Invisible Wounds: A report on the VA and vets with traumatic brain injuries

KARE 11 Investigation reveals VA using unqualified doctors and inappropriate tests on veterans with traumatic brain injuries.

Editor’s Note:  For recent developments see our update: “Invisible Wounds: Treatment and Reform”  

MINNEAPOLIS - The Department of Veterans Affairs has been using unqualified medical personnel to do examinations – and deny benefits – for traumatic brain injuries (TBI) at the Minneapolis VA Medical Center, according to records obtained during a year-long KARE 11 News investigation.

Instead of being examined by a specialist, records reveal more than 300 cases in which a veteran was examined by a doctor not qualified to diagnose traumatic brain injuries according to the VA's own policies.

After KARE 11 began asking questions, the Minneapolis VA began sending letters out to hundreds of area veterans informing them they are entitled to new examinations.

VA policy says the initial diagnosis for TBI's must be made by one of four specialists. But records obtained by KARE 11 through the Freedom of Information Act (FOIA) show that between 2010 and 2014, only one of the 21 medical professionals who conducted initial TBI exams at the Minneapolis VA was a qualified specialist.

The first chapter of the KARE 11 Investigates special.

The disclosure has prompted a federal investigation to determine whether similar improper exams were done at other VA facilities nationwide.

SKULL FRACTURE IN VIETNAM

Butch Hamersma, 67, of Spring Valley, Minnesota, is one of the veterans who's been called back for a new evaluation. The Minnesota farmer agreed to share his medical files with KARE 11.

Records show the Vietnam veteran was seriously injured – his skull shattered – in an explosion near Chu Lai in November, 1968.

"Run over a land mine," he recalled. "Three days later I woke up in Japan."

Hamersma's military records detail the price his body paid for his service. He was evacuated to a field hospital in Vietnam with multiple fractures and a tracheostomy tube to keep him breathing. From there records show he was airlifted to a hospital in Tokyo. Later, he was returned to the United States for reconstructive surgery.

"Skull fractures and fractured mandible," Hamersma told KARE 11's A. J. Lagoe. "Took all my bottom teeth, busted my jaw in 2 places."

"I don't remember hearing nothing. Nothing. Lights they were gone," he said about the explosion.

"You said the lights went out and the next thing you know you're in Japan?" Lagoe asked.

"Yup, getting off the plane," Hamersma explained, "because I was trying to tear the bandages off my head and they tied my arms down."

Pointing to the right side of his face he said, "This was just like a crushed egg."

Call it farmer humor, but Hamersma jokes there are still pieces of his head fertilizing Vietnam.

"Never went back to get 'em," he said. "And I don't plan on it either.

Back then, Hamersma was not diagnosed with what we now call a Traumatic Brain Injury or TBI.

For years, though, he says he has suffered unexplained chronic headaches. So, in 2012, after losing private insurance, he applied for benefits at the Minneapolis VA.

EXAMINED BY A NURSE PRACTITIONER - NOT A NEUROLOGIST

Records show the VA's Compensation and Pension review gave him disability ratings of 10 percent for a series of service connected injuries including his broken jaw, ringing ears, and facial scars.

"This one here is a pretty good one," Hamersma said, pointing to a large scar still crossing under his jaw.

Even so, he didn't receive any benefits for traumatic brain injury. That decision came in spite of records documenting his severe head injuries.

After his February, 2012, evaluation his VA examiner wrote,  "There is no diagnosis of TBI/concussion or TBI residual/post concussion syndrome."

KARE 11's investigation turned up evidence that Hamersma did not get a fair shot at benefits. He was examined by someone who, according to the VA's own policies, was not qualified.

In the years since Vietnam, medical experts have learned much more about the often invisible but debilitating impact of brain injuries.

So, Veterans Administration rules now state that highly trained doctors in only four specialties – including neurosurgeons and neurologists – can do the initial examination to diagnose whether a veteran suffers from a TBI.

So what type of specialist conducted Butch Hamersma's initial TBI exam?

