Joan and Doug McDonald of Neenah expected their 24-year-old son, James, to come home last Thanksgiving. And he did - in a body bag.
A few months earlier, the Army sergeant had suffered a "traumatic brain injury" when a roadside blast knocked him unconscious. In conversations with his family, he minimized the extent of his injury.
"'It's just a minor concussion, Mom,' he would tell me," recalls Joan McDonald. "I can hear my son saying, 'I'm fine, I can go back [to Iraq].'"
But James' mother sensed there was more to it. She was so anxious about her son that at one point she had to be hospitalized. And then, her worst fears were realized.
One day last November, two Army officers arrived at the McDonald home at 6 a.m. The McDonalds were somberly informed that their son had unexpectedly died due to unknown causes.
According to the Iraq and Afghanistan Veterans of America, between 150,000 and 300,000 U.S. troops have suffered traumatic brain injury, which the group labels "the signature injury of the war."
Critics charge that the armed forces have been slow to develop effective defenses against the roadside bombs, and slow to recognize the scope of the traumatic brain injury problem that likely claimed James McDonald's life. The Department of Defense still has not instituted routine screenings of returning soldiers, according to the Iraq and Afghanistan Veterans.
James had been in good spirits the previous Friday, when he went out with friends and spoke with his family. But when he failed to show up on Monday, Nov. 12, his friends went to his apartment on the Fort Hood base and found James dead, with bleeding from his eyes, nose and ears. An autopsy ruled out foul play or suicide.
But the military has thus far refused to classify James' death as combat-related. The sacrifice of his life in battle will not be memorialized, something his parents and two sisters feel would give it meaning and honor.
"Why isn't my son's name on the memorial wall at Fort Hood that he helped to build?" wonders Joan McDonald. "In our hearts, he died a hero in the war."
James McDonald, a strapping 6'3," 240-pound member of the 5th Cavalry, suffered head injuries last May 31 in Iraq while manning a machine gun on a Humvee. A roadside bomb was detonated by Iraqi insurgents, and James was knocked unconscious by the force of the blast. He was diagnosed with a traumatic brain injury and evacuated to Germany for treatment.
"We figure he gave his life for his country, but they're just saying that he died," says Doug McDonald, an inspector at a General Electric facility in Neenah.
The classification snafu has delayed payout of a $250,000 insurance policy that James took out for himself.
Doug McDonald found a copy of the policy in the glove compartment of the family's truck and called the company, Military Benefit Association, based in Virginia. He was told the firm had been mystified when James' premium payments, deducted regularly from his Army check, had suddenly stopped in December.
Informed that James had died in November, and causes such as suicide and homicide had been ruled out, the firm said the policy would be paid.
"But it looks like an underwriter got hold of it, and decided that they could delay it," says Joan McDonald. "Now they're saying that the policy can't be paid until the Army comes up with a definite cause of death."
The McDonalds suspect the Army is trying to minimize the number of deaths officially listed as combat-related in order to avoid inflaming public opinion about the toll of the war. Joan likens it to the prohibition on photos of incoming soldiers' caskets at the Air Force base in Dover, Delaware. "Everyone tells us the Army is concerned about the numbers [of combat-caused deaths]," she says.
Traumatic brain injury, or TBI, has most frequently been caused by "improvised explosive devices," whose sheer force can drive a soldier's brain against the inside of his skull with such momentum that the brain is injured. In most cases, the injury is temporary.
But many soldiers suffer long-term symptoms including memory loss, emotional problems, sleep disorders and difficulty speaking, seeing or hearing. Studies have found that 15% of traumatic brain injury victims experience persistent, ongoing symptoms.
Brain injuries have become widespread because the roadside bombs are a central weapon of Iraqi insurgents opposing the U.S. intervention, accounting for an estimated 65% of U.S. casualties, with some troops suffering burns or shrapnel wounds, and others suffering brain injuries from the force of the blasts. According to the Government Accountability Office, 30% of U.S. troops evacuated from Iraq and Afghanistan have suffered brain injuries.
The cost of caring for "polytrauma" veterans - who typically sustain traumatic brain injuries along with, for example, shrapnel wounds and post-traumatic stress disorder - will be enormous. Professor Linda Bilmes of Harvard estimates that such injuries will cost $75 billion to $150 billion over the next 40 years.
Given what they now know about traumatic brain injuries, the McDonalds feel their son required far more care than he received. His symptoms included headaches, short-term memory loss and massive nosebleeds. The nosebleeds had become particularly frequent and profuse in the weeks before his death.
"If he's injured, somebody ought to be looking in on him every day," says Doug McDonald.
Bob Kelter, the head chaplain and social worker at the Veterans Administration hospital in Madison, sees gradual improvement in how the military is handling traumatic brain injury cases.
"I think that there's a much stronger level of cooperation," he says. "When there's severe TBI or 'polytrauma,' like burns or wounds, the patients are generally transferred from the Department of Defense into the VA."
Kelter also says there is a presumption that TBI or post-traumatic stress problems are service-related, so as not to create a barrier to care.
Although their frustrations with the Army continue, the McDonalds received one hopeful sign that James' death would be properly recognized. On Feb. 7, a top officer at Fort Hood requested that his death be classified as being "in line of duty."
But meanwhile, James' death has left an imprint that is visible everywhere in the McDonalds' home. An American flag flies in front of the house, wooden signs reading "Support Our Troops" hang on the front porch, and the home on a quiet Neenah side street is filled with reminders of James' service and sacrifice.
After several of James' closest friends were killed or wounded on his first tour, he got a set of three tattoos on his left leg. Now his mother and two sisters - Jennifer, 30, and Kimberly, 25 - wear identical tattoos on their left legs.
But the pain of James' loss endures. And his family says it will continue to fight on until the Army classifies his death as combat-related.
"We're all having a hard time with this," says Joan McDonald. "We all have trouble sleeping."