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By PETER ROUSMANIERE, the Risk & Insurance® workers' compensation columnist

Late in the evening of Nov. 14, 2004, on the outskirts of Camp Anaconda, a sprawling U.S. base in Balad, Iraq, 40 miles north of Baghdad, three U.S. Army National Guard soldiers were injured by the devastatingly effective roadside bombs, also known as IEDs, used by insurgents against the U.S. military.

One of those soldiers, Sgt. Stephen Kinney, 52, of the New Hampshire 172nd Mountain Infantry Regiment, was struck by the shock of the bomb, which exploded six feet from the passenger side of his Humvee.

Kinney didn't know that he had just become one of hundreds of U.S. returning veterans whose neurological impairment threatens to overwhelm employers and military medical personnel.

The force of the explosion startled Kinney and lifted him several inches out of his chair. He was overwhelmed by a bright orange light and an ensuing wave of heat.

The blast from the rigged 155mm shell also blew him against the radio mount. His head hit the ceiling and he slammed into the door. Kinney was knocked unconscious for a few seconds.

When he came to, he heard a loud ringing in his ears. A message blared through the radio, "IED! IED!" He remembers wiggling his toes and fingers. He felt his face. There was no blood.

Kinney's fellow soldier, Specialist Ray Saucier, was shaken but otherwise unhurt. Gunner Jeremy Hileman's lip was torn. Shards of macadam and rock, propelled by the blast, also pockmarked Hileman's face.

At first blush Kinney appeared to be have survived the blast intact. Kinney was lucky, but not that lucky, as he later found out. Though he didn't know it then, Kinney had just suffered a serious brain injury.

The three warriors, shaken and wounded but alert, raced back to Anaconda and twenty minutes later staggered into the Combat Support Hospital (CSH), pronounced "cash," on the grounds of the base.

The three National Guardsmen were lucky; they all survived. Better yet, they had all made it back to the confines of relative shelter. Yet, their ordeal was hardly over.

At Camp Anaconda, the CSH intake desk immediately admitted Hileman, the most severely injured of the three soldiers. Kinney, unfortunately, had to wait at least six hours before being seen.

By the time he returned to CSH the next morning for an X-ray, he was deaf in the right ear and his throbbing right shoulder was very, very sore. A nurse mistakenly thought Kinney might have suffered nothing more serious than a sprain or strain in the shoulder or back. She gave him a five-day supply of Vicodin and sent him on his way.

Two days later, Kinney, along with other guardsmen, was sent to lodge in Abu Ghraib prison for a month while he patrolled the then-volatile city of Fallujah.

Kinney, his hearing still damaged, found in the midst of patrol that he couldn't lift his right arm. When he closed his eyes he heard a buzzing sound. The medics at Abu Ghraib gave him a bottle of Motrin and once more sent him into the field with the true nature of his injuries still undiagnosed.

Kinney's remaining tour duty was uneventful, even in the midst of horrific attacks on other U.S. military and civilian contractor personnel.

At long last, on Feb. 19, 2005, Kinney and the rest of the 172nd flew out of Anaconda and returned to Ft. Dix, N.J. They had been in the Middle East 339 days and it was time for them to come home.

FAR FROM OVER

Yet, Kinney's "war" wasn't quite over--far from it.

At Ft. Dix, the Army sent the soldiers for a post-deployment health assessment, which is standard practice for all returning military personnel.

Other soldiers on the sprawling Ft. Dix base advised members of the 172nd Mountain Infantry Regiment not to tell the medical personnel that anything was wrong. Alerting the Ft. Dix medics would simply prolong their return to their, jobs, their wives and their civilian lives.

The place to share was during the physical back at the processing center for the New Hampshire National Guard. That's exactly what Kinney did when he returned to the armory in Concord, N.H., a few days later. He finally talked of his shoulder pain and on the advice of National Guard personnel went to see a surgeon.

The doctor finally delivered the sobering news: Kinney had a torn rotator cuff. In fact, Kinney had been living with this painful condition for more than three months.

The National Guard immediately put Kinney on medical hold and would not release him until his medical condition had been resolved.

Kinney drove south from his home in Massachusetts to the base in central New Jersey on May 8th, a Sunday. But once at Ft. Dix, Kinney was told almost immediately that he was going to be sent home, back to Chelmsford, Mass.

Left in a state of limbo, Kinney discovered he wasn't alone. Other soldiers at Ft. Dix were in the same predicament. They spent their days doing light duty, washing floors and cleaning stalls. One had a broken thumb, another had knee problems, a third, who had been at Ft. Dix for more than a year, had a bad back.

When he returned to Massachusetts in mid-May, Kinney reported to a case manager at the Bedford, Mass., Veterans Administration Hospital. She investigated whether Kinney was suffering from post-traumatic stress disorder (PTSD).

Did Kinney see anyone get killed she wanted to know. Did Kinney kill anyone? In the end she arranged for PTSD counseling for the wounded National Guard sergeant.

After shoulder surgery on May 18, Kinney found his days booked--literally--trying to recover from his physical and mental wounds.

He went to physical therapy for his shoulder three days a week. Two days a week, he would show up at the VA Hospital in Bedford for counseling. When he had a free day, he would drive to the Manchester Armory and fill out paperwork.

In early 2006, nine months after the shoulder surgery and about 18 months after the initial IED explosion, Kinney's psychotherapist began probing more deeply, for signs of possible brain injury.

There was good reason to do so. Kinney's symptoms included difficulty finding the right words, lapses of memory, searing headaches and tooth ache-like pain from above his right eye to behind his right ear.

Kinney underwent a five-hour neuropsychological exam and, sure enough, the results came out positive for brain injury. Kinney's symptoms matched most of the diagnosis: decreased memory and concentration, severe headaches, slower thinking, irritability, depression and sleep disturbances.

Kinney attended 14 counseling sessions with a therapist who focused on improving his memory. He worked with another therapist for four months to improve his ability to cope with pain. They treated him using cognitive behavioral therapy techniques.

In March of 2006 the National Guard offered Kinney a 50 percent disability pension. By mid-year it had relieved him of his military obligations. Kinney finally received his first disability check in October of 2008, more than two years after he was discharged from the National Guard. While the National Guard focused its disability tests on Kinney's physical handicaps, such as the ability to cover fellow soldiers under fire, Kinney didn't need any medical tests to tell him the IED explosion had altered his mind. He could no longer complete the crossword puzzle in the Lowell Sun, his local paper, for example.

In mid-2006, Kinney returned to his postal job, taking up his letter carrier route of 330 addresses. Twice a week, he took off several hours for PTSD treatment.

He continued to experience battle nightmares, a classic PTSD symptom. He also noted that he sometimes retraced part of his carrier route to make sure that he had correctly recorded his deliveries. Most telling was his failing skill in serving as a kind of jailhouse lawyer for other postal workers.

As a union shop steward, he could tie management into knots, filing grievances on behalf of workers. In the past, he could coordinate as many as 20 grievances. Now he had trouble tracking as few as three or four.

Last November, Kinney retired from the Postal Service on a full pension. Were it not for his war wounds, he would still be delivering mail today.

Kinney also has a pension from the Guard and the U.S. Postal Service. He may be financially secure, but his life is still in limbo.

July 1, 2009

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