The details of retired Florida National Guard Sgt. Ernie Rivera's harrowing deployment to Iraq are told in the thousands of pages of his medical file.
Severe traumatic brain injury. A cracked vertebrae. Surgically repaired shoulder.
Rivera, the most-decorated man in his unit, won two Bronze Stars for his service in Iraq ending in mid 2007. But he can't get what he values most.
A Purple Heart.
The Army refuses to award Rivera a Purple Heart for harm to his brain and other less serious injuries he suffered when he was blasted by a roadside bomb and then by a second explosion in a fight with insurgents.
The refusal comes even after an Army medical board ruled that Rivera, who was hospitalized for six months, was totally disabled by combat-related traumatic brain injury, or TBI, and other injuries, records show.
One problem the Army cites to Rivera: Like many soldiers with TBI, he exhibited the most severe symptoms weeks after the blast and wasn't treated for any of his injuries immediately.
The Army says it must be sure the brain injury was caused by combat to award the medal, which is more difficult to do as time passes.
Rivera said he tried to ignore headaches and his increasing malaise for weeks after the explosion, typical behavior in the Army's macho culture.
"I'm being punished for toughing it out," said Rivera, 39, a father of two who was treated at the James A. Haley VA Medical Center's polytrauma unit in Tampa and a Miami veterans hospital. "I can't see how a person can go through what I went through and still be denied a Purple Heart."
But what makes his battle with the Army especially frustrating, Rivera said, is that he has received little help from Florida Guard leaders who could have put pressure on the Army.
Only on Thursday, after inquiries by the St. Petersburg Times, did the Guard offer him help.
To veteran advocates, Rivera's plight shows the struggles soldiers sometimes face winning recognition for an injury, invisible and insidious, that maims without drawing blood.
"You hope that this is just bureaucratic red tape that will be cleared up," said Paul Sullivan, executive director of Veterans for Common Sense. "Soldiers shouldn't have to fight their government for their Purple Hearts."
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After the roadside bomb exploded in Rivera's convoy in December 2006, he thought he had lucked out by escaping serious injury.
But in the weeks that followed, his symptoms worsened, including vertigo, muscle weakness, memory loss, and problems with cognition, vision and hearing.
Rivera said his TBI was aggravated by a second blast while fighting insurgents weeks later. Rivera was awarded a Bronze Star with valor for risking his life — and tearing up his shoulder — helping rescue three children held hostage by insurgents.
Michael Lapine, a Florida National Guard medic who treated Rivera during his deployment, saw the deterioration in Rivera as time passed.
Lapine said Rivera became shockingly forgetful. He had intense headaches. His eardrums were both displaced in the direction of the blast — one bulging inward, the other outward.
"It unnerved us," Lapine said. "He started acting different. His whole persona changed. There was clearly something wrong."
Rivera, a platoon leader, stubbornly refused to leave his men and wasn't evacuated from the field until six months after the initial blast, Lapine confirmed.
Lapine said Rivera undoubtedly deserves the Purple Heart.
It was only back in the states that doctors discovered another injury unnoticed in Iraq. A vertebrae in Rivera's neck had fractured, which Rivera believes was caused by one of the blasts.
TBI is often called the signature wound of the Iraq war, with some estimates that at least one in five troops suffers the injury. To those who have it, the wound is as real as any caused by a bullet or shrapnel.
Once a dealer of all-terrain vehicles and owner of a credit card processing company, Rivera takes nine medications a day and may never work again.
"My life is never going to be the same," he said.
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Army officials with knowledge of Rivera's case could not be reached for comment.
Wayne Hall, an Army spokesman who commented generally about policy, said soldiers suffering from TBI are eligible for a Purple Heart if their brain injuries are caused by enemy action.
Hall said Rivera's delayed treatment may have been key.
"If it's not treated in pretty short order, there is no way to verify the injury he is now citing came from the blast," Hall said. "No one questions that TBI is a valid injury. But how do you verify what caused the TBI?"
The Army also told Rivera it rejected the Purple Heart because brain scans months after his deployment revealed no hint of TBI. But Dr. Steven Scott, director of Haley's polytrauma unit, told the Times that TBI often eludes brain scans.
The Army also refused Rivera a Purple Heart based on his vertebrae fracture and shoulder injury. The Army said his shoulder injury was consistent with an exercise ailment.
"That's just ridiculous," Rivera said.
The Army's medical board, which does not make the decision on the Purple Heart, confirmed Rivera's injuries were all caused in the line of duty.
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Rivera has spent months looking for help. He has repeatedly e-mailed the governor, Congress and Guard leadership. He seldom got a response.
He said he feels like the Florida National Guard abandoned him when he needed it most.
"Once you're wounded, they basically forget about you," Rivera said.
At first, a Florida Guard spokesman told the Times nothing could be done to help Rivera get the Purple Heart. Hours later, the Guard reversed itself, assigning its inspector general to speak to the Army on Rivera's behalf.
"I'm frankly surprised he was not approved for the Purple Heart," said Gen. Michael Fleming, assistant adjutant general for the Florida Guard. "We want to assist him. He shouldn't have to feel it's him against the world."
Rivera said he wants only what he deserves.
"It takes away from the validity of the Purple Heart," he said, "if you have to fight so hard to get it."
William R. Levesque can be reached at firstname.lastname@example.org or (813) 269-5306.