Veteran matters

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22 Mar 11    Aftershock: The Blast That Shook Psycho Platoon, ProPublica, T. Christian Miller et al., comments
2 Jan 11   For Many Returning Veterans, Home Is Where the Trouble Is, NYT, LAWRENCE DOWNES
22 Oct 10   The Way We Treat Our Troops, NYT, BOB HERBERT
21 Oct 10   Veterans Reaching Out for Help Online, NYT, DEBRA WEINER
16 Oct 10   After Service, Veteran Deaths Surge, NYT, AARON GLANTZ
29 Sep 10   Gates Fears Wider Gap Between Country and Military, NYT, ELISABETH BUMILLER
29 Sep 10   Four Suicides in a Week Take a Toll on Fort Hood, NYT, JAMES C. McKINLEY Jr.
22 Sep 10   Aid to Veterans, NYT, Judith Broder, Letter to the Editor
20 Sep 10   The Wars’ Continuing Toll, NYT, Editorial
18 Sep 10   Another mental leg for the traumatised veterans: Iraqi nationality, Iconoclast
13 Jul 10   As a Brigade Returns Safe, Some Meet New Enemies, NYT, TIMOTHY WILLIAMS
9 Jul 10   Help for Damaged Warriors, NYT, Editorial
27 May 10   Out of Uniform and Out of Work, and Seeking a Break in a Tough Civilian Job Market, NYT, CARA BUCKLEY
14 Apr 10   Israel's Declining Sperm Quality Tied to Depleted Uranium Exposure, Salem-News.com,Tim King
7 Apr 10   PTSD, infertility and other consequences of war, SFBayView, Bob Nichols
 




GOGEL    September 18, 2010

On allied soldiers who served in Iraq
by Iconoclast

Post-traumatic stress disorder (PTSD) is understood to arise from individually shocking experiences, such as near-death, aggression, sudden death of a colleague or beloved-one, etc. The National Institute of Mental Health (NIMH) defines PTSD as "an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat." These experiences trigger our built-in defense mechanism against mental overload - not unlike we pass out if we experience excessive pain. As such, PTSD is a short- to long-term phenomenon which affects and is recognised by individuals differently. It is not limited to war experiences but is most discussed in relation with war service in Vietnam, Iraq and Afghanistan. And it is suspected to be the more individually disturbing and socially destabilising as it occurs on the background of a cultural shock.

The so-called Iraq war syndrom may thus be seen - and treated - as a socially enhanced mental disorder. Iraq war veterans may indeed be suffering from PTSD in as much as they were directly exposed to war actions and resultant human sufferings - and as they have gone through traumatic events for which their society had ill prepared them. And when they returned home, they found themselves to be strangers in their own country, for neither their family nor their former friends or society as a whole have really understood them any longer - in as much as the latter themselves have been ill-equipped to effectively deal with the aftermaths of the veterans' upsetting and fundamentally destabilising experiences. Essentially, a non-expected and alien dimension of the world they grew up in hit them head-on and was forced on them when they came to Iraq.

In most cases, the veterans' original value structure is seen to have turned out to be fundamentally flawed, misleading or inadequate, causing an unmanagable inner revolt against previously accepted and unquestioned home institutions. Unconsciously at least, they developed a growing affinity with the people they came to "liberate" but in fact subdued and crushed. In a variation, the Stockholm syndrome seems to have occured. In this situation, admission of their newly-gained wider perspective and enhanced personality by both themselves and their victims, may be an effective way out of their deeply-seated personal dilemma. Recognition and formal enrootment of their involontarily acquired dual personality by both themselves and the authorities at home and in Iraq might do a world of good to both these vererans and everybody else concerned. Being thus-moored in two cultures, allied veterans could thus make a real and lasting contribution to Iraq's prompt reconciliation and economic rebuilding, to Iraq's return on the international scene, and to Iraq's societal recovery, particularly with regard to the education of its lost generation. And in the case of the US society, this could become instrumental to promptly resolve at its roots the increasingly destabilising PTSD problem afflicting the US social and political body. In other words, extending full Iraqi citizenship to all honorably discharged allied soldiers could turn out to be a true win-win-solution for all concerned.





    May 27, 2010

Out of Uniform and Out of Work, and Seeking a Break in a Tough Civilian Job Market
By CARA BUCKLEY

Ample of girth, his scalp gleaming beneath a thinning thatch of hair, Alex De Francis stood out in the small sea of veterans that filled a Midtown hotel ballroom on Thursday.

They were all there for a veterans’ job fair, and while many were young, Mr. De Francis was 61. He left the military in 1972, after a tour of duty in Vietnam, before many of his fellow job seekers were born. He became a New York City police officer, worked in construction until jobs dried up last year, and spent the past eight months e-mailing his résumé to recruiters who never wrote back.

Which is how Mr. De Francis found himself at the New Yorker Hotel, his tie neatly knotted by his daughter, his shoes polished to a high shine. While thousands of active sailors and Marines in town for Fleet Week were enjoying the city’s tourist attractions, Mr. De Francis and hundreds of fellow veterans were starting from scratch, hoping their military service would afford them a foothold in an unforgiving employment market.

The job fair was organized by RecruitMilitary, a 12-year-old company founded by a former Marine that produces about 70 such expos a year. The recession has hurt veterans and nonveterans almost equally: the most recent Department of Labor figures show that the jobless rate for both hovers just above 9 percent.

Veterans tend to have qualities that can at once help and hinder them in their search for employment. Recruiters at the expo said veterans tend to be more organized and driven, and to feel drawn to a higher calling. But for newer veterans especially, figuring out what kind of civilian work best suits them can be daunting, even paralyzing.

“When I ask them what they want to do, a lot of them say, ‘Anything,’ ” said Arthur Bass, an employment coordinator with the New York office of the Department of Veterans Affairs, who was at the expo.

By the time it opened at 11 a.m., veterans were waiting by the dozens in the carpeted hallway outside the door, folders thick with résumés tucked under their arms. The women, vastly outnumbered, were largely dressed in blazers and skirts; most of the men wore crisp suits, with American flags or aviation wings pinned to their lapels. Inside, 40 or so exhibitors stood beside tables lined with key chains, pamphlets, bags of chips and pens.

There were recruiters from Citigroup, and from a New Jersey cemetery maintenance company — “We’re recession-proof,” a company executive said — and from a midsize mattress and pillow company in Connecticut that has hired about 15 veterans in the last year. “They’re ethical, they’re trained, they work with diligence and respect,” said the pillow company’s human resources manager.

The most popular stop was the Federal Bureau of Investigation’s table, where an agent told veterans to apply online. Representatives were also there from assorted colleges and the French Culinary Institute, which offers new veterans, who can use G.I. Bill benefits, a 15 percent discount on tuition.

Into the bustle stepped two friends, Vincent Perez, 24, and Luis Garcia, 23, who met two years ago while building a forward operating base in southern Iraq, and who later learned that they were both from New Jersey. Their tour ended last June, and their transition back into civilian life has been a little rocky.

After five years in the Army, Mr. Garcia, who was a cavalry scout, is studying criminal justice at Middlesex County College in Edison, N.J. He finds school so difficult, he said, he sometimes feels as if his head will explode. “I was used to simple things, like weapons,” he said.

Mr. Perez, who was a signal support system specialist, struggles with deeper demons — flashbacks of being under mortar fire that still jolt him awake at night. “I’m trying to be calm, not let little things bother me,” he said. An active reservist, he learned last month that he will be deploying to Afghanistan in the fall. But he is still looking for work in the meantime, and wore his camouflage uniform, hoping that it would give him an edge.

By the time the fair ended at 3 p.m., 468 veterans had streamed through the doors. Among them was Jason Brandle, 31, a newlywed from Long Island who flew Black Hawk helicopters over Iraq before returning home last summer. Mr. Brandle left the job fair 45 minutes before it closed. He had meant to stay longer, he said, but his body was aflame with pain.

In Iraq, the weight of body armor had ruined his back, he said, and working the heavy helicopter pedals injured his knees. He said he was looking for a decent-paying job in human resources because he and his wife wanted to start a family. He hoped one of the companies would call him back, he said; after being an officer and a battle captain, he was used to managing people.

“There’s not a whole lot of jobs for helicopter pilots,” he said as he walked away, his freshly polished shoes (“An Army thing,” he explained) moving quickly across the carpeted floor.


Editorial
    July 9, 2010

Help for Damaged Warriors

For too long, scores of thousands of veterans afflicted with post-traumatic stress disorder have been denied proper treatment and much-needed help. While routinely hailed as heroes in home-front salutes, only about half of the more than 150,000 men and women diagnosed with P.T.S.D. — suffering flashbacks, emotional numbness and other debilitating symptoms — have been approved for disability claims by the veterans department.

The Obama administration has announced new regulations that will eliminate one of the main bureaucratic roadblocks to adequate treatment: the requirement that they document in painstaking, often impossible searches such events as a specific bomb blast or firefight to prove their disability. Claimants will now have to just show that they served in a war zone in a job consistent with the events underlying their symptoms.

Veterans’ groups point out that these rules have been particularly unfair to veterans, many of them women, who did not serve in official combat roles but still saw traumatic duty.

By some estimates, of the more than two million service members deployed in Iraq and Afghanistan since 2001, one out of five veterans suffer P.T.S.D. The changes would also apply to Vietnam veterans.

Concerns have been expressed about the cost — an estimated $5 billion over seven years, with heightened health care and monthly support ranging from a few hundred dollars to $2,000. The plight of damaged veterans is a debt that must be paid in full.

The veterans department will review all cases, promising vigilance to discourage fraudulent claims. The new approach will be no simple task for an agency struggling with backlogs of veterans’ claims. Final determinations will be made by the department’s own psychological experts. They will have to be mindful that the ultimate goal is to treat symptoms and guide veterans closer to normal life, not sidetrack them into permanent dependency.




    July 13, 2010

As a Brigade Returns Safe, Some Meet New Enemies
By TIMOTHY WILLIAMS

FORT BLISS, Tex. — The soldiers of the Fourth Brigade, First Armored Division, have been home from Iraq for three months now, the danger of snipers and roadside bombs no longer a threat, the war for them over.

But the odds that some of them will die violent deaths continues, so just as he did when his battalion was operating in Iraq, Command Sgt. Maj. Sa’eed Mustafa constantly warns his soldiers about the perils of letting their guard down where they are supposed to be safest — in their own homes.

“We talk about the enemy here, which is different from the enemy downrange, but which is just as deadly,” he said, using the military term used for a combat zone.

In fact, given the brigade’s record at Fort Bliss of suicide, murder, assault, drunken driving and drug use, its troops are statistically at greater risk at home than while deployed in Iraq. During the past year, only one of the unit’s soldiers died in combat, but in 2008, the last time the brigade was home from Iraq, seven soldiers were killed and six others committed crimes in which at least four civilians and soldiers from outside the brigade died in a little more than a year.

Drugs, including heroin and a methamphetamine lab, were discovered in the barracks, as was a homemade sex tape that had been circulating among soldiers and that featured one of the brigade’s female lieutenants and five male sergeants.

“Being back in garrison is what we don’t do well, because since 9/11 it seems we’ve spent more time deployed than at home,” Lt. Col. David Wilson said.

As the United States military continues to reduce the number of troops in Iraq — to 50,000 by Sept. 1 from about 85,000 now — it has begun to shift some focus to the home front in an effort to ensure a smooth transition for soldiers, a move prompted by lessons learned from returning veterans who have struggled to adjust to lives away from war.

Leaders of the Fourth Brigade said its problems had not only been deeply embarrassing, but had revealed institutional ignorance about combat stress and traumatic brain injury that forced the unit to use a holistic approach not typically associated with the military as it confronted its issues.

“They were leaving a war zone, coming back home and not getting the care and supervision necessary, which allowed them to stay in the Mosul mind-set,” said Sergeant Major Mustafa, referring to the violent northern Iraq city where the brigade had been stationed before it returned to Fort Bliss in 2008. “This is a group of people that had been fighting and killing and taking casualties for 14 months. You can’t switch it on and off.”

The brigade is thought to have one of the worst criminal records among Army brigades, although no statistics are kept. Its leaders say that if it is successful in keeping its troops safe until its next deployment, its multifaceted approach may become a model for other units seeking to acclimate their own soldiers to peacetime.

So far, the strategy appears largely to be working: After spending nearly three months at Fort Bliss, Maj. Myles Caggins, a spokesman, said its soldiers had been involved in only a handful of cases, the most serious three arrests for drunken driving that had resulted in no injuries. The methods have ranged from the hard-nosed — kicking dozens of soldiers out of the Army and requiring groups of three or more troops to march, rather than walk, whenever they are on base — to the soft touch, including calling parents to tell them that their children had done an exemplary job in Iraq and bringing in a civilian social worker to counsel depressed soldiers.

The brigade also expanded its list of at-risk soldiers to include those the Army would not otherwise consider troubled, including troops with multiple traffic violations. Upon arrival at Fort Bliss, soldiers deemed to be at the highest risk of psychological problems were met on the landing strip and escorted to an interview with a counselor, sometimes with family members in tow.

Colonel Wilson said he had ordered his battalion’s soldiers to read “Who Moved My Cheese?” by Spencer Johnson to help them handle change. Officers, he said, were assigned “Winning Every Day,” by the former college football coach Lou Holtz.

The unit has also trained its leaders in suicide prevention programs that exceed Army requirements, and its officers, including the brigade commander until last Friday, Col. Peter A. Newell, have dropped in to bars around Fort Bliss to monitor their soldiers’ behavior.

