The Iraq War’s Invisible Wounded

Mj 618_348_the wars invisible wounded

It had all the makings of a miserable night, and the convoy commander wasn’t helping. On a barbarous stretch of road 10 clicks south of Baghdad, he ordered the mile-long procession to halt so his men could dismount and fix the chains. They were running top-heavy, carrying Abrams tanks on enormous flatbeds, and he feared that one of the tanks would pry loose. But stopping was always a bad idea, particularly on Military Supply Route Tampa, where insurgents lurked in culverts and concrete huts, holding remotes for roadside bombs. Hence, the first rule of resupply work: The convoy never stops.

From the turret of a Humvee, riding flank protection, Corporal Kevin Workman listened through headphones as his lieutenant pressed the commander to keep moving. They’d been strafed repeatedly on MSR Tampa, and with dusk coming on, pulling off was begging to be ambushed. But the commander insisted and the convoy braked.

The first shots came from Workman’s left – a machine gun in the distance. To his right, he spotted a burst from a second gunner. Workman was returning fire with his balky .50-cal when he saw a white pickup barreling at him. Its lights were off and its truck bed heavy, the sure M.O. of a suicide driver hauling a VBIED, or vehicle-borne bomb. Workman let go with a thunderhead of bullets: The truck didn’t explode so much as vaporize, blowing up a mist of phosphorus and blood and the stray, flaming parabola of a tire. Workman was getting kudos from his crew below when he saw a second pickup making for him. “VBIED!” he yelled and opened up with all he had. He quickly killed the driver but the truck kept coming, coasting on its own initiative, 60 meters out and closing. When it blew, says Workman, “it was like a black-and-white movie, this monster coming at me through the ground.”

Hurled backward by the blast, he cracked his head against the turret before spiraling through the hatch, feet first. He landed on his side and awoke to find his lieutenant hollering in his face. “Couldn’t hear a word he was saying,” says Workman. “He was bleeding from both eardrums, just like me.” Workman finally twigged that his lieutenant wanted him topside, and so, disoriented and in blue-light pain, he crawled back up as tracers sizzled a foot above him. Somehow, he got off a group of shots that knocked out one of the snipers, and as the convoy sped away, the second gunner melted into the dunes. “An amazing act of courage,” says Workman’s lieutenant, James Childers, now a captain. “Kevin saved our necks. We were sitting dead to rights.”

Workman’s crew guided the convoy north to a base 20 miles up the road. There, they topped off ammo and sat dazed through dinner. “I had a killer headache and was sore all over but figured I was good to go,” says Workman. “In fact, I thought, I’m lucky: I just got exploded, and lookit – not a stitch of metal in me.”

He had no way of knowing what had happened inside his skull. When he slammed against the turret, his brain, which, like all brains, has the texture of tepid Jell-O, was sent smashing off the superhard sheath of his skull, then caromed back again when he fell forward. That “coup contrecoup,” as neurologists call it, bruised the front and rear of his brain. He awoke with a concussion, some permanent loss of hearing, and several herniated discs at the top of his spine that would make the ensuing headaches all the fiercer. But that blow was the least of it. In the fraction of a second after the VBIED exploded, the shock of pressurized air that had thrown him backward punched through his heavy Kevlar vest. This wave, which would likely have killed him in wars past by collapsing his lungs, did no harm to his major organs, thanks to his body armor, but pushed up into his brain, either through his blood vessels or his eyes and nose. Once inside the skull, it crimped, sheared, and pulled apart neural cells and set in motion a string of chemical woes, the effects of which were subtle at first but would constitute the real threat over time.

Alas, it was April 2005, and no one – not the medics or Workman’s lieutenant, and certainly not the four-star generals who wrote policy – had a firm handle on a new kind of injury that would become the blood insignia of the war. Workman declined to be held for observation and was back out on the road an hour later. In the months and years ahead, he’d have cause to regret that, to look back on that night as the pivot point in a life flipped upside down.

