National Security

The Reckoning

The scars from today’s wars amount to a national pathology. America could take a generation to heal.

** ADVANCE FOR MONDAY NOV. 29 ** U.S. soldiers carry Spc. Jeremy Kuehl,  24, of Altoona, Iowa, from the 1-320th Alpha Battery, 2nd Brigade of the 101st Airborne Division, to a medical evacuation helicopter after he was seriously wounded by stepping on an improvised mine near COP Nolen, in the volatile Arghandab Valley, Kandahar, Afghanistan, Friday, July 30, 2010. (AP Photo/Rodrigo Abd)
AP Photo/Rodrigo Abd
Add to Briefcase
James Kitfield
Sept. 8, 2011, 11 a.m.

The troops come home from war much the way they left, largely in­vis­ible to a dis­trac­ted na­tion. Re­turn­ing units are typ­ic­ally met at an air­field by buses that shuttle them to a gated mil­it­ary base. On a parade ground, a com­mand­er re­minds the as­sembled, some of the more than 2.3 mil­lion ser­vice mem­bers de­ployed dur­ing the past dec­ade of war, of all that they ac­com­plished. He re­calls the broth­ers in arms who didn’t make it back and the memor­ies that unite those who did. The shared hard­ships, the mo­ments of ter­ror and ela­tion, the con­stant jok­ing that held the aw­ful­ness at bay. The un­bear­able mel­an­choly that des­cends at the play­ing of “Taps.”

The com­mand­er dis­misses the form­a­tion, and the troops real­ize that the ties that bound their lives to­geth­er are break­ing. The mar­ried ser­vice mem­bers run in­to the open arms of their fam­il­ies, hus­bands hold­ing ba­bies they’ve nev­er met, uni­formed wo­men hug­ging young chil­dren they can hardly re­cog­nize. Even be­fore the smiles and tears sub­side, spouses sense the vast gulf that now lies between them and won­der how to get across. Single troop­ers head for the bar­racks, crack­ing wise but of­ten wish­ing that they, too, had fam­ily to wel­come them home. And, in­ev­it­ably, there are the strag­glers — young sol­diers shuff­ling and chain-smoking, un­sure of where to go or what to do next. Hav­ing come of age on dis­tant bat­tle­fields, they are sud­denly lost in Amer­ica.

Even Col. Dav­id Suth­er­land, a dec­or­ated com­mand­er who served in Ir­aq, was shocked by the dizzy­ing sense of ali­en­a­tion he felt on reentry. “Nev­er in the his­tory of our Re­pub­lic have so few been asked to do so much for so long. And yet, when sol­diers re­turn home, they feel acutely this dis­con­nect between the mil­it­ary and a ci­vil­ian so­ci­ety that doesn’t even seem to be at war,” says Suth­er­land, the Joint Staff’s spe­cial as­sist­ant in charge of the War­ri­or and Fam­ily Sup­port pro­gram. “We fall in­to the same trap of our fath­ers from World War II or Vi­et­nam, which is to keep the memor­ies of those sac­red mo­ments on the bat­tle­field to ourselves. That’s how they be­come secrets, and secrets are not healthy.”

Tens of thou­sands of oth­er troops re­turn home on the aeromed­ic­al-evac­u­ation flights that land routinely at An­drews Air Force Base in Mary­land or Trav­is Air Force Base in Cali­for­nia, where the buses wait­ing to meet them bear large red crosses. The crit­ic­ally wounded emerge from the massive C-17 trans­ports first, nearly in­vis­ible be­neath band­ages, a jungle of med­ic­al equip­ment strapped to their gurneys. Next out are the less-dire cases, car­ried on stretch­ers. Fi­nally, the am­bu­lat­ory pa­tients shuffle single file to the wait­ing buses. In the past dec­ade, Air Mo­bil­ity Com­mand has flown more than 35,600 aeromed­ic­al-evac­u­ation sorties, trans­port­ing more than 177,000 wounded or ill ser­vice mem­bers home.

Staff Sgt. Dan Nev­ins was one of those pa­tients who landed on the tar­mac at An­drews in 2005 cling­ing to life. Hav­ing already lost one leg, he fought through 18 months and 30 sur­ger­ies at Wal­ter Reed Army Med­ic­al Cen­ter try­ing in vain to save the oth­er. “In ret­ro­spect, fi­nally let­ting go of my oth­er leg and get­ting on with my life was the best de­cision I ever made,” says Nev­ins, who now works for the non­profit Wounded War­ri­or Pro­ject help­ing oth­er in­jured vet­er­ans try to get on with their lives.