Sergeants are encouraged to pry into soldiers’ personal lives by inquiring about the health of their marriages and the state of their finances. And before going on leave, each soldier with a car was required to undergo a vehicle inspection and to show proof of insurance and a driver’s license.

“There is a burning desire to change the military,” Colonel Newell said. “We had to do something, or we would have bottomed out after eight years of war.”

A critical aspect of its approach has been to stagger those times when the unit’s leadership was reassigned from the brigade so that the highest-ranking sergeants and officers are not transferred at the same time, which typically occurs in Army units within a few months after a brigade returns from war.

During a pre-departure briefing this spring to about 360 troops at Contingency Operating Base Adder in southern Iraq, Colonel Newell paced in front of them, saying he felt uncomfortable about their impending return to Fort Bliss.

“I have a little stress over sending a brigade home,” he said. “The sad truth is that it is safer for me to keep you in Iraq drawing combat pay with people trying to kill you than it is for me to take you back home.”

One by one, he ticked off cases in which one of the unit’s soldiers had ruined his life at Fort Bliss before the brigade’s deployment to Iraq last year: four suicides, a drug overdose, a murder committed with a baseball bat, fatal drunken-driving offenses, cases of domestic violence, and a shooting after an argument in a bar.

At least six of the unit’s former soldiers are serving 15 years or more in prison for those crimes, and more trials are pending.

As part of a housecleaning, Colonel Newell dismissed more than 150 soldiers from the Army and brought formal disciplinary charges against more than 10 percent of the brigade’s 3,500 troops. In one company, 39 of 150 soldiers were court-martialed.

Capt. Rolland Johnson, 26, a company commander, said the brigade’s approach had required him to pay attention to his soldiers in ways unthinkable a few years ago.

“I can tell you everyone’s full name and hometown,” he said, adding that he had recently installed a suggestion box for his troops fashioned out of a discarded ammunition tin. “It used to be that if you saw the captain coming around you were in trouble,” Captain Johnson said. “Things have changed a lot, but it’s a new type of soldier, too, given all they’ve seen and how long they’ve been away.”

This article has been revised to reflect the following correction:
Correction: July 16, 2010
An article on Wednesday about the relatively high incidence of violent crime, drunken driving and substance abuse among soldiers of the Army’s Fourth Brigade, First Armored Division after their tours of Iraq misidentified the location in Texas where officers have dropped in to bars to monitor soldiers’ behavior. It is Fort Bliss, their home base — not Fort Worth.


Editorial
    September 20, 2010

The Wars’ Continuing Toll

The United States military has never been better at helping soldiers survive the battlefield with sophisticated advances in treatment and transportation. Service members who come home with psychic wounds and hidden traumas are still not getting enough support.

Last year, there were 239 suicides among active-duty personnel across the Army, and more than 1,700 attempts. There were 32 suicides in June, a grim high. Nobody is exactly sure how many veterans take their own lives, but the federal Centers for Disease Control and Prevention estimate that veterans make up about 20 percent of the more than 30,000 suicides each year.

The military is becoming more aware of the problem. At an event dedicated to suicide prevention this month, Health and Human Services Secretary Kathleen Sebelius was joined by Defense Secretary Robert Gates, who acknowledged the toll the epidemic has taken.

The causes of suicide can be mysterious and solutions elusive. But advocates for troubled soldiers say the military can save more lives by acknowledging that it is overmatched and directing more people to outside help.

Linda Bean, whose son Coleman committed suicide in 2008, four months after ending his second tour in Iraq, has testified to Congress and pleaded with the Veterans Affairs Department to deepen and widen its outreach.

Many soldiers don’t live near a veterans’ hospital, she said. Many are hard pressed to leave jobs and families to make mental-health appointments. Soldierly reticence is a huge problem. Before Mr. Bean’s second deployment, he received a diagnosis of post-traumatic stress disorder from doctors at the Veterans Affairs Department. The Army didn’t know, and Coleman didn’t tell his superiors.

Ms. Bean points to nonprofit groups like Give an Hour and the Soldiers Project, which provide confidential counseling, and the National Veterans Foundation, which runs a hot line staffed by trained veterans. She sees hope, too, in small peer groups, like Vets 4 Vets, an Arizona-based organization that organizes weekends for veterans of Afghanistan and Iraq.

The military and the Veterans Affairs Department have been adding mental-health staffing and studying the suicide problem. But they still need to plug gaps in care for people who shun or live far away from government services. Ms. Bean’s family was also among the many that sent body armor to undersupplied troops. They learned that when the official program isn’t working, you improvise.


Letter to the Editor
    September 22, 2010
:
Aid to Veterans
Judith Broder, Studio City, Calif.

Re “The Wars’ Continuing Toll” (editorial, Sept. 21):

Thank you for calling attention to the urgent problem facing our military service members as a result of their wartime service. Those of us who have worked “in the trenches” as private nonprofits, providing a safety net for psychological services to our troops and their loved ones, hear stories almost daily of returning service members who will not or cannot use the existing government services. Their “invisible wounds” are causing untold levels of pain to their families and to our communities.

The increasing rates of suicide, homelessness and unemployment are an unacceptable result. To their credit the Defense Department and the V.A. are now trying mightily to make up for the gross deficiencies in their level of preparation for these numbers of mental injuries.

Six years ago when the Soldiers Project began its work providing mental health care on a completely confidential and pro bono basis, we knew that the need would be great but nevertheless have been overwhelmed by the numbers of service members, vets and family members in need of help. This is a national problem and should be faced by the country as a whole.

This means not only increased financing for staff and program activities at the Defense Department and the V.A., but also financing for the several nonprofit groups like ours that try to fill the gaps for those who are unable to make use of the existing government services.

Our service members and their loved ones deserve the best, and they need readily available care. With an infusion of funds, the private nonprofit sectors could expand their safety net and perhaps spare families from unnecessary suffering.

The writer, a doctor, is founder and director of the Soldiers Project.




    September 29, 2010

Four Suicides in a Week Take a Toll on Fort Hood
By JAMES C. McKINLEY Jr.

HOUSTON — Four veterans of the conflicts in Iraq and Afghanistan died this week from what appeared to be self-inflicted gunshot wounds at Fort Hood in central Texas, raising the toll of soldiers who died here at their own hands to a record level and alarming Army commanders.

So far this year, Army officials have confirmed that 14 soldiers at Fort Hood have committed suicide. Six others are believed to have taken their own lives but a final determination has yet to be made. The highest number of suicides at Fort Hood occurred in 2008, when 14 soldiers killed themselves, said Christopher Haug, a military spokesman.

About 46,000 to 50,000 active officers and soldiers work at the base at any given time, making this year’s suicide rate about four times the national average, which the Centers for Disease Control and Prevention estimates at 11.5 deaths per 100,000 people.

The largest base in the United States, Fort Hood and the surrounding communities have suffered high rates of crime, domestic violence, suicide and various mental illnesses as wave after wave of soldiers have been deployed abroad over nine years of continual warfare, often serving more than one tour.

Last November, an Army psychiatrist, Maj. Nidal M. Hasan, was charged with killing 13 people with a pistol in a rampage at a building on the post.

On Sunday, Sgt. Michael Timothy Franklin and his wife, Jesse Ann Franklin, were found fatally shot in their house on the base.

Army investigators said they believed that Sergeant Franklin, who was 31 and had served two tours in Iraq, killed his wife and then turned the gun on himself. The couple had two small children.

Maj. Gen. William F. Grimsley, the Fort Hood senior commander, said in a statement released at a news conference on Wednesday that “leaders at all levels remain deeply concerned about this trend.”

Mr. Haug said that the general did not believe that additional measures were necessary to stop the trend and that the base already had an extensive suicide-prevention program.

But advocates for soldiers who have suffered mental breakdowns said the programs were not effective.

Cynthia Thomas runs the Under the Hood Café, an organization of antiwar activists and veterans who provide referrals for soldiers to mental health professionals. She said a stigma remained among soldiers about seeking help from Army counselors for suicidal thoughts or other mental problems. And those soldiers who do seek counseling are often given medication and put back on duty, she said.

“You don’t get counseling, you get medication,” Ms. Thomas said. “These soldiers are breaking.”




    September 29, 2010

Gates Fears Wider Gap Between Country and Military
By ELISABETH BUMILLER

DURHAM, N.C. — The United States is at risk of developing a cadre of military leaders who are cut off politically, culturally and geographically from the population they are sworn to protect, Defense Secretary Robert M. Gates told an audience at Duke University on Wednesday night.

In a speech aimed at addressing what he sees as a growing disconnect between the country as a whole and the relatively few who fight its wars, Mr. Gates said that although veterans from Iraq and Afghanistan were embraced when they came home, “for most Americans the wars remain an abstraction — a distant and unpleasant series of news items that do not affect them personally.”

Even after Sept. 11, 2001, Mr. Gates said, “in the absence of a draft, for a growing number of Americans, service in the military, no matter how laudable, has become something for other people to do.”

The defense secretary said that military recruits came increasingly from the South, the mountain West and small towns, and less often from the Northeast, West Coast and big cities. The military’s own basing decisions have reinforced the trend, he said, with a significant percentage of Army posts moved in recent years to just five states: Georgia, Kentucky, North Carolina, Texas and Washington.

The speech reflected the issues within the military about the merits and costs of an all-volunteer force fighting two wars for nearly a decade, the longest sustained combat in American history. The wars in Iraq and Afghanistan, Mr. Gates said, are the first protracted large-scale conflicts since the American Revolution fought entirely by volunteers, but with a force of 2.4 million of active and reserve members that is less than 1 percent — the smallest proportion ever — of the population it serves.

He said that it was junior and mid-level officers and sergeants in ground combat and support who had borne the brunt of repeat deployments and exposure to fire. While they are “the most battle-tested, innovative and impressive generation of military leaders this country has produced in a very long time,” he said he had to ask the question: “How long can these brave and broad young shoulders carry the burden that we — as a military, as a government, as a society — continue to place on them?”

Mr. Gates dismissed any notion of reinstituting the draft, terming the all-volunteer force that began in the 1970s a “remarkable success.” But he called for the return of R.O.T.C. to elite campuses across the country — Duke is unusual in that it has three programs — and for the academically gifted to consider military service.

“In short, students like you,” Mr. Gates told the group of 1,200 in the Page Auditorium at the university.

Mr. Gates said he was encouraged that a number of prominent universities were reconsidering having R.O.T.C. return to their campuses. He said some were doing so at the urging of well-known graduates, among them President Obama.

That was an indirect reference to Harvard, Mr. Obama’s alma mater, which expelled the R.O.T.C. program from its campus in 1969 during protests against the Vietnam War. Drew Faust, Harvard’s president, has since said she would welcome R.O.T.C. back to campus on repeal of the “don’t ask, don’t tell” policy that bars gay soldiers from serving openly in the armed forces.

In his comments to the students, Mr. Gates said that beyond the hardship and heartbreak of seeing friends die in war, there is another side to military service — “the opportunity to be given extraordinary responsibility” at a young age.

“Our young military leaders in Iraq and Afghanistan have to one degree or another found themselves dealing with development, governance, agriculture, health and diplomacy,” he said. “And they’ve done all this at an age when many of their peers are reading spreadsheets and making photocopies.”





October 16, 2010

After Service, Veteran Deaths Surge
By AARON GLANTZ

In the six years after Reuben Paul Santos returned to Daly City from a combat tour in Iraq, he battled depression with poetry, violent video games and, finally, psychiatric treatment. His struggle ended last October, when he hung himself from a stairwell. He was 27.

The high suicide rate among veterans has already emerged as a major issue for the military and the families and loved ones of military personnel. But Mr. Santos’s death is part of a larger trend that has remained hidden: a surge in the number of Afghanistan and Iraq veterans who have died not just as a result of suicide, but also because of vehicle accidents, motorcycle crashes, drug overdoses or other causes after being discharged from the military.

An analysis of official death certificates on file at the State Department of Public Health reveals that more than 1,000 California veterans under 35 died between 2005 and 2008. That figure is three times higher than the number of California service members who were killed in the Iraq and Afghanistan conflicts over the same period. The Pentagon and Department of Veterans Affairs said they do not count the number of veterans who have died after leaving the military.

The figures, according to the federal Department of Veterans Affairs, legislators and experts in post-traumatic stress, underscore how veterans in Bay Area communities and across the state engage in destructive, risky and sometimes lethal behaviors.

The data show that veterans of Iraq and Afghanistan were two and a half times as likely to commit suicide as Californians of the same age with no military service. They were twice as likely to die in a vehicle accident and five and a half times as likely to die in a motorcycle accident.

“These numbers are truly alarming and should wake up the whole country,” said United States Representative Bob Filner, Democrat of San Diego, who is the chairman of the House Veterans’ Affairs Committee. “They show a failure of our policy.”

The coroners’ reports do not indicate whether each veteran was deployed to a war zone. But the ages at which they died — 18 to 34 — match the ages of at least two-thirds of veterans who served in Iraq and Afghanistan. Even the veterans in this cohort who did not see combat served in support functions, often at locations like Walter Reed Army Medical Center in Washington or Landstuhl Regional Medical Center in Germany, caring for those who were wounded on the front-lines.

The analysis was conducted by New America Media, a non-partisan news organization, in partnership with The Bay Citizen. It examined the most recent death certificates filed by coroners, medical examiners, physicians and funeral homes from California’s 58 counties.

