The Battle After The Battle

The below is a lenghty article published in local newspaper in area where we live. Posting in entirety as it points to the gruesome realities for military families.

The battle after the battle

Soldiers say military pushes them to discharge before medical needs are met

LES BLUMENTHAL; The News Tribune
Last updated: July 11th, 2005 08:44 AM (PDT)
The day before his 22nd birthday, a bomb hanging from a tree along a road near Fallujah exploded above Rory Dunn’s Humvee.

Dunn’s forehead was crushed from ear to ear, leaving his brain exposed. His right eye was destroyed by shrapnel; the left eye nearly so. His hearing was severely damaged.

“I remember a bright flash. The trees lit up, and the Humvee was shaking,” Dunn recalled during a recent interview while curled up in an easy chair in the living room of his mother’s Renton home.

Within minutes of the May 2004 explosion, he was strapped on a stretcher and flown by helicopter to a hospital in Baghdad – the first step in his 10-month struggle to recover.

Yet, even as Dunn fought to overcome his traumatic brain injury and other wounds, his mother, Cynthia Lefever, fought the Army to ensure her son continued to receive critical care from Army specialists. Lefever said the Army tried to pressure her son into accepting a discharge before he was ready – pressure other severely wounded soldiers say they’ve experienced, too.

Lefever and other critics say the Army’s medical system, particularly Walter Reed Medical Center in Washington, D.C., has been overwhelmed by the number of wounded returning from Iraq and Afghanistan. They accuse the Army of attempting to discharge wounded soldiers before their essential medical needs are met and transfer them to Veterans Affairs medical facilities.

“The Army tried to get rid of him,” Lefever said. “It was immoral and unethical. The Army owes these kids.”

Army officials deny they’re taking advantage of wounded soldiers.

“There are no efforts to ‘rush’ anyone out of the Army or through medical treatment and the disability system,” Col. Dan Garvey, deputy commanding officer of the Army’s Physical Disability Agency, said in an interview via e-mail.

Soldiers are discharged if they no longer can “adequately perform” their assigned duties and have received “optimum medical care,” Garvey said. The process is subjective and can last months or more than year, he said, but soldiers are informed of their rights and can appeal.

“There must be a balancing act, and the system tries very hard to maintain that,” Garvey said.

The issue has attracted attention in Congress and among veterans groups.

John Fernandez, a 27-year-old retired 1st lieutenant from New York who lost part of each leg in Iraq, told the Senate Veterans Affairs Committee this spring the Army tried to discharge him before he received the medical care he was entitled to.

Sen. Patty Murray (D-Seattle), a member of the committee, said she heard similar stories from other wounded soldiers and their families.

“I think (the Army) underestimated the number of wounded. No one predicted this,” Murray said. “I don’t know whether they are overcrowded or just trying to cut costs. No one is talking about it.”

Clinging to life

Doctors initially gave Rory Dunn little chance of survival.

As he clung to life in the Baghdad hospital, they glued his left eye back into its socket and placed him in a deep medical coma to ease brain swelling. Five days later, Dunn was flown to a hospital in Germany, where his family had gone on “imminent death orders” to say their goodbyes. If he lived, they were told, he might need full-time care for the rest of his life.

Almost six weeks after he was wounded, Dunn emerged from his coma at Walter Reed, where he had been transferred. Days later, Lefever said, the Army asked her son to begin the discharge process. She objected.

During the coming months, before his skull was rebuilt, before a cornea transplant, before speech and physical therapy, the Army made at least three attempts to get her son to accept a discharge, Lefever said. In one instance, she said a top medical officer showed up in her son’s room in Ward 58, the neuroscience ward at Walter Reed, and said Dunn needed to immediately sign papers formally starting the discharge process.

“We all understood he couldn’t return to the Army, but he hadn’t even started his treatment,” Lefever said, adding that her son had just emerged from his coma.

In the fall of 2004, roughly five months after he was wounded, Lefever said her son was told to attend a meeting without his mother. During the meeting , which Lefever insisted on attending, Dunn was given three days to sign papers starting the discharge process or the Army would do it without his authorization. At that point, Dunn had not received the surgery that would rebuild his forehead.