Thou­sands of oth­er troop­ers have re­turned home in flag-draped coffins at Dover Air Force Base in Delaware. Last month, Pres­id­ent Obama and oth­er seni­or of­fi­cials traveled to Dover to hon­or the 30 Amer­ic­an troops killed in Afgh­anistan on Aug. 6 after their heli­copter was shot down, the worst single-day loss of the long Afghan war. Their names joined the hon­or roll of more than 6,000 fallen ser­vice mem­bers from Ir­aq and Afgh­anistan. The deaf­en­ing si­lence of the dead con­tin­ues to send shock waves through a land­scape of grief in­hab­ited by their fam­il­ies and com­rades — the col­lat­er­al wounded of these wars.

“A death in the mil­it­ary is un­like any oth­er loss in our so­ci­ety, be­cause there are so many com­plic­at­ing factors,” says Bon­nie Car­roll, founder and pres­id­ent of the Tragedy As­sist­ance Pro­gram for Sur­viv­ors, or TAPS, which reaches out to griev­ing mil­it­ary fam­il­ies with “peer pro­fes­sion­als” who have so­cial work de­grees and have also lost loved ones in the mil­it­ary. Be­cause deaths of­ten hap­pen on long com­bat de­ploy­ments, Car­roll says, griev­ing spouses some­times trick them­selves in­to think­ing that a miss­ing ser­vice mem­ber will still walk through the front door someday. Oth­er times, the man­ner of death is so trau­mat­ic that fam­il­ies re­ceive mul­tiple sets of re­mains. “When a death is so hor­rif­ic in nature, and the spouse hears about it re­peatedly in the me­dia or third-party ac­counts, they can cre­ate a memory that leads to their own post-trau­mat­ic stress dis­order.”

Every war leaves its im­print on those who fight it and on the na­tion­al psyche. At the 10-year mark, the wounds and men­tal scar tis­sue from Afgh­anistan and Ir­aq have amassed in­to something like a patho­logy unique to these con­flicts — one that will af­flict this coun­try for a gen­er­a­tion.

Due largely to ad­vances in com­bat medi­cine, rap­id aeromed­ic­al evac­u­ation, and body ar­mor, the wars have proven to be the least leth­al in mod­ern U.S. his­tory. Ac­cord­ing to Dr. Ron­ald Glass­er, a Vi­et­nam-era Army sur­geon and the au­thor of the re­cent book, Broken Bod­ies, Shattered Minds: A Med­ic­al Odys­sey from Vi­et­nam to Afgh­anistan, for every bat­tle­field death, 16 ser­vice mem­bers sur­vived their wounds. The ra­tio in Vi­et­nam, he said, was 2.4 wounded for every death. In the Civil War, the ra­tio was less than 1-to-1, with few sol­diers sur­viv­ing bat­tle­field wounds.

In his book, Glass­er warns that the na­tion will face a mor­al and eco­nom­ic reck­on­ing in caring for so many wounded vet­er­ans. “Be­cause of body ar­mor there have been re­l­at­ively few of the pen­et­rat­ing chest wounds or ab­dom­in­al in­jur­ies that caused so many battle deaths in past wars,” he tells Na­tion­al Journ­al. “But no one was really pre­pared for the num­ber of ser­i­ously wounded sur­viv­ors.” Ac­cord­ing to the Pentagon, 168,000 ser­vice mem­bers wounded or in­jured in these wars are graded “60 per­cent dis­abled” or high­er, and the VA faces a 492,000-case back­log of dis­ab­il­ity claims. More than 508,000 vet­er­ans of today’s wars have already been treated at VA hos­pit­als and clin­ics. The Con­gres­sion­al Budget Of­fice es­tim­ates that the med­ic­al costs as­so­ci­ated with today’s vet­er­ans could come to $40 bil­lion to $55 bil­lion over the next dec­ade.