It began with a trickle in the summer of ’03, when Baathist guerrillas in Fallujah and Mosul mined the roads with improvised bombs. Soldiers lucky enough to survive those blasts reported a suite of symptoms not seen in other wars. Though the men often looked perfectly fine, they had migraines that lasted for days and eventually turned chronic and disabling, were easily addled by basic tasks or forgot how to do them altogether, erupted in violence over small frustrations, and went weeks without a full night’s sleep. By the fall of ’04, when Workman’s national guard battalion deployed from its base in South Carolina, there were thousands of soldiers thus afflicted, and their syndrome had a name, if no known cure. It was called mild or moderate traumatic brain injury (TBI), a catchall term to distinguish its sufferers from those with penetrating head wounds.

Colonel Geoffrey Ling, an army neurologist, was working at a Baghdad combat hospital at the time. “The insurgency was going full tilt,” he says, “and the number of TBIs was overwhelming. I’d treated brain injuries since I was a resident in Baltimore, but these were so much worse. The tissue swelled fast and the vessels burst, coating the brain with blood.” Already doctors were calling it the signature wound of the war, but none really knew what they were treating. The damage done by blast waves was well beyond their triage expertise. “We were seeing all these cases, and the question arose: Is this a new disease?”

Though it shares key symptoms with post-traumatic stress disorder, with which it’s often confused, mild TBI is a physical wound and will respond only to a personalized program of rehab techniques and drugs. Dimly understood at the cellular level even by the scientists hired to solve it, the syndrome is freakishly hard to treat and can bankrupt a family in short order. (Proper care, which starts in the tens of thousands of dollars, is flimsily covered by insurers.)

For the best possible outcome, early detection is crucial, because troops kept in combat often compound a mild case through exposure to subsequent blasts. But for the first four years of this bomb-driven war, the Department of Defense made little effort to diagnose and sequester these brain-injured soldiers, sending men past the wire to face dozens more explosions while they were symptomatic. Woeful, too, was the department’s handling of TBI sufferers after they left the theater. They went largely unscreened when they stepped off the plane at home, received substandard care when they asked for help, and were left to rot in army hospitals, most notoriously at Walter Reed in Washington, D.C. In the past two years, the military has taken measures to redress this, spending millions on research, opening TBI clinics, and training everyone from medics to junior officers to identify injured troops. But for men like Kevin Workman, this is cold comfort. He wants no amends – just treatment and recognition for a wound that has cost him more than he can say.

To date, nearly 2 million soldiers have served combat tours in Iraq and Afghanistan, but no one in Washington has offered a definitive sense of how many brain-trauma victims have returned. In 2007 the Department of Defense created an agency called the Defense Centers of Excellence to count, treat, and study brain-blast victims. The centers identified about 48,000 cases dating back to 2003 and further asserted that the vast majority of the injuries were mild enough to have healed on their own. But in April 2008, the RAND Corporation ran roughshod over those figures, concluding after an exhaustive nine-month study that more than 300,000 troops had some form of TBI, and only half of them had improved over time.

“They call brain trauma ‘the invisible wound’; well, there’s nothing less visible than being uncounted,” says Paul Rieckhoff, director of Iraq and Afghanistan Veterans of America, the largest and most impactful advocacy group to emerge from the concurrent wars. Rieckhoff, a veteran of the invasion of Baghdad, says his staff is swamped with calls and e-mails from TBI troops or their loved ones, most of them asking how to access care from a military that has largely ignored them. “The VA and DOD paid no attention to this problem the first four years of the war, and now there are all these guys in need of treatment with no clear way to get it. A lot don’t even know they have head trauma, or are too afraid to admit it. They think if they raise their hand for help, it’s the end of their service career.”

Each and every morning, Kevin Workman’s girlfriend, Amy, writes down the list before leaving. It is waiting there, usually under his coffee mug, when he makes the long climb out of sleep, shambling downstairs with a head full of drugs, drenched from the previous night’s nightmares. There are times, even now, four years after Baghdad, when he sweats so thickly that the mattress is soaked all the way through to the springs. He brews the day’s first of several pots of coffee, lights up a Kool with hands that shake badly, and plops himself down at the breakfast table to squint at her few requests. They’re the same each day – make the bed, feed the dogs – but she may as well ask him to free-climb Eiger or write a string concerto. Those dogs will have to learn to feed themselves.