According to the data, veteran fatalities exceeded the number of combat deaths involving service members from almost every county from 2005 through 2008. In the Bay Area, 114 young veterans died after returning home, nearly three times the number of Bay Area service members who died in the Iraq and Afghanistan conflicts over the same period.

Suicides represented approximately one in five deaths of young veterans, the data showed. Many other deaths resulted from risky behaviors that psychologists say are common symptoms of post-traumatic stress.

Jonathan Shay, a clinical psychiatrist who counseled Vietnam veterans for more than 20 years and has taught at the U.S. Army War College, said the high number of deaths shows how the combat experience can create psychological damage that manifests itself in a range of dangerous and nihilistic activities.

Veterans with post-traumatic stress often try to re-create the rush of combat, Dr. Shay said. “There is definitely an inclination of danger seeking,” he said, “seeking out fights, living on the edge, fast motorcycle riding, anything to get that adrenaline rush.”

The Department of Veterans Affairs only began to track suicides committed by Iraq and Afghanistan veterans in 2008.

Kerri Childress, a V.A. spokeswoman, said the analysis conducted by New America Media and The Bay Citizen was more accurate than figures available from the federal government. She described the figures as “extremely high and extremely devastating.”

Paul Sullivan, a Gulf War veteran and executive director of Veterans for Common Sense, said that the V.A. and Department of Defense are not serious about slowing the death rate of returning soldiers.

These government agencies could monitor this information on a regular basis, Mr. Sullivan said, adding that many other states in addition to California report a veteran’s status on death certificates.

“V.A. and D.O.D. appear to have a policy for veterans called ‘Don’t look, don’t find,” Mr. Sullivan said.

Ms. Childress said the V.A. had begun efforts to monitor stateside casualties. The agency has started numerous outreach campaigns focusing on veterans of Iraq and Afghanistan, she said. But less than half of returning veterans turn up at a V.A. facility for treatment.

On Sept. 24, Berkeley police found Alex Lowenstein, an Iraq veteran who was months from earning his degree in Peace and Conflict studies at the University of California at Berkeley, dead in his room at the Delta Upsilon fraternity house. Mr. Lowenstein, a Mill Valley native who was 24, died of a bullet wound to the head from his own gun.

The police initially concluded that his death was a suicide, but now say it may have been accidental. According to the police report, Mr. Lowenstein had been drinking and smoking marijuana on the night he died. No suicide note was found.

He was the second Iraq war veteran to die while attending Berkeley over the past two years. In 2008, Elijah Warren, a 26-year-old political science student who served multiple tours in Iraq and Afghanistan, shot himself in the head.

“These deaths are a difficult thing for everybody because of the preventative nature of it,” said Trevor Harris, the secretary of the veterans club at the university.

Mr. Harris, a former marine who served two tours in Iraq, said he personally knew three veterans who had died from suicide or motor vehicle accidents. “We all understand that in war people get shot, but this doesn’t have to happen,” he said.

Neither Mr. Lowenstein nor Mr. Warren had visited V.A. health centers before their deaths, Ms. Childress said.

Stephen Xenakis, a retired brigadier general who formerly served as Commanding General of Southeast Army Regional Medical Command, said he expected the stateside death toll to increase because the psychological wounds associated with combat may not emerge right away.

“What you’re seeing is young men and women who saw combat in their early 20s as well as everything else that went on in the theater and then in their late 20s they get symptomatic,” he said.

When Mr. Santos, the Daly City veteran, first returned from Iraq in October 2003, his family thought he was fine. “He still had his sense of humor,” his mother Paula, a secretary at a local elementary school, said in an interview.

Mr. Santos, who was known as Chip, was the son of Native American parents. He left Westmoor High School early with a G.E.D. to join the Army. It was before the Sept. 11 attacks, and Mr. Santos never thought he would go to war, according to his parents.

After he returned from Iraq, he slowly began to lose his spark and wit, his friends and family said. He rarely worked, and he could not keep a job. He would take a class at City College of San Francisco, then drop out. Mostly, he stayed home and played violent video games for most of the day and into the night.

His fixation on the video games infuriated his parents, but in a poem published after his death by the Institute of American Indian Arts in Santa Fe, Mr. Santos described the games as a way of “holding onto denial that is burning cancer into hope.”

Mr. Santos met his girlfriend, Waci Lone Hill, at the institute. The two were enrolled in the same creative-writing program. Ms. Lone Hill said she was attracted to Mr. Santos by his intelligence, his sense of humor and his old-fashioned style of courtship.

But, as early as 2005, Mr. Santos would “wake up in the middle of the night hollering” from nightmares, his girlfriend said. Sometimes, Mr. Santos would hold her so tight that she felt like she was being strangled. He started to drive erratically, sometimes at more than 120 miles an hour. “If there was a lot of traffic, I could see the sweat break out on his forehead and hear the shallow breathing,” Ms. Lone Hill said. “He’d get this completely stone face, and I’d get scared and just be quiet.”

Not until five years after his return from Iraq did Mr. Santos see a social worker or a psychiatrist from the V.A. At first, his mother said, Mr. Santos did not want to admit that he had a problem. Then, after three years passed, he erroneously thought he was no longer eligible for V.A. health care.

When Mr. Santos finally applied, Ms. Lone Hill said it was difficult for him get regular appointments. He was only able to see a therapist once a month, she said. The therapists were often different, so Mr. Santos was forced to tell his story over and over.

Six months before his death, Mr. Santos enrolled in a study overseen by Charles Marmar, an expert in post-traumatic stress who recently left the V.A. to become chairman of the department of psychiatry at New York University. As part of the study, Mr. Santos was able to get treatment every week from the same therapist, who administered cognitive behavioral therapy, in which the veteran relives the traumatic experiences in an effort to overcome them. Dr. Marmar described the therapy as “the gold standard” for treating post-traumatic stress.

Nine weeks into the treatment, Mr. Santos left the study, Dr. Marmar said. His therapist rated him as having “no clinical anxiety at that time.” Dr. Marmar said the V.A. tried repeatedly to contact Mr. Santos after he withdrew from the study, but he did not respond.

Three months after leaving the program, Mr. Santos hung himself in his Santa Fe apartment. In an e-mail to his brother and his girlfriend that he said took him almost a month to complete, Mr. Santos wrote: “I’m tired of fighting this. I feel like I’ve tried everything but electro shock therapy.” By the time his brother opened the e-mail, Mr. Santos was dead.

aglantz@baycitizen.org





October 21, 2010

Veterans Reaching Out for Help Online
By DEBRA WEINER

As Cpl. Ricoh Danielson of the Army and his buddies left an Oklahoma Wal-Mart with a 12-pack of Corona and a case of Keystone Ice for a Fourth of July celebration, they passed a Middle Eastern-looking man accompanied by a woman wearing a head scarf. Just then, someone ignited a firecracker.

Mr. Danielson, who had recently returned from a 14-month tour in Iraq, dove beneath his car. “I was in cold sweats,” Mr. Danielson, said of the 2004 incident. “My buddies asked what I was doing. I had no clue.”

Over the next five years, which Mr. Danielson spent largely in Iraq and Afghanistan as an infantryman and civilian contractor, his experinces evolved into a full-blown struggle with post-traumatic stress disorder. He said he half-heartedly tried group therapy and medication, but it was not until he enrolled in Vets Prevail, an interactive Web program run by Prevail Health Solutions, a company based in the West Loop, that he began to deal with what he said were suicidal and homicidal thoughts.

“We’re not claiming to be a treatment for P.T.S.D.,” said Michael Amiet, director of strategy and business development for Prevail Health Solutions. “We’re a first step to care to help the walking wounded from slipping into a full-blown, clinical disorder.”

Created by veterans in early 2008, the free online program offers six half-hour lessons on managing post-deployment combat stress and symptoms of depression. Roger Sweis, president of Prevail Health Solutions, co-founded Vets Prevail with Richard Gengler, a former Navy fighter pilot who flew in Afghanistan and Iraq, while the two were graduate business students at the University of Chicago. Mr. Sweis said he hoped the program would eventually be a government-financed tool for connecting with war-weary soldiers and veterans.

A narrator guides users through the lessons, with each segment focused on a coping strategy, like scheduling activities and breaking down tasks into small steps. Participants answer questions, get homework and check in with peer counselors via instant messaging. Between sessions, they receive text messages, e-mails and phone calls encouraging them to complete assignments.

Mr. Danielson stopped participating after three lessons, when he returned to Iraq. But he still credited Vets Prevail with motivating him to take responsibility for his problems. After he returned home, he entered the residential Men’s Trauma Recovery Program at the Department of Veterans Affairs in Menlo Park, Calif.— a government-run research and education facility. He said his experience with Vets Prevail revealed a path forward. “Finally, I found someone who knew what the hell I was talking about,” he said. “It’s beyond medication and therapy,” said Mr. Danielson, now 29 and living in Arizona. “It’s accepting what happened. If it wasn’t for Vets Prevail, I’d have ended up in prison.”

Some studies estimate that almost 37 percent of the troops who served in Iraq and Afghanistan suffer from depression, post-traumatic stress disorder or other deployment-related symptoms. Yet only about half of those who need help seek care, according to a 2008 Rand Corporation report, and among that group roughly 50 percent receive adequate treatment.

Obstacles, like living far from services or fear of missing work, are thought to prevent many from seeking help. For others, the stigma of seeking psychological counseling is a barrier.

Besides the for-profit Vets Prevail, dozens of government programs offer mental-health outreach and resource guides on the Internet. The Defense Department’s Web site, afterdeployment.org, provides self-assessment tests for a host of psychological and behavioral issues. Its Real Warriors online campaign presents testimony from active-duty soldiers who have been treated for post-traumatic stress disorder.

“Today’s service members often are more comfortable accessing resources online,” Col. Robert W. Saum of the Army, director of the Defense Center for Excellence for Psychological Health and Traumatic Brain Injury, wrote in an e-mail. “Web-based, peer-to-peer programs build on the time-honored buddy system that has existed within the military for decades.”

Like many counseling Web sites, Vets Prevail emphasizes how thoughts affect mood and the program tries to reduce avoidance of anxiety-producing situations and increase pleasurable activities, said Dr. Benjamin Van Voorhees, a paid consultant who is supervising a pilot study of the Vets Prevail program. Dr. Van Voorhees is an assistant professor of medicine at the University of Chicago and president of Rise Consulting, an Internet health advising company.

The enterprise is partnering with Rush University Medical Center in Chicago and the Illinois National Guard to test an updated version of the program, which has separate content for Guard members and their families.

Not everyone, however, is sold on online programs. “The extent to which Web-based interaction is the same as, better, or worse than face-to-face interactions is the central question in our society now,” said Dr. Joseph Yount, clinical psychologist and coordinator of the P.T.S.D. Clinic at the Jesse Brown Veterans Administration Medical Center in Chicago. “Is Vets Prevail the way of the future, or do Web-based interactions lack something so meaningful that only happens when people are together?”

Dr. Stevan Hobfoll, chairman of Rush University Medical Center’s Department of Behavioral Sciences and a consultant for Vets Prevail, said, “Prevail is about prevention.” It does not replace psychotherapy or treatment for traumatic brain injury, he said, “but for young people who are so computer interactive, it could be an important piece of the puzzle.”





October 22, 2010

The Way We Treat Our Troops
By BOB HERBERT

You can only hope that the very preliminary peace efforts in Afghanistan bear fruit before long. But for evidence that the United States is letting its claim to greatness, and even common decency, slip through its fingers, all you need to do is look at the way we treat our own troops.

The idea that the United States is at war and hardly any of its citizens are paying attention to the terrible burden being shouldered by its men and women in uniform is beyond appalling.

We can get fired up about Lady Gaga and the Tea Party crackpots. We’re into fantasy football, the baseball playoffs and our obsessively narcissistic tweets. But American soldiers fighting and dying in a foreign land? That is such a yawn.

I would bring back the draft in a heartbeat. Then you wouldn’t have these wars that last a lifetime. And you wouldn’t get mind-bending tragedies like the death of Sgt. First Class Lance Vogeler, a 29-year-old who was killed a few weeks ago while serving in the Army in his 12th combat tour. That’s right, his 12th — four in Iraq and eight in Afghanistan.

Twelve tours may be unusual, but multiple tours — three, four, five — are absolutely normal. We don’t have enough volunteers to fight these endless wars. Americans are big on bumper stickers, and they like to go to sports events and demonstrate their patriotism by chanting, “U-S-A! U-S-A!” But actually putting on a uniform and going into harm’s way? No thanks.

Sergeant Vogeler was married and the father of two children, and his wife was expecting their third.

It’s a quaint notion, but true: with wars come responsibilities. The meat grinder of war takes its toll in so many ways, and we should be paying close attention to all aspects of it. Instead, we send our service members off to war, and once they’re gone, it’s out of sight, out of mind.

If we were interested, we might notice that record numbers of soldiers are killing themselves. At least 125 committed suicide through August of this year, an awful pace that if continued would surpass last year’s all-time high of 162.

Stressed-out, depressed and despondent soldiers are seeking help for their mental difficulties at a rate that is overwhelming the capacity of available professionals. And you can bet that there are even higher numbers of troubled service members who are not seeking help.

In the war zones, we medicate the troubled troops and send them right back into action, loading them up with antidepressants, sleeping pills, anti-anxiety drugs and lord knows what other kinds of medication.

