CHICAGO Sgt. Eric Edmundson arrived at the U.S. Army's Walter Reed hospital in October 2005 with a severe head concussion, a victim of one of the many roadside bombs that are a part of daily life for soldiers in Iraq.
Six months later, after intense physical rehab and an infection that made control of his limbs futile, his morale hit bottom. The Department of Veterans Affairs gave him the choice of a nursing home or returning home from a Richmond, Virginia facility, his family said.
"We felt the VA had a 'wait and see' attitude, and our belief was that time was our enemy," said Eric's father Edward, who left his job at Conagra Foods in North Carolina to be his son's full-time health advocate. "So we took him home."
Unsatisfied with the outcome, Eric and his family eventually found treatment at a private hospital, and began a slow path to recovery. But his story is unusual. Wounded vets are seldom treated at private hospitals, which say they offer expertise for severe brain injuries like Eric's. The VA is resisting using their services, setting up a clash over care for some the war's most seriously wounded veterans.
Of the nearly 24,000 wounded soldiers returning from Iraq and Afghanistan, about a third suffer from some degree of traumatic brain injury, or TBI, according to the General Accounting Office.
The government has been on the defensive about veterans' medical care after a probe found shoddy living conditions of recovering wounded at Walter Reed Army Medical Center, considered the jewel in the military's health care system.
A newly-appointed Commission on Care for America's Returning Wounded Warriors was formed by U.S. President George Bush in response. A major topic is whether the civilian sector could be used more in treating traumatic brain injury, one of the fastest growing injuries of the war.
"That is a $64,000 question, and one that the Commission will be studying," as it holds hearings in advance of drawing up recommendations for Bush, said Edward Eckenhoff, president of the National Rehabilitation Hospital in Washington and a member of the commission.
CASE BY CASE
The VA has four hospitals to treat severe brain injuries, in Minneapolis, California, Florida and Virginia. Critics say the total of 48 hospital beds in the entire VA system devoted to the brain injuries is inadequate to meet demand.
Barbara Sigford, the VA's National Director for Physical Medicine and Rehab, said the agency's expertise in spinal cord injuries and amputations, often intertwined with brain trauma, has been growing for the past 20 years.
"This isn't new for us by any means," she said. "I would say that seldom is it in someone's best interest to transfer them to another (civilian) program."
Sigford said there is no issue of overcrowding since the four VA trauma centers are running at about 80 percent capacity.
For their part, private hospitals said they have been building expertise by treating tough brain injuries for decades, whether for construction accidents or car crash victims. The VA by contrast has been caring for mostly chronic illness in Vietnam and World War II veterans, they say.
Jeremy Chwat, executive vice president of the advocacy group, the Wounded Warrior project, said the VA does a good job of caring for critical patients once they arrive, but that it could use assistance in the long road of rehabilitation.
"We've been urging them to collaborate with the private sector. It's about choice; we want veterans to choose the VA but not be captive by it," he said.
Traumatic brain injury, caused by a blow or jolt to the head, often results in severe disability, at times permanent brain damage. It is being called the signature injury of this war, as improved armor and medical advances save many more lives than in prior conflicts.
"In Vietnam, if you got your leg blown off, you bled to death. Now if they can get you to a hospital, you are not going to die," said Ronald Glasser, a Minneapolis specialist in nephrology and rheumatology, who has written several books on veteran care and was a physician during the Vietnam war.
Symptoms include blurred vision, slurred speech, and physical paralysis, among many others, and it is often coupled with amputation and spinal cord problems.
The VA estimates about 400 cases over four years were severe enough to require significant rehab, while some critics say the numbers are several times that.
Often-times lack of physical symptoms may cause slow reporting of the injury, experts said.
"The presence or absence of particularly a closed-head injury where there is not an obvious breach of the skull" is hard to diagnose, said Col. Joyce Grissom, medical director for the Defense Department's Tricare health program.
Private rehab hospitals are dealing with financial pressures, including a need to fill beds because of more stringent Medicare requirements, Chwat noted.
"Obviously dollars and sense do come into play. To say there is not a financial motive involved would be naive, but unless the family can choose to go somewhere else, you can't say they are choosing the VA."
The private sector officials say there have been encouraging signs recently. One of the private institutions, the Rehabilitation Institute of Chicago, is where Eric Edmundson wound up two months ago after his father discovered he could use a civilian facility and have it paid by GI benefits.
It was worth it, he says. About a month ago, Eric stood up by himself for the first time since 2005.
"When we first got to Walter Reed. They took us together in a room and said he'd be a vegetable his whole life," his father said.