Often called the “silent injury” of the walking wounded, veterans with traumatic brain injuries are in the spotlight after a whistleblower alleged improper screening procedures for benefits and pensions by the Amarillo Veterans Administration.

The controversy initially spilled onto the public stage when Dr. Roy Marokus, formerly chief of the Compensation and Pension unit at Thomas E. Creek VA Medical Center, blew the whistle on a spreadsheet of 70 veterans in Amarillo who were not screened by one of four types of specialists required by policy:
Psychologists, neurologists, neurosurgeons and physiatrists.

“Think about what they have to deal with if they’re misdiagnosed,” Marokus told news station KARE 11 in Minneapolis. “They’re out in never-never land. It’s a crime.”

Marokus said the diagnoses were being given by health care professionals who were unqualified and uncertified to perform traumatic brain injury screening.

Amarillo VA officials have questioned the phrasing in Marokus’ interviews, saying he omits the fact that screening for traumatic brain injuries only must be done by specialists when veterans are seeking benefits and compensation.

“I went back and I looked at every single thing that the doctor said, and he didn’t say anything correct. He was just very careful in how he picked his words,” said Michael Kiefer, director of the Amarillo VA. “He never said that veterans never got care. He said they may be disadvantaged or not compensated … Veterans who come to us for health care, we will do our best to look at their symptoms, do the diagnostics and treat them for whatever they need.”

Kiefer said people often mistake the roles of the Veterans Health Administration, which manages one of the largest health care systems in the world, and the Veterans Benefits Administration, which supplies compensation and vocational assistance to disabled veterans.

The Office of the Inspector General of the U.S. Department of Veterans Affairs has been reviewing all traumatic brain injury examination records after problems were identified at the Minneapolis VA Medical Center.

The OIG confirmed to the Globe-News it is looking at the compensation and pension exams, not the medical care.

However, this reassessment of diagnoses concerning benefits and compensation has spread nationally to every VA center and to non-VA health care providers.

Kiefer would not confirm how many veterans in Amarillo were not diagnosed by one of the four required specialists when seeking benefits, but said that as medical knowledge of traumatic brain injury improved over the past decade, screening and health care policy has struggled to keep pace.

Veterans who were not diagnosed by an approved specialist are being contacted and will be reassessed and awarded back pay for missed benefits between 2008 and 2013, Kiefer said.

Kiefer admitted a misdiagnosis when seeking benefits and compensation could discourage a veteran from seeking treatment.

Traumatic brain injury falls under four categories: Mild, moderate, severe and penetrating. Unfortunately, the illness is difficult to diagnose, as 82.5 percent of cases fall into the mild category, which is not discoverable by an X-ray CT scan.

“This is the most common injury in veterans coming back from Afghanistan and Iraq,” said Dr. Michael Lambert, chief of the Mental Health Service department at the Amarillo VA. “They were exposed to improvised explosive devices, rocket-propelled grenades and mortar blasts that were shot into the bases. It was part of the way they were waging war against us in Iraq and Afghanistan.”

The symptoms of mild traumatic brain injury, including lack of concentration, confusion, irritability and headaches, often overlap with other illnesses. Lambert said mild brain injuries often come from soldiers being close enough to an explosion to feel the shockwave.

“The symptoms are somewhat nonspecific, and what I have seen in my career with these is that if you’ve been in combat serious enough to almost get blown up, you will have post-traumatic stress disorder symptoms also,” Lambert said. “There is a strong overlap between PTSD and TBI (traumatic brain injury), and that is the challenge.”

Traumatic brain injury is also gaining attention in sports such as football and boxing, where repeated collisions can cause brain damage.

March 15 has been designated as Brain Injury Awareness Day by Congress, and the month of March has been recognized as a time to learn and discuss issues concerning brain injuries.

To learn more, visit www.biausa.org.