October Explosions in Iraq: A Story of Two Soldiers

July 15, 2009 is a date that is burned into the memories of the families of First Lieutenant Andrew K. Kinard, USMC (Ret.) and Lieutenant Colonel Raymond T. Rivas, USAR (Ret.). Their stories intertwined with explosions of an improvised explosive device and a mortar shell. The soldiers came face-to-face on April 29, 2009 when they both testified at a Senate hearing in Washington D.C. The Hearing To Examine The Implementation Of Wounded Warrior Policies and Programs was chaired by Senator Ben Nelson.

Lt. Kinard was injured October 29, 2006 in Al Anbar Province when he stepped on an IED and lost his entire body below the hips. Seventeen days earlier, on October 12, Lt. Col. Rivas was working as a civil affairs officer at the Tallil Forward Operating Base in Iraq when it was attacked by mortar fire. He sustained a traumatic brain injury.

According to Rivas, he had previously sustained at least eight concussions and, while serving in Afghanistan, had been thrown through the windshield of a vehicle. (continued below)

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He told the Senate subcommittee, "When I was originally injured in October of 2006 in Iraq, I was Medivac’d out of Theater and sent to Launsthul Regional Medical Center in Germany for evaluation. My memory is extremely vague about this. I was told that I spent 7 days there and convinced the Neurological staff that I was fit to return to duty. I returned to Iraq, of which I do not remember any of this, and spent approximately 10 days there. I was allowed to go out on missions to Forward Operating bases, and on mission convoys. It was then reported to my Chain of Command that my behavior was extremely ‘bizarre’ and I was referred to the Air Force Expeditionary Hospital Neurologist."

The neurologist diagnosed traumatic brain injury and Rivas was put on priority Medivac back to Launsthul Regional Medical Center in route to Brooke Army Medical Center (BAMC) in San Antonio, Texas. (Launsthul, you may remember, is the facility where ABC News co-anchor Bob Woodruff was sent after sustaining a brain injury from a roadside bomb.)

"What I do remember about my 1st few months at BAMC was that the system was overwhelmed with the influx of new patients. I was pretty much on my own for two to three months. I had a couple of battle‐buddies who helped me with dressing, bathing and eating, as I was not able to do any of these unassisted," Rivas said.

Colleen Rivas also testified before the Senate subcommittee. She said, "One of the issues that I feel very strongly about is the comparison being made between Traumatic Brain Injury and Post Traumatic Stress Disorder. In my opinion there are profound differences between these two injuries. TBI is a physical trauma that can range from mild to severe. PTSD is an emotional trauma which can have debilitating effects. I have dealt firsthand with both of these traumas where Raymond is concerned; PTSD more so after Afghanistan which was in the form of nightmares and some depression. What we could not deal with on our own he was able to obtain help with through the VA in the form of counseling.

"The Traumatic Brain Injury has been an entirely different matter. When Raymond first returned to the U.S. he was sent to Brooke Army Medical Center. He suffered from severe headaches that painkillers and brain blocks had no affect on. In addition to the headaches, he had trouble with his balance, his depth perception, his speech, his eye to hand coordination, his memory, which included both his long‐term and short‐term and any task that involved sequencing. He was unable to go anywhere by himself because he was constantly getting lost. It took a year for him to regain his balance and depth perception.

"Now, two and a half years later, he still suffers from daily headaches, however their severity has lessened. He has regained most of his long term memory; however he still has trouble with his short‐term memory which includes misplacing items on a daily basis and constant repetition of subjects previously discussed. In addition, he cannot follow a detailed set of instructions nor can he multi‐task. His condition is frustrating for both him and our family."

After being on his own for two to three months at Brooke Army Medical Center, Rivas met his case manager. More importantly, he was contacted by the U.S. Army Special Operations
BAMC Liaison, Sergeant First Class Craig Coker. Sgt. Coker got the ball rolling, so to speak, and Rivas began to get the care he needed.

Ray was transported from BAMC to HealthSouth Riosa in San Antonio for brain injury treatment. Therapists helped improve his balance, speech, memory and other skills. His vision and hearing suffered too in the blast, yet Rivas still maintained he was not injured.

On April 21, 2008, Lt. Col. Rivas was awarded the Purple Heart. In September, 2008 he enrolled full time at the Easter Seals Hospital Brain Injury program in San Antonio to participate in their Cognitive Rehabilitation Therapy program. Six months later he was able to testify at the Senate hearing.

On July 15, 2009, a party was held in Washington, D.C. to celebrate Andrew Kinard’s farewell to Washington as he prepared to leave for Harvard Law School. The loss of half of his body had been repaired to the point to could take on the difficulties of law school. That same night, Ray Rivas drove to Brooke Army Medical facility and committed suicide in the parking lot.

Two soldiers – two different kinds of injury – two exceedingly different outcomes.

Ray Rivas was one of thousands of U.S. troops returning with a brain injury, the signature wound of the wars in Iraq and Afghanistan. His story exemplifies the problem faced by both military and civilian medical personnel when it comes to brain injury.

A few months after he arrived in San Antonio Colleen told My SA News, "We didn’t expect the seriousness with what he came back with this time."

This is where the lives of Andrew Kinard and Ray Rivas travelled separate roads. Kinard’s injury was there for everyone to see; Rivas, though, was facing life with an invisible injury. It was an injury that goes beyond physical therapy, speech therapy and cognitive therapy. Millions of brain injury victims know all too well the effects of brain injury.

An injured brain needs rest and tires very easily. Mental fatigue is the first step on the Cycle of Response, a term coined in Brain Injury Survivor’s Guide. Those living with an injured brain face the Cycle daily – jumping from a tired brain to confusion, frustration, guilt and depression. Daily headaches, like those experienced by Rivas, are common, and this multiplies each of those steps on the Cycle. No one can think straight during a severe headache. A brain injury more often than not slows thinking skills because of memory problems and a partial shutdown of the executive functions of the brain.

While Ray Rivas was being treated at HealthSouth, he was allowed to go home to his family in New Braunfels each weekend. Colleen said he would ask the same question ten to fifteen times and, each time, family members would provide the answer as if the question had not been asked before. Short term memory problems easily lead to confusion.

Brain injury victims are aware they cannot remember a name that goes with a face or what they were doing ten minutes prior or why they’re standing in the kitchen or why they are holding a pencil. Add mental fatigue and stress to short term memory loss and Rivas’ testimony before the Senate committee that he did not remember anything about those last days in Iraq becomes clear.

The confusion of not remembering leads to frustration which is exhibited in outbursts of anger or crying or both. It is a normal progression to guilt when a brain injury victim recognizes he or she has changed. A tired, confused, and frustrated brain says,"I’m not as good as I once was." The belief that a person is not as good of a father or mother or husband or wife or employee is an expression of guilt and can quickly lead to depression.

Numerous studies of brain injury have found that unchecked depression leads to separation: separation from spouse through divorce, separation from employment and, in far too many cases, separation from life through suicide.

Ray Rivas lived the life of a hero. He wanted to serve his country as best he could. He did not want someone else standing for him in the war zone. It is my hope that America remembers Lt. Col. Raymond T. Rivas as a hero in death. It is my hope that both military and civilian medical personnel learn more about treating brain injury. It is my hope that Congress will understand the necessity of providing more timely and more complete care to the tens of thousands of soldiers returning from war with an invisible injury.

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