Brain Injuries Overlooked at Some Veterans Hospitals

Bob Woodruff has visited with many soldiers and marines over the past several months, who complain that the Veterans Administration is not equipped to care for brain injured vets once they leave the specialized rehabilitation centers and return home to their local VA hospitals.

As part of the documentary "To Iraq and Back," Woodruff questioned Jim Nicholson, who runs the Veterans Administration and serves 5.5 million veterans, as to whether the smaller VA hospitals can appropriately care for the soldiers returning from the war zone with brain injuries.

"We have organized the VA with this priority for these combatants returning back," said Nicholson.

The VA runs the largest health care system in the nation and had to adapt its services when soldiers began returning with multiple injuries from Iraq and Afghanistan. In 2005, the Veterans Administration set up four special polytrauma centers to treat these traumatic injuries.

Woodruff visited the polytrauma center in Tampa, Fla., and found that 60 percent of the Iraq and Afghanistan veterans they treated had endured a brain injury.

Dr. Steven Scott, who helped establish the polytrauma centers, told Woodruff that in Tampa they are much more experienced at treating brain injured veterans.

"Because we see a lot more here, we have more experience or [are] more attuned to what's going on, you know, with the war itself and those injury patterns," said Scott, the chief of rehabilitation of the Tampa VA.

And Scott said that it is "absolutely" much more difficult for veterans to get the kind of help they need at the smaller VA hospitals.

Patient Arrives, but Hospital Not Prepared

Sgt. Michael Boothby, who was injured by an IED blast in Iraq last September, is one of those soldiers who has had a difficult time transferring his care to his local VA.

Woodruff first met Boothby and his wife, Megan, on a visit to Bethesda Naval Hospital. Woodruff caught up with the couple three weeks later in Tampa, where Boothby was sent for his inpatient rehabilitation.

"I'm doing so good right now," Boothy told Woodruff in Tampa, with his condition improved in part by the three to five hour therapy sessions he was receiving each day.

Boothby was making good progress and planned to move home, so the day before he would leave Tampa, a teleconference was held between the Tampa VA and the center in Texas, to make sure his rehabilitation would transfer smoothly once he returned home to Texas.

"Once you leave the Department of Defense and a place like Walter Reed, or one of the polytrauma units, and you get home to your local VA, they may have never seen a traumatic brain injury," said Paul Rieckhoff, executive director, Iraq and Afghanistan Veterans of America. "The specialists aren't going to be there, evaluation methods aren't going to be there, even the paperwork's not going to be there."

That's exactly what happened when Boothby arrived home.

The VA hospital in San Antonio didn't have a program in place to treat brain injury. Boothby had to wait for paperwork to arrive to begin private rehabilitation, and while he waited, his condition deteriorated.

"Well, when we first got here, it was our understanding we were supposed to start with an outpatient program," his wife, Megan, explains, "but … there was nothing. Nothing was set up."

After making progress in Tampa, he again struggled to use his left hand, and the Boothby's believe that many of Michael's problems could have been prevented.

"I don't know whose fault it is -- they dropped the ball. But somebody left me out of the loop, basically," Michael Boothby said.

Dispute Over Number of Injured Vets

According to a July 2006 report from the Veterans Administration inspector general, brain injured veterans often fall through the cracks. It found that "multiple factors lead to suboptimal access to care" and "services are often very limited in communities where injured veterans live."

According to the Department of Defense, there have been about 23,000 nonfatal battlefield casualties in Iraq and Afghanistan. But through an internal VA report, Woodruff discovered that there are more than 200,000 veterans who have sought out the VA for care.

"What you have are two sets of books," says Paul Sullivan, who served in the first Gulf War and is now an advocate for Veterans. "The Department of Defense saying that there's 23,000 wounded from the wars in Iraq and Afghanistan, but the Department of Veterans' Affairs is actually treating 205,000 veterans from these two wars."

Secretary Nicholson seemed to downplay the numbers in his interview with Woodruff.

"A lot of them come in for, for dental problems, others come in for a lot of the, you know, the normal things that people have," he said.

The VA report lists a wide array of injuries, including post traumatic stress disorder, mental disorders, infections and parasitic diseases and ill-defined conditions.

The report does not have a category for traumatic brain injury. (Click here to read the report)

Officially, the Department of Defense says that 1,835 soldiers and Marines have a traumatic brain injury.

The force from an IED or roadside bomb can rattle the brain so severely inside the skull that it can cause life long health problems.

"There's a tremendous number of people who've served, who are at risk for traumatic brain injury, and those are folks who could have been anywhere in the vicinity of the blast," says Rieckhoff.

On Veterans Day 2004, Sgt. Nick Bennett suffered multiple wounds in an explosion in Iraq. His head didn't appear to be injured, but he knew something wasn't quite right and sought out a diagnosis at the VA hospital.

"I went a year and a half, passed all the neuropsych tests. And they're like, 'you know, you're fine,'" recalls Sgt. Bennett, saying since the explosion he has trouble with his memory. "I can't remember appointments. I can tell you, 'I've got something next week,' but who it's with, where it's at, I'm lost."

Bennett was finally diagnosed with a traumatic brain injury last June after he pushed his local VA to be tested again.

It took nearly a year and a half, after his initial injuries, for Bennett to be diagnosed with traumatic brain injury.

His situation brings to light that many more soldiers serving in Iraq or having returned from battle, may be walking around with a traumatic brain injury and not even know it.

Data obtained by ABC News, shows that 10 percent or more of the Marines and soldiers who have served in Iraq and Afghanistan have possibly sustained a brain injury.

"I can't give you an absolute number, but I think the 10 percent … is a good estimate," Scott said. "But it could be higher."

That could mean of the 1.5 million Americans, who have served or are now serving, more than 150,000 people could have a brain injury that is unrecognized by the Department of Defense.

While all may not need treatment, the Department of Defense is not routinely screening returning soldiers for brain injuries despite calls from some of the department's own brain injury experts.

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