One of the things we have long known about warfare is that the trouble follows the troops home. The Times published an article this week by Aaron Glantz, a reporter with The Bay Citizen news organization in San Francisco, that focused on the extraordinary surge of fatalities among Afghanistan and Iraq veterans. These young people died, wrote Mr. Glantz, “not just as a result of suicide, but also of vehicle accidents, motorcycle crashes, drug overdoses or other causes after being discharged from the military.”

An analysis of official death certificates showed that, from 2005 through 2008, more than 1,000 California veterans under the age of 35 had died. That’s three times the number of service members from California who were killed in Afghanistan and Iraq during the same period.

Veterans of the two wars were two-and-a-half times as likely to commit suicide as people the same age with no military service. “They were twice as likely,” Mr. Glantz reported, “to die in a vehicle accident, and five-and-a-half times as likely to die in a motorcycle accident.”

The torment that wars put people through is not something that can be turned on and off like a switch. It’s a potentially deadly burden that demands attention and care. People shouldn’t be exposed to it if there is any possible alternative.

The wars in Afghanistan and Iraq have been world-class fiascos. To continue them without taking serious account of the horrors being endured by our troops and their families is just wrong.

The war in Afghanistan, the longest in our history, began on Oct. 7, 2001. It’s now in its 10th year. After all this time and all the blood shed and lives lost, it’s still not clear what we’re doing. Osama bin Laden hasn’t been found. The Afghan Army can’t stand on its own. Our ally in Pakistan can’t be trusted, and our man in Kabul is, at best, flaky. A good and humane society would not keep sending its young people into that caldron.

Shakespeare tells us to “be not afraid of greatness.” At the moment, we are acting like we’re terrified.





January 2, 2011

For Many Returning Veterans, Home Is Where the Trouble Is
By LAWRENCE DOWNES, UTICA, N.Y.

Across the country a tide is reversing. Soldiers deployed to two long wars are coming back, bringing some of the anguish home with them. Those who leave the service are trying to restart civilian lives, rejoining their families, going to college, trying to find jobs. It doesn’t always work out.

The challenges for returning veterans are particularly visible in upstate New York, around Fort Drum, home to the Army’s 10th Mountain Division, and some of the most frequently deployed combat units anywhere. Since 9/11, tens of thousands of Drum soldiers have seen two or three, sometimes even four tours of duty. Most who return disperse around the country, but a significant percentage stay nearby. Veterans are 13 percent of the population in the Fort Drum area, compared with 9 percent in the rest of the state.

In that band of fading cities and rural communities, the governmental safety net is stretched thin. With more veterans needing help, a growing network of nonprofit organizations is rising to meet the demand.

Business is booming in the veterans outreach center in downtown Utica. The center, once a YMCA, was bright and bustling on a recent gray, snow-dusted day. Staff members proudly showed the strands of a new safety net being woven into place: dormitory rooms upstairs that will soon be converted to transitional housing, a basement full of donated clothing, housewares and furniture. Classrooms. A boxing ring and exercise room. An Internet cafe.

On Dec. 10, the center celebrated the ribbon-cutting for a new program in which veterans meet other veterans for outings, conversation, friendship. The simple idea behind it: if you haven’t been there, you don’t know.

The peer program’s coordinator is Michael Sportello, who served in Iraq. He returned to the worst recession in decades, an ocean of debt and an unhappy home. His wife left. He kept his sons. He almost gave up, but then found the center and a focus for his life.

He is working with people like William Lavier, an Army master sergeant who is striving to reinvent himself for life after warfare. Sergeant Lavier is unemployed and has a college degree and no interest in working for the minimum wage. Because the available jobs upstate are mainly in health care and education, he is studying to be a registered nurse, hoping his finances hold out long enough.

He and his wife, who works for a medical-billing company, are many tens of thousands of dollars in debt. They are one layoff away from a disaster. He is also considering leaving his family for a job in Virginia. Or signing up for another deployment — war may be hell, but it’s also a paycheck.

The world of troubled veterans is still dominated by the Vietnam era, by men in their 60s. But the veterans of Iraq and Afghanistan, young men and women in their prime, survivors of bomb blasts and bearers of brutal memories, are catching up. When they get in trouble, they are said to do so quicker and more deeply.

Mr. Sportello and Sergeant Lavier are luckier than many. They aren’t homeless or in prison. But both men speak emphatically of how difficult the re-entry to life is after combat. Over there, on patrol, Mr. Sportello said, the adrenaline is so thick the pounding in your neck makes it hard to breathe. Back home, Sergeant Lavier usually can’t sleep. Once, he dozed off to a war movie blasting in his home, the speakers shaking the house and waking everyone else up. The sounds of combat were a lullaby for his jangled nerves.

The pace of civilian life confounds many veterans. They see it as a world of slow-moving civilians who frustrate and terrify them. If a driver resents your tailgating and slows down, and another pulls up beside you — suddenly you’re boxed in, back in Baghdad. People on overpasses look like snipers. Trash on road shoulders like I.E.D.’s.

Veterans and their advocates in Utica and elsewhere had good words for the Veterans Affairs Department, which they said has begun realizing that one of the best ways to help veterans, especially the many who live far from V.A. hospitals, is through community-based services. The agency is steering money to local nonprofits and beginning its own efforts, like a pilot program in nearby Watertown and towns near other military bases around the country, to seek out veterans at risk of homelessness. This is a sharp change of attitude.

Someday the country will recognize that the population of veterans is growing, and that yellow-ribbon magnets aren’t enough to help them. Unfortunately, Congress hasn’t figured it out. Veterans Affairs Secretary Eric Shinseki has a welcome campaign to end the problem of veterans’ homelessness in five years. But a bill to give the V.A. $50 million more to address homelessness went nowhere in the lame-duck session. The next Congress must do better.




ProPublica    March 22, 2011, 1:05 p.m.

Aftershock: The Blast That Shook Psycho Platoon
by T. Christian Miller [1], ProPublica, and Daniel Zwerdling, NPR

A version of this story was co-produced with NPR [2] to air on All Things Considered [3]. (See schedule for times. [4]) This story was also published as part of Amazon's Kindle Singles program, and is available for reading [5] on that device.

A photo of Staff Sgt. Brock Savelkoul from his service in the military. (Katie Hayes Luke)

MINOT, ND -- At 8:20 p.m. on Sept. 21, 2010, Iraq veteran Brock Savelkoul decided it was time to die. He lurched from his black Tacoma pickup truck, gripping a 9-mm pistol. In front of him, a half dozen law enforcement officers crouched behind patrol cars with their weapons drawn. They had surrounded him on a muddy red road after an hour-long chase that reached speeds of 105 miles per hour. Savelkoul stared at the ring of men and women before ducking into the cab of his truck. He cranked up the radio. A country song about whiskey and cigarettes wafted out across an endless sprawl of North Dakota farmland, stubbled from the recent harvest. Sleet was falling, chilling the air. Savelkoul, 29, walked slowly toward the officers. He gestured wildly with his gun. "Go ahead, shoot me! ... Please, shoot me," he yelled, his face illuminated in a chiaroscuro of blazing spotlights and the deepening darkness. "Do it. Pull it. Do I have to point my gun at you to ... do it?"

Twenty feet away, the officers shifted nervously. Some placed their fingers on the triggers of their shotguns and took aim at Savelkoul's chest. They were exhausted, on edge after the chase and long standoff. They knew only the sketchiest of details about the man in front of them, his blond hair short, his face twisted in grief and anger. Dispatchers had told them that Savelkoul had been diagnosed with post-traumatic stress disorder. They warned that he might have been drinking. Family members told police that Savelkoul had fled his home with six weapons, including a semiautomatic assault rifle and several hundred rounds of hollow point ammunition. To Megan Christopher, a trooper with the North Dakota Highway Patrol, Savelkoul's intentions seemed obvious. "Suicide by cop," she thought. "He wants to go out in a blaze of glory."

As it happened, Savelkoul's state of mind was of interest not only to the cops, but to some of the nation's top military officers and medical researchers.

More than 2 million troops have deployed to Iraq and Afghanistan since 2001. Tens of thousands have returned with a bedeviling mix of psychological and cognitive problems. For decades, doctors have recognized that soldiers can suffer lasting wounds from the sheer terror of combat, a condition referred to today as post-traumatic stress disorder. They also have come to know that blows to the head from roadside bombs -- the signature weapon in Iraq and Afghanistan -- can result in mild traumatic injuries to the brain, or concussions, that can leave soldiers unable to remember, to follow orders, to think normally.

Now it is becoming clear that soldiers like Savelkoul are coming home afflicted with both conditions, in numbers never seen before. Studies have estimated that about 20 percent of soldiers returning from Iraq and Afghanistan have suffered a mild traumatic brain injury while deployed. Of those, anywhere between 5 percent to nearly 50 percent may suffer both PTSD and lingering problems from traumatic brain injuries. It is an epidemic so new that doctors aren't even sure what to call it, let alone how best to diagnose and treat it.

Savelkoul and four of his comrades landed on the front lines of this confounding new conflict over the minds of America's soldiers when an Iraqi rocket exploded near their trailer in January 2009. By chance, a senior Army neuropsychologist was in Iraq at the time to conduct a study on the military's tools for diagnosing concussions. After learning of the attack, he persuaded Savelkoul and the others to enroll. The men became the first fully documented victims of "pure blast" concussions -- that is, mild traumatic brain injuries caused by the force of an explosion, rather than a secondary effect, such as slamming into a Humvee wall after a roadside bomb.

The concussions marked only the beginning of the men's problems. Aftershocks from the blast would ripple through each of their lives differently, mirroring the spectrum of psychic and physical outcomes that doctors have begun to catalog. Of the five men injured that night, three remain in the Army and are currently deployed to overseas war zones. One recovered quickly, though he continues to suffer occasional severe headaches. Two recuperated more gradually but complain of forgetfulness and problems concentrating. A fourth left the military, tired of the violence and still grappling with concussion symptoms.

Savelkoul struggled the most to return to the person he had been before. On that night last September, his troubles transformed from academic data point to terrifyingly real confrontation. All the Army's men, all its research, all its treatments, had failed to prevent the desperate showdown that would unfold on a deserted stretch of highway just south of the pinched hills of the Dakota badlands. Now the outcome depended on one distraught man and a half-dozen nerve-wracked police officers, trying to negotiate a battlefield of the mind that none of them -- no one in the world, really -- understood.

An Unremarkable Blast

The football-sized hole left in the 12-foot-high concrete blast wall following a rocket attack on the camp, where soldiers Junge, Hopkins, Hollingshead, Fuller and Savelkoul were unwinding after a day of patrolling. (Photo courtesy of Spc. Jared Hollingshead)

In the violence of the wars in Iraq and Afghanistan, it was an unremarkable attack on an unremarkable day.

On the night of Jan. 16, 2009, several soldiers were hunched around a small television screen in a trailer at Camp Liberty, a sprawling base just outside of Baghdad. The men of Psycho platoon, Hell Raisers Battery, 1-7 Field Artillery of the famed 1st Infantry Division, the Big Red One, had arrived in Iraq from Fort Riley, Kan., in October 2008. They were on their second or third tours. After spending most of the day patrolling a nearby Iraqi village, they decided to unwind by playing "Call of Duty 4," a video game that allows players to act as U.S. Marines fighting in an unspecified Middle Eastern country. Subtitled "Modern Warfare," the game's scenes are harrowingly similar to the conflict in Iraq, with patrols down narrow streets of dun-colored buildings, sudden explosions and attacks by hidden enemies. "It sounds strange, but it's how we relaxed," said Staff Sgt. Derrick Junge, a muscular Illinois native with a shaved head and a fondness for reading Virgil, John Milton and Charles Dickens.

At about 8 p.m., the men heard the warning klaxon of the Phalanx, an antimissile system designed to destroy incoming mortar and artillery rounds by spraying bullets into the sky. The men continued playing "Call of Duty." Rocket attacks were common. The insurgents aimed so poorly that they rarely posed a danger. Seven minutes after the first warning, a second sounded. One man remembered that a fellow player, referring to the video game, called out "He's got a grenade!" Then, chaos enveloped the men.

Staff Sgt. James Hopkins, a Missouri native with a slight build, sharp face and a love of Red Vines candy, was sitting on his bed in a room next door to the rest of the men. He was talking to his wife on Skype. The blast force threw him to the floor. "It was just loud and thunderous. The living quarters actually shook. It was like if I were to stand next to the biggest Fourth of July explosion ever."

Interactive Timeline: How One Blast Affected Five Soldiers [6]

Spc. Jared Hollingshead was standing when the blast hit. The stocky Texan remembered "a bright flash of light, a very loud bang and everything goes blank after that. It was the most heart-wrenching thing you'll ever go through. It feels like your whole body clamps up. It's beyond words. It's utter terror."

Shane Fuller, then a corporal, was sitting with his back to the wall, listening to music on his laptop computer. "I just slumped over from the force of it," said Fuller, a Missourian who joined the Army after the lawnmower engine factory where he worked shut down. "All I could hear was ringing for 10 to 15 seconds."

An Iranian-made 107mm rocket had just slammed into one of the 12-foot-high concrete blast walls that protected the soldiers' housing compound, blowing a football-sized hole into the wall. Shrapnel, jagged and red hot, shredded the thin shell of the trailer, puncturing it with holes. Lights crashed down from the ceiling. Power went out. Fuller miraculously escaped physical injury, though shrapnel pierced the wall around him and ripped apart a Missouri State flag hanging above his head.