So the day begins for Workman, whom the army promoted to sergeant last year when he retired at 46. There is much to be done on the tumbledown house that he and Amy bought, a two-story cottage on two and a half acres in the tiny hilltop town of Genoa, New York. The porch is rotting off its piers in front, and he’d better get a guy in to price out shingles before the roof above their bedroom caves. But these things demand a focus he can’t piece together, and the hours just seem to run away. On the mornings his skull doesn’t pop like spring ice in the grip of a two-day migraine, he wanders into town to sit at Barb’s Diner and buy lunch all around for retired farmers. Not that he can afford to, but Kevin forgets that he’s broke and hasn’t paid his heating bill. He and Amy fight about his fire-wagon spending – the useless trinkets he buys at auctions, the turkey he had mounted for a fortune in town – but how do you reason with a man who can’t remember to turn off the jerky smoker before it burns down the house around him? This past summer, his father told friends at the gas station that Kevin came back from Iraq “different.” In a town of 2,000, word got around fast, and Kevin was shamed and stung by the lingering stares.

For 20-plus years he’d been unsinkable, a cop turned state trooper who’d proven his mettle by staying calm when shots rang out. “One of the bravest guys I know, always first one through the door, but the big thing was his cool in handling the public,” says Sergeant Frank Hart of the Myrtle Beach Police Department, who partnered with Workman on the bellicose streets of that inveterate party town. (Workman, once a cop in New York State, relocated after a divorce in 1990 and was a deputy or state policeman in South Carolina for more than 15 years.) “It’s crazy here on weekends – lots of gunplay and bar fights, and drunks would yell stuff like, ‘You’re ugly’ or ‘Stupid’ whenever we cuffed ’em up. Kevin would just laugh, saying, ‘Wait’ll you see my brother,’ or, ‘Matter of fact, my mama thinks so too.'”

In 2000, Workman joined the army reserve to earn some extra cash. Freshly remarried to a woman he’s since divorced, he had twins on the way and was hoping to get ahead of his new expenses. Then the war began and, inflamed by 9/11, he took a leave of absence from his state trooper job and transferred to the national guard, eager to bring his cop skills to Iraq. Instead, he was tabbed to do convoy work, guarding the long chains of mammoth trucks that carried food, gas, and ammo to forward bases. It was, he says, “like being a duck in an arcade,” barreling seven days a week on bomb-strewn roads under constant sniper fire. Even after the VBIED incident, he never took time off to recuperate. That was a mistake, though not solely of his making: Someone in command should have pulled him from duty and gotten him acute-care treatment. Thorough bed rest after a concussion is vital to recovery, along with prudent use of analgesic drugs that don’t promote bleeding, say experts. Per the army’s rules, a soldier with a concussion should be kept behind the wire till symptoms pass, then given a battery of exercise tests to ensure that the pain and dizziness don’t recur. But those rules weren’t drafted until 2007, and many medics lacked the training to spot TBI.

“There’s a cumulative effect from added exposures, especially if you still have symptoms,” says Dr. Ross Zafonte, department chairman of physical medicine at Harvard Medical School. “The analogue is athletes with multiple concussions that make them more prone to the next one. Think of players like Al Toon or Wayne Chrebet, who were symptomatic years after retiring.”

For Workman, the headaches that started following the blast got worse and worse by the week, and soon he was choking down so much Aleve that he bled on the toilet each morning. “It’s like a gun going off . . . in my brain,” he says in the kinked, sawed-off cadence of TBI. “Pressure behind my eyes, front to back.” Then he stopped sleeping, started chugging Red Bull and coffee and catching an hour-long nap before dawn. His mood turned black and his memory went to pieces, but he chalked that up to the “chemicals in the sand” and the toxins he’d inhaled from all the bombs. From the VBIED alone, he gulped so much phosphorus that his lungs filled up with fluid. He spent two days on a nebulizer, fighting the first in a series of chest infections.