"It was a nurse practitioner," he recalls.

He's right. Hamersma's VA records confirm that his TBI exam was done by Brenda Roche. She's listed as a nurse practitioner – not a neurologist.

KARE 11's investigation found Hamersma is not an isolated example. In fact, there's evidence that he is part of a disturbing pattern.

EXAMINED BY TWO UNQUALIFIED DOCTORS

In at least one case, medical records show a veteran was denied benefits not once, but twice, after being examined by two different unqualified doctors.

"There's no excuse," says attorney Ben Krause, who handled the veteran's appeals. "The VA has absolutely no excuse."

According to his military records, the veteran involved suffered a concussion in 1958 on the USS Yorktown when a heavy metal hatch smashed into his head and knocked him out.

Years later, when the veteran developed a brain tumor, VA Neurologist Khalaf Bushara concluded the old head injury "likely caused inflammation in the brain and the meningioma." He wrote the tumor "at least as likely as not" was "caused by the inflammation caused by the traumatic brain injury" he suffered on the Yorktown.

But when the veteran applied for TBI benefits, he was given a TBI exam by Dr. Danny Smith. Records show Smith is an osteopath – not an approved specialist. Dr. Smith concluded the veteran didn't have a TBI.

"Concluded he did not have traumatic brain injury when in fact he did," said Krause. "And it was clearly in the record."

When Krause filed an appeal, records show the VA agreed that Dr. Smith was "not qualified" to have done the TBI examination.

So, they agreed to order another one. This time it was conducted by Dr. Ephraim Gabriel who the VA claimed was a "qualified TBI examiner." He also found, "no current clinical diagnosis of TBI."

But attorney Krause discovered that Dr. Gabriel was not qualified to diagnosis TBI's either. He is not one of the four specialists required by VA policy.

"And they had him conduct the exam anyway and drag my client through the dirt," Krause told KARE 11.

In effect, a veteran was denied benefits after exams by two different doctors who were not qualified TBI specialists, overriding the findings of the VA's own highly trained neurologist.

When he learned of the situation, Dr. Bushara wrote a scathing memo about the "errors" in the diagnosis, saying that doctors Smith and Gabriel had "failed to consult with an expert in the field that could have provided a competent medical opinion."

After another appeal, records show the Minneapolis VA finally had a qualified doctor examine the veteran. That doctor agreed there was a TBI.

Now the veteran gets more than $1,400 a month in VA benefits.

"Had he just gone away he would have been shy a thousand dollars a month for the rest of his life," says Krause. "And that's the end incentive there, to save a little bit of money."

KARE 11 News wanted to know how many initial TBI exams were done by the same two unqualified doctors. In response to our Freedom of Information Act requests, the Minneapolis VA admitted that since 2010 Dr. Smith and Dr. Gabriel had done a total of 127 exams.

In all, records obtained by KARE 11 show 21 different medical professionals have performed initial TBI exams at the Minneapolis VA since 2010. Only one of them was a TBI specialist.

The Minneapolis VA refused to discuss their use of unqualified doctors on camera. However, just one day after KARE 11's initial report highlighting Butch Hamersma's story, VA spokesperson Ralph Heussner issued a statement that said the VA "did conduct some initial TBI evaluations with providers who were not specialists."

The VA refused to say just how many improper exams had been done.

In the wake of disclosures that unqualified doctors performed brain injury exams at the Minneapolis VA Medical Center, KARE 11 and other TEGNA-owned television stations across the county filed Freedom of Information Act (FOIA) requests asking for the names and qualifications of doctors who had performed initial TBI exams.

To help determine whether the problem was widespread, we wanted to know whether doctors performing initial TBI exams at other VA facilities were qualified specialists.

Although the VA originally released information about Dr. Smith and Dr. Gabriel at the Minneapolis VA, the Department of Veterans Affairs seemingly reversed course – and started claiming that the names of doctors who performed TBI exams is confidential.

