"A lot of the people I've had contact with are not doing very well," says Kaye Baron, a clinical psychologist in private practice in Colorado Springs. Baron estimates that 60 to 70 percent of people she sees are in the military, and of that, roughly half have served in or been affected by the Iraq war. "For one thing, they're injured psychologically or physically, and on top of that they feel they're getting disposed of by the military -- like no one really cares."
Baron has also been puzzled by military diagnoses of, for example, personality disorder (which would be a preexisting condition, not qualifying a soldier for benefits) in soldiers whose symptoms are, in her estimation, fully explicable by PTSD. "I don't understand why military mental health is not doing more given that we know combat takes a toll on soldiers and PTSD is a widely recognized phenomenon. I don't know why they're not being more thoroughly examined and diagnosed."
Theoretically, based on the unprecedented efforts the Army has made recently to acknowledge, find and treat combat stress, soldiers should be getting more thorough examinations and diagnoses. Teams have traveled to Iraq to assess the mental health needs of the soldiers there. Partially in response to the 2002 murder-suicides at Fort Bragg by soldiers returning from Afghanistan, the Army has initiated a Deployment Cycle Support Program, designed to facilitate soldiers' transition to home life by addressing their health and personal needs. There's a 24-hour hotline called Military One Source for service members and their families. There are new PTSD guides for clinicians. Detailed protocols and procedures designed to screen for, track and treat soldiers arriving in medical holdover with mental health needs are in place. "Before a soldier is considered for retirement, we have ensured that we have given him the optimum healthcare possible," says Cavazos of the Army Medical Command.
But individual soldiers in medical holdover suggest that such improvements to the system have yet to trickle down to them.
One 47-year-old high-ranking military policeman -- who, fearing reprisal, requested anonymity -- was medevac'd out of Iraq late last September for a back injury, but came home with a host of other problems. He had been on active duty before, but this was different -- and not just because of the scorching heat and rampant dysentery in his unit's ill-equipped camp. "You're out in public all the time with people coming up to you and not knowing if they're armed until they fire at you," he says. This constant sense of threat meant sky-high stress levels and hyper-alertness. He only narrowly avoided shooting a kid who marched up to him saying "Fuck Americans," rock in hand. "I had a weapon on him and in my state of mind, sad to say, I really would have put that kid down," he recalls. (The kid, seeming to realize this, took off.)
When this soldier came back to the States, he figured that his flashbacks and nightmares were "the normal stress you go through when you come out of a war zone." But while his back was being treated, his wife informed him that he "was no longer the man she married" -- uncharacteristically withdrawn, prone to rage, hardly sleeping or eating -- and if he didn't get help she'd leave him.
Eventually, a physician at Kentucky's Fort Knox, where he was on medical holdover until being allowed to go home for temporary convalescent leave last week, diagnosed him with severe post-traumatic stress disorder. The medical report cited, among other symptoms: insomnia, nightmares, flashbacks, disassociation, easy startling, quick temper, and keeping to his room for fear of hurting others, all of which were said to cause significant impairment in his "occupational and social functioning." He has been able to manage his symptoms somewhat with quite a bit of therapy and medication, but he still can't tolerate groups of people, or much food.
Just two weeks ago the soldier received word that his PTSD had received a 10 percent disability rating from the MEB/PEB. (He counters that his remaining symptoms and resulting disability, as described in a second medical report, match those described for a 30 percent rating.) He was also informed that both the PTSD and his slipped disks (rated at 20 percent) were considered chronic, not directly related to combat in Iraq -- where he wore and carried 75 pounds of equipment every day.
"I lived in Iraq, and before I left I was mentally and physically healthy," he says. "I come back and my back's broken and my mind's broken. They say it's not combat related. The processes that are supposed to be in place to help us aren't working. They're just not taking care of us."
The Army notes that soldiers have ample opportunity to review their files both before they go to the board and after initial findings are returned; should they find anything amiss, they may request a reconsideration. Still, soldiers who have attempted this describe a maddeningly muddled, even misleading, bureaucratic process. Others say they accept insufficient ratings as a means of escaping the limbo -- and often unpleasant environment -- of medical holdover.
It has already been documented that the physical conditions in medical holdover can -- due in part to sheer overload by wounded soldiers returning from Iraq -- be less than conducive to healing. A story by United Press International last fall revealed that soldiers at Georgia's Fort Stewart were housed in concrete barracks with insufficient water and no air conditioning and that soldiers at Fort Knox waited months for medical attention. Sens. Kit Bond, R-Mo., and Patrick Leahy, D-Vt., were prompted to investigate and demand improvements. Many physical problems have since been addressed, and standards have been implemented to speed up soldiers' care.
Next page: Some soldiers say that being in medical holdover is more stressful than being in Iraq