The men remember the next few minutes haphazardly, like a movie in which they duck in and out of the theater. In the dark and smoke that filled the trailer, several of them heard Savelkoul call out: "I'm hit, I'm hit!" A piece of metal from the rocket had burned his leg, making him the only soldier to suffer an external injury in the blast. Junge groped through the dark for a flashlight. Hopkins staggered out of his room to check on his men. Hollingshead grabbed his rifle. Fuller, who had blacked out, came to with blood streaming from his nose. Several ran to Savelkoul, dragging him to a nearby bunker.

Within minutes, combat medics arrived and took the men to a nearby medical clinic. They cleaned and bandaged Savelkoul's wound. They checked out Fuller but determined he had no injury. Though medics are supposed to check soldiers exposed to a blast for concussion, none of the men remembers talking about traumatic brain injury -- though all admit their memories were hazy. According to a doctor who reviewed their medical charts, none were diagnosed with concussions.

The men felt lucky. Nobody had died, nobody was seriously wounded, as far as they could tell. "I looked at it as though it wasn't a huge deal," Junge said. "You look at yourself and you say, nothing really happened to me."

By the next morning, Junge and several others went back on patrol.

As chance would have it, two weeks earlier, Lt. Col. Mike Russell -- then the Army's most senior neuropsychologist -- had landed in Iraq to begin a study of concussion at the behest of the Army's surgeon general. One of the first graduates of the neuropsychology program at Walter Reed Hospital, Russell had spent much of his career studying traumatic brain injury at Army hospitals and combat zones all over the world. He was something of an iconoclast in the military. Blunt-spoken and easily frustrated with bureaucracy, Russell decided the best way to find patients for his study was simply to hang out in military clinics, seeking blast survivors. He happened to hear about the rocket attacks at Camp Liberty and asked to examine Savelkoul and his comrades personally.

After assessing them at a field clinic on base three days after the blast, Russell concluded that five of the soldiers in the blast that night had, indeed, suffered mild traumatic brain injuries. The signs were obvious, Russell said, showing up clearly in the daylong battery of neuropsychology exams he performed. "When you work a lot with acute concussion, you actually kind of recognize even the look of a person who has been acutely concussed, which is kind of a dazed expression, a little bit unfocused, a little bit slow to respond," Russell said. "Several of them had significant gaps in their memory. And it wasn't clear how long they were unconscious. The last thing they remember is they were playing video games. The next thing they remember, they are outside the trailer in a shelter. Some minutes had actually passed where they weren't recording memories. That's post-traumatic amnesia. And that's your classic symptoms of a concussion."

For each of the men, Russell entered two diagnoses in their electronic medical records:

1. Concussion
2. Post concussive syndrome

The New Epidemic

Staff Sgt. Derrick Junge, right, was on his second tour in Iraq when he sustained a traumatic brain injury from the Jan. 16, 2009 rocket attack. (1st Lt. Mark Peek )

War has always fueled innovation, helpful and horrible. Better body armor and battlefield medicine have helped soldiers survive injuries in Iraq and Afghanistan that would have proven fatal in previous conflicts. But the advances that have saved soldiers' bodies cannot protect their minds from insurgents' primary weapon, the roadside bomb. Blast waves penetrate through Humvee doors, bulletproof vests and Kevlar helmets, rattling soldiers' brains and altering cells and circuitry. Most recover quickly, but some suffer lasting damage to their cognitive abilities. At the same time, the terrifying experience of surviving such blasts haunts them, seeping out in violent nightmares and emotional outbursts.

Given the number of troops deployed, tens of thousands of soldiers, Marines, sailors and airmen may be suffering from this pernicious combination of PTSD and lasting problems from mild traumatic brain injury. They become, quite literally, different men and women than they used to be, a generation of warriors whose fight has shifted from external combat zones to invisible internal battlefields.

The issue has ignited debate in scientific and military circles, where much of the basic science remains in dispute. Are the two conditions related? If so, how? Does having a mild traumatic brain injury increase the chance of developing post-traumatic stress disorder? Or does surviving a terrifying event somehow make it more difficult for the brain to recover from a concussion? Doctors also struggle to tell the two conditions apart. PTSD and traumatic brain injury can produce similar symptoms, such as problems with memory and concentration. Yet both conditions escape detection by medical imaging devices, hindering diagnosis. Other conditions further complicate the picture. Besides PTSD and cognitive problems stemming from brain injury, soldiers also face chronic pain, missing limbs, vision, hearing and other physical problems. "It's very complicated," said Jennifer Vasterling, who has studied the issue and treated soldiers as chief of psychology at the Boston Veteran's Administration Hospital. "There are no simple scenarios."

Until recently, concussions were not even seen as particularly serious. Boxers boasted of returning to the ring after being knocked out. Soldiers in combat shook off feeling dazed and unfocused. Symptoms of concussions can include headaches, dizziness, difficulty speaking, memory troubles and sometimes balance and visions problems. Most people recover within four to six weeks. But for some, the symptoms can persist for months or even years. Civilian studies have found that between 5 percent and 15 percent of concussion victims endure long-term problems -- a condition formally known as post-concussion syndrome. Recent studies of athletes in the NFL and other sports have shown that repeated concussions can result in chronic traumatic encephalopathy, a condition associated with dementia and other Alzheimer's-like disorders.

Some researchers believe that soldiers' concussions may pose an even more complex medical challenge. Soldiers sustain their injuries in settings dramatically different from those encountered by athletes or car accident victims. Civilian concussions are typically caused by a physical blow to the head. But nobody is sure exactly how the brain is damaged in a blast concussion. Do blast waves rupture miniature blood vessels inside the brain? Does the force sever connections between neurons? Does it damage individual brain cells? Or does it simply slam the helmet into the head hard enough to injure the brain?

After the blast, soldiers face a different environment than typical concussion victims. No fans applaud as they rise from the field. Medics often can't rush them to the safety of a hospital right away. Instead, they remain on a hostile battlefield, fighting for their lives, the violence and rush of combat filling their brain with abnormal levels of chemicals such as adrenaline. Those left dazed, but not unconscious, experience a fear so fierce that it may simultaneously trigger post-traumatic stress. Paradoxically, patients who suffer severe traumatic brain injuries are less likely to develop PTSD -- perhaps because, knocked unconscious, they do not actually experience the horror unfolding around them.

"The scientific literature does not capture or mention the kind of patient that we are seeing," said Maria Mouritidas, psychology chair at Baltimore's College of Notre Dame, who worked with soldiers returning from the battlefield. "You can't compare this to a football game or a car injury. In a football game, if you go down, the game stops. On the battlefield, the game doesn't stop. Your survival depends on it."

For decades, the military has struggled to sort out the mysteries of concussions. In response to soldiers suffering head injuries during the Gulf War, the Pentagon and the Veterans Affairs joined forces to create what is today called the Defense and Veterans Brain Injury Center [7], a network of research and treatment clinics. But the wars in Afghanistan and Iraq dramatically expanded the need. Military doctors began noticing a wave of troops suffering brain injuries in blasts. In August 2006, the Armed Forces Epidemiological Board, responsible for monitoring health trends among troops, noted the growing number of head injuries. In a memo first disclosed by USA Today [8], the board warned senior Pentagon health officials that the military's medical system "lacks a system-wide approach for proper identification, management, and surveillance for individuals who sustain a TBI, in particular mild TBI/concussion."

However, it wasn't until the Walter Reed Hospital scandal of 2007 that the military dramatically increased attention to the so-called "invisible" wounds of war. The Washington Post revealed [9] that officials at the hospital, the crown jewel of the military medical system, housed soldiers with brain damage in moldy hospital rooms, often ignoring their needs. The scandal caused an uproar in Congress and across the nation. Lawmakers passed legislation devoting more than $300 million in new research funds to brain injuries and PTSD. They ordered the military to conduct cognitive screenings of soldiers before and after deployment. President Bush created a commission headed by retired Sen. Bob Dole and former Health Secretary Donna Shalala to suggest recommendations to improve care for soldiers with PTSD and brain injury. In 2008, the Rand Corporation produced a groundbreaking report [10] estimating that 19 percent of soldiers in Iraq and Afghanistan had suffered a probable traumatic brain injury, while another 18 percent reported symptoms of PTSD or depression. About 5 percent reported a combination.

Yet, despite the pressure and the growing numbers, the Pentagon's response was uneven, at best. ProPublica and NPR reported last year [11] that the military continues to have problems diagnosing and treating brain-injured soldiers. The military's standard screens failed to catch as many as 40 percent of concussions, according to a study published earlier this month. Injuries weren't always noted in soldiers' medical files because of poor recordkeeping. In some cases, soldiers resisted admitting that they had sustained head traumas because of a desire to remain on the battlefield with comrades. In the command echelons, some high-ranking military officers dismissed the effects of mild traumatic brain injuries.

Col. Heidi Terrio, an Army doctor who has worked extensively with soldiers returning from the combat field, conducted a study published in the Journal of Head Trauma Rehabilitation [12] that reported that 7.5 percent of combat soldiers returning from Iraq and Afghanistan showed three or more symptoms associated with post-concussion syndrome, with another 20 percent reporting one symptom. Terrio said her study showed that it was important to pay attention to soldiers with concussions. "Mild traumatic injury does not mean it's a mild problem," she said. "Mild doesn't necessarily mean mild consequences. One concussion may cause you to have lifelong problems. Most of the time it doesn't but it can."

Spc. Jared Hollingshead sustained his second concussion in the rocket attack on Jan. 16, 2009. Afterward, he experienced trouble wth his balance and keeping track of orders from his superiors. (Photo courtesy of Spc. Jared Hollingshead)

The lack of clarity has frustrated battlefield commanders trying to navigate the debate in the middle of a war. "I don't feel comfortable on where the science is right now," said Gen. Peter Chiarelli, the vice chief of staff for the Army. "It's an extraordinarily tough nut to crack."

Chiarelli has worked relentlessly to change that, convening conferences of top neurologists and flying them to his wood-paneled office in the Pentagon's inner ring to hammer out possible treatments. He has encouraged researchers to find biomarkers to better diagnose brain injury. He envisions a system that, with enough data, could one day help commanders predict which soldiers were at greatest risk of committing suicide.

Interactive Timeline: How One Blast Affected Five Soldiers [6]Although he acknowledges there is more work ahead, Chiarelli's temper flares at the suggestion that the Army is not trying hard enough to improve how it diagnoses and treats soldiers with brain trauma. He points to a directive issued last year [13] that mandated rest periods for soldiers involved in blasts and thorough neurological examinations for those suffering three or more concussions. He also notes that the military has spent millions of dollars on research that has generated promising new technologies to identify and treat injuries related to PTSD and TBI.

"Our doctors are doing everything they can to come up with the best techniques possible to insure they get better at the initial diagnosis of these injuries," Chiarelli said. "But it is extremely difficult because the science is not as developed as it is with the mechanical nature of this war."

Call of Duty
Though the men of Psycho platoon returned to duty shortly after the explosion, several continued to experience aftereffects.

Hollingshead remembered stumbling across the base, unable to keep his balance on the white gravel that lined the ground between buildings. His ears rang constantly. He had difficulty keeping track of what his sergeants were telling him to do. "I just could not remember it. I'd ask three different times. It's a very unusual feeling, not being able to remember all of a sudden." Hopkins had similar trouble. "I just didn't feel right. I could barely walk a straight line," he said. "I was forgetting things, my attention span was shot, someone would be directly talking to me and I would not even really be paying attention. I couldn't recall or say back what they said to me. It was like I was paying attention but I wasn't gathering the information." Junge had splitting headaches, so he popped ibuprofen and Tylenol PM to help get to sleep.

In March, the Army held a ceremony to award the men combat action badges, given to soldiers who have attacked or been attacked by the enemy. For the wound to his leg, Savelkoul also received a Purple Heart, one of the military's most revered symbols of sacrifice, an honor dating back to George Washington. The other men, however, were turned down, even though Army regulations specifically list concussion as an injury deserving recognition. Hopkins was incensed. He began firing off appeals [14] on behalf of himself and his men, with no success. "They don't consider [concussions] to be an injury that is going to stay with you for the long term," he said. "That's a big slap in the face."

For most of the men, some symptoms improved. Their balance got better, the headaches were not as severe -- a typical recovery from mild traumatic brain injury. But the symptoms did not go away entirely. Fuller's ears kept ringing. Hollingshead's headaches remained painful, sometimes disabling. Still, the men continued providing security details for senior commanders, patrolling villages, or protecting fuel and food convoys racing across the desert. "After we saw Dr. Russell, that was it. It was back to work," Hollingshead said. "Nobody ever came back to us to follow up."

Savelkoul was awarded another commendation, the Army Achievement Medal [15], for manning a gun truck and coordinating air support during a dangerous run between Baghdad and Al Hillah. That April, he was scheduled for a rest and relaxation break. He decided to go with a friend to Thailand. On March 20, he posted a message on Facebook: "on my way to Thailand !!!!" His sister, Angie, quickly wrote back: "have fun. Don't do anything stupid."

Savelkoul didn't reply.

The Farm Kid
Savelkoul grew up in North Dakota. His father was a car salesman, then a truck driver. When Savelkoul was getting ready to enter high school, the family enrolled him in a school in Glenburn, pop. 347, in far north-central North Dakota because their hometown school in Minot, pop. 36,000, was too big. Savelkoul played football and basketball for the Glenburn High Panthers. During halftime, he played trumpet in the high school band. At Christmas at his grandparents, Savelkoul and Angie, a flute player, would play mini-concerts. The family had its troubles, and Savelkoul's parents eventually divorced, but they stayed close.

