WASHINGTON, DC—According to Staff Sgt Sean Johnson’s physicians his sight could not have been saved, even if his traumatic brain injury was discovered sooner. The damage from the mortar attack that happened on March 25, 2006 had been done and, even though much of it went unnoticed at the time, was irreversible. However, Johnson imagines that his experiences after returning home would have been unimaginably less frustrating had the full extent of his injuries been diagnosed in a timely manner—something that was impeded by a lack of partnership and communication between VA and DoD.

Missing the Symptoms

Nearly four years after his initial injury, Johnson, now fully blind, testified before the House VA Committee last month, describing a transition from DoD to VA that was far from the seamless transition that both departments have been striving for years to achieve. Deployed to Iraq in Oct 2005, Johnson was at the time a veteran of both the Persian Gulf and Bosnia. Between then and 2006, he was exposed to four mortar blasts and a rocket blast, all occurring within 30 feet of him. The last blast—the one that sent him to the hospital—was within 10 feet.

“I saw a bright light and [heard] a loud boom and that was it,” Johnson said. In the days that followed, he was hospitalized at the 332 Expeditionary Medical Group’s in-theatre hospital. He was suffering from vision problems, headaches and abdominal pain, and was diagnosed as having spinal damage from C1 to C7. Rather than concentrating on the headache and vision problems, physicians focused on the abdominal pain. The initial diagnosis was salmonella poisoning and he was given antibiotics.After symptoms persisted, he was taken to Landstuhl, Germany for evaluation, was diagnosed with Clostridium dificile infection and transferred to the states for further evaluation and treatment.

Rather than being sent to Walter Reed Army Medical Center per doctors’ orders, the Army sent Johnson to Fort Riley, KS, where he was placed in a medical holdover barracks and treated for irritable bowel syndrome. He remained there from Aug 2006 to May 2007, his abdominal symptoms persisting. During that time, Johnson wrote letters to his representatives in Congress complaining about the Army’s unwillingness to send him to WRAMC where specialists could evaluate his case. “The reserve case manager at Fort Riley said I would get treatment if I stopped contacting my senator,” Johnson told the committee. “Shortly after [that] I was transferred to another case manager when I stood up to him.”

In Dec 2006, he was finally sent to WRAMC for an evaluation at the Deployment Health Clinical Center. There he was diagnosed with medically unexplained physical symptoms and scheduled for a three-week program for pain management. In late spring 2007, having no diagnosis for his symptoms, Johnson was released from medical hold and sent home to Aberdeen, SD.

At no point in the 14 months since he was sent to the hospital following a mortar attack had he been checked for TBI.

A Hard Transition to VA

It was after he was sent home that Johnson and his wife began the arduous process of getting his care transferred to VA. “I was not contacted by a federal recovery coordinator. I wasn’t contacted by anybody. I had to copy my medical records on paper and take them to VA. And at that point they entered them into their system.And they started all over again,” Johnson explained.Again, physicians focused on his abdominal pain and searched for a GI answer to his problems. In the meantime, Johnson was suffering from dizziness, memory problems and had difficulty with decision making.

In Dec 2007, a VA physician asked him a series of questions concerning falls and blasts that he had encountered during his time in Iraq. His case was immediately flagged for evaluation for possible TBI and he was referred to the polytrauma unit at the Sioux Falls VAMC. It was the first time since his injury that anyone at VA or DoD had asked about his experiences in combat.

Physicians at the polytrauma unit diagnosed him with TBI caused by multiple blast exposures and severe PTSD, and he began receiving treatment for both. The vision loss came a year later. What began as stabbing eye pain in Dec 2008 progressed to double vision and blurriness and eventually to severe vision loss, with his eyesight noted at 20/800. “From the blast injury, my optic nerves had already started to die. With the TBI, my brain can’t comprehend what my eyes are seeing. According to what they told me, it couldn’t have been prevented,” Johnson testified.