In a series of FOIA denial letters, the agency wrote the names are private information that won't "contribute significantly to the public's understanding of the activities of the federal government."

The Department denied our requests in spite of the fact you can find the name and certification of every VA doctor, at every VA hospital, anywhere in America on its own "Our Doctors" website. What's more, as federal employees, every dollar they are paid, including bonuses, is already public information.

What's not known is which doctors performed the TBI exams. Without their names, it is impossible to verify their medical qualifications.

CONGRESS DEMANDS ANSWERS

The VA's ruling surprised some experts.

"The presumption is for access," said Leita Walker, a Twin Cities attorney specializing in freedom of information issues. She describes public access to government records as a cornerstone of democracy.

"There's an expression that sunshine is best disinfectant, right? That if you can't see what your government is doing that there's an opportunity for corruption to arise," she said.

KARE 11 and our parent company TEGNA are appealing the VA's FOIA denials, arguing that releasing the names of the doctors who have performed initial TBI exams will allow thousands of veterans and the public to determine how often exams by unqualified doctors may have denied Veterans benefits and access to medical care.

Congress is now asking questions as well. Shortly after KARE 11 began investigating, the VA notified Congressman Tim Walz (D-MN) about the TBI exam problem. Rep. Walz, who sits on the House Veterans Affairs Committee, says he was told more than 300 Minnesota veterans received initial TBI examinations by doctors not authorized to perform them.

Walz has called for a nationwide investigation.

"If it happened in Minneapolis it's possible, and I would argue probable, it happened elsewhere," Walz told KARE 11.

QUESTIONABLE CREDENTIALS

The second part of the KARE 11 Investigates special Invisible Wounds.

The FOIA denials did not stop KARE 11 from digging deeper into the qualifications of VA doctors and making another alarming discovery.

KARE 11 documented examples of false and misleading information posted about doctor's qualifications on the websites for VA hospitals across the country.

The Minneapolis VA website claimed Dr. Gabriel is Board Certified in Public Health and General Preventative Medicine. But when we fact checked that – we found there's no record of him ever holding any board certification.

"Board certification is very much about the public trust," said Dr. Lois Margaret Nora, president of American Board of Medical Specialties (ABMS).

RELATED: VA doctor certification scandal grows

The organization maintains a website called "Certification Matters" where you can check whether your own doctor is Board Certified.

"It's a tremendously important credential that tells people something very important about their physician's training, about how their physician has been assessed, and what that physician does every day as part of his or her practice," Dr. Nora said.

When KARE 11 compared the certifications the VA listed for its doctors at facilities across Minnesota and Wisconsin, against the ABMS database, we found case after case – specialty after specialty – where the VA claimed board certifications the doctors had not earned.

The head of the ABMS says that's a serious issue.

"We would be very concerned if someone was using it erroneously," Dr. Nora told KARE 11.

Our partner TEGNA television stations in Denver and Buffalo documented similar false board certification claims at VA medical facilities in Colorado and New York.

In Buffalo, station WGRZ sampled 133 doctors and found 26 who did not have the certifications the VA there claimed.

In Denver, KUSA checked 344 VA doctors and identified two dozen whose certifications had expired and four others who had never been certified.

Wisconsin Rep. Sean Duffy (D-WI) says he is "extremely concerned" about issues raised by the KARE 11 report.

In a letter to the Acting Director of the Tomah, Wisconsin VA Medical Center, Rep. Duffy wrote: "While I could understand one or two mistakes like this, the fact that there are numerous known examples demonstrates a systemic failure at the VA to ensure that its records are updated at a minimum, or at worst an effort to conceal basic yet essential information from our veterans which could compromise their care."

"When you put on your website or make public information that is not true about whether you're board certified or whether you have a license, that's a misrepresentation" said Rep. Duffy.

A ruling by a state medical board suggests that veterans nationwide may have been denied brain injury treatments and disability benefits because the Department of Veterans Affairs is using an improper test, according to a KARE 11 News investigation.

