

Congress Demands Answers on Brain Injury Care at Texas Base

2010-06-16T20:30:50-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

WASHINGTON, D.C.--In response to an investigation by ProPublica and NPR, three congressmen are demanding answers from Fort Bliss medical officials about the care being provided to soldiers with traumatic brain injuries.

Rep. Harry Teague, D-N.M., Rep. Silvestre Reyes, D-Texas, and Rep. Ciro Rodriguez, D-Texas, sent a letter to Fort Bliss' William Beaumont Army Medical Center on Tuesday expressing concern over our report that soldiers encountered debilitating delays and frustrating bureaucracy when seeking help at the base, America's third largest by number of soldiers.

Tell Us Your Story

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story. Tell us about your experiences with TBI.

A spokeswoman for Teague said today that the congressman was also considering calling for the U.S. Government Accountability Office to review the military's handling of traumatic brain injuries and may pay a visit to Fort Bliss to personally inspect the facilities.

"We are deeply concerned that our government could be failing those to whom we owe the most," the three men wrote in their letter. "These reports must be investigated and receive the full attention of the United States Congress and government."

In our investigation, we found that soldiers at Fort Bliss struggled to receive diagnosis and treatment for so-called mild traumatic brain injury. Such head traumas, also called concussions, often leave no visible signs of damage, but can result in long-term mental and physical problems.

Official military figures show that about 115,000 troops have suffered mild traumatic brain injuries since 2002. But we found that many troops have injuries that go undiagnosed or that are never documented in their medical records. Top Pentagon officials acknowledged in interviews that the true toll is likely far higher. Unpublished military studies reviewed by ProPublica and NPR suggest tens of thousands of mild traumatic brain injuries have gone uncounted.

Most soldiers with concussions recover quickly, but civilian studies indicate that 5 percent to 15 percent of those who suffer such injuries have lingering cognitive problems.

The Senate Armed Services Committee announced Wednesday that it will hold a hearing on June 22 to look into suicide, traumatic brain injury and other so-called invisible wounds.

Our investigation found that Fort Bliss had erected billions of dollars of new housing and accommodations for additional troops to deploy to war zones, but had failed to open the doors of Building 805, a traumatic brain injury clinic completed nearly a year ago. Although the Pentagon designated the base as a site for enhanced treatment for brain-injured soldiers in 2007, the base did not hire a full-time director for the program until October 2009.

Soldiers at Fort Bliss told us they waited weeks or months just to get appointments to see doctors and often received far fewer hours of therapy than patients at well-regarded civilian clinics. Some were prescribed therapy for psychological problems that did little to relieve their troubles with memory, balance and reasoning.

The three congressmen, who are part of the bipartisan Congressional Invisible Wounds Caucus, have asked the medical commander at Fort Bliss, Col. James Baunchalk, to answer several questions about the base hospital's treatment program.

They asked to know how many patients with traumatic brain injury, or TBI, were being treated at Fort Bliss, how long soldiers had to wait for appointments, and whether the hospital had systems in place to address soldiers' complaints.

"It's pretty important that (Fort Bliss) be at the front of addressing TBI and PTSD," Teague said in an interview. PTSD, or post-traumatic stress disorder, is a psychological wound that often accompanies TBI.

Fort Bliss officials have declined to answer such questions from ProPublica and NPR. Baunchalk also denied ever having received complaints regarding brain injury care, despite e-mails and letters written to his assistants and superiors by soldiers and family members.

Fort Bliss officials have defended their treatment of soldiers. In a response this evening, a base spokesman said they would respond to all questions posed by the congressmen by June 21.

"Our commitment is to provide quality health care, in a timely manner, to those who serve in our military," the statement said.

Air Marshal Investigated in Indian Ammunition Case

2010-06-15T16:10:07-05:00

by Michael Grabell, ProPublica, and Pia Malbran, CBS News -

June 16: This post has been updated.

A federal air marshal is under investigation after police in India found ammunition and two handgun magazines hidden in the air conditioning duct of his New Delhi hotel room.