But hurt soldiers are like athletes in a second regard: They never beg out of the game. “Once I asked for help, that was it for me as a policeman,” says Workman. “It’s a law that you can’t carry a gun and take these meds. How was I gonna feed my kids if I had no job?” And so he pushed on, making hellfire runs from Kuwait to the Syrian border. He was rocketed in Fallujah, mortared in Ramadi. Twelve times, his crew was struck by IEDs, including one big enough to blow the trailer of a semi straight up into the air. He emerged from those blasts a different man, one he doesn’t seem to know or want to be.

“It’s just hard, getting used to this . . . level,” Workman says. “I was always up there and – and now I’m down here. Hard for me to take that it’s . . . forever.” Laid out for him on the counter is his daily choke-roll of pills, including four antidepressants, three drugs to help him sleep, and “other things for headaches, but they don’t work,” he says. On good days, he manages to mask his condition, holding court at the luncheonette with his ex-cop’s profane charm. More than once, though, he’s menaced store clerks over petty offenses and is often out of steam after the trip to town, nodding off, upright, at the kitchen table while he waits for Amy to come home. She’s eager to get back to him – “he’s the light of my life, and I’d give anything to make him happy,” she says – but when she walks in from work, exhausted and frayed, she can’t always help herself. “Couldn’t you feed the dogs?” she hears herself snap. “It’s the one thing I ask! Can’t you at least do that?”

The science of blast injury, less than a decade old, is so preliminary that even basic tenets can only be guessed at now. How far can you be from a pressure wave without being at risk? Can TBI occur when there’s no loss of consciousness? How many blast exposures is too many, and does that vary from person to person? One such question is most germane to men like Workman: Why do some soldiers heal on their own, while others go on suffering without end?

Estimates vary according to who’s doing the counts, but between 50 and 80 percent of the milder cases do resolve themselves. But for a “miserable minority,” as clinicians call them, the symptoms are intractable and so disabling that they can’t go back to their life’s work. If there’s hope for them, it rests with people like Colonel Ling, the neurologist who treated TBI patients in Baghdad and came back in 2006 ablaze to find a cure. As a program manager at DARPA, the military’s gold-star research lab, he secured $9 million to fund a pathbreaking study that defined both the syndrome and the science. Putting out a call to the top universities, he built a team of multiple disciplines, pairing astrophysicists with biochemists and mechanical engineers. He tasked his scientists to come back to him in a year with, first, a detailed understanding of the cause of brain-blast harm, and, second, an analysis of what that harm looked like, down to the cellular level.

Conventional ways of examining the damage were all but useless here, as most of it was far too subtle to see on CT scans and MRIs. Nor, for obvious reasons, could you excise tissue from a soldier who was still alive. So one group of scientists turned to pigs as subjects, putting them in harnesses and setting off charges nearby. Another group at Harvard took neurons from rats and subjected them to simulated bombs, using tiny magnets and blast bioreactors to overstress the cells the way a wave of pressurized air would. A third crew, working out of MIT, developed software models to measure blast waves and see how they acted inside the skull.

The investigators of project PREVENT (Preventing Violent Explosive Neurotrauma) discovered that of all a blast’s components – the heat, light, and noise; the cloud of chemical toxins; and a surge of electromagnetic force – the most lethal, by far, was the supersonic wave of overpressurized air. “Here,” says Ling, clicking a tab on his laptop: “A picture’s worth a thousand words.” On his screen loops a video taken at an ATF blast facility. A 20-kilogram bomb, squarely encased in metal, blows up, and in superslow motion, a monstrous fist of visible air pounds a painted rail of 2x4s. The planks twist in one direction, then another from the underpressure, an inverse surge of suction force. “Your brain is 80 percent aqueous,” says Ling, “so it’s rippling under the wave. With even the mild cases” – those farthest from the blasts – “we’re seeing inflammation and widespread damage to the fibers of the axons,” the trunks through which cells communicate and carry out complex functions.

