Hurt soldiers' relatives fighting for better care

Families say VA is ill-equipped to care for brain-damaged troops

March 12, 2007|By New York Times News Service

When Staff Sgt. Jarod Behee was asked to select a paint color for the customized wheelchair that was going to be his future, his young wife seethed. The government, Marissa Behee believed, was giving up on her husband just five months after he took a sniper's bullet to the head during his second tour of duty in Iraq.

Marissa Behee, a sunny Californian who was just completing a degree in interior design, possessed a keen faith in her then 26-year-old husband's potential to be rehabilitated from a severe traumatic brain injury. She refused to accept what she perceived to be the more limited expectations of the Veterans Affairs hospital in Palo Alto, Calif.

"The hospital continually told me that Jarod was not making adequate progress and that the next step was a nursing home," Behee said. "I just felt that it was unfair for them to throw in the towel on him. I said, `We're out of here.' "

Because Behee had successfully resisted the Army's efforts to retire her husband into the VA health care system, his military insurance policy, it turned out, covered private care. So she moved him to a community rehabilitation center, Casa Colina, near her parents' home in Southern California in late 2005.

Three months later, Jarod Behee was walking unassisted and abandoned his government-provided wheelchair. Now he works as a volunteer in the center's outpatient gym, wiping down equipment and handing out towels. It is not the police job that he aspired to; his cognitive impairments are serious. But it is not a nursing home, either.

Like the spouses of many other soldiers with severe traumatic brain injury, Marissa Behee, now 28, transformed herself into a kind of warrior wife to get her husband the care she thought he deserved. By now, there is a veritable battery of brain-injured soldiers' relatives who have quit their jobs and, for some extended time, moved away from their homes to advocate for and care for these very wounded soldiers during long hospitalizations.

In the eyes of five such relatives interviewed, the military health care system, which is so advanced in its treatment of lost limbs, has been scrambling to deal with an unanticipated volume of traumatic brain-injury cases that it was ill-equipped to handle. Largely because of the improvised explosive devices used by insurgents in Iraq, traumatic brain injury has become the signature wound of this war, with 1,882 cases treated to date, according to the Defense and Veterans Brain Injury Center.

In general, these caregivers said that their grievously wounded soldiers had either been written off prematurely or were not given aggressive rehabilitation or options for care. From the beginning, they said, the government should have joined forces with civilian rehabilitation centers instead of trying to ramp up its limited brain-injury treatment program alone during a time of war. That way, soldiers would have had access to top-quality care at civilian institutions that were already operating at full throttle and might be closer to home.

In fact, many soldiers do have that access. But unlike Marissa Behee, many caregivers only belatedly come to understand how to negotiate the daunting military health care system.

Generally, after severely brain-injured soldiers are medically evacuated to the United States, they are treated first at Walter Reed Army Hospital or Bethesda Naval Hospital. Relatively quickly, the military, depending on the branch, initiates a medical retirement process that turns the soldiers' health care over to the VA. If soldiers succeed in deferring retirement, they remain covered by a military insurance policy that, if pressed, pays for private care.

Still, the military hospitals tend to discharge seriously brain-injured soldiers to VA hospitals, regardless of their active or retired status. It is how the system works, and challenging it requires constant haggling, which often leaves the families of the severely wounded soldiers feeling abused, resentful and anxious for those soldiers without an advocate.

"We have been let down by a system that is so bungling and bureaucratic that it doesn't know what it can and cannot do and just says `No' as a matter of course," said Debra Schulz of Friendswood, Texas, whose son, Lance Cpl. Steven Schulz, 22, of the Marines, suffered a severe brain injury during his second tour in Iraq.

Early on, at least two top-ranked nonprofit civilian centers, the Rehabilitation Institute of Chicago and the Kessler Institute for Rehabilitation in New Jersey, made overtures to the government. Since the Vietnam War, their leaders said, while the VA has focused primarily on the chronic care of aging veterans, the civilian acute rehabilitation system has been dealing daily with brain-injured patients, fine-tuning their care.

Dr. Bruce M. Gans, chief medical officer of the Kessler Institute, contacted senior military and VA physicians. "I said, `Please let us help. Please let us be used as a resource.'"

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