Traumatic Brain Injury in Veterans

Scott

Age at interview: 26
Outline: While serving as a maintenance planner on a Navy submarine, Scott suffered a concussion when an improperly latched submarine door hatch fell on him slamming his head between the hatch and the floor and knocking him unconscious. He knew something wasn’t right when after his accident he couldn’t remember maintenance codes and began jumbling up the code letters. He also began to notice frequent headaches, dizzy spells, and had issues with retention of new material. To cope with the symptoms of his condition, Scott has used resources through the VA and at school to help with memory and concentration issues.
Background: Military branch: Navy

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Scott suffered a concussion in 2010 while serving as a maintenance planner on a Navy submarine. He had been in service two years when an improperly latched submarine door hatch fell on him slamming his head between the hatch and the floor and knocking him unconscious. Scott doesn’t know how long he was out but says everything was hazy when he came to and that he had a “throbbing headache” and felt “disoriented in place and person.”

Scott experienced frequent headaches in the following months but says he really knew something was wrong when normal job duties became increasingly difficult. As a maintenance planner on the boat he had to deal with scheduling on computers and imputing codes for maintenance, and after his injury he would “forget what code went with what. There’s a zillion of these maintenance codes and the letters just seemed to always be getting jumbled up.”

Scott served six years in the Navy, including a six-month deployment overseas, before retiring in 2013. Although his frequent headaches have reduced over time he says they are now more severe when they occur. There are few pain relievers that work, but to alleviate a headache he often has to go to sleep. Other symptoms of his TBI include periodic dizzy spells and issues with memory and retention of new material.

The cognitive symptoms are especially difficult for Scott as he is a college degree. Scott has taken advantage of resources both at his school and at the local VA to help with his symptoms and to learn tips and tricks for better note taking, preparation for exams, and concentration. Even though it is difficult at times he feels he has a good outlook on life and is happy to be in school and focusing on achieving his goals.

 

Scott was hit with a metal hatch while going up a ladder on a submarine.

Scott was hit with a metal hatch while going up a ladder on a submarine.

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OK. So, my TBI happened in January of 2010. And I was in the Navy and on a submarine, so it’s probably not the same as a lot of TBIs that are more like people over in Iraq or something like that, who had IEDs or something to that effect. But what had happened was, so there’s, there’s like multiple levels on the submarine, you know, in various spaces. And then you get up those by going up ladders. And at the top of each ladder, there’s a little – like, well, not little - it’s a big metal hatch that you can put down so that way if you need to do work above where the ladder is, then you can, you can do that.

And so, I was just going up on one of these ladders, and this happened like nine million times a day, but somebody had had it down, the hatch down and when they put it up, before that – or after they were done - they didn’t latch it in properly. So, I just unwittingly went up the ladder just like normal. And I grabbed onto the wrung of the hatch and it came out and I don’t know how much these metal hatches weigh but it’s a lot. And so, I, it came out and I pulled it down with my bodyweight and slammed my head in-between it and like the floor on the level above. And I blacked out. I don’t know exactly how long I was out of consciousness. But the impact just immediately, you know, pretty hazy after that.

And so, somebody saw what had happened right away, like there was somebody in the area. And so, I was told that they just kind of ran over and grabbed me up and like pulled me up, you know, to the next level. Got the hatch open or whatever. And then I was laying on the deck again. I don’t really know how long I was out of consciousness. Not – it wasn’t like super long, like less than a minute I think. But then kind of just after that, it was like very hazy when I came to. You know, throbbing headache at that exact time and just feeling like disoriented in like place and person. You know I mean, but I still knew I was me and I still knew I was alive and, and whatnot. But I didn’t know what was happening.

So, I was laying there on the ground for seemed like hours, but it was probably, you know, thirty minutes or maybe even less. And then they kind of helped me move along to, to see the ship’s doctor. And he sent me home for the day with a friend who drove me home. But I guess the – so, so that day, you know I mean I just don’t really remember much after that. I have flashes, I remember kind of proceeding through the boat and I was awake and cognizant, but not really.

 

Scott recalls getting an icepack and some x-rays, but didn’t receive a formal diagnosis until he returned from deployment.

Scott recalls getting an icepack and some x-rays, but didn’t receive a formal diagnosis until he returned from deployment.