The discovery initially led the Delhi police to detain three Italian businessmen for several days late last month in what Indian newspapers described as a case of international smuggling. The men were released after authorities connected the equipment to the U.S. air marshal.

Undercover air marshals carry guns as part of their mission to protect U.S. airlines flying overseas, but are required to check in their weapons before entering a foreign country. When air marshals fly back to the United States, they pass through security like regular passengers and sometimes set off alarms with forgotten equipment.

The Transportation Security Administration "is investigating this incident and working with Indian government officials to ensure that the facts of this incident are thoroughly reviewed," air marshal spokesman Nelson Minerly said in a statement. The TSA investigation was first reported June 11 by CNN.

America's relationship with foreign airport security officials has drawn heightened attention since the attempted bombing of an airliner traveling from Amsterdam to Detroit on Christmas Day. Homeland Security Secretary Janet Napolitano has traveled to Nigeria, Japan, Mexico, Spain and the United Arab Emirates in recent months to shore up those international partnerships.

The Hindustan Times reported that the Delhi police issued a "look-out circular" for the three Italians on May 26 after a Radisson Hotel cleaning crew heard a rattling noise in an air conditioning duct and discovered 24 rounds of "military-grade" ammunition, two empty magazines and two pistol springs.

The Italian men, who work for a petrochemical company, were detained at airports in Mumbai and Pune and brought back to New Delhi for questioning.

Italian diplomatic officials told ProPublica that the men were never jailed and remained at their hotel as police investigated.

An assistant police commissioner in New Delhi would not comment about whether the air marshal could face criminal charges.

Minerly, of the air marshal service, said agents who violate security procedures are subject to "the full range of disciplinary measures up to and including removal."

Top directors at the air marshal service have repeatedly raised concerns about air marshal conduct overseas.

Days before the Christmas incident, director Robert Bray, who is now the second-highest-ranking official at TSA, wrote a memo to the rank and file about international missions.

"Misconduct and non-compliance with divestiture procedures may be viewed by host country officials as collective disregard for the laws of that country," Bray wrote. "This perception could lead to criminal and regulatory actions against individual FAMs. Ultimately, perceived patterns of careless conduct will adversely impact our ability to maximize our international deployments."

ProPublica reported in 2008 that dozens of air marshals had been charged with crimes ranging from smuggling drugs past airport security to aiding a human trafficking ring to solicitation to commit murder.

In January, ProPublica and CBS News reported widespread allegations of discrimination and retaliation in air marshal field offices. In one incident that is still under investigation, Orlando air marshals complained that supervisors created a "Jeopardy"-style game board with derogatory nicknames for African-Americans, Hispanics, homosexuals and veterans as a way to mete out discipline and undesirable assignments.

Update: This post has been updated to reflect that CNN first reported the TSA investigation on June 11.

Soldier Brain Injuries to Get Senate Scrutiny After ProPublica, NPR Report

2010-06-11T16:53:09-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

WASHINGTON, D.C. — Responding to an investigation by ProPublica and NPR, the chairman of the Senate Armed Services Committee said Friday that he would expand a hearing on soldier suicides to include a more extensive discussion of the military’s handling of traumatic brain injuries and post-traumatic stress disorder.

"The recent NPR and ProPublica reports on the military's diagnosis, treatment, and tracking of traumatic brain injuries are concerning," Sen. Carl Levin, D-Mich., said in a statement.

NPR and ProPublica reported this week that the military was failing to diagnose soldiers with so-called mild traumatic brain injuries. Such injuries, also called concussions, are typically difficult to detect but can cause lasting mental and physical difficulties.

Tell Us Your Story

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story.

Tell us about your experiences with TBI.

Unpublished military studies and interviews with medical officials suggest there could be tens of thousands of soldiers suffering undiagnosed traumatic brain injuries, which have been called one of the signature wounds in the wars in Iraq and Afghanistan. When soldiers were diagnosed, many received little or no treatment, even at large bases such as Fort Bliss in El Paso, Texas.

Official military statistics say 115,000 troops have suffered a mild traumatic brain injury since the wars began. But in interviews, top Army medical officials acknowledged that those figures understate the true number.