Just as the cur­rent wars have dragged on, with tac­tics and geo­graphy shift­ing over the years, the patho­logy of these wounds has also mutated over time. Early on in Afgh­anistan, for in­stance, small arms caused many in­jur­ies. A few years in­to the fight­ing in Ir­aq — as in­sur­gent bombs got big­ger and the ar­mor on U.S. mil­it­ary vehicles got thick­er — troops ab­sorbed blast waves through their seats, caus­ing a spike in spin­al-cord in­jur­ies, con­cus­sions, and brain trauma. Over the last 18 months in Afgh­anistan, the pro­file has changed again.

“As Afgh­anistan has turned primar­ily in­to a war of dis­moun­ted in­fantry, our poly­trauma wards have seen a huge in­flux of troop­ers with really massive in­jur­ies from ab­sorb­ing blasts while on foot patrol, in­clud­ing mul­tiple am­pu­ta­tions, really severe brain in­jury, and the emo­tion­al wounds that go with all of that,” says Dr. Shane Mc­Namee, the chief of phys­ic­al medi­cine and re­hab­il­it­a­tion at the VA’s Poly­trauma Re­hab­il­it­a­tion Cen­ter in Rich­mond, Va. “In the past five years, I can’t tell you how many times we have regeared to tail­or our care de­liv­ery to sub­sequent waves of ser­vice mem­bers with dif­fer­ent kinds of wounds.”

But im­pro­vised ex­plos­ive devices, the en­emy weapon of choice in both con­flicts, have caused their sig­na­ture wounds, cre­at­ing more than 1,300 am­putees, nu­mer­ous burn vic­tims, and un­known num­bers who suf­fer from trau­mat­ic brain in­jury. Ac­cord­ing to the ad­vocacy group Vet­er­ans for Com­mon Sense, more than 190,000 troops have suffered a con­cus­sion or brain in­jury. There is also grow­ing evid­ence of links between TBI and posttrau­mat­ic stress dis­order. “They both in­jure sim­il­ar areas of the brain and ex­hib­it sim­il­ar symp­toms,” says Mc­Namee. “The lines between them are pretty gray.” Ac­cord­ing to a 2008 Rand sur­vey, one in five vet­er­ans of these wars — some 300,000 people — are suf­fer­ing either from ma­jor de­pres­sion or PTSD, while 320,000 have suffered con­cus­sions or TBI.

Those grow­ing num­bers are sig­ni­fic­ant. By al­low­ing the Vi­et­nam War — and the phys­ic­al and emo­tion­al trauma it caused — to re­cede from our na­tion­al con­scious­ness, Amer­ica in­her­ited an epi­dem­ic of vet­er­ans suf­fer­ing from the at­tend­ant ills of PTSD. Today, the post-9/11 gen­er­a­tion of vo­lun­teers faces the same risk. “When a lot of us Vi­et­nam vet­er­ans re­turned from war, it took us a dec­ade or even two be­fore we would even talk about what happened, and we bottled up a lot of an­ger and hurt,” says Tom Mitchell, a state dir­ect­or for U.S. Vets, a non­profit that works to get home­less vet­er­ans off the streets. “A lot of us are de­term­ined not to let that hap­pen with this new gen­er­a­tion of com­bat vet­er­ans from Ir­aq and Afgh­anistan.”

Today’s wars are the first ex­ten­ded con­flicts to be fought not by draftees but by a re­l­at­ively small co­hort of vo­lun­teers. That partly ex­plains why the patho­lo­gies spe­cif­ic to this war have been so hard to pre­dict. Like pre­vi­ous gen­er­a­tions, however, today’s vet­er­ans gen­er­ally keep the tox­ic af­teref­fects of war to them­selves; they are simply too pain­ful to ad­mit or con­front.

The small size of the all-vo­lun­teer force, for in­stance, has ne­ces­sit­ated mul­tiple com­bat de­ploy­ments with in­ad­equate breaks in between, which men­tal-health ex­perts be­lieve greatly in­creases the propensity for PTSD and its ef­fects: de­pres­sion, drug ab­use, failed mar­riages, and emo­tion­al dis­tress. The De­fense De­part­ment’s Task Force on Men­tal Health found in 2007 that 38 per­cent of all act­ive-duty ser­vice mem­bers have re­por­ted psy­cho­lo­gic­al symp­toms after their tours. In some months this year, the sui­cide rate for act­ive-duty ser­vice mem­bers has ex­ceeded com­bat deaths, and in April, the VA’s sui­cide-pre­ven­tion hot­line re­ceived more than 14,000 calls — the most ever re­cor­ded in a single month. Dr. Robert Pet­zel, the VA un­der­sec­ret­ary of health, says that doc­tors have be­come ex­pert at re­cog­niz­ing and treat­ing PTSD. “It’s prob­ably true that mul­tiple com­bat de­ploy­ments in­crease the like­li­hood of PTSD,” he warns, “though we don’t have ad­equate re­search to prove that yet.”

