Invisible wounds of war

The following is a script from "Invisible Wounds" which aired on May 5, 2013. David Martin is the correspondent. Mary Walsh, producer.

We all learned a lot in recent years about the dangers of head injuries from contact sports like football. We now know that a hard hit can cause brain damage that only becomes apparent after an athlete's playing days are over. Football is violent, no doubt, but it's nothing compared to war. And just as the National Football League has struggled to come to grips with head injuries so has the military - but on a much vaster scale.

An estimated quarter million servicemen and women have suffered concussions over the past decade of war. Tens of thousands -- no one knows the precise number -- are dealing with lasting brain damage. The Pentagon, which did not recognize the problem until the war in Iraq was almost over, is now scrambling to treat these invisible wounds. And soldiers suffering from them sometimes end up wishing they had a wound people could see.

Ben Richards: If I could trade traumatic brain injury for a single-leg amputation I'd probably do that in a second.

You heard that right -- retired Army Major Ben Richards would rather endure the disfigurement and disability of losing a limb than live with the aftershocks of the concussions he suffered in Iraq. The first one happened on Mother's Day 2007 when his armored vehicle was rammed by a suicide car bomber.

Ben Richards: Everyone that was in the vehicle, walked away with a pretty significant concussion. My head hurt for about a week. I was nauseated for a week. Literally couldn't see straight.

David Martin: So what do you do when you have symptoms like that?

Ben Richards: Go out again and fight the next day.

David Martin: What are you doing going back into combat? I mean, you've got men you're responsible for...

Ben Richards: Exactly. That's why I went back into combat.

In two months of fighting, seven of the 17 armored vehicles under Richards command were destroyed. Richards had a second vehicle blown out from beneath him just weeks after the first.

Ben Richards: Once again we all walked out with all of our parts and pieces.

Richards had no visible wound but he had suffered an injury that would end his Army career and very nearly ruin his life.

Farrah Richards: He spent a lot of time by himself in closed rooms.

Farrah Richards could see her husband was a changed man when he came home but couldn't see why.

Farrah Richards: As a spouse, I wasn't thinking "he has traumatic brain injury." That wasn't even something that I really knew about.

Doctors at Ft. Lewis, Washington, told Richards he was simply suffering from post-traumatic stress, a diagnosis that would hang over him for four years.

Ben Richards: If you have post-traumatic stress disorder and you are not improving through counseling, then it's your fault.

David Martin: You're not trying hard enough?

Ben Richards: It was my fault that I wasn't getting better.

Not willing to give up on a promising young officer, the Army promoted Richards and gave him his dream job: professor at West Point. But he found himself blanking out in the middle of class. He got this evaluation from the head of his department: "Major Richards can't teach . . . unable to accomplish any aspect of his job . . . unable to come to work on most days. . . suicide risk high."

Ben Richards: I was in such a bad place mentally that I was really looking for a way out. I don't think I was ever suicidal. But I was...I was thinking of ways that I could break my leg or something because two weeks in the hospital, that was a better option for me.

In the military, concussion was an invisible -- and therefore neglected -- wound. It took an outsider -- Dr. David Hovda, director of the Brain Injury Research Center at UCLA -- to prove to the Pentagon that even a mild concussion can result in serious injury.

David Hovda: And the thing that was remarkable about this particular image was that this was the face of the hidden wound that people didn't see.

The brain on the right shows normal activity. The one on the left is a UCLA football player who had suffered a concussion which left him dazed, but able to answer simple questions. The one in the middle is a patient in an unresponsive coma.

David Hovda: We scanned both of those individuals.

The nearly identical images showed Hovda for the first time the physical damage even a relatively mild concussion can cause.

David Hovda: This was so stark, it looked people in the face and they said, "This is the face of concussion."

Pete Chiarelli: That was a eureka moment for me, absolutely a eureka moment, because that's what we were experiencing down range with our kids.

Retired Army General Pete Chiarelli served two tours as a combat commander in Iraq but admits he was clueless about brain injury when he became the number two man in the Army in 2008.

Pete Chiarelli: I had no idea that traumatic brain injury and post-traumatic stress were, in fact, the two largest categories of injuries that we had.

Chiarelli found that traumatic brain injury and post-traumatic stress accounted for 36 percent of the disabling injuries suffered by soldiers in Iraq and Afghanistan. Amputations accounted for 10 percent.

David Martin: What did you think when you first saw those numbers?

Pete Chiarelli: It just absolutely floored me. I couldn't believe it.

Desperate to do something, General Chiarelli brought Dr. Hovda to the Pentagon to brief the military medical establishment.

David Hovda: So I gave my shtick and then a couple of the, of the medical doctors stood up and they said, you know, "We really appreciate you coming here, but what you're advising us to do is bad medicine." And I said, "What do you mean bad medicine?" And they said, "Well, if you take an individual out of the, of theater, of a, of a battle and let them rest because they've had a concussion before you put them back in, they're going to believe that they're brain injured and you're going to make them worse."

David Martin: Bad medicine . . . among doctors those must be fighting words.

David Hovda: Yeah, I was very--I was very shocked when I heard that.

Pete Chiarelli: There's a stigma associated with anything that occurs above the neck with the brain. And that same stigma was something that I saw in the military.

David Hovda: And General Chiarelli called me on the phone and he said, "Now you understand our problem. Now you understand how bad it is."

