Sixty-six percent of the most seriously wounded soldiers returning from Afghanistan and Iraq have "invisible" injuries -- brain trauma or post-traumatic stress -- which their families and society will deal with for decades, said Gen. Peter W. Chiarelli, the Army's vice chief of staff.
"The truth is, because we don't see these injuries ... they don't receive the same level of attention as amputations, burns, shrapnel injuries," Chiarelli said. "There is simply a bias ... either conscious or subconscious toward invisible wounds and injuries.
Chiarelli made his remarks Sept. 26 at Defense Forum Washington, a one-day conference on support for wounded warriors and families. The annual event is co-sponsored by U.S. Naval Institute and Military Officers Association of American.
Before Chiarelli spoke, April Marcum, wife of retired Air Force Tech. Sgt. Tom Marcum, described how her husband saw that bias from the medical community when he returned wounded from Iraq in 2008. A combat arms training and maintenance specialist with 12 years in service, Tom Marcum had been in charge of an armory on Ali Air Base Iraq when he was knocked unconscious by an insurgents' mortar round.
He later called his wife to say that, except for a headache, he was okay. A medic told him he should rest a couple of days before returning to duty. When his tour ended several weeks later and he returned to Moody Air Force Base, Ga., she could tell he wasn't himself.
"He still had the same headache. He was confused at simple things. He had short-term memory loss. The last straw for me was the day he called me on his way from work ... and said, 'I can't remember how to get home,' " April Marcum recalled.
"The local medical community, including the Air Force medical clinic doctor, seemed to be reluctant to help," she said. "Tom's primary-care doctor implied Tom was trying to get out of work. This was a slap in the face to both of us" considering that, with two boys to raise, the couple hadn't complained during deployments.
"Then the doctor made this statement: 'I'll write you a prescription for Motrin but you really need to suck it up and go back to work,' " she said.
They pressed for an appointment with the medical group commander. Eventually Tom Marcum got a thorough evaluation at the poly-trauma unit of the VA Medical Center in Tampa, Fla. Doctors diagnosed traumatic brain injury with an orbital wall blowout fracture behind an eye. A shoulder required surgery. He also had hearing loss, vision deficit and post-traumatic stress disorder.
He spent months in Tampa and "received outstanding medical treatment," his wife said. He was medically retired from the Air Force in May 2010. Three years after returning from war, he remains on the temporary-duty retirement list awaiting word on whether the Air Force will retire him permanently. April Marcum had to quit her teaching job to care for her husband and raise their sons. While living on 70-percent disability payment from the Air Force and Social Security Disability Insurance, the Marcums exhausted their life savings, she said.
"I honestly believe it relates back to the stigma" tied to these invisible wounds of war, Chiarelli told April Marcum during the gathering. "The medical community is as much stigmatized by these injuries as anybody."
As vice chief, Chiarelli said, his top priority "is the health and well-being of the force," which explains his focus on "the signature" wounds from Iraq and Afghanistan. Many soldiers and veterans with post-traumatic stress disorder and traumatic brain injuries aren't yet receiving care because their injuries haven't been diagnosed and might not be discovered for years.
The National Institute of Health, he said, has estimated that the average length of time between the incident causing post-traumatic stress and diagnosis is 12 years.
"And lots of bad stuff happens in that 12-year period," he said, which can impact individuals, their families and careers.
Symptoms of both post-traumatic stress and traumatic brain injury can include difficulty concentrating, irritability, personality changes and memory impairment. Yet, the physiology behind these types of injuries still is not well understood, Chiarelli said.
"The reality is that we as a department and as a nation will be dealing with the symptoms and effects of these injuries for decades to come. And make no mistake, this is where your money will be spent," Chiarelli said.