Today’s all-vo­lun­teer force is also older than its draft-era coun­ter­part, with more mar­ried ser­vice mem­bers and a lar­ger num­ber of uni­formed wo­men (14.6 per­cent of the act­ive-duty total). More than 220,000 wo­men have served in Ir­aq and Afgh­anistan, mean­ing that they’ve borne a high­er share of the bur­den than in past wars. After 9/11, the mil­it­ary di­vorce rate climbed from 2.6 per­cent per year in 2001 to 3.6 per­cent in 2010. And 7.8 per­cent of wo­men in the mil­it­ary di­vorced in 2010. (Be­cause the mil­it­ary does not track over­all di­vorce rates, count as di­vorced those ser­vice mem­bers who re­marry in a giv­en year, or fol­low up on the di­vorce rate of mil­it­ary per­son­nel a year or two after they leave ser­vice, many ex­perts be­lieve the Pentagon un­der­es­tim­ates the ac­tu­al rate of mil­it­ary di­vorce.) “Over­all di­vorce rates in the mil­it­ary could climb to as high as 80 per­cent for first mar­riages, which would mean that ser­vice in the mil­it­ary is be­com­ing a pre­curs­or for di­vorce,” says Leti­cia Dreil­ing, a Hou­s­ton Vets Cen­ter mar­riage and fam­ily ther­ap­ist.

Ac­cord­ing to the VA, about one in five fe­male vet­er­ans, or 20 per­cent, have also tested pos­it­ive for posttrau­mat­ic stress re­lated to “mil­it­ary sexu­al trauma,” a catch-all cat­egory that in­cludes everything from sexu­al har­ass­ment to rape. “I ac­tu­ally think the mil­it­ary sexu­al trauma among wo­men is much high­er than the of­fi­cial fig­ures, be­cause we find that a lot of wo­men ser­vice mem­bers feel guilty even talk­ing about it,” says Ju­dith Broder, a clin­ic­al psy­cho­lo­gist who star­ted The Sol­diers Pro­ject, which of­fers free men­tal-health coun­sel­ing to re­turn­ing vet­er­ans. “Wo­men vet­er­ans of­ten feel like it’s a be­tray­al of their unit to speak about sexu­al trauma, so they tend to carry that wound a long time in si­lence, which in­creases the like­li­hood that it will de­vel­op in­to com­bat-stress dis­order.” Wo­men are also the fast­est grow­ing sub­set of the home­less-vet­er­an pop­u­la­tion in Amer­ica, ac­cord­ing to Broder. Some land on the streets with their chil­dren.

As a per­cent­age of the over­all de­ployed force, the Na­tion­al Guard and Re­serves have also shouldered more of the bur­den in Afgh­anistan and Ir­aq than in wars past. Yet as cit­izen-sol­diers, re­serv­ists are less pre­pared for the stresses of a long com­bat tour. In­deed, the Task Force on Men­tal Health found that 49 per­cent of Na­tion­al Guards­men re­por­ted ex­per­i­en­cing psy­cho­lo­gic­al troubles after their de­ploy­ments.

With the wars now wind­ing down, the Pentagon es­tim­ates that as many as 1 mil­lion ser­vice mem­bers are likely to leave act­ive duty in the next five years. They will enter a strug­gling eco­nomy where the job­less rate for young (ages 18 to 24) male vet­er­ans of Ir­aq and Afgh­anistan was 21.9 per­cent last year, and where vet­er­ans make up an es­tim­ated 20 per­cent of the home­less pop­u­la­tion. Many ex­perts be­lieve that the na­tion is simply un­pre­pared for that ap­proach­ing army of suf­fer­ing.

“There are com­bat wounds you can see, and oth­ers that are in­vis­ible un­til symp­toms de­vel­op long after ser­vice mem­bers re­turn home, and we’re see­ing an in­crease in vir­tu­ally all of the met­rics that track them,” says clin­ic­al psy­cho­lo­gist Bar­bara Van Dah­len, the founder and pres­id­ent of the non­profit Give an Hour, which con­nects vet­er­ans to a net­work of 6,000 men­tal-health pro­fes­sion­als for free treat­ment.