Traumatic Brain Injuries are often invisible, but they are considered the signature wound of the Iraq and Afghanistan wars.

The findings by the Montana Board of Psychology in the case of Army Captain Charles Gatlin indicate that a test commonly used by the VA to diagnose TBI's is missing too many brain injuries.

"I think that that's a very likely reality," said Dr. Stuart Hall, a member of the Montana board which ruled on the Gatlin case.

As a result, wounded warriors coming home are being forced into a new battle. This time with the agency sworn to take care of them.

Captain Gatlin's fight for VA benefits is an example of how difficult the battle can be.

WOUNDED BY A CAR BOMB

The third part of the KARE 11 Investigates special Invisible Wounds.

Gatlin was a platoon leader in Kirkuk, Iraq in 2006, when a car bomb detonated in front of him.

Knocked down by the blast and flying debris, he was evacuated and subsequently diagnosed with a traumatic brain injury.

Over the next three years, Army medical records show the Purple Heart recipient was given a series of full neuropsychological tests. They showed Gatlin suffered from "persistent frontal lobe dysfunction" along with processing speed deficits and significant attention problems

His injuries were so serious, Gatlin says he was forced to retire from the Army.

"I had no choice," he told KARE 11.

A 'PERMANENT' BRAIN INJURY

A final Army exam in 2009 concluded that since it has already been "3 years post injury" Captain Gatlin's neurological deficits "are likely stable and permanent."

The Army retired Gatlin with a 70 percent disability because of his TBI.

So Gatlin and his wife Ariana Del Negro relocated to Missoula, Montana, hoping to settle into a quiet life.

But the Army's finding of a "permanent" injury apparently wasn't enough for the Department of Veterans Affairs.

In order to qualify for veterans benefits, Gatlin says he was told to report to the VA facility at Fort Harrison, Montana for a re-evaluation.

"And that's where the problems started," Gatlin told KARE 11.

Records show that Dr. Robert Bateen, a VA staff psychologist, apparently ignored the Army's more thorough tests and used a brief screening tool called an RBANS to evaluate Captain Gatlin.

"I saw this man for 20 minutes," Gatlin recalls. "And a decision was made."

Based on that short RBANS test, Dr. Bateen concluded that Gatlin's so-called "permanent" condition had seemingly vanished. He wrote, "If Mr. Gatlin had a cognitive impairment in the past, it is likely that this has resolved."

As a result, the Department of Veterans Affairs dropped Captain Gatlin's TBI disability rating dramatically: from 70 percent down to just 10 percent.

The Gatlin's appealed the ruling, but the VA defended Dr. Bateen's diagnosis and claimed the psychologist observed the proper procedures.

OUTSIDE REVIEW: GATLIN SHORT-CHANGED

Frustrated by the VA's findings, Charles Gatlin filed a complaint with the Montana Board of Psychologists, the state medical board that licenses psychologists.

Gatlin challenged Dr. Bateen's findings and argued that the testing he used was inadequate.

After reviewing the case, the state Board of Psychologists agreed.

"We felt that in this case the person had been short changed," said Dr. Hall.

"Our board thought the process used by Dr. Bateen was deficient," added Board Chairman Dr. George Watson.

The state board sanctioned the VA psychologist. It ruled Dr. Bateen had violated "accepted standards of practice" when he based his diagnosis on the RBANS.

"It was not sensitive enough to do what the VA purported that it was supposed to do," Dr. Watson told KARE 11. "So we reprimanded the psychologist."

The licensing board ordered Dr. Bateen to reverse his assessment and request that Gatlin be given a full neurological exam.

JUST FOLLOWING POLICY

In his defense, Dr. Bateen stated he was just following VA policy. At a hearing, he said the RBANS evaluation he conducted during the Compensation and Pension exam "is the same one that's conducted at VA centers throughout the United States."

What's more, he said during his VA career he'd performed "about 9,000 of these C&P exams."