In animals, that caused impaired gait, sleep, and memory, which told Ling’s team that the affected areas were at the front and back of the brain. This dovetailed with what Ling saw in his practice as a neurologist at Walter Reed, where TBI soldiers complained of a linked set of symptoms. They had, besides migraines, the vertigo and nausea caused by lesions to the cerebellum, the walnut-shaped region at the rear of the brain that manages motor balance. More ominous was the damage to the frontal lobe, where higher functions are controlled – planning, judgment, problem solving. It is also where sleep and mood are regulated, and is, in essence, the home of the personality. Small wonder that the spouses and parents of some of these soldiers said they barely knew them anymore. Erratic and listless, easily confused: They acted like old men in young men’s bodies, drifting in and out of their own lives.

But so dizzyingly overwired is the human brain that, to understand the failure of a cortex bundle, it is necessary to start with a single cell. At Harvard, one of DARPA’s partner teams is studying discrete neurons battered by microstressors. Associate professor Kit Parker, who heads the project, has a distinctive investment in the work, having served a tour in northern Afghanistan as an army reserve captain in ’02. His lab manager, Josh Goss, a twice-deployed marine, leads me around the benchtop stations, where miniature marvels of the team’s invention are put to abstruse tasks. In one room, a pair of tiny tweezers pushes and pulls a neuron, the effects of which are filmed, then scanned, on a 3-D microscope. In another room, the plunger of a bioreactor pounds a tray of nerve cells with a whomp. “We developed these tools to ask a fundamental question: What does a cell feel after a blast?” says Goss.

Parker speculates that neurons left intact by the blast are “swimming in a soup of dying cells,” starving for oxygen as the blood vessels spasm, and caught in a tide of errant proteins as the axons shoot off wildly. It may be several years before he and fellow researchers know which proteases and enzymes are at fault. But once they’ve pinned those down, existing drugs might ease symptoms until new smart-bomb medicines come along. “We lack biomarkers, as we lacked them in AIDS, before we came up with viral load and CD4 counts,” says Zafonte, of Harvard Medical School. “But when we found those signs and fixed them, we also fixed the outcome.”

Parker isn’t quite as sanguine. “There are so many complex questions,” he says, that “it’s going to take a big tent” to resolve them. “We need scientific nation building, a TBI czar, and enough money to pay for the kind of innovation that has repeatedly put this country on top.” He takes pains not to add what so many in the field have muttered off the record: that the National Institutes of Health, the government colossus with a $30 billion annual budget, has largely hugged the sideline on brain-blast trauma. “My fear is we’re going to see a wave of 40-year-old soldiers showing up at the VA with dementia,” says Parker. “They played hurt and went on fighting after multiple blasts, and I hope we return their loyalty when they need it.”

Parker might have told me this much in person when I dropped by his lab in May. But at the time, he was engaged in other matters, leading a company of the 10th Mountain Division from Kabul to the Pakistani border. It’s his second tour of duty, and the bombs he swept for were vastly more potent than in ’02. “My convoy got blown up,” he told me via e-mail from his base very late one night. “Flipped an MRAP in front of me, triggering a brutal firefight when me and another dude pulled out casualties. Watching an MRAP go up in the air, [attached to] a two-ton mine roller, gives you some idea of the force.” A third of his staffers at Harvard have done combat tours in Iraq or Afghanistan, and are “after it like a ball of fire,” Parker writes. “I’ve got friends with TBI.”

Chalk it up to innocence or early impairment, but what held Kevin Workman fast through his agony in Iraq was the hope that going home would heal him. The chain-saw headaches and shot-through fatigue, the thousand things he suddenly couldn’t remember – they would all remit, he figured, to a solid week of sleep and some quality catch-up time with his young daughters. And if more was needed, well, the army would see him through. But his hopes for renewal were dashed in full when the plane touched down in New Jersey in September 2005. His marriage had cratered while he was off in Iraq, and he was greeted on the tarmac by a process server, not his wife and kids. Shattered, he decided to stay on at nearby Fort Dix while his brigade went home to South Carolina, and he was attached to a unit with the First I.D., training recruits for convoy security.

