For War’s Gravely Injured, Challenge to Find Care

In the eyes of five such relatives interviewed, the military health care system, which is so advanced in its treatment of lost limbs, has been scrambling to deal with an unanticipated volume of traumatic brain-injury cases that it was ill equipped to handle. Largely because of the improvised explosive devices used by insurgents in Iraq, traumatic brain injury has become a signature wound of this war, with 1,882 cases treated to date, according to the Defense and Veterans Brain Injury Center.

In general, these caregivers said that their grievously wounded soldiers had either been written off prematurely or not given aggressive rehabilitation or options for care. From the beginning, they said, the government should have joined forces with civilian rehabilitation centers instead of trying to ramp up its limited brain-injury treatment program alone during a time of war. That way, soldiers would have had access to top-quality care at civilian institutions that were already operating at full throttle and might be closer to home.

In fact, many soldiers do have that access. But unlike Ms. Behee, many caregivers only belatedly come to understand how to negotiate the daunting military health care system.

Generally, after severely brain-injured soldiers are medically evacuated to the United States, they are treated first at Walter Reed Army Hospital or Bethesda Naval Hospital. Relatively quickly, the military, depending on the branch, initiates a medical retirement process that turns the soldiers’ health care over to the V.A. If soldiers succeed in deferring retirement, they remain covered by a military insurance policy that, if pressed, pays for private care.

Still, the military hospitals tend to discharge seriously brain-injured soldiers to V.A. hospitals, regardless of their active or retired status. It is how the system works, and challenging it requires constant haggling, which often leaves the families of the severely wounded soldiers feeling abused, resentful and anxious for those soldiers without an advocate.

“We have been let down by a system that is so bungling and bureaucratic that it doesn’t know what it can and cannot do and just says ‘No’ as a matter of course,” said Debra Schulz of Friendswood, Tex., whose son, Lance Cpl. Steven Schulz of the Marines, 22, suffered a severe brain injury during his second tour in Iraq.