Tiffany Hanssen: It is the Brian Lehrer Show. Welcome back, everybody. I'm Tiffany Hanssen filling in for Brian, who is off today. Veterans Day has its origins as Armistice Day when World War I ended on the 11th hour of the 11th day of the 11th month. That means that this year, Veterans Day falls on Saturday, tomorrow.

Today, as we observe Veterans Day, we've invited New York Times reporter, Dave Philipps, who covers veterans and the military for the paper to talk to us about an issue that he's done some reporting on. It involves us recalling a little bit of history into US military involvement in the Middle East prior to the withdrawal of troops.

In 2016, the American military was locked in a ground offensive in both Syria and Iraq against the Islamic State. The American public was growing weary of the extended war in the Middle East. In response, military leaders devised a strategy that involved few troops on the ground and intensive bombardment by heavy artillery. That move has taken a big toll on some military members who were involved with it.

With us to talk about his investigation into the health effects of this intensive bombardment on our vets is Dave Philipps, New York Times military correspondent and author of Alpha: Eddie Gallagher and the War for the Soul of the Navy SEALs. Good morning, Dave. Welcome to the Brian Lehrer Show.

Dave Philipps: Thank you for having me on.

Tiffany Hanssen: First, I want to talk about what we mean when we say, "Intensive bombardments." Tell us a little bit about what kinds of weapons are used, how many rounds we're talking about, what kind of a crew is involved in this sort of activity.

Dave Philipps: Sure. We're going to talk about some specific stuff, but I think it's important to note that what's important about these artillery troops that went there and what they experienced is that it showed in a very clear way that levels of blast that are supposed to be safe, that come from troops' own weapons, can, in fact, be profoundly damaging. Even though we're going to talk about what happened in 2017, those weapons are being used right now, not just giant artillery cannons, but shoulder-fired missiles, powerful sniper, and machine guns.

There's this growing awareness that troops can be harmed by their own weapons. That is something that really has a broad impact.

Tiffany Hanssen: The kind of weapons we're talking about are--? You mentioned a few there,

Dave Philipps: Right. Basically, it's anything that can produce a big boom close to your head. Certainly, a giant cannon will do that, but so could a powerful sniper rifle, a machine gun, a shoulder-fired rocket. Quite frankly, you could look through the arsenal of the US and find a lot of things that are of concern. Let me tell you a little bit about this cannon because I want to make sure that I answered the question that you actually asked.

Tiffany Hanssen: Yes, great.

Dave Philipps: These guys have gone over with something called a 155-millimeter Howitzer. Basically, what that is, it's a 35-foot-long rifle that shoots a 100-pound bullet and can shoot it for about 15 miles. Of course, that's great because then you can sit far back from where the enemy is and hit targets, but a weapon that big, of course, also creates a heck of a boom. These weapons take about 10 people to operate them.

Those folks are- even though this is a very modern and sophisticated weapon, they're still working like gun crews were in World War I. They're right next to the weapon, and they actually fire it if you can believe this, by just pulling a simple nylon cord. They're literally within feet of this blast when it happens. Because this was such an intense conflict that was concentrated in a small group of people, some of these guns fired 10,000 rounds each. That's a lot of blasts that individuals were exposed to.

Tiffany Hanssen: Just to be clear, so we know what we're talking about in this particular time period, these crews were firing these types of weapons that you're describing for hours and hours at a time?

Dave Philipps: Day in and day out. One of the appeals to military planners of artillery is that it can be there if it's dark, it can be there if it's windy, it can be there if it's cloudy. It has a lot of advantages over airstrikes or drones. These guys were used relentlessly. Oftentimes, they were working 20-hour days every day.

Tiffany Hanssen: You mentioned there's roughly 10 people on each one of these artillery crew, but you also said, we're talking about not just these small crews during just this small period of time. Do we have a sense of how many people, overall, we're talking about that could have these effects from this heavy artillery?

Dave Philipps: Sure. I think that that's the most important question to think about when we talk about this, is how many people are actually impacted. That's a really hard question to answer, and let me tell you why. The injury that we're talking about is a traumatic brain injury. Energy waves from these blasts go right through helmets. They go right through skulls. They essentially whip through brain cells at about the speed of sound.

