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REBUILDING IRAQ -- CASUALTIES

Brain injuries take toll on US soldiers

WASHINGTON -- US Army First Sergeant Colin Rich felt a pain that reached from the back of his head down to his toes. It was, he would later recall, "literally very sharp and dull at the same time." He slammed face-first into the hard December ground, blinded.

Rich, who had been directing his unit in a brief but intense firefight in a remote area along the Afghanistan-Pakistan border, immediately knew he had been shot in the back of the head. "I can clearly remember the feeling of pain, anger, and helplessness as the battle raged on around me," Rich, from New Boston, N.H., recalled yesterday.

More than nine months later, his visible scars have healed but Rich suffers the enduring effects of brain trauma: His vision has only half returned, and he experiences mood swings and bouts of depression.

Rich's experience is not uncommon for US troops. According to military officials, roughly 20 percent of the wounds suffered by the troops in Iraq have been severe brain injuries. And Major General Kevin C. Kiley, commanding general of the North Atlantic Regional Medical Command, said that figure does not even take into account milder neural injuries. He estimated that as many as 70 percent of the wounds suffered by US forces in Iraq had the potential for resulting in brain injury.

Such injuries are not confined to combat: 1.5 million people sustain traumatic brain injuries annually in the United States, according to the National Brain Injury Research, Treatment, & Training Foundation. And 50,000 Americans die from these injuries each year.

Brain injuries are as old as battle, but only in the last dozen years has the US military made a concerted, coordinated effort to examine and track these wounds.

"What is becoming obvious from the nature of injuries we have seen over the last six to eight months [is] . . . bringing a lot of awareness to the front of the battlefield that troops that get up after the detonation and say `I'm OK' -- they may not be OK," said Kiley. "We see that with sporting events: A quarterback gets hurt, you give 'em time off. We need to do that with our troops."

Rich's injury was not so subtle: While the bullet was slowed enough by his Kevlar helmet to save his life, it "punched a hole slightly larger than a silver dollar in my skull," he said yesterday, addressing the 2003 Congressional Brain Injury Awareness Fair. Five fragments penetrated his skull, four of which were removed in surgery. He will carry the fifth, lodged too deeply in his brain to safely reach, for the remainder of his life.

Rich, 40, considers himself a father twice over, to his two children and to the men in his unit. But now, he said, he has been forced into the uncomfortable position of depending on others. The 18-year veteran has returned to Fort Bragg in North Carolina, but dreams of rejoining his unit in Iraq.

After the 1991 Gulf War, Congress founded the Defense and Veterans Brain Injury Center at Walter Reed Army Medical Center to more closely scrutinize neural injuries. The center is funded at $5 million annually, though last year it received an extra $5 million. This year it has only received $9.1 million, though advocates in Congress hope to add $2.9 million when members of the House and Senate reconcile their versions of the Iraq supplemental spending bill.

That funding is paying off, Kiley said, in a greater understanding of the injuries and an enhanced ability to detect cases far more subtle than Rich's. "The piece that excites me is the idea that we're in the position now where we can start to recognize the very mild, very sophisticated brain injuries," Kiley said.

Virtually all who suffer the injury, Kiley and others said, require extra attention because, unlike lost limbs, severe neural trauma is not always easily spotted. Though Rich's scars are still visible, he said, people tell him that they would not know he was disabled. "Head injuries are there," Rich said. "You don't have to see them."

Robert Schlesinger can be reached at schlesinger@globe.com

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