Savelkoul loved hunting: deer, geese, coots. When he was 14, Savelkoul and his father Bruce drove out to the North Dakota badlands on a rainy, gray winter day. They hiked up a hill, getting soaked as they searched for game for hours. Suddenly, right in front of them, Bruce spotted a mule deer. It would be Brock's first kill. He started shaking uncontrollably as he tried to lower his rifle. Bruce gently crouched in front of him and had Brock lay the rifle across his shoulder, steadying it. Brock aimed, killing the deer with a single shot. It was a beautiful buck, its antlers tall and broad above its head. The mount, which won first place at a local trophy show in 1996, would hang on the wall of Bruce's mobile home, the first thing you see when you walked in the door. "He was a good kid, a very good kid," said Bruce, who is balding, with glasses. His pride in his son is obvious. "He was a farm kid. We had farm values -- scruples and values and respect."

After high school, Brock Savelkoul attended community college but soon dropped out. He was bored and unsure of what he wanted to do. He moved to Fargo, where he got a job with a fencing company. One day, he was on a job with an older man. He suddenly realized that he didn't want to spend the rest of his life building fences in Fargo. In February 2003, he signed up with the Army. He was assigned to Fort Riley. Six months later, Savelkoul headed to Iraq for the first of three tours.

During his tours, Savelkoul took on a number of different jobs. He was the gunner on a Humvee that patrolled the streets. He did foot patrols of villages. He took a course and began to operate Ravens, small surveillance drones used to fly above roads to make sure they were clear of bombs. Mike Krebsbach, a friend from basic training, said Savelkoul was a good, conscientious soldier. They were based in Baghdad, their quarters a palace that had once belonged to Saddam Hussein. At night, they would sit on the roof, staring over the boxy brown cityscape. Krebsbach, an atheist, would debate Brock, a Catholic, about God, life, the war. "We didn't talk much about the fear," Krebsbach said.

Two incidents seemed to affect Savelkoul, changing him. During his first tour, his unit began taking fire after turning down an alleyway. The men, novices to combat, fired back, seeking desperately to escape. All survived, but the incident shook them. "Everybody was tripping out," Krebsbach said. "We were acting like a combat infantry team, but with zero training. ... There was just a bunch of really scared soldiers."

During his second tour in 2005, Savelkoul was responsible for giving the OK after he scanned a route with the Raven and determined that there were no signs of IEDs, or improvised explosive devices. In an article for a base newsletter [16], he proudly told the reporter that his job saved soldiers' lives. "We're protecting them from the sky," he said. One day, however, a convoy driving down a route he had checked hit an IED. Details are unclear. Savelkoul rarely spoke of it. The bomb destroyed one of the vehicles. Several soldiers apparently died in the blast. "It blew the truck into nothing. You didn't even know it was a Humvee," said Krebsbach, who remembered seeing the vehicle after it was towed back to base. He said Savelkoul became sullen and withdrawn afterward. "It was hard to get him not to fixate" on that incident, he said.

Bruce Savelkoul remembers getting a solemn phone call from his son after the explosion.

"Dad, I'm responsible for those deaths," Brock told his father.

"No, you're not," Bruce responded, trying to console him. One of Savelkoul's commanders, who did not want to be identified because the Army had not authorized him to comment, said that he had looked into the incident and concluded that Savelkoul was not negligent in carrying out his duties.

When the rocket hit the concrete wall protecting the soldiers' quarters, Staff Sgt. James Hopkins was thrown to the floor. He has since been fighting for Purple Hearts for his men and himself. (1st Lt. Mark Peek)

In any case, the Humvee deaths weighed on Savelkoul, as did the failure of a brief marriage, which ended in divorce just a few months before he left Iraq in January 2006. To Angie, his sister, he seemed different. Although some family members had suffered depression, Savelkoul had never shown any signs of mental distress. "He wasn't his normal self. He was very quiet, withdrawn," Angie said. "It's like he wasn't there."

With straight blond hair and an open, honest face, Angie is the glue of the Savelkoul family, the little sister who keeps tabs on everyone. A labor and delivery nurse married to a plumber, she juggles crazy work hours with family crises and the kids' basketball games. Through it all, she made sure to communicate with Brock regularly. When he deployed to Iraq again in October 2008, she convinced him to open a Facebook account. They exchanged messages after the Jan. 16 explosion. Brock assured her he was OK.

That was why Angie got nervous when Brock didn't respond to her messages after he left for Thailand. "You need to write, call, something," she wrote. " ... gettin worried ... "

She had reason to be. Her brother had begun to fall apart.

Interactive Timeline: How One Blast Affected Five Soldiers [6]

Falling Apart
Photos taken of Savelkoul in Thailand show him acting as soldiers often do on leave, partying in bars, surrounded by friends and women. It's impossible to know exactly what happened, but about a week after his arrival, he began sending out strange messages: "I'm under special army training in Thailand ... It's crazy!!!" read one. Nothing in his military records indicates he received any training in Thailand. Friends remember getting nonsensical text messages on their cell phones. Bruce Savelkoul said Brock called him from Thailand in the middle of the night.

"'Dad, there are guys trying to kill me, Dad, you got to help me,'" Bruce said his son told him. "He was absolutely paranoid. I was 7,000 miles away. What could we do?"

At some point, U.S. Embassy and military officials picked up Savelkoul and transported him to Tripler Army Medical Center in Honolulu. There he was placed under lockdown and diagnosed as having suffered a psychotic breakdown.

After stabilizing at Tripler, Savelkoul was transferred back to Fort Riley. He seemed to pine for Iraq. "You guys have no clue how bad I want to be there!!!! It's just not the same without you guys," he wrote in a Facebook message in May 2009 to a fellow soldier still in Iraq. Officials at Fort Riley declined to comment on what kind of treatment he received. Savelkoul's military record shows that his condition wasn't improving. In August 2009, he was hospitalized a second time. In October, the Army barred him from possessing weapons. Savelkoul was diagnosed as suffering from post-traumatic stress disorder.

Post-traumatic stress disorder has its own controversial history. Accounts of soldiers suffering mental afflictions after exposure to war's horrors date back thousands of years. In Homer's Iliad, some have speculated that Achilles' blind rage after the death of a beloved companion is an early description of post-traumatic stress. During the Civil War, men who struggled to return to normalcy after the war were described as suffering from "soldier's heart." In World War I, it was called shellshock. World War II brought the name "combat fatigue." All generally described soldiers numbed and haunted, unable to return to battle -- or normal life.

Military commanders showed little tolerance or understanding during earlier eras. Gen. George H. Patton became infamous for slapping and publicly berating a soldier suffering from combat fatigue, calling him a "coward" and ordering him back to the frontlines. Patton was later forced to apologize.

The Diagnostic and Statistical Manual of Mental Disorders, the psychiatrist's primary diagnostic tool, did not formally recognized the syndrome until 1980, after thousands of veterans returned from Vietnam suffering psychological distress. Today, the diagnosis requires that troops meet a series of criteria. They include having faced a risk of serious injury or death; recurring nightmares or memories; and problems with sleep, anger and emotional control that last beyond a month. Researchers continue to debate the criteria and what happens inside the brain to trigger the disorder. Does a sudden rush of chemicals in the brain change fundamental pathways for dealing with stress? Do genes play a role?

Despite the questions, after a 30-year push by veterans and their advocates, PTSD has gained greater acceptance than post-concussion syndrome. Commanders and soldiers are reminded to watch for signs constantly during military training. Nearly all VA and military medical facilities offer some form of counseling for PTSD. By comparison, mild traumatic brain injury is the new kid on the block. At times, researchers have seemed to divide into factions, with PTSD advocates seeking to protect their gains and TBI advocates fighting to make advances. Charles Hoge, a retired colonel who published groundbreaking research on PTSD in Iraq and Afghanistan, has expressed skepticism publicly regarding the severity of mild traumatic brain injury. In an opinion piece in the New England Journal of Medicine [17], Hoge worried that overdiagnosis of lingering problems from concussion will create "illusory" demands for the military's medical system. "There tends to be camps. One camp is everything is TBI and the other is nothing is TBI," said Rodney Vanderploeg, director of the brain-injury treatment program at the Tampa VA, which specializes in treating soldiers with multiple traumas. "The truth is somewhere in the middle."

Savelkoul was suffering in that middle. In November 2009, the Army made a last-ditch effort to help him, sending him to a residential mental health program at a veterans' home in Yountville, Calif., called the Pathway Home.

While now-Sgt. Shane Fuller was initially determined to be injury-free after the attack, he experienced a constant ringing in his ears and debilitating headaches from his mild traumatic brain injury even after he returned stateside. (Photo courtesy of Hillary Fuller)

It is hard to imagine a more idyllic location. Surrounded by the gentle brown hills of Napa Valley, the sprawling campus of Spanish-style buildings has towering redwoods and lush green lawns. Fred Gusman, a nationally prominent expert in PTSD who recently retired from the Department of Veterans Affairs, established the program in January 2008 for Iraq and Afghanistan veterans. The intensive, six-month program is designed for the hard cases, the troops and veterans who have had an especially difficult time recovering in traditional military settings, where therapy can be haphazard and uncoordinated. At the Pathway Home, teams of doctors and clinicians strive to take a comprehensive approach to care, coordinating treatments for psychological trauma, chronic pain and other issues, such as alcoholism. Patients have encounter groups. They go fly fishing and hiking.

Savelkoul, Gusman remembered, had symptoms similar to scores of patients that have gone through his program. He suffered nightmares, severe depression, trouble sleeping, headaches. "He's not unique in what we see," Gusman said. Savelkoul struggled to adjust to the program. Sometimes he would participate. Sometimes he would withdraw, apparently not convinced that he needed help and uncertain whether he wanted to remain in the Army. "There is anger, fear and shame. A lot of people wonder why they are in this treatment and others are not. They get stuck like that," Gusman said.

After about two months in the program, Savelkoul wandered off campus -- which is not closed -- and somehow made his way to Sacramento. Bruce Savelkoul got a call a short while later. Brock told him that he was back in Baghdad, surrounded by thousands of people. At about the same time, Gusman got a call from a staff member. Savelkoul had been found in the Old Town section of the city, a tourist area near the Sacramento River. He had been drinking and was having a panic attack, they told Gusman. Gusman sent a van to pick him up and transport him to Travis Air Force Base. Eventually, Savelkoul was sent back to Fort Riley. Gusman said Savelkoul was not yet ready for his program and that the military did not aggressively pursue other treatment options: "The problem in this country is that we haven't accepted the hard reality that we can train people to be in a war. ... But we can't train somebody in how they're going to respond."

For the military, it was the last straw. Staff Sgt. Brock B. Savelkoul was honorably discharged from the Army [18] on March 31, 2010. He had served two years, three months and four days in Iraq. His awards included the Purple Heart, the Army Commendation Medal and the Army Achievement Medal. He was placed on temporary disability due to post-traumatic stress disorder. He was ordered to be re-evaluated in six months.

Savelkoul was going home.

The Others Struggle
In September, just before Savelkoul was shipped off to California, the rest of Psycho platoon returned from Iraq. They began to split up. Junge was transferred to Fort Campbell in Kentucky. On a test he took shortly after getting back, a screen given to all soldiers to check for potential brain injury and mental health problems, Junge had filled in "Yes" for every question relating to traumatic brain injury. Positive answers are supposed to trigger an evaluation by a medical professional. But nobody at the local TBI clinic ever examined Junge.

Junge, his wife Holly and their kids moved to a modest home with two magnolia trees in the front yard in Clarksville, Tenn., a short distance from their new post. As they settled in, Holly began to notice changes. Junge would snap at the kids, something he had never done before. He started building a tree house in the front yard but never quite finished. Before joining the Army, Junge had been an air force mechanic on the B-2 stealth bomber, one of the most complicated pieces of machinery ever invented. Now he struggled to fit together the pieces of a trampoline in their backyard. Holly, a nutritionist with a soft face and brown hair, grew worried. "From day one, he was a different person," she said. "He was very irritable. He doesn't sleep well. He forgot things, little things, but kind of annoying."

One day, the couple's 10-year-old daughter asked Holly, "Why is Daddy so mean to you?" Recalling the question, Holly began to cry. "Everything was wonderful. Not that's he's not now," she said, wiping tears from her face. "But it's different."

Junge said he never considered his troubles serious enough to go see a doctor. Nobody had ever ordered him to seek counseling. He was focused on his men, he said, and getting ready to redeploy to Afghanistan. "I just don't deal with stuff like I used to," he said. "I guess you could say I used to be a different person. It kind of sucks. But it's where I'm at and you work with it the best you can."

Upon his return, Hollingshead had a mental health examination at a VA hospital in Shreveport, La. He was hoping to begin PTSD counseling, but he left the Army before treatments could begin. Hollingshead said he was simply tired of the violence and bloodshed. "I wanted to be done," he said.

He eventually moved with his wife, Lena, to be near his family in Marshall, Texas, on the far eastern edge of the state. They found a small home surrounded by piney woods. He began taking classes to learn how to become a lineman for a power company but struggled to find a job. During his time in Iraq, he had lived through two bomb blasts, the one in January 2009 and an earlier one on his first tour. Now he would wake up in the middle of the night, thrashing his arms and legs. When he went to a July 4 fireworks show, he panicked at the explosions, gripping Lena's arm so hard that it left marks. "I'm glad this military time is over," she said. "It took its toll. It took its toll."

