What was once poorly understood in WWI as "shell shock" (and, in the Civil War, as "soldier's heart") is now a much discussed, highly researched condition The Army is now acknowledging -- and devoting a great deal of resources to -- the ever growing incidence of PTSD and other mental health issues within its ranks.
According to a study performed at the Walter Reed Army Medical Center and published in the July New England Journal of Medicine, conservative estimates are that 17 percent of soldiers are coming home from Iraq and Afghanistan suffering from PTSD, along with anxiety and depression. For these soldiers (as opposed to Gulf War vets, whose PTSD rates hover at 9 percent), the strain and trauma of prolonged urban combat with a hard-to-identify enemy, and of constant exposure to violent death -- including that of fellow soldiers -- have left them with nightmares, flashbacks, and bouts of numbness and rage.
The study concludes that reducing "barriers to care among military personnel" -- barriers such as the stigma of seeking mental health care in the first place -- must be "a priority for research and a priority for the policymakers, clinicians, and leaders who are involved in providing care to those who have served in the armed forces."
However, numerous veterans of Operation Iraqi Freedom who have come home injured say that such "awareness" has yet to change a deeply engrained military culture in which the only "real" wounds are physical. Result: Soldiers -- especially National Guard and Army Reserve soldiers in " medical holdover" -- say they run into roadblocks to needed mental health care, severance arrangements that appear to downplay invisible injuries in particular, and even attempts to send mentally unfit soldiers back to Iraq.
"The DOD [Department of Defense] is taking great care of the acutely injured, the injuries you can see, the burns, the lost arms and legs that they're treating with state-of-the-art prosthetics," says Stephen Robinson, executive director of the National Gulf War Resource Center, a veterans' advocacy organization in Silver Spring, Md. "But they're doing a horrible job with the other injuries that aren't quite so evident." Robinson, who served in the Army Special Forces in the Gulf, testified in January before the House Armed Services Total Force Subcommittee that soldiers in medical holdover receive insufficient mental health screening and care. The Center for American Progress recently published his 11-page report criticizing the military's handling of mental health issues. "There are unseen costs of war that have dramatic national implications in terms of benefits and care and reintegration into society," he says. "It is a national disgrace that front-line and combat soldiers need to fight for medical care and benefits when they return home from war."
Robinson, who has spoken with thousands of Iraq war veterans, describes the typical cycle: "When soldiers come back they have to go through complicated workman's-comp-type paperwork to prove that something they did in the war is the reason they're sick," he says. "That can take from four to 16 months. So they come home injured, and rather than being integrated into society, they're stuck in medical limbo waiting for their disability rating and then being diagnosed with a preexisting condition" -- which, he adds, implies that they shouldn't have been sent over in the first place.
He claims, anecdotally, that the MEB is underevaluating soldiers by a fairly consistent 10 to 20 percent -- a key percentage if it leaves a disability rating under 30 percent. Robinson's hypothesis: The DOD simply does not want to foot these potentially substantial bills. That, or given the number of soldiers who will yet come home injured, it simply can't.
Lemke and many of his colleagues say such problems are particularly acute among National Guard and Reserve soldiers, who make up about 40 percent of deployed troops. (Of nearly 5,000 soldiers on medical hold, all but about 860 are Reserve component troops.) "I don't think they budgeted for the Reserve and Guard component," Lemke says. "And now they want to make the soldier eat it."
"Soldiers are soldiers," counters Jaime Cavazos, media relations officer for the U.S. Army Medical Command. "I doubt very seriously that an injured soldier would be thought less of because he was a guardsman or member of the Reserve."
The Army also disputes the charges of deliberately stingy severance. "There is no truth to any such opinions," says Col. Fred Schumaker, executive officer of the Army Physical Disability Agency at the Walter Reed Army Medical Center. "The Physical Evaluation Boards fully review the facts provided [by] the Medical Evaluation Board and then carefully match, as closely as possible, the compensation to the impairment in accordance with regulatory guidance. The PEBs don't just make up disability percentage rates or reduce them arbitrarily. They give each soldier exactly what he is supposed to be given." He adds: "It would be unusual if soldiers who are not compensated by the military disability system were happy about results."
Still, Guard and Reserve soldiers say that their low ratings are the final blow in a series of actions that lead them to question the Army's true commitment to caring for them, especially when their injuries are invisible.
Next page: "The processes that are supposed to be in place to help us aren't working"