Kevin Butler
Equinox Staff
A thin man, standing at six feet tall with a high-and-tight hair cut, paces through the pews of the church at Christmas Mass. At 24 he is fit; he walks straight and stands tall. He wears the distinctive dress uniform of the Marine Corps, not a button or pin out of place. He shakes the hands of friends, families and strangers who thank him for his service.
“Merry Christmas,” he replies.
People point out how good he looks in uniform and ask him how long he is home. Both children and adults look at him with wide eyes, but none of them can see the wound inside my brother.
Marine Corps Lance Corporal Mark Butler suffers from an invisible wound, a traumatic brain injury. This October, Butler was honorably discharged from the Marine Corps after four years of service.
Butler suffered the injury in August 2010, while on base in 29 Palms, CA. He went in for what he thought would be a routine operation.
“I had my wisdom teeth removed; it was supposed to be a normal procedure,” Butler said. He said he was to receive sick in quarters (SIQ) days to recover after the operation. Butler said he felt some pain and spit some blood into a cup, normal symptoms after such an operation, but then started to get dizzy and laid down for a nap.
“I laid down and that’s the last thing I remember,” Butler said.
In the 14 months since the operation Butler has tried to piece the story together, using information his roommates have told him.
“I guess I started seizing and I fell off my top rack and I slammed my head into my locker,” Butler said. “And I guess I fell to the ground, eyes rolling back, blood coming out of my mouth, and the ambulance took me to the hospital on base.”
The base hospital could not provide him with intensive care and he was flown by helicopter to a civilian hospital in Colton, CA, where Butler was in a coma for three days.
Traumatic brain injuries (TBIs) are the trademark injury of the wars in the Middle East and are on a steady rise among veterans returning from these wars.
The brain is a three-pound mass of 78 percent water and the main component of the central nervous system. It controls the body’s main functions like heart rate and breathing, the senses, handles emotions, motor skills, and other parts of the central nervous system. Movement or jarring of the brain can cause multiple levels of concussions flocculating in intensity, pain, and other symptoms.
“A lot falls into the neuro-brain realm, memory, attention. They might think more slowly,” Dr. Thomas McAllister, the director of Neuropsychiatry at Dartmouth-Hitchcock Medical Center, said. “Or more serious like changes in personality, more irritable, more impulsive.”
Butler had similar symptoms.
“I had trouble a lot with speech,” Butler said. “I had a problem early on when I would speak too fast and then would think, fumbling with words, having to slow down speaking.”
Butler listed other symptoms as being disoriented, getting dizzy easily, some loss of hearing, the effect the heat had on him, and how he would tire easily.
Butler said he had plenty of doctors helping him along the way, and a neuropsychologist who did cognitive and memory tests in April 2011. “The neuropsychologist really showed me how bad my memory was,” Butler said.
“The doctor would name animals and simple nouns and I’d have to repeat them backwards to him, and I did really badly on that,” Butler said. He described another test where the doctor would show him shapes and then made him do something else. 10 minutes later the doctor had him draw the shapes again, and Butler would struggle. “Basic memory was the biggest problem,” he said.
“Overall I’m getting better and better every day,” Butler said. “That was just immediate, when I first got out of the hospital and realized how bad I must have hit my head.”
Butler said he has had many doctors who lacked experience in treating and evaluating patients with TBIs.
Butler said, “I’ve heard from many doctors that they didn’t really know how to diagnosis TBIs, that it was sort of overlooked, but with more and more incidents with injuries resulting in TBIs, they’ve gotten a lot better at identifying them and treating them. I had one that wasn’t combat-related but it get treated the same because it’s just as serious.”
According to a study done in 2008 by the Research and Development Corporation (RAND), 57 percent of veterans reporting possible TBIs had not been evaluated for a brain injury. By the same study, the RAND Corp. found that 19 percent of a group of 55,000 troops received a TBI during deployment.
The study also found that in one group of wounded evacuees at Landstuhl Medical Center in Germany, 23 percent tested positive for TBIs and at the Walter Reed Army Medical Center in Washington D.C., another 30 percent tested positive for TBIs.
The study said, “Overall, one quarter of troops evacuated from Iraq and Afghanistan suffered from head and neck injuries.”
