WASHINGTON -- Improvised explosive devices rattled former Army Spc. Adam Pittman a dozen times in his three tours through Iraq, most severely when his Bradley fighting vehicle ran over a bomb hidden in the dirt in 2005.
Now, part of Pittman's brain has gone dormant, and on most days, he can't think straight.
He leaves the room and forgets what he was searching for. He gets migraines so piercing that his right eye wanders. Anger comes easily, inspiring rages that sometimes have his wife terrified for herself and the couple's 3-year-old daughter.
Although Pittman, who lives in Lillington, left the military in July 2008 complaining of headaches and memory loss, it took nearly a year to get a brain scan and another five months to receive temporary disability benefits because of his injury.
"They were blowing me off," Pittman, 30, said of the U.S. Department of Veterans Affairs. "I feel like things that have to happen, they're dragging their feet on."
Nearly 30,000 veterans have suffered some kind of traumatic brain injury in the wars in Afghanistan and Iraq - an estimated 2,000 of them severe enough to put warriors into comas or leave them with severe disabilities. Yet eight years into the wars, testimony before Congress shows veterans still suffer yawning gaps in coverage for what has become the conflicts' signature wound.
"It requires someone screaming and fighting on behalf of that soldier," said U.S. Sen. Richard Burr of Winston-Salem, the top Republican on the Senate Veterans Affairs Committee.
At a Senate hearing this month, Veterans Affairs officials listed recent improvements in handling veterans with traumatic brain injuries. Officials did not answer written questions from The News & Observer.
Many veterans and family members say those veterans with consistent help - a spouse or parent, usually - are the ones who are best able to navigate the system, leaving others struggling to find help.
"There's almost a culture of 'no' at the VA," Burr said.
"For the average service member or family member that asks, 'Can we do this?' the automatic answer is 'No,'" he said. "Can we get that service locally? No. Can we go to an outside rehabilitation facility? No."
Among the complaints, from advocates, veterans, family members and testimony to Congress:
Critics say the military has yet to provide an accurate baseline measurement of individuals' brain function in order to determine later when that same person has a brain injury. For now, troops fill out online questionnaires.
Veterans say it can take more than a year for service members to transition from the Department of Defense to the Veterans Affairs department, which delays both treatment and the disability ratings that veterans need to receive financial benefits.
The VA does not routinely refer patients to private providers who might have offices closer to the veteran or be more expert in treating traumatic brain injuries.
Veterans and their families say the VA has denied therapy to veterans who aren't continuing to make progress, when brain injury patients need consistent therapy just to keep from sliding backwards.
"They're just not getting what they deserve and what's available," said Karen Bohlinger, whose son suffered a severe traumatic brain injury as a Special Forces officer in Iraq.
The VA repeatedly denied Bohlinger's request to get a brain scan for her son, who now lives in a rehabilitation facility in Seattle. She eventually paid the bill herself.
"If it's available, why aren't our veterans getting it?" asked Bohlinger, who is married to Montana Lt. Gov. John Bohlinger. She testified to the Senate Committee on Veterans Affairs earlier this month.
Advances in both roadside bombs and trauma medicine have left thousands of warriors severely injured by improvised explosive devices - but alive.
Intensive rehab needed
For those with severe brain trauma, the injuries are obvious: Troops fall into comas, or are left with debilitating speech and cognitive problems. Many, like Bohlinger's son, are steered to intensive rehabilitative care.
Harder to diagnose are soldiers and Marines suffering from the more common mild or moderate traumatic brain injuries. Those come from concussions or repeated blasts, can often be mixed with post-traumatic stress syndrome, and leave veterans unable to complete basic tasks because of memory loss, disorientation or intense pain.
The military has said it is offering pre-deployment and post-deployment cognitive screenings for Marines and soldiers headed to war zones. But congressional staff have found the screenings amount to little more than filling in bubbles in online questionnaires.
"I'm just as worried about the mild TBI cases we're not picking up," Burr said.
Shannon Pittman said her husband made little progress with the VA until a friend recommended the couple contact U.S. Sen. Kay Hagan, a Democrat from Greensboro, who then paved the way for Adam Pittman first to receive an MRI and then temporary benefits.
Still, she would like to see more services for Adam, who has been told by the VA that he must return for another MRI in late 2011 to measure progress.
"He's not being given the tools to be taught how to live with it," Shannon Pittman said. "They act like it's going to go away. It's not going away."
Burr said he has seen little improvement in services since Congress gave the Veterans Affairs Department new authority in 2008 to begin contracting with private care providers for patients with brain injuries.
The VA said it has more than 300 agreements in place with private providers across the country, but it could not provide the number of veterans who have been referred to private care.
"People who have this terrible situation want the best care immediately available to them and ideally close to home," said Bruce Gans, vice president and chief medical officer at the Kessler Institute for Rehabilitation in New Jersey. Gans testified before Congress this month and said the VA could be doing much more to take advantage of private medical providers.
The 2008 defense bill also authorized the creation of federal recovery care coordinators - VA workers who try to help veterans find the type of specialized care they need.
Two years later, there are about 30 federal recovery care coordinators working across the country, according to the Veterans Affairs agency.
The VA could not tell the Senate Veterans Affairs committee what each coordinator's caseload is now. A report to the committee about the VA's progress in treating brain trauma indicated that of three individual cases in the report, only one had a federal recovery coordinator.
$5,770 per TBI case
In its report to the committee, VA Secretary Eric Shinseki said the agency paid $21.4 million last fiscal year for public and private medical services for 3,708 veterans with traumatic brain injuries. That averages less than $6,000 a patient.
The VA also has begun a pilot program to develop assisted living facilities for veterans with traumatic brain injuries. So far, the VA has identified five veterans in need and has placed three of them, the agency says.
In his report, Shinseki writes that the agency has made "significant progress" in treating brain injuries. Several advocates and members of Congress agreed.
But former soldiers such as Pittman say more needs to be done. In a recent interview, he offered advice for other veterans:
"For everybody else that's going through this, to not give up," Pittman said. "Because the way the system is set up, it's for you to get started, and get frustrated and quit. Keep trying."
