Navy chief with brain injury fights back after losing promotion
By DIANNA CAHN | The Virginian-Pilot (Tribune News Service) | Published: June 14, 2015
NORFOLK (Tribune News Service) — Chief Petty Officer John Fleming had the kind of career you can bank on: Fast-track promotion, stellar evaluations through repeated combat deployments, a stack of medals and commendations including a Bronze Star with valor. "The cornerstone of the department," one commander wrote.
As an explosives ordnance disposal tech, he unearthed and destroyed countless improvised bombs aimed at killing U.S. forces or their allies. In 2004, he was grazed by a bullet, thrown from a heavy-duty truck during a firefight and returned to combat even after being shipped home for his injuries.
Then, years later, Fleming started forgetting things. He had trouble organizing ideas. Tasks he'd been doing routinely were suddenly confounding, and pressure from his commanders at his new unit at Joint Expeditionary Base Little Creek exacerbated his confusion.
In the span of four months at Explosive Ordnance Disposal Mobile Unit 2 in 2013, Fleming's 13-year career unraveled. He received bad evaluations for failing to complete tasks — the final one stated his performance "demonstrated a lack of loyalty to the mission" — and had a pending promotion stopped. He was removed from two jobs.
In the coming months, Fleming was diagnosed with mild traumatic brain injury and later, with post-traumatic stress disorder. The TBI apparently stemmed from the truck rollover in Iraq nine years earlier. His medical records, which he shared with The Virginian-Pilot, state that the 2004 injury was compounded by repeated blasts over the years. The findings would be confirmed by other TBI and mental health experts.
Fleming received the diagnosis like a revelation. His struggles came from war wounds, not malaise. Like many combat veterans, he had apparently suffered greater injuries than he'd realized on the battlefield. He informed his command and requested his promotion be restored.
But his commanders at Little Creek appeared dubious that his troubles at work were health-related. They agreed he needed medical attention but continued to hold him accountable for his poor performance. They question the timing of his diagnosis, which came shortly after he received a reprimand for poor performance.
Fleming's bosses insist they had to protect the unit and its high-risk mission — actions they say they would take again, knowing everything they know now about his condition.
For the past year, Fleming has been on limited-duty status, assigned to Portsmouth Naval Medical Center. He is now working with a Navy defense lawyer to clear his record. He expects to eventually be medically retired.
The command's actions make Fleming and his wife, Amy — an officer with Naval Special Warfare — wonder about the Navy's commitment to sailors who've borne the brunt of battle. They say they are fighting not just to restore his record, but to counter what they perceive as a pattern of unfair treatment against servicemembers who suffer invisible combat wounds.
"The damage has been done to John," Amy Fleming said. "It's more about making it right for others who follow."
Traumatic brain injury and post-traumatic stress disorder are common among veterans of the wars in Iraq and Afghanistan. The Pentagon says it has documented 500,000 cases.
TBI accounts for some 320,000 of them — more than in any other war in U.S. history — likely because of life-saving advances in body armor and modern medicine. The flipside of that progress: A generation of combat veterans has returned home with these often invisible wounds doctors are still learning about.
Experts now know that rest is the best cure for mild TBI — which military doctors identify as a concussion, similar to injuries suffered by football players. But even a mild injury to the brain can have lasting effects.
"Just to be very clear, having a 'mild' head injury does not mean the person has 'mild' problems," writes Dr. Glen Johnson, a licensed neuropsychologist, in an online book titled "Traumatic Brain Injury Survival Guide."
"A 'mild' head injury can prevent someone from returning to work and can make family relationships a nightmare."
TBI looks different, depending on what part of the brain is injured. Doctors are studying the effects of cumulative concussions. Persistent headaches, cognitive difficulties, memory loss, sleep difficulty and environmental overload are just some of the symptoms.
A blast can do a different type of damage than a hit to the head. Equating the two "trivializes mild TBI, harming warfighters by delegitimizing a lasting injury," wrote J. Patricia Blanco Kiely in an article for the U.S. Naval Institute's Proceedings magazine in September 2011.
Most people recover from mild TBI, but "about 5 percent of people don't get better quickly and have recurring problems," said Capt. Jack Tsao, director of TBI programs at the Navy Bureau of Medicine. A lot is still unknown about the links between TBI and PTSD, he said.