Barely holding it together with fistfuls of Motrin and assorted coping maneuvers (he called everyone “Bo,” unable to remember names, and kept his hands behind his back so no one saw how much they shook), he caught his first break when he encountered Amy doing volunteer duty on base. “I was fresh off a breakup,” she says in their kitchen, “and wasn’t ready to date for a while. But we went out as friends with some people we knew from post, and he made me laugh like no one ever has.”

She sensed something was off with him – “he couldn’t remember things that really mattered to him, like the birthdays of his parents and kids” – but Workman hid behind his scabrous wit and said nothing of his constant pain. Finally, he confessed to her how sick and scared he was, and at Amy’s insistence told his barracks commander, who sent him to the doctor on post. The snap diagnosis was PTSD, and sessions were arranged with a staff psychologist at the adjoining Air Force base. But his TBI symptoms, unidentified and untreated, continued to intensify by the month.

In the fall of 2007, too ill to keep working, he was admitted to the Warrior Transition Unit, a hastily conceived cluster of on-post sick bays for seriously injured soldiers. Under its former name, the Medical Holdover Unit, the system produced one of the war’s great horrors: the neglect and abuse of wounded troops at Walter Reed. Out of that infamy came the WTU, a chain of installations at 35 bases whose mandate was to treat the thousands of soldiers needing six or more months of medical service. But, as with Walter Reed, many units were short on staff, overrun by cases too complex to manage, and hamstrung by slipshod leadership.

At the Fort Dix WTU, there was one primary doctor for the several hundred patients on base and a constant churn of caseworker types, many of them fresh out of school. Workman had four in his 15-month stay, and none seemed to know what TBI was or how to secure him help. “Me, I only knew it from this briefing they showed of a – a Humvee hit by a bomb,” he says. “I went and asked Amy to look up TBI. Sure enough, it fit me to a T.” He went back to his caseworker and insisted on being tested. Several days later, he got his exam: a 30-minute call from a clerk at Walter Reed, who asked him a series of questions over the phone. Shortly thereafter, a form arrived in the mail, telling him he’d tested negative for TBI. “I should’ve known,” he grunts. “They couldn’t even fix my goddamn molar after waiting 10 months for a crown.”

Seething, he went to his doctor on base and restated his list of symptoms and blast exposures. The doctor concurred and wrote TBI in his chart but never sent Workman to an army neurologist or referred him for rehab treatment. Indeed, of the brain-injured men on post, only the most egregiously harmed got specialized care off base. One such soldier, who asked to be unnamed while his case trudges through the retirement process, was misdiagnosed for more than a year, despite symptoms so stark he couldn’t complete a sentence or bathe and dress himself. It bears noting that, since finally getting robust treatment, he’s come a long way, cognitively, in his 15 months of rehab. His speech has improved, he can perform some daily tasks, and, on good days, recall his prewar life in lucid and moving detail. “There’s a spectrum of late recoveries acceptable to people, and if that’s 20 percent better, that’s still meaningful,” says Harvard’s Zafonte. “It might just be the difference between independent living and having to be cared for by your loved ones.”

Workman would probably have profited, too, from a stint in an outpatient clinic. There, a neuropsychologist would have reduced his meds to only those essential to managing pain; speech pathologists would have led memory training and language improvement drills; an occupational therapist would have taught him strategies to knock off daily tasks; and group counseling would have improved his labile moods. There are such services in the army system, including four elite centers for intensive treatment and a dozen more clinics, regionally scattered, for ongoing drop-in care. But in order to get these benefits, you must know that they exist, and neither Workman’s doctor nor his social workers ever thought to raise them as an option. What they told him instead was to bide his time: The VA would take care of him after he retired.

And so Workman, the good soldier, did as told and, after a year, put in papers for medical retirement. Unfit to reclaim his job as a state policeman, he had, in effect, lost two careers. What came next, however, was the final betrayal: a finding by the army’s Physical Evaluation Board that he was just 30 percent disabled by his many injuries. “Offered me $600 a month for the rest of my life, and . . . said I could get a job at a diner. There was nothing about TBI – according to them, I don’t have it – or how I’m gonna support Amy and my kids.” The army’s rating code, written in 1947, doesn’t list TBI as a combat injury for which benefits may be paid. “I’m proud I served my country and would do it . . . all over again, but I never felt so ashamed to wear the uniform.”