Des­pite im­prove­ments in the mil­it­ary and VA health care sys­tems — and the co­oper­a­tion of nearly 5,000 non­profits that serve mil­it­ary per­son­nel — Van Dah­len sees a pop­u­la­tion at severe risk. “We should have learned from Vi­et­nam, be­cause all you have to do is study the home­less pop­u­la­tion today to un­der­stand that an aw­ful lot of those vet­er­ans nev­er really made it all the way home,” she says. “If we don’t get ahead of the chal­lenge, we will risk los­ing this gen­er­a­tion of vet­er­ans.”

The odys­sey be­gins on a day like any oth­er, log­ging duty in a faraway and un­fa­mil­i­ar land. Dan Nev­in’s began in Ir­aq in a Hum­vee that was boun­cing down a dusty road out­side the Sunni-in­sur­gent strong­hold of Fal­luja. Without warn­ing, his vehicle struck a road­side bomb. In an in­stant, Nov. 10, 2004, be­came the day that changed his life forever. By the time Nev­in ar­rived at the U.S. mil­it­ary hos­pit­al in Land­stuhl, Ger­many, 12 hours later, he had already lost one leg. Even­tu­ally, he lost the oth­er to a bone in­fec­tion.

In 2004 and 2005, the in­sur­gen­cies that would even­tu­ally drive Ir­aq to the brink of civil war grew; cor­res­pond­ingly, the num­ber of crit­ic­ally wounded ser­vice mem­bers pour­ing in­to the mil­it­ary med­ic­al sys­tem spiked. Nev­in had to wait a week to get space on one of the crowded med­ic­al flights from Ger­many, and when he ar­rived at Wal­ter Reed Army Med­ic­al Cen­ter, the staff was nearly over­whelmed. The care “was ab­so­lutely world-class,” he says. But the care­givers “just couldn’t handle all of the wounded. Those guys worked day and night, but it was a con­stant battle to get ap­point­ments if you needed a modi­fic­a­tion to your pros­thet­ic leg. And when you did get an ap­point­ment, you could wait hours.”

Lead­ers of the mil­it­ary health care sys­tem were also be­gin­ning to real­ize the com­plex­ity of provid­ing life-sav­ing and re­hab­il­it­at­ive care for so many severely wounded troops. Nev­in’s Re­serve ac­tiv­a­tion had forced him to take a ma­jor pay cut from his job selling phar­ma­ceut­ic­als in Cali­for­nia. Be­cause his wife couldn’t af­ford to leave her own job, he could only see her one week­end every six weeks or so, put­ting more strain on their mar­riage. Yet com­pared to some of the young­er act­ive-duty pa­tients who were told they were too in­jured to con­tin­ue serving — mean­ing forced sep­ar­a­tion from the only job and cul­ture they had known as adults — he felt lucky. “As a re­serv­ist, I had a col­lege de­gree, a good job, and a sup­port­ive fam­ily to go home to,” Nev­in says. “Some of those young kids joined the mil­it­ary right out of high school, however, and they didn’t have any of that to fall back on. So they found every ex­cuse ima­gin­able not to be re­leased from Wal­ter Reed. I thought they were crazy at the time, but later I real­ized that those young guys barely in­to their 20s were para­lyzed with fear about what came next.”

By 2007, the prob­lems at Wal­ter Reed ex­ploded in­to a full-blown scan­dal when The Wash­ing­ton Post pub­lished a series of art­icles de­tail­ing neg­lect, over­worked case man­agers, and shoddy in­fra­struc­ture. The com­mand­er of Wal­ter Reed and the sec­ret­ary of the Army resigned. But the scan­dal helped show the Pentagon and VA that their un­der­staffed and stovepiped med­ic­al fa­cil­it­ies were still un­pre­pared for the wounded and maimed pa­tients of­ten trans­ition­ing back and forth between their sys­tems. For the Army, the res­ult was the cre­ation of the War­ri­or Trans­ition Com­mand. From the be­gin­ning, its mis­sion was to pro­tect sub­sequent waves of re­turn­ing wounded sol­diers from the para­lyz­ing fears that haunted young troop­ers at Wal­ter Reed — the no­tion that the mil­it­ary was abandon­ing them at their mo­ment of greatest need.