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It’s kind of a little sad because they’re just kind of like, “Ah, here’s an icepack. You’re fine.” You know? And I was like, I demanded x-rays at the very least. And so, I did get that. But I never had any neuropsychological testing like as a result of that. So, they did x-rays and, you know, maybe an MRI? I’m not sure. But that was pretty much it. And I never even really complained to anybody, like, “I’m feeling like I can’t do this.”

I: So, did anybody ever like officially say to you, like you may have had a brain injury or diagnose you with that?

Not really. I mean with a small crew in a submarine, I mean the ship’s doctor was like – he was trained with like the Fleet Marine Force. I mean he’s a smart guy, but at the same time like he was kind of a jack-of-all-trades as doctors go. So, there was no like specialty involved. And he’s just like, “Yeah, you were concussed pretty bad and you know, I mean you’re going to be feeling a little weird for a minute.” So, you know? But it was – yeah.

I: And when, when you come out of the Navy do they screen you at that point or does anything happen where they ask you about that possibility? Or is that more for the folks, for the people that were deployed in like Iraq and Afghanistan who – may have come into contact with that kind of?

Yeah. Well, so I mean I just, I just got involved with the VA kind of, kind of on a whim. And I’m really glad I did, because the treatment – ability to talk to people and kind of get through this. Like it’s been inspired by just the VA’s like willingness to help. And so, I actually, I have nothing bad to say about that.  But yeah, I mean like so I, I just went to the VA randomly and I was just like, “Hey, I, I want to get enrolled with healthcare options.” And they were like, “Oh, you should file a disability claim. Did anything happen to you?” And I was like, “Well, there was that one time that the hatch landed on my face.” But like, but I had never even thought of it in terms of like, you know that was probably a TBI. And, you know, maybe there’s an explanation for these lingering effects, you know. And so, so I didn’t really give it a lot of thought like while I was in until I got out and started coming to the VA. And, so I mean – yeah, so the VA has definitely like, it’s worked to help me to want to figure out like, you know, if and what quantifiable effects were there from, from what happened.

 

Scott was evaluated as likely having TBI during the post-deployment screening, but didn’t actively pursue any sort of treatment until a year or so later

Scott was evaluated as likely having TBI during the post-deployment screening, but didn’t actively pursue any sort of treatment until a year or so later

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But then I got, I got rated for the TBI without really too much – I mean I had my, when I had my first post-deployment screening, I ended up talking to the psychologist that day, who is my psychologist that I’ve been talking to regularly now. And kind of just like talked with her in more detail about what happened. And so, she did get the ball rolling by giving me a referral to the cognitive skills training group. And she said you know, “Hey, I think based upon what you’re telling me, this will help you out.” And that was in like December of 2013 that my post-deployment screening happened. And, and then I got, I got my rating for the TBI, which was just ten percent. And that happened in June of 2014. But then – let’s see, when was it? I didn’t really do anything with it for a while because after that first consultation with the psychologist in December 2013, you know, she gave me the referral and they actually, they reached out and contacted me several times because there was like, you know it’s was an eight-week course and it started like several times. But I couldn’t attend it because it was always a conflict with my school or something else. So, I tried to go but just wasn’t successful. But I did finally get into that this fall, this past fall?

So, I did that course. And then I’ve really kind of picked up steam with, with you know doing more stuff and talking to more people around that time because they kind of – it, it got more into the active system of like, hey TBI people that we’re actually dealing with. And so – and I, and I kind of realized that hey, you have to like, you’ve got to push the envelope a little bit and, and then that’s how you get, you get more help. So, it was like fall-ish of this yeah that I started really pursuing it more and started going to the psychologist again regularly in like December. Because I had my one-year post-deployment screening like, “Hey, how’s it going?” You know? And I was like, “Hey, I’m like not quite getting as much help or getting to the bottom of this more as I’d hoped I would.” And, and after that you know, that’s when it’s been, a lot more has been happening. And so that is what led to doing the neuropsychological, like the full evaluation.

 

After his injury, Scott had frequent headaches and struggled to complete tasks associated with his job on a submarine.

After his injury, Scott had frequent headaches and struggled to complete tasks associated with his job on a submarine.