"Obviously that's 9,000 opportunities for something to go wrong with a process that has some flaws in it," said Dr. Hall.

KARE 11's A.J. Lagoe asked Dr. Hall if he thought other veterans may not have gotten a fair benefits rating because of the screening process.

Dr. Hall responded: "The way that process is set up, I think that that's a very likely reality."

While KARE 11's previous reports questioned the qualifications of individual doctors to perform initial TBI exams, the Gatlin's case in Montana raises broader questions about one of the tests the VA is using across the country.

"No one is getting a fair shake," said Twin Cities-based attorney Ben Krause. Krause represented the Gatlins in their fight with the VA over TBI disability benefits.

"The VA is failing veterans across the country by not properly addressing what TBI is and how it affects people on a day to day basis," Krause said. "And they're doing that just to save a buck."

Krause claims the VA is using simple tests – like RBANS – because they're quick and inexpensive, even though the Montana board found that the RBANS training manual itself indicates "mild impairments cannot be detected."

VA DEFENDS ITS EVALUATIONS

The VA has refused to abide by the Montana Board of Psychologists ruling. It says state rules don't apply to federal facilities.

What's more, the VA is continuing to defend its use of the RBANS test for TBI Compensation and Pension evaluations.

In a letter to Senator Jon Tester (D-MT), Carolyn Clancy, the VA's Undersecretary for Health wrote, "The RBANS test is widely used and was an appropriate test for Dr. Bateen to utilize."

KARE 11 questioned the doctors from the Montana Board of Psychology about the VA's position.

Lagoe: ""The VA said that what Dr. Bateen did was consistent with VA protocol. What does that statement tell you?"

Dr. Stuart Hall: "It tells me that the VA protocol is not appropriate for all patients that are coming through for C&P evaluations with TBI issues."

Armed with the state board's findings, Captain Galtin once again appealed his case within the VA. He recently learned that his TBI benefits are being fully reinstated.

In spite of the VA's reversal in Gatlin's case, the agency has refused to re-evaluate the cases of other veterans who were denied benefits based on the RBANS testing.

"At the very least, a records review is owed to the other 8,999 veterans who were seen by Dr. Bateen," argues Gatlin's wife, Ariana Del Negro.

The ruling in Montana and KARE 11's disclosure that the Minneapolis VA had used unqualified doctors to perform initial TBI exams, prompted Congressman Tim Walz (D-MN) to call on the VA's Office of Inspector General to investigate.

KARE 11 has confirmed a nationwide review of how the Department of Veterans Affairs handles TBI benefits exams is underway, examining the use of unqualified doctors and the testing issues raised in the Gatlin case.

A Minnesota veteran is finally getting treatment for a traumatic brain injury in the wake of KARE 11's investigation.

Navy veteran Anton Welke suffered a head injury while serving on the USS John C. Stennis in 2002.

Welke was one of several hundred veterans who were seen by unqualified medical staffers when they underwent traumatic brain injury (TBI) exams at the Minneapolis VA Medical Center from 2010 through at least 2014.

After KARE 11 began questioning why the VA was violating its own policy by using unqualified doctors to do TBI exams, the agency began authorizing new exams by properly qualified specialists.

In a statement to KARE 11, a spokesperson said, "This was our oversight, and we greatly regret the inconvenience to Veterans who returned for a repeat evaluation."

For Anton Welke, the new evaluation revealed he did suffer from a TBI – and opened the door for treatment at the VA's specialized Polytrauma Rehabilitation Center in Minneapolis.

ANTON'S STORY

The final installment of the KARE 11 Investigates special Invisible Wounds.

"Grandpa Laverne he was in World War II," Anton said, pointing to photos and framed uniforms on the wall of his Plainview, Minnesota home.

"This one is my dad he was in the Army," he said, explaining how service to the country seemed to run in his family's blood. "He was in Vietnam."

"And right here's mine," he said, pointing to his uniform.

Anton served on the flight deck aboard the USS John C. Stennis in the run-up to the Iraq War.