Lt. Col. Danny Dudek, who now works for the War­ri­or Trans­ition Com­mand, real­ized how pre­cari­ous he felt when his own odys­sey began in 2007. While trav­el­ing north of Bagh­dad just three months earli­er, a pen­et­rat­ing ex­plos­ive hit his ar­mored Stryker fight­ing vehicle. The blast killed the sol­dier next to him and caused a spin­al-cord in­jury in Dudek that left him para­lyzed be­low the knee. With­in days, he had been through sur­gery at Wal­ter Reed; with­in a few months, he was sent to the VA hos­pit­al in Seattle to re­cov­er near his fam­ily. The care was ex­cel­lent, but Dudek felt bereft of the ca­marader­ie and sup­port struc­tures that he had come to de­pend on in his unit and some­what lost in the VA bur­eau­cracy. “We over­looked all the oth­er stuff that goes in­to be­ing a sol­dier, like be­ing able to rely on strong lead­er­ship, show­ing up for form­a­tion, know­ing that our fam­il­ies are taken care of,” Dudek says. “I think the Army real­ized that we can’t just treat wounded sol­diers like pa­tients. We need to con­tin­ue to treat them like sol­diers, too.”

That epi­phany led to the es­tab­lish­ment in 2007 of 29 com­munity-based War­ri­or Trans­ition Units for all sol­diers whose care re­quires at least six months of com­plex med­ic­al treat­ment. The units blend the ef­forts of a primary-care doc­tor, a nurse case man­ager, and a squad lead­er. Sol­diers help shape their own com­pre­hens­ive trans­ition plans, which in­clude ca­reer and em­ploy­ment goals; Sol­dier and Fam­ily As­sist­ance Cen­ters aid their fam­ily mem­bers.

Still, the chal­lenges are so com­plex that even this well-in­ten­tioned pro­gram ini­tially went awry in some places. Me­dia in­vest­ig­a­tions of vari­ous units showed con­flicts between the med­ic­al and mil­it­ary staff, over­crowding, and an over­re­li­ance on med­ic­a­tion. An Army In­spect­or Gen­er­al’s re­port is­sued in Janu­ary es­tim­ated that up to a third of all sol­diers in War­ri­or Trans­ition Units last year were over­med­ic­ated, hooked on drugs, or ab­us­ing il­leg­al sub­stances.

The Army has in­vest­ig­ated the charges but hasn’t backed away from the concept. “We did have some in­ex­per­i­enced lead­ers in War­ri­or Trans­ition Units who didn’t fully un­der­stand the com­plex­ity of tail­or­ing a treat­ment re­gime to each sol­dier, and some sol­diers do feel that mil­it­ary drills get in the way of their re­cov­ery,” says Dudek, who com­manded a trans­ition unit in Seattle. “There were also some con­flicts between nurse case man­agers and squad lead­ers. But with good lead­er­ship, that or­gan­iz­a­tion­al fric­tion usu­ally gets quickly re­solved.” He adds that “the last thing we need to do is come back wounded and just “˜take a knee.’ What I told my sol­diers is that you have to fight to over­come the pain, the apathy, and the fear of an un­cer­tain fu­ture. And for me and a lot of them, it is the hard­est fight of our lives.”

When Lance Cpl. Nancy Schiliro was med­ic­ally dis­charged from the Mar­ine Corps in 2005 after los­ing an eye in a mor­tar at­tack in Ir­aq, there was no long coun­sel­ing ses­sion or trans­ition unit. They hadn’t been cre­ated yet. One day she was liv­ing in the 24/7 bubble of life as a Mar­ine — be­ing told what to do, where to go, when to eat, and who to hang out with — and the next day she was home and that bubble had burst. The whole ex­per­i­ence was so dis­or­i­ent­ing that, for six months, Schiliro didn’t even real­ize that she was suf­fer­ing from PTSD. “I wasn’t sleep­ing. I jumped at loud noises. I ba­sic­ally stayed to my­self and stopped in­ter­act­ing with people. I just wasn’t me,” she says. Fi­nally, her broth­er’s fath­er-in-law, him­self a former Mar­ine, called a friend at a loc­al vet­er­ans’ cen­ter, who reached out. “It’s taken me awhile to learn how to man­age my dis­ease, and it’s got­ten bet­ter,” she says. “But I don’t think I’ll ever be totally cured.”