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And for several months after that, I had really frequent and severe headaches. And kind of just like, I, I noticed a lot of difficulties with just like orienting to whatever the task at hand was. At the time, I was the maintenance planner for the boat, which involved a lot of scheduling on computers with like codes for maintenance. And like the letters just seemed to always be getting jumbled up and I couldn’t, you know, that was – so it was almost like immediately apparent. Like I’m having some difficulties here like, you know? And it’s, I mean it’s kind of tricky stuff in general. So, I mean, you know. But it’s like, but I would like forget, you know, what, what code goes with what. And that was the main way that I like noticed, because it’s something that’s like pretty detail-oriented and I just had a lot harder time than I previously had. Keeping track of, you know, there’s a zillion of these maintenance codes. And so that was the main way that it kind of manifested for me, along with these continuing headaches.

 

Scott talks about having difficulty “coding information” into his brain.

Scott talks about having difficulty “coding information” into his brain.

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And then – kind of, yeah. Just like I’ve also – it seems like I have difficulty with like, like coding information that I hear into my brain. I mean just a minute ago, you told me the date and then like I forgot it immediately. And that seems to happen all the time, you know? More, more than a normal person or so it strikes me. And I don’t feel like I had issues like that before experiencing this. And so that’s, that’s been the, the most difficult ways. But you know, it’s kind of tough to say because I just don’t know if, if I’m just aging and you know like your memory starts to go. But at the same time, like, I feel like, I feel like for being a 26-year-old like I shouldn’t necessarily be having these problems yet.

 

Scott feels like he has to work much harder than his peers in order to keep up in the classroom.

Scott feels like he has to work much harder than his peers in order to keep up in the classroom.

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But then just in general, I’ve, I’ve noticed – because I like, I didn’t go to college right out of high school and I just started like a year and a half ago after getting out. And so that’s been a challenge, but I don’t, I don’t have a frame of reference to compare, like a college workload, pre-TBI versus post-TBI. And you know, I mean what I’ve come to realize is that college is just intense sometimes no matter what. But, but I do feel like – and I’ve told most of the people that I’ve talked to; I’ve done neuropsychological testing at the VA and stuff. And I’ve told most of the people that I feel like I’m putting in significantly more work than my peers, because like I have a lot more difficulty with kind of just like engaging in the classroom. Like, I really want to. Like and I guess that’s a good thing about being an older student, I guess? Like, you know, I think a lot of younger college students are maybe more just daydreaming because they don’t really care. But like I find myself doing that even though I don’t want to. And that’s a lot of the time. And so I really have to like work hard and focus really hard all the time to stay engaged with what the professor’s saying and be up with the material. And I feel like I’m always behind like in the classroom.

 

Scott talks about learning strategies to cope with his memory in a cognitive therapy group at the VA.

Scott talks about learning strategies to cope with his memory in a cognitive therapy group at the VA.

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Yeah, so she actually has – she’s the one that referred me to the Neuropsychology Department at the VA and initiated the whole screening, which was like hours long. And a lot of it was you know, just kind of like simple mindless stuff, like connect these two dots, you know. But then some of the other things were like memory and cognition and you know, orientation-type exercises. And that’s the stuff that I was like more interested in to see, because that’s the thing that I feel like I’m lacking on. So, I’m actually really glad that I underwent that testing to see because that’s, that’s a much more like definitive way to, you know, try and evaluate where I’m at. So, she referred me to that.

And also in light of these results, because I, I did go to the Cognitive Strategies Group. I don’t know if you guys know really about that – It’s an eight-week, an eight-week course and it, it’s offered through the VA. And I went to that – I wasn’t able to make it to every meeting, but I went to like six of them I think? And that was just kind of focused on like – you know it’s for, for people that have complaints of like memory loss. That’s, that’s a big thing too that I’ve realized is a recent issue. And I think I kind of alluded to it earlier, said like I’ve just had a lot of troubles like coding like what I hear and like, really like, like even when it’s simple stuff. You know, like the date or like, you know, whatever. But then it kind of snowballs when it’s a more complex issue, I feel like, because that’s when I have to like really get nitty gritty with it and put in more time to like cram it into my brain.