In another study, done by researchers for the American Journal of Preventive Medicine (AJPM), they found that the rate of hospitalized troops with TBIs has increased significantly over the years. The study shows that in 2007, the percentage of hospitalized troops with TBIs in Afghanistan was 28 percent and in Iraq it was 27 percent. These indicate major increases since the first records of TBIs in these wars from 2001, when the percentages were at just 10 percent in Afghanistan and 9 percent in Iraq.
The same study by the AJPM also researched TBIs admission rates over seven years in both warzones nearly tripled. In Afghanistan, it was found that 24.6 percent of every 10,000 troops admitted had some type of TBI and in Iraq that number stood at 41.8 percent.
Although the rate of TBIs is at a steady incline, the rate of mental health support for veterans is declining. According to the Pentagon’s Task Force on Mental Health in 2004 there was a 1 : 387 ratio of deployed behavioral health workers to deployed troops. By 2007, that number nearly doubled to a rate of 1 : 734.
Since September 2001, nearly two million U.S. military members have been deployed to Afghanistan and Iraq It is estimated that 22 percent of the wounded soldiers have TBIs. The study done by the RAND Corp. estimates the costs of neurological and psychological injuries suffered by veterans of these wars is between four and 6.2 billion dollars, in just the first two years after returning from combat. It also points out that if these veterans were given proper care, these costs could be lowered by 27 percent.
Butler shared his thoughts on if veterans are getting proper care and said, “Yes, but I’m really basing it on my experience. Doctors have been calling, making appointments, they’ve been referring me to other doctors, taking more MRIs, asking me every time I went in with ‘How do you feel?,’ so I think I’ve been treated really well and I’ve gotten the attention that I needed.”
He also said he has received excellent care over the past 14 months.
“The way I’ve been treated this past year, year-and-a-half was unreal,” Butler said. “The naval hospital in San Diego is state of the art, the best technology, great doctors who referred me to others and gave me proper treatment. They made sure I had everything in line for when I got out of the military.”
Although Butler’s injury is very common, the way it happened is anything but. The highest demographic of troops suffering from TBIs is an enlisted active-duty white male, aged 20-29 who suffers a TBI during combat; in other words, an infantryman in combat who crossed paths with an explosive.
Butler said that the increasing number of improvised explosive devices has led to an increase in TBIs.
“They’re very common,” Butler said. “As the war progressed we’ve gotten better at protecting our troops. Less arms and legs getting blown off, it’s more TBIs. When a vehicle gets blown up, it protects you from the outside, but you get rocked inside. It’s like the shaking baby syndrome and you and your brain just get shaken around inside the vehicles.”
Screening for TBIs is also a different process than most visits to the doctor. Many screenings are performed by the Department of Defense and, according to a study by the Iraq and Afghanistan Veterans for America group, they are “an ineffective system of paperwork.” The study points out that without a personal, face-to-face interview, many of these troops with TBIs are redeployed. It said that in surveys of redeployed troops going back to Iraq, an average of 30 percent still suffered symptoms of past concussions.
Butler, however, said he went through extensive testing by the Veteran’s Affairs to be sure he truly had this injury. He recalled a question about how long the person had been unconscious. Since Butler was in a coma for three days, he fell into the “severe” category, requiring a minimum of 36 hours loss of consciousness.
“What I’m waiting on now is for the Veteran’s Affairs to get compensation money,” Butler said. “My doctor referred me to a bunch of different specialists to reevaluate the situation: where I was to where I am now, just so they can compile my whole story together to come up with a solution and treatment, whatever I need.”
Butler is currently waiting on Veteran’s Affairs and paperwork to be able to start receiving compensation. He said, “From what I’ve been told by at least four doctors is I am getting at least 90-100 percent compensation. What they’re evaluating it on is how I will function in everyday life, will my everyday life be affected by what has happened, and what they reflect it on is how someone is going to life with this day to day.”
No one returns from war unchanged. Whether a wound is on the surface, invisible or absent, every member of the military returns with something they didn’t leave home with.
“Because I don’t have a limb blown off, no one can tell that anything is wrong with me,” Butler said. “Since it’s not on the physical side and people can’t see it they think you’re okay; that’s the biggest issue.”
Kevin Butler can be contacted at kbutler1@ksc.mailcruiser.com.