Cases like Schiliro — vet­er­ans who need care but fall in­to the gap between mil­it­ary med­ic­al treat­ment and VA fol­low-on care — have driv­en re­forms de­signed to make the trans­ition more seam­less. The Pentagon and the VA es­tab­lished a Joint Ex­ec­ut­ive Coun­cil that is­sued 26 ini­ti­at­ives to stand­ard­ize treat­ment and eval­u­ation sys­tems. For in­stance, mil­it­ary treat­ment fa­cil­it­ies today typ­ic­ally don’t re­lease a wounded ser­vice mem­ber un­til he or she has sched­uled ap­point­ments in the Vet­er­ans Health Ad­min­is­tra­tion sys­tem. If re­ques­ted, one of a hun­dred VA “trans­ition pa­tient ad­voc­ates” will even travel with ser­vice mem­bers as they move from ma­jor mil­it­ary hos­pit­als to VA hos­pit­als closer to home. An­ti­cip­at­ing de­mand, the VA also hired 7,000 men­tal-health of­fi­cials in re­cent years, ex­pan­ded sui­cide-pre­ven­tion hot­lines, and es­tab­lished care­giver pro­grams that provide sti­pends and travel al­low­ances for fam­ily mem­bers who care for ser­i­ously wounded vet­er­ans. “The de­part­ments of De­fense and Vet­er­ans Af­fairs have gone from a re­l­at­ively low-level of in­ter­ac­tion in 2001 to a de­gree of co­oper­a­tion that is his­tor­ic­ally un­pre­ced­en­ted,” says Pet­zel, the VA health un­der­sec­ret­ary.

Hun­dreds of thou­sands of vet­er­ans of Afgh­anistan and Ir­aq have or will soon re­join the ci­vil­ian world.

For all of those ad­vances, however, ma­jor prob­lems per­sist. Des­pite the move to a joint dis­ab­il­ity eval­u­ation pro­cess de­signed to stream­line claims pro­ced­ures, some vet­er­ans are still wait­ing up to 400 days for a de­cision on wheth­er they will re­ceive pay­ments and at what levels, and a back­log of nearly 500,000 late claims have gone bey­ond the 125-day stand­ard at the VA. Un­til dis­ab­il­ity pay­ments be­gin, eas­ing some of their fin­an­cial bur­dens, wounded vet­er­ans are sus­cept­ible to al­co­hol or drug ab­use — or worse — to al­le­vi­ate their suf­fer­ing. “I know that VA and DOD have big chal­lenges,” Sen­ate Vet­er­ans’ Af­fairs Com­mit­tee Chair­wo­man Patty Mur­ray, D-Wash., said at a hear­ing earli­er this year. “But ser­vice mem­bers and vet­er­ans con­tin­ue to take their own lives at an alarm­ing rate. Wait times for be­ne­fits con­tin­ue to drag on for an av­er­age of a year or far more.”

An­oth­er sign of trouble: Des­pite ag­gress­ive out­reach, only about half of the Ir­aq and Afgh­anistan vets have even re­gistered with the VA, mean­ing there is a vast at-risk pop­u­la­tion. “A chief les­son of Vi­et­nam was that we need to get new vet­er­ans help as early as pos­sible, be­fore their lives spir­al in­to crisis,” says Fern Taylor, su­per­visor of a clin­ic for re­turn­ing vet­er­ans at a VA hos­pit­al in Hou­s­ton. “Too of­ten, our first con­tact with a vet­er­an is in the emer­gency room, through the crim­in­al-justice sys­tem, or on our sui­cide-pre­ven­tion hot­line.”

Kathy Molit­or, the sui­cide-pre­ven­tion co­ordin­at­or at a VA post-de­ploy­ment clin­ic in Hou­s­ton, has no doubt that many vets need help. In 2007, the VA’s sui­cide hot­line re­ceived 9, 400 calls, she says, and the next year, it jumped to 67,400. In 2009, it reached 119,000, and last year it was up to 135,000. Just listen­ing to the calls for help can in­duce sec­ond­ary trau­mat­ic stress: I feel like an an­im­al, un­fit for civ­il­ized so­ci­ety.”¦ My hus­band only wants to hang out and drink and do drugs with his bud­dies.”¦ I can’t talk to my wife be­cause she might be in­fec­ted with my dis­ease.”¦  My hus­band barks or­ders at our chil­dren like they were sol­diers.”¦  After watch­ing my buddy blown to bits, I’m angry all the time.”¦  Why does Daddy want to go back to war? “¦ Our son is con­stantly clean­ing his gun in his room alone, and we can’t get him to stop.”¦  I’m not/she’s not/he’s not the same per­son any­more “¦

