Some Injuries Invisible, But Damage For Vets Is Real

Many veterans returning from Iraq and Afghanistan still find the transition to civilian life difficult -- particularly as a result of trauma.

C orporal Andy Peleaz has finished three tours in Iraq and Afghanistan, but his tours aren’t finished with him.

When Peleaz, 24, left his home in Queens to join the Marines in 2008, he says he was quiet and humble, nice to everyone he met.

“But now? Hell no, not anymore.”

Since returning to New York City in February 2012, Peleaz has been short-tempered and paranoid. He averages three hours of sleep per night and has trouble with concentration and short-term memory. And he grieves daily for his fallen comrades.

Pelaez suffers not only from a traumatic brain injury, or TBI, but also from post-traumatic stress disorder, or PTSD. Data from the RAND Corporation, a global nonprofit research institution, indicate that one in five veterans returning from Iraq and Afghanistan has sustained a TBI; the figure is the same for PTSD.

New York City can be an inhospitable place for someone with a heightened sensitivity to crowds or loud noises. Peleaz has a hard time on busy sidewalks. For Alexander Mobilia, a Navy vet who has PTSD, it’s sirens.

“In Iraq, when you heard a siren, it meant you were going to get shot at,” Mobilia, 28, said. “So when I hear sirens I get a bit…freaky.”

Peleaz, a mortarman, sustained his brain injury on a nighttime operation during Ramadan, August 2009, when an improvised explosive device, or IED – a makeshift bomb – exploded near a Humvee he was in.

“I hit my head – it was like a ping-pong, going left and right,” Peleaz said. “I got knocked out cold.”

The increasing frequency of IED attacks has played a major role in making TBI into what Dr. Mary Hibbard, a neuropsychologist at the NYU Langone Medical Center, calls “the signature of the wars in Iraq and Afghanistan.” In 2009, when Peleaz was injured, there were about 3,300 IED attacks executed in Afghanistan, by NATO figures; in 2011, there were over six thousand.

The danger from IEDs does not lie solely in a direct impact. The waves of pressure that are released by an exploding IED can produce a concussion even in a person not directly affected by the blast. Indirect exposure to multiple blasts can result in series of concussions, each of which compounds the trauma inflicted before.

TBI is difficult to detect because of its surface similarities to, and common co-occurrence with, PTSD. Of 497,000 soldiers who received healthcare from the Veterans Health Administration between 2005 and 2009, 5 percent received treatment for both. Both produce shorter tempers and paranoia, but the emotional damage wrought by PTSD is more readily apparent than the cognitive and behavioral deficits caused by TBI, said Judith Avner, executive director of the Brain Injury Association of New York State.

Until recently, the difficulty of detecting TBIs was further exacerbated by the military protocol for reporting them, which relied on soldier reports. The United States Department of Defense adopted new protocols for earlier detection in 2010, which include mandatory screenings and observations for soldiers who have been exposed to a blast. Dr. Hibbard said that better routine documentation of exposure to potential trauma would help improve the rate of diagnosis.

But diagnosis is only the beginning. For soldiers suffering from the one-two punch of TBI and PTSD, the transition to civilian and family life is an impossibly long road. Peleaz feels that his fellow soldiers are the only people who he can really relate to.

“We text each other every day,” he said. “They ask me if I’m doing all right. I say naw. And they aren’t doing all right either, because it’s hard for them to relate to anybody.”

Mobilia, too, said he has trouble connecting with people –including veterans from previous wars, whose experiences are unlike his.

“Where’s this vet population I keep hearing about?” he said. “Where are the people my age?”

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