It has been nearly two months since I last wrote about the health of American military personnel and veterans so let’s look at it again. The news, unfortunately, isn’t any better.

First, let’s look at the past. Today the Los Angeles times reports that researchers have found that soldiers who suffered brain injuries can develop seizures decades — as long as 35 years — after the initial injury. A study published in the journal Neurology found that among a group of 199 Vietnam veterans, about 13% developed post-traumatic epilepsy more than 14 years after they had suffered a penetrating head wound, such as a gunshot injury or shrapnel that entered brain tissue. Penetrating head injuries are generally linked with a higher risk for epilepsy than other types of head injuries, such as concussions.

It is unclear how the study relates to combatants returning from Iraq and Afghanistan today, the authors said. The Vietnam veterans in the study suffered from penetrating brain injuries, which are rarer in soldiers fighting in the current conflicts because helmets have improved. Today, closed-head injuries (where the brain is not penetrated) are more common, in part because of the helmet improvements and partly because of a change in the weaponry used in modern warfare.

Nonetheless, Grafman said, the study underscores the importance of long-term follow-up for military civilians who have suffered traumatic brain injuries.

“It’s clear that this is life-long,” he said.

Now, let’s look at the present. Suicides among military personnel are up. Salon reported last week on the suicide of Marine Sgt. Tom Bagosy at Camp Lejune, North Carolina. The article noted that last year, 52 Marines committed suicide. The suicide rate among Marines has doubled since 2005, and the Corps has the highest suicide rate in the military.

That was tragic. Even worse is that Bagosy died a year after a former Camp Lejeune psychiatrist risked his reputation and career to warn Navy officials that unless Camp Lejeune dramatically improved mental health services — and in particular, develop precise, rigorous protocols for handling Marines who might kill themselves or others — there would be deadly consequences.

That psychiatrist, Dr. Kernan Manion, repeatedly warned Camp Lejeune and Navy officials in writing starting in the spring of 2009 about the risk of more Marine suicides, murder and “immediate concerns of physical safety” if Camp Lejeune did not improve. Frustrated by what he saw as a lack of action by officials at Camp Lejeune, Manion took his concerns to a series of military inspectors general in late August. He was fired four days later.

The lessons from Bagosy’s suicide are especially provocative because minutes before his death, Bagosy was inside the Camp Lejeune Deployment Health Center, the place where doctors are supposed to help Marines like Bagosy. Healthcare workers there knew he had problems. They knew he had already been diagnosed with both a brain injury and post-traumatic stress disorder, the signature injuries of the current wars. He’d been seeing a doctor there and a therapist. He’d talked with his therapist about thoughts of suicide. Officials at the clinic the day he died also knew Bagosy was acutely suicidal that very morning and that he was armed, because his wife, Katie, had called.

In June USA Today reported that Marines are trying to kill themselves at a record pace this year despite a 2009 program aimed at stemming the problem, according to Marine Corps data.

Eighty-nine Marines tried to commit suicide through May, most commonly by overdose or lacerations. At that rate, there could be more than 210 attempted suicides this year. There were a record 164 attempted suicides in 2009.

With 21 confirmed or suspected suicides by Marines this year, the Corps is on track to near last year’s record number of 52. The Marine Corps suicide rate in 2009 was 24-per-100,000, the highest in the military. The latest demographically adjusted suicide rate among civilians in 2006 was 20 per 100,000, federal records show.

The suicide rate among American soldiers hit an all-time high last week. The Army reported 32 confirmed or suspected suicides, both active and reservists) in June – the highest number on record for a single month, soldiers killing themselves at the rate of one per day. So far this year, 145 soldiers have committed suicide, compared with 130 during the first six months of last year, which at the time was the worst on record.

Two days ago, the Washington Post reported that senior commanders have reached a turning point. After nine years of war in Afghanistan and Iraq, they are beginning to recognize age-old legacies of the battlefield – once known as shellshock or battle fatigue – as combat wounds, not signs of weakness.

In spring 2009, the top brass in the Marine Corps and the Army were seeing troubling signs that the force was starting to fray. The suicide rate in the two services was on pace to set a record. The percentage of the Army’s most severely wounded troops who were suffering from PTSD or traumatic brain injury had climbed to about 50 percent, from 38 percent a year earlier.

Recognition is spreading, albeit far too slowly, that PTSD is a serious illness, not a sign of weakness. Earlier this month the government issued new rules that will make it substantially easier for veterans who have been found to have post-traumatic stress disorder to receive disability benefits, a change that could affect hundreds of thousands of veterans from the wars in Iraq, Afghanistan and Vietnam.

The regulations from the Department of Veterans Affairs will essentially eliminate a requirement that veterans document specific events like bomb blasts, firefights or mortar attacks that might have caused P.T.S.D., an illness characterized by emotional numbness, irritability and flashbacks.

Finally, thanks to the superb series done by ProPublica and NPR in June we know that the military medical system is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan, many of whom receive little or no treatment for lingering health problems.

Officially, military figures say about 115,000 troops have suffered mild traumatic brain injuries since the wars began. But top Army officials acknowledged in interviews that those statistics likely understate the true toll. Tens of thousands of troops with such wounds have gone uncounted, according to unpublished military research.

Among their findings:

From the battlefield to the home front, the military’s doctors and screening systems routinely miss brain trauma in soldiers. One of its tests fails to catch as many as 40 percent of concussions, a recent unpublished study concluded. A second exam, on which the Pentagon has spent millions, yields results that top medical officials call about as reliable as a coin flip.

Even when military doctors diagnose head injuries, that information often doesn’t make it into soldiers’ permanent medical files. Handheld medical devices designed to transmit data have failed in the austere terrain of the war zones. Paper records from Iraq and Afghanistan have been lost, burned or abandoned in warehouses, officials say, when no one knew where to ship them.

Without diagnosis and official documentation, soldiers with head wounds have had to battle for appropriate treatment. Some received psychotropic drugs instead of  rehabilitative therapy that could help retrain their brains. Others say they have received no treatment at all, or have been branded as malingerers.

Related posts:

1. Too Important to Fail: The Least Bad Call on Afghanistan