The es­sen­tial mes­sage that Molit­or and the oth­er hot­line ther­ap­ists try to con­vey to callers is simple: War is haz­ard­ous to your men­tal health. “It’s really no sur­prise that these vet­er­ans have posttrau­mat­ic stress, be­cause these are hard is­sues for hu­mans to deal with on top of all of life’s oth­er stresses and dif­fi­culties,” she says. “On the phone, we try and let them know that these are nor­mal re­ac­tions to what are really ab­nor­mal ex­per­i­ences.”

On a re­cent swel­ter­ing day, Os­kar Gonza­lez-Yet­zirah of the non­profit U.S. Vets trolled be­neath one of Hou­s­ton’s count­less high­way over­passes, of­fer­ing bottles of wa­ter to the ragged men and wo­men gathered there. He had a simple ques­tion for any takers.

“You a vet?”

U.S. Vets is one of roughly 5,000 non­profits na­tion­wide that aid mil­it­ary per­son­nel and vet­er­ans. In a sense, they are Amer­ica’s catch­ers in the rye — the last line of help for vet­er­ans poised on the pre­cip­ice of a cliff. The vet­er­ans whom Gonza­lez-Yet­zirah finds un­der the over­pass have already hit rock bot­tom, join­ing some 3,500 home­less vet­er­ans in Hou­s­ton and 150,000 na­tion­wide. Al­most all are job­less; many are sub­stance ab­users or men­tally ill.

He tries to coax the vets in­to gov­ern­ment or non­profit as­sist­ance sys­tems. U.S. Vets has a 72-bed fa­cil­ity in down­town Hou­s­ton, but it is over­booked by 30 spaces. Gonza­lez-Yet­zirah and his boss would have to work the phones to find an open slot at an­oth­er shel­ter. He knows that many vet­er­ans who suf­fer from PTSD would rather sleep out­side than sub­ject their frayed nerves to the chaos of a home­less shel­ter. He also knows from ex­per­i­ence that if red tape keeps him from log­ging the vet­er­ans in­to the sys­tem be­fore night­fall, they will al­most surely slip through his fin­gers and dis­ap­pear onto the streets again.

As a former Mar­ine who served in Ir­aq, Gonza­lez-Yet­zirah him­self has also struggled with PTSD and re­ad­just­ment is­sues. In his first job back — wait­ing tables — he al­most clocked his boss, a pimply 18-year-old, for or­der­ing him around. That might have landed him in the Har­ris County Jail, where he runs group-ther­apy ses­sions for the 400 to 600 jailed vets be­ing held there on any giv­en day. He now sees a new wave of vets ap­proach­ing the pre­cip­ice, just one sim­il­ar out­burst away from join­ing their broth­ers in jail or un­der the bridge. “I run in­to a lot of [re­cently re­turned] vet­er­ans in my work who are not home­less yet, but they are at the stage of run­ning from place to place, sleep­ing on a buddy’s couch, liv­ing paycheck to paycheck and barely mak­ing ends meet,” Gonza­lez-Yet­zirah says.

Many are mar­ried to young wives who have little edu­ca­tion and are caring for ba­bies, even as the vet­er­ans struggle against their PTSD to hold down jobs. They tend to fol­low a pat­tern, he says: Soon, their fam­il­ies will break apart and the vets will end up on the streets. “I’ve seen that enough times to un­der­stand how it hap­pens. I just don’t un­der­stand how we as a coun­try can al­low those people who fought for our freedoms to stay home­less.”

Like pre­vi­ous gen­er­a­tions of vet­er­ans be­fore them, the post-9/11 vo­lun­teers are com­ing home from war burdened by wounds and sor­rows. Only this time it’s not too late to help them carry that weight.

The sol­diers sent to fight on our be­half are not vic­tims; they don’t want our pity, and they have much to con­trib­ute and even to teach us. But com­bat vet­er­ans strug­gling to re­gain a sense of nor­malcy in every­day life need and de­serve the same as­sur­ances at home that their bud­dies gave them on faraway bat­tle­fields: They need to know that someone has their back. 


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.