There it might have ended. But one day, while scrubbing latrines, Workman saw an ad on the wall offering pro bono aid to troops. The Military Legal Assistance Program, a pilot venture of the New Jersey Bar Association that is staffed by volunteer lawyers, has helped hundreds of soldiers process their claims with the retirement board. A senior lawyer with the program, who asked to be unnamed, filed a book-length appeal for Workman and joined him in Washington to plead his case.

Two months later, in the spring of ’08, Workman was notified that he’d been bumped to 60 percent disability, though again there was no mention of TBI. “It wasn’t great,” he said of the proffered upgrade, “but I needed to go home . . . and start over. Get as far from Fort Dix as I could.” The roughly $1,200 a month wasn’t enough to live on, but next spring his state policeman pension will kick in, and between them, he guesses he’ll get by. His lawyer, a self-described “former longhair,” is glad to have been able to render aid, though with a crowded caseload (plus his paying work), he’s fast approaching the point of saturation. “We rep 78 soldiers at this firm alone, and more keep coming through the door. Real-life heroes in a world of hurt, and the way the army’s done them rips your heart.”

He does, however, see cause for guarded hope. In 2007, Congress passed (and later strengthened) the Wounded Warrior Act, a law meant to ramp up treatment and assistance for soldiers with TBI. “In the last year or two, care has gotten better, though it’s very inconsistent,” says the lawyer. “Depending on where you live, you can get a month at Walter Reed, which has an intensive program for these guys.” But what happens, he worries, “when they’re retired and go to their rural VA to try to get help?”

For its part, the military has hired an impassioned leader to head up its TBI program. Since she took charge in September 2007, Brig. Gen. Loree Sutton has pressed to raise money, conduct outreach to soldiers, and reduce the stigma of seeking care. “Frankly, all of us wish we’d been involved years earlier, when the emphasis was on saving lives in theater,” she says. “We’re working furiously now to stand up programs and find troops who’ve fallen through the cracks. What keeps me awake at night is how to connect with soldiers who were hurt before we screened.” To that end, the military has set up a 24-hour hotline (866-966-1020) for TBI victims or their loved ones to call.

But none of that effort has trickled down to Kevin Workman. He’s been home in Genoa for almost a year and frequently drives an hour to the Syracuse VA to lobby for further care. What he’s gotten for his pains is a 10-minute workup by the staff neurologist, who tapped him on the knees, asked a couple of rote questions, then handed him a stack of new prescriptions. “The drugs, they make me fat and lazy. I need the kind of help that they don’t have here,” says Workman. “But something’s gotta give, ’cause I ain’t done yet. I got plans for the time that I have left.”

When told of Workman’s plight, Sutton offered to intervene to see that he gets the care he needs. It’s the first good turn in Workman’s dealings with the army, and with any luck, not too late to matter. He yearns for the strength to tend to his parents, both of them in failing health, and beyond that, to build a lodge for wounded vets who want to come hunt these woods. Gutchess Lumber, a local logger, has lent him the use of a thousand acres, and other friends and merchants have pitched in too, building him a website ( and forming an advisory board.

One day, Workman gives me a tour of the land, talking of adaptive turkey blinds for vets who are wheelchair-bound and tow-in paths for ATVs to carry amputees. It sounds a tad fanciful for a man so strapped he can’t afford to fix his girlfriend’s car and who, several days a week, is in the grip of such pain that he must lie down in a dark room. But out in the treeline, he seems reborn, the torpor and neuralgia falling away. As he walks, he ticks off the names of flowers and species of deep-growth pines. Suddenly he stops, eyes big as a setter’s: There, in the clearing, stands a 12-point buck, sizing us up as he chews. For a glassine moment, nothing moves or breathes, the world in soft suspension – and then the deer huffs and glides off, raising a spray of leaves.

For access to exclusive gear videos, celebrity interviews, and more, subscribe on YouTube!