Of the five soldiers who sustained mild traumatic brain injuries in the Jan. 16, 2009 rocket attack, Brock Savelkoul was the only one to be injured by shrapnel and be awarded the Purple Heart. (Katie Hayes Luke)

Hopkins and Fuller stayed at Fort Riley. Both began to see therapists at the base's traumatic brain injury clinic. Hopkins went four times a week. He did exercises to help improve his memory. He got a handheld computer device to help him make lists. He practiced reading. His wife, Brianne, labeled the closets in their home to help him remember where to put things. At first, she said, it was frustrating. Hopkins would forget things that she had asked him to do. The couple has five kids. "Sometimes I joke about having an extra child because we have to repeat ourselves to the kids to remind them to do things." After about two months, Hopkins took a new battery of neuropsychological tests. "They pretty much cleared me at that point," Hopkins said. "They asked me how I felt, and I told them I felt pretty much 100 percent better besides the headaches and things of that nature."

Interactive Timeline: How One Blast Affected Five Soldiers [6]Fuller had a similar experience. The ringing in his ears continued even after he got home. He got prescription-strength medication for his headaches, which came less frequently but still hit him hard. His wife, Hillary, who had known him since the 6th grade, noticed that he would start a sentence and then suddenly stop talking, as if frozen. He would forget to do small things, like button his shirt. He was irritable and angry. But slowly, she said, he improved. By the spring of 2010, about six months after his return, most things had returned to normal, she said. "I've dealt with him coming back from Iraq before without any complications. This was just a little different," she said.

"I think that had a lot to do with the rocket attack."

Seeking Help
Savelkoul returned to Minot and moved in with his father, into a 16-by-80-foot mobile home on the southern edge of town. On April 3, he posted on Facebook, referring to his profile picture. "Home!! Great to be home with family!!! Guess I should take that Army pic down and put up a civilian pic ... errr don't want to but that's what I am now." He tried to continue psychological treatments, but Minot is 271 miles from the nearest Veterans Affairs hospital. He started to make the drive several times but would get spooked when going under overpasses, often the site of insurgent attacks in Iraq. Savelkoul also sought help at a local VA clinic in Minot, but his counselor left. He tried going up to the Air Force base north of town but didn't feel like he fit in.

Savelkoul's troubles in finding treatment were not unusual. The majority of VA patients are older and served in the Vietnam War. The VA has struggled to figure out how best to adapt to the newer, younger veterans now seeking mental health counseling and therapy. The issue is especially acute in rural areas.

Savelkoul's family noticed how much he had changed. He couldn't remember birthdays, anniversaries or even the date his mother had died. On a shopping trip with Angie, he didn't recognize the house where they had grown up. He seemed uncoordinated and had trouble playing catch with his nephew. Trips to the Minot Zoo and a Minnesota Twins baseball game ended in disaster when he grew panicked at the crowds around him.

"All these people are dead. Why should I be alive? I'm lost. I'm confused," he would tell Angie.

The family felt confused, too, and unsure what to do. As a nurse, Angie was upset at all the different medications Savelkoul was taking -- antidepressants, antipsychotics, mood stabilizers, sleeping pills. "They weren't doing anything for his symptoms," Angie said. "Every doctor he'd see, they'd give him something different. ... You get that many meds, they interact with each other. They can be dangerous."

"We wanted him home because we thought he needed family," Bruce said. "He was not ready for the real world. ... We didn't know how to handle him."

On the evening of Sept. 21, Brock sent Angie and Bruce a text message. It read: "I love you guys more than anything. Never forget it. I can't do this anymore."

Bruce raced home. On the stove, Bruce found a grocery list that Brock had begun with the word "butter" at the top. After that, Brock had scrawled a note. It read: "No hope for me. Love you so much."

A licensed gun dealer, Bruce found that Brock had ripped open boxes containing guns that he planned to sell. Missing was a DPMS AR-15, an assault rifle similar to the M16 used in Iraq, two hunting rifles and three handguns. Also gone were two 30-round magazines and several hundred rounds of hollow point ammunition.

Bruce went to Brock's room and found he had destroyed his laptop computer. He also had smashed open a small, wooden case that hung next to his bed. It contained photos, mementos and awards from Iraq. He had taken out his Purple Heart.

Bruce knew he had no alternative. He called the police on his own son. "I didn't know what to do. I thought that he was gonna hate me forever, but I really had to call the cops," he said.

The hunt for Savelkoul had begun.

The Chase
At around 6:20 p.m. on Sept. 21, Savelkoul walked into a convenience store called the Kum N Go in Watford City, a small town about 120 miles west of Minot. Police records say that he pointed a rifle at one of the patrons and asked, "Do you want to die?" Then he fled the store.

He headed south down Highway 85, a narrow, two-lane road undergoing construction repairs. A Watford City police cruiser heard the call about the altercation at the Kum N Go, spotted Savelkoul headed out of the city and turned on his lights and siren.

Savelkoul gunned his Tacoma through the narrow gravel beds of the construction zone. He kept going faster and faster, 60, 70, 80, until he hit 105 miles an hour, police records say [19], flying down the arrow straight road, across the river, toward the North Dakota badlands.

Back home, Angie and Bruce had told a friend from the local police department about Brock's past, that he was a veteran suffering from PTSD, and heavily armed. The friend relayed the information to the police chasing Savelkoul. As the chase progressed, the friend would call Angie and Bruce to give updates. In the background, they could hear the dispatchers talk as more and more police officers were called in to stop Savelkoul.

Bruce Savelkoul realized that his son was driving toward the same area where they had stood together 15 years earlier, to shoot his prized deer. "I don't know that anybody can say why somebody wants to kill themselves," Bruce said. "But that was one of the favorite places he'd been in his life. Maybe a person wants to go to a favorite place to die. That's what I think. I think his mission that night was to die."

The chase, captured on video cameras mounted on Highway Patrol cruisers, unfolded like a movie. When a patrol car attempted to block Savelkoul's route, he pulled off the highway, bouncing through high grass, blasting through a barbed-wire fence. A few minutes later, he roared back on the highway. Finally, out of gas, he pulled over on a farm road about 15 miles from the hunting grounds where he shot the deer. Within seconds, he was surrounded by sheriff's deputies, police officers and highway patrol troopers. They began yelling: "Drop the gun, drop the gun!"

The standoff was just beginning. Over the next two hours, Savelkoul paced, smoked, brandished weapons and even shot a round into the back of his pickup. On several occasions, Savelkoul disappeared from view behind his truck. Officers worried that he was attempting to sneak through the darkness to get behind them. At perhaps the most tense moment of the standoff, he came within feet of one of the patrol cars. Raising his 9-mm handgun to his side, he begged someone to shoot. "Go ahead, shoot me!" he yelled. As the officers held their fire, he reassured them he would not shoot first. "You already ... know that I won't ... hurt, I will not ever shoot, a law enforcement agent," he said. "This gun will go to my head before it will go to you. I guarantee it."

North Dakota State Trooper Megan Christopher never stopped talking to Brock during the two-hour standoff on Sept. 21, 2010. (John W. Poole/NPR)

Through it all, one officer, Megan Christopher, talked to Savelkoul nonstop, working feverishly to save his life. Christopher had joined the North Dakota Highway patrol only two years earlier. With high cheekbones and bright blue eyes, she had already made her mark, helping chase down four fugitives featured on an episode of "America's Most Wanted." In her brown trooper's hat and carefully pressed uniform, she could pass for a real life version of the cop Frances McDormand played in the movie "Fargo."

On the evening of Sept. 21, she had been sitting down to dinner when the call came in. She and her commander raced to join the chase. When Savelkoul finally ran out of gas, Christopher was one of the first on the scene.

Interactive Timeline: How One Blast Affected Five Soldiers [6]Although she was a junior officer with no real training or experience in crisis negotiation, she was the first officer to use her patrol car megaphone to talk with Savelkoul. Savelkoul seemed to respond to Christopher, the only woman on the scene. "I tried to put myself in his shoes and empathize," she said. "I think my voice was softer and not expected."

Christopher tried anything she could think of to convince Savelkoul to surrender. When she learned his first name, she introduced herself. "Brock," she said. "My name is Megan." When Savelkoul took out a tube of Chapstick, Christopher needled him. "What kind of Chapstick was that? I need some," she said. "My lips are really dry now. I've been talking a lot." When he turned up the radio, Christopher tried to sing along. "La, la, la. It's time for Karaoke," she joked. She appealed to his past. "You sound like you're pretty proud of the medal that you have," she said, referring to his Purple Heart. "I appreciate everything that you've done for your country, for me and my country." She urged him to think of his future. "You have a lot of people who want to help you," she said. "What you're doing is not fair to anybody. And especially not to you."

With a cell phone in one hand to communicate with one of Savelkoul's friends and a microphone in the other, Christopher never stopped the chatter and never left her position crouched behind the door of her patrol car. The cold cramped her hands. The sleet soaked her uniform. Over and over, she made a simple, emotional plea: She wanted to meet Savelkoul in person, alive and well. "Brock, I'd like to meet you. Put the gun down so we can meet," she said.

Finally, at about 9:30 p.m., more than three hours after the chase began, Savelkoul aimed his gun toward the open prairie and fired a round. Then, the videotape shows, he walked toward Christopher. After she promised to give him a cell phone if he put down the gun, he placed it at his feet. Christopher walked toward him, holding the cell phone in front of her, her own weapon holstered. Her voice broke as she neared him. "I'm kinda new at this. Sorry," she said. "I think I'm going to cry."

Suddenly, Savelkoul turned toward her. Two coiled, white wires unspool through the night air. Another officer, believing that Savelkoul was turning to attack, had fired his Taser, a weapon designed to shock a person into incapacitation. Savelkoul stiffened and fell to the ground. Police officers ran toward him from all sides, their knees on his back, arms, legs. They handcuffed Savelkoul. Christopher walked toward him and knelt. She put her hand to his cheek.

"I'm Megan," she said, "I'm glad I get to meet you."

New Mission
In November 2009, Lt. Col. Mike Russell presented his initial findings [20] involving Savelkoul and nearly 300 other soldiers at the annual meeting of the National Academy of Neuropsychology. His conclusion: The primary test the Army was using to evaluate whether soldiers had suffered concussions was "only slightly better than a coin toss." Another tool being deployed was even worse. The tests were fixable, Russell told the gathering, but the Army was still a long way from diagnosing and treating soldiers like Savelkoul and his buddies. "We did not design our health care system for mild traumatic brain injury," Russell told the audience. "There are a tremendous number of people who have concussions ... meet the diagnostic criteria for mild traumatic brain injury, that never seek professional attention."

Russell's work featured prominently in the Army's Surgeon General's testimony before Congress on problems at the military's top medical center for brain injury. The Army is working now to develop better tests. Russell has recently launched a follow-up investigation in which he hopes to re-evaluate the soldiers in his original study.

In October 2010, a few months after Congress learned of Russell's results, Staff Sgt. Derrick Junge redeployed to Afghanistan. Before he left, he visited a doctor for the first time since the January 2009 blast, discussing his troubles with short-term memory and concentration. The doctor recommended that he visit Fort Campbell's clinic for traumatic brain injury. Junge declined. "I told them to hold off. I didn't want it to keep me from deploying," he said. Last month, Junge survived another roadside explosion while on a convoy with his men in Paktika, a remote province in southern Afghanistan. He was checked by a medic, who cleared him to return to duty, said his wife, Holly. Junge, who has only occasional access to e-mail, could not be reached for details. Holly said that her husband continued to have problems with his memory. On a recent break, he suggested renewing their wedding vows. He asked her to write down his request in case he later forgot making it. "It's worrisome," she said. "I told him that as long as he doesn't forget my name and the kid's names, we're OK."

Brock Savelkoul completed the eight-week residential treatment program at the St. Cloud VA hospital. He now lives in Fargo, N.D., with his new dog Lucky and continues treatments as part of the deal to dismiss the three felony charges against him. (Katie Hayes Luke)

Hollingshead is still seeking steady work. He and his wife are looking forward to the birth of their first child this summer. Memories of the blast still haunt him, he said. "We weren't missing an arm or a leg or a finger. We weren't bleeding. But the brain is just as important. If it's injured, it's injured. I'm going to have these issues for the rest of my life," he said. Hollingshead is still waiting for an appointment to see a doctor at the nearest VA hospital, which is 45 minutes away. He has already signed up to be in Russell's follow-up study. "I'd like to get an MRI and do whatever. It'll help soldiers down the line later on. What they find out in me might help somebody else later on. Anything that I can do to help the future, I'll do it."

Fuller, now a sergeant, and Hopkins have both redeployed to Iraq. Fuller, who has had a ringing in his ears since the explosion, said he is returning to the war zone convinced of the severity of even mild traumatic brain injuries. "TBI effects different people in different ways. It's critical that this is discussed. It's a serious injury, even though you can't see it," Fuller said. A few days after his arrival, he visited the trailer where the January 2009 blast had occurred. It still stands, the shrapnel holes patched with white caulking.

Prosecutors charged Savelkoul with three felonies and a misdemeanor. His sister, father and a local veterans' advocate lobbied North Dakota's governor and other officials, urging that he get treatment instead of remaining in jail. At a court hearing in October, the judge agreed to release Savelkoul [21] on a $10,000 bond, as long as he attended a VA treatment program.