When that happens, it can cause profound but minuscule damage; damage that can't be seen by any current brain scan or blood tests, but can be seen in the samples of brains of veterans that have been exposed to this stuff after they've died. We know that damage is real. It's physical.

When folks who have this injury come home, oftentimes, it presents as something that we might think of more as PTSD. They seem to have a lot of issues that seem to be primarily psychiatric issues; depression, anxiety, pronounced fear response, anger, things that we classically associate with consciously experiencing the horrors of war, but actually may be caused by a physical wound to the brain.

Here's why it's hard to answer that question of how many people are affected. We've sent well over a million people to Iraq and Afghanistan, and many, many thousands of them were exposed to both the horrors of war and all sorts of blasts from their weapons. When they come home, it's very difficult to say, "Okay, now we can document that you're acting different." We can't say how much of this is caused by post-traumatic stress disorder, how much of it is caused by a brain injury.

What was remarkable about these artillery troops, why they are so important to us all in understanding what's happening to veterans, is that they sat far, far back from the front lines of fighting. Most of them never even saw the enemy. They were never attacked. All they did was do their job. All they did was fire weapons and get exposed to this blast. Yet, they came home with something that looked like PTSD.

By seeing that isolated- it's almost like a control group in the study- we can better understand this brain injury that a lot of times is tangled and muddled with all sorts of other war experiences.

Tiffany Hanssen: Dave, I hear you talking about how these weapons affects service members' brains, and it brings to mind a antiquated phrase that we used for people returning from combat, "shell shock."

Dave Philipps: That's right.

Tiffany Hanssen: We don't use that phrase anymore. We say PTSD, but it actually sounds like maybe that is a little accurate.

Dave Philipps: Well, that's right, but it's something more profound than that. In World War I, when they coined the term "shell shock", that was a very new idea that, hey, all these people who are coming back with psychiatric disorders, they may have had a physical injury from blast. They're not bleeding. They have all of their limbs. Yet, maybe the pressure energy wave from the blast of being hit by artillery has damaged them.

That idea fell out of favor during World War II and Vietnam, and then in Iraq and Afghanistan was widely recognized as true that if you're hit by an IED or by an enemy explosion, even if it doesn't leave any physical marks on you, it can deeply affect the brain.

What's different here is that what the science is starting to tell us is that not only can those big explosions profoundly affect the brain, but even relatively small explosions, the occupational blast of firing your own weapon, which military guidelines have long said is safe, that can have profound effects.

I think the way to think about it is, yes, it is both a lot like shell shock, but it's also a lot like what we have come to realize about different kinds of contact sports that you can have these repetitive injuries that don't lead to any concussion or any obvious outward signs but, over time, can really impact the brain in lasting ways.

Tiffany Hanssen: Dave, I want to get to what the military is saying about this, and what they are or not doing about it in a minute, but first, we are observing Veterans Day today, so I would love to hear from veterans. Talk to us about your experiences. Do you have effects from using this intensive artillery in these intense situations, just as Dave is describing? We would love to hear from you.

Also, if this really echoes any experience that you may have had post-deployment in terms of your own health effects, or ill effects that you've suffered because of your service, we want to hear from you. You can call us at 212-433-WNYC, 212-433-9692. You can also text that number. I'll say it again now a little slower. 212-433-9692. We're talking with Dave Phillips about his New York Times investigation into the devastating health effects of intensive artillery bombardment. Veterans, this is your story, and we would absolutely love to hear from you. 212-433-9692.

I said we'd get to this part about the military response. At the time, the military said, "Hey, it's fine. It's all good. There's no issue here." Is that right?

Dave Philipps: Yes. Essentially, all of their doctrine says, firing these weapons is safe, therefore, we should not expect any injuries. No one was essentially looking for any problems, not the medical folks, not the leaders of the units that came home. That was complicated by what this type of injury looks like.