"I think it's everyone's duty they should do it, he said. "That's why I did it."

But that service very nearly cost him his marriage to wife Christina – and much more.

"I'm like we're not going to make it, this is not working," she recalled.

"Almost made me take my own life," Anton said.

INJURED AT SEA

Just what could spark a man who appears to have so much to live for to contemplate ending it all?

The answer seems to be buried in the pages of his military records. "April 6, 2002 running up ladder well, hit head on bulkhead," the entry states.

Anton remembers the night battle station alarms were sounded on-board the Stennis. That's when a heavy metal hatch slammed down on his head.

"Bam! I was sitting on the ground and grab my hand and there was blood all over it," he said. "And I was just kind of like, whoa!"

He remembers vomiting and being treated on the ship.

"Took me down to medical got me stitched up and went right back to work," he recalled.

The blow to the head was soon forgotten. But within a few months the young sailor says he started having mysterious problems.

"Sleeping was one of my main issues and anger," he said. "I had anger issues, I fly off the handle, bad anger issues."

His wife noticed the changes, too.

"I started realizing the guy that I married," she remembers, "I wasn't sure who was going to wake up every morning."

RETURNING TO MINNESOTA

After leaving the Navy, Anton and Christina returned home to Plainview and started a family. But the once happy-go-lucky Anton seemed to be battling an ever growing list of internal demons.

"Dr. Jekyll and Hyde, you know," he said. "I'd just get mad at my wife. I get mad, I lose feelings in my arms. And just - I'm so drained, I can't stay awake."

"He has a sleeping disorder," said Christina as she listed his problems. "He has a mood disorder, he has panic disorder, he has been diagnosed with PTSD."

In 2012, believing Anton's issues might be related to his military service, his private doctors recommended he go to the VA for help.

"I truly thought I was going for help," Anton said.

"He's trying to tell them I need help," his wife remembers. "Not 'I need money,' I need help! Help me!"

Because of the old blow to the head detailed in his service records, Anton received a traumatic brain injury or TBI exam by a doctor in the Compensation and Pension Department at the Minneapolis VA.

Records show Dr. Wanda Blaylark didn't do any "neuropsychological testing" and didn't diagnose a TBI. With no diagnosis, Anton was sent home with no TBI treatment.

The veteran found himself at his church, spending hours on his knees contemplating taking his life.

"I just had nothing left in me," he remembers. "I didn't care no more. I was physically and mentally tired."

Looking up - and in - Anton found strength through faith and family.

"In our most intimate moments, he's looked at me in the eyes and said I'm trying, I'm trying. Like I don't want to lose you guys," Christina said.

"I knew I still had something to live for," the father of two decided.

But there was still the question: Why did he have these problems?

Three years would pass before Welke got an answer.

A NEW DIAGNOSIS

VA policy mandates only four types of specialists, including neurologists and neurosurgeons, are qualified to make an initial TBI diagnosis.

Dr. Wanda Blaylark did Anton's exam. She is board certified in occupational medicine. But she is not a TBI specialist.

So, after KARE 11 began asking questions, Anton got a new exam – this time with a qualified doctor.

"He actually did tests with me," Anton said. "I wasn't a number. Finally, I was actually getting care."

And a new diagnosis.

"Without a doubt you have a traumatic brain injury," Christina remembers the specialist saying. "And thank you for your service."

That finding by a qualified TBI specialist threw open the doors at the VA that were previously closed.

Anton is now receiving treatment and cognitive therapy in the Minneapolis VA's top notch Polytrauma Center, one of just five nationwide. He's also begun receiving benefits payments.

But he's left to wonder why the VA first used a doctor who wasn't properly qualified to diagnose his injuries. In effect, that denied him the help he needed three years ago.

A nation-wide review mandated by Congress into how the VA has handled traumatic brain injury benefits exams is currently underway.

Veterans tell KARE 11 they hope that investigation will finally provide answers and spark system-wide reform at the Department of Veterans Affairs.

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