In recent years, there has been a concerted push by military doctors to make servicemembers and commanders more aware of TBI and PTSD, said Capt. John Ralph, an officer with the bureau's wounded, ill and injured program.
"The primary concern is the health of the servicemembers," Ralph said. "We want commanders to be aware of that, spot signs of that to be sure the person gets the help they need. It's also a readiness issue — so commanders can spot that."
Unlike in 2004, military branches now require that all servicemembers who suffer concussions are checked by a doctor.
But many are reluctant to come forward because they fear losing their jobs or being ostracized.
"This is the stigma: If you associate with someone who is ill, you will become ill," Fleming said. "Like you are damaged goods."
Command officials would take questions about Fleming's case only in writing, and they provided written answers.
The seven-page response stressed several points: that Fleming has received top-notch medical treatment and had more than 400 "encounters" with health care providers. That Explosive Ordnance Disposal is a high-risk command, even in training, and if sailors cannot perform, they must be removed to ensure the safety of their fellow servicemembers.
Cmdr. Charles Eckhart, who until June 4 was skipper of Fleming's old unit, EOD Mobile Unit 2, explained the gravity of removing substandard sailors this way:
"If I fail to act," he wrote, "someone in my charge will pay for my mistake in blood."
Eckhart said he did not take removing Fleming's promotion lightly, and he and his subordinates made a concerted effort to help him succeed. "Only after his complete disregard to complete any of the assigned tasks was an adverse action taken to document substandard performance," he wrote.
The command questioned the timing of his diagnosis — it came only after he got a poor evaluation — and said Fleming's records contain no mention of a vehicle rollover or any head injuries — including pre- and post-deployment health assessments for overseas deployments Fleming did in 2006, 2008 and 2009.
Fleming has documentation of the rollover. He was deployed with the Marines at the time and the incident apparently never made it into his Navy record.
The command also questioned the link between his diagnosis and Fleming's poor performance, saying neuropsychological testing did not identify any brain dysfunction in Fleming.
"While Chief Fleming was assigned to EODMU 2, there was no diagnosis that could be directly attributed to Chief Fleming's lack of performance," Eckhart wrote.
The Navy's response repeatedly cited a mental health assessment from the chief of clinical operations at the National Intrepid Center of Excellence, a military institute for TBI and mental health treatment and research. According to the command, the doctor found that Fleming was "fully accountable and responsible for his behavior."
That line, say the Flemings, citing his current psychologist, is a blanket textbook statement for any patient who does not have to be hospitalized and can function independently in society.
The Navy would not make the center's official available for this story.
Fleming shared his center assessment summary. It diagnosed him with mild TBI and recommended continued treatment for post-traumatic tension headaches, treatment for back pain and sleep disorder. The document called for a comprehensive neuropsychological re-evaluation at the center in one year "to rule out or confirm a diagnosis of Mild Neurocognitive Disorder due to TBI versus the negative effects of chronic pain, sleep disordered breathing, chronic post-traumatic headaches, and symptoms of depression, anxiety and posttraumatic stress."
In late 2004, the roads and riverbanks of Fallujah, Iraq, were riddled with homemade bombs.
Petty Officer 2nd Class Fleming, then working with a Marine Corps small craft company that patrolled the Euphrates River, had the task of clearing banks under sniper fire.
Fleming cleared a stretch of riverbank before being grazed in the leg by a ricocheting assault rifle round, according to the Navy and Marine Corps Achievement Medal with valor he was awarded.
The next day, while volunteering on another mission, Fleming's convoy came under fire, according to the medal citation. A medical document in his file corroborates Fleming's account that his truck flipped, throwing him and others from the truck bed. One Marine was killed, Fleming said. He awoke on the ground with another servicemember; both were confused and disoriented.
At the time, the extent of his injuries appeared to be to his leg, but shoulder and back injuries were later identified. The medal says he was sent back to the U.S. to recuperate and returned to Iraq after two months, then conducted 23 missions.
In 2006, Fleming earned a Bronze Star with valor for his service with a team of Navy SEALs in Iraq, going on 77 operations to unearth improvised bombs buried on their route, that commendation said.
Those and other deployments — to Afghanistan and Africa — all took their toll on Fleming in ways he says he didn't recognize until later. He had headaches, back and shoulder pain, and leg problems.
After his deployment from Afghanistan in 2008, Amy Fleming began noticing other differences in her husband. He was more anxious and had trouble sleeping. He was more forgetful, forgetting words when he spoke.
