What might keep you from getting tested for TBI?

I have a strong opinion about this right now, and I am so disappointed in, and angry with, the Army medical community. (Disclaimer, I am a retired medical SGM, having retired from MEDCOM staff 1 April 2012.) I have been helping a Battle Buddy for the last year as he has struggled to get help. He called me because he got to the point he wasn't understanding what was going on and how to deal with things anymore. We have known each other 15 years and I have watched him deteriorate over time (he has had nine or ten deployments and over five known TBIs, but with over 850 jumps - many with hard landings and injuries prior to that - there were undoubtedly more). He was too hard-headed to get treatment at the time, and his troops loved their CSM so they just 'took care' of him, even this last time. The mortar blast knocked him off an MRAP, unconscious, and they dragged him face down into the bunker. He was unconscious for an undetermined amount of time, then groggy for a couple of days. The time before that he had been knocked around by being too close to an IED blast, and been so nauseated and dizzy he had to move to the rear vehicle (he NEVER had someone else ride in the second vehicle because he wouldn't want someone else in the most dangerous spot taking his place and getting hurt). So at least the last two were probably moderate TBIs if he had gotten evaluated.
When he got back to the states he was having ALL the symptoms of TBI, still, and PTSD. I had seen this happening over time and had urged him to get treatment. Finally he couldn't deny the symptoms, especially the memory loss and other cognitive deficits. So he went in and asked for help. The test examiner treated him like he was stupid (in his words) because he couldn't understand and/or remember the instructions or perform some of the tasks (which is why he was there.) Knowing how it went, I have a feeling she may have thought he was trying to get over on the test for some reason, but also knowing how much trouble he is having, I know he genuinely can't do those tasks. He got frustrated and gave up trying, just doing what he had to in order to get out of the room quickly. The doc evaluating the results was a psychologist (not a neuropsychiatrist) and saw 'variable results', didn't talk to him about it, and just said it must be due to PTSD rather than TBI. He also said that if it was TBI my Buddy would have gotten over it by then. No one took into account the effects of repetitive TBI or bothered to delve into how severe the initial TBI might actually have been (figuring that if he wasn't treated it must not have been too bad, not taking into account this guy was special ops for most of his career and had continued mission with broken bones and torn ACL before).
So he ended up giving up his wreath and going to a staff position (a good staff position, but not a CSM job - he couldn't multitask any longer though and his memory was shot and his mood was unpredictable). He got some speech therapy, but with his new job he didn't have a secretary to remind him of appointments which he couldn't remember (and he did have to answer to the CG) so he missed appointments and got kicked out of that program. So that was the extent of any treatment for TBI. He sees a therapist for depression and PTSD, and they wanted him to go to an inpatient program, but he couldn't go because of the length of the program. So...for three years he just struggled. Finally he let me in on what was going on when he was told they were going to send him to an MEB and he didn't know what was going on or how to handle it. I had just retired and was having surgery and recovering myself when he was first seeking treatment, so I kick myself for not knowing earlier how much he was struggling.
But this last year I was able to see what was done, or not done, for him. And I saw how the MEB process worked, or didn't work, at his duty station. I traveled there to help him numerous times. And OVER and OVER I explained to people that his initial evaluation was flawed, and that he has had several TBIs, and that he is STILL experiencing the symptoms. I pulled all the research from MEDLINE showing that repetitive TBI can cause permanent damage with the EXACT symptoms he has (migraines, memory loss, cognitive deficit, personality changes, etc). Going into the MEB process got him pulled from the board that would have gotten him into a nominative position to stay in to 35 years, putting him in the 1-year window for his mandatory retirement date, so the MEB came back fit-for-duty (the MEB lawyer REFUSED to preemptively challenge the presumption of fitness). And his installation just wasn't putting people into the WTB.
But the ombudsman did work with us to help get him to another TBI program to get evaluated, finally. Only to have them look at that same evaluation that was done three years prior, with that one statement by that psychologist, and say "they determined it was from your PTSD. What do you want us to do?" Some second opinion! Reading the first opinion is NOT a second opinion! He was ready to give up ever getting help. I wasn't. So I went in and talked to the program director and explained the entire situation. I talked to her at great length and she agreed to let him into the program there, if he would finish the PTSD Intensive Outpatient Program at his base first, prior to his retirement. He dreaded doing that, but he was willing to in order to get to the TBI program.