Chiarelli didn't wait for the argument to be settled. In late 2009, he issued new orders to all Army units in Afghanistan - any soldier with a concussion had to be held out of the fight until he was fully recovered.

Pete Chiarelli: But, the problem is, if you have a second concussion before the first one is healed, then we see cognitive issues. Long-term cognitive issues can develop that cause all kinds of issues.

It's a problem Dr. Hovda had seen before as a consultant to the National Football League.

David Hovda: Are these individuals that are going come back from Iraq and Afghanistan that have had repeat mild traumatic brain injuries, are those going to be like the retired NFL players that are committing suicide who have problems with dementia?

While the military scrambled to prevent future brain injuries, a private citizen named Arnold Fisher, for years one of the military's greatest patrons, set out to help troops already suffering from invisible wounds.

For information on Arnold Fisher's foundation, click here

Arnold Fisher: We owe them.

Head of one of New York's most successful construction firms, Fisher offered to build a state of the art brain injury center. His foundation would raise the money. All he asked of the government was to stay out of his way.

Arnold Fisher: We can build it in half the time, half the cost and twice the quality.

Fisher had already built a $52 million facility for amputee care in San Antonio.

[Arnold Fisher: That's their building.]

Then he raised $72 million in private donations to build a brain injury center at the Walter Reed National Military Medical Center just outside Washington, D.C.

[Arnold Fisher: For traumatic brain injury and post-traumatic stress.]

It opened in June 2010. Fisher called the new building the National Intrepid Center of Excellence - NICoE for short. It is a mental health facility like no other in the military. Each patient is assigned a seven-person team of specialists and examined by the latest in brain scanning technology.

[Technician: We can see the orbits. We can see the inner ear area. We can see the nerves.]

James Kelley: This particular machinery gathers 41,000 images and the conventional MRI scanner would actually capture somewhere between three and 400 such images.

Dr. James Kelley, the director of NICoE showed us how one soldier's brain looked normal in a conventional CT scan while more sophisticated screenings revealed physical damage.

James Kelley: Using the more advanced technology called SWI just in that same plane of the brain there are multiple black dots, unequivocal evidence of traumatic brain injury.

David Martin: No more guess work. I mean, that's--that's a big deal in any field.

James Kelley: It's huge. We've been able to detect in more than a third and not quite half of our patients' abnormalities that hadn't been seen in any previous imaging.

David Martin: Nearly half the, the soldiers who come here are seeing for the first time that they have physical damage to their brains.

James Kelley: It's between 40 and 50 percent.

But here's the catch: NICoE treats only 20 patients a month. So just a fraction of the servicemen and women suffering from traumatic brain injury ever get in the door.

Technician: All right. Here we go.

David Martin: And what are the estimated number of cases of traumatic brain injury?

James Kelley: Traumatic brain injury has been diagnosed over the last 11 years in about a quarter of a million service members.

Most of them have simple concussions and will recover. But tens of thousands - the Pentagon is not sure exactly how many - have serious, perhaps permanent, injuries to their brain, injuries which, because they're invisible, can be hard to explain. Sgt. Allen Hill suffered concussions in Iraq and Afghanistan but it wasn't until he got his brain scanned at NICoE that he could prove he wasn't just faking.

Allen Hill: There's folks out there that just accuse soldiers of being malingerers, of faking symptoms and that's like calling me a coward and I'm not.

David Martin: So when you see that physical damage to your brain, what does that say after a year of being told you were a malingerer?

Allen Hill: Makes me want to whip someone's ass for that kind of carrying on.

Doctor: I'd like to show you the brain MRI images that you had done.

After four years of blaming himself for not getting better, Ben Richards came to NICoE and found out he was suffering from more than post-traumatic stress.

There it is - a significant loss of activity on one side of his brain.

Ben Richards: It does seem to really affirm that this is a physical injury. You know, I've actually been damaged. This is not something that's just made up. It really lifts a burden that there's a reason why I have trouble getting back to that normal that - just always seems out of grasp.

And likely to remain out of grasp because doctors at NICoE cannot cure brain damage. The best they can do is help soldiers cope with the lasting effects of their battlefield concussions.

David Martin: The science says you should have sat out. If you had to do it over, what would you do?

Ben Richards: I could not have made a different choice.

David Martin: Because?

Ben Richards: In the fight we were in . . .

David Martin: It's OK, take your time.

Ben Richards: Some days we didn't come back. We were out in our combat outposts five or six days a week, sometimes literally fighting from the walls of our combat outposts. Maybe having a little residual traumatic brain injury seemed like the least of our worries.

[Marine: How you doing, sir?

Arnold Fisher: How ya doing?

Marine: Nice to meet you.]

No one is more moved by stories like that than 80-year-old Arnold Fisher . . .

[Arnold Fisher: We owe you guys. You, know, we owe you guys a lot.]

...who is once again a man on a mission: This time to raise $90 million to build nine more brain injury centers at military bases around the country.

[Manager: You just let me know what you need and when you need it. We'll get it there.

Arnold Fisher: I'll hold you to that.

Manager: That's not a problem.]

One of the first is under construction at Camp Lejeune, North Carolina.

Arnold Fisher: People say to me the government should be doing this. Yeah, the government should be doing this, but they're not. So we do it.

Nine would enable the military to care for 9,000 brain injuries a year which is the number of new cases they are expecting even with the war in Afghanistan winding down.