“I felt bullied,” Lefever said.

During a six-week period stretching into February, Lefever said the Army stepped up the pressure, at one point offering to send her son to a hospital in Palo Alto, Calif., that specializes in traumatic brain injuries – but only if he first agreed to a discharge.

“I was disgusted,” Lefever said.

Though Dunn wanted out, Lefever said he wasn’t ready and felt the Army was trying to play her son off against her. In phone calls and in meetings, Lefever said her son was repeatedly told that his discharge was “none of his mom’s business.”

“Rory left his right eye, his forehead and his blood in the dirt in Iraq because the Army sent him there,” Lefever said in one e-mail to medical officials at Walter Reed. “Rory went and did his job as ordered by the Army, and deserves so much better than to sit and wait … depressed, angry, frustrated and contemplating suicide. Rory deserves the opportunity to ‘come back’ 100 percent both physically and mentally.”

Feeling overwhelmed, Lefever said she sought assistance from a veterans group, Disabled Veterans of America, as well as Sen. Murray’s office. The veterans group assigned an advocate named Danny Soto to Dunn’s case.

Soto said lots of soldiers feel they’re being “pushed out the door.” He blames the military for failing to adequately explain to the families of wounded soldiers that there will be a “continuity” of medical care after discharge.

After a series of meetings involving Dunn, Soto, a Murray aide, Lefever and Army officials, an agreement was reached that allowed Dunn to be sent to Palo Alto for treatment, then accept a discharge.

“All I wanted was the best for my son,” said Lefever, who made her feelings known to a string of Army officials, including generals at the Pentagon and then-Deputy Secretary of Defense Paul Wolfowitz.

Lefever’s fight wasn’t unique.

‘I felt I was being rushed’

Fernandez, the retired 1st lieutenant, was injured in a friendly fire incident in Iraq in April 2003. His right leg was amputated below the knee, as was his left foot. He was fitted with eight prosthetics before he found ones that were comfortable.

A graduate of West Point, where he captained the academy’s lacrosse team, Fernandez studied the regulations and was able to “push back” and fend off the discharge for months.

“I had to fight to stay on duty,” Fernandez said, adding he didn’t want to be discharged until the Army provided him with the care he felt he deserved.

“A private just out of high school who doesn’t know his rights might just go with the flow,” he said. “You are dealing with injuries that will affect you and your family for the rest of your life. It’s an emotional time. Then you get overwhelmed with all this information.”

Former Staff Sgt. Jessica Clements of Canton, Ohio, suffered a traumatic brain injury when a bomb – the military calls them “improvised explosive devices” – detonated while she was riding in a convoy near the Baghdad airport. To relieve brain swelling, Clements said, a neurosurgeon at the Baghdad hospital clipped off a piece of her skull and temporarily inserted it into her belly for safe keeping.

“I could feel it,” said Clements of the piece of skull stored in her belly for four months before it was removed and reattached.

As she lay in a bed at Walter Reed, Clements said, she received repeated telephone calls from an Army official telling her she needed to start the discharge process.

“I had no idea what was going on,” she said in an interview. “It was only two months after I was injured. I felt I was being rushed. My skull was in my stomach, and I was doing eight hours of therapy a day. It was very frustrating.”

Panel reviews each case

Army officials won’t comment on individual medical cases, but they say they try to be sensitive when discharging seriously wounded soldiers.

“We get complaints and criticisms of the process not infrequently,” said Col. James Gilman, head of the Walter Reed Health Care System. “We get complaints it takes too long and we get complaints it goes too quickly. Our goal is to take care of the soldiers.”

When it becomes apparent a wounded soldier won’t be able to return to active duty, a medical board made up of Army physicians reviews the case. The medical board review can’t be completed until it’s decided the wounded soldier has received “optimal medical care,” said Gilman. And that’s the tricky part.

“It can be very subjective,” Gilman said, adding the medical boards have some flexibility. “We don’t just follow the regulations blindly. It’s not a one-way street.”

