JIM LEHRER: Now: a story about hearts and minds. That’s Purple Hearts and soldiers with traumatic brain injuries suffered in combat. Our report is an unusual public media collaboration. The NewsHour worked with our colleagues at PBS’ “Frontline” to produce this story. It was based on the reporting of T. Christian Miller the online reporting Web site ProPublica and Daniel Zwerdling of National Public Radio.
He’s the one with the headsets on.
MAJ. MICHELLE DYARMAN (RET.), U.S. Army: I don’t remember a lot anymore. I don’t even remember a lot of my childhood anymore.
DANIEL ZWERDLING, National Public Radio: Michelle Dyarman was a major in the army. We met her at the farmhouse in Pennsylvania where she grew up.
MAJ. MICHELLE DYARMAN: Coming here today, I got lost three times. I had to turn around and find my way three times. And I have driven that route many a time.
DANIEL ZWERDLING: Dyarman was on the dean’s list back in college. She got a master’s. But everything changed in Iraq.
Two days before Christmas 2005, Dyarman’s platoon was coming back from a mission, and a roadside bomb exploded in front of her, like the one in this archive footage. Studies show that the blast wave shoots through metal, it shoots through soldiers’ brains, and it damages the brains cells and circuits. Dyarman says, it’s hazy, but she remembers that she wrenched her back and neck, and she thinks the medics gave her Tylenol and Valium.
MAJ. MICHELLE DYARMAN: I realized I had a screaming bad headache. Take the worst headache you have ever had, and multiply it by about 1,000. And I have had an ongoing headache ever since.
DANIEL ZWERDLING: Michelle’s father, John, doesn’t know what’s wrong with her.
JOHN DYARMAN, father of Maj. Michelle Dyarman: She’s not the person she was. Michelle used to do everything for me, you know, take care of all my paperwork and stuff. And I kind of help her now.
DANIEL ZWERDLING: Oh, my goodness. That’s all your records? Dyarman’s files tell the story. She’s had to fight the Army to figure out what’s wrong with her brain.
MAJ. MICHELLE DYARMAN: This box is heavy.
DANIEL ZWERDLING: Six weeks after the explosion, the Army sent Dyarman home. But she says she could hardly function. So, the Army sent her to Walter Reed Hospital. The doctors there gave her counseling for post-traumatic stress disorder and physical therapy for her neck and back, but nobody diagnosed her main injury until Dyarman left the Army, persistent symptoms from traumatic brain injury, or TBI.
Anybody at Walter Reed ever say to you, Michelle, there’s something called a traumatic brain injury, and there’s — you have been in two blasts and a motor vehicle accident; perhaps you have one; we’re going to look into this?
MAJ. MICHELLE DYARMAN: No.
DANIEL ZWERDLING: Dyarman’s not alone. The Pentagon’s official figures show that 115,000 troops have suffered TBIs. Some studies suggest the true number could be several times higher.
Most soldiers get better within days of a TBI. But Dyarman’s part of what researchers call the miserable minority. Their symptoms last for years, maybe forever. Studies suggest there could be tens of thousands of soldiers like Dyarman. But, Dyarman’s files show that many commanders still don’t believe that TBIs are really an injury. She has applied several times for the Purple Heart, and the Army has never approved it.
So, what is it about the Purple Heart that feels especially important to you?
MAJ. MICHELLE DYARMAN: It says that I was injured in combat, in — in a war. It’s a part of history. And I can’t seem to get that documented.
DANIEL ZWERDLING: For soldiers like Dyarman, the Purple Heart says: You faced the enemy. You sacrificed for your country. It’s been awarded since the 1930s.
NARRATOR: Purple Hearts are awarded to United States soldiers who bravely met the attacks of communist bandits and suffered heroically under fire.
DANIEL ZWERDLING: The Army spells out the kinds of injuries that merit Purple Hearts, like bullet wounds, illness from poison gas, and concussion from explosions, which is the same as TBI.
NARRATOR: The Purple Heart award is only an indirect expression of the real appreciation of a grateful nation.
DANIEL ZWERDLING: So, we went to the Pentagon to find out, why hasn’t the Army given Purple Hearts to many soldiers with TBI?
GEN. PETER CHIARELLI, U.S. Army vice chief of staff: The Purple Heart shows that you did your job, you met with and closed with the enemy, that you went into harm’s way to — to stand up for something your country believes in.
DANIEL ZWERDLING: Peter Chiarelli is the second most powerful general in the Army. He’s the vice chief of staff. He’s the point man on health issues like TBI. Chiarelli says, it’s true, some commanders still don’t award Purple Hearts for concussion, despite the regulations. They still don’t get that TBI is really an injury. But he says he’s trying to change that.
