Nineteen-year-old Alexis Courneen was a new seaman serving on the Coast Guard buoy tender Katherine Walker when she was struck by a several-ton buoy as it was being lifted onto the cutter deck for repair.
The massive maritime marker hit her with brute force, crushing the nerves of her right arm, breaking her hip and slamming her head into the deck.
She lost consciousness for an extended time and was evacuated from the boat for medical treatment.
Courneen received care for her physical ailments but got no treatment for what turned out to be persistent symptoms, such as migraines, vision problems, tinnitus and balance issues.
The year was 1998, and Courneen's command did not recognize the signs of a potential traumatic brain injury.
"My military doctors wanted to keep me for testing. But I was remanded back to the boat. It was bad," said Courneen, wincing at the memory of struggling to maintain job performance while her cognitive abilities were in a tailspin.
Courneen eventually left the Coast Guard and sought treatment through the Veterans Affairs Department.
There, she was diagnosed correctly and able to access services that helped her recovery. She and her husband, Jason, moved to the Boston area to take advantage of the extensive services offered by the VA Boston Medical System.
But throughout Courneen's recovery, the couple struggled. Jason Courneen said he often was forced to choose between going to work and helping his wife, who has mobility issues, memory lapses and speech challenges.
With two children, Jason also said he often felt torn between meeting his wife's needs and his children's care requirements.
"Every time she had an appointment 200 miles form home, I had to make a decision: Did I want to be a provider today, or should I go with her, " Courneen said.
Today, there are several programs to support spouses and parents who care for injured service members from the post-9/11 era. The VA provides a monthly stipend, travel expenses, access to health insurance, mental health services, training and respite care for designated caregivers.
The Defense Department also provides special compensation for caregivers who give up employment to care for their ill or injured service member.
But for the families of Alexis Courneen and countless other veterans injured before Sept. 11, 2001, there is no help beyond medical services.
Some members of Congress want to change that. For the second straight year, Sen. Patty Murray, D-Wash., has introduced the Military and Caregiver Services Improvement Act to extend benefits to those who help injured or ill veterans of all eras — not just post-9/11, Iraq- and Afghanistan-era veterans.
Murray's bill also would remove restrictions on who is eligible to receive benefits as a caregiver — to include siblings and friends — and would allow veterans to transfer their Post-9/11 GI Bill benefits to dependents and make the DoD's compensation tax-exempt, among other changes.
Murray said the legislation is needed because some caregivers devote full-time hours to supporting their loved ones and need assistance.
"These caregivers don't necessarily wear uniforms or go overseas but they serve our country nonetheless. … They are a critical support system for our veterans yet they ask for very little in return," Murray said.
Jessica Klein's husband, Army Capt. Flip Klein, was injured by an IED blast in Afghanistan in 2012, losing both legs and most of his right arm. Klein said the caregiver stipend she receives allowed her to "drop everything" to care for her husband long-term.
Those same programs also free her to help support other spouses and family members starting their journeys as caregivers.
"I get to rescue other people who were just like me and I am so grateful for it," Klein said.
According to Murray's office, there are 5.5 million caregivers of veterans and service members in the U.S., 1.1 million of them caring for post-9/11 veterans.
The Congressional Budget Office last year estimated that the legislation would cost VA $9.5 billion over four years.
The current version would phase in veterans of other eras based on need, reducing the immediate impact on VA, Murray said.
Last year's bill never made it out of committee.
Murray said cost should not be an issue, arguing that caregivers save the government billions by providing care that otherwise would have to be furnished by VA-funded nurses, home health workers or in-patient facilities.
"It's unacceptable that we let caregivers and veterans handle this on their own," she said.
During a news conference announcing introduction of the bill Wednesday, Jason Courneen urged its passage and expressed happiness that post-9/11 veterans have access to these programs and services.
He also said that although his family has not been able to tap those programs, they have benefited — especially when it comes to improvements at the VA in treating traumatic brain injury and providing services for women.
"It's been bittersweet i. If I sit here and think about what we've gone through, I get pissed off. But the reality is, the VA has expanded services and we've been able to ride the wave," Courneen said.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