Civilian studies suggest up to 15 percent of people with mild traumatic brain injuries experience lingering problems with memory, concentration, sleep and balance problems.

"While the Department of Defense and the military services have made progress toward increasing knowledge about and awareness of the causes, diagnosis, and treatment of traumatic brain injuries, there is still a good deal to learn, both in the military and civilian medical environments," Levin said in his statement.

Levin’s spokeswoman said the hearing will take place later this month, though the date has not been finalized. It will look at the complex web of illnesses that have afflicted troops returning from the wars in Iraq and Afghanistan and the role those disorders play in soldier suicides. The issue has been a growing concern in the military.

Soldiers with traumatic brain injury often also suffer from post-traumatic stress disorder, or PTSD, a debilitating psychological wound. Those who survive roadside blasts can suffer both a brain injury and PTSD, which can be triggered by the terror of the event.

"Traumatic brain injury, post traumatic stress, and suicide are all related issues, at times making diagnosis difficult," Levin said in his statement.

Army officials said they have been working to improve their systems to diagnose soldiers. They said soldiers with brain injuries have received appropriate treatment.

In an interview earlier this week, Gen. Peter Chiarelli, the Army's vice chief of staff, said the military took traumatic brain injuries "extremely seriously."

Chiarelli, who has worked to raise awareness about the severity of so-called invisible wounds such as mild traumatic brain injury and PTSD, said medical officials must diagnose and treat a complicated mix of illnesses.

"It's time we realize that TBI and PTSD are real injuries," Chiarelli told “Talk of the Nation” host Neal Conan. "We've got to ensure our soldiers get the care that they need."

Top Officer Says Military Takes Brain Injuries ‘Extremely Seriously’

2010-06-09T17:15:30-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

June 10: This post has been corrected.

WASHINGTON, D.C.— Gen. Peter Chiarelli, the Army's vice chief of staff, defended the military's handling of soldiers who suffered brain injuries in Iraq and Afghanistan.

"We are taking this extremely seriously," Chiarelli said Wednesday in response to an investigation by National Public Radio and ProPublica which found the military is failing to identify and treat soldiers with so-called mild traumatic brain injuries. "There's no reason for us not to try to diagnose it."

Mild traumatic brain injuries, which are frequently caused by roadside blasts, leave no visible scars, but can cause lingering mental and physical damage. Officially, military figures show that about 115,000 soldiers have suffered mild traumatic brain injury since 2002. But we talked to military doctors and reviewed unpublished studies that suggest far more soldiers could have sustained such wounds. While most recovery quickly, estimates suggest that between 5 percent to 15 percent go on to develop cognitive problems.

In an interview on the NPR program "Talk of the Nation," Chiarelli said that the military had diagnosed thousands of soldiers with traumatic brain injuries, also called TBIs. But he said it was important to focus not only on TBI. Many soldiers are also suffering from post-traumatic stress, or PTS, a debilitating psychological wound that can be caused by the intense terror of being involved in a roadside blast.

Many soldiers suffer from both conditions at the same time, making it important to treat the symptoms, whatever the cause. He said the military was diagnosing and treating soldiers suffering from both wounds, which he described as the signature injuries of the wars.

"It's time we realize that TBI and PTS are real injuries," Chiarelli told Talk of the Nation host Neal Conan. "We've got to ensure our soldiers get the care that they need."

Chiarelli noted that the military is planning to implement a policy where soldiers exposed to nearby blasts will be evaluated by two separate tests to determine whether they have suffered a concussion before being returned to the battlefield. He said that doctors have advised him that soldiers at most risk of developing long-term problems suffer from multiple mild traumatic brain injuries, which are also called concussions.

"If either one of the exams in that 24-hour period indicates the individual had a concussion, they are pulled out of the fight until the concussion has an opportunity to heal," Chiarelli said. "The key here is not to have that second concussion while the brain has not recovered from the first."

But the NPR and ProPublica investigation found major problems with the two primary screening systems now used in the field. After a blast or blow to the head, soldiers take a paper-and-pencil exam called the MACE, or Military Acute Concussion Evaluation. In interviews, doctors and soldiers acknowledged that troops often manipulate the test to obtain a passing score and rejoin their comrades in battle.