In December, Savelkoul was committed to a psychological lockdown ward at the Fargo VA hospital as he waited for an opening at the nearest VA residential treatment program. He was the only patient on the ward. His room had a single plastic chair and a single bed. There was nothing sharp. The bathroom door was a piece of foam covered in soft beige fabric. He looked hollow, bewildered and tired. He said that he could not recall details of the police standoff. But he did recall wanting to end it all.

"I was suicidal. That was the main plan," he said. "I was thinking that I was worthless, about the constant struggle I was putting my family through. Family is everything to me. Having to see them go through what they were going through for me was too much. It all came to an overwhelming point."

A private man, embarrassed over what had happened, he spoke guardedly about his experiences: the blast, the trip to Thailand, the psychological breakdowns. He said he had difficulty adjusting to civilian life. He had loved the Army and had planned to make his career there. Now, he said, he felt like a failure for being unable to stay in.

"Civilian life is so slow that it's hard. You don't have that day-to-day adrenaline. Everything that goes through your mind is, I've got to do something different. Maybe I can do something more dangerous," he said.

"Now it's my goal, or my mission, to do whatever it takes to get better for them and for myself."

Eight weeks later, on Jan. 31, Savelkoul finished residential treatment at the St. Cloud VA. As part of it, he completed a program for alcoholism and a second program to help him deal with post-traumatic stress. He and a small group of other veterans had undergone so-called "exposure therapy," remembering and reliving the events that seared them. He called it an "educated hell," a kind of boot camp for the mind to help him regain control of his emotions. "I finally got to talk about the demons and what the real demons were," he said. "We talked, we cried together and we shared intimate details that won't ever leave that room. It helped a lot."

Under a plea deal reached this month [22], Savelkoul will have the felony charges dropped if he meets a series of conditions, including remaining in treatment until he is cleared by a doctor. He's now back in Fargo, where he is receiving outpatient treatment from the local VA. He recently rented an apartment and bought a dog, whom he named Lucky. He wants to attend school and resume a normal life, perhaps aiding other veterans in similar situations.

One day last month, he climbed into his black Tacoma pickup—restored with $11,000 worth of repairs since the chase. He drove through minus-15 degree weather to a coffee shop a few miles from the Veterans Affairs hospital. Snow covered the ground. The sky stretched endless and blue above the city.

Savelkoul seemed more at peace, more rested, more confident of the life ahead of him. He had taken the first steps, he said, toward understanding the war in his mind. He said that the VA and the military were helping.

"They teach us how to get over there," he said. "Now they need to teach us how to get back."

Inform our investigations: Do you have information or expertise relevant to this story? Help us and journalists around the country by sharing your stories and experiences.

1./site/author/t_christian_miller
2.http://www.npr.org/templates/story/story.php?storyId=134657905
3.http://www.npr.org/programs/all-things-considered/
4.http://www.npr.org/templates/stations/schedule/index.php?prgId=2
5.http://www.amazon.com/Aftershock-Psycho-Platoon-Kindle-ebook/dp/B004SUOY78/ref=amb_link_355641722_3?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=auto-sparkle&pf_rd_r=0J8GYD2PGR6QKWWXKQX0&pf_rd_t=301&pf_rd_p=1291693582&pf_rd_i=ProPublica
6.http://www.propublica.org/special/tbi-psycho-platoon-timeline
7.http://www.dvbic.org/
8.http://www.usatoday.com/printedition/news/20070308/1a_lede08_dom.art.htm
9.http://www.washingtonpost.com/wp-srv/nation/walter-reed/index.html
10.http://www.rand.org/pubs/monographs/MG720.html
11.http://www.propublica.org/series/brain-wars
12.http://journals.lww.com/headtraumarehab/Abstract/2009/01000/Traumatic_Brain_Injury_Screening__Preliminary.3.aspx
13.http://www.propublica.org/article/pentagon-issues-new-policy-for-diagnosing-and-treating-brain-injuries
14.http://www.propublica.org/documents/item/staff-sgt-james-hopkins-purple-heart-request-and-denial
15.http://www.propublica.org/documents/item/army-achievement-medal-recommendation-by-capt-mike-guelich-for-brock-savelk
16.http://www.dvidshub.net/publication/issues/0388
17.http://www.nejm.org/doi/full/10.1056/NEJMp0810606
18.http://www.propublica.org/documents/item/staff-sgt-brock-savelkoul-discharge-notice
19.http://www.propublica.org/documents/item/brock-savelkoul-arrest-report
20.http://www.propublica.org/documents/item/lt-col-russells-study-on-acute-concussion-in-a-combat-environment
21.http://www.bismarcktribune.com/news/local/crime-and-courts/article_f79b84c2-d1c7-11df-9d12-001cc4c03286.html
22.http://www.bismarcktribune.com/news/state-and-regional/article_e7e3bcfe-46e1-11e0-92a8-001cc4c03286.html

13 comments

margarida    Yesterday, 1:16 p.m.
this is DU poisoning..it is NOT “bedeviling”...they KNOW what it is..there is no cure -
so angry at our government for allowing this..

Jason    Yesterday, 2:14 p.m.
Tremendous journey and story - I hope and pray all involved find peace and purpose.

Mike McLaughlin    Yesterday, 3:20 p.m.
    in 1988 our oldest son was hit by a car while he was riding a bicycle in training for a triathlon. He had a TBI and lots of other injuries. He developed PTSD while in recovery for his physical injuries. He received emergency and follow-up care at MCV, Medical College of Virginia.
    His care was prompt, and excellent. He is now a productive member of society, working as a Certified Rehabilitation Counselor. Now he participates in Ultra-Triathlons.
    In 1988 MCV had federal funding to help export their system to other hospitals.The methods of care that MCV used for our son should have been available for our service members for YEARS.

Joe Bloggs    Yesterday, 3:20 p.m.
    Gen. Chiarelli, with due respect, you are in deep denial. Medcom, DVBIC and DCoE have screwed the pooch. While Tomei figures look in line, we new about this years ago. Where are the senior medical officers responsible for the botched policies? Why is no one being fired? Why are the lack of scientific results not being investigated? Why has it taken so long cost so much and produced so little?
    It is time to dig into this.
    We will be paying for this for the next 40 years.

Dr Chaudhry    Yesterday, 3:34 p.m.
Mr McLaughlin,
With all due respect, the PTSD suffered in wars is far more severe and different from one that’s suffered in RTA (road traffic accidents). Every case is different and whilst your son was able to respond well to therapy, other’s are not so lucky.

Barry Schmittou    Yesterday, 3:38 p.m.
    Insurance companies are endangering numerous Psychological claimantsn the U.S. !!
    In the case of Zanny verses MetLife, U.S. District Judge Richard Enslen wrote :
    “Metlife and its henchmen should appreciate that such conduct may itself precipitate the suicide death of a person who has placed implicit trust in their organization. This record is an open indictment of MetLife’s practices and treatment of the mentally-ill and long-term disability benefits.
    In my personal case my Psycologist wrote that MetLife caused my PTSD. Here are exact quotes from her report :
    “It is my impression that three medical doctors paid by Metlife appeared to have ignored medical evidence. For example, Metlife’s paid consultant, Dr. Yanik, “evaluated” Mr. Schmittou without ever having seen him or his medical record from 2004 through 2008.
    In fact, from the time he filed the claims in 2002 until the Court ordered a review in 2008, Metlife ignored both his claims for long-term disability based on vision impairments and on psychological impairments. In treatment, I have observed that the impact of such actions by Metlife has resulted in exacerbation of Mr. Schmititou’s psychological symptoms and periods of significant destabilization.
While being diagnosed with cancer was itself traumatizing, the subsequent nine-year struggle with Metlife has proved even more devastating to Mr. Schmittou. His COBRA insurance expired. He had no money for food, housing, insurance, medical treatment, or medication for four years until he received Social Security Disability benefits. His credit has been ruined. He has had to move in with his parents. He has developed desperate fears about homelessness. Understandably, his mental health deteriorated, traumatized by this threat to his life, his well-being, his sense of wholeness.
    Now, in addition to his impaired vision, he has intense psychological distress, impaired concentration, impaired frustration tolerance, fitful sleep, irritability, and hypervigilance, all hallmarks of Post-traumatic Stress Disorder (PTSD). As a result, he is at greater risk for impulsive acts against himself or others.
At various times, Mr. Schmittou has informed Metlife how desperate he has become. He has begged Metlife to stop the delays and obfuscations, because they added to his stress and depression, even to the point he often wished he were dead. Currently, he is so demoralized he is not seeking treatment for suspicious skin lesions or disturbing GI symptoms.
    In light of the violations Metlife has committed against Mr. Schmittou and Metlife’s awareness of the additional harm caused him, Metlife’s actions seem irresponsible, inhumane, dangerous, and reckless.”
(end of quotes)
    To see many more case quotes including quotes from numerous U.S. Judges’ who wrote that doctors’ paid by Metlife have ignored brain lesions, Multiple Sclerosis, and a foot a new mother broke in five places, please go to the following website where you will also see how the DOL and DOJ refuse to enforce numerous laws: http://www.obamaknowsdoctorscrimesendangerlives.blogspot.com
    To see how identical crimes are being committed by multiple insurance companies in five different types of insurance including injured war zone contractors and injured American workers please go to :        http://www.5typesofdeadlyinsurancecompanycrimes.blogspot.com
    (Bullet point one of that website is in reference to the first link listed above)
    I pray someone will help soon because thousands of lives are being destroyed every year !!

Fred Barnes    Yesterday, 3:51 p.m.
Gen. Chiarelli is confusing activity with achievement.

Mike McLaughlin    Yesterday, 5:18 p.m.
    Dr, Chaudhry states: “. . . the PTSD suffered in wars is far more severe and different from one that’s suffered in RTA (road traffic accidents). Every case is different and whilst your son was able to respond well to therapy, other’s are not so lucky.”
    I agree with you Dr. I fully recognize that “battle PTSD” is significantly different, usually (but not necessarily) worse than getting run down by a Chrysler on a rural road.
    My point is: Why hasn’t the DOD adopted, or at least studied, MCV’s program of 1988? It has only been known for a mere 20 years!

Barry Schmittou    Yesterday, 5:27 p.m.
    It is very embarrassing but I am trying to share my PTSD hoping it will help others.
    Every human has a breaking point !!
    My PTSD was caused by three MetLife doctor’s ignoring my eye cancer.
    I can’t begin to imagine how bad the soldiers in war zones PTSD makes them feel !!!!
    Here are quotes from an urgent letter that my Psychologist wrote to Assistant Secretary of Labor Ms. Borzi and Metlife Senior Management on December 2nd, 2010.
    “His intense emotional misery is a daily struggle. His thoughts and emotions are so troubled he describes feeling “like my brain is on fire”. I think he struggles to express the fullness of his distress. The fact that he has not sought recommended medical treatment for a variety of physical symptoms because he “doesn’t see the use” is evidence of the severity of his depression, in my opinion.”
    “I have deep concern for my patient if he has to repeat the appeals process. He needs for this claim ordeal to be over.”
    After receiving this, the DOL Directors’ instructed me to be sure to file the appeal.
    Obviously the U.S. Government does not understand how serious PTSD is !!
    The DOL is also responsible for regulating the benefits for injured war zone contractors’ and they are doing a horrendous job as evidenced in the reporting of T. Christian Miller.
    I respectfully request that ProPublica will become more demanding with the U.S. Government and seek immediate resolution and recognition of the dangers of PTSD and all the other problems I have posted on the websites I listed above !!
    I feel very fortunate that instead of harming the insurance company or others I have been able to internalize the anger from having no money for medical while three insurance company doctors’ ignored my eye cancer problems and other visual problems.
    The internalization has destroyed my life as evidenced by how much I post on your web comments, and many times after I post I fall or nearly fall due to the extreme strain that typing causes.
    God please be with everyone who has PTSD or any medical problems !! Your experience with the insurance companies and the U.S. government may be even worse than the disease you have !!

Steve Pittsley    Yesterday, 9:31 p.m.
    This is nothing new; The same injuries have occurred , and been suffered from, since Caemen fought with clubs. Tens of thousands of soldiers suffered from it , in WW ll ( Just ask Gen. Patton )  However , there were always SO MANY calsaulties, the ” No Blood , No Foul ” rule went into place.
     Today , with the amounts of causaulties so Very Low , theses injuries are now evident. Its not likw this is anything bew, that needs New attention ..  War , is hell, we all know that ... And Injuries DO happen , there is no way to avoid them . Now, it’s time to step - up, and help these guys that gave so much for their country . The cost /  Geez, if we had WW ll now, we couldn’t afford the bandages, never mind anything else.
    Cost should never be a factor, when you are talking lives…

Janet    Yesterday, 10:45 p.m.
They are all heroes, and I hope they all get the help they need.  I agree that this will haunt us for decades.  I hope Brock and his family know how much we appreciate him, and hope he hangs in there and gets better.  I will try to make sure soldiers returning to my state of Maine, and their families are getting the help and support they need. Thanks for an excellent, eye-opening article.

Lizzi    Today, 12:27 a.m.
    Such a sad story that these young men, and women, are going through.  I know that a concussion from an incident as this is not as serious as a injury from sports, but it seems our highschool has better tools to monitor our athletes to see if they received a concussion and how severe.  If a high school can have programs like this, why is it that our military doesn’t?
    I pray always for the health and well being of all our men and women serving the military.  And for all the innocient country men that will have these same problems.

Marco Rossi    0 minutes ago
Amazing piece as always. Propublica reports items you don’t normally get from mainstream media (except NPR, possibly).