The findings of a medical board are turned over to a Physical Evaluation Board, part of the Army’s Human Resources Command, which ultimately decides whether a soldier stays on active duty or is discharged, and what percentage of disability a soldier receives.

Some 11,300 U.S. military personnel have been evacuated due to injuries or illness since hostilities began in Afghanistan and Iraq in October 2001. Of those, 740 had been discharged as of last week, according to the Army.

Medical advances help reduce the number of deaths in wars. With more soldiers surviving near-fatal wounds, hospitals are overburdened.

Gilman said Walter Reed, where many of the wounded are initially treated when they return to the United States, has been swamped at times.

“The installation was not built to handle all the outpatients we have now,” Gilman said.

A hotel on the hospital grounds for soldiers receiving outpatient care and their families is mostly full. Some outpatients are housed at nearby hotels or government-leased apartments.

Other Army medical facilities also feel the strain, including those in the South Sound.

Barracks at Fort Lewis have been upgraded to include, among other things, wheelchair-accessible quarters to house wounded soldiers treated as outpatients at Madigan Army Hospital, the General Accountability Office told Congress earlier this year.

Veterans organizations say they are aware that the military medical system is stretched.

“It’s obvious when you go to Walter Reed,” said Cathy Wiblemo, the American Legion’s deputy director for health care. “They are running out of room.”

Wiblemo said she has no specific knowledge that the Army has moved to discharge wounded soldiers too quickly. But she said she wouldn’t be surprised.

“The Army’s medical bills are going up, and it’s encroaching on other things they have to pay for,” she said.

Murray: Dunn’s case ‘one of many’

Dunn, Fernandez and Clements have been discharged and are being treated at VA facilities or through the military’s Tri-Care System, a health plan that covers military personnel, dependents and retirees.

Murray, who has taken a personal interest in Dunn’s case and awarded him his Purple Heart in June, said she has talked with soldiers who feel the Army has tried to “push them out.”

“Rory Dunn is just one of many,” Murray said. “It strikes me as amazing that Rory needs an advocate in the U.S. Senate. He shouldn’t have to go through this.”

As Dunn’s physical scars fade, the emotional ones linger, as do the memories of that day outside Fallujah a year ago.

“It got me, boy did it get me,” Dunn said of the explosion. “The last thing I remember was stumbling around shouting, ‘Charge, charge,’ and my buddies trying to get me to sit down.”

Though his forehead has been rebuilt, Dunn covers it with a purple baseball cap that says “Combat Wounded” and has the symbol of a purple heart. With thick glasses, he can see out of his left eye. With hearing aides, he can hear.

Lefever said she was surprised when her son joined the Army about a year after high school. She remembers him as a good student who played football and basketball. She said he also had a rebellious streak and was sort of a “cowboy.”

Dunn just shrugs when asked why he joined and later volunteered for duty in Iraq.

“It was a terrible, terrible mistake,” he said. “I was a fool.”

Dunn fidgets as he talks. His attention span is short. He ducks out for a cigarette and to play with his dog Duke, a 6-month-old German shorthair. His memory is intact, as is his sense of humor. He remembers the name of the girl he took to the senior prom. He’s looking forward to getting his own apartment and a driver’s license.

He’s also angry and impatient.

“I feel better, but I wish I could get on with my life,” he said. “I lived in hospitals and rehab for a year. It was the worst thing I ever had to go through.”

Lefever said she refused to give up until her son received the care that she says Army regulations require.

“I remain angry and disgusted with them for certain things, but I am eternally grateful to them for other things,” she said.

Col. Gilman of Walter Reed said he remembers spending a lot of time with Lefever and her son.

“We are grateful for the families who are interested. The mothers, fathers, brothers and sisters,” he said. “The ones who worry me the most are the ones whose families aren’t involved.”

Originally published: July 10th, 2005 12:01 AM (PDT)
© Copyright 2005 Tacoma News, Inc.

The News Tribune - The battle after the battle (print): "� Copyright 2005 Tacoma News, Inc."