A second computerized test used on the battlefield, known as the ANAM, or Automated Neuropsychological Assessment Metrics, failed to catch nearly half of all soldiers who had suffered a concussion, according to a recent unpublished study obtained by ProPublica and NPR. Lt. Gen. Eric Scoomaker, the Army's top medical official, recently testified in Congress that results from the test are no better than a "coin flip."

In recognition of the military's problems with screening, two Congressmen called for the military to implement legislation that would require veterans to receive individual, one-on-one evaluations for traumatic brain injuries and other battlefield illnesses.

Reps. Tom Rooney, R-Fla., and Michael E. McMahon, D-N.Y., cited the ProPublica and NPR investigation as further evidence of the need to pass the legislation, known as the Veterans Mental Health Screening and Assessment Act.

"Our troops and veterans deserve action to improve screening and detection of traumatic brain injuries," Rooney and McMahon said in a joint press release. "We hope the House of Representatives will move quickly to take up and pass this critical legislation."

Correction: This post originally said Gen. Peter Chiarelli was the Army's second in command. He is in fact the Army's vice chief of staff.

At Fort Bliss, Brain Injury Treatments Can Be as Elusive as Diagnosis

2010-06-08T21:00:29-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

FORT BLISS, Texas -- At this rapidly expanding base 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.

"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."

Tell Us Your Story

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story. Tell us about your experiences with TBI.

Previously, ProPublica and NPR 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 ProPublica and NPR 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.

ProPublica and NPR 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 soldiers with speech and occupational therapy for their brain injuries sometimes had only minimal training in cognitive rehabilitation, records show.

Staffing shortfalls also meant soldiers 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 ProPublica and NPR, 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 the base's sole neurologist, Capt. Brett Theeler. 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 he 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 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 get 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."

After Our Investigation, Pentagon Puts Its Spin on Brain Injuries

2010-06-08T13:57:34-05:00

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR -

ProPublica and NPR reported today that the military is failing to diagnose soldiers who suffered brain injuries in Iraq and Afghanistan. It didn't take long to get a response. Soon after learning that the stories were about to air, the Pentagon's public affairs machine began circulating talking points on traumatic brain injuries—just in case senior medical commanders weren't up to speed on what the military's been doing for troops with one of the wars' signature wounds.

The talking points, which we obtained and were sent to top Army officials, don't directly address the findings of our investigation. We found that the military's system has repeatedly overlooked soldiers with so-called mild traumatic brain injuries. These blast injuries, which some doctors call concussions, leave no visible scars but can cause lasting physical and mental harm in some cases. The Pentagon's official figures say about 115,000 soldiers have suffered a mild traumatic brain injury since the wars began. But we found that military doctors and screening tools routinely miss soldiers who have suffered mild traumatic brain injuries on the battlefield. Experts we interviewed and documents we obtained said the military's count may understate the true toll by tens of thousands of soldiers.

The talking points are upbeat. One says that the Department of Defense has the "world's best TBI medical care for our service members." Leading neuropsychologists and rehabilitation therapists have told us that's not true, however. They say the military doesn't always provide the kind of intensive cognitive rehabilitation therapy most experts recommend. The talking points also stressed that one military screen, called the ANAM, for Automated Neuropsychological Assessment Metrics, will be "utilized when soldiers come home to help measure the effects of any identified mild brain trauma that may have gone unnoticed or untreated."

But when we talked to the man who ran that program, he told us the ANAM was rarely used that way. Lt. Col. Mike Russell, the Army's senior neuropsychologist, said that more than 580,000 ANAM tests have been administered to soldiers before they deploy to the battlefield. But doctors have only used them about 1,500 times to diagnose soldiers after they've suffered a blow to the head.

The talking points tick off a number of initiatives the military has undertaken to better diagnose and treat the soldiers. But as we note in our stories, the problem is not the lack of initiatives, it's that nine years into the war, nobody at the Pentagon knows how big the problem is, nor how best to treat it. You can find the complete talking points memos and PowerPoint here.

Phone calls to the medical command's spokeswoman were not immediately returned.