He let his unit know he HAD to do this, and the ombudsman helped get the paperwork done (because of course the folks at his installation LOST the paperwork twice). He went through that program that was so excruciating to him that I had to talk to him every single day to help him get through it. And during the last week I called the TBI program director to arrange his appointment with her (she had said to call her back when he finished to set up the appointment.) And she had the program case manager call me back to say that 'since the problem is mainly PTSD' the program director thinks it would be better for him to be seen at the VA.
I talked to them about the fact that we just put him through hell on the promise that he would be in this better TBI program if he did that PTSD IOP so this would seriously damage trust, and that we DON'T KNOW that the problem is PTSD, and that he wouldn't have any care established at VA for a while, to no avail. I even asked if they would be willing to at least redo the neuropsychiatric testing before making the decision, or so they could do a better warm handover to the VA - with more accurate information, to no avail. The best I could do was that the director would talk to him to explain that they are going to turf him to the VA.
I even called the regional CSM and an ombudsman there to try to get some help. Everyone goes back to that one neuropsych test three years ago - the ONLY evaluation he has EVER been given, and to the fact that he didn't go get help while in theater. The party line seems to be "well, he didn't go get help at that time, so we aren't obligated to help him now." Especially since they had one person do testing - however flawed, and render an evaluation - however unsatisfactory. They keep saying that TBI wouldn't still be causing problems, but IT IS. He is having EXACTLY the symptomology described in the literature for those who have had, as he has had, repetitive incidents of mTBI or moderate TBI. But the military medical community is refusing to help this Soldier.
And this guy has given so much - I served 32 years and I am not exaggerating when I say he is the BEST Soldier I have ever known - he is my hero. I am about to the point where I am ready to blow this up and go to the press to make the point about what the flaws in the system are. And I HATE when that happens (I used to have to deal with issues arising from things like that.) But I know that if they are doing this to HIM, what is happening to young PFCs or SPCs???
So....why don't people report it? Because they see their CSM raise his hand, go in uniform to get tested so others see that it is OK to show you need help, get ridiculed at the test site, and see that nothing gets done for him. When they see that even a CSM gets treated like that, what do you think they feel their chances are? He never once bad-mouthed the medical community, but I am so mad I could chew nails and spit tacks.
We (still including myself in the AMEDD) are FAILING our Soldiers. If a Soldier needs help, it shouldn't matter what they told us when, if they were injured or are ill, we treat them NOW. Turfing them to a VA system we KNOW is broken, with test results we are TOLD are not accurate (with an explanation of why) is unconscionable.
This is another Walter Reed scandal waiting to happen, except this time there is a warning, if anyone cares to pay attention. At Walter Reed the leaders were trying to do their best given what they knew and what they believed their constraints to be. This time some of us are standing up and letting them know what the issues are. Will it make a difference?

When troops have their post deployment physicals they are so emotional about being home they run through the questions with out thinking. In my oppion these are health questions that should be run down one on one between patient and health care provider. The attitude still remains that "if you don't answer no to everything they will try to force you out" and that has to change. If you look at these symptoms do they seem consistent with someone who can sit for 20-30 minuets and fill out a lengthy form. We need to educate our troops and then provide a supportive environment surrounding their post deployment physicals...not just run them through like cattle with yes no questions. But that's just my experiences with patient/troop concerns.

I'm not sure what 'testing' is offered, but I've gone straight to the clinic every time I've had a head injury or been at risk for one (impact vicinity) and was always given the "why the fuck are you here" look. Excuse the profanity. It makes me believe there are a lot of service-members out there that have TBIs or should at least be given a more thorough evaluation, but were brushed off by the medical clinic.