When these artillery crews came home, here's what was being experienced widely across different groups of gun crews that had never met, that had been in even different branches, army, marines, they were all experiencing roughly the same thing. Intense sleeplessness, disturbing dreams when they could sleep, depression, headaches, anxiety, also physical things that might surprise some listeners, elevated heart rate, real problems with their digestion. Those may be caused by the fact that communication between the brain and other organs was compromised.

Now, if you're a 21-year-old, who's just come back from Syria, and you can't sleep, and you're having nightmares, and you're angry all the time, and you're depressed, but no one has ever told you, "Hey, you may have a brain injury," most of them went through this thought process. "Huh, I kind of feel like I have PTSD, but that doesn't make any sense because I was never in any real combat, so what the heck is wrong with me?"

A lot of them started to think that they were crazy. They hid their symptoms, or tried to downplay them. Even some of them, they started to slip into psychosis. They were seeing things. Some of them were having bipolar- like intense episodes of bipolar. They didn't really want to admit what was happening.

Oftentimes, if they did go to military doctors or VA doctors, those people weren't trained to recognize what happened either, and so oftentimes they were diagnosed with routine civilian disorders, hyperactivity, attention deficit disorder, or a sleep disorder, or a run-of-the-mill depression. It wasn't seen as a wound of war over and over and over.

Tiffany Hansen: Dave, that's talking to me that you're telling me that military doctors not-- I can see maybe going to a civilian doctor, but military doctors didn't recognize this as an issue.

Dave Philipps: Right. I think it comes down to how much was based on this broad assumption that, hey, this level of blast is safe. These are folks that were not educated to say like, look for a repetitive concussion injury, in the same way that sports doctors have probably missed this over and over and over for generations in the NFL.

Tiffany Hansen: I want to get into that a little bit more, but I also want to, before we get too far from it, talk about this initial assessment made by the military that it's all fine, that using these weapons in this way, will not cause any harm to you, to the military service people that are using these.

For me, it immediately brought up a burn pit issue response, like, oh, this reminds me of what we were hearing or what I knew about burn pits that initially, the military was saying, no, no, it was all fine, not so far as nothing to see here. Then it turns out, and then there's all the things that happened after- there was finally some recognition for these people who were suffering after being at these burn pits and exposed to all of the toxicity there. I'm wondering if you also see some similarities.

Dave Philipps: Well, it's kind of the same disconnect. If you talk to people in uniform who repeatedly fired a lot of these big weapons, they'll tell you that it's pretty clear that it has an effect, that afterwards, they feel terrible, that they have headaches, in the same way that if you talk to people who around burn pits alot, they'll tell you that it was awful. Yet, people in the Pentagon who are gathering data on this or in charge of creating the guidelines, whatever they're basing their decisions on, there's a disconnect and they don't see it. I think it's the same thing.

Last research in the military for a long time was focused on, what is the largest blast that our troops can survive. It was really based on, "Hey, do you have any immediate obvious effects? Are you still standing? Are you two days to function? No? Good." They set a safety level, and basically, their safety level was based not on brain health, which they couldn't see and didn't understand, but on eardrums.

If a blast was so loud that it would blow out your ears, obviously, that would affect the mission. They set this level, which they use pounds per square inch level to measure blast pressure. They put a level of four pounds per square inch, and they said anything above this is not safe. It turns out that these artillery crews were firing guns that were pretty good measure below that safety level, and yet they came home with profound and lasting injuries.

Tiffany Hansen: I want to get to a little bit more of what you said, but I also would like to bring our callers in here. Dave, of course, this is a veterans issue. I would love to hear from our veterans. 212-433-9692. Let's hear right now from Gail in Wilmington, North Carolina. Good morning, Gail.

Gail: Good morning. I am a transplant from New York and I still listen. I'm speaking for my husband. He is in a nursing home, and we're watching him die, and I get upset. The Vietnam vets have been blessed. I, just coming down here, had a wonderful neurologist when my husband could get out of bed. It was noted he had PSP. The Army never told anything. I went to the veterans, and they said, "Oh, he doesn't have Parkinson's. I could give you money right away, but PSP," and that was just a year and a half ago, but I found out if I go to the disabled vet, they would help me get a claim.