However, he said, having the TBI diagnosed sooner, physicians could have picked up on the early signs of vision loss, allowing Johnson’s transition to severe visual impairment to be less traumatic. “It really bothers me it took 21 months to figure out a TBI. I went through all the Army treatment, part of the VA treatment, and it took them 21 months to discern it was a traumatic brain injury,” he declared. “And that’s really scary. Because you can’t get the treatment you need timely enough tobenefityou.And the federal recovery coordinators? We didn’t even know about them.”

Two days before testifying last month before Congress, Johnson received his first call from a recovery coordinator—a full four years after leaving Iraq. “There’s no transition between case managers on the DoD side and the VA side. If I wouldn’t have brought my paperwork, they wouldn’t have known what was going on,” he declared.

Too Few Resources, Not Enough Communication

Johnson’s experience is the latest in a series of worst-case-scenario stories that legislators have been privy to over the last several years. However, there is growing concern among congressional overseers that stories of extreme disconnection between DoD and VA are not outliers, but are perhaps closer to the norm. VSO representatives testifying alongside Johnson echoed that concern. During the American Legion’s 2009 site visits to VA and DoD facilities, volunteers found insufficient staff trying to meet an ever-increasing workload, a lack of family support for returning severely inured veterans, and difficulty reaching new veterans with information about what services are available.

“The American Legion continues to express that service members and their families are easily overwhelmed when dealing with the bureaucracy of multiple departments,” explained Joseph Wilson, American Legion deputy director. “However, a more expeditious process that explicitly focuses on moving service members from point A to point B, ie, DoD to VA, respectively, would ensure timely and accessible care.”

Concern about an understaffed VA social worker system was seconded by Tom Tarantino, legislative associate for Iraq and Afghanistan Veterans of America. “VA Social Workers play an indispensible role in the treatment of veterans recovering from multiple traumatic injuries. The VA must rapidly expand their numbers,” Tarantino stated. “Private sector social workers, on average, work on a caseworker to client ratio of 1-to-10 or 1-to-15. In comparison, in house VA social workers operate near a ratio of 1-to-35. The VA must address this issue before the ratios expand further. These caseworkers cannot properly address the needs of our veterans and their families under these currently crushing workloads.”

As for federal recovery coordinators—a position created in 2007 to assist servicemembers transitioning from DoD to VA—VArecently announced that it had hired five new coordinators, bringing the total to 20. These 20 coordinators currently provide services to 419 veterans.

The core of the problem comes down to a lack of communication between VA and DoD, not only in the area of transferring medical records, but in sharing information on what programs are available and which patients might benefit from them. “If you evaluate the VA, you’re going to find very good programs. In the DoD? Very good programs. But there’s very little communication between them,” Wilson declared.

“There is a serious lack of communication,” added Tarantino. “Particularly for service members in the Guard and Reserve. The VA does not make itself known to the reserve component. Soldiers get these invisible injuries. They get discharged 48 to 72 hours after they leave Baghdad. Now, they’re home. They’re drilling. And they need care. There’s no mechanism to bring them back into the fold of DoD so they can get taken care of and get medically discharged.”

Something similar happened to Johnson, who was required to attend drills, despite being physically unable to participate. “I was put into a holding cell, and I was told until my Medical Evaluation Board was over and they give me a disability rating, they have to give me monthly drills. I go into a room; I sit there; that’s it,” Johnson said. He was medically discharged in June 2008.

According to Tarantino, this is not a unique occurrence. “We’re seeing [reservists] who are 75% to 80% disabled who are getting called back to active duty, because DoD has absolutely no idea these guys are injured. That is the nightmare scenario we are seeing with our membership,” he said.

For some legislators, it confirmed that the attention paid to the issue of seamless transition over the last decade has been both justified and somewhat fruitless. “My colleagues have heard me talk about seamless transition until I was blue in the face. And I think there’s reason for that,” declared Rep Tim Walz, D-MN. “When we first started talking about this here, that was before I did basic training and had a 25-year career and took some time off and came to Congress, and here we sit today still talking about it. It’s not getting care to our veterans, it’s costing us money, and it’s undermining the faith in what we do for them.”

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