When the couple got shore duty assignments in Maryland in 2010, they were relieved for a chance to regroup and focus on family. Their second child, a boy, was born.
In 2013, orders came for Fleming to head to Mobile Unit 2 at Little Creek.
Immediately after arriving, he had trouble putting together the type of training plan he'd done countless times before. His attempts to seek help from other chiefs were rebuffed. He came home confused, stressed and angry.
In September, two months after his arrival, Fleming received his first evaluation. Not meeting expectations, it said. "Continues to face challenges" as platoon leading chief petty officer.
After his November evaluation said he lacked leadership capabilities and commitment to the mission, Fleming was fired from his job as a platoon officer and transferred to the readiness and training section. Eckhart recommended his pending promotion to senior chief be stopped.
A former boss of Fleming contacted unit leaders to say he'd known Fleming for 10 years and he was always an asset to the community. He urged them to give him another chance.
Amy had access to resources the Flemings say John was not getting at his own command. She found out about Focus House — a mental health resource available to both the EOD and special warfare communities, she says. It was through this resource they learned that John should seek a medical care advocate in his command.
In February 2014, he participated in a two-week evaluation at the brain trauma recovery intervention program at Portsmouth Naval Medical Center.
With new awareness of his medical condition, Fleming met with Eckhart the following month. He requested his record and promotion be restored. Eckhart refused.
The commander told Fleming that his decision "was based on performance" and that reinstating his promotion "would put undue stress on him and will set unrealistic expectations of his performance in the community and any command he may be assigned to in the future," Eckhart recounted in a memorandum for the record of the meeting.
Eckhart told Fleming he'd be placed on limited-duty status so he could focus exclusively on getting well.
Fleming's diagnosis came a few days later: mild TBI, stemming from the rollover in 2004 "and also several [blasts/concussions] afterward as an EOD tech."
Since then, Fleming has remained on limited duty, trying for a while to work part time with EOD until the command sent him to Portsmouth Naval Medical Center full time in August.
In November 2014, he went to the National Intrepid Center for Excellence at Bethesda, Md. — part of Walter Reed National Military Medical Center — which specializes in the treatment of TBI and mental health disorders.
Doctors there diagnosed Fleming with PTSD. They recommended continued treatment for both the stress disorder and the traumatic brain injury.
The command statement says Fleming never took the steps open to him to protest his evaluation and the lost promotion and responded to his negative evaluation only in May — 18 months later. Under Navy rules, the Flemings have two years
to counter the evaluation and to petition the Navy corrections board. They say they were waiting for medical paperwork — and for help in navigating the process.
Early this year, the Flemings got a call from a Navy defense lawyer. A colleague of Fleming had reached out to a contact at the Pentagon. That official called the lawyer in Norfolk and asked him to help Fleming.
Since he began reporting to the medical center last summer, Fleming said he had not heard from anyone in his old command until a Navy investigator called him recently, after the newspaper began inquiring about the case.
Lt. Mike Hanzel, his lawyer, calls the command's treatment of Fleming an "injustice."
"To see someone like him who has sacrificed so much for his country and to see what he has gone through — the disrespect, the mental anguish — and to have all that he's done in his service called into question, is tragic," Hanzel said. "That's where I see the injustice here. He had earned the right to be a senior chief. He's been a high performer his whole career until now, and all that was taken from him."
In his written statement to the newspaper, Eckhart said promotions are given to people who are able to do the job they are being promoted to, and Fleming did not demonstrate that capability.
But the Flemings — and their lawyer — contend that Fleming had earned his promotion and should not have lost it because of combat injuries.
Fleming said he's come forward to shine a light on what he sees as a systematic effort by the command to get rid of sailors suffering from injuries like his.
"It's a moral injury," he said. "Not only am I dealing with combat injuries, the people I looked to for help, and with whom I worked side by side, turned their backs on me. This is not looking after their own."
Hanzel is working with Fleming on a petition to the Board of Corrections for Naval Records to restore Fleming's promotion. He said the command failed to give Fleming enough time or attention to explore why he was faltering. Once Fleming had a diagnosis, the command failed to take care of him, he added.
"Part of the tragedy here is that you have somebody who is part of an elite unit, who went into harm's way a lot, and he shows up in a new command and his symptoms flare, and the command doesn't recognize any of that."
Dianna Cahn, 757-222-5846, firstname.lastname@example.org
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