There are thousands of men who, for 50 years, have suffered and have not gotten anything. No health, no diagnosis correct, and they've been-- I know, one of his friends died of a very rare brain disease. At least four people who are all 75 and older, and they have Parkinson's or as my husband now has called parkinsonism, which is a little of this and a little of that, but we're watching him die.

Tiffany Hansen: Gail, thank you so much for calling in and talking about something that is really very difficult to talk about and difficult to hear, Dave, but I'm sure you heard a lot of it.

Dave Philipps: Well, let me address something that I think Gail is raising, is the question of, if this brain damage is happening long in service, just like some forms of repeated concussion from things like boxing or football, is there a risk that it could cause a progressive degenerative disease? The state of the science right now is unfortunately that we don't know. There's a really robust effort by the Defense Department right now to collect the brains of veterans that might have been exposed to blast to try to look for patterns that suggest whether this disease progresses or not once the injury takes place, but that question is not answered.

In many ways, the brain is remarkably robust. If pathways are broken, it can create new pathways. These are definitely injuries that people can recover from and learn to live with. What we don't know is how permanent they are or if they'll get worse over time.

Certainly, there are a lot of people in their 70s, who served in Vietnam and fired a lot of artillery rounds and other heavy weapons, and how are they affected? We don't know. The truth is, is that nobody, at least for that generation is looking that far back and trying to answer that question.

Tiffany Hanssen: Dave, Ali in Saratoga Springs says "I would say the greatest effect on my mental health was being sleep deprived, and the atmosphere amplified my anxiety. I was also surrounded by a culture that had a lot of sexual harassment that wasn't being dealt with. It ended up being a big factor in the decision not to re-enlist." I want to take a call here, Dave. Jonathan in West Orange, welcome to The Brian Lehrer Show.

Jonathan: Thank you so much.

Tiffany Hanssen: Yes. You are a doctor?

Jonathan: I'm not just saying, I'm a neurologist with specialty training in brain injury rehabilitation, so right up the alley here.

Tiffany Hanssen: Great. Your comment?

Jonathan: Well, I've taken care of lots of military folks over the years that clearly the military doctors missed this. They just weren't trained to appreciate this. I think a lot of civilians too, who after the military, now, they're police officers, and firefighters very commonly, and there, I just wanted people to know, there are treatments. It shouldn't just be chalked up to psychiatric purely. It's like a silent epidemic. Yes, it's frustrating for people when you can't see anything wrong on an MRI. It's like long COVID. You can't see anything on an MRI, but they got many of the same symptoms. It's treatable, and there is hope.

Tiffany Hanssen: Dave, are you [crosstalk]?

Dave Philipps: I think that's really important to recognize is that there are good treatments out there. It's not that the damage can be repaired, although that's certainly what the science is striving for, but there are different treatments for the different symptoms. I've certainly met a number of veterans, even from the artillery group that I wrote about, who are living productive lives because they've been able to get some relief for some of the symptoms that they have.

Tiffany Hanssen: We have a question that was texted into us. "The speaker keeps saying that the soldiers using artillery could not have PTSD because they have been far from combat. I had been told that military drone pilots operating drones internationally, even if the pilots remained in the US have experienced PTSD or symptoms of PTSD." Could you speak to that, Dave?

Dave Philipps: Yes. Thank you for asking that question because maybe you read the reporting that I wrote on that. I think that's very true that people can be traumatized by the act of killing. If they see it on a high-definition screen, versus from a trench, it doesn't mean that they're not harmed.

I got to tell you, when I first started recording this story, it's because a few veterans from one of the affected units came to me and said that they were having all sorts of problems that looked like PTSD. That's what they thought it was. I thought that this was a story about exactly what you were talking about, that these guys realized that they had caused a great deal of harm. They were aware of it. Even though they weren't near the front lines, it had deeply affected them. I thought that that was an important story to report.

As I started talking to more and more of the guys who are in these gun crews, what I realized is that they don't see where their weapons hit. They're not told what they're aiming at. They essentially get a string of coordinates that help them aim the gun, but there's zero awareness in many cases of what the actual impact was.

