New Medical Survival Advances With Veterans and Contractors Leads to Challenges for Long-Term Care

New Medical Survival Advances With Veterans and Contractors Leads to Challenges for Long-Term CareVictims and practitioners have long known and understood that the scars of war do not heal until long after the conflict has passed. Now, researchers are getting a better idea of just how long it takes.

The good news for Iraq veterans is that the injury survival rate is around 90%, meaning that many wounds that would have been fatal in the Persian Gulf War are no longer so. However, with the high survival rate comes challenges because stabilizing a patient who received a near-mortal wound is one thing and helping that patient fully recover is quite another. In fact, according to one study, 80% of Iraq veterans continue to struggle with a long-term injury, such as chronic severe pain, a brain injury, or substance abuse, well after they are discharged from military hospitals, and 59% of these victims must cope with two or more of these issues simultaneously. Researchers theorize that multiple deployments, explosive blast wounds, and the cumulative effects of exposure are fueling this trend. The effects are real, as comorbid victims (patients with two or more chronic conditions) have much higher healthcare costs and have a much harder time readjusting to civilian life.

Study author Dr. Kristin M. Phillips, who is at Haley Veterans Hospital in Tampa, was surprised at the high number of patients that struggle with chronic pain and suggested that these victims receive extended physical therapy to deal with brain injuries and related issues.

Traumatic Brain Injuries

For years, practitioners have called brain injuries the “signature wounds” of the Iraq War. One victim, Lance Cpl. Sam Reyes, suffered a brain injury after a truck explosion that killed eighteen members of his unit. “I thought I was a mess-up, just damn near dumb,” he recalled. “It made me feel like I wasn’t a Marine no more,” he added. VA neuropsychologist Dr. Harriet Zeiner explained that brain injuries are almost like being struck by lightning, and “[y]our brain is not meant to handle that energy blast going through it.”

Combat-related TBIs are notoriously hard to diagnose. First, the brain is adept at concealing its own injury; second, many soldiers do not want to go off the line. The delayed diagnosis means that it is also difficult to treat TBIs stemming from:

  • Concussion Wounds: Blows to the head from shrapnel, bullets, and other objects often cause TBIs; even if the victim’s helmet absorbs much of the initial impact, the jarring motion that comes when victims are thrown essentially shoves the brain against the inside of the skull.
  • Shock Waves: Researchers are still not sure how explosive blasts create shock waves that disrupt brain functions, so even contractors that do not sustain trauma wounds may have serious brain injuries.
  • Long-Term Effects: Repeated exposure to combat stress erodes the amygdala, which is the part of the brain that controls decision-making, memory, and emotional reactions. In other words, Post Traumatic Stress Disorder is a physical injury and not a processing disorder.

Since many contractors are in-country for more than one deployment, the chances of suffering all three types of brain injuries are significantly elevated.

Dealing with Brain Injuries

Previously, practitioners believed that short-term physical therapy was best for TBI patients, under the theory that these victims would either recover fairly quickly or not at all. Then, earlier this year, researchers in San Diego made a startling discovery. Brain-injured rats actually started spouting new dendritic spines after long-term physical therapy, yielding 50% better results.

These findings are probably related to the advancing medical technology referenced earlier that makes combat injuries much more survivable. Before, physical therapy reached its limits after only a few weeks or months because if the brain did not respond to rudimentary techniques, the theory was that rehabilitation had reached its ceiling and that the law of diminishing returns was about to kick in. Now, TBI patients that had been essentially written off before may be able to fully recover and fully re-integrate.

Compensation for Brain Injuries

The Defense Base Act is designed to help contractors completely recover from their injuries, and in today’s world, complete recovery nearly always means high medical bills and often means rather unconventional medical and therapeutic practices that are nonetheless evidenced-based.

In addition to emergency care, follow-up medical care, payment of prescriptions, physical therapy, etc., the DBA provides insurance benefits that pays compensation for missed work, so instead of worrying about bills, victims can concentrate on getting better.

In DBA cases, the insurance company is quick to challenge the causal relationship of many injuries to the work environment on the grounds that they are not work-related or are “ordinary diseases/conditions of life.” Insurance companies eagerly trot out expert witnesses to testify to this effect. So, in addition to consulting the treating physician, the victim’s attorney often partners with independent medical experts to  rebut the opinions of the insurance company’s “hired guns.”

Contact Barnett, Lerner, Karsen & Frankel for more information about qualifying for injury compensation.