GEN. PETER CHIARELLI: We have got to change the culture of the Army, we have got to change the culture of society, to get people the help they need. But it is a long process. Just because you don’t see blood, just because you don’t see a bullet hole, just because you don’t see a missing appendage doesn’t mean an individual hasn’t been injured.
DANIEL ZWERDLING: So, if I am a soldier or a Marine, and I’m in a blast, and a doctor diagnoses me with having a concussion or a mild traumatic brain injury as a result of that blast, I should get the Purple Heart?
GEN. PETER CHIARELLI: Yes, you should.
DANIEL ZWERDLING: No question?
GEN. PETER CHIARELLI: Well, you’re going to have to go through a process.
DANIEL ZWERDLING: And then General Chiarelli got into the fine print. And soldiers say that fine print makes it almost impossible for them to get the Purple Hearts they say they deserve.
Take Nathan Scheller. He was a tank commander. He suffered multiple concussions in Iraq. He says, at first, he felt he didn’t deserve a Purple Heart. Some of his buddies lost their legs. But now that he’s home, Scheller realizes his brain doesn’t work right anymore. His wife, Miriam, agrees.
MIRIAM SCHELLER, wife of Sgt. Nathan Scheller: It’s a lot more to try to even get his attention. He repeats himself a lot more, now that he’s been home, as well. In the five minutes he’s telling a simple story, he will tell that story five times. You can’t see his injury, really. He looks perfectly fine. So, there’s even times that I, as a spouse, forget something’s really going on with him.
DANIEL ZWERDLING: Scheller was home from Iraq for a year before doctors diagnosed his traumatic brain injury. They sent him to a brain rehabilitation clinic. But when it comes to the Purple Heart, he has to prove what happened to him in Iraq. He has to prove he was wounded in a specific explosion on a specific day. He has to show that a doctor diagnosed his TBI and treated him. And that can be a huge problem for a lot of soldiers, because Army doctors didn’t keep many of those records.
SGT. NATHAN SCHELLER (RET.), U.S. Army: I would get told that, well, I got to have this form. So I would get this form, start over. The Army wants to ask you, well, how long were you knocked out for? How the hell do I know? So, I prepared all this paperwork myself, and then I submitted it.
DANIEL ZWERDLING: To whom?
SGT. NATHAN SCHELLER: To — to my commander. But it would never go any farther than this.
DANIEL ZWERDLING: We asked the Army two simple questions: Which commanders rejected Purple Hearts for Scheller and other soldiers with TBI, and why? A spokesmen told us, they don’t keep that information.
But we obtained internal Army documents, and they suggest one answer. These e-mails show that commanders in Iraq debated whether they should give Purple Hearts to most soldiers with TBI. Some thought it was like giving the Purple Heart for minor scrapes.
That mind-set became official policy under General Joseph Caravalho. He ran the medical system in Iraq in 2008. His memo said, “In many cases, soldiers wouldn’t get Purple Hearts if they only got minimal medical treatment.”
The problem is, the official regulations don’t say anything about how much treatment you have to get for a bullet wound of any other injury. So, Caravalho’s memo creates a much tougher standard for TBI. Caravalho wouldn’t talk to us, but he told us in e-mail that he was trying to help. We showed his memo to General Chiarelli.
Were you aware of this memo before yesterday or today?
GEN. PETER CHIARELLI: No, I wasn’t. I have asked my lawyers to look at it to make sure that we don’t — we have not made this more restrictive than the Army regulation.
DANIEL ZWERDLING: Chiarelli says some soldiers with TBIs have received Purple Hearts. But the Pentagon told us they don’t know how many, and they don’t know how many have been denied.
GEN. PETER CHIARELLI: And I appreciate you bringing this to my attention. I will go downrange and ensure that I talk to them and let them know that they need to be more in line with the regulation.
DANIEL ZWERDLING: We asked officials at the Pentagon, what’s the Purple Heart policy in Afghanistan, now that the fighting and explosions are shifting there? They said they’re revising the policy.
Meanwhile, the military says they’re making progress on traumatic brain injury in general. They have just opened a center to study it. And they have rolled out new policies designed to diagnosis and treat it better. But, for soldiers like Michelle Dyarman, those changes haven’t come fast enough. She’s been fighting for proper treatment for almost five years.
MAJ. MICHELLE DYARMAN: It feels like nobody cares, like I was left behind. And one of the things you always learn from the very beginning is, never leave a soldier behind. I was left behind.
DANIEL ZWERDLING: Dyarman and her family and friends say she’s still struggling with her brain injury, and she’s still waiting for her Purple Heart.
JIM LEHRER: On our Web site, you can explore how the NewsHour has followed the emergence of TBI as a serious medical issue in the military, plus find links to “Frontline”‘s coverage of the subject.