I probed these guys to see if even the unknown was bothering them, and in many cases, it wasn't. I looked for that type of injury and didn't find it. I was scratching my head saying, "Well, what is going on? Because clearly these guys are affected, but they're not affected by what they've done, or at least not most of them, and so what is it?" It was only after talking to many more people that I realized that these blasts that supposedly were safe were not.

Tiffany Hanssen: I'm wondering if there's a trust issue here. We talked about how the military reassured our service members that things are safe. Burn pits are safe. We know that they're not. I'm just wondering, what seems like an erosion of trust, what does that do on top of everything else?

Dave Philipps: Well, I think that's a really good point. It's important to know that people in uniform they don't have a lot of the options that civilians have. If they do have a lack of trust, or they think that that's something in their job is risky, they can't quit, and they can't refuse to do the job. Both of those are triumphs in the military. You have to do what you're told, and you have to show up for work.

They also, if they are injured on the job, they can't sue for negligence. That's a right that they don't have. They're really backed into a corner in terms of their options. That's why it's really important for us to hold the military accountable to make sure that they're taking care of people.

Now, the military is coming around to understanding that there's a risk posed by these weapons. It's created basically a task force to look at this and funded a lot of studies. I got to say, it's slow-moving. What that means is that you could go to the field right now and watch people training with heavy weapons. These are weapons that the Pentagon has recognized are probably dangerous. There's not much that's being done to mitigate that risk. People are still being exposed over and over to the blasts, which is upsetting.

Tiffany Hanssen: I want to bring another call in Dave before we wrap things up. Charles in Forest Hill. Good morning, Charles.

Charles: Good morning.

Tiffany Hanssen: Welcome to The Brian Lehrer Show.

Charles: Yes, what a sad show. I lost several friends. Every one of them was in an environment that had depleted uranium used in our weaponry, especially the two-engine jet that was so effective, I think the Warthog. It fired depleted uranium. When that area would be replaced with American troops, they're breathing that. The three that I know, share that, and they would always have these cancerous cell lumps that grew in them, and they were fatal. They are still using depleted uranium now because it's a heavy, heavy weapon that can get through almost anything. It's probably killed more American troops than it did the enemy.

Tiffany Hanssen: Charles, thank you for the call. Thank you for calling in. We appreciate it. Dave?

Dave Philipps: Yes, thank you, Charles. I think he touches on something that is absolutely related to this problem. When I was speaking about how there's a lack of options for troops to make decisions to protect themselves, and they can't sue over negligence by the military, what that creates is an environment where all sorts of things, whether it's depleted uranium, or other toxins in weapons, they can essentially coexist with troops even though there may be real questions about their safety.

Over and over, the United States government has deferred to the military in making decisions because it doesn't want to tie its hands in war. I think we can all understand that. Some of the fallout of that is that a lot of times troops are exposed to needless risk and don't really have much recourse.

Tiffany Hanssen: You mentioned the military is coming around a little bit. I'm wondering if there are any other studies being done on folks who have these health issues.

Dave Philipps: Here's why it's so difficult to study. This is not an excuse for inaction, but it does get the part of the problem. Let's say you want to understand how blast affects the brain of veterans. Well, there's not a good way to measure how much blast people have been exposed to, at least after the fact. You can put blast gauges on them and follow them around but that's not being widely done. You don't know how much they've exposed to. You don't know the dose.

Then you can't see the injury in anyone who's living. It's too minute, too deep in the brain cells to see with current imaging technology. How do you get to the problem and show it to policymakers so that they can see it? Now the military is trying to do some studies that track this stuff.

I actually was just in the field with people firing rocket launchers. After they fired the rocket launchers, they had sensors on them, and they took blood tests, and they took brain scans, and they gave them memory tests. They're doing all this stuff to track and show whether this is harmful but science is slow.

Like I said, in the meantime, there's a lot of free and easy things that we could be doing to limit exposure to blast and protect troops and in a lot of cases, the military is not doing.

Tiffany Hanssen: Dave Philipps is a reporter with The New York Times who writes about veterans and the military. He has also got a book, Alpha: Eddie Gallagher and the War for the Soul of the Navy SEALs. Dave, thanks so much for your time today. We appreciate it.

Dave Philipps: Appreciate you having me on.

 

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