I: Yeah, so what types of things do they do in this cognitive skills group?

It was a lot of just stuff like, like strategies for like remembering tasks and you know, cost-benefit analysis and, and stuff like that. And actually, it was a lot of help, because I, I guess I wasn’t very organized before?  And so, it taught a lot of skills for that. And so like, I’ve started using my iPhone calendar for like everything. Like, even if it’s just like, you know, like I need to go give this paper to somebody, then like I put it in my iPhone calendar with reminders that go off like multiple times. And like, so that’s, that’s been a big help. And it’s like, you know, it doesn’t make the issue go away but it’s like a way to address it. And just stuff, like making grocery lists and stuff. I never really did that before and then I would always go to the grocery store and as soon as I’m there, I forget what I even need. Like everything, not just like you know, get home and realize I didn’t, like, “Shoot, I didn’t buy cream cheese.” Like, it’s like I’m at the grocery store; it’s like, what do I need? You know? Like I don’t even know why I’m here. So, like making lists in advance and stuff like that – just, just general skills like that. You know, it was, it was pretty basic but it was also, it was helpful.

 

In addition to the VA, Scott sought help through the Disabled American Veterans organization.

In addition to the VA, Scott sought help through the Disabled American Veterans organization.

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I mean I’ve been, I’ve been working with the DAV, Disabled American Veterans to – they, they mostly just help with claims. And so kind of, I guess also what kind of got the, the whole ball rolling with seeking additional treatment for like unidentified, undiagnosed cognitive difficulties was like I was just talking to my DAV service officer one day and he was like, he was like, “It sounds like you maybe you might have PTSD.” And he was like, “Maybe you should file a claim for that.” And I did. I don’t think that they’ll probably approve that, but that actually probably is one thing that helped get the ball rolling just in terms of like, “Well if it’s not PTSD, let’s find out what it is.” You know? Like so – but he just said, you know, it might be PTSD because of that event was traumatic, you know. And you know, and I was talking to him about these difficulties that, that I’ve expressed. And so that’s, that’s really the only other organization. Mostly just through the VA and, and then at school a little bit. So.

 

Scott realized he needed to push the envelope a little bit to get more help.

Scott realized he needed to push the envelope a little bit to get more help.

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And so – and I, and I kind of realized that hey, you have to like, you’ve got to push the envelope a little bit and, and then that’s how you get, you get more help. So, it was like fall-ish of this yeah that I started really pursuing it more and started going to the psychologist again regularly in like December. Because I had my one-year post-deployment screening like, “Hey, how’s it going?” You know? And I was like, “Hey, I’m like not quite getting as much help or getting to the bottom of this more as I’d hoped I would.” And, and after that you know, that’s when it’s been, a lot more has been happening. And so that is what led to doing the neuropsychological, like the full evaluation. Because I’ve also just felt like I, aside from the TBI, I’ve just felt like maybe I have a, like some psychological oddities as a result of service. And I don’t, I don’t need to go into that I guess since that’s not really the focus of this. But, so I wrapped that type of stuff into TBI and that’s why they did the full neuropsychological testing.

 

Scott says that there is little the VA can do to prepare you for how different you will be from other people after deployment.

Scott says that there is little the VA can do to prepare you for how different you will be from other people after deployment.

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Their transition programs are more just like focused on like how to write a resume and how to get a job. You know? And I mean that’s really important. And you know, and they also talked quite a bit about the college benefits. But I feel like not, you know out of the number of people that get out of the military, I feel like not that many people are using the GI Bill.  And so like I had to, I had to navigate a lot of that for myself. And it’s tricky. But yeah, just like – you know, there’s not a lot of talk about like, “Hey, you’re going to be different from all the people that you end up working with, wherever you end up working because, you know, they’re not going to be able to relate to you because they haven’t been on a submarine for six months underwater.” You know? Or whatever, whatever your case may be. They haven’t had IEDs blown up next to them in Iraq, you know? And like, and I don’t know. I think, I think there should be more of a focus on that because that’s – I didn’t realize it until I’m a year out. I mean it makes perfect sense thinking about it; it’s not surprising. But it’s just like, you know, I wasn’t really prepared for that and I, again, I feel like I’m kind of just navigating it on my own and trying to figure it out.

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